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- Jansson, Jan-Håkan, et al.
(författare)
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Snus (Swedish smokeless tobacco) use and risk of stroke: pooled analyses of incidence and survival
- 2014
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Ingår i: Journal of Internal Medicine. - : Wiley. - 1365-2796 .- 0954-6820. ; 276:1, s. 87-95
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Tidskriftsartikel (refereegranskat)abstract
- Background. Snus is a moist smokeless tobacco product with high nicotine content. Its use has a short-term effect on the cardiovascular system, but the relationship between snus use and stroke is unclear. Objective. The aim of this study was to assess the associations between use of snus and incidence of and survival after stroke, both overall and according to subtypes. Methods. Pooled analyses of eight Swedish prospective cohort studies were conducted, including 130 485 men who never smoked. We estimated hazard ratios (HRs) with 95% confidence intervals (CIs) of incidence and death after diagnosis using Cox proportional hazard regression models and case fatality and survival using logistic regression and Kaplan-Meier methods, respectively. Results. No associations were observed between the use of snus and the risk of overall stroke (HR 1.04, 95% CI 0.92-1.17) or of any of the stroke subtypes. The odds ratio (OR) of 28-day case fatality was 1.42 (95% CI 0.99-2.04) amongst users of snus who had experienced a stroke, and the HR of death during the follow-up period was 1.32 (95% CI 1.08-1.61). Conclusion. Use of snus was not associated with the risk of stroke. Hence, nicotine is unlikely to contribute importantly to the pathophysiology of stroke. However, case fatality was increased in snus users, compared with nonusers, but further studies are needed to determine any possible causal mechanisms.
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- Wengström, Yvonne, 1959-, et al.
(författare)
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Developing patient reported outcome measures (PROM) for implementation in the Swedish National Breast Cancer Quality Register
- 2013
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Ingår i: European Journal of Cancer. - 0959-8049 .- 1879-0852. ; 49, s. S329-S329
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Tidskriftsartikel (refereegranskat)abstract
- Background: The local authorities for health and welfare support the introduction of Patient Reported Outcome Measures (PROM) in the quality registers in Sweden. Valid and reliable instruments measuring PROM do not exist that could be used throughout the whole breast cancer process. We sought to develop and implement PROM for breast cancer at different stages in the disease course in different Swedish geographic regions for later use in the Swedish National Quality Register for breast cancer. The aim was to develop appropriate PROM to assess symptoms and problems among patients with breast cancer about one year after diagnosis.Materials and Methods: A scoping review and focus group discussions were conducted with women invited by the breast cancer association Amazona (Stockholm). The symptoms that emerged from the scoping review and focus group discussions formed the basis for the development of a web based questionnaire consisting of validated instruments (EORTC QLQ-C30, BR 23, MSAS) for measuring PROM. The women who participated in the focus group discussions were invited to respond to a pilot version of the web based questionnaire. The results were used to revise the web based questionnaire. An invitation was sent to a national random sample from the Swedish National Breast Cancer Quality Register diagnosed one year earlier to respond to the revised version of the web based questionnaire.Results: The results will present the work process of the development of the PROM as well as plans for further work on the implementation of the PROM in the Swedish National Quality Register for breast cancer. Preliminary data shows that about 70% responded to the revised version of the web based questionnaire. However, some women requested a paper version of the questionnaire mostly because they did not have access to a computer.Conclusion: In the development of PROM in quality registers it is important to include patients experiences in order to develop relevant outcome measures to influence the quality of the health care delivery.
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