| 1. |
- Andren, Ann, et al.
(author)
-
Effects of treatment with oral appliance on 24-h blood pressure in patients with obstructive sleep apnea and hypertension : a randomized clinical trial
- 2013
-
In: Sleep and Breathing. - : Springer Science and Business Media LLC. - 1520-9512 .- 1522-1709. ; 17:2, s. 705-712
-
Journal article (peer-reviewed)abstract
- Continuous positive airway pressure treatment has been shown to lower blood pressure (BP) in patients with obstructive sleep apnea (OSA). The aims of the present pilot study were to evaluate the potential effects of oral appliance (OA) therapy on BP, to assess various outcome BP measures, and to inform sample size calculation. Seventy-two patients with OSA and hypertension were randomly assigned to intervention with either an OA with mandibular advancement (active group) or an OA without advancement (control group). Before and after 3 months of treatment, the patients underwent nocturnal somnographic registration and 24-h ambulatory BP monitoring. Among the various BP measures, the largest trend toward effect of OA treatment was seen in 24-h mean systolic BP with a 1.8 mmHg stronger BP reduction in the active group compared with controls. A stronger trend toward effect was seen in a subgroup with baseline ambulatory daytime mean systolic BP > 135/85 mmHg where the mean systolic BP fell, on average, 2.6 mmHg. Additional exclusion of patients with baseline apnea hypopnea index (AHI) a parts per thousand currency sign15 gave a significant reduction in mean systolic BP of 4.4 mmHg (P = 0.044) in the active group compared with controls. In patients with OSA and hypertension, OA treatment had a modest trend toward effect on reducing BP. A stronger trend toward treatment effect was seen after excluding patients with normal baseline ambulatory BP. Additional exclusion of patients with baseline AHI a parts per thousand currency sign15 showed a significant treatment effect. Data to inform sample size for an adequately powered randomized study are provided.
|
|
| 2. |
|
|
| 3. |
|
|
| 4. |
- Hedberg, Pär, et al.
(author)
-
Left ventricular systolic dysfunction in outpatients with peripheral atherosclerotic vascular disease : prevalence and association with location of arterial disease
- 2014
-
In: European Journal of Heart Failure. - : Wiley. - 1388-9842 .- 1879-0844. ; 16:6, s. 625-632
-
Journal article (peer-reviewed)abstract
- Aims: We aimed to determine the prevalence of left ventricular systolic dysfunction (LVSD) in outpatients with peripheral atherosclerotic vascular disease (PAVD). Further, the associations of stenotic internal carotid artery disease (SICAD) and lower extremity artery disease (LEAD) with LVSD were evaluated.Methods and results: In the Peripheral Artery Disease in Vastmanland study, consecutive outpatients with ultrasonographically identified mild to severe stenosis in the internal carotid artery or symptoms of claudication combined with either ankle brachial index of 0.90 or ultrasonographic occlusive findings were included (n=437). Population-based control subjects were matched to the patients (n=395). LVSD was defined as echocardiographically determined left ventricular ejection fraction (LVEF) <55%, and moderate or greater LVSD was defined as LVEF <45%. The prevalence of LVSD was significantly greater in patients than in controls (13.7% vs. 6.1%, P<0.001). The prevalence of moderate or greater LVSD in participants not on treatment with a combination of angiotensin-converting enzyme inhibitor and beta-blocker was 2.3% in patients and 1.3% in controls (P=0.31). When LEAD and SICAD were analysed together, adjusted for potential confounders, SICAD [odds ratio (OR) 2.54, 95% confidence interval (CI) 1.03-6.32], but not LEAD (OR 1.59, 95% CI 0.80-3.18), was independently associated with LVSD.Conclusions: In outpatients with PAVD, we found a 13.7% prevalence of LVSD. However, the prevalence of at least moderate LVSD in patients not on treatment with angiotensin-converting enzyme inhibitor and a beta-blocker was only 2.3% and not significantly different from controls. Stenotic artery disease in the internal carotid artery, but not in the lower extremities, was independently associated with LVSD.
|
|
| 5. |
- Magnusson, Niklas, 1975-, et al.
(author)
-
The time profile of groin hernia recurrences
- 2010
-
In: Hernia. - : Springer. - 1265-4906 .- 1248-9204. ; 14:4, s. 341-344
-
Journal article (peer-reviewed)abstract
- PURPOSE: If the pathogeneses of the development of a recurrence varies following the different methods of hernia repair, the time required to develop a recurrence could be expected to vary. The aim of the study was to identify risk factors affecting the time interval between the primary repair and the reoperation.METHODS: Data from the Swedish Hernia Register were used. Each year of the 5-year follow-up period was treated as a separate subgroup and merged together into one large group. For each risk factor, we performed a Cox proportional hazard analysis, testing for interactions between the year and the risk factor, with reoperation as the endpoint.RESULTS: Altogether, 142,578 repairs were recorded, of which 7.7% were performed on women. The mean age of the cohort was 59 years. The overall recurrence rate in the 5-year period was 4.3%. Multivariate analysis showed that recurrence following surgery for recurrent hernia occurred relatively early (P < 0.05).Recurrence also appeared early if postoperative complications were registered (P < 0.05). Recurrence after suture repair or laparoscopic repair appeared relatively early compared to recurrence following open mesh repair (P < 0.05). In a separate analysis, a relatively higher risk for early recurrence was seen for all sutured repairs compared to all mesh repairs (P < 0.05).CONCLUSIONS: The pathogenesis behind the development of recurrence probably differs depending on the technique applied during the hernia repair. The higher proportion of early recurrences following laparoscopic repair, suture repair and recurrent repair may be explained by the high proportion of technical failures.
|
|
| 6. |
- Nilsson, Göran, et al.
(author)
-
Inflammation and the Metabolic Syndrome : Clustering and Impact on Survival in a Swedish Community-Based Cohort of 75 Year Olds
- 2013
-
In: Metabolic Syndrome and Related Disorders. - : Mary Ann Liebert Inc. - 1540-4196 .- 1557-8518. ; 11:2, s. 92-101
-
Journal article (peer-reviewed)abstract
- Background: High blood concentrations of inflammatory markers, including white blood cell (WBC) count, are closely related to the metabolic syndrome. Both conditions predict dismal survival. We determined prospective associations between mortality and factors derived by a factor analysis of WBC count and the basic components of the metabolic syndrome. Methods and Results: We performed a factor analysis of WBC count and the continuous components of the metabolic syndrome in 196 men and 200 women, comprising 64% of the originally invited 75 year olds from the Swedish city Vasteras. The analysis revealed three factors in men and two in women. The first factor included fasting glucose, high-density lipoprotein cholesterol, triglycerides, and waist circumference in men and in addition WBC count in women. The second factor included diastolic blood pressure and systolic blood pressure in both sexes. In men, the third factor included fasting glucose and WBC count. These factors explained 66% (first factor, 28%; second factor, 23%; third factor, 15%) of the variation in men and 57% (first factor, 34%; second factor, 23%) in women. Prospective associations of the derived factors and all-cause mortality during 10-year follow-up were assessed by Cox regression [hazard ratio (HR)]. The first factor was significantly related to increased mortality in men: HR=1.22 [95% confidence interval (CI) 1.05-1.41; p = 0.008] and women: HR=1.25 (95% CI 1.06-1.48; p = 0.010). Pooling men and women adjusting for established cardiovascular risk factors gave HR= 1.16 (95% CI 1.04-1.29; p = 0.010). In men the third factor was significantly related to mortality; HR= 1.29 (95% CI 1.07-1.57; p = 0.009). Conclusions: A metabolic inflammatory factor and a blood pressure factor were identified. In men, the former was split into a metabolic and an inflammatory factor. Factors including metabolic and inflammatory components were significantly related to 10-year mortality and the relation remained after adjusting for established cardiovascular risk factors.
|
|
| 7. |
- Nilsson, Göran, et al.
(author)
-
Low Psychological General Well-Being (PGWB) is associated with deteriorated 10-year survival in men but not in women among the elderly
- 2011
-
In: Archives of gerontology and geriatrics (Print). - : Elsevier BV. - 0167-4943 .- 1872-6976. ; 52:2, s. 167-171
-
Journal article (peer-reviewed)abstract
- We studied Psychological General Well-Being (PGWB) and its relation to 10-year survival in 75-year-olds from the general population. The PGWB global score (sum of six subscale scores) and the subscale scores were transformed to 0-100 scales. Ten-year survival in relation to PGWB global and subscale scores was studied in a cohort of 204 men and 213 women. Global PGWB score (median) was 83 in men and 79 in women (for difference p = 0.001). Significantly higher male scores were found for most PGWB subscales. Global PGWB score was significantly related to better 10-year survival in men (relative risk per ten points of score was 0.80; p = 0.001 and 0.85; p = 0.022 adjusting for chronic diseases and living alone) but not in women (relative risk 0.94; p = 0.478 unadjusted). Among 75-year-olds, PGWB score was significantly higher for men. A high PGWB score was significantly related to better survival in men but not in women.
|
|
| 8. |
- Nilsson, Göran, et al.
(author)
-
Survival of the fattest : unexpected findings about hyperglycaemia and obesity in a population based study of 75-year-olds
- 2011
-
In: BMJ Open. - : BMJ. - 2044-6055. ; 1:1
-
Journal article (peer-reviewed)abstract
- OBJECTIVE: To study the relationship between body mass index (BMI) and mortality among 75-year-olds with and without diabetes mellitus type 2 (DM) or impaired fasting glucose (IFG).DESIGN: Prospective population-based cohort study with a 10-year follow-up.PARTICIPANTS: A random sample of 618 of the 1100 inhabitants born in 1922 and living in the city of Västerås in 1997 were invited to participate in a cardiovascular health survey; 70% of those invited agreed to participate (432 individuals: 210 men, 222 women).OUTCOME MEASURES: All-cause and cardiovascular mortality.RESULTS: 163 of 432 (38%) participants died during the 10-year follow-up period. The prevalence of DM or IFG was 41% (35% among survivors, 48% among non-survivors). The prevalence of obesity/overweight/normal weight/underweight according to WHO definitions was 12/45/42/1% (14/43/42/1% among survivors, 9/47/42/2% among non-survivors). The hazard rate for death decreased by 10% for every kg/m(2) increase in BMI in individuals with DM/IFG (HR 0.91, 95% CI 0.86 to 0.97; p=0.003). After adjustment for sex, current smoking, diagnosed hypertension, diagnosed angina pectoris, previous myocardial infarction and previous stroke/transient ischaemic attack, the corresponding decrease in mortality was 9% (HR 0.92, 95% CI 0.86 to 0.99; p=0.017). These findings remained after exclusion of individuals with BMI<20 or those who died within 2-year follow-up. In individuals without DM/IFG, BMI had no effect on mortality (HR 1.01, 95% CI 0.95 to 1.07; p=0.811). The HR for BMI differed significantly between individuals with and without DM/IFG (p interaction=0.025). The increased all-cause mortality in individuals with DM/IFG in combination with lower BMI was driven by cardiovascular death.CONCLUSION: High all-cause and cardiovascular mortality was associated with lower BMI in 75-year-olds with DM/IFG but not in those without DM/IFG. Further studies on the combined effect of obesity/overweight and DM/IFG are needed in order to assess the appropriateness of current guideline recommendations for weight reduction in older people with DM/IFG.
|
|
| 9. |
- Nilsson, Göran, et al.
(author)
-
White blood cell count in elderly is clinically useful in predicting long-term survival.
- 2014
-
In: Journal of Aging Research. - : Hindawi Limited. - 2090-2204 .- 2090-2212. ; 2014, s. 475093-
-
Journal article (peer-reviewed)abstract
- Introduction. White blood cell (WBC) count is often included in routine clinical checkups. We determined the prognostic impact of WBC count on all-cause, cardiovascular, and noncardiovascular mortality during an 11-year followup in a general population of 75-year-olds. Study Population. The study included 207 men and 220 women comprising 69% of the invited 75-year-olds in a defined geographical area. Main Results. The median WBC count (in 10(9)/L) was 6.3 (interquartile range 5.4-7.2) for men and 5.7 (4.9-6.8) for women, P < 0.001 for sex difference. The hazard ratio (HR) for all-cause mortality per 10(9)/L increase in WBCs was 1.16 (95% confidence interval, 1.03-1.32; P = 0.016) in men and 1.28 (1.10-1.50; P = 0.002) in women. These HRs were essentially unchanged by adjustment for established risk factors (current smoking, known hypertension, prior myocardial infarction, known diabetes, total cholesterol, high-density lipoprotein cholesterol, and body mass index). Furthermore, increased WBC count was significantly associated with cardiovascular mortality in both sexes and with noncardiovascular mortality in women. Conclusions. The WBC count deserves attention as a potentially clinical useful predictor of survival in the 75-year-olds, especially among women.
|
|
| 10. |
- Rosengren, Kristina, 1963-, et al.
(author)
-
Quality registry, a tool for patient advantages - from a preventive caring perspective
- 2012
-
In: Journal of Nursing Management. - : Blackwell Publishing. - 0966-0429 .- 1365-2834. ; 20:2, s. 196-205
-
Journal article (peer-reviewed)abstract
- Aim: The aim of this study was to describe nurses' experiences of a recently implemented quality register, Senior Alert, at two hospitals in Sweden.Background: In Sweden, in recent decades, a system of national quality registries has been established in health and medical services for better outcomes for patients, professional development and a better functioning system. Senior Alert (SA) is one quality registry, aimed at preventing malnutrition, pressure ulcers and falls in elderly care.Methods: The study comprised a total of eight interviews with nurses working with SA at the ward level. The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. All persons who were asked to participate in the study consented to do so.Results: One category 'Patient Advantages' and three subcategories 'Conscious Persevering', 'Supporting Structure' and 'Committed Leadership' were identified to describe staff experiences of implementing SA.Conclusions: Implementation processes need to be sustainable at both staff and managerial levels. A key factor in implementing and using a quality registry in prevention care could be described as keeping the flame burning. However, further research is needed on how patient advantages could be developed using other quality registries in order to improve care from a patient perspective.Implications for nursing management: The results of this study could help other organizations implement quality registries or other change processes, for example new guidelines and treatment. Strategies concerning organizational structure and committed leadership could increase the usefulness of knowledge systems on all levels, which could enable continuous learning and quality improvement in health care.
|
|
