Aims/hypothesis
The workplace is a potentially important arena for prevention of type 2 diabetes and the first step is to identify occupations where the disease is common and/or risk is high. ...Therefore, our aim was to analyse incidence and prevalence of type 2 diabetes across all occupational groups in Sweden.
Methods
This nationwide study included all Swedish citizens born between 1937 and 1979 and gainfully employed between 2001 and 2013 (
N
= 4,550,892), and followed for a diagnosis of diabetes from 2006 to 2015 (
n
= 201,717) through national registers. Prevalence in 2013 (mean age 51 years; range 35–67) and age-standardised incidence (per 1000 person-years) were analysed across the 30 most common occupations among men and women. Information on BMI, physical fitness and smoking was obtained through the National Conscription (mean age 18) and Medical Birth Registers (mean age 29).
Results
Prevalence of type 2 diabetes was 5.2% in men and 3.2% in women; in men it was highest among motor vehicle drivers (8.8%) and in women it was highest among manufacturing workers (6.4%). Incidence varied dramatically across occupational groups. In men, it was highest among manufacturing workers (9.41) and professional drivers (9.32) and lowest among university teachers (3.44). In women, incidence was highest in manufacturing workers (7.20) and cleaners (6.18) and lowest in physiotherapists (2.20). We found major differences in the prevalence of being overweight and smoking and in the level of physical fitness across these occupational groups even at young ages.
Conclusions/interpretation
Professional drivers, manufacturing workers and cleaners have a threefold increased risk of type 2 diabetes compared with university teachers and physiotherapists. These differences most likely reflect dramatic differences in the prevalence of lifestyle risk factors. If workplace interventions could reduce weight and increase physical activity among employees in these occupations, major health gains may be made.
Data on the future diabetes burden in Scandinavia is limited. Our aim was to project the future burden of diabetes in Sweden by modelling data on incidence, prevalence, mortality, and demographic ...factors.
To project the future burden of diabetes we used information on the prevalence of diabetes from the national drug prescription registry (adults ≥ 20 years), previously published data on relative mortality in people with diabetes, and population demographics and projections from Statistics Sweden. Alternative scenarios were created based on different assumptions regarding the future incidence of diabetes.
Between 2007 and 2013 the prevalence of diabetes rose from 5.8 to 6.8% in Sweden but incidence remained constant at 4.4 per 1000 (2013). With constant incidence and continued improvement in relative survival, prevalence will increase to 10.4% by year 2050 and the number of afflicted individuals will increase to 940 000. Of this rise, 30% is accounted for by changes in the age structure of the population and 14% by improved relative survival in people with diabetes. A hypothesized 1% annual rise in incidence will result in a prevalence of 12.6% and 1 136 000 cases. Even with decreasing incidence at 1% per year, prevalence of diabetes will continue to increase.
We can expect diabetes prevalence to rise substantially in Sweden over the next 35 years as a result of demographic changes and improved survival among people with diabetes. A dramatic reduction in incidence is required to prevent this development.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Divergent strategies have emerged for the management of severe asthma. One strategy utilises high and fixed doses of maintenance treatment, usually inhaled corticosteroid/long-acting β2-agonist ...(ICS/LABA), supplemented by a short-acting β2-agonist (SABA) as needed. Alternatively, budesonide/formoterol is used as both maintenance and reliever therapy. The latter is superior to fixed-dose treatment in reducing severe exacerbations while achieving similar or better asthma control in other regards. Exacerbations may be reduced by the use of budesonide/formoterol as reliever medication during periods of unstable asthma. We examined the risk of a severe exacerbation in the period after a single day with high reliever use.
Episodes of high reliever use were quantified and exacerbations occurring post-index day with these episodes were examined post hoc in two double-blind studies comparing the efficacy and safety of budesonide/formoterol maintenance and reliever therapy (Symbicort SMART™, Turbuhaler®) 160/4.5 μg twice daily plus as needed with similar or higher maintenance doses of ICS/LABA plus SABA or formoterol.
Budesonide/formoterol maintenance and reliever therapy significantly reduced the risk of episodes of high reliever use (>6 inhalations/day) vs. all alternative ICS/LABA regimens. With conventional fixed-dose treatment the need for exacerbation treatment within 21 days ranged from 6.0-10.1% of days post-index for all regimens compared with 2.5-3.4% of days with budesonide/formoterol maintenance and reliever therapy.
Budesonide/formoterol maintenance and reliever therapy reduces the incidence of high reliever episodes and the exacerbation burden immediately following these episodes vs. alternative ICS/LABA plus SABA regimens at up to double the maintenance dose of ICS.
These studies do not have registration numbers as they were conducted before clinical trial registration was required.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Summary
Objective
Given the increasing attention being paid to potential strategies for sudden unexpected death in epilepsy (SUDEP) prevention, we analyzed the circumstances of SUDEP and its ...incidence in relation to time of year, week, and day.
Methods
Prospective case‐series based on persons with an International Classification of Diseases (ICD‐10) code for epilepsy in the Swedish Patient Registry 1998‐2005, who were alive on June 30, 2006 (n = 60 952). Linkage to the National Cause‐of‐Death Registry identified all deaths from July 2006 through December 2011, with epilepsy mentioned on death certificate, together with all deaths during 2008 (n = 3166). Death certificates, medical charts, autopsy, and police reports were reviewed to identify SUDEP cases and related circumstances. Autopsied non‐SUDEP deaths (n = 60) from the study population served as a reference.
Results
There were 329 SUDEPs (63% men) of which 167 were definite, 89 probable, and 73 possible. SUDEP cases were younger at death (50.8 years) than non‐SUDEP deaths (73.3 years) (P < .001) and more likely to be male (63% vs 55%, P = .0079). Most SUDEP cases died at night (58%), at home (91%), and 65% were found dead in bed. When documented, 70% were found in prone position. In 17%, death was witnessed and in 88% of these, a seizure was observed. Of the 329 SUDEP cases, 71% were living alone and 14% shared a bedroom. Compared to an autopsied non‐SUDEP reference group, definite SUDEPs were more likely to die at home, during the night, unwitnessed, in the prone position, to live alone, and more often with a preceding seizure.
Significance
SUDEP cases live alone, die unwitnessed at home at night, with indication of a preceding seizure, supporting the critical role of lack of supervision. These facts need to be considered in the development of preventive strategies.
Interest in the application of machine learning (ML) to the design, conduct, and analysis of clinical trials has grown, but the evidence base for such applications has not been surveyed. This ...manuscript reviews the proceedings of a multi-stakeholder conference to discuss the current and future state of ML for clinical research. Key areas of clinical trial methodology in which ML holds particular promise and priority areas for further investigation are presented alongside a narrative review of evidence supporting the use of ML across the clinical trial spectrum.
Conference attendees included stakeholders, such as biomedical and ML researchers, representatives from the US Food and Drug Administration (FDA), artificial intelligence technology and data analytics companies, non-profit organizations, patient advocacy groups, and pharmaceutical companies. ML contributions to clinical research were highlighted in the pre-trial phase, cohort selection and participant management, and data collection and analysis. A particular focus was paid to the operational and philosophical barriers to ML in clinical research. Peer-reviewed evidence was noted to be lacking in several areas.
ML holds great promise for improving the efficiency and quality of clinical research, but substantial barriers remain, the surmounting of which will require addressing significant gaps in evidence.
Objective This study aimed to examine the effects of various aspects of night and shift work on the risk of incident ischemic heart disease (IHD) and atrial fibrillation (AF) using detailed and ...registry-based exposure data. Methods This prospective cohort study included >30 300 healthcare employees (eg, nurses, nursing assistants) employed for at least one year in Region Stockholm 2008-2016. Information on daily working hours was obtained from a computerized administrative employee register and outcomes from national and regional registers. Using discrete-time proportional hazard models, we analyzed the outcomes as functions of working hour characteristics the preceding year, adjusted for sex, age, country of birth, education, and profession. Results We observed 223 cases of IHD and 281 cases of AF during follow-up 2009-2016. The risk of IHD was increased among employees who the preceding year had permanent night shifts compared to those with permanent day work hazard ratio (HR) 1.61, 95% confidence interval (CI) 1.06-2.43 and among employees working night shifts >120 times per year compared to those who never worked night (HR 1.53, 95% CI 1.05-2.21). When restricted to non-night workers, the risk of IHD was increased for employees having frequent quick returns from afternoon shifts. No increased risks were observed for AF. Conclusions Night work, especially working permanent night shifts and frequent night shifts, is associated with an increased risk of incident IHD but not AF. Moreover, frequent quick returns from afternoon shifts (among nonnight workers) increased IHD risk. Organizing work schedules to minimize these exposures may reduce IHD risk.
The global pharmaceutical industry portfolio is skewed towards cancer and rare diseases due to more predictable development pathways and financial incentives. In contrast, drug development for major ...chronic health conditions that are responsible for a large part of mortality and disability worldwide is stalled. To examine the processes of novel drug development for common chronic health conditions, a multistakeholder Think Tank meeting, including thought leaders from academia, clinical practice, non-profit healthcare organizations, the pharmaceutical industry, the Food and Drug Administration (FDA), payors as well as investors, was convened in July 2022. Herein, we summarize the proceedings of this meeting, including an overview of the current state of drug development for chronic health conditions and key barriers that were identified. Six major action items were formulated to accelerate drug development for chronic diseases, with a focus on improving the efficiency of clinical trials and rapid implementation of evidence into clinical practice:1.Involve implementation science in the early phases of drug development.2.Involve regulatory agencies early in drug development, simplify clinical trial conduct and improve inter-agency collaboration.3.Involve payors early in drug development.4.Investigate novel implementation strategies.5.Increase focus on and funding for implementation science to develop strategies that improve utilization of proven effective treatments.6.Change public perception.
Background Concerns exist that regular long-acting β2 -adrenergic agonist (LABA) therapy may increase the risk of serious asthma-related events. Objective To assess risks of formoterol-containing ...versus non-LABA treatment by using a large asthma database. Methods This analysis included all blind, parallel-arm, randomized, active-controlled and/or placebo-controlled AstraZeneca-sponsored asthma studies with formoterol-containing and non-LABA comparator arms. Serious adverse events were assessed for inclusion in all-cause death, asthma-related death, asthma-related intubation, and asthma-related hospitalization categories by using blind adjudication. Data were combined across trials; relative risk (RR) was assessed by using Mantel-Haenszel methods. Results Data were from 13,542 formoterol-randomized and 9968 non-LABA patients 4 years or older (42 trials), of whom 93% and 89%, respectively, received inhaled corticosteroid as part of randomized treatment or allowed medication. Incidence of all-cause death was low (n = 3 and n = 4, respectively), with numerically lower all-cause deaths/1000 patient-treatment years in the formoterol-treated group (0.53) versus the non-LABA group (0.82) (RR, 0.64; 95% confidence interval CI, 0.14-2.92). No asthma-related deaths and 1 asthma-related intubation (formoterol-treated group) occurred. Asthma-related hospitalizations/1000 patient-treatment years were lower numerically in the formoterol-treated group (12.1) versus the non-LABA group (16.4) (RR, 0.73; 95% CI, 0.54-1.01), with fewer study discontinuations in the formoterol-treated group (12.7% vs 15.4%, respectively; RR, 0.79; 95% CI, 0.74-0.85). Relative to non-LABA, increasing daily formoterol dose (≥4.5, 9, 18, 36 μg) did not increase the rate or incidence of asthma-related hospitalization. Conclusion No evidence of increased risk of asthma-related hospitalization, no asthma-related deaths, and a low incidence of all-cause death and asthma-related intubation were seen with formoterol-containing versus non-LABA treatment.
Abstract
Background
Previous studies of preterm birth (PTB) concerning night work have been inconclusive and partly limited by imprecise data on working schedules. This study investigated the risk of ...PTB in relation to detailed, registry-based data on working hours.
Methods
In a register-based prospective cohort study, we identified 4970 singleton births with information on PTB from the Swedish Medical Birth Register of health care employees in Stockholm. Day-by-day information on working hours 2008–16 was obtained from a computerized employee register. Odds ratios (ORs) of PTB according to work hour characteristics were analysed by logistic regression adjusted for mother’s age, stature, body mass index (BMI), parity, smoking habits, education, profession and country of birth.
Results
There was an increased risk of PTB among those who frequently worked night shifts (>25 times) OR, 1.62; 95% confidence interval (CI), 1.03–2.53 and who ever worked ≥3 consecutive night shifts (OR, 1.43; 95% CI, 1.03–1.99) during the first trimester. Frequently (> 8 times) working 3 or more consecutive nights, and frequently (>18 times) having quick returns from night shifts (<28 h) during the first trimester showed 3–4 fold increased risk of PTB. Moreover, working frequent (>20 times) long shifts (≥10 h) (OR 1.63; 95% CI, 1.07–2.49) during the first trimester and working any Week >40 h (OR 2.05; 95% CI, 1.31–3.22) during the third trimester were associated with PTB.
Conclusions
In this cohort of Swedish health care employees with registry-based data on working hours, night work, especially working frequent consecutive nights, and quick returns from night shifts during the first trimester were associated with increased risk of PTB among pregnant women.
This study aimed to investigate the effects of various aspects of night and shift work regarding incident cerebrovascular disease (CeVD).
The cohort included 26 667 women and 3793 men (nurses and ...nursing assistants) who were employed for at least one year 2008-2016 in Region Stockholm, Sweden. Information about the cohort and working hours were obtained from a computerized employee-register and diagnoses were retrieved from national and regional registers. We used discrete time proportional hazard models to assess the risk of CeVD (2009-2017), in relation to work hour characteristics, adjusting for sex, age, country of birth, education and profession.
We observed an excess risk of CeVD (N=223) among employees who, during the preceding year, worked night shifts >30 times hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.04-1.99 or ≥3 consecutive night shifts >15 times (HR 1.69, 95% CI 1.18-2.42) or with >30 quick returns (<28 hours) from night shifts (HR 1.52, 95% CI 1.10-2.10) compared to those who did not work nights. We also observed an excess risk among employees with a long duration (>5 years) of exposure to night shift work (HR 1.87, 95% CI 1.27-2.77), all supported by a dose-response pattern.
Our results show that the risk of CeVD among nurses and nursing assistants is associated with night shift work. The number of years with night shift work, the frequency of night shifts per year, the frequency of consecutive night shifts, and short recovery after night shifts influenced the risk. Work schedules aiming at minimizing these aspects of night shift work may reduce the risk.
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