| 1. |
- Tegnell, Anders, 1956-, et al.
(författare)
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Coagulase-negative staphylococci and sternal infections after cardiac operation
- 2000
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Ingår i: Annals of Thoracic Surgery. - 0003-4975 .- 1552-6259. ; 69:4, s. 1104-1119
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Tidskriftsartikel (refereegranskat)abstract
- Background. Coagulase negative staphylococci (CoNS) have been recognized as important pathogens in nosocomial infections, especially in connection with implanted foreign materials. In cardiac operation they are among the most common pathogens isolated from infected sternal wounds. The definition of the infection is very important. In this study we focus on deep postoperative chest infections.Methods. By studying 33 infected patients retrospectively and comparing them to 33 matched uninfected controls, we studied the characteristics and costs of the infections.Results. Typical for these infections is the late and insidious onset, and that the infections initially give only minor symptoms such as pain, redness, and serous secretion. We found the following risk factors for infection: number of preoperative days in a hospital, the total length of the operation, and if the patient had undergone an early reoperation due to causes other than infection. This kind of infection more than doubled the hospital costs for the patients affected.Conclusions. Coagulase negative staphylococci are the most important pathogens in deep postoperative infections in this material. They cause infections that are difficult to recognize since they give only discrete symptoms and start well after the patients leave the hospital. The risk factors for patients with CoNS infections are mostly associated with a long exposure to the hospital environment. The treatment is often difficult and costly because of multiresistant bacteria and frequent need for repeated surgical revisions.
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| 2. |
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| 3. |
- Tegnell, Anders, 1956-, et al.
(författare)
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Krim-Kongoblödarfeber i Kosovo
- 2001
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 98, s. 5670-5671
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 4. |
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| 5. |
- Tegnell, Anders, et al.
(författare)
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[Anthrax : the Swedish perspective]
- 2001
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 98, s. 5742-
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- The recent occurrence in the USA of deliberate release of virulent Bacillus anthracis in letters sent to three media corporations and to the American senate has led to a great anxiety in Sweden and elsewhere in Europe. Numerous letters have been suspected to contain B. anthracis spores and several have contained powder of different types. In none of the tested letters collected by the Swedish police have we been able to detect anthrax bacilli. Powder containing letters have been tested with either bacterial isolation and/or B. anthracis specific PCR. Anthrax is a disease found naturally in herbivores and is occasionally spread to humans. It is caused by the gram-positive rod B. anthracis that was discovered by Robert Koch in 1876. Beginning in the 1930s many states have developed B. anthracis for use as a weapon. A few releases of the bacteria have been reported before October 2001. B. anthracis causes three forms of disease, cutaneous, pulmonary and gastro-intestinal. The pulmonary form is the most dangerous and may lead to death merely one to two days after onset of severe symptoms. This is due to the rapid growth and release of several potent toxins that engage the immune system and promote tissue destruction. B. anthracis infection can be treated with several antibiotics, among which quinolones and tetracyclins have been recommended. Diagnosis can readily be achieved by microscopy, bacterial isolation and PCR at the Swedish Institute for Infectious Disease Control and the Swedish Defence Research Agency. Antibiotics relevant for treatment of B. anthracis infections are already stockpilled in our country. Further actions to strengthen our capability to deal with bioterrorism are ongoing.
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| 6. |
- Roffey, Roger, et al.
(författare)
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[Update on biological weapons and bioterrorism. Important that health services pay attention to unusual events]
- 2001
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 98:50, s. 5746-5752
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Biological weapons and biological terrorism have recently been in focus due to the deliberate release of Bacillus anthracis via mail delivered in the USA. Since the 1930s biological weapons have been developed in a number of countries. In 1975 a biological and toxin weapons convention prohibiting the use of these weapons were signed by a large majority of world countries. Unfortunately, a number of countries have failed to respect this treaty. The Soviet union continued and expanded its biological weapons program and after the Gulf war it was revealed that Iraq also had an extensive bio-weapons program. Large scale deliberate release of for example B. anthracis or an epidemic following a release of smallpox virus would have a devastating effect. This has urged the world community to strengthen the biological and toxin weapons convention with a control function which as of yet has not been successful. Furthermore, many countries including Sweden, increase stocks of antibiotics and smallpox vaccines. Sweden is also increasing preparedness regarding diagnostics of these and similar agents and is setting up an epidemiological task force that can be used in infectious disease emergencies such as the deliberate release of a biological weapon.
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| 7. |
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| 8. |
- Tegnell, Anders, 1956-, et al.
(författare)
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Wound infections after cardiac surgery : a Wound Scoring System may Improve Early Detection
- 2002
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa UK Limited. - 1401-7431 .- 1651-2006. ; 36:1, s. 60-64
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Tidskriftsartikel (refereegranskat)abstract
- Objective - This study was aimed at describing the early development of wound infections after cardiac surgery to identify markers for upcoming infections.Design - We followed a cohort of 200 patients for 3 months after cardiac surgery to establish the incidence of all types of postoperative infections. Wound healing and C-reactive protein (CRP) were followed for the first 2 weeks.Results - A total of 175 patients out of 200 could be followed up. Using a broad definition of wound infection a total of 30% of the patients had some kind of wound infection. The diagnosis of most infections occurred after the patients had left the cardiac surgery unit (median 12 d after surgery). Our wound scoring method shows significant differences at an early stage between infected and non-infected wounds. At the time of diagnoses CRP was elevated in patients with deep sternal infection.Conclusion - A long follow-up period is needed to establish the true incidence of infection. Wound scoring can give an early indication of wound infections and CRP can help in the diagnoses of deep infections.
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| 9. |
- Tegnell, Anders, 1956-
(författare)
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The epidemiology and consequences of wound infections caused by coagulase negative staphylococci after thoracic surgery
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Nosocomial infections in general and postoperative infections in pmticular are important aspects of modern health care. They are important factors to be taken into account when planning and organizing any kind of surgery. Thoracic surgery has become a common and important form of surgery involving significant amounts of patients and resources. Different kinds of infectious complications are not uncommon and cause considerable problems. Many microbes have been implicated in post-operative infections, but one of the most important ones in activities such as thoracic surgety is Coagulase Negative Staphylococci (CoNS). They exist in our environment and produce infections that are difficult to diagnose and complicated to treat. The source of the infections and the transmission routes remain to a great extent unclear.Aims To describe the basic epidemiology of sterna! infections after cardiac surgery and to find early indications of infections.To investigate the epidemiology of Coagulase Negative Staphylococci causing sternal infections and to describe the development of antibiotic resistance.Methods and resultsTo describe and evaluate the impact of infections after thoracic surgety in our hospital we followed different patient populations. When examining the patients being infected we could show that risk factors mostly involved surgery and hospital related variables. The diagnosis of the infections was often late and the treatment is difficult and consuming major resomces. The late diagnosis could be explained by the discrete symptoms and that a marker for infection like CRP are difficult to evaluate in the post-operative patient. With increased surveillance of the wounds an earlier diagnosis would be possible. Following the development of the management of the infections in our hospital during the 90's we could also show that the time to diagnosis and the treatment periods became shorter.CoNS caused the majority of the infections in our patients with little change during the 10-year petiod. Preliminary results indicate that the source of the CoNS is the hospital environment in a majority of the serious infections. The place and route of transmission is unclear but the operating theatre remains a possible place of transmissions. Even if the resistance patterns of the CoNS are quite diverse they are often multi resistant and to a substantial degree vancomycin remains the only antibiotic that can be used for the treatment.Conclusions Wound infections after cardiac surgery are an important cause of morbidity and mortality, and CoNS play a major role in these infections. Risk factors that contribute to the infections are often associated with complicated surgery. Symptoms of the infections are often discrete and the diagnosis and treatment of the infections often stmt late. Intensified surveillance of the wounds could improve management of infections. We found a clone of CoNS causing a majority of the infections indicating that the source of the bacteria is often the hospital environment. CoNS as a major pathogen makes antibiotic treatment difficult, and there is a high risk of extensive antibiotic resistance.
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| 10. |
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| 11. |
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| 12. |
- Tegnell, Anders, et al.
(författare)
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[Smallpox : eradicated disease and a potential terrorist weapon]
- 2002
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 99:19, s. 2145-2149
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Smallpox is a disease that followed humanity for thousands of years up until thirty years ago. It was possible to eradicate, since an effective live vaccine from crossreacting vaccinia could be developed. Twenty years passed since vaccinations stopped and very few people are protected against the disease today. Variola today has become an object of discussion due to the possibility that it can be used as a bioweapon. Due to the number of complications that can be expected a general vaccination is probably not possible. Research is ongoing to develop new vaccines. Many countries are improving their capabilities to respond to a renewed threat of a smallpox epidemic.
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| 13. |
- Tegnell, Anders, 1956-, et al.
(författare)
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Changes in the appearance and treatment of deep sternal infections
- 2002
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Ingår i: Journal of Hospital Infection. - : Elsevier BV. - 0195-6701 .- 1532-2939. ; 50:4, s. 298-303
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Tidskriftsartikel (refereegranskat)abstract
- The Department of Thoracic Surgery at the University Hospital, Linköping, Sweden, has actively followed up infectious complications of cardiac surgery since 1989. The aim of this study was to investigate whether changes occurred during the 1990s in the appearance and the management of deep infections. This was done by studying patients undergoing surgical revision of infected wounds. We studied 42 patients during 1990–94 and 49 during 1997–98 (total number of operations in these periods, 3075 and 1646, respectively). Pre-operative and intra-operative variables were recorded for the two patient populations. The proportion of cardiac surgery procedures followed by a surgical revision for an infection in the sternal wound increased between the two periods (1.4% vs. 3.0%). Variables associated with the surgical procedures preceding the infection remained unchanged. In the later period, treatment was started earlier (64 vs. 24 days), and the length of antibiotic treatment was decreased (115 vs. 72 days). The incidence of osteomyelitis of the sternal bone was lower (61% vs. 27%). It appears that as the proportion of patients undergoing surgical revision increased, management of the infections became more effective, with aggressive surgical and antibiotic treatment policies and shorter treatment periods. This indicates that in order to evaluate the overall impact of measures designed to reduce infections after cardiac surgery, not only the incidence of infection needs to be followed up but other factors also need to be taken into account.
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| 14. |
- Tegnell, Anders, 1956-, et al.
(författare)
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A clone of coagulase-negative staphylococci among patients with post-cardiac surgery infections
- 2002
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Ingår i: Journal of Hospital Infection. - : Elsevier BV. - 0195-6701 .- 1532-2939. ; 52:1, s. 37-42
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Tidskriftsartikel (refereegranskat)abstract
- Coagulase-negative staphylococci (CoNS) are important causes of hospital-acquired infections such as infections after cardiac surgery. Efforts to reduce these infections are hampered by the lack of knowledge concerning the epidemiology of CoNS in this setting. Forty strains of CoNS collected during the surgical revision of 27 patients operated on between 1997 and 2000 were analysed. Strains were also collected from the ambient air in the operating suite. Their pulsed-field gel electrophoresis (PFGE) characteristics and antibiotic resistance were analysed. Using PFGE 19 of 40 strains from 15 of 27 patients were shown to belong to one clone, and strains from this clone were also isolated from the ambient air. This clone had caused infections throughout the period. Antibiotic resistance did not correlate with PFGE patterns. Using PFGE one clone could be identified that caused 56% of the CoNS infections during this period. A strain from this clone was also found in the air of the operating suite suggesting the origin of the CoNS causing infections was the hospital environment.
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| 15. |
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| 16. |
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| 17. |
- Eliasson, Henrik, et al.
(författare)
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The 2000 tularemia outbreak : a case-control study of risk factors in disease-endemic and emergent areas, Sweden
- 2002
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Ingår i: Emerging Infectious Diseases. - : Centers for Disease Control and Prevention (CDC). - 1080-6040 .- 1080-6059. ; 8:9, s. 956-960
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Tidskriftsartikel (refereegranskat)abstract
- A widespread outbreak of tularemia in Sweden in 2000 was investigated in a case-control study in which 270 reported cases of tularemia were compared with 438 controls. The outbreak affected parts of Sweden where tularemia had hitherto been rare, and these "emergent" areas were compared with the disease-endemic areas. Multivariate regression analysis showed mosquito bites to be the main risk factor, with an odds ratio (OR) of 8.8. Other risk factors were owning a cat (OR 2.5) and farm work (OR 3.2). Farming was a risk factor only in the disease-endemic area. Swollen lymph nodes and wound infections were more common in the emergent area, while pneumonia was more common in the disease-endemic area. Mosquito bites appear to be important in transmission of tularemia. The association between cat ownership and disease merits further investigation.
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| 18. |
- Tegnell, Anders, et al.
(författare)
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Study of developed resistance due to antibiotic treatment of coagulase-negative Staphylococci.
- 2003
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Ingår i: Microbial Drug Resistance. - : Mary Ann Liebert Inc. - 1076-6294 .- 1931-8448. ; 9:1, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- Coagulase-negative Staphylococci (CoNS) are a major cause of postoperative infections. These infections are often associated with foreign material implants and/or a compromised immune system in the patient. Multiresistant strains are increasingly common in the hospital environment and there is concern that the infections will become difficult or impossible to treat. This report is based on a study of 75 patients, with postoperative infections caused by CoNS after thoracic surgery. All patients were treated with surgical revision and antibiotic therapy. One or more bacterial cultures were made in each case, and the resistance pattern of the CoNS found was determined. The goal of the study was to evaluate possible relationships between antibiotic therapy and the appearance of resistance to antibiotics in CoNS found. To describe this relationship, three models were constructed and analyzed by multiple logistic regression. The results indicate an increased resistance to beta-lactam antibiotics and clindamycin after the use of cephalosporins. Also, the use of vancomycin or vancomycin in combination with rifampicin or fusidic acid increases the risk for development of resistance to beta-lactam antibiotics, ciprofloxacin, fusidic acid, clindamycin, netilmycin, and rifampicin. The hypothesis that a combination of antibiotics will curtail the development of resistance was not supported in this study.
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| 19. |
- Dannetun, Eva, et al.
(författare)
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Timeliness of MMR vaccination - Influence on vaccination coverage
- 2004
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Ingår i: Vaccine. - : Elsevier BV. - 0264-410X .- 1873-2518. ; 22:31-32, s. 4228-4232
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Tidskriftsartikel (refereegranskat)abstract
- Over the last seven years, and especially in 2001, a declining coverage for MMR vaccination in 2-year-olds has been noted in Sweden. By recording actual date of vaccination in a cohort of almost 4000 children in a county in central Sweden, we found that parents' decision to postpone vaccination by up to 1.5 years beyond the stipulated age of 18 months accounted for about half the reported drop in 2001. Even if coverage thus improves with time, postponed vaccination adds to the pool of unprotected children in the population. The design of the current national surveillance system overestimates coverage at 2 years and fails to record delayed vaccination. To avoid future outbreaks that can appear around imported cases of measles it is crucial to attain high coverage levels by timely vaccination. © 2004 Elsevier Ltd. All rights reserved.
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| 20. |
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| 21. |
- Carlsson, Rose-Marie, et al.
(författare)
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[Time for booster doses against whooping cough for 10-year-old children]
- 2005
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Ingår i: Lakartidningen. - 0023-7205. ; 102:35, s. 2394-8
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Acellular pertussis vaccine was introduced in Sweden in 1996 at the age of 3, 5 and 12 months, after a 17 year period without general vaccination against pertussis. At present, the incidence of notified pertussis has decreased to 1/10 of what was seen 10 years ago. In spite of the dramatic decrease, the disease is not eliminated. In accordance with the experience of other countries, most cases in Sweden are reported among older children and adults, while the highest risk of severe disease is still seen in infants. Many industrialized countries have introduced booster dose(s) in order to control the spread of pertussis. The Swedish National Board of Health and Welfare has recently initiated a major revision of the vaccines used and the schedule of the national vaccination program. Until the final proposal and in order not to miss the opportunity to boost pertussis immunity in children who were vaccinated as infants at the reintroduction of pertussis vaccination, the Board now recommends the Swedish municipalities as an interim measure to include pertussis in the current school booster against diphtheria and tetanus at 10 years of age with a full dose vaccine.
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| 22. |
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| 23. |
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| 24. |
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| 25. |
- Brouwers, Lisa, 1967-, et al.
(författare)
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Economic consequences to society of pandemic H1N1 influenza 2009 : preliminary results for Sweden
- 2009
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Ingår i: Eurosurveillance. - : European Centre for Disease Control and Prevention (ECDC). - 1025-496X .- 1560-7917. ; 14:37, s. 19333-
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Tidskriftsartikel (refereegranskat)abstract
- Experiments using a microsimulation platform show that vaccination against pandemic H1N1 influenza is highly cost-effective. Swedish society may reduce the costs of pandemic by about SEK 2.5 billion (approximately EUR 250 million) if at least 60 per cent of the population is vaccinated, even if costs related to death cases are excluded. The cost reduction primarily results from reduced absenteeism. These results are preliminary and based on comprehensive assumptions about the infectiousness and morbidity of the pandemic, which are uncertain in the current situation.
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| 26. |
- Askling, Helena H, et al.
(författare)
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Serologic Analysis of Returned Travelers with Fever, Sweden
- 2009
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Ingår i: Emerging Infectious Diseases. - Atlanta, GA, USA : U.S. Department of Health and Human Services * Centers for Disease Control and Prevention. - 1080-6040 .- 1080-6059. ; 15:11, s. 1805-1808
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Tidskriftsartikel (refereegranskat)abstract
- We studied 1,432 febrile travelers from Sweden who had returned from malaria-endemic areas during March 2005-March 2008. In 383 patients, paired serum samples were blindly analyzed for influenza and 7 other agents. For 21% of 115 patients with fever of unknown origin, serologic analysis showed that influenza was the major cause.
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| 27. |
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| 28. |
- Widgren, Katarina, et al.
(författare)
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Delayed HIV diagnosis common in Sweden, 2003-2010
- 2014
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa Healthcare. - 0036-5548 .- 1651-1980. ; 46:12, s. 862-867
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Tidskriftsartikel (refereegranskat)abstract
- Background: Early diagnosis of HIV is important for the prognosis of individual patients, because antiretroviral treatment can be started at the appropriate time, and for public health, because transmission can be prevented. Methods: Data were collected from 767 HIV patients who were diagnosed in Sweden during 2003-2010 and were infected in Sweden or born in Sweden and infected abroad. A recent infection testing algorithm (RITA) was applied to BED-EIA test results (OD-n less than 0.8), CD4 counts (greater than= 200 cells/mu l), and clinical information. A recent infection classification was used as indicator for early diagnosis. Time trends in early diagnosis were investigated to detect population changes in HIV testing behavior. Patients with early diagnosis were compared to patients with delayed diagnosis with respect to age, gender, transmission route, and country of infection (Sweden or abroad). Results: Early diagnosis was observed in 271 patients (35%). There was no statistically significant time trend in the yearly percentage of patients with early diagnosis in the entire study group (p = 0.836) or in subgroups. Early diagnosis was significantly more common in men who have sex men (MSM) (45%) than in heterosexuals (21%) and injecting drug users (27%) (p less than 0.001 and p = 0.001, respectively) in both univariate and multivariable analyses. The only other factor that remained associated with early diagnosis in multivariable analysis was young age group. Conclusion: Approximately one-third of the study patients were diagnosed early with no significant change over time. Delayed HIV diagnosis is a considerable problem in Sweden, which does not appear to diminish.
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| 29. |
- Dahl, Viktor, et al.
(författare)
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Communicable Diseases Prioritized According to Their Public Health Relevance, Sweden, 2013
- 2015
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 10:9
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Tidskriftsartikel (refereegranskat)abstract
- To establish strategic priorities for the Public Health Agency of Sweden we prioritized pathogens according to their public health relevance in Sweden in order to guide resource allocation. We then compared the outcome to ongoing surveillance. We used a modified prioritization method developed at the Robert Koch Institute in Germany. In a Delphi process experts scored pathogens according to ten variables. We ranked the pathogens according to the total score and divided them into four priority groups. We then compared the priority groups to self-reported time spent on surveillance by epidemiologists and ongoing programmes for surveillance through mandatory and/or voluntary notifications and for surveillance of typing results. 106 pathogens were scored. The result of the prioritization process was similar to the outcome of the prioritization in Germany. Common pathogens such as calicivirus and Influenza virus as well as blood-borne pathogens such as human immunodeficiency virus, hepatitis B and C virus, gastro-intestinal infections such as Campylobacter and Salmonella and vector-borne pathogens such as Borrelia were all in the highest priority group. 63% of time spent by epidemiologists on surveillance was spent on pathogens in the highest priority group and all pathogens in the highest priority group, except for Borrelia and varicella-zoster virus, were under surveillance through notifications. Ten pathogens in the highest priority group (Borrelia, calicivirus, Campylobacter, Echinococcus multilocularis, hepatitis C virus, HIV, respiratory syncytial virus, SARS- and MERS coronavirus, tick-borne encephalitis virus and varicella-zoster virus) did not have any surveillance of typing results. We will evaluate the possibilities of surveillance for the pathogens in the highest priority group where we currently do not have any ongoing surveillance and evaluate the need of surveillance for the pathogens from the low priority group where there is ongoing surveillance in order to focus our work on the pathogens with the highest relevance.
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| 30. |
- Grahn, Anna, 1973, et al.
(författare)
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Imported case of lassa fever in Sweden with encephalopathy and sensorineural hearing deficit
- 2016
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Ingår i: Open Forum Infectious Diseases. - : Oxford University Press (OUP). - 2328-8957. ; 3:4
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Tidskriftsartikel (refereegranskat)abstract
- © The Author 2016.We describe an imported case of Lassa fever with both encephalopathy and bilateral sensorineural hearing deficit. Absence of fever during hospitalization, initially nonspecific symptoms, and onset of hearing deficit in a late stage of disease probably contributed to delayed diagnosis (14 days after admittance to hospital). The pathogenesis of neurological manifestations of Lassa fever is poorly understood and no specific treatment was given. A total of 118 personnel had close contact with the patient, but no secondary cases occurred. This case highlights the importance of considering Lassa fever as a differential diagnosis in patients with recent travel to endemic areas.
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| 31. |
- Gaines, Hans, et al.
(författare)
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Six-week follow-up after HIV-1 exposure: a position statement from the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy
- 2016
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Ingår i: Infectious Diseases. - : Informa UK Limited. - 2374-4235 .- 2374-4243. ; 48:2, s. 93-98
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Forskningsöversikt (refereegranskat)abstract
- In 2014 the Public Health Agency of Sweden and the Swedish Reference Group for Antiviral Therapy (RAV) conducted a review and analysis of the state of knowledge on the duration of follow-up after exposure to human immunodeficiency virus (HIV). Up until then a follow-up of 12 weeks after exposure had been recommended, but improved tests and new information on early diagnosis motivated a re-evaluation of the national recommendations by experts representing infectious diseases and microbiology, county medical officers, the RAV, the Public Health Agency, and other national authorities. Based on the current state of knowledge the Public Health Agency of Sweden and the RAV recommend, starting in April 2015, a follow-up period of 6 weeks after possible HIV-1 exposure, if HIV testing is performed using laboratory-based combination tests detecting both HIV antibody and antigen. If point-of-care rapid HIV tests are used, a follow-up period of 8 weeks is recommended, because currently available rapid tests have insufficient sensitivity for detection of HIV-1 antigen. A follow-up period of 12 weeks is recommended after a possible exposure for HIV-2, since presently used assays do not include HIV-2 antigens and only limited information is available on the development of HIV antibodies during early HIV-2 infection. If pre- or post-exposure prophylaxis is administered, the follow-up period is recommended to begin after completion of prophylaxis. Even if infection cannot be reliably excluded before the end of the recommended follow-up period, HIV testing should be performed at first contact for persons who seek such testing.
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| 32. |
- Pini, Alessandro, et al.
(författare)
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Socioeconomic disparities associated with 29 common infectious diseases in Sweden, 2005-14 : an individually matched case-control study
- 2019
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Ingår i: The Lancet - Infectious diseases. - : ELSEVIER SCI LTD. - 1473-3099 .- 1474-4457. ; 19:2, s. 165-176
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Tidskriftsartikel (refereegranskat)abstract
- Background Although the association between low socioeconomic status and non-communicable diseases is well established, the effect of socioeconomic factors on many infectious diseases is less clear, particularly in high-income countries. We examined the associations between socioeconomic characteristics and 29 infections in Sweden. Methods We did an individually matched case-control study in Sweden. We defined a case as a person aged 18-65 years who was notified with one of 29 infections between 2005 and 2014, in Sweden. Cases were individually matched with respect to sex, age, and county of residence with five randomly selected controls. We extracted the data on the 29 infectious diseases from the electronic national register of notified infections and infectious diseases (SmiNet). We extracted information on country of birth, educational and employment status, and income of cases and controls from Statistics Sweden's population registers. We calculated adjusted matched odds ratios (amOR) using conditional logistic regression to examine the association between infections or groups of infections and place of birth, education, employment, and income. Findings We included 173 729 cases notified between Jan 1, 2005, and Dec 31, 2014 and 868 645 controls. Patients with invasive bacterial diseases, blood-borne infectious diseases, tuberculosis, and antibiotic-resistant infections were more likely to be unemployed (amOR 1.59, 95% CI 1.49-1.70; amOR 3.62, 3.48-3.76; amOR 1.88, 1.65-2.14; and amOR 1.73, 1.67-1.79, respectively), to have a lower educational attainment (amOR 1.24, 1.15-1.34; amOR 3.63, 3.45-3.81; amOR 2.14, 1.85-2.47; and amOR 1.07, 1.03-1.12, respectively), and to have a lowest income (amOR 1.52, 1.39-1.66; amOR 3.64, 3.41-3.89; amOR 3.17, 2.49-4.04; and amOR 1.2, 1.14-1.25, respectively). By contrast, patients with food-borne and water-borne infections were less likely than controls to be unemployed (amOR 0.74, 95% CI 0.72-0.76), to have lower education (amOR 0.75, 0.73-0.77), and lowest income (amOR 0.59, 0.58-0.61). Interpretation These findings indicate persistent socioeconomic inequalities in infectious diseases in an egalitarian high-income country with universal health care. We recommend using these findings to identify priority interventions and as a baseline to monitor programmes addressing socioeconomic inequalities in health.
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| 33. |
- Dahl, Viktor, et al.
(författare)
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Lyme neuroborreliosis epidemiology in Sweden 2010 to 2014 : clinical microbiology laboratories are a better data source than the hospital discharge diagnosis register
- 2019
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Ingår i: Eurosurveillance. - 1025-496X .- 1560-7917. ; 24:20, s. 6-12
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Tidskriftsartikel (refereegranskat)abstract
- Background:In a study from 2013 that prioritised communicable diseases for surveillance in Sweden, we identified Lyme borreliosis as one of the diseases with highest priority. In 2014, when the present study was designed, there were also plans to make neuroborreliosis notifiable within the European Union.Aim:We compared possibilities of surveillance of neuroborreliosis in Sweden through two different sources: the hospital discharge register and reporting from the clinical microbiology laboratories.Methods:We examined the validity of ICD-10 codes in the hospital discharge register by extracting personal identification numbers for all cases of neuroborreliosis, defined by a positive cerebrospinal fluid-serum anti-Borrelia antibody index, who were diagnosed at the largest clinical microbiology laboratory in Sweden during 2014. We conducted a retrospective observational study with a questionnaire sent to all clinical microbiology laboratories in Sweden requesting information on yearly number of cases, age group and sex for the period 2010 to 2014.Results:Among 150 neuroborreliosis cases, 67 (45%) had received the ICD-10 code A69.2 (Lyme borreliosis) in combination with G01.9 (meningitis in bacterial diseases classified elsewhere), the combination that the Swedish National Board of Health and Welfare recommends for neuroborreliosis. All 22 clinical laboratories replied to our questionnaire. Based on laboratory reporting, the annual incidence of neuroborreliosis in Sweden was 6.3 cases per 100,000 in 2014.Conclusion:The hospital discharge register was unsuitable for surveillance of neuroborreliosis, whereas laboratory-based reporting was a feasible alternative. In 2018, the European Commission included Lyme neuroborreliosis on the list of diseases under epidemiological surveillance.
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| 34. |
- Chew, Michelle, et al.
(författare)
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National outcomes and characteristics of patients admitted to Swedish intensive care units for COVID-19 A registry-based cohort study
- 2021
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Ingår i: European Journal of Anaesthesiology. - : LIPPINCOTT WILLIAMS & WILKINS. - 0265-0215 .- 1365-2346. ; 38:4, s. 335-343
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Mortality among patients admitted to intensive care units (ICUs) with COVID-19 is unclear due to variable follow-up periods. Few nationwide data are available to compare risk factors, treatment and outcomes of COVID-19 patients after ICU admission. OBJECTIVE To evaluate baseline characteristics, treatments and 30-day outcomes of patients admitted to Swedish ICUs with COVID-19. DESIGN Registry-based cohort study with prospective data collection. SETTING Admissions to Swedish ICUs from 6 March to 6 May 2020 with laboratory confirmed COVID-19 disease. PARTICIPANTS Adult patients admitted to Swedish ICUs. EXPOSURES Baseline characteristics, intensive care treatments and organ failures. MAIN OUTCOMES AND MEASURES The primary outcome was 30-day all-cause mortality. A multivariable model was used to determine the independent association between potential predictor variables and death. RESULTS We identified 1563 patients with complete 30-day follow-up. The 30-day all-cause mortality was 26.7%. Median age was 61 [52 to 69], Simplified Acute Physiology Score III (SAPS III) was 53 [46 to 59] and 62.5% had at least one comorbidity. Median PaO2/FiO(2) on admission was 97.5 [75.0 to 140.6] mmHg, 74.7% suffered from moderate-to-severe acute respiratory failure. Age, male sex [adjusted odds ratio (aOR) 1.5 (1.1 to 2.2)], SAPS III score [aOR 1.3 (1.2 to 1.4)], severe respiratory failure [aOR 3.0 (2.0 to 4.7)], specific COVID-19 pharmacotherapy [aOR 1.4 (1.0 to 1.9)] and continuous renal replacement therapy [aOR 2.1 (1.5 to 3.0)] were associated with increased mortality. Except for chronic lung disease, the presence of comorbidities was not independently associated with mortality. CONCLUSIONS Thirty-day mortality rate in COVID-19 patients admitted to Swedish ICUs is generally lower than previously reported despite a severe degree of hypoxaemia on admission. Mortality was driven by age, baseline disease severity, the presence and degree of organ failure, rather than pre-existing comorbidities.
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