| 1. |
- Agvall, Björn, et al.
(författare)
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Factors influencing hospitalization or emergency department visits and mortality in type 2 diabetes following the onset of new cardiovascular diagnoses in a population-based study
- 2024
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Ingår i: Cardiovascular Diabetology. - London : BioMed Central (BMC). - 1475-2840. ; 23:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Individuals with type 2 diabetes (T2D) are at increased risk of developing cardiovascular disease (CVD) which necessitates monitoring of risk factors and appropriate pharmacotherapy. This study aimed to identify factors predicting emergency department visits, hospitalizations, and mortality among T2D patients after being newly diagnosed with CVD.Methods: In a retrospective observational study conducted in Region Halland, individuals aged > 40 years with T2D diagnosed between 2011 and 2019, and a new diagnosis of CVD between 2016 and 2019, were followed for one year from the date of CVD diagnosis. The first encounter for CVD diagnosis was categorized as inpatient-, outpatient-, primary-, or emergency department care. Follow-up included laboratory tests, blood pressure, pharmacotherapies, and healthcare utilization. Hazard ratios (HR) in two Cox regression analyses determined relative risks for emergency visits/hospitalization and mortality, adjusting for age, sex, glucose regulation, lipid levels, kidney function, blood pressure, pharmacotherapy, and healthcare utilization.Results: The study included a total of 1759 T2D individuals who received a new CVD diagnosis, with 67% diagnosed during inpatient care. The average hospitalization stay was 6.5 days, and primary care follow-up averaged 10.1 visits. Patients with CVD diagnosed in primary care had a HR 0.52 (confidence interval [CI] 0.35–0.77) for emergency department visits/hospitalization, but age had a HR 1.02 (CI 1.00-1.03). Pharmacotherapy with insulin, DPP4-inhibitors, aldosterone antagonists, and beta-blockers had a raised HR. Highest mortality risk was observed when CVD was diagnosed inpatient care, systolic blood pressure < 100 mm Hg and elevated HbA1c. Age had a HR 1.05 (CI 1.03–1.08), eGFR < 30 ml/min HR 1.46 (CI 1.01–2.11), and LDL-Cholesterol > 2,5 h 1.46 (CI 1.01–2.11) and associated with increased mortality risk. Pharmacotherapy with metformin had a HR 0.41 (CI 0.28–0.62), statins a HR 0.39 (CI 0.27–0.57), and a primary care follow-up < 30 days a HR 0.53 (CI 0.37–0.77) and associated with lower mortality risk.Conclusions: T2D individuals who had a new diagnosis of CVD were predominantly diagnosed when hospitalized, while follow-up typically occurred in primary care. Identifying factors that predict risks of mortality and hospitalization should be a focus of follow-up care, underscoring the critical role of primary care in the effective management of T2D and CVD. © The Author(s) 2024.
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| 2. |
- Ahrén, Jonatan, et al.
(författare)
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A hypothesis - generating Swedish extended national cross-sectional family study of multimorbidity severity and venous thromboembolism
- 2023
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Ingår i: BMJ Open. - 2044-6055. ; 13:6, s. 1-8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Venous thromboembolism (VTE) is a common worldwide disease. The burden of multimorbidity, that is, two or more chronic diseases, has increased. Whether multimorbidity is associated with VTE risk remains to be studied. Our aim was to determine any association between multimorbidity and VTE and any possible shared familial susceptibility.DESIGN: A nationwide extended cross-sectional hypothesis - generating family study between 1997 and 2015.SETTING: The Swedish Multigeneration Register, the National Patient Register, the Total Population Register and the Swedish cause of death register were linked.PARTICIPANTS: 2 694 442 unique individuals were analysed for VTE and multimorbidity.MAIN OUTCOMES AND MEASURES: Multimorbidity was determined by a counting method using 45 non-communicable diseases. Multimorbidity was defined by the occurrence of ≥2 diseases. A multimorbidity score was constructed defined by 0, 1, 2, 3, 4 or 5 or more diseases.RESULTS: Sixteen percent (n=440 742) of the study population was multimorbid. Of the multimorbid patients, 58% were females. There was an association between multimorbidity and VTE. The adjusted odds ratio (OR) for VTE in individuals with multimorbidity (2 ≥ diagnoses) was 3.16 (95% CI: 3.06 to 3.27) compared with individuals without multimorbidity. There was an association between number of diseases and VTE. The adjusted OR was 1.94 (95% CI: 1.86 to 2.02) for one disease, 2.93 (95% CI: 2.80 to 3.08) for two diseases, 4.07 (95% CI: 3.85 to 4.31) for three diseases, 5.46 (95% CI: 5.10 to 5.85) for four diseases and 9.08 (95% CI: 8.56 to 9.64) for 5 ≥ diseases. The association between multimorbidity and VTE was stronger in males OR 3.45 (3.29 to 3.62) than in females OR 2.91 (2.77 to 3.04). There were significant but mostly weak familial associations between multimorbidity in relatives and VTE.CONCLUSIONS: Increasing multimorbidity exhibits a strong and increasing association with VTE. Familial associations suggest a weak shared familial susceptibility. The association between multimorbidity and VTE suggests that future cohort studies where multimorbidity is used to predict VTE might be worthwhile.
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| 3. |
- Andersson, Kajsa, et al.
(författare)
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Factors associated with development of retinopathy in patients with type 2 diabetes mellitus at onset and within three years after diagnosis
- 2024
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Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the prevalence of diabetes retinopathy and evaluate the factors influencing its occurrence both at the onset of type 2 diabetes (T2D) and three years into its duration. Design: Retrospective population-based study. Setting: Data was retrieved from Regional Healthcare Information Platform in Region Halland 2016–2020. Subjects: Patients 35-75 years old in Region Halland receiving first-time diabetes diagnosis according to ICD-code E11-14 in 2016–17. The total cohort consisted of 1659 patients. Main outcome measures: The main outcome measure of the study was the occurrence of diabetes retinopathy at onset and within three years from the diabetes diagnosis. Multivariate logistic regression analysis was conducted for diabetes retinopathy at onset and within three years, adjusted for age, gender, comorbidities, levels of HbA1c, cholesterol, kidney functional and blood pressure. Results: At onset, there were 12% with diabetes retinopathy and after three years, 32% of the patients had developed diabetes retinopathy. In the study cohort, 71 of patients who were examined with fundus photography within three years after onset, and 8% had had dietary recommendation without pharmacotherapy. High HbA1c levels, blood pressure values and impaired renal function already at onset were associated with development of diabetes retinopathy at onset and this association persisted after three years. The odds ratio for diabetes retinopathy was increased adjusted for HbA1c elevations, renal impairment, and increased blood pressure at index and when adjusted for these variables three years from index. Conclusion: These findings indicate that the risk of developing diabetes retinopathy is present early on at onset and within the first three years of diabetes diagnosis. This highlights the importance of promptly regulating glucose- and blood-pressure levels and follow up kidney dysfunction to mitigate the risk of diabetes retinopathy.
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| 4. |
- Aronsson, Mora, et al.
(författare)
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Sveriges arter och naturtyper i EU:s art- och habitatdirektiv : Resultat från rapportering 2019 till EU av bevarandestatus 2013-2018
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Sverige har en variationsrik natur med storslagen fjällmiljö, myllrande våtmarker, vattendrag och sjöar, kust och hav, skogar och odlingslandskap, alla med ett rikt växt och djurliv. Den här fantastiska biologiska mångfalden tas ofta för given och ibland som en lyx, men oavsett vilket är det en förutsättning för vår överlevnad.2019 rapporterade Sverige statusen till EU för perioden 2013–2018 för de naturtyper och arter i Sverige som är listade i art- och habitatdirektivet. Den berättar att 20 procent av naturtyperna och 40 procent av arterna mår bra. Den biologiska mångfalden är hårt trängd i såväl Sverige som i andra EU-länder.Den här rapporten sammanfattar Sveriges rapportering och innehåller beskrivningar av status för naturtyper och arter, påverkan, hot och trender. Rapporten ger kunskap om tillståndet för den biologiska mångfalden i Sverige med hjälp av de arter och naturtyper som är listade i EU:s art- och habitatdirektiv.Rapporten visar hur naturmiljöerna i Sverige förändas, och sammanfattar den senaste kunskapen om vilka faktorer som driver dessa förändringar. Även exempel på hur vi genom restaurerings- och skötselåtgärder kan hejda förlusten av biologisk mångfald tas upp.
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| 5. |
- Backåberg, Sofia, 1979-, et al.
(författare)
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Evaluation of the Skeleton Avatar Technique for Assessment of Mobility and Balance Among Older Adults
- 2020
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Ingår i: Frontiers of Computer Science. - : Frontiers Media S.A.. - 2095-2228 .- 2095-2236 .- 2624-9898. ; 2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mobility and balance is essential for older adults’ well-being an independence and the ability tomaintain physically active. Early identification of functionalimpairmentmay enable early risk-of-fall assessments and preventivemeasures. There is a need to find new solutions to assess functional ability in easy, efficient, and accurateways, which can be clinically used frequently and repetitively. Therefore, we need to understand how functional tests and expert assessments (EAs) correlate with new techniques.Objective: To explore whether the skeleton avatar technique (SAT) can predict the results of functional tests (FTs) of mobility and balance: Timed Up and Go (TUG), the 30-s chair stand test (30sCST), the 4-stage balance test (4SBT), and EA scoring of movement quality.Methods: Fifty-four older adults (+65 years) were recruited through pensioners’ associations. The test procedure contained three standardized FTs: TUG, 30sCST, and 4SBT. The test performances were recorded using a three-dimensional SAT camera. EA scoring was performed based on the video recordings of the 30sCST. Functional ability scores were aggregated from balance and mobility scores. Probability theory-based statistical analyses were used on the data to aggregate sets of individual variables into scores, with correlation analysis used to assess the dependency between variables and between scores. Machine learning techniques were used to assess the appropriateness of easily observable variables/scores as predictors of the other variables included.Results: The results indicate that SAT data of the fourth 4SBT stage could be used to predict the aggregated results of all stages of 4SBT (with 7.82% mean absolute error), the results of the 30sCST (11.0%), the TUG test (8.03%), and the EA of the sit-to-stand movement (8.79%). There is a moderate (significant) correlation between the 30sCST and the 4SBT (0.31, p = 0.03), but not between the EA and the 30sCST.Conclusion: SAT can predict the results of the 4SBT, the 30sCST (moderate accuracy), and the TUG test and might add important qualitative information to the assessment of movement performance in active older adults. SAT might in the future provide the means for a simple, easy, and accessible assessment of functional ability among older adults.
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| 6. |
- Davidge, Jason, et al.
(författare)
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Clinical characteristics at hospital discharge that predict cardiovascular readmission within 100 days in heart failure patients – An observational study
- 2023
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Ingår i: International Journal of Cardiology Cardiovascular Risk and Prevention. - Philadelphia, PA : Elsevier. - 2772-4875. ; 16
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Tidskriftsartikel (refereegranskat)abstract
- Background: After a heart failure (HF) hospital discharge, the risk of a cardiovascular (CV) related event is highest in the following 100 days. It is important to identify factors associated with increased risk of readmission. Method: This retrospective, population-based study examined HF patients in Region Halland (RH), Sweden, hospitalized with a HF diagnosis between 2017 and 2019. Data regarding patient clinical characteristics were retrieved from the Regional healthcare Information Platform from admission until 100 days post-discharge. Primary outcome was readmission due to a CV related event within 100 days. Results: There were 5029 included patients being admitted for HF and discharged and 1966 (39%) were newly diagnosed. Echocardiography was available for 3034 (60%) patients and 1644 (33%) had their first echocardiography while admitted. The distribution of HF-phenotypes was 33% HF with reduced ejection fraction (EF), 29% HF with mildly reduced EF and 38% HF with preserved EF. Within 100 days, 1586 (33%) patients were readmitted, and 614 (12%) died. A Cox regression model showed that advanced age, longer hospital length of stay, renal impairment, high heart rate and elevated NT-proBNP were associated with an increased risk of readmission regardless of HF-phenotype. Women and increased blood pressure are associated with a reduced risk of readmission. Conclusions: One third had a CV-readmission within 100 days. This study found clinical factors already present at discharge that are associated with increased risk of readmission which should be considered at discharge. © 2023 The Authors
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| 7. |
- Garpenhag, Lars, et al.
(författare)
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The role of primary care in the cancer care continuum : a qualitative study of cancer survivors’ experiences
- 2023
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Ingår i: Scandinavian Journal of Primary Health Care. - : Informa UK Limited. - 0281-3432 .- 1502-7724. ; 41:1, s. 13-22
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore how cancer survivors have experienced their contacts with primary care after being diagnosed with cancer, focusing on the integration between cancer specialist and primary care, and participants’ views on what could make primary care services better at catering to the needs of cancer survivors. Design: A qualitative study in which data was collected through semi-structured digital focus group interviews and analyzed using a template analysis approach. Setting and subjects: Adult residents of Skåne, Sweden, who had been diagnosed with and initiated treatment for either of five common cancer forms, recruited through patient advocacy groups. Main outcome measures: A qualitative description of participants’ experiences and perceptions as expressed in focus group interview data. Results: Most participants felt that primary care services had not played a significant role for them, despite patterns of both increased and unmet health needs. Insufficient coordination and communication with specialist cancer care, low availability, lacking personal continuity, low cancer competence and lacking commitment to cancer-related needs were presented as barriers to satisfactory primary care. A strengthened bond between cancer and primary care services, privileged access, and holistic perspectives were all suggested as measures to make primary care more suitable to cancer survivors’ needs. Conclusion: The study suggests that cancer survivors experience a range of issues that hinders primary care services from playing a productive role in the cancer care process. The results speak for a need for interventions to remove barriers to satisfactory primary care contacts in this group of patients.KEY POINTS The growing number of cancer survivors highlights the role of primary care services in the cancer care continuum. Despite the presence of unmet needs, few cancer survivors felt that primary care services had been significant to their care. Survivors identified a number of barriers to satisfactory primary care, including lacking coordination and communication between cancer and primary care. Strengthened links between healthcare services, privileged access, and holistic perspectives were suggested to improve primary care delivery for cancer survivors.
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| 8. |
- Reuter, Marek, et al.
(författare)
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Sustainability, COVID-19 and staying focused on the longer term: A pandemic that strikes unequally and can prevent sustainability investments
- 2020
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Ingår i: Sweden through the crisis. - Stockholm : Stockholm School of Economics Institute for Research. - 9789186797386 ; , s. 289-301
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Bokkapitel (övrigt vetenskapligt/konstnärligt)abstract
- The 2020 COVID-19 pandemic and social and economic responses are amplifying social inequalities and hampering strategic, long-term investments into sustainability by firms and governments. Researchers affiliated with Misum (Mistra Center for Sustainable Markets) discuss how the global response to the pandemic has slowed progress toward the Sustainable Development Goals adopted by the United Nations in 2015. The article emphasizes that low-income groups are most affected by the economic consequences of the coronavirus crisis, that the pandemic is reducing the ability and willingness of firms to make strategic investments, and that companies and governments need to deploy resources that ensure a sustainable recovery from the crisis.
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| 9. |
- Samskog, Viktor, et al.
(författare)
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Heart failure patients without echocardiography are more commonly diagnosed in hospital care and are associated with higher mortality compared to primary care
- 2023
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Ingår i: Scandinavian Journal of Primary Health Care. - 0281-3432.
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This Swedish study aimed to assess the prevalence, associated clinical factors, and mortality rates of heart failure patients diagnosed without echocardiograms in both hospital and primary care settings. Design: We conducted a retrospective population-based study using data from the Region Halland healthcare database in Sweden covering 330,000 residents. Subjects: From 2013–2019, 3,903 patients received an incidental heart failure diagnosis without an echocardiogram and they were followed for one year. Main outcome measures: Using logistic and Cox regression analyses, we evaluated the prevalence, clinical characteristics, and all-cause mortality at intervals of 30, 100, and 365 days post-diagnosis. Results: In this Swedish cohort, the one-year all-cause mortality rate was markedly higher for patients diagnosed in hospitals (42%) compared to those in primary care (20%, p < 0.001). Patients diagnosed in primary care were older and had fewer comorbidities and lower NT-proBNP levels. Hospital-diagnosed patients faced a significantly higher mortality rate in the initial 30 days but saw similar rates to primary care patients thereafter. Conclusion: In a Swedish region, heart failure diagnoses without echocardiograms were more common in hospitals, and these patients initially faced worse prognoses. After the first month, however, the prognosis of hospital-diagnosed patients mirrored that of those diagnosed in primary care. These findings emphasize the need for improved diagnostic and treatment approaches in both care settings to enhance outcomes.
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| 10. |
- Scholten, Mia, et al.
(författare)
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Associations of heart failure to prevalence of haematologic- and solid malignancies in southern Sweden : A cross-sectional study
- 2023
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Ingår i: PLoS ONE. - 1932-6203. ; 18:10 October
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Tidskriftsartikel (refereegranskat)abstract
- Heart failure (HF) and cancer are common diseases among the elderly population. Many chronic diseases, including diabetes mellitus (DM), share risk factors and increase the incidence of HF and cancer. The aim of this study was to investigate if there was an association between HF and the prevalence of haematologic- and solid malignancies. Methods The study population was comprised of almost one million adults living in southern Sweden in 2015. All participants were divided into seven age groups from 20 and onwards, and 10 percentiles according to their socioeconomic status (SES). All data concerning diagnoses from each consultation in both primary- and secondary health care were collected during 18 months. The prevalence of haematologic and solid malignancies was measured separately for men and women, age groups, SES and multimorbidity levels. Multivariable logistic regression was used to determine the associations between HF and the probability of having haematologic- and solid malignancies in more complex models including stratifying variables. Results People with HF had a higher prevalence of haematologic- and solid malignancies than the general population, but a lower prevalence of solid malignancies than the multimorbid population. The people with HF had an increased OR for haematologic malignancies, 1.69 (95% CI 1.51–1.90), and solid malignancies, OR 1.21 (95% CI 1.16–1.26), when adjusted for gender and age. In more complex multivariate models, multimorbidity explained the increased OR for haematologic- and solid malignancies in people with HF. Increasing socioeconomic deprivation was associated with a decreased risk for solid malignancies, with the lowest risk in the most socioeconomically deprived CNI-percentile. Conclusions HF was shown to be associated with malignancies, especially haematologic malignancies. Multimorbidity, however, was an even more important factor for both haematologic- and solid malignancies than HF in our study, but not socioeconomic deprivation. Further research on the interactions between the chronic conditions in people with HF is warranted to examine the strength of association between HF and malignancies.
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