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| 2. |
- Kennerfalk, A, et al.
(författare)
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Geriatric drug therapy and healthcare utilization in the United Kingdom
- 2002
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Ingår i: The Annals of Pharmacotherapy. - 1060-0280 .- 1542-6270. ; 36:5, s. 797-803
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE To describe the use of prescription drug therapy, especially polypharmacy, in an elderly general population; to relate that use to age, gender, and different types of healthcare utilization; and to investigate the influence of selection of different time windows on the result of the quantity as well as the categories of drugs used. METHODS Data on a sample of 5000 patients aged 65-90 years in 1996 were derived from the General Practice Research Database (GPRD). The population covered by GPRD is broadly representative of the UK population treated in general practice. Drug use was assessed using 2 time windows - current use of individual drugs on a random day (index date) and 1 month following the index date. Healthcare utilization was analyzed by use of information on visits to general practitioners (GPs), hospitalizations, and referrals to specialists. RESULTS Women used more drugs than men; however, the prevalence of polypharmacy, defined as concomitant use of > or =5 drugs, was similar in both genders. The most frequently used therapeutic groups were cardiovascular, central nervous, and gastrointestinal system drugs. Almost 80% of both women and men visited a GP at least once a year. Overall, women used more ambulatory care services and men were hospitalized more often. Use of random date compared with 1-month period resulted in a significant underestimation of the amount of drugs used for acute conditions and, consequently, the risk of polypharmacy. CONCLUSIONS The overall results confirm the findings in earlier studies suggesting that the GPRD might be a useful tool in further studies on prescription drug use among elderly persons. More information on the appropriateness of drug use is needed to prevent overuse as well as underuse of medications among the elderly.
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| 3. |
- Shaheen, H. I., et al.
(författare)
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Phenotypic profiles of enterotoxigenic Escherichia coli associated with early childhood diarrhea in rural Egypt
- 2004
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Ingår i: J Clin Microbiol. ; 42:12, s. 5588-95
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Tidskriftsartikel (refereegranskat)abstract
- Enterotoxigenic Escherichia coli (ETEC) causes substantial diarrheal morbidity and mortality in young children in countries with limited resources. We determined the phenotypic profiles of 915 ETEC diarrheal isolates derived from Egyptian children under 3 years of age who participated in a 3-year population-based study. For each strain, we ascertained enterotoxin and colonization factor (CF) expression, the O:H serotype, and antimicrobial susceptibility. Sixty-one percent of the strains expressed heat-stable enterotoxin (ST) only, 26% expressed heat-labile enterotoxin (LT) alone, and 12% expressed both toxins. The most common CF phenotypes were colonization factor antigen I (CFA/I) (10%), coli surface antigen 6 (CS6) (9%), CS14 (6%), and CS1 plus CS3 (4%). Fifty-nine percent of the strains did not express any of the 12 CFs included in our test panel. Resistance of ETEC strains to ampicillin (63%), trimethoprim-sulfamethoxazole (52%), and tetracycline (43%) was common, while resistance to quinolone antibiotics was rarely detected. As for the distribution of observed serotypes, there was an unusually wide diversity of O antigens and H types represented among the 915 ETEC strains. The most commonly recognized composite ETEC phenotypes were ST CS14 O78:H18 (4%), ST (or LTST) CFA/I O128:H12 (3%), ST CS1+CS3 O6:H16 (2%), and ST CFA/I O153:H45 (1.5%). Temporal plots of diarrheal episodes associated with ETEC strains bearing common composite phenotypes were consistent with discrete community outbreaks either within a single or over successive warm seasons. These data suggest that a proportion of the disease that is endemic to young children in rural Egypt represents the confluence of small epidemics by clonally related ETEC strains that are transiently introduced or that persist in a community reservoir.
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| 4. |
- Anderberg, Arne A., et al.
(författare)
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Phylogenetic relationships in the order Ericales s.l. : analyses of molecular data from five genes from the plastid and mitochondrial genomes
- 2002
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Ingår i: American Journal of Botany. - : Wiley. - 0002-9122 .- 1537-2197. ; 89:4, s. 677-687
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Tidskriftsartikel (refereegranskat)abstract
- Phylogenetic interrelationships in the enlarged order Ericales were investigated by jackknife analysis of a combination of DNA sequences from the plastid genes rbcL, ndhF, atpB, and the mitochondrial genes atp1 and matR. Several well‐supported groups were identified, but neither a combination of all gene sequences nor any one alone fully resolved the relationships between all major clades in Ericales. All investigated families except Theaceae were found to be monophyletic. Four families, Marcgraviaceae, Balsaminaceae, Pellicieraceae, and Tetrameristaceae form a monophyletic group that is the sister of the remaining families. On the next higher level, Fouquieriaceae and Polemoniaceae form a clade that is sister to the majority of families that form a group with eight supported clades between which the interrelationships are unresolved: Theaceae‐Ternstroemioideae with Ficalhoa, Sladenia, and Pentaphylacaceae; Theaceae‐Theoideae; Ebenaceae and Lissocarpaceae; Symplocaceae; Maesaceae, Theophrastaceae, Primulaceae, and Myrsinaceae; Styracaceae and Diapensiaceae; Lecythidaceae and Sapotaceae; Actinidiaceae, Roridulaceae, Sarraceniaceae, Clethraceae, Cyrillaceae, and Ericaceae.
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| 6. |
- Fransson, Ann-Mari, et al.
(författare)
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Aluminum complexation suppresses citrate uptake by acid forest soil microorganisms
- 2004
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Ingår i: Soil Biology and Biochemistry. - : Elsevier. - 0038-0717 .- 1879-3428. ; 36:2, s. 353-357
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Tidskriftsartikel (refereegranskat)abstract
- Organo-mineral interactions have been hypothesized to play a major role in biogeochemical cycling and pedogenesis in some forest soils. These processes are likely to be controlled to some extent by their persistence in soil, however, the factors regulating their bioavailability remain poorly understood. Therefore, we investigated the microbial utilization of 14C-labeled citrate in glass bead filled bioreactors containing a biofilm developed from an inoculum from an acid forest soil. The removal of Al-citrate in the bioreactors was negligible compared to the rate of citrate removal in the absence of Al. There was no evidence that in the short-term the microbial community adapted to increase the utilization of Al-citrate. In bioreactors filled with a Picea abies forest soil (Haplic Arenosol) the rates of citrate utilization were always slightly higher than that of Al-citrate. We conclude that complexation of citrate by metals such as Al may have a significant effect on their role in soil biogeochemical cycles.
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| 7. |
- Garcia Rodriguez, LA, et al.
(författare)
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Detection of colorectal tumor and inflammatory bowel disease duringfollow-up of patients with initial diagnosis of irritable bowel syndrome.
- 2000
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Ingår i: Scandinavian Journal of Gastroenterology. - 0036-5521 .- 1502-7708. ; 35:3, s. 306-311
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND We wanted to estimate the incidence of irritable bowel syndrome (IBS) and functional dyspepsia (FD) in the general population, and the detection of colorectal tumor (CRT) and inflammatory bowel disease (IBD) after the diagnosis of IBS and FD. METHODS Patients aged 20-79 years newly diagnosed with IBS (N = 2956) or FD (N = 9900), together with a comparison cohort randomly sampled from the general source population, were followed-up during a mean time of 3 years. RESULTS We found an overall incidence of 10.3 per 1000 person-years for FD and 2.6 per 1000 person-years for IBS. There was a greater prevalence of depression, stress, fatigue, and pain disorders among IBS and FD patients than in the general population. During the 1st year after a diagnosis of IBS the cumulative risk of detecting CRT was close to 1% in IBS patients. After the 1st year the risk of CRT in IBS patients was close to that in the general population. We found a significantly increased risk of detecting IBD among patients initially diagnosed as having IBS (relative risk (RR), 16.3; 95% confidence interval (CI), 6.6-40.7), which was constant during all the follow-up period. No association was found between dyspepsia and CRT, or IBD. CONCLUSION IBS and FD shared some comorbidity features, yet demographics and incidence rates were different. Unlike the detection of colorectal tumor, the excess risk of IBD after an initial diagnosis of IBS was cumulatively increased during all the follow-up period. The continuously increased risk of IBD detection in IBS patients favors a true association between IBS and IBD.
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| 8. |
- Hollowell, J, et al.
(författare)
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The incidence of bleeding complications associated with warfarin treatmentin general practice in the United Kingdom
- 2003
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Ingår i: British Journal of General Practice. - 0960-1643 .- 1478-5242. ; 53:489, s. 312-314
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to estimate and explore the incidence of warfarin-related bleeding in a representative sample of patients in the United Kingdom. We identified 3958 patients aged 40 to 84 years, newly treated with warfarin and with no prior history of bleeding from the General Practice Research Database, and followed them for 12 months. The overall incidence of first-time, idiopathic bleeding was 15.2 per 100 patient-years of current warfarin exposure: the incidence of fatal/hospitalised and referred bleeding was 3.5 and 2.6 per 100 patient-years, respectively.
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| 9. |
- Johansson, Saga, et al.
(författare)
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Incidence of newly diagnosed heart failure in UK general practice
- 2001
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Ingår i: European Journal of Heart Failure. - 1388-9842 .- 1879-0844. ; 3:2, s. 225-231
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Tidskriftsartikel (refereegranskat)abstract
- AIM To estimate the incidence rate of heart failure in the general population and to assess risk factors associated with the occurrence of newly diagnosed heart failure. METHODS From the source population that was derived from the UK General Practice Research Database, we identified patients aged 40--84 years newly diagnosed with heart failure in 1996, and estimated incidence rates. We sent questionnaires to a random sample of heart failure patients (N=1200) and performed a nested case-control analysis to assess risk factors for heart failure. RESULTS The overall incidence rate for heart failure was 4.4 per 1000 person-years in men and 3.9 per 1000 person-years in women. The incidence increased steeply with age in both sexes. The relative risk of heart failure was 2.1 (95% C.I.: 1.7--2.6) among men compared with women less than 65 years old and 1.3 (95% C.I.: 1.2--1.4) above the age of 65. Slightly more than half of the cases were categorized in NYHA III--IV at the time of the first diagnosis. Within one month of initial diagnosis 62% of the men and 50% of the women were referred to specialists and/or hospitalized for heart failure. Smoking, hypertension, diabetes, obesity were independently associated with heart failure as well as history of distant dyspnoea. Coronary heart disease was the most common cause of heart failure with a greater relative prevalence in men than women. CONCLUSION Incident heart failure cases mainly comprised elderly men and women frequently burdened with several diseases in general practice. Women had a lower incidence of heart failure than men. However, traditional risk factors such as smoking, hypertension, obesity, diabetes and dyspnoea appeared to confer the same relative increase in heart failure risk among women and men.
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| 10. |
- Johansson, Saga, et al.
(författare)
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Is there any association between myocardial infarction, gastro-oesophagealreflux disease and acid-suppressing drugs?
- 2003
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Ingår i: Alimentary Pharmacology and Therapeutics. - : Wiley. - 0269-2813 .- 1365-2036. ; 18:10, s. 973-978
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND A link between gastro-oesophageal reflux disease and coronary heart disease has been suggested. AIM To estimate the incidence of myocardial infarction in patients with newly diagnosed gastro-oesophageal reflux disease in comparison with that in the general population. METHODS A population-based cohort study was performed in the UK. Patients aged 18-79 years with a first diagnosis of gastro-oesophageal reflux disease (n = 7084) were identified and a group of 10,000 patients free of gastro-oesophageal reflux disease were sampled. A nested case-control analysis was performed to assess the risk factors for myocardial infarction. RESULTS The incidence of myocardial infarction in the general population was 4.0 per 1,000 person-years [95% confidence interval (CI), 3.2-4.9] and 5.1 per 1,000 person-years (95% CI, 4.1-6.4) in patients with gastro-oesophageal reflux disease. The relative risk of myocardial infarction in patients with gastro-oesophageal reflux disease was 1.4 (95% CI, 1.0-1.9). The increased risk of myocardial infarction was limited to the immediate days after the diagnosis of gastro-oesophageal reflux disease. Previous chest pain was an important predictor of myocardial infarction in patients free of gastro-oesophageal reflux disease. No association was found between the use of acid-suppressing drugs and the risk of myocardial infarction. CONCLUSION Our results suggest that gastro-oesophageal reflux disease is not an independent predictor of myocardial infarction. Rather, the increased risk of myocardial infarction in patients with gastro-oesophageal reflux disease in the immediate days after diagnosis indicates that prodromal ischaemic symptoms were misinterpreted as reflux symptoms.
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