| 1. |
- Boven, A., et al.
(författare)
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Clostridioides difficile infection, recurrence and the associated healthcare consumption in Sweden between 2006 and 2019 : a population-based cohort study
- 2024
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Ingår i: BMC Infectious Diseases. - : BioMed Central (BMC). - 1471-2334. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Clostridioides difficile infection (CDI) causes a major burden to individuals and society, yet the impact may vary depending on age, sex, underlying comorbidities and where CDI was acquired (hospital or community). Methods: This Swedish nationwide population-based cohort study (2006–2019) compared all 43,150 individuals with CDI to their 355,172 matched controls (first year and entire follow-up). Negative binomial regression models compared the cumulated length of stay, number of in-hospital admissions, outpatient visits and prescriptions after the first CDI episode expressed as incidence rate ratios (IRR) and 95% confidence intervals for the entire follow-up. Results: Overall, 91.6% of CDI cases were hospital acquired, and 16.8% presented with recurrence(s); 74.8%of cases were ≥ 65 years and 54.2% were women. Compared to individuals without CDI, in-hospital stay rates were 18.01 times higher after CDI (95% CI 17.40–18.63, first-year: 27.4 versus 1.6 days), 9.45 times higher in-hospital admission (95% CI 9.16–9.76, first-year: 2.6 versus 1.3 hospitalisations), 3.94 times higher outpatient visit (95% CI 3.84–4.05, first-year: 4.0 versus 1.9 visits) and 3.39 times higher dispensed prescriptions rates (95% CI 3.31–3.48, first-year: 25.5 versus 13.7 prescriptions). For all outcomes, relative risks were higher among the younger (< 65 years) than the older (≥ 65 years), and in those with fewer comorbidities, but similar between sexes. Compared to those without recurrence, individuals with recurrence particularly showed a higher rate of hospital admissions (IRR = 1.18, 95% 1.12–1.24). Compared to community-acquired CDI, those with hospital-acquired CDI presented with a higher rate of hospital admissions (IRR = 7.29, 95% CI 6.68–7.96) and a longer length of stay (IRR = 7.64, 95% CI 7.07–8.26). Conclusion: CDI was associated with increased health consumption in all affected patient groups. The majority of the CDI burden could be contributed to hospital-acquired CDI (~ 9/10), older patients (~ 3/4) and those with multiple comorbidities (~ 6/10 Charlson score ≥ 3), with 1/5 of the total CDI burden contributed to individuals with recurrence. Yet, relatively speaking the burden was higher among the younger and those with fewer comorbidities, compared to their peers without CDI.
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| 2. |
- Canabarro, Ana Paula Finatto, et al.
(författare)
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Cognitive social capital as a health-enabling factor for STI testing among young men in Stockholm, Sweden : A cross-sectional population-based study
- 2023
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Ingår i: Heliyon. - : Elsevier. - 2405-8440. ; 9:10
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess whether different forms of cognitive social capital increased the relative probability of testing for sexually transmitted infections (STIs) among young men living in Stockholm, Sweden.Methods: A population-based cross-sectional study was conducted in 2017 with men aged 20–29 years living in Stockholm County, Sweden (n = 523). The main outcome was STI testing patterns (never tested, tested only within a 12-month period, tested only beyond a 12-month period, repeatedly tested). The main exposure were two forms of cognitive social capital: social support (having received help, having someone to share inner feelings with) and institutionalized trust (in school, healthcare, media). Data were analyzed using weighted multivariable multinomial logistic regression to obtain adjusted weighted relative probability ratio (aRPR).Results: After adjusting for confounding factors, receiving help (aRPR: 5.2, 95% CI: 1.7–16.2) and having someone to share inner feelings with (aRPR: 3.1, 95% CI: 1.2–7.7) increased the relative probabilities of young men testing for STIs, but only for those testing beyond a 12-month period. Trust in media increased the relative probability of STI testing for those testing only within a 12-month period (aRPR: 2.6, 95% CI: 1.1–6.1) and for those testing repeatedly (aRPR: 3.6, 95% CI: 1.5–8.8).Conclusion: Young men in Stockholm County exhibit distinct STI testing patterns. Social support and trust in media were factors that increased the probability of being tested for STIs, with this effect varying according to the young men's STI testing pattern. Further studies are required to explore how trust in media might promote STI testing in this population.
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| 3. |
- Elinder, Liselotte S., et al.
(författare)
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Effect and process evaluation of a structural health intervention in community residences for adults with intellectual disabilities
- 2018
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Ingår i: Journal of Policy and Practice in Intellectual Disabilities. - : John Wiley & Sons. - 1741-1122 .- 1741-1130. ; 15:4, s. 319-328
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Tidskriftsartikel (refereegranskat)abstract
- Interventions to improve health among adults with intellectual disabilities (ID) living in community residences are needed as unhealthy behaviors, obesity, and chronic diseases are more common in this group than in the general population. This study evaluated effectiveness of a structural health intervention, a study circle for paid carers aiming to improve health promotion work routines for residents, and explored barriers and facilitators in the implementation process. A quasi-experimental design was used. Eight municipalities with 84 community residences agreed to participate with 70 of these completing the study. A 26-item questionnaire was used regarding staff work routines in three domains (general health promotion, food and meals, physical activity) and a total score to evaluate effectiveness. An inductive qualitative method was used to explore barriers and facilitators in the implementation process. The intervention group (n = 42 residences) improved their health promoting work routines significantly more than the comparison group (n = 28 residences) in the domains of general health promotion (p =.05), physical activity (p =.02), and for the total score (p =.002), but no significant change was found in the food and meal domain (p =.11). Regarding barriers and facilitators in the implementation process, a “Need for a supportive structure and key persons with a mandate to act,” was identified as an overarching theme. Barriers and facilitators were identified within four categories: (1) characteristics of the study circle, (2) staff capacity, (3) organizational capacity, and (4) external support. This study provides evidence that a structural intervention targeting staff in community residences for people with ID can improve health promoting work routines and that the results might be generalizable. If disseminated on a wider scale, this intervention has the potential of improving health and preventing obesity and other chronic diseases in adults with ID.
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| 4. |
- Elinder, Liselotte S., et al.
(författare)
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Longitudinal changes in health behaviours and body weight among Swedish school children - Associations with age, gender and parental education - The SCIP school cohort
- 2014
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Ingår i: BMC Public Health. - : BioMed Central. - 1471-2458. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- In order to develop health promotion initiatives it is important to identify at what age gender and socioeconomic inequalities in health-related behaviours emerge. The aim of this longitudinal study was to analyse how health-related behaviours and weight status differed by age-group, gender, family socio-economic status and over time in three cohorts of school children. Methods. All children in grades 2, 4 and 7 in a Swedish semi-urban municipality were invited to participate (n = 1,359) of which 813 (60%) consented. At baseline and after 2 years a health questionnaire was answered by all children. Height and weight was measured. Fourteen outcomes were analysed. The main and interaction effects of time, gender and parental educational level on the health-related behaviours, weight status and body mass index standard deviation score (BMIsds) were analysed by the Weighted Least Squares method for categorical repeated measures and Analysis of Variance. Results: Nine of 12 health behaviours deteriorated over the two years: consumption of breakfast and lunch, vegetables and fruit, intake of sweetened drinks, TV viewing, club membership, being outdoors, and school recess activity; two behaviours were unchanged: intake of sweets, and active transport. Only sports participation increased with time. Girls consumed more vegetables, less sweetened drinks, performed less sports, were less physically active during recess, and had lower BMIsds, compared to boys. Those with more highly educated parents had more favourable or similar behaviours compared to those with less educated parents in 10 out of 12 health behaviours, the only exception being intake of sweets and being outdoors, and had lower BMIsds. Conclusions: This study adds to our knowledge regarding the temporal development of health behaviours and weight status in school children. Differences with regard to gender and socioeconomic status were seen already at a young age. These results contribute to our understanding of several important determinants of obesity and chronic diseases and may inform future interventions regarding how to decrease gender and social inequalities in health.
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| 5. |
- Enriquez, R., et al.
(författare)
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Prevalence and risk factors of metabolic dysfunction-associated steatotic liver disease in south Central Uganda : A cross-sectional survey
- 2024
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Ingår i: Alimentary Pharmacology and Therapeutics. - : John Wiley & Sons. - 0269-2813 .- 1365-2036.
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite numerous risk factors and serious consequences, little is known about metabolic dysfunction-associated steatotic liver disease (MASLD) at population level in Africa. Aim: The aim of the study was to estimate the prevalence and risk factors of MASLD in people living with and without HIV in Uganda. Methods: We collected data from 37 communities in South Central Uganda between May 2016 and May 2018. We estimated MASLD prevalence using the fatty liver index and advanced liver fibrosis using the dynamic aspartate-to-alanine aminotransferase ratio. We collected additional data on sociodemographics, HIV and cardiovascular disease (CVD) risk factors. We used multivariable logistic regression to determine the association between HIV, CVD risk factors and MASLD. Results: We included 759 people with HIV and 704 HIV-negative participants aged 35–49. MASLD prevalence was 14% in women and 8% in men; advanced liver fibrosis prevalence was estimated to be <1%. MASLD prevalence was more common in women (15% vs. 13%) and men (9% vs. 6%) with HIV. Being female (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.4–3.3) was associated with a higher odds of MASLD after adjustment for confounders; HIV infection was borderline associated with MASLD (OR = 1.4; 95% CI: 1.0–2.0). Conclusions: In a relatively young cohort in Uganda, 14% of women and 8% of men had MASLD. There was an indication of an association between HIV and MASLD in multivariable analysis. These data are the first to describe the population-level burden of MASLD in sub-Saharan Africa using data from a population-based cohort.
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| 6. |
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| 7. |
- Falkstedt, Daniel, et al.
(författare)
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Prevalence, co-occurrence, and clustering of health-risk behaviors among people with different socio-economic trajectories : A population-based study
- 2016
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Ingår i: Preventive Medicine. - : Elsevier. - 0091-7435 .- 1096-0260. ; 93, s. 64-69
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Tidskriftsartikel (refereegranskat)abstract
- Only a few previously published studies have investigated the co-occurrence and clustering of health-risk behaviors in people with different socio-economic trajectories from childhood to adulthood. This study was based on data collected through the Stockholm County Council's public health surveys. We selected the 24,241 participants aged 30 to 65 years, who responded to a postal questionnaire in 2010. Information on parents' and participants' educational levels was used for classification of four socio-economic trajectories, from childhood to adulthood: the ‘stable high’, the ‘upwardly mobile’, the ‘downwardly mobile’, and the ‘stable low’. Information on daily smoking, risky drinking, physical inactivity, and poor diet was used for assessment of health-risk behaviors: their prevalence, co-occurrence, and clustering. We found all health-risk behaviors to be more prevalent among women and men with a downwardly mobile or stable low socio-economic trajectory. Accordingly, having three or four co-occurring health-risk behaviors were much more likely (up to 4 times, in terms of odds ratios) in these groups as compared to the women and men with an upwardly mobile or a stable high socio-economic trajectory. However, clustering of the health-risk behaviors was not found to be stronger in those with a downwardly mobile or stable low socio-economic trajectory. Thus, the fact that women and men with a disadvantageous socio-economic career were found to have co-occurring health-risk behaviors more often than people with an advantageous socio-economic career seemed to be generated by differences in prevalence of the health-risk behaviors, not by differences in clustering of the behaviors.
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| 9. |
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| 10. |
- Hallgren, Mats, et al.
(författare)
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Exercise and internet-based cognitive-behavioural therapy for depression : Multicentre randomized controlled trial with 12-month follow-up
- 2016
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Ingår i: British Journal of Psychiatry. - : Cambridge University Press. - 0007-1250 .- 1472-1465. ; 209:5, s. 414-420
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Tidskriftsartikel (refereegranskat)abstract
- Background Evidence-based treatment of depression continues to grow, but successful treatment and maintenance of treatment response remains limited.Aims To compare the effectiveness of exercise, internet-based cognitive-behavioural therapy (ICBT) and usual care for depression.Method A multicentre, three-group parallel, randomised controlled trial was conducted with assessment at 3 months (posttreatment) and 12 months (primary end-point). Outcome assessors were masked to group allocation. Computer-generated allocation was performed externally in blocks of 36 and the ratio of participants per group was 1:1:1. In total, 945 adults with mild to moderate depression aged 18-71 years were recruited from primary healthcare centres located throughout Sweden. Participants were randomly assigned to one of three 12-week interventions: supervised group exercise, clinician-supported ICBT or usual care by a physician. The primary outcome was depression severity assessed by the Montgomery-Åsberg Depression Rating Scale (MADRS).Results The response rate at 12-month follow-up was 84%. Depression severity reduced significantly in all three treatment groups in a quadratic trend over time. Mean differences in MADRS score at 12 months were 12.1 (ICBT), 11.4 (exercise) and 9.7 (usual care). At the primary end-point the group x time interaction was significant for both exercise and ICBT. Effect sizes for both interventions were small to moderate.Conclusions The long-term treatment effects reported here suggest that prescribed exercise and clinician-supported ICBT should be considered for the treatment of mild to moderate depression in adults.
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