Very urgent carotid endarterectomy confers increased procedural risk.

BACKGROUND AND PURPOSE: Current Swedish guidelines recommend that carotid endarterectomy should be performed within 14 days of a qualifying neurological event, but it is not clear if very urgent surgery after an event is associated with increased perioperative risk. The aim of this study was to determine how the time between the event and carotid endarterectomy affects the procedural risk of mortality and stroke. METHODS: We prospectively analyzed data on all patients who underwent carotid endarterectomies for symptomatic carotid stenosis between May 12, 2008, and May 31, 2011, with records in the Swedish Vascular Registry (Swedvasc). Patients were divided according to time between the qualifying event and surgery (0-2 days, 3-7 days, 8-14 days, 15-180 days). Stroke rate and mortality at 30 days postsurgery were determined. RESULTS: We analyzed data for 2596 patients and found that the combined mortality and stroke rate for patients treated 0 to 2 days after qualifying event was 11.5% (17 of 148) versus 3.6% (29 of 804), 4.0% (27 of 677), and 5.4% (52 of 967) for the groups treated at 3 to 7 days, 8 to 14 days, and 15 to 180 days, respectively. In a multivariate analysis, time was an independent risk factor for perioperative complications: patients treated at 0 to 2 days had a relative OR of 4.24 (CI, 2.07-8.70; P<0.001) compared with the reference 3- to 7-day group. CONCLUSIONS: In this study of patients treated for symptomatic carotid disease, it was safe to perform surgery as early as Day 3 after a qualifying neurological event in contrast to patients treated within 0 to 2 days, which has a significantly increased perioperative risk.

The inverse care law and the significance of income for utilization of longterm care services in a Nordic welfare state.

The Inverse Care Law states that the availability of good medical care tends to vary inversely with the need of the population served, with previous research indicating that migrant populations might be particularly at risk of this phenomenon. However, the degree to which the law applies to long-term care services (LTCS) in diverse ageing societies, where sizable older migrant populations need to be accounted for, has not been well investigated. To ensure equitable service provision, and to achieve European goals promoting a social right to care, it is critical to assess the extent to which such diverse populations are being neglected. This paper investigates the relationship between income and utilization of LTCS in Sweden amongst older native-born residents and older migrants born in low-, middle-, and high-income countries. The universality of its welfare system and the documented income differentials between foreign- and Swedish-born persons makes Sweden a particularly interesting case for assessing whether the most disadvantaged are the most underserved. The analysis uses register data on a total population of all older residents in Sweden, encompassing approximately two million persons. The results indicate that the Inverse Care Law does not apply to the utilization of LTCS by Swedish-born older people, nor by the majority of older migrants. However, the Inverse Care Law does appear to operate for older persons born in low-income countries who do not have a partner.

How are Immigrant Children in Sweden Faring? Mean Income, Affluence and Poverty Since the 1980s.

This article presents new research on income-based child indicators for immigrant children from 17 different national backgrounds and children of parents born in Sweden observed during the 3-year periods 1983-85, 1995-97 and 2008-10. This research examines mean household income, representation at the top of the income distribution and relative poverty differ for immigrant children from the corresponding levels among children with native born parents. Most of the analysis is concentrated on the second generation of immigrant children. It is shown that the relative position of immigrant children deteriorated between 1983-85 and 1995-97 when the labour market situation of immigrant parents weakened more than among native born parents. Changes thereafter were more complex. Children born in Sweden to parents from Denmark, Norway or Germany were as likely as children of native born parents to be observed at the top of the income distribution in contrast to children of parents from countries with middle or low human development. Poverty rates among immigrant children were higher among all categories of immigrant children in 2008-10 than among children of native born parents. These cross origin differences in income-based child indicators can be attributed to the reasons and qualifications parents had when they entered Sweden and the number of years since their immigration. A majority of children living in Sweden that are classified as poor in 2008-10 were immigrant children of various categories.

Disability pension among immigrants in Sweden.

Using large samples, disability pensions among foreign-born and native-born women and men living in Sweden is studied here for the period 1981-1999. The results show foreign-born individuals having higher rates of disability pension. The risk of being on disability pension is very low for newly arrived immigrants, but increases rapidly on a yearly basis after immigration. Higher rates of disability pension are reported for persons born in Greece, Yugoslavia, Turkey and Finland. Results from multivariate analysis indicate that factors such as education, country of residence and marital status cannot fully explain the high rates of disability pension observed among many immigrant groups. Future research needs to address which possible causes are most important for policies to address.