| 1. |
- Alfredsson, Joakim, 1962-, et al.
(författare)
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Randomized comparison of early supplemental oxygen versus ambient air in patients with confirmed myocardial infarction : Sex-related outcomes from DETO2X-AMI
- 2021
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Ingår i: American Heart Journal. - : Mosby Inc.. - 0002-8703 .- 1097-6744. ; 237, s. 13-24
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Tidskriftsartikel (refereegranskat)abstract
- Background: The purpose of this study is to investigate the impact of oxygen therapy on cardiovascular outcomes in relation to sex in patients with confirmed myocardial infarction (MI).Methods: The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction trial randomized 6,629 patients to oxygen at 6 L/min for 6-12 hours or ambient air. In the present subgroup analysis including 5,010 patients (1,388 women and 3,622 men) with confirmed MI, we report the effect of supplemental oxygen on the composite of all-cause death, rehospitalization with MI, or heart failure at long-term follow-up, stratified according to sex.Results: Event rate for the composite endpoint was 18.1% in women allocated to oxygen, compared to 21.4% in women allocated to ambient air (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.65-1.05). In men, the incidence was 13.6% in patients allocated to oxygen compared to 13.3% in patients allocated to ambient air (HR 1.03, 95% CI 0.86-1.23). No significant interaction in relation to sex was found (P=.16). Irrespective of allocated treatment, the composite endpoint occurred more often in women compared to men (19.7 vs 13.4%, HR 1.51; 95% CI, 1.30-1.75). After adjustment for age alone, there was no difference between the sexes (HR 1.06, 95% CI 0.91-1.24), which remained consistent after multivariate adjustment.Conclusion: Oxygen therapy in normoxemic MI patients did not significantly affect all-cause mortality or rehospitalization for MI or heart failure in women or men. The observed worse outcome in women was explained by differences in baseline characteristics, especially age
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| 2. |
- Bergström, Göran, 1964, et al.
(författare)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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Ingår i: Circulation. - Philadelphia : American Heart Association. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Tidskriftsartikel (refereegranskat)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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| 3. |
- Bergström, Göran, et al.
(författare)
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Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
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Ingår i: Circulation. - : Wolters Kluwer. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
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Tidskriftsartikel (refereegranskat)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
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| 4. |
- Bohman, Tony, et al.
(författare)
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Does a healthy lifestyle behaviour influence the prognosis of low back pain among men and women in a general population? A population-based cohort study
- 2014
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 4:12
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES:To study the influence of healthy lifestyle behaviour on the prognosis of occasional low back pain among men and women in a general population.DESIGN:Cohort study with a 4-year follow-up.SETTINGS:General population in Stockholm County, Sweden.PARTICIPANTS:The study sample comprised 3938 men and 5056 women aged 18-84 from the Stockholm Public Health Cohort reporting occasional low back pain in the baseline questionnaire 2006.MEASURES:Lifestyle factors and potential confounders were assessed at baseline. The lifestyle factors smoking habits, alcohol consumption, leisure physical activity and consumption of fruit and vegetables were dichotomised using recommendations for a health-enhancing lifestyle and combined to form the exposure variable 'healthy lifestyle behaviour'. The exposure was categorised into five levels according to the number of healthy lifestyle factors met. The follow-up questionnaire in 2010 gave information about the outcome, long duration troublesome low back pain. Crude and adjusted binomial regression models were applied to estimate the association between the exposure and the outcome analysing men and women separately.RESULTS:The risk of developing long duration troublesome low back pain among women with occasional low back pain decreased with increasing healthy lifestyle behaviour (trend test: p=0.006). 21% (28/131) among women with no healthy lifestyle factor (reference) experienced the outcome compared to 9% (36/420) among women with all four factors. Compared to the reference group, the risk was reduced by 35% (RR 0.65, 95% CI 0.44 to 0.96) for women with one healthy lifestyle factor and 52% (RR 0.48, 95% CI 0.31 to 0.77) for women with all four healthy lifestyle factors. There were no clear associations found among men.CONCLUSIONS:Healthy lifestyle behaviour seems to decrease the risk of developing long duration troublesome low back pain among women with occasional low back pain and may be recommended to improve the prognosis.
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| 5. |
- Bohman, Tony, et al.
(författare)
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The influence of self-reported leisure time physical activity and the body mass index on recovery from persistent back pain among men and women : a population-based cohort study
- 2013
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 13, s. 385-
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is limited knowledge about leisure time physical activity and the body mass index (BMI) as prognostic factors for recovery from persistent back pain. The aim of this study was to assess the influence of leisure time physical activity and BMI on recovery from persistent back pain among men and women in a general population. Methods: The study population (n=1836) in this longitudinal cohort study consisted of participants reporting persistent back pain in the baseline questionnaire in 2002-2003. Data on leisure time physical activity, BMI and potential confounders were also collected at baseline. Information on recovery from persistent back pain (no back pain periods >= 7 days during the last 5 years) was obtained from the follow-up questionnaire in 2007. Log-binomial models were applied to calculate Risk Ratios with 95 percent Confidence Intervals (CI) comparing physically active and normal weight groups versus sedentary and overweight groups. Results: Compared to a sedentary leisure time, all measured levels of leisure time physical activity were associated with a greater chance of recovery from persistent back pain among women. The adjusted Risk Ratios was 1.46 (95% CI: 1.06, 2.01) for low leisure time physical activity, 1.51 (95% CI: 1.02, 2.23) for moderate leisure time physical activity, and 1.67 (95% CI: 1.08, 2.58) for high leisure time physical activity. There were no indications that leisure time physical activity influenced recovery among men, or that BMI was associated with recovery from persistent back pain either among men or among women. Conclusions: Regular leisure time physical activity seems to improve recovery from persistent back pain among women.
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| 6. |
- Engström, Gunnar, et al.
(författare)
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Pulmonary function and atherosclerosis in the general population : causal associations and clinical implications
- 2024
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Ingår i: European Journal of Epidemiology. - : Springer Nature. - 0393-2990 .- 1573-7284. ; 39:1, s. 35-49
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Tidskriftsartikel (refereegranskat)abstract
- Reduced lung function is associated with cardiovascular mortality, but the relationships with atherosclerosis are unclear. The population-based Swedish CArdioPulmonary BioImage study measured lung function, emphysema, coronary CT angiography, coronary calcium, carotid plaques and ankle-brachial index in 29,593 men and women aged 50–64 years. The results were confirmed using 2-sample Mendelian randomization. Lower lung function and emphysema were associated with more atherosclerosis, but these relationships were attenuated after adjustment for cardiovascular risk factors. Lung function was not associated with coronary atherosclerosis in 14,524 never-smokers. No potentially causal effect of lung function on atherosclerosis, or vice versa, was found in the 2-sample Mendelian randomization analysis. Here we show that reduced lung function and atherosclerosis are correlated in the population, but probably not causally related. Assessing lung function in addition to conventional cardiovascular risk factors to gauge risk of subclinical atherosclerosis is probably not meaningful, but low lung function found by chance should alert for atherosclerosis.
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| 7. |
- Palmlof, Lina, et al.
(författare)
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The impact of work related physical activity and leisure physical activity on the risk and prognosis of neck pain : a population based cohort study on workers
- 2016
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background: The effect of physical activity on risk and prognosis for neck pain has been studied earlier with inconclusive results. There is a need for large prospective studies on the subject. The aim of this study was to investigate if work related physical activity and physical activity during leisure time are of importance for the risk and prognosis of neck pain in men and women. Methods: We used the Stockholm Public Health Cohort and formed two sub-cohorts of the working population based on data from 2002. Cohort I (risk cohort) included persons without neck pain (n = 4681), and cohort II (prognostic cohort) included persons with occasional neck pain (n = 6820) during the previous six months. Both cohorts were assessed for the outcome long duration troublesome neck pain (LDNP) in 2007. The exposures and potential confounders were assessed through a questionnaire in 2002. The question regarding work related physical activity over the past 12 months had five answering categories ranging from "sedentary" to "heavy". The question regarding leisure physical activity for the past 12 months had five answering categories ranging from "sedentary" to "regular physical activity". LDNP in 2007 was defined as having had troublesome neck pain lasting >= 3 consecutive months during the previous five years. Associations between work related physical activity and LDNP, as well as leisure physical activity and LDNP, were investigated by multivariable logistic regression, considering potential confounding factors. Results: In cohort I (risk cohort) we found an association between leisure physical activity and LDNP. In cohort II (prognostic cohort) we found no association between the exposures and the outcome. Conclusion: The results suggest that leisure physical activity has a protective effect on the risk of developing LDNP in a population free from neck pain. It did not, however, affect the prognosis of occasional neck pain. Neither the risk nor the prognosis of neck pain was affected by work related physical activity in this study.
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| 8. |
- Palmlöf, Lina, et al.
(författare)
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Does income matter for troublesome neck pain? : A population-based study on risk and prognosis
- 2012
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 66:11, s. 1063-1070
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Tidskriftsartikel (refereegranskat)abstract
- Background Studies have shown associations between higher income and better health, but income has not been studied in relation to neck pain. The aims of this cohort study were to assess the sex-specific role of disposable income for onset and prognosis of neck pain in the general population and if economic stress influences such potential associations. Methods Two subcohorts were identified in the Stockholm Public Health Cohort with data from 2002. Cohort I (risk cohort) included persons without neck pain (n = 8348). Cohort II (prognostic cohort) included persons with occasional neck pain during the previous 6 months (n =0 523). Both cohorts were assessed for long duration troublesome neck pain (LDNP) in 2007. Individual income was defined as aggregated annual family income in 2002 with each family member assigned a weighted consumption share, based on salary, pensions and social benefits. LDNP in 2007 was defined as having had troublesome neck pain lasting for three or more consecutive months the previous 5 years. Association between income and LDNP, considering potential confounding, was investigated by multivariable logistic regression. Economic stress was tested as effect modifier between income and LDNP. Results In both cohorts, associations were found between lower income and a higher risk for LDNP. The results were similar between the sexes. Economic stress modified the associations in both cohorts. Conclusions Low income may be a risk as well as prognostic factor for developing LDNP. Furthermore, the results indicate that economic stress may be an underlying factor to consider when studying associations between income and neck pain.
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| 9. |
- Skillgate, Eva, et al.
(författare)
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Is smoking and alcohol consumption associated with long-term sick leave due to unspecific back or neck pain among employees in the public sector? Results of a three-year follow-up cohort study
- 2009
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Ingår i: Journal of Rehabilitation Medicine. - : Medical Journals Sweden AB. - 1650-1977 .- 1651-2081. ; 41:7, s. 550-556
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To investigate the associations between smoking and alcohol consumption, and long-term sick leave due to unspecific back or neck pain among employees in the public sector. DESIGN: A 3-year prospective cohort study. SUBJECTS: Approximately 9000 persons in the public sector in Sweden were invited to participate. Of these, 7533 answered a questionnaire and 6532 were included in the study, classified as having "good health for working". METHODS: New periods of sick leave >or= 28 days were consecutively reported from the employers or the occupational health service during a period of 3 years. Rate ratios were estimated by means of Cox proportional hazard regression model. RESULTS: Smoking was associated with an increased risk of long-term sick leave due to unspecific back or neck pain. Compared with people who have never smoked, "ever smokers" had a higher risk (rate ratio = 1.8, 95% confidence interval: 1.3-2.4). Alcohol consumption tended to be associated with a decreased risk, but the results were not statistically significant. CONCLUSION: Our results suggest that smoking is a risk factor for long-term sick leave due to unspecific back or neck pain. Moderate alcohol consumption tends to have a protective effect, at least among women in the public sector.
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| 10. |
- Skillgate, Eva, et al.
(författare)
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Life events and the risk of low back and neck/shoulder pain of the kind people are seeking care for : results from the MUSIC-Norrtalje case-control study
- 2007
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 0143-005X .- 1470-2738. ; 61:4, s. 356-361
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To expand the knowledge about the occurrence of life events, and how they affect the risk of low back and neck/shoulder pain. Design: A population-based case-control study. Setting: Men and women 20-59-years old, living in and not working outside the municipality of Norrtalje, Sweden, from November 1993 to November 1997. Participants: Cases (n = 1 148) were defined as all subjects from the study base who sought healthcare for a new episode of low back and/or neck/shoulder pain by any of the care givers in the municipality. Controls (n = 1 700) were selected as a stratified random sample from the study base, considering sex and age. Study subjects were interviewed about life events and critical life changes. Critical life changes were defined as events that brought about a marked psychosocial change. Odds ratios (ORs) associated with different numbers of life events or critical life changes were calculated. Results: Having experienced at least two life events during the preceding 5 years was associated with an increased risk of neck/shoulder pain (OR = 1.6, 95% CI 1.1 to 2.4). At least two critical life changes were associated with an increased risk of neck/shoulder pain (OR = 1.9, 95% CI 1.3 to 2.7). In general, no associations were observed in relation to risk of low back pain. Conclusion: Life events and critical life changes are of importance for the risk of neck/shoulder pain of the kind that people are seeking care for. The study provides useful information for clinical practice and for future aetiological research on neck/shoulder pain.
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| 11. |
- Skillgate, Eva, et al.
(författare)
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Naprapathic manual therapy or evidence-based care for back and neck pain : a randomized, controlled trial
- 2007
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Ingår i: The Clinical Journal of Pain. - 0749-8047 .- 1536-5409. ; 23:5, s. 431-439
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To compare naprapathic manual therapy with evidence-based care for back or neck pain regarding pain, disability, and perceived recovery. Naprapathy that is common in the Nordic countries and in some states in the United States is characterized by manual manipulations with a focus on soft and connective tissues, aiming to decrease pain and disability in the musculoskeletal system. Methods: Four hundred and nine patients with pain and disability in the back or neck lasting for at least 2 weeks, recruited at 2 large public companies in Sweden in 2005, were included in this randomized controlled trial. The 2 interventions were naprapathy, including spinal manipulation/mobilization, massage, and stretching (Index Group) and support and advice to stay active and how to cope with pain, according to the best scientific evidence available, provided by a physician (Control Group). Pain, disability, and perceived recovery were measured by questionnaires at baseline and after 3, 7, and 12 weeks. Results: At 7-week and 12-week follow-ups, statistically significant differences between the groups were found in all outcomes favoring the Index Group. At 12-week follow-up, a higher proportion in the naprapathy group had improved regarding pain [risk difference (RD) = 27%, 95% confidence interval (Cl): 17-37], disability (RD = 18%, 95% Cl: 7-28), and perceived recovery (RD = 44%, 95% Cl: 35-53). Separate analysis of neck pain and back pain patients showed similar results. Discussion: This trial suggests that combined manual therapy, like naprapathy, might be an alternative to consider for back and neck pain patients.
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| 12. |
- Skillgate, Eva, et al.
(författare)
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The long-term effects of naprapathic manual therapy on back and neck pain : results from a pragmatic randomized controlled trial
- 2010
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 11, s. 26-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Back and neck pain are very common, disabling and recurrent disorders in the general population and the knowledge of long-term effect of treatments are sparse. The aim of this study was to compare the long-term effects (up to one year) of naprapathic manual therapy and evidence-based advice on staying active regarding non-specific back and/or neck pain. Naprapathy, a health profession mainly practiced in Sweden, Finland, Norway and in the USA, is characterized by a combination of manual musculoskeletal manipulations, aiming to decrease pain and disability in the neuromusculoskeletal system. METHODS: Subjects with non-specific pain/disability in the back and/or neck lasting for at least two weeks (n = 409), recruited at public companies in Sweden, were included in this pragmatic randomized controlled trial. The two interventions compared were naprapathic manual therapy such as spinal manipulation/mobilization, massage and stretching, (Index Group), and advice to stay active and on how to cope with pain, provided by a physician (Control Group). Pain intensity, disability and health status were measured by questionnaires. RESULTS: 89% completed the 26-week follow-up and 85% the 52-week follow-up. A higher proportion in the Index Group had a clinically important decrease in pain (risk difference (RD) = 21%, 95% CI: 10-30) and disability (RD = 11%, 95% CI: 4-22) at 26-week, as well as at 52-week follow-ups (pain: RD = 17%, 95% CI: 7-27 and disability: RD = 17%, 95% CI: 5-28). The differences between the groups in pain and disability considered over one year were statistically significant favoring naprapathy (p < or = 0.005). There were also significant differences in improvement in bodily pain and social function (subscales of SF-36 health status) favoring the Index Group. CONCLUSIONS: Combined manual therapy, like naprapathy, is effective in the short and in the long term, and might be considered for patients with non-specific back and/or neck pain.
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| 13. |
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| 14. |
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| 15. |
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| 16. |
- Tödt, Tim, et al.
(författare)
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Relationship between treatment delay and final infarct size in STEMI patients treated with abciximab and primary PCI
- 2012
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Ingår i: BMC Cardiovascular Disorders. - : Springer Science and Business Media LLC. - 1471-2261 .- 1471-2261. ; 12:9, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundStudies on the impact of time to treatment on myocardial infarct size have yielded conflicting results. In this study of ST-Elevation Myocardial Infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), we set out to investigate the relationship between the time from First Medical Contact (FMC) to the demonstration of an open infarct related artery (IRA) and final scar size.Between February 2006 and September 2007, 89 STEMI patients treated with primary PCI were studied with contrast enhanced magnetic resonance imaging (ceMRI) 4 to 8 weeks after the infarction. Spearman correlation was computed for health care delay time (defined as time from FMC to PCI) and myocardial injury. Multiple linear regression was used to determine covariates independently associated with infarct size.ResultsAn occluded artery (Thrombolysis In Myocardial Infarction, TIMI flow 0-1 at initial angiogram) was seen in 56 patients (63%). The median FMC-to-patent artery was 89 minutes. There was a weak correlation between time from FMC-to-patent IRA and infarct size, r = 0.27, p = 0.01. In multiple regression analyses, LAD as the IRA, smoking and an occluded vessel at the first angiogram, but not delay time, correlated with infarct size.ConclusionsIn patients with STEMI treated with primary PCI we found a weak correlation between health care delay time and infarct size. Other factors like anterior infarction, a patent artery pre-PCI and effects of reperfusion injury may have had greater influence on infarct size than time-to-treatment per se.
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| 17. |
- Alfredsson, Eva C., et al.
(författare)
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Industrial climate mitigation strategies and the remaining fair carbon budget – The case of Sweden
- 2024
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Ingår i: Next Sustainability. - 2949-8236. ; 3, s. 100031-100031
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Tidskriftsartikel (refereegranskat)abstract
- This article explores the climate mitigation strategies of the 15 industries with the largest carbon dioxide emissions in Sweden. Starting from two carbon budget alternatives, we analyse the mitigation projections of the companies in relation to what can be considered their fair share of the remaining carbon budget for Sweden.We furthermore determine the uncertainties associated with the strategies. The results suggest that if the communicated mitigation plans are implemented as planned, the companies overdraft our main, 1.5-degree, budget option but stay within the alternative 1.7-degree budget. The analysis shows, however, that the timing and efficiency of emission reductions are crucial.Already small delays or lower efficiency in implementation, result in evident overdrafts of also the alternative budget. There are also substantial political and technical risks which can prevent timely mitigations. The article makes a novel contribution by analyzing industries’ mitigation strategies relative to their share of the remaining carbon budget.The article demonstrates the importance of transparent industrial climate mitigation strategies and in particular the need for policymakers to set incentive structures to promote strategy implementation.
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| 18. |
- Alfredsson, Eva C., et al.
(författare)
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Prospects for economic growth in the 21st century : A survey covering mainstream, heterodox and scientifically oriented perspectives
- 2017
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Ingår i: Economic Issues. - : ECONOMIC ISSUES EDUCATION FUND. - 1363-7029. ; 22, s. 65-87
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Tidskriftsartikel (refereegranskat)abstract
- Despite the importance of economic growth for the current economy, business and societal planning there are few long-term growth projections undertaken. There is, however, a vivid debate on what is called the 'new normal' - secular stagnation - which is undertaken within academic disciplines. This overview covers mainstream, heterodox and scientifically oriented economic perspectives on the prospects for economic growth in the 21st century. The survey shows that existing long-term projections and scenarios indicate growth rates ranging from around half a percentage point less than during the last two decades (projected by the Organisation for Economic Co-operation and Development, OECD), to dramatically lower growth rates). Differences stem from different perspectives on the determinants of economic growth and the potential for improvements in productivity. Headwinds are: an aging population, especially in OECD countries; resource constraints, including energy; increasing environmental costs in particular due to the consequences of climate change; overaccumulation; increasing income differences; and declining social capital. One conclusion is that policymaking based on the assumption that economic growth will continue at pre-crisis levels is unwise and risky.
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| 19. |
- Alfredsson, Eva, et al.
(författare)
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Environmental efficiency and costs of environmental regulations : The Swedish pulp and paper industry 2000 - 2007
- 2011
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Ingår i: Yearbook on Productivity 2011. - Stockholm : SCB. ; , s. 11-34
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- In this study we apply Data Envelopment Analysis (DEA) to analyse efficiency in presence of both desired and undesired outputs. We use register data from the Swedish national environmental accounts. The study concerns the Swedish pulp and paper industry. To compute efficiency, we use a directional distance function approach that allows scaling for different directions, both desired and undesired output directions under the assumption of equal importance. The analysis show that efficiency have increased over time, both in terms of desired output and in terms of environmental efficiency. The first analysis measure inefficiency if scaling is done with equal importance given to desired output and undesired output. This analysis shows an inefficiency of around 12 % meaning that there is a 12% potential to simultaneously reduce pollution and increase production of pulp and paper. In the second analysis scaling is only allowed in the direction of undesired outputs. This analysis shows that the average potential reduction in pollution is 22%. If, on the other hand, the potential is computed in terms of only desired output keeping undesired output constant, the average potential increase in desired output is 14%. In a forth analysis we discuss the potential to evaluate the costs of environmental regulations using the DEA methodology.Keywords: Environmental efficiency, directional distance function,
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| 20. |
- Alfredsson, Eva, 1963-
(författare)
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Green consumption energy use and carbon dioxide emission
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis is to explore the quantitative potential to reduce energy requirements and CO2 emissions through changed patterns of consumption, given unchanged levels of consumption expenditure. The thesis question is analysed using a systems analysis approach which in this case means that life cycle assessment data on energy requirements and CO2 emissions related to household consumption are combined with a financial and behavioural analysis to make sure that the budget constraint is kept and that both the first and second order effects of adopting a green consumption pattern are analysed. The budget constraints are kept using a general linear model. By using marginal propensities to spend to direct the reallocation of saved or deficit money calculated utility is maintained as far as possible. Further, investigations explore the impact of individual household demographic characteristics and geographic context on household consumption patterns, energy requirements and CO2 emissions. The key result of this thesis is that changed household behaviour, choosing “green“ products and energy efficient technology will not make a big difference. What can be achieved in the short time perspective by adopting an almost completely green consumption pattern and energy efficient technology is a reduction of energy requirements by around 8% and CO2 emissions by around 13%. With a longer time perspective and further technological change that provides additional possibilities to move consumption patterns in a greener direction, the effect on energy requirements and CO2 emissions is still fairly small. By 2020, the potential to reduce energy requirements is around 13% and CO2 emissions around 25%. In the most extreme scenario (2050), the scope for reducing energy requirements is 17% and for CO2 emissions 30%. All these reductions will be outpaced by growth in income almost as soon as they are implemented. Of policy relevance the results reveal that very limited impact can be expected by a policy relying on greener consumption patterns, whether adopted voluntarily or as a result of incentives such as tax changes. Such a policy cannot achieve more than a small and temporary reduction to growth in energy requirements and CO2 emissions. It is also shown that, prescribing specific consumption patterns as a means of reducing energy requirements and CO2 emissions has to be done with care. This is illustrated by one of the experiments in which adopting a partly green consumption pattern, a green diet, in fact increased total energy requirements and CO2 emissions. This, and the results of all the other experiments show the importance of applying a systems approach. It demonstrates that life cycle data alone are irrelevant for assessing the total effects of adopting green consumption patterns. Further research on the potential to reduce energy requirements and CO2 emissions thus primarily needs to better capture system wide effects rather than to improve on, and fine tune the measurement of the energy requirements and CO2 emissions related to individual products.
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| 21. |
- Alfredsson, Eva, et al.
(författare)
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Internalising external environmental effects in efficiency analysis : The Swedish pulp and paper industry 2000-2007
- 2016
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Ingår i: Economic Analysis and Policy. - : Elsevier. - 0313-5926. ; 51, s. 22-31
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Tidskriftsartikel (refereegranskat)abstract
- This paper investigates the efficiency in the Swedish pulp and paper industry using national account data. By using a directional distance function approach we are able to investigate different aspects of efficiency relating to the direction of scaling. In the first analysis, desired output (pulp and paper) and undesired output (pollution) are considered equally important. This analysis shows that there is a 12% potential to simultaneously reduce pollution and increase the production of pulp and paper. In the second analysis, only undesired output is considered. The analysis shows an average potential reduction in pollution of 22%. If, on the other hand, this potential is computed in terms of desired output, keeping undesired output constant, the average potential increase in desired output is 14%. In a fourth analysis we discuss the potential to evaluate the costs of environmental regulations using the DEA methodology. Finally, our paper demonstrates that data from national accounts can be used to investigate different aspects of environmental efficiency.
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| 22. |
- Alfredsson, Eva, 1963-, et al.
(författare)
-
Investeringar för en rättvis klimatomställning
- 2023
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Annan publikation (populärvet., debatt m.m.)abstract
- Inom forskningsprogrammet FAIRTRANS har en workshop hållits om investeringars roll i klimatomställningen. Syftet var att lyfta fram olika gruppers behov av investeringar för en rättvis fossilfri framtid inom ramen för en svensk koldioxidbudget.
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| 23. |
- Alfredsson, Eva, 1963-, et al.
(författare)
-
Investeringars betydelse för klimatomställningen
- 2023
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Rapport (populärvet., debatt m.m.)abstract
- Syftet med detta kunskapsunderlag är att förbereda för deltagande och dialog inför FAIRTRANS Workshop 2. Fokus för diskussionen är vilka investeringar som bör prioriteras för att Sverige ska nå en rättvis koldioxidbudget.
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| 24. |
- Alfredsson, Eva, et al.
(författare)
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Real capital investments and sustainability : - The case of Sweden
- 2019
-
Ingår i: Ecological Economics. - : Elsevier. - 0921-8009 .- 1873-6106. ; 161, s. 216-224
-
Tidskriftsartikel (refereegranskat)abstract
- Real capital investments are important for a transition to a more sustainable economy and for the continuous process of creative destruction and economic development. At the same time investments have negative environmental effects. In this paper we analyze to what extent the current investments in real capital (i.e.,buildings, machinery and infrastructures) in Sweden are sustainable in regard of the most important resources used in investments and in terms of CO2 emissions. This is evaluated based on Sweden's share of a sustainable use of these resources and our share of the remaining carbon budget for achieving the Paris agreement. In the analysis we have used best publicly available data and methods to indicatively establish sustainable levels of resource use and emissions. We find that 1 million invested SEK (US$ 110,000) generate 15–75 tonnes of CO2 emissions and use 80–260 MWh of energy, and on average 4.8 tonnes of iron, 0.2 tonnes of aluminum, 260 tonnes of gravel and sand and 6 tonnes of timber. Our analysis shows that within 50 years current investment would use up Sweden's CO2 budget available for achieving the Paris agreement, leaving no room for emissions from consumption. The use of timber, gravel and sand is above Sweden's share of a global yearly sustainable production. The current use of iron and aluminum can be maintained for 20–50 years, but approaches the sustainability criteria with a 200 year perspective.
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| 25. |
- Alfredsson, Eva, 1963-, et al.
(författare)
-
Why achieving the Paris Agreement requires reduced overall consumption and production
- 2018
-
Ingår i: Sustainability. - : Informa UK Limited. - 1548-7733. ; 14
-
Tidskriftsartikel (refereegranskat)abstract
- Technological solutions to the challenge of dangerous climate change are urgent and necessary but to be effective they need to be accompanied by reductions in the total level of consumption and production of goods and services. This is for three reasons. First, private consumption and its associated production are among the key drivers of greenhouse-gas (GHG) emissions, especially among highly emitting industrialized economies. There is no evidence that decoupling of the economy from GHG emissions is possible at the scale and speed needed. Second, investments in more sustainable infrastructure, including renewable energy, needed in coming decades will require extensive amounts of energy, largely from fossil sources, which will use up a significant share of the two-degree carbon budget. Third, improving the standard of living of the world’s poor will consume a major portion of the available carbon allowance. The scholarly community has a responsibility to put the issue of consumption and the associated production on the research and policy agenda.
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| 26. |
- Alfredsson, Joakim, et al.
(författare)
-
Although women are less likely to be admitted to coronary care units, they are treated equally to men and have better outcome : A prospective cohort study in patients with non ST-elevation acute coronary syndromes
- 2009
-
Ingår i: Acute cardiac care. - : Informa Healthcare. - 1748-295X .- 1748-2941. ; 11:3, s. 173-180
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of this study was to assess gender differences in admission level of care, management and outcome in patients with non ST-elevation acute coronary syndromes (NSTE-ACS), initially admitted to either coronary care units (CCU) or general wards. Method: Patients admitted to CCUs were routinely registered in the RIKS-HIA registry. In addition, patients admitted to general wards with suspected ACS were also identified and registered. Multivariable regression analysis was used to adjust for baseline differences between the genders. Results: We included 570 consecutive patients with a discharge diagnosis of NSTE-ACS. Women were less likely to be admitted to coronary care units (56% versus 69%, P=0.002), even after adjustment (odds ratio (OR), 0.65; 95% confidence interval (CI): 0.43-0.98). After adjustment for differences in baseline characteristics, women were treated similarly to men. We found no significant differences in crude short-, or long-term mortality between the genders. However, adjustment for background characteristics revealed lower one-year mortality in women (OR: 0.58; 95% CI: 0.34-0.99). Conclusion: In this study on patients with NSTE-ACS, women were less likely to be admitted to coronary care units. However, the overall treatment was as intensive for women as for men. Moreover, after adjustment, one-year mortality was lower in women.
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| 27. |
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| 28. |
- Alfredsson, Joakim, et al.
(författare)
-
Gender differences in management and outcome in non-ST-elevation acute coronary syndrome
- 2007
-
Ingår i: Heart. - : BMJ Publishing group Ltd. - 1355-6037 .- 1468-201X. ; 93:11, s. 1357-1362
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To study gender differences in management and outcome in patients with non-ST-elevation acute coronary syndrome. Design, setting and patients: Cohort study of 53 781 consecutive patients (37% women) from the Register of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA), with a diagnosis of either unstable angina pectoris or non-ST-elevation myocardial infarction. All patients were admitted to intensive coronary care units in Sweden, between 1998 and 2002, and followed for 1 year. Main outcome measures: Treatment intensity and in-hospital, 30-day and 1 -year mortality. Results: Women were older (73 vs 69 years, p<0.001) and more likely to have a history of hypertension and diabetes, but less likely to have a history of myocardial infarction or revascularisation. After adjustment, there were no major differences in acute pharmacological treatment or prophylactic medication at discharge. Revascularisation was, however, even after adjustment, performed more often in men (OR 1.15, 95% CI, 1.09 to 1.21). After adjustment, there was no significant difference in in-hospital (OR 1.03, 95% CI, 0.94 to 1.13) or 30-days (OR 1.07, 95% CI, 0.99 to 1.15) mortality, but at 1 year being male was associated with higher mortality (OR 1.12, 95% CI, 1.06 to 1.19). Conclusion: Although women are somewhat less intensively treated, especially regarding invasive procedures, after adjustment for differences in background characteristics, they have better long-term outcomes than men.
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| 29. |
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| 30. |
- Alfredsson, Joakim, et al.
(författare)
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Impact of an invasive strategy on 5 years outcome in men and women with non-ST-segment elevation acute coronary syndromes
- 2014
-
Ingår i: American Heart Journal. - : Elsevier. - 0002-8703 .- 1097-6744. ; 168:4, s. 522-529
-
Tidskriftsartikel (refereegranskat)abstract
- Background A routine invasive (RI) strategy in non-ST-segment elevation acute coronary syndromes (NSTE ACS) has been associated with better outcome compared with a selective invasive (SI) strategy in men, but results in women have yielded disparate results. The aim of this study was to assess gender differences in long-term outcome with an SI compared with an RI strategy in NSTE ACS. Methods Individual patient data were obtained from the FRISC II trial, ICTUS trial, and RITA 3 trial for a collaborative meta-analysis. Results Men treated with an RI strategy had significantly lower rate of the primary outcome 5-year cardiovascular (CV) death/myocardial infarction (MI) compared with men treated with an SI strategy (15.6% vs 19.8%, P = .001); risk-adjusted hazards ratio (HR) 0.73 (95% CI 0.63-0.86). In contrast, there was little impact of an RI compared with an SI strategy on the primary outcome among women (16.5% vs 15.1%, P = .324); risk-adjusted HR 1.13 (95% CI 0.89-1.43), interaction P = .01. For the individual components of the primary outcome, a similar pattern was seen with lower rate of MI (adjusted HR 0.69, 95% CI 0.57-0.83) and CV death (adjusted HR 0.71, 95% CI 0.56-0.89) in men but without obvious difference in women in MI (adjusted HR 1.13, 95% CI 0.85-1.50) or CV death (adjusted HR 0.97, 95% CI 0.68-1.39). Conclusions In this meta-analysis comparing an SI and RI strategy, benefit from an RI strategy during long-term follow-up was confirmed in men. Conversely, in women, there was no evidence of benefit.
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| 31. |
- Alfredsson, Joakim, et al.
(författare)
-
Individual long-term variation of platelet reactivity in patients with dual antiplatelet therapy after myocardial infarction.
- 2019
-
Ingår i: Platelets. - : Informa UK Limited. - 0953-7104 .- 1369-1635. ; 30:5, s. 572-578
-
Tidskriftsartikel (refereegranskat)abstract
- There is a large inter-individual variation in response to clopidogrel treatment, and previous studies have indicated higher risk of thrombotic events in those with high residual platelet reactivity (HPR). Less is known about individual variation over time. The aim of this prospective cohort study was to investigate intra-individual variation in platelet reactivity. Platelet aggregation in whole blood was assessed in 77 patients, at 3 days, 8 days and 6 months after admission for acute myocardial infarction and loading dose of clopidogrel. All patients were treated with aspirin and clopidogrel through 6-month follow-up. We found a significant increase in median ADP-stimulated aggregation from third to eighth day (195 vs. 250 AU*min, p-value = 0.001) but not from day 8 to 6 months (250 vs. 223 AU*min, p-value = 0.666). There was no significant change in the overall rate of HPR (15.6% vs 20.8%, p-value 0.503) or low platelet reactivity (LPR) (37.7% vs 33.8%, p-value = 0.609) from day 8 to 6-month follow-up. In contrast, more than one in four changed HPR status, 15.6% from non-HPR to HPR and 10.4% HPR to non-HPR. A shift in LPR status appeared even more frequent, occurring in about one of three patients. In spite of similar median aggregation and rate of HPR during 6-month follow-up, about one in four of the patients changed HPR status and one in three changed LPR status. This may be important information for a concept of risk stratification based on a single aggregation value early after an acute coronary syndromes.
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| 32. |
- Alfredsson, Joakim, et al.
(författare)
-
Large early variation of residual platelet reactivity in Acute Coronary Syndrome patients treated with clopidogrel : Results from Assessing Platelet Activity in Coronary Heart Disease (APACHE).
- 2015
-
Ingår i: Thrombosis Research. - : Pergamon Press. - 0049-3848 .- 1879-2472. ; 136:2, s. 335-340
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: There is a large inter-individual variation in response to clopidogrel treatment and previous studies have indicated higher risk of thrombotic events in patients with high residual platelet reactivity (HRPR), but the optimal time-point for testing is not established. The aim of this study was to investigate the optimal time-point for aggregometry testing and the risk of major adverse cardiac events associated with HRPR.METHOD AND RESULTS: We included 125 patients with ACS (73 with STEMI, and 71 received abciximab). The prevalence of HRPR varied substantially over time. The rate of HRPR in patients treated and not treated with abciximab were 43% vs 67% (p=0.01) before, 2% vs 23% (p=0.001) 6-8h after, 8% vs 9% (p=0.749) 3days after, and 23% vs 12% (p=0.138) 7-9 days after loading dose of clopidogrel. We found HRPR in 18% of the patients but only four ischemic events during 6months follow-up, with no significant difference between HRPR patients compared to the rest of the population. There were 3 TIMI major bleedings, all of which occurred in the low residual platelet reactivity (LRPR) group.CONCLUSION: There is a large variation in platelet reactivity over time, also depending on adjunctive therapy, which has a large impact on optimal time-point for assessment. We found HRPR in almost 1 in 5 patients, but very few MACE, and not significantly higher in HRPR patients. In a contemporary ACS population, with low risk for stent thrombosis, the predictive value of HRPR for ischemic events will probably be low.
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| 33. |
- Alfredsson, Joakim
(författare)
-
Management and Outcome in Non ST-Elevation Acute Coronary Syndromes : Similarities and Differences Between Women and Men
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Non ST-elevation Acute Coronary Syndromes are the most frequent manifestations of acute ischemic heart disease. Gender differences in treatment intensity, including differences in level of care, have been reported. Also differences in benefit from certain treatments, especially invasive treatment, have been discussed. Finally, difference in outcome between men and women, have been proposed. Results have been inconsistent, partly depending on if and how adjustment for differences in background characteristics has been made. The aims of the studies in this thesis were to assess differences between the genders in baseline characteristics, level of care, medical treatment and non-invasive and invasive cardiac procedures. The aims were also to determine gender differences in short and long-term mortality, including impact of level of care, and to determine differences between the genders in benefit from an invasive strategy, with special reference to benefit in women.Method: We used prospectively collected data from the RIKS-HIA registry in two studies (Paper I and IV). In one study we merged data from patients admitted to general wards in the south-east region of Sweden (The AKUT registry), with data from patients admitted to CCU´s (RIKS-HIA) at participating hospitals during the same time (Paper II). We also randomly assigned women to a routine invasive or a selective invasive treatment strategy, and performed a meta-analysis, to determine gender differences in benefit from a routine invasive strategy (Paper III).Results: Women were older than men and more likely to have a history of diabetes and hypertension, while men were more likely to have a history of myocardial infarction and revascularisation. Women were also more likely to have normal coronary arteries on the angiogram. After adjustment for baseline differences there were only minor, and directionally inconsistent, differences between women and men in pharmacological treatment. Men were more often referred for coronary angiography, even after adjustment. While CABG-rate was lower in women, after adjustment PCI-rate was similar or even higher compared to men. After adjustment for differences in age, longterm outcome was better in women. In our small but randomised trial there was no benefit from a routine invasive strategy in women. A meta-analysis indicated interaction between gender and treatment strategy, with lack of benefit in women, in contrast to in men. However, our large observational study indicated no gender difference with an invasive strategy. Moreover, benefit was similar in women and men with invasive treatment.Conclusion: There are substantial differences between women and men in baseline characteristics that affect management and outcome more than gender per se. After adjustment women have better long-term outcome than men. There appear to be a difference in benefit from a routine invasive strategy between the genders, with less benefit in women, but in routine clinical management there was no difference between women and men managed with an invasive strategy.
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| 34. |
- Alfredsson, Joakim, et al.
(författare)
-
Management of acute coronary syndromes from a gender perspective
- 2010
-
Ingår i: FUNDAMENTAL and CLINICAL PHARMACOLOGY. - : Blackwell Publishing Ltd.. - 0767-3981. ; 24:6, s. 719-728
-
Forskningsöversikt (refereegranskat)abstract
- Acute Coronary Syndromes are the most frequent manifestations of coronary heart disease (CHD). Gender differences in treatment intensity, including differences in level of care, have been reported. Also differences in benefit from certain treatments, especially invasive treatment, have been discussed. Finally, differences in outcome between men and women have been proposed. Results have been inconsistent, partly depending on if and how adjustment for differences in background characteristics has been made.
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| 35. |
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| 36. |
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| 37. |
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| 38. |
- Alfredsson, Joakim, et al.
(författare)
-
Similar outcome with an invasive strategy in men and women with Non ST-Elevation Acute Coronary Syndromes
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background: Gender differences in benefit from an early invasive strategy in patients with Non ST-elevation Acute Coronary Syndromes (NSTE ACS) have been debated and results are conflicting. Some studies have even indicated harm for women associated with a routine invasive strategy. Method: We included 46 455 patients ( 14 819 women (32%) and 31 636 men (68%)) from The Register of Information and Knowledge about Swedish Heart Intensive care Admissions (RIKS-HIA), with a diagnosis of either unstable angina pectoris or non-ST-elevation myocardial infarction. All patients were admitted to intensive coronary care units in Sweden, between 2000 and 2006, and followed for 1 year. Adjustment for baseline differences between the genders was made. Results: In the non-invasive strategy arm relative risk (RR) of death was (women vs. men) 1.02 (95% CI, 0.94-1.11) and in the invasive strategy arm 1.12 (95% CI, 0.96-1.29). After adjustment for baseline differences between the genders with propensity score and discharge medication there was a trend towards lower mortality among women, RR 0.90 (95% CI, 0.82-0.99) in the early non-invasive group but still no difference in the early invasive cohort RR 0.90 (95% CI, 0.76-1.06). Results were similar with the combined end-point death/MI. The risk reduction with an invasive strategy was similar in women (RR 0.46 (95% CI 0.38-0.55)) and men (RR 0.45 (95% CI 0.40-0.52). Conclusion: In this large cohort of patients with NSTE ACS, reflecting real life management, women and men had similar outcome and similar benefit with an early invasive strategy.
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| 39. |
- Alfredsson, Joakim, et al.
(författare)
-
Similar outcome with an invasive strategy in men and women with non-ST-elevation acute coronary syndromes From the Swedish Web-System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART)
- 2011
-
Ingår i: European Heart Journal. - : Oxford University Press (OUP): Policy B. - 0195-668X .- 1522-9645. ; 32:24, s. 3128-3136
-
Tidskriftsartikel (refereegranskat)abstract
- Aims To assess gender differences in outcome with an early invasive or non-invasive strategy in patients with non-ST-elevation acute coronary syndromes (NSTE ACS). less thanbrgreater than less thanbrgreater thanMethods and results We included 46 455 patients [14 819 women (32%) and 31 636 men (68%)] from the SWEDEHEART register, with NSTE ACS, between 2000 and 2006, and followed them for 1 year. In the non-invasive strategy arm, the relative risk (RR) of death was (women vs. men) 1.02 [95% confidence interval (CI), 0.94-1.11] and in the invasive strategy arm 1.12 (95% CI, 0.96-1.29). After adjustment for baseline differences between the genders, with propensity score and discharge medication, there was a similar trend towards better outcome among women in both the early non-invasive cohort [RR 0.90 (95% CI, 0.82-0.99)] and the early invasive cohort [RR 0.90 (95% CI, 0.76-1.06)], although it did not reach statistical significance in the early invasive cohort. Results were similar with the combined endpoint death/myocardial infarction. An early invasive treatment was associated with a marked, and similar, mortality reduction in women [RR 0.46 (95% CI, 0.38-0.55)] and men [RR 0.45 (95% CI, 0.40-0.52)], without interaction with gender. less thanbrgreater than less thanbrgreater thanConclusion In this large cohort of patients with NSTE ACS, reflecting real-life management, women and men had similar and better outcome associated with an invasive strategy.
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| 40. |
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| 41. |
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| 42. |
- Ambrosi, Aurelie, et al.
(författare)
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Development of heart block in children of SSA/SSB-autoantibody-positive women is associated with maternal age and displays a season-of-birth pattern
- 2012
-
Ingår i: Annals of the Rheumatic Diseases. - London : BMJ Publishing Group. - 0003-4967 .- 1468-2060. ; 71:3, s. 334-340
-
Tidskriftsartikel (refereegranskat)abstract
- Objective Congenital heart block may develop in the fetuses of Ro/SSA-positive and La/SSB-positive mothers. Recurrence rates of only 10-20% despite persisting maternal antibodies indicate that additional factors are critical for the establishment of heart block. The authors investigated the influence of other maternal and fetal factors on heart block development in a Swedish population-based cohort. less thanbrgreater than less thanbrgreater thanMethods The influence of fetal gender, maternal age, parity and time of birth on heart block development was analysed in 145 families, including Ro/La-positive (n=190) and Ro/La-negative (n=165) pregnancies. less thanbrgreater than less thanbrgreater thanResults There was a recurrence rate of 12.1% in Ro/La-positive women, and no recurrence in Ro/La-negative women. Fetal gender and parity did not influence the development of heart block in either group. Maternal age in Ro/La-positive pregnancies with a child affected by heart block was, however, significantly higher than in pregnancies resulting in babies without heart block (pandlt;0.05). Seasonal timing of pregnancy influenced the outcome. Gestational susceptibility weeks 18-24 occurring during January-March correlated with a higher proportion of children with heart block and lower vitamin D levels during the same period in a representative sample of Swedish women and a corresponding higher proportion of children with heart block born in the summer (pandlt;0.02). Maternal age or seasonal timing of pregnancy did not affect the outcome in Ro/La-negative pregnancies. less thanbrgreater than less thanbrgreater thanConclusion This study identifies maternal age and seasonal timing of pregnancy as novel risk factors for heart block development in children of Ro/La-positive women. These observations may be useful for counselling when pregnancy is considered.
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| 43. |
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| 44. |
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| 45. |
- Andersson, Eva, 1955, et al.
(författare)
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Incidence of asthma among workers exposed to sulfur dioxide and other irritant gases
- 2006
-
Ingår i: European Respiratory Journal. - : European Respiratory Society (ERS). - 0903-1936 .- 1399-3003. ; 27:4, s. 720-5.
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to investigate whether repeated peak exposure (gassings) to sulphur dioxide (SO2) and other irritant gases increases the risk of new-onset asthma. A questionnaire was sent to 4,112 sulphite workers, of whom 1,919 completed the questionnaire and 396 completed the short-form questionnaire, which was sent out as a last reminder. A sample of 130 nonrespondents completed a telephone interview using the short-form questionnaire. The incidence of adult-onset, physician-diagnosed asthma during employment duration was analysed in relation to exposure to SO2 and gassings giving rise to respiratory symptoms. Incidence rates, as well as incidence rate ratios with 95% confidence interval (CI), were calculated. Further Cox regression models were used allowing assessment of hazard ratios (HR) stratified for sex and adjusted for atopy, smoking habits and age. The incidence rate for asthma among sulphite mill workers reporting gassings of SO2 was 6.2 out of 1,000 person-yrs, compared with 1.9 out of 1,000 person-yrs among subjects unexposed to SO2 and any gassings (HR (95% CI) 4.0 (2.1-7.7)). Among males reporting gassings to SO2, the HR (95% CI) for asthma was 5.8 (2.6-13) compared with unexposed males. In conclusion, repeated peak exposure to sulphur dioxide increased the incidence of asthma during work in sulphite pulp mills, which supports the hypothesis of irritant-induced asthma.
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| 46. |
- Beecham, Ashley H, et al.
(författare)
-
Analysis of immune-related loci identifies 48 new susceptibility variants for multiple sclerosis.
- 2013
-
Ingår i: Nature genetics. - : Springer Science and Business Media LLC. - 1546-1718 .- 1061-4036. ; 45:11, s. 1353-60
-
Tidskriftsartikel (refereegranskat)abstract
- Using the ImmunoChip custom genotyping array, we analyzed 14,498 subjects with multiple sclerosis and 24,091 healthy controls for 161,311 autosomal variants and identified 135 potentially associated regions (P < 1.0 × 10(-4)). In a replication phase, we combined these data with previous genome-wide association study (GWAS) data from an independent 14,802 subjects with multiple sclerosis and 26,703 healthy controls. In these 80,094 individuals of European ancestry, we identified 48 new susceptibility variants (P < 5.0 × 10(-8)), 3 of which we found after conditioning on previously identified variants. Thus, there are now 110 established multiple sclerosis risk variants at 103 discrete loci outside of the major histocompatibility complex. With high-resolution Bayesian fine mapping, we identified five regions where one variant accounted for more than 50% of the posterior probability of association. This study enhances the catalog of multiple sclerosis risk variants and illustrates the value of fine mapping in the resolution of GWAS signals.
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| 47. |
- Bengtsson, Magnus, et al.
(författare)
-
Transforming systems of consumption and production for achieving the sustainable development goals : moving beyond efficiency
- 2018
-
Ingår i: Sustainability Science. - : SPRINGER JAPAN KK. - 1862-4065 .- 1862-4057. ; 13:6, s. 1533-1547
-
Tidskriftsartikel (refereegranskat)abstract
- The United Nations formulated the sustainable development goals (SDGs) in 2015 as a comprehensive global policy framework for addressing the most pressing social and environmental challenges currently facing humanity. In this paper, we analyse SDG 12, which aims to ensure sustainable consumption and production patterns. Despite long-standing political recognition of this objective, and ample scientific evidence both on its importance and on the efficacy of various ways of promoting it, the SDGs do not provide clear goals or effective guidance on how to accomplish this urgently needed transformation. Drawing from the growing body of research on sustainable consumption and production (SCP), the paper identifies two dominant vantage pointsone focused on promoting more efficient production methods and products (mainly through technological improvement and informed consumer choice) and the other stressing the need to consider also overall volumes of consumption, distributional issues, and related social and institutional changes. We label these two approaches efficiency and systemic. Research shows that while the efficiency approach contains essential elements of a transition to sustainability, it is by itself highly unlikely to bring about sustainable outcomes. Concomitantly, research also finds that volumes of consumption and production are closely associated with environmental impacts, indicating a need to curtail these volumes in ways that safeguard social sustainability, which is unlikely to be possible without a restructuring of existing socioeconomic arrangements. Analysing how these two perspectives are reflected in the SDGs framework, we find that in its current conception, it mainly relies on the efficiency approach. On the basis of this assessment, we conclude that the SDGs represent a partial and inadequate conceptualisation of SCP which will hamper implementation. Based on this determination, this paper provides some suggestions on how governments and other actors involved in SDGs operationalisation could more effectively pursue SCP from a systemic standpoint and use the transformation of systems of consumption and production as a lever for achieving multiple sustainability objectives.
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| 48. |
- Ekerstad, Niklas, 1969-, et al.
(författare)
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Frailty as a Predictor of Short-Term Outcomes for Elderly Patients with non-ST-Elevation Myocardial Infarction (NSTEMI)
-
Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background – For the large and growing population of elderly patients with cardiovascular disease it is important to identify clinically relevant measures of biological age and their contribution to risk. Frailty is an emerging concept in medicine denoting increased vulnerability and decreased physiologic reserves. We analyzed how the variable frailty predicts short-term outcomes for elderly NSTEMI patients. Methods and Results – Patients, aged 75 years or older, with diagnosed NSTEMI were included at three centers, and clinical data including judgement of frailty were collected prospectively. Frailty was defined according to the Canadian Study of Health and Aging (CSHA) Clinical Frailty Scale (CFS). Of 307 patients, 150 (48.5%) were considered frail. Frail patients were slightly older and presented with a greater burden of comorbidity. By multiple logistic regression, frailty was found to be a strong independent risk factor for inhospital mortality, one-month mortality (OR 3.8, 95% CI 1.3 to 10.8) and the primary composite outcome (OR 2.2, 95% CI 1.3 to 3.7). Particularly frail patients with a high comorbidity burden manifested a markedly increased risk for the primary composite outcome. By multiple linear regression, frailty was identified as a strong independent predictor for prolonged hospital care (frail 13.4 bed days, non-frail 7.5 bed days; P<0.0001). Conclusions - Frailty is a strong independent predictor of in-hospital mortality, one-month mortality, prolonged hospital care and the primary composite outcome. The combined use of frailty and comorbidity may constitute an ultimate risk prediction concept regarding cardiovascular patients with complex needs.
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| 49. |
- Ekerstad, Niklas, et al.
(författare)
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Frailty as an instrument for evaluation of elderly patients with non-ST-segment elevation myocardial infarction: A follow-up after more than 5 years
- 2018
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Ingår i: European Journal of Preventive Cardiology. - : SAGE PUBLICATIONS LTD. - 2047-4873 .- 2047-4881. ; 25:17, s. 1813-1821
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Tidskriftsartikel (refereegranskat)abstract
- Background There is a growing body of evidence on the relevance of using frailty measures also in a cardiovascular context. The estimated time to death is crucial in clinical decision-making in cardiology. However, data on the importance of frailty in long-term mortality are very scarce. The aim of the study was to assess the prognostic value of frailty on mortality at long-term follow-up of more than 5 years in patients 75 years or older hospitalised for non-ST-segment elevation myocardial infarction. We hypothesised that frailty is independently associated with long-term mortality. Design This was a prospective, observational study conducted at three centres. Methods and results Frailty was assessed according to the Canadian Study of Health and Aging clinical frailty scale (CFS). Of 307 patients, 149 (48.5%) were considered frail according to the study instrument (degree 5-7 on the scale). The long-term all-cause mortality of more than 5 years (median 6.7 years) was significantly higher among frail patients (128, 85.9%) than non-frail patients (85, 53.8%), (P amp;lt; 0.001). In Cox regression analysis, frailty was independently associated with mortality from the index hospital admission to the end of follow-up (hazard ratio 2.06, 95% confidence interval 1.51-2.81; P amp;lt; 0.001) together with age (P amp;lt; 0.001), ejection fraction (P = 0.012) and Charlson comorbidity index (P = 0.018). Conclusions In elderly non-ST-segment elevation myocardial infarction patients, frailty was independently associated with all-cause mortality at long-term follow-up of more than 6 years. The combined use of frailty and comorbidity may be the ultimate risk prediction concept in the context of cardiovascular patients with complex needs.
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- Ekerstad, Niklas, et al.
(författare)
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Frailty is independently associated with 1-year mortality for elderly patients with non-ST-segment elevation myocardial infarction
- 2014
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Ingår i: European Journal of Preventive Cardiology. - : Sage Publications. - 2047-4873 .- 2047-4881. ; 21:10, s. 1216-1224
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: For the large population of elderly patients with cardiovascular disease, it is crucial to identify clinically relevant measures of biological age and their contribution to risk. Frailty is denoting decreased physiological reserves and increased vulnerability. We analysed the manner in which the variable frailty is associated with 1-year outcomes for elderly non-ST-segment elevation myocardial infarction (NSTEMI) patients. METHODS AND RESULTS: Patients aged 75 years or older, with diagnosed NSTEMI were included at three centres, and clinical data including judgment of frailty were collected prospectively. Frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale. Of 307 patients, 149 (48.5%) were considered frail. By Cox regression analyses, frailty was found to be independently associated with 1-year mortality after adjusting for cardiovascular risk and comorbid conditions (hazard ratio 4.3, 95% CI 2.4-7.8). The time to the first event was significantly shorter for frail patients than for nonfrail (34 days, 95% CI 10-58, p = 0.005). CONCLUSIONS: Frailty is strongly and independently associated with 1-year mortality. The combined use of frailty and comorbidity may constitute an important risk prediction concept in regard to cardiovascular patients with complex needs.
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