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1.
Artículo en Inglés | MEDLINE | ID: mdl-33806787

RESUMEN

International data suggest that exposure to nature is beneficial for mental health and well-being. The restrictions related to the COVID-19 pandemic have created a setting that allows us to investigate the importance of greenness exposure on mental health during a period of increased isolation and worry. Based on 2060 responses from an online survey in Stockholm County, Sweden, we investigated: (1) whether the COVID-19 pandemic changed peoples' lifestyle and nature-related habits, and (2) if peoples' mental health differed depending on their exposure to greenness. Neighborhood greenness levels were quantified by using the average normalized difference vegetation index (NDVI) within 50 m, 100 m, 300 m, and 500 m buffers surrounding the participant's place of residence. We found that the number of individuals that reported that they visited natural areas "often" was significantly higher during the pandemic than before the pandemic. Higher levels of greenness surrounding one's location of residence were in general associated with higher mental health/well-being and vitality scores, and less symptoms of depression, anxiety, and perceived and cognitive stress, after adjustments for demographic variables and walkability. In conclusion, the results from the present study provided support to the suggestion that contact with nature may be important for mental health in extreme circumstances.


Asunto(s)
Salud Mental , Adulto , Humanos , Pandemias , Características de la Residencia , Suecia/epidemiología
2.
Artículo en Inglés | MEDLINE | ID: mdl-33806951

RESUMEN

The COVID-19 pandemic has become a public health emergency of international concern, which may have affected lifestyle habits and mental health. Based on national health profile assessments, this study investigated perceived changes of lifestyle habits in response to the COVID-19 pandemic and associations between perceived lifestyle changes and mental health in Swedish working adults. Among 5599 individuals (50% women, 46.3 years), the majority reported no change (sitting 77%, daily physical activity 71%, exercise 69%, diet 87%, alcohol 90%, and smoking 97%) due to the pandemic. Changes were more pronounced during the first wave (April-June) compared to the second (October-December). Women, individuals <60 years, those with a university degree, white-collar workers, and those with unhealthy lifestyle habits at baseline had higher odds of changing lifestyle habits compared to their counterparts. Negative changes in lifestyle habits and more time in a mentally passive state sitting at home were associated with higher odds of mental ill-health (including health anxiety regarding one's own and relatives' health, generalized anxiety and depression symptoms, and concerns regarding employment and economy). The results emphasize the need to support healthy lifestyle habits to strengthen the resilience in vulnerable groups of individuals to future viral pandemics and prevent health inequalities in society.


Asunto(s)
Pandemias , Adulto , Ansiedad , Estudios Transversales , Depresión , Femenino , Hábitos , Humanos , Estilo de Vida , Masculino , Salud Mental , Suecia/epidemiología
3.
PLoS One ; 16(3): e0248918, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33750984

RESUMEN

BACKGROUND: Serological response and association to clinical manifestation is important for understanding the pathogenesis of COVID-19. MATERIALS AND METHODS: A prospective observational study was conducted where antibody responses of IgG and IgA towards SARS-CoV-2 spike protein were studied over time in patients with COVID-19. Possible associations between antibody titers and outcome were analyzed. RESULTS: Forty patients with COVID-19, hospitalized at Skåne University hospital, Sweden, between April and June 2020 were included. IgG antibody responses were detected for all patients with the highest levels four weeks after COVID-19 diagnosis. Levels of IgA were generally higher at diagnosis and decreased towards baseline 4 weeks after confirmed COVID-19. Patients with severe COVID-19 had higher levels of antibodies directed against SARS-CoV-2 spike protein compared with patients with mild disease. CONCLUSION: IgG and IgA antibodies towards the spike protein follow different kinetics during COVID-19 and patients with severe disease develop higher antibody levels.


Asunto(s)
Anticuerpos Antivirales/sangre , /patología , Anciano , Formación de Anticuerpos , Femenino , Humanos , Inmunoglobulina A/sangre , Inmunoglobulina G/sangre , Cinética , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Glicoproteína de la Espiga del Coronavirus/inmunología , Suecia
4.
Zootaxa ; 4908(2): zootaxa.4908.2.4, 2021 Jan 14.
Artículo en Inglés | MEDLINE | ID: mdl-33756622

RESUMEN

The type material of Australian Anoplognathini (Coleoptera: Scarabaeidae: Rutelinae) housed in Swedish natural history collections is reviewed, concerning three genera: Anoplognathus Leach, 1815, Amblyterus MacLeay, 1819, and Repsimus MacLeay, 1819. The species were described by G.J. Billberg, J.W. Dalman, L. Gyllenhal, C.J. Schönherr, O. Swartz, and C.P. Thunberg. The contemporary type material of W.S. MacLeay in the Macleay Museum, Sydney, is also examined as it has been overlooked by previous researchers. In total, type specimens for 12 species described between 1817 and 1822 were found in the Naturhistoriska Riksmuseet in Stockholm the Evolutionsmuseet in Uppsala and the Macleay Museum. Five of these species are valid: Anoplognathus brunnipennis, (Gyllenhal, 1817); A. olivieri (Schönherr Dalman, 1817); A. porosus (Dalman, 1817); Amblyterus cicatricosus (Gyllenhal, 1817); and Repsimus manicatus (Swartz, 1817). The other seven species are junior synonyms, as follows (senior synonym first): A. brunnipennis = Rutela chloropyga Thunberg, 1822 (new synonym); A. olivieri = Rutela lacunosa Thunberg, 1822 (new synonym); A. viridiaeneus (Donovan, 1805) = A. latreillei (Schönherr Gyllenhal, 1817); A. viriditarsus Leach, 1815 = Rutela analis Dalman, 1817; and R. manicatus = Anoplognathus brownii W.J. MacLeay, 1819 = A. dytiscoides W. J. MacLeay, 1819 = Rutela ruficollis Thunberg, 1822 (new synonym). Authorship of A. latreillei and A. olivieri is corrected, as noted above. Anoplognathus brunnipennis has been misidentified for the last 60 years at least, leading to the synonymy noted above. Anoplognathus flavipennis Boisduval, 1835 (revised status), is reinstated as the oldest available name for the misidentified A. brunnipennis and the types of A. flavipennis in the Muséum National d'Histoire Naturelle, Paris, are illustrated. Lectotypes are designated for: Anoplognathus brownii, A. flavipennis, A. dytiscoides, Melolontha cicatricosa, Rutela analis, R. brunnipennis, R. lacunosa, R. latreillei, R. manicata, R. olivieri, R. porosa, R. ruficollis, and R. chloropyga. Photographs of all type specimens examined are presented for the first time.


Asunto(s)
Escarabajos , Animales , Australia , Museos , Suecia
5.
Lakartidningen ; 1182021 03 15.
Artículo en Sueco | MEDLINE | ID: mdl-33720381

RESUMEN

Sweden does not have a national blood authority and guidelines for blood transfusions are lacking, leading to varying routines of production and usage of blood in the different regions. The minimum quality requirements are defined in EU Directive 2002/98/EG and in the Swedish SOSFS 2009:28. The standard blood components are red blood cells, plasma and platelets, while special components such as irradiated, washed, frozen-thawed or antigen-matched products are prescribed on certain clinical indications. Thresholds for transfusion of red blood cells and platelets are discussed as well as indications for plasma transfusions. Further, there is evidence that early, balanced blood transfusions in massive bleeding reduce mortality, which has led to requests for blood products in prehospital settings.


Asunto(s)
Transfusión de Componentes Sanguíneos , Transfusión Sanguínea , Hemorragia , Humanos , Suecia
6.
Lakartidningen ; 1182021 03 15.
Artículo en Sueco | MEDLINE | ID: mdl-33720382

RESUMEN

Postpartum hemorrhage is responsible for one fourth of the maternal mortality worldwide. In high resource countries there is an increasing trend in frequency of postpartum hemorrhage and need of blood transfusions. The reason for this increase is probably multifactorial. Major bleeding requires massive blood transfusion (MT), defined as transfusion of >10 units of erythrocytes within 24 hours. In Sweden the incidence of MT due to obstetric hemorrhage is reported to be 53 per 100 000 deliveries and the majority of the cases are due to placental complications, such as placenta previa and placenta accreta. These placental complications have increased over the past years as a consequence of a higher rate of cesarean deliveries. To reduce the number of deliveries requiring blood transfusion postpartum, prophylactic measures such as identification of women at increased risk, optimizing management of hemorrhage and evaluating the effect of every transfused unit of erythrocytes is important.


Asunto(s)
Placenta Accreta , Placenta Previa , Hemorragia Posparto , Transfusión Sanguínea , Femenino , Humanos , Histerectomía , Placenta Accreta/cirugía , Placenta Previa/cirugía , Placenta Previa/terapia , Hemorragia Posparto/epidemiología , Hemorragia Posparto/terapia , Embarazo , Estudios Retrospectivos , Suecia/epidemiología
7.
BMC Public Health ; 21(1): 528, 2021 03 17.
Artículo en Inglés | MEDLINE | ID: mdl-33731066

RESUMEN

BACKGROUND: The COVID-19 pandemic has triggered national recommendations encouraging people to work from home (WFH), but the possible impact of WFH on physical behaviors is unknown. This study aimed to determine the extent to which the 24-h allocation of time to different physical behaviors changes between days working at the office (WAO) and days WFH in office workers during the pandemic. METHODS: Data were collected on 27 office workers with full-time employment at a Swedish municipal division during the COVID-19 outbreak in May-July 2020. A thigh-worn accelerometer (Axivity) was used to assess physical behavior (sedentary, stand, move) during seven consecutive days. A diary was used to identify periods of work, leisure and sleep. 24-h compositions of sedentary, standing and moving behaviors during work and non-work time were examined using Compositional data analysis (CoDA), and differences between days WAO and days WFH were determined using repeated measures ANOVA. RESULTS: Days WFH were associated with more time spent sleeping relative to awake, and the effect size was large (F = 7.4; p = 0.01; ηp2 = 0.22). The increase (34 min) in sleep time during WFH occurred at the expense of a reduction in work and leisure time by 26 min and 7 min, respectively. Sedentary, standing and moving behaviors did not change markedly during days WFH compared to days WAO. CONCLUSION: Days working from home during the COVID-19 pandemic in Sweden were associated with longer duration of sleep than days working at the office. This behavioral change may be beneficial to health.


Asunto(s)
Ejercicio Físico , Actividades Recreativas , Conducta Sedentaria , Sueño , /estadística & datos numéricos , Acelerometría/instrumentación , Adulto , Análisis de Datos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Suecia/epidemiología
8.
Artículo en Inglés | MEDLINE | ID: mdl-33673575

RESUMEN

Gambling has been suggested as one of the potential mental health consequences of the COVID-19 pandemic. In earlier self-report studies, increased gambling has been reported by a limited proportion of respondents characterized with a high degree of problem gambling. The present study, carried out with the same methodology and in the same geographical setting, around seven months later in the pandemic, aimed to repeat and to extend the understanding of potential gambling changes in the population during COVID-19. An anonymous sample of web panel members was assessed, altogether 2029 individuals (52% women, 10% moderate-risk or problem gamblers). Results indicated that 6% reported increased gambling, and 4% reported decreased gambling during the pandemic. Having increased gambling was associated with more severe gambling problems (OR 2.78, 95% confidence interval 2.27-3.40), increased alcohol consumption (OR 2.92, 1.71-4.98), and psychological distress (OR 3.38, 1.83-6.23). In the group reporting increased gambling during COVID-19, moderate-risk/problem gambling was very common (62%). Recent governmental policy interventions in the area were known to a minority (30%) of respondents, but awareness of the regulations was markedly more common in individuals with at least moderate-risk gambling (56%) and in self-excluders (78%). Reporting of any perceived influence from policy changes was low (3%), and divided between those reporting an increasing and decreasing effect, respectively. Increased gambling may be a consequence of COVID-19-related changes in everyday lives of individuals with problematic gambling patterns. Thus, a vulnerable group demonstrates higher rates of gambling migration and psychosocial problems, and may require particular attention in screening and treatment contexts, and further scientific evaluations.


Asunto(s)
Juego de Azar , Pandemias , Femenino , Juego de Azar/epidemiología , Humanos , Masculino , Políticas , Suecia/epidemiología
9.
Front Public Health ; 9: 579948, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33681118

RESUMEN

Influenza viruses have caused disease outbreaks in human societies for a long time. Influenza often has rapid onset and relatively short duration, both in the individual and in the population. The case fatality rate varies for different strains of the virus, as do the effects on total mortality. Outbreaks related to coronavirus infections have recently become a global concern but much less is known about the dynamics of these outbreaks and their effects on mortality. In this work, disease outbreaks in Sweden, in the time period of 1860-2020, are characterized and compared to the currently ongoing COVID-19 outbreak. The focus is on outbreaks with a sharp increase in all-cause mortality. Outbreak onset is defined as the time point when death counts start to increase consistently for a period of at least 10 days. The duration of the outbreak is defined as the time period in which mortality rates are elevated. Excess mortality is estimated by standard methods. In total there were 15 outbreaks detected in the time period, the first 14 were likely caused by influenza virus infections, the last by SARS-CoV-2. The mortality dynamics of the SARS-CoV-2 outbreak is shown to be similar to outbreaks due to influenza virus, and in terms of the number of excess deaths, it is the worst outbreak in Sweden since the "Spanish flu" of 1918-1919.


Asunto(s)
/mortalidad , Brotes de Enfermedades/historia , Gripe Humana/mortalidad , Causas de Muerte , Historia del Siglo XIX , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Gripe Humana/historia , Mortalidad/historia , Suecia/epidemiología
10.
Lakartidningen ; 1182021 03 11.
Artículo en Sueco | MEDLINE | ID: mdl-33709387

RESUMEN

The outbreak of SARS-CoV-2 has led to a sharp rise in intensive care unit (ICU) admissions and consequently a need to perform tracheotomies on patients with Covid-19. A number of guidelines have been published with recommendations for the timing of tracheostomy in Covid-19 patients, suggesting tracheotomy should be delayed until day 14-21 of mechanical ventilation.  We present the first 66 patients treated in the ICU at Södra Älvsborg hospital in Sweden as a result of Covid-19. A total of 29 patients received a tracheostomy, median time 9 days post oral intubation, which is earlier than recommended. The mortality rate was 21%, which is slightly lower than reported from The Swedish Intensive Care Registry (25%). None of the doctors performing tracheotomies developed Covid-19 linked to the tracheotomy procedure.


Asunto(s)
Traqueotomía , Humanos , Respiración Artificial , Suecia/epidemiología , Factores de Tiempo , Traqueostomía/efectos adversos
11.
Medicine (Baltimore) ; 100(8): e23718, 2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33663038

RESUMEN

ABSTRACT: Pain as a result of cervical radiculopathy (CR) can be widespread, nondermatomal and individually specific, but the association between pain extent and other clinical features has never been explored. The objective of this study is to investigate whether pain extent relates to clinical variables including pain intensity in addition to health indicators including disability, general health, depression, somatic anxiety, coping strategies or self-efficacy.An observational cohort study was conducted. Participants were recruited from 4 hospital spinal centres in Sweden. Pain extent was quantified from the pain drawings of 190 individuals with cervical disc disease, verified with magnetic resonance imaging (MRI) and compatible with clinical findings (examined by a neurosurgeon), that show cervical nerve root compression. Pain extent was evaluated in relation to neck pain, arm pain, and headache intensity. Multiple linear regression analysis were then used to verify whether pain extent was associated with other health indicators including disability, health-related quality of life, depression, somatic anxiety, coping strategies and self-efficacy.Pain extent was directly related to neck, arm and headache pain intensity (all P < .01). Multiple linear regression revealed that pain extent was significantly associated only to the level of perceived disability (P < .01).Increased pain extent in people with CR is associated with higher headache, neck and arm pain intensity, and disability but not measures of general health, depression, somatic anxiety, coping strategies or self-efficacy.


Asunto(s)
Evaluación de la Discapacidad , Estado de Salud , Dolor/etiología , Dolor/psicología , Radiculopatía/complicaciones , Adaptación Psicológica , Adulto , Factores de Edad , Anciano , Vértebras Cervicales , Depresión/etiología , Personas con Discapacidad , Ejercicio Físico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Calidad de Vida , Autoeficacia , Factores Sexuales , Factores Socioeconómicos , Suecia , Evaluación de Capacidad de Trabajo , Adulto Joven
12.
Chemosphere ; 271: 129763, 2021 May.
Artículo en Inglés | MEDLINE | ID: mdl-33736225

RESUMEN

Active pharmaceutical ingredients (APIs) are vital to human health and welfare, but following therapeutic use, they may pose a potential ecological risk if discharged into the environment. Today's conventional municipal wastewater treatment plants are not designed to remove APIs specifically, and various techniques, preferably cost-effective and environmentally friendly, are being developed and evaluated. Microalgae-based treatment of wastewater is a sustainable and low-cost approach to remove nutrients and emerging contaminants. In this study, a North Sweden high-rate algal pond (HRAP) using municipal untreated wastewater as medium, was investigated in terms of API distribution and fate. Three six-day batches were prepared during 18 days and a total of 36 APIs were quantified within the HRAP of which 14 were removed from the aqueous phase above 50% and seven removed above 90% of their initial concentrations. Twelve APIs of a hydrophobic nature were mostly associated with the algal biomass that was harvested at the end of each batch. HRAPs treatment successfully removed 69% of studied APIs (25 of 36 studied) in six day time. The distribution of various APIs between the aqueous phase and biomass suggested that several removal mechanisms may occur, such as hydrophobicity driven removal, passive biosorption and active bioaccumulation.


Asunto(s)
Microalgas , Preparaciones Farmacéuticas , Biomasa , Humanos , Estanques , Suecia , Eliminación de Residuos Líquidos , Aguas Residuales
13.
Lakartidningen ; 1182021 03 02.
Artículo en Sueco | MEDLINE | ID: mdl-33650097

RESUMEN

This is a short report of the recently published Swedish guidelines for acute pancreatitis, which are based on international guidelines as well as original publications. The report covers diagnosis, classification, treatment and follow up for patients with acute pancreatitis. Early rehydration and goal-based fluid therapy is recommended as well as oral intake of food on demand. Risk factors for development of severe disease and organ failure should be considered already in the emergency unit. Abdominal computer tomography is generally not recommended the first 5-7 days from onset of symptoms. Antibiotic therapy is only recommended when there is suspicion of or a confirmed infection. If intervention is needed for patients with moderate or severe disease a minimal-invasive step-up approach is recommended. Endoscopic Retrograde Cholangiography is generally not recommended as a treatment in the acute phase of the disease. Identification and treatment of the etiology causing acute pancreatitis is essential to prevent new episodes of the disease.


Asunto(s)
Laparoscopía , Pancreatitis , Enfermedad Aguda , Fluidoterapia , Humanos , Pancreatitis/diagnóstico , Pancreatitis/etiología , Pancreatitis/terapia , Suecia
14.
Sensors (Basel) ; 21(4)2021 Feb 18.
Artículo en Inglés | MEDLINE | ID: mdl-33670528

RESUMEN

The aim of the current study was to evaluate the relation of automatically determined body condition score (BCS) and inline biomarkers such as ß-hydroxybutyrate (BHB), milk yield (MY), lactate dehydrogenase (LDH), and progesterone (mP4) with the pregnancy success of cows. The cows (n = 281) had 2.1 ± 0.1. lactations on average, were 151.6 ± 0.06 days postpartum, and were once tested with "Easy scan" ultrasound (IMV imaging, Scotland) at 30-35 d post-insemination. According to their reproductive status, cows were grouped into two groups: non-pregnant (n = 194 or 69.0% of cows) and pregnant (n = 87 or 31.0% of cows). Data concerning their BCS, mP4, MY, BHB, and LDH were collected each day from the day of insemination for 7 days. The BCS was collected with body condition score camera (DeLaval Inc., Tumba, Sweden); mP4, MY, BHB, and LDH were collected with the fully automated real-time analyzer Herd Navigator™ (Lattec I/S, Hillerød, Denmark) in combination with a DeLaval milking robot (DeLaval Inc., Tumba, Sweden). Of all the biomarkers, three differences between groups were significant. The body condition score (BCS) of the pregnant cows was higher (+0.49 score), the milk yield (MY) was lower (-4.36 kg), and milk progesterone in pregnant cows was (+6.11 ng/mL) higher compared to the group of non-pregnant cows (p < 0.001). The pregnancy status of the cows was associated with their BCS assessment (p < 0.001). We estimated that cows with BCS > 3.2 were 22 times more likely to have reproductive success than cows with BCS ≤ 3.2.


Asunto(s)
Biomarcadores , Leche , Progesterona , Ácido 3-Hidroxibutírico , Animales , Bovinos , Femenino , L-Lactato Deshidrogenasa , Lactancia , Embarazo , Suecia
15.
Artículo en Inglés | MEDLINE | ID: mdl-33671210

RESUMEN

The COVID-19 pandemic and its impact on society has been suspected to affect gambling behaviors. Potentially, the pandemic crisis may result in increased problem gambling, for example, due to COVID-19-related psychological distress, unemployment, and financial difficulties. In addition, the cancellation of sports in early parts of the crisis has been suspected to alter gambling behaviors. Policy makers have called for action and, in some cases, have changed regulations, and media have reported possible increases in treatment seeking. However, research data are hitherto lacking. The present study assessed the treatment uptake at a regional specialized gambling-disorder unit in the healthcare system of Region Skåne, Sweden. Number of patients, treatment contacts, and patterns of rescheduling or cancellations of appointments were quantified for each month, January-December 2020, and compared to corresponding months of 2018 and 2019. Possible trends were analyzed, using an interrupted time-series analysis. Results did not indicate an increase in treatment uptake for gambling disorder during the months of COVID-19 impact in Sweden. The proportion of digital treatment increased, but total treatment uptake was unaffected by the pandemic. In conclusion, during the first ten months of the pandemic in Sweden, no obvious increase in treatment uptake for gambling disorder could be seen. Moreover, longer follow-up may be necessary in order to see if effects of worsening socioeconomic conditions may be a possible long-term risk factor of increased gambling after COVID-19.


Asunto(s)
Juego de Azar/terapia , Aceptación de la Atención de Salud/estadística & datos numéricos , Femenino , Juego de Azar/epidemiología , Humanos , Masculino , Pandemias , Suecia/epidemiología
16.
Sci Rep ; 11(1): 5160, 2021 03 04.
Artículo en Inglés | MEDLINE | ID: mdl-33664279

RESUMEN

The extent that antibodies to SARS-CoV-2 may protect against future virus-associated disease is unknown. We invited all employees (n = 15,300) at work at the Karolinska University Hospital, Stockholm, Sweden to participate in a study examining SARS-Cov-2 antibodies in relation to registered sick leave. For consenting 12,928 healthy hospital employees antibodies to SARS-CoV-2 could be determined and compared to participant sick leave records. Subjects with viral serum antibodies were not at excess risk for future sick leave (adjusted odds ratio (OR) controlling for age and sex: 0.85 [95% confidence interval (CI) (0.85 (0.43-1.68)]. By contrast, subjects with antibodies had an excess risk for sick leave in the weeks prior to testing [adjusted OR in multivariate analysis: 3.34 (2.98-3.74)]. Thus, presence of viral antibodies marks past disease and protection against excess risk of future disease. Knowledge of whether exposed subjects have had disease in the past or are at risk for future disease is essential for planning of control measures.Trial registration: First registered on 02/06/20, ClinicalTrials.gov NCT04411576.


Asunto(s)
Anticuerpos Antivirales/sangre , /inmunología , Ausencia por Enfermedad/estadística & datos numéricos , Adulto , Anticuerpos Antivirales/inmunología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Suecia/epidemiología
17.
Bone Joint J ; 103-B(3): 469-478, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33641419

RESUMEN

AIMS: To develop and externally validate a parsimonious statistical prediction model of 90-day mortality after elective total hip arthroplasty (THA), and to provide a web calculator for clinical usage. METHODS: We included 53,099 patients with cemented THA due to osteoarthritis from the Swedish Hip Arthroplasty Registry for model derivation and internal validation, as well as 125,428 patients from England and Wales recorded in the National Joint Register for England, Wales, Northern Ireland, the Isle of Man, and the States of Guernsey (NJR) for external model validation. A model was developed using a bootstrap ranking procedure with a least absolute shrinkage and selection operator (LASSO) logistic regression model combined with piecewise linear regression. Discriminative ability was evaluated by the area under the receiver operating characteristic curve (AUC). Calibration belt plots were used to assess model calibration. RESULTS: A main effects model combining age, sex, American Society for Anesthesiologists (ASA) class, the presence of cancer, diseases of the central nervous system, kidney disease, and diagnosed obesity had good discrimination, both internally (AUC = 0.78, 95% confidence interval (CI) 0.75 to 0.81) and externally (AUC = 0.75, 95% CI 0.73 to 0.76). This model was superior to traditional models based on the Charlson (AUC = 0.66, 95% CI 0.62 to 0.70) and Elixhauser (AUC = 0.64, 95% CI 0.59 to 0.68) comorbidity indices. The model was well calibrated for predicted probabilities up to 5%. CONCLUSION: We developed a parsimonious model that may facilitate individualized risk assessment prior to one of the most common surgical interventions. We have published a web calculator to aid clinical decision-making. Cite this article: Bone Joint J 2021;103-B(3):469-478.


Asunto(s)
Artroplastia de Reemplazo de Cadera/mortalidad , Modelos Estadísticos , Mortalidad/tendencias , Osteoartritis de la Cadera/cirugía , Complicaciones Posoperatorias/mortalidad , Medición de Riesgo/métodos , Factores de Edad , Toma de Decisiones Conjunta , Inglaterra/epidemiología , Femenino , Humanos , Internet , Irlanda/epidemiología , Masculino , Valor Predictivo de las Pruebas , Sistema de Registros , Factores de Riesgo , Factores Sexuales , Suecia/epidemiología , Gales/epidemiología
19.
BMC Infect Dis ; 21(1): 236, 2021 Mar 02.
Artículo en Inglés | MEDLINE | ID: mdl-33653292

RESUMEN

BACKGROUND: Patients with injection drug use (IDU) have increased risk of developing infective endocarditis (IE). Previous studies have reported recurrent IE, increased duration of hospital stay, poor adherence and compliance as well as higher mortality and worse outcomes after surgery in the IDU-IE patient group. Further studies are needed to provide a basis for optimized care and prevention of readmissions in this population. This study aims to describe the clinical characteristics and outcomes among patients with IDU-IE. METHODS: Data of adults with IDU-IE and non-IDU-IE, treated between 2008 and 2017 at the Karolinska University Hospital in Stockholm were obtained from the Swedish National Registry of Infective Endocarditis. Clinical characteristics, microbiological results, treatment durations, results from echocardiography and in-hospital mortality were compared between the groups. RESULTS: Of the total 522 patients, 165 (32%) had IDU-IE. Patients with IDU-IE were younger than the patients with non-IDU-IE (mean age IDU-IE: 41.6 years, SD 11.9 years; non-IDU-IE: 64.3 years, SD 16.4 years; P <  0.01). No difference in distribution of gender was observed, 33% were females in both the IDU-IE and the non-IDU-IE group. History of previous IE (IDU-IE: n = 49, 30%; non-IDU-IE: n = 34, 10%; P <  0.01) and vascular phenomena (IDU-IE: n = 101, 61%; non-IDU-IE: n = 120, 34%; P <  0.01) were more common among patients with IDU-IE while prosthetic heart valves (IDU-IE: n = 12, 7%; non-IDU-IE: n = 83, 23%; P <  0.01) and known valvular disease (IDU-IE: n = 3, 2%; non-IDU-IE: n = 78, 22%; P <  0.01) were more common among patients with non-IDU-IE. Aetiology of Staphylococcus aureus (IDU-IE: n = 123, 75%; non-IDU-IE: n = 118, 33%; P <  0.01) as well as tricuspid (IDU-IE: n = 91, 55%; non-IDU-IE: n = 23, 6%; P <  0.01) or pulmonary valve vegetations (IDU-IE: n = 7, 4%; non-IDU-IE: n = 2, 1%; P <  0.01) were more common in the IDU-IE group. The overall incidence of IDU-IE decreased during the study period, while the incidence of definite IE increased (P <  0.01). CONCLUSIONS: This study presents that patients with IDU-IE were younger, less frequently treated with surgery and had higher prevalence of vascular phenomena and history of previous IE, aspects that are important for improved management of this population.


Asunto(s)
Endocarditis/epidemiología , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Anciano , Endocarditis/etiología , Endocarditis/patología , Endocarditis/terapia , Femenino , Mortalidad Hospitalaria , Hospitales Universitarios , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Abuso de Sustancias por Vía Intravenosa/etiología , Abuso de Sustancias por Vía Intravenosa/patología , Abuso de Sustancias por Vía Intravenosa/terapia , Suecia/epidemiología
20.
Trials ; 22(1): 209, 2021 Mar 16.
Artículo en Inglés | MEDLINE | ID: mdl-33726804

RESUMEN

OBJECTIVES: The main goal of the COVIDENZA trial is to evaluate if inhibition of testosterone signalling by enzalutamide can improve the outcome of patients hospitalised for COVID-19. The hypothesis is based on the observation that the majority of patients in need of intensive care are male, and the connection between androgen receptor signalling and expression of TMPRSS2, an enzyme important for SARS-CoV-2 host cell internalization. TRIAL DESIGN: Hospitalised COVID-19 patients will be randomised (2:1) to enzalutamide plus standard of care vs. standard of care designed to identify superiority. PARTICIPANTS: Included participants, men or women above 50 years of age, must be hospitalised for PCR confirmed COVID-19 symptoms and not in need of immediate mechanical ventilation. Major exclusion criteria are breast-feeding or pregnant women, hormonal treatment for prostate or breast cancer, treatment with immunosuppressive drugs, current symptomatic unstable cardiovascular disease (see Additional file 1 for further details). The trial is registered at Umeå University Hospital, Region Västerbotten, Sweden and 8 hospitals are approved for inclusion in Sweden. INTERVENTION AND COMPARATOR: Patients randomised to the treatment arm will be treated orally with 160 mg (4x40 mg) enzalutamide (Xtandi®) daily, for five consecutive days. The study is not placebo controlled. The comparator is standard of care treatment for patients hospitalised with COVID-19. MAIN OUTCOMES: The primary endpoints of the study are (time to) need of mechanical ventilation or discharge from hospital as assessed by a clinical 7-point ordinal scale (up to 30 days after inclusion). RANDOMISATION: Randomisation was stratified by center and sex. Each strata was randomized separately with block size six with a 2:1 allocation ratio (enzalutamide + "standard of care": "standard of care"). The randomisation list, with consecutive subject numbers, was generated by an independent statistician using the PROC PLAN procedure of SAS version 9.4 software (SAS Institute, Inc, Cary, North Carolina) BLINDING (MASKING): This is an open-label trial. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): The trial is designed to have three phases. The first, an exploration phase of 45 participants (30 treatment and 15 control) will focus on safety and includes a more extensive laboratory assessment as well as more frequent safety evaluation. The second prolongation phase, includes the first 100 participants followed by an interim analysis to define the power of the study. The third phase is the continuation of the study up to maximum 600 participants included in total. TRIAL STATUS: The current protocol version is COVIDENZA v2.0 as of September 10, 2020. Recruitment started July 29, 2020 and is presently in safety pause after the first exploration phase. Recruitment is anticipated to be complete by 31 December 2021. TRIAL REGISTRATION: Eudract number 2020-002027-10 ClinicalTrials.gov Identifier: NCT04475601 , registered June 8, 2020 FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Antivirales/uso terapéutico , Feniltiohidantoína/análogos & derivados , /efectos de los fármacos , Antivirales/efectos adversos , /virología , Ensayos Clínicos Fase II como Asunto , Femenino , Interacciones Huésped-Patógeno , Humanos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Feniltiohidantoína/efectos adversos , Feniltiohidantoína/uso terapéutico , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto , Suecia , Factores de Tiempo , Resultado del Tratamiento , Internalización del Virus/efectos de los fármacos
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