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Burden of informal care giving to patients with psychoses: a descriptive and methodological study.

https://arctichealth.org/en/permalink/ahliterature129510
Source
Int J Soc Psychiatry. 2013 Mar;59(2):137-46
Publication Type
Article
Date
Mar-2013
Author
Lena Flyckt
Anna Löthman
Leif Jörgensen
Anders Rylander
Thomas Koernig
Author Affiliation
Department of Clinical Neurosciences, Stockholm Centre of Psychiatric Research, Karolinska Institutet, Stockholm, Sweden. lena.flyckt@ki.se
Source
Int J Soc Psychiatry. 2013 Mar;59(2):137-46
Date
Mar-2013
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Aged
Ambulatory Care - economics - methods - psychology
Caregivers - economics - psychology
Cost of Illness
Female
Humans
Male
Medical Records - standards - statistics & numerical data
Middle Aged
Patient Care - economics - psychology
Process Assessment (Health Care) - economics - methods - standards
Psychotic Disorders - economics
Questionnaires
Stress, Psychological - etiology - psychology
Sweden
Time Factors
Abstract
There is a lack of studies of the size of burden associated with informal care giving in psychosis.
To evaluate the objective and subjective burden of informal care giving to patients with psychoses, and to compare a diary and recall method for assessments of objective burden.
Patients and their informal caregivers were recruited from nine Swedish psychiatric outpatient centres. Subjective burden was assessed at inclusion using the CarerQoL and COPE index scales. The objective burden (time and money spent) was assessed by the caregivers daily using diaries over four weeks and by recall at the end of weeks 1 and 2.
One-hundred and seven patients (53% females; mean age 43 ± 11) and 118 informal caregivers (67%; 58 ± 15 years) were recruited. Informal caregivers spent 22.5 hours/week and about 14% of their gross income on care-related activities. The time spent was underestimated by two to 20 hours when assessed by recall than by daily diary records. The most prominent aspects of the subjective burden were mental problems.
Despite a substantial amount of time and money spent on care giving, the informal caregivers perceived the mental aspects of burden as the most troublesome. The informal caregiver burden is considerable and should be taken into account when evaluating effects of health care provided to patients with psychoses.
Notes
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PubMed ID
22100570 View in PubMed
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A clinical-pathological review of hidradenitis suppurativa: using immunohistochemistry one disease becomes two.

https://arctichealth.org/en/permalink/ahliterature124423
Source
APMIS. 2012 Jun;120(6):433-40
Publication Type
Article
Date
Jun-2012
Author
Silje Fismen
Gisli Ingvarsson
Dagfinn Moseng
Deirdre Nathalie Dufour
Leif Jørgensen
Author Affiliation
Department of Pathology, University Hospital Northern Norway, Tromsø, Norway.
Source
APMIS. 2012 Jun;120(6):433-40
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Factors
Apocrine Glands - metabolism - pathology
Biopsy
Child
Female
Hidradenitis Suppurativa - metabolism - pathology
Humans
Immunohistochemistry - methods
Male
Middle Aged
Sex Factors
Young Adult
Abstract
We report the results of a re-examination of a series of 57 biopsies from 50 patients with the clinical diagnosis of hidradenitis suppurativa, submitted to the Department of Pathology at the University Hospital of Northern Norway, Tromsø, Norway. The biopsy material came from hospitals and physicians all over northern Norway in the years 2000-2007. All tissue material was resectioned and stained with the immunohistochemical reagent, cytokeratin (AE1/AE3/PKC26), and that made it possible to divide the material into two different disease categories: (1) 36 biopsies from 30 cases had tissue inflammation after rupture of keratin-rich epidermal cysts, which we call 'horny cell inflammation', followed by extensive cutaneous thrombi and infarcts, and (2) 21 biopsies from 20 cases had 'apocrinitis' defined here as an inflammatory destruction of apocrine skin glands, and partly of close eccrine glands. The two disease populations differed: the patients with a diagnosis of horny cell inflammation were younger and mainly women; those with a diagnosis of apocrinitis, as defined here, were older, men and women equally represented.
PubMed ID
22583355 View in PubMed
Less detail

COPD health care in Sweden - A study in primary and secondary care.

https://arctichealth.org/en/permalink/ahliterature146912
Source
Respir Med. 2010 Mar;104(3):404-11
Publication Type
Article
Date
Mar-2010
Author
Claes-Göran Löfdahl
Björn Tilling
Tommy Ekström
Leif Jörgensen
Gunnar Johansson
Kjell Larsson
Author Affiliation
Department of Respiratory Medicine and Allergology, Lund University Hospital, SE-222 41 Lund, Sweden. claes-goran.lofdahl@med.lu.se
Source
Respir Med. 2010 Mar;104(3):404-11
Date
Mar-2010
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Guideline Adherence - economics
Humans
Male
Middle Aged
Practice Guidelines as Topic
Process Assessment (Health Care)
Pulmonary Disease, Chronic Obstructive - economics - nursing - therapy
Quality Indicators, Health Care
Quality of Life
Questionnaires
Respiratory Function Tests
Retrospective Studies
Spirometry - economics
Sweden
Treatment Outcome
Abstract
To map out-patients with Chronic Obstructive Pulmonary Disease (COPD) with special reference to patients suffering from acute exacerbations, and to describe COPD health care structure and process in Swedish clinical practice in a real life setting.
Retrospective, non-interventional, epidemiological survey.
141 hospital based out patient clinics (OPC, n=30) and primary health care clinics (PC, n=111) were included in the structure evaluation.
1004 COPD diagnosed patients from 100 of the centres (OPC, n=26) participated in the process evaluation.
All Swedish OPC (n=40) and a random sample of 180 PC were asked to answer a questionnaire regarding COPD care. In addition, data from 10 randomly selected patients with a documented COPD disease were analysed from the centres.
Spirometers were available at all OPCs and at 99% of the PCs. Spirometry had been performed in 52% of PC-patients and in 89% of OPC-patients during the last 2 years prior to the study. More severe patients, as judged by investigator and lung function data, were treated at OPCs than at PCs. Physiotherapists, occupational therapists and dieticians were available at >80% of centres. Exacerbation rate was higher at PCs without a specialized nurse, 2.2/year versus 0.9/year at centres with a specialized nurse.
Special attention to COPD, marked by a specialised nurse in primary care improves the quality, as assessed by a lower number of exacerbations. The structure of COPD care in Sweden for diagnosed individuals seems satisfactory, but could be improved mainly through higher availability and educational activities.
PubMed ID
19963361 View in PubMed
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Economic burden of COPD in a Swedish cohort: the ARCTIC study.

https://arctichealth.org/en/permalink/ahliterature295005
Source
Int J Chron Obstruct Pulmon Dis. 2018; 13:275-285
Publication Type
Journal Article
Observational Study
Date
2018
Author
Karin Lisspers
Kjell Larsson
Gunnar Johansson
Christer Janson
Madlaina Costa-Scharplatz
Jean-Bernard Gruenberger
Milica Uhde
Leif Jorgensen
Florian S Gutzwiller
Björn Ställberg
Author Affiliation
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala.
Source
Int J Chron Obstruct Pulmon Dis. 2018; 13:275-285
Date
2018
Language
English
Publication Type
Journal Article
Observational Study
Keywords
Absenteeism
Age Factors
Aged
Cost of Illness
Female
Health Care Costs - trends
Health Expenditures - trends
Humans
Income
Male
Middle Aged
Models, Economic
Primary Health Care - economics - trends
Pulmonary Disease, Chronic Obstructive - diagnosis - economics - epidemiology - therapy
Registries
Retrospective Studies
Sick Leave - economics
Sweden
Time Factors
Treatment Outcome
Abstract
We assessed direct and indirect costs associated with COPD in Sweden and examined how these costs vary across time, age, and disease stage in a cohort of patients with COPD and matched controls in a real-world, primary care (PC) setting.
Data from electronic medical records linked to the mandatory national health registers were collected for COPD patients and a matched reference population in 52 PC centers from 2000 to 2014. Direct health care costs (drug, outpatient or inpatient, PC, both COPD related and not COPD related) and indirect health care costs (loss of income, absenteeism, loss of productivity) were assessed.
A total of 17,479 patients with COPD and 84,514 reference controls were analyzed. During 2013, direct costs were considerably higher among the COPD patient population (€13,179) versus the reference population (€2,716), largely due to hospital nights unrelated to COPD. Direct costs increased with increasing disease severity and increasing age and were driven by higher respiratory drug costs and non-COPD-related hospital nights. Indirect costs (~€28,000 per patient) were the largest economic burden in COPD patients of working age during 2013.
As non-COPD-related hospital nights represent the largest direct cost, management of comorbidities in COPD would offer clinical benefits and relieve the financial burden of disease.
Notes
Cites: Int J Chron Obstruct Pulmon Dis. 2014 Mar 19;9:289-300 PMID 24672234
Cites: Respir Med. 2016 Feb;111:39-46 PMID 26725462
Cites: Popul Health Manag. 2012 Oct;15(5):267-75 PMID 22401150
Cites: COPD. 2015 Aug;12(4):381-9 PMID 25415366
Cites: Respir Med. 2007 Mar;101(3):539-46 PMID 16889949
Cites: Int J Chron Obstruct Pulmon Dis. 2017 Feb 23;12 :735-744 PMID 28260880
Cites: Eur Respir J. 2008 Dec;32(6):1433-42 PMID 19043008
Cites: J Occup Environ Med. 2008 Oct;50(10):1130-8 PMID 18849758
Cites: Respir Med. 2002 Sep;96(9):700-8 PMID 12243316
Cites: PLoS One. 2016 Apr 19;11(4):e0152618 PMID 27092775
Cites: Respir Med. 2010 Mar;104(3):404-11 PMID 19963361
Cites: Respir Med. 2014 Sep;108(9):1345-54 PMID 25002194
Cites: Prim Care Respir J. 2010 Jun;19 Suppl 1:S1-20 PMID 20514388
Cites: PLoS One. 2015 Apr 13;10(4):e0123292 PMID 25875204
Cites: J Glob Health. 2015 Dec;5(2):020415 PMID 26755942
Cites: Respir Med. 2003 Mar;97 Suppl C:S81-9 PMID 12647946
Cites: Eur Respir Rev. 2014 Sep;23(133):345-9 PMID 25176970
Cites: Eur Respir J. 2006 Jan;27(1):188-207 PMID 16387952
Cites: Int J Chron Obstruct Pulmon Dis. 2010 May 06;5:125-32 PMID 20461144
Cites: Dan Med J. 2013 Jan;60(1):A4557 PMID 23340185
Cites: Prim Care Respir J. 2014 Mar;23(1):38-45 PMID 24346825
Cites: BMJ Open. 2014 Jan 06;4(1):e004069 PMID 24394800
Cites: Int J Chron Obstruct Pulmon Dis. 2014 Oct 14;9:1145-54 PMID 25342899
Cites: Arch Intern Med. 2000 Sep 25;160(17):2653-8 PMID 10999980
Cites: Respir Med. 2012 Apr;106(4):540-8 PMID 22100535
Cites: Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55 PMID 17507545
Cites: Clin Med Insights Circ Respir Pulm Med. 2015 Mar 12;9:5-21 PMID 25788838
Cites: Respir Med. 2013 Dec;107(12):1931-8 PMID 23910072
Cites: Eur Respir J. 2008 Oct;32(4):962-9 PMID 18579551
Cites: Prim Care Respir J. 2013 Dec;22(4):393-9 PMID 24114334
Cites: Int J Chron Obstruct Pulmon Dis. 2015 Dec 03;10:2609-18 PMID 26664109
Cites: COPD. 2005 Sep;2(3):311-8 PMID 17146996
Cites: Respir Med. 2010 May;104(5):697-704 PMID 19954941
Cites: Respir Med. 2008 Sep;102(9):1248-56 PMID 18620852
PubMed ID
29391785 View in PubMed
Less detail

Economic burden of COPD in a Swedish cohort: the ARCTIC study.

https://arctichealth.org/en/permalink/ahliterature289388
Source
Int J Chron Obstruct Pulmon Dis. 2018; 13:275-285
Publication Type
Journal Article
Date
2018
Author
Karin Lisspers
Kjell Larsson
Gunnar Johansson
Christer Janson
Madlaina Costa-Scharplatz
Jean-Bernard Gruenberger
Milica Uhde
Leif Jorgensen
Florian S Gutzwiller
Björn Ställberg
Author Affiliation
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala.
Source
Int J Chron Obstruct Pulmon Dis. 2018; 13:275-285
Date
2018
Language
English
Publication Type
Journal Article
Abstract
We assessed direct and indirect costs associated with COPD in Sweden and examined how these costs vary across time, age, and disease stage in a cohort of patients with COPD and matched controls in a real-world, primary care (PC) setting.
Data from electronic medical records linked to the mandatory national health registers were collected for COPD patients and a matched reference population in 52 PC centers from 2000 to 2014. Direct health care costs (drug, outpatient or inpatient, PC, both COPD related and not COPD related) and indirect health care costs (loss of income, absenteeism, loss of productivity) were assessed.
A total of 17,479 patients with COPD and 84,514 reference controls were analyzed. During 2013, direct costs were considerably higher among the COPD patient population (€13,179) versus the reference population (€2,716), largely due to hospital nights unrelated to COPD. Direct costs increased with increasing disease severity and increasing age and were driven by higher respiratory drug costs and non-COPD-related hospital nights. Indirect costs (~€28,000 per patient) were the largest economic burden in COPD patients of working age during 2013.
As non-COPD-related hospital nights represent the largest direct cost, management of comorbidities in COPD would offer clinical benefits and relieve the financial burden of disease.
Notes
Cites: Int J Chron Obstruct Pulmon Dis. 2014 Mar 19;9:289-300 PMID 24672234
Cites: Respir Med. 2016 Feb;111:39-46 PMID 26725462
Cites: Popul Health Manag. 2012 Oct;15(5):267-75 PMID 22401150
Cites: COPD. 2015 Aug;12(4):381-9 PMID 25415366
Cites: Respir Med. 2007 Mar;101(3):539-46 PMID 16889949
Cites: Int J Chron Obstruct Pulmon Dis. 2017 Feb 23;12 :735-744 PMID 28260880
Cites: Eur Respir J. 2008 Dec;32(6):1433-42 PMID 19043008
Cites: J Occup Environ Med. 2008 Oct;50(10):1130-8 PMID 18849758
Cites: Respir Med. 2002 Sep;96(9):700-8 PMID 12243316
Cites: PLoS One. 2016 Apr 19;11(4):e0152618 PMID 27092775
Cites: Respir Med. 2010 Mar;104(3):404-11 PMID 19963361
Cites: Respir Med. 2014 Sep;108(9):1345-54 PMID 25002194
Cites: Prim Care Respir J. 2010 Jun;19 Suppl 1:S1-20 PMID 20514388
Cites: PLoS One. 2015 Apr 13;10(4):e0123292 PMID 25875204
Cites: J Glob Health. 2015 Dec;5(2):020415 PMID 26755942
Cites: Respir Med. 2003 Mar;97 Suppl C:S81-9 PMID 12647946
Cites: Eur Respir Rev. 2014 Sep;23(133):345-9 PMID 25176970
Cites: Eur Respir J. 2006 Jan;27(1):188-207 PMID 16387952
Cites: Int J Chron Obstruct Pulmon Dis. 2010 May 06;5:125-32 PMID 20461144
Cites: Dan Med J. 2013 Jan;60(1):A4557 PMID 23340185
Cites: Prim Care Respir J. 2014 Mar;23(1):38-45 PMID 24346825
Cites: BMJ Open. 2014 Jan 06;4(1):e004069 PMID 24394800
Cites: Int J Chron Obstruct Pulmon Dis. 2014 Oct 14;9:1145-54 PMID 25342899
Cites: Arch Intern Med. 2000 Sep 25;160(17):2653-8 PMID 10999980
Cites: Respir Med. 2012 Apr;106(4):540-8 PMID 22100535
Cites: Am J Respir Crit Care Med. 2007 Sep 15;176(6):532-55 PMID 17507545
Cites: Clin Med Insights Circ Respir Pulm Med. 2015 Mar 12;9:5-21 PMID 25788838
Cites: Respir Med. 2013 Dec;107(12):1931-8 PMID 23910072
Cites: Eur Respir J. 2008 Oct;32(4):962-9 PMID 18579551
Cites: Prim Care Respir J. 2013 Dec;22(4):393-9 PMID 24114334
Cites: Int J Chron Obstruct Pulmon Dis. 2015 Dec 03;10:2609-18 PMID 26664109
Cites: COPD. 2005 Sep;2(3):311-8 PMID 17146996
Cites: Respir Med. 2010 May;104(5):697-704 PMID 19954941
Cites: Respir Med. 2008 Sep;102(9):1248-56 PMID 18620852
PubMed ID
29391785 View in PubMed
Less detail

Epidemiology of cutaneous melanoma in Sweden-Stage-specific survival and rate of recurrence.

https://arctichealth.org/en/permalink/ahliterature282299
Source
Int J Cancer. 2016 Dec 15;139(12):2722-2729
Publication Type
Article
Date
Dec-15-2016
Author
Julia Rockberg
Justyna M Amelio
Aliki Taylor
Leif Jörgensen
Peter Ragnhammar
Johan Hansson
Source
Int J Cancer. 2016 Dec 15;139(12):2722-2729
Date
Dec-15-2016
Language
English
Publication Type
Article
Keywords
Adult
Aged
Disease Progression
Female
Follow-Up Studies
Humans
Male
Melanoma - epidemiology - mortality - pathology
Middle Aged
Neoplasm Recurrence, Local
Neoplasm Staging
Population Surveillance
Prognosis
Proportional Hazards Models
Registries
Retrospective Studies
Survival Rate
Sweden - epidemiology
Abstract
Cutaneous malignant melanoma (CMM) incidence is increasing globally, making a thorough understanding of the disease and its outcomes essential for optimizing care even more urgent. In this population-based, retrospective study, we investigated stage-specific survival and recurrence/progression rates of CMM among patients diagnosed in Stockholm County Council during 2005-2012, before the wide introduction of targeted therapy. A total of 3,554 CMM patients from the Stockholm Melanoma Register were included. Information on comorbidities, progression, death, and treatments was obtained from nationwide registers and hospital electronic medical records. Unadjusted 5-year survival varied from 91.4% for stage I to 24.6% for stage IV patients. Stage, age and gender were predictors of survival, with gender an independent predictor of survival for stages IA and IIA. 74.6% of patients remained recurrence/progression-free during follow-up, with 5-year recurrence/progression-free survival rates varying from 85.3% to 12.9% among stages I and IV patients, respectively. In addition to stage, male gender, and age, circulatory system comorbidities increased the risk for recurrence/progression. No statistically significant differences in progression rate for operated and non-operated patients could be detected, possibly due to high rate (98.9%) of surgery. Our estimates of survival and recurrence rates are consistent with historical and global expectations and can serve as a baseline to gauge population-level improvements with use of novel melanoma treatments.
PubMed ID
27563839 View in PubMed
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Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study.

https://arctichealth.org/en/permalink/ahliterature307773
Source
NPJ Prim Care Respir Med. 2019 12 10; 29(1):45
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Date
12-10-2019
Author
Karin Lisspers
Kjell Larsson
Christer Janson
Björn Ställberg
Ioanna Tsiligianni
Florian S Gutzwiller
Karen Mezzi
Bine Kjoeller Bjerregaard
Leif Jorgensen
Gunnar Johansson
Author Affiliation
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden. karin.lisspers@ltdalarna.se.
Source
NPJ Prim Care Respir Med. 2019 12 10; 29(1):45
Date
12-10-2019
Language
English
Publication Type
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't
Keywords
Aged
Drug Administration Routes
Female
Follow-Up Studies
Forecasting
Glucocorticoids - administration & dosage
Humans
Incidence
Male
Middle Aged
Prognosis
Pulmonary Disease, Chronic Obstructive - drug therapy - epidemiology
Retrospective Studies
Sex Distribution
Sex Factors
Survival Rate - trends
Sweden - epidemiology
Abstract
The present study aimed to generate real-world evidence regarding gender differences among chronic obstructive pulmonary disease (COPD) patients, especially as regards the diagnosis and outcomes in order to identify areas for improvement and management and optimize the associated healthcare resource allocation. ARCTIC is a large, real-world, retrospective cohort study conducted in Swedish COPD patients and a matched reference population from 52 primary care centers in 2000-2014. The incidence of COPD, prevalence of asthma and other comorbidities, risk of exacerbations, mortality rate, COPD drug prescriptions, and healthcare resource utilization were analyzed. In total, 17,479 patients with COPD were included in the study. During the study period, COPD was more frequent among women (53.8%) and women with COPD experienced more exacerbations vs. men (6.66 vs. 4.66). However, the overall mortality rate was higher in men compared with women (45% vs. 38%), but no difference for mortality due to COPD was seen between genders over the study period. Women seemed to have a greater susceptibility to asthma, fractures, osteoporosis, rheumatoid arthritis, rhinitis, depression, and anxiety, but appeared less likely to have diabetes, kidney diseases, and cardiovascular diseases. Furthermore, women had a greater risk of COPD-related hospitalization and were likely to receive a significantly higher number of COPD drug prescriptions compared with men. These results support the need to reduce disease burden among women with COPD and highlight the role of healthcare professionals in primary care who should consider all these parameters in order to properly diagnose and treat women with COPD.
PubMed ID
31822681 View in PubMed
Less detail

 Identifying the associated risks of pneumonia in COPD patients: ARCTIC an observational study.

https://arctichealth.org/en/permalink/ahliterature297708
Source
Respir Res. 2018 Sep 10; 19(1):172
Publication Type
Journal Article
Observational Study
Date
Sep-10-2018
Author
Christer Janson
Gunnar Johansson
Björn Ställberg
Karin Lisspers
Petter Olsson
Dorothy L Keininger
Milica Uhde
Florian S Gutzwiller
Leif Jörgensen
Kjell Larsson
Author Affiliation
Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Akademiska sjukhuset, 75185, Uppsala, Sweden. christer.janson@medsci.uu.se.
Source
Respir Res. 2018 Sep 10; 19(1):172
Date
Sep-10-2018
Language
English
Publication Type
Journal Article
Observational Study
Keywords
Aged
Cohort Studies
Electronic Health Records - trends
Female
Humans
Longitudinal Studies
Male
Middle Aged
Pneumonia - diagnosis - epidemiology
Primary Health Care - trends
Pulmonary Disease, Chronic Obstructive - diagnosis - epidemiology
Registries
Retrospective Studies
Risk factors
Sweden - epidemiology
Abstract
Inhaled corticosteroids (ICS) are associated with an increased risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). Other factors such as severity of airflow limitation and concurrent asthma may further raise the possibility of developing pneumonia. This study assessed the risk of pneumonia associated with ICS in patients with COPD.
Electronic Medical Record data linked to National Health Registries were collected from COPD patients and matched reference controls in 52 Swedish primary care centers (2000-2014). Levels of ICS treatment (high, low, no ICS) and associated comorbidities were assessed. Patients were categorized by airflow limitation severity.
A total of 6623 patients with COPD and 48,566 controls were analyzed. Patients with COPD had a more than 4-fold increase in pneumonia versus reference controls (hazard ratio [HR] 4.76, 95% confidence interval [CI]: 4.48-5.06). ICS use increased the risk of pneumonia by 20-30% in patients with COPD with forced expiratory volume in 1 s?=?50% versus patients not using ICS. Asthma was an independent risk factor for pneumonia in the COPD population. Multivariate analysis identified independent predictors of pneumonia in the overall population. The highest risk of pneumonia was associated with high dose ICS (HR 1.41, 95% CI: 1.23-1.62).
Patients with COPD have a greater risk of pneumonia versus reference controls; ICS use and concurrent asthma increased the risk of pneumonia further.
PubMed ID
30200965 View in PubMed
Less detail

 Identifying the associated risks of pneumonia in COPD patients: ARCTIC an observational study.

https://arctichealth.org/en/permalink/ahliterature294874
Source
Respir Res. 2018 Sep 10; 19(1):172
Publication Type
Journal Article
Date
Sep-10-2018
Author
Christer Janson
Gunnar Johansson
Björn Ställberg
Karin Lisspers
Petter Olsson
Dorothy L Keininger
Milica Uhde
Florian S Gutzwiller
Leif Jörgensen
Kjell Larsson
Author Affiliation
Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Akademiska sjukhuset, 75185, Uppsala, Sweden. christer.janson@medsci.uu.se.
Source
Respir Res. 2018 Sep 10; 19(1):172
Date
Sep-10-2018
Language
English
Publication Type
Journal Article
Abstract
Inhaled corticosteroids (ICS) are associated with an increased risk of pneumonia in patients with chronic obstructive pulmonary disease (COPD). Other factors such as severity of airflow limitation and concurrent asthma may further raise the possibility of developing pneumonia. This study assessed the risk of pneumonia associated with ICS in patients with COPD.
Electronic Medical Record data linked to National Health Registries were collected from COPD patients and matched reference controls in 52 Swedish primary care centers (2000-2014). Levels of ICS treatment (high, low, no ICS) and associated comorbidities were assessed. Patients were categorized by airflow limitation severity.
A total of 6623 patients with COPD and 48,566 controls were analyzed. Patients with COPD had a more than 4-fold increase in pneumonia versus reference controls (hazard ratio [HR] 4.76, 95% confidence interval [CI]: 4.48-5.06). ICS use increased the risk of pneumonia by 20-30% in patients with COPD with forced expiratory volume in 1 s?=?50% versus patients not using ICS. Asthma was an independent risk factor for pneumonia in the COPD population. Multivariate analysis identified independent predictors of pneumonia in the overall population. The highest risk of pneumonia was associated with high dose ICS (HR 1.41, 95% CI: 1.23-1.62).
Patients with COPD have a greater risk of pneumonia versus reference controls; ICS use and concurrent asthma increased the risk of pneumonia further.
Notes
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PubMed ID
30200965 View in PubMed
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Impact of COPD diagnosis timing on clinical and economic outcomes: the ARCTIC observational cohort study.

https://arctichealth.org/en/permalink/ahliterature300866
Source
Int J Chron Obstruct Pulmon Dis. 2019; 14:995-1008
Publication Type
Journal Article
Date
2019
Author
Kjell Larsson
Christer Janson
Björn Ställberg
Karin Lisspers
Petter Olsson
Konstantinos Kostikas
Jean-Bernard Gruenberger
Florian S Gutzwiller
Milica Uhde
Leif Jorgensen
Gunnar Johansson
Author Affiliation
Work Environment Toxicology, Karolinska Institutet, Stockholm, Sweden.
Source
Int J Chron Obstruct Pulmon Dis. 2019; 14:995-1008
Date
2019
Language
English
Publication Type
Journal Article
Abstract
Purpose: Assess the clinical and economic consequences associated with an early versus late diagnosis in patients with COPD. Patients and methods: In a retrospective, observational cohort study, electronic medical record data (2000-2014) were collected from Swedish primary care patients with COPD. COPD indicators (pneumonia, other respiratory diseases, oral corticosteroids, antibiotics for respiratory infections, prescribed drugs for respiratory symptoms, lung function measurement) registered prior to diagnosis were applied to categorize patients into those receiving early (2 or less indicators) or late diagnosis (3 or more indicators registered >90 days preceding a COPD diagnosis). Outcome measures included annual rate of and time to first exacerbation, mortality risk, prevalence of comorbidities and health care utilization. Results: More patients with late diagnosis (n=8827) than with early diagnosis (n=3870) had a recent comorbid diagnosis of asthma (22.0% vs 3.9%; P
PubMed ID
31190785 View in PubMed
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