Biomedical subjects

Anders Sundström

Publications and source records attributed to Anders Sundström.

7 recordsLinked to original sources

PubMed2007

The new Swedish Prescribed Drug Register--opportunities for pharmacoepidemiological research and experience from the first six months.

PURPOSE: To describe the content and potentials of the new Swedish national register on prescribed and dispensed medicines. METHODS: The Swedish Prescribed Drug Register contains information about age, sex and unique identifier of the patient as well as the prescriber's profession and practice. Information regarding drug utilization and expenditures for prescribed drugs in the entire Swedish population was extracted from the first six months July-December 2005 and compared with total drug sales in the country including OTC and hospital use. RESULTS: The total quantity of drugs sold in Sweden was 2666 million DDDs, corresponding to 1608 DDD/1000 inhabitants daily. The total expenditures were 1.6 billion Euro. The prescribed drugs, included in the register, accounted for 84% of the total utilization and 77% of the total expenditures. About half of all men and two-thirds of all women in the country purchased drugs. The proportion increased by age. The most common drugs for chronic treatment were diuretics among women (8.8% of the population) and antithrombotic agents among men (7.6%). Psychotropic drugs, corticosteroids and analgesics were more common among women, while men used antithrombotic agents, antidiabetic drugs, lipid lowering agents and ACE inhibitors to a greater extent. CONCLUSIONS: The new register provides valuable data on exposure to drugs and is useful to study patterns of drug utilization. The possibilities for record linkage to other health registers gives from an international perspective good opportunities to explore drug and disease associations and the risks, benefits, effectiveness and health economical effects of drug use.

Adolescent↗

PubMed2006

Acid-suppressing drugs and gastroesophageal reflux disease as risk factors for acute pancreatitis--results from a Swedish Case-Control Study.

PURPOSE: To study risk factors for acute pancreatitis, here with emphasis on gastro-intestinal diseases and their treatments. METHODS: Population based case-control study covering four areas in Sweden encompassing 2.2 million inhabitants. Included were 462 incident cases of acute pancreatitis aged 20-85 years, hospitalized from 1 January 1995-31 May 1998, and 1,781 unmatched controls randomly selected from the study base using a population register. Information was captured from medical records and structured telephone interviews. RESULTS: Current use of H(2) antagonists starting within 6 months of index-date was associated with acute pancreatitis with an adjusted OR of 4.9 (95% confidence interval (CI) 1.6-15), and current use of proton pump inhibitors (PPIs) with an adjusted OR of 3.2 (95%CI 1.4-7.4). For both drug classes, the ORs tended to be higher at higher doses. Gastritis/gastro-esophageal reflux disease (GERD) within the last 12 months not treated with PPIs or H(2)-antagonists and inflammatory bowel disease (IBD) not treated with anti-inflammatory or immunosuppressive drugs were associated with development of acute pancreatitis with adjusted odds ratios (OR) of 1.9 (95%CI 1.2-3.0) and 5.1 (95%CI 2.0-13) respectively. CONCLUSIONS: Current IBD without treatment and gastritis/GERD without treatment were found to be associated with increased risks to develop acute pancreatitis but the nature of the latter association needs to be further evaluated. On balance, we judge that the observed associations between current use of H(2)-antagonists and PPIs and increased risk of acute pancreatitis are unlikely to be explained by bias.

Adult↗

PubMed2006

Alopecia associated with treatment with selective serotonin reuptake inhibitors (SSRIs).

PURPOSE: To study the association between alopecia and selective serotonin reuptake inhibitors (SSRIs) by estimating reporting rates and by making association comparisons within databases of adverse drug reactions (ADRs). METHODS: All reports of alopecia with marketed SSRIs until the end of 2004 were identified in SWEDIS, the national Swedish database for spontaneously reported ADRs, and in Vigibase, the international ADR database of the World Health Organization. Total SSRI sales volumes in Sweden until the end of 2004 were obtained from the National Corporation of Swedish Pharmacies. The Bayes' Confidence Propagation Neural Network (BCPNN) method was used to estimate associations between alopecia and each of the SSRIs within the two databases. RESULTS: A total of 27 reports of alopecia were identified in SWEDIS. As two reports concerned the use of two SSRIs, there was a total of 29 drug-ADR combinations. All except three reports concerned women (88.9%). The reporting rate of alopecia in Sweden was significantly higher with sertraline compared with citalopram; 20.1 (95%CI 10.7-34.4) reports per million patient-years versus 4.5 (95%CI 1.8-9.3) reports per million patient-years. No significant differences in reporting rates were noted for the remaining SSRIs. Sertraline also showed a statistically significant association with alopecia in both SWEDIS and Vigibase. Citalopram was significantly associated with alopecia in Vigibase, but not in SWEDIS. No statistically significant associations were found for any of the other SSRIs. CONCLUSIONS: Alopecia appears to be a rare ADR to SSRIs. The risk of alopecia seems to vary between the different SSRIs, and might be higher in women than in men.

Adult↗

PubMed2006

Interviewer variability - quality aspects in a case-control study.

Quality assurance and quality control are important for the reliability of case-control studies. Here we describe the procedures used in a previously published study, with emphasis on interviewer variability. To evaluate risk factors for acute pancreatitis, information including previous diagnoses and medication was collected from medical records and by telephone interviews from 462 cases and 1781 controls. Quality assurance procedures included education and training of interviewers and data validity checks. Quality control included a classification test, annual test interviews, expert case validation, and database validation. We found pronounced variations between interviewers. The maximal number of interviews per day varied from 3 to 9. The adjusted average (95% CI) number of diagnoses captured per interview of cases was 4.1 (3.8-4.3) and of controls 3.5 (3.4-3.7) (excluding one deviating interviewer). For drugs, the average (95% CI) number per interview was 3.9 (3.7-4.1) for cases and 3.3 (3.2-3.4) for controls (excluding one deviating interviewer). One of the fourteen interviewers deviated significantly from the others, and more so for controls than for cases. This interviewer's data ;were excluded. Nonetheless, data concerning controls more frequently needed correction and supplementation than for cases. Erroneous coding of diagnoses and medication was also more frequent among controls. Thus, a system for quality control of coding practices is crucial. Variability in interviewers' ability to ascertain information is a possible source of bias in interview-based case-control studies when "blinding" cannot be achieved.

Acute Disease↗

PubMed2006

Antihypertensive medication and the risk of acute pancreatitis: the European case-control study on drug-induced acute pancreatitis (EDIP).

OBJECTIVE: Angiotensin-converting enzyme (ACE) inhibitors and diuretics have been associated with acute pancreatitis. We quantified the risk of acute pancreatitis associated with the use of antihypertensive medication in the European study on drug-induced acute pancreatitis (EDIP). MATERIAL AND METHODS: The EDIP study is a multicenter population-based European case-control investigation of the association between drug use and acute pancreatitis. Patients between 40 and 85 years of age hospitalized for acute pancreatitis were included in the study between 1 October 1994 and 31 December 1998. For each case, age- and gender-matched community controls were recruited. Detailed information on drug use and potential confounders (e.g. comorbidity, alcohol use) was obtained through a structured interview. RESULTS: In all, 724 patients with acute pancreatitis and 1791 community controls were identified and interviewed. Use of ACE inhibitors in the week prior to the index date was associated with an increased risk of acute pancreatitis (adjusted odds ratio 1.5; 95% CI: 1.1-2.2). The risk of acute pancreatitis associated with ACE inhibitors increased with higher daily doses and was highest in the first 6 months of therapy. Calcium channel blockers increased the risk of acute pancreatitis (adjusted odds ratio 1.5; 95% CI: 1.1-2.1) without an apparent dose- or response relationship. Loop and thiazide diuretic use was not associated with an increased risk of acute pancreatitis. Potassium-sparing diuretics elevated the risk of acute pancreatitis, albeit non-significantly. CONCLUSION: Use of ACE inhibitors is associated with a modest increase in the risk of acute pancreatitis during the first months of treatment.

Acute Disease↗

PubMed2002

A Swedish case-control network for studies of drug-induced morbidity--acute pancreatitis.

OBJECTIVE: To evaluate risk factors - notably drugs - for developing acute pancreatitis. METHODS: A population-based, case-control study, encompassing 1.4 million inhabitants aged 20-85 years from four regions in Sweden between 1 January 1995 and 31 May 1998. A total of 462 cases were hospitalised in surgical departments with their first episode of acute pancreatitis without previously known biliary stone disease. From a population register, 1781 controls were randomly selected. Information was obtained from medical records and through telephone interviews. RESULTS: Fifty-seven percent of the cases were males. An expert group found evidence for biliary stones in 50% of the cases, alcohol intake in 23%, but in 29% neither of these factors were present. In all, "other" factors, e.g. drugs, could have contributed to the development of acute pancreatitis in 52% of the cases. In a multivariate analysis, the adjusted odds ratios (ORs) for H(2) antagonists were 2.4 (95% CI 1.2-4.8) for proton pump inhibitors (PPIs), 2.1 (1.2-3.4) for non-steroidal anti-inflammatory drugs (NSAIDs), 2.3 (1.3-4.0) for those derived from acetic acid and 1.9 (1.1-3.2) for antibacterials for systemic use. Significant ORs were found for a history of gastrointestinal tract disorders [1.5 (1.1-1.9)] and inflammatory bowel disease (IBD) [3.4 (1.5-7.9)]. Smoking was significantly associated with acute pancreatitis [1.7 (1.2-2.1)] and, for those smoking more than 20 cigarettes per day, the OR was 4.0 (2.2-7.5). Alcohol in moderate amounts did not increase the risk, but for those drinking more than 420 g alcohol per week the OR was 4.1 (2.2-7.5). CONCLUSION: In addition to cholelithiasis, smoking and heavy alcohol use, drugs may be an important risk factor for acute pancreatitis.

Acute Disease↗

PubMed2002

Obesity and treatment of diabetes with glyburide may both be risk factors for acute pancreatitis.

OBJECTIVE: To evaluate risk factors, notably drugs, for acute pancreatitis. RESEARCH DESIGN AND METHODS: A population-based case-control study was conducted of 1.4 million inhabitants, aged 20-85 years, of four regions in Sweden between 1 January 1995 and 31 May 1998. A total of 462 case subjects were hospitalized in surgery departments for their first episode of acute pancreatitis without previous gallbladder disease. A total of 1,781 control subjects were randomly selected from a population register. Information was obtained from case records and through telephone interviews. RESULTS: A total of 27 case subjects (6%) and 55 control subjects (3%) had prevalent diabetes. A total of 53 case subjects (11%) and 130 control subjects (7%) had a BMI >30 kg/m(2). Use of glyburide had a crude odds ratio (OR) of 3.2 (95% CI 1.5-5.9), and in a multivariate logistic regression adjusted for covariates, the OR for use of glyburide was 2.5 (1.1-5.9). BMI had a continuous OR of 1.2 (1.1-1.4) per 5 units of BMI. The relative risk for hospitalization longer than 14 days or treatment in an intensive care unit was 2.4 (1.1-5.4) among patients with a BMI >30 kg/m(2) when compared with patients with a BMI between 20 and 25 kg/m(2). CONCLUSIONS: Use of glyburide and obesity may both be risk factors for acute pancreatitis. Obesity is associated with an extended hospitalization time in subjects with acute pancreatitis.

Acute Disease↗