RESUMO
BACKGROUND: Oral health problems are common among care-dependent older adults living in nursing homes. Developing strategies to prevent the deterioration of oral health is therefore crucial to avoid pain and tooth loss. A standardized work widely used in nursing homes in Sweden is the quality register Senior Alert (SA), which assesses age-related risks concerning e.g. pressure sores, falls, malnutrition and oral health. The oral health assessment is performed with the Revised Oral Assessment Guide-Jönköping (ROAG-J), which also includes planning and implementation of preventive oral care interventions with the goal of achieving good quality care. However, what facilitates and hinders healthcare workers in working with oral health in SA remains unexplored. The aim of this study was to describe healthcare workers' experiences of assessing oral health with the ROAG-J, planning and performing preventive oral health care actions in accordance with SA in nursing homes. METHODS: Healthcare workers (n = 28) in nursing homes in two Swedish municipalities participated and data was collected through six focus group interviews. Reflexive thematic analysis was used to identify patterns of meaning in the data. RESULTS: Themes generated in the analysis were: (1) A structured process promotes communication and awareness and stresses the importance of oral health; (2) Oral care for frail older adults is challenging and triggers ethical dilemmas; (3) Unclear responsibilities, roles and routines in the organization put oral health at risk; (4) Differences in experience and competence among healthcare staff call for educational efforts. CONCLUSIONS: The structured way of working increases staff awareness and prioritization of oral health in nursing homes. The main challenges for the healthcare workers were residents' reluctance to participate in oral care activities and oral care being more complicated since most older adults today are dentate. Organizational challenges lay in creating good routines and clarifying staff roles and responsibilities, which will require continuous staff training and increased management involvement.
Assuntos
Pessoal de Saúde , Casas de Saúde , Saúde Bucal , Pesquisa Qualitativa , Humanos , Saúde Bucal/normas , Masculino , Pessoal de Saúde/psicologia , Feminino , Pessoa de Meia-Idade , Adulto , Suécia/epidemiologia , Idoso , Instituição de Longa Permanência para Idosos , Grupos Focais/métodosRESUMO
BACKGROUND: Identifying problem drinking patterns across industries is essential for addressing drinking problems in the workforce. Still, it is not well understood how problem drinking differs across industries and whether it is associated with industry gender composition. This study aimed to measure the prevalence of problem drinking (PPD) across Swedish industries and investigate possible associations between gender-typed industries and problem drinking. METHODS: 9,155 current workers were selected from the Swedish Longitudinal Occupational Survey of Health (SLOSH) data collected in 2020. Participants' work industries were identified through the Swedish Standard Industrial Classification (SNI) codes. Seven gender-typed industry categories were created based on gender composition and main job activity in each industry. Self-reported problem drinking was measured using a slightly modified Cut-down, Annoyed, Guilt, Eye-opener (CAGE) questionnaire and a cut-off score 2 was used to determine problem drinking. Poisson regression with robust standard errors was used to investigate the association between gender-typed industries and problem drinking. RESULTS: PPD in the workforce was 6.6%. Men (8.5%) had a higher prevalence than women (5.3%). Across industries, PPD varied from 2.3% in Water supply and waste management to 15.4% in Mining and quarrying. The highest prevalence for men was in Mining and quarrying (18.2%), whereas for women it was in Construction (11.1%). Within gender-typed industries, the highest PPD was in male-dominated Goods and Energy Production (7.7%), and the lowest was in female-dominated Health and Social Care (4.7%). In the regression analysis, both Education (aPR: 1.39, p = 0.03) and Labour-intensive Services (aPR: 1.39, p = 0.02) had higher adjusted prevalence ratios (aPR) compared with Health and Social Care. However, there was no significant difference in aPR among gender-typed industries when considering the gender composition of industries only. CONCLUSIONS: PPD in the Swedish workforce varied significantly across industries, with differences observed between men and women. Problem drinking differed between industries when categorized by gender composition and main job activity, but not when categorized by gender composition only. Future research should investigate how industry-specific psychosocial factors influence individual alcohol consumption.
Assuntos
Indústrias , Humanos , Suécia/epidemiologia , Masculino , Feminino , Adulto , Prevalência , Pessoa de Meia-Idade , Indústrias/estatística & dados numéricos , Fatores Sexuais , Adulto Jovem , Alcoolismo/epidemiologia , Estudos Longitudinais , Ocupações/estatística & dados numéricos , AdolescenteRESUMO
Middle-aged adults engaging in unhealthy lifestyle behaviors are at higher risk of chronic diseases. However, little is known about the co-occurrence of these behaviors and their determinants. This cohort study examined the co-occurrence of unhealthy lifestyle behaviors (alcohol consumption, diet, physical inactivity, and smoking) in 30,154 middle-aged adults and their associations with sociodemographic factors, social support, and disease history. Alcohol use was measured by the AUDIT, diet by the MiniMeal-Q, and physical inactivity and smoking by single questions. Participants had a mean age of 58 years, with 51% being female. Of them, 14% had no unhealthy behaviors, 38% had one, 36% had two, 10% had three, and 2% had all four. The most common co-occurrence was between physical inactivity and poor diet (38%). Higher education decreased the likelihood of having three or four unhealthy behaviors, while financial difficulties, having no one around who appreciated one's efforts, and suffering of a lung disease increased it. In conclusion, middle-aged adults exhibit varying levels of unhealthy lifestyle behaviors. Higher education is linked to reduced engagement in multiple unhealthy behaviors, whereas financial strain, lower quality of social support, and lung disease increase the risk.
Assuntos
Estilo de Vida , Humanos , Feminino , Masculino , Pessoa de Meia-Idade , Suécia/epidemiologia , Fumar/epidemiologia , Comportamentos Relacionados com a Saúde , Consumo de Bebidas Alcoólicas/epidemiologia , Comportamento Sedentário , Dieta , Estudos de Coortes , Idoso , Apoio Social , Fatores de RiscoRESUMO
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.
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COVID-19 , Transtornos da Alimentação e da Ingestão de Alimentos , Autorrelato , Humanos , Suécia/epidemiologia , Adolescente , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Feminino , Masculino , Criança , COVID-19/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Prevalência , SARS-CoV-2 , Psiquiatria Infantil , Psiquiatria do AdolescenteRESUMO
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.
Assuntos
Emigrantes e Imigrantes , Hemocromatose , Humanos , Suécia/epidemiologia , Hemocromatose/genética , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estudos de Coortes , Idoso , Fatores de Risco , Modelos de Riscos Proporcionais , Adulto Jovem , Adolescente , Sistema de Registros , IncidênciaRESUMO
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.
Assuntos
Medula Cervical , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal , Humanos , Traumatismos da Medula Espinal/reabilitação , Traumatismos da Medula Espinal/fisiopatologia , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Idoso , Medula Cervical/lesões , Prognóstico , Caminhada , Adulto Jovem , Adolescente , Resultado do Tratamento , Suécia/epidemiologia , Vértebras Cervicais/lesões , Vértebras Cervicais/fisiopatologia , Idoso de 80 Anos ou maisRESUMO
BACKGROUND: Swine dysentery, caused by Brachyspira hyodysenteriae, is a severe pig disease. Resistance to tylosins is common and resistance to tiamulin has been reported since the 1990s. Still, dysentery is not notifiable to authorities. The disease therefore escapes control from an overall population perspective. In Sweden, a program that aimed to control dysentery at national level was initiated in 2020, mainly due to the unexpected diagnosis of tiamulin resistant Brachyspira hyodysenteriae in 2016. RESULTS: Through joint efforts of a network including farmers, government, animal health organisations and abattoirs it was concluded that outbreaks of dysentery had taken place in 25 herds between 2016 and 2019. By 1 January 2020, nine of these herds were still not declared free from the disease. From that date, the network decided that Brachyspira hyodysenteriae was to be cultured whenever dysentery could be suspected. Thus, 148, 157 and 124 herds were scrutinised for Brachyspira hyodysenteriae in 2020, 2021 and 2022, respectively, whereof five, three and two new herds were confirmed positive. By 31 December 2022, four herds were judged as impossible to sanitise. However, they posed no problem since they were identified by the network, pigs to and from these enterprises could be transported without jeopardising other herds. When Brachyspira hyodysenteriae was diagnosed in fattening herds purchasing growers, Brachyspira hyodysenteriae could not be detected in the delivering herds. That result, together with other observations, indicated that Brachyspira hyodysenteriae ought to be regarded as ubiquitous, although at a low level in healthy pigs. CONCLUSIONS: Eradication of dysentery contributed to substantial welfare and financial improvements in affected herds. Dysentery was controlled successfully at national level through the united efforts from competing stake holders, such as different abattoirs and animal health organisations. However, as Brachyspira hyodysenteriae was assumed to be ubiquitous, although at a low level in healthy pigs, the duration of the successful control of dysentery was concluded to only be transient. Without permanent monitoring for Brachyspira hyodysenteriae, the knowledge of the national status will rapidly decline to the level prior to the initiation of the control program.
Assuntos
Brachyspira hyodysenteriae , Disenteria , Infecções por Bactérias Gram-Negativas , Doenças dos Suínos , Animais , Suécia/epidemiologia , Doenças dos Suínos/microbiologia , Doenças dos Suínos/epidemiologia , Doenças dos Suínos/prevenção & controle , Suínos , Infecções por Bactérias Gram-Negativas/veterinária , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Disenteria/veterinária , Disenteria/epidemiologia , Disenteria/microbiologia , Surtos de Doenças/veterináriaRESUMO
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.
Assuntos
COVID-19 , Cuidado Pós-Natal , Pesquisa Qualitativa , Humanos , COVID-19/epidemiologia , COVID-19/psicologia , Feminino , Gravidez , Suécia/epidemiologia , Adulto , Masculino , SARS-CoV-2 , Pandemias , Trabalho de Parto/psicologia , Pessoa de Meia-Idade , Cônjuges/psicologiaRESUMO
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.
Assuntos
Arritmias Cardíacas , Pênfigo Familiar Benigno , Humanos , Arritmias Cardíacas/genética , Feminino , Masculino , Pênfigo Familiar Benigno/genética , Pênfigo Familiar Benigno/complicações , Pessoa de Meia-Idade , Adulto , Suécia/epidemiologia , Idoso , Estudos de Coortes , ATPases Transportadoras de Cálcio/genética , ATPases Transportadoras de Cálcio/metabolismo , Fatores de Risco , Estudos de Casos e ControlesRESUMO
Heart transplant patients have an increased risk of developing cancer. Patients who underwent HTx between 1985 and 2017 were included. Detection of cancer was obtained by cross-checking the study population with the Swedish Cancer-Registry and the Cause-of-Death-Registry. A total of 664 patients were followed for a median of 7.7 years. In all, 231 malignancies were diagnosed in 138 patients. Compared to the general population the excess risk of cancer following HTx was 6.2-fold calculated as the standardized incidence ratio (SIR) and 2.9-fold after exclusion of non-melanoma skin cancer (NMSC). The most common malignancies were NMSC, non-Hodgins lymphoma, and lung cancer. There was no significant difference in overall survival between those with and without a history of cancer before HTx (p = 0.53). During a median follow-up of 7.7 years, 19% of HTx recipients developed cancer, 6.2-fold higher relative to the general population, and 2.9-fold higher when excluding NMSC. Risk factors for malignancies (excluding NMSC) included previous smoking, hypertension and prolonged ischemic time; and for NMSC, increasing age, seronegative CMV-donors, and azathioprine. A previous cancer in selected recipients results in similar survival compared to those without cancer prior to HTx.
Assuntos
Transplante de Coração , Neoplasias , Humanos , Transplante de Coração/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Suécia/epidemiologia , Fatores de Risco , Neoplasias/epidemiologia , Neoplasias/etiologia , Incidência , Idoso , Sistema de Registros , Neoplasias Cutâneas/etiologia , Neoplasias Cutâneas/epidemiologia , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologiaRESUMO
Lung transplantation (LTx) is a well-known treatment for end-stage lung disease. This study aimed to report the incidence of cancer after LTx and long-term outcome among lung transplant recipients with a pretransplant diagnosis of cancer. Patients who underwent LTx between 1990-2016 were included in the study. Detection of cancer was obtained by cross-checking the study population with the Swedish Cancer Registry and the Cause-of-Death registry. A total of 614 patients were followed for a median of 5.1 years. In all, 159 malignancies were diagnosed. The excess risk of cancer or standardized incidence ratio (SIR) following LTx was 5.6-fold compared to the general Swedish population. The most common malignancies were non-melanoma skin cancer (NMSC) (SIR 76.5 (95%CI 61.7-94.8); non-Hodgkin lymphoma (SIR 23.5, 95%CI 14.8-37.2); and lung cancer (SIR 8.89, 95%CI 5.67-13.9). There was no significant difference in overall survival between those with and without a history of cancer before LTx (p = 0.56). In total, 159 malignancies were identified after LTx, which was a 5.6-fold higher relative to the general population. A history of previous cancer yields similar survival in selected recipients, compared to those without cancer prior to LTx.
Assuntos
Transplante de Pulmão , Sistema de Registros , Humanos , Transplante de Pulmão/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Suécia/epidemiologia , Adulto , Incidência , Idoso , Neoplasias/epidemiologia , Neoplasias/etiologia , Neoplasias Pulmonares/epidemiologia , Adulto Jovem , Neoplasias Cutâneas/epidemiologia , Neoplasias Cutâneas/etiologia , Fatores de Risco , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologiaRESUMO
BACKGROUND: Metformin is a hypoglycaemic medication that has been proposed to treat or prevent preeclampsia. Combining national birth data from Scotland and Sweden, we investigated whether metformin used during pregnancy was associated with an altered risk of developing a hypertensive disorder of pregnancy. METHODS: We utilised data from two population-based cohorts: Scotland (2012-2018) and Sweden (2007-2019). Nulliparous women with gestational diabetes or type 2 diabetes who had birth outcome data linked with medications prescribed during pregnancy were included. The association between metformin prescription and hypertensive disorders of pregnancy was characterised using inverse probability weighted regression analysis, adjusting for variables that predict metformin use and potential confounders. Adverse neonatal outcomes were included as secondary outcomes. Results from both countries were then combined in a meta-analysis using a random effects model. RESULTS: The Scottish cohort included 3859 women with gestational diabetes or type 2 diabetes. Of these women, 30.8% (n = 1187) received at least one metformin prescription during pregnancy. For Sweden, 7771 women with gestational diabetes were included where 19.3% (1498) used metformin during pregnancy. Metformin prescription was not associated with an altered risk of any hypertensive disorder of pregnancy (Scotland adjusted relative risk (aRR) 0.88 [95% confidence interval (CI) 0.66-1.19]; Sweden aRR 1.08 [95% CI 0.86-1.37]) or preeclampsia (Scotland aRR 1.02 [95% CI 0.66-1.60]; Sweden aRR 1.00 [95% CI 0.72-1.39]). Combining adjusted results in a meta-analysis produced similar findings, with a pooled RR of 0.98 (95% CI 0.79-1.18) for any hypertensive disorder and RR 1.01 ([95% CI 0.73-1.28]) for preeclampsia. For neonatal outcomes, metformin was associated with a reduced risk of birthweight > 4500 g in Scotland (aRR 0.39 [95% CI 0.21-0.71]) but not in Sweden. There was no association between metformin and preterm birth or birthweight < 3rd or < 10th percentiles. Pooling results from both countries, metformin was not associated with adverse neonatal outcomes, including preterm birth (RR 1.00 [95% CI 0.89-1.13]), and birthweight < 10th percentile (RR 0.82 [95% CI 0.60-1.13]) or < 3rd percentile (RR 0.78 [95% CI 0.41-1.48]). CONCLUSIONS: In this two-country analysis, metformin use in pregnancy among women with diabetes was not associated with an altered risk of developing any hypertensive disorder of pregnancy. In the combined meta-analysis, metformin was not associated with an altered risk of adverse neonatal outcomes.
Assuntos
Diabetes Mellitus Tipo 2 , Diabetes Gestacional , Hipoglicemiantes , Metformina , Pré-Eclâmpsia , Humanos , Metformina/uso terapêutico , Metformina/efeitos adversos , Feminino , Gravidez , Adulto , Pré-Eclâmpsia/epidemiologia , Suécia/epidemiologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/epidemiologia , Hipoglicemiantes/efeitos adversos , Hipoglicemiantes/uso terapêutico , Diabetes Gestacional/epidemiologia , Diabetes Gestacional/tratamento farmacológico , Escócia/epidemiologia , Estudos de Coortes , Recém-NascidoRESUMO
In Region Sörmland, the burden of critical illness during the first wave of Covid-19 in april 2020 lead to a 25-fold increase in the number of patients requiring invasive mechanical ventilation. The decision was made that quantity should be prioritised before individual quality. This led to a highly standardised care during the intensive care period. All patients admitted to any of the county's three hospitals were assessed as regarded their ability to survive invasive mechanical ventilation. The assessment was based on the Charlson Age-adjusted Comorbidity Index and the Clinical Frailty Scale. Of all >2000 admitted patients with Covid-19, 37% were assessed as not to benifit from mechanical ventilation. The outcome of intensive care patients was very good in Region Sörmland compared to the rest of Sweden, with a 30-day mortality rate of 14% following intensive care. The outcome after Covid-19-associated intensive care in Sweden differed highly between ICUs, with a span of 7-58% 30-day mortality rate.
Assuntos
COVID-19 , Cuidados Críticos , Unidades de Terapia Intensiva , Respiração Artificial , SARS-CoV-2 , COVID-19/epidemiologia , COVID-19/mortalidade , Humanos , Suécia/epidemiologia , Pandemias , IdosoRESUMO
BACKGROUND: Lower air temperature and cold spells have been associated with an increased risk of various diseases. However, the short-term effect of lower air temperature and cold spells on myocardial infarction (MI) remains incompletely understood. OBJECTIVES: The purpose of this study was to investigate the short-term effects of lower air temperature and cold spells on the risk of hospitalization for MI in Sweden. METHODS: This population-based nationwide study included 120,380 MI cases admitted to hospitals in Sweden during the cold season (October to March) from 2005 to 2019. Daily mean air temperature (1 km2 resolution) was estimated using machine learning, and percentiles of daily temperatures experienced by individuals in the same municipality were used as individual exposure indicators to account for potential geographic adaptation. Cold spells were defined as periods of at least 2 consecutive days with a daily mean temperature below the 10th percentile of the temperature distribution for each municipality. A time-stratified case-crossover design incorporating conditional logistic regression models with distributed lag nonlinear models using lag 0 to 1 (immediate) and 2 to 6 days (delayed) was used to evaluate the short-term effects of lower air temperature and cold spells on total MI, non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI). RESULTS: A decrease of 1-U in percentile temperature at a lag of 2 to 6 days was significantly associated with increased risks of total MI, NSTEMI, and STEMI, with ORs of 1.099 (95% CI: 1.057-1.142), 1.110 (95% CI: 1.060-1.164), and 1.076 (95% CI: 1.004-1.153), respectively. Additionally, cold spells at a lag of 2 to 6 days were significantly associated with increased risks for total MI, NSTEMI, and STEMI, with ORs of 1.077 (95% CI: 1.037-1.120), 1.069 (95% CI: 1.020-1.119), and 1.095 (95% CI: 1.023-1.172), respectively. Conversely, lower air temperature and cold spells at a lag of 0 to 1 days were associated with decreased risks for MI. CONCLUSIONS: This nationwide case-crossover study reveals that short-term exposures to lower air temperature and cold spells are associated with an increased risk of hospitalization for MI at lag 2 to 6 days.
Assuntos
Temperatura Baixa , Hospitalização , Infarto do Miocárdio , Humanos , Suécia/epidemiologia , Masculino , Feminino , Temperatura Baixa/efeitos adversos , Idoso , Infarto do Miocárdio/epidemiologia , Hospitalização/estatística & dados numéricos , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Fatores de TempoRESUMO
PURPOSE: This study explores the association of the American Society of Anesthesiologists (ASA) score with 90-day mortality in complicated mild traumatic brain injury (mTBI) patients, and in trauma patients without a TBI. METHODS: This retrospective study was conducted using a cohort of trauma patients treated at a level III trauma center in Stockholm, Sweden from January to December 2019. The primary endpoint was 90-day mortality. The population was identified using the Swedish Trauma registry. The Trauma and Injury Severity Score (TRISS) was used to estimate the likelihood of survival. Trauma patients without TBI (NTBI) were used for comparison. Data analysis was conducted using R software, and statistical analysis included univariate and multivariate logistic regression. RESULTS: A total of 244 TBI patients and 579 NTBI patients were included, with a 90-day mortality of 8.2% (n = 20) and 5.4% (n = 21), respectively. Deceased patients in both cohorts were generally older, with greater comorbidities and higher injury severity. Complicated mTBI constituted 97.5% of the TBI group. Age and an ASA score of 3 or higher were independently associated with increased mortality risk in the TBI group, with odds ratios of 1.04 (95% 1.00-1.09) and 3.44 (95% CI 1.10-13.41), respectively. Among NTBI patients, only age remained a significant mortality predictor. TRISS demonstrated limited predictive utility across both cohorts, yet a significant discrepancy was observed between the outcome groups within the NTBI cohort. CONCLUSION: This retrospective cohort study highlights a significant association between ASA score and 90-day mortality in elderly patients with complicated mTBI, something that could not be observed in comparative NTBI cohort. These findings suggest the benefit of incorporating ASA score into prognostic models to enhance the accuracy of outcome prediction models in these populations, though further research is warranted.
Assuntos
Concussão Encefálica , Humanos , Estudos Retrospectivos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Adulto , Suécia/epidemiologia , Concussão Encefálica/mortalidade , Estudos de Coortes , Idoso de 80 Anos ou mais , Sistema de RegistrosRESUMO
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.
Assuntos
Análise Custo-Benefício , Infecções Pneumocócicas , Vacinas Pneumocócicas , Vacinas Conjugadas , Humanos , Vacinas Pneumocócicas/economia , Vacinas Pneumocócicas/administração & dosagem , Suécia/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Infecções Pneumocócicas/economia , Infecções Pneumocócicas/epidemiologia , Pré-Escolar , Lactente , Vacinas Conjugadas/economia , Vacinas Conjugadas/administração & dosagem , Criança , Anos de Vida Ajustados por Qualidade de Vida , Masculino , Feminino , Adolescente , Programas de Imunização/economia , Cadeias de Markov , Recém-NascidoRESUMO
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.
Assuntos
Amputação Cirúrgica , Extremidade Inferior , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amputação Cirúrgica/estatística & dados numéricos , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Pé Diabético/cirurgia , Pé Diabético/epidemiologia , Pé Diabético/etiologia , Estilo de Vida , Extremidade Inferior/cirurgia , Modelos de Riscos Proporcionais , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Suécia/epidemiologia , Idoso de 80 Anos ou maisRESUMO
Cataract is a leading cause of blindness worldwide, necessitating a deeper understanding of its risk factors. We analyzed two cohorts: 1000 individuals from the general Swedish population and 933 patients who received plaque brachytherapy for uveal melanoma. Using Kaplan-Meier and cumulative incidence analyses, as well as Cox and competing risk regressions, we assessed whether there is a relationship between sex and cataract surgery. In the general population, female sex was a significant risk factor for cataract surgery, with a 10-year incidence of 16% compared to 10% for males (subdistribution hazard ratio adjusted for age, 1.35, P < 0.001). In the brachytherapy cohort, female sex was not associated with an increased incidence of cataract surgery, with a 10-year incidence of 25% versus 23% for males (HR 1.08, P = 0.61). Visual acuity at the time of cataract surgery did not significantly differ between sexes in either cohort, suggesting that differences in surgery rates are not due to health-seeking behavior or surgery assessment thresholds. These findings indicate that female sex is associated with a higher risk of cataract surgery in the general population, but not among those treated with plaque brachytherapy for uveal melanoma.
Assuntos
Braquiterapia , Extração de Catarata , Catarata , Melanoma , Neoplasias Uveais , Humanos , Neoplasias Uveais/radioterapia , Neoplasias Uveais/epidemiologia , Melanoma/radioterapia , Melanoma/epidemiologia , Feminino , Masculino , Braquiterapia/efeitos adversos , Pessoa de Meia-Idade , Idoso , Catarata/epidemiologia , Catarata/etiologia , Fatores Sexuais , Fatores de Risco , Adulto , Incidência , Suécia/epidemiologia , Idoso de 80 Anos ou maisRESUMO
BACKGROUND AND OBJECTIVE: Misdiagnosis of ruptured abdominal aortic aneurysms (rAAA) contributes to delayed treatment and potentially higher mortality. The symptomatology in patients with rAAA is complex and challenging, 25-50% presumably fulfill the criteria of the standard triad of signs (STS). The objective was to determine the initial signs registered for patients with verified rAAAs, and to investigate if an expanded diagnostic triad could increase the diagnostic accuracy. METHODS: A population-based study was conducted among all patients presenting with verified rAAAs in Stockholm County, Sweden, from January 2010 to October 2021. Patients were identified with ICD code 171.3 (rAAA). The STS was defined as (1) abdominal pain, (2) syncope and (3) the finding of a pulsatile abdominal mass, the prevalence of STS was investigated. An expanded triad included similar and related signs commonly registered for patients with rAAA, and was referred to as the modified abdominal aortic aneurysm rupture signs (MARS). The MARS-signs encompassed (1) the registered pain-associated symptoms or signs, (2) all hypovolemic associated signs, and (3) pulsatile abdominal mass and/or ultrasound finding, and the prevalence was similarly investigated. Finally, the STS and MARS were compared to evaluate the usefulness and performance of the MARS-score. RESULTS: A total of 216 patients were identified. The majority were men (77%) with a median age of 78 years. The dominating symptom was abdominal pain (84%), followed by dizziness (50%). Few patients presented with three STS (13%), two STS were found in 37% and one STS in almost half of the patients (41%). By contrast, when applying MARS 35% presented with the complete expanded triad, 47% with two and 17% with one. Comparison of accuracy favored MARS (13 vs. 35% with 3 signs, P < 0.001 for STS vs. MARS) (2 or 3 signs, 48 vs. 82% STS vs. MARS, P < 0.001). CONCLUSIONS: The expanded MARS-signs could aid in easier and faster identification of rAAA patients, thus facilitating the first step with accurate diagnosis into the lifesaving rAAA care chain. Supportive diagnostic mnemonics and tools are especially important when targeting fatal diagnoses such as rAAA. Further studies are needed to investigate the implementation of the MARS-signs in various clinical settings.
Assuntos
Aneurisma da Aorta Abdominal , Ruptura Aórtica , Humanos , Aneurisma da Aorta Abdominal/diagnóstico , Aneurisma da Aorta Abdominal/epidemiologia , Aneurisma da Aorta Abdominal/complicações , Masculino , Ruptura Aórtica/diagnóstico , Ruptura Aórtica/epidemiologia , Feminino , Suécia/epidemiologia , Idoso , Dor Abdominal/etiologia , Dor Abdominal/diagnóstico , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Síncope/etiologia , Síncope/diagnósticoRESUMO
PURPOSE: Primary chronic osteomyelitis (PCO) of the jaw is a non-infectious, inflammatory state of the jawbone of unknown etiology. This study aimed to investigate the occurrence of PCO in Sweden between the years 2012 and 2018, the characteristics of the condition, treatment methods, and outcomes. Material and methods: The search for patients with PCO in Sweden 2012-2018 was performed at 24 oral and maxillofacial surgery units in Sweden. RESULTS: During this 6-year period, 17 patients were identified as diagnosed with PCO in Sweden. The mean age was 10.6 years at diagnosis, and the female:male ratio was 4:1. CONCLUSION: We conclude that PCO is a very rare disease in Sweden, and that standardized, well-defined criteria are necessary to calculate incidence rates but also to increase knowledge about etiology, clinical characteristics, and treatment outcomes in rare conditions such as PCO.