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  • 1
    Online Resource
    Online Resource
    Circulating vitamin D concentration and risk of seven cancers: Mendelian randomisation study
    BMJ ; 2017
    In:  BMJ
    Details
    In: BMJ, BMJ
    Type of Medium: Online Resource
    ISSN: 0959-8138 , 1756-1833
    URL: Article
    DOI: 10.1136/bmj.j4761
    Language: English
    Publisher: BMJ
    Publication Date: 2017
    detail.hit.zdb_id: 1479799-9
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  • 2
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    Brain atrophy predicts mortality after mechanical thrombectomy of proximal anterior circulation occlusion
    BMJ ; 2021
    In:  Journal of NeuroInterventional Surgery Vol. 13, No. 5 ( 2021-05), p. 415-420
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 13, No. 5 ( 2021-05), p. 415-420
    Abstract: Brain atrophy is associated with an inferior functional outcome in patients undergoing mechanical thrombectomy (MT) for acute ischemic stroke. We hypothesized that brain atrophy determined from pre-interventional non-contrast-enhanced CT scans would also be linked to increased mortality in this cohort. Methods A total of 204 patients treated with MT for acute occlusions of the internal carotid artery (ICA) or the M1 segment of the middle cerebral artery (M1) at Tampere University Hospital, Finland between 2013 and 2017 were retrospectively studied. Brain atrophy index (BAI), masseter muscle surface area and density, chronic ischemic lesions, and white matter lesions were evaluated from pre-interventional CT studies. Logistic regression was applied in analyzing the association of BAI with 3-month mortality. Results Median age at baseline was 69.9 years (IQR 15.6) and mortality at 3 months was 13.2% (n=27). BAI, measured with excellent reproducibility (intraclass correlation coefficient ≥0.894, p 〈 0.001), was significantly associated with age (r=0.54), white matter lesions (r=0.43), dental status (r=−0.31), masseter area (r=−0.24), masseter density (r=−0.28), and chronic ischemic lesions (r=0.24) (p≤0.001 for all). In univariable analysis, BAI demonstrated a strong association with mortality (OR 2.02, 95% CI 1.34 to 3.05, per 1 SD increase), and none of the other factors associated with mortality remained as significant when included in the same multivariable model. The results remained similar when extending the follow-up up to 2.5 years. Conclusions Brain atrophy predicts 3-month mortality after MT of the ICA or the M1 independent of age, masseter sarcopenia, chronic ischemic lesions, or white matter lesions.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2020-016168
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2506028-4
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  • 3
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    Online Resource
    Excess mortality by suicide in high-risk subgroups of suicide attempters: a prospective study of standardised mortality rates in suicide attempters examined at a medical emergency inpatient unit
    BMJ ; 2022
    In:  BMJ Open Vol. 12, No. 5 ( 2022-05), p. e054898-
    Details
    In: BMJ Open, BMJ, Vol. 12, No. 5 ( 2022-05), p. e054898-
    Abstract: The primary aim of the present study was to investigate the putative excess mortality by suicide in suicide attempters. As a secondary aim, we investigate excess mortality in specific, clinically relevant subgroups: individuals with repeated suicide attempts (RA); individuals who used violent method at the attempt (VA); and those who scored high on the Suicide Intent Scale (HS) at the time of the baseline attempt. Finally, we investigate excess mortality in men and women separately and within 5 years and over 5 years after hospital admission for attempted suicide. Design Prospective register-based follow-up for 21–32 years. Standardised mortality ratio (SMR) was calculated for suicide using national census data. Clinically relevant subgroups were investigated separately. Setting Medical emergency inpatient unit in the south of Sweden. Participants 1039 individuals who were psychiatrically assessed at admission to medical inpatient care for attempted suicide between 1987 and 1998. Outcome measure Suicide. Results The overall SMR for suicide was 23.50 (95% CI 18.68 to 29.56); significantly higher (p 〈 0.001) among women (30.49 (95% CI 22.27 to 41.72)) than men (18.61 (95% CI 13.30 to 26.05)). Mortality was highest within the first 5 years after the index suicide attempt (48.79 (95% CI 35.64 to 66.77)) compared with those who died after 5 years (p 〈 0.001) (14.74 (10.53 to 20.63)). The highest independent SMR was found for VA (70.22 (95% CI 38.89 to 126.80)). In a regression model including RA, VA and HS all contributed significantly to excess suicide mortality. Conclusions An elevated risk of premature death by suicide was found in suicide attempters compared with the general population. Assessment of previous suicide attempts is important, even though the attempt/s may have occurred decades ago. When assessing suicide risk, clinicians should consider repeated attempts and whether the attempts involved high suicidal intent and violent method. Healthcare interventions may benefit from targeting identified subgroups of attempters.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2021-054898
    Language: English
    Publisher: BMJ
    Publication Date: 2022
    detail.hit.zdb_id: 2599832-8
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  • 4
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    Long-term risk factors for suicide in suicide attempters examined at a medical emergency in patient unit: results from a 32-year follow-up study
    BMJ ; 2020
    In:  BMJ Open Vol. 10, No. 10 ( 2020-10), p. e038794-
    Details
    In: BMJ Open, BMJ, Vol. 10, No. 10 ( 2020-10), p. e038794-
    Abstract: The overall aim of this study is to gain greater knowledge about the risk of suicide among suicide attempters in a very long-term perspective. Specifically, to investigate possible differences in clinical risk factors at short (≤5 years) versus long term ( 〉 5 years), with the hypothesis that risk factors differ in the shorter and longer perspective. Design Prospective study with register-based follow-up for 21–32 years. Setting Medical emergency inpatient unit in the south of Sweden. Participants 1044 individuals assessed by psychiatric consultation when admitted to medical inpatient care for attempted suicide during 1987–1998. Outcome measures Suicide and all-cause mortality. Results At follow-up, 37.6% of the participants had died, 7.2% by suicide and 53% of these within 5 years of the suicide attempt. A diagnosis of psychosis at baseline represented the risk factor with the highest HR at long-term follow-up, that is, 〉 5 years, followed by major depression and a history of attempted suicide before the index attempt. The severity of a suicide attempt as measured by SIS (Suicide Intent Scale) showed a non-proportional association with the hazard for suicide over time and was a relevant risk factor for suicide only within the first 5 years after an attempted suicide. Conclusions The risk of suicide after a suicide attempt persists for up to 32 years after the index attempt. A baseline diagnosis of psychosis or major depression or earlier suicide attempts continued to be relevant risk factors in the very long term. The SIS score is a better predictor of suicide risk at short term, that is, within 5 years than at long term. This should be considered in the assessment of suicide risk and the implementation of care for these individuals.
    Type of Medium: Online Resource
    ISSN: 2044-6055 , 2044-6055
    URL: Article
    DOI: 10.1136/bmjopen-2020-038794
    Language: English
    Publisher: BMJ
    Publication Date: 2020
    detail.hit.zdb_id: 2599832-8
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  • 5
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    Online Resource
    Impact of extra-articular spondyloarthritis manifestations and comorbidities on drug retention of a first TNF-inhibitor in ankylosing spondylitis: a population-based nationwide study
    BMJ ; 2018
    In:  RMD Open Vol. 4, No. 2 ( 2018-10), p. e000762-
    Details
    In: RMD Open, BMJ, Vol. 4, No. 2 ( 2018-10), p. e000762-
    Abstract: To assess the impact of extra-articular spondyloarthritis (SpA) manifestations (anterior uveitis, psoriasis and inflammatory bowel disease (IBD)), and of comorbidities, on tumour necrosis factor alpha inhibitor (TNFi) drug retention in ankylosing spondylitis (AS). Methods We identified all bio-naïve patients with AS starting a first ever TNFi July 2006 to December 2015 from the Swedish Rheumatology Quality register and followed these from treatment start through December 2015. We determined the presence of extra-articular SpA-manifestations, comorbidities (cardiovascular disease, affective disease, diabetes, malignancies, chronic lung disease and kidney disease) and socioeconomic status before TNFi start, through linkage to five other national registers, and calculated, for each factor, crude and adjusted HRs for discontinuing the TNFi. Results 2577 patients with AS (71% men) started a first TNFi during the study period. 27% had a history of anterior uveitis, 6% psoriasis and 7% IBD. Anterior uveitis was associated with a superior TNFi drug retention (HR 0.72; 0.62 to 0.83), psoriasis with an inferior (HR 1.48; 1.18 to 1.86), whereas IBD did not affect TNFi drug retention. The effect of the SpA manifestations on TNFi drug retention was of a similar magnitude to that of the comorbidities. Conclusions In AS, anterior uveitis and psoriasis, but not IBD, affect TNFi drug retention. Possible explanations include differential effects of TNFi on these extra-articular SpA manifestations, or inherent differences in AS, associated with the inflammatory phenotype. Further, comorbidities and socioeconomy affect TNFi drug retention to a similar magnitude as the SpA manifestations, and should, as such, receive due attention in clinical practice.
    Type of Medium: Online Resource
    ISSN: 2056-5933
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1136/rmdopen-2018-000762
    DOI: 10.1136/rmdopen-2018-000762.supp1
    DOI: 10.1136/rmdopen-2018-000762.supp2
    Language: English
    Publisher: BMJ
    Publication Date: 2018
    detail.hit.zdb_id: 2812592-7
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  • 6
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    Association of masseter area and radiodensity with three-month survival after proximal anterior circulation occlusion
    BMJ ; 2021
    In:  Journal of NeuroInterventional Surgery Vol. 13, No. 1 ( 2021-01), p. 25-29
    Details
    In: Journal of NeuroInterventional Surgery, BMJ, Vol. 13, No. 1 ( 2021-01), p. 25-29
    Abstract: Masseter area (MA), a surrogate for sarcopenia, appears to be useful when estimating postoperative survival, but there is lack of consensus regarding the potential predictive value of sarcopenia in acute ischemic stroke (AIS) patients. We hypothesized that MA and density (MD) evaluated from pre-interventional CT angiography scans predict postinterventional survival in patients undergoing mechanical thrombectomy (MT). Materials and methods 312 patients treated with MT for acute occlusions of the internal carotid artery (ICA) or the M1 segment of the middle cerebral artery (M1-MCA) between 2013 and 2018. Median follow-up was 27.4 months (range 0–70.4). Binary logistic (alive at 3 months, OR 〈 1) and Cox regression analyses were used to study the effect of MA and MD averages (MAavg and MDavg) on survival. Results In Kaplan–Meier analysis, there was a significant inverse relationship with both MDavg and MAavg and mortality (MDavg P 〈 0.001, MAavg P=0.002). Long-term mortality was 19.6% (n=61) and 3-month mortality 12.2% (n=38). In multivariable logistic regression analysis at 3 months, per 1-SD increase MDavg (OR 0.61, 95% CI 0.41 to 0.92, P=0.018:) and MAavg (OR 0.57, 95% CI 0.35 to 0.91, P=0.019) were the independent predictors associated with lower mortality. In Cox regression analysis, MDavg and MAavg were not associated with long-term survival. Conclusions In acute ischemic stroke patients, MDavg and MAavg are independent predictors of 3-month survival after MT of the ICA or M1-MCA. A 1-SD increase in MDavg and MAavg was associated with a 39%–43% decrease in the probability of death during the first 3 months after MT.
    Type of Medium: Online Resource
    ISSN: 1759-8478 , 1759-8486
    URL: Article
    DOI: 10.1136/neurintsurg-2020-015837
    Language: English
    Publisher: BMJ
    Publication Date: 2021
    detail.hit.zdb_id: 2506028-4
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  • 7
    Online Resource
    Online Resource
    Prediction of breast cancer risk by genetic risk factors, overall and by hormone receptor status
    BMJ ; 2012
    In:  Journal of Medical Genetics Vol. 49, No. 9 ( 2012-09), p. 601-608
    Details
    In: Journal of Medical Genetics, BMJ, Vol. 49, No. 9 ( 2012-09), p. 601-608
    Type of Medium: Online Resource
    ISSN: 0022-2593 , 1468-6244
    URL: Article
    DOI: 10.1136/jmedgenet-2011-100716
    RVK:
    WA 15000
    Language: English
    Publisher: BMJ
    Publication Date: 2012
    detail.hit.zdb_id: 2009590-9
    SSG: 12
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  • 8
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    Mortality in patients with psoriatic arthritis in Sweden: a nationwide, population-based cohort study
    BMJ ; 2023
    In:  Annals of the Rheumatic Diseases
    Details
    In: Annals of the Rheumatic Diseases, BMJ
    Abstract: To compare all-cause mortality and causes of death between patients with psoriatic arthritis (PsA) and the general population in Sweden. Methods Adults with at least one main PsA diagnosis (International Classification of Diseases-10: L40.5/M07.0–M07.3) from outpatient rheumatology/internal medicine departments 2001–2017 were identified from the National Patient Register. Each case was matched to five population comparator-subjects on sex/county/age at the case’s first arthritis diagnosis. Follow-up ran from 1 January 2007, or from first PsA diagnosis thereafter, until death, emigration or 31 December 2018. Mortality was assessed overall, and stratified by sex and duration since diagnosis (diagnosis before/after 1 January 2007), using matched Cox proportional hazard regression (excluding/including adjustments for comorbidity) or Breslow test, as appropriate. Incidence rate ratios (IRR) of death, overall and stratified by sex/duration since diagnosis/age, as well as causes of death in PsA cases and comparator-subjects were also described. Results All-cause mortality was elevated in PsA (HR: 1.11 (95% CI: 1.07 to 1.16); IRR: 1.18 (95% CI: 1.13 to 1.22)), mainly driven by increased risks in women (HR: 1.23 (95% CI: 1.16 to 1.30)) and cases with longer time since diagnosis (HR: 1.18 (95% CI: 1.12 to 1.25)). IRR of death were significantly increased for all ages except below 40 years, with the numerically highest point-estimates for ages 40–59 years. When adjusted for comorbidity, however, the elevated mortality risk in PsA disappeared. Causes of death were similar among PsA cases/comparator-subjects, with cardiovascular disease and malignancy as the leading causes. Conclusions Mortality risk in PsA in Sweden was about 10% higher than in the general population, driven by excess comorbidity and with increased risks mainly in women and patients with longer disease duration.
    Type of Medium: Online Resource
    ISSN: 0003-4967 , 1468-2060
    URL: Article
    DOI: 10.1136/ard-2023-224965
    RVK:
    XA 10000
    Language: English
    Publisher: BMJ
    Publication Date: 2023
    detail.hit.zdb_id: 1481557-6
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