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Kjell Asplund

Publications and source records attributed to Kjell Asplund.

At least 37 records · Page 2Linked to original sources
PubMed2003

Sex differences in management and outcome after stroke: a Swedish national perspective.

BACKGROUND AND PURPOSE: It is disputed whether there are sex differences in management and outcome after stroke; early studies have shown inconsistent results. The objective of this study was to verify and explain differences between men and women in management and outcome after stroke in a national perspective. METHODS: In 2001, 20 761 stroke patients were registered in Riks-Stroke, the national quality register for stroke care in Sweden in which all 84 hospitals participate. Data from 9 hospitals that had reported <70% of the estimated stroke events were excluded from analyses, leaving 19 547 patients (9666 women, 9881 men) at 75 hospitals for the present analyses. RESULTS: Women were older than men (77.8 versus 73.2 years). After age adjustment, female patients were more often disabled, living at home with community support, or in institutions before the stroke. They also had a different cardiovascular risk factor profile. Case fatality ratios during the first 3 months were similar in men and women. After 3 months, more women were physically and mentally impaired and dependent on other persons. Female patients with atrial fibrillation received oral anticoagulants less often than men. Even after multiple adjustments for differences between sexes, female sex was independently associated with institutional living 3 months after the stroke (odds ratio, 1.2; 95% confidence interval, 1.0 to 1.4). CONCLUSIONS: Women have a worse prestroke condition. Except for case fatality ratios, they also have a worse outcome after stroke after adjustment for other prognostic factors. There are also sex differences in the medical management of stroke that need to be rectified.

Aged↗
PubMed2003

[Use of snuff entails lower risk of cardiovascular diseases than does smoking].

Oral snuff, a form of smokeless tobacco, causes an immediate rise in heart rate and blood pressure, but snuff users do not show permanent changes in heart rate or blood pressure when not exposed to tobacco. Cardiac output during workload and maximal work capacity are unaffected. Snuff users usually do not show the biochemical stigmata that regular smokers do with the exception of a possible excess risk of type 2 diabetes. Two studies have found that snuff users, as opposed to smokers, do not show increased intima-media thickness or atherosclerotic lesions when investigated by ultrasonography. Results on the risk of myocardial infarction have provided conflicting evidence, two case-control studies showing the same risk as in non-tobacco users and one cohort study showing an increased risk of cardiovascular death. A nested case-control study failed to show an excess risk of stroke in snuff users. It is concluded that the use of smokeless tobacco (with snuff being the most studied variant) entails a lower risk of adverse cardiovascular effects than does smoking.

Arteriosclerosis↗
PubMed2003

UK-279,276, a neutrophil inhibitory glycoprotein, in acute stroke: tolerability and pharmacokinetics.

BACKGROUND AND PURPOSE: UK-279,276, a recombinant glycoprotein, binds selectively to the CD11b/CD18 integrin on neutrophils and has the potential to modulate the neuroinflammation associated with acute stroke. After preclinical evidence of neuroprotection, UK-279,276 has entered clinical development. The purposes of this study were to evaluate the safety and tolerability of UK-279,276 and to examine its pharmacokinetics and pharmacodynamics (binding to neutrophil CD11b) in patients with acute stroke. METHODS: This was a multicenter, double-blind, dose-escalation study in 176 patients randomized to a single intravenous dose of UK-279,276 (6 cohorts: 0.06, 0.1, 0.2, 0.5, 1.0, 1.5 mg/kg) or placebo (3:1 randomization within each cohort) within 12 hours of stroke onset. RESULTS: Age and stroke severity were well balanced across groups, with a mean age of 70 years (range, 39 to 92 years) and moderate baseline stroke severity (mean Scandinavian Stroke Scale score, 36.5 to 43.2; mean National Institutes of Health Stroke Scale score, 6.3 to 8.5). UK-279,276 was well tolerated at doses up to 1.5 mg/kg. There was no evidence of a relationship between dose of UK-279,276 and adverse events or clinical chemistry or hematology laboratory tests, or of an increased incidence of infection-related adverse events with the study drug. A dose-dependent UK-279,276-specific IgG antibody response was observed in patients treated with the 1.0- and 1.5-mg/kg doses. UK-279,276 displayed nonlinear pharmacokinetics across the dose range investigated. The duration of CD11b saturation was dose dependent, with >80% saturation achieved for at least 7 days after treatment with UK-279,276 1.0 and 1.5 mg/kg. CONCLUSIONS: UK-279,276 was well tolerated in acute stroke patients at single doses up to 1.5 mg/kg. Further clinical investigation of UK-279,276 is ongoing.

Acute Disease↗
PubMed2003

Smokeless tobacco as a possible risk factor for stroke in men: a nested case-control study.

BACKGROUND AND PURPOSE: Snuff and other forms of smokeless tobacco are widely used in some populations. Whereas the detrimental cardiovascular effects of smoking are well documented, possible health hazards associated with the use of smokeless tobacco remain controversial. The purpose of this study was to explore whether the use of snuff, a smokeless tobacco product, increases the risk of stroke in men. METHODS: In a nested case-control study (1 case and 2 matched controls without cardiovascular disease), information on tobacco habits was collected through population risk factor surveys. During follow-up, first-ever fatal and nonfatal strokes occurring among 25- to 74-year-old participants were identified in a population-based stroke register. The study was restricted to men (276 cases, 551 controls). RESULTS: The unadjusted odds ratio for stroke in regular cigarette smokers compared with men who never used tobacco was 2.21 (95% CI, 1.29 to 3.79). When never-smoking regular snuff dippers (excluding ex-smokers) were compared with men who never used tobacco, the unadjusted odds ratio was 1.05 (95% CI, 0.37 to 2.94). The odds ratio for never-snuffing smokers versus never-smoking snuff users was 2.90 (95% CI, 0.92 to 9.1). After adjustment for multiple cardiovascular risk factors, the odds ratio for having a stroke was 1.74 (95% CI, 0.85 to 3.54) in regular smokers and 0.87 (95% CI, 0.41 to 1.83) in regular snuff users. CONCLUSIONS: Whereas regular smoking doubles the risk of stroke in men, snuff use is not associated with any apparent excess risk. Chemical moieties produced by burning tobacco are probably the most important contributors to smokers' excess risk of atherothrombotic disease, including stroke.

Adult↗
PubMed2003

Trends in stroke and coronary heart disease in the WHO MONICA Project.

BACKGROUND AND PURPOSE: Coronary heart disease (CHD) and stroke are leading causes of death and disability. Because they share major common risk factors, it would be expected that trends in mortality and incidence of these 2 major cardiovascular diseases would be similar. METHODS: Data from the World Health Organization (WHO) Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project were used to compare 10-year trends in mortality, event rates, and case fatality from both CHD and stroke. Fifteen populations in the WHO MONICA Project provided data on both CHD (60 763 events) and stroke (10 442 events) in men and women aged 35 to 64 years (23.4 million person-years of observation in total). RESULTS: Trends for the 2 cardiovascular diseases varied within and between populations, and when data from all populations were combined, trends in CHD and stroke mortality differed in men (P=0.001) but not in women, whereas trends in event rates differed significantly in both men and women (P<0.001 and P=0.011, respectively). The differences in trends for CHD and stroke case fatality were not statistically significant in either men or women. In sensitivity analyses, differences in trends in event rates remained statistically significant in men (P<0.001) but not in women. CONCLUSIONS: Trends for CHD and stroke mortality rates, event rates, and case fatality differ substantially between and within the study populations.

Adult↗
PubMed2003

[Genetic research on blood samples stored for years in biobanks. Most people are willing to provide informed consent].

Genetic research involving biobanks has been the subject of numerous declarations, recommendations and guidelines produced by professionals, administrators, legislators and other decision-makers. Yet, there is little published empirical information on people's willingness to participate in genetic studies on blood samples that they donated many years ago, at a time when the informed consent did not include the possibility of genetic research. We here report on our experiences of obtaining informed consent for academic and as well as commercial genetic research on blood samples collected more than a decade ago. Participants in a population-based risk factor survey who had donated blood to a biobank in 1990 were contacted eleven years later (in 2001) and asked for informed consent for genetic studies. A total of 1,311 out of 1,409 participants (93%) gave their consent to use blood samples for academic genetic research, provided that an Ethics Committee had approved the research. Thirty-one participants (2.2%) did not give their consent for academic genetic research. Another 35 subjects (2.5%) did not consent to industrial genetic research even if their blood samples were anonymized. Sixty-four individuals did not reply or provided incomplete answers (together 4.8%). Of the 1,311 individuals that agreed to participate, 292 (22.3%) wanted to be informed and give their concent to every new specific project. All the others gave a general concent provided that an Ethics Committee had approved the research.

Adult↗
PubMed2003

Health care resource use and stroke outcome. Multinational comparisons within the GAIN International trial.

BACKGROUND AND PURPOSE: Outcome in patients hospitalized for acute stroke varies considerably between populations. Within the framework of the GAIN International trial, a large multicenter trial of a neuroprotective agent (gavestinel, glycine antagonist), stroke outcome in relation to health care resource use has been compared in a large number of countries, allowing for differences in case mix. METHODS: This substudy includes 1,422 patients in 19 countries grouped into 10 regions. Data on prognostic variables on admission to hospital, resource use, and outcome were analyzed by regression models. RESULTS: All results were adjusted for differences in prognostic factors on admission (NIH Stroke Scale, age, comorbidity). There were threefold variations in the average number of days in hospital/institutional care (from 20 to 60 days). The proportion of patients who met with professional rehabilitation staff also varied greatly. Three-month case fatality ranged from 11% to 28%, and mean Barthel ADL score at three months varied between 64 and 73. There was no relationship between health care resource use and outcome in terms of survival and ADL function at three months. The proportion of patients living at home at three months did not show any relationship to ADL function across countries. CONCLUSIONS: There are wide variations in health care resource use between countries, unexplained by differences in case mix. Across countries, there is no obvious relationship between resource use and clinical outcome after stroke. Differences in health care traditions (treatment pathways) and social context seem to be major determinants of resource use. In making comparisons between countries, great care should be exercised in using outcome variables as indicators of quality of stroke care.

Activities of Daily Living↗
PubMed2003

The CTLA4 region as a general autoimmunity factor: an extended pedigree provides evidence for synergy with the HLA locus in the etiology of type 1 diabetes mellitus, Hashimoto's thyroiditis and Graves' disease.

We have identified a large family in the northern part of Sweden with multiple cases of autoimmune diseases, namely type 1 diabetes (T1D), Graves' disease (GD) and Hashimoto's thyroiditis (HT). The family members affected by any of these diseases share a region of 2.4 Mb that comprises among others the CTLA4 gene. We determined that all affected members of the family shared the HLA susceptibility haplotype (DR4-DQA1*0301-DQB1*0302). Analysis of genetic interaction conditioning for HLA haplotype provided strong evidence that the critical region which includes the CTLA4 gene acts together with the HLA locus on the etiology of disease (lodscore 4.20 (theta=0.0). The study of this family allowed us to: (1) reinforce a number of reports on linkage and association of the CTLA4 region to T1D and AITD; (2) demonstrate that a single haplotypic variant in this region constitutes an etiological factor to disease susceptibility in T1D, GD and HT; (3) reveal a strong genetic interaction of the CTLA4 and HLA loci in the genetic architecture of autoimmune disease; (4) emphasise the value of large pedigrees drawn from isolated populations as tools to single out the effect of individual loci in the etiology of complex diseases.

Abatacept↗
PubMed2003

Stroke in Northern Sweden.

BACKGROUND: Stroke is one of the most common causes of death and long-term disability worldwide. Although stroke mortality has decreased in most industrialized countries, there are populations, particularly in East Europe, in which the mortality has increased. The WHO initiated, 20 years ago, the MONICA Project. The aim of the study was to measure trends in coronary heart disease and stroke and to assess the extent to which these were related to changes in known risk factors. DESIGN: The Northern Sweden MONICA stroke study started in 1985 and is still ongoing. All individuals with an acute stroke in the age group 25-74 years have been included in the stroke register. Death certificates, discharge records, and GPs' records are screened and validated using strict MONICA criteria. RESULTS: Stroke event rates (first ever and recurrent stroke) per 100000 and year in the age group 25-74 years varied little over the years. Between 1985 and 1998 the annual incidence varied between 318 and 372 in men and between 195 and 240 in women, with no secular trends at all. The 28-day case fatality decreased in both men and women, from 19% to 11%. Logistic regression analyses showed a risk reduction in dying from stroke to 0.55 (p<0.0001) the last year compared with the first, with an absolute annual reduction in case fatality of 3%, in both men and women. In international comparison Northern Sweden shows an intermediately high incidence and one of the lowest case fatality rates of all participating populations. The incidence in subarachnoid haemorrhage was among the highest. CONCLUSION: The ongoing decline in stroke mortality in Sweden is driven exclusively by declining case fatality, whereas event rates (first ever and recurrent stroke) have remained the same since 1985. This, together with more people entering advanced, stroke-prone age groups, implies that the burden of stroke will continue to increase in Sweden.

Adult↗
PubMed2003

The events registration and survey procedures in the Northern Sweden MONICA Project.

INTRODUCTION: The WHO MONICA Project (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease) was initiated in 1982. The purpose was to evaluate to what extent mortality trends could be explained by changes over time in the population load of conventional cardiovascular risk factors. To test this hypothesis, time trends in cardiovascular event rates have been correlated with trends in levels of risk factors in 35- to 64-year-old men and women in 38 populations. In most MONICA populations, the study has covered a period of 10 years or more. METHODS: All acute myocardial infarction and stroke events have been registered in a population-based setting in Norrbotten and Västerbotten counties from 1985 and onwards. The total population is approximately 510000 inhabitants. In the frame of the WHO MONICA Project, the same strict criteria have been used in all years. Another part of the MONICA Project is population risk factor surveys. In Northern Sweden the first survey took place in 1986 and the following surveys were performed in 1990, 1994, and 1999, including the age group 25-74 years (the first two surveys were of the age range 25-64 years). RESULTS: From 1985 to 2000, in total 18105 suspected stroke events, aged 25-74 years, were scrutinized and validated at the central stroke office in Northern Sweden. Of these, 13908 were found to fulfil the MONICA criteria of an acute stroke. During the period 1985 to 1998, in total 13228 cases of suspected acute myocardial infarction, aged 25-64 years, were registered. Of these, 8744 fulfilled the MONICA criteria for acute myocardial infarction. In the four surveys, in total 9000 randomly selected men and women were invited for survey. Of these 6952 (77%) participated in the surveys. CONCLUSION: From 1985 and onwards, the WHO MONICA project has been going on in Northern Sweden. During the whole time the same strict WHO criteria have been followed.

Cardiovascular Diseases↗
PubMed2003

Psychosocial distress and impaired quality of life--targets neglected in the secondary prevention in women with ischaemic heart disease.

BACKGROUND: Secondary prevention in patients with ischaemic heart disease (IHD) focusing on classical risk factors has been less successful in women than in men. Previous studies have suggested that psychosocial factors may be new targets for secondary prevention. In the present study, psychosocial factors have been compared in women with and without IHD. METHODS AND SUBJECTS: Using a cross-sectional comparison, classical cardiovascular risk factors and self-rated stress behaviour, vital exhaustion, stressful life events and quality of life were assessed in 198 women (age 35-77 years) who had IHD and a population-based sample of 206 women (age 45-74 years) without IHD. RESULTS: Control of classical risk factors was most often adequate in women with IHD. The prevalence of smoking was 9% in women with versus 18% in women without IHD (P<0.001), blood pressure levels were similar, and a very large share of women with IHD were on treatment with anti-thrombotic, anti-hypertensive and/or lipid-lowering drugs (P<0.001 compared with women free of IHD). In contrast, women with IHD scored significantly worse than women without IHD in self-rated stress behaviour (P=0.003 after adjustment for other possible determinants), and in vital exhaustion (P=0.003). In univariate analyses, quality of life was significantly worse in women with IHD. Stressful life events did not differ between the two groups. CONCLUSIONS: In this group of women with IHD, control of classical risk factors was good, whereas control of psychosocial risk factors was clearly inadequate. Secondary prevention by psychosocial intervention in women with IHD should be evaluated in randomized controlled trials.

Adaptation, Psychological↗
PubMed2003

Riks-stroke - a Swedish national quality register for stroke care.

BACKGROUND: Riks-Stroke, the Swedish national quality register on stroke care, provides unique opportunities to evaluate stroke units in routine clinical care. METHODS: Basic patient characteristics, process indicators and outcome variables are recorded in all 85 hospitals admitting acute stroke patients. A 3-month follow-up is included. RESULTS: There are wide variations between hospitals in the proportion of patients admitted to a stroke unit, in secondary prevention and in the proportion of patients in institutional care at 3 months. Even after adjustment for available prognostic indicators, case fatality is lower and functional outcome is better in patients treated in stroke units than in patients treated in general wards. CONCLUSION: Riks-Stroke shows that outcome is consistently better in patients treated in a stroke unit than in general wards, not only in randomised trials but also in routine stroke care.

Health Services↗
PubMed2003

The role of the data safety and monitoring committee in stroke trials.

There are many good reasons why any human experiment should have appropriate oversight. In clinical trials, the data safety and monitoring committee (DSMC) serves to protect the interests of the patients. In stroke trials, its members usually together represent a broad expertise in neurology, internal medicine, cardiology and biostatistics. Independency and integrity are key words, especially in the relationship to the sponsor of the trial. The DSMC members should have no long-term financial strings to the sponsor, and they should not be personally involved in patient recruitment and evaluation. The DSMC provides recommendations to the steering committee of the trial on whether to continue or to stop patient recruitment and on protocol amendments that may be necessary to protect the safety of the patients.

Clinical Trials as Topic↗