Identifying sociodemographic risk factors associated with residential fire fatalities: a matched case control study.

OBJECTIVES: This study aimed to investigate the association between sociodemographic factors and residential fire fatalities in Sweden. A majority of fatal fires occur in housing. An understanding of risk factors and risk groups is a must for well-founded decisions regarding targeted prevention efforts. There is a lack of consideration of the interrelation between sociodemographic factors and fire fatalities and there is a lack of high quality large-scale studies. METHODS: In this matched case-control study, residential fire fatalities (cases, n=850) (age above 19 years old) were identified in the national register on fatal fires. Four controls per case were randomly matched by gender and age. ORs were calculated to assess the association between different sociodemographic factors with residential fire fatalities using conditional logistic regression. RESULTS: Having low income, receiving social allowance and receiving health-related early retirement pension were associated with an increased risk of dying in residential fires. The results also show clearly that adults dying in residential fires to a significantly lower extent were living together with a partner, were in work, were highly educated and lived in urban areas. However, contrary to previous research, living in rented apartments appeared not to influence the risk of death. CONCLUSIONS: In this study, we show that fatalities due to residential fires in Sweden are associated with some but not all of previously published sociodemographic risk factors. The results provide valuable information that can improve the guiding and targeting of fire mortality prevention strategies in Sweden.

Assessment of Use vs Discontinuation of Oral Anticoagulation After Pulmonary Vein Isolation in Patients With Atrial Fibrillation.

Importance: Pulmonary vein isolation (PVI) is a recommended treatment for patients with atrial fibrillation, but it is unclear whether it results in a lower risk of stroke. Objectives: To investigate the proportion of patients discontinuing anticoagulation treatment after PVI in association with the CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) score, identify factors predicting stroke after PVI, and explore the risk of cardiovascular events after PVI in patients with and without guideline-recommended anticoagulation treatment. Design, Setting, and Participants: A retrospective cohort study was conducted using Swedish national health registries from January 1, 2006, to December 31, 2012, with a mean-follow up of 2.6 years. A total of 1585 patients with atrial fibrillation undergoing PVI from the Swedish Catheter Ablation Register were included, with information about exposure to warfarin in the national quality register Auricula. Data analysis was performed from January 1, 2015, to April 30, 2016. Exposures: Warfarin treatment. Main Outcomes and Measures: Ischemic stroke, intracranial hemorrhage, and death. Results: In this cohort of 1585 patients, 73.0% were male, the mean (SD) age was 59.0 (9.4) years, and the mean (SD) CHA2DS2-VASc score was 1.5 (1.4). Of the 1585 patients, 1175 were followed up for more than 1 year after PVI. Of these, 360 (30.6%) discontinued warfarin treatment during the first year. In patients with a CHA2DS2-VASc score of 2 or more, patients discontinuing warfarin treatment had a higher rate of ischemic stroke (5 events in 312 years at risk [1.6% per year]) compared with those continuing warfarin treatment (4 events in 1192 years at risk [0.3% per year]) (P = .046). Patients with a CHA2DS2-VASc score of 2 or more or those who had previously experienced an ischemic stroke displayed a higher risk of stroke if warfarin treatment was discontinued (hazard ratio, 4.6; 95% CI, 1.2-17.2; P = .02 and hazard ratio, 13.7; 95% CI, 2.0-91.9; P = .007, respectively). Conclusions and Relevance: These findings indicate that discontinuation of warfarin treatment after PVI is not safe in high-risk patients, especially those who have previously experienced an ischemic stroke.

Baby boomers as future care users--An analysis of expectations in print media.

The aim of the study was to investigate media presentations of baby boomers as future care users. The Swedish baby boomer generation, born in the 1940s, and known as the '40s generation, has been characterized as youthful and powerful, and a question investigated in the study was whether boomers are supposed to display these characteristics as care users. We analyzed 481 articles in Swedish newspapers, published between 1995 and 2012, with a qualitative content analysis. The results showed that the '40s generation was predicted to become a new breed of demanding, self-aware care users. These claims were supported by descriptions of the formative events and typical characteristics of these individuals, which were then projected onto their future behavior as care users. Such projections tended to portray contemporary care users as passive, submissive, and partly responsible for problems associated with elder care. Consequently, approaches that focus on differences between cohorts need to incorporate a constructionist dimension to highlight the problem of generationism.

The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study.

BACKGROUND: Errors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The reason can be the change of focus in prehospital care from the traditional "scoop and run" practice to a more complex assessment and this new focus imposes real demands on clinical judgment. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. However, there are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. One possible way to increase compliance with guidelines could be to introduce guidelines in a Computerized Decision Support System (CDSS). There is limited evidence relating to the effect of CDSS in a prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST). METHODS: In this time-series study, data from prehospital medical records were collected on a weekly basis during the study period. Medical records were rated with the guidance of a rating protocol and data on OST were collected. The difference between baseline and the intervention period was assessed by a segmented regression. RESULTS: In this study, 371 patients were included. Compliance with the assessment process described in the prehospital CG was stable during the baseline period. Following the introduction of the CDSS, compliance rose significantly. The post-intervention slope was stable. The CDSS had no significant effect on OST. CONCLUSIONS: The use of CDSS in prehospital care has the ability to increase compliance with the assessment process of patients with a medical emergency. This study was unable to demonstrate any effects of OST.

Experiences of Swedish military medical personnel in combat zones: adapting to competing loyalties.

OBJECTIVES: The aim of this qualitative study is to explore the Swedish military personnel's experience of what it means to perform a caring role in a combat zone. This study assesses the challenges faced by military medical personnel in the context of a combat zone. METHODS: The design was descriptive with a qualitative inductive approach. Twenty military medical personnel (physicians, nurses, and combat lifesavers) were interviewed individually. They had been involved in international military operations between 2009 and 2012. This study was analyzed using qualitative content analysis. RESULTS: The analysis produced four categories: being in a primarily noncaring organization, caring in emotionally charged relationships, lacking an open dialog about expectations of killing and having to prioritize scarce resources. CONCLUSIONS: This study shows that medical personnel easily adapt to a military setting. They care but also perform other tasks when they are in a combat zone. The medical personnel want to give care to host nation but use drugs they can spare.

Conducting industry-partnered trials in orthopaedic surgery.

We have seen an emergence of larger scale collaborative multi-center trials in surgery. These larger trials have the advantage of increased generalisability of the results and the potential for large scale and efficient recruitment (1000 patients or more). It is estimated that the average cost of bringing a new drug to market approximates 500 million dollars. The funding limitations in most national peer-reviewed agencies provides a compelling rationale for industry co-sponsors. To limit biases associated with industry-sponsored research, researchers should develop specific protocols to ensure accurate and transparent reporting of funding sources, design and implementation of surgical trials, manuscript preparation and the criteria for authorship.