Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Den kulturella moderaten : En jämförande kvalitativ studie över tid

The aim of this essay is examine how the Moderate party ideas and values have changed over time in relation to the so-called GAL-TAN dimension. The dimension theorizes values regarding green, alternative and libertarianism against traditional, authoritarian and nationalism. The dimension has recently become relevant for the Swedish political party system and political culture. The source material we use are documents of the Moderate party from 1904 to 2013. We have examine the Moderate party ideas using qualitative and comparative method, the results are presented in the form of a “codified text analysis”. Also, to find a deeper understanding, the results is evaluated in an idea analysis. Finally, we offer an understanding of values and ideas from a cultural and social perspective. The results show that the dimension existed from the very beginning in the Moderate party and that it is most prominent today. The study compared over time, making possible comparisons of cultural positions over time

Loneliness and social isolation in the elderly : a literature review

Bakgrund Ensamhet och social isolering är en växande utmaning i takt med att befolkningen blir äldre. I vissa länder är det upp till en tredjedel av de äldre personerna som upplever ensamhet. Ensamheten och den sociala isoleringen kan ha negativa hälsoeffekter samt leda till ökade behov av sjukvård. Trots att äldre personer som upplever ensamhet och social isolering uppsöker hälso- och sjukvården i högre grad blir den här gruppen ofta förbisedd. Detta till följd av en brist på tid samt kunskap och medvetenhet om problemområdet hos vårdpersonal. Syfte Syftet var att belysa äldre personers upplevelse av ensamhet och social isolering. Metod En icke-systematisk litteraturöversikt genomfördes baserat på 19 vetenskapliga originalartiklar med kvalitativ och kvantitativ design. De inkluderade artiklarna inhämtades i databaserna PubMed och CINAHL. Samtliga artiklar har genomgått en kvalitetsgranskning utifrån Sophiahemmet Högskolas bedömningsmall. Artiklarna analyserades med integrerad dataanalys. Resultat Tre huvudkategorier identifierades; Ensamhetens upplevda ursprung, Upplevda känslor relaterade till ensamhet och Upplevda hanteringsstrategier mot ensamhet. Resultatet visade att ensamhet upplevdes orsakas av den åldrande kroppen, förlusten och frånvaron av viktiga personer, av en avsaknad av meningsfulla aktiviteter samt personlighetsdrag. Ensamhet och social isolering kunde leda till känslor av tomhet, övergivenhet och hopplöshet men även till positiva upplevelser. Hanteringsstrategier mot ensamheten handlade om acceptans och anpassning samt attityder och inställning. Vidare framkom tro och spiritualitet, aktiviteter och relationer som viktiga hanteringsstrategier. Slutsats Litteraturstudien visade att upplevelsen av ensamhet och social isolering innefattade såväl fysiska, sociala som emotionella aspekter. Främst kunde upplevelsen kopplas till ett lidande hos den äldre personen. En ökad förståelse och kunskap om hur äldre personer upplever ensamhet och social isolering kan medvetandegöra problematiken samt berika sjuksköterskans kompetens.Background  Loneliness and social isolation are growing challenges as the population ages. In some countries up to a third of older persons experience loneliness. Loneliness and social isolation can have negative health effects and lead to an increased need for healthcare. Despite the fact that older persons who experience loneliness and social isolation seek health care to a greater extent, this group is often overlooked. This is due to a lack of time as well as knowledge and awareness of the problem on the part of healthcare staff. Aim  The aim was to describe elderly persons’ experience of loneliness and social isolation. Method  A non-systematic literature review was conducted based on 19 original articles with a qualitative and quantitative design. The included articles were retrieved from the databases PubMed and CINAHL. All articles have undergone a quality review based on Sophiahemmet University's assessment template. The articles were analyzed using integrated data analysis. Results  Three main categories were identified; Perceived origins of loneliness, feelings related to loneliness and coping strategies against loneliness. The results showed that loneliness was perceived to be caused by the aging body, the absence and loss of important persons, by a lack of meaningful activities and by a person's personality traits. Loneliness and social isolation could lead to feelings of emptiness, abandonment and hopelessness but also to positive experiences. Coping strategies included acceptance and adaptation as well as attitudes. Furthermore, faith and spirituality, activities and relationships emerged as important coping strategies. Conclusions  This literature review showed that the experience of loneliness and social isolation included physical, social and emotional aspects. Mainly, the experience could be linked to suffering for the elderly person. An increased understanding and knowledge of how older persons experience loneliness and social isolation can raise awareness of the problem and enrich the nurse's competence

Loneliness and social isolation in the elderly : a literature review

Bakgrund Ensamhet och social isolering är en växande utmaning i takt med att befolkningen blir äldre. I vissa länder är det upp till en tredjedel av de äldre personerna som upplever ensamhet. Ensamheten och den sociala isoleringen kan ha negativa hälsoeffekter samt leda till ökade behov av sjukvård. Trots att äldre personer som upplever ensamhet och social isolering uppsöker hälso- och sjukvården i högre grad blir den här gruppen ofta förbisedd. Detta till följd av en brist på tid samt kunskap och medvetenhet om problemområdet hos vårdpersonal. Syfte Syftet var att belysa äldre personers upplevelse av ensamhet och social isolering. Metod En icke-systematisk litteraturöversikt genomfördes baserat på 19 vetenskapliga originalartiklar med kvalitativ och kvantitativ design. De inkluderade artiklarna inhämtades i databaserna PubMed och CINAHL. Samtliga artiklar har genomgått en kvalitetsgranskning utifrån Sophiahemmet Högskolas bedömningsmall. Artiklarna analyserades med integrerad dataanalys. Resultat Tre huvudkategorier identifierades; Ensamhetens upplevda ursprung, Upplevda känslor relaterade till ensamhet och Upplevda hanteringsstrategier mot ensamhet. Resultatet visade att ensamhet upplevdes orsakas av den åldrande kroppen, förlusten och frånvaron av viktiga personer, av en avsaknad av meningsfulla aktiviteter samt personlighetsdrag. Ensamhet och social isolering kunde leda till känslor av tomhet, övergivenhet och hopplöshet men även till positiva upplevelser. Hanteringsstrategier mot ensamheten handlade om acceptans och anpassning samt attityder och inställning. Vidare framkom tro och spiritualitet, aktiviteter och relationer som viktiga hanteringsstrategier. Slutsats Litteraturstudien visade att upplevelsen av ensamhet och social isolering innefattade såväl fysiska, sociala som emotionella aspekter. Främst kunde upplevelsen kopplas till ett lidande hos den äldre personen. En ökad förståelse och kunskap om hur äldre personer upplever ensamhet och social isolering kan medvetandegöra problematiken samt berika sjuksköterskans kompetens.Background  Loneliness and social isolation are growing challenges as the population ages. In some countries up to a third of older persons experience loneliness. Loneliness and social isolation can have negative health effects and lead to an increased need for healthcare. Despite the fact that older persons who experience loneliness and social isolation seek health care to a greater extent, this group is often overlooked. This is due to a lack of time as well as knowledge and awareness of the problem on the part of healthcare staff. Aim  The aim was to describe elderly persons’ experience of loneliness and social isolation. Method  A non-systematic literature review was conducted based on 19 original articles with a qualitative and quantitative design. The included articles were retrieved from the databases PubMed and CINAHL. All articles have undergone a quality review based on Sophiahemmet University's assessment template. The articles were analyzed using integrated data analysis. Results  Three main categories were identified; Perceived origins of loneliness, feelings related to loneliness and coping strategies against loneliness. The results showed that loneliness was perceived to be caused by the aging body, the absence and loss of important persons, by a lack of meaningful activities and by a person's personality traits. Loneliness and social isolation could lead to feelings of emptiness, abandonment and hopelessness but also to positive experiences. Coping strategies included acceptance and adaptation as well as attitudes. Furthermore, faith and spirituality, activities and relationships emerged as important coping strategies. Conclusions  This literature review showed that the experience of loneliness and social isolation included physical, social and emotional aspects. Mainly, the experience could be linked to suffering for the elderly person. An increased understanding and knowledge of how older persons experience loneliness and social isolation can raise awareness of the problem and enrich the nurse's competence