Contractility, ventriculoarterial coupling, and stroke work after acute myocardial infarction using CMR-derived pressure-volume loop data.

BACKGROUND: Noninvasive left ventricular (LV) pressure-volume (PV) loops derived by cardiac magnetic resonance (CMR) have recently been shown to enable characterization of cardiac hemodynamics. Thus, such PV loops could potentially provide additional diagnostic information such as contractility, arterial elastance (Ea ) and stroke work (SW) currently not available in clinical routine. This study sought to investigate to what extent PV-loop variables derived with a novel noninvasive method can provide incremental physiological information over cardiac dimensions and blood pressure in patients with acute myocardial infarction (MI). METHODS: A total of 100 patients with acute MI and 75 controls were included in the study. All patients underwent CMR 2-6 days after MI including assessment of myocardium at risk (MaR) and infarct size (IS). Noninvasive PV loops were generated from CMR derived LV volumes and brachial blood pressure measurements. The following variables were quantified: Maximal elastance (Emax ) reflecting contractility, Ea , ventriculoarterial coupling (Ea /Emax ), SW, potential energy, external power, energy per ejected volume, and efficiency. RESULTS: All PV-loop variables were significantly different in MI patients compared to healthy volunteers, including contractility (Emax : 1.34 ± 0.48 versus 1.50 ± 0.41 mmHg/mL, p = .024), ventriculoarterial coupling (Ea /Emax : 1.27 ± 0.61 versus 0.73 ± 0.17, p < .001) and SW (0.96 ± 0.32 versus 1.38 ± 0.32 J, p < .001). These variables correlated to both MaR and IS (Emax : r2 = 0.25 and r2 = 0.29; Ea /Emax : r2 = 0.36 and r2 = 0.41; SW: r2 = 0.21 and r2 = 0.25). CONCLUSIONS: Noninvasive PV-loops provide physiological information beyond conventional diagnostic variables, such as ejection fraction, early after MI, including measures of contractility, ventriculoarterial coupling, and SW.

A Swedish nationwide forensic study of the manner of death in single stab injuries to the trunk.

INTRODUCTION: Forensic pathologists are frequently confronted with questions about whether an injury is likely to have been inflicted by an assault or be self-inflicted. However, little is known of the epidemiological variables that might be applicable to differentiate between homicides and suicides in deaths caused by single stab injuries to the trunk. METHOD: Using the Swedish forensic autopsy register, we identified 94 homicides and 45 suicides between 2010 and 2021 in which death followed a single stab injury to the trunk. We extracted characteristics from the cases and performed statistical analyses using the Mann-Whitney U test, Chi-square test and logistic regression model. RESULTS: Victims of homicides were younger than suicide victims (median age 33 years vs. 52 years, p < 0.05), and males were in the majority in both groups (93% vs. 82%). In numerous homicide victims, stab wounds were placed in the back and in axillar regions, unlike in suicides victims in which the stabs were all placed on the medial part of the anterior trunk. Vertical entrance wounds in the skin combined with a medially running injury channel (n = 13) showed a positive predictive value of 100% (95% CI 75.3-100) for homicide, although the sensitivity was low. Homicides were conclusively associated with an outdoor death scene (OR 19.0, 95% CI 7.6-47.1), injury to thoracic bone/cartilage (OR 3.8, 95% CI 1.6-9.0), influence of alcohol (OR 7.1, 95% Cl 2.9-17.7) and illicit drugs (OR 4.3, 95% CI 1.5-11.9). DISCUSSION AND CONCLUSION: The observed forensic characteristics of stab injuries could be used as a tool when assessing the manner of death in single stabs. Further research on variables associated with manner of death are needed and we suggest also including characteristics of surviving victims in such analyses.

Prognostic utility and characterization of left ventricular hypertrophy using global thickness.

Cardiovascular magnetic resonance (CMR) can accurately measure left ventricular (LV) mass, and several measures related to LV wall thickness exist. We hypothesized that prognosis can be used to select an optimal measure of wall thickness for characterizing LV hypertrophy. Subjects having undergone CMR were studied (cardiac patients, n = 2543; healthy volunteers, n = 100). A new measure, global wall thickness (GT, GTI if indexed to body surface area) was accurately calculated from LV mass and end-diastolic volume. Among patients with follow-up (n = 1575, median follow-up 5.4 years), the most predictive measure of death or hospitalization for heart failure was LV mass index (LVMI) (hazard ratio (HR)[95% confidence interval] 1.16[1.12-1.20], p < 0.001), followed by GTI (HR 1.14[1.09-1.19], p < 0.001). Among patients with normal findings (n = 326, median follow-up 5.8 years), the most predictive measure was GT (HR 1.62[1.35-1.94], p < 0.001). GT and LVMI could characterize patients as having a normal LV mass and wall thickness, concentric remodeling, concentric hypertrophy, or eccentric hypertrophy, and the three abnormal groups had worse prognosis than the normal group (p < 0.05 for all). LV mass is highly prognostic when mass is elevated, but GT is easily and accurately calculated, and adds value and discrimination amongst those with normal LV mass (early disease).

Relationships between Charlson comorbidity index associated biomarkers and outcomes among participants in the Malmö diet and cancer study.

INTRODUCTION: The aim was to evaluate two biomarker scores trained to identify comorbidity burden in the prediction of specified chronic morbidities, and mortality in the general population. METHODS: Cardiovascular biomarkers were measured in the cardiovascular cohort of the Malmö Diet and Cancer Study. A score of 19 biomarkers associated with Charlson Comorbidity Index (CCI) was created (BSMDC). Individuals with CCI diagnoses and other major comorbidities were excluded. Another score of 11 biomarkers associated with comorbidity burden from a previous study of acute dyspnea was also created (BSADYS). The scores were prospectively evaluated for prediction of mortality, and some chronic diseases, using Cox Proportional Hazards Model. RESULTS: Fully adjusted models showed that BSMDC was significantly associated per 1 SD increment of the score with incident COPD, 55%, and congestive heart failure, 32%; and with mortality, 33% cardiovascular, 91% respiratory, 30% cancer, and 45% with all-cause mortality. The BSADYS showed no association with these outcomes, after simultaneous inclusion of both biomarker scores to all the clinical covariates. CONCLUSION: BSMDC shows strong prediction of morbidity and mortality in individuals free from comorbidities at baseline, and the results suggest that healthy individuals with high level of BSMDC would benefit from intense preventive actions.

A score of 19 biomarkers associated with Charlson Comorbidity Index was created, the Biomarker Score of Malmö Diet and Cancer study (BSMDC).The created BSMDC index was associated with both incident COPD, and incident CHF.BSMDC was also associated with cardiovascular mortality, respiratory mortality, cancer mortality and with all-cause mortality.

Understanding medical aspects of violent crimes in Sweden's region Skåne: a retrospective cross-sectional design of the ViCS project.

Introduction: While there has been a reduction in specific homicide categories in Sweden, the last decade has witnessed an increase in the overall rate. The escalation is predominantly linked to heightened gun violence associated with criminal gangs. As a result, Sweden faces an extreme rate of shootings and firearm-related homicides, constituting one of the most severe instances across Europe. However, comprehensive scientific studies on this phenomenon are lacking. This paper presents the design of the Violent Crimes in Skåne (ViCS) project, which aims to investigate violent crimes requiring hospitalization or causing death in Sweden's region Skåne from a medical, forensic, and criminological perspective. The project aims to examine the epidemiology and trends of violent crimes, injury profiles, treatments, patient outcomes, causes of death, and victim demographics. Methods and analysis: Using a retrospective cross-sectional design, ViCS will examine trauma by violent crimes from 2000 to 2019. Data will be sourced from several institutions, including hospital records from nine emergency hospitals, and the National Board of Forensic Medicine Agency. The project aims to study medical and criminological aspects of violent crimes, primarily focusing on assaults involving firearms, sharp weapons, blunt instruments, kicks, punches, and other types of assault like strangulation. Data analysis will involve descriptive and inferential statistics. Discussion: ViCS aims to contribute to the limited body of knowledge about victims of violent crimes in Sweden. The findings may inform evidence-based interventions in medical, forensic, and criminological fields, potentially enabling targeted prevention strategies and improvements in emergency care for victims.

The effects of sociodemographic factors and comorbidities on sepsis: A nationwide Swedish cohort study.

Sepsis is a severe condition, representing a significant public health concern, especially in the elderly. There is, however, little insight into the potential effects of sociodemographic factors and comorbidities on sepsis incidence and how these factors interact. This was a nationwide open cohort study including individuals (N = 6 746 010) in Sweden ≥ 18 years of age spanning from 1997 to 2018, with 116 175 995 person years of follow-up. The outcome was time to first occurrence of sepsis. The following variables were included in the analysis: sociodemographic factors (age, sex, income, education, marital status, region of residency, and country of origin), severe mental disorders (schizophrenia and bipolar disorders), and Charlson Comorbidity Index. Interaction tests were conducted. A total of 161 558 individuals were diagnosed with sepsis during the study period, corresponding to an incidence rate of 13.9 per 10 000 person years (95% CI: 13.8 - 14.0). The main findings were that male sex, high age, low education, and comorbid conditions were positively associated with sepsis, after adjustments for the other covariates. Being aged 80 years and above yielded a HR of 18.19 (95% CI: 17.84 - 18.55) and the effect of high age was more than twice as high in men than in women. In conclusion, this large nationwide cohort found that several sociodemographic factors and comorbid conditions were independently associated with sepsis and men were more affected by higher age than women. These findings can help improve sepsis awareness and preventive work in risk groups.

Demographic characteristics of convicted child sexual abusers in South of Sweden, between 2013 and 2018: a pilot study.

This study evaluates variables concerning demographic characteristics for all adult male offenders convicted of Child Sexual Abuse (CSA) aged 0-17 in Malmö, Sweden between 2013 and 2018. All convictions (n = 18) based on court documents from the District Court, the Court of Appeals and information from the Swedish Tax Agency were reviewed. A total of 30 victims were identified. Frequency analyses show that the most common features were that of a single offender, averaging 25 years old, with a non-Swedish background and a high school degree. The predominately extrafamilial CSA (i.e. committed by an acquaintance to the family) occurred in a private setting and consisted of penetrative acts. Girls averaging 13 years old were abused multiple times, under fear and pressure. Although assumptions based on these results are preliminary, they provide a clearer image of the typical circumstances under which CSA occurred within this time frame and geographical location. This study is a first attempt to construct an overview of demographic characteristics of CSA. As more data are gathered from this region, more sophisticated analyses can be conducted, providing stronger generalizations. Information of this kind may be important for research, classification of offender profiling and in case linking.

[Undergraduate teaching, training and examination of critical emergency management]. / Simulatorträning ger nya läkare självförtroende vid akuta tillstånd.

Current national objectives of Swedish medical schools state that new doctors should be able to independently start rapid and appropriate early treatment and diagnostic assessment in life-threatening situations. Since 2017 more than one thousand senior undergraduate students at Lund University have undergone compulsory five-week training in initial management of potentially reversible medical emergency conditions. The students participate in thematic full-scale simulations of life-threatening bedside challenges associated with chest or abdominal pain, vital organ dysfunction, and major trauma, and also take part in lectures, case-based seminars and clinical emergency practice under individual supervision. The course is concluded by a structured simulation-based holistic examination, designed to test individual abilities of relevant decision-making, rapid and appropriate bedside action, and professional approach.

Neighbourhood crime and major depression in Sweden: A national cohort study.

BACKGROUND: The association between neighbourhood crime and major depression (MD) has been described before but previous studies may be limited by biases in self-reported data and the use of homogenous study populations. Our study aimed to examine the association between neighbourhood crime and clinically diagnosed MD among the immigrant and non-immigrant populations in Sweden. METHODS: A retrospective cohort study was performed, which included non-immigrants and first- and second-generation immigrants residing in Sweden, who were born between 1960 and 1996. We used linked Swedish national registers, geospatial analysis and multilevel logistic regression models to examine the potential effect of neighbourhood crime on the odds of major depression between January 1, 2012, and December 31, 2015. RESULTS: Overall, individuals living in neighbourhoods with high levels of neighbourhood crime had higher odds of MD than those who did not. There was a significant interaction by immigrant status; the odds of MD among those with non-immigrant backgrounds were more strongly associated with increases in neighbourhood crime, after adjusting for potential confounders. Male and female immigrants born outside Sweden did not seem to be affected by increases in neighbourhood crime. CONCLUSION: The apparent effect of increases in neighbourhood crime on the odds of MD seemed to differ between those of different immigrant statuses. Future research should aim to explore the possible mechanisms behind the differences in the rates of MD among the non-immigrant and immigrant populations in neighbourhoods with high crime.

Safe and Healthy Para sport project (SHAPE): a study protocol of a complex intervention within Para sport.

Elite Para athletes report a high incidence of sports injuries, illnesses and other health issues. Despite this, there are few prevention programmes in Para sport, and many of the existing prevention programmes are not adapted to Para athletes. To improve the success of preventive measures, it has been suggested that sports safety work should facilitate health promotion, including athlete health education. Therefore, the overarching aim of this project is to evaluate an accessible health promotion web platform as part of a complex intervention that aims to improve knowledge of athlete health in Para sport. In this protocol, the development, future implementation and evaluation of the intervention are described. To inform the implementation and use of such interventions, it is recommended to involve end users in the development and implementation process. Therefore, a participatory design process, including athletes and the sports organisation, was used to develop an accessible health promotion web platform. To evaluate this complex intervention, a process evaluation combining quantitative evaluation assessing causal pathways with qualitative methods assessing multifaceted pathways will be used. The primary outcomes are injury/illness incidence, athlete health parameters, health literacy and user behaviour. A cohort of elite Para athletes (n=150) from Sweden and South Africa will be invited to participate. This project will be the first that aims to improve athlete health in Para sport through pragmatic and accessible health promotion. It is a boundary-crossing project that will be conducted in a real-world sport setting, including athletes with different socioeconomic backgrounds.

A Comparison between Indoor and Outdoor Rape Suspects in Sweden.

As the number of rapes is increasing in Sweden, and the number of individuals convicted of these crimes is decreasing, it is of importance to study offender characteristics of those committing these crimes and the circumstances in which these crimes are conducted, such as indoors or outdoors. Data from Swedish population-based registers were used to identify individuals suspected of rape, aggravated rape, attempted rape or attempted aggravated rape (in short: rape+) against females ≥18 years old between 2007-2017. Latent Class Analysis was then used to identify classes of rape+ suspects with respect to the location of the rape+ and then compare the two groups. A total of 19,723 individuals were included of which the majority (n = 17,520; 88.8%) were suspected of indoor rape+. In both groups, we identified a low offenders' class and a high offenders' class. In addition, first-generation immigrants had a higher odds of being suspected of outdoor rape+ than Swedish-born suspects, and a previous conviction of violent crime was a risk factor for committing outdoor rape+.

Glucose and high-sensitivity troponin T predict a low risk of major adverse cardiac events in emergency department chest pain patients.

Background. Glucose is emerging as a biomarker for early and safe rule-out of acute myocardial infarction in emergency department (ED) chest pain patients. We evaluated the diagnostic accuracy of dual testing with high sensitivity TnT (hs-cTnT) and glucose for prediction of major adverse cardiac events (MACE) within 30 days. Methods. This was a secondary analysis of a single-center prospective observational study of 1167 ED chest-pain patients with hs-cTnT and glucose testing at presentation (0 h), and hs-cTnT 1 h later. We tested the addition of glucose <5.6 mmol/L to three MACE rule-out strategies: hs-cTnT <5 ng/L, ≤14 ng/L or a 0 h/1h algorithm, i.e. initial hs-cTnT <12 ng/L with a 1 h change of <3 ng/L. We also tested the addition of glucose ≥11mmol/L to three rule-in strategies: hs-cTnT ≥52 ng/L, a 1 h change ≥5 ng/L or hs-cTnT >14 ng/L. The outcomes were 30-day MACE and 30-day MACE without UA. Results. Two dual-testing approaches reached our target NPV for rule-out: A 0 h hs-cTnT ≤14 ng/L and glucose <5.6 mmol/L identified 252 patients (24.4%) with a 98.8% NPV for 30-day MACE and 99.6% for MACE without UA. The 0 h/1h hs-cTnT algorithm combined with glucose identified 240 patients (23.2%) with a 99.2% NPV for 30-day MACE and 100.0% for MACE without UA. No dual rule-in strategy performed better than using hs-cTnT alone. Conclusions. A combination of hs-cTnT and blood glucose at presentation can be used to identify almost » of ED chest pain patients with a very low risk of 30-day MACE where further testing is not needed. Adding glucose did not improve the rule-in of 30-day MACE.

Improving Machine Learning 30-Day Mortality Prediction by Discounting Surprising Deaths.

BACKGROUND: Machine learning (ML) is an emerging tool for predicting need of end-of-life discussion and palliative care, by using mortality as a proxy. But deaths, unforeseen by emergency physicians at time of the emergency department (ED) visit, might have a weaker association with the ED visit. OBJECTIVES: To develop an ML algorithm that predicts unsurprising deaths within 30 days after ED discharge. METHODS: In this retrospective registry study, we included all ED attendances within the Swedish region of Halland in 2015 and 2016. All registered deaths within 30 days after ED discharge were classified as either "surprising" or "unsurprising" by an adjudicating committee with three senior specialists in emergency medicine. ML algorithms were developed for the death subclasses by using Logistic Regression (LR), Random Forest (RF), and Support Vector Machine (SVM). RESULTS: Of all 30-day deaths (n = 148), 76% (n = 113) were not surprising to the adjudicating committee. The most common diseases were advanced stage cancer, multidisease/frailty, and dementia. By using LR, RF, and SVM, mean area under the receiver operating characteristic curve (ROC-AUC) of unsurprising deaths in the test set were 0.950 (SD 0.008), 0.944 (SD 0.007), and 0.949 (SD 0.007), respectively. For all mortality, the ROC-AUCs for LR, RF, and SVM were 0.924 (SD 0.012), 0.922 (SD 0.009), and 0.931 (SD 0.008). The difference in prediction performance between all and unsurprising death was statistically significant (P < .001) for all three models. CONCLUSION: In patients discharged to home from the ED, three-quarters of all 30-day deaths did not surprise an adjudicating committee with emergency medicine specialists. When only unsurprising deaths were included, ML mortality prediction improved significantly.

Swedish rape offenders - a latent class analysis.

Sweden has witnessed an increase in the rates of sexual crimes including rape. Knowledge of who the offenders of these crimes are is therefore of importance for prevention. We aimed to study characteristics of individuals convicted of rape, aggravated rape, attempted rape or attempted aggravated rape (abbreviated rape+), against a woman ≥18 years of age, in Sweden. By using information from the Swedish Crime Register, offenders between 15 and 60 years old convicted of rape+ between 2000 and 2015 were included. Information on substance use disorders, previous criminality and psychiatric disorders were retrieved from Swedish population-based registers, and Latent Class Analysis (LCA) was used to identify classes of rape+ offenders. A total of 3 039 offenders were included in the analysis. A majority of them were immigrants (n = 1 800; 59.2%) of which a majority (n = 1 451; 47.7%) were born outside of Sweden. The LCA identified two classes: Class A - low offending class (LOC), and Class B - high offending class (HOC). While offenders in the LOC had low rates of previous criminality, psychiatric disorders and substance use disorders, those included in the HOC had high rates of previous criminality, psychiatric disorders and substance use disorders. While HOC may be composed by more "traditional" criminals probably known by the police, the LOC may represent individuals not previously known by the police. These two separated classes, as well as our finding in regard to a majority of the offenders being immigrants, warrants further studies that take into account the contextual characteristics among these offenders. Key pointsRape, aggravated rape, attempted rape or attempted aggravated rape (rape+) are increasing in Sweden.The majority of those convicted of rape+ are immigrants.LCA identifies two classes of rape+ offenders: LOC and HOC.

Characteristics of convicted male-on-female rapists in the South of Sweden between 2013 and 2018: a pilot study.

The objective of this study was to evaluate the main characteristics of adult male offenders convicted of rape or aggravated rape against adult females. We reviewed all convictions (n = 21) based on court documents from the District Court, the Court of Appeal and information from the Swedish Tax Agency in Malmö, Sweden, between 2013 and 2018. The findings indicated that the most common offender characteristics were a single status, mean age of 33 years and foreign background. The rapes primarily occurred within a private setting while the victims (who were often younger and knew the offender) were unconscious. Although assumptions based on these results should be made with caution, our findings provide a clear image of the typical circumstances under which these rapes occurred. This study should be viewed as a first attempt to create a database of characteristics of convicted rapists. As more data are added, more sophisticated analyses can be performed and stronger generalizations may be made. Information of this kind may also be important for further research, classification of rapists in offender profiling, and case linking.

Deadly violence in Sweden: Profiling offenders through a latent class analysis.

BACKGROUND: Sweden has in recent years witnessed increasing rates of firearm-related violence and homicide, which has contributed to increased rates of deadly violence. Attempts to profile offenders committing such crimes are of major importance, because such efforts may contribute to better preventive measures. We therefore aimed to study the characteristics of individuals convicted and/or suspected of homicide, attempted homicide, preparation to commit homicide as well as conspiration to commit homicide (for simplicity called homicide+) in Sweden. METHODS: By using information from the Swedish Crime Register and the Swedish Criminal Suspect Register, individuals being 15-60 years old and convicted and/or suspected of homicide+ between 2000 and 2015 were included in the study. Using these registers and also other population and health care registers, information on previous criminality, substance abuse, and psychiatric disorders were added to the Latent Class Analysis (LCA) that was used to identify latent classes of individuals convicted and/or suspected for homicide+. In addition, several individual variables were added for validation purposes. RESULTS: A total of 14,466 individuals were included in the analysis. The majority were male (n = 12,802; 88.5%) and Swedish-born with Swedish-born parents (n = 8247; 57.0%). The LCA identified three classes where Conviction Class (CC) contained mostly convicted individuals whereas Mixed Class A (MCA) and Mixed Class B (MCB) contained almost equal rates of both convicted and suspected individuals. The CC was characterized by individuals with low rates of previous criminality, substance abuse and psychiatric disorders. The MCA and the MCB were characterized by individuals with higher rates of previous criminality, substance abuse, and psychiatric disorders as well as lower education and worse economy in comparison with the CC. CONCLUSION: While MCA and MCB may be constituted by "traditional" criminals often well known by the police and/or the social authorities, the CC was mainly constituted by convicted offenders who may more easily escape the radar of the authorities.