| 1. |
- Lundgren, Markus, et al.
(författare)
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Analgesic antipyretic use among young children in the TEDDY study : No association with islet autoimmunity
- 2017
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Ingår i: BMC Pediatrics. - : Springer Science and Business Media LLC. - 1471-2431. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The use of analgesic antipyretics (ANAP) in children have long been a matter of controversy. Data on their practical use on an individual level has, however, been scarce. There are indications of possible effects on glucose homeostasis and immune function related to the use of ANAP. The aim of this study was to analyze patterns of analgesic antipyretic use across the clinical centers of The Environmental Determinants of Diabetes in the Young (TEDDY) prospective cohort study and test if ANAP use was a risk factor for islet autoimmunity. Methods: Data were collected for 8542 children in the first 2.5 years of life. Incidence was analyzed using logistic regression with country and first child status as independent variables. Holm's procedure was used to adjust for multiplicity of intercountry comparisons. Time to autoantibody seroconversion was analyzed using a Cox proportional hazards model with cumulative analgesic use as primary time dependent covariate of interest. For each categorization, a generalized estimating equation (GEE) approach was used. Results: Higher prevalence of ANAP use was found in the U.S. (95.7%) and Sweden (94.8%) compared to Finland (78.1%) and Germany (80.2%). First-born children were more commonly given acetaminophen (OR 1.26; 95% CI 1.07, 1.49; p = 0.007) but less commonly Non-Steroidal Anti-inflammatory Drugs (NSAID) (OR 0.86; 95% CI 0.78, 0.95; p = 0.002). Acetaminophen and NSAID use in the absence of fever and infection was more prevalent in the U.S. (40.4%; 26.3% of doses) compared to Sweden, Finland and Germany (p < 0.001). Acetaminophen or NSAID use before age 2.5 years did not predict development of islet autoimmunity by age 6 years (HR 1.02, 95% CI 0.99-1.09; p = 0.27). In a sub-analysis, acetaminophen use in children with fever weakly predicted development of islet autoimmunity by age 3 years (HR 1.05; 95% CI 1.01-1.09; p = 0.024). Conclusions: ANAP use in young children is not a risk factor for seroconversion by age 6 years. Use of ANAP is widespread in young children, and significantly higher in the U.S. compared to other study sites, where use is common also in absence of fever and infection.
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| 2. |
- Gustafsson, Lars L., et al.
(författare)
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The 'wise list'- a comprehensive concept to select, communicate and achieve adherence to recommendations of essential drugs in ambulatory care in Stockholm
- 2011
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Ingår i: Basic & Clinical Pharmacology & Toxicology. - Copenhagen : Blackwell Publishing. - 1742-7835 .- 1742-7843. ; 108:4, s. 224-233
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to present and evaluate the impact of a comprehensive strategy over 10 years to select, communicate and achieve adherence to essential drug recommendations (EDR) in ambulatory care in a metropolitan healthcare region. EDRs were issued and launched as a 'Wise List' by the regional Drug and Therapeutics Committee in Stockholm. This study presents the concept by: (i) documenting the process for selecting, communicating and monitoring the impact of the 'Wise List'; (ii) analysing the variation in the number of drug substances recommended between 2000 and 2010; (iii) assessing the attitudes to the 'Wise List' among prescribers and the public; (iv) evaluating the adherence to recommendations between 2003 and 2009. The 'Wise List' consistently contained 200 drug substances for treating common diseases. The drugs were selected based on their efficacy, safety, suitability and cost-effectiveness. The 'Wise List' was known among one-third of a surveyed sample of the public in 2002 after initial marketing campaigns. All surveyed prescribers knew about the concept and 81% found the recommendations trustworthy in 2005. Adherence to recommendations increased from 69% in 1999 to 77% in 2009. In primary care, adherence increased from 83% to 87% from 2003 to 2009. The coefficient of variation (CV%) decreased from 6.1% to 3.8% for 156 healthcare centres between these years. The acceptance of the 'Wise List' in terms of trust among physicians and among the public and increased adherence may be explained by clear criteria for drug recommendations, a comprehensive communication strategy, electronic access to recommendations, continuous medical education and involvement of professional networks and patients.
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| 3. |
- Haghighi, Mona, et al.
(författare)
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A Comparison of Rule-based Analysis with Regression Methods in Understanding the Risk Factors for Study Withdrawal in a Pediatric Study
- 2016
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 6
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Tidskriftsartikel (refereegranskat)abstract
- Regression models are extensively used in many epidemiological studies to understand the linkage between specific outcomes of interest and their risk factors. However, regression models in general examine the average effects of the risk factors and ignore subgroups with different risk profiles. As a result, interventions are often geared towards the average member of the population, without consideration of the special health needs of different subgroups within the population. This paper demonstrates the value of using rule-based analysis methods that can identify subgroups with heterogeneous risk profiles in a population without imposing assumptions on the subgroups or method. The rules define the risk pattern of subsets of individuals by not only considering the interactions between the risk factors but also their ranges. We compared the rule-based analysis results with the results from a logistic regression model in The Environmental Determinants of Diabetes in the Young (TEDDY) study. Both methods detected a similar suite of risk factors, but the rule-based analysis was superior at detecting multiple interactions between the risk factors that characterize the subgroups. A further investigation of the particular characteristics of each subgroup may detect the special health needs of the subgroup and lead to tailored interventions.
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| 4. |
- Karlsson, Johan, 1991, et al.
(författare)
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Intersection crossing with reduced number of conflicts
- 2018
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Ingår i: IEEE Conference on Intelligent Transportation Systems, Proceedings, ITSC. ; , s. 1993-1999
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Konferensbidrag (refereegranskat)abstract
- In this paper, an optimization based algorithm for safe and efficient collaborative driving in intersections is formulated. The problem is to determine the optimal order in which vehicles should travel through an intersection under the assumptions that the longitudinal velocity of all vehicles can be controlled along a predefined path. In the original formulation one quadratic optimization program was solved for each possible crossing order of the vehicles and collisions were avoided by formulating constraints that only allowed one vehicle at the time inside the intersection. To make this algorithm more effective, we formulate less restrictive collision avoidance constraints by introducing one critical zone for each point where two predefined paths cross. It is shown that this formulation leads to a decrease in the number of quadratic optimization programs that need to be solved to find the best crossing order. Further, an algorithm is provided that finds the number of crossing sequences which yield unique formulations of the optimization program. The results show that when simulating more complex scenarios, like four vehicles traveling through an ordinary intersection, the reduction of computational time and the total time it takes for all vehicles to make it through the intersection can be significantly reduced using these less restrictive constraints.
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| 5. |
- Roos, Susanne, et al.
(författare)
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Bowel symptoms, self-image and comorbidity impact on well-being of women with coeliac disease
- 2011
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Ingår i: Journal of Nursing and Healthcare of Chronic Illness. - Oxford : Wiley-Blackwell. - 1752-9816 .- 1752-9824. ; 3:3, s. 302-309
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Tidskriftsartikel (refereegranskat)abstract
- Aim. To explore if gastrointestinal (GI) symptoms, self-image and comorbidity are related to well-being in women with coeliac disease (CD) and whether a history of CD in childhood impacts on well-being in adulthood. Background. Women in Sweden living with CD show a reduced level of well-being and report a high rate of GI complaints for unclear reasons. The self-image of these women is unknown. Design. A cross-sectional survey of 231 Swedish women with CD on long-term treatment (≥5 years) with a gluten-free diet (GFD) was conducted in 2010. Results. The study showed that well-being is related to a high rate GI symptoms (OR 16·9, 95% CI 5·6-50·7), a negative self-image (OR 8·9, 95% CI 3·5-22·9) and comorbidity (OR 3·3, 95% CI 1·7-6·4). There was no impact of childhood symptoms on well-being, GI symptoms, self-image or comorbidity in adulthood. Half of the study population showed reduced well-being compared with norms. Practically all women (97%) declared that they were always or usually following a GFD and 62% reported at least one disease besides CD. Conclusion. The study demonstrated that the well-being of women living with CD is affected by GI complaints, self-image and a high rate of comorbidity whereas a history of signs and symptoms of CD in childhood not seems to impact on the well-being in adulthood. Relevance to clinical practice. Gastrointestinal symptoms, self-image and comorbidity are factors contributing to a low level of well-being of CD women living on a GFD. Launching a multi-disciplinary team for follow-up would represent a novel approach to support these women and may prove valuable in improving their subjective health.
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