Inhabitants In Sweden Research Articles

Variability of pre-test probability for obstructive coronary artery disease between referring primary care physicians and estimations from the referral letters

Abstract Background Estimation of Pre-Test Probability (PTP) for obstructive Coronary Artery Disease (CAD), derived from sex, age and characterization of chest pain or dyspnea, is recommended by European guidelines to guide further investigation. When Coronary Computed Tomography Angiography (CCTA) was introduced as first line investigation in patients with PTP <15%, in the primary care of a catchment area of ~470 000 inhabitants in Sweden, attachment of PTP was made compulsory to the referral. The interrater variability, or consistency of agreement, of PTP estimation is not known. The validity of PTP to guide healthcare decisions depends to some extent on the reliability of estimations. Appropriate prioritization of invesigations is reliant on the information included in referral letters. Purpose The purpose was to study the interrater variability of estimations of PTP. We hypothesized: 1) the interrater variability of PTP estimations to be less than excellent (ICC < 0.9), and 2) not statistically different among PTP classes; 3) a significant difference between clinical estimations and estimations made from the referral letters. Methods We studied the 545 patients referred for CCTA from primary care, 1st of June 2021 to 7th of Dec. 2022, with available PTP estimations. The interrater variability, expressed as Intraclass Correlation Coefficients (ICC), was determined for estimations of PTP by the referring physicians (RP) and three external raters (ER). The latter were physicians practising in primary care who rated PTP based on the referral letters to CCTA, independently and blinded. Each rater assessed multiple patients and each patient was assessed by all raters. ICC with a two-way random consistency model for single raters was calculated and evaluated according to a proposed standard(1). Results The ICC for PTP estimations between the RP and the median of three ER was 0.75 (CI 95 % 0.71-0.83, p<0.001). ICC was higher for PTP class > 15% compared to the lower classes: <5% (n = 65, ICC ≈ 0); 5-15% (n = 343, ICC 0.48, CI 95 % [0.39-0.56]); >15% (n = 137, ICC 0.71, CI 95 % [0.62-0.78]) (Figure 1). The ICC for PTP estimations was significantly higher between the three ER (0.88, SE 0.009, CI 95% [0.86-0.89]) than when the RP was added as a rater (ICC 0.80, SE 0.012, CI 95 % [0.77-0.82]). Adding a fixed effect of the difference in ratings between RP and ERs to the ICC model did not change model output (R = 0.80 (SE 0.012, CI 95 % [0.77-0.82]). Conclusions There is a good repeatability, in estimation of PTP based on medical history as described in referral letters, between blinded independent reviewers of CCTA referrals. The repeatability between the external raters and the referring physicians’ compulsory entered PTPs is lower, yet good. The variability of PTP estimations, speculatively from disagreement on main symptom and inconsistency in characterization of chest pain, may impact patient selection and outcomes and is understudied.

Drones can be used to provide dispatch centres with on-site photos before arrival of EMS in time critical incidents

BackgroundDrones are able to deliver automated external defibrillators in cases of out-of-hospital cardiac arrest (OHCA) but can be deployed for other purposes. Our aim was to evaluate the feasibility of sending live photos to dispatch centres before arrival of other units during time-critical incidents. MethodsIn this retrospective observational study, the regional dispatch centre implemented a new service using five existing AED-drone systems covering an estimated 200000 inhabitants in Sweden. Drones were deployed automatically over a 4-month study period (December 2022–April 2023) in emergency calls involving suspected OHCAs, traffic accidents and fires in buildings. Upon arrival at the scene, an overhead photo was taken and transmitted to the dispatch centre. Feasibility of providing photos in real time, and time delays intervals were examined. ResultsOverall, drones were deployed in 59/440 (13%) of all emergency calls: 26/59 (44%) of suspected OHCAs, 20/59 (34%) of traffic accidents, and 13/59 (22%) of fires in buildings.The main reasons for non-deployment were closed airspace and unfavourable weather conditions (68%). Drones arrived safely at the exact location in 58/59 cases (98%). Their overall median response time was 3:49 min, (IQR 3:18–4:26) vs. emergency medical services (EMS), 05:51 (IQR: 04:29–08:04) p-value for time difference between drone and EMS = 0,05. Drones arrived first on scene in 47/52 cases (90%) and the largest median time difference was found in suspected OHCAs 4:10 min, (IQR: 02:57–05:28). The time difference in the 5/52 (10%) cases when EMS arrived first the time difference was 5:18 min (IQR 2:19–7:38), p = NA. Photos were transmitted correctly in all 59 alerts. No adverse events occurred. ConclusionIn a newly implemented drone dispatch service, drones were dispatched to 13% of relevant EMS calls. When drones were dispatched, they arrived at scene earlier than EMS services in 90% of cases. Drones were able to relay photos to the dispatch centre in all cases.Although severely affected by closed airspace and weather conditions, this novel method may facilitate additional decision-making information during time-critical incidents.

Monitoring disease activity of pollen allergies: What crowdsourced data are telling us

BackgroundPollen allergies are a major public health concern worldwide. An IgE-mediated systemic inflammatory response to pollen allergens causes symptoms of allergic rhinitis or even asthma. They have a significant impact on individual quality of life and cause high socioeconomic strain. The aim of this study was to examine the value of pollen allergy-related web search data for public health. MethodsAn in-depth analysis of search volumes and contents, and their correlation with factors of disease activity such as rates of dispensed medicine and pollen concentration, was conducted. In this retrospective longitudinal study, Google Ads Keyword Planner was used to determine the internet search volume of terms related to pollen allergies across Germany and Sweden as a whole and in each of the 16 German federal states and 21 Swedish provinces between January 2017 and December 2020. This search volume was converted into searches per 100,000 inhabitants and categorized qualitatively. ResultsA total search volume of 7405 searches per 100,000 inhabitants in Germany and 17,592 searches per 100,000 inhabitants in Sweden was observed, with the total yearly search volume increasing continually in both countries during the study period. Regional search volume correlated with antihistamine dispensation rates (ρ = 0.848–0.960) and pollen concentration (ρ = 0.566–0.922). While overall search interest was higher in Sweden, a higher interest in treatment options was identified in Germany. ConclusionInternet websearch data is an excellent proxy for disease activity of allergic rhinitis. In the 4-year study period, the interest in pollen allergies has increased and there are unmet medical needs in both countries.

Efficiency and equity – The Swedish economy in comparison to other countries at the beginning of the 21st century

Abstract Referring to economic ideals of efficiency and equity, we are comparing the state of the Swedish economy in the early 21st century to the situation in other countries, especially the other Nordic countries, the United States (US), and Poland. After presenting the basic facts about Nordic countries we examine the issue of economic efficiency. In addition to gross domestic product (GDP) we use the Human Development Index (HDI), the findings of the economics of happiness, and the number of registered triadic patent families as measures of efficiency. Then we analyze the issue of equity. We use the Gini coefficient, the extent of poverty, the level of unemployment, and the level of intergenerational mobility of earnings as measures of equity. The analysis reveals that inhabitants of Sweden and the other Nordic countries have been achieving some of the best economic results in the world. This applies to the level of GDP per capita in these countries, to the capability of inhabitants to utilize their full potential, and to their life satisfaction. These countries’ ability to create innovation is impressive. At the same time, Nordics have successfully reduced the scale of social inequalities and ensured relatively equal opportunities for all citizens. This is evidenced by low income inequality, low unemployment, and low poverty rate in these countries. Sweden and the other Nordic countries are superior to the US both in terms of efficiency and equity. Poland, on the other hand, lags far behind Nordics, as well as the US, in terms of efficiency, as exemplified by the relatively low GDP per capita and very low innovation in Poland. In terms of equity, however, Poland loses to Nordics but seems to win to the US.

Vaccination against swine flu caused narcolepsy in several european countries

Narcolepsy is a rare sleeping disorder that gives sleep onset rapid eye movement periods and excessive daytime sleepiness. It is divided into two subgroups, narcolepsy type 1 where there also is orexin deficiency and cataplexy and narcolepsy type 2 that lack these features. Narcolepsy type 1 is assumed to be an autoimmune disease with destruction of orexinproducing cells. The pathology behind is unclear. There is a strong association to a class II HLA allele, HLADQB1*06:02 and the H1N1-virus and streptococcal infections has also been associated with narcolepsy. The severity of narcolepsy differs between patients from those who can manage their disease without medication to those who has a severe impact on their everyday life. There is a diagnostic delay between the onset of symptoms and time for diagnosis that in some cases can be more than a decade. The global mean prevalence is 30 per 100 000 inhabitants. The incidence in children in northern Europe has risen since 2010. An early study of the 2009 H1N1 influenza A pandemic indicated a high mortality and prompted efforts to rapidly come up with a vaccine. One of these was Pandemrix that was the most widely used in Europe and 61 % of the inhabitants in Sweden was vaccinated. Studies have shown an increased incidence of narcolepsy type 1 in European countries that had used Pandemrix, but no increased risk was seen in countries that had used other vaccines than Pandemrix.

К проблеме вакцинации против свиного гриппа и ее связи с нарколепсией в нескольких европейских странах

Narcolepsy is a rare sleeping disorder that gives sleep onset rapid eye movement periods and excessive daytime sleepiness. It is divided into two subgroups, narcolepsy type 1 where there also is orexin deficiency and cataplexy and narcolepsy type 2 that lack these features. Narcolepsy type 1 is assumed to be an autoimmune disease with destruction of orexinproducing cells. The pathology behind is unclear. There is a strong association to a class II HLA allele, HLADQB1*06:02 and the H1N1-virus and streptococcal infections has also been associated with narcolepsy. The severity of narcolepsy differs between patients from those who can manage their disease without medication to those who has a severe impact on their everyday life. There is a diagnostic delay between the onset of symptoms and time for diagnosis that in some cases can be more than a decade. The global mean prevalence is 30 per 100 000 inhabitants. The incidence in children in northern Europe has risen since 2010. An early study of the 2009 H1N1 influenza A pandemic indicated a high mortality and prompted efforts to rapidly come up with a vaccine. One of these was Pandemrix that was the most widely used in Europe and 61 % of the inhabitants in Sweden was vaccinated. Studies have shown an increased incidence of narcolepsy type 1 in European countries that had used Pandemrix, but no increased risk was seen in countries that had used other vaccines than Pandemrix.

8.L. Workshop: The children and parents in focus: Challenges in evaluating a public health approach to parenting

Abstract Parenting programs have strong evidence in promoting positive changes in both parents and children and are considered as evidence-based treatments for children with externalising problems such as conduct problems and ADHD. It is expected that a public health approach to parenting - i.e., the availability of parenting programs to all parents regardless of their risk status - will reduce the number of children with externalising problems at the population level. However, the evidence on the effectiveness of this approach is inconclusive. This is largely due to difficulties in conducting the needed large population trials of universal parenting programs. The objective of the workshop is to facilitate a discussion on planning and conducting research projects to successfully evaluate the effectiveness of psychological interventions such as parenting programs when they are offered universally to everyone. We will describe three main challenges in evaluating a public health approach to parenting: difficulties in collecting data from the whole population (and not only those exposed to the intervention), lack of validated instruments to measure population-level impact, and low program exposure. To illustrate our points, we use a population-based cluster randomised controlled trial as an example. The aim of the project - Children and Parents in Focus - was to test the effectiveness of a universally offered parenting program in addressing emotional and behavioural problems in preschool children. The project was carried out for four years in a municipality with 200 000 inhabitants in Sweden. Data were collected from mothers, fathers and teachers of over 7 000 children aged 3 to 5 years. The workshop will include a brief introduction and three presentations. In the first presentation, we focus on recruitment of parents into the study. We discuss the rational for recruiting parents of all children aged 3-5 into the study through child health centres and the steps that we took to increase the number of parents who participated in the study. In the second presentation, we describe the primary outcome measure in the study i.e., the Strengths and Difficulties Questionnaires (SDQ) collected from fathers, mothers and preschool teachers. We discuss how we validated the SDQ for all the three informants and developed a guideline for using the SDQ during routine health check-ups. In the third presentation, we explain our challenges in recruiting parents to the intervention, particularly the restrictions imposed on us by the trial design and describe how we addressed low program participation. After each presentation, the participants will be invited to share their experiences, thoughts and ideas. Their comments will be first collected through a digital interactive platform and then discussed in the room. Key messages Successful evaluation of a public health interventions at the population-level requires ample attention to the recruitment of participants into research and intervention. Program uptake can be increased using simple low cost direct-to-consumer marketing strategies; however, it does take time to build demand for the program.

Trends in antidepressant use among children and adolescents: a Scandinavian drug utilization study.

To compare antidepressant utilization in individuals aged 5-19years from the Scandinavian countries. A population-based drug utilization study using publicly available data of antidepressant use from Denmark, Norway, and Sweden. In the study period from 2007 to 2017, the proportion of antidepressant users increased markedly in Sweden (9.3-18.0/1000) compared to Norway (5.1-7.6/1000) and Denmark (9.3-7.5/1000). In 2017, the cumulated defined daily doses (DDD) of selective serotonin reuptake inhibitors were 5611/1000 inhabitants in Sweden, 2709/1000 in Denmark, and 1848/1000 in Norway. The use of 'other antidepressants' (ATC code N06AX) also increased in Sweden with a higher DDD in 2017 (497/1000) compared to Denmark (225/1000) and Norway (170/1000). The use of tricyclic antidepressants was generally low in 2017 with DDDs ranging between 30-42 per 1000. The proportion of antidepressant users was highest among 15- to 19-year-old individuals. Girls were more likely to receive treatment than boys, and the treated female/male ratios per 1000 were similar in Sweden (2.39), Denmark (2.44), and Norway (2.63). Even in highly comparable healthcare systems like the Scandinavian countries', variation in antidepressant use is considerable. Swedish children and adolescents have a markedly higher and still increasing use of antidepressants compared to Danish and Norwegian peers.

Early predictors of mortality in parkinsonism and Parkinson disease: A population-based study.

ObjectiveTo examine mortality and associated risk factors, including possible effects of mild cognitive impairment, imaging, and CSF abnormalities, in a community-based population with incident parkinsonism and Parkinson disease.MethodsOne hundred eighty-two patients with new-onset, idiopathic parkinsonism were diagnosed from January 2004 through April 2009, in a catchment area of 142,000 inhabitants in Sweden. Patients were comprehensively investigated according to a multimodal research protocol and followed prospectively for up to 13.5 years. A total of 109 patients died. Mortality rates in the general Swedish population were used to calculate standardized mortality ratio and expected survival, and Cox proportional hazard models were used to investigate independent predictors of mortality.ResultsThe standardized mortality ratio for all patients was 1.84 (95% confidence interval 1.50–2.22, p < 0.001). Patients with atypical parkinsonism (multiple system atrophy or progressive supranuclear palsy) had the highest mortality. In early Parkinson disease, a mild cognitive impairment diagnosis, freezing of gait, hyposmia, reduced dopamine transporter activity in the caudate, and elevated leukocytes in the CSF were significantly associated with shorter survival.ConclusionAlthough patients presenting with idiopathic parkinsonism have reduced survival, the survival is highly dependent on the type and characteristics of the parkinsonian disorder. Patients with Parkinson disease presenting with normal cognitive function seem to have a largely normal life expectancy. The finding of a subtle CSF leukocytosis in patients with Parkinson disease with short survival may have clinical implications.

Consumer views on safety of over-the-counter drugs, preferred retailers and information sources in Sweden: after re-regulation of the pharmacy market.

Background:The availability of over-the-counter drugs (OTCs) has increased in Sweden since a re-regulation of the pharmacy market in 2009, through which non-pharmacy retailers became permitted to provide certain OTCs.Objective:To examine the adult general public’s views on safety, purchasing and information channels, storage and disposal of OTCs in Sweden, three years after the re-regulation of the pharmacy market.Methods:A questionnaire study in 2012-13 in a stratified, random sample of all inhabitants in Sweden ≥ 18 years old.Results:Totally 8,302 people (42%) answered the questionnaire. Seven percent found OTCs completely harmless regardless of how they are being used, 18% felt they should be used only on health professionals’ recommendation. Differences in how OTCs are perceived were however found with regards to respondents’ country of birth, family type, educational level and income. The pharmacy was still the preferred OTC drug retailer by 83% of the respondents and preferred information source by 80% Reasons for preferred retailers were primarily due to out of habit (45%), counseling provided (35%), the product range (34%) and the confidence in staff (27%). Analgesics are the most common OTCs to have at home (90%). The bathroom cabinet is the primary site for storage (42%) and 16% throw their OTC leftovers in the trash.Conclusions:The study population does not consider OTCs as harmless regardless of how they are used, but on the other hand feels they should not be taken on health professionals’ recommendation only. The pharmacy is still the preferred retailer and information source, and there is room for further improvement in the storage and disposal of OTCs. A return of OTC drug leftovers to the pharmacy should be further encouraged. Due to several limitations, great caution should however be observed when generalizing the results to the adult population of Sweden.

Emergency readmission following acute upper gastrointestinal bleeding.

To assess the occurrence, clinical predictors, and associated mortality of all-cause emergency readmissions after acute upper gastrointestinal bleeding (AUGIB). All patients with AUGIB from an area of 600 000 inhabitants in Sweden admitted in a single institution in 2009-2011 were retrospectively identified. All medical records were scrutinized and relevant data (such as comorbid illness and medications, endoscopy, rebleeding, inhospital mortality, and 30-day emergency readmission) were extracted. The Charlson comorbidity index was calculated. A total of 174 out of 1056 patients discharged alive following AUGIB (16.5%) had an emergency readmission within 30 days. Nineteen percent of readmissions were because of rebleeding, whereas the rest were because of other reasons, mainly bacterial infections (9.8%) and cardiovascular events (8%). Inhospital mortality did not differ significantly between index admissions and readmissions (13.7 vs. 9.8%, P=0.181). In logistic regression analysis, only a higher Charlson comorbidity index [odds ratio (OR): 1.154, 95% confidence interval (CI): 1.056-1.261] was related to emergency readmission. Bisphosphonate use (OR: 3.933, 95% CI: 1.264-12.233), previous AUGIB (OR: 2.407, 95% CI: 1.157-5.009), and length of stay at index admission (>5 days; OR: 0.246, 95% CI: 0.093-0.649) were found to be independent predictors of postdischarge rebleeding. All-cause emergency readmission following AUGIB is frequent. It is related to rebleeding in one-fifth of cases and mortality is similar to that in index admissions. The presence of comorbid illness appears to predict readmissions. Reduced length of stay and bisphosphonate use appear to be important, potentially modifiable, predictors of postdischarge rebleeding.

Availability of pulmonary rehabilitation in primary care for patients with COPD: a cross-sectional study in Sweden

BackgroundPulmonary rehabilitation (PR) is an important, evidence-based component for the management of individuals with chronic obstructive pulmonary disease (COPD). In daily practice, the majority of COPD patients are treated in primary care. However, information about the availability of PR in primary care in Sweden is lacking. The aim was to investigate the availability of rehabilitation resources in primary care settings for patients with COPD in Sweden.MethodsA cross-sectional descriptive design was applied, using web-based questionnaires sent to all primary care centres in four regions, comprising more than half of the 9.6 million inhabitants of Sweden. The main questionnaire included questions about the content and availability of rehabilitation resources for COPD patients. PR was defined as exercise training and one or more of the following activities: education, nutritional intervention, energy conservation techniques or psychosocial support.ResultsA total of 381 (55.9%) of the 682 primary care centres answered the main questionnaire. In addition to physicians and nurses, availability of healthcare professionals for rehabilitation in primary care settings was physiotherapists 92.0%, occupational therapists 91.9%, dieticians 83.9% and social workers or psychologists 98.4%. At 23.7% of all centres, PR was not available to COPD patients – neither in primary care nor at hospitals.ConclusionDespite high availability of professionals for rehabilitation in primary care settings, about one-quarter of managers at primary care centres stated that their COPD patients had no access to PR. This indicates a need to structure resources for rehabilitation and to present and communicate the available resources within the healthcare system.

Is natural gas a backup fuel against shortages of biogas or a threat to the Swedish vision of pursuing a vehicle fleet independent of fossil fuels?

The objective of this study is to verify whether natural gas is only a backup fuel against shortages of upgraded biogas or a threat to the Swedish vision of pursuing a vehicle fleet independent of fossil fuels. The paper uses Stockholm County as a case study to guide our analysis. The region not only concentrates the largest number of inhabitants in Sweden but also holds alone around 35% of the Swedish fleet of passenger cars using gas as fuel. The region's potential vehicle gas demands are 460 GWh by 2020 and 1202 GWh by 2030. The methodological approach relies on Network Theory to guide the numerical analysis of the vehicle gas supply chain in the region. Our results show that natural gas will keep on being an important resource and playing a vital role within the local vehicle gas supply chain but no longer as a backup fuel against upgraded biogas shortages. In fact, natural gas has become a price regulator responsible for vehicle gas attractiveness, especially for passenger cars in the region. As a result, phasing out natural gas could hamper future developments of biogas supply chain in the country, hindering the achievement of a green fleet.

Diagnosis-specific disability pension and risk of all-cause and cause-specific mortality--a cohort study of 4.9 million inhabitants in Sweden.

BackgroundThe incidence of disability pension (DP) is high in several European countries. However, knowledge on associations of cause-specific DP and premature death is limited. The aims were to: 1) investigate the association between cause-specific DP and all-cause and cause-specific mortality among women and men and 2) examine period effects of this association.MethodsThree prospective population-based cohort studies were conducted, the first including all individuals aged 16–64 years who lived in Sweden all of 1995 and who were not on DP before 1995 (N = 5 006 523, 48.8% women). Those granted DP in 1995 were compared to those not granted DP regarding mortality during 1996–2009. Two other cohorts were created in a similar fashion, for 2000 and 2005, respectively, and in comparisons each of the three cohorts were followed up for four years with regard to all-cause mortality as well as death due to cancer, circulatory disorders, or suicide. All analyses were stratified by sex and we controlled for a number of socio-demographic factors and inpatient care.ResultsIndividuals with granted DP had a higher mortality risk, women (HR 1.75; 95% CI 1.68-1.82) and men (HR 1.66; 95% CI 1.61-1.71) and highest for cancer. People on DP with some diagnoses had higher risk of premature death in other causes of death than their DP diagnoses. All-cause mortality risk varied with DP-diagnosis and was lowest for musculoskeletal diagnoses. The mortality HR decreased among women with DP between the cohort 1995, HR 2.07 (1.92–2.24) and the cohort 2005, 1.84 (1.71–1.99). Here, temporal decreases in mortality risk occurred particularly in DP due to mental diagnoses and cancer.ConclusionsAll DP diagnoses were associated with a higher mortality risk. Even individuals granted DP due to diagnoses with low mortality risk displayed a higher risk for premature death. This warrants close monitoring of disability pensioners and further studies on consequences of being on disability pension.

Are all-cause and diagnosis-specific sickness absence, and sick-leave duration risk indicators for suicidal behaviour? A nationwide register-based cohort study of 4.9 million inhabitants of Sweden

ObjectivesRecent studies have found an increased risk of suicide in people on sickness absence, but less is known about to what extent diagnosis-specific sickness absence is a risk indicator for...

The changing face of heart failure: are we really making progress?

The changing face of heart failure: are we really making progress?

The epidemiology of heart failure, based on data for 2.1 million inhabitants in Sweden

The epidemiology of congestive heart failure (CHF) is likely to have changed due to changes in demography, risk factors, diagnostic procedures, and medical care. Prevailing information is in part old, incomplete, and to some extent contradictory. We determined the current prevalence, incidence, mortality, and 5-year survival rate of CHF, and possible temporal changes in Sweden. This was a cross-sectional study on individual patient data from an administrative health data register in the Stockholm region, Sweden, comprising 2.1 million inhabitants. This contained all recorded diagnoses on all consultations in primary and secondary care (defined as specialist outpatient care), and on all hospitalizations. Prevalence, incidence, and mortality were estimated for the entire Swedish population, adjusted for demographic composition in 2010. The study population consisted of 88 038 patients (51% women). The prevalence was 2.2% (both women and men), the incidence was 3.8/1000 person-years (both women and men), and mortality was 3.2/1000 person-years in women and 3.0/1000 person-years in men (P < 0.001); the 5-year survival rate was 48%. Mortality (age adjusted; hazard ratio and 95% confidence intervals) was higher in men, 1.29, 1.24-1.34; P < 0.001. Prevalence remained essentially unchanged from 2006 to 2010, while incidence decreased by 24% (P < 0.001) and mortality by 19% (both women and men; P < 0.001). The estimated prevalence of CHF in Sweden is 2.2%, incidence 3.8/1000 person-years, and mortality 3.1/1000 person-years. There has been a decrease in incidence and mortality from 2006 to 2010 in both women and men, with no major change in prevalence over time.

Correlates of Ecstasy use in the Swedish General Population

The aim of the present study was to report independent correlates of ecstasy use in the Swedish general population. Data were drawn from a Swedish national household survey conducted in 2008–2009 on a random, stratified sample of 58,000 inhabitants of Sweden, aged 15 to 64. The response rate was 38.3%. Logistic regression analysis was used to identify correlates of recent (past-year) and former ecstasy use. Results are discussed and limitations of the study are noted.

Sickness Absence Due to Specific Mental Diagnoses and All-Cause and Cause-Specific Mortality: A Cohort Study of 4.9 Million Inhabitants of Sweden

BackgroundDespite the magnitude and increase of sickness absence due to mental diagnoses, little is known regarding long-term health outcomes. The aim of this nationwide population-based, prospective cohort study was to investigate the association between sickness absence due to specific mental diagnoses and the risk of all-cause and cause-specific mortality. MethodsA cohort of all 4 857 943 individuals living in Sweden on 31.12.2004 (aged 16–64 years, not sickness absent, or on retirement or disability pension), was followed from 01.01.2005 through 31.12.2008 for all-cause and cause-specific mortality (suicide, cancer, circulatory disease) through linkage of individual register data. Individuals with at least one new sick-leave spell with a mental diagnosis in 2005 were compared to individuals with no sickness absence. Hazard ratios (HR) and 95% confidence intervals (CI) were estimated by Cox regression, adjusting for age, sex, education, country of birth, family situation, area of residence, and pre-existing morbidity (diagnosis-specific hospital inpatient (2000–2005) and outpatient (2001–2005) care).ResultsIn the multivariate analyses, mental sickness absence in 2005 was associated with an increased risk for all-cause mortality: HR: 1.65, 95% CI: 1.47–1.86 in women and in men: 1.73, 1.57–1.91; for suicide, cancer (both smoking and non-smoking related) as well as mortality due to circulatory disease only in men. Estimates for cause-specific mortality ranged from 1.48 to 3.37. Associations with all-cause mortality were found for all mental sickness absence diagnostic groups studied.ConclusionsKnowledge about the prognosis of patients sickness absent with specific mental diagnoses is of crucial clinical importance in health care. Sickness absence due to specific mental diagnoses may here be used as a risk indictor for subsequent mortality.

Resource recovery from source separated domestic waste(water) streams; full scale results

A major fraction of nutrients emitted from households are originally present in only 1% of total wastewater volume. New sanitation concepts enable the recovery and reuse of these nutrients from feces and urine. Two possible sanitation concepts are presented, with varying degree of source separation leading to various recovery products. Separate vacuum collection and transport followed by anaerobic treatment of concentrated black water (BW) demonstrated on a scale of 32 houses preserve 7.6 g/N/p/d and 0.63 gP/p/d amounting to respectively 69 and 48% of the theoretically produced N and P in the household, and 95% of the retained P was shown to be recoverable via struvite precipitation. Reuse of the anaerobic sludge in agriculture can substantially increase the P recovery. Energy recovery in the form of biogas from anaerobic digestion of concentrated BW, fits well in new concepts of sustainable, zero energy buildings. Nutrient recovery from separately collected urine lowers the percentage of nutrient recovery in comparison with BW but can, on the other hand, often be implemented in existing sanitation concepts. Theoretically 11gN/p/d and 1.0 g P/p/d are produced with urine, of which 38-63 and 34-61% were recovered in practice on a scale of 8-160 inhabitants in Sweden. New sanitation concepts with resource recovery and reuse are being demonstrated worldwide and more and more experience is being gained.