| 1. |
- Ederle, Joerg, et al.
(författare)
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Carotid artery stenting compared with endarterectomy in patients with symptomatic carotid stenosis (International Carotid Stenting Study): an interim analysis of a randomised controlled trial
- 2010
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Ingår i: The Lancet. - 1474-547X. ; 375:9719, s. 985-997
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Tidskriftsartikel (refereegranskat)abstract
- Background Stents are an alternative treatment to carotid endarterectomy for symptomatic carotid stenosis, but previous trials have not established equivalent safety and efficacy. We compared the safety of carotid artery stenting with that of carotid endarterectomy. Methods The International Carotid Stenting Study (ICSS) is a multicentre, international, randomised controlled trial with blinded adjudication of outcomes. Patients with recently symptomatic carotid artery stenosis were randomly assigned in a 1:1 ratio to receive carotid artery stenting or carotid endarterectomy. Randomisation was by telephone call or fax to a central computerised service and was stratified by centre with minimisation for sex, age, contralateral occlusion, and side of the randomised artery. Patients and investigators were not masked to treatment assignment. Patients were followed up by independent clinicians not directly involved in delivering the randomised treatment. The primary outcome measure of the trial is the 3-year rate of fatal or disabling stroke in any territory, which has not been analysed yet. The main outcome measure for the interim safety analysis was the 120-day rate of stroke, death, or procedural myocardial infarction. Analysis was by intention to treat (ITT). This study is registered, number ISRCTN25337470. Findings The trial enrolled 1713 patients (stenting group, n=855; endarterectomy group, n=858). Two patients in the stenting group and one in the endarterectomy group withdrew immediately after randomisation, and were not included in the ITT analysis. Between randomisation and 120 days, there were 34 (Kaplan-Meier estimate 4.0%) events of disabling stroke or death in the stenting group compared with 27 (3.2%) events in the endarterectomy group (hazard ratio [HR] 1.28, 95% CI 0.77-2.11). The incidence of stroke, death, or procedural myocardial infarction was 8.5% in the stenting group compared with 5.2% in the endarterectomy group (72 vs 44 events; HR 1.69, 1.16-2.45, p=0.006), Risks of any stroke (65 vs 35 events; HR 1.92, 1.27-2.89) and all-cause death (19 vs seven events; HR 2.76, 1.16-6.56) were higher in the stenting group than in the endarterectomy group. Three procedural myocardial infarctions were recorded in the stenting group, all of which were fatal, compared with four, all non-fatal, in the endarterectomy group. There was one event of cranial nerve palsy in the stenting group compared with 45 in the endarterectomy group. There were also fewer haematomas of any severity in the stenting group than in the endarterectomy group (31 vs 50 events; p=0.0197). Interpretation Completion of long-term follow-up is needed to establish the efficacy of carotid artery stenting compared with endarterectomy. In the meantime, carotid endarterectomy should remain the treatment of choice for patients suitable for surgery.
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| 2. |
- Corsi, D. J., et al.
(författare)
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Prospective Urban Rural Epidemiology (PURE) study: Baseline characteristics of the household sample and comparative analyses with national data in 17 countries
- 2013
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Ingår i: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 166:4
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The PURE study was established to investigate associations between social, behavioural, genetic, and environmental factors and cardiovascular diseases in 17 countries. In this analysis we compare the age, sex, urban/rural, mortality, and educational profiles of the PURE participants to national statistics. METHODS: PURE employed a community-based sampling and recruitment strategy where urban and rural communities were selected within countries. Within communities, representative samples of adults aged 35 to 70 years and their household members (n = 424,921) were invited for participation. RESULTS: The PURE household population compared to national statistics had more women (sex ratio 95.1 men per 100 women vs 100.3) and was older (33.1 years vs 27.3), although age had a positive linear relationship between the two data sources (Pearson's r = 0.92). PURE was 59.3% urban compared to an average of 63.1% in participating countries. The distribution of education was less than 7% different for each category, although PURE households typically had higher levels of education. For example, 37.8% of PURE household members had completed secondary education compared to 31.3% in the national data. Age-adjusted annual mortality rates showed positive correlation for men (r = 0.91) and women (r = 0.92) but were lower in PURE compared to national statistics (7.9 per 1000 vs 8.7 for men; 6.7 vs 8.1 for women). CONCLUSIONS: These findings indicate that modest differences exist between the PURE household population and national data for the indicators studied. These differences, however, are unlikely to have much influence on exposure-disease associations derived in PURE. Further, incidence estimates from PURE, stratified according to sex and/or urban/rural location will enable valid comparisons of the relative rates of various cardiovascular outcomes across countries.
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| 3. |
- Zuberbier, T., et al.
(författare)
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Economic burden of inadequate management of allergic diseases in the European Union: a GA(2)LEN review
- 2014
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Ingår i: Allergy. - : Wiley. - 0105-4538. ; 69:10, s. 1275-1279
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn the European Union (EU), between 44 and 76 million individuals of the 217 million EU employees suffer from allergic disease of the airways or the skin. Up to 90% of these persons are untreated or insufficiently treated. This has major socio-economic consequences such as absence from work (absenteeism), particularly reduced productivity at work (presenteeism). MethodsWe used published literature and online statistical information from Eurostat and Eurofound to assess the costs of allergic disease to society. ResultsAllergies have an impact on direct, indirect, intangible and opportunity costs. Most importantly, for the EU, avoidable indirect costs per patient insufficiently treated for allergy range between Euro55 and Euro151 billion per annum due to absenteeism and presenteeism, that is, Euro2405 per untreated patient per year. On the other hand, appropriate therapy for allergic diseases is available at comparatively low costs at an average of Euro125 per patient annually, equalling only 5% of the costs of untreated disease, allowing potential savings of up to Euro142 billion. ConclusionsA better care for allergies based on guideline-based treatment would allow Europe's economy substantial savings. In addition, allergies have an impact on learning and performance at school and university, leading to opportunity costs for society. This cannot be calculated moneywise but will have an impact in a modern knowledge-based society. Still allergies are trivialized in society, noting that the costs of therapy are paid by patients and healthcare services, whereas economic savings are made by employers and society. A change of this mindset is urgently needed.
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| 4. |
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| 5. |
- Lynch, Kristian, et al.
(författare)
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Context and disease when disease risk is low: the case of type 1 diabetes in Sweden
- 2010
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Ingår i: Journal of Epidemiology and Community Health. - : BMJ. - 1470-2738 .- 0143-005X. ; 64:9, s. 789-795
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Tidskriftsartikel (refereegranskat)abstract
- Background Several European studies have found significant small area variation in the risk of childhood onset (type 1) diabetes (T1D) which has been interpreted as evidence for contextual determinants of T1D. However, this conclusion may be fallacious since the limited number of newborn infants and the low risk for T1D is a source of spurious variability not properly handled by usual statistical methods. This study investigates the existence of contextual effects in the genesis of T1D, compares conclusions in previous reports with results obtained in a multilevel regression framework and highlights analysis of variance as a useful approach in public health. Methods All singletons born in Sweden between 1987 and 1991 were identified in the Medical Birth Registry (n=560 766) and followed for diabetes until age 14 using the Hospital Discharge Registry. Area variation in the cumulative incidence of T1D was estimated by different statistical methods including multilevel logistic regression. Results The risk of T1D ranged from 4.3 to 6.5 per 1000 newborns across the counties (n=24) and from 0.0 to 19.2 per 1000 newborns across the municipalities (n=284). These differences were significant in standard statistical tests (counties, p=0.02; municipalities, p=0.007). However, according to multilevel analyses, the risk of T1D ranged from 4.7 to 5.7 and from 4.4 to 6.0 per 1000 newborns in counties and municipalities, respectively, and the area variation was small and without practical relevance (counties, sigma(2)=0.006; municipalities, sigma(2)=0.017). Conclusions Previous reports based on standard statistical tests are misleading. According to multilevel analysis, administrative areas have minor relevance for individual risk of T1D in Sweden.
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| 6. |
- Malmberg, Bo, et al.
(författare)
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Links between ill health and regional economic performance : Evidence from Swedish longitudinal data
- 2010
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Ingår i: Environment and planning A. - : SAGE Publications. - 0308-518X .- 1472-3409. ; 42:5, s. 1210-1220
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Tidskriftsartikel (refereegranskat)abstract
- While poor health has been associated with economic outcomes at the national level, its effect on economic outcomes at the individual and local level remains less well known. Using nationally representative longitudinal data from Sweden, we examined the extent to which an individual’s poor health leads to poor economic outcomes for that individual. In order to understand the effects of poor health at a regional level, we also examined the spillover effects of the individual’s poor health on the economic outcomes of the people linked to the individual. We report an association between an individual’s poor health and both that individual’s subsequent adverse economic outcomes and adverse economic outcomes of the individual’s network. Our study highlights the importance of the association between health and economic well-being as well as potential adverse spillover effects of poor health on local economies.
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| 7. |
- Merlo, Juan, et al.
(författare)
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Revisiting causal neighborhood effects on individual ischemic heart disease risk: A quasi-experimental multilevel analysis among Swedish siblings.
- 2013
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 1873-5347 .- 0277-9536. ; 76, s. 39-46
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Tidskriftsartikel (refereegranskat)abstract
- Neighborhood socioeconomic disadvantage is associated to increased individual risk of ischemic heart disease (IHD). However, the value of this association for causal inference is uncertain. Moreover, neighborhoods are often defined by available administrative boundaries without evaluating in which degree these boundaries embrace a relevant socio-geographical context that condition individual differences in IHD risk. Therefore, we performed an analysis of variance, and also compared the associations obtained by conventional multilevel analyses and by quasi-experimental family-based design that provides stronger evidence for causal inference. Linking the Swedish Multi-Generation Register to several other national registers, we analyzed 184,931 families embracing 415,540 full brothers 45-64 years old in 2004, and residing in 8408 small-area market statistics (SAMS) considered as "neighborhoods" in our study. We investigated the association between low neighborhood income (categorized in groups by deciles) and IHD risk in the next four years. We distinguished between family mean and intrafamilial-centered low neighborhood income, which allowed us to investigate both unrelated individuals from different families and full brothers within families. We applied multilevel logistic regression techniques to obtain odds ratios (OR), variance partition coefficients (VPC) and 95% credible intervals (CI). In unrelated individuals a decile unit increase of low neighborhood income increased individual IHD risk (OR = 1.04, 95% CI: 1.03-1.07). In the intrafamilial analysis this association was reduced (OR = 1.02, 95% CI: 1.02-1.04). Low neighborhood income seems associated with IHD risk in middle-aged men. However, despite the family-based design, we cannot exclude residual confounding by genetic and non-shared environmental factors. Besides, the low neighborhood level VPC = 1.5% suggest that the SAMS are a rather inappropriate construct of the socio-geographic context that conditions individual variance in IHD risk. In contrast the high family level VPC = 20.1% confirms the relevance of the family context for understanding IHD risk.
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| 8. |
- Nicholls, Ian A., et al.
(författare)
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Rational design of biomimetic molecularly imprinted materials : theoretical and computational strategies for guiding nanoscale structured polymer development
- 2011
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Ingår i: Analytical and Bioanalytical Chemistry. - : Springer Science and Business Media LLC. - 1618-2642 .- 1618-2650. ; 400:6, s. 1771-1786
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Forskningsöversikt (refereegranskat)abstract
- In principle, molecularly imprinted polymer science and technology provides a means for ready access to nano-structured polymeric materials of predetermined selectivity. The versatility of the technique has brought it to the attention of many working with the development of nanomaterials with biological or biomimetic properties for use as therapeutics or in medical devices. Nonetheless, the further evolution of the field necessitates the development of robust predictive tools capable of handling the complexity of molecular imprinting systems. The rapid growth in computer power and software over the past decade has opened new possibilities for simulating aspects of the complex molecular imprinting process. We present here a survey of the current status of the use of in silico-based approaches to aspects of molecular imprinting. Finally, we highlight areas where ongoing and future efforts should yield information critical to our understanding of the underlying mechanisms sufficient to permit the rational design of molecularly imprinted polymers.
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| 9. |
- Orrling, Diana, 1978-
(författare)
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Towards Abatement of Selected Emissions from Metals Manufacturing
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Although the metallurgical industry has made great strides in the reduction of unwanted emissions to the atmosphere as a result of production processes, significant challenges still exist. From a global perspective, even large reductions in emissions per produced ton become immaterial when considering that the total world production of metals continues to increase. Two such particularly hazardous emissions are sulfur dioxide, primarily from copper ore roasting, and mercury, which has had increasing emissions from the steel industry in recent years. Both pollutants have severe consequences for the environment and also for human health. The primary motivations of this work have hence been: (1). to study sulfate formation on soot from sulfur dioxide emissions reacting with ozone and H2O in the vapor phase and (2). to study factors involving the behavior of mercury adsorption on metal surfaces involved in steelmaking, in order to further the understanding of select emissions from scrap-based steelmaking. Gas phase experiments were conducted to examine the heterogeneous oxidation of sulfur dioxide on soot in the presence of ozone and water vapor. The sulfur dioxide oxidation into sulfate was quantified using a particle-into-liquid sampler coupled with ion chromatography to measure the sulfate formation at atmospheric pressure. Water vapor, ozone and sulfur dioxide concentrations were controlled. Due to the ozone oxidation, multilayer adsorption of sulfur dioxide on soot, as well as sulfate formation and physisorption on secondary surface layer sites were observed. The exposure also caused the soot to become hydrophilic, due to the sulfur dioxide adsorption and also likely the formation of carboxyl groups on the surface. No significant increase in sulfate formation was observed at ozone concentrations above 1000 ppm. The effects of common surface contaminants such as oxygen and chlorine were examined on the metal surfaces, as well as the impact of changes in temperature, with controlled conditions using thermal desorption auger electron spectroscopy. It was established that low temperatures (82 K through 111 K) were conducive to mercury adsorption, wherein physisorption and subsequent lateral mercury interactions in mercury adlayers occurred. Chlorine appeared to favor mercury uptake, as determined by the increased mercury coverage at low temperatures on polycrystalline iron, copper and zinc. Oxygen, however, was found to be an inhibitor of mercury, most notably at room temperature. It was surprising to establish that no mercury adsorbed on zinc surfaces at room temperature and only on polycrystalline samples at low temperature. The mercury signal intensity increased up to the limit of the melting temperature for iron systems, on the oxidized copper surface and the polycrystalline zinc surfaces, prior to desorption from the surfaces. It is suggested that this is due to a rearrangement of mercury atoms on the surface at increasing temperatures, whereas at 85 K, mercury adhered to its initial adsorption position. In other words, mercury wet these surfaces on annealing, transitioning from an islanded surface at low temperature to a smooth layer before desorption. Based on these results, it was concluded that the mercury bond to the oxidized surface was weakened compared to clean copper. Furthermore, it is proposed that a surface phase transition occurred on polycrystalline zinc prior to desorption. No such transition was observed on iron. Activation energies of desorption were calculated for the relevant metal surfaces. It was established that clean iron had the highest activation energy of desorption. The large bond strength between mercury and iron may account for the highest desorption temperature of the iron systems. Zinc and copper had similar activation energies and desorption temperatures, which were respectively lower than that of iron. X-Ray Photoelectron and Auger Electron Spectroscopy were used to ascertain common surface contamination, i.e. chlorine, oxygen and sulfur, which affected mercury adsorption. Laser Ablation Inductively Coupled Plasma Time of Flight Mass Spectrometry was used to determine the depth of mercury adsorption on the samples. The technique also showed that the samples contained mercury in the surface layers. Accompanied by the rising demand for metals is the increase in emissions from metals manufacturing. Moreover, it is critical to minimize sulfur dioxide emissions as particulates from soot continue to be released in the atmosphere. For scrap-based steelmaking, monolayer mercury adsorption on clean iron and copper at room temperature are significant results. With the rising use of electronic devices in vehicles, the sorting of scrap becomes increasingly important. Mercury not adsorbing on zinc at room temperature is also of relevance as it disproves the theory of increased mercury adsorption with the increased use of galvanized scrap in summer conditions. However, the low temperature studies showed multilayer adsorption of mercury on iron, zinc and copper, which has relevance for the reported temporal variations of mercury deposition in arctic regions. Keywords: mercury, iron, zinc, sulfur dioxide, adsorption, pollution, thermal desorption, polycrystalline, surfaces, spectroscopy
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