| 41. |
- Hellgren, Margareta, 1955, et al.
(författare)
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Feasibility of the FINDRISC questionnaire to identify individuals with impaired glucose tolerance in Swedish primary care. A cross-sectional population-based study.
- 2012
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Ingår i: Diabetic Medicine. - : Wiley. - 1464-5491 .- 0742-3071. ; 29:12
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To evaluate the performance of the FINDRISC questionnaire as a tool to recruit individuals with impaired glucose tolerance for lifestyle intervention programmes. Methods: A cross-sectional population-based study in primary Health Care Centres in a middle-sized Swedish town. All 9734 individuals, aged 35–75 years, living within a defined area, were invited by mail to fill in and return the FINDRISC questionnaire. Participants with a risk score ≥ 15 (n = 525) were invited to perform an oral glucose tolerance test while those with known diabetes were excluded. Results: In total, 5452 questionnaires (58%) were returned and revealed a mean risk-score of 8.5 ± 4.5 (mean ± SD). We found that 525 participants had a risk-score ≥ 15 and 302 (58%) were further examined with an oral glucose tolerance testing (OGTT). Among them we detected 11% with previously undiagnosed Type 2 diabetes, 16% with impaired glucose tolerance and 29% with impaired fasting glucose. A FINDRISC score ≥ 15 was associated with a positive predictive value of 55% for impaired glucose metabolism (impaired fasting glucose + impaired glucose tolerance + Type 2 diabetes) and of 16% for impaired glucose tolerance, respectively. The positive predictive value for impaired glucose tolerance did not increase to more than 17% when choosing the cut-point 17, while there was a significant increase in the positive predictive value for impaired glucose metabolism (70%). Conclusions: The FINDRISC questionnaire is a useful instrument for identification of individuals with impaired glucose metabolism but seems less effective for detection of individuals with impaired glucose tolerance. Strategies to find individuals with impaired glucose tolerance for implementation of lifestyle changes in primary care should therefore be developed further.
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| 42. |
- Hesse, Ulrik, et al.
(författare)
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Impact of Delisting ARBs, Apart from Losartan, on ARB Utilisation Patterns in Denmark: Implications for Other Countries.
- 2013
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Ingår i: Applied health economics and health policy. - : Springer Science and Business Media LLC. - 1179-1896 .- 1175-5652. ; 11:6, s. 677-85
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Tidskriftsartikel (refereegranskat)abstract
- Renin-angiotensin inhibitor drugs have been a target for health authority initiatives across Europe with the potential for substantial savings once generic angiotensin-converting enzyme inhibitors (ACEIs) became available without compromising care. Recently, losartan was the first angiotensin receptor blocker (ARB) to lose its patent. In Denmark, the authorities removed all other ARBs from the reimbursement list, apart from losartan, as they were all seen as essentially similar for the management of hypertension or congestive heart failure at appropriate doses, but more expensive. Similarly, all other ARB fixed-dose combinations (FDCs), apart from losartan, were removed from the reimbursement list.
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| 43. |
- Hohwu, L., et al.
(författare)
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Web-Based Versus Traditional Paper Questionnaires: A Mixed-Mode Survey With a Nordic Perspective
- 2013
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Ingår i: Journal of Medical Internet Research. - : JMIR Publications Inc.. - 1438-8871. ; 15:8
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Tidskriftsartikel (refereegranskat)abstract
- Background: Survey response rates have been declining over the past decade. The more widespread use of the Internet and Web-based technologies among potential health survey participants suggests that Web-based questionnaires may be an alternative to paper questionnaires in future epidemiological studies. Objective: To compare response rates in a population of parents by using 4 different modes of data collection for a questionnaire survey of which 1 involved a nonmonetary incentive. Methods: A random sample of 3148 parents of Danish children aged 2-17 years were invited to participate in the Danish part of the NordChild 2011 survey on their children's health and welfare. NordChild was conducted in 1984 and 1996 in collaboration with Finland, Iceland, Norway, and Sweden using mailed paper questionnaires only. In 2011, all countries used conventional paper versions only except Denmark where the parents were randomized into 4 groups: (1) 789 received a paper questionnaire only (paper), (2) 786 received the paper questionnaire and a log-in code to the Web-based questionnaire (paper/Web), (3) 787 received a log-in code to the Web-based questionnaire (Web), and (4) 786 received log-in details to the Web-based questionnaire and were given an incentive consisting of a chance to win a tablet computer (Web/tablet). In connection with the first reminder, the nonresponders in the paper, paper/Web, and Web groups were also present with the opportunity to win a tablet computer as a means of motivation. Descriptive analysis was performed using chi-square tests. Odds ratios were used to estimate differences in response rates between the 4 modes. Results: In 2011, 1704 of 3148 (54.13%) respondents answered the Danish questionnaire. The highest response rate was with the paper mode (n=443, 56.2%). The other groups had similar response rates: paper/Web (n=422, 53.7%), Web (n=420, 53.4%), and Web/tablet (n=419, 53.3%) modes. Compared to the paper mode, the odds for response rate in the paper/Web decreased by 9% (OR 0.91, 95% CI 0.74-1.10) and by 11% (OR 0.89, 95% CI 0.73-1.09) in the Web and Web/tablet modes. The total number of responders for NordChild declined from 10,291 of 15,339 (67.09%) in 1984 and 10,667 of 15,254 (69.93%) in 1996 to 7805 of 15,945 (48.95%) in 2011 with similar declines in all 5 Nordic countries. Conclusions: Web-based questionnaires could replace traditional paper questionnaires with minor effects on response rates and lower costs. The increasing effect on the response rate on participants replying for a nonmonetary incentive could only be estimated within the 2 Web-based questionnaire modes before the first reminder. Alternative platforms to reach higher participation rates in population surveys should reflect the development of electronic devices and the ways in which the population primarily accesses the Internet.
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| 44. |
- Holmström, Alexandra, et al.
(författare)
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An integrated multiple marker modality is superior to NT-proBNP alone in prognostic prediction in all-cause mortality in a prospective cohort of elderly heart failure patients
- 2013
-
Ingår i: European Geriatric Medicine. - : Elsevier BV. - 1878-7649. ; 4:6, s. 365-371
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Identifying the individual mortality risk for elderly heart failure (HF) patients is challenging because of heterogeneity, comorbidity and higher age. To overcome this, an integrated multiple marker modality has been proposed for better prognostic prediction than a single variable, this has not been evaluated. Aim: The aim of this study is to identify whether a multiple marker modality is better than N-terminal pro-B-type natriuretic peptide (NT-proBNP) alone for all-cause mortality in elderly HF patients. Methods: A prospective cohort of 361 patients (65 +/- 15 years) referred for echocardiography because of suspected HF was studied, among them, 179 had HF (71 +/- 13). In this cohort blood sampling, electrocardiogram and clinical examinations were performed within approximately 24 hours after the echocardiography. To assess prognostic value of multiple marker modality for all-cause mortality, patients were followed up for 24 +/- 7 months. Results: In the three multivariate analyses, NT-proBNP, cystatin C, red blood cell distribution width (RDW), midregional pro-atrial natriuretic peptide (MR-proANP), pulmonary artery pressure, estimated glomerular filtration rate (eGFR) less than 60 mL/min, anemia, diuretics and sinus rhythm are prognostic predictors of all-cause mortality in elderly HF patients. When analyzing all these variables in one multivariate analysis, only NT-proBNP, eGFR less than 60 mL/min, anemia and diuretics are prognostic predictors of all-cause mortality in elderly HF patients. Two different multiple marker models incorporating NT-proBNP, clinical and laboratory variables were created. The sensitivity and specificity of the two different multiple marker modalities are higher than for NT-proBNP alone. The risk score based on multivariate analysis Wald X-2 values is preferred considering its simplicity and feasibility in daily clinical practice. Conclusion: A multiple marker modality was proven to improve prognostic prediction in elderly HF patients compared to NT-proBNP alone. (C) 2013 Elsevier Masson SAS and European Union Geriatric Medicine Society. All rights reserved.
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| 45. |
- Holmström, Alexandra, et al.
(författare)
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Levels of copeptin among elderly patients in relation to systolic heart failure and heart failure with normal ejection fraction
- 2013
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Ingår i: European Geriatric Medicine. - : Elsevier BV. - 1878-7649. ; 4:3, s. 139-144
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Tidskriftsartikel (refereegranskat)abstract
- Background: High copeptin levels are linked to a poor prognosis in heart failure (HF). Studies of copeptin levels in elderly HF patients with normal left ventricular ejection fraction (HFNEF) have reported conflicting results. Aim: The aim is to study the relationship between copeptin levels and HF in the elderly. Methods: In a prospective cohort of 261 patients with a mean age of 70 +/- 11 years, referred for echocardiography due to suspected HF. Electrocardiography, blood sampling and clinical examination were performed within approximately 24 hours after echocardiography. The study group was categorised according to the following definitions: systolic HF (SHF) (39%), HFNEF (previously called diastolic HF) (19%), uncertain HFNEF (19%), where only symptoms and partial echocardiography signs supported the diagnosis and a group in which HF was excluded (Non-HF) (23%). Results: Copeptin levels were higher in patients with SHF and HFNEF compared with non-HF patients. Patients with uncertain HFNEF had similar copeptin levels as the non-HF group. Copeptin across quartiles was related to an increased proportion of SHF, low ejection fraction (LVEF), high pulmonary artery pressure (PA) (all P < 0.01), signs of increased preload (LVDD) (P < 0.05), and higher levels of a panel of biomarkers (P < 0.01), but not to the incidence of HFNEF. In a stepwise multiple linear regression analysis there was a positive relationship between copeptin and cystatin C, high-sensitivity troponin T (both P < 0.001) and male gender (P < 0.05). Conclusion: Copeptin levels are elevated in both SHF and HFNEF in the elderly but not in patients in whom the HFNEF diagnosis is based only on symptoms and partial echocardiography findings.
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| 46. |
- Holmström, Alexandra, et al.
(författare)
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Re-evaluation of prognostic significance of NT-proBNP in a 5-year follow-up study assessing all-cause mortality in elderly patients (≥ 75 years) admitted to hospital due to suspect heart failure
- 2013
-
Ingår i: European Geriatric Medicine. - : Elsevier BV. - 1878-7649. ; 4:1, s. 8-14
-
Tidskriftsartikel (refereegranskat)abstract
- Background: N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a prognostic biomarker in heart failure (HF), especially in younger population. The prognostic value of NT-proBNP in an elderly HF population (≥ 75 years) remains less studied. The purpose of this study is to evaluate the prognostic value of NT-proBNP in patients aged ≥ 75 years and admitted to hospital due to suspect HF with a median follow-up of 5 years. Methods: A prospective hospital cohort of 243 patients (82 ± 4 years) who had NT-proBNP analyzed due to suspect HF during 2005-2007 was studied. Results: Among the study population, 75% had acute decompensated HF. Multivariable Cox proportional-hazard regression analysis and univariable Kaplan-Meier survival analysis demonstrated that NT-proBNP was not prognostic significant in HF cohort ≥ 75 years old, and instead, pulmonary hypertension, history of valvular surgery and use of aldosterone receptor antagonist were significant prognostic indicators. However, subgroup analysis showed that in patients with NT-proBNP levels > 8000 (ng/L), NT-proBNP is the only significant independent indicator for 5-year mortality whereas in patients with NT-proBNP ≤ 8000 (ng/L), enlargement of left atrium and pulmonary hypertension, instead of NT-proBNP, were significant prognostic indicators for mortality. Conclusion: In a HF population ≥ 75 years old with acute decompensated HF, NT-proBNP was not significant prognostic indicator, except in a subgroup with NT-proBNP > 8000 (ng/L). Therefore, the prognostic value of NT-proBNP in those HF patients ≥ 75 years has to be interpreted with caution due to higher age and comorbidity. Crown Copyright © 2012 Published by Elsevier Masson SAS. All rights reserved.
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| 47. |
- Holmström, Alexandra, et al.
(författare)
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Red blood cell distribution width and its relation to cardiac function and biomarkers in a prospective hospital cohort referred for echocardiography
- 2012
-
Ingår i: European Journal of Internal Medicine. - : Elsevier BV. - 0953-6205. ; 23:7, s. 604-609
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Red blood cell distribution width (RDW), a measure of anisocytosis, is a prognostic biomarker for heart failure (HF). However it is still unclear how RDW is associated with heart function and established cardiac biomarkers. Methods and results: In a prospective hospital cohort of 296 patients referred for echocardiography because of suspected HF, blood sampling and clinical examination were performed within 24 h after echocardiography. The patients were divided into four HF groups, including one group where the HF diagnosis was uncertain (gray zone). In the patients the mean age was 70 +/- 11 years, 44% with systolic HF (SHF), 18% with heart failure with normal ejection fraction (HFNEF), 17% with gray zone and 21% without HF (non-HF). RDW was higher among patients with SHF and HFNEF, compared with gray zone and non-HF patients. The distribution of different variables over the RDW quartiles showed an inverse correlation between RDW levels and LVEF and a positive correlation between RDW and NT-proBNP levels. Further analysis with stepwise multiple linear regression demonstrated that NT-proBNP levels, but not LVEF, were independently correlated with RDW. Conclusion: In patients referred for echocardiography because of suspected HF, RDW levels were higher in patients with SHF and HFNEF. Moreover, NT-proBNP levels were independently linked with elevated RDW. (C) 2012 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
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| 48. |
- Johansson, Emily White, 1976-, et al.
(författare)
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Diagnostic Testing of Pediatric Fevers: Meta-Analysis of 13 National Surveys Assessing Influences of Malaria Endemicity and Source of Care on Test Uptake for Febrile Children under Five Years
- 2014
-
Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 9:4
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Tidskriftsartikel (refereegranskat)abstract
- Background: In 2010, the World Health Organization revised guidelines to recommend diagnosis of all suspected malaria cases prior to treatment. There has been no systematic assessment of malaria test uptake for pediatric fevers at the population level as countries start implementing guidelines. We examined test use for pediatric fevers in relation to malaria endemicity and treatment-seeking behavior in multiple sub-Saharan African countries in initial years of implementation. Methods and Findings: We compiled data from national population-based surveys reporting fever prevalence, care-seeking and diagnostic use for children under five years in 13 sub-Saharan African countries in 2009-2011/12 (n = 105,791). Mixed-effects logistic regression models quantified the influence of source of care and malaria endemicity on test use after adjusting for socioeconomic covariates. Results were stratified by malaria endemicity categories: low (PfPR(2-10)<5%), moderate (PfPR(2-10) 5-40%), high (PfPR(2-10)>40%). Among febrile under-fives surveyed, 16.9% (95% CI: 11.8%-21.9%) were tested. Compared to hospitals, febrile children attending non-hospital sources (OR: 0.62, 95% CI: 0.56-0.69) and community health workers (OR: 0.31, 95% CI: 0.23-0.43) were less often tested. Febrile children in high-risk areas had reduced odds of testing compared to low-risk settings (OR: 0.51, 95% CI: 0.42-0.62). Febrile children in least poor households were more often tested than in poorest (OR: 1.63, 95% CI: 1.39-1.91), as were children with better-educated mothers compared to least educated (OR: 1.33, 95% CI: 1.16-1.54). Conclusions: Diagnostic testing of pediatric fevers was low and inequitable at the outset of new guidelines. Greater testing is needed at lower or less formal sources where pediatric fevers are commonly managed, particularly to reach the poorest. Lower test uptake in high-risk settings merits further investigation given potential implications for diagnostic scale-up in these areas. Findings could inform continued implementation of new guidelines to improve access to and equity in point-of-care diagnostics use for pediatric fevers.
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| 49. |
- Kardassis, Dimitris, et al.
(författare)
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Impact of body composition, fat distribution and sustained weight loss on cardiac function in obesity.
- 2012
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 1874-1754 .- 0167-5273. ; 159:2, s. 128-133
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Tidskriftsartikel (refereegranskat)abstract
- Background Obesity is associated with alterations in left ventricular function varying along with the degree of fatness, but the mechanisms underlying this co-variation are not clear. In a case–control study we examined how sustained weight losses affect cardiac function and report on how body composition and fat distribution relate to the left ventricular performance. Methods At the 10-year follow-up of the Swedish obese subjects (SOS) study cohort we identified 44 patients with sustained weight losses after bariatric surgery (surgery group) and 44 matched obese control patients who remained weight stable (obese group). We also recruited 44 matched normal weight subjects (lean group). Dual-energy X-ray absorptiometry, computed tomography and echocardiography were performed to evaluate body composition, fat distribution and cardiac function. Results BMI was 42.5 kg/m2, 31.5 kg/m2 and 24.4 kg/m2 for the obese, surgery and lean groups respectively. Increasing degree of obesity was associated with larger left ventricular volumes (p < 0.001), higher cardiac output (p < 0.001), reduced systolic myocardial velocity (p < 0.001) and impaired ventricular relaxation (p = 0.015). In multivariate analyses, left ventricular volume, stroke volume and cardiac output primarily associated with lean body mass, whereas blood pressure, heart rate and variables reflecting cardiac dysfunction were more related to total body fat and visceral adiposity. Conclusion Obesity is associated with discrete but distinct disturbances in the left ventricular performance appearing to be related to both the total amount of body fat and degree of visceral adiposity. Patients with sustained weight losses display superior left ventricular systolic and diastolic functions as compared with their obese counterparts remaining weight stable.
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| 50. |
- Kassebaum, N. J., et al.
(författare)
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Global, regional, and national levels and causes of maternal mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013
- 2014
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Ingår i: Lancet. - : Elsevier BV. - 0140-6736. ; 384:9947, s. 980-1004
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Tidskriftsartikel (refereegranskat)abstract
- Background The fifth Millennium Development Goal (MDG 5) established the goal of a 75% reduction in the maternal mortality ratio (MMR; number of maternal deaths per 100 000 livebirths) between 1990 and 2015. We aimed to measure levels and track trends in maternal mortality, the key causes contributing to maternal death, and timing of maternal death with respect to delivery. Methods We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to analyse a database of data for 7065 site-years and estimate the number of maternal deaths from all causes in 188 countries between 1990 and 2013. We estimated the number of pregnancy-related deaths caused by HIV on the basis of a systematic review of the relative risk of dying during pregnancy for HIV-positive women compared with HIV-negative women. We also estimated the fraction of these deaths aggravated by pregnancy on the basis of a systematic review. To estimate the numbers of maternal deaths due to nine different causes, we identified 61 sources from a systematic review and 943 site-years of vital registration data. We also did a systematic review of reports about the timing of maternal death, identifying 142 sources to use in our analysis. We developed estimates for each country for 1990-2013 using Bayesian meta-regression. We estimated 95% uncertainty intervals (UIs) for all values. Findings 292 982 (95% UI 261017-327792) maternal deaths occurred in 2013, compared with 376 034 (343483-407574) in 1990. The global annual rate of change in the MMR was -0.3% (-1.1 to 0.6) from 1990 to 2003, and -2.7% (-3.9 to -1.5) from 2003 to 2013, with evidence of continued acceleration. MMRs reduced consistently in south, east, and southeast Asia between 1990 and 2013, but maternal deaths increased in much of sub-Saharan Africa during the 1990s. 2070 (1290-2866) maternal deaths were related to HIV in 2013, 0.4% (-0.2-0.6) of the global total. MMR was highest in the oldest age groups in both 1990 and 2013. In 2013, most deaths occurred intrapartum or postpartum. Causes varied by region and between 1990 and 2013. We recorded substantial variation in the MMR by country in 2013, from 956.8 (685.1-1262.8) in South Sudan to 2.4 (1.6-3.6) in Iceland. Interpretation Global rates of change suggest that only 16 countries will achieve the MDG 5 target by 2015. Accelerated reductions since the Millennium Declaration in 2000 coincide with increased development assistance for maternal, newborn, and child health. Setting of targets and associated interventions for after 2015 will need careful consideration of regions that are making slow progress, such as west and central Africa.
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