| 1. |
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| 2. |
- Cederholm, Jan, et al.
(författare)
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Systolic blood pressure and risk of cardiovascular diseases in type 2 diabetes : an observational study from the Swedish national diabetes register
- 2010
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Ingår i: Journal of Hypertension. - 0263-6352 .- 1473-5598. ; 28:10, s. 2026-2035
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To estimate risks of fatal/nonfatal coronary heart disease (CHD), stroke and cardiovascular disease (CVD) with SBP in an observational study of patients with type 2 diabetes. Methods: Twelve thousand, six hundred and seventy-seven patients aged 30–75 years, treated with antihypertensive drugs, without previous congestive heart failure, followed for 5 years. Results: Risk curves of CHD and stroke increased progressively with higher baseline or updated mean SBP in a Cox model, in all participants, and in two subgroups without (n = 10 304) or with (n = 2373) a history of CVD, with no J-shaped risk curves at low SBP levels. Hazard ratios for CHD and stroke per 10-mmHg increase in updated mean SBP in all participants, adjusting for clinical characteristics and traditional risk factors, were 1.08 (1.04–1.13) and 1.20 (1.13–1.27), P < 0.001. With updated mean SBP of 110–129 mmHg as reference, SBP of at least 140 mmHg showed risk increases of 37% for CHD, 86% for stroke and 44% for CVD (P = 0.001 to <0.001), whereas SBP of 130–139 mmHg showed nonsignificant risk increases for these outcomes. With baseline SBP of 110–129 mmHg, CHD and CVD risks increased with further SBP reduction, hazard ratios were 1.77 and 1.73 (P = 0.002), but decreased considerably for CHD, stroke and CVD with higher baseline SBP. Conclusion: Risks of CHD and stroke increased progressively with higher SBP, with no J-shaped curves, although risk increase was significant only for SBP of at least 140 mmHg, but not comparing 130–139 and 110–129 mmHg. Additionally, baseline SBP of 110–129 mmHg showed increased CHD and CVD risk with further SBP reduction during follow-up, whereas baseline SBP of at least 130 showed benefits.
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| 3. |
- Diczfalusy, Ulf, et al.
(författare)
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Marked upregulation of cholesterol 25-hydroxylase expression by lipopolysaccharide
- 2009
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Ingår i: Journal of Lipid Research. - 1539-7262 .- 0022-2275. ; 50:11, s. 2258-2264
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Tidskriftsartikel (refereegranskat)abstract
- During screening of genes upregulated by lipopolysaccharide (LPS; endotoxin) treatment of bone marrow-derived mouse macrophages, it was unexpectedly found that cholesterol 25-hydroxylase (Ch25h) was strongly upregulated. Treatment of macrophages with 10 ng/ml of LPS for 2 h resulted in a 35-fold increase in the expression of Ch25h. In contrast, LPS treatment did not increase the expression of Cyp27a1 or Cyp7b1. The increased Ch25h expression was found to be independent of Myeloid differentiation protein 88 signaling but dependent on Toll-like receptor 4 signaling. LPS treatment of macrophages caused a 6- to 7-fold increase in cellular 25-hydroxycholesterol concentration. When macrophages were treated with increasing concentrations of 25-hydroxycholesterol, a dose-dependent release of CCL5 into the culture medium was observed. Intravenous injection of LPS in eight healthy volunteers resulted in an increase in plasma 25-hydroxycholesterol concentration. The possibility is discussed that 25-hydroxycholesterol may have a role in the inflammatory response, in addition to its more established role in the regulation of cholesterol homeostasis.-Diczfalusy, U., K. E. Olofsson, A- M. Carlsson, M. Gong, D. T. Golenbock, O. Rooyackers, U. Flaring, and H. Bjorkbacka. Marked upregulation of cholesterol 25-hydroxylase expression by lipopolysaccharide. J. Lipids Res. 2009. 50: 2258-2264.
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| 4. |
- Ejnell, Hasse, et al.
(författare)
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Nationella rekommendationer för trakeotomi och trakeostomivård : [National recommendations for tracheotomy and tracheostomy care. Consensus for safe tracheostomy care of adult patients]
- 2020
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Ingår i: Läkartidningen. - : Sveriges läkarförbund. - 0023-7205 .- 1652-7518. ; 117
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Tidskriftsartikel (refereegranskat)abstract
- This article describes new Swedish guidelines for the care of adult patients having a tracheostomy. A national expert panel of ENT and anaesthesiology specialists appointed by each national specialist association reviewed fatal patient cases involving tracheostomy failure as well as national and international guidelines to produce a "best of practice" document. The main recommendation is that the health care provider has the full responsibility to ensure that the combined surgical competence at the hospital can handle acute airway problems also under difficult anatomical conditions. The distribution of percutaneous and surgical tracheotomy should be weighted to ensure the competence in both.
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| 5. |
- Nellgård, Per, et al.
(författare)
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National recommendations for tracheotomy and for tracheostomy care
- 2017
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Ingår i: Abstracts from the Scandinavian Society of Anesthesiology and Intensive Care Medicine 34th Congress. - : John Wiley & Sons. ; , s. 1034-1035
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Konferensbidrag (refereegranskat)abstract
- Background: Every year 2000 tracheotomies are performed in Sweden. Severe or lethal complications and shortcomings in the valuation of risks pre-, per- and postoperatively occurs. This work intends, based on best available evidence, to reduce injuries related to tracheotomy.Material and Method: Anaesthesiologists and otorhinolaryngologists from University Hospitals compiled a document with guidelines to reduce risks to cause severe complications and death at tracheotomy operations. Landstingens Omse- € sidiga Fors € €akringsbolag (LOF, Swedish insur- € ance company for publicly funded health care providers) also took part.Results: Surgical tracheotomy is recommended for children and adults with known or expected difficult intubation such as Cormack-Lehane IIIIV, short/thick neck, distance between cricoid cartilage and jugulum<15 mm, neck circumference >45 cm, tumors in head and neck area, BMI >35, rheumatoid arthritis, severe obstructive sleep apnea syndrome, high intracranial pressure, unstable neck fracture and coagulopathies. Acta Anaesthesiologica Scandinavica 61 (2017) 962–1062 1034 ª 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd SSAI ABSTRACTS Percutaneous tracheostomy (PCT) could be performed in intensive care patients. A tracheotomy cannula with an inner cannula should be used. Common complications include acute obstruction of tracheal cannula, dislocation, emphysema of the neck, trauma to dorsal tracheal wall. Some deaths have occurred due to lack of education to perform a surgical tracheotomy in patients where percutaneous tracheostomy were not possible to perform.Conclusion: Tracheotomy should be performed at hospitals where competence exist for surgical tracheotomy, including patients with difficult anatomy, regardless of the tracheotomy technique. At each hospitals the distribution between percutaneous and surgical tracheostomies must be weighted as to preserve overall competence for both techniques. A guideline of acute tracheal cannula occlusion is presented (Figure).
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| 6. |
- Nilsson, Peter, et al.
(författare)
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Trends in blood pressure control in patients with type 2 diabetes : data from the Swedish National Diabetes Register (NDR)
- 2011
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Ingår i: Blood Pressure. - : Informa UK Limited. - 0803-7051 .- 1651-1999. ; 20:6, s. 348-354
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Tidskriftsartikel (refereegranskat)abstract
- We assessed blood pressure (BP) trends in patients with type 2 diabetes from a national diabetes register using three cross-sectional samples (aged 30?85 years) in 2005, 2007 and 2009, and in patients from 2005 followed individually until 2009. The prevalence of hypertension was 87% among all 180 369 patients in 2009, although lower in subgroups with ages 30?39, 40?49 and 50?59 years: 40%, 60% and 77%. In the three cross-sectional surveys, mean BP decreased (141/77?136/76 mmHg), uncontrolled BP? 140/90 mmHg decreased (58?46%), and antihypertensive drug treatment (AHT) increased (73?81%). Comparatively in 79 185 patients followed individually for 5 years, mean BP decreased (141/77?137/75 mmHg), uncontrolled BP ?140/90 mmHg decreased (58?47%) and AHT increased (73?82%). Independent predictors of BP decrease were BMI decrease (stronger) and increase in AHT. AHT occurred among 81% of all patients in 2009. In 57 645 patients on AHT followed individually, mean BP decreased (143/77?138/75 mmHg) and uncontrolled BP ?140/90 mmHg decreased (63?50%). Among 5164 patients with nephropathy on AHT followed individually, BP <130/80 mmHg increased (12?21%). In conclusion, BP control improved from 2005 to 2009, relative to BMI decrease and AHT increase, although still about half had BP ?140/90 mmHg.
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| 7. |
- Olofsson, Katarina E, et al.
(författare)
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Nanomolar concentrations of lysophosphatidylcholine recruit monocytes and induce pro-inflammatory cytokine production in macrophages
- 2008
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Ingår i: Biochemical and Biophysical Research Communications - BBRC. - : Elsevier BV. - 0006-291X .- 1090-2104. ; 370:2, s. 348-352
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Tidskriftsartikel (refereegranskat)abstract
- Lysophosphatidylcholine (LPC) has been attributed a pro-inflammatory role in atherosclerosis. Cell culture studies have identified stimulation of cytokine expression and chemotaxis by micromolar (muM) concentrations of LPC. In the present study we have investigated if LPC, in similarity with many other lipid mediators, has pro-inflammatory effects also at nanomolar (nM) concentrations. Cultured mouse bone marrow derived and RAW264.7 macrophages exposed to LPC demonstrated two peaks of increased MIP-2 release and mRNA expression; one at 0.1-10nM and another at muM concentrations. Both concentration ranges of LPC were also found to stimulate THP-1 monocyte chemotaxis. However, stimulation of the cells with muM concentrations of LPC may cause cell injury as increased release of lactate dehydrogenase was observed. Our findings demonstrate two peaks of LPC-induced pro-inflammatory activity, one in the nM and one in the muM range, and indicate that the latter may involve a stress response to lipid cytotoxicity.
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| 8. |
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| 9. |
- Teige, Anna, et al.
(författare)
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CD1d-dependent NKT cells play a protective role in acute and chronic arthritis models by ameliorating antigen-specific Th1 responses.
- 2010
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Ingår i: Journal of immunology. - : The American Association of Immunologists. - 1550-6606 .- 0022-1767. ; 185:1, s. 345-356
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Tidskriftsartikel (refereegranskat)abstract
- A protective and anti-inflammatory role for CD1d-dependent NKT cells (NKTs) has been reported in experimental and human autoimmune diseases. However, their role in arthritis has been unclear, with conflicting reports of CD1d-dependent NKTs acting both as regulatory and disease-promoting cells in arthritis. These differing modes of action might be due to genetic differences of inbred mice and incomplete backcrossing of gene-modified mice. We therefore put special emphasis on controlling the genetic backgrounds of the mice used. Additionally, we used two different murine arthritis models, Ag-induced arthritis (AIA) and collagen-induced arthritis (CIA), to evaluate acute and chronic arthritis in CD1d knockout mice and mice depleted of NK1.1(+) cells. CD1d-deficient mice developed more severe AIA compared with wild-type littermates, with a higher degree of inflammation and proteoglycan depletion. Chronic arthritis in CIA was also worse in the absence of CD1d-dependent NKTs. Elevated levels of Ag-specific IFN-gamma production accompanied these findings rather than changes in IL-17alpha. Depletion of NK1.1(+) cells supported these findings in AIA and CIA. This report provides support for CD1d-dependent NKTs being suppressor cells in acute and chronic arthritis, likely via inhibition of arthritogenic Th1 cells. These results make CD1d-dependent NKTs an attractive target for therapeutic intervention.
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| 10. |
- Wigren, Maria, et al.
(författare)
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Atheroprotective effects of Alum are associated with capture of oxidized LDL antigens and activation of regulatory T cells
- 2009
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Ingår i: Circulation Research. - 0009-7330 .- 1524-4571. ; 104:12, s. e62-70
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Tidskriftsartikel (refereegranskat)abstract
- The immune system represents a promising novel target for prevention of atherosclerosis. Several pilot vaccines that reduce atherosclerosis in experimental animals have been developed. The aluminum hydroxide adjuvant Alum has been shown to have antiatherogenic properties in itself, suggesting that it may be a suitable adjuvant in possible future atherosclerosis vaccines. To characterize the immune pathways mediating this protection, we treated wild-type C57BL/6 and Apoe(-)(/)(-) mice with Alum or PBS. Analyses of splenocytes isolated from 12-week-old mice demonstrated that Alum increased the presence of CD4(+)CD25(+)FoxP3(+) regulatory T cells and downregulated the expression of T cell activation markers CD28 and ICOS in Apoe(-)(/)(-) mice but not in C57BL/6 wild-type mice. A similar immunosuppressive phenotype was found also in 25-week-old Apoe(-)(/)(-) mice and was associated with reduced atherosclerosis. Alum precipitates recovered from the injection site of Apoe(-)(/)(-) mice contained antigens derived from oxidized LDL. These findings demonstrate that treatment of Apoe(-)(/)(-) mice with Alum results in an increase of regulatory T cells and suggest that these are activated by tolerogenic antigen-presenting cells presenting oxidized LDL antigens. Our findings provide improved mechanistic understanding of the atheroprotective properties of aluminum hydroxide adjuvants but also point to the importance of determining if hypercholesterolemia may compromise the efficacy of Alum-containing vaccines used clinically today.
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| 11. |
- Zhao, Ming, et al.
(författare)
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Fc{gamma}RIIB Inhibits the Development of Atherosclerosis in Low-Density Lipoprotein Receptor-Deficient Mice.
- 2010
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Ingår i: Journal of Immunology. - : The American Association of Immunologists. - 1550-6606 .- 0022-1767. ; 184:5, s. 2253-2260
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Tidskriftsartikel (refereegranskat)abstract
- The immune processes associated with atherogenesis have received considerable attention during recent years. IgG FcRs (FcgammaR) are involved in activating the immune system and in maintaining peripheral tolerance. However, the role of the inhibitory IgG receptor FcgammaRIIB in atherosclerosis has not been defined. Bone marrow cells from FcgammaRIIB-deficient mice and C57BL/6 control mice were transplanted to low-density lipoprotein receptor-deficient mice. Atherosclerosis was induced by feeding the recipient mice a high-fat diet for 8 wk and evaluated using Oil Red O staining of the descending aorta at sacrifice. The molecular mechanisms triggering atherosclerosis was studied by examining splenic B and T cells, as well as Th1 and Th2 immune responses using flow cytometry and ELISA. The atherosclerotic lesion area in the descending aorta was approximately 5-fold larger in mice lacking FcgammaRIIB than in control mice (2.75 +/- 2.57 versus 0.44 +/- 0.42%; p < 0.01). Moreover, the FcgammaRIIB deficiency resulted in an amplified splenocyte proliferative response to Con A stimulation (proliferation index 30.26 +/- 8.81 versus 2.96 +/- 0.81%, p < 0.0001) and an enhanced expression of MHC class II on the B cells (6.65 +/- 0.64 versus 2.33 +/- 0.25%; p < 0.001). In accordance, an enlarged amount of CD25-positive CD4 T cells was found in the spleen (42.74 +/- 4.05 versus 2.45 +/- 0.31%; p < 0.0001). The plasma Ab and cytokine pattern suggested increased Th1 and Th2 immune responses, respectively. These results show that FcgammaRIIB inhibits the development of atherosclerosis in mice. In addition, they indicate that absence of the inhibiting IgG receptor cause disease, depending on an imbalance of activating and inhibiting immune cells.
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| 12. |
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| 13. |
- Adamo, Karin, et al.
(författare)
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Risk for developing perianal abscess in type 1 and type 2 diabetes and the impact of poor glycemic control
- 2021
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Ingår i: International Journal of Colorectal Disease. - : Springer. - 0179-1958 .- 1432-1262. ; 36:5, s. 999-1005
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The primary aim of this study was to see whether perianal abscess rate differs between patients with type 1 and type 2 diabetes. A secondary aim was to determine whether poor glycemic control increases the risk for perianal abscess.Methods: Data from the Swedish National Diabetes Registry and the Swedish National Patient Registry between January 2008 and June 2015 were matched. The risk for anal abscess was evaluated in univariate and multivariate analyses with type of diabetes, HbA1c level, BMI, and various diabetes complications as independent factors.Results: Patients with type 1 diabetes had a lower rate of perianal abscess than patients with type 2 diabetes when adjusted for HbA1c, sex, and age (OR 0.65; 95% CI 0.57–0.73). The risk for perianal abscess increased with higher HbA1c. Incidence of perianal abscess was also elevated in diabetes patients with complications related to poor glycemic control such as ketoacidosis and coma (OR 2.63; 95% CI 2.06–3.35), gastroparesis, and polyneuropathy (OR 1.81; 95% CI 1.41–2.32).Conclusions: The prevalence of perianal abscess was higher among patients with type 2 diabetes than those with type 1, suggesting that metabolic derangement may be more important than autoimmune factors. Poor glycemic control was associated with higher risk for perianal abscess.
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| 14. |
- Adamo, Karin, et al.
(författare)
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Risk for developing perianal abscess in type 1 and type 2 diabetes and the impact of poor glycemic control
- 2021
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Ingår i: INTERNATIONAL JOURNAL OF COLORECTAL DISEASE. - : Springer Science and Business Media LLC. - 0179-1958 .- 1432-1262. ; 36:5, s. 999-1005
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The primary aim of this study was to see whether perianal abscess rate differs between patients with type 1 and type 2 diabetes. A secondary aim was to determine whether poor glycemic control increases the risk for perianal abscess. Methods Data from the Swedish National Diabetes Registry and the Swedish National Patient Registry between January 2008 and June 2015 were matched. The risk for anal abscess was evaluated in univariate and multivariate analyses with type of diabetes, HbA1c level, BMI, and various diabetes complications as independent factors. Results Patients with type 1 diabetes had a lower rate of perianal abscess than patients with type 2 diabetes when adjusted for HbA1c, sex, and age (OR 0.65; 95% CI 0.57-0.73). The risk for perianal abscess increased with higher HbA1c. Incidence of perianal abscess was also elevated in diabetes patients with complications related to poor glycemic control such as ketoacidosis and coma (OR 2.63; 95% CI 2.06-3.35), gastroparesis, and polyneuropathy (OR 1.81; 95% CI 1.41-2.32). Conclusions The prevalence of perianal abscess was higher among patients with type 2 diabetes than those with type 1, suggesting that metabolic derangement may be more important than autoimmune factors. Poor glycemic control was associated with higher risk for perianal abscess.
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| 15. |
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| 16. |
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| 17. |
- Albanese-O'Neill, A., et al.
(författare)
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Changes in HbA1c Between 2011 and 2017 in Germany/Austria, Sweden, and the United States: A Lifespan Perspective
- 2022
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Ingår i: Diabetes Technology & Therapeutics. - : Mary Ann Liebert Inc. - 1520-9156 .- 1557-8593. ; 24:1, s. 32-41
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Tidskriftsartikel (refereegranskat)abstract
- Aims: This study assessed hemoglobin A1c (HbA1c) across the lifespan in people with type 1 diabetes (T1D) in Germany/Austria, Sweden, and the United States between 2011 and 2017 to ascertain temporal and age-related trends. Methods: Data from the Diabetes-Patienten-Verlaufsdokumentation (DPV) (n = 25,651 in 2011, n = 29,442 in 2017); Swedish Pediatric Diabetes Quality Registry (SWEDIABKIDS)/National Diabetes Register (NDR), (n = 44,474 in 2011, n = 53,690 in 2017); and T1D Exchange (n = 16,198 in 2011, n = 17,087 in 2017) registries were analyzed by linear regression to compare mean HbA1c overall and by age group. Results: Controlling for age, sex, and T1D duration, HbA1c increased in the United States between 2011 and 2017, decreased in Sweden, and did not change in Germany/Austria. Controlling for sex and T1D duration, mean HbA1c decreased between 2011 and 2017 in all age cohorts in Sweden (P < 0.001). In the United States, HbA1c stayed the same for participants <6 years and 45 to <65 years and increased in all other age groups (P < 0.05). In Germany/Austria, HbA1c stayed the same for participants <6 to <13 years and 18 to <25 years; decreased for participants ages 13 to <18 years (P < 0.01); and increased for participants >= 25 years (P < 0.05). Conclusions: The comparison of international trends in HbA1c makes it possible to identify differences, explore underlying causes, and share quality improvement processes. National quality improvement initiatives are well accepted in Europe but have yet to be implemented systematically in the United States. However, disparities created by the lack of universal access to health care coverage, unequal access to diabetes technologies (e.g., continuous glucose monitoring) regardless of insurance status, and high out-of-pocket cost for the underinsured ultimately limit the potential of quality improvement initiatives.
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| 18. |
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| 19. |
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| 20. |
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| 21. |
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| 22. |
- Bharate, Jaideep B., et al.
(författare)
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K2S2O8-mediated coupling of 6-amino-7-aminomethyl-thiazolino-pyridones with aldehydes to construct amyloid affecting pyrimidine-fused thiazolino-2-pyridones
- 2021
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Ingår i: Organic and biomolecular chemistry. - : The Royal Society of Chemistry. - 1477-0520 .- 1477-0539. ; 19:44, s. 9758-9772
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Tidskriftsartikel (refereegranskat)abstract
- We herein present the synthesis of diversely functionalized pyrimidine fused thiazolino-2-pyridones via K2S2O8-mediated oxidative coupling of 6-amino-7-(aminomethyl)-thiazolino-2-pyridones with aldehydes. The developed protocol is mild, has wide substrate scope, and does not require transition metal catalyst or base. Some of the synthesized compounds have an ability to inhibit the formation of Amyloid-β fibrils associated with Alzheimer's disease, while others bind to mature amyloid-β and α-synuclein fibrils.
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| 23. |
- Björklund, Camilla, et al.
(författare)
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Matematikkundervisning
- 2013
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Denna boken är skriven av en grupp erfarna norska och svenska lärarutbildare i matematik. Boken bygger på utprövad erfarenhet - såväl egen som andras - och på aktuell, relevant forskning i matematikdidaktik. Texten väver samman matematik och matematikdidaktik, det vill säga ämnet som det undervisas i och frågor om hur ämnet kan läras och undervisas. Boken innehåller det som är absolut viktigast att få med sig i den grundläggande lärarutbildningen i matmatik.
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| 24. |
- Blennow, Kaj, 1958, et al.
(författare)
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No association between the alpha2-macroglobulin (A2M) deletion and Alzheimer's disease, and no change in A2M mRNA, protein, or protein expression.
- 2000
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Ingår i: Journal of neural transmission (Vienna, Austria : 1996). - : Springer Science and Business Media LLC. - 0300-9564 .- 1435-1463. ; 107:8-9, s. 1065-79
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Tidskriftsartikel (refereegranskat)abstract
- A polymorphism consisting of a deletion near the 5' splice site of exon 18 on the alpha2-macroglobulin (A2M) gene (A2M-2) has been suggested to be associated with Alzheimer's disease (AD) in family-based studies. We studied the A2M-2 allele together with the ApoE alleles in a large series on patients with AD (n = 449) and age-matched controls (n = 349). Neuropathologically confirmed diagnoses were available in 199 cases (94 AD and 107 control cases). We found no increase in A2M-2 genotype or allele frequencies in AD (27.5% and 14.6%) versus controls (26.4% and 14.9%). In contrast, a marked increase (p < 0.0001) in ApoE epsilon4 genotype or allele frequencies was found in AD (66.6% and 41.2%) as compared with controls (29.8% and 16.5%), suggesting sufficient statistical power in our sample. No relation was found between the A2M-2 and the ApoE epsilon4 allele. No change in A2M exon 17-18 mRNA size or sequence or A2M protein size was found in cases carrying the A2M-2 deletion, suggesting that there is no biological consequences of the A2M intronic deletion. No change in A2M protein level in cerebrospinal fluid was found in AD, suggesting that the A2M-2 allele does not effect the A2M protein expression in the brain. The lack of an association between the A2M-2 allele and AD in the present study, and the lack of abnormalities in the A2M mRNA or protein suggest that the A2M-2 allele is not associated with AD.
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| 25. |
- BLOMQVIST, Peter, et al.
(författare)
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PLANKTON AND WATER CHEMISTRY IN LAKE NJUPFATET BEFORE AND AFTER LIMING
- 1995
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Ingår i: CANADIAN JOURNAL OF FISHERIES AND AQUATIC SCIENCES. - 0706-652X. ; 52:3, s. 551-565
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Tidskriftsartikel (refereegranskat)abstract
- Moderately acidified Lake Njupfatet was studied during 2 consecutive years, before and after liming (calcite), and compared with corresponding data from six reference lakes. After liming, the concentration of total phosphorus in the lake water decreased b
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| 26. |
- Borg, Sixten, et al.
(författare)
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Patient-reported outcome and experience measures for diabetes: development of scale models, differences between patient groups and relationships with cardiovascular and diabetes complication risk factors, in a combined registry and survey study in Sweden
- 2018
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Purpose The Swedish National Diabetes Register (NDR) has developed a diabetes-specific questionnaire to collect information on individuals' management of their diabetes, collaboration with healthcare providers and the disease’s impact on daily life. Our main objective was to develop measures of well-being, abilities to manage diabetes and judgements of diabetes care, and to detect and quantify differences using the NDR questionnaire.Design, setting and participants The questionnaire was analysed with using responses from 3689 participants with type 1 and 2 diabetes, randomly sampled from the NDR population, combined with register data on patient characteristics and cardiovascular and diabetes complication risk factors.Methods We used item response theory to develop scales for measuring well-being, abilities to manage diabetes and judgements of diabetes care (scores). Test–retest reliability on the scale level was analysed with intraclass correlation. Associations between scores and risk factor levels were investigated with subgroup analyses and correlations.Results We obtained scales with satisfactory measurement properties, covering patient reported outcome measures such as general well-being and being free of worries, and patient reported experience measure, for example, access and continuity in diabetes care. All scales had acceptable test–retest reliability and could detect differences between diabetes types, age, gender and treatment subgroups. In several aspects, for example, freedom of worries, type 1 patients report lower than type 2, and younger patients lower than older. Associations were found between some scores and glycated haemoglobin, but none with systolic blood pressure or low-density lipoprotein cholesterol. Clinicians report positive experience of using scores, visually presented, in the patient dialogue.Conclusions The questionnaire measures and detects differences in patient well-being, abilities and judgements of diabetes care, and identifies areas for improvement. To further improve diabetes care, we conclude that patient-reported measures are important supplements to cardiovascular and diabetes complication risk factors, reflecting patient experiences of living with diabetes and diabetes care.
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| 27. |
- Borg, Sixten, et al.
(författare)
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Quality of life in chronic conditions using patient-reported measures and biomarkers: a DEA analysis in type 1 diabetes
- 2019
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Ingår i: Health Economics Review. - : Springer Science and Business Media LLC. - 2191-1991. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background A chronic disease impacts a patient's daily life, with the burden of symptoms and managing the condition, and concerns of progression and disease complications. Such aspects are captured by Patient-Reported Outcomes Measures (PROM), assessments of e.g. wellbeing. Patient-Reported Experience Measures (PREM) assess patients' experiences of healthcare and address patient preferences. Biomarkers are useful for monitoring disease activity and treatment effect and determining risks of progression and complications, and they provide information on current and future health. Individuals may differ in which among these aspects they consider important. We aimed to develop a measure of quality of life using biomarkers, PROM and PREM, that would provide an unambiguous ranking of individuals, without presuming any specific set of importance weights. We anticipated it would be useful for studying needs and room for improvement, estimating the effects of interventions and comparing alternatives, and for developing healthcare with a broad focus on the individual. We wished to examine if efficiency analysis could be used for this purpose, in an application to individuals with type 1 diabetes. Results We used PROM and PREM data linked to registry data on risk factors, in a large sample selected from the National Diabetes Registry in Sweden. Efficiency analysis appears useful for evaluating the situation of individuals with type 1 diabetes. Quality of life was estimated as efficiency, which differed by age. The contribution of different components to quality of life was heterogeneous, and differed by gender, age and duration of diabetes. Observed quality of life shortfall was mainly due to inefficiency, and to some extent due to the level of available inputs. Conclusions The efficiency analysis approach can use patient-reported outcomes measures, patient-reported experience measures and comorbidity risk factors to estimate quality of life with a broad focus on the individual, in individuals with type 1 diabetes. The approach enables ranking and comparisons using all these aspects in parallel, and allows each individual to express their own view of which aspects are important to them. The approach can be used for policy regarding interventions on inefficiency as well as healthcare resource allocation, although currently limited to type 1 diabetes.
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| 28. |
- Brinck, J., et al.
(författare)
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Cardiovascular Outcomes in Patients With Both Diabetes and Phenotypic Familial Hypercholesterolemia: A Nationwide Register-Based Cohort Study
- 2022
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Ingår i: Diabetes care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 45:12, s. 3040-3049
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE Patients with diabetes or familial hypercholesterolemia (FH) have an increased incidence of cardiovascular diseases compared with the population, but whether this risk is exacerbated in patients with combined traits is unknown. RESEARCH DESIGN AND METHODS In this Swedish nationwide, register-based cohort study, patients with diabetes were included between 2002 and 2020. Adjusted Cox proportional hazards models were used to assess the risk of cardiovascular events in patients with or without phenotypic FH (‡6 points for phenotypic FH according to Dutch Lipid Clinic Network criteria) compared with general population control subjects without diabetes as reference. RESULTS A total of 45,585 patients with type 1 diabetes (227,923 control subjects) and 655,250 patients with type 2 diabetes (655,250 control subjects) were followed for a median of 14.1 and 7.9 years, respectively. Of those, 153 and 7,197, respectively, had phenotypic FH. Compared with control subjects, patients with diabetes and phenotypic FH had higher risk of cardiovascular mortality (type 1: Hazard ratio 21.3 [95% CI 14.6-31.0]; type 2: 2.40 [2.19-2.63]) and of a cardiovascular event (type 1: 15.1 [11.1-20.5]; type 2: 2.73 [2.58-2.89]). Further, patients with diabetes and phenotypic FH had higher LDL-cholesterol levels during observation (P < 0.05) and increased risk of all major cardiovascular outcomes (P < 0.0001) than patients with diabetes but without FH. The proportion receiving lipid-lowering treatment was higher in patients with phenotypic FH (P < 0.0001). CONCLUSIONS Patients with both diabetes and phenotypic FH are more at risk for adverse cardiovascular outcomes and have higher LDL-cholesterol levels despite receiving intensified lipid-lowering therapy.
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| 29. |
- Cederholm, Jan, et al.
(författare)
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A new model for 5-year risk of cardiovascular disease in Type 1 diabetes : from the Swedish National Diabetes Register (NDR)
- 2011
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Ingår i: Diabetic Medicine. - : Wiley. - 0742-3071 .- 1464-5491. ; 28:10, s. 1213-1220
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Tidskriftsartikel (refereegranskat)abstract
- Aims: We assessed the association between risk factors and cardiovascular disease in an observational study of patients with Type 1 diabetes from the Swedish National Diabetes Register.Methods: A derivation sample of 3661 patients, aged 30-65 years, 6.1% with previous cardiovascular disease, baseline 2002, and 197 cardiovascular disease events when followed for 5 years until 2007. A separate validation data set of 4484 patients, baseline 2003, 201 cardiovascular disease events when followed for 4 years.Results: Adjusted hazard ratios at Cox regression for fatal/non-fatal cardiovascular disease were: diabetes duration 2.76 (2.21-3.44); onset age 1.47 (1.21-1.78); log ratio total cholesterol:HDL cholesterol 1.26 (1.09-1.45); log HbA(1c) 1.19 (1.03-1.38); log systolic blood pressure 1.17 (1.01-1.34) (1 SD increase in continuous variables); smoker 1.76 (1.27-2.46); macroalbuminuria (> 200 mu g/min) 1.52 (1.10-2.10); previous cardiovascular disease 3.51 (2.54-4.84). All eight variables were used to elaborate a risk equation for 5-year cardiovascular disease risk. Regarding calibration in the derivation data set, ratio predicted 5-year risk (mean 5.4 +/- 7.9%) to observed event rate was 1.0. Discrimination was sufficient, with C-statistic 0.83, sensitivity and specificity 72 and 77%, respectively, for the top quartile of predicted risk. Similarly, calibration and discrimination were adequate in the validation data set: ratio of predicted 4-year risk/observed rate 0.94, C-statistic 0.80, sensitivity and specificity 62 and 77%, respectively, for the top quartile.Conclusions: This 5-year cardiovascular disease risk model from a large observational study of patients with Type 1 diabetes in routine care showed adequate calibration and discrimination and can be useful for clinical practice. It should also be tested in patients with Type 1 diabetes from other countries.
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| 30. |
- Cederholm, Jan, et al.
(författare)
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Blood pressure and risk of cardiovascular diseases in type 2 diabetes : further findings from the Swedish National Diabetes Register (NDR-BP II)
- 2012
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Ingår i: Journal of Hypertension. - 0263-6352 .- 1473-5598. ; 30:10, s. 2020-2030
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Estimate risks of coronary heart disease (CHD), stroke and cardiovascular disease (CVD) with updated mean systolic (SBP) and diastolic (DBP) blood pressure in an observational study of patients with type 2 diabetes. Methods: Thirty-five thousand and forty-one patients treated with antihypertensive drugs, and 18 512 untreated patients, aged 30-75 years, without previous heart failure, followed for 6 years until 2009. Results: In treated patients, nonlinear splines for 6-year risk of fatal/nonfatal CHD, stroke and CVD by BP as a continuous variable showed a progressive increase with higher SBP from 140 mmHg and higher, and with DBP from 80 mmHg, with a J-shaped risk curve at lowest SBP levels, but not obviously at lowest DBP levels. Analysing intervals of SBP with 130-134 mmHg as reference at Cox regression, adjusted hazard ratios (HR) for fatal/nonfatal CHD, stroke and CVD with at least 140 mmHg were 1.22 [95% confidence interval (CI): 1.08-1.39], 1,43 (1.18-1.72), 1.26 (1.13-1.41), all P<0.001. HR with 115-129 and 135-139 mmHg were nonsignificant, whereas increased with 100-114 mmHg, 1.96 (P<0.001), 1.75 (P=0.02), 2.08 (P < 0.001), respectively. With DBP 75-79 mmHg as reference, adjusted HR for fatal/nonfatal CHD, stroke and CVD with DBP 80-84 mmHg were 1.42 (1.26-1.59), 1.46 (1.24-1.72), 1.39 (1.26-1.53), all P< 0.001. Corresponding HR with DBP at least 85 mmHg were 1.70 (1.50-1.92), 2.35 (1.99-2.77), 1..87 (1.69-2.07), all P < 0.001. Corresponding HR with DBP 60-69 and 70-74 mmHg were nonsignificant. The picture was similar in 7059 patients with previous CVD and in untreated patients. Conclusion: BP around 130-135/75-79 mmHg showed lower risks of cardiovascular diseases in patients with type 2 diabetes.
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| 31. |
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| 32. |
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| 33. |
- Cederholm, Jan, et al.
(författare)
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Risk prediction of cardiovascular disease in type 2 diabetes : A risk equation from the Swedish National Diabetes Register (NDR)
- 2008
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Ingår i: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 31:10, s. 2038-2043
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE - Risk prediction models obtained in samples from the general population do mot perform well in type 2 diabetic patients. Recently, 5-year risk estimates were proposed as being more accurate than 10-year risk estimates. This study presents a diabetes-specific equation for estimation of the absolute 5-year risk of first incident fatal/nonfatal cardiovascular disease (CVD) in type 2 diabetic patients with the use of A1C and clinical characteristics.RESEARCH DESIGN AND METHODS - The study was based on 11,646 female and male patients, aged 18-70 years, from the Swedish National Diabetes Register with 1,482 first incident CVD events based on 58,342 person-years with mean follow-up) of 5.64 years.RESULTS - This risk equation incorporates A1C, as in the UK Prospective Diabetes Study risk engine, and several clinical characteristics: onset age of diabetes, diabetes duration, sex, BMI, smoking, systolic blood pressure, and antihypertensive and lipid-reducing drugs. All predictors included were associated with the Outcome (P < 0.0001, except for BMI P = 0.0016) with Cox regression analysis. Calibration was excellent when assessed by comparing observed and predicted risk. Discrimination was sufficient, with a receiver operator curve statistic of 0.70. Mean 5-year risk of CVD in all patients was 12.0 +/- 7.5%, whereas 54% of the patients had a 5-year risk >= 10%.CONCLUSIONS - This more simplified risk equation enables 5-year risk prediction of CVD based on easily available nonlaboratory predictors in clinical practice and A1C and was elaborated in a large observational study obtained from the normal patient population aged up to 70 years.
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| 34. |
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| 35. |
- Cederholm, Jan, et al.
(författare)
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Riskfaktorer för hjärt- kärlsjukdom : Resultat från Nationella diabetesregistret jämförs med internationella studier
- 2013
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 110:17-18, s. 882-885
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Forskningsöversikt (refereegranskat)abstract
- Observationsstudier från Nationella diabetesregistret visar att vid typ 1- och typ 2-diabetes ses en ökande risk för hjärt–kärlsjukdom med stigande HbA1c-värden, men ingen förhöjd risk vid lägre HbA1c.Vid typ 2-diabetes ses påtagligt lägre risk för hjärt–kärlsjukdom vid blodtryck 130–135/75 mm Hg än vid 140/80 mm Hg eller högre.Lipidkvoten non-HDL-/HDL-kolesterol är en starkare riskfaktor för ischemisk hjärtsjukdom än LDL-kolesterol. Lägre värden för kvoten ger lägre triglycerider och högre HDL-kolesterol.Två verktyg för beräkning av 5-årsrisken för hjärt–kärlsjukdom vid typ 1-och typ 2-diabetes presenteras.
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| 36. |
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| 37. |
- Celis-Morales, C. A., et al.
(författare)
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Type 2 Diabetes, Glycemic Control, and Their Association With Dementia and Its Major Subtypes: Findings From the Swedish National Diabetes Register
- 2022
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 45:3, s. 634-641
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Type 2 diabetes has been associated with high dementia risk. However, the links to different dementia subtypes is unclear. We examined to what extent type 2 diabetes is associated with dementia subtypes and whether such associations differed by glycemic control. RESEARCH DESIGN AND METHODS: We used data from the Swedish National Diabetes Register and included 378,299 patients with type 2 diabetes and 1,886,022 control subjects matched for age, sex, and county randomly selected from the Swedish Total Population Register. The outcomes were incidence of Alzheimer disease, vascular dementia, and nonvascular dementia. The association of type 2 diabetes with dementia was stratified by baseline glycated hemoglobin (HbA1c) in patients with type 2 diabetes only. Cox regression was used to study the excess risk of outcomes. RESULTS: Over the follow-up (median 6.8 years), dementia developed in 11,508 (3.0%) patients with type 2 diabetes and 52,244 (2.7%) control subjects. The strongest association was observed for vascular dementia, with patients with type 2 diabetes compared with control subjects having a hazard ratio [HR] of 1.34 (95% CI 1.28, 1.41). The association of type 2 diabetes with nonvascular dementia was more modest (HR 1.10 [95% CI 1.07, 1.13]). However, risk for Alzheimer disease was lower in patients with type 2 diabetes than in control subjects (HR 0.94 [95% CI 0.90, 0.99]). When the analyses were stratified by circulating concentrations of HbA1c, a dose-response association was observed. CONCLUSIONS: The association of type 2 diabetes with dementia differs by subtypes of dementia. The strongest detrimental association is observed for vascular dementia. Moreover, patients with type 2 diabetes with poor glycemic control have an increased risk of developing vascular and nonvascular dementia. © 2022 by the American Diabetes Association.
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| 38. |
- Cheng, Qing, et al.
(författare)
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Preclinical PET imaging of EGFR levels : pairing a targeting with a non-targeting Sel-tagged Affibody-based tracer to estimate the specific uptake
- 2016
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Ingår i: EJNMMI Research. - : Springer. - 2191-219X. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Background: Though overexpression of epidermal growth factor receptor (EGFR) in several forms of cancer is considered to be an important prognostic biomarker related to poor prognosis, clear correlations between biomarker assays and patient management have been difficult to establish. Here, we utilize a targeting directly followed by a non-targeting tracer-based positron emission tomography (PET) method to examine some of the aspects of determining specific EGFR binding in tumors. Methods: The EGFR-binding Affibody molecule Z(EGFR:2377) and its size-matched non-binding control Z(Taq:3638) were recombinantly fused with a C-terminal selenocysteine-containing Sel-tag (Z(EGFR:2377)-ST and Z(Taq:3638)-ST). The proteins were site-specifically labeled with DyLight488 for flow cytometry and ex vivo tissue analyses or with C-11 for in vivo PET studies. Kinetic scans with the C-11-labeled proteins were performed in healthy mice and in mice bearing xenografts from human FaDu (squamous cell carcinoma) and A431 (epidermoid carcinoma) cell lines. Changes in tracer uptake in A431 xenografts over time were also monitored, followed by ex vivo proximity ligation assays (PLA) of EGFR expressions. Results: Flow cytometry and ex vivo tissue analyses confirmed EGFR targeting by ZE(GFR:2377)-ST-DyLight488. [Methyl-C-11]-labeled Z(EGFR:2377)-ST-CH3 and Z(Taq:3638)-ST-CH3 showed similar distributions in vivo, except for notably higher concentrations of the former in particularly the liver and the blood. [Methyl-C-11]-Z(EGFR:2377)-ST-CH3 successfully visualized FaDu and A431 xenografts with moderate and high EGFR expression levels, respectively. However, in FaDu tumors, the non-specific uptake was large and sometimes equally large, illustrating the importance of proper controls. In the A431 group observed longitudinally, non-specific uptake remained at same level over the observation period. Specific uptake increased with tumor size, but changes varied widely over time in individual tumors. Total (membranous and cytoplasmic) EGFR in excised sections increased with tumor growth. There was no positive correlation between total EGFR and specific tracer uptake, which, since Z(EGFR:2377) binds extracellularly and is slowly internalized, indicates a discordance between available membranous and total EGFR expression levels. Conclusions: Same-day in vivo dual tracer imaging enabled by the Sel-tag technology and C-11-labeling provides a method to non-invasively monitor membrane-localized EGFR as well as factors affecting non-specific uptake of the PET ligand.
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| 39. |
- Dalenbäck, Jan-Olof, 1954, et al.
(författare)
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Ställ tekniska egenskapskrav och använd deklarationerna
- 2014
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Ingår i: Energi & Miljö. - 1101-0568. ; 2014:4, s. 40-41
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Ta bort energikraven i BBR och ersätt dem med ändamålsenliga egenskaps¬krav. Gör sedan energideklarationerna värda namnet genom att inkludera hushålls- och verk¬sam¬hets¬el så att de kan användas för att följa upp energi¬användningen. I anslutning till Boverkets regeringsuppdrag (N2014/75/E) att definiera nya energihus¬håll¬ningskrav, finns det all anledning att diskutera om vi är på rätt väg med de krav på bygg¬naders energi¬prestanda som ställs i Boverkets Byggregler (BBR). Speciellt om dess uppfyllelse ska vara juridiskt bindande.
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| 40. |
- Danielsson, Erna, 1954-, et al.
(författare)
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Krishanteringens logiker i hanteringen av migraitonen hösten 2015 : En kritisk analys
- 2020
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Ingår i: Genus, risk och kris. - Lund : Studentlitteratur AB. - 9789144124995 ; , s. 77-95
-
Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- Syftet med detta kapitel är att analysera och diskutera de processer genom vilka krishanteringen verkar och de styrningsrelationer som krishanteringsretoriken grundas i och genererar. Till vår hjälp tar vi Dorothy Smiths institutionella etnografi och kritisk riskteori. Fallet vi utgår från är en utvärdering som vi författare gjorde av Myndighetens för samhällsskydd och beredskaps insatser under hösten 2015 när ett ovanligt stort antal personer från andra länder sökte asyl i Sverige.
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| 41. |
- Dehlin, Stefan, et al.
(författare)
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Effektive projektering av lågenergihus
- 2011
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Byggbranschen står inför stora miljö- som affärsmässiga utmaningar med krav på att reducera energiförbrukning och miljöpåverkan. Detta projekt syftar till att bidra medkunskap hur energiprojektering kan effektiviseras vid nyproduktion avlågenergibyggnader där det övergripande målet är att stödja ett långsiktigt hållbart och lönsamt byggande. Studien har genomförts i samverkan mellan byggbransch och akademi genom fallstudier och enkätundersökningen.Resultatet visar på behovet och nyttan av att redan i tidigt planeringsskede utreda konsekvensen av olika alternativ av exempelvis byggnadsutformning ochklimatskärmens tekniska prestanda. Det spelar mindre roll vilket energiberäkningsverktyg man använder om resultatet används för att jämföra olika alternativ med varandra.Skillnaderna i krav och institutionella ramverk vad gäller energiprestanda påverkar också projektering av energieffektiva byggnader. En jämförande studie av hur man hanterar energifrågor från krav till färdig lösning mellan Tyskland och Sverige visar på ett behov av vidareutbildning i energifrågor för arkitekter och ingenjörer i Sverige som kommer in tidigt i byggprocessen. Undersökningen och jämförelsen pekar också mot ett behov av en sammanlänkande funktion, här kallad energisamordnare.Energisamordnarens roll är att föra in energikompetens in i projektet, säkerställa att krav och mål formuleras och hanteras samt aktivt delta i projekteringen för att guida utformningen av byggnaden mot en effektiv och låg energiförbrukning.Vi kan konstatera att det är marknadskrafter och engagemang från byggare, beställare och lokala myndigheter snarare än nationella krav som driverenergieffektivisering framåt i Sverige idag. Det kan emellertid leda till en situation där krav på energieffektivitet blir lokalt satta vilket kan leda till svårigheter för utvecklare av olika typer av byggnadssystem för bostäder och lokaler. Därför är det önskvärt att utvecklingen av byggnadstekniken som skett de senaste åren också följs upp av Boverket i form av krav som ligger i framkant snarare än minimikrav för att förhindra att en flora av lokala krav uppstår som kan verka som "handelshinder" för den fortsatta utvecklingen av det industriella byggandet i Sverige.Vi ser också ett tydligt behov för ökad samverkan och integration för att kunna driva energieffektiviseringen framåt men samtidigt också ett tydligt behov av att utveckla upphandlings- och samverkansformer för att möjliggöra detta. Upphandlingen, till exempel, bör utformas så att lämpliga aktörer väljs utifrån mjuka parametrar och involveras tidigt under projekteringsskedet samt ges ekonomiska incitamentkopplade till projektets mål, ekonomi och tidplan.Projektet har också undersökt hur man skall åstadkomma en mer integreradprojekteringsprocess genom att: Skapa en struktur för att samla, uttrycka och klargöra mål och krav ochutveckla dessa mot funktionskrav och tekniska lösningar. Genomföra en modellbaserad projektering som detaljerar tekniska lösningarallteftersom de utvecklas.Införa beslutsstöd för energifrågor i projektutveckling där produktensprestanda successivt jämförs mot funktionskrav med hjälp av alltmerdetaljerade prestandaanalyser.I projektet har också ett nyutvecklat formellt beslutsstöd exemplifierats där fleraalternativa lösningar kan utvärderas mot olika kriterier (MADM) vilka kanorganiseras och viktas hierarkiskt utifrån projektets mål och krav.I projektets har en prototyp, en så kallad energikonfigurator, utvecklats för atteffektivisera produkt och projektutveckling av s.k. konceptbyggande. Användandet har demonstrerats på NCC:s koncept P303 där man optimerat konfigureringen i produkt och projektutveckling efter både subjektiva och objektiva kriterier som tänkas efterlikna ett visst kundsegment. Hundratals alternativa utformningar kan utvärderas på några minuter i jämförelse med dagar och veckor om samma analyser skulle göras för hand med hjälp av energiberäkningsprogram med manuell inmatning av indata.För att effektivisera projekteringen mot ett energieffektivt byggande rekommenderar projektet att:Man tidigt upphandlar och involverar de viktigaste aktörerna så att man tidigtkan inkludera energiaspekter i utformning av koncept. Beställaren aktivt deltar i kravformuleringen och i analys- ochbeslutsprocessen. Dels för att säkerställa val mot uppställda krav och behovoch dels för att tillgodose de praktiska behov som uppstår i och med enintegrerad och modellbaserad projekteringsprocess. Utse en energisamordnare som skall säkerställa att formulerade energikravoch mål hanteras optimalt för att guida utformningen av byggnaden mot eneffektiv och låg energiförbrukning. Använda en modellbaserad projekteringsprocess för utformning, simuleringoch analys av konceptlösningar gentemot energirelaterade aspekter. Energianalyser som görs i tidigt skede används för att jämföra olikaalternativa utformningar. När detaljeringsnivån ökar bör man användadynamiska verktyg och för att beräkna energiförbrukning och inneklimat pårumsnivå. Man bör tidigt inkludera utformning av t ex ventilation ocheventuella maskinrum då de kan ha stor inverkan på energiförbrukningen. Man utför prestandaanalyser av energi och inneklimat innan man fryserdesign av klimatskärm och VVS så att resultatet kan guida konstruktörer ochinstallatörer i den slutliga utformningen av systemhandlingarna. Man i driftfasen utför en mer automatisk och kontinuerlig jämförelse mellansimulerad och verklig energiförbrukning för att bekräfta att byggnadenuppfyller initiala krav samt för att inhämta data och erfarenheter för vidareoptimering eller andra framtida projektFörändring sker i och med att beställaren möjliggör en miljö som initierar ochstödjer en hög grad av samverkan och integration mellan inblandade aktörer, därtyngden på beslutsfattandet flyttas till ett tidigare skede, där rätt kompetenserkan komma in vid rätt tillfälle och där fokus är på slutprodukten och desslivscykel och inte på avskilda åtaganden
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| 42. |
- Dena, Mary, et al.
(författare)
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Renal Complications and Duration of Diabetes: An International Comparison in Persons with Type 1 Diabetes
- 2021
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Ingår i: Diabetes Therapy. - : Springer Science and Business Media LLC. - 1869-6953 .- 1869-6961. ; :12, s. 3093-3105
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Renal complications are both a marker of previous suboptimal glycaemic control and a major risk factor for cardiovascular disease in persons with type 1 diabetes (T1D). The aim of the study was to evaluate the prevalence of renal complications in persons with T1D in four geographical regions. Methods Nationwide registry data from Austria/Germany, Sweden and the US were used to estimate the prevalence of renal complications from January 2016 until September 2018. Chronic kidney disease (CKD) and albuminuria in the study population and each registry were analysed by diabetes duration. Risk factors for renal complications were described by registry. Results In the total cohort of 78.926 adults with T1D, mean age was 44.4 +/- 18.43 years and mean diabetes duration was 21.6 +/- 22 years. Mean estimated glomerular filtration rate (eGFR) was 94.0 +/- 31.45 ml/min, 13.0% had microalbuminuria and 3.9% had macroalbuminuria. Mean age, diabetes duration, use of insulin pumps and continuous glucose monitoring, as well as presence of albuminuria, varied between registries. Albuminuria was present in approximately 10% of persons with diabetes duration < 20 years and impaired renal function (eGFR < 60 ml/min) was present in 17%. In persons with diabetes duration > 40 years, approximately one-third had albuminuria and 25% had impaired renal function. Conclusions This analysis used three nationwide registries of persons with T1D. Despite recent use of more effective diabetes therapies, a substantial proportion of persons with T1D have renal complications at < 20 years after diagnosis. Efficient glucose-lowering and renal-protective strategies are needed in persons with T1D.
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| 43. |
- Eeg-Olofsson, Katarina, 1968
(författare)
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Cardiovaskular risk factors and complications in type 1 and type 2 diabetes
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients with diabetes have increased risk of cardiovascular disease (CVD) and mortality compared to the general population. The aim of this work was to describe the clinical characteristics and risk factors in patients with type 1 diabetes, and also to investigate the association between glycaemic control and CVD in type 1 and type 2 diabetes, and to analyse the association between BMI, overweight and obesity, and CVD in type 2 diabetes. These observational studies comprise patients from the Swedish National Diabetes Register (NDR). Clinical characteristics and risk factor control in type 1 diabetes were analysed in two cross-sectional samples, in 1997 and 2004. 7454 patients with type 1 diabetes were followed from 2002/03 to 2007, and 13,087 patients (Study III) and 18,336 (Study IV) with type 2 diabetes were followed from 1997/98 to 2003, regarding fatal/non-fatal CVD events. Cox proportional hazard models were used to estimate adjusted hazard ratios with 95% confidence intervals and to estimate 5- and 6-year event rates for the outcomes. In patients with type 1 diabetes slight but significant improvements were seen in glycaemic control, blood pressure and lipid levels from 1997 to 2004. Hazard ratios for coronary heart disease (CHD) and CVD per 1%-unit increase in baseline HbA1c were 1.31 and 1.26 (p<0.001), respectively, when adjusted for age, sex, duration of diabetes and cardiovascular risk factors. Adjusted 5-year event rates of CHD and CVD increased progressively with higher HbA1c levels. Patients with HbA1c levels of 5-7.9% (mean 7.2%) at baseline had about 40% lower risk for CHD and CVD, compared with patients with HbA1c 8-11.9% (mean 9.0%). In type 2 diabetes adjusted hazard ratios for a 5-unit increase in BMI were 1.15 for first-incident CHD and 1.13 for CVD. Obesity was associated with a 44% increase in risk of CVD, and overweight with a 24% increase in risk, compared with normal weight. Adjusted hazard ratios for a 1%-unit increase in HbA1c were 1.11 for CHD and 1.10 for CVD (p<0.001), and the corresponding adjusted 6-year event rates for these outcomes increased progressively with higher baseline and updated mean HbA1c values, also when sub-grouping the data by duration, previous CVD or hypoglycaemic treatment. A group of patients with a mean baseline HbA1c of 6.5% showed a 20% lower risk of CHD and a 16% lower risk of CVD, than a group with a mean HbA1c of 7.5%. These large observational studies on patients with diabetes in everyday clinical practice show a slow improvement in glycaemic control and risk factors in type 1 diabetes. Higher HbA1c level was found to be independently associated with increased risk of CHD and CVD, emphasizing the role of HbA1c as a strong independent risk factor in type 1 diabetes. In type 2 diabetes, increasing risks of CHD and CVD were seen in patients with higher HbA1c levels, while no risk increase was seen in those with low HbA1c levels. HbA1c levels lower than 7% were associated with a lower risk of CVD, providing support for current treatment guidelines. Higher BMI, overweight and obesity independently increased the risk of CHD and CVD in patients with type 2 diabetes, providing additional evidence that overweight and obesity should be counteracted in type 2 diabetes.
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| 44. |
- Eeg-Olofsson, Katarina, 1968, et al.
(författare)
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Considerably decreased risk of cardiovascular disease with combined reductions in HbA1c, blood pressure and blood lipids in type 2 diabetes: Report from the Swedish National Diabetes Register
- 2016
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Ingår i: Diabetes & Vascular Disease Research. - : SAGE Publications. - 1479-1641 .- 1752-8984. ; 13:4, s. 268-277
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Assess the effect of risk factors changes on risk for cardiovascular disease and mortality in patients with type 2 diabetes selected from the Swedish National Diabetes Register. Methods: Observational study of 13,477 females and males aged 30-75years, with baseline HbA1c 41-67mmol/mol, systolic blood pressure 122-154mmHg and ratio non-HDL:HDL 1.7-4.1, followed for mean 6.5years until 2012. Four groups were created: a reference group (n=6757) with increasing final versus baseline HbA1c, systolic blood pressure and non-HDL:HDL cholesterol during the study period, and three groups with decreasing HbA1c (n=1925), HbA1c and systolic blood pressure (n=2050) or HbA1c and systolic blood pressure and non-HDL:HDL (n=2745). Results: Relative risk reduction for fatal/nonfatal cardiovascular disease was 35% with decrease in HbA1c only (mean 6 to final 49mmol/mol), 56% with decrease in HbA1c and systolic blood pressure (mean 12 to final 128mmHg) and 75% with combined decreases in HbA1c, systolic blood pressure and non-HDL:HDL (mean 0.8 to final 2.1), all p<0.001 adjusting for clinical characteristics, other risk factors, treatments and previous cardiovascular disease. Similar risk reductions were found for fatal/nonfatal coronary heart disease, fatal cardiovascular disease, all-cause mortality and also in a subgroup of 3038 patients with albuminuria. Conclusion: Considerable risk reductions for cardiovascular disease and mortality were seen with combined long-term risk factor improvement.
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- Eeg-Olofsson, Katarina, 1968, et al.
(författare)
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Glycemic and risk factor control in type 1 diabetes: results from 13,612 patients in a national diabetes register
- 2007
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Ingår i: Diabetes Care. - : American Diabetes Association. - 1935-5548 .- 0149-5992. ; 30:3, s. 496-502
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: This study was designed to investigate the clinical characteristics of a large type 1 diabetic population and to evaluate the degree of fulfillment of recently updated treatment goals. RESEARCH DESIGN AND METHODS: The Swedish National Diabetes Register was initiated in 1996 as a tool for quality assurance in diabetes care. A1C levels, treatment, and risk factors were analyzed in two cross-sectional samples of 9,424 patients in 1997 and 13,612 patients in 2004 and in a smaller longitudinal sample from 1997 to 2004. RESULTS: Mean A1C decreased from 8.2 +/- 1.3% in 1997 to 8.0 +/- 1.2% in 2004 (P < 0.001). The proportion of patients reaching A1C <7.0% increased from 17.4 to 21.2% in 2004. A slow but significant improvement in blood pressure levels was seen, but only 61.3% reached the blood pressure goal of <130/80 mmHg in 2004. Lipid control improved, and the use of lipid-lowering drugs increased. Among patients treated with lipid-lowering agents, 38% reached the goal of total cholesterol <4.5 mmol/l, and 48% reached the goal of LDL cholesterol <2.5 mmol/l. Successful long-term glycemic and blood pressure control were both independently predicted by low BMI and the absence of microalbuminuria in 1997. CONCLUSIONS: In this large cohort of type 1 diabetic patients, there was a slow improvement in glycemic and risk factor control from 1997 to 2004, although the gap between the clinical results and current Swedish and American treatment goals is still unsatisfactory. It is crucial that additional measures be taken to improve risk factor control in type 1 diabetic patients.
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| 49. |
- Eeg-Olofsson, Katarina, 1968, et al.
(författare)
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Patients' and Health Care Professionals' Perceptions of the Potential of Using the Digital Diabetes Questionnaire to Prepare for Diabetes Care Meetings: Qualitative Focus Group Interview Study
- 2020
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 22:8
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Tidskriftsartikel (refereegranskat)abstract
- Background: In effective diabetes management, it is important that providers and health care systems prioritize the delivery of patient-centered care and that they are respectful of and responsive to individual patient preferences and barriers. Objective: The objective of the study was to conduct focus group interviews to capture patients' and health care professionals' perceptions and attitudes regarding digital technology and to explore how the digital Diabetes Questionnaire can be used to support patient participation in diabetes care, as a basis for an implementation study. Methods: A qualitative study was conducted with six focus group discussions with diabetes specialist nurses and medical doctors (n=29) and four focus group discussions with individuals with diabetes (n=23). A semistructured focus group interview guide was developed, including probing questions. The data were transcribed verbatim, and qualitative content analysis was performed using an inductive approach. Results: Two main categories were revealed by the qualitative analysis: perceptions of digital technology and the digital questionnaire in diabetes management and care and perceptions of participation in diabetes care. An overarching theme that emerged from the focus group interviews was patients' and professionals' involvement in diabetes care using digital tools. Conclusions: The analysis identified important factors to consider when introducing the digital Diabetes Questionnaire in clinical use. Both professionals and patients need support and training in the practical implementation of the digital questionnaire, as well as the opportunity to provide feedback on the questionnaire answers.
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| 50. |
- Eeg-Olofsson, Katarina, 1968, et al.
(författare)
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Real-world study of flash glucose monitoring among adults with type 2 diabetes within the Swedish National Diabetes Register
- 2022
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Ingår i: DIABETES & VASCULAR DISEASE RESEARCH. - : SAGE Publications. - 1479-1641 .- 1752-8984. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe Swedish National Diabetes Register (NDR) initiated registration of the FreeStyle Libre (R) system and other continuous glucose monitoring (CGM) systems in June 2016. We investigated change in HbA1c for people with type 2 diabetes (T2DM) using FreeStyle Libre in Sweden.MethodsWe included adults with T2DM, registered in the NDR after January 1, 2014, and an index date for first use of FreeStyle Libre of June 2016 or later. Methodology was a before/after comparison of HbA1c within 6 months before the index date versus HbA1c around 6 and 12 months after the index date.Results711 adults with T2DM using FreeStyle Libre had HbA1c measurements within the study period. Mean HbA1c was significantly reduced at 6 months (-0.50%-unit) and at 12 months (-0.52%-unit) in this group. Degree of change was negatively correlated to baseline HbA1c. Reductions in HbA1c were observed in incident users of FreeStyle Libre with T2DM who were truly naive to CGM or had unknown prior experience of CGM, and aged 25-74 years.ConclusionsThis real-world study on the Swedish NDR shows that people with T2DM using FreeStyle Libre system for 6 and 12 months significantly reduced their HbA1c.
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