Vaccination against pandemic A/H1N1 2009 influenza in pregnancy and risk of fetal death: cohort study in Denmark

Objective To investigate whether an adjuvanted pandemic A/H1N1 2009 influenza vaccine in pregnancy was associated with an increased risk of fetal death

Use of sodium glucose cotransporter 2 inhibitors and risk of major cardiovascular events and heart failure:Scandinavian register based cohort study

Objective To investigate the cardiovascular effectiveness of sodium glucose cotransporter 2 (SGLT2) inhibitors in routine clinical practice. Design Cohort study using data from nationwide registers and an active-comparator new-user design. Setting Denmark, Norway, and Sweden, from April 2013 to December 2016. Participants 20 983 new users of SGLT2 inhibitors and 20 983 new users of dipeptidyl peptidase 4 (DPP4) inhibitors, aged 35-84, matched by age, sex, history of major cardiovascular disease, and propensity score. Main outcome measures Primary outcomes were major cardiovascular events (composite of myocardial infarction, stroke, and cardiovascular death) and heart failure (hospital admission for heart failure or death due to heart failure). Secondary outcomes were the individual components of the cardiovascular composite and any cause death. In the primary analyses, patients were defined as exposed from treatment start throughout follow-up (analogous to intention to treat); additional analyses were conducted with an as-treated exposure definition. Cox regression was used to estimate hazard ratios. Results Mean age of the study cohort was 61 years, 60% were men, and 19% had a history of major cardiovascular disease. Of the total 27 416 person years of follow-up in the SGLT2 inhibitor group, 22 627 (83%) was among patients who initiated dapagliflozin, 4521 (16%) among those who initiated empagliflozin, and 268 (1%) among those who initiated canagliflozin. During follow-up, 467 SGLT2 inhibitor users (incidence rate 17.0 events per 1000 person years) and 662 DPP4 inhibitor users (18.0) had a major cardiovascular event, whereas 130 (4.7) and 265 (7.1) had a heart failure event, respectively. Hazard ratios were 0.94 (95% confidence interval 0.84 to 1.06) for major cardiovascular events and 0.66 (0.53 to 0.81) for heart failure. Hazard ratios were consistent among subgroups of patients with and without history of major cardiovascular disease and with and without history of heart failure. Hazard ratios for secondary outcomes, comparing SGLT2 inhibitors with DPP4 inhibitors, were 0.99 (0.85 to 1.17) for myocardial infarction, 0.94 (0.77 to 1.15) for stroke, 0.84 (0.65 to 1.08) for cardiovascular death, and 0.80 (0.69 to 0.92) for any cause death. In the as-treated analyses, hazard ratios were 0.84 (0.72 to 0.98) for major cardiovascular events, 0.55 (0.42 to 0.73) for heart failure, 0.93 (0.76 to 1.14) for myocardial infarction, 0.83 (0.64 to 1.07) for stroke, 0.67 (0.49 to 0.93) for cardiovascular death, and 0.75 (0.61 to 0.91) for any cause death. Conclusions In this large Scandinavian cohort, SGLT2 inhibitor use compared with DPP4 inhibitor use was associated with reduced risk of heart failure and any cause death, but not with major cardiovascular events in the primary intention-to-treat analysis. In the additional as-treated analyses, the magnitude of the association with heart failure and any cause death became larger, and a reduced risk of major cardiovascular events that was largely driven by the cardiovascular death component was observed. These data help inform patients, practitioners, and authorities regarding the cardiovascular effectiveness of SGLT2 inhibitors in routine clinical practice

Use of sodium-glucose co-transporter 2 inhibitors and risk of serious renal events:Scandinavian cohort study

OBJECTIVE To assess the association between use of sodiumglucose co-transporter 2 (SGLT2) inhibitors and risk of serious renal events in data from routine clinical practice. DESIGN Cohort study using an active comparator, new user design and nationwide register data. SETTING Sweden, Denmark, and Norway, 2013-18. PARTICIPANTS Cohort of 29 887 new users of SGLT2 inhibitors (follow-up time: dapagliflozin 66.1%; empagliflozin 32.6%; canagliflozin 1.3%) and 29 887 new users of an active comparator, dipeptidyl peptidase-4 inhibitors, matched 1:1 on the basis of a propensity score with 57 variables. Mean follow-up time was 1.7 (SD 1.0) years. EXPOSURES SGLT2 inhibitors versus dipeptidyl peptidase-4 inhibitors, defined by filled prescriptions and analysed according to intention to treat. MAIN OUTCOME MEASURES The main outcome was serious renal events, a composite including renal replacement therapy, death from renal causes, and hospital admission for renal events. Secondary outcomes were the individual components of the main outcome. RESULTS The mean age of the study population was 61.3 (SD 10.5) years; 11 108 (19%) had cardiovascular disease, and 1974 (3%) had chronic kidney disease. Use of SGLT2 inhibitors, compared with dipeptidy

Guillain-Barré syndrome and adjuvanted pandemic influenza A (H1N1) 2009 vaccines: A multinational self-controlled case series in Europe

BACKGROUND: The risk of Guillain-Barré syndrome (GBS) following the United States' 1976 swine flu vaccination campaign in the USA led to enhanced active surveillance during the pandemic influenza (A(H1N1)pdm09) immunization campaign. This study aimed to estimate the risk of GBS following influenza A(H1N1)pdm09 vaccination. METHODS: A self-controlled case series (SCCS) analysis was performed in Denmark, Finland, France, Netherlands, Norway, Sweden, and the United Kingdom. Information was collected according to a common protocol and standardised procedures. Cases classified at levels 1-4a of the Brighton Collaboration case definition were included. The risk window was 42 days starting the day after vaccination. Conditional Poisson regression and pooled random effects models estimated adjusted relative incidences (RI). Pseudo likelihood and vaccinated-only methods addressed the potential contraindication for vaccination following GBS. RESULTS: Three hundred and three (303) GBS and Miller Fisher syndrome cases were included. Ninety-nine (99) were exposed to A(H1N1)pdm09 vaccination, which was most frequently adjuvanted (Pandemrix and Focetria). The unadjusted pooled RI for A(H1N1)pdm09 vaccination and GBS was 3.5 (95% Confidence Interval (CI): 2.2-5.5), based on all countries. This lowered to 2.0 (95% CI: 1.2-3.1) after adjustment for calendartime and to 1.9 (95% CI: 1.1-3.2) when we accounted for contra-indications. In a subset (Netherlands, Norway, and United Kingdom) we further adjusted for other confounders and there the RI decreased from 1.7 (adjusted for calendar month) to 1.4 (95% CI: 0.7-2.8), which is the main finding. CONCLUSION: This study illustrates the potential of conducting European collaborative vaccine safety studies. The main, fully adjusted analysis, showed that the RI of GBS was not significantly elevated after influenza A(H1N1)pdm09 vaccination (RI = 1.4 (95% CI: 0.7-2.8). Based on the upper limits of the pooled estimate we can rule out with 95% certainty that the number of excess GBS cases after influenza A(H1N1)pdm09 vaccination would be more than 3 per million vaccinated

Guillain-Barré syndrome and adjuvanted pandemic influenza A (H1N1) 2009 vaccines: A multinational self-controlled case series in Europe

Background: The risk of Guillain-Barré syndrome (GBS) following the United States' 1976 swine flu vaccination campaign in the USA led to enhanced active surveillance during the pandemic influenza (A(H1N1)pdm09) immunization campaign. This study aimed to estimate the risk

Discrimination between two classes of radar emitters based on the radio frequency distributions

The subject of this thesis is to investigate methods for discrimination between two classes of radar emitters on the basis of the distribution of the radio frequencies. For the first class, the radio frequency is uniformly distributed within a certain frequency band. For the second class, the radio frequency belongs to a set of discrete frequencies where each frequency is equally probable. Two methods has been investigated. The first method is a recursive algorithm that applies multiple Kalman filters. The second method is a clustering algorithm. It is a non-recursive algorithm that for each acquired measurement processes all measurements in a batch. To compare the different methods, the posterior probability of each class was calculated given a sequence of measurements. The posterior probability represents all knowledge of the emitters, and constitutes the base for further decisions. The results show that both methods are capable of discriminating between the two classes. For the method that applies multiple Kalman filters, the probability of each class quickly converges towards the desired results. The number of discrete frequencies is chosen as 10 in the simulations, and the number of required measurements is then approximately 30. For the clustering algorithm, the number of required measurements is substantially larger than for the method with the multiple Kalman filters.Validerat; 20101217 (root

Det femte I:et - om elevinflytande på en gymnasieskola i Malmö

Syftet med följande arbete är att belysa och förklara orsakerna till en enskild gymnasieskolas så kallat ”dåliga” resultat vad gäller elevinflytande i Malmö stads gymnasieenkät 2005. Utgångspunkten är begreppet ”elevinflytande” och hur detta tolkas av skolans olika intressenter. Arbetet ger en översikt av tidigare forskning kring elevinflytande, samt presenterar resultatet från 2005 års gymnasieenkät i Malmö. Genom kvalitativa intervjuer med lärare och elever vid en gymnasieskola i Malmö ville vi se om det finns någon skillnad mellan de båda gruppernas tolkning av ”elevinflytande”, och om denna skillnad i så fall kan förklara enkätresultatet. Sammanfattningsvis kan konstateras att elevinflytande inte är något enhetligt begrepp utan skiljer sig mellan och inom de intervjuade grupperna. Detta tyder på att resultatet i gymnasieenkäten 2005 inte är helt tillförlitligt, då elevernas enkätsvar inte nödvändigtvis handlar om samma sak som frågorna.The purpose of the following study is to illuminate and explain the causes for the so called "poor" results of one high school regarding students' influence, as measured by the Malmö City High School Survey of 2005. The study's foundation lies in the term "students' influence" and how it is interpreted by the school's various interest groups. The report provides an overview of previously conducted research in the field of students' influence, as well as the results of the Malmö City High School Survey of 2005. By means of qualitative interviews with teachers and students of a Malmö High School, we wanted to investigate if there are any differences between the various groups' interpretations of the term "students' influence", and if such a difference could explain the survey results. As a summary, it can be safely stated that students' influence is not a unanimous term, but is very differently interpreted between and within the groups interviewed. This is indicative of the survey results of 2005 not being completely reliable, since the students' survey answers do not necessarily correspond to the intentions of the questionnaire

Konsumentprisindex för kläder och skor 1986-2005 - Dekomponering och prognostisering

The essay initially intends to find adequate models to describe and forecast monthly data for the Swedish Consumer Price Index sub group Clothes and Shoes 1986-2005. The time series observations during 2006 are considered “out of sample period” which is used to evaluate the forecasts. The purpose is to perform time series decomposition and to investigate and analyze the seasonal pattern. The Box-Jenkins approach is used to find adequate ARIMA models. Further the investigation assumes the approach of SCB for seasonal decomposition and the so called likelihood principal. The statistical program package TRAMO/SEATS is used throughout the investigation. The formulation of adequate ARIMA models is carried out through the automatic function of TRAMO and seasonal decomposition is performed by SEATS. On the basis of different pre-transformations four ARIMA-models are composed. Based on the assumed criteria’s one of the models proves to be adequate. Non-adequate models are rejected and the adequate model is used for predictions and seasonal decomposition. It shows that a Box-Cox transformation usingλ = −1 produces a stationary time-series and further an ARIMA-model by the form (0,1,1) (0,1,1). It shows that 9 out 12 monthly predictions made for 2006 are within a 95%-prediction interval. Decomposition of the time-series shows that CPI for Clothes and Shoes is initially characterised by a relatively even positive trend, which however declines and gradually passes into a negative trend during the latest years. The seasonally decomposed series further shows an evidently reduced variance which indicates a well adapted model. A closer analysis of the seasonal pattern indicates that the time series is increasingly influenced by seasonal effects. Further, the results indicate that the seasonal pattern is changing by affecting more months. The investigation of the seasonal component shows that the last months of the year have the highest CPI and the largest positive seasonal component. In a corresponding way the early months and the months during summer are characterised by low prices. The investigation suggests that this is an increasing process. The analysis of the seasonal patterns shows thus far a price level increasingly related to season