The Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) - A psychometric evaluation of adolescents in Sweden during the COVID-19 pandemic.

The Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) is effective in assessing positive aspects of mental health. Despite its advantages, little is known about group differences in the interpretation of SWEMWBS items across age groups, especially during the adolescence period. Hence, this study examined the psychometric properties of the SWEMWBS through Confirmatory Factor Analysis (CFA), Rasch analysis and network analysis of Swedish adolescents during the COVID-19 pandemic. A total of 5548 participants from the south of Sweden (i.e., Jönköping County) took part in this cross-sectional study through an online platform between September 2020 and October 2020. The CFA, Rasch (including differential item functioning, DIF) analysis and network analysis were used to examine the psychometric properties and measurement invariance of the SWEMWBS. The SWEMWBS had a unidimensional structure with robust psychometric properties. The CFA demonstrated measurement invariance across gender, school year and country of birth, which was also confirmed by Rasch DIF. Furthermore, considerable associations between the items of the SWEMWBS, general health and COVID-19 impact items were observed in network analysis. The SWEMWBS showed robust psychometric properties capable of assessing positive aspects of mental health and well-being among adolescents.

Healthcare professionals' experiences of targeted health dialogues in primary health care.

BACKGROUND: In Sweden, population-based targeted health dialogues are an important part of health promotion and disease prevention in primary health care. Targeted health dialogues are performed with a pedagogical approach to allow individuals to reflect over their resources, situation and motivation to change lifestyle habits together with a healthcare professional. AIM: The aim of this study was to explore healthcare professionals' experiences of targeted health dialogues in primary health care. METHODS: Three focus group interviews were conducted with 20 healthcare professionals. The interviews were analysed using qualitative content analysis. RESULTS: The main category A possibility to promote healthy behaviours and prevent disease describes how the targeted health dialogues were experienced as a valuable opportunity to promote health among inhabitants. The significance of the primary healthcare centre's health promotion and prevention strategies was emphasised to enable the targeted health dialogues as a part of the assignment to promote health. These strategies were expressed as shared focus and organisational space and support making it possible for example to reach all socioeconomic groups. The work with targeted health dialogue was described as a complex task requiring extensive competence. Furthermore, the pedagogical tool including the visual health profile was experienced to have an important impact on the dialogue offering direction for actions to promote health and prevent disease. CONCLUSIONS: Targeted health dialogues can be a valuable opportunity for healthcare professionals in primary health care to promote a healthy lifestyle among inhabitants. Certain preconditions at both the meso- and the micro level is however required for this to come about.

What Factors Identified in Initial Osteoarthritis Management Are Associated With Poor Patient-reported Outcomes After THA? A Register-based Study.

BACKGROUND: Some patients report long-term pain or no improvement in health-related quality of life (HRQoL) or are dissatisfied after THA. However, factors associated with these poorer patient-reported outcomes after surgery are inconsistent and have typically been studied in the late phase of hip osteoarthritis (OA) among patients already eligible for surgery. Earlier identification of risk factors would provide time to address modifiable factors, helping to improve patients' pain, HRQoL, and satisfaction after surgery and reduce the burden on orthopaedic clinics by referring patients who are better prepared for surgery. QUESTIONS/PURPOSES: We analyzed data from patients with hip OA referred to a first-line OA intervention program in primary healthcare at a stage when they had not been referred for THA, and asked: (1) What percentage of patients who proceed to THA report lack of improvement in pain, lack of improvement in HRQoL as measured by the EQ-5D, or are not satisfied with surgery 1 year after THA? (2) What associations exist between baseline factors at referral to this first-line OA intervention program and these poorer patient-reported outcomes 1 year after THA? METHODS: We included 3411 patients with hip OA (mean age 67 ± 9 years, 63% [2160 of 3411] women) who had been referred for first-line OA interventions between 2008 and 2015 and subsequently underwent THA for OA. All patients were initially identified through the Swedish Osteoarthritis Register, which follows and evaluates patients in a standardized national first-line OA intervention program. Then, we identified those who were also registered in the Swedish Arthroplasty Register with a THA during the study period. We included only those with complete patient-reported outcome measures for pain, HRQoL, and satisfaction preoperatively and 1-year postoperatively, representing 78% (3411 of 4368) of patients, who had the same baseline characteristics as nonrespondents. Multiple logistic regression was used to assess the associations between 14 baseline factors and the aforementioned patient-reported outcomes of pain, HRQoL, and satisfaction 1 year after THA, adjusted for all included factors. RESULTS: Five percent (156 of 3411) of the study population lacked improvement in pain, 11% (385 of 3411) reported no improvement in HRQoL, and 10% (339 of 3411) reported they were not satisfied with surgery 1 year after THA. Charnley Class C (multiple-joint OA or another condition that affects the ability to walk) was associated with all outcomes: lack of improvement in pain (OR 1.84 [95% CI 1.24 to 2.71]; p = 0.002), lack of improvement in HRQoL (OR 1.83 [95% CI 1.42 to 2.36]; p < 0.001), and not being satisfied (OR 1.40 [95% CI 1.07 to 1.82]; p = 0.01). Older age was associated with a lack of improvement in pain (OR per year 1.03 [95% CI 1.01 to 1.05]; p = 0.02), lack of improvement in HRQoL (OR per year 1.04 [95% CI 1.03 to 1.06]; p < 0.001), and not being satisfied (OR per year 1.03 [95% CI 1.01 to 1.05]; p < 0.001). Depression was associated with a lack of improvement in pain (OR 1.54 [95% CI 1.00 to 2.35]; p = 0.050) and with not being satisfied (OR 1.50 [95% CI 1.11 to 2.04]; p = 0.01) but not with a lack of improvement in HRQoL (OR 1.04 [95% CI 0.76 to 1.43]; p = 0.79). Having four or more comorbidities was associated with a lack of improvement in HRQoL (OR 2.08 [95% CI 1.39 to 3.10]; p < 0.001) but not with a lack of improvement in pain and not being satisfied. CONCLUSION: The results of this study showed that older age, Charley Class C, and depression in patients with first-line OA interventions were risk factors associated with poorer outcomes regarding pain, HRQoL, and satisfaction after THA. Screening patients with hip OA for depression early in the disease course would provide increased time to optimize treatments and may contribute to better patient-reported pain, HRQoL, and satisfaction after future THA. Further research should focus on identifying the optimal time for surgery in patients with depression, as well as what targeted interventions for depression can improve outcome of surgery in these patients. LEVEL OF EVIDENCE: Level III, therapeutic study.

Perspectives on health care and self-management of osteoarthritis among patients who desire surgery: A qualitative interview study.

BACKGROUND: Expressing a desire for surgery before participating in first-line osteoarthritis (OA) interventions (patient education and exercise therapy) has been shown to contribute to poorer outcomes from the interventions, but we lack knowledge on how these patients reflect on health care and self-management of OA. OBJECTIVES: To explore and describe patients' perspectives of health care and self-management of OA among those expressing a desire for surgery before participating in first-line OA interventions. METHODS: Sixteen patients with hip or knee OA referred to participate in a standardized first-line OA intervention program in primary health care in Sweden were included in the study. We used individual semi-structured interviews to collect data, which were analyzed using inductive qualitative content analysis. RESULTS: One theme of meaning "A multifaceted picture of needs, expectations, and individual choices" and five categories were identified as perspectives from the participants regarding health care and self-management of OA: 1) lacking control and needing support; 2) standing alone in an unsupportive environment; 3) going with the flow; 4) having expectations; and 5) taking ownership. CONCLUSION: Patients who express a desire for surgery before participating in first-line interventions for OA are not a homogeneous group. They describe a broad range of perspectives on how they reason and reflect on health care and self-management of OA based on their own needs, expectations, and choices. Findings from this study strengthen insights on the importance of exploring the patient's perspectives and individualizing OA interventions to achieve the lifestyle changes that first-line interventions strive to accomplish.

Progression to arthroplasty surgery among patients with hip and knee osteoarthritis : a study from the Swedish BOA Register.

AIMS: The aim of this study was to estimate time to arthroplasty among patients with hip and knee osteoarthritis (OA), and to identify factors at enrolment to first-line intervention that are prognostic for progression to surgery. METHODS: In this longitudinal register-based observational study, we identified 72,069 patients with hip and knee OA in the Better Management of Patients with Osteoarthritis Register (BOA), who were referred for first-line OA intervention, between May 2008 and December 2016. Patients were followed until the first primary arthroplasty surgery before 31 December 2016, stratified into a hip and a knee OA cohort. Data were analyzed with Kaplan-Meier and multivariable-adjusted Cox regression. RESULTS: At five years, Kaplan-Meier estimates showed that 46% (95% confidence interval (CI) 44.6 to 46.9) of those with hip OA, and 20% (95% CI 19.7 to 21.0) of those with knee OA, had progressed to arthroplasty. The strongest prognostic factors were desire for surgery (hazard ratio (HR) hip 3.12 (95% CI 2.95 to 3.31), HR knee 2.72 (95% CI 2.55 to 2.90)), walking difficulties (HR hip 2.20 (95% CI 1.97 to 2.46), HR knee 1.95 (95% CI 1.73 to 2.20)), and frequent pain (HR hip 1.56 (95% CI 1.40 to 1.73), HR knee 1.77 (95% CI 1.58 to 2.00)). In hip OA, the probability of progression to surgery was lower among those with comorbidities (e.g. ≥ four conditions; HR 0.64 (95% CI 0.59 to 0.69)), with no detectable effects in the knee OA cohort. Instead, being overweight or obese increased the probability of OA progress in the knee cohort (HR 1.25 (95% CI 1.15 to 1.37)), but not among those with hip OA. CONCLUSION: Patients with hip OA progressed faster and to a greater extent to arthroplasty than patients with knee OA. Progression was strongly influenced by patients' desire for surgery and by factors related to severity of OA symptoms, but factors not directly related to OA symptoms are also of importance. However, a large proportion of patients with OA do not seem to require surgery within five years, especially among those with knee OA. Cite this article: Bone Joint J 2022;104-B(7):792-800.

Health status of individuals referred to first-line intervention for hip and knee osteoarthritis compared with the general population: an observational register-based study.

OBJECTIVES: To describe the prevalence of comorbidities in a population referred to standardised first-line intervention (patient education and exercise) for hip and knee osteoarthritis (OA), in comparison with the general population. Furthermore, we aimed to evaluate if eventual differences were associated with socioeconomic inequalities. DESIGN: Register-based study. SETTING: Primary healthcare, Sweden. PARTICIPANTS: Individuals with hip and/or knee OA included in the Better Management for Patients with Osteoarthritis Register between 2008 and 2016 and and an age-matched, sex-matched and residence-matched reference cohort (1:3) from the general Swedish population. OUTCOME MEASURES: Comorbidities were identified with the RxRisk Index, the Elixhauser Comorbidity Index and the Charlson Comorbidity Index, and presented with descriptive statistics as (1) individual diseases, (2) disease categories and (3) scores for each index. The prevalence of comorbidities in the two populations was tested using logistic regression, with separate analyses for age groups and the most affected joint. We then adjusted the analyses for socioeconomic status. RESULTS: In this OA population, 85% had ≥1 comorbidity compared with 78% of the reference cohort (OR; 1.62 (95% CI 1.59 to 1.66)). Cardiovascular/blood diseases were the most common comorbidities in both populations (OA, 59%; reference, 54%), with OR; 1.22 (95% CI 1.20 to 1.24) for the OA population. Younger individuals with OA were more comorbid than their matched references overall, and population differences decreased with age (eg, ≥3 comorbidities, aged ≤45 years OR; 1.74 (95% CI 1.52 to 1.98), ≥81 years OR; 0.95 (95% CI 0.87 to 1.04)). Individuals with knee OA were more comorbid than those with hip OA overall. Adjustment for socioeconomic status did not change the estimates. CONCLUSION: Comorbidities were more common among individuals with hip and knee OA than among matched references from the general population. The differences could not be explained by socioeconomic status. TRIAL REGISTRATION NUMBER: NCT03438630.

Socioeconomic status of patients in a Swedish national self-management program for osteoarthritis compared with the general population-a descriptive observational study.

BACKGROUND: First-line treatment for hip and knee osteoarthritis (OA) including education and supervised exercises, delivered as a self-management program, is considered one of the mainstays in OA treatment. However, the socioeconomic profile of the population that utilizes first-line treatment for hip and knee OA is unclear. The aim of this study was to describe the socioeconomic status (SES) of a population referred to a self-management program for OA, in comparison with that of the general Swedish population. METHODS: This is a cross-sectional study including 72,069 patients with hip or knee OA enrolled in the National Quality Register for Better management of patients with Osteoarthritis (BOA) between 2008 and 2016, and registered before participation in a structured OA self-management program. A reference cohort (n = 216,207) was selected from the general Swedish population by one-to-three matching by year of birth, sex and residence. Residential municipality, country of birth, marital status, family type, educational level, employment, occupation, disposable income and sick leave were analyzed. RESULTS: The BOA population had higher educational level than the reference group, both regarding patients with hip OA (77.5% vs 70% with ≥10 years of education), and with knee OA (77% vs 72% with ≥10 years of education). Their average disposable income was higher (median [IQR] in Euro (€), for hip €17,442 [10,478] vs €15,998 [10,659], for knee €17,794 [10,574] vs €16,578 [11,221]). Of those who worked, 46% of patients with hip OA and 45% of the reference group had a blue-collar occupation. The corresponding numbers for knee OA were 51 and 44% respectively. Sick leave was higher among those with hip and knee OA (26%) than those in the reference groups (13% vs 12%). CONCLUSIONS: The consistently higher SES in the BOA population compared with the general population indicates that this self-management program for OA may not reach the more socioeconomically disadvantaged groups, who are often those with a higher disease burden.

Study protocol for an observational register-based study on health and risk factors in patients with hip and knee osteoarthritis.

INTRODUCTION: Hip and knee osteoarthritis is a leading cause of disability worldwide. Currently, the course of deterioration in pain and physical functioning in individuals with osteoarthritis is difficult to predict. Factors such as socioeconomic status and comorbidity contribute to progression of osteoarthritis, but clear associations have not been established. There is a need for early identification of individuals with slow disease development and a good prognosis, and those that should be recommended for future joint replacement surgery. METHODS AND ANALYSIS: This nationwide register-based study will use data for approximately 75 000 patients who sought and received core treatment for osteoarthritis in primary healthcare, and were registered in the Swedish population-based National Quality Register for Better Management of Patients with Osteoarthritis. These data will be merged with data for replacement surgery, socioeconomic factors, healthcare consumption and comorbidity from the Swedish Hip Arthroplasty Register, the Swedish Knee Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare, Sweden. The linkage will be performed using personal identity numbers that are unique to all citizens in Sweden. ETHICS AND DISSEMINATION: The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (dnr 1059-16). The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBER: NCT03438630.

Trends in prevalence of thinness, overweight and obesity among Swedish children and adolescents between 2004 and 2015.

AIM: This study explored weight trends among children aged 4, 7, 11, 14 and 17 years in Jönköping County Sweden, from 2004 to 2015. METHODS: The study had a repeated cross-sectional design, and body mass index (BMI) was calculated based on height and weight measurements collected from child health and school health records. The prevalence of thinness, overweight and obesity was estimated with international cut-offs, with linear trends calculated separately for boys and girls. RESULTS: There were 190 965 measurements of BMI and these covered 82-97% of the younger children and 55-69% of the older children during the study period. The prevalence of thinness varied between 0.2% and 2.2% across time and age groups and did not change over the study period. There was a small decrease in overweight among both girls and boys aged four years. There were increasing trends in overweight and obesity in both girls and boys aged 11 and 14 years of age and a sharp increase among 17-year-old boys, with 7.3% obese in 2014/2015 and 3.6% in 2004/2005. CONCLUSION: The prevalence of obesity decreased from 2004 to 2015 or was stable in younger Swedish children, but increased among older children, with a large increase in adolescent boys.

Birth weight in relation to leisure time physical activity in adolescence and adulthood: meta-analysis of results from 13 nordic cohorts.

BACKGROUND: Prenatal life exposures, potentially manifested as altered birth size, may influence the later risk of major chronic diseases through direct biologic effects on disease processes, but also by modifying adult behaviors such as physical activity that may influence later disease risk. METHODS/PRINCIPAL FINDINGS: We investigated the association between birth weight and leisure time physical activity (LTPA) in 43,482 adolescents and adults from 13 Nordic cohorts. Random effects meta-analyses were performed on categorical estimates from cohort-, age-, sex- and birth weight specific analyses. Birth weight showed a reverse U-shaped association with later LTPA; within the range of normal weight the association was negligible but weights below and above this range were associated with a lower probability of undertaking LTPA. Compared with the reference category (3.26-3.75 kg), the birth weight categories of 1.26-1.75, 1.76-2.25, 2.26-2.75, and 4.76-5.25 kg, had odds ratios of 0.67 (95% confidence interval: 0.47, 0.94), 0.72 (0.59, 0.88), 0.89 (0.79, 0.99), and 0.65 (0.50, 0.86), respectively. The shape and strength of the birth weight-LTPA association was virtually independent of sex, age, gestational age, educational level, concurrent body mass index, and smoking. CONCLUSIONS/SIGNIFICANCE: The association between birth weight and undertaking LTPA is very weak within the normal birth weight range, but both low and high birth weights are associated with a lower probability of undertaking LTPA, which hence may be a mediator between prenatal influences and later disease risk.

Associations of birthweight and infant growth with body composition at age 15--the COMPASS study.

Size at birth and postnatal growth have been positively associated with obesity in adulthood. However, associations between postnatal growth and body composition later in life have rarely been studied. The overall purpose was to explore the associations between birthweight, weight gain during first year of life and height, weight, body mass index, fat free mass index (FFMI), fat mass index, % fat mass (FM) and waist circumference in adolescence. The COMPASS study is a population-based study of adolescents from a well-defined area in Stockholm County, Sweden. Birth characteristics and weight during childhood were collected from registers and child health centre records, and body composition at age 15 years was measured by bioelectric impedance by trained nurses. Complete data were available for 2453 adolescents. Associations between predictor and outcome variables were assessed with linear regression modelling. Birthweight was positively associated with all outcome variables, except for %FM among girls. FFMI increased by 0.49 kg/m(2)[95% CI 0.34, 0.63] (boys) and 0.25 kg/m(2)[0.12, 0.38] (girls) per 1 SD increase in birthweight. Increased weight gain in infancy showed strong, positive associations with all measures of body composition. FFMI increased by 0.73 kg/m(2)[0.60, 0.87] (boys) and 0.63 kg/m(2)[0.50, 0.76] (girls) per unit increase in weight z-score during first year of life. The effect of increased weight gain in infancy was not modified by birthweight. Birthweight and postnatal growth were both positively related to body composition in adolescence. Increased weight gain during the first year of life had stronger effect than prenatal growth, suggesting infancy to be a more critical period.

Associations between parents' and 12-year-old children's sport and vigorous activity: the role of self-esteem and athletic competence.

BACKGROUND: The aims of this study were to investigate parent-child physical activity (PA) associations and whether children's self-esteem or athletic competence mediates such associations. METHODS: The study population comprised 1124 12-year-old children and their parents. Parents' PA was assessed using the Baecke questionnaire and a question about sport participation. Children's PA was assessed by questions about participation in sport and vigorous activities. The children's self-esteem and athletic competence were assessed by Harter's Self-Perception Profile for Adolescents. RESULTS: Parents' PA was strongly associated with their children's PA. With 2 active parents, the odds ratio for their children to participate in sport was 3.9 (95% CI = 2.2-6.9, girls) and 8.8 (95% CI = 4.3-18.0, boys) compared with having inactive parents. Athletic competence partly mediated these associations. CONCLUSIONS: The family is an important target for interventions to increase PA among children, and it might be important to consider ways to reinforce children's athletic competence.

Genetic factors in physical activity and the equal environment assumption-- the Swedish young male twins study.

The aims of this study were to examine the genetic contribution on physical activity (PA) within a nationwide population of young adult male twin pairs from Sweden and to investigate the equal environment assumption (EEA) in relation to PA. Information on PA was collected by questionnaires in 1998 and 2002 and the impact of genetic factors was estimated by structural equation modeling (SEM). The study included 1,022 pairs of twins and the best fitting SEM-model gave a heritability of 49% (95% CI, 40-56%) for total PA and all PA dimensions showed genetic contributions between 40% and 65%. Non-shared environmental factors were also important, whereas shared environmental factors did not contribute to PA behaviors. The EEA was investigated with a linear regression model, examining if the twins contact frequency predicted within-pair differences in PA, and further by a simulation study. We found no support for violation of the EEA.

Changes in shape and location of BMI distributions of Swedish children.

AIMS: One aim was to disentangle how the shape and location of the BMI distribution changed among Swedish children over a 12 y period. Another aim was to identify the age during childhood when changes occurred or became manifest. METHODS: Two population-based cohorts-2,591 children from Stockholm born 1985-1987 and 3,650 from Gothenburg born 1973-1975-were compared with respect to BMI distributions from 2 to 15 y of age. RESULTS: Differences between the BMI distributions of the two cohorts were present from 5-6 y of age. From age 7, the children born in 1985-1987 and belonging to the upper parts of the BMI distribution, e.g. those above the 90th or 95th BMI percentiles, had much higher BMI mean values compared to their counterparts born 12 y earlier. Comparisons with respect to the 5th, 10th, 25th, 50th, 75th, 90th and 95th BMI percentiles showed that changes appeared above the 25th percentile and became increasingly pronounced in the upper parts of the BMI distributions. CONCLUSION: School-aged children in the rightmost parts of the BMI distributions may be more susceptible to "obesogenic" environmental exposures than those in the middle or leftmost parts. The results support the suggestion that the period of BMI rebound is critical for the development of obesity.