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- Valassi, E., et al.
(författare)
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High mortality within 90 days of diagnosis in patients with Cushing's syndrome: results from the ERCUSYN registry
- 2019
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Ingår i: European Journal of Endocrinology. - : Oxford University Press (OUP). - 0804-4643 .- 1479-683X. ; 181:5, s. 461-472
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Patients with Cushing's syndrome (CS) have increased mortality. The aim of this study was to evaluate the causes and time of death in a large cohort of patients with CS and to establish factors associated with increased mortality. Methods: In this cohort study, we analyzed 1564 patients included in the European Registry on CS (ERCUSYN); 1045 (67%) had pituitary-dependent CS, 385 (25%) adrenal-dependent CS, 89 (5%) had an ectopic source and 45 (3%) other causes. The median (IQR) overall follow-up time in ERCUSYN was 2.7 (1.2-5.5) years. Results: Forty-nine patients had died at the time of the analysis; 23 (47%) with pituitary-dependent CS, 6 (12%) with adrenal-dependent CS, 18 (37%) with ectopic CS and two (4%) with CS due to other causes. Of 42 patients whose cause of death was known, 15 (36%) died due to progression of the underlying disease, 13 (31%) due to infections, 7 (17%) due to cardiovascular or cerebrovascular disease and 2 due to pulmonary embolism. The commonest cause of death in patients with pituitary-dependent CS and adrenal-dependent CS were infectious diseases (n = 8) and progression of the underlying tumor (n = 10) in patients with ectopic CS. Patients who had died were older and more often males, and had more frequently muscle weakness, diabetes mellitus and ectopic CS, compared to survivors. Of 49 deceased patients, 22 (45%) died within 90 days from start of treatment and 5 (10%) before any treatment was given. The commonest cause of deaths in these 27 patients were infections (n = 10; 37%). In a regression analysis, age, ectopic CS and active disease were independently associated with overall death before and within 90 days from the start of treatment. Conclusion: Mortality rate was highest in patients with ectopic CS. Infectious diseases the commonest cause of death soon after diagnosis, emphasizing the need for careful vigilance at that time, especially in patients presenting with concomitant diabetes mellitus.
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| 3. |
- Granquist, Sandra M., 1979-
(författare)
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Ecology, tourism and management of harbour seals (Phoca vitulina)
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In cases where human and wildlife are co-using the same geographical areas and resources, management issues often get complex and stakeholder conflicts are common. The Icelandic harbour seal (Phoca vitulina) population is rapidly decreasing, but direct culling of seals still occurs. At the same time seals are becoming an important resource due to increased interest in wildlife watching. Despite the complicated management situation, the Icelandic harbour seal population is one of the least studied pinniped populations in the world. Mapping the typical haul-out pattern is an important foundation for further studies. In paper I haul-out behaviour of harbour seals was investigated and a seasonal haul-out pattern was detected with the maximum number of seals hauling out during summer. A bimodal distribution curve was found during the summer time, suggesting that pupping period occurs in late May to early June, while moulting occurs in late July to early August. Tidal state, air-temperature and wind-speed affected the haul-out boots. Today, the main reason for culling harbour seals in Iceland is to reduce harbour seal predation on salmonids, despite limited knowledge on the effect of seal predation on salmonid populations and salmon angling. The diet of harbour seals that haul out in the estuary area of Bjargós and Ósar in NW-Iceland was therefore investigated using hard-part (paper II) and DNA metabarcoding analysis (paper III). Both methods showed that the main prey species were sand eels, flatfishes, gadoids, herring and capelin, while salmonids were not an important prey in this area. Based on these results, culling of harbour seals in the area is not likely to have a positive effect on salmonid angling. These results have crucial management implications, especially in the light of the severe decline in the Icelandic harbour seal population. Potential effects of seal watching tourism on the harbour seal population must also be considered in management plans. In paper IV, we investigated the effects of land based seal watching on seal behaviour and found that spatial distribution and vigilance was affected by tourists. Calm tourists behaviour had less effect, meaning that disturbance could be reduced if tourist behaviour is modified. In paper V, this line of investigation was followed by analysing knowledge transfer from academia to the tourist industry and a model was presented where a synergy effect of working interdisciplinary is hypothesised. Finally, in paper VI, the effect of signage on tourist behaviour was studied. Empirical testing showed that teleological information is more effective than ontological in terms of modifying general tourist behaviour. In this thesis, I present new knowledge on behaviour and diet of harbour seals, as well as new empirical findings on tourist behaviour in wildlife tourism settings. Further I explore interdisciplinary management approaches for seal watching tourism. The findings presented in this thesis have an important value within academic research in environmental-, life- and social sciences and the knowledge can be applied in several areas of harbour seal management in Iceland and elsewhere.
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- Holmström, Alexandra, et al.
(författare)
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Increased comorbidities in heart failure patients >/=85years but declined from >90years: Data from the Swedish Heart Failure Registry
- 2013
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Ingår i: International journal of cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 167:6, s. 2747-2752
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Epidemiological studies of elderly heart failure (HF) patients (>/=85years) are limited with inconsistent findings. Our objective is to confirm and extend epidemiological study in elderly (>/=85years) patients using the Swedish Heart Failure Registry database. METHODS: This retrospective study included 8,347 HF patients aged /=85years. Elderly population was further divided into two subgroups: 11,412 patients were 85-90years and 4,477 patients were >90years. RESULTS: The >/=85year group was characterized by more women, higher systolic blood pressure (SBP), lower body-mass index (BMI), more than twice as many HF with normal left ventricular ejection fraction (HFNEF), higher incidence of cardiovascular and non-cardiovascular comorbidities and less use of proven therapeutics compared with the 90year subgroup had a decline in cardiovascular and non-cardiovascular comorbidities except renal insufficiency and anaemia which continued to increase with ageing (p<0.01). Tendency was the same regardless of gender but slightly different between systolic HF (SHF) and HFNEF. In the group with HFNEF, there were more women, higher SBP, lower N-terminal pro-B-type natriuretic peptide levels, less ischaemic heart disease, more hypertension and left bundle branch block regardless of age. Atrial fibrillation was more frequent in patients with HFNEF than with SHF in the elderly group (p<0.01). Patients with HFNEF in the >90year subgroup had increasing incidence of ischaemic heart disease compared to 85-90year group (p<0.01). CONCLUSIONS: HF patients >/=85years had increased cardiovascular and non-cardiovascular comorbidities but with a decline from >90years.
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