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1.
Glob Health Action ; 15(1): 2051222, 2022 Dec 31.
Artículo en Inglés | MEDLINE | ID: mdl-35522127

RESUMEN

'The midwife's role in achieving the Sustainable Development Goals: Protect and Invest Together' is a report providing the reader the opportunity for understanding and appreciating the history of midwifery in Sweden and the interlinked nature of the United Nation's SDGs supporting health and wellbeing of women and children. To realise the opportunity to have a country with well-educated midwives of high academic standard, and, at the same time, promoting gender equality and equity we need to protect and invest together in midwives. This paper provides the foundation for a revitalised discussion on midwives' role for women and child health in the 21st century. The full Swedish Midwifery report was published in October 2021.


Asunto(s)
Partería , Desarrollo Sostenible , Niño , Femenino , Humanos , Embarazo , Suecia
2.
3.
BMC Pediatr ; 22(1): 252, 2022 05 05.
Artículo en Inglés | MEDLINE | ID: mdl-35513880

RESUMEN

BACKGROUND: Pain is a common symptom in children receiving hospital care. Adequate pain management in paediatric patients is of the utmost importance. Few studies have investigated children's own experiences of pain during hospitalization. AIM: To describe the prevalence of pain, self-reported pain intensity at rest and during movement, pain management and compliance with pain treatment guidelines in children and adolescents receiving hospital care. Furthermore, to examine self-reported statements about pain relief and how often staff asked about pain. METHODS: A quantitative, cross-sectional study with descriptive statistics as the data analysis method was conducted at a county hospital in western Sweden. Sixty-nine children/adolescents aged 6-18 years who had experienced pain during their hospital stay were included. A structured, verbally administered questionnaire was used to obtain pain reports. The participants were also asked what they considered alleviated pain and how often they told staff about pain. Patient demographics, prescribed analgesics and documentation of pain rating were obtained from medical records. RESULTS: Fifty children/adolescents (72%) experienced moderate to severe pain in the previous 24 hours. At the time of the interview 36% reported moderate to severe pain at rest and 58% during movement. Seven participants (10%) reported severe pain both at rest and during movement. About one-third were on a regular multimodal analgesic regimen and 28% had used a validated pain rating scale. Thirty children/adolescents (43%) reported that they had experienced procedural pain in addition to their underlying pain condition. Most of the children/adolescents (74%) reported that analgesics provided pain relief. Forty (58%) stated that various non-pharmacological methods were helpful. CONCLUSIONS: Despite evidence-based guidelines, half of the children/adolescents experienced moderate to severe pain, highlighting the need for improvement. Pain levels should be assessed both at rest and during movement. Response to treatment should be evaluated to prevent undertreatment of pain. Compliance with guidelines and professional communication are of the utmost importance for pain management in children/adolescents. Non-pharmacological methods are a valuable part of a pain management strategy. This study shows that it is important to evaluate and improve pain care also outside specialised tertiary clinics.


Asunto(s)
Manejo del Dolor , Dolor , Adolescente , Analgésicos/uso terapéutico , Niño , Estudios Transversales , Hospitales , Humanos , Dolor/epidemiología , Dolor/etiología , Manejo del Dolor/métodos , Suecia/epidemiología
4.
BMC Public Health ; 22(1): 916, 2022 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-35534826

RESUMEN

BACKGROUND: Temporomandibular disorders (TMD) are common and affect approximately 10% of the adult population. TMD is usually associated with headache, pain in the masticatory muscles and/or the temporomandibular joint, clicking or crepitations during mandibular movement as well as painful and/or reduced mouth opening. This study aimed to investigate the level TMD-patients use social insurance benefits before and after their first time of diagnosis or first surgical event, compared to the general population. Furthermore, the aim was to investigate the differences in the use of social insurance benefits between surgically and non-surgically treated TMD-patients that were diagnosed in a hospital setting. METHODS: All Swedish citizens aged 23-59 diagnosed with TMD in a hospital setting and/or surgically treated for the condition during 1998-2016 were identified via the Swedish National Board of Health and Welfare. A non-exposed comparison cohort was collected via the Total Population Registry. Outcome and sociodemographic data were collected via Statistics Sweden. Main outcome was annual net days on sick leave and disability pension five years before (-T5) and five years after (T5) diagnosis and/or surgical treatment (T0). Regression analysis was conducted with generalized estimated equations. RESULTS: The study included 219 255 individuals (73% female) - 19 934 in the exposed cohort and 199 321 in the comparison cohort. The exposed group was classified into three subgroups: non-surgical, surgically treated once, and surgically treated twice or more. The mean annual net days of sick leave and disability pension combined during the ten-year follow-up was 61 days in the non-surgical group, 76 days in the surgically treated once group, and 104 days in the surgically treated twice or more subgroup. The corresponding number for the non-exposed comparison cohort was 32 days. CONCLUSION: Patients diagnosed with TMD in a hospital setting are 2-3 times more dependent on the use of social benefits than the general population. The reliance on sick leave and disability pension is seen as early as five years before diagnosis, and the reliance remains after surgical treatment. The reliance is stronger in patients with several surgical interventions. These findings indicate that patients diagnosed with TMD constitute a patient group with a high burden of health issues causing long-term dependence on social security benefits.


Asunto(s)
Ausencia por Enfermedad , Trastornos de la Articulación Temporomandibular , Adulto , Femenino , Humanos , Masculino , Pensiones , Sistema de Registros , Suecia/epidemiología , Trastornos de la Articulación Temporomandibular/epidemiología , Trastornos de la Articulación Temporomandibular/cirugía
5.
BMC Med Res Methodol ; 22(1): 130, 2022 05 02.
Artículo en Inglés | MEDLINE | ID: mdl-35501701

RESUMEN

BACKGROUND: A relative survival approach is often used in population-based cancer studies, where other cause (or expected) mortality is assumed to be the same as the mortality in the general population, given a specific covariate pattern. The population mortality is assumed to be known (fixed), i.e. measured without uncertainty. This could have implications for the estimated standard errors (SE) of any measures obtained within a relative survival framework, such as relative survival (RS) ratios and the loss in life expectancy (LLE). We evaluated the existing approach to estimate SE of RS and the LLE in comparison to if uncertainty in the population mortality was taken into account. METHODS: The uncertainty from the population mortality was incorporated using parametric bootstrap approach. The analysis was performed with different levels of stratification and sizes of the general population used for creating expected mortality rates. Using these expected mortality rates, SEs of 5-year RS and the LLE for colon cancer patients in Sweden were estimated. RESULTS: Ignoring uncertainty in the general population mortality rates had negligible (less than 1%) impact on the SEs of 5-year RS and LLE, when the expected mortality rates were based on the whole general population, i.e. all people living in a country or region. However, the smaller population used for creating the expected mortality rates, the larger impact. For a general population reduced to 0.05% of the original size and stratified by age, sex, year and region, the relative precision for 5-year RS was 41% for males diagnosed at age 85. For the LLE the impact was more substantial with a relative precision of 1286%. The relative precision for marginal estimates of 5-year RS was 3% and 30% and for the LLE 22% and 313% when the general population was reduced to 0.5% and 0.05% of the original size, respectively. CONCLUSIONS: When the general population mortality rates are based on the whole population, the uncertainty in the estimates of the expected measures can be ignored. However, when based on a smaller population, this uncertainty should be taken into account, otherwise SEs may be too small, particularly for marginal values, and, therefore, confidence intervals too narrow.


Asunto(s)
Neoplasias del Colon , Esperanza de Vida , Anciano de 80 o más Años , Humanos , Masculino , Análisis de Supervivencia , Suecia/epidemiología , Incertidumbre
6.
Int Breastfeed J ; 17(1): 35, 2022 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-35527258

RESUMEN

BACKGROUND: Positive breastfeeding experiences positively influence subsequent attitudes towards breastfeeding, and increase mothers' confidence, self-efficacy, motivation and intention to breastfeed. However, the strategies that mothers find useful and effective for creating positive breastfeeding experiences remain largely unknown. The aim of our study was thus to describe experience-based knowledge from mothers about strategies for creating positive breastfeeding experiences. METHODS: The study followed a qualitative design involving the critical incident technique. Data were collected with an online survey containing open-ended questions that was administered to a Sweden-based parenting group on Facebook in September 2018. Ultimately, 340 incidents from 176 women were identified as offering strategies for creating positive breastfeeding experiences. Data from the written replies were extracted as textual units, condensed and categorised until categories were mutually exclusive, which resulted in six categories. RESULTS: Participating women were on average 31.2 years old and the median number of children per participant was two. Mothers' strategies for creating positive breastfeeding experiences generally included being calm and accepting that initiating breastfeeding takes time and can be difficult initially. Participants described feeling close to the baby by maintaining skin-to-skin contact and being present in the moment by taking time to appreciate the child and the breastfeeding situation, and temporarily forgetting about the world and simply being with the child in the here and now. Participants advocated baby-led breastfeeding and following correct techniques. They also described the importance of keeping an effortless mindset about breastfeeding to prevent perceiving breastfeeding as a compulsion. Mothers described acquiring knowledge about breastfeeding so that they could be prepared if breastfeeding problems occurred and getting support from professionals and family was described as significant for having a positive breastfeeding experience. Caring for oneself and one's body, with aids if necessary, were described as important strategies, as were having a positive attitude and a strong desire to breastfeed. CONCLUSION: Because positive breastfeeding experiences and support are predictors of future breastfeeding initiation and duration, assisting women in creating positive breastfeeding experiences is important. Asking mothers to formulate strategies that they find useful could facilitate breastfeeding by making their approaches more conscious and visible.


Asunto(s)
Lactancia Materna , Madres , Adulto , Niño , Femenino , Humanos , Intención , Masculino , Encuestas y Cuestionarios , Suecia
7.
BMJ Open ; 12(5): e055557, 2022 May 10.
Artículo en Inglés | MEDLINE | ID: mdl-35537790

RESUMEN

PURPOSE: The rationale behind the SUDden cardiac Death in the Young (SUDDY) cohort was to provide a complete nationwide, high-quality platform with integrated multisource data, for clinical and genetic research on sudden cardiac death (SCD) in the young, with the ultimate goal to predict and prevent SCD. PARTICIPANTS: The cohort contains all SCD victims <36 years, in Sweden during the period 2000-2010. We assigned five population-based controls per case, together with parents of cases and controls, in total 15 633 individuals. Data of all individuals were extracted from multiple mandatory registries; the National Patient Registry, the Medical Birth Registry, the Prescribed Drug registry, the Cause of Death registry, the Multigeneration Registry, combined with socioeconomic data from Statistics Sweden. From SCD victims, the autopsy report, medical records, ECGs, parental information and biological samples were gathered. FINDINGS TO DATE: We identified 903 individuals diagnosed with SCD (67% men, 33% women). The cases comprised 236 infants <1 year of age (26%), 90 individuals aged 1-15 years (10%), 186 individuals aged 15-25 years (21%) and 391 aged 25-35 years (43%). Hospitalisations and outpatient clinic visits due to syncope were significantly more common among cases than controls. DNA obtained from dried blood spots tests (DBS) stored from birth was equally suitable as venous blood samples for high-throughput genetic analysis of SCD cases. FUTURE PLANS: We will explore the SUDDY cohort for symptoms and healthcare consumption, socioeconomic variables and family history of SCD. Furthermore, we will perform whole exome sequencing analysis on DNA of cases obtained from DBS or postmortem samples together with parental blood samples in search for gene variants associated with cardiac disease. The genetic analysis together with data compiled in the nationwide cohort is expected to improve current knowledge on the incidence, aetiology, clinical characteristics and family history of SCD.


Asunto(s)
Muerte Súbita Cardíaca , Electrocardiografía , Estudios de Cohortes , Muerte Súbita Cardíaca/epidemiología , Muerte Súbita Cardíaca/etiología , Femenino , Humanos , Incidencia , Lactante , Masculino , Factores de Riesgo , Suecia/epidemiología
8.
BMJ Open ; 12(5): e060314, 2022 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-35508341

RESUMEN

INTRODUCTION: Elder abuse is prevalent and associated with different forms of ill health. Despite this, healthcare providers are often unaware of abusive experiences among older patients and many lack training about elder abuse. The overall aim of this study is to determine the effectiveness of an educational intervention on healthcare providers' propensity to ask older patients questions about abusive experiences. METHODS AND ANALYSIS: Healthcare providers at hospital clinics and primary healthcare centres in Sweden will undergo full-day education about elder abuse between the fall of 2021 and spring of 2023. The education consists of (1) theory and group discussions; (2) forum theatre, a form of interactive theatre in which participants are given the opportunity to practise how to manage difficult patient encounters; and (3) post-training reflection on changing practices.The design is a non-randomised cluster, stepped wedge trial in which all participants (n=750) gradually transit from control group to intervention group with 6-month interval, starting fall 2021. Data are collected using the Responding to Elder Abuse in GERiAtric care-Provider questionnaire which was distributed to all clusters at baseline. All participants will also be asked to answer the questionnaire in conjunction with participating in the education as well as at 6-month and 12-month follow-up. Main outcome is changes in self-reported propensity to ask older patients questions about abuse post-intervention compared with pre-intervention. Linear mixed models including cluster as a random effect will be used to statistically evaluate the outcome. ETHICS AND DISSEMINATION: The study has been approved by the Swedish Ethical Review Authority. The results will be published in peer-reviewed journals and conference proceedings. If the intervention is successful, a manual of the course content will be published so that the education can be disseminated to other clinics. TRIAL REGISTRATION NUMBER: NCT05065281.


Asunto(s)
Abuso de Ancianos , Anciano , Abuso de Ancianos/prevención & control , Personal de Salud/educación , Humanos , Encuestas y Cuestionarios , Suecia
9.
Euro Surveill ; 27(18)2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35514304

RESUMEN

We compared vaccine effectiveness against severe COVID-19 between December 2021 and March 2022 when Omicron BA.1 and BA.2 were the dominating SARS-CoV-2 variants in Scania county, Sweden. Effectiveness remained above 80% after the transition from BA.1 to BA.2 among people with at least three vaccine doses but the point estimate decreased markedly to 54% among those with only two doses. Protection from prior infection was also lower after the transition to BA.2. Booster vaccination seems necessary to maintain sufficient protection.


Asunto(s)
COVID-19 , SARS-CoV-2 , COVID-19/epidemiología , COVID-19/prevención & control , Vacunas contra la COVID-19 , Humanos , Suecia/epidemiología
10.
BMC Emerg Med ; 22(1): 79, 2022 05 06.
Artículo en Inglés | MEDLINE | ID: mdl-35524195

RESUMEN

BACKGROUND: The number of ambulance assignments and the influx of patients to the emergency departments (EDs) in Sweden have increased in recent years. This is one reason the protocol for prehospital emergency care was developed around referring patients for non-conveyance, either through the see-and-convey elsewhere approach or through the see-and-treat approach. However, this protocol has led to challenges in patient assessments. This study aimed to investigate the underlying causes of patient harm among those referred for the see-and-treat approach by the emergency medical services. METHODS: This three-phase study involved a mixed-methods design. Cases of injuries, internal investigations and incident analyses of referrals for the see-and-treat approach in two regions in south eastern Sweden from 2015 to 2020 were examined using qualitative content analysis. This qualitative analysis was the basis for the quantitative analysis of the ambulance records. After the qualitative analysis was completed, a review protocol was developed; 34 variables were used to review 240 randomly selected ambulance records logged in 2020, wherein patients were referred for the see-and-treat approach. Finally, the review results were synthesised. RESULTS: The qualitative analysis revealed three common themes: 'assessment of patients', 'guidelines' and 'environment and organisation'. These results were confirmed by a medical journal review. Shortcomings were found in the anamnesis and in the number of targeted examinations performed. The checklist for referring patients for the see-and-treat approach and the information sheet to be provided to the patients were not used. In 34% of the ambulance records examined, the EMS clinicians deviated from the current guidelines for a see-and-treat referral. CONCLUSIONS: The results indicated that the low adherence to guidelines and the patient assessment deviating from the protocol put patients at risk of being harmed during a see-and-treat referral. Measures are needed to guarantee a safe assessment of an increasing number of patients who are referred for the see-and-treat approach, especially the multi-sick elderly patients.


Asunto(s)
Ambulancias , Servicios Médicos de Urgencia , Anciano , Servicio de Urgencia en Hospital , Humanos , Derivación y Consulta , Suecia
11.
JAMA Netw Open ; 5(5): e2211065, 2022 May 02.
Artículo en Inglés | MEDLINE | ID: mdl-35532933

RESUMEN

Importance: The COVID-19 pandemic has had a large impact on health care systems, not least the treatment of malignant diseases, including colorectal cancer. Objective: To investigate the treatment of colorectal cancer and short-term outcomes during the first wave of the COVID-19 pandemic, compared with the year before. Design, Setting, and Participants: This register-based cohort study used information from the Swedish Colorectal Cancer Registry during the years 2020 and 2019. Patients were from the Stockholm-Gotland region, 1 of 6 health care regions in Sweden, with approximately one-fifth of the country's population and 8 hospitals. All patients with a diagnosis of colorectal cancer from March 1 to August 31, 2019, and March 1 to August 31, 2020, were eligible. Data were analyzed from May to June 2021. Exposures: Diagnosis of colorectal cancer during the peak of the COVID-19 pandemic in 2020. Main Outcomes and Measures: The study aimed to compare the number of patients, time to surgery, operation methods, short-term complications, and residents' involvement in surgical practice between 2019 and 2020. Subanalyses were conducted for colon and rectal cancer. Results: A total of 1140 patients (583 men [51%]; median [IQR] age, 74 [26-99] years in 2019 and 73 [24-96] years in 2020) were enrolled. Fewer patients received a diagnosis of colorectal cancer in March through August 2020 compared with the same months in 2019 (550 vs 590 patients). Overall, patient characteristics were similar, but pretherapeutic tumor stage was more advanced in 2020 compared with 2019, with an increased proportion of T4 tumors (30% [172 patients] vs 22% [132 patients]; χ23 = 21.1; P < .001). The proportion of patients undergoing laparoscopic surgery, time to surgery, and 30-day complications were similar, but the proportion of patients treated with ostomy almost doubled between 2019 and 2020, from 17% (53 patients) to 30% (96 patients) (absolute risk, 13.0%; 95% CI, 6.8% to 20.0%). Residents participated in fewer resections in 2020 than in 2019 (35% [108 patients] vs 27% [83 patients]; absolute risk, -7.90%; 95% CI, -15.00% to -0.55%). On the other hand, the treatment and outcomes for rectal cancer were comparable between the years. Significantly more patients were transferred to the nonemergency, COVID-free hospital in the region in 2020. Conclusions and Relevance: In this Swedish register-based cohort study of patients who received a diagnosis of colorectal cancer during the most intense period of the COVID-19 pandemic, a significant increase in ostomy formation for patients with colon cancer and a lower participation of residents during surgery were observed. These changes most likely were aimed at reducing complications and intensive care unit care.


Asunto(s)
COVID-19 , Neoplasias Colorrectales , Neoplasias del Recto , Anciano , COVID-19/epidemiología , Estudios de Cohortes , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Masculino , Pandemias , Neoplasias del Recto/epidemiología , Suecia/epidemiología
12.
BMJ Open ; 12(5): e058244, 2022 May 09.
Artículo en Inglés | MEDLINE | ID: mdl-35534077

RESUMEN

INTRODUCTION: The target of a class of antiplatelet medicines, P2Y12R inhibitors, exists both on platelets and on brain immune cells (microglia). This protocol aims to describe a causal (based on a counterfactual model) approach for analysing whether P2Y12R inhibitors prescribed for secondary prevention poststroke may increase the risk of cognitive disorder or dementia via their actions on microglia, using real-world evidence. METHODS AND ANALYSIS: This will be a cohort study nested within the Swedish National Health and Medical Registers, including all people with incident stroke from 2006 to 2016. We developed directed acyclic graphs to operationalise the causal research question considering potential time-independent and time-dependent confounding, using input from several experts. We developed a study protocol following the components of the target trial approach described by Hernan et al and describe the data structure that would be required in order to make a causal inference. We also describe the statistical approach required to derive the causal estimand associated with this important clinical question; that is, a time-to-event analysis for the development of cognitive disorder or dementia at 1, 2 and 5-year follow-up, based on approaches for competing events to account for the risk of all-cause mortality. Causal effect estimates and the precision in these estimates will be quantified. ETHICS AND DISSEMINATION: This study has been approved by the Ethics Committee of the University of Gothenburg and Confidentiality Clearance at Statistics Sweden with Dnr 937-18, and an approved addendum with Dnr 2019-0157. The analysis and interpretation of the results will be heavily reliant on the structure, quality and potential for bias of the databases used. When we implement the protocol, we will consider and document any biases specific to the dataset and conduct appropriate sensitivity analyses. Findings will be disseminated to local stakeholders via conferences, and published in appropriate scientific journals.


Asunto(s)
Demencia , Antagonistas del Receptor Purinérgico P2Y , Cognición , Estudios de Cohortes , Demencia/epidemiología , Humanos , Antagonistas del Receptor Purinérgico P2Y/uso terapéutico , Sistema de Registros , Suecia/epidemiología
13.
Lakartidningen ; 1192022 05 11.
Artículo en Sueco | MEDLINE | ID: mdl-35543074

RESUMEN

Around 36 000 people seek care in Sweden due to burns annually. This usually requires repeated wound care and in some case surgery. Iatrogenic burns are rare but may be deep. One cause could be preparation of a patient with alcohol before surgery, or direct skin contact with a diathermic probe. In this case series we present two patients with this type of burns. These cases highlight the potential harm toward the patient, and it is important to have clear guidelines and take precautions when performing a diathermy.


Asunto(s)
Quemaduras , Diatermia , Quemaduras/etiología , Quemaduras/terapia , Diatermia/efectos adversos , Etanol/efectos adversos , Humanos , Piel , Suecia
14.
BMC Public Health ; 22(1): 881, 2022 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-35509072

RESUMEN

BACKGROUND: Despite the importance of having trust in the health system, there is a paucity of research in this field in Sweden. The aim of this study was to estimate the level of trust in the health system and to assess the factors associated with it in northern Sweden. METHODS: A cross-sectional survey was conducted in 2014 in the four northern regions of Sweden. A total of 24 795 participants (48% response rate) aged 18 to 84 years were involved in the study. A log-binomial regression was used to measure the association between sociodemographic factors and trust in the health system. RESULTS: Two thirds of the participants (68.5%) reported high trust in the health system i.e. had very much or quite a lot confidence in the health system. Women had lower prevalence of trust compared to men (PR = 0.96; 95% CI = 0.94-0.98) while older participants had a higher trust compared to youth (PR = 1.11; 95% CI = 1.06-1.16). Participants with lower level of education, those who experienced economic stress, those who were born outside Sweden and those living in small municipalities also had lower prevalence of trust in the health system. Conversely, lower income was associated with higher trust (PR = 1.08; 95% CI = 1.04-1.12). Finally, a strong relationship between higher social capital (having emotional and instrumental support, horizontal trust, and higher social participation) and trust in the health system was also found. CONCLUSIONS: Trust in the health system was moderately high in northern Sweden and strongly associated with sociodemographic and social capital factors. Trust is a complex phenomenon and a deeper exploration of the relation between trust in the health system and sociodemographic factors is needed.


Asunto(s)
Factores Sociales , Confianza , Adolescente , Estudios Transversales , Femenino , Humanos , Masculino , Apoyo Social , Factores Socioeconómicos , Encuestas y Cuestionarios , Suecia , Confianza/psicología
15.
Vet Parasitol Reg Stud Reports ; 30: 100713, 2022 05.
Artículo en Inglés | MEDLINE | ID: mdl-35431071

RESUMEN

A questionnaire was sent to sheep owners in Sweden to get information about anthelmintic drug use. The survey also investigated how respondents experienced problems with gastrointestinal nematode infections (GIN) focusing on Haemonchus contortus. The response rate was 31% and included both conventional and organic farms. The use of anthelmintics was low (45%), among which a majority (76%) drenched ewes on a single occasion, mostly with ivermectin (59%) followed by albendazole (19%). Other drugs were used rarely, however, unawareness of GIN risk was high (19%), especially among respondents with few animals. Anthelmintic dose calculations were done after visual appraisal by 63% and 22% calibrated the equipment before drug delivery, which is worrying since underdosing is a risk factor for the development of anthelmintic resistance. Like with anthelmintics, the perceived risk for GIN increased with herd size both by conventional and organic farmers. Faecal examination for the presence of GIN was done by 65% of the respondents and, among their sheep, H. contortus was or had been diagnosed in 41% of the herds. Irrespective of new stock had been imported from other countries or not, common problems were reported by 5% and 7% of the organic and conventional producers, respectively. Land use and grazing management strategies differed more in relation to herd size than by production form, with a majority (47%) having their sheep grazed in several paddocks, or at least the lambs were moved when separated from the ewes at weaning (25%). In contrast set stocked grazing was mainly reported on smaller farms. Co-grazing with cattle and horses were also frequently reported irrespective of production form, but with cattle to a somewhat greater degree on larger organic farms. Wild cervids, especially roe deer, were frequently observed on sheep pastures (87%). The veterinary involvement was higher on organic (65%) than on conventional farms (53%), and only 5% considered advice unimportant. Still, some conventional and organic producers treated sheeps routinely without a prior diagnosis, against the national regulations. 46% of the respondents drenched new and replacement stock. In conclusion, although some differences were observed between conventional and organic producers, the divergences were mainly due to herd size categories. Furthermore, despite a high veterinary involvement, we identified factors which can contribute to anthelmintic use, such as poor quarantine procedures, and deworming routines that can contribute to anthelmintic resistance in H. contortus.


Asunto(s)
Antihelmínticos , Enfermedades de los Bovinos , Ciervos , Enfermedades Gastrointestinales , Enfermedades de los Caballos , Parasitosis Intestinales , Nematodos , Infecciones por Nematodos , Parásitos , Enfermedades de las Ovejas , Animales , Antihelmínticos/uso terapéutico , Bovinos , Enfermedades de los Bovinos/parasitología , Agricultores , Femenino , Enfermedades Gastrointestinales/parasitología , Enfermedades Gastrointestinales/veterinaria , Enfermedades de los Caballos/tratamiento farmacológico , Caballos , Humanos , Parasitosis Intestinales/tratamiento farmacológico , Parasitosis Intestinales/epidemiología , Parasitosis Intestinales/prevención & control , Parasitosis Intestinales/veterinaria , Infecciones por Nematodos/veterinaria , Percepción , Ovinos , Enfermedades de las Ovejas/tratamiento farmacológico , Enfermedades de las Ovejas/epidemiología , Enfermedades de las Ovejas/prevención & control , Suecia/epidemiología
16.
Int J Drug Policy ; 103: 103669, 2022 May.
Artículo en Inglés | MEDLINE | ID: mdl-35364405

RESUMEN

In this article, we analyse the treatment of gender in Canadian and Swedish quantitative research on alcohol and violence and compare it with the treatment of gender in similar Australian research. In previously published work, we argued that Australian research on 'alcohol-related presentations' to emergency departments, and on alcohol and violence among young people participating in the night-time economy, tends to overlook the stark gendering of violence in its analyses and policy recommendations. It does this via a series of 'gendering practices' (Bacchi, 2017): omitting gender from consideration; overlooking clearly gendered data when making gender-neutral policy recommendations; rendering gender invisible via methodological considerations; displacing men and masculinities via a focus on environmental, geographical and temporal factors; and addressing gender in limited ways. We identify a similar set of gendering practices at work in Canadian and Swedish quantitative research on alcohol and violence, as well as a key difference. This key difference emerges in relation to the practice of addressing gender. Here, we see a bifurcation in the Canadian studies: between one group of articles in which gender is central to the analyses and ensuing policy recommendations, and a second group containing only one example in which gender is partially addressed. We draw attention to the differing realities of gender, alcohol and violence iterated by these contrasting knowledge practices, and offer two possible explanations for this difference. We close by asking how future research analyses and policy recommendations might differ if gender-sensitive quantitative tools were developed, gender considerations were systematically integrated, and gendered effects were taken into account when alcohol policy choices are made.


Asunto(s)
Masculinidad , Violencia , Adolescente , Australia , Canadá , Humanos , Masculino , Suecia
17.
Lakartidningen ; 1192022 04 26.
Artículo en Sueco | MEDLINE | ID: mdl-35471725

RESUMEN

Familial hypercholesterolemia (FH) is an autosomal dominant hereditary dyslipidemia that leads to high plasma cholesterol levels and a severely increased risk for premature cardiovascular disease. Early primary prevention with lipid lowering drugs can markedly reduce this risk. FH is underdiagnosed in Sweden. With a prevalence of 1:311, approximately 33 000 individuals in Sweden are expected to have FH but only a small percentage have been diagnosed up until now. We developed a digiphysical cascade screening model to diagnose FH in relatives of an index case with a confirmed pathogenic mutation in a FH disease gene. It has the potential to provide high-throughput and effective screening and the work model is now part of the clinical routine care at Karolinska University Hospital.


Asunto(s)
Hiperlipoproteinemia Tipo II , Pruebas Genéticas , Humanos , Hiperlipoproteinemia Tipo II/diagnóstico , Hiperlipoproteinemia Tipo II/genética , Tamizaje Masivo , Mutación , Suecia
18.
JAMA Netw Open ; 5(4): e226815, 2022 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-35476068

RESUMEN

Importance: Adults with attention-deficit/hyperactivity disorder (ADHD) are at greater risk for unemployment. Pharmacological treatment is effective in reducing the core symptoms of ADHD, but whether it helps to reduce the unemployment rate among adult patients remains unclear. Objective: To investigate the association between use of ADHD medication and long-term unemployment in working-age adults with ADHD. Design, Setting, and Participants: Data for this population-based cohort study were extracted from Swedish national registers. Among 25 358 individuals with ADHD born from 1958 to 1978, 12 875 middle-aged adults among the workforce were included. The longitudinal cohort was followed up from January 1, 2008, to December 31, 2013. Data were analyzed from March 1, 2020, through May 31, 2021. Exposures: Use of medication for ADHD during the previous 2 years was the main exposure, as both categorical and continuous variables. Main Outcomes and Measures: Yearly accumulated unemployed days were derived from the Public Employment Service, and long-term unemployment was defined as 90 or more days of unemployment per year. Overall and sex-specific relative risks (RRs) with 95% CIs were estimated using generalized estimating equations. Results: Among 12 875 individuals with ADHD (5343 women [41.50%] and 7532 men [58.50%]; mean [SD] age, 37.9 [5.6] years), the use of ADHD medications during the previous 2 years was associated with a 10% lower risk of long-term unemployment in the following year (adjusted RR, 0.90 [95% CI, 0.87-0.95]). An association between use of ADHD medications and long-term unemployment was found among women (RR, 0.82 [95% CI, 0.76-0.89]) but not men (RR, 0.96 [95% CI, 0.91-1.01]). Longer treatment duration was associated with a lower risk of subsequent long-term unemployment among women (RR for use of 1-6 months, 0.86 [95% CI, 0.78-0.95]; RR for use of 18-24 months, 0.72 [95% CI, 0.58-0.90]; P < .001 for trend). Within-individual comparisons showed that the long-term unemployment rate was lower during periods of ADHD medication treatment compared with nontreatment periods (RR, 0.89; 95% CI, 0.85-0.94). Conclusions and Relevance: The findings of this cohort study suggest that the use of ADHD medication is associated with a lower risk of subsequent long-term unemployment for middle-aged women. These findings should be considered together with the existing knowledge of risks and benefits of ADHD medication when developing treatment plans for working-age adults.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Adulto , Trastorno por Déficit de Atención con Hiperactividad/tratamiento farmacológico , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Riesgo , Suecia/epidemiología , Desempleo
19.
JAMA Netw Open ; 5(4): e228959, 2022 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-35482309

RESUMEN

Importance: Mortality rates resulting from bladder cancer have remained unchanged for more than 30 years. The surgical community has put hope in robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) in an effort to improve surgical outcomes and bladder cancer survival without strong supporting evidence. Objective: To evaluate perioperative, safety, and survival outcome differences between RARC with ICUD and open radical cystectomy (ORC). Design, Setting, and Participants: This nationwide population-based cohort study used data from the Swedish National Register of Urinary Bladder Cancer and population-based Cause of Death Register, which includes clinical information on tumor characteristics, treatment, and survival and covers approximately 97% of patients with urinary bladder cancer in Sweden. All patients who underwent radical cystectomy for bladder cancer in any hospital between January 2011 and December 2018 were included. Follow-up data were collected until December 2019. Data analysis was conducted from June to December 2020. Exposures: RARC or ORC. Main Outcomes and Measures: The main outcomes were all-cause and cancer-specific mortality between RARC and ORC, compared using propensity score matching. Secondary outcomes were differences in perioperative outcomes after the different surgical approaches. Results: Throughout the observation period, 889 patients underwent RARC and 2280 patients underwent ORC at 24 Swedish hospitals. The median (IQR) age was 71 (66-76) years and 2386 patients (75.3%) were men. After a median (IQR) follow-up of 47 (28-71) months, the 5-year cancer-specific mortality rates were 30.2% (variance, 1.59) for ORC and 27.6% (variance, 3.12) for RARC, and the overall survival rates were 57.7% (variance, 2.46) for ORC and 61.4% (variance, 5.11) for RARC. In the propensity score-matched analysis, RARC was associated with a lower all-cause mortality (hazard ratio, 0.71; 95% CI, 0.56-0.89; P = .004). Compared with ORC, RARC was associated with a lower estimated blood loss (median [IQR] 150 [100-300] mL vs 700 [400-1300] mL; P < .001), intraoperative transfusion rate (odds ratio [OR], 0.05; 95% CI, 0.03-0.08; P < .001), and shorter length of stay (median [IQR], 9 [6-13] days vs 13 [10-17] days; P < .001), and with a higher lymph node yield (median [IQR], 20 [15-27] lymph nodes vs 14 [8-24] lymph nodes; P < .001) and 90-day rehospitalization rate (OR, 1.28; 95% CI, 1.02-1.60; P = .03). The RARC group, compared with the ORC group had lower risk of Clavien-Dindo grade III or higher complications (OR, 0.62; 95% CI, 0.43-0.87; P = .009). Conclusions and Relevance: These findings suggest that compared with ORC, RARC with ICUD was associated with a lower overall mortality rate, fewer high-grade complications, and more favorable perioperative outcomes.


Asunto(s)
Procedimientos Quirúrgicos Robotizados , Robótica , Neoplasias de la Vejiga Urinaria , Anciano , Estudios de Cohortes , Cistectomía/efectos adversos , Cistectomía/métodos , Femenino , Humanos , Masculino , Procedimientos Quirúrgicos Robotizados/métodos , Suecia/epidemiología , Resultado del Tratamiento , Neoplasias de la Vejiga Urinaria/cirugía
20.
BJS Open ; 6(2)2022 Mar 08.
Artículo en Inglés | MEDLINE | ID: mdl-35383831

RESUMEN

BACKGROUND: Risk-adjusted mortality (RAM) analysis and comparisons of clinically relevant subsets of trauma patients allow hospitals to assess performance in different processes of care. The aim of the study was to develop a RAM model and compare RAM ratio (RAMR) in subsets of severely injured adult patients treated in university hospitals (UHs) and emergency hospitals (EHs) in Sweden. METHODS: This was a retrospective study of the Swedish trauma registry data (2013 to 2017) comparing RAMR in patients (aged 15 years or older and New Injury Severity Score (NISS) of more than 15) in the total population (TP) and in multisystem blunt (MB), truncal penetrating (PEN), and severe traumatic brain injury (STBI) subsets treated in UHs and EHs. The RAM model included the variables age, NISS, ASA Physical Status Classification System Score, and physiology on arrival. RESULTS: In total, 6690 patients were included in the study (4485 from UHs and 2205 from EHs). The logistic regression model showed a good fit. RAMR was 4.0, 3.8, 7.4, and 8.5 percentage points lower in UH versus EH for TP (P < 0.001), MB (P < 0.001), PEN (P = 0.096), and STBI (P = 0.005), respectively. The TP and MB subsets were subgrouped in with (+) and without (-) traumatic brain injury (TBI). RAMR was 7.5 and 7.0, respectively, percentage points lower in UHs than in EHs in TP + TBI and MB + TBI (both P < 0.001). In the TP-TBI (P = 0.027) and MB-TBI (P = 0.107) subsets the RAMR was 1.6 and 1.8 percentage points lower, respectively. CONCLUSION: The lower RAMR in UHs versus EH were due to differences in TBI-related mortality. No evidence supported that Swedish EHs provide inferior quality of care for trauma patients without TBI or for patients with penetrating injuries.


Asunto(s)
Lesiones Traumáticas del Encéfalo , Adolescente , Adulto , Lesiones Traumáticas del Encéfalo/terapia , Humanos , Puntaje de Gravedad del Traumatismo , Sistema de Registros , Estudios Retrospectivos , Suecia/epidemiología
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