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Stegmayr, Birgitta
Publications (10 of 82) Show all publications
Asplund, K., Lundström, S. & Stegmayr, B. (2018). End of life after stroke: a nationwide study of 42,502 deaths occurring within a year after stroke. European Stroke Journal, 3(1), 74-81
Open this publication in new window or tab >>End of life after stroke: a nationwide study of 42,502 deaths occurring within a year after stroke
2018 (English)In: European Stroke Journal, ISSN 2396-9873, E-ISSN 2396-9881, Vol. 3, no 1, p. 74-81Article in journal (Refereed) Published
Abstract [en]

Introduction: In the scientific literature, there is very limited empirical information on end-of-life issues after stroke in the scientific literature. The present nationwide study describes the circumstances surrounding deaths that occur within a year after a stroke. Patients and methods: Datasets from three nationwide Swedish registers (on stroke, palliative care and cause of death) were linked. Basic information was available for 42,502 unselected cases of death that occurred within a year after a stroke and more detailed information was available for 16,408 deaths. Odds ratios for characteristics of end-of-life care were calculated by logistic regression. Results: In the late phase after stroke (three months to one year), 46% of patients died in a nursing home, whereas 37% of patients died in a hospital after readmission and 10% of patients died at home. Eleven per cent of deaths were reported as being unexpected. A next of kin was present at 49% of deaths. The frequency of unattended deaths (neither next of kin nor staff were present at the time of death) ranged from 5% at home with specialised home care to 25% in hospitals. Discussion: This is, by far, the largest study published on end-of-life issues after stroke. Major differences between countries in healthcare, community services, family structure and culture may limit direct transfer of the present results to other settings. Conclusion: There is considerable discordance between presumed good death' late after stroke (dying at home surrounded by family members) and the actual circumstances at the end of life.

Place, publisher, year, edition, pages
Sage Publications, 2018
Keywords
Stroke, end of life, terminal care, death, next of kin, nursing homes
National Category
Neurology Neurosciences
Identifiers
urn:nbn:se:umu:diva-147349 (URN)10.1177/2396987317736202 (DOI)000429801100009 ()
Available from: 2018-05-11 Created: 2018-05-11 Last updated: 2019-05-16Bibliographically approved
Eriksson, M., Glader, E.-L., Norrving, B., Stegmayr, B. & Asplund, K. (2017). Acute stroke alert activation, emergency service use, and reperfusion therapy in Sweden. Brain and Behavior, 7(4), Article ID e00654.
Open this publication in new window or tab >>Acute stroke alert activation, emergency service use, and reperfusion therapy in Sweden
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2017 (English)In: Brain and Behavior, ISSN 2162-3279, E-ISSN 2162-3279, Vol. 7, no 4, article id e00654Article in journal (Refereed) Published
Abstract [en]

Objectives: Ambulance services and stroke alerts reduce the time from stroke onset to acute stroke diagnosis. We describe the use of stroke alerts and ambulance services in different hospitals and patient groups and their relationship with reperfusion therapy. Methods: This nationwide study included 49,907 patients admitted with acute stroke who were registered in The Swedish Stroke Register (Riksstroke) in 2011-2012. Results: The proportions of patients admitted as stroke alerts out of all acute stroke admissions varied from 12.2% to 45.7% in university hospitals (n=9), 0.5% to 38.7% in specialized nonuniversity hospitals (n=22), and 4.2% to 40.3% in community hospitals (n=41). Younger age, atrial fibrillation (AF), living in an institution, reduced consciousness upon admission, and hemorrhagic stroke were factors associated with a higher probability of stroke alerts. Living alone, primary school education, non-European origin, previous stroke, diabetes, smoking, and dependency in activities of daily living (ADL) were associated with a lower probability of stroke alert. The proportion of patients arriving at the hospital by ambulance varied from 60.3% to 94.5%. Older age, living alone, primary school education, being born in a European country, previous stroke, AF, dependency in ADL, living in an institution, reduced consciousness upon admission, and hemorrhagic stroke were associated with ambulance services. Hospital stroke alert frequencies correlated strongly with reperfusion rates (r=.75). Conclusion: Acute stroke alerts have a significant potential to improve stroke reperfusion rates. Prehospital stroke management varies conspicuously between hospitals and patient groups, and the elderly and patients living alone have a markedly reduced likelihood of stroke alerts.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:umu:diva-132774 (URN)10.1002/brb3.654 (DOI)000399452500010 ()28413705 (PubMedID)
Available from: 2017-03-23 Created: 2017-03-23 Last updated: 2018-06-09Bibliographically approved
Darehed, D., Norrving, B., Stegmayr, B., Zingmark, K. & Blom, M. C. (2017). Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: a Swedish multicenter register study. European Stroke Journal, 2(2), 178-186
Open this publication in new window or tab >>Patients with acute stroke are less likely to be admitted directly to a stroke unit when hospital beds are scarce: a Swedish multicenter register study
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2017 (English)In: European Stroke Journal, ISSN 2396-9873, E-ISSN 2396-9881, Vol. 2, no 2, p. 178-186Article in journal (Refereed) Published
Abstract [en]

Introduction: It is well established that managing patients with acute stroke in dedicated stroke units is associated with improved functioning and survival. The objectives of this study are to investigate whether patients with acute stroke are less likely to be directly admitted to a stroke unit from the Emergency Department when hospital beds are scarce and to measure variation across hospitals in terms of this outcome.

Patients and methods: This register study comprised data on patients with acute stroke admitted to 14 out of 72 Swedish hospitals in 2011-2014. Data from the Swedish stroke register were linked to administrative daily data on hospital bed occupancy (measured at 6 a.m.). Logistic regression analysis was used to analyse the association between bed occupancy and direct stroke unit admission.

Results: A total of 13,955 hospital admissions were included; 79.6% were directly admitted to a stroke unit from the Emergency Department. Each percentage increase in hospital bed occupancy was associated with a 1.5% decrease in odds of direct admission to a stroke unit (odds ratio = 0.985, 95% confidence interval = 0.978-0.992). The best-performing hospital exhibited an odds ratio of 3.8 (95% confidence interval = 2.6-5.5) for direct admission to a stroke unit versus the reference hospital.

Discussion and conclusion: We found an association between hospital crowding and reduced quality of care in acute stroke, portrayed by a lower likelihood of patients being directly admitted to a stroke unit from the Emergency Department. The magnitude of the effect varied considerably across hospitals.

Place, publisher, year, edition, pages
Sage Publications, 2017
Keywords
Stroke, stroke unit, hospital bed occupancy, hospital admission, stroke care, emergency care, emergency department, bed crisis, The Swedish stroke register
National Category
Neurology
Identifiers
urn:nbn:se:umu:diva-153857 (URN)10.1177/2396987317698328 (DOI)000446624400010 ()
Funder
Norrbotten County Council
Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2019-05-16Bibliographically approved
Söderholm, A., Stegmayr, B., Glader, E.-L. & Asplund, K. (2016). Validation of Hospital Performance Measures of Acute Stroke Care Quality. Riksstroke, the Swedish Stroke Register. Neuroepidemiology, 46(4), 229-234
Open this publication in new window or tab >>Validation of Hospital Performance Measures of Acute Stroke Care Quality. Riksstroke, the Swedish Stroke Register
2016 (English)In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 46, no 4, p. 229-234Article in journal (Refereed) Published
Abstract [en]

Background: Registers are increasingly used to monitor stroke care performance. Fair benchmarking requires sufficient data quality. We have validated acute care data in Riksstroke, the Swedish Stroke Register.

Methods: Completeness was assessed by comparisons with diagnoses at hospital discharge recorded in the compulsory National Patient Register and content validity by comparisons with (a) key variables identified by European stroke experts, and (b) items recorded in other European stroke care performance registers. Five test cases recorded by 67 hospitals were used to estimate inter-hospital reliability.

Results: All 72 Swedish hospitals admitting acute stroke patients participated in Riksstroke. The register was estimated to cover at least 90% of acute stroke patients. It includes 18 of 22 quality indicators identified by international stroke experts and 14 of 15 indicators used by at least 2 stroke performance registers in other European countries. Inter-hospital reliability was high (85%) in 77 of 81 Riksstroke items.

Conclusions: A nationwide stroke care register can be maintained with sufficient data quality to permit between-hospital performance benchmarking. Our experiences may serve as a model for other stroke registers while evaluating data quality.

Keywords
Stroke register, Validation, Data quality, Performance measurement
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Neurology Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-122591 (URN)10.1159/000444679 (DOI)000376812100001 ()26975057 (PubMedID)
Available from: 2016-06-20 Created: 2016-06-20 Last updated: 2018-06-07Bibliographically approved
Asplund, K., Sukhova, M., Wester, P. & Stegmayr, B. (2015). Diagnostic procedures, treatments, and outcomes in stroke patients admitted to different types of hospitals. Stroke, 46(3), 806-812
Open this publication in new window or tab >>Diagnostic procedures, treatments, and outcomes in stroke patients admitted to different types of hospitals
2015 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 46, no 3, p. 806-812Article in journal (Refereed) Published
Abstract [en]

Background and Purpose: In many countries, including Sweden, initiatives have been taken to reduce between-hospital differences in the quality of stroke services. We have explored to what extent hospital type (university, specialized nonuniversity, or community hospital) influences hospital performance. Methods: Riksstroke collects clinical data during hospital stay (national coverage 94%). Follow-up data at 3 months were collected using administrative registers and a questionnaire completed by surviving patients (response rate 88%). Structural data were collected from a questionnaire completed by hospital staff (response rate 100%). Multivariate analyses with adjustment for clustering were used to test differences between types of hospitals. Results: The proportion of patients admitted directly to a stroke unit was highest in community hospitals and lowest in university hospitals. Magnetic resonance, carotid imaging, and thrombectomy were more frequently performed in university hospitals, and the door-to-needle time for thrombolysis was shorter. Secondary prevention with antihypertensive drugs was used less often, and outpatient follow-up was less frequent in university hospitals. Fewer patients in community hospitals were dissatisfied with their rehabilitation. After adjusting for possible confounders, poor outcome (dead or activities of daily living dependency 3 months after stroke) was not significantly different between the 3 types of hospital. Conclusions: In a setting with national stroke guidelines, stroke units in all hospitals, and measurement of hospital performance and benchmarking, outcome (after case-mix adjustment) is similar in university, specialized nonuniversity, and community hospitals. There seems to be fewer barriers to organizing well-functioning stroke services in community hospitals compared with university hospitals.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2015
Keywords
Riksstroke, stroke, thrombolytic therapy
National Category
Neurology Cardiac and Cardiovascular Systems Neurosciences
Identifiers
urn:nbn:se:umu:diva-101599 (URN)10.1161/STROKEAHA.114.007212 (DOI)000350284900044 ()25657174 (PubMedID)
Available from: 2015-04-13 Created: 2015-04-07 Last updated: 2018-06-07Bibliographically approved
Feigin, V. L., Parmar, P. G., Barker-Collo, S., Bennett, D. A., Anderson, C. S., Thrift, A. G., . . . Kasabov, N. (2014). Geomagnetic Storms Can Trigger Stroke Evidence From 6 Large Population-Based Studies in Europe and Australasia. Stroke, 45(6), 1639-1645
Open this publication in new window or tab >>Geomagnetic Storms Can Trigger Stroke Evidence From 6 Large Population-Based Studies in Europe and Australasia
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2014 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 45, no 6, p. 1639-1645Article in journal (Refereed) Published
Abstract [en]

Background and Purpose-Although the research linking cardiovascular disorders to geomagnetic activity is accumulating, robust evidence for the impact of geomagnetic activity on stroke occurrence is limited and controversial. Methods-We used a time-stratified case-crossover study design to analyze individual participant and daily geomagnetic activity (as measured by Ap Index) data from several large population-based stroke incidence studies (with information on 11 453 patients with stroke collected during 16 031 764 person-years of observation) in New Zealand, Australia, United Kingdom, France, and Sweden conducted between 1981 and 2004. Hazard ratios and corresponding 95% confidence intervals (CIs) were calculated. Results-Overall, geomagnetic storms (Ap Index 60+) were associated with 19% increase in the risk of stroke occurrence (95% CI, 11%-27%). The triggering effect of geomagnetic storms was most evident across the combined group of all strokes in those aged <65 years, increasing stroke risk by >50%: moderate geomagnetic storms (60-99 Ap Index) were associated with a 27% (95% CI, 8%-48%) increased risk of stroke occurrence, strong geomagnetic storms (100-149 Ap Index) with a 52% (95% CI, 19%-92%) increased risk, and severe/extreme geomagnetic storms (Ap Index 150+) with a 52% (95% CI, 19%-94%) increased risk (test for trend, P<2x10(-16)). Conclusions-Geomagnetic storms are associated with increased risk of stroke and should be considered along with other established risk factors. Our findings provide a framework to advance stroke prevention through future investigation of the contribution of geomagnetic factors to the risk of stroke occurrence and pathogenesis.

Keywords
environment, stroke
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-91149 (URN)10.1161/STROKEAHA.113.004577 (DOI)000337090700018 ()
Available from: 2014-07-17 Created: 2014-07-15 Last updated: 2018-06-07Bibliographically approved
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
Open this publication in new window or tab >>Trends in Stroke Treatment and Outcome between 1995 and 2010: Observations from Riks-Stroke, the Swedish Stroke Register
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2014 (English)In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 37, no 1, p. 22-29Article in journal (Refereed) 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

Keywords
Quality improvement, Stroke registries, Stroke risk factors, Time trends
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-86843 (URN)10.1159/000356346 (DOI)000330857800004 ()
Available from: 2014-03-13 Created: 2014-03-11 Last updated: 2018-06-08Bibliographically approved
Koster, M., Asplund, K., Johansson, Å. & Stegmayr, B. (2013). Refinement of Swedish Administrative Registers to Monitor Stroke Events on the National Level. Neuroepidemiology, 40(4), 240-246
Open this publication in new window or tab >>Refinement of Swedish Administrative Registers to Monitor Stroke Events on the National Level
2013 (English)In: Neuroepidemiology, ISSN 0251-5350, E-ISSN 1423-0208, Vol. 40, no 4, p. 240-246Article in journal (Refereed) Published
Abstract [en]

Background: Routinely collected databases are kept for administrative purposes. We have refined the analyses of the Swedish National Patient Register and the Cause of Death Register and explored their validity to monitor stroke at the population level. Methods: First-ever strokes (incident cases) and all stroke events were measured by combining the two administrative registers and adding refinements. The administrative registers were validated against the Northern Sweden MONICA, a well-validated population-based epidemiological stroke register. Positive predictive values (PPVs) and sensitivity were calculated. Results: After refinements (restriction to first-ever strokes and additional minor delineations), the PPV of the two administrative registers combined was 94% and sensitivity 92% when compared with all MONICA stroke categories together. For stroke attacks (first and recurrent events together), the PPV in the administrative registers was 85% and sensitivity 91%. The PPV was higher in women than in men, whereas the sensitivity was similar. The PPV was lower but sensitivity higher in people below compared with those above 75 years of age. Both PPV and sensitivity were lower among fatal cases than among cases that survived 28 days. Conclusions: After refinement, Swedish national administrative registers may, with some caveats, be used as a low-resource-consuming alternative to crudely monitor stroke incidence rates at the national level. If further accuracy is strived for, high-quality conventional epidemiological registers are required. Copyright (C) 2013 S. Karger AG, Basel

Place, publisher, year, edition, pages
Basel: S. Karger, 2013
National Category
General Practice
Identifiers
urn:nbn:se:umu:diva-73588 (URN)10.1159/000345953 (DOI)000318839200002 ()
Available from: 2013-06-25 Created: 2013-06-25 Last updated: 2018-06-08Bibliographically approved
Johansson, I., Nilsson, L. M., Stegmayr, B., Boman, K., Hallmans, G. & Winkvist, A. (2012). Associations among 25-year trends in diet, cholesterol and BMI from 140,000 observations in men and women in Northern Sweden. Nutrition Journal, 11, Article ID 40.
Open this publication in new window or tab >>Associations among 25-year trends in diet, cholesterol and BMI from 140,000 observations in men and women in Northern Sweden
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2012 (English)In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 11, article id 40Article in journal (Refereed) Published
Abstract [en]

Background: In the 1970s, men in northern Sweden had among the highest prevalences of cardiovascular diseases (CVD) worldwide. An intervention program combining population- and individual-oriented activities was initiated in 1985. Concurrently, collection of information on medical risk factors, lifestyle and anthropometry started. Today, these data make up one of the largest databases in the world on diet intake in a population- based sample, both in terms of sample size and follow-up period. The study examines trends in food and nutrient intake, serum cholesterol and body mass index (BMI) from 1986 to 2010 in northern Sweden.

Methods: Cross-sectional information on self-reported food and nutrient intake and measured body weight, height, and serum cholesterol were compiled for over 140,000 observations. Trends and trend breaks over the 25-year period were evaluated for energy-providing nutrients, foods contributing to fat intake, serum cholesterol and BMI.

Results: Reported intake of fat exhibited two significant trend breaks in both sexes: a decrease between 1986 and 1992 and an increase from 2002 (women) or 2004 (men). A reverse trend was noted for carbohydrates, whereas protein intake remained unchanged during the 25-year period. Significant trend breaks in intake of foods contributing to total fat intake were seen. Reported intake of wine increased sharply for both sexes (more so for women) and export beer increased for men. BMI increased continuously for both sexes, whereas serum cholesterol levels decreased during 1986 - 2004, remained unchanged until 2007 and then began to rise. The increase in serum cholesterol coincided with the increase in fat intake, especially with intake of saturated fat and fats for spreading on bread and cooking.

Conclusions: Men and women in northern Sweden decreased their reported fat intake in the first 7 years (19861992) of an intervention program. After 2004 fat intake increased sharply for both genders, which coincided with introduction of a positive media support for low carbohydrate-high-fat (LCHF) diet. The decrease and following increase in cholesterol levels occurred simultaneously with the time trends in food selection, whereas a constant increase in BMI remained unaltered. These changes in risk factors may have important effects on primary and secondary prevention of cardiovascular disease (CVD).

Keywords
Diet, Fat, Alcohol, Cholesterol, BMI, Tme trend, Sweden
National Category
Nutrition and Dietetics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-62175 (URN)10.1186/1475-2891-11-40 (DOI)000310777000001 ()
Available from: 2012-12-11 Created: 2012-12-10 Last updated: 2018-06-08Bibliographically approved
Werneke, U., Ott, M., Salander Renberg, E., Stegmayr, B. & Taylor, D. (2012). Long-term lithium treatment and the risk of renal failure vs. risk of suicide: a decision analysis. Paper presented at 15th Annual Meeting of the European Association for Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) & 29th European Conference on Psychosomatic Research (ECPR): “Towards a New Agenda: Cross-disciplinary Approach to Psychosomatic Medicine” A selection of the best abstracts submitted. Aarhus, Denmark, June 27th – June 30th, 2012. Journal of Psychosomatic Research, 72(6), 508-508
Open this publication in new window or tab >>Long-term lithium treatment and the risk of renal failure vs. risk of suicide: a decision analysis
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2012 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 72, no 6, p. 508-508Article in journal, Meeting abstract (Other academic) Published
Keywords
Bipolar disorder, decision analysis, end stage renal disease, lithium, suicide
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-57371 (URN)10.1016/j.jpsychores.2012.03.004 (DOI)000305440700154 ()
Conference
15th Annual Meeting of the European Association for Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) & 29th European Conference on Psychosomatic Research (ECPR): “Towards a New Agenda: Cross-disciplinary Approach to Psychosomatic Medicine” A selection of the best abstracts submitted. Aarhus, Denmark, June 27th – June 30th, 2012
Available from: 2012-07-17 Created: 2012-07-16 Last updated: 2018-06-08Bibliographically approved
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