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Jonsson, Fredrik
Publikasjoner (10 av 11) Visa alla publikasjoner
Wahlin, B., Meedt, T., Jonsson, F., Henein, M. Y. & Wållberg-Jonsson, S. (2016). Coronary Artery Calcification Is Related to Inflammation in Rheumatoid Arthritis: A Long-Term Follow-Up Study. BioMed Research International, Article ID 1261582.
Åpne denne publikasjonen i ny fane eller vindu >>Coronary Artery Calcification Is Related to Inflammation in Rheumatoid Arthritis: A Long-Term Follow-Up Study
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2016 (engelsk)Inngår i: BioMed Research International, ISSN 2314-6133, E-ISSN 2314-6141, artikkel-id 1261582Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective. A long-term follow-up of patients with rheumatoid arthritis (RA) to evaluate factors related to coronary artery calcification (CAC). Methods. All 22 eligible patients (4 males/18 females, mean age 65 years, and RA-duration 30-36 years) from the original (baseline; n = 39) study of atherosclerosis were included. Inflammation, cardiovascular risk factors, and biomarkers were measured at baseline. At follow-up 13 years later, CAC was assessed by computed tomography (CT) and the grade of inflammation was measured. Multivariate analysis of differences between patients with low (0-10) and high CAC (>10) was done by orthogonal projection to latent structures (OPLS). Results. Ten patients had CAC 0-10 and 12 had >10 (range 18-1700). Patients with high CAC had significantly higher ESR (24.3 versus 9.9 mm/h) and swollen joint count (2 versus 0). The OPLS models discriminated between patients having high or low CAC. With only baseline variables, the sensitivity was 73% and the specificity 82%. The model that also included inflammatory variables from follow-up had a sensitivity of 89% and a specificity of 85%. Exclusion of baseline intima media thickness and plaque from the latter model modestly reduced the accuracy (sensitivity 80% and specificity 83%). Conclusions. CAC is related to inflammation in patients with RA.

HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-126539 (URN)10.1155/2016/1261582 (DOI)000383093900001 ()27648442 (PubMedID)
Tilgjengelig fra: 2016-10-18 Laget: 2016-10-10 Sist oppdatert: 2019-04-12bibliografisk kontrollert
Thålin, C., Rudberg, A.-S., Johansson, F., Jonsson, F., Laska, A. C., Nygren, A. T., . . . Aspberg, S. (2015). Elevated Troponin Levels in Acute Stroke Patients Predict Long-term Mortality. Journal of Stroke & Cerebrovascular Diseases, 24(10), 2390-2396
Åpne denne publikasjonen i ny fane eller vindu >>Elevated Troponin Levels in Acute Stroke Patients Predict Long-term Mortality
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2015 (engelsk)Inngår i: Journal of Stroke & Cerebrovascular Diseases, ISSN 1052-3057, E-ISSN 1532-8511, Vol. 24, nr 10, s. 2390-2396Artikkel, forskningsoversikt (Fagfellevurdert) Published
Abstract [en]

Background: Elevated plasma levels of troponin in acute stroke patients are common and have in several studies been shown to predict in-hospital and short-term mortality. Little is, however, known about the long-term prognosis of these patients. The aim of this study was to determine patient characteristics and 5-year mortality in patients with acute stroke and troponin elevation on admission. Methods: A retrospective cohort study of all consecutive patients with acute stroke and a plasma troponin I (TnI) analyzed on admission to Danderyd Hospital between January 1, 2005, and January 1, 2006 (n = 247). Patient characteristics were obtained from the Swedish National Stroke Register, Riksstroke, as well as hospital records. Mortality data were obtained from the Swedish Cause of Death Register. Results: There were 133 patients (54%) with TnI less than .03 mu g/L (normal), 74 patients (30%) with TnI .03-.11 mu g/L (low elevation), and 40 patients (16%) with TnI greater than .11 mu g/L (high elevation). TnI elevations were associated with a higher age, prior ischemic stroke, chronic heart failure, renal insufficiency, stroke severity, and ST segment elevation or depression on admission. The rate of hyperlipidemia decreased with increasing TnI. Adjusted for age and comorbidity, elevated TnI values on admission had a significantly and sustained increased mortality over the 5-year follow-up, with a hazard ratio of 1.90 (95% confidence interval, 1.33-2.70). Conclusions: Troponin elevation in patients with acute stroke, even when adjusted for several possible confounders, is associated with an almost 2-fold increased risk of 5-year mortality.

Emneord
Acute stroke, troponin elevation, myocardial damage, long-term prognosis
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-110553 (URN)10.1016/j.jstrokecerebrovasdis.2015.06.043 (DOI)000362181400036 ()26236002 (PubMedID)
Tilgjengelig fra: 2015-10-26 Laget: 2015-10-23 Sist oppdatert: 2018-06-07bibliografisk kontrollert
Appelros, P., Jonsson, F., Asberg, S., Asplund, K., Glader, E.-L., Asberg, K. H., . . . Terent, A. (2014). Trends in Stroke Treatment and Outcome between 1995 and 2010: Observations from Riks-Stroke, the Swedish Stroke Register. Cerebrovascular Diseases, 37(1), 22-29
Åpne denne publikasjonen i ny fane eller vindu >>Trends in Stroke Treatment and Outcome between 1995 and 2010: Observations from Riks-Stroke, the Swedish Stroke Register
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2014 (engelsk)Inngår i: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 37, nr 1, s. 22-29Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Continuous changes in stroke treatment and care, as well as changes in stroke characteristics, may alter stroke outcome over time. The aim of this paper is to describe time trends for treatment and outcome data, and to discuss if any such changes could be attributed to quality changes in stroke care.

Methods: Data from Riks-Stroke, the Swedish stroke register, were analyzed for the time period of 1995 through 2010. The total number of patients included was 320,181. The following parameters were included: use of computed tomography (CT), stroke unit care, thrombolysis, medication before and after the stroke, length of stay in hospital, and discharge destination. Three months after stroke, data regarding walking, toileting and dressing ability, as well social situation, were gathered. Survival status after 7, 27 and 90 days was registered. Results: In 1995, 53.9% of stroke patients were treated in stroke units. In 2010 this proportion had increased to 87.5%. Fewer patients were discharged to geriatric or rehabilitation departments in later years (23.6% in 2001 compared with 13.4% in 2010), but more were discharged directly home (44.2 vs. 52.4%) or home with home rehabilitation (0 vs. 10.7%). The need for home help service increased from 18.2% in 1995 to 22.1% in 2010. Regarding prevention, more patients were on warfarin, antihypertensives and statins both before and after the stroke. The functional outcome measures after 3 months did improve from 2001 to 2010. In 2001, 83.8% of patients were walking independently, while 85.6% were independent in 2010. For toileting, independence increased from 81.2 to 84.1%, and for dressing from 78.0 to 80.4%. Case fatality (CF) rates after 3 months increased from 18.7% (2001) to 20.0% (2010). This trend is driven by patients with severe strokes.

Conclusions: Stroke outcomes may change over a relatively short time period. In some ways, the quality of care has improved. More stroke patients have CT, more patients are treated in stroke units and more have secondary prevention. Patients with milder strokes may have benefited more from these measures than patients with severe strokes. Increased CF rates for patients with severe stroke may be caused by shorter hospital stays, shorter in-hospital rehabilitation periods and lack of suitable care after discharge from hospital. (C) 2013 S. Karger AG, Basel

Emneord
Quality improvement, Stroke registries, Stroke risk factors, Time trends
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-86843 (URN)10.1159/000356346 (DOI)000330857800004 ()
Tilgjengelig fra: 2014-03-13 Laget: 2014-03-11 Sist oppdatert: 2018-06-08bibliografisk kontrollert
diva2:617440
Åpne denne publikasjonen i ny fane eller vindu >>A high blood level in the venous chamber and a wet-stored dialyzer help to reduce exposure for microemboli during hemodialysis
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2013 (engelsk)Inngår i: Hemodialysis International, ISSN 1492-7535, E-ISSN 1542-4758, Vol. 17, nr 4, s. 612-617Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

During hemodialysis (HD), microemboli develop in the blood circuit of the apparatus. These microemboli can pass through the venous chamber and enter into the patient's circulation. The aim of this study was to investigate whether it is possible to reduce the risk for exposure of microemboli by altering of the treatment mode. Twenty patients on chronic HD were randomized to a prospective cross-over study of three modes of HD: (a) a dry-stored dialyzer (F8HPS, Fresenius, steam sterilized) with a low blood level in the venous chamber (DL), (b) the same dialyzer as above, but with a high level in the venous chamber (DH), and (c) a wet-stored dialyzer (Rexeed, Asahi Kasei Medical, gamma sterilized) with a high blood level (WH). Microemboli measurements were obtained in a continuous fashion during 180 minutes of HD for all settings. A greater number of microemboli were detected during dialysis with the setting DL vs. WH (odds ratio [OR] 4.07, 95% confidence interval [CI] 4.03–4.11, P < 0.0001) and DH vs. WH (OR 1.18, 95% CI 1.17–1.19, P < 0.0001) and less for DH vs. DL (OR 0.290, 95% CI 0.288–0.293, P < 0.0001). These data indicate that emboli exposure was least when using WH, greater with DH, and most with DL. This study shows that using a high blood level in the venous chamber and wet-stored dialyzers may reduce the number of microemboli.

Emneord
hemodialysis, microbubbles, microemboli, venous chamber, dialyzer, in vivo
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-68675 (URN)10.1111/hdi.12052 (DOI)000325137100019 ()23627921 (PubMedID)
Tilgjengelig fra: 2013-04-23 Laget: 2013-04-22 Sist oppdatert: 2019-01-25bibliografisk kontrollert
Chroinin, D. N., Asplund, K., Asberg, S., Callaly, E., Cuadrado-Godia, E., Diez-Tejedor, E., . . . Kelly, P. J. (2013). Statin Therapy and Outcome After Ischemic Stroke: Systematic Review and Meta-Analysis of Observational Studies and Randomized Trials. Stroke, 44(2), 448-456
Åpne denne publikasjonen i ny fane eller vindu >>Statin Therapy and Outcome After Ischemic Stroke: Systematic Review and Meta-Analysis of Observational Studies and Randomized Trials
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2013 (engelsk)Inngår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 44, nr 2, s. 448-456Artikkel, forskningsoversikt (Fagfellevurdert) Published
Abstract [en]

Background and Purpose-Although experimental data suggest that statin therapy may improve neurological outcome after acute cerebral ischemia, the results from clinical studies are conflicting. We performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischemic stroke. Methods-The primary analysis investigated statin therapy at stroke onset (prestroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included the following: (1) acute poststroke statin therapy (<= 72 hours after stroke), and (2) thrombolysis-treated patients. Results-The primary analysis included 113 148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (pooled odds ratio [OR], 1.41; 95% confidence interval [CI], 1.29-1.56; P<0.001), but not 1 year (OR, 1.12; 95% CI, 0.9-1.4; P=0.31), and with reduced fatality at 90 days (pooled OR, 0.71; 95% CI, 0.62-0.82; P<0.001) and 1 year (OR, 0.80;95% CI, 0.67-0.95; P=0.01). In the single randomized controlled trial reporting 90-day functional outcome, statin treatment was associated with good outcome (OR, 1.5; 95% CI, 1.0-2.24; P=0.05). No reduction in fatality was observed on meta-analysis of data from 3 randomized controlled trials (P=0.9). In studies restricted to of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02-1.52; P=0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90-1.44; 4012 patients). Conclusion-In the largest meta-analysis to date, statin therapy at stroke onset was associated with improved outcome, a finding not observed in studies restricted to thrombolysis-treated patients. Randomized trials of statin therapy in acute ischemic stroke are needed.

Emneord
cerebral infarction, ischemia, neuroprotective agents, outcomes assessment, stroke, therapy
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-66645 (URN)10.1161/STROKEAHA.112.668277 (DOI)000313754800036 ()
Tilgjengelig fra: 2013-03-05 Laget: 2013-02-26 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Evans, J., Goedecke, J. H., Söderström, I., Burén, J., Alvehus, M., Blomquist, C., . . . Olsson, T. (2011). Depot- and ethnic-specific differences in the relationship between adipose tissue inflammation and insulin sensitivity. Clinical Endocrinology, 74(1), 51-59
Åpne denne publikasjonen i ny fane eller vindu >>Depot- and ethnic-specific differences in the relationship between adipose tissue inflammation and insulin sensitivity
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2011 (engelsk)Inngår i: Clinical Endocrinology, ISSN 0300-0664, E-ISSN 1365-2265, Vol. 74, nr 1, s. 51-59Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Objective  It is unclear whether there are differences in inflammatory gene expression between abdominal and gluteal subcutaneous adipose tissue (SAT), and between black and white women. We therefore tested the hypotheses that SAT inflammatory gene expression is greater in the abdominal compared to the gluteal depot, and SAT inflammatory gene expression is associated with differential insulin sensitivity (S(I) ) in black and white women.

Design and methods  S(I) (frequently sampled intravenous glucose tolerance test) and abdominal SAT and gluteal SAT gene expression levels of 13 inflammatory genes were measured in normal-weight (BMI 18-25 kg/m(2) ) and obese (BMI >30 kg/m(2) ) black (n = 30) and white (n = 26) South African women.

Results  Black women had higher abdominal and gluteal SAT expression of CCL2, CD68, TNF-α and CSF-1 compared to white women (P < 0·01). Multivariate analysis showed that inflammatory gene expression in the white women explained 56·8% of the variance in S(I) (P < 0·005), compared to 20·9% in black women (P = 0·30). Gluteal SAT had lower expression of adiponectin, but higher expression of inflammatory cytokines, macrophage markers and leptin than abdominal SAT depots (P < 0·05).

Conclusions  Black South African women had higher inflammatory gene expression levels than white women; however, the relationship between AT inflammation and S(I) was stronger in white compared to black women. Further research is required to explore other factors affecting S(I) in black populations. Contrary to our original hypothesis, gluteal SAT had a greater inflammatory gene expression profile than abdominal SAT depots. The protective nature of gluteo-femoral fat therefore requires further investigation.

Identifikatorer
urn:nbn:se:umu:diva-38726 (URN)10.1111/j.1365-2265.2010.03883.x (DOI)20874774 (PubMedID)
Tilgjengelig fra: 2010-12-23 Laget: 2010-12-23 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Asplund, K., Hulter Åsberg, K., Appelros, P., Bjarne, D., Eriksson, M., Johansson, Å., . . . Wester, P.-O. (2011). The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care. International Journal of Stroke, 6(2), 99-108
Åpne denne publikasjonen i ny fane eller vindu >>The Riks-Stroke story: building a sustainable national register for quality assessment of stroke care
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2011 (engelsk)Inngår i: International Journal of Stroke, ISSN 1747-4930, E-ISSN 1747-4949, Vol. 6, nr 2, s. 99-108Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background Riks-Stroke, the Swedish Stroke Register, is the world's longest-running national stroke quality register (established in 1994) and includes all 76 hospitals in Sweden admitting acute stroke patients. The development and maintenance of this sustainable national register is described.

Methods Riks-Stroke includes information on the quality of care during the acute phase, rehabilitation and secondary prevention of stroke, as well as data on community support. Riks-Stroke is unique among stroke quality registers in that patients are followed during the first year after stroke. The data collected describe processes, and medical and patient-reported outcome measurements. The register embraces most of the dimensions of health-care quality (evidence-based, safe, provided in time, distributed fairly and patient oriented).

Result Annually, approximately 25 000 patients are included. In 2009, approximately 320 000 patients had been accumulated (mean age 76-years). The register is estimated to cover 82% of all stroke patients treated in Swedish hospitals. Among critical issues when building a national stroke quality register, the delicate balance between simplicity and comprehensiveness is emphasised. Future developments include direct transfer of data from digital medical records to Riks-Stroke and comprehensive strategies to use the information collected to rapidly implement new evidence-based techniques and to eliminate outdated methods in stroke care.

Conclusions It is possible to establish a sustainable quality register for stroke at the national level covering all hospitals admitting acute stroke patients. Riks-Stroke is fulfilling its main goals to support continuous quality improvement of Swedish stroke services and serve as an instrument for following up national stroke guidelines.

sted, utgiver, år, opplag, sider
Sage Publications, 2011
Emneord
coverage, implementation, outcomes, processes, quality control, stroke registers
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-44039 (URN)10.1111/j.1747-4949.2010.00557.x (DOI)000288016700003 ()21371269 (PubMedID)
Tilgjengelig fra: 2011-05-18 Laget: 2011-05-18 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Eriksson, M., Jonsson, F., Appelros, P., Åsberg, K. H., Norrving, B., Stegmayr, B., . . . Asplund, K. (2011). Trombolys som akutbehandling vid ischemisk stroke sprids över landet: Men regionala variationer är ännu stora, visar Riks-Stroke-analys. Läkartidningen, 108(1-2), 21-25
Åpne denne publikasjonen i ny fane eller vindu >>Trombolys som akutbehandling vid ischemisk stroke sprids över landet: Men regionala variationer är ännu stora, visar Riks-Stroke-analys
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2011 (svensk)Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, nr 1-2, s. 21-25Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [sv]

Spridningen av trombolys som akutbehandling vid ischemisk stroke har analyserats hos patienter registrerade i Riks-Stroke under 2003–2009.

Implementeringen har varit långsam, även om den varit snabbare än i många andra länder.

De regionala variationerna i införandet av trombolys är stora.

Trombolys har införts med 2–3 års fördröjning vid icke-universitetssjukhus jämfört med universitetssjukhus.

Andra oberoende prediktorer för trombolysbehandling har varit bl a låg ålder, sammanboende, intagning på strokeenhet och intagning på neurologklinik i stället för medicinklinik.

Andelen trombolyslarm i målgruppen har nära samband med behandlingsfre­kvensen.

Spridningen till mindre sjukhus har kunnat genomföras med bevarad patientsäkerhet.

HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-44035 (URN)21365809 (PubMedID)
Tilgjengelig fra: 2011-05-18 Laget: 2011-05-18 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Eriksson, M., Jonsson, F., Appelros, P., Asberg, K. H., Norrving, B., Stegmayr, B., . . . Asplund, K. (2010). Dissemination of thrombolysis for acute ischemic stroke across a nation: experiences from the Swedish stroke register, 2003 to 2008. Stroke, 41(6), 1115-22
Åpne denne publikasjonen i ny fane eller vindu >>Dissemination of thrombolysis for acute ischemic stroke across a nation: experiences from the Swedish stroke register, 2003 to 2008
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2010 (engelsk)Inngår i: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 41, nr 6, s. 1115-22Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

BACKGROUND AND PURPOSE: We used Riks-Stroke, the Swedish Stroke Register, to explore how thrombolysis has been disseminated in Swedish hospitals since it was approved in 2003. METHODS: All 78 hospitals in Sweden admitting patients with acute stroke participate in Riks-Stroke. Between 2003 and 2008, 72 033 adult patients were hospitalized for acute ischemic stroke. We analyzed thrombolysis use by region, patient characteristics, and stroke service settings. RESULTS: Nationwide, the use of thrombolysis increased from 0.9% in 2003 to 6.6% in 2008. There were marked regional differences in the dissemination of thrombolysis, but these gaps narrowed over time. Nonuniversity hospitals reached treatment levels similar to university settings, although with a 2- to 3-year delay. Symptomatic intracranial hemorrhage remained at the 3% to 9% level without an apparent time trend during dissemination. Independent predictors of higher thrombolysis use included younger age, male sex, not living alone, and no history of stroke or diabetes. In 2008, patients admitted to a stroke unit were 5 times more likely to receive thrombolysis than those admitted to general wards. CONCLUSIONS: Nationwide implementation of thrombolysis has been slow but has accelerated mainly due to increased access outside university hospitals. The increased use has been achieved safely, but access has been unequal.

HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-35678 (URN)10.1161/STROKEAHA.109.577106 (DOI)000278019400010 ()20395610 (PubMedID)
Tilgjengelig fra: 2010-08-31 Laget: 2010-08-31 Sist oppdatert: 2018-06-08bibliografisk kontrollert
Appelros, P., Jonsson, F., Asplund, K., Eriksson, M., Glader, E.-L., Asberg, K. H., . . . Terént, A. (2010). Trends in baseline patient characteristics during the years 1995-2008: observations from Riks-Stroke, the Swedish Stroke Register. Cerebrovascular Diseases, 30(2), 114-119
Åpne denne publikasjonen i ny fane eller vindu >>Trends in baseline patient characteristics during the years 1995-2008: observations from Riks-Stroke, the Swedish Stroke Register
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2010 (engelsk)Inngår i: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 30, nr 2, s. 114-119Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Many baseline parameters in Riks-Stroke have changed over the years. This has consequences for the interpretation of outcome data. Some changes may be due to inclusion bias, others due to alterations in general health, evolution of vascular risk factors or demographics.

Emneord
Quality improvement, Stroke registries, Stroke risk factors, Trends, stroke patients
Identifikatorer
urn:nbn:se:umu:diva-38718 (URN)10.1159/000314714 (DOI)20501996 (PubMedID)
Tilgjengelig fra: 2010-12-23 Laget: 2010-12-23 Sist oppdatert: 2018-06-08bibliografisk kontrollert
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