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Nilsson A, Strömberg U, Björk J, Forsberg A, Fritzell K, Kemp Gudmundsdottir KR, Engdahl J, Bonander C. Examining the continuum of resistance model in two population-based screening studies in Sweden. Prev Med Rep 2023; 35:102317. [PMID: 37519442 PMCID: PMC10372382 DOI: 10.1016/j.pmedr.2023.102317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/20/2023] [Accepted: 07/08/2023] [Indexed: 08/01/2023] Open
Abstract
In studies recruited on a voluntary basis, lack of representativity may impair the ability to generalize findings to the target population. Previous studies, primarily based on surveys, have suggested that generalizability may be improved by exploiting data on individuals who agreed to participate only after receiving one or several reminders, as such individuals may be more similar to non-participants than what early participants are. Assessing this idea in the context of screenings, we compared sociodemographic characteristics and health across early, late, and non-participants in two large population-based screening studies in Sweden: STROKESTOP II (screening for atrial fibrillation; 6,867 participants) and SCREESCO (screening for colorectal cancer; 39,363 participants). We also explored the opportunities to reproduce the distributions of characteristics in the full invited populations, either by assuming that the non-participants were similar to the late participants, or by applying a linear extrapolation model based on both early and late participants. Findings showed that early and late participants exhibited similar characteristics along most dimensions, including civil status, education, income, and health examination results. Both these types of participants in turn differed from the non-participants, with fewer married, lower educational attainments, and lower incomes. Compared to early participants, late participants were more likely to be born outside of Sweden and to have comorbidities, with non-participants similar or even more so. The two empirical models improved representativity in some cases, but not always. Overall, we found mixed support that data on late participation may be useful for improving representativeness of screening studies.
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Affiliation(s)
- Anton Nilsson
- Epidemiology, Population Studies and Infrastructures (EPI@LUND), Lund University, Lund, Sweden
| | - Ulf Strömberg
- Region Halland, Halmstad, Sweden
- Health Economics and Policy, School of Public Health & Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Jonas Björk
- Epidemiology, Population Studies and Infrastructures (EPI@LUND), Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Anna Forsberg
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kaisa Fritzell
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- The Hereditary Cancer Clinic, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | | | - Johan Engdahl
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Carl Bonander
- Health Economics and Policy, School of Public Health & Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
- Centre for Societal Risk Research, Karlstad University, Sweden
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Dahl M, Søndergaard SF, Al-Allaq RS, Diederichsen A, Lindholt JS. Arabic-speaking male immigrants' perceptions of preventive initiatives: An interview study. Health Expect 2023. [PMID: 37095730 DOI: 10.1111/hex.13766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/03/2023] [Accepted: 04/10/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Arabic-speaking men are a sparsely investigated population in health promotion and disease prevention. This may hamper their ability to achieve the highest obtainable health due to less accessibility and acceptability of preventive measures. AIM We explored Arabic-speaking (Palestinian, Iraqi and Somali) male immigrants' perceptions of preventive initiatives in general and such initiatives for cardiovascular diseases (CVD) in particular to understand how to address inequalities in engagement in prevention. METHODS This qualitative study employed content analysis of semistructured interviews with 60-66-year-old Arabic-speaking men living in Denmark. Supplementary, structured data, for example, health data, were collected. From June to August 2020, 10 men were interviewed. FINDINGS Preventive initiatives were found ethically and culturally acceptable alongside personally and socially relevant; they were perceived as humanitarian and caring for the participants' health, respecting of their self-determination and enabling their empowerment. Thus, the participants entreated that their fellow countrymen be assisted in achieving the prerequisite coping capabilities to address inequality in access, perceived acceptance and relevance. This led us to define one main category 'Preventive initiatives - Caring and humanitarian aid empower us' with the underlying subcategories: 'We are both hampered and strengthened by our basic assumptions' and 'We need help to achieve coping capabilities enabling us to engage in preventive initiatives'. CONCLUSION Prevention was perceived as acceptable and relevant. Even so, Arabic-speaking men may be a hard-to-reach group due to their basic assumptions and impaired capabilities for engaging in prevention. Addressing inequality in accessibility, acceptability and relevance in regard to prevention may be promoted through a person-centred approach embracing invitees' preferences, needs and values; and by strengthening invitees' health literacy through efforts at the structural, health professional and individual levels. PUBLIC CONTRIBUTION This study was based on interviews. The interviewees were recruited as public representatives to assist us in building an understanding of Arabic-speaking male immigrants' perceptions of preventive initiatives in general and preventive initiatives for CVD in particular.
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Affiliation(s)
- Marie Dahl
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Viborg, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Unit of Cardiac, Thoracic, and Vascular surgery, Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Susanne F Søndergaard
- Centre for Research in Clinical Nursing, Viborg Regional Hospital and School of Nursing, VIA University Collage, Viborg, Denmark
- Department of Public Health, Nursing, Aarhus University, Aarhus, Denmark
| | - Rafel Salman Al-Allaq
- Department of Science in Public Health, University of Southern Denmark, Odense, Denmark
| | - Axel Diederichsen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jes S Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Elitary Research Centre of Individualized Medicine in Arterial Disease (CIMA), Odense, Denmark
- Cardiovascular Centre of Excellence in Southern Denmark (CAVAC), Odense, Denmark
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3
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Rosén A, Otten J, Stomby A, Vallin S, Wennberg P, Brunström M. Oral glucose tolerance testing as a complement to fasting plasma glucose in screening for type 2 diabetes: population-based cross-sectional analyses of 146 000 health examinations in Västerbotten, Sweden. BMJ Open 2022; 12:e062172. [PMID: 35676014 PMCID: PMC9185658 DOI: 10.1136/bmjopen-2022-062172] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To assess the effect of adding an oral glucose tolerance test (OGTT) to fasting plasma glucose (FPG) in terms of detection of type 2 diabetes (T2D) and impaired glucose tolerance (IGT). DESIGN Retrospective analysis of serial cross-sectional screening study. SETTING Population-based health examinations within primary care in Västerbotten County, Sweden. PARTICIPANTS Individuals aged 40- 50 and 60 years with participation from 1985 to 2017. Those with previously diagnosed diabetes and FPG≥7 mmol/L were excluded. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of hyperglycaemia on the OGTT (IGT and T2D defined as 2-hour postload capillary plasma glucose of 8.9-12.1 mmol/L and ≥12.2 mmol/L, respectively). Analyses were further stratified by age, sex and risk factor burden to identify groups at high or low risk of IGT and T2D on testing. The numbers needed to screen (NNS) to prevent one case of T2D through detection and treatment of IGT was estimated, combining prevalence numbers with average progression rates and intervention effects from previous meta-analyses. RESULTS The prevalence of IGT ranged from 0.9% (95% CI 0.7% to 1.1%) to 29.6% (95% CI 27.4% to 31.7%), and the prevalence of T2D ranged from 0.06% (95% CI 0.02% to 0.11%) to 7.0% (95% CI 5.9% to 8.3%), depending strongly on age, sex and risk factor burden. The estimated NNS to prevent one case of T2D through detection and lifestyle treatment of IGT ranged from 1332 among 40-year-old men without risk factors, to 39 among 60-year-old women with all risk factors combined. CONCLUSIONS The prevalence of hyperglycaemia on OGTT is highly dependent on age, sex and risk factor burden; OGTT should be applied selectively to high-risk groups to avoid unnecessary testing in the general population.
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Affiliation(s)
- Anna Rosén
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - Julia Otten
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
| | - Andreas Stomby
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Futurum, Region Jönköping County, Jönköping, Sweden
| | - Simon Vallin
- Northern Register Centre, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden
| | - Mattias Brunström
- Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå, Sweden
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Kelleher D, Doherty E, O'Neill C. Examining the transnational preventive healthcare utilisation of a group of Eastern European migrants living full-time in another European state. Health Policy 2022; 126:318-324. [DOI: 10.1016/j.healthpol.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 02/07/2022] [Accepted: 02/16/2022] [Indexed: 11/04/2022]
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Innes HM, Walsh K, Österberg T. The inverse care law and the significance of income for utilization of longterm care services in a Nordic welfare state. Soc Sci Med 2021; 282:114125. [PMID: 34216942 DOI: 10.1016/j.socscimed.2021.114125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/18/2021] [Accepted: 06/08/2021] [Indexed: 11/29/2022]
Abstract
The Inverse Care Law states that the availability of good medical care tends to vary inversely with the need of the population served, with previous research indicating that migrant populations might be particularly at risk of this phenomenon. However, the degree to which the law applies to long-term care services (LTCS) in diverse ageing societies, where sizable older migrant populations need to be accounted for, has not been well investigated. To ensure equitable service provision, and to achieve European goals promoting a social right to care, it is critical to assess the extent to which such diverse populations are being neglected. This paper investigates the relationship between income and utilization of LTCS in Sweden amongst older native-born residents and older migrants born in low-, middle-, and high-income countries. The universality of its welfare system and the documented income differentials between foreign- and Swedish-born persons makes Sweden a particularly interesting case for assessing whether the most disadvantaged are the most underserved. The analysis uses register data on a total population of all older residents in Sweden, encompassing approximately two million persons. The results indicate that the Inverse Care Law does not apply to the utilization of LTCS by Swedish-born older people, nor by the majority of older migrants. However, the Inverse Care Law does appear to operate for older persons born in low-income countries who do not have a partner.
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Affiliation(s)
- Hanna Mac Innes
- University of Gothenburg, Department of Social Work, Sprängkullsgatan 23-25. PO Box 720, SE, 405 30, Gothenburg, Sweden; University of Gothenburg Centre for Ageing and Health (Age Cap), Sweden Institute of Neuroscience and Physiology, Wallinsgatan 6, SE, 431 41, Mölndal, Sweden.
| | - Kieran Walsh
- Professor of Ageing and Public Policy, Director - Irish Centre for Social Gerontology Institute for Lifecourse and Society, NUI, Galway, Ireland
| | - Torun Österberg
- University of Gothenburg, Department of Social Work, Sprängkullsgatan 23-25. PO Box 720, SE, 405 30, Gothenburg, Sweden
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Fattahi N, Rosenblad A, Kragsterman B, Hultgren R. Risk factors in 50-year-old men predicting development of abdominal aortic aneurysm. J Vasc Surg 2020; 72:1337-1346.e1. [DOI: 10.1016/j.jvs.2019.11.062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/21/2019] [Indexed: 11/30/2022]
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7
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Kjeldgaard AH, Hørslev-Petersen K, Wehberg S, Soendergaard J, Primdahl J. Does socioeconomic status make a difference? A register-based study on the extent to which cardiovascular screening in patients with inflammatory arthritis leads to recommended follow-up in general practice. RMD Open 2020; 6:rmdopen-2019-000940. [PMID: 32868450 PMCID: PMC7507734 DOI: 10.1136/rmdopen-2019-000940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/07/2019] [Accepted: 07/29/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate to what extent patients with inflammatory arthritis (IA) follow recommendations given in a secondary care nurse-led cardiovascular (CV) risk screening consultation to consult their general practitioner (GP) to reduce their CV risk and whether their socioeconomic status (SES) affects adherence. METHODS Adults with IA who had participated in a secondary care screening consultation from July 2012 to July 2015, based on the EULAR recommendations, were identified. Patients were considered to have high CV risk if they had risk Systematic COronary Risk Evaluation (SCORE) ≥5%, according to the European SCORE model or systolic blood pressure ≥145 mmHg, total cholesterol ≥8 mmol/L, LDL cholesterol ≥5 mmol/L, HbA1c ≥42 mmol/mol or fasting glucose ≥6 mmol/L. The primary outcome was a consultation with their GP and at least one action focusing on CV risk factors within 6 weeks after the screening consultation. RESULTS The study comprised 1265 patients, aged 18-85 years. Of these, 336/447 (75%) of the high-risk patients and 580/819 (71%) of the low-risk patients had a GP consultation. 127/336 (38%) of high-risk patients and 160/580 (28%) of low-risk patients received relevant actions related to their CV risk, for example, blood pressure home measurement or prescription for statins, antihypertensives or antidiabetics. Education ≥10 years increased the odds for non-adherence (OR 0.58, 95% CI 0.0.37 to 0.92, p=0.02). CONCLUSIONS 75% of the high-risk patients consulted their GP after the secondary care CV risk screening, and 38% of these received an action relevant for their CV risk. Higher education decreased adherence.
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Affiliation(s)
| | - Kim Hørslev-Petersen
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg 6400, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense 5000, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense 5000, Denmark
| | - Jens Soendergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense 5000, Denmark
| | - Jette Primdahl
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Soenderborg 6400, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense 5000, Denmark.,Hospital of Southern Jutland, University Hospital of Southern Denmark, Aabenraa 6200, Denmark
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8
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Hultgren R, Elfström KM, Öhman D, Linné A. Long-Term Follow-Up of Men Invited to Participate in a Population-Based Abdominal Aortic Aneurysm Screening Program. Angiology 2020; 71:641-649. [PMID: 32351123 DOI: 10.1177/0003319720921741] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A screening program for abdominal aortic aneurysm (AAA), inviting 65-year-old men, was started in Stockholm in 2010 (2.3 million inhabitants). The aim was to present a long-term follow-up of men participating in screening, as well as AAA repair and ruptures among nonparticipants. Demographics were collected for men with screening detected with AAA 2010 to 2016 (n = 672) and a control group with normal aortas at screening (controls, n = 237). Medical charts and regional Swedvasc (Swedish Vascular registry) data were analyzed for aortic repair for men born 1945 to 1951. Ultrasound maximum aortic diameter (AD) as well as Aortic Size Index (ASI) was recorded. Participation was 78% and prevalence of AAA was 1.2% (n = 672). Aortic repair rates correlated with high ASI and AD. During the study period, 22% of the AAA patients were treated with the elective repair; 35 men in surveillance died (5.2%), non-AAA-related causes (82.9%) dominated, followed by unknown causes among 4 (11.4%), and 2 (5.7%) possibly AAA-related deaths. Abdominal aortic aneurysm rupture rate was higher among nonparticipants (0.096% vs 0.0036%, P < .001). The low dropout rate confirms acceptability of follow-up after screening. The efficacy is shown by the much higher rupture rate among the nonparticipating men.
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Affiliation(s)
- Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | | | - Daniel Öhman
- Regional Cancer Center Stockholm-Gotland, Stockholm, Sweden
| | - Anneli Linné
- Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden.,Department of Surgery, Section of Vascular Surgery, Södersjukhuset, Stockholm, Sweden
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9
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Pharmacological Preventive Potential Among Attenders at Vascular Screening: Findings from the VIVA Trial. Eur J Vasc Endovasc Surg 2020; 59:662-673. [PMID: 32063462 DOI: 10.1016/j.ejvs.2019.12.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 11/21/2019] [Accepted: 12/29/2019] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Findings from the Viborg Vascular (VIVA) trial show a mortality benefit of multi-faceted vascular screening which was mainly ascribed to the initiation of prophylactic medication. However, the pharmacological preventive potential, which exists when individuals have a positive screening test result and do not already use statins and anti-platelet agents, has not been analysed. The aim of this study was to investigate factors associated with a pharmacological preventive potential of statins and anti-platelet agents among attenders vascular screening for abdominal aortic aneurysm (AAA) and peripheral arterial disease (PAD). METHODS This cross-sectional study used data from the VIVA trial screening arm including 25 074 men aged 64-75 years recruited between October 2008 and January 2011. Explanatory variables comprised socio-demographic- and socio-economic characteristics, comorbidities, medication use, and travel distance derived from nationwide registries. Outcomes included a positive screening test result, a pharmacological preventive potential, and attendance. Associations between the explanatory variables and the outcomes were investigated using the chi-square test and multivariate logistic regression. RESULTS The factors most likely to be associated with a pharmacological preventive potential for positive AAA screening comprised age >70 years (odds ratio (OR) 1.23, 95% confidence interval 1.00-1.51), existing chronic obstructive pulmonary disease (COPD) (OR 2.22, 95% CI 1.38-3.57), and use of anti-hypertensives (OR 1.37, 95% CI 1.09-1.71). For positive PAD screening age >70 years (OR 1.41, 95% CI 1.25-1.60), living alone (OR 1.34, 95% CI 1.14-1.56), low income, COPD (OR 2.13, 95% CI 159-283), use of anti-hypertensives (OR 1.14, 95% CI 1.00-1.29) or anti-diabetics (OR 1.12, 95% CI 1.01-1.28), and short travel distance were associated with a pharmacological preventive potential. For combined vascular screening, age >70 years, living alone, low income, COPD, and use of anti-hypertensives were associated with a pharmacological preventive potential. Among these subgroups, lower attendance was associated with age >70 years, living alone, low income, COPD, and use of anti-diabetics. CONCLUSION Future vascular screening programmes might benefit from tailoring information to subgroups who are more likely to benefit from screening but less likely to accept an offer.
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10
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Nielen JT, Driessen JH, Dagnelie PC, Boonen A, van den Bemt B, van Onzenoort HA, Neef C, Henry RM, Burden AM, Sep SJ, van der Kallen CJ, Schram MT, Schaper N, Stehouwer CD, Smits L, de Vries F. Drug utilization in the Maastricht Study: A comparison with nationwide data. Medicine (Baltimore) 2020; 99:e18524. [PMID: 31895787 PMCID: PMC6946313 DOI: 10.1097/md.0000000000018524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Within the southern region of the Netherlands, the Maastricht Study is an on-going observational prospective population-based cohort study that focuses on the etiology of Type 2 diabetes mellitus (T2DM). Representativeness of the participating population is a crucial but often an unknown factor in population-based cohort studies such as the Maastricht Study. We therefore aimed to assess the representativeness of the study population by comparing drug utilization of the participants of the Maastricht Study with the general population of the Netherlands.Since T2DM patients were oversampled in this study, a sampling method was applied in order to ensure a similar distribution of T2DM over the study population. Drug use in the study population was compared with drug use in the population of the Netherlands, using a Z-test to compare 2 independent proportions.In general, drug use in the study was similar compared with national data. However, in the age group 65 to 74 years total drug use was lower in the study population (833/1000 persons) versus nationwide data (882/1000 persons). The use of pulmonary medications was lower (104/1000 persons vs 141/1000 persons) and the use of hypnotics/anxiolytics was higher (90/1000 persons vs 36/1000 persons) in the Maastricht Study as compared with national data.Drug use in the Maastricht Study population is largely comparable to that in the total Dutch population aged 45 to 74. Therefore, data on drug use by participants in the Maastricht Study can be used to perform studies assessing outcomes associated with drug use.
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Affiliation(s)
- Johannes T.H. Nielen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
| | - Johanna H.M. Driessen
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht
- School for nutrition, and translational research in metabolism (NUTRIM), Maastricht University
| | - Pieter C. Dagnelie
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Epidemiology, Maastricht University
- School for Public Health and Primary Care (CAPHRI), Maastricht University
| | - Annelies Boonen
- School for Public Health and Primary Care (CAPHRI), Maastricht University
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center +, Maastricht
| | - Bart van den Bemt
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
- Department of Pharmacy, Sint Maartenskliniek
- Department of Pharmacy, Radboud University Medical Center, Nijmegen
| | - Hein A.W. van Onzenoort
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
- Department of Clinical Pharmacy, Amphia Hospital, Breda
| | - Cees Neef
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
| | - Ronald M.A. Henry
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Andrea M. Burden
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
- Institute of Pharmaceutical Sciences, Department of Chemistry and Applied Biosciences, Eidgenossische Technische Hochschule Zurich, Zurich, Switzerland
| | - Simone J.S. Sep
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Carla J. van der Kallen
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Miranda T. Schram
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Nicolaas Schaper
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Epidemiology, Maastricht University
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Coen D.A. Stehouwer
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Department of Epidemiology, Maastricht University
- Department of Internal Medicine, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Luc Smits
- Department of Epidemiology, Maastricht University
| | - Frank de Vries
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center +
- School for Cardiovascular Diseases (CARIM), Maastricht University, Maastricht
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences, Utrecht
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Nyrønning LÅ, Stenman M, Hultgren R, Albrektsen G, Videm V, Mattsson E. Symptoms of Depression and Risk of Abdominal Aortic Aneurysm: A HUNT Study. J Am Heart Assoc 2019; 8:e012535. [PMID: 31642357 PMCID: PMC6898822 DOI: 10.1161/jaha.119.012535] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Depression is associated with cardiovascular diseases, but the evidence is scarce regarding depression and risk of abdominal aortic aneurysms (AAA). The aim was to determine whether individuals with depressive symptoms have increased risk of AAA. Methods and Results This population‐based prospective study included 59 136 participants (52.4% women) aged 50 to 106 years from the HUNT (Norwegian Nord‐Trøndelag Health Study). Symptoms of depression were assessed using the depression subscale of the Hospital Anxiety and Depression Scale (HADS). During a median follow‐up of 13 years, there were 742 incident cases of AAA (201 women). A total of 6401 individuals (12.3%) reported depressive symptoms (defined as HADS depression scale [HADS‐D]) ≥8) (52.5% women). The annual incidence rate of AAA was 1.0 per 1000 individuals. At all ages, the estimated proportion of individuals diagnosed with AAA was higher among those with depressive symptoms (log‐rank test, P<0.001). People with HADS‐D ≥8 were older than those with HADS‐D<8 (median 57.8 versus 52.3 years, P<0.001) and a statistically significantly higher proportion of them (P<0.001) were smokers, overweight or obese, and reported a history of coronary heart disease, diabetes mellitus, and hypertension. In a Cox proportional hazard regression model adjusted for these factors, individuals with depressive symptoms had a ≈30% higher risk of AAA than those without (hazard ratio, 1.32, 95% CI 1.08–1.61, P=0.007). Conclusions This study shows that individuals with depressive symptoms have significantly higher risk of incident AAA, after adjustments for established risk factors.
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Affiliation(s)
- Linn Åldstedt Nyrønning
- Department of Vascular Surgery St. Olavs Hospital Trondheim Norway.,Department of Circulation and Medical Imaging NTNU- Norwegian University of Science and Technology Trondheim Norway
| | - Malin Stenman
- Perioperative Medicine and Intensive Care Function University Hospital Stockholm Sweden.,Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Rebecka Hultgren
- Department of Vascular Surgery Karolinska University Hospital Stockholm Sweden.,Department of Molecular Medicine and Surgery Karolinska Institutet Stockholm Sweden
| | - Grethe Albrektsen
- Department of Public Health and Nursing NTNU- Norwegian University of Science and Technology Trondheim Norway
| | - Vibeke Videm
- Department of Immunology and Transfusion Medicine St. Olavs Hospital Trondheim Norway.,Department of Clinical and Molecular Medicine NTNU- Norwegian University of Science and Technology Trondheim Norway
| | - Erney Mattsson
- Department of Vascular Surgery St. Olavs Hospital Trondheim Norway.,Department of Circulation and Medical Imaging NTNU- Norwegian University of Science and Technology Trondheim Norway
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Hansen TB, Lindholt JS, Diederichsen A, Søgaard R. Do Non-participants at Screening have a Different Threshold for an Acceptable Benefit-Harm Ratio than Participants? Results of a Discrete Choice Experiment. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2019; 12:491-501. [PMID: 31165400 DOI: 10.1007/s40271-019-00364-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE The objective of the study was to investigate non-participants' preferences for cardiovascular disease screening programme characteristics and whether non-participation can be rationally explained by differences in preferences, decision-making styles and informational needs between non-participants and participants. METHODS We conducted a discrete choice experiment at three screening sites between June and December 2017 among 371 male non-participants and 830 male participants who were asked to trade different levels of five key programme characteristics (chance of health benefit, risk of overtreatment, risk of later regret, screening duration and screening location). Data were analysed using a multinomial mixed-logit model. Health benefit was used as a payment vehicle for estimation of marginal substitution rates. RESULTS Non-participants were willing to accept that 0.127 (95% confidence interval 0.103-0.154) fewer lives would be saved to avoid overtreatment of one individual, whilst participants were willing to accept 0.085 (95% confidence interval 0.077-0.094) fewer lives saved. This translates into non-participants valuing health benefits 7.9 times higher than overtreatment. The corresponding value of participants is 11.8. Similarly, non-participants had higher requirements than participants for advanced technology and a quicker screening duration. With regard to their participation decision, 64% of the non-participants felt certain about their choice compared with 89% among participants. CONCLUSIONS This study shows that non-participants have different preferences than participants at screening as they express relatively more concern about overtreatment and have higher requirements for a high-tech screening programme. Non-participants also report to be more uncertain about their participation decision and more often seek additional information to the standard information provided in the invitation letter. Further studies on informational needs and effective communication strategies are warranted to ensure that non-participation is a fully informed choice.
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Affiliation(s)
- Tina Birgitte Hansen
- Department of Cardiology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark. .,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark.
| | - Jes Sanddal Lindholt
- Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark.,Elitary Research Unit of Personalized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense, Denmark
| | - Axel Diederichsen
- Elitary Research Unit of Personalized Medicine in Arterial Disease (CIMA), Odense University Hospital, Odense, Denmark.,Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Individual preferences on the balancing of good and harm of cardiovascular disease screening. Heart 2019; 105:761-767. [DOI: 10.1136/heartjnl-2018-314103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 01/19/2023] Open
Abstract
ObjectiveTransition towards value-based healthcare requires insight into what makes value to the individual. The aim was to elicit individual preferences for cardiovascular disease screening with respect to the difficult balancing of good and harm as well as mode of delivery.MethodsA discrete choice experiment was conducted as a cross-sectional survey among 1231 male screening participants at three Danish hospitals between June and December 2017. Participants chose between hypothetical screening programmes characterised by varying levels of mortality risk reduction, avoidance of overtreatment, avoidance of regretting participation, screening duration and location. A multinomial mixed logit model was used to model the preferences and the willingness to trade mortality risk reduction for improvements on other characteristics.ResultsRespondents expressed preferences for improvements on all programme characteristics. They were willing to give up 0.09 (95% CI 0.08 to 0.09) lives saved per 1000 screened to avoid one individual being over treated. Similarly, respondents were willing to give up 1.22 (95% CI 0.90 to 1.55) or 5.21 (95% CI 4.78 to 5.67) lives saved per 1000 screened to upgrade the location from general practice to a hospital or to a high-tech hospital, respectively. Subgroup analysis revealed important preference heterogeneity with respect to smoking status, level of health literacy and self-perceived risk of cardiovascular disease.ConclusionsIndividuals are able to express clear preferences about what makes value to them. Not only health benefit but also time with health professionals and access to specialised facilities were important. This information could guide the optimal programme design in search of value-based healthcare.
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Hansen TB, Lindholt JS, Søgaard R. Role of Experience With Preventive Medication and Personal Risk Attitude in Non-Attendance at Triple Vascular Screening. Eur J Vasc Endovasc Surg 2018; 56:282-290. [DOI: 10.1016/j.ejvs.2018.04.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 04/22/2018] [Indexed: 10/14/2022]
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Zommorodi S, Leander K, Roy J, Steuer J, Hultgren R. Understanding abdominal aortic aneurysm epidemiology: socioeconomic position affects outcome. J Epidemiol Community Health 2018; 72:904-910. [DOI: 10.1136/jech-2018-210644] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 11/04/2022]
Abstract
BackgroundLow socioeconomic position (SEP) has been demonstrated to negatively influence outcome in several cardiovascular patient groups. The aim of this study was to analyse time trends of incidence of intact abdominal aortic aneurysm (iAAA) and ruptured AAA (rAAA), respectively, and to investigate whether SEP had any influence on the probability to present with rupture and, finally, to determine the impact of SEP on outcome.MethodsNationwide population-based study including all individuals with iAAA or rAAA in Sweden during 2001–2015.ResultsThe number of individuals with an AAA was 41 222; the majority were identified as iAAA 33 254 (80.7%) and 7968 (19.3%) as rAAA. Time trends showed decreasing incidence of rAAA but increase in iAAA during the study period. Individuals with low income or low educational level were more likely to present with a rAAA rather than iAAA: OR 2.16 (95 % CI 1.98 to 2.36, p<0.001) and OR 1.33 (95 % CI 1.21 to 1.46, p<0.001), respectively. Low income was also associated with increased 90-day mortality and 1-year mortality after treatment for rAAA, OR 1.42 (95% CI 1.07 to 1.89, p=0.014) and OR 1.39 (95% CI 1.13 to 1.97, p=0.005).ConclusionThis large nationwide study showed a decreasing incidence of rAAA. Individuals with low SEP were found to have an augmented risk of presenting with rAAA rather than iAAA and, in addition, to fare worse after repair. Consequently, SEP should be regarded as a relevant risk factor that should be included in considerations for improved care flow of patients with AAA.
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Khashram M, Pitama S, Williman JA, Jones GT, Roake JA. Survival Disparity Following Abdominal Aortic Aneurysm Repair Highlights Inequality in Ethnic and Socio-economic Status. Eur J Vasc Endovasc Surg 2017; 54:689-696. [DOI: 10.1016/j.ejvs.2017.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/20/2017] [Indexed: 12/15/2022]
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A Majority of Admitted Patients With Ruptured Abdominal Aortic Aneurysm Undergo and Survive Corrective Treatment: A Population-Based Retrospective Cohort Study. World J Surg 2017; 40:3080-3087. [PMID: 27549597 PMCID: PMC5104803 DOI: 10.1007/s00268-016-3705-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Abdominal aortic aneurysm (AAA) is an asymptomatic, potentially lethal condition predominantly found in elderly. The mortality is 100 % if rupture occurs and left untreated, but even in treated patients the mortality is substantial. Female sex and treatment with open repair rather than endovascular aortic repair (EVAR) have been reported to negatively affect outcome. The objective was to describe the contemporary care and outcome of all treated and untreated patients with ruptured AAA (rAAA) admitted to hospital. Method Population-based retrospective investigation, including all patients admitted to the emergency departments within Stockholm County diagnosed with rAAA 2009–2013. All identified patients’ charts (n = 297) were analyzed; the study cohort includes 283 verified patients. Results Men were in majority [214 (76 %), 69 (24 %) women] and were younger than women (78 vs 82 years, p < 0.001). A majority of patients were treated (212/283, 75 %), a similar proportion of women and men. Untreated patients had a higher mean age (84 vs 77 years, p < 0.001). The proportion treated with EVAR was 27 %, and they were older than OR treated (79 vs 76 years, p = 0.043). Forty-seven percentage of patients admitted with rAAA survived 30 days, and 62 % of treated patients survived 30 days. The 30-day mortality for women and men was similar. Conclusions Our results and other contemporary series show a shift toward a higher rate of treated patients with rAAA, and improving outcomes, similar for women and men. The increased use of EVAR contributes to this improvement in short-term outcome. High age influences the willingness to treat patients with rAAA.
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Lindquist Liljeqvist M, Hultgren R, Siika A, Gasser TC, Roy J. Gender, smoking, body size, and aneurysm geometry influence the biomechanical rupture risk of abdominal aortic aneurysms as estimated by finite element analysis. J Vasc Surg 2017; 65:1014-1021.e4. [PMID: 28342508 DOI: 10.1016/j.jvs.2016.10.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/14/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Finite element analysis (FEA) has been suggested to be superior to maximal diameter measurements in predicting rupture of abdominal aortic aneurysms (AAAs). Our objective was to investigate to what extent previously described rupture risk factors were associated with FEA-estimated rupture risk. METHODS One hundred forty-six patients with an asymptomatic AAA of a 40- to 60-mm diameter were retrospectively identified and consecutively included. The patients' computed tomography angiograms were analyzed by FEA without (neutral) and with (specific) input of patient-specific mean arterial pressure (MAP), gender, family history, and age. The maximal wall stress/wall strength ratio was described as a rupture risk equivalent diameter (RRED), which translated this ratio into an average aneurysm diameter of corresponding rupture risk. RESULTS In multivariate linear regression, RREDneutral increased with female gender (3.7 mm; 95% confidence interval [CI], 0.13-7.3) and correlated with patient height (0.27 mm/cm; 95% CI, 0.11-0.43) and body surface area (BSA, 16 mm/m2; 95% CI, 8.3-24) and inversely with body mass index (BMI, -0.40 mm/kg m-2; 95% CI, -0.75 to -0.054) in a wall stress-dependent manner. Wall stress-adjusted RREDneutral was raised if the patient was currently smoking (1.1 mm; 95% CI, 0.21-1.9). Age, MAP, family history, and patient weight were unrelated to RREDneutral. In specific FEA, RREDspecific increased with female gender, MAP, family history positive for AAA, height, and BSA, whereas it was inversely related to BMI. All results were independent of aneurysm diameter. Peak wall stress and RRED correlated with aneurysm diameter and lumen volume. CONCLUSIONS Female gender, current smoking, increased patient height and BSA, and low BMI were found to increase the mechanical rupture risk of AAAs. Previously described rupture risk factors may in part be explained by patient characteristic-dependent variations in aneurysm biomechanics.
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Affiliation(s)
| | - Rebecka Hultgren
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Antti Siika
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - T Christian Gasser
- Department of Solid Mechanics, School of Engineering Sciences, Royal Institute of Technology, Stockholm, Sweden
| | - Joy Roy
- Vascular Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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20
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Linné A, Forsberg J, Leander K, Hultgren R. Screening of siblings to patients with abdominal aortic aneurysms in Sweden. SCAND CARDIOVASC J 2017; 51:167-171. [PMID: 28325098 DOI: 10.1080/14017431.2017.1303189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The prevalence of Abdominal Aortic Aneurysm (AAA) is higher for First Degree Relatives to AAA-patients compared to the general population, regardless of sex. The prevalence of AAA is also higher in the North of Sweden compared to the Mid and South. A regional strong hereditary trait has been suggested as an explanation to this. The aim of this study was to investigate if siblings to AAA-patients in the North have a higher prevalence of AAA compared to siblings in the Mid-region. DESIGN Cohort study. MATERIALS AND METHODS All patients treated for AAA in a northern region (Norrbotten county, North) were screened for siblings. Consenting siblings, age 40-80, were examined (n = 379) with ultrasound. The results were compared to the previously published results of 150 ultrasound-screened siblings in the Mid-region (Stockholm county). RESULTS The male/female ratio in the sibling cohort was 48% vs 52%. The prevalence of AAA in siblings in the North was 37/379 (brothers 14%, sisters 6%). This was not different from the prevalence among the Mid-region siblings 16/150 (brothers 17%, sisters 6% (p = 0.75). The distribution of risk factors was similar in the two regions. CONCLUSION The results reinforce the importance of a more systematic approach towards selective screening of all siblings to AAA patients. Ultrasound should be performed in all eligible siblings, since the distribution of AAA is similar over regions. A correlation between the familial distribution and the reported high prevalence of AAA in general population in the North could not be shown.
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Affiliation(s)
- Anneli Linné
- a Section of Vascular Surgery, Department of Surgery, Department of Clinical Science and Education , Karolinska Institutet at Södersjukhuset , Stockholm , Sweden
| | - Johan Forsberg
- b Department of Molecular Medicine and Surgery , Karolinska Institutet , Luleå , Stockholm.,c Department of Surgery , Sunderby Hospital , Luleå , Sweden
| | - Karin Leander
- d Institute of Environmental Medicine, Unit of Cardiovascular Epidemiology , Karolinska Institutet , Stockholm , Sweden
| | - Rebecka Hultgren
- b Department of Molecular Medicine and Surgery , Karolinska Institutet , Luleå , Stockholm.,e Department of Vascular Surgery , Karolinska University Hospital , Stockholm , Sweden
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Graetz V, Rechel B, Groot W, Norredam M, Pavlova M. Utilization of health care services by migrants in Europe-a systematic literature review. Br Med Bull 2017; 121:5-18. [PMID: 28108435 DOI: 10.1093/bmb/ldw057] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/25/2016] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Our study reviewed the empirical evidence on the utilization of health care services by migrants in Europe, and on differences in health service utilization between migrants and non-migrants across European countries. SOURCES OF DATA A systematic literature review was performed, searching the databases Medline, Cinahl and Embase and covering the period from January 2009 to April 2016. The final number of articles included was 39. AREAS OF AGREEMENT Utilization of accident and emergency services and hospitalizations were higher among migrants compared with non-migrants in most countries for which evidence was available. In contrast, screening and outpatient visits for specialized care were generally used less often by migrants. AREAS OF CONTROVERSY Utilization of general practitioner services among migrants compared with non-migrants presents a diverging picture. GROWING POINTS Compared with previous systematic reviews, the results indicate a clearer picture of the differences in health service utilization between migrants and non-migrants in Europe. AREAS TIMELY FOR DEVELOPING RESEARCH A comprehensive comparison across European countries is impossible because the number of studies is still limited. Further research should also help to identify barriers regarding the utilization of health care services by migrants.
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Affiliation(s)
- V Graetz
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - B Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene & Tropical Medicine, London, UK
| | - W Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
| | - M Norredam
- Department of Public Health, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark
| | - M Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Zommorodi S, Roy J, Steuer J, Hultgren R. High proportion of known abdominal aortic aneurysm in patients with rupture indicates surveillance deficiency. J Vasc Surg 2016; 64:949-955.e1. [PMID: 27666443 DOI: 10.1016/j.jvs.2016.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 04/06/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study assessed the proportion of previously known abdominal aortic aneurysm (AAA) in patients presenting with a ruptured AAA (rAAA) and analyzed the reasons for nontreatment at the time of the initial AAA diagnosis. METHODS This retrospective, observational study included all patients with rAAA admitted to a hospital in the counties of Stockholm and Gotland during 2009 to 2013. The patients' records were retrospectively reviewed, with extraction of data on previously detected AAA, demographics, and mortality at 30 and 90 days. RESULTS We identified 283 patients (76% men) with a mean age of 78.7 years. An AAA had been previously detected in 85 (30%). The overall mortality was higher (68% vs 53%; P = .018) and the intervention rate was lower in patients with a previously detected AAA (59% vs 82%, P < .001). The 90-day mortality rate for all treated rAAA was 43%. Reasons for nontreatment at the initial AAA detection were denial of elective surgery in 31 (36%), patient choice in 15 (18%), size-related in 11 (13%), and surveillance deficiency in 26 (31%). The latter group included patients who failed to comply, missed referral for computed tomography scans, and lack of follow-up of radiology reports. At the time of rupture, 22 patients (85%) were treated, with 30-day and 90-day mortality rates both at 41% (n = 9). CONCLUSIONS One-third of patients admitted with a rAAA had a previously detected AAA. The surgeons' decision to deny elective surgery and surveillance deficiency were the two main reasons for nontreatment at time of the AAA diagnosis. Improved patient-specific protocols to reduce the surveillance gaps and new methods of determining rupture risk in each case of AAA could be two possible future strategies to reduce the incidence of rupture.
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Affiliation(s)
- Sayid Zommorodi
- Department of Surgery, Section for Vascular Surgery, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Joy Roy
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Johnny Steuer
- Department of Surgery, Section for Vascular Surgery, Södersjukhuset, Stockholm, Sweden; Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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Engdahl J, Holmén A, Svennberg E, Friberg L, Frykman-Kull V, Al-Khalili F, Rosenqvist M, Strömberg U. Geographic and socio-demographic differences in uptake of population-based screening for atrial fibrillation: The STROKESTOP I study. Int J Cardiol 2016; 222:430-435. [PMID: 27505329 DOI: 10.1016/j.ijcard.2016.07.198] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 07/28/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND The rationale behind screening for atrial fibrillation (AF) is to prevent ischemic stroke. Socio-demographic differences are expected to affect screening uptake. Geographic differences may provide further insights leading to targeted interventions for improved uptake. The objective of this study was to evaluate geographic and socio-demographic differences in uptake of AF screening in the population-based study STROKESTOP I. METHODS STROKESTOP was carried out in two Swedish counties with a total population of 2.3 million inhabitants. Half of the residents aged 75-76years were randomized to the screening arm: invitation to clinical examination followed by ambulant ECG recording. Information on each invited person's residential parish (n=157) was used. On parish-level, aggregated data for the participants and non-participants, respectively, were obtained with respect to socioeconomic variables: educational level, disposable income, immigrant and marital status. Geo-maps displaying participation ratios were estimated by hierarchical Bayes methods. RESULTS The overall participation rate was similar in men and women but lower in Stockholm, 47.6% (5665/11,903) than in Halland, 61.2% (1495/2443). Participation was clearly associated with the socioeconomic variables. Participation not taking into account socioeconomy varied more markedly across the parishes in the Stockholm county (range: 0.65-1.26) than in the Halland county (0.94-1.27). After adjustment for socioeconomic variables, a geographic variation remained in Stockholm, but not in Halland. CONCLUSION Participation in AF screening varied according to socioeconomic conditions. Geographic variation in participation was marked in the Stockholm county, with only one screening clinic. Geo-mapping of participation yielded useful information needed to intervene for improved screening uptake.
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Affiliation(s)
- Johan Engdahl
- Department of Medicine, Halland Hospital Halmstad, Sweden; Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital Division of Cardiovascular Medicine, Stockholm, Sweden.
| | - Anders Holmén
- Department of Research and Development, Halland Hospital, Sweden
| | - Emma Svennberg
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Leif Friberg
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Viveka Frykman-Kull
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital Division of Cardiovascular Medicine, Stockholm, Sweden
| | | | - Mårten Rosenqvist
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Ulf Strömberg
- Health Metrics Unit, Department of Public Health and Community Medicine, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Tuveson V, Löfdahl HE, Hultgren R. Patients with abdominal aortic aneurysm have a high prevalence of popliteal artery aneurysms. Vasc Med 2016; 21:369-75. [DOI: 10.1177/1358863x16648404] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients with abdominal aortic aneurysms (AAA) are more prone to develop popliteal artery aneurysms (PAA), but the prevalence is not well known. Our aim was to investigate the prevalence of PAA in patients with AAA, and to determine whether a certain risk factor profile is more commonly found in patients with concurrent aneurysms. All AAA patients (ICD code I71.3, I71.4) attending the outpatient clinic at the Karolinska University Hospital between 2011 and 2013 were included in the study cohort ( n=465); 48% (225) had been subjected to an ultrasound or computed tomography scan of their popliteal arteries. In these patients, three definitions of PAA were considered (⩾ 10.5, ⩾ 12, ⩾ 15 mm), although the overall analysis is based on PAA ⩾ 12 mm. The mean age was 70.7 years (SD 7.5), 89% were men, and the mean AAA diameter was 47 mm (SD 14). The prevalence of PAA was 19% ( n=43) by definition ⩾ 12 mm, and 11% ( n=25) with 15 mm. Claudication was more frequently found in AAA patients with PAA than patients without PAA. Sensitivity between clinical examination and radiology was 26%, and the specificity for clinical examination was 90%. In conclusion, owing to the high prevalence of PAA in AAA patients, described by us and others, the low cost and risks associated with ultrasound and the poor sensitivity at clinical examination, all women and men with AAA should undergo one radiological examination of their popliteal arteries.
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Affiliation(s)
- Viktoria Tuveson
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Hedvig E Löfdahl
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Rebecka Hultgren
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden
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Linné A, Forsberg J, Lindström D, Ideskog E, Hultgren R. Age at detection of abdominal aortic aneurysms in siblings of patients with abdominal aortic aneurysms. J Vasc Surg 2016; 63:883-7. [DOI: 10.1016/j.jvs.2015.10.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/07/2015] [Indexed: 11/26/2022]
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Screening results from a large United Kingdom abdominal aortic aneurysm screening center in the context of optimizing United Kingdom National Abdominal Aortic Aneurysm Screening Programme protocols. J Vasc Surg 2015; 63:301-4. [PMID: 26482996 DOI: 10.1016/j.jvs.2015.08.091] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 08/18/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND After its introduction in six pilot centers in 2009, the National Abdominal Aortic Aneurysm Screening Programme (NAAASP) is now established across the United Kingdom, demonstrating significant benefit in terms of fewer emergency surgeries and reduced 30-day surgical mortality. However, according to publication of data on annual screened abdominal aortic aneurysm (AAA) detection, a lower incidence than predicted in the original screening trials has been found. In this audit we assessed features and risk factors of men found to have a positive scan result in the southwest London AAA screening program, to determine screening yield for subgroups of populations and assess the case for a more targeted screening program. METHODS Data from the NAAASP screening database for England were extracted for all men who attended screening from the April 1, 2009 through October 16, 2013 in the southwest London area. Primary outcomes were aneurysm prevalence, risk factors, and incidence within subgroups. Results were reviewed against nationally reported data and London census data. RESULTS Of 24,891 men who were screened in the southwest London program during this period, 292 AAAs were identified (1.18%). Patients were asked to categorize their ethnic background according to classifications provided by the office of national statistics. Those at highest risk of AAA were white-British (1.35%), followed by black and black British (0.65%), and Asian/Asian British (0.23%). Number needed to screen to identify one AAA was calculated as 78, 154, and 431, respectively. The relative proportions of patients screened were similar to that described in the most recent United Kingdom census, except for white-British patients, indicating a shortfall in acceptance of screening invitations in this group. There were no AAA identified in Chinese men. A positive smoking history was found in 90%, a confirmed diagnosis of hypertension in 50%, hypercholesterolemia in 34%, and ischemic heart disease in 21%. CONCLUSIONS Within southwest London, AAA was most strongly associated with being white-British, a previous or current smoker, and known hypertension. Targeted education in patient groups with identified risk factors for AAA should be considered to improve screening yield without excluding any subgroup from the screening program. This could draw on resources released by unused scans because of lower than predicted prevalence. AAA diagnosis should be seen as an opportunity to address the increased all-cause mortality associated with aortic aneurysmal disease.
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Björck M, Bown M, Choke E, Earnshaw J, Flørenes T, Glover M, Kay M, Laukontaus S, Lees T, Lindholt J, Powell J, van Rij A, Svensjö S, Wanhainen A. International Update on Screening for Abdominal Aortic Aneurysms: Issues and Opportunities. Eur J Vasc Endovasc Surg 2015; 49:113-5. [DOI: 10.1016/j.ejvs.2014.08.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 08/18/2014] [Indexed: 12/13/2022]
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Linné A, Smidfelt K, Langenskiöld M, Hultgren R, Nordanstig J, Kragsterman B, Lindström D. Low Post-operative Mortality after Surgery on Patients with Screening-detected Abdominal Aortic Aneurysms: A Swedvasc Registry Study. Eur J Vasc Endovasc Surg 2014; 48:649-56. [DOI: 10.1016/j.ejvs.2014.08.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 08/24/2014] [Indexed: 11/26/2022]
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