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- Eliasson, Gabriella, et al.
(author)
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Comorbid conditions as predictors of mortality in severe COPD - an eight-year follow-up cohort study
- 2023
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In: European Clinical Respiratory Journal. - : Taylor & Francis. - 2001-8525. ; 10:1
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Journal article (peer-reviewed)abstract
- Purpose: Co-morbidities are common in chronic obstructive pulmonary disease (COPD) and are associated with increased morbidity and mortality. The aim of the present study was to explore the prevalence of several comorbid conditions in severe COPD, and to investigate and compare their associations with long-term mortality.Methods: In May 2011 to March 2012, 241 patients with COPD stage 3 or 4 were included in the study. Information was collected on sex, age, smoking history, weight and height, current pharmacological treatment, number of exacerbations the recent year and comorbid conditions. At December 31st, 2019, mortality data (all-cause and cause specific) were collected from the National Cause of Death Register. Data were analyzed using Cox-regression analysis with gender, age, previously established predictors of mortality and comorbid conditions as independent variables, and all-cause mortality and cardiac and respiratory mortality, respectively, as dependent variables.Results: Out of 241 patients, 155 (64%) were deceased at the end of the study period; 103 patients (66%) died of respiratory disease and 25 (16%) of cardiovascular disease. Impaired kidney function was the only comorbid condition independently associated with increased all-cause mortality (HR (95% CI) 3.41 (1.47-7.93) p=0.004) and respiratory mortality (HR (95%CI) 4.63 (1.61 to 13.4), p = 0.005). In addition, age >= 70, BMI <22 and lower FEV1 expressed as %predicted were significantly associated with increased all-cause and respiratory mortality.Conclusion: In addition to the risk factors high age, low BMI and poor lung function; impaired kidney function appears to be an important risk factor for mortality in the long term, which should be taken into account in the medical care of patients with severe COPD.
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| 2. |
- Kisiel, Marta A., 1984-, et al.
(author)
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Agreement between reported questionnaire data and medical records on diagnosis and COVID-19 symptoms at onset
- 2023
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In: European Clinical Respiratory Journal. - : Taylor & Francis. - 2001-8525. ; 10:1
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Journal article (peer-reviewed)abstract
- The aim of this study was to assess whether there was agreement between self-reported data in a survey and medical records regarding diagnoses and symptoms at COVID-19 onset. The impact of sociodemographic factors on agreement between the two data sources was also assessed. Cross-sectional data were extracted from a Swedish longitudinal cohort study. In total, 401 non-hospitalized patients with a polymerase chain reaction-confirmed COVID-19 infection responded to a survey and agreed to a review of their electronic medical records. Agreement, estimated using the kappa statistic, sensitivity, and specificity were calculated for nine diagnoses and eleven symptoms. Differences between subgroups based on sociodemographic factors were assessed. The agreement between the self-reported data and medical records was at a substantial to moderate level for diagnoses such as diabetes mellitus (kappa 0.65, sensitivity 86%) and hypertension (kappa 0.59, sensitivity 56%) and at a fair level for more difficult-to-define conditions such as ongoing immunosuppressive treatment (kappa 0.27, sensitivity 25%). The agreement between the two data sources on symptoms was between fair and poor (kappa 0.36 for fever; kappa 0.05 for fatigue). Agreement for some diagnoses and symptoms varied across some sociodemographic subgroups, e.g. agreement in diabetes mellitus was significantly better in males (kappa 1.0) than females (kappa 0.52, homogeneity tests p = 0.02). In general, kappa values were lower for symptoms than diagnoses. The agreement between the two sources varied with diagnoses and symptoms and was also influenced by sociodemographic factors. This study illustrates that it is important to consider type of data used in the epidemiological studies as different information sources differ with quality and accuracy.
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| 3. |
- Saukkosalmi, P., et al.
(author)
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Defined daily dose definition in medication adherence assessment in asthma
- 2023
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In: European Clinical Respiratory Journal. - 2001-8525. ; 10:1
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Journal article (peer-reviewed)abstract
- Adherence to inhaled corticosteroids (ICS) has been described as poor. In adherence studies, if the actual prescribed dosing is not available, generic defined daily doses (DDD) are applied instead when assessing adherence. We evaluated asthma patients' adherence in a large prospective follow-up survey. We also analysed whether World Health Organization (WHO) and Global Initiative for Asthma (GINA) reference doses give different results. The current study was cross-sectional and included respondents attending to HeSSup follow-up questionnaire in 2012. Altogether 1,141 of 12,854 adult participants answered positively to the question about having asthma. According to the Finnish Social Insurance Institutions' medication register, 686 of them had purchased ICS medication during 2011. DDDs for ICS by WHO as well as medium doses from GINA report were used as reference doses to evaluate adherence. To estimate adherence to ICS, the proportion of days covered (PDC) over one year was calculated for every patient. If the lower limit of GINA medium ICS dose was used as a reference, 65% of the patients were adherent (PDC >= 80%). Use of WHO's DDD as reference halved the proportion of adherent patients. Adherence was higher among those using a combination inhaler of corticosteroid and long-acting beta(2)-agonist compared to those using steroid only inhalers. Use of WHO's daily defined doses as reference values may lead to underestimation of adherence to inhaled corticosteroids. Thus, attention should be paid when choosing the reference doses for the evaluation of adherence to inhaled corticosteroids in asthma.
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