Upsala journal of medical sciences最新文献

Background: Two out of three randomised controlled trials (RCTs) fail to meet their recruitment goals. Recruitment to Efficacy oF Fluoxetine - a randomisEd Controlled Trial in Stroke (EFFECTS), fluoxetine for stroke recovery was slower than anticipated. We aimed to evaluate an intervention to improve recruitment to EFFECTS.

Methods: This stepped wedge, cluster randomised study investigated whether a teleconference with the study personnel and the head of department could enhance recruitment in the ongoing EFFECTS. We included 20 low- and medium recruiting active centres. We excluded high recruiting centres. All centres started as controls and were followed by 60 days of observation. We used block randomisation. The primary outcome was a 20% increase of recruitment within 60 days post intervention compared within 60 days pre intervention. Secondary outcomes were comparing recruitment between different types of centres, that is small versus large or experienced versus non-experienced centres, and university versus non-university hospitals. In exploratory analyses, recruitment within 30 days post versus 30 days pre intervention was compared.

Results: The recruitment increased by 10% at 60 days. We noticed a short-lived increase of 23% the first month. The increased recruitment was most pronounced in low-recruiting, small and non-university hospitals. The recruitment of patients increased after the first contact with the centres where we announced that there would be a conference.

Conclusion: A teleconference with the study personnel and the head of department increased the recruitment by 23% within 30 days and by 10%, 60 days post intervention in this embedded RCT. This implies that this structured intervention aimed at increased recruitment was short-lived and would need frequent repetitions in order to be effective.

Objective: The aim of this review is to describe the regulatory background of the COVID-19 vaccines, the national recommendations for use issued and vaccine uptake in Sweden. It includes an overview of licensing and relevant safety aspects identified by the European Medicines Agency (EMA) and the national vaccination plan issued by the Public Health Agency (PHA) of Sweden.

Materials and methods: Information on dates of licensing and safety aspects of importance identified by EMA published on its website, was compiled and presented in a chronological order. National recommendations on COVID-19-vaccination and vaccinations-data on uptake and coverage using the national-vaccine-register are presented.

Results: COVID-19 vaccines development, assessments using rolling review and licensing of the covid-19 vaccines was done in 2020 during less than a year. Large-scale production was implemented. Monthly safety reviews performed by the EMA identified risk for thrombosis with thrombocytopenia syndrome with adenoviral vaccines and myocarditis for mRNA vaccines which led to restrictions in national recommendations for specified groups.National vaccinations were launched in a phased manner during 2021. Persons of high age, risk groups and nursing home personnel were prioritised during primary vaccinations and for initial boosters. In the Swedish population, 85% recieved at least on vaccine dose from the age of 12. At least two doses were recieved by 81% from age 18 and 95% from age 80.

Conclusion: Recommendations for national use adhered to relevant adverse drug reactions identified. The vaccine coverage was high. Timelines presented should be considered in follow-up studies of COVID-19-vaccines to manage possible selection bias and confounding.

Introduction: Investigating factors associated with contraceptive satisfaction is important to create a basis for tailored contraceptive counseling. In this study, we aimed to explore how sociodemographic characteristics affected women's level of satisfaction and choice of different contraceptive methods, using data collected during a randomized controlled trial (RCT) in the region Örebro County, Sweden.

Methods: This cross-sectional study utilized data from a previously conducted RCT. Eligible participants were women aged 20-40 years who sought contraceptive counseling. All women who participated in the RCT and completed a follow-up questionnaire were included in the analysis.

Results: Between February 2015 and March 2016, 1,946, participants were enrolled in the trial, with 1,198 (61.6%) completing the 2-month follow-up questionnaire. Overall, 81.3% of women reported being 'very satisfied' or 'satisfied' with their contraceptive method. Participants aged 27-40 years used long-acting reversible contraception (LARC) to a higher extent compared with those aged 20-26 years (adjusted odds ratio [aOR] 1.92, 95% confidence interval [CI] 1.44-2.56). Older age was associated with lower satisfaction (aOR 0.55, 95% CI 0.33-0.94).Participants with a body mass index (BMI) ≥ 25 more often used LARC (aOR 1.68, 95% CI 1.24-2.28) but were also more likely to report no use of contraceptives at all (aOR 1.56, 95% CI 1.01-2.43) compared with BMI < 25. The level of satisfaction tended to decrease with increasing BMI. Country of birth and educational level were not associated with satisfaction.

Conclusions: The use of LARC was more common among women with BMI ≥ 25 and older women. While BMI, education, and place of birth did not affect satisfaction, women aged 27-40 reported lower satisfaction. These findings contrast with prior studies and highlight the complex sociodemographic influences on contraception experiences.

Background: Patients, who are subjected to a patient's injury, are legally allowed a compensation for their suffering.

Aim: The negligence claims after surgical treatment of abdominal aortic aneurysms (AAA) registered in the National Swedish patient insurance company (Landstingens Ömsesidiga Försäkringsbolag [LÖF]) between 2006 and 2020 were analyzed. More than 95% of negligence claims are covered by LÖF. Special emphasis on avoidable or unavoidable injuries was made.

Material: In 15 years 17,000 abdominal aortic interventions were recorded in the Swedish vascular register (SWEDVASC), where vascular interventions in the whole country of Sweden are registered. A total of 151 negligence claims (0.9%) were reported to the insurance company. Available clinical information in the company's file of the claims was analyzed. The SWEDVASC data on AAA treatment were accessible.

Results: The number of Endovascular repair (EVAR) increased significantly, but the total number of interventions decreased. There were less claims after EVAR (0.7%) compared to open surgery (1.1%). There was an increase in avoidable injuries that were economically compensated (p = 0.02). Spinal cord ischemia and intestinal ischemia were dominating causes for claims.

Conclusion: The increase in the number of avoidable injuries should have an impact on how to train and support colleagues under education and efforts to diminish the injuries are essential. To develop methods to diminish the risk for non-avoidable complications is important.

Background: This study aimed to describe eating patterns among individuals with overweight and obesity and to investigate associations between eating patterns and anthropometric measures, including body mass index (BMI) and waist circumference, and blood pressure.

Methods: This study enrolled a cohort of adults with overweight or obesity (n = 176) participating in a clinical trial focused on weight reduction. Self-reported eating patterns were assessed as part of the trial's baseline survey. Trained study nurses conducted measurements of anthropometric indicators and blood pressure. To examine associations, statistical analyses included the application of the Mann-Whitney U-test, Fisher's exact test, the chi-squared test, and linear regression models as appropriate.

Results: The median age of the participants was 55 years (interquartile range [IQR] 12), 79% were female, and the median BMI was 33 kg/m² (IQR 5). The predominant eating pattern identified was characterized by five meals per day, including breakfast, two prepared meals, and two snacks. Among older participants (≥ 55 years), 51% reported eating two prepared meals per day as compared to 75% among the younger (P <> 0.05). A higher percentage of older participants reported consuming more than one snack per day (82% vs. 68%, P = 0.04). Additionally, older participants were more likely to rate their eating habits as 'good' compared to their younger counterparts (64% vs. 52%, P = 0.03). Women reported a higher number of eating occasions than men (> 3/day: 93% vs. 78%, P = 0.01) and a higher frequency of snacks (> 1 snack/day: 79% vs. 61%, P = 0.03). No significant associations between the number of eating occasions or number of snacks and BMI, waist circumference, or blood pressure (systolic and/or diastolic) were found in regression models when age and sex were considered.

Conclusions: Varying eating patterns were observed among adults with overweight and obesity according to age and sex. No association between eating patterns and anthropometric measures or blood pressure independent of age and sex was found.

Background: Acute respiratory distress syndrome (ARDS), which is often observed in severe cases of coronavirus disease 2019 (COVID-19), is known to be a major contributor to higher mortality rates. This study assesses how hematological parameters, inflammatory biomarkers, cytokines, and the -1,082 A/G polymorphism are associated with ARDS severity in COVID-19 patients.

Methods: Following exclusions, a 6-month prospective case-control study included 82 healthy controls (HCs) and 158 COVID-19 patients with varying severities of ARDS (mild: 73, moderate: 53, and severe: 32). Blood samples were collected at admission, and laboratory biomarkers were assessed using various methods. Statistical analyses included one-way analysis of variance with Tukey's test for group comparisons, Pearson correlation, and receiver operating characteristic curve for analyzing independent associations with COVID-19 severity. Multiple linear regression and chi-square tests were used to evaluate quantitative outcomes and categorical associations, respectively.

Results: Severe ARDS patients exhibited higher C-reactive protein (CRP) levels compared to HCs. Compared to HCs, patients with moderate and severe ARDS had higher neutrophil to lymphocyte ratio (NLR), neutrophil counts, tumor necrosis factor-alpha, and interleukin-10 (IL-10), as well as lower lymphocyte counts and reduced partial pressure of oxygen/fraction of inspired oxygen (PaO₂/FiO₂) ratio. IL-10, body mass index, CRP, and NLR were associated with reduced PaO₂/FiO₂ ratio. IL-10 and CRP had the highest area under curve values toward ARDS severity. COVID-19 patients possessing the -1,082 A/G single nucleotide IL-10 GG and GA genotypes and the G allele presented with less severe ARDS.

Conclusion: Hematological indices (neutrophil count and NLR), CRP, and serum IL-10 hold promise in monitoring ARDS severity in COVID-19 patients. In addition, COVID-19 patients with GG and AG genotypes and the G allele of the IL-10 gene's-1,082 A/G polymorphism experience less severe ARDS. This highlights the potential protective role of IL-10 genetic variation in modulating the severity of inflammatory responses during severe acute respiratory syndrome-coronavirus-2 infection and may serve as a useful genetic marker for risk stratification in clinical settings.

Introduction and aim: The risk of asthma and its phenotypes may be modified by gene-environmental interactions. The previous studies on the interactions between genetic variations in the toll like 4 (TLR4), the main receptor for bacterial endotoxin, and asthma were contradictory as they were underpowered and did not consider different asthma phenotypes. The main aim of this study was to identify interactions between two single nucleotide polymorphisms (SNPs) within the TLR4 gene, Asp299Gly and Thr399Ile, and residential area (urban or rural) in females and males with asthma and different asthma phenotypes.

Method: This study was performed on 38,332 asthmatics and 322,852 non-asthma (both British Caucasians) subjects from the UK Biobank database. Asthma was also divided into phenotypes, such as asthma with/without allergy and early/late onset asthma. The residential area was based on the population area density and classified as urban or rural living. Multivariate regression models adjusted for age, body mass index, and smoking status were used to analyze interactions between the SNPs, residential area in asthma, and asthma phenotypes. The association between asthma and residential area or the SNPs was also determined.

Result: There were no significant associations between the SNPs and asthma risk (for Asp299Gly: OR (95% CI): 1.00 (0.97-1.02), for Thr399Ile: 0.99 (0.96-1.02) or between the SNPs and asthma phenotypes in either sex or combined cohorts. The effects of the SNPs were not modified by residential area population density in either sex with asthma or across asthma phenotypes. Asthma and its phenotypes were not associated with the SNPs or residential area.

Conclusions: Our study found no statistically significant association between TLR4 polymorphisms and asthma, regardless of sex or residential area. Further studies are needed to clarify the functional impact of TLR4 variation in asthma pathophysiology.

Background and aims: The associations between physical fitness markers and liver volume in the general population are unclear. We investigated the associations of peak oxygen uptake (VO_2peak)and handgrip strength with liver volume in a general population sample.

Methods and results: Data were taken from 1,531 German adults (51.3% women), aged 20 to 88 years, from two cohorts of the population-based Study of Health in Pomerania (SHIP-START-2 and SHIP-TREND-0). We analysed cross-sectional associations of VO_2peak and handgrip strength with liver volume derived from magnetic resonance imaging (MRI) by using multivariable linear regression models. These models were adjusted for age, sex, body fat mass, pre-existing type 2 diabetes, daily alcohol consumption, smoking status, and use of hypoglycaemic or antihypertensive medications. We observed significant associations of lower VO_2peak and handgrip strength with a smaller liver volume in the whole population, as well as in both men and women. In the whole population, a 1 L/min lower VO_2peak was associated with a 0.15 cm³ (95% confidence interval [CI]: 0.11 to 0.19; P < 0.0001) smaller liver volume for both sexes together. Similarly, a 1 kg lower handgrip strength was associated with a 7.05 cm³ (95% CI: 4.87 to 9.23; P < 0.001) smaller liver volume in the whole population.

Conclusion: Our results derived from a large community-based sample showed that lower values of VO_2peak and handgrip strength were associated with a smaller liver volume. These results might explain the possible negative effects of sedentary lifestyle on liver volume - the sedentary liver.

Background: Transcatheter aortic valve implantation (TAVI) has shown similar or improved clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis at low risk for surgical mortality. This cost-utility analysis compared TAVI with SAPIEN 3 versus SAVR in symptomatic severe aortic stenosis patients at low risk of surgical mortality from the perspective of the Swedish healthcare system.

Methods: A published, two-stage, Markov-based cost-utility model that captured clinical outcomes from the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated according to Recommended Therapies (SWEDEHEART) registry (2018-2020) was adapted from the perspective of the Swedish healthcare system using local general population mortality, utility and costs data. The model had a lifetime horizon. Model outputs included changes in direct healthcare costs and health-related quality of life from using TAVI as compared with SAVR.

Results: TAVI with SAPIEN 3 resulted in lifetime costs per patient of 484,142 SEK Swedish krona (SEK) and lifetime quality-adjusted life years (QALYs) per patient of 7.16, whilst SAVR resulted in lifetime costs and QALYs per patient of 457,625 SEK and 6.81 QALYs, respectively. Compared with SAVR, TAVI offered an incremental improvement of +0.35 QALY per patient at an increased cost of +26,517 SEK per patient over a lifetime horizon, resulting in an incremental cost-effectiveness ratio of 76,532 SEK per QALY gained.

Conclusion: TAVI with SAPIEN 3 is a cost-effective option versus SAVR for patients with symptomatic severe aortic stenosis at low risk for surgical mortality treated in the Swedish healthcare setting. These findings may inform policy decisions in Sweden for the management of this patient group.