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  • 151. Bomba, David
    et al.
    Svärdsudd, Kurt
    Kristiansson, Per
    A comparison of patient attitudes towards the use of computerized medical records and unique identifiers in Australia and Sweden2004Inngår i: Australian Journal of Primary Health, ISSN 1448-7527, E-ISSN 1836-7399, Vol. 10, s. 36-41Artikkel i tidsskrift (Fagfellevurdert)
  • 152.
    Bondesson, Elisabeth
    et al.
    Lund Univ, Fac Med, Dept Clin Sci Lund, Div Orthopaed, Lund, Sweden.;Skane Univ Hosp, Dept Neurosurg & Pain Rehabil, Lund, Sweden.
    Joud, Anna
    Lund Univ, Fac Med, Dept Clin Sci Lund, Div Orthopaed, Lund, Sweden.;Lund Univ, Fac Med, Dept Lab Med, Div Occupat & Environm Med, Lund, Sweden.;Skane Univ Hosp, Dept Res & Educ, Lund, Sweden.
    Stigmar, Kjerstin
    Lund Univ, Dept Hlth Sci, Div Physiotherapy, Lund, Sweden.
    Ringqvist, Asa
    Skane Univ Hosp, Dept Neurosurg & Pain Rehabil, Lund, Sweden.
    Kraepelien, Martin
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Hlth Care Serv, Stockholm, Sweden.
    Kaldo, Viktor
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Stockholm Hlth Care Serv, Stockholm, Sweden.;Linnaeus Univ, Fac Hlth & Life Sci, Dept Psychol, Växjö, Sweden.
    Wettermark, Björn
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaci.
    Forsell, Yvonne
    Karolinska Inst, Dept Global Publ Hlth, Stockholm, Sweden.
    Petersson, Ingemar F.
    Lund Univ, Fac Med, Dept Clin Sci Lund, Div Orthopaed, Lund, Sweden.;Skane Univ Hosp, Dept Res & Educ, Lund, Sweden.
    Schelin, Maria E. C.
    Skane Univ Hosp, Dept Res & Educ, Lund, Sweden.;Lund Univ, Lund, Sweden.;Inst Palliat Care, Lund, Sweden.
    Utilization of healthcare and prescription medicines after non-pharmacological interventions for depression - A 3-year register follow-up of an RCT in primary care2022Inngår i: Preventive Medicine Reports, E-ISSN 2211-3355, Vol. 25, artikkel-id 101658Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Depression is a common, recurrent disorder. There is a need for readily available treatments with few negative side effects, that demands little resources and that are effective both in the short- and long term. Our aim was to investigate the long-term effectiveness of two different interventions; physical exercise and internet-based cognitive behavioural therapy (internet-CBT), compared to usual care in patients with mild to moderate depression in a Swedish primary care setting. We performed a register-based 3-year follow-up study of participants in the randomized controlled trial REGASSA (n = 940) using healthcare utilization and dispensed medicines as outcomes. We found no difference between the three groups regarding proportion of participants consulting healthcare due to mental illness or pain during follow-up. Regarding number of consultations, there was no difference between the groups, except for consultations related to pain. For this outcome both treatment arms had significantly fewer consultations compared to usual care, during year 2-3, the risk ratio (RR) for physical exercise and internet-CBT was 0.64 (95% CI = 0.43-0.95) and 0.61 (95% CI = 0.41-0.90), respectively. A significantly lower proportion of patients in both treatment arms were dispensed hypnotics and sedatives year 2-3 compared to the usual care arm, RR for both physical exercise and internet-CBT was 0.72 (95% CI = 0.53-0.98). No other differences between the groups were found. In conclusion, considering long-term effects, both physical exercise and internet-CBT, being resource-efficient treatments, could be considered as appropriate additions for patients with mild to moderate depression in primary care settings.

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  • 153.
    Borssen, Åsa D.
    et al.
    Umeå University, Sweden.
    Palmqvist, Richard
    Umeå University, Sweden.
    Kechagias, Stergios
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Magtarmmedicinska kliniken.
    Marschall, Hanns-Ulrich
    University of Gothenburg, Sweden.
    Bergquist, Annika
    Karolinska University, Sweden.
    Rorsman, Fredrik
    Uppsala University, Sweden.
    Weiland, Ola
    Karolinska University, Sweden.
    Verbaan, Hans
    Lund University, Sweden.
    Nyhlin, Nils
    Örebro University, Sweden.
    Nilsson, Emma
    Lund University, Sweden.
    Werner, Marten
    Umeå University, Sweden.
    Histological improvement of liver fibrosis in well-treated patients with autoimmune hepatitis A cohort study2017Inngår i: Medicine, ISSN 0025-7974, E-ISSN 1536-5964, Vol. 96, nr 34, artikkel-id e7708Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Autoimmune hepatitis (AIH) is a chronic autoimmune liver disease that if left untreated may lead to the development of cirrhosis. Previous studies on AIH patients have suggested that fibrosis and even cirrhosis can be reversed by medical treatment. The aim of this study was to evaluate the efficacy of medical treatment for protection of developing fibrosis and cirrhosis. A total of 258 liver biopsies from 101 patients (72 women, 29 men) were analyzed by a single pathologist and classified according to the Ishak grading (inflammation) and staging (fibrosis) system. Liver histology was stratified according to the temporal changes of fibrosis stage (increased, decreased, or stable), and groups were compared. Complete or partial response to medical treatment was 94.9%. Reduction of fibrosis stage from the first to the last biopsy was seen in 63 patients (62.4%). We found an association between a reduction in the fibrosis stage and continuous glucocorticoid medication, as well as lowered scores of inflammation at last biopsy. Twenty-one patients had cirrhosis (Ishak stage 6) at least in one of the previous biopsies, but only 5 patients at the last biopsy. Histological improvement is common in AIH patients that respond to medical treatment, and a reduction or stabilization of fibrosis stage occurs in about 2/3 of such patients.

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  • 154.
    Bower, Hannah
    et al.
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Frisell, Thomas
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Di Giuseppe, Daniela
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Delcoigne, Benedicte
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Alenius, Gerd-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Baecklund, Eva
    Unit of Rheumatology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Chatzidionysiou, Katerina
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Feltelius, Nils
    Swedish Medical Products Agency, Uppsala, Sweden; Department of Public Health and Caring Sciences, Uppsala Universitet, Uppsala, Sweden.
    Forsblad-Delia, Helena
    Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kastbom, Alf
    Department of Biomedical and Clinical Sciences, Linkopings Universitet, Linkoping, Sweden.
    Klareskog, Lars
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Lindqvist, Elisabet
    Department of Clinical Sciences, Rheumatology Lund University, Lund, Sweden.
    Lindstrom, Ulf
    Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Turesson, Carl
    Rheumatology, Department of Clinical Sciences, Lund University, Malmo, Sweden.
    Sjowall, Christopher
    Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden.
    Askling, Johan
    Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Effects of the COVID-19 pandemic on patients with inflammatory joint diseases in Sweden: From infection severity to impact on care provision2021Inngår i: RMD Open, E-ISSN 2056-5933, Vol. 7, nr 3, artikkel-id e001987Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To compare risks for COVID-19-related outcomes in inflammatory joint diseases (IJDs) and across disease-modifying antirheumatic drugs (DMARDs) during the first two waves of the pandemic and to assess effects of the pandemic on rheumatology care provision.

    Methods: Through nationwide multiregister linkages and cohort study design, we defined IJD and DMARD use annually in 2015-2020. We assessed absolute and relative risks of hospitalisation or death listing COVID-19. We also assessed the incidence of IJD and among individuals with IJD, rheumatologist visits, DMARD use and incidence of selected comorbidities.

    Results: Based on 115 317 patients with IJD in 2020, crude risks of hospitalisation and death listing COVID-19 (0.94% and 0.33% across both waves, respectively) were similar during both waves (adjusted HR versus the general population 1.33, 95% CI 1.23 to 1.43, for hospitalisation listing COVID-19; 1.23, 95% CI 1.08 to 1.40 for death listing COVID-19). Overall, biological disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) did not increase risks of COVID-19 related hospitalisation (with the exception of a potential signal for JAK inhibitors) or death. During the pandemic, decreases were observed for IJD incidence (-7%), visits to rheumatology units (-16%), DMARD dispensations (+6.5% for bDMARD/tsDMARDs and-8.5% for conventional synthetic DMARDs compared with previous years) and for new comorbid conditions, but several of these changes were part of underlying secular trends.

    Conclusions: Patients with IJD are at increased risk of serious COVID-19 outcomes, which may partially be explained by medical conditions other than IJD per se. The SARS-CoV-2 pandemic has exerted measurable effects on aspects of rheumatology care provision demonstrated, the future impact of which will need to be assessed.

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  • 155.
    Bower, Hannah
    et al.
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Frisell, Thomas
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Di Giuseppe, Daniela
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Delcoigne, Bénédicte
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Alenius, Gerd-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Reumatologi.
    Baecklund, Eva
    Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Chatzidionysiou, Katerina
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Feltelius, Nils
    Swedish Medical Products Agency, Uppsala, Sweden.
    Forsblad-D'elia, Helena
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kastbom, Alf
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Klareskog, Lars
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Lindqvist, Elisabet
    Department of Clinical Sciences, Lund University, Lund, Sweden.
    Lindström, Ulf
    Department of Rheumatology and Inflammation Research, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Turesson, Carl
    Rheumatology, Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Sjöwall, Christopher
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Askling, Johan
    Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
    Impact of the COVID-19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population: a nationwide Swedish cohort study2021Inngår i: Annals of the Rheumatic Diseases, ISSN 0003-4967, E-ISSN 1468-2060, Vol. 80, nr 8, s. 1086-1093Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To estimate absolute and relative risks for all-cause mortality and for severe COVID-19 in inflammatory joint diseases (IJDs) and with antirheumatic therapies.

    Methods: Through Swedish nationwide multiregister linkages, we selected all adult patients with rheumatoid arthritis (RA, n=53 455 in March 2020), other IJDs (here: spondyloarthropathies, psoriatic arthritis and juvenile idiopathic arthritis, n=57 112), their antirheumatic drug use, and individually matched population referents. We compared annual all-cause mortality March-September 2015 through 2020 within and across cohorts, and assessed absolute and relative risks for hospitalisation, admission to intensive care and death due to COVID-19 March-September 2020, using Cox regression.

    Results: During March-September 2020, the absolute all-cause mortality in RA and in other IJDs was higher than 2015-2019, but relative risks versus the general population (around 2 and 1.5) remained similar during 2020 compared with 2015-2019. Among patients with IJD, the risks of hospitalisation (0.5% vs 0.3% in their population referents), admission to intensive care (0.04% vs 0.03%) and death (0.10% vs 0.07%) due to COVID-19 were low. Antirheumatic drugs were not associated with increased risk of serious COVID-19 outcomes, although for certain drugs, precision was limited.

    Conclusions: Risks of severe COVID-19-related outcomes were increased among patients with IJDs, but risk increases were also seen for non-COVID-19 morbidity. Overall absolute and excess risks are low and the level of risk increases are largely proportionate to those in the general population, and explained by comorbidities. With possible exceptions, antirheumatic drugs do not have a major impact on these risks.

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  • 156.
    Bozaghian, Sadaf
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    McGrath, Aleksandra M
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Handkirurgi. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Karlsson, Roger
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Evidensbaserad konsultation som får plats i fickan2020Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117, artikkel-id FXP7Artikkel i tidsskrift (Annet (populærvitenskap, debatt, mm))
  • 157.
    Bozorg, Soran Rabin
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Various Aspects of Gastrointestinal Disease: Examining Validity and Health Economic Outcomes2022Licentiatavhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Introduction: Recent years have seen significant research advances within the gastroenterological field. Some of these consist of the recognition of serrated polyps as a precursor to colorectal cancer, and the realization of the health economic burden associated with gastrointestinal diseases.

    Aim: In this thesis, we aim to validate the specificity of serrated polyps in the ESPRESSO cohort (Paper I). We also aim to estimate work loss in patients with celiac disease, including the temporal relationship of work loss before and after diagnosis (Paper II).

    Method: By using the ESPRESSO cohort, we collected data on patients with serrated polyps and patients with celiac disease. In Paper I, the specificity of serrated polyps in the ESPRESSO cohort were validated by a structured retrospective review of patient chart. In Paper II, we estimated work loss in patients with celiac disease as compared withgeneral-population comparators matched on age, sex, county of residence and year of diagnosis.

    Result: The presence of a serrated polyp was confirmed in 101 out of 106 individuals identified through the ESPRESSO cohort, yielding a positive predictive value of 95% (95% confidence interval: 89-98%). Patients with celiac disase had 42.5 lost work days as compared to 28.6 days in comparators (mean difference, 14.7; 95% confidence interval, 13.2-16.2), corresponding to a relative increase of 49%. Excess work loss in patients with celiac disease was observed even 5 years before diagnosis and remained eleveated during the years after diagnosis this loss. Notebly, the excess work loss was concentrated to a small proportion while most celiac patients did not have any work loss before or after diagnosis. 

    Conclusion: The ESPRESSO cohort has a high specificity for serrated polyps. Patients with celiac disease miss more work days than the general population even before diagnosis, and this loss persists after diagnosis.

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  • 158.
    Brenda, Trinh
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Diagnostisk träffsäkerhet av mediaotit hos läkarstudenter och ST-läkare i allmänmedicin2023Independent thesis Advanced level (professional degree), 20 poäng / 30 hpOppgave
  • 159.
    Brinck, Jonas
    et al.
    Patientområde Endokrinologi och njurmedicin - Stockholm, Sweden .
    Hagström, Emil
    Akademiska sjukhuset - Uppsala, Sweden .
    Benedek, Peter
    Karolinska institutet - Stockholm, Sweden .
    Hedelin, Rikard
    Norrlands universitetssjukhus - Umea, Sweden .
    Muhr, Thomas
    Region Östergötland, Hjärt- och Medicincentrum, Kardiologiska kliniken US.
    Svennberg, Lars
    Region Gävleborg - Gävle, Sweden .
    Reinhardt, Wolfgang
    Skånes universitetssjukhus Malmö, Sweden.
    Eriksson, Mats
    Karolinska Universitetssjukhuset - Stockholm, Sweden.
    E78.0A – en unik, ny ICD-10-kod för familjär hyperkolesterolemi [Sweden introduces a new specific ICD-10 code for the disease familial hypercholesterolemia]2019Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 116Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    At the turn of the year 2018/19, a new ICD-10 code (E78.0A) will be introduced in Sweden for the hereditary blood lipid disorder familial hypercholesterolemia (FH). Patients with FH have a significantly increased risk of developing atherosclerotic disease, such as myocardial infarction before the age of 50. However, early diagnosis and start of treatment of FH can ameliorate the diseases negative long term effects. The Swedish National Board of Health and Welfare gave in its guidelines from 2015 a high priority to the work of identifying and diagnosing individuals with FH in the general population. The introduction of the ICD-10 code E78.0A for FH may, when properly used, be an effective tool in this work.

  • 160.
    Bro, Tomas
    Linköpings universitet, Institutionen för biomedicinska och kliniska vetenskaper, Avdelningen för sinnesorgan och kommunikation. Linköpings universitet, Medicinska fakulteten.
    Worldwide ophthalmological research production 2000-2020, with special focus on the Nordic contribution2022Inngår i: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 100, nr 8, s. e1760-e1766Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose To explore the trends in worldwide ophthalmic research production over a 21-year period in relation to journals, contributing countries and dominating topics with special focus on the Nordic region. Methods Articles published between 2000 and 2020 in 20 top-ranked ophthalmology journals were included. Number of articles and impact points were measured per country for each year. The most frequently occurring keywords were calculated worldwide and for the top five contributing countries and the Nordic countries. Trends were explored using linear regression. Results The analysis included 65 220 articles. Linear regression showed an increase with 56 articles per year (beta = 56.3, R-2 = 0.72, p-value < 0.01). The United States published the most articles, comprising 35% of the worldwide total, followed by the United Kingdom (9%) and Japan (7%). Population-adjusted productivity revealed that Iceland was the most prolific country with 10 articles per million inhabitants/year. Singapore was second and Denmark third with corresponding numbers of nine and seven. Analysing regional trends, Asia had the largest increase in yearly number of articles (beta = 29.1, R-2 = 0.89, p-value < 0.01). The strongest positive trend was observed in China (beta = 15.7, R-2 = 0.94, p-value < 0.01). The Nordic countries contributed with 3.6% of worldwide ophthalmological papers. Among these, Denmark was the only country with a significant positive trend in impact points per million inhabitants per year (beta = 0.6, R-2 = 0.54, p-value < 0.01). The most frequently occurring eye disease within the whole time frame was myopia (5.8%) followed by macular degeneration (5.4%) and glaucoma (5.3%). Linear regression showed a significant increase in the proportion of articles about diabetic retinopathy (beta = 0.2%, R-2 = 0.88, p-value < 0.01) a significant decrease in the proportion in articles about cataract (beta = -0.1%, R-2 = 0.70, p-value < 0.01) and myopia (beta = -0.1%, R-2 = 0.67, p-value < 0.01). Conclusions The worldwide ophthalmic research productivity has maintained a growing trend from 2000 to 2020. While North America and Europe are the major contributors, the scientific activity in Asia and especially China is growing impressively. With the current progress, Asia is forecast to outweigh Europe in 2025 and North America in 2033. Diabetic retinopathy was the most common eye disease in ophthalmologic papers in 2020, and also the topic with the strongest positive trend during 2000-2020.

  • 161.
    Brochard, Laurent
    et al.
    St Michaels Hosp, Li Ka Shing Knowledge Inst, Keenan Res Ctr, 30 Bond St, Toronto, ON M5B 1W8, Canada.;Univ Toronto, Interdept Div Crit Care Med, Toronto, ON, Canada..
    Hedenstierna, Göran
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Klinisk fysiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Hedenstiernalaboratoriet.
    Ten physiologic advances that improved treatment for ARDS2016Inngår i: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 42, nr 5, s. 814-816Artikkel i tidsskrift (Annet vitenskapelig)
  • 162.
    Brodin, Daniel
    et al.
    Capio St Gorans Hosp, Dept Med, Stockholm, Sweden..
    Tornhammar, Per
    Karolinska Inst, Funct Area Emergency Med, Stockholm, Sweden..
    Ueda, Peter
    Karolinska Inst, Dept Med, Clin Epidemiol Div, Solna, Stockholm, Sweden..
    Krifors, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Karolinska Inst, Dept Physiol & Pharmacol, Stockholm, Sweden.;Uppsala Univ, Ctr Clin Res Vastmanland, Uppsala, Sweden..
    Westerlund, Eli
    Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden..
    Athlin, Simon
    Örebro Univ, Sch Med Sci, Örebro, Sweden..
    Wojt, Sandra
    Danderyd Hosp, Dept Internal Med, Stockholm, Sweden..
    Elvstam, Olof
    Cent Hosp Växjö, Dept Infect Dis, Växjö, Sweden..
    Neumann, Anca
    Capio St Gorans Hosp, Dept Med, Stockholm, Sweden..
    Elshani, Arsim
    Karlskoga Hosp, Dept Med & Geriatr, Karlskoga, Sweden..
    Giesecke, Julia
    Karolinska Inst, Funct Area Emergency Med, Stockholm, Sweden..
    Edvardsson-Kaellkvist, Jens
    Karolinska Univ Hosp, Stockholm, Sweden..
    Bunpuckdee, Sayam
    Karolinska Inst, Funct Area Emergency Med, Stockholm, Sweden..
    Unge, Christian
    Danderyd Hosp, Dept Internal Med, Stockholm, Sweden..
    Larsson, Martin
    Karolinska Univ Hosp, Dept Endocrinol, Stockholm, Sweden.;Karolinska Inst, Dept Mol Med & Surg, Stockholm, Sweden..
    Johansson, Bjorn
    Hallands Hosp Halmstad, Dept Infect Dis, Halmstad, Sweden..
    Ljungberg, Johan
    Hallands Hosp Halmstad, Dept Infect Dis, Halmstad, Sweden..
    Lindell, Jonas
    Visby Hosp, Dept Infect Dis, Visby, Sweden..
    Hansson, Johan
    Östersund Hosp, Dept Infect Dis, Östersund, Sweden..
    Blennow, Ola
    Capio St Gorans Hosp, Dept Med, Stockholm, Sweden.;Karolinska Univ Hosp, Dept Infect Dis, Stockholm, Sweden..
    Andersson, Daniel Peter
    Karolinska Univ Hosp, Karolinska Inst, Dept Med Huddinge H7, Stockholm, Sweden..
    Inhaled ciclesonide in adults hospitalised with COVID-19: a randomised controlled open-label trial (HALT COVID-19)2023Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 13, nr 2, artikkel-id e064374Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To assess the efficacy of inhaled ciclesonide in reducing the duration of oxygen therapy (an indicator of time to clinical improvement) among adults hospitalised with COVID-19.

    Design: Multicentre, randomised, controlled, open-label trial

    .Setting: 9 hospitals (3 academic hospitals and 6 non-academic hospitals) in Sweden between 1 June 2020 and 17 May 2021.

    Participants: Adults hospitalised with COVID-19 and receiving oxygen therapy.

    Intervention: Inhaled ciclesonide 320 mu g two times a day for 14 days versus standard care.

    Main outcome measures: Primary outcome was duration of oxygen therapy, an indicator of time to clinical improvement. Key secondary outcome was a composite of invasive mechanical ventilation/death.

    Results: Data from 98 participants were analysed (48 receiving ciclesonide and 50 receiving standard care; median (IQR) age, 59.5 (49-67) years; 67 (68%) men). Median (IQR) duration of oxygen therapy was 5.5 (3-9) days in the ciclesonide group and 4 (2-7) days in the standard care group (HR for termination of oxygen therapy 0.73 (95% CI 0.47 to 1.11), with the upper 95% CI being compatible with a 10% relative reduction in oxygen therapy duration, corresponding to a < 1 day absolute reduction in a post-hoc calculation). Three participants in each group died/received invasive mechanical ventilation (HR 0.90 (95% CI 0.15 to 5.32)). The trial was discontinued early due to slow enrolment.

    Conclusions: In patients hospitalised with COVID-19 receiving oxygen therapy, this trial ruled out, with 0.95 confidence, a treatment effect of ciclesonide corresponding to more than a 1 day reduction in duration of oxygen therapy. Ciclesonide is unlikely to improve this outcome meaningfully.

    Fulltekst (pdf)
    fulltext
  • 163.
    Brorstad, Alette
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Oscarsson, Kristina Bergstedt
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Ahlm, Clas
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi, Infektionssjukdomar.
    Early diagnosis of hantavirus infection by family doctors can reduce inappropriate antibiotic use and hospitalization2010Inngår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 28, nr 3, s. 179-184Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Raised awareness in general practice regarding emerging infections and better diagnostic tools are desirable. This study of a Hantavirus outbreak shows that general practitioners are frontline doctors during outbreaks and through early and correct diagnosis they can reduce antibiotic treatment and hospitalization.

  • 164.
    Brunström, Mattias
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Questionable Conclusions Regarding Blood Pressure End Points Reply2018Inngår i: JAMA Internal Medicine, ISSN 2168-6106, E-ISSN 2168-6114, Vol. 178, nr 4, s. 575-576Artikkel i tidsskrift (Fagfellevurdert)
  • 165.
    Brunström, Mattias
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Ng, Nawi
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Department of Public Health and Community Medicine, University of Gothenburg, Gothenburg, Sweden.
    Dahlström, John
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Lindholm, Lars H.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Lönnberg, Göran
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Norberg, Margareta
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Kardiologi.
    Nyström, Lennarth
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Weinehall, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för epidemiologi och global hälsa.
    Carlberg, Bo
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Association of Physician Education and Feedback on Hypertension Management With Patient Blood Pressure and Hypertension Control2020Inngår i: JAMA Network Open, E-ISSN 2574-3805, Vol. 3, nr 1, artikkel-id e1918625Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Importance: Elevated systolic blood pressure (SBP) is the most important risk factor for premature death worldwide. However, hypertension detection and control rates continue to be suboptimal.

    Objective: To assess the association of education and feedback to primary care physicians with population-level SBP and hypertension control rates.

    Design, Setting, and Participants: This pooled series of 108 population-based cohort studies involving 283 079 patients used data from primary care centers in 2 counties (Västerbotten and Södermanland) in Sweden from 2001 to 2009. Participants were individuals aged 18 years or older who had their blood pressure (BP) measured and recorded in either county during the intervention period. All analyses were performed in February 2019.

    Exposures: An intervention comprising education and feedback for primary care physicians in Västerbotten County (intervention group) compared with usual care in Södermanland County (control group).

    Main Outcomes and Measures: Difference in mean SBP levels between counties and likelihood of hypertension control in the intervention county compared with the control county during 24 months of follow-up.

    Results: A total of 136 541 unique individuals (mean [SD] age at inclusion, 64.6 [16.1] years; 57.0% female; mean inclusion BP, 142/82 mm Hg) in the intervention county were compared with 146 538 individuals (mean [SD] age at inclusion, 65.7 [15.9] years; 58.3% female; mean inclusion BP, 144/80 mm Hg) in the control county. Mean SBP difference between counties during follow-up, adjusted for inclusion BP and other covariates, was 1.1 mm Hg (95% CI, 1.0-1.1 mm Hg). Hypertension control improved by 8.4 percentage points, and control was achieved in 37.8% of participants in the intervention county compared with 29.4% in the control county (adjusted odds ratio, 1.30; 95% CI, 1.29-1.31). Differences between counties increased during the intervention period and were more pronounced in participants with higher SBP at inclusion. Results were consistent across all subgroups.

    Conclusions and Relevance: This study suggests that SBP levels and hypertension control rates in a county population may be improved by educational approaches directed at physicians and other health care workers. Similar strategies may be adopted to reinforce the implementation of clinical practice guidelines for hypertension management.

    Fulltekst (pdf)
    fulltext
  • 166. Bruun Kristensen, Kasper
    et al.
    Karlstad, Øystein
    Martikainen, Jaana E.
    Pottegård, Anton
    Wastesson, Jonas W.
    Stockholms universitet, Samhällsvetenskapliga fakulteten, Centrum för forskning om äldre och åldrande (ARC), (tills m KI).
    Zoega, Helga
    Schmidt, Morten
    Nonaspirin Nonsteroidal Antiinflammatory Drug Use in the Nordic Countries from a Cardiovascular Risk Perspective, 2000-2016: A Drug Utilization Study2019Inngår i: Pharmacotherapy, ISSN 0277-0008, E-ISSN 1875-9114, Vol. 39, nr 2, s. 150-160Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Study Objective

    Evidence on the cardiotoxicity of nonaspirin nonsteroidal antiinflammatory drugs (NSAIDs), particularly diclofenac and the newer selective cyclooxygenase (COX)-2 inhibitors, has accumulated over the last decade. Our objective was to examine whether the use of NSAIDs in the Nordic countries changed with the emerging evidence, regulatory statements, and clinical guidelines advocating caution for the use of specific NSAIDs.

    Design

    Drug utilization study.

    Data Sources

    Nationwide wholesale statistics and prescription registries in Denmark, Finland, Iceland, Norway, and Sweden (2000-2016).

    Measurements and Main Results

    Our main outcome measures were yearly total sales, expressed as number of sold defined daily doses (DDDs)/1000 inhabitants/day, and yearly prevalence of prescription use, expressed as number of prescription users per 1000 inhabitants. The DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Total sales of NSAIDs increased in all countries and were highest in Iceland, with 74.3 DDDs/1000 inhabitants/day sold in 2016, followed by Finland (73.9), Sweden (54.4), Norway (43.8), and Denmark (31.8). Diclofenac use declined after 2008 in all countries but remained the most widely prescribed NSAID in Norway, with 63 prescription users/1000 inhabitants in 2016. Diclofenac sales also remained high in Iceland (12.7 DDD/1000 inhabitants/day), Norway (8.1), and Sweden (7.8). Since its introduction in 2003, the use of etoricoxib, a newer selective COX-2 inhibitor, increased in all countries except Denmark, with highest sales in Finland (6.7 DDD/1000 inhabitants/day in 2016).

    Conclusion

    Sales and prescription patterns of NSAIDs in the Nordic countries has changed along with the accumulating evidence for the cardiovascular risks of specific NSAIDs. However, given existing evidence on the cardiovascular risks associated with the use of diclofenac and etoricoxib, the persistent high use of diclofenac in Iceland, Norway, and Sweden, the persistent over-the-counter availability of diclofenac in Norway and Sweden, and the increasing use of etoricoxib in most of the Nordic countries pose a cardiovascular health concern.

  • 167.
    Brynildsen, Jon
    et al.
    Akershus Univ Hosp, Div Med, Sykehusveien 25, N-1478 Lorenskog, Norway;Univ Oslo, Inst Clin Med, Ctr Heart Failure Res, Oslo, Norway.
    Petaja, Liisa
    Univ Helsinki, Div Anaesthesiol Intens Care & Pain Med, Helsinki, Finland;Helsinki Univ Hosp, Helsinki, Finland.
    Myhre, Peder L.
    Akershus Univ Hosp, Div Med, Sykehusveien 25, N-1478 Lorenskog, Norway;Univ Oslo, Inst Clin Med, Ctr Heart Failure Res, Oslo, Norway.
    Lyngbakken, Magnus N.
    Akershus Univ Hosp, Div Med, Sykehusveien 25, N-1478 Lorenskog, Norway;Univ Oslo, Inst Clin Med, Ctr Heart Failure Res, Oslo, Norway.
    Nygard, Stale
    Oslo Univ Hosp, Bioinformat Core Facil, Inst Med Informat, Oslo, Norway;Univ Oslo, Oslo, Norway.
    Stridsberg, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Christensen, Geir
    Univ Oslo, Inst Clin Med, Ctr Heart Failure Res, Oslo, Norway;Oslo Univ Hosp, Expt Med Res Inst, Oslo, Norway.
    Ottesen, Anett H.
    Akershus Univ Hosp, Div Med, Sykehusveien 25, N-1478 Lorenskog, Norway;Univ Oslo, Inst Clin Med, Ctr Heart Failure Res, Oslo, Norway;Oslo Univ Hosp, Expt Med Res Inst, Oslo, Norway.
    Pettila, Ville
    Univ Helsinki, Div Anaesthesiol Intens Care & Pain Med, Helsinki, Finland;Helsinki Univ Hosp, Helsinki, Finland.
    Omland, Torbjorn
    Akershus Univ Hosp, Div Med, Sykehusveien 25, N-1478 Lorenskog, Norway;Univ Oslo, Inst Clin Med, Ctr Heart Failure Res, Oslo, Norway.
    Rosjo, Helge
    Akershus Univ Hosp, Div Med, Sykehusveien 25, N-1478 Lorenskog, Norway;Univ Oslo, Inst Clin Med, Ctr Heart Failure Res, Oslo, Norway.
    Circulating Secretoneurin Concentrations After Cardiac Surgery: Data From the FINNish Acute Kidney Injury Heart Study2019Inngår i: Critical Care Medicine, ISSN 0090-3493, E-ISSN 1530-0293, Vol. 47, nr 5, s. E412-E419Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives:

    Secretoneurin is associated with cardiomyocyte Ca2+ handling and improves risk prediction in patients with acute myocardial dysfunction. Whether secretoneurin improves risk assessment on top of established cardiac biomarkers and European System for Cardiac Operative Risk Evaluation II in patients undergoing cardiac surgery is not known.

    Design:

    Prospective, observational, single-center sub-study of a multicenter study.

    Setting:

    Prospective observational study of survival in patients undergoing cardiac surgery.

    Patients:

    A total of 619 patients undergoing cardiac surgery.

    Interventions:

    Patients underwent either isolated coronary artery bypass graft surgery, single noncoronary artery bypass graft surgery, two procedures, or three or more procedures. Procedures other than coronary artery bypass graft were valve surgery, surgery on thoracic aorta, and other cardiac surgery.

    Measurements and Main Results:

    We measured preoperative and postoperative secretoneurin concentrations and adjusted for European System for Cardiac Operative Risk Evaluation II, N-terminal pro-B-type natriuretic peptide, and cardiac troponin T concentrations in multivariate analyses. During 961 days of follow- up, 59 patients died (9.5%). Secretoneurin concentrations were higher among nonsurvivors compared with survivors, both before (168 pmol/L [quartile 1-3, 147-206 pmol/L] vs 160 pmol/L [131-193 pmol/L]; p = 0.039) and after cardiac surgery (173 pmol/L [129-217 pmol/L] vs 143 pmol/L [111-173 pmol/L]; p < 0.001). Secretoneurin concentrations decreased from preoperative to postoperative measurements in survivors, whereas we observed no significant decrease in secretoneurin concentrations among nonsurvivors. Secretoneurin concentrations were weakly correlated with established risk indices. Patients with the highest postoperative secretoneurin concentrations had worse outcome compared with patients with lower secretoneurin concentrations (p < 0.001 by the log-rank test) and postoperative secretoneurin concentrations were associated with time to death in multivariate Cox regression analysis: hazard ratio ln secretoneurin 2.96 (95% CI, 1.46-5.99; p = 0.003). Adding postoperative secretoneurin concentrations to European System for Cardiac Operative Risk Evaluation II improved patient risk stratification, as assessed by the integrated discrimination index: 0.023 (95% CI, 0.0043-0.041; p = 0.016).

    Conclusions:

    Circulating postoperative secretoneurin concentrations provide incremental prognostic information to established risk indices in patients undergoing cardiac surgery.

  • 168. Bränström, R
    et al.
    Arrelöv, B
    Gustavsson, Catharina
    Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
    Kjeldgård, L
    Ljungquist, T
    Nilsson, G H
    Alexanderson, K
    Sickness certification at oncology clinics: perceived problems, support, need for education and reasons for certifying unnecessarily long sickness absences2014Inngår i: European Journal of Cancer Care, ISSN 0961-5423, E-ISSN 1365-2354, Vol. 23, nr 1, s. 89-97Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Physicians' work with sickness certifications is an understudied field. The aims of this study were to gain knowledge of experiences concerning the sickness certification process among physicians working at oncology clinics. In 2008, all physicians working in Sweden (n = 36 898) were sent a questionnaire concerning sick-listing practices. All respondents working at an oncology clinic (n = 428) were included in the current study. Most of the physicians had sickness certification consultations at least weekly (91.3%). More than one fifth (22.3%) reported that they worked at a clinic with a workplace policy regarding the handling of sickness certification and 61.1% reported receiving at least some support in such cases from their immediate manager. Issuing unnecessary long sickness certificates were related to experiencing delicate interactions with patients and to lack of time. To a moderate degree, further competence was requested regarding: different types of compensation in the social insurance system, responsibilities of the Social Insurance Agency and employers, and sickness insurance rules. The large majority of physicians working in oncology reported regularly having consultations involving sickness certification. Overall, they reported few problems, low level of need for more competence regarding sickness certification, and low frequency of issuing sickness absences for longer periods than necessary.

  • 169. Bränström, Richard
    et al.
    Arrelöv, Britt
    Gustavsson, Catharina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Kjeldgård, Linnea
    Ljungquist, Therese
    Nilsson, Gunnar H
    Alexanderson, Kristina
    Reasons for and factors associated with issuing sickness certificates for longer periods than necessary: results from a nationwide survey of physicians.2013Inngår i: BMC Public Health, E-ISSN 1471-2458, Vol. 13, s. 478-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Physicians' work with sickness certifications is an understudied field. Physicians' experience of sickness certifying for longer periods than necessary has been previous reported. However, the extent and frequency of such sickness certification is largely unknown. The aims of this study were: a) to explore the frequency of sickness certifying for longer periods than necessary among physicians working in different clinical settings; b) to examine main reasons for issuing sickness certificates for longer periods than necessary; and c) to examine factors associated with unnecessary issued sickness certificates.

    METHODS: In 2008, all physicians living and working in Sweden (a total of 36,898) were sent an invitation to participate in a questionnaire study concerning their sick-listing practices. A total of 22,349 (60.6%) returned the questionnaire. In the current study, physicians reporting handling sickness certification consultations at least weekly were included in the analyses, a total of 12,348.

    RESULTS: The proportion of physicians reporting issuing sickness certificates for longer periods than actually necessary varied greatly between different types of clinics, with the highest frequency among those working at: occupational medicine, orthopedic, primary health care, and psychiatry clinics; and lowest among those working in: eye, dermatology, ear/nose/throat, oncology, surgery, and infection clinics. Logistic analyses showed that sickness certifying for longer periods than necessary due to limitations in the health care system was particularly common among physicians working at occupational medicine, orthopedic, and primary health care clinics. Sickness certifying for longer periods than necessary due to patient-related factors was much more common among physicians working at psychiatric clinics. In addition to differences between clinics, frequency of sickness certificates issued for longer periods than necessary varied by age, physicians' experiences of different situations, and perceived problems.

    CONCLUSIONS: This study showed that physicians issued sickness certificates for longer periods than actually necessary quite frequently at some types of clinics. Differences between clinics were to a large extent associated with frequency of problems, lack of time, delicate interactions with patients, and need for more competence.

  • 170.
    Bröms, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    A Nationwide Study of Asthma and Allergy in Swedish Preschool Children: with Special Reference to Environment, Daycare, Prevalence, Co-ocurrence and Incidence2010Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Aim: The aim of this project was to study the age and sex specific occurrence of atopic and non-atopic asthma and other atopic manifestations in a nationwide sample of Swedish pre-school children.

    Methods: All 70 allergen avoidance day-care centres (AADC) with 84 sections and 140 matched ordinary day-care centres with 440 sections in 62 municipalities across Sweden were sampled. In 2000 the staff at each section responded to a questionnaire on indoor and outdoor environment at the section. In 2002 parents of 5,886 children attending the AADCs and ODCs responded to a postal questionnaire regarding symptoms indicating prevalent asthma, allergic rhinitis, eczema, and food, furred pet and pollen allergy and other data in their children. In 2007, parents of 4255 children responded to an almost identical follow-up questionnaire.

    Results: The AADCs had far more strict rules than ODCs on furred pets and smoking at home and on perfume use, and the indoor environment was better, owing to better cleaning. The age specific asthma prevalence was curvilinear with a peak at age 3 of 11.4% among boys and 9.8% among girls. In addition the prevalence increased by municipality population density, a proxy for degree of urbanisation. There was a highly significant co-occurrence between all asthma-atopic manifestations, but there was no evidence of ordered sequence of manifestation onset. The asthma incidence was highly dependent on presence or absence of co-occurrence variables. Given the variable mix in the present study population, the annual asthma incidence ranged from 0.6% to 1.2%.

    Conclusions: AADCs had more strict rules and a better indoor environment than ODCs. The asthma prevalence was affected by age, sex and degree of urbanisation. There was close co-occurrence between all asthma and atopic manifestations but no evidence of ordered sequence of onsets. The annual asthma incidence was strongly dependent of co-occurrence conditions.

    Fulltekst (pdf)
    FULLTEXT02
  • 171.
    Bröms, Kristina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Eriksson, Margaretha
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Svärdsudd, Kurt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    A nationwide study of asthma incidence and its determinants in preschool children during five years of follow upManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background: Many studies on asthma prevalence have been published, but the number of studies on asthma incidence in preschool children is limited.

    A number of studies on asthma prevalence have been published, but there are few studies on asthma incidence in preschool children. In this project a nationwide sample of preschool children were followed with the aim to estimate 5-year asthma incidence and its determinants.

    Methods: Parents of 5886 children 1-6 years of age, sampled from day-care centres in 62 municipalities all over Sweden, responded in 2002 to a baseline postal questionnaire with questions regarding symptoms indicating possible asthma or atopic conditions, and a number of other variables. In 2007, 4255 of the parents responded to an almost identical questionnaire.

    Results: A large number of potential baseline determinants for 5-year asthma incidence were identified. Of these, food allergy, wheezing last 12 months, rhinitis, parental rhinitis, parental asthma, ever asthma, age, and eczema, on rank order of importance, remained significant in multivariate logistic regression analysis. The asthma incidence was highly dependent on presence or absence of these variables. Given the variable mix in the present study population, the incidence ranged from 2.9% in the oldest to 5.8% in the youngest children, corresponding to an annual asthma incidence of 0.6% to 1.2%.

    Conclusions: The incidence of asthma is highly dependent on the composition of the underlying population. However, an annual incidence in range a half to one percent in preschool children in the general population appears probable.

  • 172.
    Bröms, Kristina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Norbäck, Dan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Arbets- och miljömedicin.
    Erikssson, Margaretha
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Sundelin, Claes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Pediatrik.
    Svärdsudd, Kurt F
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och klinisk epidemiologi.
    Prevalence and co-occurrence of asthma and allergic manifestations in preschool childrenManuskript (preprint) (Annet vitenskapelig)
    Abstract [en]

    Background: It has been claimed that preschool children may embark on ‘the atopic march’, which means that atopic manifestations show up one after another in a certain order. The aim of this study was to make an in-depth analysis of the co-occurrence of asthma and atopic manifestations.

    Methods: Parents of 5886 children 1-6 years of age, sampled from day-care centres in 62 municipalities all over Sweden, responded to a postal questionnaire regarding symptoms indicating prevalent asthma, allergic rhinitis, eczema, food allergy, furred pet and pollen allergy and other data in their children. Age specific prevalence of asthma, rhinitis, eczema, and food allergy was computed, adjusted for municipality population size.

    Results: The overall prevalence of asthma was 8.9%, of eczema 21.7%, of rhinitis 8.1%, and of food allergy 6.6%. There was a highly significant co-occurrence between all asthma-atopic manifestations. Presence of pet allergy was the manifestation showing the closest co-occurrence with presence of asthma, presence of pollen allergy with presence of rhinitis, and presence of food allergy with presence of eczema. Assessed from plots of age specific prevalence of asthma, rhinitis, eczema and food allergy the prevalence of all manifestations increased from one to three years of age and then decreased, except for rhinitis where the prevalence increased until six years of age. There was no evidence of a rank order of asthma and allergy manifestation onset.

    Conclusions: There was close co-occurrence between all asthma-atopic manifestations but no evidence of a rank order of onsets.

  • 173. Bui, Christine L
    et al.
    Kaye, James A
    Castellsague, Jordi
    Calingaert, Brian
    McQuay, Lisa J
    Riera-Guardia, Nuria
    Saltus, Catherine W
    Quinlan, Scott C
    Holick, Crystal N
    Wahl, Peter M
    Suzart, Kiliana
    Rothman, Kenneth J
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Perez-Gutthann, Susana
    Validation of acute liver injury cases in a population-based cohort study of oral antimicrobial users2014Inngår i: Current Drug Safety, ISSN 1574-8863, E-ISSN 2212-3911, Vol. 9, nr 1, s. 23-28Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    We conducted a cohort study of acute, noninfectious liver injury among oral antimicrobial users. Potential cases were identified in the HealthCore Integrated Research Database (HIRD(SM)) population between July 1, 2001, and March 31, 2009, using ICD-9-CM codes primarily for acute and subacute necrosis of the liver, hepatic coma, and unspecified hepatitis.

    Liver test results were used to confirm case status according to published criteria. Two physician reviewers experienced in studying acute liver injury (blinded to study drug exposures) evaluated data abstracted from hospital and emergency department records to validate potential cases. Of 715 potential cases having claims associated with any of the primary screening codes, 312 (44%) were valid cases, 108 (15%) were not cases, and 295 (41%) were of uncertain status (records inadequate for validation). Among potential cases with adequate medical records, the PPV for presence of any of the primary codes was 74% (95% CI, 70%-78%). The highest PPV for a single code was for acute and subacute necrosis of the liver (84%; 95% CI, 77%-90%).

    Evaluation of cases of noninfectious liver injury using hospital and emergency department medical records continues to represent the preferred approach in studies using insurance claims data.

  • 174.
    Burstedt, Marie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Oftalmiatrik.
    Jonsson, Frida
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap.
    Köhn, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Patologi.
    Burstedt, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Kivitalo, Markus
    Golovleva, Irina
    Umeå universitet, Medicinska fakulteten, Institutionen för medicinsk biovetenskap, Medicinsk och klinisk genetik.
    Genotype-phenotype correlations in Bothnia dystrophy caused by RLBP1 gene sequence variations2013Inngår i: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 91, nr 5, s. 437-444Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: To evaluate phenotypes caused by different RLBP1 mutations in autosomal recessive retinitis pigmentosa of Bothnia type. Methods: Compound heterozygotes for mutations in the RLBP1 gene [c.677T>A]+[c.700C>T] (p.M226K+p.R234W), n=10, aged 7-84years, and homozygotes c.677T>A (p.M226K), n=2, aged 63 and 73years, were studied using visual acuity (VA), low-contrast VA, visual fields (VFs) and optical coherence tomography (OCT). Retrospective VA and VFs, standardized dark adaptation and full-field electroretinograms (ERGs) were analysed and prolonged dark adaptometry and ERG (at 24hr) were performed. Results: Progressive decline of VA and VF areas was age-dependent. Retinal degenerative maculopathy, peripheral degenerative changes and retinitis punctata albescens (RPA) were present. Early retinal thinning in the central foveal, foveal (O 1mm), and inner ring (O 3mm) in the macular region, with homogenous, high-reflectance RPA changes, was visualized in and adjacent to the retinal pigment epithelium/choriocapillaris using OCT. Reduced dark adaptation and affected ERGs were present in all ages. Prolonged dark adaptation and ERG (at 24hr), an increase in final threshold, and ERG rod and mixed rod/cone responses were found. Conclusions: The two RLBP1 genotypes presented a phenotypical and electrophysiological expression of progressive retinal disease similar to that previously described in homozygotes for the c.700C>T (p.R234W) RLBP1 mutation. The uniform phenotypical expression of RLBP1 mutations is relevant information for the disease and of importance in planning future treatment strategies.

  • 175.
    Burtin, Chris
    et al.
    Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Center, BIOMED Biomedical Research Institute Hasselt University, Hasselt, Belgium.
    Wadell, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    The rationale for pulmonary rehabilitation2021Inngår i: ERS Monograph, ISSN 2312-508X, E-ISSN 2312-5098, Vol. 2021, nr 93, s. 1-10Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Decreased exercise capacity, skeletal muscle dysfunction and a physically inactive lifestyle are associated with symptoms of fatigue and dyspnoea in patients with chronic lung disease. Many of these extrapulmonary features have been identified as treatable traits for PR, a comprehensive individualised nonpharmacological intervention that includes exercise training, education and behaviour change. PR improves exercise capacity, symptoms and QoL to a clinically relevant extent. In patients with COPD, it also appears to be a cost-effective intervention and is suggested to improve mortality. PR can be delivered in various settings, such as hospital based, community based, home based and telerehabilitation. The choice of setting needs to be made in light of the complexity of the patient. Unfortunately, referral to PR is very low worldwide, making the enhancement of access to PR the number one challenge for the near future in the field of PR.

  • 176.
    Butler, Stephen
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Acad Hosp, Ctr Multidisciplinary Pain, S-75185 Uppsala, Sweden.
    The triumvirate of co-morbid chronic pain, depression, and cognitive impairment: Attacking this "chicken-and-egg" in novel ways2017Inngår i: Scandinavian Journal of Pain, ISSN 1877-8860, E-ISSN 1877-8879, Vol. 15, s. 148-149Artikkel i tidsskrift (Annet vitenskapelig)
  • 177.
    Butler, Stephen
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin. Norwegian Univ Sci & Technol, Fac Med, Dept Circulat & Med Imaging, N-7034 Trondheim, Norway; Univ Uppsala Hosp, Pain Ctr, ING 79,2 TR, S-75185 Uppsala, Sweden.
    Landmark, Tormod
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Glette, Mari
    Norwegian Univ Sci & Technol, Fac Med, Dept Circulat & Med Imaging, N-7034 Trondheim, Norway.
    Borchgrevink, Petter
    Norwegian Univ Sci & Technol, Fac Med, Dept Circulat & Med Imaging, N-7034 Trondheim, Norway; St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway.
    Woodhouse, Astrid
    St Olavs Univ Hosp, Natl Competence Ctr Complex Symptom Disorders, Trondheim, Norway; Norwegian Univ Sci & Technol, Fac Med, Dept Publ Hlth & Gen Practice, N-7034 Trondheim, Norway.
    Chronic widespread pain - the need for a standard definition2016Inngår i: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 157, nr 3, s. 541-543Artikkel, forskningsoversikt (Fagfellevurdert)
  • 178. Byles, Julie E
    et al.
    Dolja-Gore, Xenia
    Loxton, Deborah J
    Parkinson, Lynne
    Stewart Williams, Jennifer A
    Research Centre for Gender, Health & Ageing, Faculty of Health, University of Newcastle, Level 2 David Maddison Building, Callaghan NSW 2308, Australia.
    Women's uptake of Medicare Benefits Schedule mental health items for general practitioners, psychologists and other allied mental health professionals.2011Inngår i: The Medical journal of Australia, ISSN 1326-5377, Vol. 194, nr 4, s. 175-179Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: To quantify women's uptake of Medicare Benefits Schedule mental health items, compare characteristics of women by mental health service use, and investigate the impact on Medicare costs.

    DESIGN, SETTING AND PARTICIPANTS: Analysis of linked survey data and Medicare records (November 2006 - December 2007) of 14 911 consenting participants of the Australian Longitudinal Study on Women's Health (ALSWH) across three birth cohorts (1921-1926 ["older cohort"], 1946-1951 ["mid-age cohort"], and 1973-1978 ["younger cohort"]).

    MAIN OUTCOME MEASURES: Uptake of mental health items; 36-Item Short Form Health Survey (SF-36) Mental Health Index scores from ALSWH surveys; and patient (out-of-pocket) and benefit (government) costs from Medicare data.

    RESULTS: A large proportion of women who reported mental health problems made no mental health claims (on the most recent survey, 88%, 90% and 99% of the younger, mid-age and older cohorts, respectively). Socioeconomically disadvantaged women were less likely to use the services. SF-36 Mental Health Index scores among women in the younger and mid-age cohorts were lowest for women who had accessed mental health items or self-reported a recent mental health condition. Mental health items are associated with higher costs to women and government.

    CONCLUSION: Although there has been rapid uptake of mental health items, uptake by women with mental health needs is low and there is potential socioeconomic inequity.

  • 179.
    Bäck, Maria
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Univ Gothenburg, Sweden; Sahlgrens Univ Hosp, Sweden.
    Leosdottir, Margret
    Lund Univ, Sweden; Skane Univ Hosp, Sweden.
    Hagstrom, Emil
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Norhammar, Anna
    Karolinska Univ Hosp, Sweden; Capio Srt Gorans Hosp, Sweden.
    Hag, Emma
    Cty Hosp Ryhov, Sweden.
    Jernberg, Tomas
    Danderyd Hosp, Sweden.
    Wallentin, Lars
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Lindahl, Bertil
    Uppsala Univ, Sweden; Uppsala Univ, Sweden.
    Hambraeus, Kristina
    Falun Cent Hosp, Sweden.
    The SWEDEHEART secondary prevention and cardiac rehabilitation registry (SWEDEHEART CR registry)2021Inngår i: European Heart Journal - Quality of Care and Clinical Outcomes, ISSN 2058-5225, E-ISSN 2058-1742, Vol. 7, nr 5, s. 431-437Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims The quality registry SWEDEHEART covers data across the patient pathway after an acute myocardial infarction (MI), from hospital care to secondary prevention. Although cardiac rehabilitation (CR) is strongly recommended after an MI, there is still heterogeneity regarding standards, uptake, and adherence rates. The aim of the SWEDEHEART-CR registry is to provide continuous information on secondary prevention and CR performance to support the audit and development of evidence-based practice. To facilitate quality improvement and research initiatives, a description of the characteristics and development of the SWEDEHEART-CR registry is needed. Methods and results The SWEDEHEART-CR registry starts with data obtained during hospital care and then collects data at out-patient visits 2 months and 1-year after discharge, and at start and end of an exercise-based CR programme. The registry data covers comorbidities, biochemistry, blood pressure, anthropometric variables, medication, psychosocial- and lifestyle variables, readmissions, patient-reported outcome measures, attendance in CR-related programmes, and physical fitness variables. Over 100 000 patients with MI have been included in the SWEDEHEART-CR registry since its start in 2005. From initially covering 35 centres (47%) and 2200 patients annually (27%), SWEDEHEART-CR has developed to a nation-wide registry with 75 centres (100%) and 8800 patients annually (80%) in 2020. Conclusion The SWEDEHEART-CR registry includes a high proportion of the national MI population entering a CR programme and is a powerful tool for quality audit, improvement, and research. The registry provides insights into the characteristics, treatment, and outcomes of evidence-based secondary preventive practice, ultimately leading to better cardiovascular health.

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  • 180.
    Cabalgante, Sandra
    et al.
    Linnéuniversitetet, Fakultetsnämnden för hälsa, socialt arbete och beteendevetenskap, Institutionen för hälso- och vårdvetenskap, HV.
    Zapata Pon, Milagros
    Linnéuniversitetet, Fakultetsnämnden för hälsa, socialt arbete och beteendevetenskap, Institutionen för hälso- och vårdvetenskap, HV.
    Hur sexuella övergreppsupplevelser i barndomen påverkar den vuxna människans möte med vården2010Independent thesis Basic level (degree of Bachelor), 10 poäng / 15 hpOppgave
  • 181.
    Cajander, Sara
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Dynamics of Human Leukocyte Antigen-D Related expression in bacteremic sepsis2017Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Monocytic human leukocyte antigen-D related (mHLA-DR) expression determined by flow cytometry has been suggested as a biomarker of sepsisinduced immunosuppression.

    In order to facilitate use of HLA-DR in clinical practice, a quantitative real-time PCR technique measuring HLA-DR at the transcription level was developed and evalutated. Levels of HLA-DR mRNA correlated to mHLADR expression and were robustly measured, with high reproducibility, during the course of infection. Dynamics of mHLA-DR expression was studied during the first weeks of bloodstream infection (BSI) and was found to be dependent on the bacterial etiology of BSI. Moreover, mHLA-DR was shown to be inversely related to markers of inflammation. In patients with unfavourable outcome, sustained high C-reactive protein level and high neutrophil count were demonstrated along with low mHLA-DR expression and low lymphocyte count. This supports the theory of sustained inflammation in sepsis-induced immunosuppression. The association between mHLA-DR and bacterial etiology may be linked to the clinical trajectory via differences in ability to cause intractable infection. Staphylococcus aureus was the dominating etiology among cases with unfavourable outcome. With focus on patients with S. aureus BSI, those with complicated S. aureus BSI were found to have lower HLA-DR mRNA expression during the first week than those with uncomplicated S. aureus BSI. If these results can be confirmed in a larger cohort, HLA-DR measurement could possibly become an additional tool for early identification of patients who require further investigation to clear infectious foci and achieve source control.

    In conclusion, PCR-based measurement of HLA-DR is a promising method for measurements of the immune state in BSI, but needs further evaluation in the intensive care unit setting to define the predictive and prognostic value for deleterious immunosuppression. The etiology of infection should be taken into consideration in future studies of translational immunology in sepsis.

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  • 182.
    Cajander, Sara
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Rasmussen, Gunlög
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Tina, Elisabet
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Magnuson, Anders
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Söderquist, Bo
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Källman, Jan
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Strålin, Kristoffer
    Karolinska University Hospital, Stockholm, Sweden; Karolinska Institute, Stockholm, Sweden .
    Monocytic HLA-DR expression differs between bacterial etiologies and is inversely related to C-reactive protein and neutrophil count during the course of bloodstream infectionManuskript (preprint) (Annet vitenskapelig)
  • 183.
    Calais, Fredrik
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Coronary artery disease and prognosis in relation to cardiovascular risk factors, interventional techniques and systemic atherosclerosis2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Aim: To evaluate the prognosis associated with location and severity of coronary and systemic atherosclerosis in patients with coronary artery disease (CAD) in relation to risk factors and interventional techniques.

    Methods: The thesis comprised six longitudinal studies based on three patient cohorts: The Swedish Coronary Angiography and Angioplasty Registry, the Västmanland Myocardial Infarction Survey, and the Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia study, to evaluate clinical outcome relative to coronary lesion location and severity, extracoronary artery disease (ECAD), intervention techniques, and leisuretime physical inactivity (LTPI).

    Results: Stent placement in the proximal left anterior descending artery (LAD) was more often associated with restenosis than was stenting in the other coronary arteries. The use of drug-eluting stents in the LAD was associated with a lower risk of restenosis and death compared to baremetal stents. Thrombus aspiration in in the LAD during acute ST elevation myocardial infarction (MI) did not improve clinical outcome, irrespective of adjunct intervention technique. Clinical, but not subclinical, ECAD was associated with poor prognosis in patients with MI. Longitudinal extent of CAD at the time of MI was a predictor of ECAD, and coexistence of extensive CAD and ECAD was associated with particularly poor prognosis following MI. Self-reported LTPI was associated with MI and all-cause mortality independent of ECAD.

    Conclusions: Drug-eluting stents, but not thrombus aspiration, improved prognosis following percutaneous coronary intervention in the proximal LAD. Self- reported LTPI, clinical ECAD, and systemic atherosclerosis defined groups with poor prognosis after MI.

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  • 184.
    Calais, Fredrik
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Eriksson Östman, Maja
    Örebro University, Faculty of Health, Department of Cardiology, Sweden.
    Hedberg, Pär
    Centre for Clinical Research, Uppsala University and Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden.
    Rosenblad, Andreas
    Centre for Clinical Research, Uppsala University Västmanland County Hospital, Västerås, Sweden.
    Leppert, Jerzy
    Centre for Clinical Research, Uppsala University Västmanland County Hospital, Västerås, Sweden.
    Fröbert, Ole
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Incremental prognostic value of coronary and systemic atherosclerosis aftermyocardial infarctionManuskript (preprint) (Annet vitenskapelig)
  • 185.
    Cao, Yang
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län.
    Fang, Xin
    Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Ottosson, Johan
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    Näslund, Erik
    Division of Surgery, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.
    Stenberg, Erik
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Surgery.
    A Comparative Study of Machine Learning Algorithms in Predicting Severe Complications after Bariatric Surgery2019Inngår i: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 8, nr 5, artikkel-id 668Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Severe obesity is a global public health threat of growing proportions. Accurate models to predict severe postoperative complications could be of value in the preoperative assessment of potential candidates for bariatric surgery. So far, traditional statistical methods have failed to produce high accuracy. We aimed to find a useful machine learning (ML) algorithm to predict the risk for severe complication after bariatric surgery.

    Methods: We trained and compared 29 supervised ML algorithms using information from 37,811 patients that operated with a bariatric surgical procedure between 2010 and 2014 in Sweden. The algorithms were then tested on 6250 patients operated in 2015. We performed the synthetic minority oversampling technique tackling the issue that only 3% of patients experienced severe complications.

    Results: Most of the ML algorithms showed high accuracy (>90%) and specificity (>90%) in both the training and test data. However, none of the algorithms achieved an acceptable sensitivity in the test data. We also tried to tune the hyperparameters of the algorithms to maximize sensitivity, but did not yet identify one with a high enough sensitivity that can be used in clinical praxis in bariatric surgery. However, a minor, but perceptible, improvement in deep neural network (NN) ML was found.

    Conclusion: In predicting the severe postoperative complication among the bariatric surgery patients, ensemble algorithms outperform base algorithms. When compared to other ML algorithms, deep NN has the potential to improve the accuracy and it deserves further investigation. The oversampling technique should be considered in the context of imbalanced data where the number of the interested outcome is relatively small.

  • 186.
    Carlberg, Bo
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Samuelsson, Ola
    Lindholm, Lars H
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Finns möjligen hela bilden om atenolol hos Kent Forsén?2005Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 102, nr 3, s. 151-152Artikkel i tidsskrift (Annet vitenskapelig)
  • 187.
    Carling, Anna
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Impaired balance and fall risk in people with multiple sclerosis2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    The symptoms from the neurological disease multiple sclerosis vary from person to person and over time. Impaired balance is common in people with multiple sclerosis and can lead to falls. Fall frequency is high in people with multiple sclerosis, above 50%. Multiple sclerosis affects not only the person having the disease but also their next of kin. To be able to reduce fall risk it is important to know when, why and where people with multiple sclerosis fall, and how to improve balance and reduce falls with exercise. It is also important to know how the falls affect the residing next of kin to people with multiple sclerosis.

    The overall aim of this thesis was to gain enhanced knowledge by investigating when and why people with MS fall and how these falls possibly affect their next of kin, and also to evaluate the effects and perceptions of participating in a specific balance exercise.

    Data were gathered using four different data collections, and this thesis contains both qualitative and quantitative data.

    The major finding in this thesis is that people with multiple sclerosis fall in the course of everyday life activities, most often in their own homes due to various intrinsic and extrinsic factors. Balance can be improved and falls reduced and everyday life may be made easier and facilitated after participating in the CoDuSe balance exercise. This is important also for the next of kin, since they are adapting, adjusting and renouncing their activities due to the falls of the PwMS, in order to make it work for the whole family.

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  • 188.
    Carling, Anna
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Physiotherapy, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Nilsagård, Ylva
    Health Care Management, Region, Örebro County, Örebro, Sweden .
    Forsberg, Anette
    Department of Physiotherapy.
    Making it work: experience of living with a person who falls due to multiple sclerosisManuskript (preprint) (Annet vitenskapelig)
  • 189.
    Carlsson, Axel C.
    et al.
    Karolinska Institute, Sweden; Uppsala University, Sweden.
    Östgren, Carl Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Närsjukvården i västra Östergötland, Primärvården i västra länsdelen.
    Nyström, Fredrik H
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Endokrinmedicinska kliniken.
    Länne, Toste
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Thorax-kärlkliniken i Östergötland.
    Jennersjö, Pär
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten.
    Larsson, Anders
    Uppsala University, Sweden.
    Arnlov, Johan
    Uppsala University, Sweden; Dalarna University, Falun, Sweden.
    Association of soluble tumor necrosis factor receptors 1 and 2 with nephropathy, cardiovascular events, and total mortality in type 2 diabetes2016Inngår i: Cardiovascular Diabetology, ISSN 1475-2840, E-ISSN 1475-2840, Vol. 15, nr 1, s. 40-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Aims/hypothesis: Soluble tumor necrosis factor receptors 1 and 2 (sTNFR1 and sTNFR2) contribute to experimental diabetic kidney disease, a condition with substantially increased cardiovascular risk when present in patients. Therefore, we aimed to explore the levels of sTNFRs, and their association with prevalent kidney disease, incident cardiovascular disease, and risk of mortality independently of baseline kidney function and microalbuminuria in a cohort of patients with type 2 diabetes. In pre-defined secondary analyses we also investigated whether the sTNFRs predict adverse outcome in the absence of diabetic kidney disease. Methods: The CARDIPP study, a cohort study of 607 diabetes patients [mean age 61 years, 44 % women, 45 cardiovascular events (fatal/non-fatal myocardial infarction or stroke) and 44 deaths during follow-up (mean 7.6 years)] was used. Results: Higher sTNFR1 and sTNFR2 were associated with higher odds of prevalent kidney disease [odd ratio (OR) per standard deviation (SD) increase 1.60, 95 % confidence interval (CI) 1.32-1.93, p &lt; 0.001 and OR 1.54, 95 % CI 1.21-1.97, p = 0.001, respectively]. In Cox regression models adjusting for age, sex, glomerular filtration rate and urinary albumin/creatinine ratio, higher sTNFR1 and sTNFR2 predicted incident cardiovascular events [hazard ratio (HR) per SD increase, 1.66, 95 % CI 1.29-2.174, p &lt; 0.001 and HR 1.47, 95 % CI 1.13-1.91, p = 0.004, respectively]. Results were similar in separate models with adjustments for inflammatory markers, HbA1c, or established cardiovascular risk factors, or when participants with diabetic kidney disease at baseline were excluded (p &lt; 0.01 for all). Both sTNFRs were associated with mortality. Conclusions/Interpretations: Higher circulating sTNFR1 and sTNFR2 are associated with diabetic kidney disease, and predicts incident cardiovascular disease and mortality independently of microalbuminuria and kidney function, even in those without kidney disease. Our findings support the clinical utility of sTNFRs as prognostic markers in type 2 diabetes.

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  • 190.
    Carlsson, Jan-Olof
    et al.
    Orebro Univ Hosp, Sweden.
    Fricke, Otto
    Region Östergötland, Sinnescentrum, Ögonkliniken US.
    Dahlberg, Anton
    Orebro Univ Hosp, Sweden.
    Crafoord, Sven
    Orebro Univ, Sweden.
    Retinal surgery quality indicators for uncomplicated primary rhegmatogenous retinal detachment without a national registry2022Inngår i: Acta Ophthalmologica, ISSN 1755-375X, E-ISSN 1755-3768, Vol. 100, nr 8, s. e1589-e1594Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose The objective of this study was to evaluate the possibility of analysing quality indicators for uncomplicated primary rhegmatogenous retinal detachment in a hospital department of ophthalmology without the support of a national registry or need to collect data from referring ophthalmological centres. Methods In 2014, we operated 231 consecutive eyes with uncomplicated retinal detachment. Our quality indicators were primary anatomical success, final anatomical success and postoperative endophthalmitis. We reviewed medical records in our university surgical department retrospectively and compared them with medical records from the regional hospitals that had referred most of the operated patients and done their own postoperative examination. Our hypothesis was that any retinal re-detachment and/or serious postoperative complication would be reported back. Results The medical records at the surgical department revealed primary anatomic success for 91.3% of eyes and final anatomical success of 99.6%. The data from the regional hospitals confirmed that our hypothesis was correct. All patients with adverse outcomes were referred back for reoperation. Patients who were not referred again had an attached retina and showed no signs of endophthalmitis. Conclusion Our hypothesis that data in the surgical departments medical records would closely reflect those in referring hospitals was borne out. This supports, under current conditions, an effective strategy for analysing chosen quality indicators without relying on a national registry or reviewing records from regional hospitals.

  • 191.
    Carlsson, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Healthcare and patient factors affecting sick leave: From a primary health care perspective2017Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Background: For indeterminate reasons, there have been major variations in sick leave in Sweden, and many physicians have perceived sick leave assignments as burdensome.

    Aim: To gain more knowledge and understanding, from a perspective of primary health care, about factors in health care and patients that affect sick leave. Thereby help patients in the best way, facilitate the work of physicians and other health professionals involved in the rehabilitation process, and use the health care resources optimally.

    Methods: This thesis is based on a randomised controlled trial (RCT) in a primary health care centre with participants on short-term sick leave, due to pain and/or mental illness, who received a multidisciplinary assessment. Qualitative focus-group discussions with physicians in primary health care centres. A cohort of women on very long-term sick leave due to pain and/or mental illness, who lost sickness benefits due to a new time limit on sickness insurance, were randomised to multidisciplinary assessment and multimodal intervention (TEAM), or to Acceptance and Commitment Therapy (ACT). In an extended cohort, including some men on very long-term sick leave due to pain and/or mental illness, the importance of the motivation for return to work (RTW) was investigated.

    Results. Very early multidisciplinary assessment increased days on sick leave in the first three month period. Physicians at primary health care centres perceived sick leave assignments as burdensome, but clearer rules and cooperation with other professionals have made sick leave assignments less burdensome. TEAM intervention resulted in an increase in working hours per week as well as an increase in work-related engagements, compared to control in the RCT. Motivation for RTW was associated with RTW or increased employability in the rehabilitation of patients

    Conclusions: Continued studies are needed to find those who are at risk of long-term sick leave, the time when rehabilitation efforts should be started, and the content of rehabilitation. Collaboration in teams facilitates sick leave assignments for physicians at primary care health centres. Motivation for RTW might be a factor of importance for the effect of rehabilitation and needs to be studied further.

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  • 192.
    Carlén, Anna
    et al.
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Nylander, Eva
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärtcentrum, Fysiologiska kliniken US.
    Gustafsson, Mikael
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för diagnostik och specialistmedicin. Linköpings universitet, Medicinska fakulteten. Hjärtspecialisterna i Linköping, Sverige.
    Oklar nytta av upprepade arbets-EKG hos brandmän [Pre-duty medical assessment in fire-fighters requires modernization - relevance of exercise ECG is questioned]2020Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 117Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Medical assessment of Swedish smoke diving firefighters includes cardiac evaluation by maximal exercise testing with ECG recording. The exercise ECG procedure for firefighters was introduced in 1986, and remains consistent in the recently updated guidelines from 2019.  Exercise ECG is a non-invasive and easily available method for detection of chronic coronary syndromes, but due to the declining population risk in high-income countries, its ability to accurately detect disease has decreased. Thus, the clinical relevance of exercise ECG in firefighters is questioned and the pre-duty medical assessment requires modernization.

  • 193. Carrasquilla, Germán D
    et al.
    Berglund, Anita
    Gigante, Bruna
    Landgren, Britt-Marie
    de Faire, Ulf
    Hallqvist, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Leander, Karin
    Does menopausal hormone therapy reduce myocardial infarction risk if initiated early after menopause?: A population-based case-control study2014Inngår i: Menopause: The Journal of the North American Menopause, ISSN 1072-3714, E-ISSN 1530-0374, Vol. 22, nr 6, s. 598-606Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: This study aims to assess whether the timing of menopausal hormone therapy initiation in relation to onset of menopause and hormone therapy duration is associated with myocardial infarction risk.

    METHODS: This study was based on the Stockholm Heart Epidemiology Program, a population-based case-control study including 347 postmenopausal women who had experienced a nonfatal myocardial infarction and 499 female control individuals matched for age and residential area. Odds ratios (with 95% CIs) for myocardial infarction were calculated using logistic regression.

    RESULTS: Early initiation of hormone therapy (within 10 y of onset of menopause or before age 60 y), compared with never use, was associated with an odds ratio of 0.87 (95% CI, 0.58-1.30) after adjustments for lifestyle factors, body mass index, and socioeconomic status. For late initiation of hormone therapy, the corresponding odds ratio was 0.97 (95% CI, 0.53-1.76). For hormone therapy duration of 5 years or more, compared with never use, the adjusted odds ratio was 0.64 (95% CI, 0.35-1.18). For hormone therapy duration of less than 5 years, the odds ratio was 0.97 (95% CI, 0.63-1.48).

    CONCLUSIONS: Neither the timing of hormone therapy initiation nor the duration of therapy is significantly associated with myocardial infarction risk.

  • 194.
    Cars, Otto
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionssjukdomar.
    Securing access to effective antibiotics for current and future generations. Whose responsibility?2014Inngår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 119, nr 2, s. 209-214Artikkel i tidsskrift (Annet vitenskapelig)
  • 195.
    Carson, Dean
    et al.
    School of Business and Law, University of Australia, Cairns..
    Wennberg, Patrik
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hultin, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för kirurgisk och perioperativ vetenskap, Anestesiologi och intensivvård.
    Andersson, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Hedman, Mante
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Berggren, Peter
    Centre of Rural Medicine, Västerbotten County Counsil, Storuman, Sweden.
    Umeå University's proposed "Rural Stream": An effective alternative to the longitudinal integrated clerkship model for small rural communities?2020Inngår i: Education for Health, ISSN 1357-6283, E-ISSN 1469-5804, Vol. 33, nr 1, s. 3-7Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Umeå University Faculty of Medicine (UUFM), Sweden, has a regionalized medical program in which students spend the final 2½ years of their undergraduate degree in district hospitals. In late 2018, UUFM started a "rural stream" pilot exposing students to smaller rural locations.

    Methods: The objectives are to deliver the benefits for medical education and rural workforce development that have been observed in longitudinal integrated clerkships (LICs) while maintaining consistency between learning experiences in the main campus, regional campuses, and rural locations. This article compares the UUFM rural stream with those typical of the LICs described in the medical education literature. Comparisons are made in terms of the four key criteria for LIC success, and additional characteristics including peer and interprofessional learning, "'continuity," and curriculum development.

    Results: The rural stream has elements of length, immersion, position in the degree program, and community engagement that are both similar to, and different from, LICs. Key challenges are to ensure that participating students create close relationships with host medical facilities and communities. The rural stream also has some potential advantages, particularly in relation to team learning.

    Discussion: Alternatives to the LIC rural stream model as typically described in the literature may be required to allow for immersive medical education to occur in smaller rural communities and to be suitable for medical schools with more traditional approaches to education.

  • 196.
    Carstens, Adam
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Chronic inflammatory bowel diseases: studies of microbiota and its influence2021Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Introduction: Inflammatory bowel diseases are becoming increasingly common. The underlying mechanisms are not entirely known but the gut microbiota seem to be involved in the pathogenesis. 

    Aim: The aim of this thesis was to characterise gut microbiota related to diagnosis, disease course and response to biological treatment, taking aspects of the source of biological material into account. 

    Materials and methods: Patients and healthy individuals from several different cohorts in Sweden and Europe were invited. Faecal samples and mucosal biopsies were analysed using different sequencing platforms to investigate the gut microbiota. In Study I the faecal microbiota was correlated to different inflammatory bowel diseases. In Study II we compared the microbiota in faeces to the microbiota in mucosal biopsies. In StudyIII we related the faecal microbiota to the outcome of biological treatment. In Study IV we investigated the diagnostic and prognostic properties of the GAmapTM Dysbiosis Test.

    Results: The faecal microbiota in collagenous colitis resembles the faecalmicrobiota in inflammatory bowel disease. The faecal microbiota differs from the mucosal microbiota. Faecal microbiota at initiation of biological treatment among patients with Crohn’s disease differ between responders and non-responders. The GAmapTM Dysbiosis Test discriminates patients with inflammatory bowel disease from healthy individuals.

    Conclusion: Collagenous colitis may share microbial underpinnings with other inflammatory bowel diseases. Conclusions about mucosal interactions with the gut microbiota should be made with caution when usingfaecal samples to characterise the microbiota. In Crohn’s disease, the faecal microbiota may be included in a model to predict the outcome of biological treatment. The GAmap Dysbiosis Test does not seem to be superior to other current diagnostic tools in clinical decision-making. 

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  • 197.
    Carstens, Adam
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Internal Medicine, Ersta Hospital, Stockholm, Sweden; Department of Gastroenterology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Björkqvist, Olle
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Lindqvist, Carl Mårten
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Rangel, I.
    Department of Internal Medicine, Ersta Hospital, Stockholm, Sweden.
    Repsilber, Dirk
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Eriksson, Carl
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology.
    Bergemalm, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Gastroenterology.
    Bresso, F.
    Division of Gastroenterology, Department of Gastroenterology, Dermatology and Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
    Strid, H.
    Department of Internal Medicine, Södra Älvsborgs Hospital, Borås, Sweden.
    Hjortswang, H.
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Keita, Å.
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Magnusson, M. K.
    Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
    Hedin, C.
    Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden; Karolinska University Hospital, Gastroenterology unit, Department of Gastroenterology, Dermatovenereology and Rheumatology, Stockholm, Sweden.
    Kruse, Robert
    Örebro universitet, Institutionen för medicinska vetenskaper.
    Engstrand, L.
    Department of Microbiology, Tumor and Cell Biology (MTC), Karolinska Institutet, Solna, Sweden.
    Carlson, M.
    Department of Medical Sciences, Gastroenterology Research Group, Uppsala University, Uppsala, Sweden.
    Söderholm, J.
    Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden; Department of Surgery, Linköping University, Linköping, Sweden.
    Öhman, L.
    Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden.
    Halfvarson, Jonas
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Gastroenterology.
    Gut microbiota associated with treatment outcome to biological treatment in inflammatory bowel diseaseManuskript (preprint) (Annet vitenskapelig)
  • 198.
    Carstensen, John
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Hälsa och samhälle. Linköpings universitet, Filosofiska fakulteten.
    Andersson, David
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet.
    André, Malin
    Landstinget i Uppsala län.
    Engström, Sven
    Landstinget i Jönköpings län.
    Magnusson, Henric
    Linköpings universitet, Institutionen för medicin och hälsa, Sjukgymnastik. Linköpings universitet, Hälsouniversitetet.
    Borgquist, Lars
    Linköpings universitet, Institutionen för medicin och hälsa, Allmänmedicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i västra Östergötland, Forsknings- och utvecklingsenheten för Närsjukvården i Östergötland.
    How does comorbidity influence healthcare costs? A population-based cross-sectional study of depression, back pain and osteoarthritis2012Inngår i: BMJ Open, E-ISSN 2044-6055, Vol. 2, s. e000809-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives To analyse how comorbidity among patients with back pain, depression and osteoarthritis influences healthcare costs per patient. A special focus was made on the distribution of costs for primary healthcare compared with specialist care, hospital care and drugs.

    Design Population-based cross-sectional study.

    Setting The County of Östergötland, Sweden.

    Patients Data on diagnoses and healthcare costs for all 266 354 individuals between 20 and 75 years of age, who were residents of the County of Östergötland, Sweden, in the year 2006, were extracted from the local healthcare register and the national register of drug prescriptions.

    Main outcome measures The effects of comorbidity on healthcare costs were estimated as interactions in regression models that also included age, sex, number of other health conditions and education.

    Results The largest diagnosed group was back pain (11 178 patients) followed by depression (7412 patients) and osteoarthritis (5174 patients). The largest comorbidity subgroup was the combination of back pain and depression (772 patients), followed by the combination of back pain and osteoarthritis (527 patients) and the combination of depression and osteoarthritis (206 patients). For patients having both a depression diagnosis and a back pain diagnosis, there was a significant negative interaction effect on total healthcare costs. The average healthcare costs among patients with depression and back pain was SEK 11 806 lower for a patient with both diagnoses. In this comorbidity group, there were tendencies of a positive interaction for general practitioner visits and negative interactions for all other visits and hospital days. Small or no interactions at all were seen between depression diagnoses and osteoarthritis diagnoses.

    Conclusions A small increase in primary healthcare visits in comorbid back pain and depression patients was accompanied with a substantial reduction in total healthcare costs and in hospital costs. Our results can be of value in analysing the cost effects of comorbidity and how the coordination of primary and secondary care may have an impact on healthcare costs.

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  • 199.
    Cauwenberghs, Nicholas
    et al.
    Univ Leuven, Belgium.
    Hedman, Kristofer
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för kardiovaskulär medicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Hjärt- och Medicincentrum, Fysiologiska kliniken US. Stanford Univ, CA 94305 USA.
    Kobayashi, Yukari
    Stanford Univ, CA 94305 USA.
    Vanassche, Thomas
    Univ Leuven, Belgium.
    Haddad, Francois
    Stanford Univ, CA 94305 USA.
    Kuznetsova, Tatiana
    Univ Leuven, Belgium.
    The 2013 ACC/AHA risk score and subclinical cardiac remodeling and dysfunction: Complementary in cardiovascular disease prediction2019Inngår i: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 297, s. 67-74Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Echocardiography might enhance cardiovascular (CV) risk stratification beyond tools grading the risk for atherosclerotic CV diseases (ASCVD). We therefore studied the complementarity between the ASCVD risk score recommended by American cardiology societies and echocardiographic profiling in predicting adverse CV outcome in the community. Methods: 984 community-dwelling individuals between 40 and 79 years old (51.3% women) underwent CV risk profiling and echocardiography. We estimated their 10-year ASCVD risk from baseline risk factors using the Pooled Cohort Equations. Participants were categorized as at low (amp;lt;2.5%), borderline (2.5-amp;lt;7.5%) or intermediate-to-high (amp;gt;= 7.5%) ASCVD risk. Main outcome was the incidence of CV events collected on average 7.5 years later. Results: The probability for cardiac remodeling and/or dysfunction as assessed by echocardiography rose progressively with increasing 10-year ASCVD risk. During follow-up, 116 participants experienced at least one CV endpoint (15.8 events per 1000 person-years). With increasing 10-year ASCVD risk, the CV event rate increased stronger in participants with amp;gt;= 1 LV abnormality at baseline. Indeed, in individuals with an intermediate-to-high ASCVD risk and amp;gt;= 1 LV abnormality at baseline, the risk was significantly higher than the average population risk for a first CV event (HR: 3.00, P amp;lt; 0.001). Adding the presence of amp;gt;= 1 LV abnormality to a ASCVD risk score-based model yielded significant improvement in C-statistics (P = 0.024), integrated discrimination (P=0.0085) and net reclassification (P amp;lt; 0.001) for adverse CV events. Conclusions: Echocardiographic profiling enhanced CV risk stratification in individuals at intermediate-to-high ASCVD risk. Echocardiographic screening might supplement traditional ASCVD risk grading for CV disease prediction. (C) 2019 Elsevier B.V. All rights reserved.

    Fulltekst (pdf)
    fulltext
  • 200. Cea Soriano, Lucía
    et al.
    Wallander, Mari-Ann
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Allmänmedicin och preventivmedicin.
    Andersson, Susan
    Filonenko, Anna
    García Rodríguez, Luis Alberto
    The continuation rates of long-acting reversible contraceptives in UK general practice using data from The Health Improvement Network2015Inngår i: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 24, nr 1, s. 52-58Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    PURPOSE: The purpose of this study was to determine the continuation rates of new users of long-acting reversible contraceptive (LARC) methods in the UK, using data from general practice.

    METHODS: We conducted an observational study using a general practitioner (GP) database, The Health Improvement Network (THIN). The methods studied were copper intrauterine devices (Cu-IUDs), levonorgestrel-releasing intrauterine system (LNG-IUS), progestogen-only implants and progestogen-only injections. The study population comprised women in THIN aged 18-44 years during the period 2004-2009 who had been registered with their GP for at least 5 years, with a computerized prescription history of at least 1 year. Using computer algorithms, the database was searched for the Read and Multilex codes for each LARC method. New LARC users were identified and followed until there was a record indicating termination of use or the study period ended.

    RESULTS: The proportion of women who discontinued use during the same year of administration was 7.5% for Cu-IUDs, 10.6% for LNG-IUS, 13.2% for progestogen-only implants and 54.4% for progestogen-only injections. By the end of the study, a higher proportion of Cu-IUD and LNG-IUS users (21.1 and 18.6%, respectively) undertook consecutive use of the same method than progestogen-only implant users (10.7%). Manual review of computerized profiles demonstrated the validity of this approach.

    CONCLUSIONS: In the UK, the continuation rates of LARCs are high, and approximately one fifth of women chose to have a second intrauterine device fitted after expiry of the first device. A validation step demonstrated the reliability of the methodology and computer algorithms used.

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