| 1. |
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| 2. |
- Björk, Jonas, et al.
(author)
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Predicting participation in the population-based Swedish cardiopulmonary bio-image study (SCAPIS) using register data
- 2017
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In: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 45, s. 45-49
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Journal article (peer-reviewed)abstract
- Aims: To illustrate the importance of access to register data on determinants and predictors of study participation to assess validity of population-based studies. In the present investigation, we use data on sociodemographic conditions and disease history among individuals invited to the Swedish cardiopulmonary bio-image study (SCAPIS) in order to establish a model that predicts study participation. Methods: The pilot study of SCAPIS was conducted within the city of Gothenburg, Sweden, in 2012, with 2243 invited individuals (50% participation rate). An anonymous data set for the total target population (n = 24,502) was made available by register authorities (Statistics Sweden and the National Board of Health and Welfare) and included indicators of invitation to and participation in SCAPIS along with register data on residential area, sociodemographic variables, and disease history. Propensity scores for participation were estimated using logistic regression. Results: Residential area, country of birth, civil status, education, occupational status, and disposable income were all associated with participation in multivariable models. Adding data on disease history only increased overall classification ability marginally. The associations with disease history were diverse with some disease groups negatively associated with participation whereas some others tended to increase participation. Conclusions: The present investigation stresses the importance of a careful consideration of selection effects in population-based studies. Access to detailed register data also for non-participants can in the statistical analysis be used to control for selection bias and enhance generalizability, thereby making the results more relevant for policy decisions.
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| 3. |
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| 4. |
- Bonander, Carl, et al.
(author)
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Participation weighting based on sociodemographic register data improved external validity in a population-based cohort study
- 2019
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In: Journal of Clinical Epidemiology. - : Elsevier BV. - 0895-4356. ; 108, s. 54-63
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Journal article (peer-reviewed)abstract
- Objective: To investigate whether inverse probability of participation weighting (IPPW) using register data on sociodemographic and disease history variables can improve external validity in a cohort study with selective participation. Study Design and Setting: We fitted various IPPW models by logistic regression using register data for the participants (n = 1,111) and nonparticipants (n = 1,132) of a Swedish cohort study. For each of six diagnostic groups, we then estimated (1) weighted disease prevalence proportions and (2) weighted cross-sectional associations (odds ratios) between sociodemographic variables and disease prevalence. Using register data on the remaining individuals of the entire study population of men and women aged 50-64 years (n = 22,259), we addressed how the choice of variables used for IPPW influenced estimation errors. Results: Disease prevalence proportions were generally underestimated in the absence of IPPW but became markedly closer to population values after IPPW using sociodemographic variables. We found limited evidence of selective participation bias in association estimates, but IPPW improved external validity when bias was present. Conclusions: IPPW using sociodemographic register data can improve the external validity of disease prevalence estimates in cohort studies with selective participation. The performance of IPPW for association estimates merits further investigations in longitudinal settings and larger cohorts. © 2018 Elsevier Inc.
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| 5. |
- Dehlin, Mats, 1968, et al.
(author)
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Factors associated with initiation and persistence of urate-lowering therapy
- 2017
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In: Arthritis Resarch and Therapy. - 1478-6354. ; 19
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Journal article (peer-reviewed)abstract
- Background: Gout is the most common inflammatory arthritic disease and is caused by crystal deposition secondary to persistent hyperuricemia. Etiological treatment with urate-lowering therapy (ULT) has been available since the 1950s but previous studies have demonstrated suboptimal degree of treatment. In recent years we have seen recommendations for ULT earlier in the course of the disease, but there are few contemporary reports reflecting the current situation. Therefore we set out to investigate proportion receiving and persisting with ULT after gout diagnosis and predictors thereof. Method: A population-based cohort study using regional and national population-based registers. Cohort of patients (n = 7709) from western Sweden with incident gout aged 18 years and above from 2011 to 2013. An incident case of gout was defined as having been given a diagnosis of gout (ICD-10 M10, M14.0-14.1) not preceded by a gout diagnosis or a dispensation of ULT during the previous 5 years. Main outcome measures were cumulative incidence and predictors for start of, and persistence with, ULT in gout. Results: Within the first year after first gout diagnosis, 32% received ULT. Male sex, presence of diabetes or cardiovascular comorbidity, reduced kidney function but not diagnosed "end-stage kidney failure"increased the likelihood of receiving ULT. Of those starting ULT a majority (75%) did not persist with ULT treatment within the first 2 years. Age < 50 years, lack of comorbidities, and "normal kidney function"or "end-stage kidney failure"were associated with non-persistence with ULT. Conclusions: Only a minority of patients received ULT and a majority of these did not persist with treatment over the next 2 years. However, the older patients with renal impairment and comorbidities, possibly suffering from a more severe gout disease, were more likely to receive and persist with treatment. There is thus still room for considerable improvement with regards to management of ULT in gout.
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| 6. |
- Engdahl, J., et al.
(author)
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A prospective 5-year follow-up after population-based systematic screening for atrial fibrillation
- 2018
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In: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - : Oxford University Press (OUP). - 1532-2092. ; 20:FI3
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Journal article (peer-reviewed)abstract
- Aims: Thrombo-embolic stroke risk in atrial fibrillation (AF) is significantly reduced with oral anticoagulant (OAC) treatment. Atrial fibrillation is often asymptomatic (silent) and therefore undiagnosed. The long-term course of silent AF as well as OAC treatment adherence after AF screening is not known. We aim at studying long-term adherence to OAC treatment, AF symptoms, and stroke incidence on population level after systematic AF screening. Methods and results: All inhabitants in a Swedish municipality who were born in 1934 and 1935 (n=1335) were invited to participate in an AF screening trial between 2010 and 2012. Participants with a previously known or screening-detected AF were invited to a 5-year follow-up. Time trends of ischaemic stroke incidence were compared for population groups residing in the intervention municipality and in a surrounding control area where no AF screening trial was carried out. After the screening procedure, 103 of 121 participants (85%) with AF were treated with OAC. At the follow-up examination, 94 of 106 living patients (88%) were still on OAC treatment. Among the 23 long-term surviving patients who were diagnosed with paroxysmal AF during screening, 6 had developed permanent silent AF. The incidence of ischaemic stroke between ages 76-80years declined significantly after the AF screening trial in the intervention area (P=0.003) but not in the control area. Conclusion: Adherence to OAC treatment 5years after AF screening was high. Silent AF has a natural course similar to symptomatic AF. The observed incidences of ischaemic stroke suggest a beneficial population-level effect of systematic AF screening.
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| 7. |
- Engdahl, Johan, 1968, et al.
(author)
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Geographic and socio-demographic differences in uptake of population-based screening for atrial fibrillation: The STROKESTOP I study
- 2016
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In: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 222, s. 430-435
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Journal article (peer-reviewed)abstract
- BACKGROUND: The rationale behind screening for atrial fibrillation (AF) is to prevent ischemic stroke. Socio-demographic differences are expected to affect screening uptake. Geographic differences may provide further insights leading to targeted interventions for improved uptake. The objective of this study was to evaluate geographic and socio-demographic differences in uptake of AF screening in the population-based study STROKESTOP I. METHODS: STROKESTOP was carried out in two Swedish counties with a total population of 2.3 million inhabitants. Half of the residents aged 75-76years were randomized to the screening arm: invitation to clinical examination followed by ambulant ECG recording. Information on each invited person's residential parish (n=157) was used. On parish-level, aggregated data for the participants and non-participants, respectively, were obtained with respect to socioeconomic variables: educational level, disposable income, immigrant and marital status. Geo-maps displaying participation ratios were estimated by hierarchical Bayes methods. RESULTS: The overall participation rate was similar in men and women but lower in Stockholm, 47.6% (5665/11,903) than in Halland, 61.2% (1495/2443). Participation was clearly associated with the socioeconomic variables. Participation not taking into account socioeconomy varied more markedly across the parishes in the Stockholm county (range: 0.65-1.26) than in the Halland county (0.94-1.27). After adjustment for socioeconomic variables, a geographic variation remained in Stockholm, but not in Halland. CONCLUSION: Participation in AF screening varied according to socioeconomic conditions. Geographic variation in participation was marked in the Stockholm county, with only one screening clinic. Geo-mapping of participation yielded useful information needed to intervene for improved screening uptake.
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| 8. |
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| 9. |
- Grimsholm, Ola, 1979, et al.
(author)
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Absence of surrogate light chain results in spontaneous autoreactive germinal centres expanding V(H)81X-expressing B cells
- 2015
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In: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 6
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Journal article (peer-reviewed)abstract
- Random recombination of antibody heavy- and light-chain genes results in a diverse B-cell receptor (BCR) repertoire including self-reactive BCRs. However, tolerance mechanisms that prevent the development of self-reactive B cells remain incompletely understood. The absence of the surrogate light chain, which assembles with antibody heavy chain forming a pre-BCR, leads to production of antinuclear antibodies (ANAs). Here we show that the naive follicular B-cell pool is enriched for cells expressing prototypic ANA heavy chains in these mice in a non-autoimmune background with a broad antibody repertoire. This results in the spontaneous formation of T-cell-dependent germinal centres that are enriched with B cells expressing prototypic ANA heavy chains. However, peripheral tolerance appears maintained by selection thresholds on cells entering the memory B-cell and plasma cell pools, as exemplified by the exclusion of cells expressing the intrinsically self-reactive V(H)81X from both pools.
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| 10. |
- Gummesson, Anders, 1973, et al.
(author)
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Non-alcoholic fatty liver disease is a strong predictor of coronary artery calcification in metabolically healthy subjects: A cross-sectional, population-based study in middle-aged subjects
- 2018
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In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 13:8
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Journal article (peer-reviewed)abstract
- Objectives This study aims to estimate the relationship between non-alcoholic fatty liver disease (NAFLD) and measures of atherosclerotic cardiovascular disease (ASCVD), and to determine to what extent such relationships are modified by metabolic risk factors. The study was conducted in the population-based Swedish CArdioPulmonary bioImage Study (SCAPIS) pilot cohort (n = 1015, age 50-64 years, 51.2% women). NAFLD was defined as computed tomography liver attenuation <= 40 Hounsfield Units, excluding other causes of liver fat. Coronary artery calcification score (CACS) was assessed using the Agatston method. Carotid plaques and intima media thickness (IMT) were measured by ultrasound. Metabolic status was based on assessments of glucose homeostasis, serum lipids, blood pressure and inflammation. A propensity score model was used to balance NAFLD and non NAFLD groups with regards to potential confounders and associations between NAFLD status and ASCVD variables in relation to metabolic status were examined by logistic and generalized linear regression models. NAFLD was present in 106 (10.4%) of the subjects and strongly associated with obesity-related traits. NAFLD was significantly associated with CACS after adjustment for confounders and metabolic risk factors (OR 1.77, 95% CI 1.07-2.94), but not with carotid plaques and IMT. The strongest association between NAFLD and CACS was observed in subjects with few metabolic risk factors (n = 612 [60% of all] subjects with 0-1 out of 7 predefined metabolic risk factors; OR 5.94, 95% CI 2.13-16.6). NAFLD was independently associated with coronary artery calcification but not with measures of carotid atherosclerosis in this cohort. The association between NAFLD and CACS was most prominent in the metabolically healthy subjects.
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| 11. |
- Hellström Ängerud, Karin, 1967-
(author)
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Symptoms and care seeking behaviour during myocardial infarction in patients with diabetes
- 2015
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Doctoral thesis (other academic/artistic)abstract
- Background: In Myocardial infarction (MI) it is well established that timely diagnosis and treatment may reduce mortality and improve the prognosis. Therefore it is important that patients with MI seek medical care as soon as possible. Patients with diabetes have a higher risk for MI and worse prognosis compared to patients without diabetes. Previous research is inconclusive regarding symptoms and pre-hospital delay times in MI among patients with diabetes and there is lack of research in how patients with diabetes perceive, interpret and respond to MI symptoms. Aim: The overall aim of this thesis was to explore symptoms and care seeking behaviour during MI in patients with diabetes. Methods: This thesis comprises four studies. Studies I and II were based on data from the Northern Sweden MONICA myocardial infarction registry to describe symptoms in 4028 patients (I) and pre-hospital delay and factors associated with pre-hospital delay of ≥ 2 h in 4266 patients (II). Study III included 694 patients, at five hospitals in Sweden. The patients answered a questionnaire about symptoms, response to symptoms and delay times in MI. In study IV data were collected through interviews about experiences of getting MI and the decision to seek medical care. Results: Study I showed that typical MI symptoms according to MONICA criteria were common in both men and women, both with and without diabetes, and no differences between the groups were found. Study II showed that more patients with diabetes had pre-hospital delay times of ≥ 2 h compared to patients without diabetes. In Study III, chest pain was the most common self-reported MI symptom in patients with and without diabetes and there were no differences between the groups. Shoulder pain/discomfort, shortness of breath and tiredness were more common in patients with diabetes whereas cold sweat was less common compared to patients without diabetes. Less than 40 % of patients with diabetes called the emergency medical services (EMS) as their first medical contact (FMC) and about 60 % initially contacted a spouse after symptom onset. Patients with diabetes reported longer patient delay than patients without diabetes, but after age and gender adjustments the results were not significant. Pain, pressure or discomfort in the stomach, anxiety, symptoms that come and go and thoughts that the symptoms would disappear were associated with longer patient delay in patients with diabetes. In study IV, the analysis revealed the core category “Becoming ready to act” and the categories perceiving symptoms, becoming aware of illness, feeling endangered, and acting on illness experience. Patients with diabetes described a variety of different MI symptoms, the onsets of MI varied and it was sometimes difficult to interpret symptoms as related to MI. The decision to seek medical care for MI was complex with several barriers for timely care seeking. Conclusion: Chest pain was common in patients with diabetes and in contrast to our hypothesis chest pain was equally common in both patients with and without diabetes. There were more similarities than differences in MI symptoms between patients with and without diabetes. However, patients with diabetes were more likely to have pre-hospital delay for 2 hours or more compared to those without diabetes and there seems to be an underutilization of the use of emergency medical services as first medical contact. The process to seek care for MI was complex, initiated by perceiving symptoms, followed by illness awareness, feelings of being endangered and finally acting on the illness experience.
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| 12. |
- Hjelmgren, Ola, et al.
(author)
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Does retinopathy predict stroke recurrence in type 2 diabetes patients: A retrospective study?
- 2019
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In: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 14:1
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Journal article (peer-reviewed)abstract
- Aims To study if retinopathy increases the risk of stroke recurrence in stroke patients with type 2 diabetes. Also, to study if stroke patients with type 2 diabetes have an increased risk of stroke recurrence compared to non-diabetics and if stroke patients with type 2 diabetes, regardless of retinopathy, have a higher incidence of carotid stenosis. Also, to study if stroke patients with type 2 diabetes retinopathy have increased incidence of carotid stenosis. We included 445 patients with type 2 diabetes mellitus and a matched control group of 445 patients without diabetes, who had all suffered their first stroke or TIA. Information on retinopathy, risk factors and stroke recurrence were obtained from registers and medical records. Retinopathy did not increase the risk of stroke recurrence in diabetes patients, HR 0.89 (0.51-1.53), p = 0.67. The risk of stroke recurrence was not increased in diabetics compared to non-diabetes. Diabetes patients had an increased prevalence of carotid stenosis compared to non-diabetics, 1.69 (1.15-2.48), p = 0.008. The prevalence of carotid stenosis in diabetics with retinopathy was not increased compared to diabetics without retinopathy. Retinopathy is not a predictor of stroke recurrence or carotid stenosis in type 2 diabetes patients.
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| 13. |
- Holmen, A., et al.
(author)
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Effect of risk-based payment model on caries inequalities in preschool children assessed by geo-mapping
- 2018
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In: Bmc Oral Health. - : Springer Science and Business Media LLC. - 1472-6831. ; 18:1
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Journal article (peer-reviewed)abstract
- Background: To describe, with aid of geo-mapping, the effects of a risk-based capitation model linked to caries-preventive guidelines on the polarization of caries in preschool children living in the Halland region of Sweden. Methods: The new capitation model was implemented in 2013 in which more money was allocated to Public Dental Clinics surrounded by administrative parishes inhabited by children with increased caries risk, while a reduced capitation was allocated to those clinics with a low burden of high risk children. Regional geo-maps of caries risk based on caries prevalence, level of education and the families purchasing power were produced for 3-6-year-old children in 2010 (n = 10,583) and 2016 (n = 7574). Newly migrated children to the region (n = 344 in 2010 and n = 522 in 2016) were analyzed separately. A regional caries polarization index was calculated as the ratio between the maximum and minimum estimates of caries frequency on parish-level, based on a Bayesian hierarchical mapping model. Results: Overall, the total caries prevalence (dmfs > 0) remained unchanged from 2010 (10.6%) to 2016 (10.5%). However, the polarization index decreased from 7.0 in 2010 to 5.6 in 2016. Newly arrived children born outside Sweden had around four times higher caries prevalence than their Swedish-born peers. Conclusions: A risk-based capitation model could reduce the socio-economic inequalities in dental caries among preschool children living in Sweden. Although updated evidence-based caries-preventive guidelines were released, the total prevalence of caries on dentin surface level was unaffected 4 years after the implementation.
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| 14. |
- Komban, Rathan, et al.
(author)
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Activated Peyer's patch B cells sample antigen directly from M cells in the subepithelial dome.
- 2019
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In: Nature communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 10:1
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Journal article (peer-reviewed)abstract
- The germinal center (GC) reaction in Peyer's patches (PP) requires continuousaccess to antigens, but how this is achieved is not known. Here we show that activated antigen-specific CCR6+CCR1+GL7- B cells make close contact with M cells in the subepithelial dome (SED). Using in situ photoactivation analysis of antigen-specific SED B cells, we find migration of cells towards the GC. Following antigen injection into ligated intestinal loops containing PPs, 40% of antigen-specific SED B cells bind antigen within 2h, whereas unspecifc cells do not, indicating B cell-receptor involvment. Antigen-loading is not observed in M cell-deficient mice, but is unperturbed in mice depleted of classical dendritic cells (DC). Thus, we report a M cell-B cell antigen-specific transporting pathway in PP that is independent of DC. We propose that this antigen transporting pathway has a critical role in gut IgA responses, and should be taken into account when developing mucosal vaccines.
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| 15. |
- Larsson, Glenn, et al.
(author)
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Cognitive status following a hip fracture and its association with postoperative mortality and activities of daily living : A prospective comparative study of two prehospital emergency care procedures
- 2019
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In: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier BV. - 1878-1241.
-
Journal article (peer-reviewed)abstract
- Introduction: Early assessment of hip fracture patients’ cognitive function is important for preventing pre- and postoperative complications. The aim of this study was twofold: (1) to assess prehospital cognitive function in hip fracture patients and establish whether cognitive status differs pre- and postoperatively between prehospital fast track care (PFTC) and the traditional emergency department (ED) pathway and (2) whether preoperative cognitive function is associated with postoperative mortality and activities of daily living (ADL) ability. Methods: Three hundred and ninety one hip fracture patients were prospectively included. The Short Portable Mental Status Questionnaire (SPMSQ) was used prehospital, at the orthopaedic ward and three days postoperatively. ADL was followed up after four months. Results: No difference in patients’ cognitive function was observed between PFTC and ED. Four-month mortality was 37% for patients with dementia, 21% for those with cognitive impairment and 10% for patients without cognitive impariment. Only 26% of patients with dementia and 47% with cognitive impairment had full ADL ability, compared with 70% of patients with intact cognitive function (p < 0.001). Conclusion: PFTC did not influence hip fracture patients’ cognitive function. Patients with prehospital cognitive impairment had a poor outcome in terms of mortality and ADL, indicating the need for special care interventions.
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| 16. |
- Larsson, Glenn, et al.
(author)
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It was not a hip fracture - you were lucky this time - or perhaps not! A prospective study of clinical outcomes in patients with low-energy pelvic fractures and hip contusions
- 2019
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In: Injury-International Journal of the Care of the Injured. - : Elsevier BV. - 0020-1383. ; 50:4, s. 913-918
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Journal article (peer-reviewed)abstract
- Introduction: Prehospital and hospital emergency care guidelines have been developed for patients with suspected hip fracture. Initial radiography can identify a number of patients with other injuries, generally pelvic fractures and hip contusions. Little is known about the prognosis for these patients. The aim of this study is twofold: i) to investigate the injury pattern of patients assessed in prehospital emergency care as suffering from a suspected hip fracture and ii) to compare clinical outcomes between patients with verified hip fracture (HF) and those with other hip injuries (OHI). Method: The study design was prospective. Older patients with suspected HF after low-energy trauma were identified in prehospital emergency care. Injury type was determined by radiological imaging. Comparisons of length of stay, adverse events, repeated prehospital emergency care and mortality were made between verified HF and OHI cases. Results: 449 patients were included, 400 in the HF and 149 in the OHI group (86 hip contusions, 46 pelvic fractures and 17 other injuries/diseases). The HF group had a significantly longer hospital stay (9.5 days vs. 6.3 for the OHI group; p < 0.001) and more adverse events while in hospital (34% vs. 19%; p < 0.001). We found no evidence that the groups differed with regard to other outcomes: mortality during hospital stay (4% vs. 2%, p = 0.42), at 4 (16% vs. 13%; p = 0.35) and 12 months (21 vs. 23%; p = 0.64), the proportion that experienced an adverse event (24% vs. 22%; p = 0.65) and the proportion that required another ambulance transport within 6 months after discharge (40% vs. 34%; p = 0.16). The results were not strongly affected by adjustments for possible confounders. Conclusion: Older patients who suffer a low-energy pelvic fracture or a hip contusion are common in prehospital and hospital emergency care. These patients need attention as they have poor outcomes in terms of adverse events, mortality and recurrent need for ambulance transport after discharge from hospital. While individualized multidisciplinary care is recommended for hip fracture patients, it might also be suitable for other geriatric hip injuries. (C) 2019 Elsevier Ltd. All rights reserved.
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| 17. |
- Larsson, Glenn, et al.
(author)
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Patient satisfaction with prehospital emergency care following a hip fracture : A prospective questionnaire-based study
- 2018
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In: BMC Nursing. - : Springer Science and Business Media LLC. - 1472-6955. ; 17:1
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Journal article (peer-reviewed)abstract
- Background: Older patients with a hip fracture require specialized emergency care and their first healthcare encounter before arriving at the hospital is often with the ambulance service. Since 2005 there has been a registered nurse on the crew of every ambulance in Sweden in order to provide prehospital emergency care and to prepare the patients for hospitalization. It is important to investigate patient satisfaction with prehospital emergency care following a hip fracture to ensure that their expectations of good care are met. The aim of this study was to investigate patient satisfaction with prehospital emergency care following a hip fracture by comparing two similar emergency care contexts. Methods: The study was conducted using the Consumer Emergency Care Satisfaction Scale (CECSS) on patients treated for hip fracture in prehospital emergency care. The data were collected within a randomized controlled study for the purpose of comparing prehospital fast track care (PFTC) and the traditional type of transport to an accident and emergency department (A&E). Results: Questionnaire data from 287 patients, 188 women (66%) and 99 men (34%) with a mean age of 80.9years, were analysed. More than 80% of the patients selected the most positive response alternatives, but 16% were dissatisfied with the nursing information provided. Patients in PFTC responded more positively on specific caring behaviour than those transported to the A&E department in the traditional way. Conclusion: Patient satisfaction with prehospital emergency care following a hip fracture is an important outcome and this study highlights the fact that patients expressed a high level of satisfaction with the prehospital emergency care provided by ambulance nurses in both care contexts under study. However, some areas need to be improved in terms of nursing information.
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| 18. |
- Larsson, Glenn, et al.
(author)
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Prehospital fast track care for patients with hip fracture: Impact on time to surgery, hospital stay, post-operative complications and mortality a randomised, controlled trial.
- 2016
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In: Injury. - : Elsevier BV. - 1879-0267 .- 0020-1383.
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Journal article (peer-reviewed)abstract
- Ambulance organisations in Sweden have introduced prehospital fast track care (PFTC) for patients with suspected hip fracture. This means that the ambulance nurse starts the pre-operative procedure otherwise implemented at the accident & emergency ward (A&E) and transports the patient directly to the radiology department instead of A&E. If the diagnosis is confirmed, the patient is transported directly to the orthopaedic ward. No previous randomised, controlled studies have analysed PFTC to describe its possible advantages. The aim of this study is to examine whether PFTC has any impact on outcomes such as time to surgery, length of stay, post-operative complications and mortality.
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| 19. |
- Lawson, Claire A., et al.
(author)
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Comorbidity health pathways in heart failure patients: A sequences-of-regressions analysis using cross-sectional data from 10,575 patients in the Swedish Heart Failure Registry
- 2018
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In: PLoS Medicine. - : PUBLIC LIBRARY SCIENCE. - 1549-1277 .- 1549-1676. ; 15:3
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Journal article (peer-reviewed)abstract
- Background amp; para;amp; para;Optimally treated heart failure (HF) patients often have persisting symptoms and poor health-related quality of life. Comorbidities are common, but little is known about their impact on these factors, and guideline-driven HF care remains focused on cardiovascular status. The following hypotheses were tested: (i) comorbidities are associated with more severe symptoms and functional limitations and subsequently worse patient-rated health in HF, and (ii) these patterns of association differ among selected comorbidities.amp; para;amp; para;Methods and findings amp; para;amp; para;The Swedish Heart Failure Registry (SHFR) is a national population-based register of HF patients admitted to amp;gt;85% of hospitals in Sweden or attending outpatient clinics. This study included 10,575 HF patients with patient-rated health recorded during first registration in the SHFR (1 February 2008 to 1 November 2013). An a priori health model and sequences-of-regressions analysis were used to test associations among comorbidities and patient-reported symptoms, functional limitations, and patient-rated health. Patient-rated health measures included the EuroQol-5 dimension (EQ-5D) questionnaire and the EuroQol visual analogue scale (EQ-VAS). EQ-VAS score ranges from 0 (worst health) to 100 (best health). Patient-rated health declined progressively from patients with no comorbidities (mean EQVAS score, 66) to patients with cardiovascular comorbidities (mean EQ-VAS score, 62) to patients with non-cardiovascular comorbidities (mean EQ-VAS score, 59). The relationships among cardiovascular comorbidities and patient-rated health were explained by their associations with anxiety or depression (atrial fibrillation, odds ratio [OR] 1.16, 95% CI 1.06 to 1.27; ischemic heart disease [IHD], OR 1.20, 95% CI 1.09 to 1.32) and with pain (IHD, OR 1.25, 95% CI 1.14 to 1.38). Associations of non-cardiovascular comorbidities with patient-rated health were explained by their associations with shortness of breath (diabetes, OR 1.17, 95% CI 1.03 to 1.32; chronic kidney disease [CKD, OR 1.23, 95% CI 1.10 to 1.38; chronic obstructive pulmonary disease [COPD], OR 95% CI 1.84, 1.62 to 2.10) and with fatigue (diabetes, OR 1.27, 95% CI 1.13 to 1.42; CKD, OR 1.24, 95% CI 1.12 to 1.38; COPD, OR 1.69, 95% CI 1.50 to 1.91). There were direct associations between all symptoms and patient-rated health, and indirect associations via functional limitations. Anxiety or depression had the strongest association with functional limitations (OR 10.03, 95% CI 5.16 to 19.50) and patient-rated health (mean difference in EQ-VAS score, -18.68, 95% CI -23.22 to -14.14). HF optimizing therapies did not influence these associations. Key limitations of the study include the cross-sectional design and unclear generalisability to other populations. Further prospective HF studies are required to test the consistency of the relationships and their implications for health.amp; para;amp; para;Conclusions amp; para;amp; para;Identification of distinct comorbidity health pathways in HF could provide the evidence for individualised person-centred care that targets specific comorbidities and associated symptoms.
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| 20. |
- Ljung Faxen, Ulrika, et al.
(author)
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N-terminal pro-B-type natriuretic peptide in chronic heart failure: The impact of sex across the ejection fraction spectrum
- 2019
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In: International Journal of Cardiology. - : ELSEVIER IRELAND LTD. - 0167-5273 .- 1874-1754. ; 21, s. 225-225
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Journal article (peer-reviewed)abstract
- Objective: The aim was to assess sex-specific differences in N-terminal B-type natriuretic peptide (NT-proBNP) regarding concentrations, predictors of high concentrations, and prognostic role, in a large and unselected population with chronic heart failure (HF) with preserved (HFpEF), mid-range (HFmrEF), and reduced ejection fraction (HFrEF). Methods and results: In 9847 outpatients with HFpEF, HFmrEF, and HFrEF (49 vs. 35 vs. 25% females, respectively) from the Swedish HF Registry, median NT-proBNP concentrations were 1598 ng/L in females vs. 1310 ng/L in males in HFpEF, 1764 vs. 1464 ng/L in HFmrEF, and 2543 vs. 2226 ng/L in HFrEF (p amp;lt; 0.05 for all). The differences persisted after multiple adjustment. The largest sex-difference in NT-proBNP levels was observed in HFpEF with sinus rhythm, where median concentrations were 1.4 folds higher in females (923 vs. 647 ng/L). Independent predictors of NT-proBNP levels (defined as above the different medians according to sex and HF phenotype) were overall consistent across sexes and EF. NT-proBNP levels were similarly associated with risk of all-cause death/HF hospitalization in both sexes regardless of EF. Conclusion: Concentrations of NT-proBNPwere higher in females across the EF spectrum, with larger relative differences in HFpEF with sinus rhythm. However, similar predictors of high levels were observed in both sexes. There were no sex-differences in the prognostic role of NT-proBNP. These findings support the use of NT-proBNP for prognostic purposes in chronic HF, regardless of sex. (c) 2019 Elsevier B.V. All rights reserved.
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| 21. |
- Löf, Liza, et al.
(author)
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Flow Cytometric Measurement of Blood Cells with BCR-ABL1 Fusion Protein in Chronic Myeloid Leukemia
- 2017
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In: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 7:1
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Journal article (peer-reviewed)abstract
- Chronic myeloid leukemia (CML) is characterized in the majority of cases by a t(9;22)(q34;q11) translocation, also called the Philadelphia chromosome, giving rise to the BCR-ABL1 fusion protein. Current treatment with tyrosine kinase inhibitors is directed against the constitutively active ABL1 domain of the fusion protein, and minimal residual disease (MRD) after therapy is monitored by real-time quantitative PCR (RQ-PCR) of the fusion transcript. Here, we describe a novel approach to detect and enumerate cells positive for the BCR-ABL1 fusion protein by combining the in situ proximity ligation assay with flow cytometry as readout (PLA-flow). By targeting of the BCR and ABL1 parts of the fusion protein with one antibody each, and creating strong fluorescent signals through rolling circle amplification, PLA-flow allowed sensitive detection of cells positive for the BCR-ABL1 fusion at frequencies as low as one in 10,000. Importantly, the flow cytometric results correlated strongly to those of RQ-PCR, both in diagnostic testing and for MRD measurements over time. In summary, we believe this flow cytometry-based method can serve as an attractive approach for routine measurement of cells harboring BCR-ABL1 fusions, also allowing simultaneously assessment of other cell surface markers as well as sensitive longitudinal follow-up.
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| 24. |
- Nilsson, Anton, et al.
(author)
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Assessing heterogeneous effects and their determinants via estimation of potential outcomes
- 2019
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In: European Journal of Epidemiology. - : Springer Science and Business Media LLC. - 0393-2990 .- 1573-7284. ; 34:9, s. 823-835
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Journal article (peer-reviewed)abstract
- When analyzing effect heterogeneity, the researcher commonly opts for stratification or a regression model with interactions. While these methods provide valuable insights, their usefulness can be somewhat limited, since they typically fail to take into account heterogeneity with respect to many dimensions simultaneously, or give rise to models with complex appearances. Based on the potential outcomes framework and through imputation of missing potential outcomes, our study proposes a method for analyzing heterogeneous effects by focusing on treatment effects rather than outcomes. The procedure is easy to implement and generates estimates that take into account heterogeneity with respect to all relevant dimensions at the same time. Results are easily interpreted and can additionally be represented by graphs, showing the overall magnitude and pattern of heterogeneity as well as how this relates to different factors. We illustrate the method both with simulations and by examining heterogeneous effects of obesity on HDL cholesterol in the Malmo Diet and Cancer cardiovascular cohort. Obesity was associated with reduced HDL in almost all individuals, but effects varied with smoking, risky alcohol consumption, higher education, and energy intake, with some indications of non-linear effects. Our approach can be applied by any epidemiologist who wants to assess the role and strength of heterogeneity with respect to a multitude of factors.
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| 25. |
- Nordander, Catarina, et al.
(author)
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Exposure-response relationships for work-related neck and shoulder musculoskeletal disorders - Analyses of pooled uniform data sets
- 2016
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In: Applied Ergonomics. - : Elsevier BV. - 1872-9126 .- 0003-6870. ; 55, s. 70-84
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Journal article (peer-reviewed)abstract
- There is a lack of quantitative data regarding exposure-response relationships between occupational risk factors and musculoskeletal disorders in the neck and shoulders. We explored such relationships in pooled data from a series of our cross-sectional studies. We recorded the prevalence of complaints/discomfort (Nordic Questionnaire) and diagnoses (physical examination) in 33 groups (24 female and 9 male) within which the workers had similar work tasks (3141 workers, of which 817 were males). In representative sub-groups, we recorded postures and velocities of the head (N = 299) and right upper arm (inclinometry; N = 306), right wrist postures and velocities (electrogoniometry; N = 499), and muscular activity (electromyography) in the right trapezius muscle (N = 431) and forearm extensors (N = 206). We also assessed the psychosocial work environment (Job Content Questionnaire). Uni- and multivariate linear meta-regression analysis revealed several statistically significant group-wise associations. Neck disorders were associated with head inclination, upper arm elevation, muscle activity of the trapezius and forearm extensors and wrist posture and angular velocity. Right-side shoulder disorders were associated with head and upper arm velocity, activity in the trapezius and forearm extensor muscles and wrist posture and angular velocity. The psychosocial work environment (low job control, job strain and isostrain) was also associated with disorders. Women exhibited a higher prevalence of neck and shoulder complaints and tension neck syndrome than men, when adjusting for postures, velocities, muscular activity or psychosocial exposure. In conclusion, the analyses established quantitative exposure-response relationships between neck and shoulder disorders and objective measures of the physical workload on the arm. Such information can be used for risk assessment in different occupations/work tasks, to establish quantitative exposure limits, and for the evaluation of preventive measures.
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