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Risk, Risk Analysis and Decision-making with Reference to Biostatistics and the Field of Medicine
KTH, School of Architecture and the Built Environment (ABE), Transport and Economics (closed 20110301), Safety Research (closed 20110301).ORCID iD: 0000-0001-7606-8771
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Risk, risk analysis and decision-making are essential aspects of health care andmedicine, for patients as well as for physicians and for society as a whole, andthe concept of risk and risk analysis in decision-making has a long history. Theword risk has many different interpretations and has no commonly accepteddefinition. In this thesis, we shall let risk stand for the combination of randomor uncertain events with negative consequences for human health, life and/orwelfare and/or the environment together with some measures of the likelihoodof such events. We believe this is the dominant concept and understanding ofrisk, the risk being the likelihood or probability of an event followed by somenegative consequences or activities of that event.

In this doctoral thesis, we focus on biostatistics, risks and risk analysis in thefield of medicine, a science which has been using methods from the area of riskanalysis for a long time. The seven papers (paper I - paper VII) presented inthis thesis, together with a general introduction to risk, risk analysis anddecision-making, will be used to illustrate and discuss risk analysis as a tool fordecision-making in the field of medicine. From my point a view, risk analysisin the field of medicine aims to reduce pain, raise the quality of life, reduce therisk of adverse events, compare cost efficiency between different treatmentregimes and prolong a healthy life. Based on results presented in the thesis, weconclude that biostatistics, risks and risk analysis used in the field of medicineare valuable methods for evaluation of hypotheses within the health care areaand a good basis for decision-making.

Place, publisher, year, edition, pages
Stockholm: KTH Royal Institute of Technology, 2010. , 51 p.
Series
TRITA-TEC-PHD, ISSN 1653-4468 ; 10:004
Keyword [en]
risk analysis, risk, consequence, system, biostatistics, decision, decision-making, health care, medicine
National Category
Medical Laboratory and Measurements Technologies
Identifiers
URN: urn:nbn:se:kth:diva-24304ISBN: 978-91-85539-62-8 (print)OAI: oai:DiVA.org:kth-24304DiVA: diva2:346458
Public defence
2010-09-15, F3, Lindstedtsvägen 26, KTH, Stockholm, 10:15 (English)
Opponent
Supervisors
Note

QC 20100901

Available from: 2010-09-01 Created: 2010-09-01 Last updated: 2017-02-22Bibliographically approved
List of papers
1. Perceived consequences among pregnant and non-pregnant women of continuing or ceasing to smoke.
Open this publication in new window or tab >>Perceived consequences among pregnant and non-pregnant women of continuing or ceasing to smoke.
2007 (English)In: International Journal of Gynecology & Obstetrics, ISSN 0020-7292, Vol. 99, no 2, 117-121 p.Article in journal (Refereed) Published
Abstract [en]

Objective

To examine the perception of risk of smoking-related psychological and social outcomes, and the effect of pregnancy and intention to stop smoking on the perceived risk.

Methods

Eighty women were asked to make judgments about the probability of outcomes for smoking-related consequences. Four subgroups were created using the variables of pregnancy (pregnant versus not pregnant) and cessation of smoking (intention to stop versus no intention to stop). Judgments were based on the decision to stop and not stop smoking.

Result

Intention to stop smoking affected the estimated probabilities for the occurrence of consequences for both continuing and stopping smoking, whereas pregnancy did not affect the estimated probabilities. The estimated effect of stopping smoking was statistically significant.

Conclusion

Health messages about smoking for all population groups should consider both future risk of mortality and immediate quality-of-life effects of smoking.

Place, publisher, year, edition, pages
Elsevier, 2007
Keyword
Pregnancy, Smoking, Risk
Identifiers
urn:nbn:se:kth:diva-9960 (URN)10.1016/j.ijgo.2007.04.039 (DOI)000251225900009 ()2-s2.0-35248872013 (Scopus ID)
Note
QC20100831Available from: 2009-02-20 Created: 2009-02-16 Last updated: 2010-09-01Bibliographically approved
2. Values and beliefs about consequences related to smoking among pregnant and non-pregnant women
Open this publication in new window or tab >>Values and beliefs about consequences related to smoking among pregnant and non-pregnant women
2007 (English)In: Journal of Obstetrics and Gynaecology, ISSN 0144-3615, E-ISSN 1364-6893, Vol. 27, no 6, 558-563 p.Article in journal (Refereed) Published
Abstract [en]

The purpose of the study was to test a model based on the product of value and belief, called expected utility (EU), on the addictive behaviour of smoking. A total of 40 pregnant and 40 non-pregnant women over a period of 2 weeks performed judgements on values and beliefs about consequences related to smoking for the conditions of continuing and stopping smoking. There were no differences between pregnant and non-pregnant women in the EU of smoking. Differences in expected utility between the conditions of continuing and stopping smoking were larger for health consequences compared with psychological and social consequences and consequences related to pregnancy. Expected utility gives a good description of judgements over time. Values as well as beliefs related to health consequences should be stressed in smoking cessation programmes, especially among pregnant women.

Keyword
Beliefs, decision, pregnancy, smoking, values
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-9961 (URN)10.1080/01443610701469883 (DOI)000251069100002 ()17896249 (PubMedID)2-s2.0-34848834801 (Scopus ID)
Note
QC 20100831Available from: 2009-02-16 Created: 2009-02-16 Last updated: 2017-12-13Bibliographically approved
3. Effect of intravenous nimodipine on blood pressure and outcome after acute stroke
Open this publication in new window or tab >>Effect of intravenous nimodipine on blood pressure and outcome after acute stroke
2000 (English)In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 31, no 6, 1250-1255 p.Article in journal (Refereed) Published
Abstract [en]

Background and Purpose-The Intravenous Nimodipine West European Stroke Trial (INWEST) found a correlation between nimodipine-induced reduction in blood pressure (BP) and an unfavorable outcome in acute stroke. We sought to confirm this correlation with and without adjustment for prognostic variables and to investigate outcome in subgroups with increasing levels of BP reduction. Methods-Patients with a clinical diagnosis of ischemic stroke (within 24 hours) were consecutively allocated to receive placebo (n=100), 1 mg/h (low-dose) nimodipine (n=101), or 2 mg/h (high-dose) nimodipine (n=94). The correlation between average BP change during the first 2 days and the outcome at day 21 was analysed. Results-Two hundred sixty-five patients were included in this analysis (n=92, 93, and 80 for placebo, low dose, and high dose. respectively). Nimodipine treatment resulted in a statistically significant reduction in systolic BP (SBP) and diastolic BP (DBP) from baseline compared with placebo during the first few days. In multivariate analysis, a significant correlation between DBP reduction and worsening of the neurological score was round for the high-close group (beta=0.49, P=0.048). Patients with a DBP reduction of greater than or equal to 20% in the high-dose group had a significantly increased adjusted OR for the compound outcome variable death or dependency (Barthel Index <60) (n/N=25/26, OR 10.16, 95% CI 1.02 to 101.74) and death alone (n/N=9/26, OR 4.3361 95% CI 1.131 16.619) compared with all placebo patients (n/N=62/92 and 14/92. respectively). There was no correlation between SEP change and outcome. Conclusions-DBP, but not SEP, reduction was associated with neurological worsening after the intravenous administration of high-dose nimodipine after acute stroke. For low-dose nimodipine, the results were not conclusive. These results do not confirm or exclude a neuroprotective property of nimodipine.

Keyword
blood pressure, cerebral ischemia, nimodipine, stroke, acute, acute ischemic stroke, cerebrovascular-disease, cerebral infarction, glucose-metabolism, controlled trial, hypertension, flow, thresholds, tomography, treat
Identifiers
urn:nbn:se:kth:diva-19793 (URN)000087335200008 ()
Note
QC 20100525Available from: 2010-08-10 Created: 2010-08-10 Last updated: 2017-12-12Bibliographically approved
4. Addition of intravenous iron to epoetin beta increases hemoglobin response and decreases epoetin dose requirement in anemic patients with lymphoproliferative malignancies: a randomized multicenter study
Open this publication in new window or tab >>Addition of intravenous iron to epoetin beta increases hemoglobin response and decreases epoetin dose requirement in anemic patients with lymphoproliferative malignancies: a randomized multicenter study
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2007 (English)In: Leukemia, ISSN 0887-6924, E-ISSN 1476-5551, Vol. 21, no 4, 627-632 p.Article in journal (Refereed) Published
Abstract [en]

This randomized study assessed if intravenous iron improves hemoglobin (Hb) response and permits decreased epoetin dose in anemic (Hb 9 - 11 g/dl), transfusion-independent patients with stainable iron in the bone marrow and lymphoproliferative malignancies not receiving chemotherapy. Patients (n = 67) were randomized to subcutaneous epoetin beta 30 000 IU once weekly for 16 weeks with or without concomitant intravenous iron supplementation. There was a significantly (P < 0.05) greater increase in mean Hb from week 8 onwards in the iron group and the percentage of patients with Hb increase >= 2 g/dl was significantly higher in the iron group (93%) than in the no-iron group (53%) (per-protocol population; P < 0.001). Higher serum ferritin and transferrin saturation in the iron group indicated that iron availability accounted for the Hb response difference. The mean weekly patient epoetin dose was significantly lower after 13 weeks of therapy (P < 0.029) and after 15 weeks approximately 10 000 IU (425%) lower in the iron group, as was the total epoetin dose (P = 0.051). In conclusion, the Hb increase and response rate were significantly greater with the addition of intravenous iron to epoetin treatment in iron-replete patients and a lower dose of epoetin was required.

Keyword
anemia, cancer, erythropoietin, intravenous iron, lymphoproliferative malignancies
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:kth:diva-9954 (URN)10.1038/sj.leu.2404562 (DOI)000245117600007 ()2-s2.0-33947405774 (Scopus ID)
Note
QC 20100826Available from: 2009-02-20 Created: 2009-02-16 Last updated: 2017-12-13Bibliographically approved
5. Regular hypnotic drug treatment in a sample of 32,679 Swedes: associations with somatic and mental health, inpatient psychiatricdiagnoses and suicide, derived with automated record-linkage
Open this publication in new window or tab >>Regular hypnotic drug treatment in a sample of 32,679 Swedes: associations with somatic and mental health, inpatient psychiatricdiagnoses and suicide, derived with automated record-linkage
1991 (English)In: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 53, no 1, 101-108 p.Article in journal (Refereed) Published
Abstract [en]

We studied Swedish survey responders who reported regular treatment with hypnotic drugs, to find associations to perceived health problems, inpatient psychiatric diagnoses, and subsequent suicide. Among 32,679 sampled Swedes, 26,952 (83%) participated, 500 of which (2%) reported regular hypnotic drug treatment. The rate of treatment was higher in women, and increased by age in both sexes. The major findings were high odds of concurrent psychoactive drug treatments, nervous symptoms and insomnia, as well as high rates of circulatory and musculoskeletal conditions in both sexes, with indicators of disability and sleep-disturbing symptoms. During a 15-year period, 35% of the men and 21% of the women who reported regular hypnotic drug treatment had also been admitted to inpatient psychiatric care. Substance abuse was diagnosed in 20% of the men and 4.3% of the women reporting hypnotic drug treatment. In multiple logistic regression models, the highest odds for regular hypnotic drug treatment were incurred by recent/current insomnia, nervous symptoms, and other psychoactive drug treatment. We conclude that therapy was principally given according to some current peer guidelines. Yet, further research is needed into the risk/benefit ratio of sustained hypnotic drug therapy in patients with qualifying somatic and psychiatric disorders to obtain a more uniformly based consensus.

Identifiers
urn:nbn:se:kth:diva-24299 (URN)A1991EV35000009 ()
Note
QC20100901Available from: 2010-09-01 Created: 2010-09-01 Last updated: 2017-12-12Bibliographically approved
6. Effects of metoprolol vs verapamil in patients with stable angina pectoris: The Angina Prognosis Study in Stockholm (APSIS)
Open this publication in new window or tab >>Effects of metoprolol vs verapamil in patients with stable angina pectoris: The Angina Prognosis Study in Stockholm (APSIS)
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1996 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 17, no 1, 76-81 p.Article in journal (Refereed) Published
Abstract [en]

Objective To study long-term treatment effects of metoprolol or verapamil on combined cardiovascular end points and psychological variables in patients with stable angina pectoris. Design Randomized, double-blind, double-dummy trial. Patients The study included 809 patients under 70 years of age with stable angina pectoris. The mean age of the patients was 59 +/- 7 years and 31% were women. Exclusion criteria were myocardial infarction within the previous 3 years and contraindications to beta-blockers and calcium antagonists. The patients were followed between 6 and 75 months (median 3.4 years and a total of 2887 patient years). Intervention The patients were treated with either metoprolol (Seloken ZOC 200 mg o.d.) or verapamil (Isoptin Retard 240 b.i.d.). Acetylsalicylic acid, ACE inhibitors, lipid lowering drugs and long acting nitrates were allowed in the study. End points Death, non-fatal cardiovascular events including acute myocardial infarction, incapacitating or unstable angina, cerebrovascular or peripheral vascular events. Psychological variables reflecting quality of life i.e. psychosomatic symptoms, sleep disturbances and an evaluation of overall life satisfaction. Results Combined cardiovascular events did not differ and occurred in 30.8% and 29.3% of metoprolol and verapamil treated patients respectively. Total mortality in metoprolol and verapamil treated patients was 5.4 and 6.2%, respectively. Cardiovascular mortality was 4.7% in both groups. Non-fatal cardiovascular events occurred in 26.1 and 24.3% of metoprolol and verapamil-treated patients, respectively. Psychosomatic symptoms and sleep disturbances were significantly improved in both treatment groups. The magnitudes of change were small and did not differ between treatments. Life satisfaction did not change on either drug. Withdrawals due to side effects occurred in 11.1 and 14.6%, respectively. Conclusion This long term study indicates that both drugs are well tolerated and that no difference was shown on the effect on mortality, cardiovascular end points and measures of quality of life.

Identifiers
urn:nbn:se:kth:diva-24301 (URN)A1996UA01000012 ()
Note
QC20100901Available from: 2010-09-01 Created: 2010-09-01 Last updated: 2017-12-12Bibliographically approved
7. Does early EBV infection protect against IgE sensitization?
Open this publication in new window or tab >>Does early EBV infection protect against IgE sensitization?
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2005 (English)In: Journal of Allergy and Clinical Immunology, ISSN 0091-6749, E-ISSN 1097-6825, Vol. 116, no 2, 438-444 p.Article in journal (Refereed) Published
Abstract [en]

Background: There is indirect evidence that an increased infectious burden is associated with a decreased prevalence of IgE-mediated allergy during childhood. Objective: To determine whether there is a relation between the serostatus of 13 different viruses and parentally reported infections and IgE sensitization in 2-year-old children. To investigate whether there is an interaction between cytomegalovirus (CMV) and Epstein-Barr virus (EBV) in relation to IgE sensitization. Methods: A total of 246 infants were followed prospectively to 2 years of age with clinical examinations, skin prick test, and specific IgE analyses and through analysis of seropositivity against adenovirus, influenza, parainfluenza, respiratory syncytial virus, CMV, EBV, herpes simplex virus, human herpesvirus 6, and varicella-zoster virus. Results: There was some evidence that IgE sensitization (24%) tended to be more common among children who were seropositive against few compared with children who were seropositive against many viruses, but this was not statistically significant, and there was no consistent trend across the groups. IgE sensitization was statistically significantly less prevalent at 2 years of age among infants who were seropositive against EBV but not other viruses (adjusted odds ratio, 0.34; 95% CI, 0.14-0.86). The interaction of seropositivity against both CMV and EBV antibodies indicated a further reduction in the risk for IgE sensitization (adjusted odds ratio for interaction, 0.10; 95% CI, 0.01-0.92), indicating effect modification associated with seropositivity against CMV. Conclusion: Our results indicate that acquisition of EBV infection during the first 2 years of life is associated with a reduced risk of IgE sensitization, and this effect is enhanced by CMV coinfection.

Keyword
childhood, CMV, EBV, IgE, infections, sensitization, serology, viral infections, barr-virus-infection, cytomegalovirus-infection, early-childhood, atopic disease, cord blood, antibodies, children, cells, life, schoolchildren
Identifiers
urn:nbn:se:kth:diva-15326 (URN)10.1016/j.jaci.2005.04.027 (DOI)000235686400031 ()2-s2.0-23244448469 (Scopus ID)
Note
QC 20100525Available from: 2010-08-05 Created: 2010-08-05 Last updated: 2017-12-12Bibliographically approved

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