[New Swedish National care process for pediatric obstructive sleep disordered breathing]. / Nytt vårdförlopp för barn med OSDB är godkänt att tas i bruk.

Obstructive sleep disordered breathing (OSDB) is a spectrum from habitual snoring and labored breathing to obstructive sleep apnea (OSA), which is common and potentially serious in children. The process contains a new question at child care centers, directed at caretakers with children at age 18 months and 3 years, concerning habitual snoring (3 times a week or more). A primary care doctor verifies the suspicion of OSDB in case of a positive answer to one of 7 additional questions or 4 status findings (e.g. tonsil hypertrophy). The process starts with the suspicion of OSDB, from the age of 18 months to 18 years, and ends when symptoms are improved after watchful waiting or upper airway surgery. National equality is a goal, with increased access to nocturnal respiratory recordings of children with comorbidities or doubtful cases. Also, with short waiting time to first visit at ORL department, and to surgery. Children with comorbidities or severe symptoms get postoperative follow-ups with a nurse after 6 months. The new ICD code for OSDB is R06.8A.

Metabolic surgery and oral health: A register-based study.

OBJECTIVE: The impact of weight loss surgery on oral health is not clear. The aim of the present study was to investigate its impact on the risk for dental interventions. MATERIALS AND METHODS: All adults who underwent metabolic surgery in Sweden between January 1, 2009 and December 31, 2018 were identified in the Scandinavian Obesity Surgery Registry (SOReg; n = 53,643). A control cohort from the general population was created, matched 10:1 on sex, age and place of residence (n = 536,430). All individuals were followed in the Swedish Dental Register regarding event rates for four types of dental intervention: restorative, endodontic and periodontal interventions, and tooth extractions. RESULTS: The surgical cohort had increased interventional rates postoperatively regarding all studied outcomes except periodontal interventions. Dental interventions were more common in the surgical cohort both pre- and postoperatively. The difference between the groups increased markedly in the postoperative period. The between-group comparison postoperatively showed increased event rates for restorations (IRR 1.8; 95% CI 1.7-1.8), extractions (1.9; 95% CI 1.9-2.0) and endodontics (2.1; 95% CI 2.0-2.1). CONCLUSION: The surgical intervention might cause a substantial negative impact on oral health. These results imply an important role for counselling metabolic surgery patients regarding preventive oral health measures.

Ambient temperature and stillbirth risks in northern Sweden, 1880-1950.

BACKGROUND: Climate vulnerability of the unborn can contribute to adverse birth outcomes, in particular, but it is still not well understood. We investigated the association between ambient temperature and stillbirth risk among a historical population in northern Sweden (1880-1950). METHODS: We used digitized parish records and daily temperature data from the study region covering coastal and inland communities some 600 km north of Stockholm, Sweden. The data included 141,880 births, and 3,217 stillbirths, corresponding to a stillbirth rate of 22.7 (1880-1950). The association between lagged temperature (0-7 days before birth) and stillbirths was estimated using a time-stratified case-crossover design. Incidence risk ratios (IRR) with 95% confidence intervals were computed, and stratified by season and sex. RESULTS: We observed that the stillbirth risk increased both at low and high temperatures during the extended summer season (April to September), at -10°C, and the IRR was 2.3 (CI 1.28, 4.00) compared to the minimum mortality temperature of +15°C. No clear effect of temperature during the extended winter season (October to March) was found. Climate vulnerability was greater among the male fetus compared to the female counterparts. CONCLUSION: In this subarctic setting before and during industrialization, both heat and cold during the warmer season increased the stillbirth risk. Urbanization and socio-economic development might have contributed to an uneven decline in climate vulnerability of the unborn.

Implications for cardiac arrest coverage using straight-line versus route distance to nearest automated external defibrillator.

AIM: Quantifying the ratio describing the difference between "true route" and "straight-line" distances from out-of-hospital cardiac arrests (OHCAs) to the closest accessible automated external defibrillator (AED) can help correct likely overestimations in AED coverage. Furthermore, we aimed to examine to what extent the closest AED based on true route distance differed from the closest AED using "straight-line". METHODS: OHCAs (1994-2016) and AEDs (2016) in Copenhagen, Denmark and in Toronto, Canada (2007-2015 and 2015, respectively) were identified. Three distances were calculated between OHCA and target AED: 1) the straight-line distance ("straight-line") to the closest AED, 2) the corresponding true route distance to the same AED ("true route"), and 3) the closest AED based only on true route distance ("shortest true route"). The ratio between "true route" and "straight-line" distance was calculated and differences in AED coverage (an OHCA ≤ 100 m of an accessible AED) were examined. RESULTS: The "straight-line" AED coverage of 100 m was 24.2% (n = 2008/8295) in Copenhagen and 6.9% (n = 964/13916) in Toronto. The corresponding "true route" distance reduced coverage to 9.5% (n = 786) and 3.8% (n = 529), respectively. The median ratio between "true route" and "straight-line" distance was 1.6 in Copenhagen and 1.4 in Toronto. In 26.1% (n = 2167) and 22.9% (n = 3181) of all Copenhagen and Toronto OHCAs respectively, the closest AED in "shortest true route" was different than the closest AED initially found by "straight-line". CONCLUSIONS: Straight-line distance is not an accurate measure of distance and overestimates the actual AED coverage compared to a more realistic true route distance by a factor 1.4-1.6.

Climate vulnerability of Swedish newborns: Gender differences and time trends of temperature-related neonatal mortality, 1880-1950.

BACKGROUND: In resource-poor societies, neonatal mortality (death in the first 28 days of life) is usually very high. Young infants are particularly vulnerable to environmental health risks, which are modified by socioeconomic factors that change over time. We investigated the association between ambient temperature and neonatal mortality in northern Sweden during the demographic transition. METHODS: Parish register data and temperature data in coastal Västerbotten, Sweden, between 1880 and 1950 were used. Total and sex-specific neonatal mortality was modelled as a function of mean temperature, adjusting for age, seasonality and calendar time, using discrete-time survival analysis. A linear threshold function was applied with a cut point at 14.5 °C (the minimum mortality temperature). Odds ratios (ORs) with 95% confidence intervals (CIs) were computed. Further analyses were stratified by study period (1800-1899, 1900-1929, and 1930-1950). RESULTS: Neonatal mortality was 32.1 deaths/1000 live births, higher in boys than in girls, and decreased between 1880 and 1950, with high inter-annual variability. Mean daily temperature was +2.5 °C, ranging from -40.9 °C to +28.8 °C. At -20 °C, the OR of neonatal death was 1.56 (CI 1.30-1.87) compared to the reference at +14.5 °C. Among girls, the OR of mortality at -20 °C was 1.17 (0.88-1.54), and among boys, it was 1.94 (1.53-2.45). A temperature increase from +14.5 to +20 °C was associated with a 25% increase of neonatal mortality (OR 1.25, CI 1.04-1.50). Heat- and cold-related risks were lowest between 1900 and 1929. CONCLUSIONS: In this remote sub-Arctic region undergoing socio-economic changes, we found an increased mortality risk in neonates related to low but also to high temperature. Climate vulnerability varied across time and was particularly high among boys. This demonstrates that environmental impacts on human health are complex and highly dependent on the specific local context, with many, often unknown, contributing determinants of vulnerability.

Effect of Optimized Versus Guidelines-Based Automated External Defibrillator Placement on Out-of-Hospital Cardiac Arrest Coverage: An In Silico Trial.

Background Mathematical optimization of automated external defibrillator (AED) placement may improve AED accessibility and out-of-hospital cardiac arrest (OHCA) outcomes compared with American Heart Association (AHA) and European Resuscitation Council (ERC) placement guidelines. We conducted an in silico trial (simulated prospective cohort study) comparing mathematically optimized placements with placements derived from current AHA and ERC guidelines, which recommend placement in locations where OHCAs are usually witnessed. Methods and Results We identified all public OHCAs of presumed cardiac cause from 2008 to 2016 in Copenhagen, Denmark. For the control, we computationally simulated placing 24/7-accessible AEDs at every unique, public, witnessed OHCA location at monthly intervals over the study period. The intervention consisted of an equal number of simulated AEDs placements, deployed monthly, at mathematically optimized locations, using a model that analyzed historical OHCAs before that month. For each approach, we calculated the number of OHCAs in the study period that occurred within a 100-m route distance based on Copenhagen's road network of an available AED after it was placed ("OHCA coverage"). Estimated impact on bystander defibrillation and 30-day survival was calculated by multivariate logistic regression. The control scenario involved 393 AEDs at historical, public, witnessed OHCA locations, covering 15.8% of the 653 public OHCAs from 2008 to 2016. The optimized locations provided significantly higher coverage (24.2%; P<0.001). Estimated bystander defibrillation and 30-day survival rates increased from 15.6% to 18.2% (P<0.05) and from 32.6% to 34.0% (P<0.05), respectively. As a baseline, the 1573 real AEDs in Copenhagen covered 14.4% of the OHCAs. Conclusions Mathematical optimization can significantly improve OHCA coverage and estimated clinical outcomes compared with a guidelines-based approach to AED placement.

Smartphone Activation of Citizen Responders to Facilitate Defibrillation in Out-of-Hospital Cardiac Arrest.

BACKGROUND: Dispatching citizen responders through a smartphone application (app) holds the potential to increase bystander cardiopulmonary resuscitation (CPR) and defibrillation in out-of-hospital cardiac arrest (OHCA). OBJECTIVES: This study investigated arrival at the OHCA location of app-dispatched citizen responders before the Emergency Medical Services (EMS) and the association with bystander CPR and bystander defibrillation. METHODS: Suspected OHCAs with alerted citizen responders from September 1, 2017, to August 31, 2018, were included. Citizen responders located 1.8 km (1.1 miles) from the OHCA were dispatched to start CPR or retrieve an automated external defibrillator. OHCAs where at least 1 citizen responder arrived before EMS were compared with OHCAs where EMS arrived first. In both groups, random bystanders could be present before the arrival of citizen responders and the EMS. Primary outcomes were bystander CPR and bystander defibrillation, which included CPR and defibrillation by citizen responders and random bystanders. RESULTS: Citizen responders were alerted in 819 suspected OHCAs, of which 438 (53.5%) were confirmed cardiac arrests eligible for inclusion. At least 1 citizen responder arrived before EMS in 42.0% (n = 184) of all included OHCAs. When citizen responders arrived before EMS, the odds for bystander CPR increased (odds ratio: 1.76; 95% confidence interval: 1.07 to 2.91; p = 0.027) and the odds for bystander defibrillation more than tripled (odds ratio: 3.73; 95% confidence interval: 2.04 to 6.84; p < 0.001) compared with OHCAs in which citizen responders arrived after EMS. CONCLUSIONS: Arrival of app-dispatched citizen responders before EMS was associated with increased odds for bystander CPR and a more than 3-fold increase in odds for bystander defibrillation. (The HeartRunner Trial; NCT03835403).

Occurrence of shockable rhythm in out-of-hospital cardiac arrest over time: A report from the COSTA group.

BACKGROUND: Prior research suggests that the proportion of a shockable initial rhythm in out-of-hospital cardiac arrest (OHCA) declined during the last decades. This study aims to investigate if this decline is still ongoing and explore the relationship between location of OHCA and proportion of a shockable initial rhythm as initial rhythm. METHODS: We calculated the proportion of patients with a shockable initial rhythm between 2006-2015 using pooled data from the COSTA-group (Copenhagen, Oslo, Stockholm, Amsterdam). Analyses were stratified according to location of OHCA (residential vs. public). RESULTS: A total of 19,054 OHCA cases were included. Overall, the total proportion of cases with a shockable initial rhythm decreased from 42% to 37% (P < 0.01) from 2006 to 2015. When stratified according to location, the proportion of cases with a shockable initial rhythm decreased for OHCAs at a residential location (34% to 27%; P = 0.03), while the proportion of a shockable initial rhythm was stable among OHCAs in public locations (59%-57%; P = 0.2). During the last years of the study period (2011-2015), the overall proportion of a shockable initial rhythm remained stable (38%-37%; P = 0.45); this was observed for both residential and public OHCA. CONCLUSION: We found a decline in the proportion of patients with a shockable initial rhythm in OHCAs at a residential location; this decline levelled off during the second half of the study period (2011-2015). In public locations, we observed no decline in shockable initial rhythm over time.

Improving bystander defibrillation in out-of-hospital cardiac arrests at home.

AIMS: Most out-of-hospital cardiac arrests occur at home with dismal bystander defibrillation rates. We investigated automated external defibrillator coverage of home arrests, and the proportion potentially reachable with an automated external defibrillator before emergency medical service arrival according to different bystander activation strategies. METHODS AND RESULTS: Cardiac arrests in homes (private/nursing/senior homes) in Copenhagen, Denmark (2008-2016) and registered automated external defibrillators (2007-2016), were identified. Automated external defibrillator coverage (distance from arrest to automated external defibrillator) and accessibility at the time of arrest were examined according to route distance to nearest automated external defibrillator and emergency medical service response time. The proportion of arrests reachable with an automated external defibrillator by bystander was calculated using two-way (from patient to automated external defibrillator and back) and one-way (from automated external defibrillator to patient) potential activation strategies. Of 1879 home arrests, automated external defibrillator coverage ≤100 m was low (6.3%) and a two-way bystander could potentially only retrieve an accessible automated external defibrillator before emergency medical service in 31.1% (n=37) of cases. If a bystander only needed to travel one-way to bring an automated external defibrillator (≤100 m, ≤250 m and ≤500 m), 45.4% (n=54/119), 37.1% (n=196/529) and 29.8% (n=350/1174) could potentially be reached before the emergency medical service based on current automated external defibrillator accessibility. CONCLUSIONS: Few home arrests were reachable with an automated external defibrillator before emergency medical service if bystanders needed to travel from patient to automated external defibrillator and back. However, nearly one-third of arrests ≤500 m of an automated external defibrillator could be reached before emergency medical service arrival if the bystander only needed to travel one-way from the automated external defibrillator to the patient.

Neonatal Mortality and Temperature in Two Northern Swedish Rural Parishes, 1860-1899-The Significance of Ethnicity and Gender.

The aim of this study was to analyze the association between season of birth and daily temperature for neonatal mortality in two Swedish rural parishes between 1860 and 1899. Further, we aimed to study whether the association varied according to ethnicity (indigenous Sami reindeer herders and non-Sami settlers) and gender. The source material for this study comprised digitized parish records from the Demographic Data Base, Umeå University, combined with local weather data provided by the Swedish Meteorological and Hydrological Institute. Using a time event-history approach, we investigated the association between daily temperature (at birth and up to 28 days after birth) and the risk of neonatal death during the coldest months (November through March). The results showed that Sami neonatal mortality was highest during winter and that the Sami neonatal mortality risk decreased with higher temperatures on the day of birth. Male neonatal risk decreased with higher temperatures during the days following birth, while no effect of temperature was observed among female neonates. We conclude that weather vulnerability differed between genders and between the indigenous and non-indigenous populations.

Regional variation in out-of-hospital cardiac arrest: Incidence and survival - A nationwide study of regions in Denmark.

AIM: Regional variation in incidence and survival after out-of-hospital cardiac arrest (OHCA) may be caused by many factors including differences in definitions and reporting. We examined regional differences in Denmark. METHODS: From the Danish Cardiac Arrest Registry we identified adult OHCA patients between 2009-2014 of presumed cardiac cause. Patients were grouped according to the five administrative/geographical regions of Denmark and survival was examined based on all arrest-cases (30-day survival percentage) and number of survivors per 100,000 inhabitants. RESULTS: We included 12,902 OHCAs of which 1550 (12.0 %) were alive 30 days after OHCA. No regional differences were observed in age, sex or comorbidities. Incidence of OHCA ranged from 32.9 to 42.4 per 100,000 inhabitants; 30-day survival percentages ranged from 8.5% to 13.8% and number of survivors per 100,000 inhabitants ranged from 3.5 to 5.9, across the regions. In one of the regions car-manned pre-hospital physicians were discontinued from 2011. Here, the incidence of OHCA per 100,000 inhabitants increased markedly from 37.1 in 2011 to 52.2 in 2014 and 30-day survival percentage decreased from 10.9 % in 2011 to 7.5 % in 2014; while the number of survivors per 100,000 inhabitants stagnated from 4.0 in 2011 to 3.9 in 2014. In comparison, survival increased in the other four regions. CONCLUSION: Differences in incidence and 30-day survival after OHCA were observed between the five regions of Denmark. Comparisons of survival should not only be based on survival percentages, but also on number of survivors of the background population as inclusion bias can influence survival outcomes.

Out-of-hospital cardiac arrest: 30-day survival and 1-year risk of anoxic brain damage or nursing home admission according to consciousness status at hospital arrival.

AIM: To investigate the association between consciousness status at hospital arrival and long-term outcomes in out-of-hospital cardiac arrest (OHCA) patients. METHODS: OHCAs between 18-100 years of age were identified from the Danish Cardiac Arrest Registry during 2005-2014. Patients with return of spontaneous circulation (ROSC) or ongoing cardiopulmonary resuscitation (CPR) at hospital arrival were included. Thirty-day survival was evaluated using Kaplan-Meier estimates. Risk of anoxic brain damage or nursing home admission and return to work among 30-day survivors were evaluated using Aalen-Johansen estimates and cause-specific Cox regression. RESULTS: Upon hospital arrival of 13,953 OHCA patients, 776 (5.6%) had ROSC and were conscious (Glasgow Coma Score [GCS]>8), 5205 (37.3%) had ROSC, but were comatose (GCS ≤ 8), and 7972 (57.1%) had ongoing CPR. Thirty-day survival according to status at hospital arrival among patients that were conscious, comatose, or had ongoing CPR was 89.0% (95% confidence interval [CI] 86.8%-91.2%), 39.0% (95% CI 37.6%-40.3%), and 1.2% (95% CI 1.0%-1.4%), respectively. Among 30-day survivors, 1-year risks of new onset anoxic brain damage or nursing home admission according to consciousness status were 2.4% (95% CI 1.2%-3.6%), 12.9% (95% CI 11.4%-14.3%), and 19.4% (95% CI 11.3%-27.4%), respectively. Among 30-day working-age survivors, more than 65% in each group returned to work within 5 years. CONCLUSION: Consciousness status at hospital arrival was strongly associated with 30-day survival in OHCA patients. Among 30-day survivors, a minority was diagnosed with anoxic brain damage or admitted to a nursing home and the majority returned to work independent of consciousness status at hospital arrival.

Survival of patients with and without diabetes following out-of-hospital cardiac arrest: A nationwide Danish study.

BACKGROUND: Research regarding out-of-hospital cardiac arrest (OHCA) survival of diabetes patients is sparse and it remains unknown whether initiatives to increase OHCA survival benefit diabetes and non-diabetes patients equally. We therefore examined overall and temporal survival in diabetes and non-diabetes patients following OHCA. METHODS: Adult presumed cardiac-caused OHCAs were identified from the Danish Cardiac Arrest Registry (2001-2014). Associations between diabetes and return of spontaneous circulation upon hospital arrival and 30-day survival were estimated with logistic regression adjusted for patient- and OHCA-related characteristics. RESULTS: In total, 28,955 OHCAs were included of which 4276 (14.8%) had diabetes. Compared with non-diabetes patients, diabetes patients had more comorbidities, same prevalence of bystander-witnessed arrests (51.7% vs. 52.7%) and bystander cardiopulmonary resuscitation (43.2% vs. 42.0%), more arrests in residential locations (77.3% vs. 73.0%) and were less likely to have shockable heart rhythm (23.5% vs. 27.9%). Temporal increases in return of spontaneous circulation and 30-day survival were seen for both groups (return of spontaneous circulation: 8.8% in 2001 to 22.3% in 2014 (diabetes patients) vs. 7.8% in 2001 to 25.7% in 2014 (non-diabetes patients); and 30-day survival: 2.8% in 2001 to 9.7% in 2014 vs. 3.5% to 14.8% in 2014, respectively). In adjusted models, diabetes was associated with decreased odds of return of spontaneous circulation (odds ratio 0.74 (95% confidence interval 0.66-0.82)) and 30-day survival (odds ratio 0.56 (95% confidence interval 0.48-0.65)) (interaction with calendar year p=0.434 and p=0.243, respectively). CONCLUSION: No significant difference in temporal survival was found between the two groups. However, diabetes was associated with lower odds of return of spontaneous circulation and 30-day survival.

Weather extremes and perinatal mortality - Seasonal and ethnic differences in northern Sweden, 1800-1895.

BACKGROUND: Many studies have shown the impact of heat and cold on total and age-specific mortality, but knowledge gaps remain regarding weather vulnerability of very young infants. This study assessed the association of temperature extremes with perinatal mortality (stillbirths and deaths in the first week of life), among two ethnic groups in pre-industrial northern Sweden. METHODS: We used population data of indigenous Sami and non-Sami in selected parishes of northern Sweden, 1800-1895, and monthly temperature data. Multiple logistic regression models were conducted to estimate the association of cold (<10th percentile of temperature) and warmth (>90th percentile) in the month of birth with perinatal mortality, adjusted for cold and warmth in the month prior birth and period, stratified by season and ethnicity. RESULTS: Perinatal mortality was slightly higher in Sami than in non-Sami (46 vs. 42 / 1000 live and stillbirths), but showed large variations across the region and over time. Both groups saw the highest perinatal mortality in autumn. For Sami, winter was a high-risk time as well, while for non-Sami, seasonality was less distinct. We found an association between exposure to cold and perinatal mortality among winter-born Sami [Odds ratio (OR) 1.91, 95% confidence interval (CI) 1.26-2.92, compared to moderate temperature], while there was little effect of cold or warmth during other seasons. Non-Sami, meanwhile, were affected in summer by warmth (OR 0.20, CI 0.05-0.81), and in autumn by cold (OR 0.39, CI 0.19-0.82). CONCLUSIONS: In this pre-industrial, subarctic setting, the indigenous Sami's perinatal mortality was influenced by extreme cold in winter, while non-Sami seemed to benefit from high temperature in summer and low temperature in autumn. Climate vulnerability of these two ethnic groups sharing the same environment was shaped by their specific lifestyles and living conditions.

In Silico Trial of Optimized Versus Actual Public Defibrillator Locations.

BACKGROUND: Automated external defibrillators (AEDs) are often placed in areas of low risk and limited temporal availability. Mathematical optimization can improve AED accessibility but has not been compared with current practices. OBJECTIVES: This study sought to determine whether, compared with real AED locations, optimized AED locations improve coverage of out-of-hospital cardiac arrests (OHCAs). METHODS: The authors conducted the first retrospective in silico trial of an AED placement intervention. This study identified all public OHCAs of presumed cardiac cause and real AED deployed (control group) from 2007 to 2016 in Copenhagen, Denmark. Optimization models trained on historical OHCAs (1994 to 2007) were used to optimize an equal number of AEDs to the control group in locations with availabilities based on building hours (intervention #1) or 24/7 access (intervention #2). The 2 interventions and control scenario were compared using the number of OHCAs that occurred within 100 m of an accessible AED ("OHCA coverage") during the 2007 to 2016 period. Change in bystander defibrillation and 30-day survival were estimated using multivariate logistic regression. RESULTS: There were 673 public OHCAs and 1,573 registered AEDs from 2007 to 2016. OHCA coverage of real AED placements was 22.0%. OHCA coverage of interventions #1 and #2 was significantly higher at 33.4% and 43.1%, respectively; relative gains of 52.0% to 95.9% (p < 0.001). Bystander defibrillation increased from 14.6% (control group) to 22.5% to 26.9% (intervention #1 to intervention #2); relative increase of 52.9% to 83.5% (p < 0.001). The 30-day survival rates increased from 31.3% (control group) to 34.7% to 35.4%, which is a relative increase of 11.0% to 13.3% (p < 0.001). CONCLUSIONS: Optimized AED placements increased OHCA coverage by approximately 50% to 100% over real AED placements, leading to significant predicted increases in bystander defibrillation and 30-day survival.

Season of birth, stillbirths, and neonatal mortality in Sweden: the Sami and non-Sami population, 1800-1899.

Seasonal patterns of neonatal mortality and stillbirths have been found around the world. However, little is known about the association between season of birth and infant mortality of pre-industrial societies in a subarctic environment. In this study, we compared how season of birth affected the neonatal and stillbirth risk among the Sami and non-Sami in Swedish Sápmi during the nineteenth century. Using digitised parish records from the Demographic Data Base at Umeå University, we applied logistic regression models for estimating the association of season of birth with stillbirths and neonatal mortality, respectively. Higher neonatal mortality was found among the winter- and autumn-born Sami, compared to summer-born infants. Stillbirth risk was higher during autumn compared to summer among the Sami, whereas we found no seasonal differences in mortality among the non-Sami population. We relate the higher neonatal mortality risk among winter-born Sami to differences in seasonality of living conditions associated with reindeer herding.

The association between cold extremes and neonatal mortality in Swedish Sápmi from 1800 to 1895.

Background: Studies in which the association between temperature and neonatal mortality (deaths during the first 28 days of life) is tracked over extended periods that cover demographic, economic and epidemiological transitions are quite limited. From previous research about the demographic transition in Swedish Sápmi, we know that infant and child mortality was generally higher among the indigenous (Sami) population compared to non-indigenous populations. Objective: The aim of this study was to analyse the association between extreme temperatures and neonatal mortality among the Sami and non-Sami population in Swedish Sápmi (Lapland) during the nineteenth century. Methods: Data from the Demographic Data Base, Umeå University, were used to identify neonatal deaths. We used monthly mean temperature in Tornedalen and identified cold and warm month (5th and 95th) percentiles. Monthly death counts from extreme temperatures were modelled using negative binomial regression. We computed relative risks (RR) with 95% confidence intervals (CI), adjusting for time trends and seasonality. Results: Overall, the neonatal mortality rate was higher among Sami compared to non-Sami infants (62/1,000 vs 35/1,000 live births), although the differences between the two populations decreased after 1860. For the Sami population prior 1860, the results revealed a higher neonatal incidence rate during cold winter months (<-15.4°C, RR = 1.60, CI 1.14-2.23) compared to infants born during months of medium temperature. No association was found between extreme cold months and neonatal mortality for non-Sami populations. Warm months (+15.1°C) had no impact on Sami or non-Sami populations. Conclusions: This study revealed the role of environmental factors (temperature extremes) on infant health during the demographic transition where cold extremes mainly affected the Sami population. Ethnicity and living conditions contributed to differential weather vulnerability.

Data concerning AED registration in the Danish AED Network, and cardiac arrest-related characteristics of OHCAs, including AED coverage and AED accessibility.

The data presented in this article is supplemental data related to the research article entitled "Automated external defibrillator accessibility is crucial for bystander defibrillation and survival: a registry-based study" (Karlsson et al., 2019). We present detailed data concerning: 1) the type of location for deployed and registered automated external defibrillators (AEDs) in the nationwide Danish AED Network; 2) the number of registered AEDs in the nationwide Danish AED Network, and changes in AED registration (according to year and type of AED location); 3) the number of AEDs being withdrawn from the AED network between the years 2007-2016. We also report data on baseline cardiac arrest-related characteristics of out-of-hospital cardiac arrests (OHCAs) that occurred in Copenhagen, Denmark, between 2008 and 2016. Cardiac arrest-related characteristics are further described according to AED accessibility (accessible vs. inaccessible AED at the time of OHCA) for OHCAs covered by an AED (AED ≤200 m route distance of an OHCA). Finally, we report data on distance to the nearest accessible AED for bystander defibrillated OHCAs covered by an AED ≤200 m route distance where the AED was inaccessible at the time of OHCA.

Automated external defibrillator accessibility is crucial for bystander defibrillation and survival: A registry-based study.

AIMS: Optimization of automated external defibrillator (AED) placement and accessibility are warranted. We examined the associations between AED accessibility, at the time of an out-of-hospital cardiac arrest (OHCA), bystander defibrillation, and 30-day survival, as well as AED coverage according to AED locations. METHODS: In this registry-based study we identified all OHCAs registered by mobile emergency care units in Copenhagen, Denmark (2008-2016). Information regarding registered AEDs (2007-2016) was retrieved from the nationwide Danish AED Network. We calculated AED coverage (AEDs located ≤200 m route distance from an OHCA) and, according to AED accessibility, the likelihoods of bystander defibrillation and 30-day survival. RESULTS: Of 2500 OHCAs, 22.6% (n = 566) were covered by a registered AED. At the time of OHCA, <50% of these AEDs were accessible (n = 276). OHCAs covered by an accessible AED were nearly three times more likely to receive bystander defibrillation (accessible: 13.8% vs. inaccessible: 4.8%, p < 0.001) and twice as likely to achieve 30-day survival (accessible: 28.8% vs. inaccessible: 16.4%, p < 0.001). Among bystander-witnessed OHCAs with shockable heart rhythms (accessible vs. inaccessible AEDs), bystander defibrillation rates were 39.8% vs. 20.3% (p = 0.01) and 30-day survival rates were 72.7% vs. 44.1% (p < 0.001). Most OHCAs were covered by AEDs at offices (18.6%), schools (13.3%), and sports facilities (12.9%), each with a coverage loss >50%, due to limited AED accessibility. CONCLUSIONS: The chance of a bystander defibrillation was tripled, and 30-day survival nearly doubled, when the nearest AED was accessible, compared to inaccessible, at the time of OHCA, underscoring the importance of unhindered AED accessibility.

Bystander cardiopulmonary resuscitation and long-term outcomes in out-of-hospital cardiac arrest according to location of arrest.

Aims: Bystander cardiopulmonary resuscitation (CPR) has increased in several countries following nationwide initiatives to facilitate bystander resuscitative efforts in out-of-hospital cardiac arrest (OHCA). We examined the importance of public or residential location of arrest on temporal changes in bystander CPR and outcomes. Methods and results: From the nationwide Danish Cardiac Arrest Registry, all OHCAs from 2001 to 2014 of presumed cardiac cause and between 18 and 100 years of age were identified. Arrests witnessed by emergency medical services personnel were excluded. Of 25 505 OHCAs, 26.4% (n = 6738) and 73.6% (n = 18 767) were in public and residential locations, respectively. Bystander CPR increased during 2001-2014 in both locations: from 36.4% [95% confidence interval (CI) 30.6-42.6%] to 83.1% (95% CI 80.0-85.8%) in public (P < 0.001) and from 16.0% (95% CI 13.2-19.3%) to 61.0% (95% CI 58.7-63.2%) in residential locations (P < 0.001). Concurrently, 30-day survival increased in public from 6.4% (95% CI 4.0-10.0%) to 25.2% (95% CI 22.1-28.7%) (P < 0.001), and in residential from 2.9% (95% CI 1.8-4.5%) to 10.0% (95% CI 8.7-11.4%) (P < 0.001). Among 2281 30-day survivors, 1-year risk of anoxic brain damage/nursing home admission during 2001-2014 decreased from 18.8% (95% CI 6.6-43.0%) to 6.8% (95% CI 3.9-11.8%) in public (P < 0.001), whereas the corresponding change was insignificant in residential locations from 11.8% (95% CI 3.3-34.3) to 17.6% (95% CI 12.7-23.9%) (P = 0.52). Conclusion: During 2001-2014, bystander CPR and 30-day survival more than doubled in both public and residential OHCA locations. A significant decrease in anoxic brain damage/nursing home admission was observed among 30-day survivors in public, but not among survivors from residential OHCAs.