| 1. |
- Isaksson, Eva, et al.
(författare)
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Identifying important barriers to recruitment of patients in randomised clinical studies using a questionnaire for study personnel
- 2019
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Ingår i: Trials. - : BMC. - 1745-6215. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many randomised controlled trials (RCT) fail to meet their recruitment goals. Study personnel play a key role in recruitment. The aim of this study was to identify successful strategies that study personnel consider to be important in patient recruitment to RCT. Methods: We constructed a questionnaire based on the literature, discussions with colleagues and our own experience as trialists. The survey was named "What is Important for Making a Study Successful questionnaire" (WIMSS-q). Our target group was the study personnel in the ongoing EFFECTS study. The questionnaire was sent out electronically to all physicians and nurses (n = 148). Success factors and barriers were divided according to patient, centre and study level, respectively. Results: Responses were received from 94% of the study personnel (139/148). The five most important factors at centre level for enhancing recruitment were that the research question was important (97%), a simple procedure for providing information and gaining consent (92%), a highly engaged local principal investigator and research nurse (both 87%), and that study-related follow-ups are practically feasible and possible to coordinate with the clinical follow-up (87%). The most significant barrier at the local centre was lack of time and resources devoted to research (72%). Important patient-related barriers were fear of side effects (35%) and language problems (30%). Conclusions: For recruitment in an RCT to be successful, the research question must be relevant, and the protocol must be simple and easy to implement in the daily routine.
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| 2. |
- Isaksson, Eva, et al.
(författare)
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Validation of the Simplified Modified Rankin Scale Questionnaire
- 2020
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Ingår i: European Neurology. - : S. Karger. - 0014-3022 .- 1421-9913. ; 83:5, s. 493-499
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The modified Rankin scale (mRS) is the most common assessment tool for measuring overall functional outcome in stroke studies. The traditional way of using mRS face-to-face is time- and cost-consuming. The aim of this study was to test the validity of the Swedish translation of the simplified modified Rankin scale questionnaire (smRSq) as compared with the mRS assessed face-to-face 6 months after a stroke.Methods: Within the ongoing EFFECTS trial, smRSq was sent out to 108 consecutive stroke patients 6 months after a stroke. The majority, 90% (97/108), of the patients answered the questionnaire; for the remaining 10%, it was answered by the next of kin. The patients were assessed by face-to-face mRS by 7 certified healthcare professionals at 4 Swedish stroke centres. The primary outcome was assessed by Cohen's kappa and weighted kappa.Results: There was good agreement between postal smRSq, answered by the patients, and the mRS face-to-face; Cohen's kappa was 0.43 (CI 95% 0.31-0.55), weighted kappa was 0.64 (CI 95% 0.55-0.73), and Spearman rank correlation was 0.82 (p < 0.0001). In 55% (59/108), there was full agreement, and of the 49 patients not showing exact agreement, 44 patients differed by 1 grade and 5 patients had a difference of 2 grades.Discussion/Conclusion: Our results show good validity of the postal smRSq, answered by the patients, compared with the mRS carried out face-to-face at 6 months after a stroke. This result could help trialists in the future simplify study design and make multicentre trials and quality registers with a large number of patients more feasible and time-saving.
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| 3. |
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| 4. |
- Lundström, Erik, 1964-, et al.
(författare)
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Effects of Fluoxetine on Outcomes at 12 Months After Acute Stroke Results From EFFECTS, a Randomized Controlled Trial
- 2021
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Ingår i: Stroke. - : Ovid Technologies (Wolters Kluwer Health). - 0039-2499 .- 1524-4628. ; 52:10, s. 3082-3087
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND PURPOSE: The EFFECTS (Efficacy of Fluoxetine-a Randomised Controlled Trial in Stroke) recently reported that 20 mg fluoxetine once daily for 6 months after acute stroke did not improve functional outcome but reduced depression and increased fractures and hyponatremia at 6 months. The purpose of this predefined secondary analysis was to identify if any effects of fluoxetine were maintained or delayed over 12 months. METHODS: EFFECTS was an investigator-led, randomized, placebo-controlled, double-blind, parallel group trial in Sweden that enrolled adult patients with stroke. Patients were randomized to 20 mg oral fluoxetine or matching placebo for 6 months and followed for another 6 months. The primary outcome was functional outcome (modified Rankin Scale), at 6 months. Predefined secondary outcomes for these analyses included the modified Rankin Scale, health status, quality of life, fatigue, mood, and depression at 12 months. RESULTS: One thousand five hundred patients were recruited from 35 centers in Sweden between 2014 and 2019; 750 were allocated fluoxetine and 750 placebo. At 12 months, modified Rankin Scale data were available in 715 (95%) patients allocated fluoxetine and 712 (95%) placebo. The distribution of modified Rankin Scale categories was similar in the 2 groups (adjusted common odds ratio, 0.92 [95% CI, 0.76-1.10]). Patients allocated fluoxetine scored worse on memory with a median value of 89 (interquartile range, 75-100) versus 93 (interquartile range, 82-100); P=0.0021 and communication 93 (interquartile range, 82-100) versus 96 (interquartile range, 86-100); P=0.024 domains of the Stroke Impact Scale compared with placebo. There were no other differences in secondary outcomes. CONCLUSIONS: Fluoxetine after acute stroke had no effect on functional outcome at 12 months. Patients allocated fluoxetine scored worse on memory and communication on the Stroke Impact Scale compared with placebo, but this is likely to be due to chance.
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| 5. |
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| 6. |
- Ängskog, Per, 1964-
(författare)
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Protection of Complex Infrastructure Systems against Intentional Electromagnetic Interference
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis the effects of, and defense against, antagonistic attacks using Intentional Electromagnetic Interference (IEMI) are treated; especially when targeting infrastructure critical to society (CI).IEMI as a means to disturb or destroy electronic equipment draws its roots from military methods to interrupt or interfere with enemy activities. Especially since the end of the cold war these methods have been adopted by various criminal groups and have been utilized on several occasions. How often and the severity of the outcome is difficult to know since it is difficult to understand whether it is IEMI or something else that causes disturbances in computers, networks, sensors, and other types of electronic equipment. Contributing to this is the fact that IEMI does notl eave any viable forensic evidence when used. This, together with low interest in reporting security flaws publicly suggests that the number of incidents is underreported. Although not a large-scale problem, it could be devastating for the trust in the society’s ability to defend itself and its citizens. As IEMI as an antagonistic method has the capacity to interrupt the function of CIs, the need for protective measures has been raised by the Swedish Civil Contingencies Agency (MSB). Few reported cases, together with the antagonistic nature of the threat, render probabilistic risk analysis inadequate for the defense of infrastructures critical to society. Instead, a shift towards resilience engineering and vulnerability analysis is suggested to manage these antagonistic threats. As part of building protection improvement, the shielding efficiency of different generations of windows and panes has been measured and analyzed.
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| 7. |
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| 8. |
- Ceccato, Vania, Professor, 1968-, et al.
(författare)
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Comparing responses from a paper-based survey with a web-based survey in environmental criminology
- 2024
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Ingår i: Crime Prevention & Community Safety. - : Palgrave Macmillan. - 1460-3780 .- 1743-4629. ; 26:2, s. 216-243
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Tidskriftsartikel (refereegranskat)abstract
- This article aims to compare the pattern of responses obtained by a web-based and a paper-based survey used to investigate the transit safety of travellers in railway stations in Sweden. This aim is achieved by evaluating whether the response and the completion rates change as the surveys progress, assessing the effect of the survey mode on respondents' answers (after controlling for the surveys' internal consistency and differences in the samples), and the potential impact of the order of alternatives in multiple-choice questions on the responses. To carry out the study, a sample of 500 responses was taken from each population and later compared using a series of statistical tests. Findings indicate that despite the surveys' high internal consistency, the prevalence of victimisation, fear of crime, and precautions detected in the web survey was higher than those found in the paper survey. The web survey shows a major drop just after the initial questions, while the paper survey shows a more stable pattern of responses, but was also affected by a single compulsory question that pushed the completion rate down. Finally, the order of alternatives in multiple-choice questions (fixed or random) did not affect the answers given by the respondents, providing a solid base for safety interventions in transit environments, regardless of survey mode. The article concludes by making suggestions for both research and practice.
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| 9. |
- Ceccato, Vania, Professor, 1968-, et al.
(författare)
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The impact of fear on young people’s mobility
- 2021
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Ingår i: European Journal of Criminology. - : SAGE Publications. - 1477-3708 .- 1741-2609.
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Tidskriftsartikel (refereegranskat)abstract
- This study makes use of a dataset recently collected among young people in Stockholm, Sweden (N = 1122), to investigate the impact of fear on young people?s mobility and precautionary behaviour, after controlling for previous victimization as well as situational characteristics of daily trips. Geographical Information Systems (GIS) and logistic regression models underlie the methodology of the study. Previous victimization, especially for sexual crimes, triggers precautionary behaviour among young people using trains and the metro. Signs of poorly maintained transit environments also affect young riders? mobility patterns, as they state that they avoid particular stations or routes at particular times. Informed by principles of environmental criminology and the theory of fear of crime, the implications of the findings for both theory and practice are discussed.
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| 10. |
- Ceccato, Vania, Professor, 1968-, et al.
(författare)
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Young people’s victimization and safety perceptions along the trip
- 2021
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Ingår i: Nordic Journal of Criminology. - 2578-983X. ; 22:1, s. 106-125
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this article is to assess whether, how and why young people’s safety perceptions vary along the trip. Informed by principles of environmental criminology, this study makes use of a dataset recently collected among young riders of public transportation (1,122 university students) in Stockholm, Sweden. Geographical Information Systems (GIS) and logistic regression models underlie the methodology of the study. Findings indicate that safety perceptions of young riders are affected by previous experience of sexual crimes but are not affected by overall victimization. More importantly, being exposed to high crime environments on the way to the metro significantly reduces young people’s safety perceptions (but not on the way to bus stops), especially for men. Drunk people tend to affect women’s safety perceptions, especially in bus systems. The article finishes by discussing the implications of the results for future research and helps advocate more inclusion of young people’s safety needs when implementing safety and transportation policies.
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| 11. |
- Ferrannini, Giulia, et al.
(författare)
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Antiphospholipid antibodies in patients with dysglycaemia : A neglected cardiovascular risk factor?
- 2020
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Ingår i: Diabetes & Vascular Disease Research. - : SAGE PUBLICATIONS LTD. - 1479-1641 .- 1752-8984. ; 17:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cardiovascular disease is a serious complication in patients with dysglycaemia, defined as either type 2 diabetes or impaired glucose tolerance. Research focusing on the identification of potential markers for atherothrombotic disease in these subjects is warranted. The antiphospholipid syndrome is a common acquired prothrombotic condition, defined by a combination of thrombotic events and/or obstetric morbidity and positivity of specific antiphospholipid antibodies. Available information on antiphospholipid antibodies in dysglycaemia is scarce. Objective: This study investigates the association between antiphospholipid antibodies and dysglycaemia. Patients/Methods: The PAROKRANK (periodontitis and its relation to coronary artery disease) study included 805 patients, investigated 6-10 weeks after a first myocardial infarction, and 805 matched controls. Participants without known diabetes (91%) underwent an oral glucose tolerance test. Associations between antiphospholipid antibodies (anti-cardiolipin and anti-beta 2 glycoprotein-I IgG, IgM and IgA) and dysglycaemia were analysed. Results: In total, 137 (9%) subjects had previously known type 2 diabetes and 371 (23%) newly diagnosed dysglycaemia. Compared with the normoglycaemic participants, those with dysglycaemia had a higher proportion with first myocardial infarction (61% vs 45%,p < 0.0001) and were more often antiphospholipid antibody IgG positive (8% vs 5%;p = 0.013). HbA1c, fasting glucose and 2-h glucose were significantly associated to antiphospholipid antibody IgG. Odds ratios (ORs) were 1.04 (95% confidence interval [CI] 1.02-1.06), 1.14 (95% CI 1.00 - 1.27) and 1.12 (95% CI 1.04 - 1.21), respectively, after adjustments for age, gender and smoking. Conclusions: This study reports an association between antiphospholipid antibody IgG positivity and dysglycaemia. Further studies are needed to verify these findings and to investigate if antithrombotic therapy reduces vascular complications in antiphospholipid antibody positive subjects with dysglycaemia.
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| 12. |
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| 13. |
- Ferrannini, Giulia, et al.
(författare)
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Long-term prognosis after a first myocardial infarction : eight years follow up of the case-control study PAROKRANK
- 2022
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 56:1, s. 337-342
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Tidskriftsartikel (refereegranskat)abstract
- Objective. To explore long-term cardiovascular outcomes and mortality in patients after a first myocardial infarction (MI) compared with matched controls in a contemporary setting. Methods. During 2010-2014 the Swedish study PAROKRANK recruited 805 patients <75 years with a first MI and 805 age-, gender-, and area-matched controls. All study participants were followed until 31 December 2018, through linkage with the National Patient Registry and the Cause of Death Registry. The primary endpoint was the first of a composite of all-cause death, non-fatal MI, non-fatal stroke, and heart failure hospitalization. Event rates in cases and controls were calculated using a Cox regression model, subsequently adjusted for baseline smoking, education level, and marital status. Kaplan-Meier curves were computed and compared by log-rank test. Results. A total of 804 patients and 800 controls (mean age 62 years; women 19%) were followed for a mean of 6.2 (0.2-8.5) years. The total number of primary events was 211. Patients had a higher event rate than controls (log-rank test p < .0001). Adjusted hazard ratio (HR) for the primary outcome was 2.04 (95% CI 1.52-2.73). Mortality did not differ between patients (n = 38; 4.7%) and controls (n = 35; 4.4%). A total of 82.5% patients and 91.3% controls were event-free during the follow up. Conclusions. In this long-term follow up of a contemporary, case-control study, the risk for cardiovascular events was higher in patients with a previous first MI compared with their matched controls, while mortality did not differ. The access to high quality of care and cardiac rehabilitation might partly explain the low rates of adverse outcomes.
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| 14. |
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| 15. |
- Fortin, Elena, et al.
(författare)
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Empagliflozin improves insulin sensitivity in patients with recent acute coronary syndrome and newly detected dysglycaemia : Experiences from the randomized, controlled SOCOGAMI trial
- 2023
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Ingår i: Cardiovascular Diabetology. - : Springer Nature. - 1475-2840. ; 22:1, s. 208-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Empagliflozin reduces the risk of cardiovascular disease (CVD) in patients with type 2 diabetes (T2DM) and high cardiovascular risk via mechanisms which have not been fully explained. The mechanisms of such benefit have not been fully understood, and whether empagliflozin can be safely administered as first-line treatment in patients with CVD at the initial stages of glycaemic perturbations remains to be established. We investigated the effects of empagliflozin on insulin resistance, insulin sensitivity and β-cell function indexes in patients with a recent acute coronary event and newly detected dysglycaemia, i.e., impaired glucose tolerance (IGT) or T2DM. METHODS: Forty-two patients (mean age 67.5 years, 19% females) with a recent myocardial infarction (n = 36) or unstable angina (n = 6) and newly detected dysglycaemia were randomized to either empagliflozin 25 mg daily (n = 20) or placebo (n = 22). Patients were investigated with stress-perfusion cardiac magnetic resonance imaging before randomization, 7 months after the start of study drug and 3 months following its cessation. Indexes of insulin resistance, sensitivity and β-cell function were calculated based on glucose and insulin values from 2-hour oral glucose tolerance tests (OGTT) and fasting C-peptide. The differences in glucose, insulin, C-peptide, mannose levels and indexes between the two groups were computed by repeated measures ANOVA including an interaction term between the treatment allocation and the time of visit. RESULTS: After 7 months, empagliflozin significantly decreased glucose and insulin values during the OGTT, whereas C-peptide, mannose and HbA1c did not differ. Empagliflozin significantly improved insulin sensitivity indexes but did not impact insulin resistance and β-cell function. After cessation of the drug, all indexes returned to initial levels. Insulin sensitivity indexes were inversely correlated with left ventricular mass at baseline. CONCLUSIONS: Empagliflozin improved insulin sensitivity indexes in patients with a recent coronary event and drug naïve dysglycaemia. These findings support the safe use of empagliflozin as first-line glucose-lowering treatment in patients at very high cardiovascular risk with newly diagnosed dysglycaemia. TRIAL REGISTRATION NUMBER: EudraCT number 2015-004571-73.
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| 16. |
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| 17. |
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| 18. |
- Fortin, Elena, et al.
(författare)
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Plasma mannose as a novel marker of myocardial infarction across different glycaemic states : A case control study
- 2022
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Ingår i: Cardiovascular Diabetology. - : Springer Nature. - 1475-2840. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Plasma mannose, an emerging novel biomarker of insulin resistance, is associated with both diabetes mellitus and coronary atherosclerosis, but the relationship between mannose concentrations and myocardial infarction (MI) across different glycaemic states remains to be elucidated. The aim of this study was to investigate the independent association between mannose and a first MI in a group of subjects characterized according to their glycaemic state. Methods Fasting plasma mannose concentrations were analysed in 777 patients 6-10 weeks after a first myocardial infarction and in 770 matched controls by means of high-performance liquid chromatography coupled to tandem mass spectrometry. Participants without known diabetes mellitus were categorized by an oral glucose tolerance test (OGTT) as having normal glucose tolerance (NGT, n = 1045), impaired glucose tolerance (IGT, n = 246) or newly detected type 2 diabetes (T2DM, n = 112). The association between mannose and MI was investigated across these glycaemic states by logistic regression. Results Mannose levels increased across the glycaemic states (p < 0.0001) and were significantly associated with a first MI in the whole study population (odds ratio, OR: 2.2; 95% CI 1.4 to - 3.5). Considering the different subgroups separately, the association persisted only in subjects with NGT (adjusted OR: 2.0; 95% CI 1.2-3.6), but not in subgroups with glucose perturbations (adjusted OR: 1.8, 95% CI 0.8-3.7). Conclusions Mannose concentrations increased across worsening levels of glucose perturbations but were independently associated with a first MI only in NGT individuals. Thus, mannose might be a novel, independent risk marker for MI, possibly targeted for the early management of previously unidentified patients at high cardiovascular risk.
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| 19. |
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| 20. |
- Kalafatis, Dimitrios, et al.
(författare)
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Distal Lung Microenvironment Triggers Release of Mediators Recognized as Potential Systemic Biomarkers for Idiopathic Pulmonary Fibrosis
- 2021
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Ingår i: International Journal of Molecular Sciences. - : MDPI AG. - 1661-6596 .- 1422-0067. ; 22:24, s. 13421-
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Tidskriftsartikel (refereegranskat)abstract
- Idiopathic pulmonary fibrosis (IPF) is a progressive fibrotic lung disease with an unmet need of biomarkers that can aid in the diagnostic and prognostic assessment of the disease and response to treatment. In this two-part explorative proteomic study, we demonstrate how proteins associated with tissue remodeling, inflammation and chemotaxis such as MMP7, CXCL13 and CCL19 are released in response to aberrant extracellular matrix (ECM) in IPF lung. We used a novel ex vivo model where decellularized lung tissue from IPF patients and healthy donors were repopulated with healthy fibroblasts to monitor locally released mediators. Results were validated in longitudinally collected serum samples from 38 IPF patients and from 77 healthy controls. We demonstrate how proteins elevated in the ex vivo model (e.g., MMP7), and other serum proteins found elevated in IPF patients such as HGF, VEGFA, MCP-3, IL-6 and TNFRSF12A, are associated with disease severity and progression and their response to antifibrotic treatment. Our study supports the model's applicability in studying mechanisms involved in IPF and provides additional evidence for both established and potentially new biomarkers in IPF.
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| 21. |
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| 22. |
- Kang, Yuhao, et al.
(författare)
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Assessing differences in safety perceptions using GeoAI and survey across neighbourhoods in Stockholm, Sweden
- 2023
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Ingår i: Landscape and Urban Planning. - : Elsevier BV. - 0169-2046 .- 1872-6062. ; 236, s. 104768-104768
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Tidskriftsartikel (refereegranskat)abstract
- The safety perception of the built environment, rather than the sheer number of crimes and incivility behavior, is a fundamental driver of public policies intended to improve urban safety. Traditional surveys often capture neighborhood residents’ perceived safety, but may not fully reflect the perceptions of people who are unfamiliar with the area. In this study, focused on the city of Stockholm, Sweden, we develop a geospatial artificial intelligence (GeoAI) approach using street view images and recruiting locals to create a measure of citywide residents’ safety perceptions. We compare the measures from the survey based on neighborhood residents’ responses with those from the GeoAI approach to better understand the relationship between these safety measures. We model the two forms of safety perceptions and their disparities (i.e., perception bias) as a function of the city’s land use and its socio-demographics. Results confirm that while the GeoAI-based measures better capture people’s instant impressions of the built environment across the city, the survey-based measures reflect their overall daily experiences of specific areas. Regions that appear to be economically vibrant and have inner-city streetscapes are perceived as safe places from visual appearance but are not always perceived as such by residents. Older adults tend to overestimate their likelihood of being victimized by crime, which may enlarge perception bias. The study concludes by critically assessing the potential ethical issues (e.g., spatial bias, population bias) in the proposed methodology and making suggestions for future research.
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| 23. |
- Kjellström, Barbro, et al.
(författare)
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Adherence to disease-specific drug treatment among patients with pulmonary arterial hypertension or chronic thromboembolic pulmonary hypertension
- 2020
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Ingår i: European Respiratory Journal Open Research. - Sheffield : European Respiratory Society (ERS). ; 6:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) require lifelong treatment. The aim of the present study was to investigate adherence to disease-specific treatment in patients with PAH or CTEPH. Methods: The study comprised an adult population diagnosed with PAH (n=384) or CTEPH (n=187) alive in 2016-2017. The study utilised three registries: the Swedish PAH registry, the National Board of Health and Welfare, and Statistics Sweden. Withdrawals from pharmacies of disease-specific oral treatments were studied. Adherence was assessed as: 1) Number of days covered defined as the difference between the total number of daily dosages dispensed and the total number of days covered; and 2) Manual assessment by two persons that independently reviewed each patient's prescription fill history to detect anomalies or patterns of deteriorating or improving adherence over time. Results: The mean age was 61±16 years, 61% were female and mean time since diagnosis was 4.6 years. Adherence was 62% using the Number of days covered method and 66% by the Manual assessment method. Drug-specific adherence varied from 91% for riociguat to 60% for sildenafil. Good adherence was associated with shorter time since diagnosis in patients with PAH and with lower number of concomitant other chronic treatments in patients with CTEPH. Age, sex, socioeconomic status or number of pulmonary hypertension (PH) treatments were not associated with adherence. Conclusion: Adherence to oral disease-specific treatment was 60-66% and associated with time since diagnosis and number of concomitant chronic treatments. Sex, age or socioeconomic factors did not affect adherence.
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| 24. |
- Lundin, Magnus, et al.
(författare)
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SOdium-glucose CO-transporter inhibition in patients with newly detected Glucose Abnormalities and a recent Myocardial Infarction (SOCOGAMI)
- 2022
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Ingår i: Diabetes Research and Clinical Practice. - : Elsevier BV. - 0168-8227 .- 1872-8227. ; 193, s. 110141-
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Tidskriftsartikel (refereegranskat)abstract
- Aims/hypothesis: Established dysglycaemia (impaired glucose tolerance [IGT] or type 2 diabetes [T2DM]) is a risk factor for further cardiovascular events in patients with coronary artery disease. Sodium-glucose cotransporter 2 inhibitors reduce this risk. The aim of the present investigation was to test the hypothesis that empagliflozin exerts beneficial effects on myocardial function in patients with a recent acute coronary syndrome and newly detected dysglycaemia. Methods: Forty-two patients (mean age 67.5 years, 81 % male) with recent myocardial infarction (n = 36) or unstable angina (n = 6) and newly detected IGT (n = 27) or T2DM (n = 15) were randomised to 25 mg of empagliflozin daily (n = 20) or placebo (n = 22) on top of ongoing therapy. They were investigated with oral glucose tolerance tests, stress-perfusion cardiac magnetic resonance imaging (CMR) and echocardiography at three occasions: before randomisation, after seven months on study drug and three months following cessation of such drug. Primary outcome was a change in left ventricular (LV) end-diastolic volume (LVEDV) and secondary outcomes were a change in a) systolic and diastolic LV function; b) coronary flow reserve; c) myocardial extracellular volume (ECV) in non-infarcted myocardium; d) aortic pulse wave velocity. Results: Empagliflozin induced a significant decrease in fasting and post load glucose (p < 0.05) and body weight (p < 0.01). Empagliflozin did not influence LVEDV, LV systolic or mass indexes, coronary flow reserve, ECV or aortic pulse wave velocity. Echocardiographic indices of LV diastolic function (E/e' and mitral E/A ratio) were not influenced. No safety concerns were identified. Conclusions/interpretation: Empagliflozin had predicted effects on the dysglycaemia but did not influence vari-ables expressing LV function, coronary flow reserve and ECV. An explanation may be that the LV function of the patients was within the normal range.
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| 25. |
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| 26. |
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| 27. |
- Mead, Gillian Elizabeth, et al.
(författare)
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Update to the FOCUS, AFFINITY and EFFECTS trials studying the effect(s) of fluoxetine in patients with a recent stroke : statistical analysis plan for the trials and for the individual patient data meta-analysis
- 2020
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Ingår i: Trials. - : Springer Nature. - 1745-6215. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThree large trials of fluoxetine for stroke recovery (FOCUS (fluoxetine or control under supervision), AFFINITY (the Assessment oF FluoxetINe In sTroke recovery) and EFFECTS (Efficacy oF Fluoxetine-a randomisEd Controlled Trial in Stroke)) have been collaboratively designed with the same basic protocol to facilitate an individual patient data analysis (IPDM). The statistical analysis plan for the three individual trials has already been reported in Trials, including a brief description of the IPDM. In this protocol, we describe in detail how we will perform the IPDM.Methods/designData from EFFECTS and AFFINITY will be transferred securely to the FOCUS statistician, who will perform a one-stage IPDM and a two-stage IPDM. For the one-stage IPDM, data will be combined into a single data set and the same analyses performed as described for the individual trials. For the two-stage IPDM, the results for the three individual trials will be combined using fixed effects meta-analyses.The primary and secondary outcome domains for the IPDM are the same as for individual trials. We will also perform analyses according to several subgroups including country of recruitment, ethnicity and trial. We will also explore the effects of fluoxetine on our primary and secondary outcomes in subgroups defined by combinations of characteristics.We also describe additional research questions that will be addressed using the combined data set, and published subsequently, including predictors of important post-stroke problems such as seizures, low mood and bone fractures.DiscussionAn IPDM of our three large trials of fluoxetine for stroke recovery will allow us to provide the most precise estimates of any risks and benefits of fluoxetine vs placebo, to detect reliably a smaller overall effect size than those detectable by the individual trials, to better determine the effects of fluoxetine vs placebo in subgroups of patients and outcomes and to broaden the generalisability of the results. Also, we may identify differences in treatment effects between studies.Trial registrationFOCUS: ISRCTN ISRCTN83290762. Registered on 23 May 2012. EudraCT 2011-005616-29. Registered on 3 February 2012.AFFINITY: Australian New Zealand Clinical Trials Registry ACTRN12611000774921. Registered on 22 July 2011.EFFECTS: ISRCTN ISRCTN13020412. Registered on 19 December 2014. ClinicalTrials.gov NCT02683213. Registered on 2 February 2016. EudraCT 2011-006130-16. Registered on 8 August 2014.
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| 28. |
- Meziani, Sara, et al.
(författare)
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Mannose-binding lectin does not explain the dismal prognosis after an acute coronary event in dysglycaemic patients : A report from the GAMI cohort
- 2022
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Ingår i: Cardiovascular Diabetology. - : Springer Nature. - 1475-2840. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background Mannose binding lectin (MBL) has been suggested to be associated with an impaired cardiovascular prognosis in dysglycaemic conditions, but results are still contrasting. Our aims are (i) to examine whether MBL levels differ between patients with an acute myocardial infarction (MI) and healthy controls and between subgroups with different glucose tolerance status, and (ii) to investigate the relation between MBL and future cardiovascular events. Methods MBL levels were assessed at discharge and after 3 months in 161 AMI patients without any previously known glucose perturbations and in 183 age- and gender-matched controls from the Glucose metabolism in patients with Acute Myocardial Infarction (GAMI) study. Participants were classified as having dysglycaemia, i.e. type 2 diabetes or impaired glucose tolerance, or not by an oral glucose tolerance test. The primary outcome was a composite of cardiovascular events comprising cardiovascular death, AMI, stroke or severe heart failure during 11 years of follow-up. Total and cardiovascular mortality served as secondary outcomes. Results At hospital discharge patients had higher MBL levels (median 1246 mu g/L) than three months later (median 575 mu g/L; p < 0.01), the latter did not significantly differ from those in the controls (801 mu g/L; p = 0.47). MBL levels were not affected by dysglycaemia either in patients or controls. Independent of glycaemic state, increasing MBL levels did not predict any of the studied outcomes in patients. In unadjusted analyses increasing MBL levels predicted cardiovascular events (hazard ratio HR: 1.67, 95% confidence interval CI 1.06-2.64) and total mortality (HR 1.53, 95% CI 1.12-2.10) in the control group. However, this did not remain in adjusted analyses. Conclusions Patients had higher MBL levels than controls during the hospital phase of AMI, supporting the assumption that elevated MBL reflects acute stress. MBL was not found to be independently associated with cardiovascular prognosis in patients with AMI regardless of glucose state.
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| 29. |
- Moberg, Bengt, et al.
(författare)
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ERAS-Evaluation of realistic approach scenarios for minimal noise : preliminary findings
- 2021
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Ingår i: 32nd Congress of the International Council of the Aeronautical Sciences, ICAS 2021. - : International Council of the Aeronautical Sciences.
-
Konferensbidrag (refereegranskat)abstract
- During approach to an airport aircraft as noise sources change along the approach paths they travel. Extension of slats, flaps and landing gear will affect aerodynamic noise and as a consequence of increased drag also engine noise will be affected. In the ERAS-project the overall possibilities at an airport to reduce noise by implementing operational procedures for arriving aircraft is evaluated. As a first step a number of aircraft types were selected and the operational descriptions in the Aircraft Noise and Performance database (ANP), maintained by Eurocontrol were compared to the operational descriptions in the aircrafts' operating manuals (FCOM). One aircraft type where discrepancies was found between the ANP and the FCOM and where flight data from real flights were available was selected for further analysis. Flight data recorder data from 1 357 flights were analyzed in order to find operational possibilities and limitations. Based on the outcome from actual flights and the FCOM, twelve operationally feasible approach scenarios were developed in which noise and fuel calculations were performed for the developed scenarios. The results suggest that there exists possibilities for airports to reduce both noise and CO2 emissions by implementing operational recommendations for landing aircraft.
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| 30. |
- Moberg, B., et al.
(författare)
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Operational noise optimization of aircraft approaches
- 2021
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Ingår i: Proceedings of INTER-NOISE 2021 - 2021 International Congress and Exposition of Noise Control Engineering. - : Institute of Noise Control Engineering (INCE). ; , s. 499-507
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Konferensbidrag (refereegranskat)abstract
- The characteristics of an aircraft as a noise source changes as the pilots slow the aircraft down and extend flaps and landing gear in preparation for landing. In the OPNOP project, the possibility to use this variation in noise generation to minimize noise at a specified location is examined. Such analysis requires an increased understanding about aircraft noise generation as the aircraft changes configuration and speed during the approach, where theoretical models available can be overly simplistic and of little use for this purpose. Using flight data from 113 Airbus A321 flights, and corresponding noise measurements on the ground, this study reports on the findings forming the foundation on which further analysis will be conducted. Findings relate to: a comparison between models and actual measurements, the distance variability to the runway for various flap selections and extension of the landing gear as well as a comparison between flight data and on-ground noise measurements. Captured data suggest that it should be possible to use speed and configuration recommendations to reduce noise over selected approach areas. Future research will include scenario generation and incorporate flight data from an earlier study to increase validity.
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| 31. |
- Nelldal, Bo-Lennart, 1946-, et al.
(författare)
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Förseningarnas påverkan på efterfrågan av tågresor – en tidsserieanalys
- 2022
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Förseningar utgör en del av resenärernas uppoffring. Hypotesen är att när förseningarna blir för frekventa och för stora kan det påverka efterfrågan på tågresor. Om resenärerna inte kan lita på tåget finns det en risk att andra färdmedel väljs i stället eller att resandet uteblir. Detta kan tyckas självklart ändå finns det nästan inga kvantitativa analyser av hur mycket förseningarna i tågtrafiken påverkar efterfrågan. Detta projekt syftar till att få fram sådana samband. Med detta projekt går det även att få fram hur andra faktorer påverkar efterfrågan såsom restid, turtäthet och pris vilket också nödvändigt för att kunna särskilja effekten av förseningarna.Syftet är att hitta samband mellan förseningar och efterfrågan på tågresor d.v.s. hur mycket minskar tågresandet när förseningarna ökar? En metod att få fram detta är att använda tidsserieanalys. Vi har gjort detta genom att kombinera följande data som KTH har tillgång till i kombination med statistiska metoder för tidserieanalys.· KTH utbudsdatabas med restider, turtäthet och priser för olika linjer och produkter 1990-2020· Trafikverkets databas över förseningar 2001-2020 per linje t.ex. andel tåg i tid inom 5 min och medelförsening· Databas från SJ, Trafikhuvudmän och privata operatörer över efterfrågan per linje eller trafiksystem 1990-2020· Makroekonomiska data såsom privat konsumtion· Befolkningsutveckling längs linjerna· Bilinnehav och bensinpriserMed hjälp av tidserieanalys kan man få fram hur mycket varje faktor bidrar till utvecklingen av efterfrågan på tågresor. Syftet är således att kunna skilja på effekten av kortare restid, ökad turtäthet, ändrade priser och förseningar. För de flesta variabler finns data för perioden 1990-2020 men för förseningar 2001-2020.Ett stort antal mått på förseningar har tagits fram t.ex. andel försenade tåg inom 5 min (RT+5) och medelförsening för försenade tåg samt andel inställda tåg. Ett nytt mått på har tagits fram i form av antal förseningsminuter per 1000 tågkilometer. Ett stort arbete har lagts ned på att bearbeta förseningsdata från Trafikverkets LUPP-data för att få dem per linje (ca 50 linjer i Sverige) och produkt (snabbtåg, regionaltåg etc.). Bearbetningen visar på stora förseningar under 2010-2011 p.g.a. vinterproblemen och 2018 p.g.a. den varma sommaren. Den bästa punktligheten var det 2004 och 2019 samt 2020. 2020 har dock inte används i tidserieanalysen eftersom efterfrågan var onormal p.g.a. coronapandemin.Det mått som hittills har gett bäst resultat är medelförsening för tåg som är mer än 5 minuter försenade (RT+5). Med hjälp av tidserieanalys har en elasticitet beräknas mellan medelförsening RT+5 och antalet personkilometer med fjärrtrafik. Elasticiteten blev -0,6 vilket innebär att om medelförseningen ökar med 10% så minskar efterfrågan i personkilometer med 6%. Det innebär t.ex. om ett snabbtåg i medeltal är 20 minuter försenat för RT+5 (typiskt värde för snabbtåg) och medelförseningen ökar till 24 minuter eller med 20% så kommer efterfrågan att minska med 0,6*20=12%. Detta stämmer också väl med de observationer vi har. Med hjälp av den resandestatistik som vi har och ett tidsvärde samt värderingen av förseningstid jämfört med restid (enligt ASEK 3,5) kan man beräkna resenärernas förluster i form av tidskostnad. Den totala kostnaden per år kan också beräknas.
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| 32. |
- Nelldal, Bo-Lennart, 1946-, et al.
(författare)
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Vidareutveckling av effektsamband för förseningarnas påverkan på efterfrågan av tågresor
- 2022
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- I projektet ”Förseningarnas påverkan på efterfrågan av tågresor – en tidsserieanalys” togs samband fram om hur punktligheten i tågtrafiken påverkar efterfrågan på resor. Detta samband var i form av en elasticitet (e) mellan förseningar och efterfrågan. Mest signifikant blev sambandet mellan förändringen av den genomsnittliga förseningen i minuter för tåg som är mer än 5 minuter försenade och efterfrågan i personkilometer. Elasticiteten för fjärrtåg blev – 0,6 vilket innebär att om medelförseningen i minuter för de tåg som är mer än 5 minuter försenade ökar med 10 % så minskar efterfrågan med 6 %, i detta fall antalet personkilometer med tåg under ett år.Från Trafikverket har efterfrågats samband mellan genomsnittsförseningen för alla tåg och efterfrågan och inte bara för tåg som är mer än 5 minuter försenade. En anledning till detta är att detta mått används i samhällsekonomiska kalkyler. Från branschen finns önskemål om ett samband mellan andel försenade tåg som är mer än 5 minuter och efterfrågan då det är det vanligaste måttet som används för förseningar. Medelvärden för de olika måtten beräknats för åren 2001-2020 för olika linjer och sedan har relationen mellan dem beräknats. För alla tåg på Trafikverkets nät är medelförseningen 15,5 minuter för RT+5 min och 1,6 minuter för alla tåg. Med index 100 för medelförseningen i minuter för RT+5 blir index för alla tåg 10. Andelen försenade tåg är 0,55 av medelförseningen i minuter för RT+5.För snabb- och fjärrtåg (långdistans) är medelförseningen för alla tåg 25 % av medelförseningen för RT+5 min och andelen försenade tåg har kvoten 1,05 d.v.s. ungefär lika med medelförseningen i minuter för RT+5 min.För regionaltåg (medeldistans) är medelförseningen för alla tåg 12 % av medelförseningen för RT+5 min och andelen försenade tåg har kvoten 0,66 d.v.s. två tredjedelar av medelförseningen i minuter för RT+5 min.För pendel- och flygtåg (kortdistans) är medelförseningen för alla tåg 8 % av medelförseningen för RT+5 min och andelen försenade tåg har kvoten 0,55 d.v.s. ungefär hälften av medelförseningen i minuter för RT+5 min.Detta är naturligt då tåg som går långt har en större andel förseningar över 5 minuter och får då både längre medelförseningar och större andel försenade tåg genom att risken för att råka ut för en störning blir större ju längre man kör.I den tidigare tidsserieanalysen testades ett stort antal kontrollvariabler för utbud och socioekonomiska faktorer. Det var emellertid få som fick genomslag, huvudsakligen var det privat konsumtion och turtäthet. I detta fall har vi valt att inte testa så många variabler utan huvudsakligen analyserat hur medelförseningen för alla tåg och andelen försenade tåg påverkar efterfrågan.Ett stort antal tidserieanalyser har körts fram för de olika variablerna. Vi har valt ut de som är mest signifikanta. Därefter har dessa kalibrerats mot faktiska data på ett antal järnvägslinjer med olika karaktär: Snabbtåg Stockholm-Göteborg, regionaltåg Gävle-Ljusdal, och pendeltågen på Östgötapendeln. Ett problem med tågtrafiken är att den ökat så snabbt att det ofta är svårt att se förseningarnas påverkan enskilda år. Vi har därför valt att analysera utvecklingen under den svåra vintern 2009-2010 där man kan se en tydlig förändring av förseningarna och efterfrågan. Vi har sedan valt de elasticiteter som både är signifikanta och stämmer bäst med den faktiska utvecklingen.Samband mellan förändringen av medelförsening för alla tåg och förändringen av efterfrågan. Vi får en elasticitet i storleksordningen -0,14 vilket kan jämföras med -0,6 för sambandet med medelförseningen för försenade tåg RT+ 5 min. Det innebär att om medelförseningen för alla tåg ökar med 10 % så minskar resandet med 1,4 %. Det ser också ut att finnas en tendens att regionaltåg och pendeltåg har en liknande elasticitet som fjärrtåg. Regionaltåg får -0,151 och pendeltåg -0,129 jämfört med fjärrtågens 0,141. En elasticitet på 0,141 för alla produkter och ett T-värde på 9,01 och med 950 observationer som grund är det säkraste.Samband mellan medelförseningen i minuter för alla tåg och förändringen av efterfråganResultatet blir en koefficient som i genomsnitt för alla tåg blir 0,044. Det innebär att om medelförseningen i minuter för alla tåg ökar med en minut så minskar efterfrågan i personkilometer med 4,4 %. Regionaltåg och pendeltåg har en högre koefficient än fjärrtåg. Regionaltåg får -0,073 och pendeltåg -0,160 jämfört med fjärrtågens 0,026. Det förklaras av att för pendeltåg och regionaltåg får de mindre förseningarna större betydelse som delvis skalas bort om man enbart räknar medelförseningen för förseningar mer än 5 minuter.Samband mellan andelen försenade tåg mer än 5 minuter och förändringen av efterfrågan. Vi får en koefficient i storleksordningen -1,0 vilket kan jämföras med elasticiteten -0,6 för sambandet med medelförseningen för försenade tåg RT+ 5 min. Detta är ju två olika mått – minuter och procent. Fjärrtåg får en koefficient på -1,07 liksom för alla produkter verkar dock rimlig och har hög signifikans och bygger på mycket data. Även här finns en tendens till att regionaltåg och pendeltåg får en högre elasticitet med -1,43 för regionaltåg och -2,50 för pendeltåg. Det kan också vara naturligt då variationerna bli mindre i andel försenade tåg för dessa tåg som ligger närmare 90 % punktlighet.Tabeller har tagits fram för effekterna av de olika elasticitetstalen på efterfrågan för olika produkter. Tabellerna anger värden inom elasticiteternas ungefärliga giltighetsområde där värden över storleksordningen 30 % inte är sannolika.För andel försenade tåg är värden upp till 20 procentenheter möjliga åtminstone för fjärrtåg där de låg på denna nivå 2010. För regionaltåg är värden över 15 procentenheter inte sannolika då de normalt ligger på 85 % och vid en förbättring inte kan komma över 100 % liksom för pendeltåg som normalt ligger på 90-95 %.Medelförseningen för alla tåg ligger normalt mellan 0,5 och 6 minuter varför förändringar över 10 minuter inte är sannolika för fjärrtåg. För pendel- och regionaltåg är de mindre än 2-4 minuter.Förändringen av medelförseningen i minuter för försenade tåg RT+5 är inte lämplig att använda för pendel- och regionaltåg där en stor andel av förseningarna är mindre än 5 minuter. Därför har dessa värden gråmarkerats i tabellen.Förändringen i % av medelförseningen i minuter för alla tåg går däremot att använda för alla produkter och ger rimliga värden upp till 150 %.Observera att elasticiteterna avser årsvärden på punktlighet och efterfrågan och att större variationer kan förekomma under åren samt att särskilt för fjärrtrafik det kan finnas en fördröjning ”lag” så att efterfrågan inte återgår till den normala förrän efter fler år även om punktligheten förbättras. Eftersom data innehåller både försämringar och förbättringar av punktligheten bör sambanden även kunna användas för att beräkna effekterna av förbättrad punktlighet.
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| 33. |
- Nygren, Å., et al.
(författare)
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Residential multimodal job focused rehabilitation for teachers increases return to work
- 2019
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Ingår i: Läkartidningen. - : NLM (Medline). - 0023-7205 .- 1652-7518. ; 116
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Tidskriftsartikel (refereegranskat)abstract
- Stress induced exhaustion disorder is the disease that caused most sickleavedays in Sweden during the last 10 years. Teachers have the highest percentage of sick leave, and is the group where the number on sick leave increases most. No previous studies have achieved a statistically significant increased return to work after any specific treatment for exhaustion disorder. The current multimodal occupational specific treatment for exhaustion disorder among teachers showed statistically significant return to work at follow-up 1-1.5 years after treatment. The treatment focus was reflective peer support group sessions which ended with a recommended an individualised course of action to deal with job stressors for each participant. The treatment model works well for teachers. Continued research is needed to test other occupational groups.
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| 34. |
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| 35. |
- Näsman, Per, Docent, 1954-, et al.
(författare)
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Impacts of On-Street Parking Fees in Suburbs
- 2020
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Ingår i: International Journal of Transportation Engineering and technology. - : Science Publishing Group. - 2575-1743 .- 2575-1751. ; 6:3, s. 75-85
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Tidskriftsartikel (refereegranskat)abstract
- Street parking fees are common in many cities across the world. Knowledge on how such fees impact parking demand is crucial for designing charging schemes. Empirical studies of parking fees are however scares and often hampered by a lack of data systematically collected before and after policy changes. Moreover, almost all studies analyzing the impact of fees on parking demand focuses on dense city centers. This paper aims as showing how on-street parking count conducted before and after the introduction of parking fees of in the suburbs of Stockholm impact parking demand. This paper analyses data conducted before and after the implementation of the new parking policy in 2017, where on-street parking fees were introduced for the first time in the inner suburbs. At the same time, the amount of the fee was also increased in the inner city. Moreover, the fine was raised for the parking ticket issued to cars parked in breach of parking regulations. We find a 35-40 percent reduction in the number of parked cars in response to the introduction of parking fees in the suburbs. However, the increase in the parking fees in the inner city had a substantially lower effect or no effect at all on demand. The effect of increasing the amount of the fine had no impact on the number of the cars violating parking restrictions.
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| 36. |
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| 37. |
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| 38. |
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| 39. |
- Riccio, Alessia, et al.
(författare)
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Sex differences in the association between insulin resistance and non-fatal myocardial infarction across glycaemic states
- 2024
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Ingår i: Cardiovascular Diabetology. - : Springer Nature. - 1475-2840. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Females are generally less prone to cardiovascular (CV) events than males, but this protection is trumped by diabetes. The mechanism behind the increased relative risk in females with diabetes is not fully understood. Insulin resistance (IR) is suggested to be a more important contributor to CV morbidity in females than in males. We aim to investigate differences in the association between IR indexes (Homeostatic Model Assessment of IR - HOMA-IR, visceral adiposity index – VAI, and triglycerides/high-density lipoprotein-cholesterol - TG/HDL-C index), and a first non-fatal myocardial infarction (MI) across different glycaemic states. Methods: IR indexes were calculated in a population with (n = 696) and without (n = 707) a first non-fatal MI, free from known diabetes. MI cases were investigated at least six weeks after the event. All participants were categorized by an oral glucose tolerance test as having normal glucose tolerance, impaired fasting glucose, impaired glucose tolerance, or newly diagnosed diabetes. Comparison of proportion of glycaemic states by sex was tested by chi-square test. The associations between sex, a first non-fatal MI, IR indexes, and traditional CV risk factors were analysed by multivariate logistic regression models. Continuous variables were logarithmically transformed. Results: Of the total population 19% were females and 81% males, out of whom 47% and 50% had a first non-fatal MI, respectively. Compared with males, females were older, less often smokers, with lower body mass index and higher total cholesterol and high-density lipoprotein cholesterol levels. The proportion of glycaemic states did not differ between the sexes (p = 0.06). Females were less insulin resistant than males, especially among cases and with normal glucose tolerance. In logistic regression models adjusted for major CV risk factors including sex, the associations between VAI and TG/HDL-C index and a first non-fatal MI remained significant only in females (odds ratios and 95% confidence intervals: 1.7, 1.0-2.9, and 1.9, 1.1–3.4 respectively). Conclusions: These results support the assumption that IR indexes based on anthropometrics and lipid panel, i.e., VAI and TG/HDL-C, could be a better measure of IR and CV-predictor for non-fatal MI in females, even without glycaemic perturbations.
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| 40. |
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| 41. |
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| 42. |
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| 43. |
- Smaradottir, M. I., et al.
(författare)
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Copeptin is associated with mortality in elderly people
- 2021
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Ingår i: European Journal of Clinical Investigation. - : John Wiley and Sons Inc. - 0014-2972 .- 1365-2362. ; 51:7
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Tidskriftsartikel (refereegranskat)abstract
- Background: Elevated copeptin, a marker for vasopressin release, has been associated with impaired prognosis in acute myocardial infarction (MI). The aim was to investigate whether this association extends beyond the acute phase and whether it is related to markers of stress (cortisol) and heart failure (NTproBNP). Methods: Copeptin, cortisol and NTproBNP were measured in 926 participants (age: 76.0; male: 48.5%) in the ICELAND MI study whereof 246 had a previous MI (91 recognizable (RMI) and 155 previously unrecognizable (UMI) detected by cardiac magnetic resonance imaging). The primary endpoint was cardiovascular events (CVEs), and secondary endpoints were total mortality, heart failure and MI (median follow-up was 9.1 years). The relation between copeptin and prognosis was assessed with the Cox proportional hazard regression (unadjusted, adjusted for cortisol and NTproBNP, respectively, and a multiple model: copeptin, cortisol, NTproBNP, age, sex, serum creatinine, heart failure). Results: Copeptin was higher in participants with MI (8.9 vs. 6.4 pmol/L; P <.01), with no difference between RMI vs. UMI. Increased copeptin correlated with evening cortisol (r =.11; P <.01) and NTproBNP (r =.07; P =.04). Copeptin was associated with CVE and total mortality after adjusting for cortisol and NTproBNP separately, and remained significantly associated with total mortality in the multiple model. Conclusions: Copeptin was higher in subjects with previous MI regardless whether previously recognized or not. Copeptin correlated weakly with cortisol and NTproBNP, and was independently associated with total mortality. This indicates that the prognostic implications of copeptin are not only mediated by heart failure or stress, supporting the assumption that copeptin is a marker of general vulnerability.
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| 44. |
- Wang, Anne, et al.
(författare)
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Androgen receptor polymorphism, testosterone levels, and prognosis in patients with acute myocardial infarction
- 2021
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Ingår i: European Heart Journal Open. - : Oxford University Press (OUP). - 2752-4191. ; 1:2
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Tidskriftsartikel (refereegranskat)abstract
- Aims Low testosterone has been associated with cardiovascular disease in men but with contradictory findings. Testosterone bind to the androgen receptor and polymorphisms of the receptor gene such as CAG repeat length may affect transcriptional activity, possibly mitigating testosterone effects. The aims were to study the CAG repeat length and testosterone levels at four time points following a myocardial infarction (MI) and to analyse possible relationships between CAG repeat length and cardiovascular prognosis. Methods and results Male patients admitted for acute MI (n = 122) from the Glucose in Acute Myocardial Infarction study were included. Blood samples were drawn at four time points (day after admission, at discharge, and at 3 and 12 months post-infarction) for assessment of testosterone levels. Patients were followed for a median of 11.6 years. Cox regression analyses were performed for CAG repeat length by one unit increment and by > vs. <_median for cardiovascular events and all-cause mortality. Median CAG repeat length was 20. There was no difference in testosterone levels at each time point when dividing the cohort into <_ vs. >CAG repeat median (=20). There was no association between CAG repeat length either as a continuous or categorical variable in unadjusted and age-adjusted Cox analyses for cardiovascular events. While CAG >20 was associated with all-cause mortality in unadjusted analyses (hazard ratio 2.19, 95% confidence interval 1.13–4.22; P = 0.02), it did not remain significant following adjustment for age. Conclusion CAG repeat length was not associated with testosterone levels or prognosis in men with acute MI.
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