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  • Barywani, Salim B., 1968, et al. (författare)
  • Predictors of long-term outcome of percutaneous coronary intervention in octogenarians with acute coronary syndrome
  • 2014
  • Ingår i: IJC Heart and Vessels. - 2214-7632. ; 4:1, s. 138-144
  • Tidskriftsartikel (refereegranskat)abstract
    • The majority of patients with acute coronary syndrome (ACS) are elderly. Limited evidence makes decision-making on the use of percutaneous coronary intervention (PCI) mainly empirical. Old age is one risk factor, but other factors than age may have an impact on mortality as well. Therefore, we investigated predictors of long-term all-cause mortality among octogenarians who have undergone PCI due to ACS. A total of 182 patients ≥. 80 years who underwent PCI during 2006-2007 at Sahlgrenska University Hospital were studied consecutively from recorded clinical data. All-cause five-year mortality of follow-up was 46.2%. Mean age was 83.7. ±. 2.8, 62% were male, 76% were in sinus rhythm, and 42% had left ventricular ejection fraction. < 45%. Indications for PCI were STEMI (52%), NSTEMI (36%) and unstable angina (11%). Multivariate analysis in two steps identified atrial fibrillation, moderate tricuspid valve regurgitation, moderate mitral valve regurgitation, dependency in ADL and eGFR. ≤. 30. ml/min at the first step and moderate mitral valve regurgitation, atrial fibrillation and eGFR. ≤. 30 ml/min at the last step, as independent predictors of all-cause mortality. Kaplan Meier analysis of positive parameters from both steps of multivariate analysis showed high significant difference in survival between patients having these parameters and those who were free from these parameters, with worst prognosis in patients with accumulation of these parameters. Accordingly, we have, in an octogenarian patient cohort who suffered from ACS, undergone PCI in daily clinical practice, identified five prognostic predictors for all-cause death after five years' follow-up.
  • Barywani, Salim B., 1968, et al. (författare)
  • Prognostic impact of heart rate in elderly with systolic heart failure and concomitant atrial fibrillation
  • 2017
  • Ingår i: Scandinavian Cardiovascular Journal. - 1401-7431. ; 51:4, s. 190-196
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The present study aimed to investigate the impact of resting heart rate (HR) on 5-year all-cause mortality in patients 80 years with heart failure (HF) with reduced ejection fraction (HFrEF) and concomitant atrial fibrillation (AF) after optimal up-titration of beta-blockers (BBs).Methods: Patients (n=185) aged 80 years with HF and left ventricular ejection fraction 40% were included between January 2000 and January 2008 from two university hospitals, Sahlgrenska and ostra and retrospectively studied from January 2 to May 30, 2013. Up-titrations of guideline recommended medications were performed at HF outpatient clinics.Results: Of whole study population, 54% (n=100) had AF. After optimal up-titration of BBs and angiotensin converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), mean HR in patients with AF was 7315 beats/minute (bpm), 36% had resting HR65 bpm. Five-year all-cause mortality among patients with AF was significantly lower in patients with HR65 bpm (63%) compared to HR>65 (80%). Cox proportional-hazard regression analysis adjusted for clinically important baseline variables and doses of ACEIs/ARBs and BBs demonstrated resting HR65 bpm as an independent predictor of improved survival compared to resting HR>65 bpm (HR 0.3, 95%CI 0.1-0.7, P 0.005).Discussion: In octogenarians with HFrEF and concomitant AF, lowering resting HR to levels as low as HR65 bpm was still associated with improved survival from all-cause mortality. Our data indicate that mortality in AF became comparable to SR when patients were on maximally up-titrated beta-blocker doses with HR as low as 75 bpm.
  • Basso, C., et al. (författare)
  • Improved dengue fever prevention through innovative intervention methods in the city of Salto, Uruguay
  • 2015
  • Ingår i: Transactions of the Royal Society of Tropical Medicine and Hygiene. - 0035-9203. ; 109:2, s. 134-142
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Uruguay is located at the southern border of Aedes aegypti distribution on the South American sub-continent. The reported dengue cases in the country are all imported from surrounding countries. One of the cities at higher risk of local dengue transmission is Salto, a border city with heavy traffic from dengue endemic areas. Methods: We completed an intervention study using a cluster randomized trial design in 20 randomly selected 'clusters' in Salto. The clusters were located in neighborhoods of differing geography and economic, cultural and social aspects. Results: Entomological surveys were carried out to measure the impact of the intervention on vector densities. Through participatory processes of all stakeholders, an appropriate ecosystem management intervention was defined. Residents collected the abundant small water holding containers and the Ministry of Public Health and the Municipality of Salto were responsible for collecting and eliminating them. Additional vector breeding places were large water tanks; they were either altered so that they could not hold water any more or covered so that oviposition by mosquitoes could not take place. Conclusions: The response from the community and national programme managers was encouraging. The intervention evidenced opportunities for cost savings and reducing dengue vector densities (although not to statistically significant levels). The observed low vector density limits the potential reduction due to the intervention. A larger sample size is needed to obtain a statistically significant difference.
  • Basso, C., et al. (författare)
  • Scaling up of an innovative intervention to reduce risk of dengue, chikungunya, and Zika transmission in Uruguay in the framework of an intersectoral approach with and without community participation
  • 2017
  • Ingår i: American Journal of Tropical Medicine and Hygiene. - 0002-9637. ; 97:5, s. 1428-1436
  • Tidskriftsartikel (refereegranskat)abstract
    • To contribute to the prevention of dengue, chikungunya, and Zika, a process of scaling up an innovative intervention to reduce Aedes aegypti habitats, was carried out in the city of Salto (Uruguay) based on a transdisciplinary analysis of the eco-bio-social determinants. The intervention in one-third of the city included the distributions of plastic bags for all households to collect all discarded water containers that were recollected by the Ministry of Health and the Municipality vector control services. The results were evaluated in 20 randomly assigned clusters of 100 households each, in the intervention and control arm. The intervention resulted in a significantly larger decrease in the number of pupae per person index (as a proxy for adult vector abundance) than the corresponding decrease in the control areas (both areas decreased by winter effects). The reduction of intervention costs (“incremental costs”) in relation to routine vector control activities was 46%. Community participation increased the collaboration with the intervention program considerably (from 48% of bags handed back out of the total of bags delivered to 59% of bags handed back). Although the costs increased by 26% compared with intervention without community participation, the acceptability of actions by residents increased from 66% to 78%.
  • Beer, Netta, et al. (författare)
  • High effective coverage of vector control interventions in children after achieving low malaria transmission in Zanzibar, Tanzania.
  • 2013
  • Ingår i: Malaria journal. - 1475-2875. ; 12
  • Tidskriftsartikel (refereegranskat)abstract
    • ABSTRACT: Background: Formerly a high malaria transmission area, Zanzibar is now targeting malaria elimination. A major challenge is to avoid resurgence of malaria, the success of which includes maintaining high effective coverage of vector control interventions such as bed nets and indoor residual spraying (IRS). In this study, caretakers' continued use of preventive measures for their children is evaluated, following a sharp reduction in malaria transmission. Methods: A cross-sectional community-based survey was conducted in June 2009 in North A and Micheweni districts in Zanzibar. Households were randomly selected using two-stage cluster sampling. Interviews were conducted with 560 caretakers of under-five-year old children, who were asked about perceptions on the malaria situation, vector control, household assets, and intention for continued use of vector control as malaria burden further decreases. Results: Effective coverage of vector control interventions for under-five children remains high, although most caretakers (65%; 363/560) did not perceive malaria as presently being a major health issue. Seventy percent (447/643) of the under-five children slept under a long-lasting insecticidal net (LLIN) and 94% (607/643) were living in houses targeted with IRS. In total, 98% (628/643) of the children were covered by at least one of the vector control interventions. Seasonal bed-net use for children was reported by 25% (125/508) of caretakers of children who used bed nets. A high proportion of caretakers (95%; 500/524) stated that they intended to continue using preventive measures for their under-five children as malaria burden further reduces. Malaria risk perceptions and different perceptions of vector control were not found to be significantly associated with LLIN effective coverage. Conclusions: While the majority of caretakers felt that malaria had been reduced in Zanzibar, effective coverage of vector control interventions remained high. Caretakers appreciated the interventions and recognized the value of sustaining their use. Thus, sustaining high effective coverage of vector control interventions, which is crucial for reaching malaria elimination in Zanzibar, can be achieved by maintaining effective delivery of these interventions.
  • Berg, Johanna, et al. (författare)
  • Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries
  • 2022
  • Ingår i: Bmj Open. - : BMJ Publishing Group. - 2044-6055. ; 12:6
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective To compare experts' perceived usefulness of audit filters from Ghana, Cameroon, WHO and those locally developed; generate context-appropriate audit filters for trauma care in selected hospitals in urban India; and explore characteristics of audit filters that correlate to perceived usefulness. Design A mixed-methods approach using a multicentre online Delphi technique. Setting Two large tertiary hospitals in urban India. Methods Filters were rated on a scale from 1 to 10 in terms of perceived usefulness, with the option to add new filters and comments. The filters were categorised into three groups depending on their origin: low and middle-income countries (LMIC), WHO and New (locally developed), and their scores compared. Significance was determined using Kruskal-Wallis test followed by Wilcoxon rank-sum test. We performed a content analysis of the comments. Results 26 predefined and 15 new filter suggestions were evaluated. The filters had high usefulness scores (mean overall score 9.01 of 10), with the LMIC filters having significantly higher scores compared with those from WHO and those newly added. Three themes were identified in the content analysis relating to medical relevance, feasibility and specificity. Conclusions Audit filters from other LMICs were deemed highly useful in the urban India context. This may indicate that the transferability of defined trauma audit filters between similar contexts is high and that these can provide a starting point when implemented as part of trauma quality improvement programmes in low-resource settings.
  • Bergh, Niklas, 1979, et al. (författare)
  • Efficacy and safety of clopidogrel versus ticagrelor as part of dual antiplatelet therapy in acute coronary syndrome - a systematic review and meta-analysis.
  • 2022
  • Ingår i: Journal of cardiovascular pharmacology. - 1533-4023. ; 79:5, s. 620-631
  • Tidskriftsartikel (refereegranskat)abstract
    • The efficacy and safety of clopidogrel compared with ticagrelor as part of dual antiplatelet therapy (DAPT) in patients with acute coronary syndrome is reviewed. PubMed, Embase, the Cochrane Library, Medline, and HTA databases were searched (Sep 2nd 2020) for randomised controlled trials (RCTs). ACS patients subjected to clopidogrel or ticagrelor as part of DAPT were included. Pooled risk-differences were estimated using random-effects meta-analyses, and certainty of evidence was assessed according to GRADE. In ACS patients subjected to DAPT, the pooled risk difference for all-cause mortality was 0·6% (-0·03% to 1·3%; I2: 18%); cardiovascular mortality: 0·6% (0·01% to 1·1%; I2: 22%); MI: 0·9% (0·4% to 1·3%; I2: 5%); stent thrombosis: 0·7% (0·4 to 1·1%; I2: 0%); clinically significant bleeding: -1·9% (-3·7% to -0·2%; I2: 69%); major bleeding: -0·9% (-1·6% to -0·1%; I2: 32%); and dyspnea: -5·8% (-7·7% to -3·8%; I2: 63%). In the subgroup of older patients there were no differences between the comparison groups regarding all-cause mortality, CV mortality and MI, whereas the risk of clinically significant bleeding and major bleeding was lower in the clopidogrel group, -5·9% (-11 to -0·9%, 1 RCT) and -2·4% (-4·4% to -0·3%, I2: 0%), respectively. Compared with ticagrelor, clopidogrel may result in little or no difference regarding all-cause mortality. In older patients, clopidogrel may be slightly less efficient in reducing the risk of cardiovascular mortality and MI. Clopidogrel results in a reduced risk of bleedings and dyspnea.
  • Bergman, Eva, et al. (författare)
  • Self-administered measuremuent of symphysis-funds heights
  • 2007
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - 0001-6349 .- 1600-0412. ; 86:6, s. 671 - 677
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. Antenatal identification of infants small for gestational age (SGA) improves their perinatal outcome. Repeated measurement of symphysis-fundus (SF) heights performed by midwives is the most widespread screening method for detection of SGA. However, the inefficiency of this method necessitates improved practices. Earlier start and more frequent SF measurements, which could be accomplished by self-administered measurements, might improve the ability to detect deviant growth. The present study was set up to evaluate whether pregnant women can reliably perform SF measurements by themselves. Method. Forty healthy women with singleton and ultrasound-dated pregnancies from 2 antenatal clinics in Uppsala, Sweden, were asked to perform 4 consecutive SF measurements once every week, from 20 to 25 weeks of gestation until delivery. The self-administered SF measurements were recorded and systematically compared with midwives' SF measurements. Results. Thirty-three pregnant women performed self-administered SF measurements over a 14-week period (range: 1-21). The SF curves constructed from self-administered SF measurements had the same shape as previously constructed population-based reference curves. The variance for self-administered SF measurements was higher than that of the midwives. Conclusions. Pregnant women are capable of measuring SF heights by themselves, but with higher individual variance than midwives. Repeated measurements at each occasion can compensate for the higher variance. The main advantage of self-administered SF measurements is the opportunity to follow fetal growth earlier and more frequently.
  • Bergman, Eva, 1959-, et al. (författare)
  • Self-administered symphysis-fundus measurements analyzed with a novel statistical method for detection of intrauterine growth restriction: A clinical evaluation
  • 2011
  • Ingår i: Acta Obstetricia et Gynecologica Scandinavica. - 0001-6349 .- 1600-0412. ; 90:8, s. 890-896
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. To assess the ability of self-administered symphysis-fundus measurements used with the Shiryaev-Roberts statistical method (SR method) to identify growth-restricted (IUGR) fetuses and compare it with the traditional SF method (symphysis-fundus measurements used with a population-based reference curve). Design. Longitudinal study. Setting. Pregnant women attending primary antenatal care centres. Population. From a population of 1 888 women with singleton ultrasound-dated pregnancies, we analyzed data from 1 122 women. Methods. Weekly self-administered SF measurements from gestational week 25 until delivery were analyzed according to the SR method. Neonatal morbidity and small for gestational age (SGA) were used as proxies for IUGR. Small for gestational age was defined as a birthweight less than two standard deviations (SD) and <10th percentile. We assessed the sensitivity of the SR and the SF methods to detect neonatal morbidity and SGA. Main Outcome Measures. Birth-related mortality, respiratory distress, hypoglycemia, Apgar score ≤6 at five minutes, pH a;circ7.00 in the umbilical artery, neonatal care, preterm delivery, operative delivery for fetal distress and SGA. Results. For the SR method, the sensitivity for neonatal morbidity was between 6.0 and 36.4%, for SGA <2SD 36.8%, and for SGA <10th percentile 20.9%. The SF method had a sensitivity between 6.0 and 13.8% for neonatal morbidity, 52.3% for SGA <2SD and 28.6% for SGA <10th percentile. Conclusions. The SR and the SF methods had low sensitivities for neonatal morbidity. © 2011 Nordic Federation of Societies of Obstetrics and Gynecology.
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