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1.
J Glob Health ; 12: 05017, 2022 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-35932219

RESUMO

Background: Countries making up the Nordic region - Denmark, Finland, Iceland, Norway, and Sweden - have minimal socioeconomic, cultural, and geographical differences between them, allowing for a fair comparative analysis of the health policy and economy trade-off in their national approaches towards mitigating the impact of the COVID-19 pandemic. Methods: This study utilized publicly available COVID-19 data of the Nordic countries from January 2020 to January 3, 2021. COVID-19 epidemiology, public health and health policy, health system capacity, and macroeconomic data were analysed for each Nordic country. Joinpoint regression analysis was performed to identify changes in temporal trends using average monthly percent change (AMPC) and average weekly percent change (AWPC). Results: Sweden's health policy, being by far the most relaxed response to COVID-19, was found to have the largest COVID-19 incidence and mortality, and the highest AWPC increases for both indicators (13.5, 95% CI = 5.6, 22.0, P < 0.001; 6.3, 95% CI = 3.5, 9.1, P < 0.001). Denmark had the highest number of COVID-19 tests per capita, consistent with their approach of increased testing as a preventive strategy for disease transmission. Iceland had the second-highest number of tests per capita due to their mass-testing, contact tracing, quarantine and isolation response. Only Norway had a significant increase in unemployment (AMPC = 2.8%, 95% CI = 0.7-4.9, P < 0.009) while the percentage change in real Gross Domestic Product (GDP) was insignificant for all countries. Conclusions: There was no trade-off between public health policy and economy during the COVID-19 pandemic in the Nordic region. Sweden's relaxed and delayed COVID-19 health policy response did not benefit the economy in the short term, while leading to disproportionate COVID-19 hospitalizations and mortality.


Assuntos
COVID-19 , Pandemias , COVID-19/epidemiologia , Política de Saúde , Humanos , Incidência , Pandemias/prevenção & controle , Países Escandinavos e Nórdicos/epidemiologia
2.
Forensic Sci Rev ; 34(2): 131-143, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35932486

RESUMO

This article reviews how the Nordic countries of Denmark, Finland, Norway, and Sweden enforce their legislation pertaining to driving under the influence of alcohol and/or other impairing drugs. The evidence necessary for a successful prosecution of traffic offenders has undergone radical changes over the past 50 years. The once widely used clinical tests of impairment are no longer a major element of the prosecution case and a physician is more seldom required to examine apprehended drivers and document any clinical signs and symptoms of alcohol and/or drug influence. These clinical tests have been superseded by results derived from a comprehensive toxicological analysis of psychoactive substances in samples of the driver's blood. The current statutory limits of blood-alcohol concentration (BAC) are among the lowest in the world: Norway and Sweden (0.20 g/kg) and Denmark and Finland (0.50 g/kg). Results from using evidential quality breath-alcohol instruments are accepted as evidence in drunk-driving cases and this has necessitated setting statutory breath-alcohol concentration (BrAC) limits. Laws dealing with driving under the influence of drugs (DUID) other than alcohol have also been updated and made more pragmatic for prosecution of traffic offenders. In Finland and Sweden zero-tolerance laws exist, making it illegal to drive with any quantifiable amount of a scheduled drug in the driver's blood. Prescription drugs are exempt from this zero-tolerance mandate provided the medication was used in accordance with a physician's ordination. Lacking a valid prescription or if there is a supratherapeutic concentration of the drug in blood, this will lead to a prosecution for DUID. In Denmark and Norway threshold concentration limits have been established for many psychoactive drugs, both licit and illicit. After these stricter laws for DUID were introduced, the number of suspects apprehended by the police per year increased by as much as tenfold in some Nordic countries. There is increasing evidence that many traffic delinquents in the Nordic countries suffer from a substance-use disorder, because repeat-offending is a common occurrence. This suggests that some type of treatment and rehabilitation program might be more beneficial compared with conventional penalties for people arrested for DUI and/or DUID.


Assuntos
Condução de Veículo , Dirigir sob a Influência , Transtornos Relacionados ao Uso de Substâncias , Acidentes de Trânsito/prevenção & controle , Concentração Alcoólica no Sangue , Etanol , Humanos , Países Escandinavos e Nórdicos , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
3.
PLoS One ; 17(7): e0270262, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35776708

RESUMO

This study seeks to provide a basic approach to fulfill the spatial visualization of geopolitical environmental factors required for the navigation of vessels in the Arctic. Multi-dimensional geopolitical environmental factors of the Arctic Passage are analyzed and classified into geopolitics, geoeconomics, geo-military, geoculture, and laws and regulations related to geography. Their characteristics are extracted to form an attribute information table matching spatial layers. Based on the information category and basic characteristics, the spatial match method is applied and connected with the spatial layers to examine the spatial point, polyline, and polygon. According to the qualitative description, the study extracted the quantitative indicators for the following spatial-temporal pattern analysis. The standard deviational ellipse is used to analyze the spatial-temporal patterns and trends of the geopolitical environmental indicators of the Arctic Passage in the Arctic and Northeast Asia. The expansion and contraction of geoinformation coexist in the countries surrounding the Arctic Passage. The spatial-temporal changes indicate that the Arctic channel has a great economic impact on the Nordic countries and Northeast Asia, especially the coastal areas of China and Japan. The characteristic extraction and spatial match of the geopolitical environment provide integrated Arctic geoinformation inquiry and services for the diplomatic, administrative, and legal preparations required for Arctic navigation. Therefore, the geospatial analysis conducted provides scientific support and a basis for the geographical distribution and developing trends of visualization and spatial-temporal pattern in Arctic navigation. The results of this research will help decision-makers to make a comprehensive judgment on governance related to the sustainable development of the Arctic Passage.


Assuntos
Análise Espacial , Regiões Árticas , China , Japão , Países Escandinavos e Nórdicos
4.
Int Rev Psychiatry ; 34(2): 118-127, 2022 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-35699102

RESUMO

The aim of this study was to compare financial and human resources for mental health services in selected Scandinavian and Eurasian countries. A cross-sectional descriptive and analytical approach was adopted to analyse questionnaire data provided by members of the Ukraine-Norway-Armenia Partnership Project. We compared Scandinavia (Sweden and Norway) and Eurasia (Armenia, Georgia, Kyrgyzstan and Ukraine). Health expenditure in Eurasia was generally below 4% of gross domestic product, with the exception of Georgia (10.2%), compared with 11% in Scandinavia. Inpatient hospital care commonly exceeded 50% of the mental health budget. The central governments in Eurasia paid for over 50% of the health expenditure, compared to 2% in Scandinavia. The number of mental health personnel per head of population was much smaller in Eurasia than Scandinavia. Financial and human resources were limited in Eurasia and mainly concentrated on institutional services. Health activities were largely managed by central governments. Community-based mental healthcare was poorly implemented, compared to Scandinavia, especially for children and adolescents.


Assuntos
Serviços de Saúde Mental , Adolescente , Criança , Estudos Transversais , Gastos em Saúde , Humanos , Saúde Mental , Países Escandinavos e Nórdicos
5.
Trials ; 23(1): 385, 2022 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-35550003

RESUMO

BACKGROUND: Patient recruitment for clinical trials is challenging-only approximately one third of all trials recruit their participants as planned. The pharmaceutical industry's views on recruitment success have not been comprehensively investigated, although the industry globally conducts almost one third of all clinical drug trials. This study explored patient recruitment success and failure factors and the role of electronic health records (EHR) in the recruitment of trial participants in the Nordic countries. METHODS: A descriptive qualitative interview study was conducted with 21 representatives of the pharmaceutical industry or contract research organizations operating in Finland, Sweden, Denmark, and Norway. The interviews covered 34 clinical pre-market drug trials. Qualitative data were analyzed using inductive content analysis. RESULTS: Four main categories were derived to represent both success and failure factors, whereas a fifth category represented only failure factors: (1) sponsor-related (protocol and trial preparation and feasibility evaluations), (2) site/investigator-related (access to patients, motivation, commitment and resources), (3) patient-related recruitment factors (medical need, patients' role in their care and attitudes towards trials), (4) Sponsor-sites-patients collaboration factors, and (5) start-up related factors. EHR was the most important source of recruitment, utilized in 29 out of 34 trials discussed. Revision of the legislation regulating the secondary use of EHR was highlighted as the most effective measure to facilitate the use of EHR in recruitment of trial participants. CONCLUSIONS: The industry representatives recognized quite well their own role in contributing to the success or failure of the recruitment: to facilitate recruitment of trial participants, many obstacles can be avoided with better trial preparation and proper feasibility evaluations. As access to patients represents one of the key success or failure factors of recruitment, and as the EHR is regarded the main source of searching for and finding patients, the development of EHR utilization appears to represent a powerful tool to improve patient recruitment.


Assuntos
Ensaios Clínicos como Assunto , Registros Eletrônicos de Saúde , Seleção de Pacientes , Humanos , Pesquisa Qualitativa , Pesquisadores , Países Escandinavos e Nórdicos
6.
Scand J Public Health ; 50(6): 787-794, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35546571

RESUMO

AIMS: To investigate the differences between Sweden, Denmark, Finland and Norway regarding residential/home care units' and frontline managers' background factors, the resources allocated and measures taken during the initial phases of the COVID-19 pandemic, and whether and how these differences were associated with COVID-19 among older people in residential/home units. METHODS: Register- and survey-based data. Responses from managers in municipal and private residential/home units. Number of municipal COVID-19 cases from national registries. Multilevel logistic multivariate regression analysis with presence of COVID-19 among older people in residential/home units as the outcome variable. RESULTS: The proportions of residential/home units with client COVID-19 cases, mid-March-April 2020 were Denmark 22.7%, Finland 9.0%, Norway 9.7% and Sweden 38.8%, most cases found in clusters. The proportions were similar among employees. Client likelihood of having COVID-19 was six-fold higher if the employees had COVID-19. Mean client cases per residential/home unit were Denmark 0.78, Finland 0.46, Norway 0.22 and Sweden 1.23. For the same municipal infection incidence class, Sweden's mean client infection levels were three-fold those of other countries. The regression analysis variables country, municipal COVID-19 incidence proportion, and care type were associated with client cases at p ⩽ .001. Compared with Denmark, the odds ratios (ORs) for Sweden, Norway and Finland were 1.86, 0.41 and 0.35 respectively. The variable difficulties in preventive testing had an OR of 1.56, p ⩽ .05. CONCLUSIONS: Municipal COVID-19 incidence, employee cases, and the lack of testing resources somewhat explained the confirmed COVID-19 cases among older people in residential/home units. A two- to five-fold unexplained inter-country difference in ORs in the multivariate analyses was notable. The level of protection of vulnerable older clients in municipal and private residential/home units differed between the included countries.


Assuntos
COVID-19 , Idoso , COVID-19/epidemiologia , Estudos Transversais , Humanos , Incidência , Noruega/epidemiologia , Pandemias , Países Escandinavos e Nórdicos/epidemiologia , Suécia/epidemiologia
7.
Acta Vet Scand ; 64(1): 9, 2022 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-35379275

RESUMO

On farm mortality is an increasing problem in cattle production systems in the Nordic countries. It represents an economic loss to the farmer and raises questions of sustainability, food waste and animal welfare. On-farm emergency slaughter (OFES) represents, in some situations, an opportunity for a farmer to salvage some of the economic value from an animal that cannot be transported to a slaughterhouse. The basis of the regulation of OFES in the Nordic countries originates largely from legislation from the European Union. However, this review has found that the availability and practice of OFES in the Nordic countries differs considerably. For example, in Norway 4.2% of all cattle slaughter is OFES, whilst in Iceland OFES has never been recorded. National food safety authorities have issued differing regulations and guidelines regarding the suitability of sick and injured animals for OFES. This review shows there is a paucity of data regarding the incidence and reasons for the use of OFES of cattle in the Nordic countries and points out the need for more investigation into this area to improve veterinary education, consumer protection and animal welfare.


Assuntos
Alimentos , Eliminação de Resíduos , Matadouros , Animais , Bovinos , Fazendas , Países Escandinavos e Nórdicos
8.
Artigo em Inglês | MEDLINE | ID: mdl-35409633

RESUMO

The aim of the article is to assess of development of poverty in EU countries in 2010 and 2019. The study used the model method of the linear ordering of objects-TOPSIS, considering the distance of each object from both the pattern and the non-pattern development. The originality of the work consists in the use of primary data obtained from the Eurostat database and the winsorized data that were created on the basis of outliers. The indicators characterizing the first goal of sustainable development-"No poverty" were used. The results of the research indicate that the inhabitants of western Europe and Scandinavia are less affected by poverty than the population of eastern and southern Europe. The division of countries according to the scale of poverty is reflected in the level of GDP per capita.


Assuntos
Pobreza , Europa (Continente) , Países Escandinavos e Nórdicos , Fatores Socioeconômicos
9.
Int J Cancer ; 151(3): 381-395, 2022 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-35419824

RESUMO

The severity of the COVID-19 pandemic and subsequent mitigation strategies have varied across the Nordic countries. In a joint Nordic population-based effort, we compared patterns of new cancer cases and notifications between the Nordic countries during 2020. We used pathology notifications to cancer registries in Denmark, the Faroe Islands, Finland, Iceland, Norway and Sweden to determine monthly numbers of pathology notifications of malignant and in situ tumours from January to December 2020 compared to 2019 (2017-2019 for Iceland and the Faroe Islands). We compared new cancer cases per month based on unique individuals with pathology notifications. In April and May 2020, the numbers of new malignant cases declined in all Nordic countries, except the Faroe Islands, compared to previous year(s). The largest reduction was observed in Sweden (May: -31.2%, 95% CI -33.9, -28.3), followed by significant declines in Finland, Denmark and Norway, and a nonsignificant decline in Iceland. In Denmark, Norway, Sweden and Finland the reporting rates during the second half of 2020 rose to almost the same level as in 2019. However, in Sweden and Finland, the increase did not compensate for the spring decline (annual reduction -6.2% and -3.6%, respectively). Overall, similar patterns were observed for in situ tumours. The COVID-19 pandemic led to a decline in rates of new cancer cases in Sweden, Finland, Denmark and Norway, with the most pronounced reduction in Sweden. Possible explanations include the severity of the pandemic, temporary halting of screening activities and changes in healthcare seeking behaviour.


Assuntos
COVID-19 , Neoplasias , COVID-19/epidemiologia , Dinamarca/epidemiologia , Finlândia/epidemiologia , Humanos , Islândia/epidemiologia , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Noruega , Pandemias , Países Escandinavos e Nórdicos/epidemiologia , Suécia/epidemiologia
10.
Ugeskr Laeger ; 184(14)2022 04 04.
Artigo em Dinamarquês | MEDLINE | ID: mdl-35410658

RESUMO

This review summarises the current knowledge of the use of collaborative care (CC) in Denmark. CC is an evidence-based approach to the treatment of depression and anxiety in primary care services. An optimised treatment is needed in Denmark, and a Danish CC model called Collabri, later Collabri Flex, was developed and evaluated in randomised controlled trials. The evaluation in the randomised controlled trials was needed since CC is an organizational model primarily tested in countries outside of Scandinavia. The effect evaluated is promising, but the cost-effectiveness of the model still needs to be established (ongoing study).


Assuntos
Transtornos de Ansiedade , Ansiedade , Ansiedade/terapia , Transtornos de Ansiedade/terapia , Análise Custo-Benefício , Humanos , Países Escandinavos e Nórdicos
11.
Sci Rep ; 12(1): 4764, 2022 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-35306516

RESUMO

European ash (Fraxinus excelsior) and narrow-leafed ash (F. angustifolia) are keystone forest tree species with a broad ecological amplitude and significant economic importance. Besides global warming both species are currently under significant threat by an invasive fungal pathogen that has been spreading progressively throughout the continent for almost three decades. Ash dieback caused by the ascomycete Hymenoscyphus fraxineus is capable of damaging ash trees of all age classes and often ultimately leads to the death of a tree after years of progressively developing crown defoliation. While studies at national and regional level already suggested rapid decline of ash populations as a result of ash dieback, a comprehensive survey at European level with harmonized crown assessment data across countries could shed more light into the population decline from a pan-European perspective and could also pave the way for a new conservation strategy beyond national boarders. Here we present data from the ICP Forests Level I crown condition monitoring from 27 countries resulting in > 36,000 observations. We found a substantial increase in defoliation and mortality over time indicating that crown defoliation has almost doubled during the last three decades. Hotspots of mortality are currently situated in southern Scandinavia and north-eastern Europe. Overall survival probability after nearly 30 years of infection has already reached a critical value of 0.51, but with large differences among regions (0.20-0.86). Both a Cox proportional hazard model as well as an Aalen additive regression model strongly suggest that survival of ash is significantly lower in locations with excessive water regime and which experienced more extreme precipitation events during the last two decades. Our results underpin the necessity for fast governmental action and joint rescue efforts beyond national borders since overall mean defoliation will likely reach 50% as early as 2030 as suggested by time series forecasting.


Assuntos
Fraxinus , Animais , Europa Oriental , Florestas , Fraxinus/microbiologia , Doenças das Plantas/microbiologia , Países Escandinavos e Nórdicos
12.
Diabetes Care ; 45(4): 994-1006, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35349653

RESUMO

BACKGROUND: The epidemiology of adult-onset type 1 diabetes (T1D) incidence is not well-characterized due to the historic focus on T1D as a childhood-onset disease. PURPOSE: We assess the incidence of adult-onset (≥20 years) T1D, by country, from available data. DATA SOURCES: A systematic review of MEDLINE, Embase, and the gray literature, through 11 May 2021, was undertaken. STUDY SELECTION: We included all population-based studies reporting on adult-onset T1D incidence and published from 1990 onward in English. DATA EXTRACTION: With the search we identified 1,374 references of which 46 were included for data extraction. Estimates of annual T1D incidence were allocated into broad age categories (20-39, 40-59, ≥60, or ≥20 years) as appropriate. DATA SYNTHESIS: Overall, we observed the following patterns: 1) there is a paucity of data, particularly in low- and middle-income countries; 2) the incidence of adult-onset T1D is lowest in Asian and highest in Nordic countries; 3) adult-onset T1D is higher in men versus women; 4) it is unclear whether adult-onset T1D incidence declines with increasing age; and 5) it is unclear whether incidence of adult-onset T1D has changed over time. LIMITATIONS: Results are generalizable to high-income countries, and misclassification of diabetes type cannot be ruled out. CONCLUSIONS: From available data, this systematic review suggests that the incidence of T1D in adulthood is substantial and highlights the pressing need to better distinguish T1D from T2D in adults so that we may better assess and respond to the true burden of T1D in adults.


Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Adulto , Asiáticos , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Incidência , Masculino , Países Escandinavos e Nórdicos , Adulto Jovem
13.
BMC Cancer ; 22(1): 147, 2022 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-35123422

RESUMO

BACKGROUND: Multiple myeloma remains an incurable disease with multiple relapses due to residual myeloma cells in the bone marrow of patients after therapy. Presence of small number of cancer cells in the body after cancer treatment, called minimal residual disease, has been shown to be prognostic for progression-free and overall survival. However, for multiple myeloma, it is unclear whether patients attaining minimal residual disease negativity may be candidates for treatment discontinuation. We investigated, if longitudinal flow cytometry-based monitoring of minimal residual disease (flow-MRD) may predict disease progression earlier and with higher sensitivity compared to biochemical assessments. METHODS: Patients from the Nordic countries with newly diagnosed multiple myeloma enrolled in the European-Myeloma-Network-02/Hovon-95 (EMN02/HO95) trial and undergoing bone marrow aspiration confirmation of complete response, were eligible for this Nordic Myeloma Study Group (NMSG) substudy. Longitdudinal flow-MRD assessment of bone marrow samples was performed to identify and enumerate residual malignant plasma cells until observed clinical progression. RESULTS: Minimal residual disease dynamics were compared to biochemically assessed changes in serum free light chain and M-component. Among 20 patients, reaching complete response or stringent complete response during the observation period, and with ≥3 sequential flow-MRD assessments analysed over time, increasing levels of minimal residual disease in the bone marrow were observed in six cases, preceding biochemically assessed disease and clinical progression by 5.5 months and 12.6 months (mean values), respectively. Mean malignant plasma cells doubling time for the six patients was 1.8 months (95% CI, 1.4-2.3 months). Minimal malignant plasma cells detection limit was 4 × 10-5. CONCLUSIONS: Flow-MRD is a sensitive method for longitudinal monitoring of minimal residual disease dynamics in multiple myeloma patients in complete response. Increasing minimal residual disease levels precedes biochemically assessed changes and is an early indicator of subsequent clinical progression. TRIAL REGISTRATION: NCT01208766.


Assuntos
Citometria de Fluxo/estatística & dados numéricos , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/mortalidade , Neoplasia Residual/diagnóstico , Neoplasia Residual/mortalidade , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/patologia , Valor Preditivo dos Testes , Prognóstico , Ensaios Clínicos Controlados Aleatórios como Assunto , Indução de Remissão , Países Escandinavos e Nórdicos , Sensibilidade e Especificidade , Suspensão de Tratamento , Adulto Jovem
14.
Cancer Med ; 11(8): 1850-1859, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35166068

RESUMO

BACKGROUND: While the excess in lung cancer risk among lower socioeconomic status individuals has been widely described, the magnitude of this association across lung cancer subtypes, as well as histotype-related long-term incidence trends, are inconclusively reported. AIMS: We explored the variation in the incidence of the three main lung cancer histotypes (i.e. squamous cell carcinoma, small cell carcinoma and adenocarcinoma) by socioeconomic status (SES, i.e. upper and lower white collar, upper and lower blue collar, and farming/forestry/fishing) in the adult population of four Nordic countries (i.e. Sweden, Norway, Finland and Denmark). MATERIALS & METHODS: We have used data from the Nordic Occupational Cancer Study (NOCCA), computing age-standardized incidence rates per 100,000 person-years truncated at ages 50-69 years, by sex, histotype, country and SES, for the period 1971-2005. We estimated relative risks and the corresponding 95% confidence intervals through Poisson regression models, including terms for SES, age, sex and country, as indicated. RESULTS: A clear socioeconomic gradient, with a progressive increase in lung cancer risk as SES level decreases, was observed in all subtypes and in both sexes. Favourable lung cancer incidence trends were seen among men for squamous cell and small cell carcinomas, although for adenocarcinomas rates were increasing everywhere except for Finland. Among women, upward temporal trends were seen in all SES groups and for all subtypes, although rates increased to a greater extent for low, compared to high, SES, especially in Denmark and Norway. Farmers showed comparatively lower risks compared to other SES categories. DISCUSSION: This prospective cohort study shows that substantial socioeconomic inequalities in the incidence of the most important lung cancer histotypes exist in the Nordic Countries, and that these inequalities are on the rise, especially among women. CONCLUSION: Smoking habits are likely to largely explain the observed social gradient for lung cancer histotypes in both sexes.


Assuntos
Adenocarcinoma , Neoplasias Pulmonares , Adenocarcinoma/epidemiologia , Adulto , Idoso , Feminino , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Países Escandinavos e Nórdicos/epidemiologia , Classe Social
15.
BMC Pregnancy Childbirth ; 22(1): 20, 2022 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-34996383

RESUMO

BACKGROUND: The success of antiretroviral therapy has normalized pregnancy among women living with HIV (WWH) with a very low risk of perinatal transmission of HIV. Despite these advances, WWH still face complex medical and psychosocial issues during pregnancy and postpartum. The aim of this study was to assess differences in psychosocial health outcomes between pregnant WWH, non-pregnant WWH, and pregnant women without HIV, and further identify factors associated with probable depression in the third trimester and postpartum. METHODS: In a longitudinal survey study, participants were included from sites in Denmark, Finland, and Sweden during 2019-2020. Data was collected in the 3rd trimester, 3 and 6 months postpartum using standardized questionnaires assessing depression, perceived stress, loneliness, and social support. Mixed regression models were used to assess changes over time within and between groups. Logistic regression models were used to identify factors associated with depression in pregnancy and postpartum. RESULTS: A total of 47 pregnant WWH, 75 non-pregnant WWH, and 147 pregnant women without HIV were included. The prevalence of depression was high among both pregnant and non-pregnant WWH. There was no significant difference between pregnant and non-pregnant WWH in depression scores, perceived stress scores, or social support scores at any time point. Compared to pregnant women without HIV, pregnant WWH reported worse outcomes on all psychosocial scales. Social support and loneliness were associated with an increased odds of depressive symptoms in the adjusted analysis. CONCLUSIONS: A high burden of adverse psychosocial outcomes was observed in both pregnant and non-pregnant women living with HIV compared to pregnant women without HIV. Loneliness and inadequate social support were associated with increased odds of depression in pregnancy and should be a focus in future support interventions.


Assuntos
Depressão Pós-Parto/epidemiologia , Depressão/epidemiologia , Infecções por HIV/psicologia , Complicações Infecciosas na Gravidez/psicologia , Gestantes/psicologia , Adulto , Dinamarca , Feminino , Finlândia , Humanos , Modelos Logísticos , Solidão , Estudos Longitudinais , Gravidez , Países Escandinavos e Nórdicos , Apoio Social , Estresse Psicológico , Suécia
16.
Womens Health (Lond) ; 18: 17455065211068688, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34983258

RESUMO

OBJECTIVE: The success of antiretroviral therapy has resulted in the normalization of pregnancy among women living with HIV and a very low risk of perinatal transmission of HIV. Despite these advances, women living with HIV still face complex medical and psychosocial issues during pregnancy. The purpose of this study is to describe experiences of pregnancy and the relevance of social support among women living with HIV in Nordic countries. METHODS: This qualitative study examined data from pregnant women living with HIV from sites in Denmark, Sweden and Finland from 2019 to 2020. Data were collected in the third trimester via individual interviews using a hybrid, narrative/semistructured format. The transcribed interviews were analyzed using narrative thematic analysis. RESULTS: In total, 31 women living with HIV were enrolled, of whom 61% originated from an African country and 29% from a Nordic country. The analysis generated four primary narrative themes: just a normal pregnancy, unique considerations and concerns, interactions with healthcare, and social support. Women living with HIV have a strong desire to have normal pregnancies and to be treated like any other pregnant woman. However, this normality is fragile, and being pregnant and living with HIV does come with unique considerations and concerns, such as fear of transmission, antiretroviral therapy, and the need for specialized care, which are fundamental to the women's experiences. Interactions with healthcare providers and social support influence their experiences in both positive and negative ways. CONCLUSION: The findings emphasize a sense of normality in pregnancy among women living with HIV. However, pregnancy does come with unique considerations and concerns, which highly influence the women's experience of pregnancy. Healthcare providers should focus on person-centered care, ensuring continuity and that women living with HIV do not feel discriminated against throughout their pregnancy.


Assuntos
Infecções por HIV , Transmissão Vertical de Doenças Infecciosas , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Gravidez , Gestantes/psicologia , Pesquisa Qualitativa , Países Escandinavos e Nórdicos/epidemiologia
17.
Acta Obstet Gynecol Scand ; 101(2): 248-255, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34988971

RESUMO

INTRODUCTION: The aim was to describe and compare changes in the reproductive pattern of women in their 40s observed over a decade in Scandinavia. MATERIAL AND METHODS: Cross-sectional study using the total population of women aged 40-49 years between 2008-2018 in Denmark, Norway and Sweden (on average n = 1.5 million). Aggregated data concerning birth and induced abortion rate were collected and analyzed from national health registers. National data on redeemed prescriptions of hormonal contraceptives in the three countries were collected from prescription registers. Births after spontaneous and assisted conceptions were identified by using cross-linked data on deliveries from the Medical Birth Registers and National Registers of Assisted Reproduction in the three countries. RESULTS: Use of hormonal contraception increased among women aged 40-44 years in Denmark from 24% to 31%, in Sweden from 27% to 30%, and in Norway from 22% to 24%. The levonorgestrel-releasing intrauterine device was the most frequently used method in all countries. Birth rates among women 40-44 years increased continuously from 9.5 to 12/1000 women in Denmark and from 11.7 to 14.3/1000 in Sweden, but remained stable in Norway at ~11/1000 women. There was a doubling of assisted conceptions in Denmark from 0.71 to 1.71/1000 women, Sweden from 0.43 to 0.81/1000 and Norway from 0.25 to 0.53/1000 women 40-49 years of age. Sweden had the highest induced abortion rate (7.7 to 8.1/1000 women) in women aged 40-49 years during the study period. CONCLUSIONS: From 2008 to 2018, birth rates continuously increased among women aged 40-49 years in Denmark and Sweden and births resulting from assisted reproductive technology doubled in all three countries.


Assuntos
Coeficiente de Natalidade/tendências , Idade Materna , Adulto , Estudos Transversais , Feminino , Fertilização In Vitro , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Gravidez , Resultado da Gravidez , Sistema de Registros , Países Escandinavos e Nórdicos/epidemiologia
18.
Clin Nutr ; 41(2): 441-451, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-35007813

RESUMO

BACKGROUND & AIMS: Intake assessment in multicenter trials is challenging, yet important for accurate outcome evaluation. The present study aimed to characterize a multicenter randomized controlled trial with a healthy Nordic diet (HND) compared to a Control diet (CD) by plasma and urine metabolic profiles and to associate them with cardiometabolic markers. METHODS: During 18-24 weeks of intervention, 200 participants with metabolic syndrome were advised at six centres to eat either HND (e.g. whole-grain products, berries, rapeseed oil, fish and low-fat dairy) or CD while being weight stable. Of these 166/159 completers delivered blood/urine samples. Metabolic profiles of fasting plasma and 24 h pooled urine were analysed to identify characteristic diet-related patterns. Principal components analysis (PCA) scores (i.e. PC1 and PC2 scores) were used to test their combined effect on blood glucose response (primary endpoint), serum lipoproteins, triglycerides, and inflammatory markers. RESULTS: The profiles distinguished HND and CD with AUC of 0.96 ± 0.03 and 0.93 ± 0.02 for plasma and urine, respectively, with limited heterogeneity between centers, reflecting markers of key foods. Markers of fish, whole grain and polyunsaturated lipids characterized HND, while CD was reflected by lipids containing palmitoleic acid. The PC1 scores of plasma metabolites characterizing the intervention is associated with HDL (ß = 0.05; 95% CI: 0.02, 0.08; P = 0.001) and triglycerides (ß = -0.06; 95% CI: -0.09, -0.03; P < 0.001). PC2 scores were related with glucose metabolism (2 h Glucose, ß = 0.1; 95% CI: 0.05, 0.15; P < 0.001), LDL (ß = 0.06; 95% CI: 0.01, 0.1; P = 0.02) and triglycerides (ß = 0.11; 95% CI: 0.06, 0.15; P < 0.001). For urine, the scores were related with LDL cholesterol. CONCLUSIONS: Plasma and urine metabolite profiles from SYSDIET reflected good compliance with dietary recommendations across the region. The scores of metabolites characterizing the diets associated with outcomes related with cardio-metabolic risk. Our analysis therefore offers a novel way to approach a per protocol analysis with a balanced compliance assessment in larger multicentre dietary trials. The study was registered at clinicaltrials.gov with NCT00992641.


Assuntos
Glicemia/metabolismo , Dieta Saudável/métodos , Síndrome Metabólica/dietoterapia , Metabolômica/métodos , Avaliação Nutricional , Área Sob a Curva , Biomarcadores/sangue , Biomarcadores/urina , Fatores de Risco Cardiometabólico , Ingestão de Alimentos/fisiologia , Jejum/sangue , Jejum/urina , Feminino , Humanos , Mediadores da Inflamação/sangue , Lipídeos/sangue , Lipoproteínas/sangue , Masculino , Síndrome Metabólica/complicações , Pessoa de Meia-Idade , Sobrepeso/complicações , Sobrepeso/dietoterapia , Análise de Componente Principal , Ensaios Clínicos Controlados Aleatórios como Assunto , Países Escandinavos e Nórdicos , Triglicerídeos/sangue
19.
Artigo em Inglês | MEDLINE | ID: mdl-35055504

RESUMO

New tobacco and nicotine products have emerged on the market in recent years. Most research has concerned only one product at a time, usually e-cigarettes, while little is known about the multiple use of tobacco and nicotine products among adolescents. We examined single, dual, and triple use of cigarettes, e-cigarettes, and snus among Nordic adolescents, using data of 15-16-year-olds (n = 16,125) from the European School Survey Project on Alcohol and other Drugs (ESPAD) collected in 2015 and 2019 from Denmark, Finland, Iceland, Norway, Sweden, and the Faroe Islands. Country-specific lifetime use of any of these products ranged between 40% and 50%, and current use between 17% and 31%. Cigarettes were the most common product in all countries except for Iceland, where e-cigarettes were remarkably more common. The proportion of dual and triple users was unexpectedly high among both experimental (24%-49%) and current users (31-42%). Triple use was less common than dual use. The users' patterns varied somewhat between the countries, and Iceland differed substantially from the other countries, with a high proportion of single e-cigarette users. More knowledge on the patterns of multiple use of tobacco and nicotine products and on the potential risk and protective factors is needed for targeted intervention and prevention efforts.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Produtos do Tabaco , Tabaco sem Fumaça , Adolescente , Humanos , Países Escandinavos e Nórdicos/epidemiologia , Uso de Tabaco
20.
BMC Emerg Med ; 22(1): 7, 2022 01 11.
Artigo em Inglês | MEDLINE | ID: mdl-35016618

RESUMO

BACKGROUND: The northern regions of the Nordic countries have common challenges of sparsely populated areas, long distances, and an arctic climate. The aim of this study was to compare the cause and rate of fatal injuries in the northernmost area of the Nordic countries over a 5-year period. METHODS: In this retrospective cohort, we used the Cause of Death Registries to collate all deaths from 2007 to 2011 due to an external cause of death. The study area was the three northernmost counties in Norway, the four northernmost counties in Finland and Sweden, and the whole of Iceland. RESULTS: A total of 4308 deaths were included in the analysis. Low energy trauma comprised 24% of deaths and high energy trauma 76% of deaths. Northern Finland had the highest incidence of both high and low energy trauma deaths. Iceland had the lowest incidence of high and low energy trauma deaths. Iceland had the lowest prehospital share of deaths (74%) and the lowest incidence of injuries leading to death in a rural location. The incidence rates for high energy trauma death were 36.1/100000/year in Northern Finland, 15.6/100000/year in Iceland, 27.0/100000/year in Northern Norway, and 23.0/100000/year in Northern Sweden. CONCLUSION: We found unexpected differences in the epidemiology of trauma death between the countries. The differences suggest that a comparison of the trauma care systems and preventive strategies in the four countries is required.


Assuntos
Estudos Retrospectivos , Finlândia/epidemiologia , Humanos , Islândia/epidemiologia , Incidência , Noruega/epidemiologia , Países Escandinavos e Nórdicos/epidemiologia
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