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Jiang X.,Karolinska Institutet | Alfredsson L.,Karolinska University Hospital | Klareskog L.,Institute of Environmental Medicine | Bengtsson C.,Karolinska Institutet
Arthritis Care and Research | Year: 2014

Results. In total, 254 (13%) cases were ever moist snuff users compared with 290 (13%) controls, resulting in an OR of 1.0 (95% CI 0.8-1.2) of RA overall. When exposure to moist snuff was analyzed in relation to ACPA-positive and ACPA-negative disease, no associations were observed. Neither current nor past moist snuff use was related to the risk of any of the 2 RA subgroups. Analyses restricted to never smokers provided similar results.Conclusion. The use of moist snuff was not associated with the risk of either ACPA-positive or ACPA-negative RA. The increased risk of RA associated with smoking is most probably not due to nicotine.Objective. To investigate the association between snuff use (smokeless tobacco containing nicotine) and the risk of anti-citrullinated protein/peptide antibody (ACPA)-positive and ACPA-negative rheumatoid arthritis (RA).Methods. Data from the Swedish Epidemiological Investigation of Rheumatoid Arthritis, a population-based case-control study including 1,998 incident cases and 2,252 randomly selected controls (matched on age, sex, and residential area) ages 18-70 years, were analyzed. Ever, current, and past moist snuff users were compared with never users. We calculated odds ratios (ORs) with 95% confidence intervals (95% CIs) by means of unconditional logistic regression models. All analyses were adjusted for cigarette smoking, alcohol consumption, and the matching variables. © 2014, American College of Rheumatology.

Jorgensen L.,Karolinska Institutet | Ahlbom A.,Institute of Environmental Medicine | Allebeck P.,Karolinska Institutet | Dalman C.,Karolinska Institutet
Acta Psychiatrica Scandinavica | Year: 2010

Objective: To estimate the incidence rate of schizophrenia and non-affective psychoses from registers, to highlight the importance of including data from out-patient care, and to assess the proportion of persons treated in out-patient care only. Method: Data from out-patient and in-patient psychiatric care in Stockholm and information from several national registers constitute 'The Stockholm Non-Affective Psychoses Study' (SNAPS). Incidence rates based on SNAPS data were calculated and compared to in-patient care incidence rates. Results: The incidence rate was 72/100 000 for non-affective psychoses (age group 18-44) and 28/100 000 for schizophrenia (age group 18-34) in the SNAPS. This was higher compared to in-patient based incidence rates (42 and 13/100 000 respectively). The proportion of individuals with psychosis treated in out-patient care only was 25%. Conclusion: There are substantial differences in the incidence rates of non-affective psychoses and schizophrenia depending on the availability of data. Not including out-patient care will underestimate the incidence rates. © 2009 John Wiley & Sons A/S.

Frostegard J.,Institute of Environmental Medicine
BMC Medicine | Year: 2013

Atherosclerosis, the major cause of cardiovascular disease (CVD), is a chronic inflammatory condition with immune competent cells in lesions producing mainly pro-inflammatory cytokines. Dead cells and oxidized forms of low density lipoproteins (oxLDL) are abundant. The major direct cause of CVD appears to be rupture of atherosclerotic plaques. oxLDL has proinflammatory and immune-stimulatory properties, causes cell death at higher concentrations and contains inflammatory phospholipids with phosphorylcholine (PC) as an interesting epitope. Antibodies against PC (anti-PC) may be atheroprotective, one mechanism being anti-inflammatory. Bacteria and virus have been discussed, but it has been difficult to find direct evidence, and antibiotic trials have not been successful. Heat shock proteins could be one major target for atherogenic immune reactions. More direct causes of plaque rupture include pro-inflammatory cytokines, chemokines, and lipid mediators. To prove that inflammation is a cause of atherosclerosis and CVD, clinical studies with anti-inflammatory and/or immune-modulatory treatment are needed. The potential causes of immune reactions and inflammation in atherosclerosis and how inflammation can be targeted therapeutically to provide novel treatments for CVD are reviewed. © 2013 Frostegård; licensee BioMed Central Ltd.

Lindgren P.,Institute of Environmental Medicine | Jonsson B.,Stockholm School of Economics
European Journal of Health Economics | Year: 2012

Background The economic evaluation of statins has undergone a development from risk-factor-based models to modeling of hard end points in clinical trials with a shift back to risk-factor models after increased confidence in their predictive power has now been established. At this point, we can look back on the historical economic data on simvastatin to see what lesson regarding reimbursement we can learn. Methods Historical data on the usage and sales of simvastatin in Sweden were combined with published epidemiological and clinical data to calculate the social value of simvastatin to the present day and to make projection until projected until 2018. The distribution of the social surplus was calculated by taking the costs born by society and the producer of the drug into consideration. Results The cost of simvastatin fell drastically following patent expiration, although the number of treated patients has continued to grow. Presently, the use of simvastatin is close to cost neutrality taking direct and indirect cost savings from reduced morbidity into account. However, the major part of the social surplus generated comes from the value of improved quality-adjusted survival. Of the social surplus generated, the producer appropriated 20-43% of the value during the on-patent period, a figure dropping to 1% following loss of exclusivity. The total producer surplus between 1987 and 2018 is 2-5% of the total social surplus. Conclusion Only a small part of the surplus value generated was appropriated by the producer. A regulatory and reimbursement approach that favors early market access and coverage with evidence development as opposed to long-term trials as a pre-requisite for launch is more attractive from both a company and social perspective. © 2011 Springer-Verlag.

Tsinganou E.,Institute of Environmental Medicine
German medical science : GMS e-journal | Year: 2010

Human intestinal spirochetosis (IS) is a condition defined histologically by the presence of spirochetal microorganisms attached to the apical cell membrane of the colorectal epithelium. Intestinal spirochetes comprise a heterogeneous group of bacteria. In humans, Brachyspira aalborgi and Brachyspira pilosicoli predominate. Prevalence rates of IS are low where living standards are high, in contrast to poorly developed areas where IS is common. Homosexuals and HIV-infected individuals are at high risk of being colonized. Clinical significance in individual cases has remained unclear up to now. A review of the literature assumes that invasion of spirochetes beyond the surface epithelium may be associated with gastrointestinal symptoms which respond to antibiotic treatment (metronidazole), whereas individuals lacking this feature may be mostly asymptomatic. Of unknown reason, homosexual and HIV-positive men as well as children are more likely to be symptomatic irrespective of invasion. Rare cases of spirochetemia and multiple organ failure have been reported in critically ill patients with IS.

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