| 1. |
- Menkveld, Albert J., et al.
(author)
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Nonstandard Errors
- 2024
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In: JOURNAL OF FINANCE. - : Wiley-Blackwell. - 0022-1082 .- 1540-6261. ; 79:3, s. 2339-2390
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Journal article (peer-reviewed)abstract
- In statistics, samples are drawn from a population in a data-generating process (DGP). Standard errors measure the uncertainty in estimates of population parameters. In science, evidence is generated to test hypotheses in an evidence-generating process (EGP). We claim that EGP variation across researchers adds uncertainty-nonstandard errors (NSEs). We study NSEs by letting 164 teams test the same hypotheses on the same data. NSEs turn out to be sizable, but smaller for more reproducible or higher rated research. Adding peer-review stages reduces NSEs. We further find that this type of uncertainty is underestimated by participants.
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| 2. |
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| 3. |
- Bonde, J. P. E., et al.
(author)
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COVID-19-related hospital admission in spouses of partners in at-risk occupations
- 2023
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In: Scandinavian Journal of Work Environment & Health. - : Scandinavian Journal of Work, Environment and Health. - 0355-3140 .- 1795-990X. ; 49:3, s. 193-200
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Journal article (peer-reviewed)abstract
- Objective This study aimed to quantify the risk of COVID-19-related hospital admission in spouses living with partners in at-risk occupations in Denmark during 2020-21.Methods Within a registry-based cohort of all Danish employees (N=2 451 542), we identified cohabiting couples, in which at least one member (spouse) held a job that according to a job exposure matrix entailed low risk of occupational exposure to SARS-CoV-2 (N=192 807 employees, 316 COVID-19 hospital admissions). Risk of COVID-19-related hospital admission in such spouses was assessed according to whether their partners were in jobs with low, intermediate or high risk for infection. Overall and sex-specific incidence rate ratios (IRR) of COVID-19-related hospital admission were computed by Poisson regression with adjustment for relevant covariates.Results The risk of COVID-19-related hospital admission was increased among spouses with partners in highrisk occupations [adjusted IRR (IRRadj)1.59, 95% confidence interval (CI) 1.1-2.2], but not intermediate-risk occupations (IRRadj 0.97 95% 0.8-1.3). IRR for having a partner in a high-risk job was elevated during the first three pandemic waves but not in the fourth (IRRadj 0.48 95% CI 0.2-1.5). Sex did not modify the risk of hospital admission.Conclusions SARS-CoV-2 transmission at the workplace may pose an increased risk of severe COVID-19 among spouses in low-risk jobs living with partners in high-risk jobs, which emphasizes the need for preventive measures at the workplace in future outbreaks of epidemic contagious disease. When available, effective vaccines seem essential.
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| 4. |
- Bonde, J. P. E., et al.
(author)
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Occupational risk of SARS-CoV-2 infection: a nationwide register-based study of the Danish workforce during the COVID-19 pandemic, 2020-2021
- 2023
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In: Occupational and Environmental Medicine. - : BMJ. - 1351-0711 .- 1470-7926. ; 80:4, s. 202-208
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Journal article (peer-reviewed)abstract
- ObjectiveMost earlier studies on occupational risk of COVID-19 covering the entire workforce are based on relatively rare outcomes such as hospital admission and mortality. This study examines the incidence of SARS-CoV-2 infection by occupational group based on real-time PCR (RT-PCR) tests. MethodsThe cohort includes 2.4 million Danish employees, 20-69 years of age. All data were retrieved from public registries. The incidence rate ratios (IRRs) of first-occurring positive RT-PCR test from week 8 of 2020 to week 50 of 2021 were computed by Poisson regression for each four-digit Danish Version of the International Standard Classification of Occupations job code with more than 100 male and 100 female employees (n=205). Occupational groups with low risk of workplace infection according to a job exposure matrix constituted the reference group. Risk estimates were adjusted by demographic, social and health characteristics including household size, completed COVID-19 vaccination, pandemic wave and occupation-specific frequency of testing. ResultsIRRs of SARS-CoV-2 infection were elevated in seven healthcare occupations and 42 occupations in other sectors, mainly social work activities, residential care, education, defence and security, accommodation and transportation. No IRRs exceeded 2.0. The relative risk in healthcare, residential care and defence/security declined across pandemic waves. Decreased IRRs were observed in 12 occupations. DiscussionWe observed a modestly increased risk of SARS-CoV-2 infection among employees in numerous occupations, indicating a large potential for preventive actions. Cautious interpretation of observed risk in specific occupations is needed because of methodological issues inherent in analyses of RT-PCR test results and because of multiple statistical tests.
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| 5. |
- Fagerberg, Björn, et al.
(author)
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Extremvärme ett ökande problem för globala folkhälsan : Klimatförändringarnas negativa hälsoeffekter drabbar även Sverige
- 2016
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In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 113:31-33
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Research review (other academic/artistic)abstract
- High temperatures have a direct impact on body functions. Heat waves increase mortality risks due to myocardial infarction, stroke, and pulmonary disease. Cold temperatures also increase mortality, but with a longer latency. A recent study found only a small difference between the minimal mortality temperature (MMT) and the temperatures at which mortality rose steeply, although the majority of deaths occurred at temperatures below MMT. Global climate change with increasing temperatures seriously threatens health, work capacity, and generation of household incomes, particularly among poor people in hot countries. In Sweden, heat waves increase mortality in vulnerable groups of elderly people and patients with chronic heart and lung diseases, as well as those performing intensive physical work in hot environments. The medical profession can play an important role not only in prevention of climate change, but also in adaptation to climate change with the goal of minimizing health risks.
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| 6. |
- Hulthén, Erik, 1980, et al.
(author)
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Implementing Real-time Optimization on a secondary Cone Crusher for Iron Ore Production, part 1
- 2013
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In: Preprints Conference in Minerals Engineering, Luleå, 5-6 February 2013. ; , s. 71-80
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Conference paper (other academic/artistic)abstract
- Cone crushers are often used as an intermediate comminution step in the mining industry. Real-time feedback data on the product streams can be obtained by applying mass-flow sensors to the process. Systems used for controlling the Closed Side Setting (CSS) on cone crushers are widely used to compensate for wear of the manganese crushing liners and to protect the machines from overloads. With a frequency converter also the eccentric speed in a cone crusher can be adjusted in real-time in addition to the CSS. The eccentric speed affects the dynamic interaction between the rock material and the crusher liners. The adjustment of these two online parameters in real time can result in an increased potential for production yield; however, a nontrivial optimization problem with a large solution space also arises. As the feed material also varies, and the wear is highly evident, the optimal setting for the parameters varies in time. In this paper we report on the preparation of a secondary cone crusher for real-time optimization. The cone crusher, a Sandvik CH680, has got a frequency converter installed and the temperature in the crusher is measured in order to ensure that the crusher as a mechanical machine is working under good operating conditions. The conveyor belts around the crusher have all been equipped with mass-flow meters. Thus the different product yields from the crushing plant can be monitored continuously. The results of the electrical and instrumental installations are that both the CSS and now also the eccentric speed can be operated and monitored in real time without interrupting the process at one of LKAB Malmbergets secondary cone crushers. The first guiding tests indicate a more beneficial operating point, where a higher power consumption can be achieved in the crusher without increasing the pressure as much. The results of the capacities, both the crusher and the crushing stage, indicate the same direction. There are operating points which are more beneficial than others, and it is not the nominal one that is the best. The range of the change in capacity of the circuit is -6.1% to +2.3% from the nominal point.
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| 7. |
- Malm, Ellen, et al.
(author)
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Maternal Serum Concentrations of Per- and Polyfluoroalkyl Substances in Early Pregnancy and Small for Gestational Age in Southern Sweden
- 2023
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In: Toxics. - 2305-6304. ; 11:9
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Journal article (peer-reviewed)abstract
- Small for gestational age (SGA) is considered an adverse birth outcome. Per- and polyfluoralkyl substances (PFAS) have become increasingly investigated as contributing environmental factors, thus far with inconclusive results. The current study aimed to investigate the hypothesized association between increased maternal PFAS levels in early pregnancy and an increased risk for SGA birth. This population-based study used data from a sample of children born in Scania, Southern Sweden, between 1995 and 2009. Two groups were compared: cases born with SGA (n = 298) and non-SGA controls (n = 580). The cases consisted of two subgroups: one included women whose children’s growth in late pregnancy was in the lowest quartile, and another included women from the remaining growth quartiles. Corresponding maternal serum samples were collected from a biobank and analyzed for concentrations of four types of PFAS: perfluorooctanoic acid (PFOA), perfluorononanoic acid (PFNA), perfluorohexane sulfonic acid (PFHxS), and perfluorooctane sulfonic acid (PFOS) using liquid chromatography–tandem mass spectrometry (LC/MS/MS). The results were combined with information from birth registers and analyzed using Mann–Whitney U-tests and logistic regression—unadjusted as well as adjusted for potential confounders. In conclusion, elevated maternal concentrations of PFAS were not associated with an increased risk of SGA birth. However, significant ORs were observed in a subgroup analysis restricted to women of Nordic origin (unadjusted OR 3.2 and adjusted OR 2.4) for PFHxS.
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| 8. |
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| 9. |
- Mulinari, Shai, et al.
(author)
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Five years of pharmaceutical industry funding of patient organisations in Sweden: cross-sectional study of companies, patient organisations and drugs
- 2020
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203.
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Journal article (peer-reviewed)abstract
- BackgroundMany patient organisations collaborate with drug companies, resulting in concerns about commercial agendas influencing patient advocacy. We contribute to an international body of knowledge on patient organisation-industry relations by considering payments reported in the industry’s centralised ‘collaboration database’ in Sweden. We also investigate possible commercial motives behind the funding by assessing its association with drug commercialisation.MethodsOur primary data source were 1,337 payment reports from 2014–2018. After extraction and coding, we analysed the data descriptively, calculating the number, value and distribution of payments for various units of analysis, e.g. individual companies, diseases and payment goals. The association between drug commercialisation and patient organisation funding was assessed by, first, the concordance between leading companies marketing drugs in specific diseases and their funding of corresponding patient organisations and, second, the correlation between new drugs in broader condition areas and payments to corresponding patient organisations.Results46 companies reported paying €6,449.224 (median €2,411; IQR €1,024–4,569) to 77 patient organisations, but ten companies provided 67% of the funding. Small payments dominated, many of which covered costs of events organised by patient organisations. An association existed between drug commercialisation and industry funding. Companies supported patient organisations in diseases linked to their drug portfolios, with the top 3 condition areas in terms of funding–cancer; endocrine, nutritional and metabolic disorders; and infectious and parasitic disorders–accounting for 63% of new drugs and 56% of the funding.ConclusionThis study reveals close and widespread ties between patient organisations and drug companies. A relatively few number of companies dominated the funding landscape by supporting patient organisations in disease areas linked to their drug portfolios. This commercially motivated funding may contribute to inequalities in resource and influence between patient organisations. The association between drug commercialisation and industry funding is also worrying because of the therapeutic uncertainty of many new drugs. Our analysis benefited from the existence of a centralised database of payments–which should be adopted by other countries too–but databases should be downloadable in an analysable format to permit efficient and independent analysis.
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| 10. |
- Mulinari, Shai, et al.
(author)
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Is there evidence for the racialization of pharmaceutical regulation? : Systematic comparison of new drugs approved over five years in the USA and the EU
- 2021
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In: Social Science and Medicine. - : Elsevier BV. - 1873-5347 .- 0277-9536. ; 280
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Journal article (peer-reviewed)abstract
- Recent decades have seen much interest in racial and ethnic differences in drug response. The most emblematic example is the heart drug BiDil, approved by the US Food and Drug Administration in 2005 for “self-identified blacks.” Previous social science research has explored this “racialization of pharmaceutical regulation” in the USA, and discussed its implications for the “pharmaceuticalization of race” in terms of reinforcing certain taxonomic schemes and conceptualizations. Yet, little is known about the racialization of pharmaceutical regulation in the USA after BiDil, and how it compares with the situation in the EU, where political and regulatory commitment to race and ethnicity in pharmaceutical medicine is weak. We have addressed these gaps by investigating 397 product labels of all novel drugs approved in the USA (n = 213) and the EU (n = 184) between 2014 and 2018. Our analysis considered statements in labeling and the racial/ethnic categories used. Overall, it revealed that many labels report race/ethnicity demographics and subgroup analyses, but that there are important differences between the USA and the EU. Significantly more US labels specified race/ethnicity demographics, as expected given the USA's greater commitment to race and ethnicity in pharmaceutical medicine. Moreover, we found evidence that reporting of race/ethnicity demographics in EU labels was driven, in part, by statements in US labels, suggesting the spillover of US regulatory standards to the EU. Unexpectedly, significantly more EU labels reported differences in drug response, although no drug was restricted to a racial/ethnic population in a manner similar to BiDil. Our analysis also noted variability and inconsistency in the racial/ethnic taxonomy used in labels. We discuss implications for the racialization of pharmaceutical regulation and the pharmaceuticalization of race in the USA and EU.
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| 11. |
- Mulinari, Shai, et al.
(author)
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Revisiting the pharmaceuticalisation of pandemic influenza using Lukes’ framework of power
- 2020
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In: Sociology of Health & Illness. - : Wiley. - 1467-9566 .- 0141-9889. ; 42:2, s. 327-341
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Journal article (peer-reviewed)abstract
- The power of social actors to drive or block pharmaceutical uptake has been a concern in sociological debates on pharmaceuticalisation, including in the case of pandemic vaccination. We build on Steven Lukes’ three-dimensional view of power to explore the 2009 H1N1 pandemic vaccination in Sweden and Denmark – two similar countries that arrived at conflicting vaccination strategies. Drawing on interviews with members of each country’s pandemic steering group and on document analysis, we explore three consecutive stages of pandemic vaccination response: planning, vaccine procurement, and the vaccination campaign. The paper makes two contributions to studies of pharmaceuticalisation and pandemics. Conceptually, we advocate the suitability of Lukes’ framework over the ‘countervailing powers’ framework repeatedly used to model power in the pharmaceutical field. Empirically, our study confirms that government-appointed experts steered pandemic planning in both countries, but we show that the state, industry, and the WHO also exerted power by enabling and constraining experts’ decision-making, including by keeping some information secret. Furthermore, we argue that mass vaccination in Sweden was a pervasive expression of state power, in Lukes’ sense, since it rested on keeping latent the tension between many individuals’ health interests and the state’s interests in protecting social and economic functioning.
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| 12. |
- Olofsson, Tobias, et al.
(author)
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Dataset : COVID-19 epidemic policy and events timeline (Sweden)
- 2022
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In: Data in Brief. - : Elsevier BV. - 2352-3409. ; 40
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Journal article (peer-reviewed)abstract
- The Swedish approach to managing the 2020-2021 COVID-19 pandemic has received significant attention in international scholarly work and press. For this dataset, we have reviewed governmental and media archives to build a detailed timeline that chronicles significant policies, interventions, and events in the Swedish management of COVID-19. The dataset contains summary descriptions of what took place, when it happened, and who the principal actors involved were. Links to primary sources are provided for each entry. Because of the level of detail and saturation, the dataset offers a detailed account of Swedish pandemic governance and will benefit anyone working on Swedish pandemic management or doing comparative work between Sweden and other jurisdictions.
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| 13. |
- Olofsson, Tobias, et al.
(author)
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Sweden
- 2021
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In: Comparative Covid Response : Crisis, Knowledge, Politics - Crisis, Knowledge, Politics.
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Book chapter (other academic/artistic)abstract
- Country case study for an international report on the COVID-19 management in 16 countries with a focus on health, economic, and political dimensions and outcomes.
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| 14. |
- Olofsson, Tobias, et al.
(author)
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The making of a Swedish strategy : How organizational culture shaped the Public Health Agency's pandemic response
- 2022
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In: SSM Qualitative Research in Health. - : Elsevier BV. - 2667-3215. ; 2
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Journal article (peer-reviewed)abstract
- Several suggestions have been made as to why Sweden's approach to managing the COVID-19 pandemic came to rely on a strategy based on voluntary measures. Two of the most prominent explanations for why the country chose a different strategy than many other countries have focused on micro- and macro-level factors, explaining the strategy either in terms of the psychologies of prominent actors or by pointing to particularities in Swedish constitutional law. Supported by a qualitative analysis using interviews and text analysis, we argue that the Swedish strategy cannot be understood without paying attention to the meso-level and the organizations that produced the strategy. Moreover, we argue that to understand why one of the central organizations in Swedish pandemic management, the Public Health Agency, came to favor certain interventions, one must investigate the culture of production inside the organization and how it created precedents that led the Agency to approach pandemic management with a focus on balancing current and future health risks.
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| 15. |
- Sant'Anna, A., et al.
(author)
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Nudging healthcare professionals in clinical settings: a scoping review of the literature
- 2021
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In: Bmc Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 21:1
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Journal article (peer-reviewed)abstract
- BackgroundHealthcare organisations are in constant need of improvement and change. Nudging has been proposed as a strategy to affect people's choices and has been used to affect patients' behaviour in healthcare settings. However, little is known about how nudging is being interpreted and applied to change the behaviour of healthcare professionals (HCPs). The objective of this review is to identify interventions using nudge theory to affect the behaviour of HCPs in clinical settings.MethodsA scoping review. We searched PubMed and PsycINFO for articles published from 2010 to September 2019, including terms related to "nudging" in the title or abstract. Two reviewers screened articles for inclusion based on whether the articles described an intervention to change the behaviour of HCPs. Two reviewers extracted key information and categorized included articles. Descriptive analyses were performed on the data.ResultsSearch results yielded 997 unique articles, of which 25 articles satisfied the inclusion criteria. Five additional articles were selected from the reference lists of the included articles. We identified 11 nudging strategies: accountable justification, goal setting, suggested alternatives, feedback, information transparency, peer comparison, active choice, alerts and reminders, environmental cueing/priming, defaults/pre-orders, and education. These strategies were employed to affect the following 4 target behaviours: vaccination of staff, hand hygiene, clinical procedures, prescriptions and orders. To compare approaches across so many areas, we introduced two independent dimensions to describe nudging strategies: synchronous/asynchronous, and active/passive.ConclusionThere are relatively few studies published referring to nudge theory aimed at changing HCP behaviour in clinical settings. These studies reflect a diverse set of objectives and implement nudging strategies in a variety of ways. We suggest distinguishing active from passive nudging strategies. Passive nudging strategies may achieve the desired outcome but go unnoticed by the clinician thereby not really changing a behaviour and raising ethical concerns. Our review indicates that there are successful active strategies that engage with clinicians in a more deliberate way. However, more research is needed on how different nudging strategies impact HCP behaviour in the short and long term to improve clinical decision making.
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| 16. |
- Skoog, Malin, et al.
(author)
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Health care professionals' experiences of screening immigrant mothers for postpartum depression-a qualitative systematic review
- 2022
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 17:7
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Journal article (peer-reviewed)abstract
- INTRODUCTION: Postpartum depression is considered a major public health problem, which immigrant mothers are at particular risk of being affected by, but it can also have long-lasting traumatic effects on the child's health and development. The Edinburgh Postnatal Depression Scale is the world's most commonly employed screening instrument for postpartum depression, used in connection with a clinical interview to screen for symptoms of postpartum depression. The aim of this study was to synthesize health care professionals (HCPs) experiences of identifying signs of postpartum depression and performing screening on immigrant mothers, since previous research suggested that this task might be challenging.METHODS: The databases CINAHL, PubMed, PsycINFO, SocINDEX, Embase and Cochrane were searched for papers published January 2000-December 2020, reporting qualitative data on immigrants, postpartum depression and the Edinburgh Postnatal Depression Scale. Eight papers representing eight studies from four countries were included and the Critical Appraisal Skills Program was used to assess their quality. The synthesis of studies was guided by Noblit & Hare's seven-step method based on meta-ethnography.FINDINGS: The synthesis resulted in two final themes: "I do my best, but I doubt that it's enough" and "I can find no way forward". The themes convey the fear and frustration that health care professionals experienced; fear of missing mothers with signs of postpartum depression, related to feeling uncomfortable in the cross-cultural setting and frustration in handling difficulties associated with communication, translated versions of the Edinburgh Postnatal Depression Scale and cultural implications of postpartum depression.CONCLUSIONS AND CLINICAL IMPLICATION: By supporting HCPs' self-efficacy in handling cultural implications of postpartum depression and by developing evidence-based clinical guidelines for the use of interpreters and translated versions of the Edinburgh Postnatal Depression Scale the screening of immigrant mothers may be facilitated.
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| 17. |
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| 18. |
- Svensson, Tommy, et al.
(author)
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A Pill for the Ill? Patients’ Reports of Their Experience of the Medical Encounter in the Treatment of Depression
- 2013
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In: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:6
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Journal article (peer-reviewed)abstract
- Background Starting in the 1960s, a broad-based patients’ rights movement began to question doctors’ paternalism and to demand disclosure of medical information, informed consent, and active participation by the individual in personal health care. According to scholars, these changes contributed to downplay the biomedical approach in favor of a more patient-oriented perspective. The Swedish non-profit organization Consumer Association for Medicines and Health (KILEN) has offered the possibility for consumers to report their perceptions and experiences from their use of medicines in order to strengthen consumer rights within the health care sector. Methodology In this paper, qualitative content analysis was used to analyze 181 KILEN consumer reports of adverse events from antidepressant medications in order to explore patients’ views of mental ill health symptoms and the doctor-patient interaction. Principal Findings Overall, the KILEN stories contained negative experiences of the patients’ medical encounters. Some reports indicated intense emotional outrage and strong feelings of abuse by the health care system. Many reports suggested that doctors and patients had very different accounts of the nature of the problems for which the patient was seeking help. Although patients sought help for problems like tiredness and sleeplessness (often with a personal crisis of some sort as a described cause), the treating doctor in most cases was exceptionally quick in both diagnosing depression and prescribing antidepressant treatment. When patients felt they were not being listened to, trust in the doctor was compromised. This was evident in the cases when the doctor tried to convince them to take part in medical treatment, sometimes by threatening to withdraw their sick-listing. Conclusions Overall, this study suggests that the dynamics happening in the medical encounter may still be highly affected by a medical dominance, instead of a patient-oriented perspective. This may contribute to a questionable medicalization and/or pharmaceuticalization of depression.
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| 19. |
- Thacher, Jesse D, et al.
(author)
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Exposure to Paracetamol in Early Pregnancy and the Risk of Developing Cerebral Palsy : A Case-Control Study Using Serum Samples
- 2024
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In: Journal of Pediatrics. - 1097-6833.
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Journal article (peer-reviewed)abstract
- OBJECTIVE: To investigate whether maternal paracetamol use in early pregnancy is associated with cerebral palsy (CP) in offspring.STUDY DESIGN: We conducted a registry and biobank-based case-control study with mother-child pairs. We identified CP cases (n=322) born between 1995-2014 from a nationwide CP-registry. Randomly selected controls (n=343) and extra preterm controls (n=258) were obtained from a birth registry. For each mother, a single serum sample from early pregnancy (gestation weeks 10-14) was retrieved from a biobank and analyzed for serum concentrations of paracetamol, categorized into unexposed (<1 ng/ml), mildly exposed (1-100 ng/ml), and highly exposed (>100 ng/ml), and in quartiles. Analyses were performed using logistic regression and adjusted for potential confounders. Separate analyses were conducted including only those children born preterm and only those born term.RESULTS: Of the 923 participants, 36.8% were unexposed, 53.2% mildly exposed, and 10% highly exposed to paracetamol. Overall, prenatal exposure to paracetamol was not associated with CP. Sensitivity and subgroup analyses showed no clear associations between paracetamol and CP across strata of term/preterm birth as well as subtypes of CP.CONCLUSIONS: The present study does not support an association between intrauterine exposure to paracetamol in early pregnancy and the risk of CP. However, it is important to stress that the exposure estimate is based on a single serum sample.
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| 20. |
- Thacher, Jesse D., et al.
(author)
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Influence of the COVID-19 pandemic on births and induced abortions in Southern Sweden : A register-based study
- 2024
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In: BMJ Sexual and Reproductive Health. - : BMJ Publishing Group Ltd. - 2515-1991 .- 2515-2009. ; , s. 1-9
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Journal article (peer-reviewed)abstract
- Background: Pandemics are linked with declining birth rates, but little is known about how the COVID-19 pandemic has influenced childbearing decisions. We aimed to investigate the associations between the COVID-19 pandemic and reproductive decisions, specifically to identify potential changes in the frequency of deliveries and induced abortions in Skåne, Sweden. Methods: Using the Skåne Healthcare Register, we identified women aged 15-45 years who had at least one pregnancy-related care visit registered between 1 January 2013 and 11 November 11 2021. Deliveries and induced abortions were identified, and changes in weekly delivery and abortion counts were assessed using an interrupted time series design. Relative risks (RRs) and 95% confidence intervals (CIs) were estimated from a Poisson regression model. Results: During the study period we identified 129 131 deliveries and 38 591 abortions. Compared with the counterfactual (exposed interval assuming COVID-19 had not occurred), pandemic exposure was associated with fewer deliveries (RR 0.93; 95% CI 0.89 to 0.98). For abortions, pandemic exposure appeared to be associated with fewer abortions (RR 0.95; 95% CI 0.90 to 1.00); however, age-related differences were found. Among women aged 25 years and over, pandemic exposure was more strongly associated with fewer abortions. Contrastingly, among women aged under 25 years, abortions appeared to increase. Conclusions: The COVID-19 pandemic seemed to have contributed to a decline in births in Southern Sweden. During the same period, abortions declined in women in the older age range, but contrastingly increased among younger women.
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| 21. |
- Vilhelmsson, Andreas
(author)
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A Pill for the Ill? : Depression, Medicalization and Public Health
- 2014
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Doctoral thesis (other academic/artistic)abstract
- Mental disorders, especially depression, have been increasingly described as a growing burden to global public health. Critics argue, however, that the use of mental health surveys, underlying these descriptions, tends to overestimate the prevalence of mental disorders by not distinguishing everyday experiences of distress from pathological conditions. This medicalization of public health is believed to narrow the focus of public health practices. The aim of this thesis is twofold. The first objective is to describe and analyze experiences with antidepressant treatment for depression as expressed in adverse drug reaction (ADR) reports from patients, i.e. “consumers reports.” A second goal is to conduct a theoretical discussion, by looking at broad societal changes, and analyzing the consequences of mental ill health as a significant public health problem. Special attention will be given to medicalization. Reports of suspected adverse reactions regarding antidepressant mediations were submitted from 2002 to 2009 to an open Internet-based reporting system in Sweden. These were analyzed according to common psychiatric reactions and narrative experiences. Furthermore, a literature overview in a broad and general sense was performed to underpin a theoretical discussion on health, public health, mental ill health and medicalization. The main findings of this thesis were that patients reporting to an open Internet-based system in Sweden seemed, to a large extent, to experience psychiatric ADR symptoms of mental disturbances (sometimes severe), which affected them in many different ways, especially during discontinuation. These reports also suggested a negative doctor-patient interaction from the patient’s perspective. Risks leading to increased medicalization as a result of overdiagnoses of depression were found. Pharmaceuticalization resulting from overprescribed antidepressants was also deemed problematic. According to a theoretical discussion on public health and medicalization, increased medicalization as a result of excessive diagnosing risks individualizing mental problems and may divert the focus from the social and political context of public health. According to patient reports, there seems to be a potential problem as to how patients are diagnosed with depression and prescribed antidepressant medication in the medical encounter. Increased drug treatment risks lead to increased health care costs and potential harm from adverse drug reactions. Overdiagnosis and overtreatment may in turn lead to diminished trust in the health system. If depression is going to be viewed as a growing public health problem, it, therefore, calls for a distinction between ill health problems that are medical and those that are not. Arguments for increased medication must be related to a possible danger of medicalizing social problems and life crises.
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| 22. |
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| 23. |
- Vilhelmsson, Andreas, et al.
(author)
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Experiences from consumer reports on psychiatric adverse drug reactions with antidepressant medication : a qualitative study of reports to a consumer association
- 2012
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In: BMC Pharmacology. - : BioMed Central. - 1471-2210. ; 13
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Journal article (peer-reviewed)abstract
- BackgroundThe new European pharmacovigilance legislation has been suggested as marking the beginning of a new chapter in drug safety, making patients an important part of pharmacovigilance. In Sweden since 2008 it has been possible for consumers to report adverse drug reactions (ADRs) to the Medical Products Agency (MPA), and these reports are now understood as an increasingly valuable contribution in the monitoring of safety aspects in medicines. Already in 2002 it was possible to report experiences with medicines to the non-profit and independent organization Consumer Association for Medicines and Health (KILEN) through a web-based report form with an opportunity to describe ADR experiences in free text comments. The aim of this study was to qualitatively analyze the free text comments appended to consumer reports on antidepressant medication.MethodsAll reports of suspected adverse reactions regarding antidepressant medications submitted from January 2002 to April 2009 to KILEN’s Internet-based reporting system in Sweden were analyzed according to reported narrative experience(s). Content analysis was used to interpret the content of 181 reports with free text comments.ResultsThree main categories emerged from the analyzed data material: (1) Experiences of drug treatment with subcategories (a) Severe psychiatric adverse reactions, and (b) Discontinuation symptoms; (2) Lack of communication and (3) Trust and distrust. A majority of the reports to KILEN were from patients experiencing symptoms of mental disturbances (sometimes severe) affecting them in many different ways, especially during discontinuation. Several report included narratives of patients not receiving information of potential ADRs from their doctor, but also that there were no follow-ups of the treatment. Trust was highlighted as especially important and some patients reported losing confidence in their doctor when they were not believed about the suspected ADRs they experienced, making them attempt to discontinue their antidepressant treatment on their own.ConclusionsThe present study indicates that free text comments as often contained in case reports directly submitted by patients can be of value in pharmacovigilance and provide important information on how a drug may affect the person using it and influence his or her personal life.
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| 24. |
- Vilhelmsson, Andreas, et al.
(author)
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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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In: Science of the Total Environment. - 1879-1026. ; 899
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Journal article (peer-reviewed)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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