251 research outputs found
Management of acute coronary syndromes from a gender perspective
No full textAcute Coronary Syndromes are the most frequent manifestations of coronary heart disease (CHD). Gender differences in treatment intensity, including differences in level of care, have been reported. Also differences in benefit from certain treatments, especially invasive treatment, have been discussed. Finally, differences in outcome between men and women have been proposed. Results have been inconsistent, partly depending on if and how adjustment for differences in background characteristics has been made.This is the pre-reviewed version of the following article:Joakim Alfredsson and Eva Swahn, Management of acute coronary syndromes from a gender perspective, 2010, FUNDAMENTAL and CLINICAL PHARMACOLOGY, (24), 6, 719-728.which has been published in final form at: http://dx.doi.org/10.1111/j.1472-8206.2010.00837.xCopyright: Blackwell Publishing Ltd.http://eu.wiley.com/WileyCDA/Brand/id-35.htm
Description and initial evaluation of an educational and psychosocial support model for adults with congenitally malformed hearts
No full textOBJECTIVE: Various programmes for adults with congenitally malformed hearts have been developed, but detailed descriptions of content, rationale and goals are often missing. The aim of this study was to describe and make an initial evaluation of a follow-up model for adults with congenitally malformed hearts, focusing on education and psychosocial support by a multidisciplinary team (EPS). METHODS: The model is described in steps and evaluated with regards to perceptions of knowledge, anxiety and satisfaction. RESULTS: The EPS model included a policlinic visit to the physician/nurse (medical consultation, computer-based and individual education face-to-face as well as psychosocial support) and a 1-month telephone follow-up. Fifty-five adults (mean age 34, 29 women) with the nine most common forms of congenitally malformed hearts participated in the EPS model as well as the 3-months follow-up. Knowledge about congenital heart malformation had increased in 40% of the participants at the 3-months follow-up. CONCLUSION: This study describes and evaluates a model that combines a multidisciplinary approach and computer-based education for follow-up of adults with congenitally malformed hearts. The EPS model was found to increase self-estimated knowledge, but further evaluations need to be conducted to prove patient-centred outcomes over time. PRACTICE IMPLICATIONS: The model is now ready to be implemented in adults with congenitally malformed hearts.Original Publication:Helén Rönning, Niels Erik Nielsen, Eva Swahn and Anna Strömberg, Description and initial evaluation of an educational and psychosocial support model for adults with congenitally malformed hearts, 2011, Patient Education and Counseling, (83), 2, 247-251.http://dx.doi.org/10.1016/j.pec.2010.06.015Copyright: Elsevier Science B.V., Amsterdam.http://www.elsevier.com
To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial
No full textBackground: Major adverse cardiac events (MACEs) are a common cause of deathafter non-cardiac surgery. Despite evidence for the benefitof aspirin for secondary prevention, it is often discontinuedin the perioperative period due to the risk of bleeding. Methods: We conducted a randomized, double-blind, placebo-controlledtrial in order to compare the effect of low-dose aspirin withthat of placebo on myocardial damage, cardiovascular, and bleedingcomplications in high-risk patients undergoing non-cardiac surgery.Aspirin (75 mg) or placebo was given 7 days before surgery andcontinued until the third postoperative day. Patients were followedup for 30 days after surgery. Results: A total of 220 patients were enrolled, 109 patients receivedaspirin and 111 received placebo. Four patients (3.7%) in theaspirin group and 10 patients (9.0%) in the placebo group hadelevated troponin T levels in the postoperative period (P=0.10).Twelve patients (5.4%) had an MACE during the first 30 postoperativedays. Two of these patients (1.8%) were in the aspirin groupand 10 patients (9.0%) were in the placebo group (P=0.02). Treatmentwith aspirin resulted in a 7.2% absolute risk reduction [95%confidence interval (CI), 1.3–13%] for postoperative MACE.The relative risk reduction was 80% (95% CI, 9.2–95%).Numbers needed to treat were 14 (95% CI, 7.6–78). No significantdifferences in bleeding complications were seen between thetwo groups. Conclusions: In high-risk patients undergoing non-cardiac surgery, perioperativeaspirin reduced the risk of MACE without increasing bleedingcomplications. However, the study was not powered to evaluatebleeding complications. This is a pre-copy-editing, author-produced PDF of an article accepted for publication in British Journal of Anaesthesia following peer review. The definitive publisher-authenticated version:Anna Oscarsson Tibblin, Anil Gupta, Mats Fredrikson, Johannes Järhult, Matti Nyström, Eva Pettersson, Bijan Darvish, Helena Krook, Eva Swahn and Christina Eintrei, To continue or discontinue aspirin in the perioperative period: a randomized, controlled clinical trial, 2010, British Journal of Anaesthesia, (104), 3, 305-312.is available online at: http://dx.doi.org/doi:10.1093/bja/aeq003Copyright: Oxford University Presshttp://www.oxfordjournals.org
Gender difference in prevalence and prognostic impact of renal insufficiency in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention
No full textObjective To evaluate if female gender is associated with renal insufficiency in patients with ST-elevation myocardial infarction (STEMI) and if there is a gender difference in the prognostic importance of renal insufficiency in STEMI. Design Single-centre observational study. Setting One tertiary cardiac centre. Patients All consecutive patients with STEMI planned for primary percutaneous coronary intervention in one Swedish county in 2005 (98 women and 176 men). Main outcome measures Logistic regression analyses were conducted to evaluate the predictors of renal insufficiency, associations between estimated glomerular filtration rate (eGFR) and outcome in each gender and a possible interaction between gender and eGFR regarding outcome. Results Renal insufficiency was defined as eGFR less than 60 ml/min per 1.73 m(2). 67% of women had renal insufficiency compared with 26% of men, OR 5.06 (95% CI 2.66 to 9.59) after multivariable adjustment. In women each 10 ml/min per 1.73 m 2 increment of eGFR was associated with a 63% risk reduction for 1-year mortality, OR 0.37 (95% CI 0.15 to 0.89). No such association was found in men, OR 1.05 (95% CI 0.63 to 1.76). A trend towards a significant interaction between gender and eGFR regarding 1-year mortality was found, OR 2.05 (95% CI 0.93 to 4.50). Conclusions A considerable gender difference in the prevalence of renal insufficiency in STEMI was found and renal insufficiency seemed to be a more important prognostic marker in women. These results are important as previous STEMI studies have shown higher multivariable adjusted mortality in women than in men but renal function has seldom been taken into consideration.Original Publication:Sofia Lawesson, Tim Tödt, Joakim Alfredsson, Magnus Janzon, Ulf Stenestrand and Eva Swahn, Gender difference in prevalence and prognostic impact of renal insufficiency in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention, 2011, HEART, (97), 4, 308-314.http://dx.doi.org/10.1136/hrt.2010.194282Copyright: BMJ Publishing Group; 1999http://group.bmj.com
Antiprogestin Drugs; Research and Clinical Use in Sweden
No full textDr. Marc Bygdeman and his co-author, Dr. Marja-Liisa Swahn, describe
their pioneering contribution to the use of RU 486 as an abortifacient. Their
work in Sweden, initially published in 1984, showed that the administration of
RU 486 with subsequent use of a prostaglandin made RU 486 significantly more
effective. They also explain their work determining the acceptability of the
drug to women, and their finding that "it...seems unlikely that a medical
abortion method with a limited duration of application will influence any
significant number of indecisive women to perform an abortion which they would
later regret." The authors describe their research on the use of combined RU
486/prostaglandin therapy for second trimester abortion, explaining that their
initial findings show greater efficacy and decreased side effects and pain.
Finally, they explain that their preliminary findings indicate that the use of
RU 486 as a contraceptive administered after ovulation on a monthly basis may
prove to be an attractive alternative to present contraceptive methods
A Macrolevel Examination of County-Level Risk Factors for Underage Drinking Prevention: Intervention Opportunities to Protect Youth in the State of Georgia
No full textIntroduction: Underage drinking can have profoundly negative impacts on childhood development. This study compares 4 categories of known underage drinking risk factors with alcohol consumption. The social indicators in these categories will be compared in the 10 most-at-risk (MAR) counties and the 10 least-at-risk (LAR) counties identified in Georgia.
Methods: Independent 2-tailed t-tests were conducted to compare group means among MAR and LAR counties for all identified risk factors.
Results: Significant differences were observed in all factors included in the poverty and alcohol outlet density categories.
Discussion. The findings underscore the importance of better understanding youth drinking, poverty, and alcohol outlet density. However, our findings, supported by previous individual and aggregated level research, support strategies for researchers and policy makers to more proactively respond to poverty-stricken and high-density alcohol outlet indicators. The current ecological evaluation of underage drinking risk assessed on a macrolevel offers insights into the demographic features, social structures, and cultural patterns of counties that potentially predispose youth to greater health risks specifically associated with underage drinking.This article was originally published in Child Development Research and is reposted here with the permission of the author. Copyright © 2011 Karen E. O'Quin, Sheryl M. Strasser, and Monica H. Swahn. This is an open access article distributed under a Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p
Relations between professional medical associations and the health-care industry, concerning scientific communication and continuing medical education : a policy statement from the European Society of Cardiology
No full textPhysicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. Medical education and training in research include learning how to assess the quality and reliability of any information. There is some risk of bias in any form of scientific communication including intellectual, professional, and financial and it is essential that in particular, the latter must be acknowledged by full disclosure. It is essential that there is strong collaboration between basic and clinical researchers from academic institutions on the one hand, with engineers and scientists from the research divisions of device and pharmaceutical companies on the other. This is vital so that new diagnostic methods and treatments are developed. Promotion of advances by industry may accelerate their implementation into clinical practice. Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry.</p
Relations between professional medical associations and the healthcare industry, concerning scientific communication and continuing medical education – a Policy Statement from the European Society of Cardiology <em>Executive Summary</em>, December 2011
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