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- Hellström Ängerud, Karin, et al.
(författare)
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Differences in symptoms in relation to myocardial infarction.
- 2016
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: In myocardial infarction (MI) rapid diagnosis and treatment is crucial for the prognosis. Previous research has found that symptom presentation influence pre hospital delay times but studies about differences in MI symptoms between patients with ST-elevation myocardial infarction (STEMI) and non ST-elevation myocardial infarction (NSTEMI) are sparse and inconclusive. To enhance the understanding of symptom presentation in regard to MI type, we aimed to describe symptoms in relation to MI type and to find predictors of STEMI versus NSTEMI in patients with MI.Methods: Patients with MI (n=694) from the SymTime study were included. SymTime was a multicentre cross-sectional study of symptoms and actions in the prehospital phase of MI and data were collected using a previously validated questionnaire administered to MI patients within 24 h of admission to hospital.Results: Patients with STEMI were younger, more often men and smokers. Patients with NSTEMI were more likely to have a history of hypertension, MI and stroke. Chest pain was the most common symptom in both groups. Pain, discomfort, or pressure located in the jaw or teeth, vertigo/pre-syncope, cold sweat and nausea/vomiting were significantly more frequent in patients with STEMI (Table 1). In a multivariate logistic regression model patients with STEMI were more likely to present with cold sweat (OR 4.13, 95% CI 2.71–6.29) jaw pain (OR 2.14, 95% CI 1.02–4.50), and nausea (OR 2.01, 95% CI 1.20–3.33), and less likely to have a history of stroke (OR 0.35, 95% CI 0.15–0.84), fluctuating symptoms (OR 0.54, 95% CI 0.36–0.83) and anxiety (OR 0.54, 95% CI 0.32–0.92) compared to patients with NSTEMI.Conclusion: Patients with STEMI differed significantly from those with NSTEMI regarding symptom presentation. This knowledge is important for health care personnel to recognize symptoms alarming for STEMI when evaluating patients with MI symptoms.
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| 4. |
- Pourhamidi, Kaveh, 1985-, et al.
(författare)
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Intraepidermal nerve fibre density is associated with weight
- 2011
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: Intraepidermal nerve fibre density (IENFD) quantification is regarded to be a sensitive and specific measure of small nerve fibre dysfunction and IENFD loss is an early feature in glucose dysregulation. Our aims were to study IENFD in individuals with normal glucose tolerance (NGT), impaired glucose tolerance (IGT) and type 2 diabetes (T2D) and to study if IENFD was associated to metabolic traits, e.g. obesity and dyslipidemia, and to neurophysiologic assessments of nerve function.Materials and methods: Participants were consecutively recruited from the population-based Västerbotten Intervention Program; NGT (n=22), IGT (n=14), T2D (n=24), at the age of 60±1 years. The individuals’ height and weight were measured. Blood glucose and lipids were measured. Nerve conduction studies (NCS) were performed (sural and peroneal nerves) and the results were standardized to z-scores and compiled into a composite Z-score representing the nerve function in the leg. Neuropathy disability score (NDS) was used to evaluate neuropathic signs. In addition, thermal threshold tests (TTT) were performed to assess small nerve fibre function. Skin biopsies were performed using a 3-mm punch taken 10 cm proximal to the lateral malleolus. The intraepidermal nerve fibres were evaluated by routine immunohistochemistry and stained with anti-PGP9.5 (ubiquitin carboxyl-terminal hydrolase) antibodies. Light microscopy was used to identify nerve fibres in thin sections (5 µm) according to a standardized protocol. The IENFD was given as the mean of counts in 3 sections per millimeter of epidermal length. The assessors were blinded to the identity of the samples.Results: Patients with diabetes had lower IENFD (median 2.9 nerves mm-1, IQR 1.2-4.8) than controls (median 4.4 nerves mm-1, IQR 3.5-6.3; Mann-Whitney U test p=0.007). IGT individuals did not differ in IENFD (median 3.2 nerves mm-1, IQR 1.4-5.5) compared to controls (p=0.12) or diabetic patients (p=0.53). IENFD was positively correlated to NCS (r=0.39, p=0.002), but not to TTT and NDS. Individuals in the 3rd tertile of composite Z-score (i.e. better nerve conduction) had higher IENFD (median 4.1 nerves mm-1, IQR 2.7-5.8) than individuals in the 1st tertile (median 2.4 nerves mm-1, IQR 0.7-3.9; p=0.009). Triglycerides and cholesterols were not associated with IENFD. However, a stepwise multiple linear regression analysis revealed that weight was independently associated to IENFD, after adjustment for age, sex, height, and diabetic status (β=-0.419, p<0.001).Conclusion: We conclude that skin biopsies for IENFD quantification in thin sections is a simple useful method for assessing small nerve fibre neuropathy in individuals with diabetes. The association between weight and IENFD indicates that metabolic traits other than glucose dysmetabolism might play a role in the development small nerve fibre neuropathy.
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| 5. |
- Scandurra, Isabella, 1973-, et al.
(författare)
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Is 'patient's online access to health records' a good reform? : Opinions from Swedish healthcare professionals differ
- 2015
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Ingår i: Conference On Enterprise Information Systems/International Conference On Project Management/Conference On Health And Social Care Information Systems And Technologies, Centeris/Projman / Hcist 2015. - Amsterdam, Netherlands : Elsevier BV. ; 64, s. 964-968
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Konferensbidrag (refereegranskat)abstract
- Patients' access to their own electronic health record is a controversial issue. Many care professionals are concerned about negative effects deriving from patients reading their record information without support from clinicians. Patients on the other hand often think their concerns are outweighed by the benefits. In Sweden a pilot county has provided the health record online to its 350 000 patients for 2.5 years. This study highlights one of the most important questions to handle before and during implementation of such public eHealth services; the opinions of the care professionals regarding online records as a good reform. Results from three questionnaires to various care professions show that opinions from healthcare professionals differ not only between the professions but more importantly also between those who have experience from their patients reading their health record online and those who to date have no real experience. The experienced staff was more positive. This study concludes that in order to provide for successful national implementation, it is important to quickly elicit and disseminate opinions of care professionals with real experience to their unexperienced peers. Healthcare professionals should also be more involved in the implementation of Public eHealth services that regard electronic health records and their work processes.
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| 6. |
- Eriksson, Janna, 1992, et al.
(författare)
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The effects of iron and selenium in iodine containing multivitamins on thyroid related compounds during pregnancy in Sweden: a randomized placebo cotrolled trial
- 2017
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Ingår i: 87th Annual Meeting of the American Thyroid Association. Thyroid, 27(S1), poster 71. - : Mary Ann Liebert Inc. - 1050-7256 .- 1557-9077.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Multivitamins with iodine are advocated to pregnant women to avoid iodine deficiency, as iodine may be beneficial for brain development in the child. Multivitamins also contain iron and selenium that may affect thyroid hormone metabolism. Iron is included in the tyreoperoxidase enzyme promoting the coupling of iodine to thyroglobulin (Tg) and selenium is incorporated in deiodinases that regulates levels of thyroxine (T4) and triiodothyronine (T3). There is no previous studies on the effects of iodine containing multivitamins on iron and selenium levels in pregnant women and the relation to thyroid hormone levels. This was a randomized, double-blinded controlled trial of 200 pregnant women, who were randomized to multivitamins containing 150 lg iodine, 12 mg iron and 50 lg selenium/day or multivitamins without iodine, iron and selenium in pregnancy week 7–12 until delivery, besides iron supplements on usual routines. Thyroid hormones, Tg, selenium (ref 0.7– 1.2 lmol/L) and iron measurements (ferritin (ref 15–150 mg/L), transferrin saturation (ref 0.1–0.5)) were collected in the third trimester. Urinary iodine concentration confirmed mild ID in the control group with a Tg increase. In the third trimester, 139 patients were left for sampling. In the active group (n = 67) median (interquartile range (IQR)) selenium levels were 0.72 (0.16) vs 0.61 (0.14) in the control group (n = 72), p < 0.001. Low selenium values were noted in 70.0% of participants and it was more common in the control group (81.9%), p < 0.001. Median (IQR) Tg levels was higher in those with low selenium 30.0 (30.5) than in those with normal selenium 20.5 (21.5), p = 0.037. Thyroid hormones did not differ between active/control groups or low/normal selenium groups, but FT3/FT4 ratio was higher in the low selenium group than in the normal selenium group (0.35 (0.08) vs 0.33 (0.08)), p= 0.025. Ferritin in the active group was 22.0 (21.0) and 20.0 (21.5) in the control group, p = 0.393 and transferrin saturation 0.20 (0.11) and 0.18 (0.18), p = 0.802, respectively. Multivitamins used during pregnancy to increase iodine levels also increase selenium levels where effects on thyroid metabolism needs further evaluation.
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| 8. |
- Elrud, Rasmus, et al.
(författare)
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Sickness absence among passenger car occupants following a Crash
- 2017
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Ingår i: Conference proceedings International Research Council on the Biomechanics of Injury, IRCOBI. - 2235-3151. ; 2017-September, s. 79-90
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Konferensbidrag (refereegranskat)abstract
- Sickness absence is a common consequence of road traffic crashes, with high costs for the individual and society. Yet, scarcely studied, therefore, the aim was to describe sickness absence among injured car occupants. A population-based study using register data was conducted, including all car occupants of working age living in Sweden, who in 2010 had specialised in-or outpatient healthcare due to a car crash (n=9427). Individuals were categorised based on age, sex, and injury type. Odds ratios with 95% confidence intervals for a new sickness absence spell >14 days were estimated. After excluding the 9% already on sickness absence or disability pension, 10% had a new sickness absence spell >14 days. Sex and crash type were not associated with new sickness absence, while old age and being born outside Europe were associated with higher odds ratios. Odds ratios varied with the type of injury and injured body region. The odds ratio for sickness absence was highest for injuries to the spine and spinal cord odds ratio: 8.64 (95% confidence interval 6.45-11.57). Traumatic brain injuries except concussion had an odds ratio of 6.99 (4.04-12.08) while concussions had an odds ratio of 2.66 (1.80-3.93).
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| 9. |
- Mortazavi, S. A.R., et al.
(författare)
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Can Reactivation of SARS-CoV-2 Decrease the Chance of Success of Future Deep Space Missions?
- 2021
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Ingår i: IEEE Aerospace Conference Proceedings. - 1095-323X. ; 2021-March
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Konferensbidrag (refereegranskat)abstract
- Korean CDC experts first reported the likelihood of reactivation in COVIOD-19 patients. They hypothesized that like childhood chicken pox infections which lie dormant for tens of years only to cause shingles in seniors, SARS-CoV-2 can reactivate. However, as testing for the virus had been flawed at that time, U.S. infectious disease experts were skeptical about the reports of second COVID-19 infections. New reports have addressed the urgent need to conduct large-scale studies to better understand the potential recurrence of SARS-CoV-2 in COVID-19 patients. Moreover, some case studies show possible reactivation of SARS-CoV-2 in a family cluster. Given this consideration, major space stressors such as microgravity and space radiation and their interactions which are not fully known, so far can increase the risk of reactivation of SARS-CoV-2 in future space missions, an event that can easily impact the success of any space mission. Since about 80% of infected people are either asymptomatic or show only mild symptoms, in a near future, it would be likely that astronauts who start their mission even after complex medical examinations, experience reactivation of the virus during their mission. Moreover, we have previously addressed the potential higher fatality of COVID-19 infections in space due to 1) uselessness of social distancing due to microgravity 2) immune system dysregulation 3) possibly higher mutation rates of the novel coronavirus (SARS-CoV-2) as a RNA virus 4) higher risk of reactivation of the virus 5) existence of strong selective pressure and 6) decreased maximum oxygen uptake.
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| 10. |
- Abbas, Abdul-Karim, 1959
(författare)
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Evidence based medicine: a critical inquiry. Seminar Lecture
- 2010
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Ingår i: The 5th Annual Meeting of International Iraqi Medical Association, April 1-3, 2010, Sharjah, UAE.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Evidence-based medicine and practice (EBM/EBP) have since their inception in the early 1990s had widespread impact on the teaching and practice of medicine and health care. While the western societies are becoming more postmodernist, the medical system remains increasingly modernist in its outlook, this may make it increasingly irrelevant to the needs of a changing society. However, criticism is essentially a changing process of our realities. Hence, the prominence given to EBM can not be seen as a solely attempt to reassert modernism within the field, but as an improved paradigm reviewing itself in lights of challenges it faces. Relevant to my topic here is that the debate, which took sometimes, unfortunately, metaphorical and aggressive directions, has contributing effect on both the EBM and its critics moderating both methodologies and epistemes especially the introducing of other kinds of researches, than randomized controlled trails (RCT), systematic reviews or meta-analysis of RCTs, like user-led research and qualitative researches which focus on personal experience of both the patient and clinician. In the developing countries there are many challenges, whether technical, social or epistemological, facing practicing and using them. Although few Arab countries have recently developed either centers or associations for EBM, Iraq still lacks such kind of practice. Presenting an outlook of EMB from within the current intellectual debate and examining the environment and essential aspects of this debate between the EMB and its postmodernist critics might be helpful in not a merely dogmatic promotion of its practice nor a blind call for adopting and applying its guidelines and techniques but in enforcing the discussion and dialogue between the current disputable paradigms in the one hand and improve the possibilities and resources to use it as the “best” paradigm in medical practices and education. A conclusion has drawn on here that EBM paradigm does not only improve the decision-making in health services and provides a serious attempt to invent a new language that might reunite the Babel of doctors and patients, managers and consumers, but also it understands medical care in both the closed and open systems. Epistemological, methodological, ethical and social questions about the patient/subject are addressed here aiming to encourage the health and educational authorities in Iraq to take this paradigm seriously and introduce it in their future programs.
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