Stockholm County Research Articles

Predictors of adverse pathology on radical prostatectomy specimen in men initially enrolled in active surveillance for low-risk prostate cancer

PurposeTo evaluate clinical variables, including magnetic resonance imaging (MRI) predictive of adverse pathology (AP) at radical prostatectomy (RP) in men initially enrolled in active surveillance (AS).MethodsA population-based cohort study of men diagnosed with low-risk prostate cancer (PCa), in Stockholm County, Sweden, during 2008–2017 enrolled in AS their intended primary treatment followed by RP. AP was defined as ISUP grade group ≥ 3 and/or pT-stage ≥ T3. Association between clinical variables at diagnosis and time to AP was evaluated using Cox regression and multivariate logistic regression to evaluate the association between AP and clinical variables at last biopsy before RP.ResultsIn a cohort of 6021 patients with low-risk PCa, 3116 were selected for AS and 216 underwent RP. Follow-up was 10 years, with a median time on AS of 23 months. 37.7% of patients had AP at RP. Clinical T-stage [Hazard ratio (HR): 1.81, 95% confidence interval (CI) 1.04–3.18] and PSA (HR: 1.31, 95% CI 1.17–1.46) at diagnosis and age [Odds Ratio (OR): 1.09, 95% CI 1.02–1.18), PSA (OR: 1.22, 95% CI 1.07–1.41), and PI-RADS (OR 1.66, 95% CI 1.11–2.55)] at last re-biopsy were significantly associated with AP.ConclusionPI-RADS score is significantly associated with AP at RP and support current guidelines recommending MRI before enrollment in AS. Furthermore, age, cT-stage, and PSA are significantly associated with AP.

Range of Radiologist Performance in a Population-based Screening Cohort of 1 Million Digital Mammography Examinations.

Background There is great interest in developing artificial intelligence (AI)-based computer-aided detection (CAD) systems for use in screening mammography. Comparative performance benchmarks from true screening cohorts are needed. Purpose To determine the range of human first-reader performance measures within a population-based screening cohort of 1 million screening mammograms to gauge the performance of emerging AI CAD systems. Materials and Methods This retrospective study consisted of all screening mammograms in women aged 40-74 years in Stockholm County, Sweden, who underwent screening with full-field digital mammography between 2008 and 2015. There were 110 interpreting radiologists, of whom 24 were defined as high-volume readers (ie, those who interpreted more than 5000 annual screening mammograms). A true-positive finding was defined as the presence of a pathology-confirmed cancer within 12 months. Performance benchmarks included sensitivity and specificity, examined per quartile of radiologists' performance. First-reader sensitivity was determined for each tumor subgroup, overall and by quartile of high-volume reader sensitivity. Screening outcomes were examined based on the first reader's sensitivity quartile with 10 000 screening mammograms per quartile. Linear regression models were fitted to test for a linear trend across quartiles of performance. Results A total of 418 041 women (mean age, 54 years ± 10 [standard deviation]) were included, and 1 186 045 digital mammograms were evaluated, with 972 899 assessed by high-volume readers. Overall sensitivity was 73% (95% confidence interval [CI]: 69%, 77%), and overall specificity was 96% (95% CI: 95%, 97%). The mean values per quartile of high-volume reader performance ranged from 63% to 84% for sensitivity and from 95% to 98% for specificity. The sensitivity difference was very large for basal cancers, with the least sensitive and most sensitive high-volume readers detecting 53% and 89% of cancers, respectively (P < .001). Conclusion Benchmarks showed a wide range of performance differences between high-volume readers. Sensitivity varied by tumor characteristics. © RSNA, 2020 Online supplemental material is available for this article.

Prevalence of childhood hearing impairment in the County of Stockholm – a 40-year perspective from Sweden and other high-income countries

Objective The purpose of this study was to determine the current prevalence of childhood hearing impairment (HI) in Sweden and to compare our data with previous studies from Sweden and other high-income countries.Design This was a cross-sectional study based on a register of children diagnosed with HI. Our results were compared with prevalence data from 18 studies from Sweden and other high-income countries, covering data collected from 1964 to the present.Study sample In December 2017, a total of 1911 out of 524,957 children 0–18 years of age and living in Stockholm County were enrolled in the regional programme for HI intervention.Results The overall prevalence of unilateral and bilateral HI >20 dB was 3.6/1000. The overall prevalence of bilateral HI >40 dB HL was 1.5/1000, split into age groups the prevalence was 0.4/1000 (<1 year of age), 1/1000 (1–4 years), 1.5/1000 (5–9 years), 1.6/1000 (10–14 years), and 2.14/1000 (15–18 years). From 1 to 18 years of age, the prevalence increased by a factor of 3.5 for moderate to profound HI >40 dB HL (0.7 to 2.4/1000).Conclusion The prevalence of HI across childhood in Stockholm County today is not significantly different from previous reports from Sweden and other high-income countries.

Perspectives on Exercise Intensity, Volume and Energy Expenditure in Habitual Cycle Commuting.

Background: Knowledge about exercise intensity and energy expenditure combined with trip frequency and duration is necessary for interpreting the character and potential influencing capacity of habitual cycle commuting on e.g., health outcomes. It needs to be investigated with validated methods, which is the purpose of this study.Methods: Ten male and 10 female middle-aged habitual commuter cyclists were studied at rest and with maximal exercise tests on a cycle ergometer and a treadmill in the laboratory. During their normal commute in the Stockholm County, Sweden, their oxygen uptake, heart rate, energy expenditure, ventilation, blood lactate, rated perceived exertion, number of stops, durations, route distances and cycling velocities were monitored with validated methods. The frequency of trips was self-reported.Results: The relative exercise intensity was 65% of maximal oxygen uptake, and the energy expenditure was 0.46 kcal per km and kg body weight for both sexes. Sex differences in MET-values (men, 8.7; women 7.4) mirrored higher levels of cycling speed (20%), body weight (29%), oxygen uptake (54%) and ventilation (51%) in men compared to women. The number of METhours per week during peak cycling season averaged 40 for the men and 28 for the women. It corresponded to a total energy expenditure of about 3,500 and 1,880 kcal for men and women, respectively. The number of trips per year was about 370, and the annual distance cycled was on average 3,500 km for men and 2,300 for women.Conclusion: Cycle commuting is characterized by equal relative aerobic intensity levels and energy requirements for a given distance cycled by men and women. Based on an overall evaluation, it represents a lower range within the vigorous intensity category. The combined levels of oxygen uptake, durations and trip frequencies lead to high levels of METhours and energy expenditure in both men and women during both peak cycling season as well as over the year. Overall, the study presents a novel basis for interpreting cycle commuting in relation to various health outcomes.

Cholestasis after very preterm birth was associated with adverse neonatal outcomes but no significant long-term liver disease: A population-based study.

To describe outcome linked to neonatal cholestasis in a defined cohort of very preterm infants. Population-based retrospective case-control study of preterm infants, gestational age <30weeks, surviving for 28days, in Stockholm County. Cholestasis was defined as conjugated bilirubin ≥30μmol/L exceeding 20% of total level at least twice and graded as high if exceeding 100μmol/L. Cholestatic cases were matched on gestational week with two non-cholestatic controls. The incidence rate of cholestasis was 37/250 (14.8%), with increasing rates in lower gestational weeks. Perinatal factors associated with cholestasis were pre-eclampsia and being born small for gestational age. Cholestatic infants had three times more bronchopulmonary dysplasia and eight times more retinopathy of prematurity. The mortality was 13.5% in cholestatic infants versus 2.7% in controls (P=.040). All deceased cholestatic infants had high-grade cholestasis. No surviving infants developed chronic liver disease by 10years of age. Cholestasis was common in very preterm infants and linked to disease severity and adverse outcome. Cholestasis may be an independent risk factor for bronchopulmonary dysplasia and retinopathy of prematurity and more severe cholestasis associated with increased mortality. Cholestasis was not associated with chronic liver disease later in childhood.

Short-term effects of air pollutants on daily mortality in the Stockholm county – A spatiotemporal analysis

Short-term exposure to air pollutants has been extensively related to daily mortality, however most of the evidence comes from studies conducted in major cities, and little is known on the extent of the spatial heterogeneity in the effects within areas including both urban and non-urban settings. We aimed to investigate the short-term association of air pollutants with daily cause-specific mortality in the Stockholm county, and to test whether an association exists also outside the metropolitan area. We used a spatiotemporal random forest model to predict daily concentrations of fine and inhalable particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2) and ozone (O3) at 1-km spatial resolution over Sweden for 2005–2016. We collected data on daily mortality for each small area for market statistics (SAMS) of the Stockholm county, to which we matched daily exposures to air pollutants and air temperature. We applied a case-crossover design to investigate the short-term association between the four pollutants and mortality from non-accidental, cardiovascular and respiratory causes. We compared the associations in and out the Stockholm urban area, by SAMS population density and across the 26 municipalities of the county. We found weak effects of most air pollutants on cause-specific mortality in the full year analysis, with estimates much larger and significant only during the warmer months (April to September): non-accidental mortality increased by 4.58% (95% confidence interval – 95% CI: 0.89%, 8.41%) and by 2.21% (95% CI: 0.71%, 3.73%) per 10 μg/m3 increase in lag 0–1 PM2.5 and O3, respectively. Associations were in general higher in the Stockholm city and in SAMS with high population density. When comparing the 26 municipalities, we didn't detect a significant heterogeneity in the short-term associations with air pollutants. In conclusion, we found a suggestion of a harmful role of air pollution also in non-urban areas, but the study was underpowered to draw firm conclusions. We consider this study as a pilot to investigate the spatial heterogeneity of the association between daily air pollution and mortality at the national level in Sweden.

Prevalence of low anterior resection syndrome and impact on quality of life after rectal cancer surgery: population-based study.

BackgroundThe prevalence of major low anterior resection syndrome (LARS) after rectal cancer surgery varies from 17·8 to 56·0 per cent, but data from high‐quality studies are sparse. The aim of this study was to determine the prevalence of LARS and its association with quality of life (QoL) in a large, well defined, population‐based cohort.MethodsThis was a population‐based study that included all patients who had curative rectal cancer surgery with total or partial mesorectal excision in Stockholm County in Sweden between 2007 and 2013. Patients without a remaining stoma, free from cancer and alive in April 2017 were eligible for the study. The LARS score questionnaire, EORTC QLQ‐C30 and Cleveland Clinic Florida Fecal Incontinence score were used as outcome measures. Adjusted mean scores (and differences) of EORTC QLQ‐C30 for LARS groups were calculated using repeated measures ANCOVA regression models while adjusting for predefined confounders.ResultsIn total, 481 patients (82·6 per cent response rate) were included in the analysis. Mean follow‐up time was 6·7 (range 3·4–11·0) years after surgery. The prevalence of LARS was 77·4 per cent (370 of 478 patients), with 53·1 per cent (254 of 478) experiencing major LARS. Patients with major LARS reported worse on all EORTC QLQ‐C30 subscales (except for financial difficulties) than patients without LARS. A higher mean LARS score was associated with a greater impact on bowel‐related QoL.ConclusionAfter anterior resection for rectal cancer, the majority of patients suffer from major LARS with a negative impact on QoL.

Moving from vision to action- integrating ecosystem services in the Swedish local planning context

Policies and planning processes related to land use play an important role in maintaining and developing ecosystem services. The incorporation of ecosystem services into local plans is considered an indicator of the plan’s capacity to implement strategic action. This study provides a national overview of the incorporation of the ecosystem service concept in current municipal comprehensive plans in Sweden and explores the actions taken by three municipalities in Stockholm County to implement the ecosystem service concept in practice. A multi-method design was employed including a qualitative content analysis of 231 municipal comprehensive plans, a statistical analysis analyzing temporal changes from 2005 – 2017, and dialogue meetings with municipal practitioners from the three municipalities. We divided the level of integration to four categories, A (Advanced) - D (Not included). Overall, the integration of the ecosystem service concept has significantly increased in municipal comprehensive plans during the last decade. At national level, 23% of municipalities have explicitly mentioned ecosystem services, and within Stockholm County, 42%. The dialogue meetings with municipal practitioners revealed that the municipalities were at different stages of implementing the ecosystem service concept, with diverse actions being implemented for advancing practice. These included capacity building, participatory processes and development of thematic plans and operational documents. To support the future implementation of the ecosystem service concept from vision to action, both local and national initiatives are needed.

Effectiveness of a 3-Month Mobile Phone-Based Behavior Change Program on Active Transportation and Physical Activity in Adults: Randomized Controlled Trial.

BackgroundActive transportation (AT; ie, walking and cycling as a mode for transportation) has been associated with decreased morbidity and mortality; however, low-cost and scalable intervention programs are lacking.ObjectiveThe goal of the research was to determine the effectiveness of a 3-month behavior change program delivered via a mobile phone app to promote AT (TravelVu Plus) on time spent in moderate-to-vigorous physical activity (MVPA).MethodsFor this 2-arm parallel randomized controlled trial, we recruited a population-based sample of 254 adults from Stockholm County who were aged 20 to 65 years and had access to a smartphone. On completion of 1-week baseline measures, the 254 participants were randomized to either the control or intervention group (1:1 ratio). Both groups had access to the standard TravelVu app (Trivector AB) for monitoring their AT for 6 months. The intervention group also received a 3-month behavior change program to promote AT (TravelVu Plus app). Assessors of outcomes were blinded to group allocation. Outcomes were objectively measured MVPA at 3 (primary) and 6 months. Secondary outcomes were AT, attitudes toward AT, and health-related quality of life at 3 and 6 months.ResultsNo effect on MVPA was observed after 3 months (P=.29); however, at 6 months the intervention group had a greater improvement in MVPA than the controls (6.05 minutes per day [95% CI 0.36 to 11.74; P=.04]). A Bayesian analyses showed that there was a 98% probability that the intervention had any effect at 6 months, and a 63% probability that this effect was >5 minute MVPA per day.ConclusionsNo effect on MVPA immediately after the intervention period (at 3 months) was observed; however, there was a delayed effect on MVPA (6 minutes per day) at 6 months, which corresponds to approximately 30% of the weekly MVPA recommendation. Our findings suggest that a behavior change program promoting AT delivered via an app may have a relevant effect on PA.Trial RegistrationClinicalTrials.gov NCT03086837; https://clinicaltrials.gov/ct2/show/NCT03086837International Registered Report Identifier (IRRID)RR2-10.1186/s12889-018-5658-4

Increased risk for uterine cancer among first-degree relatives to Swedish gastric cancer patients

PurposeIn order to further understand genetically predisposing factors of gastric cancer, a retrospective study on 107 patients with gastric cancer was conducted. The family history of cancer cases was registered, in search of associations between gastric cancer and other cancer types.Materials and methodsWithin Stockholm County in Sweden, all patients previously diagnosed with gastric cancer and still alive were invited to participate in the study. Patients were asked to complete a questionnaire about their gastric cancer diagnosis and if any cancers had occurred in their family. A blood sample for DNA extraction was collected. The proportions of different cancer types in the relatives of the patients were compared to the general Swedish population in 1970 and 2010.ResultsAmong first- and second-degree relatives to the index patients with gastric cancer, the frequency of uterine cancer as well as gastric cancer was significantly overrepresented compared to the general population in Sweden. The frequency of breast cancer was significantly lower.ConclusionsThere seems to be an increased risk of both gastric cancer and uterine cancer in the families of gastric cancer survivors, indicating a possible hereditary connection between these two cancer types.

Impact of integrated care on trends in the rate of emergency department visits among older persons in Stockholm County: an interrupted time series analysis.

ObjectiveTo investigate the association between the implementation of an integrated care (IC) system in Norrtälje municipality and changes in trends of the rate of emergency department (ED) visits.DesignInterrupted time series analysis from 2000 to 2015.SettingStockholm County.ParticipantsAll inhabitants 65+ years in Stockholm County on 31 December of each study year.InterventionIC was established by combining the funding, administration and delivery of health and social care for older persons in Norrtälje municipality, within Stockholm County.OutcomeRates of hospital-based ED visits.ResultsIC was associated with a decrease in the rate of ED visits (incidence rate ratio: 0.997, 95% CI 0.995 to 0.998) among inhabitants 65+ years in Norrtälje. However, the rate of ED visits remained higher in Norrtälje than the rest of Stockholm in the preintervention and postintervention periods. Stratified analyses showed that IC was associated with a decline in the trend of the rate of ED visits among those 65–79 years, the lowest income group and born outside of Sweden. However, there was no significant decrease in the trend among those 80+ years.ConclusionThe implementation of IC was associated with a modest change in the trend of ED visits in Norrtälje, though the rate of ED visits remained higher than in the rest of Stockholm. Changes in the composition of the population and contextual changes may have impacted our findings. Further research, using other outcome measures is needed to assess the impact of IC on healthcare utilisation.

Risk of transition from occasional neck/back pain to long-duration activity limiting neck/back pain: a cohort study on the influence of poor work ability and sleep disturbances in the working population in Stockholm County.

ObjectivesThe prevalence of neck/back pain (NBP) is high worldwide. Limited number of studies have investigated workers with occasional NBP regarding the risk of developing long-duration activity limiting NBP (LNBP). The objectives were to assess (1) the effect of poor work ability and sleep disturbances in persons with occasional NBP on the risk of LNBP, and (2) the interaction effect of these exposures.DesignCohort study based on three subsamples from the Stockholm Public Health Cohort.SettingsThe working population in Stockholm County.ParticipantsPersons aged 18–60 years, reporting occasional NBP the past 6 months at baseline year 2010 (n=16 460).MeasuresWork ability was assessed with items from the Work Ability Index, perceived mental and/or physical work ability. Sleep disturbances were self-reported current mild/severe disturbances. The outcome in year 2014 was reporting NBP the previous 6 months, occurring ≥couple of days per week and resulting in decreased work ability/restricted other daily activities. The additive effect of having both poor work ability and sleep disturbances was modelled with a dummy variable, including both exposures. Poisson log-linear regression was used to calculate risk ratios (RRs) and 95% CIs.ResultsAt follow-up, 9% had developed LNBP. Poor work ability and sleep disturbances were independent risk factors for LNBP; adjusted RR 1.7 (95% CI: 1.4 to 2.0) and 1.4 (95% CI: 1.2 to 1.5), respectively. No additive interaction was observed.ConclusionWorkers with occasional NBP who have poor work ability and/or sleep disturbances are at risk of developing LNBP. Having both conditions does not exceed additive risk.

Changes in parental feeding practices and preschoolers’ food intake following a randomized controlled childhood obesity trial

Childhood obesity treatment involving parents is most effective during the preschool age. However, the mechanisms of change are not known. The present study reports on secondary outcomes (changes in parental feeding practices and child food intake) of early obesity treatment. The More and Less study is a randomized controlled trial conducted in Stockholm County, Sweden. Children with obesity (n = 174, mean BMI SDS 3.0, mean age 5 years, 56% girls) and their parents (60% with foreign background, 40% with a university degree) were randomized to: 1) standard treatment focusing on lifestyle recommendations (ST), 2) a parent support program with boosters (PGB), and 3) a parent support program without boosters (PGNB). The Child Feeding Questionnaire (CFQ) was used to measure parental feeding practices. Child food intake was assessed with a Food Frequency Questionnaire (FFQ). We calculated the monthly changes in CFQ practices and FFQ items based on four measurements. We did not find any significant between-group differences in parental feeding practices and child food intake over time. However, general linear models showed that changes in certain feeding practices predicted changes in child food intake. When ST was compared to the parent support groups, some associations moved in opposite directions. For example, increasing maternal restriction predicted increased consumption of cookies/buns in PGNB (b = 2.3, p < 0.05) and decreased consumption of cookies/buns in ST (b = −2.1, p < 0.05). This is among the few studies to examine the effect of parental feeding practices on child food intake and weight status after obesity treatment among preschoolers. We found no evidence that changes in feeding practices or changes in child food intake mediated child weight loss. Future studies should consider other intermediary processes related to general parenting practices and parent-child interactions.

Relationship between socioeconomic status and incidence of out-of-hospital cardiac arrest is dependent on age

BackgroundThe association between socioeconomic status (SES) and incidence of out-of-hospital cardiac arrest (OHCA) is not fully understood. The aim of this study was to see if area-level socioeconomic differences, measured...

U-shaped association between maternal age at delivery and dental caries in offspring

Objective To determine the association between maternal age at delivery and caries in offspring. Materials and methods This registry-based cohort study included all children born between 2000 and 2003 and who were residing in Stockholm County, Sweden, at 7 years of age. Between 2007 and 2010, the cohort (n = 65,259) was examined to determine caries experience (deft scores) at 7 years of age. Age of mother at childbirth was retrieved from the patient histories. Data were analysed using linear regressions. Results The lowest mean deft occurred in children born to mothers aged 25–34 years. The final model – adjusted for sex, income, educational level, migration background, family situation, smoking, obesity, small for gestational age, and number of siblings – found that young mothers and older mothers were significant risk indicators for caries experience at 7 years of age. Conclusions The present study found a U-shaped relationship between maternal age at childbirth and caries experience in the offspring at age 7 years. The offspring of mothers under 25 or over 34 years of age are at greater risk of having more teeth with caries experience.

Open-source planning support system for sustainable regional planning: A case study of Stockholm County, Sweden

Population increases and environmental degradation are challenges for urban sustainability. Planning support systems are available to assist local authorities in developing strategies toward sustainability and resilience of urban areas, but are not always used in practice. We adapted an open-source planning support system to the case of Stockholm County, Sweden, where there is a productive working relationship between researchers, city planners, and regional planners. We employed a collaborative approach in extending and updating the planning support system and analyzed the outcomes, in order to both improve the planning support system and to investigate the process of planner engagement in planning support system development. The approach involved systematic interactions with local planning authorities and e.g. additional data processing, integrating scientific knowledge, policy, and engagement by planners in the complex process of planning for sustainable urban development. This made the planning support system more user-friendly for local planners, facilitating adoption by planning authorities through overcoming common quality and acceptance barriers to the use of planning support system in practice. Involving planners in planning support system development thus increases (i) planning support system quality, producing relevant and up-to-date outputs, and (ii) acceptance for planning support system by regional planners. Further assessment is required to determine whether planners can operate the adapted planning support system unaided.

MP74-06 90-DAY CAUSE-SPECIFIC MORTALITY AFTER RADICAL PROSTATECTOMY. NATIONWIDE POPULATION-BASED SWEDISH REGISTRY STUDY

You have accessJournal of UrologyProstate Cancer: Localized: Surgical Therapy IV (MP74)1 Apr 2020MP74-06 90-DAY CAUSE-SPECIFIC MORTALITY AFTER RADICAL PROSTATECTOMY. NATIONWIDE POPULATION-BASED SWEDISH REGISTRY STUDY Johan Björklund*, Pär Stattin, Markus Aly, and Olof Akre Johan Björklund*Johan Björklund* More articles by this author , Pär StattinPär Stattin More articles by this author , Markus AlyMarkus Aly More articles by this author , and Olof AkreOlof Akre More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000960.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In a previous study we found that 90-day mortality after radical prostatectomy (RP) was low (39/22 344, 0.17%). However, one third of patients who died within 90 days died of prostate cancer according to Cause of Death Registry (CDR). It is unlikely that a patient would die with a disseminated prostate cancer (PC) within 90-days of curative surgery. To investigate this we conducted a validation study. METHODS: Through the National Prostate Cancer Register of Sweden (NPCR), we identified all men registered undergoing radical prostatectomy (RP) between 1st of Jan 1998 – 30th of June 2018 and died within 90 days after RP. Medical records from the surgery and from the time of death as well as autopsy reports were obtained. The information provided from the NPCR was compared with the data collected via the medical records. RESULTS: In NPCR, 45 148 patients were registered with a RP within the study period. 58 patients met the final criteria of death within 90 days of a RP, with a 90-day all-cause mortality rate of 0.13%. 16 (28%) patients died of PC according to CDR, however no patient had metastatic disease documented in their chart. The most common causes of death within 90 days in the chart review was heart disease (28%) and venous thromboembolic events (VTE) (19%). The 90-day all-cause mortality was 0.09% for Robotically assisted laparoscopic radical prostatectomy (RARP), and 0.18% for Retropubic Radical Prostatectomy (RRP) OR 1.97 (95%CI 1.1-3.4, p=0.002). RARP were however more performed in the later part of the study period, represented by the median year of 90-day mortality after RP was 2006 for RRP and 2013 for RARP. The risk of a VTE-related death with in 90 days was twice as high after RRP compared to RARP. CONCLUSIONS: This study shows that there is ascertainment bias in the CDR since it is unlikely that a man would die of PC within 90-days after RP when no metastasis has been documented. The study show differences in rates and in type of mortality between RRP and RARP, however, due to the differences in time when the different surgeries were performed there are substantial risks of bias influencing these findings. The most common cause of death within 90-days of RP was related to cardiac diseases. Source of Funding: Stockholm County Council © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1133-e1134 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Johan Björklund* More articles by this author Pär Stattin More articles by this author Markus Aly More articles by this author Olof Akre More articles by this author Expand All Advertisement PDF downloadLoading ...

Improving Insomnia in Primary Care Patients a Randomized Controlled Trial of Nurse-Led Group Treatment: A Literature Review

Introduction: Insomnia is generally defined as complaints of poor or unsatisfactory sleep, which can include difficulty initiating sleep, awakening after sleep onset, poor sleep quality, early morning awakenings, short sleep times, short total sleep times and daytime consequences. Chronic insomnia is a common problem in primary health care, affecting 10 - 19% of those seeking primary care.&#x0D; Method: Patient is a randomly selected sample of 165 people and divided into 2 groups, namely 90 treatment groups and 75 control groups in seven routine primary health care in Stockholm County, Sweden between August 2011 and June 2014. The intervention to be given was in the treatment group given the intervention consisting of a group treatment program for insomnia based on the CBT-I technique while the control group was free to undergo insomnia treatment as usual.&#x0D; Result: The formulation of the research problem is to compare how the effect of nurse-led group treatment with the effect of treatment as usual in routine primary health care in Stockholm County, Sweden. In this study, the researcher determined a sample of 165 people who met the research requirements, and divided respondents randomly (single-blinded) consisting of 90 treatment groups and 75 control groups.&#x0D; Conclusion: There was a significant difference between the treatment of insomnia with cognitive therapy and the treatment of insomnia with drugs. So that we can reduce the long-term effects of using drugs to treat insomnia.

Cannabis use, subsequent other illicit drug use and drug use disorders: A 16-year follow-up study among Swedish adults

AimsTo examine the association between cannabis use and subsequent other illicit drug use and drug use disorders (harmful use and dependence). Design, Setting, ParticipantsWe used survey data from a population-based cohort in Stockholm County (collected 1998–2000), with linkage to the National Patient Register. The study base comprised participants aged 20–64 years (N = 10 345), followed-up until 2014. Cox and logistic regression analyses were conducted to test associations between self-reported cannabis use and risk of subsequent other illicit drug use (three-year follow-up) and drug use disorders (16-year follow-up). FindingsThe odds ratio (OR) for other illicit drug use onset at three-year follow-up for lifetime cannabis users was 7.00 (4.47–10.35, 95% CI) and for recent cannabis users 34.41 (19.14–61.88, 95% CI). Adjusting for age and AUDIT score attenuated the association, for lifetime users: OR = 5.48 (3.69–8.13, 95% CI) and OR = 5.65 (3.80–8.41, 95% CI), and for recent users: OR = 18.32 (9.88–33.99, 95% CI) and OR = 20.88 (11.19–38.95, 95% CI). For cannabis users only, the hazard ratio (HR) for drug use disorders at 16-year follow-up was 0.89 (0.31–2.61, 95%CI). For cannabis and other illicit drug users, the corresponding HR was 7.27 (3.85–13.75, 95% CI). ConclusionsThere was no independent association between cannabis use and subsequent drug use disorders. The association with subsequent drug use disorders was rather explained by other illicit drug use, which cannabis users were at higher risk of at the three-year follow-up.

Contraceptive use at the time of and after an ectopic pregnancy: a retrospective cohort study

Objectives: Approximately, 1–2% of all pregnancies are ectopic; 25% of unintended pregnancies are conceived despite the use of contraception. The primary objective of our study was to explore the proportion of ectopic pregnancies (EPs) that were conceived during contraceptive use among women in Stockholm County. Secondary objectives were to establish the prevalence of contraceptive methods used at the time of EP and the intended contraceptive method after treatment completion.Methods: We performed a retrospective cohort study of 1180 women diagnosed with and treated for EP between 1 December 2013 and 30 April 2017 at all hospitals in Stockholm County. Demographic variables and contraceptive use before and after treatment were noted. Exclusion criteria were uncertainty about the diagnosis of EP in the patient records and planned treatment/follow-up outside Stockholm County.Results: A total of 222/1180 (18.8%) EPs were conceived during known contraceptive use. A total of 112/222 (50.5%) women with known use of contraception at the time of conception discontinued contraceptive use and 81/857 (9.5%) women with no prior use of contraception initiated contraceptive use. Among the 857 women, 520 (60.7%) expressed a desire to conceive. Results were compared using the Mann–Whitney U test or Fisher's exact test as appropriate.Conclusion: EP occurring during use of contraception is an unexplored problem. Contraceptive use decreased in women who were using contraception at the time of EP conception, leaving these women at risk of a subsequent unintended pregnancy. There should be more focus on contraceptive use after treatment for EP, in order to preserve fertility.