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BACKGROUND: Due to changes in Swedish maternity care during the COVID-19 pandemic, partners were often excluded from antenatal and postnatal care. AIM: To explore partners' experiences of pregnancy, labour, and postnatal care in relation to the COVID-19 pandemic restrictions. METHODS: A descriptive qualitative interview study with 15 partners of women who gave birth from March 2020 to March 2022. Data was collected from April to November 2022, and analysed using inductive thematic analysis. FINDINGS: Two themes and six subthemes were identified. The first theme, Feelings of loss and exclusion, emphasises the expectation and desire to share the journey of becoming a parent together with the pregnant partner. When excluded from maternity care, a feeling of missing out was described which could create a sense of distance from the unborn child. The second theme, Dealing with powerlessness, relates to the fear of infection and not being able to participate during the birth, and life being adapted to restrictions. Mixed feelings regarding the restrictions were described since the reasons behind were not always perceived as clear and logical. DISCUSSION: Sweden prides itself on gender equality, where partners normally are a natural part of maternity care. This likely contributed to strong feelings of exclusion when partners were prevented from participating in maternity care during the COVID-19 pandemic. CONCLUSION: Partners of women giving birth during the COVID-19 pandemic were substantially affected by the restrictions within maternity care. Partners wish to be involved in pregnancy and birth and want to receive clear information as part of their preparation for parenthood. Society-including maternity care-must decide how to address these needs.

Asunto(s)

COVID-19 , Atención Posnatal , Investigación Cualitativa , Humanos , COVID-19/epidemiología , COVID-19/psicología , Femenino , Embarazo , Suecia/epidemiología , Adulto , Masculino , SARS-CoV-2 , Pandemias , Trabajo de Parto/psicología , Persona de Mediana Edad , Esposos/psicología

RESUMEN

BACKGROUND: Hailey-Hailey disease (HHD) is a rare autosomal dominant skin disease caused by mutations in the ATP2C1 gene, which encodes the secretory Ca2+/Mn2+-ATPase (SPCA1) pump in the Golgi apparatus. Although ATP2C1 is ubiquitously expressed in the body, possible extracutaneous manifestations of HHD are unknown. However, dysfunction of the Golgi apparatus not specifically coupled to ATP2C1 has been associated with heart disease. OBJECTIVE: To investigate the association between HHD and common heart disease in a Swedish, population-based cohort. METHODS: We conducted a population-based cohort study based on a linkage of Swedish nationwide registers to investigate the relationship between HHD and heart disease. We have been granted ethical approval from the Swedish Ethical Review Authority to conduct this study. The patients in this manuscript have given written informed consent to the publication of their case details. A total of 342 individuals with an ICD-10 diagnosis of HHD (Q82.8E) were identified and matched with randomly selected comparison individuals without HHD on a 1:100 ratio. Furthermore, in a separate clinical cohort we matched 23 HHD patients for age, sex, and BMI with control subjects to examine electrocardiogram parameters, electrolytes, and cardiovascular biomarkers. RESULTS: Compared with individuals without HHD, individuals with HHD had an excess risk of arrhythmia (RR 1.4, CI 1.0-2.0), whereas no increased risks of myocardial infarction (RR 1.1, CI 0.6-1.7) or heart failure (RR 1.0, CI 0.6-1.6; Table 1) were found. We found no difference in ECG parameters, cardiovascular biomarkers, and electrolytes in the clinical subset. CONCLUSION: This study reveals that HHD is associated with an increased risk of arrhythmia and represents the first data of any extracutaneous comorbidity in HHD. Thus, HHD may be a systemic disease. Our findings also shed light on the importance of the Golgi apparatus' Ca2+/Mn2+ homeostasis in common heart disease.

Asunto(s)

Arritmias Cardíacas , Pénfigo Familiar Benigno , Humanos , Arritmias Cardíacas/genética , Femenino , Masculino , Pénfigo Familiar Benigno/genética , Pénfigo Familiar Benigno/complicaciones , Persona de Mediana Edad , Adulto , Suecia/epidemiología , Anciano , Estudios de Cohortes , ATPasas Transportadoras de Calcio/genética , ATPasas Transportadoras de Calcio/metabolismo , Factores de Riesgo , Estudios de Casos y Controles

RESUMEN

Eating disorders are common disorders that cause significant suffering and functional impairment for those affected. They often emerge in adolescence and can go undetected for many years before an individual presents to services. Early diagnosis and treatment have been shown to significantly improve the prognosis, highlighting the need for proactive screening. This study compared the frequency of self-reported eating disorder symptoms in (n = 2137) outpatients at the Child and Adolescent Psychiatry Clinic (BUP) in Region Västmanland, Sweden between 2018 and 2022. The results showed that the proportion of young people reporting frequent eating disorder symptoms increased from 16% to 28% over this time period. This result is in line with previous research describing an increase in the prevalence of eating disorder symptoms among different groups in relation to the Covid-19 pandemic. It underscores the importance of screening for eating disorder symptoms to better address care needs.

Asunto(s)

COVID-19 , Trastornos de Alimentación y de la Ingestión de Alimentos , Autoinforme , Humanos , Suecia/epidemiología , Adolescente , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Trastornos de Alimentación y de la Ingestión de Alimentos/diagnóstico , Femenino , Masculino , Niño , COVID-19/epidemiología , Pacientes Ambulatorios/estadística & datos numéricos , Prevalencia , SARS-CoV-2 , Psiquiatría Infantil , Psiquiatría del Adolescente

RESUMEN

AIMS: Risk factors for lower limb amputation (LLA) in individuals with diabetes have been under-studied. We examined how 1/demographic and socioeconomic, 2/medical, and 3/lifestyle risk factors may be associated with LLA in people with newly diagnosed diabetes. METHODS: Using the Swedish national diabetes register from 2007 to 2016, we identified all individuals ≥18 years with an incident diabetes diagnosis and no previous amputation. These individuals were followed from the date of diabetes diagnosis to amputation, emigration, death, or the end of the study in 2017 using data from the In-Patient Register and the Total Population Register. The cohort consisted of 66,569 individuals. Information about demographic, socioeconomic, medical, and lifestyle risk factors was ascertained around the time of the first recorded diabetes diagnosis, derived from the above-mentioned registers. Cox proportional hazard models were used to obtain hazard ratios (HR) with 95% confidence intervals (CI). RESULTS: During the median follow-up time of 4 years, there were 133 individuals with LLA. The model adjusting for all variables showed a higher risk for LLA with higher age, HR 1.08 (95% CI 1.05-1.10), male sex, HR 1.57 (1.06-2.34), being divorced, HR 1.67 (1.07-2.60), smokers HR 1.99 (1.28-3.09), insulin treated persons HR 2.03 (1.10-3.74), people with low physical activity (PA) HR 2.05 (1.10-3.74), and people with an increased foot risk at baseline HR > 4.12. People with obesity had lower risk, HR 0.46 (0.29-0.75). CONCLUSIONS: This study found a higher risk for LLA among people with higher age, male sex, who were divorced, had a higher foot risk group, were on insulin treatment, had lower PA levels, and were smokers. No significant association was found between risk for LLA and education level, country of origin, type of diabetes, blood glucose level, hypertension, hyperlipidemia, creatinine level, or glomerular filtration rate. Obesity was associated with lower risk for LLA. Identified variables may have important roles in LLA risk among people with diabetes.

Asunto(s)

Amputación Quirúrgica , Extremidad Inferior , Humanos , Masculino , Femenino , Amputación Quirúrgica/estadística & datos numéricos , Suecia/epidemiología , Persona de Mediana Edad , Factores de Riesgo , Anciano , Adulto , Extremidad Inferior/cirugía , Pie Diabético/cirugía , Pie Diabético/epidemiología , Pie Diabético/etiología , Sistema de Registros , Estilo de Vida , Estudios de Cohortes , Modelos de Riesgos Proporcionales , Diabetes Mellitus/epidemiología

RESUMEN

OBJECTIVES: We examined how asymptomatic metabolic syndrome (MetS) in midlife affects cardiovascular (CV) morbidity and all-cause mortality later in life and studied difference in time to event and from the individual components related to MetS. DESIGN: Population-based matched cohort study including data from a screening programme for identification of CV risk factors. SETTING: Primary care, County of Västmanland, Sweden. PARTICIPANTS: All inhabitants turning 40 or 50 years between 1990 and 1999 were invited to a health screening. Total 34 269 (60.1%) individuals completed the health examination. Participants that met a modified definition of MetS were individually matched to two controls without MetS with regard to age, sex and date of health examination. INTERVENTIONS: None. MAIN OUTCOME MEASURES: CV events and all-cause mortality from the index examination to June 2022. RESULTS: All 5084 participants with MetS were matched to two controls. There were 1645 (32.4%) CV events in the MetS group and 2321 (22.8%) CV events for controls. 1317 (25.9%) MetS and 1904 (18.7%) control subjects died. The adjusted HRs (aHR) for CV event and death were significantly higher when MetS was present (aHR) 1.39*** (95% CI 1.28 to 1.50) and 1.27*** (95% CI 1.16 to 1.40) respectively. The factor analysis identified three dominating factors: blood pressure, cholesterol and blood glucose. Mean time for first CV event and death was 2.6 years and 1.5 years shorter respectively for participants within the highest quartile compared with participants with lower mean arterial blood pressure (MAP). The aHR for each 10 mm Hg increased MAP were 1.19*** (95% CI 1.15 to 1.23) for CV event and 1.16*** (95% CI 1.11 to 1.21) for death. CONCLUSION: The risk of a CV event and premature death is significantly increased when MetS is present. Early detection of metabolic risk factors, especially, high blood pressure, opens a window of opportunity to introduce preventive treatment to reduce CV morbidity and all-cause mortality.

Asunto(s)

Enfermedades Cardiovasculares , Síndrome Metabólico , Humanos , Síndrome Metabólico/epidemiología , Síndrome Metabólico/mortalidad , Síndrome Metabólico/complicaciones , Femenino , Persona de Mediana Edad , Masculino , Suecia/epidemiología , Enfermedades Cardiovasculares/mortalidad , Enfermedades Cardiovasculares/epidemiología , Adulto , Estudios de Seguimiento , Causas de Muerte , Factores de Riesgo , Estudios de Cohortes , Estudios de Casos y Controles

RESUMEN

BACKGROUND: To determine the frequency of pregnancy complications and their association with the risk of cardiovascular outcomes in women with structural heart disease (SHD). METHODS: This nationwide registry-based cohort study included women in Sweden with SHD (pulmonary arterial hypertension, congenital heart disease or acquired valvular heart disease) with singleton births registered in the national Medical Birth Register (MBR) between 1973 and 2014. Exposures were pregnancy complications; pre-eclampsia/gestational hypertension (PE/gHT), preterm birth and small for gestational age (SGA) collected from MBR. The outcomes were cardiovascular mortality and hospitalisations defined from the Cause of Death Register and the National Patient Register. Cox regression models were performed with time-dependent covariates, to determine the possible association of pregnancy complications for cardiovascular outcomes. RESULTS: Among the total of 2 134 239 women included in the MBR, 2554 women with 5568 singleton births were affected by SHD. Women without SHD (N=2 131 685) were used as a reference group. PE/gHT affected 5.8% of pregnancies, preterm birth 9.7% and SGA 2.8%. Preterm birth (adjusted HR, aHR 1.91 (95% CI 1.38 to 2.64)) was associated with an increased risk of maternal all-cause mortality. PE/gHT (aHR 1.64 (95% CI 1.18 to 2.29)) and preterm birth (aHR 1.56 (95% CI 1.19 to 2.04)) were associated with an increased risk of hospitalisations for atherosclerotic CVD. CONCLUSIONS: Pregnancy complications were frequent in women with SHD. With a median follow-up time of 22 years, preterm birth was associated with a higher risk of cardiovascular mortality, and PE/gHT and preterm birth were associated with cardiovascular morbidity. In women with SHD, pregnancy complications may provide additional information for the risk assessment of future cardiovascular outcomes.

Asunto(s)

Sistema de Registros , Humanos , Femenino , Embarazo , Adulto , Suecia/epidemiología , Medición de Riesgo/métodos , Factores de Riesgo , Factores de Tiempo , Recién Nacido , Estudios de Seguimiento , Complicaciones Cardiovasculares del Embarazo/epidemiología , Nacimiento Prematuro/epidemiología , Incidencia , Adulto Joven , Estudios Retrospectivos , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/mortalidad

Asunto(s)

Enfermedades de la Piel , Humanos , Suecia/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Adulto , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/epidemiología , Enfermedades de la Piel/terapia , Anciano , Adolescente , Adulto Joven , Programas Nacionales de Salud , Niño , Lactante , Preescolar

RESUMEN

In September 2023, 10-valent pneumococcal conjugate vaccine (PCV) was replaced by 15-valent PCV (PCV15) in Sweden's pediatric national immunization program. Following European approval of 20-valent PCV (PCV20) in March 2024, we assessed the cost-effectiveness of PCV20 versus PCV15, both under 2 + 1 schedule, among Sweden's pediatric population. A Markov state-transition model evaluated the economic and health benefits of PCV20 versus PCV15 among all ages over a 10-year time horizon. The base case adopted a Swedish payer perspective with an annual cycle length and 3.0% discount rate for costs and outcomes. Country-specific data informed population size, epidemiology, costs, and quality of life estimates. PCV15/PCV20 effect estimates were informed by PCV13 clinical effectiveness and impact studies plus PCV7 efficacy studies. Sensitivity analyses evaluated model robustness, including PCV20 under a 3 + 1 schedule. PCV20 was associated with higher quality-adjusted life year gains versus PCV15, averting an estimated 3,116 invasive pneumococcal disease cases 21,109 inpatient pneumonia cases, 6,618 outpatient pneumonia cases, and 36,209 otitis media cases, plus 3,281 pneumococcal disease-related deaths. PCV20 yielded substantial cost savings exceeding 5.4 billion SEK over a 10-year time horizon, primarily attributed to reduced direct medical costs due to improved health outcomes compared with PCV15. The findings confirmed the dominance of PCV20 in the base case, which remained robust across deterministic and probabilistic sensitivity analyses as well as scenario assessments. PCV20 was the dominant strategy versus PCV15 over 10 years. The broader serotype coverage of PCV20 suggests superior clinical and economic advantages over PCV15, warranting inclusion in Sweden's pediatric immunization program.

Asunto(s)

Análisis Costo-Beneficio , Infecciones Neumocócicas , Vacunas Neumococicas , Vacunas Conjugadas , Humanos , Vacunas Neumococicas/economía , Vacunas Neumococicas/administración & dosificación , Suecia/epidemiología , Infecciones Neumocócicas/prevención & control , Infecciones Neumocócicas/economía , Infecciones Neumocócicas/epidemiología , Preescolar , Lactante , Vacunas Conjugadas/economía , Vacunas Conjugadas/administración & dosificación , Niño , Años de Vida Ajustados por Calidad de Vida , Masculino , Femenino , Adolescente , Programas de Inmunización/economía , Cadenas de Markov , Recién Nacido

RESUMEN

The aim is to investigate the evidence for shared genetic architecture between each of asthma, allergic rhinitis and eczema with gastro-esophageal reflux disease (GERD). Structural equation models (SEM) and polygenic risk score (PRS) analyses are applied to three Swedish twin cohorts (n = 46,582) and reveal a modest genetic correlation between GERD and asthma of 0.18 and bidirectional PRS and phenotypic associations ranging between OR 1.09-1.14 and no correlations for eczema and allergic rhinitis. Linkage disequilibrium score regression is applied to summary statistics of recently published GERD and asthma/allergic disease genome wide association studies and reveals a genetic correlation of 0.48 for asthma and GERD, and Genomic SEM supports a single latent factor. A gene-/gene-set analysis using MAGMA reveals six pleiotropic genes (two at 12q13.2) associated with asthma and GERD. This study provides evidence that there is a common genetic architecture unique to asthma and GERD that may explain comorbidity and requires further investigation.

Asunto(s)

Asma , Reflujo Gastroesofágico , Estudio de Asociación del Genoma Completo , Humanos , Reflujo Gastroesofágico/genética , Asma/genética , Femenino , Masculino , Predisposición Genética a la Enfermedad , Suecia/epidemiología , Adulto , Persona de Mediana Edad , Herencia Multifactorial , Hipersensibilidad/genética , Desequilibrio de Ligamiento

RESUMEN

INTRODUCTION: Limited data exists on oncological outcomes following rectal cancer surgery in men who have previously been diagnosed with prostate cancer (PC). This study aimed to assess overall mortality and rectal cancer recurrence in men previously diagnosed with PC who underwent bowel resection. METHODS: Data from the Swedish Colorectal Cancer Registry identified men who had rectal cancer surgery between 2000 and 2016, and the National Prostate Cancer Registry was used to identify those with a prior PC diagnosis. Cox regression analysis with propensity score matching was employed for data analysis. The primary outcome was overall mortality. Secondary outcome was recurrence for rectal cancer. RESULTS: Out of 13,299 men undergoing bowel resection for rectal cancer between 2000 and 2016, 1130 had a history of PC. Overall mortality did not significantly differ between men with and without a prior PC diagnosis. Cox regression analyses with propensity score matching revealed that men with previously diagnosed low- or intermediate-risk (HR, 0.79; 95% CI, 0.70-0.90) and high-risk PC (HR, 0.85; 95% CI, 0.74-0.98) had lower overall mortality after rectal cancer surgery compared with men without a PC. There was no significant difference in rectal cancer recurrence between men with a previous low or intermediate-risk PC (HR, 0.92; 95% CI, 0.74-1.14) or high-risk PC (HR, 0.73; 95% CI, 0.52-1.01) compared with those without PC history. CONCLUSION: Men undergoing rectal cancer surgery with a previous diagnosis of prostate cancer do not experience an increased risk of rectal cancer recurrence or overall mortality compared with men without a previous history of prostate cancer.

Asunto(s)

Recurrencia Local de Neoplasia , Neoplasias de la Próstata , Neoplasias del Recto , Sistema de Registros , Humanos , Masculino , Suecia/epidemiología , Neoplasias de la Próstata/mortalidad , Neoplasias de la Próstata/cirugía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/diagnóstico , Neoplasias del Recto/mortalidad , Neoplasias del Recto/cirugía , Neoplasias del Recto/patología , Anciano , Factores de Riesgo , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Puntaje de Propensión , Anciano de 80 o más Años

RESUMEN

Endometriosis and provoked vestibulodynia (PVD) are prevalent pain conditions among women of reproductive age, significantly impacting their quality of life and psychological well-being. However, comprehensive evidence regarding the lifelong health and socioeconomic outcomes for these individuals remains scarce. Additionally, many prior studies rely on limited and sometimes unrepresentative samples. This study aims to inform on the long-term consequences of these disorders by examining health, fertility, and employment outcomes in a cohort of women diagnosed with endometriosis and/or PVD, tracing their experiences from childhood to their 40s. Leveraging nationwide administrative data from Sweden and employing a matched case-control design, we investigate both similarities and differences between women with these diagnoses and those without. Our findings indicate that women diagnosed with endometriosis and/or PVD demonstrate elevated healthcare utilization patterns, commencing in their early teenage years and progressively increasing over time. Notably, disparities in labor market outcomes emerge in their 20s, showcasing lower labor earnings and a rise in sickness benefit receipt. Moreover, our results show a higher likelihood among these women to experience mental health disorders and concurrent chronic pain diseases, as well as infertility. While the association between endometriosis and infertility is well-documented, this study offers novel insights into a potential similar link between PVD and infertility. Our study informs healthcare professionals and policymakers about the considerable burden of compromised health, adverse psychosocial well-being, and reduced productivity in the labor market faced by young women with these common pain conditions. These findings underscore the urgency of addressing the multifaceted challenges encountered by individuals diagnosed with endometriosis and PVD across their lifespan.

Asunto(s)

Endometriosis , Sistema de Registros , Vulvodinia , Humanos , Femenino , Endometriosis/psicología , Endometriosis/complicaciones , Endometriosis/epidemiología , Suecia/epidemiología , Adulto , Vulvodinia/psicología , Vulvodinia/epidemiología , Adulto Joven , Estudios Longitudinales , Adolescente , Calidad de Vida , Factores Socioeconómicos , Estudios de Casos y Controles , Persona de Mediana Edad , Empleo , Infertilidad Femenina/psicología , Infertilidad Femenina/epidemiología

RESUMEN

Turner syndrome (TS) is a genetic condition characterized by partial or complete monosomy X. A reduced life expectancy has been shown in TS, depending on an increased risk of aortic dissection, and ischemic heart disease. Studies covering the occurrence of psychiatric conditions are sparse within TS. Several case reports describe concomitant TS and neuropsychiatric abnormalities that may represent a pathogenetic link to genetics, as well as feature correlates of TS. The aim of this study was to determine the presence, and the frequency of psychiatric diagnosis in women with TS in a Swedish cohort followed during 25 years' time. Statistics from the entire female population in Sweden of corresponding age was used as reference. Data were retrieved from clinical examinations and validated from the National Board of Health and Welfare registries for women with TS (n = 487), aged 16 to 84 years, with respect to mental health disorders. The most common diagnoses in TS were mood and anxiety disorders. There was no increase in psychiatric diagnosis within the group with time, nor correlation to specific karyotype or somatic comorbidity as congenital heart disease and hypothyroidism, hormonal treatment, or childbirth. In addition, the frequency of psychiatric diagnosis in TS was lower than in the population-based data. Further investigations are needed in the view of the fact that women with Turner syndrome should not be burdened with more severe diagnoses.

Asunto(s)

Comorbilidad , Trastornos Mentales , Síndrome de Turner , Humanos , Síndrome de Turner/epidemiología , Síndrome de Turner/complicaciones , Síndrome de Turner/genética , Femenino , Adulto , Persona de Mediana Edad , Suecia/epidemiología , Adolescente , Adulto Joven , Anciano , Estudios Retrospectivos , Anciano de 80 o más Años , Trastornos Mentales/epidemiología , Sistema de Registros , Trastornos de Ansiedad/epidemiología , Trastornos del Humor/epidemiología , Estudios de Cohortes

RESUMEN

BACKGROUND: Most studies about accidents and about PTSD, respectively, have been conducted either on blue-collar workers, or on the entire working population. There are very few such studies on white-collar workers. AIM: To examine diagnosis-specific sickness absence (SA) and disability pension (DP) after a work accident or PTSD, respectively, among white-collar workers in the private retail and wholesale industry. METHODS: A prospective population-based cohort study of all 192,077 such workers aged 18-67 (44% women) in Sweden in 2012, using linked microdata from nationwide registers. We identified individuals who had secondary healthcare due to work-related accidents (n = 1114; 31% women) or to PTSD (n = 216; 79% women) in 2012-2016. Their average number of net days of diagnosis-specific SA (in SA spells > 14 days) and DP were calculated for 365 days before and 365 days after the healthcare visit. RESULTS: 35% of the women and 24% of the men had at least one new SA spell during the 365 days after healthcare due to work accidents. Among women, the average number of SA/DP days increased from 14 in the year before the visit to 31 days the year after; among men from 9 to 21 days. SA days due to fractures and other injuries increased most, while SA days due to mental diagnoses increased somewhat. 73% of women and 64% of men who had healthcare due to PTSD had at least one new SA spell in the next year. Women increased from 121 to 157 SA/DP days and men from 112 to 174. SA due to stress-related disorders and other mental diagnoses increased the most, while DP due to stress-related diagnoses and SA due to musculoskeletal diagnoses increased slightly. CONCLUSIONS: About a quarter of those who had secondary healthcare due to work accidents, and the majority of those with such healthcare due PTSD, had new SA in the following year. SA due to injury and mental diagnoses, respectively, increased most, however, SA/DP due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP in different diagnoses after work accidents and among people with PTSD.

Asunto(s)

Accidentes de Trabajo , Ausencia por Enfermedad , Trastornos por Estrés Postraumático , Humanos , Suecia/epidemiología , Masculino , Femenino , Adulto , Persona de Mediana Edad , Ausencia por Enfermedad/estadística & datos numéricos , Trastornos por Estrés Postraumático/epidemiología , Adolescente , Accidentes de Trabajo/estadística & datos numéricos , Estudios Longitudinales , Adulto Joven , Anciano , Estudios Prospectivos , Industrias/estadística & datos numéricos , Pensiones/estadística & datos numéricos , Comercio/estadística & datos numéricos

RESUMEN

BACKGROUND: Despite the detrimental impact of abnormal glucose metabolism on cardiovascular prognosis after myocardial infarction (MI), diabetes is both underdiagnosed and undertreated. We investigated associations between structured diabetes care routines in cardiac rehabilitation (CR) and detection and treatment of diabetes at one-year post-MI. METHODS: Center-level data was derived from the Perfect-CR survey, which evaluated work routines applied at Swedish CR centers (n = 76). Work routines involving diabetes care included: (1) routine assessment of fasting glucose and/or HbA1c, (2) routine use of oral glucose tolerance test (OGTT), (3) having regular case rounds with diabetologists, and (4) whether glucose-lowering medication was adjusted by CR physicians. Patient-level data was obtained from the national MI registry SWEDEHEART (n = 7601, 76% male, mean age 62.6 years) and included all post-MI patients irrespective of diabetes diagnosis. Using mixed-effects regression we estimated differences between patients exposed versus. not exposed to the four above-mentioned diabetes care routines. Outcomes were newly detected diabetes and the proportion of patients receiving oral glucose-lowering medication at one-year post-MI. RESULTS: Routine assessment of fasting glucose/HbA1c was performed at 63.2% (n = 48) of the centers, while 38.2% (n = 29) reported using OGTT for detecting glucose abnormalities. Glucose-lowering medication adjusted by CR physicians (n = 13, 17.1%) or regular case rounds with diabetologists (n = 7, 9.2%) were less frequently reported. In total, 4.0% of all patients (n = 304) were diagnosed with diabetes during follow-up and 17.9% (n = 1361) were on oral glucose-lowering treatment one-year post-MI. Routine use of OGTT was associated with a higher rate of newly detected diabetes at one-year (risk ratio [95% confidence interval]: 1.62 [1.26, 1.98], p = 0.0007). At one-year a higher proportion of patients were receiving oral glucose-lowering medication at centers using OGTT (1.22 [1.07, 1.37], p = 0.0046) and where such medication was adjusted by CR physicians (1.31 [1.06, 1.56], p = 0.0155). Compared to having none of the structured diabetes care routines, the more routines implemented the higher the rate of newly detected diabetes (from 0 routines: 2.7% to 4 routines: 6.3%; p for trend = 0.0014). CONCLUSIONS: Having structured routines for diabetes care implemented within CR can improve detection and treatment of diabetes post-MI. A cluster-randomized trial is warranted to ascertain causality.

Asunto(s)

Biomarcadores , Glucemia , Rehabilitación Cardiaca , Diabetes Mellitus , Prueba de Tolerancia a la Glucosa , Hemoglobina Glucada , Hipoglucemiantes , Infarto del Miocardio , Sistema de Registros , Humanos , Masculino , Femenino , Persona de Mediana Edad , Glucemia/metabolismo , Glucemia/efectos de los fármacos , Suecia/epidemiología , Anciano , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/rehabilitación , Infarto del Miocardio/terapia , Infarto del Miocardio/epidemiología , Infarto del Miocardio/sangre , Resultado del Tratamiento , Hipoglucemiantes/uso terapéutico , Hemoglobina Glucada/metabolismo , Factores de Tiempo , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiología , Diabetes Mellitus/sangre , Diabetes Mellitus/terapia , Biomarcadores/sangre , Valor Predictivo de las Pruebas , Control Glucémico , Encuestas de Atención de la Salud , Pautas de la Práctica en Medicina

RESUMEN

Importance: Neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are increasingly common. Individuals with NDDs have heightened obesity risks, but long-term data on body mass index (BMI) trends over time in this population are lacking. Objective: To assess secular BMI changes from 2004 to 2020 among children with NDDs compared with those without NDDs. Design, Setting, and Participants: This repeated cross-sectional study used data from the Child and Adolescent Twin Study in Sweden. Children born between January 1, 1992, and December 31, 2010, were screened for neurodevelopmental symptoms using the Autism-Tics, ADHD, and Other Comorbidities inventory between July 2004 and April 2020 when they were 9 or 12 years of age. Data analysis was conducted between September 27, 2023, and January 30, 2024. Main Outcomes and Measures: BMI percentiles (15th, 50th, and 85th) were modeled using quantile regression and compared between youths with and without NDDs. Secular changes in BMI percentiles over time spanning 2004 to 2020 were evaluated and stratified by NDD subtype. Results: The cohort included 24 969 Swedish twins (12 681 [51%] boys) born between 1992 and 2010, with mean (SD) age of 9 (0.6) years. Of these, 1103 (4%) screened positive for 1 or more NDDs, including ADHD, ASD, and/or learning disability. Results indicated that at the 85th BMI percentile, there was a greater increase in BMI from 2004 to 2020 among youths with NDDs compared with those without NDDs (ß for interaction [ßint] between NDD status and time, 1.67; 95% CI, 0.39-2.90). The greatest divergence was seen for ASD (ßint, 2.12; 95% CI, 1.26-3.70) and learning disability (ßint, 1.92; 95% CI, 0.65-3.82). Within the latest cohort (2016-2020), the 85th BMI percentile was 1.99 (95% CI, 1.08-2.89) points higher among children with NDDs compared with those without NDDs. Conclusions and Relevance: In this repeated cross-sectional study, at the higher end of the BMI distribution, children with NDDs had significantly greater increases in BMI compared with peers without NDDs over a 16-year period, highlighting an increasing risk of overweight over time in youths with NDDs compared with those without NDDs. Targeted obesity prevention efforts for this high-risk population are needed.

Asunto(s)

Índice de Masa Corporal , Trastornos del Neurodesarrollo , Humanos , Femenino , Masculino , Niño , Estudios Transversales , Suecia/epidemiología , Trastornos del Neurodesarrollo/epidemiología , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Trastorno del Espectro Autista/epidemiología , Adolescente , Obesidad Infantil/epidemiología

RESUMEN

This retrospective study analyzed prognostic factors for neurological improvement and ambulation in 194 adult patients (≥ 15 years) with traumatic cervical spinal cord injuries treated at the neurological SCI unit (SCIU) at the Karolinska University Hospital Stockholm, Sweden, between 2010 and 2020. The primary outcome was American spinal injury association impairment scale (AIS) improvement, with secondary focus on ambulation restoration. Results showed 41% experienced AIS improvement, with 51% regaining ambulation over a median follow-up of 3.7 years. Significant AIS improvement (p < 0.001) and reduced bladder/bowel dysfunction (p < 0.001) were noted. Multivariable analysis identified initial AIS C-D (< 0.001), central cord syndrome (p = 0.016), and C0-C3 injury (p = 0.017) as positive AIS improvement predictors, while lower extremity motor score (LEMS) (p < 0.001) and longer ICU stays (p < 0.001) were negative predictors. Patients with initial AIS C-D (p < 0.001) and higher LEMS (p < 0.001) were more likely to regain ambulation. Finally, older age was a negative prognostic factor (p = 0.003). In conclusion, initial injury severity significantly predicted neurological improvement and ambulation. Recovery was observed even in severe cases, emphasizing the importance of tailored rehabilitation for improved outcomes.

Asunto(s)

Médula Cervical , Recuperación de la Función , Traumatismos de la Médula Espinal , Humanos , Traumatismos de la Médula Espinal/rehabilitación , Traumatismos de la Médula Espinal/fisiopatología , Femenino , Masculino , Persona de Mediana Edad , Adulto , Estudios Retrospectivos , Anciano , Médula Cervical/lesiones , Pronóstico , Caminata , Adulto Joven , Adolescente , Resultado del Tratamiento , Suecia/epidemiología , Vértebras Cervicales/lesiones , Vértebras Cervicales/fisiopatología , Anciano de 80 o más Años

RESUMEN

Importance: Metabolic dysfunction-associated steatotic liver disease (MASLD) has become the most common chronic liver disease worldwide and is increasingly being diagnosed at younger ages, affecting more than one-third of young people with obesity. Objective: To evaluate associations between perinatal conditions and risk of MASLD and associated progressive liver disease. Design, Setting, and Participants: This nationwide, population-based case-control study included all biopsy-confirmed cases of MASLD in Sweden. Individuals aged 25 years or younger (hereafter, young individuals) with biopsy-proven MASLD between January 1, 1992, and December 31, 2016, were matched to up to 5 general population control individuals. Granular data on maternal and perinatal characteristics were retrieved from the Swedish Medical Birth Register. Data were analyzed from June 2023 to June 2024. Exposures: Birth weight (low [<2500 g], reference [2500 to <4000 g], or high [≥4000 g]), gestational age (GA), and birth weight for GA (small for GA [SGA; <10th percentile], appropriate for GA [10th-90th percentile], or large for GA [LGA; >90th percentile]), compared between patients and matched controls. Main Outcomes and Measures: The main outcome was odds of biopsy-proven MASLD and MASLD-associated progressive liver disease (ie, liver fibrosis or cirrhosis) according to birth weight, GA, and birth weight for GA, adjusted for matching factors. Results: In total, 165 young individuals with biopsy-proven MASLD (median age at diagnosis: 12.0 years [IQR, 4.4-16.9 years]; 100 [60.6%] male) were matched with 717 controls. There was an association between low birth weight and future development of MASLD (adjusted odds ratio [AOR], 4.05; 95% CI, 1.85-8.88) but no association between high birth weight and odds of MASLD (AOR, 0.64; 95% CI, 0.38-1.08) compared with the reference birth weight. An association was seen for SGA (AOR, 3.36; 95% CI, 2.00-5.64) compared with appropriate size for GA (reference category) but not for LGA (AOR, 0.57; 95% CI, 0.27-1.20). Progressive liver disease was more common in individuals born with low birth weight (AOR, 6.03; 95% CI, 1.66-21.87) or SGA (AOR, 4.90; 95% CI, 2.15-11.14). Conclusions and Relevance: In this nationwide study of young individuals with biopsy-proven MASLD, low birth weight and SGA were associated with development of MASLD and progressive liver disease, suggesting a need for structured screening measures to diagnose these conditions early in high-risk individuals.

Asunto(s)

Peso al Nacer , Edad Gestacional , Humanos , Femenino , Estudios de Casos y Controles , Masculino , Suecia/epidemiología , Adolescente , Niño , Factores de Riesgo , Recién Nacido , Hígado Graso/epidemiología , Preescolar , Adulto , Adulto Joven

RESUMEN

Peyronie's disease (PD) has detrimental effects on the quality of life, mental health, sexual functioning and several other aspects that increase the risk of relationship problems. However, no study to date has assessed the risk of relationship separation in med with PD. Herein, we utilized data from Swedish national registers to examine the risk of relationship separation in men with PD. We conducted a matched cohort study on men born 1933-1992, followed from 1997 to 2013. PD was defined as a physician-assigned diagnosis according to the International Classification of Diseases, Tenth version. Each man with PD (n = 8020) was matched with 10 comparison men. We defined relationship separation as (1) ever separated, and (2) separation rate. We used log-linear regression to estimate the risk ratio, and rate ratio of relationship separation. We adjusted for matching variables (birth year and country of birth), and an indicator of each follow-up year. We found that men with PD had a 13% increased risk of relationship separation (risk ratio 1.13, 95% confidence interval [CI] 1.08-1.17). The rate of relationship separation events, measured on a yearly basis, was increased by 18% (rate ratio 1.18, CI 1.12-1.24), and remained similar when adjusting for follow-up year and socio-economic status.

Asunto(s)

Induración Peniana , Humanos , Masculino , Induración Peniana/epidemiología , Suecia/epidemiología , Persona de Mediana Edad , Anciano , Estudios de Cohortes , Factores de Riesgo , Calidad de Vida , Adulto , Sistema de Registros

RESUMEN

Purpose: We aimed to analyze the risk of hereditary hemochromatosis (HH) among first-generation and second-generation immigrants in Sweden using Swedish-born individuals and Swedish-born individuals with Swedish-born parents as referents, respectively. Methods: All individuals aged 18 years of age and older, n = 6,180,500 in the first-generation study, and n = 4,589,930 in the second-generation study were included in the analyses. HH was defined as at least one registered diagnosis International Classification of Diseases 10th edition (E83.1) in the National Patient Register between January 1, 1998 and December 31, 2018. Cox regression was used to estimate the hazard ratios (HRs) with 99% confidence intervals (CI) owing to multiple testing, of incident HH with adjustments for age, cancer, other comorbidities, and socio-demographics. Results: In the first-generation study, there were 5,112 cases of HH, and in the second-generation study 4,626 cases of HH. The adjusted HRs for first-generation men and women overall were 0.72 (99% CI: 0.63-0.82) and 0.61 (99% CI: 0.52-0.72), respectively, and for the second-generation men and women 0.72 (99% CI: 0.62-0.83) and 0.97 (99% CI: 0.83-1.14), respectively, with a higher risk found only among first-generation men from Western Europe, HR 1.47 (99% CI: 1.05-2.06), compared to the control group. Conclusions: Our findings indicate that the overall risk of HH was lower among both first-generation and second-generation immigrants when compared to individuals born in Sweden or with Swedish-born parents. An elevated risk for HH was observed exclusively among first-generation men originating from Western Europe. These findings represent new knowledge and should be of global interest.

Asunto(s)

Emigrantes e Inmigrantes , Hemocromatosis , Humanos , Suecia/epidemiología , Hemocromatosis/genética , Masculino , Femenino , Adulto , Persona de Mediana Edad , Estudios de Cohortes , Anciano , Factores de Riesgo , Modelos de Riesgos Proporcionales , Adulto Joven , Adolescente , Sistema de Registros , Incidencia

RESUMEN

OBJECTIVE: To measure the 1 year cumulative incidence of and analyse the risk factors associated with workplace violence directed towards the ambulance service in a Swedish region. DESIGN: Prospective cohort study. SETTING: The ambulance services in Örebro County Council (Sweden) contain approximately 300 000 inhabitants. PARTICIPANTS: All ambulance missions during the period of 12 months (n=28 640) were assessed. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was workplace violence together with the associated risk factors. RESULTS: The 1 year cumulative incidence of workplace violence within the ambulance service was 0.7%. Non-physical violence was most common. There was an increased odds for violence when the patient was under the influence of alcohol or drugs or suffering from mental illness. There was an association between the dispatch categories intoxication, unconsciousness or mental health problems and workplace violence against ambulance personnel. The offenders were mostly men aged 18-29 and workplace violence was more likely to occur in public places. CONCLUSIONS: The 1 year cumulative incidence of workplace violence within the regional ambulance service was low in comparison to that of previous research. The overall regression model had low explanatory power, indicating that the phenomenon is complex and that additional variables need to be taken into account when trying to predict when workplace violence will occur. Additional research is needed to fully understand why workplace violence within the ambulance service occurs and how to mitigate such situations.

Asunto(s)

Ambulancias , Violencia Laboral , Humanos , Suecia/epidemiología , Masculino , Estudios Prospectivos , Adulto , Factores de Riesgo , Ambulancias/estadística & datos numéricos , Violencia Laboral/estadística & datos numéricos , Femenino , Incidencia , Persona de Mediana Edad , Adulto Joven , Adolescente , Anciano