| 1. |
- Bondesson, Elisabeth, et al.
(författare)
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Can Baseline Characteristics Predict Successful Outcomes after Individual, Physiotherapist-Led Rehabilitation in Patients with Chronic Musculoskeletal Pain?
- 2023
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Ingår i: Pain research & management. - 1203-6765. ; 2023
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: No strong and consistent variables to predict outcome after pain rehabilitation have been reported in patients with chronic musculoskeletal pain. The aim of the present study was to clarify if baseline variables could predict successful outcome after a unique, individualized, physiotherapist-led rehabilitation of nine sessions.METHODS: In 274 individuals with severe chronic musculoskeletal pain, the risk ratio (RR) and 95% confidence intervals (CIs) were estimated for potentially predictive baseline variables on successful outcomes of pain management, overall health, and pain rating.RESULTS: Statistically significant results show that patients rating moderate or severe baseline pain were in both cases 14% less likely to improve pain management compared to patients rating mild baseline pain (RR = 0.86; 95% CI 0.77-0.97, RR = 0.86; 95% CI 0.74-1.00). Patients with the shortest pain duration were 1.61 times more likely to improve overall health (RR = 1.61; 95% CI 1.13-2.29) compared to patients reporting the longest pain duration (>5 years). Patients reporting anxiety/depression or severe pain were in both cases 1.48 times more likely to improve overall health compared to better baseline presentations (RR = 1.48; 95% CI 1.16-1.88, RR = 1.48; 95% CI 1.03-2.15). Patients with regional/generalized pain were 36% less likely to rate pain reduction (RR = 0.64; 95% CI 0.41-1.00) compared to patients rating localized baseline pain. Of 17 potentially predictive baseline variables, four reached statistical significance for at least one of the three outcomes; although none of them for all three outcomes.CONCLUSIONS: Of 17 potentially predictive baseline variables, mild pain ratings, short pain duration, and localized baseline pain were statistically significantly associated with improvements after individual, physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain. This suggests that this type of rehabilitation probably should be offered early in the pain process. Reporting anxiety/depression or severe pain at the baseline did not hinder the improvements of overall health.
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| 2. |
- Trulsson Schouenborg, Anna, et al.
(författare)
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Physiotherapist-led rehabilitation for patients with chronic musculoskeletal pain : interventions and promising long-term outcomes
- 2021
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Ingår i: BMC Musculoskeletal Disorders. - : Springer Science and Business Media LLC. - 1471-2474. ; 22:1, s. 910-910
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: There is no consensus on best content, set-up, category of involved healthcare professionals or duration of rehabilitation-programs for patients with chronic musculoskeletal pain, and outcomes show varying results. Individual care regimes for sub-groups of patients have been proposed.AIM: To describe the type of interventions used in a physiotherapist-led, rehabilitation-program for patients with chronic musculoskeletal pain, refractory to preceding treatments. A second aim was to report clinical outcomes at 1-year follow-up after the intervention period.METHODS: All patients referred to physiotherapist within a specialist pain-unit due to being refractory to preceding treatments, and deemed fit to undergo physiotherapy-based, individualized rehabilitation during 2014-2018 were consecutively included and followed-up 1 year after ending the program. The inclusion was based on structured 'clinical reasoning' using the referral, examination and on patient-relevant outcome measures. The individual interventions, recorded according to a manual used when reading the patients' medical records, were described. Primary outcomes were clinical results of perceived pain, disability and overall health at start, discharge and 1 year after discharge.RESULTS: In total, 274 patients (mean age 42 years, 71% women) were included, suffering from chronic, severe, musculoskeletal pain (VAS median 7/10, duration median 2.8 years) and moderate disability. The most frequent interventions were education, sensorimotor training, physical activity-advice and interventions for structures/functions (for example manual techniques, stretching) for a median of nine sessions during five months. Despite refractory to preceding treatments, 45% of the patients rated clinically important improvements on pain, 61% on disability and 50% on overall health at discharge and the figures were similar at 1-year follow-up.CONCLUSIONS: A physiotherapist-led, one-to-one, rehabilitation-program of median nine sessions during five months, combining individualized education, sensorimotor training, physical activity-advice and interventions for structures/functions rendered clinically relevant improvements on pain, disability and overall health in half of the patients at 1-year follow-up. Since the cohort consisted of patients refractory to preceding treatments, we believe that these results warrant further studies to identify the subgroups of patients with chronic musculoskeletal pain that will improve from new, distinctive, resource-effective rehabilitation-programs involving individualized rehabilitation.
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| 3. |
- Agger, Erik, et al.
(författare)
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Negative prognostic impact of tumor deposits in rectal cancer – a national study cohort
- 2023
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Ingår i: Annals of Surgery. - 1528-1140. ; 273:3, s. 526-533
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate whether tumor deposits (TDs) in rectal cancer are associated withincreased recurrence risk and decreased survival.Summary background data: Tumor deposits (TDs) are considered a risk factor forrecurrence after colon cancer resection and presence of TDs prompts adjuvant chemotherapy.The prognostic relevance of TDs in rectal cancer requires further exploration.Methods: All patients treated with abdominal resection surgery for rectal cancer in Swedenbetween 2011 and 2014 were eligible for inclusion in this retrospective cohort-study based onprospectively collected data from the Swedish ColoRectal Cancer Registry. Primary endpointwas local recurrence or distant metastasis. Secondary outcomes were overall and relativesurvival.Results: 5455 patients were identified. 3769 patients were analysed after exclusion. TDs werefound in 404 (10.7%) patients including where 140 (3.7%) patients with had N1c-status. InTD-positive patients, local recurrence and distant metastasis rates at 5 years were 6.3% [95%CI 3.8-8.8%] and 38.9% [95% CI, 33.6-43.5%] compared to 2.7% [95% CI, 2.1-3.3%] and14.3% [95% CI, 13.1-15.5%] in TD-negative patients. In multivariable regression analysis,risk of local recurrence and distant metastasis were increased; HR 1.86 [95% CI, 1.09-3.19;P=0.024] and 1.87 [95% CI, 1.52-2.31; P=was 68.8% [95% CI, 64.4-73.4%] in TD-positive patients and 80.7% [95% CI, 79.4-82.1%] inTD-negative patients. pN1c-patients had similar outcomes regarding local recurrence, distantCopyright © 2022 Wolters Kluwer Health, Inc. Unauthorized reproduction of the article is prohibited.ACCEPTEDmetastasis and survival as pN1a-b stage patients. TD-positive pN1a-b patients hadsignificantly worse outcomes while TDs did not affect outcomes in pN2a-b patients.Conclusion: This study suggests that TDs have a negative impact on prognosis in rectalcancer. Thus, efforts should be made to diagnose TD-positive rectal cancer patientspreoperatively.
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| 4. |
- Berthold, Elisabet, et al.
(författare)
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The risk of depression and anxiety is not increased in individuals with juvenile idiopathic arthritis - results from the south-Swedish juvenile idiopathic arthritis cohort
- 2022
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Ingår i: Pediatric Rheumatology. - : Springer Science and Business Media LLC. - 1546-0096. ; 20:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundChildren with chronic diseases are reported to have increased risk of psychiatric comorbidity. Few studies have investigated this risk in juvenile idiopathic arthritis (JIA), with conflicting results. We performed a population-based, longitudinal cohort study of the risk of depression and anxiety in south-Swedish patients with juvenile arthritis.MethodsThe south-Swedish JIA cohort (n = 640), a population-based cohort with validated JIA diagnosis 1980 – 2010 and comparators, a reference group of 3200 individuals free from JIA, matched for sex, year of birth and residential region, was used. Data on comorbid diagnosis with depression or anxiety were obtained from the Skåne Healthcare Register, containing all healthcare contacts in the region, from 1998 to 2019. We used Cox proportional models for the calculation of hazard ratios.ResultsDuring the study period, 1998 to 2019, 93 (14.5%) of the individuals in the JIA group were diagnosed with depression, and 111 (17.3%) with anxiety. Corresponding numbers among the references was 474 (14.8%) with depression and 557 (17.4%) with anxiety. Hazard ratio for depression was 1.1 (95% CI 0.9 – 1.5) in females and 0.8 (95% CI 0.5 – 1.4) in males, and for anxiety 1.2 (95% CI 0.9 – 1.5) in females and 0.6 (95% CI 0.4 – 1.1) in males. There were no statistically significant hazard ratios when analyzing subgroups of JIA patients with long disease duration or treatment with disease-modifying antirheumatic drugs.ConclusionsIndividuals with JIA do not have any statistically increased risk of being diagnosed with depression or anxiety compared to matched references.
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| 5. |
- Bondesson, Elisabeth, et al.
(författare)
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Health care utilization among individuals who die by suicide as compared to the general population : a population-based register study in Sweden
- 2022
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Ingår i: BMC Public Health. - : Springer Science and Business Media LLC. - 1471-2458. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Globally, 700 000 people die every year by suicide. Health care consultation patterns the period before suicide could be one potential way to identify people at risk for suicide. Therefore, this study examines health care patterns up to one year prior to the suicide by age, sex and prior diagnoses and specifically investigates if and how this differs from the general population of Skåne, Sweden.METHODS: This cohort study includes all individuals, aged 15 and older, that died by suicide in Region Skåne, Sweden from 2004 to 2015 (n = 1653). The individuals were identified through the Cause of death register and then linked to the Skåne healthcare register. Health care data was analyzed as proportions consulting different types of health care the month and year preceding the suicide, we also investigated the impact of age, sex and the occurrence of prior psychiatric and pain diagnoses. Additionally, we compared the proportion of consulting care among the suicide victims and the general population of Skåne.RESULTS: In the month before their death, 53% of the suicide victims had any health care consultation, compared with 20% in the general population of Skåne, a given month (p < 0.0001). The corresponding figures for the year prior to suicide was 86% among those who died by suicide, compared to 69% in the general population of Skåne, a given year (p < 0.0001). Women, and those having a documented history of psychiatric diagnosis were more likely to have health care consultations in the month and year preceding suicide (p < 0.001), compared to men and suicide victims without a history of psychiatric disease. Older adults that died by suicide, were less likely to consult psychiatric care compared to the younger suicide victims (p < 0.001).CONCLUSION: A majority of the suicide victims consulted health care in the near time before death and the proportion of seeking health care was significantly higher than in the general population of Skåne and higher among female suicide victims as compared to males. Alternative preventive screening measures should be considered for individuals consulting health care, especially for older people and individuals outside the psychiatric care.
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| 6. |
- Bondesson, Elisabeth, et al.
(författare)
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Utilization of healthcare and prescription medicines after non-pharmacological interventions for depression - A 3-year register follow-up of an RCT in primary care
- 2022
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Ingår i: Preventive Medicine Reports. - : Elsevier. - 2211-3355. ; 25
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Tidskriftsartikel (refereegranskat)abstract
- Depression is a common, recurrent disorder. There is a need for readily available treatments with few negative side effects, that demands little resources and that are effective both in the short- and long term. Our aim was to investigate the long-term effectiveness of two different interventions; physical exercise and internet-based cognitive behavioural therapy (internet-CBT), compared to usual care in patients with mild to moderate depression in a Swedish primary care setting. We performed a register-based 3-year follow-up study of participants in the randomized controlled trial REGASSA (n = 940) using healthcare utilization and dispensed medicines as outcomes. We found no difference between the three groups regarding proportion of participants consulting healthcare due to mental illness or pain during follow-up. Regarding number of consultations, there was no difference between the groups, except for consultations related to pain. For this outcome both treatment arms had significantly fewer consultations compared to usual care, during year 2-3, the risk ratio (RR) for physical exercise and internet-CBT was 0.64 (95% CI = 0.43-0.95) and 0.61 (95% CI = 0.41-0.90), respectively. A significantly lower proportion of patients in both treatment arms were dispensed hypnotics and sedatives year 2-3 compared to the usual care arm, RR for both physical exercise and internet-CBT was 0.72 (95% CI = 0.53-0.98). No other differences between the groups were found. In conclusion, considering long-term effects, both physical exercise and internet-CBT, being resource-efficient treatments, could be considered as appropriate additions for patients with mild to moderate depression in primary care settings.
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| 7. |
- Gerlee, Philip, 1980, et al.
(författare)
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Computational models predicting the early development of the COVID-19 pandemic in Sweden: systematic review, data synthesis, and secondary validation of accuracy
- 2022
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Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Computational models for predicting the early course of the COVID-19 pandemic played a central role in policy-making at regional and national levels. We performed a systematic review, data synthesis, and secondary validation of studies that reported on prediction models addressing the early stages of the COVID-19 pandemic in Sweden. A literature search in January 2021 based on the search triangle model identified 1672 peer-reviewed articles, preprints and reports. After applying inclusion criteria 52 studies remained out of which 12 passed a Risk of Bias Opinion Tool. When comparing model predictions with actual outcomes only 4 studies exhibited an acceptable forecast (mean absolute percentage error, MAPE < 20%). Models that predicted disease incidence could not be assessed due to the lack of reliable data during 2020. Drawing conclusions about the accuracy of the models with acceptable methodological quality was challenging because some models were published before the time period for the prediction, while other models were published during the prediction period or even afterwards. We conclude that the forecasting models involving Sweden developed during the early stages of the COVID-19 pandemic in 2020 had limited accuracy. The knowledge attained in this study can be used to improve the preparedness for coming pandemics.
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| 8. |
- Gerlee, Philip, 1980, et al.
(författare)
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Predicting regional COVID-19 hospital admissions in Sweden using mobility data.
- 2021
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Ingår i: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- The transmission of COVID-19 is dependent on social mixing, the basic rate of which varies with sociodemographic, cultural, and geographic factors. Alterations in social mixing and subsequent changes in transmission dynamics eventually affect hospital admissions. We employ these observations to model and predict regional hospital admissions in Sweden during the COVID-19 pandemic. We use an SEIR-model for each region in Sweden in which the social mixing is assumed to depend on mobility data from public transport utilisation and locations for mobile phone usage. The results show that the model could capture the timing of the first and beginning of the second wave of the pandemic 3weeks in advance without any additional assumptions about seasonality. Further, we show that for two major regions of Sweden, models with public transport data outperform models using mobile phone usage. We conclude that a model based on routinely collected mobility data makes it possible to predict future hospital admissions for COVID-19 3weeks in advance.
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| 9. |
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| 10. |
- Jöud, Anna, et al.
(författare)
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Associations between antenatal and perinatal risk factors and cerebral palsy : a Swedish cohort study
- 2020
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 10:8
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To investigate known and suggested risk factors associated with cerebral palsy in a Swedish birth cohort, stratified by gestational age. SETTING: Information on all births between 1995 and 2014 in Skåne, the southernmost region in Sweden, was extracted from the national birth register. PARTICIPANTS: The cohort comprised a total of 215 217 children. Information on confirmed cerebral palsy and subtype was collected from the national quality register for cerebral palsy (Cerebral Palsy Follow-up Surveillance Programme). PRIMARY AND SECONDARY OUTCOME MEASURES: We calculated the prevalence of risk factors suggested to be associated with cerebral palsy and used logistic regression models to investigate the associations between potential risk factors and cerebral palsy. All analyses were stratified by gestational age; term (≥37 weeks), moderately or late preterm (32-36 weeks) and very preterm (<32 weeks). RESULTS: In all, 381 (0.2 %) children were assigned a cerebral palsy diagnosis. Among term children, maternal preobesity/obesity, small for gestational age, malformations, induction, elective and emergency caesarian section, Apgar <7 at 5 min and admission to neonatal care were significantly associated with cerebral palsy (all p values<0.05). Among children born moderately or late preterm, small for gestational age, malformations, elective and emergency caesarian section and admission to neonatal care were all associated with cerebral palsy (all p values <0.05), whereas among children born very preterm no factors were significantly associated with the outcome (all p values>0.05). CONCLUSION: Our results support and strengthen previous findings on factors associated with cerebral palsy. The complete lack of significant associations among children born very preterm probably depends on to the small number of children with cerebral palsy in this group.
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| 11. |
- Jöud, Anna, et al.
(författare)
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Infertility, pregnancy loss and assisted reproduction in women with asthma : a population-based cohort study
- 2022
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Ingår i: Human Reproduction. - : Oxford University Press (OUP). - 0268-1161 .- 1460-2350. ; 37:12, s. 2932-2941
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Tidskriftsartikel (refereegranskat)abstract
- STUDY QUESTION: Is the chance of childbirth, and risk of infertility, pregnancy loss and need for assisted reproduction different for women with asthma compared to women without asthma?SUMMARY ANSWER: Women with asthma had comparable chances of giving birth compared to the reference population, however, their risk of both infertility and pregnancy loss, as well their need for medically assisted reproduction, was higher.WHAT IS KNOWN ALREADY: Reproductive dysfunction has been reported among women with asthma, including longer time to pregnancy, increased risk of pregnancy loss and a higher need of medically assisted reproduction, but their risk of clinical infertility is unknown.STUDY DESIGN, SIZE, DURATION: This longitudinal register-based cohort study included all women with a healthcare visit for delivery, infertility, pregnancy loss or induced abortion in the southernmost county in Sweden, over the last 20 years.PARTICIPANTS/MATERIALS, SETTING, METHODS: Using the Skåne Healthcare Register, we identified all women aged 15-45 between 1998 and 2019, who received a diagnosis of asthma before their first reproductive outcome (n = 6445). Chance of childbirth and risk of infertility, pregnancy loss and assisted reproduction were compared to a healthcare seeking population of women without any asthma (n = 200 248), using modified Poisson regressions.MAIN RESULTS AND THE ROLE OF CHANCE: The chance of childbirth was not different between women with asthma versus those without, adjusted risk ratio (aRR) = 1.02, 95% CI: 1.01-1.03. The risk of seeking care for infertility was increased, aRR = 1.29, 95% CI: 1.21-1.39, and women with asthma more often needed assisted reproduction aRR = 1.34 95% CI: 1.18-1.52. The risk of suffering a pregnancy loss was higher, aRR = 1.21, 95% CI: 1.15-1.28, and induced abortions were more common, aRR = 1.15, 95% CI: 1.11-1.20, among women with asthma.LIMITATIONS, REASONS FOR CAUTION: The study was an observational study based on healthcare visits and lacked detailed anthropometric data, thus residual confounding cannot be excluded. Only women with a healthcare visit for a reproductive outcome were included, which cannot be translated into pregnancy intention. A misclassification, presumed to be non-differential, may arise from an incorrect or missing diagnosis of asthma or female infertility, biasing the results towards the null.WIDER IMPLICATIONS OF THE FINDINGS: This study points towards reproductive dysfunction associated with asthma, specifically in regards to the ability to maintain a pregnancy and the risk of needing medically assisted reproduction following clinical infertility, but reassuringly the chance of subsequently giving birth was not lower for these women.STUDY FUNDING/COMPETING INTEREST(S): This article is part of the ReproUnion collaborative study, co-financed by EU Interreg ÖKS, Capital Region of Denmark, Region Skåne and Ferring Pharmaceuticals. The authors have no competing interests to disclose.TRIAL REGISTRATION NUMBER: N/A.
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| 12. |
- Jöud, Anna, et al.
(författare)
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Sammanställning och utvärdering av modeller för pandemiprediktion i Sverige under 2020
- 2021
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Mindre än två månader – så kort kan tiden enligt uppskattningar vara från upptäckten av ett virus med pandemisk potential till dess att virusets spridning över världen når exponentiell takt. Nationella regeringar och myndigheter har därför kort tid på sig för att i samråd med internationella organ planera och införa åtgärder för att hindra eller begränsa smittspridningen inom respektive land.I det tidiga skedet av en viruspandemi är kunskapen om virusets natur och spridningsvägar låg. Detta ställer prediktion av pandemins utveckling inför metodologiska utmaningar. Under år 2020 har prediktionsmodeller legat till grund för nationellt beslutsfattande och vårdplanering inom sjukvårdsregioner i Sverige. Det är viktigt att klarlägga tillförlitligheten och precisionen i dessa modeller relaterat till den faktiska utvecklingen av covid-19 i landet. Målsättningen med den här studien var att:Beskriva modeller för prediktion av spridning av covid-19 och relaterad sjukvårdsbelastning i Sverige publicerade mellan 2020-01-01 och 2020-12-31 (prediktioner, scenarion, prognoser etc.), samtUtvärdera modellerna ur kvalitetssynpunkt och jämföra modellerat/predicerat utfall med det observerade utfallet under den aktuella tidsperioden.Studien genomfördes som en systematisk litteraturgenomgång och resultatsyntes (sammanställning). För ändamålet utfördes sökningar efter vetenskapliga publikationer (vetenskapligt granskade innan publicering), preprints (artiklar av vetenskaplig karaktär som publiceras öppet utan föregående granskning) samt den grå litteraturen (rapporter och underlag publicerade av organisationer och myndigheter). Studieprotokollet är registrerat i databasen för strukturerade litteratursynteser och metaanalyser PROSPERO (International prospective register of systematic reviews) dnr CRD42021229514 (tillgänglig: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021229514).I litteratursökningen identifierades initialt 1478 artiklar; 892 genom systematisk sökning efter kollegialt granskade vetenskapliga artiklar, 566 genom explorativ sökning i preprint-arkiv, samt 20 rapporter via uppslagssökning i den grå litteraturen. Efter granskning av sammanfattningar och därefter hela titlar med avseende på urvalskriterierna kvarstod totalt 33. Elva av dessa uteslöts på grund av risk för påverkan från felkällor. Av de 22 titlar som ingick i den avslutande resultatsyntesen var omkring hälften vetenskapliga publikationer och de övriga var myndighetsrapporter.Den detaljerade analysen visade att prediktionernas faktiska precision och tillförlitlighet sällan rapporterades tillsammans med modellerna. Endast ett fåtal artiklar beskrev någon form av validering och bara två modeller hade utvärderats framåtblickande (prospektivt). När vi gjorde en sekundär utvärdering mot faktiska data fann vi att bara två modeller av beläggning på intensivvårdsavdelningar och fyra modeller av antalet dödsfall överensstämde tillfredsställande med det faktiska utfallet. Att jämföra modeller och dra slutsatser var dock svårt då somliga prediktioner publicerades avsevärt före den tidsperiod som de gällde, medan andra publicerades i anknytning till perioden eller i efterhand.Avsaknaden av metodologiskt väl utförda utvärderingar begränsar möjligheterna att samla erfarenheter om värdet av att vid framtida pandemier använda prediktionsmodellering. Förutom brister gällande validering och utvärdering noterade vi att dokumentationen av modellerna, och redovisningen av de antaganden som gjorts, generellt var otillräcklig.Trots dessa brister måste prediktionsmodellerna anses ha bidragit positivt till förståelsen av pandemins utveckling i Sverige under 2020 och möjligheterna att genomföra interventioner. Exempelvis visade modellerna att smittspridningen kunde förväntas skilja sig avsevärt åt mellan de svenska sjukvårdsregionerna. Scenariomodellerna visade även hur förändringar i sociala kontaktmönster har samband med smittspridning givet olika fasta antaganden. Bidraget skulle ha varit ännu mer värdefullt om rapporteringen av modellerna hade varit tydligare med om de ansågs vara prediktioner, eller om de skulle betraktas som en del av större scenarion med alternativa utvecklingar givet olika antaganden.Vi drar slutsatserna att forskare, myndigheter och andra organ som publicerar pandemimodeller måste vara tydliga i sin kommunikation med avseende på avsedda mottagare (andra forskare, myndigheter, allmänheten, etc.), avsikten med modellen (scenario eller prediktion), data och antaganden som använts, samt hur tillförlitligheten i utfallet ska tolkas. I synnerhet behöver rapporteringen av pandemimodeller vara tydlig med avseende på om modellerna ska betraktas som prediktioner av en trolig utveckling, eller som scenarier som beskriver hypotetiska förlopp givet olika antaganden.Vid framtida pandemier behöver kunskap om prediktioners tillförlitlighet grundläggas redan tidigt under spridningsförloppet. Utvärderingsprotokoll bör skapas och registreras i internationella databaser för forskningsprotokoll före initiering av datainsamlingen. Rutiner för samarbete mellan nationella myndigheter, sjukvårdsregioner och akademiska institutioner behöver etableras för att sammanföra modelleringskompetens och data.Fortsatt utvecklingsarbete och forskning behövs om utvärderingsmetoder för pandemimodeller. Förutom att prediktioner måste vara tillförlitliga och begripliga, ska scenariomodeller generera realistiska scenarier. Därför behöver metoder för utvärdering av scenariomodellers interna logik, rimlighet och pluralism utvecklas.
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| 13. |
- Lindqvist, Elisabet, et al.
(författare)
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How good is the agreement between clinical diagnoses and classification criteria fulfilment in axial spondyloarthritis? Results from the SPARTAKUS cohort
- 2023
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Ingår i: Scandinavian Journal of Rheumatology. - : Informa UK Limited. - 0300-9742 .- 1502-7732. ; 52:4, s. 364-373
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Tidskriftsartikel (refereegranskat)abstract
- Objectives To study the agreement between clinical axial spondyloarthritis (axSpA) diagnoses and fulfilment of the Assessment of SpondyloArthritis international Society (ASAS) axSpA and modified New York (mNY) classification criteria, and to compare disease/health status between axSpA subtypes. Method Patients with prevalent, clinical axSpA attending a rheumatology clinic were enrolled in a cross-sectional study. Assessments included physical evaluation, laboratory testing, questionnaires, and appropriate imaging, allowing classification. Standard axSpA outcome measures were compared between patients fulfilling mNY/radiographic versus non-radiographic axSpA (r-axSpA/nr-axSpA) criteria. Results Of 239 consecutively included patients, 141 fulfilled ASAS r-axSpA and/or mNY criteria, while 57 fulfilled nr-axSpA criteria. The agreement between r-axSpA and mNY criteria fulfilment was 94%. The positive predictive value (PPV) of a clinical ankylosing spondylitis (AS) diagnosis for mNY criteria fulfilment was 71%; the PPV of an undifferentiated axSpA (u-axSpA) diagnosis for fulfilment of nr-axSpA criteria was 30% and 40% for mNY criteria. Patients with r-axSpA/AS were older, more often men, and had longer disease duration, more uveitis, and worse spinal mobility than nr-axSpA patients, who had more enthesitis and dactylitis. Conclusion We found an overall good concordance between clinical axSpA diagnoses and classification criteria fulfilment, with 83% fulfilling ASAS axSpA and/or mNY criteria. Regarding axSpA subtypes, the concordance was weaker, and although the ICD-10 code for AS correctly identified patients meeting mNY criteria in 71% of cases, one-third of mNY-positive patients lacked an AS diagnosis. Moreover, clinical u-axSpA diagnoses could not serve as a proxy to identify nr-axSpA, highlighting the importance of thorough classification in research on axSpA subtypes.
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| 14. |
- Löfvendahl, Sofia, et al.
(författare)
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The value of the Skåne Health-care Register : Prospectively collected individual-level data for population-based studies
- 2020
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1651-1905 .- 1403-4948. ; 48:1, s. 56-63
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Tidskriftsartikel (refereegranskat)abstract
- Aims: This study aimed to examine the population-based Skåne Health-care Register (SHR) regarding feasibility for scientific research and also strengths and weaknesses. Methods: To analyse the feasibility of the SHR, we performed a bibliographic search for peer-reviewed articles based on SHR data from 2000 to 2018. To analyse strengths and weaknesses, we used original SHR data about coverage and validity. Results: We identified 58 articles based on SHR data, covering different study designs and disorders. Most studies focused on musculoskeletal disorders with a cohort design. The majority of all consultations recorded in the SHR have an assigned diagnosis. However, this differs between the levels of care and between types of consultation. For inpatient care, the proportion of consultations with an assigned diagnosis was close to 100% between 1998 and 2017. The proportion of consultations with an assigned diagnosis was lowest within primary care, although the proportion markedly increased in 2004 when the prerequisite for consultation reimbursement was linked to the requirement for an assigned diagnosis. Limitations are that the SHR does not cover health-care provided within nursing homes and equivalent facilities or treatments received by the population of Skåne outside the region. Conclusions: The SHR may be used as a reliable data source for analyses of clinical changes and improvements. Extended use of the SHR in a research context may highlight important shortcomings within the register and thus serve as a way of indirect quality control. To enhance the use of the SHR further, better harmonisation between registers, within and outside of the region and internationally, is of crucial importance.
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| 15. |
- Mattsson, Kristina, et al.
(författare)
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Fertility outcomes in women with pre-existing type 2 diabetes-a prospective cohort study
- 2021
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Ingår i: Fertility and Sterility. - : Elsevier. - 0015-0282 .- 1556-5653. ; 116:2, s. 505-513
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To study childbirth and the risk of miscarriage and infertility among women who have received a diagnosis of type 2 diabetes before the start of their reproductive journey.DESIGN: Register-based cohort study using the Skåne Healthcare Register SETTING: All healthcare visits for the whole population of the southernmost region in Sweden over the past 20 years PATIENT(S): All women who were aged 18-45 years between January 1, 1998 and December 31, 2019 and who received a clinical diagnosis of type 2 diabetes before their first childbirth, miscarriage, or infertility diagnosis (n = 230) were compared with a healthcare-seeking population of women without any type of diabetes, matched for calendar year and age (n = 179,434).INTERVENTION(S): None MAIN OUTCOME MEASURE(S): Childbirth, miscarriage, and infertility diagnosis RESULT(S): The birthrate was lower among women with type 2 diabetes (62.6% vs. 83.8%), and they were less likely to give birth (crude risk ratio [RR] = 0.73, 95% confidence interval [CI]: 0.66-0.81). They had a higher risk of experiencing a miscarriage (RR = 1.88, 95% CI: 1.50-2.36). The risk of infertility was increased (RR = 3.44, 95% CI: 2.88-4.10) as was the risk of having infertility and not giving birth (RR = 4.47, 95% CI: 3.44-5.82). All results remained the same after adjustment for polycystic ovary syndrome and obesity.CONCLUSION(S): Women with type 2 diabetes with onset before their reproductive journey were more often childless compared with women without diabetes and had a higher risk of experiencing both miscarriage and infertility. This patient group may be in need of targeted information regarding potential fertility issues as part of their clinical treatment.
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| 16. |
- Nielsen, Christel, et al.
(författare)
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Cohort profile : The Swedish Tattoo and Body Modifications Cohort (TABOO)
- 2023
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Ingår i: BMJ Open. - 2044-6055. ; 13:5
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE: The Swedish Tattoo and Body Modifications Cohort (TABOO) cohort was established to provide an infrastructure for epidemiological studies researching the role of tattoos and other body modifications as risk factors for adverse health outcomes. It is the first population-based cohort with detailed exposure assessment of decorative, cosmetic, and medical tattoos, piercing, scarification, henna tattoos, cosmetic laser treatments, hair dyeing, and sun habits. The level of detail in the exposure assessment of tattoos allows for investigation of crude dose-response relationships.PARTICIPANTS: The TABOO cohort includes 13 049 individuals that participated in a questionnaire survey conducted in 2021 (response rate 49%). Outcome data are retrieved from the National Patient Register, the National Prescribed Drug Register and the National Cause of Death Register. Participation in the registers is regulated by Swedish law, which eliminates the risk of loss to follow-up and associated selection bias.FINDINGS TO DATE: The tattoo prevalence in TABOO is 21%. The cohort is currently used to clarify the incidence of acute and long-lasting health complaints after tattooing based on self-reported data. Using register-based outcome data, we are investigating the role of tattoos as a risk factor for immune-mediated disease, including hypersensitisation, foreign body reactions and autoimmune conditions.FUTURE PLANS: The register linkage will be renewed every third year to update the outcome data, and we have ethical approval to reapproach the responders with additional questionnaires.
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| 17. |
- Nielsen, Christel, et al.
(författare)
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Susceptibility to COVID-19 after High Exposure to Perfluoroalkyl Substances from Contaminated Drinking Water: An Ecological Study from Ronneby, Sweden
- 2021
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Ingår i: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1660-4601. ; 18:20
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Tidskriftsartikel (refereegranskat)abstract
- There is concern that immunotoxic environmental contaminants, particularly perfluoroalkyl substances (PFAS), may play a role in the clinical course of COVID-19 and epidemiologic studies are needed to answer if high-exposed populations are especially vulnerable in light of the ongoing pandemic. The objective was, therefore, to determine if exposure to highly PFAS-contaminated drinking water was associated with an increased incidence of COVID-19 in Ronneby, Sweden, during the first year of the pandemic. We conducted an ecological study determining the sex- and age-standardized incidence ratio (SIR) in the adult population relative to a neighboring reference town with similar demographic characteristics but with only background levels of exposure. In Sweden, COVID-19 is subject to mandatory reporting, and we retrieved aggregated data on all verified cases until 3 March 2021 from the Public Health Agency of Sweden. The SIR in Ronneby was estimated at 1.19 (95% CI: 1.12; 1.27). The results suggest a potential link between high PFAS exposure and susceptibility to COVID-19 that warrants further research to clarify causality.
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| 18. |
- Nielsen, Christel, et al.
(författare)
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Tattoos as a risk factor for malignant lymphoma: a population-based case–control study
- 2024
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Ingår i: EClinicalMedicine. - 2589-5370. ; 72
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Tidskriftsartikel (refereegranskat)abstract
- Background The popularity of tattoos has increased dramatically over the last few decades. Tattoo ink often contains carcinogenic chemicals, e.g., primary aromatic amines, polycyclic aromatic hydrocarbons, and metals. The tattooing process invokes an immunologic response that causes translocation of tattoo ink from the injection site. Deposition of tattoo pigment in lymph nodes has been confirmed but the long-term health effects remain unexplored. We used Swedish National Authority Registers with full population coverage to investigate the association between tattoo exposure and overall malignant lymphoma as well as lymphoma subtypes.Methods We performed a case–control study where we identified all incident cases of malignant lymphoma diagnosed between 2007 and 2017 in individuals aged 20–60 years in the Swedish National Cancer Register. Three random age- and sex-matched controls per case were sampled from the Total Population Register using incidence density sampling. We assessed exposure through a questionnaire in 2021, and data on potential confounders were retrieved from registers. We used multivariable logistic regression to estimate the incidencerate ratio (IRR) of malignant lymphoma in tattooed individuals.Findings The study population consisted of 11,905 individuals, and the response rate was 54% among cases (n = 1398) and 47% among controls (n = 4193). The tattoo prevalence was 21% among cases and 18% among controls. Tattooedindividuals had a higher adjusted risk of overall lymphoma (IRR = 1.21; 95% CI 0.99–1.48). The risk of lymphoma was highest in individuals with less than two years between their first tattoo and the index year (IRR = 1.81; 95% CI 1.03–3.20). The risk decreased with intermediate exposure duration (three to ten years) but increased again in individuals who received their first tattoo ≥11 years before the index year (IRR = 1.19; 95% CI 0.94–1.50). We found no evidence of increasing risk with a larger area of total tattooed body surface. The risk associated with tattoo exposure seemed to be highest for diffuse large B-cell lymphoma (IRR 1.30; 95% CI 0.99–1.71) and follicular lymphoma (IRR 1.29; 95% CI 0.92–1.82).Interpretation Our findings suggested that tattoo exposure was associated with an increased risk of malignant lymphoma. More epidemiologic research is urgently needed to establish causality.
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| 19. |
- Nived, Ola, et al.
(författare)
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Disease duration, age at diagnosis and organ damage are important factors for cardiovascular disease in SLE
- 2020
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Ingår i: Lupus science & medicine. - : BMJ. - 2053-8790. ; 7
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To report the incidence rate ratios (IRR) of acute myocardial infarctions (AMI) and cerebrovascular events (CVE) in incident SLE cases from a defined population. To study the risk factors for cardiovascular events in all patients with SLE at our unit.METHODS: Patients with SLE diagnosed from 1981 to 2006 were followed through to 2016. IRRs of AMI and CVE were calculated. The AMI and CVE incidence patterns for patients with SLE were studied in relation to hypertension, smoking, renal dysfunction, anticardiolipin (aCL) antibodies at diagnosis, disease duration and organ damage before an event.RESULTS: 262 patients with SLE were included in the study; of these 175 were from the defined population. Overall, 37 AMI and 44 CVE were recorded. An increased IRR of 3 for AMI was found (p<0.001). Smoking, hypertension and reduced renal function were risk factors for AMI. An increased IRR of 3.3 for ischaemic CVE was found for women (p<0.001). Hypertension and aCL were risk factors for CVE. Organ damage before events was increased.CONCLUSIONS: Cardiovascular events are increased in SLE and are associated with hypertension, smoking and increased damage rate.
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| 20. |
- Olofsson, Tor, et al.
(författare)
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Pain over 2 years after start of biological versus conventional combination treatment in early rheumatoid arthritis : results from the randomised controlled SWEFOT trial
- 2021
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 73:9, s. 1312-1321
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To compare the pain course between methotrexate (MTX)-refractory early rheumatoid arthritis (RA) patients randomised to infliximab (IFX) versus sulfasalazine+hydroxychloroquine (SSZ+HCQ).METHODS: The randomised, controlled, open-label SWEFOT (SWedish FarmacOTherapy) trial enrolled new-onset RA patients Oct 2002-Dec 2005. After 3 months on MTX, patients not reaching low disease activity (28-joint Disease Activity Score; DAS28≤3.2) were randomised to adding IFX (n=128) or SSZ+HCQ (n=130) and followed for 21 months. Here, outcomes included area-under-the-curve (AUC) for Visual Analogue Scale (VAS) of pain, unacceptable pain (VAS pain>40mm [0-100]); and unacceptable pain despite inflammation control (refractory pain; VAS pain>40+C-reactive protein<10mg/L). Between-group differences were analysed with multivariate regression models.RESULTS: Overall, 50% of randomised patients (n=258) in the crude setting, reported unacceptable pain at randomisation, declining to 29% at 21 months (p<0.001), when refractory pain constituted 82% of all unacceptable pain. Comparing randomised arms (intention-to-treat analysis), AUC for VAS pain was lower in the MTX+IFX-group (p=0.01), and at 21 months 32% with MTX+IFX and 45% with MTX+SSZ+HCQ had unacceptable pain (adjusted relative risk 0.68 [95%CI:0.51-0.90]; p=0.008). Regarding refractory pain, no between-group differences were observed.CONCLUSION: Despite active combination treatment, almost 1/3 of new-onset RA patients reported unacceptable pain after 21 months and refractory pain constituted more than 4/5 of this pain load. Adding IFX versus SSZ+HCQ to MTX reduced both cumulative pain and unacceptable pain at 21 months, suggesting less long-term pain for the biological therapy. These results display insufficient effects of current treatment strategies on inflammation-independent pain components, warranting alternative approaches in affected patients.
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| 21. |
- Shen, Qing, et al.
(författare)
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Diagnostic codes of cancer in Skåne healthcare register : a validation study using individual-level data in southern Sweden
- 2021
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Ingår i: BMC Cancer. - : Springer Science and Business Media LLC. - 1471-2407. ; 21:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Swedish healthcare is decentralised to 21 regions. Detailed information on all delivered care in the southernmost region, Skåne, is prospectively collected in the Skåne Healthcare Register (SHR). The data is updated daily and hence a good source for epidemiological studies. However, the diagnostic codes used to identify cancer patients in SHR have not yet been validated. Methods: We conducted a validation study including 1,473,204 residents in Skåne region during 2005–2014, with at least one physical consultation in SHR. Newly diagnosed cancer from the Swedish Cancer Register was considered the ‘gold standard’ reference. We estimated the positive predictive value (PPV), sensitivity, and area under the curve (AUC) of a cancer diagnosis based on SHR by level of consultation, for any cancer, and for different cancer types. Results: There were 61,693 cancers from the Swedish Cancer Register, and 87,650 cancers from SHR. The PPV of SHR-based diagnosis of any cancer was 63.76% (95% confidence interval (CI): 63.44–64.08%) with a sensitivity of 90.58% (95% CI: 90.35–90.81%). The AUC was 0.94, for any cancer. The measures of PPV, sensitivity and AUC varied across levels of care and were higher in specialized care than in primary care. The highest PPV was observed for specialist inpatient care in SHR (89.17, 95% CI 88.89–89.45%) whereas the highest sensitivity was observed for specialized outpatient care in SHR (86.39, 95%CI 86.12–86.66%). Robust validity was noted among most cancers, except for cancers of soft tissues, central nervous system and eye, and endocrine glands. Conclusions: Our study supports that SHR is a valid and robust healthcare register for cancer diagnosis, with varying validities across levels of care and cancer types. This makes SHR a useful data source for cancer epidemiological studies, especially because the data covers the entire cancer care pathways without time lags for further linkage.
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| 22. |
- Shen, Qing, et al.
(författare)
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Psychiatric Disorders and Cardiovascular Diseases During the Diagnostic Workup of Suspected Prostate Cancer
- 2021
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Ingår i: JNCI Cancer Spectrum. - : Oxford University Press. - 2515-5091. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: It is unknown whether the rate of psychiatric disorders and cardiovascular disease increases during the diagnostic workup of suspected prostate cancer.Methods: We designed a population-based cohort study including 579 992 men living during 2005-2014 in Skåne, Sweden, according to the Swedish Total Population Register and the Skåne Healthcare Register (SHR). We used the Swedish Cancer Register and the SHR to identify all men with a new diagnosis of prostate cancer (N = 10 996), and all men underwent a prostate biopsy without receiving a cancer diagnosis (biopsy group, N = 20 482) as exposed to a diagnostic workup. Using Poisson regression, we compared the rates of psychiatric disorders and cardiovascular disease during the period before diagnosis or biopsy of exposed men with the corresponding rates of unexposed men.Results: We found an increased rate of psychiatric disorders during the period before diagnosis or biopsy among men with prostate cancer (incidence rate ratio [IRR] = 1.87, 95% confidence interval [CI] = 1.67 to 2.10) and men in the biopsy group (IRR = 2.22, 95% CI = 2.08 to 2.37). The rate of cardiovascular disease increased during the period before diagnosis or biopsy among men with prostate cancer (IRR = 2.22, 95% CI = 2.12 to 2.32) and men in the biopsy group (IRR = 2.56, 95% CI = 2.49 to 2.63). Greater rate increases were noted for a diagnostic workup due to symptoms than due to other reasons.Conclusions: There was an increased risk of psychiatric disorders and cardiovascular disease during the diagnostic workup of suspected prostate cancer regardless of the final cancer diagnosis.
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| 23. |
- Soltesz, Kristian, et al.
(författare)
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The effect of interventions on COVID-19
- 2020
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 588:7839, s. 26-28
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Tidskriftsartikel (refereegranskat)
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| 24. |
- Spreco, Armin, et al.
(författare)
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Effectiveness of the BNT162b2 mRNA Vaccine Compared with Hybrid Immunity in Populations Prioritized and Non-Prioritized for COVID-19 Vaccination in 2021–2022 : A Naturalistic Case-Control Study in Sweden
- 2022
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Ingår i: Vaccines. - : MDPI AG. - 2076-393X. ; 10:8
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Tidskriftsartikel (refereegranskat)abstract
- The term hybrid immunity is used to denote the immunological status of vaccinated individuals with a history of natural infection. Reports of new SARS-CoV-2 variants of concern motivate continuous rethought and renewal of COVID-19 vaccination programs. We used a naturalistic case-control study design to compare the effectiveness of the BNT162b2 mRNA vaccine to hybrid immunity 180 days post-vaccination in prioritized and non-prioritized populations vaccinated before 31 July 2021 in three Swedish counties (total population 1,760,000). Subjects with a positive SARS-CoV-2 test recorded within 6 months before vaccination (n = 36,247; 6%) were matched to vaccinated-only controls. In the prioritized population exposed to the SARS-CoV-2 Alpha and Delta variants post-vaccination, the odds ratio (OR) for breakthrough infection was 2.2 (95% CI, 1.6–2.8; p < 0.001) in the vaccinated-only group compared with the hybrid immunity group, while in the later vaccinated non-prioritized population, the OR decreased from 4.3 (95% CI, 2.2–8.6; p < 0.001) during circulation of the Delta variant to 1.9 (95% CI, 1.7–2.1; p < 0.001) with the introduction of the Omicron variant (B.1.617.2). We conclude that hybrid immunity provides gains in protection, but that the benefits are smaller for risk groups and with circulation of the Omicron variant and its sublineages.
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| 25. |
- Spreco, Armin, et al.
(författare)
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Nowcasting (Short-Term Forecasting) of COVID-19 Hospitalizations Using Syndromic Healthcare Data, Sweden, 2020
- 2022
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Ingår i: Emerging Infectious Diseases. - : Centers for Disease Control and Prevention (CDC). - 1080-6040 .- 1080-6059. ; 28:3, s. 564-571
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Tidskriftsartikel (refereegranskat)abstract
- We report on local nowcasting (short-term forecasting) of coronavirus disease (COVID-19) hospitalizations based on syndromic (symptom) data recorded in regular healthcare routines in Östergötland County (population ≈465,000), Sweden, early in the pandemic, when broad laboratory testing was unavailable. Daily nowcasts were supplied to the local healthcare management based on analyses of the time lag between telenursing calls with the chief complaints (cough by adult or fever by adult) and COVID-19 hospitalization. The complaint cough by adult showed satisfactory performance (Pearson correlation coefficient r>0.80; mean absolute percentage error <20%) in nowcasting the incidence of daily COVID-19 hospitalizations 14 days in advance until the incidence decreased to <1.5/100,000 population, whereas the corresponding performance for fever by adult was unsatisfactory. Our results support local nowcasting of hospitalizations on the basis of symptom data recorded in routine healthcare during the initial stage of a pandemic. © 2022 Centers for Disease Control and Prevention (CDC). All rights reserved.
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| 26. |
- Spreco, Armin, et al.
(författare)
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Nowcasting (Short Term Forecasting) of Influenza Epidemics in Local Settings, Sweden, 2008-2019
- 2020
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Ingår i: Emerging Infectious Diseases. - Atlanta, GA, United States : CENTERS DISEASE CONTROL & PREVENTION. - 1080-6040 .- 1080-6059. ; 26:11, s. 2669-2677
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Tidskriftsartikel (refereegranskat)abstract
- The timing of influenza case incidence during epidemics can differ between regions within nations and states. We conducted a prospective 10-year evaluation (January 2008-February 2019) of a local influenza nowcasting (short-term forecasting) method in 3 urban counties in Sweden with independent public health administrations by using routine health information system data. Detection-of-epidemic-start (detection), peak timing, and peak intensity were nowcasted. Detection displayed satisfactory performance in 2 of the 3 counties for all nonpandemic influenza seasons and in 6 of 9 seasons for the third county. Peak-timing prediction showed satisfactory performance from the influenza season 2011-12 onward. Peak-intensity prediction also was satisfactory for influenza seasons in 2 of the counties but poor in 1 county. Local influenza nowcasting was satisfactory for seasonal influenza in 2 of 3 counties. The less satisfactory performance in 1 of the study counties might be attributable to population mixing with a neighboring metropolitan area.
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| 27. |
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| 28. |
- Vilhelmsson, Andreas, et al.
(författare)
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Exposure to per- and polyfluoroalkyl substances in early pregnancy and risk of cerebral palsy in children
- 2023
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Ingår i: Science of the Total Environment. - 1879-1026. ; 899
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Most cerebral palsy (CP) cases have an unexplained etiology, but a role for environmental exposures has been suggested. One purported environmental risk factor is exposure to endocrine-disrupting pollutants specifically per- and polyfluoroalkyl substances (PFAS).OBJECTIVES: We investigated the association between prenatal PFAS exposures and CP in Swedish children.METHODS: In this case-control study, 322 CP cases, 343 population controls, and 258 preterm controls were identified from a birth registry in combination with a CP follow-up program from 1995 to 2014 and linked to a biobank which contains serum samples from week 10-14 of pregnancy. Maternal serum concentrations of four PFAS compounds: perfluorohexane sulfonate (PFHxS), perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), and perfluorooctane sulfonate (PFOS) were analyzed using liquid chromatography-tandem-mass-spectrometry. We estimated odds ratios (ORs) and 95 % confidence intervals (CIs) for CP and each PFAS in quartiles and as continuous variables controlling for various sociodemographic and lifestyle factors.RESULTS: In crude and adjusted analyses, we did not find consistent evidence of associations between serum PFHxS, PFOA, PFNA, PFOS and concentrations in early pregnancy and CP, except in preterm infants. The ORs comparing the highest PFAS quartiles to the lowest were 1.05 (95 % CI: 0.63-1.76), 0.96 (95 % CI: 0.55-1.68), 0.71 (95 % CI: 0.41-1.25), and 1.17 (95 % CI: 0.61-2.26), for PFHxS, PFOA, PFNA, and PFOS, respectively. Some positive associations were observed for preterm infants, but the results were imprecise. Similar patterns were observed in analyses treating PFAS as continuous variables.CONCLUSIONS: In this study, we found little evidence that early pregnancy prenatal exposure to PFHxS, PFOA, PFNA, or PFOS increases the risk of CP. However, some positive associations were observed for preterm cases and warrant further investigation.
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| 29. |
- Wacker, Andreas, et al.
(författare)
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Estimating the SARS-CoV-2 infected population fraction and the infection-to-fatality ratio: a data-driven case study based on Swedish time series data.
- 2021
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Ingår i: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 11:1
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Tidskriftsartikel (refereegranskat)abstract
- We demonstrate that finite impulse response (FIR) models can be applied to analyze the time evolution of an epidemic with its impact on deaths and healthcare strain. Using time series data for COVID-19-related cases, ICU admissions and deaths from Sweden, the FIR model gives a consistent epidemiological trajectory for a simple delta filter function. This results in a consistent scaling between the time series if appropriate time delays are applied and allows the reconstruction of cases for times before July 2020, when RT-PCR testing was not widely available. Combined with randomized RT-PCR study results, we utilize this approach to estimate the total number of infections in Sweden, and the corresponding infection-to-fatality ratio (IFR), infection-to-case ratio (ICR), and infection-to-ICU admission ratio (IIAR). Our values for IFR, ICR and IIAR are essentially constant over large parts of 2020 in contrast with claims of healthcare adaptation or mutated virus variants importantly affecting these ratios. We observe a diminished IFR in late summer 2020 as well as a strong decline during 2021, following the launch of a nation-wide vaccination program. The total number of infections during 2020 is estimated to 1.3 million, indicating that Sweden was far from herd immunity.
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| 30. |
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| 31. |
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