Norrbotten County Research Articles

A retrospective analysis of mission reports in the national Swedish Police Registry on mountain rescue 2018–2022: here be snowmobiles

BackgroundIncreasing mountain activity and decreasing participant preparedness, as well as climate change, suggest needs to tailor mountain rescue. In Sweden, previous medical research of these services are lacking. The aim of the study is to describe Swedish mountain rescue missions as a basis for future studies, public education, resource allocation, and rescuer training.MethodsRetrospective analysis of all mission reports in the national Swedish Police Registry on Mountain Rescue 2018–2022 (n = 1543). Outcome measures were frequencies and characteristics of missions, casualties, fatalities, traumatic injuries, medical conditions, and incident mechanisms.ResultsJämtland county had the highest proportion of missions (38%), followed by Norrbotten county (36%). 2% of missions involved ≥ 4 casualties, and 44% involved ≥ 4 mountain rescuers. Helicopter use was recorded in 59% of missions. Non-Swedish citizens were rescued in 12% of missions. 37% of casualties were females. 14% of casualties were ≥ 66 or ≤ 12 years of age. Of a total 39 fatalities, cardiac event (n = 14) was the most frequent cause of death, followed by trauma (n = 10) and drowning (n = 8). There was one avalanche fatality. 8 fatalities were related to snowmobiling, and of the total 1543 missions, 309 (20%) were addressing snowmobiling incidents. Of non-fatal casualties, 431 involved a medical condition, of which 90 (21%) suffered hypothermia and 73 (17%) cardiovascular illness.ConclusionsThese baseline data suggest snowmobiling, cardiac events, drownings, multi-casualty incidents, and backcountry internal medicine merit future study and intervention.

Targeting Tularemia: Clinical, Laboratory, and Treatment Outcomes From an 11-year Retrospective Observational Cohort in Northern Sweden.

Tularemia is an important reemerging disease with a multimodal transmission pattern. Treatment outcomes of current recommended antibiotic regimens (including ciprofloxacin and doxycycline) remain unclear. In this retrospective cohort study, we report clinical, laboratory, geographical, and treatment outcomes of laboratory-confirmed tularemia cases over an 11-year period in Northern Sweden. Data from reported tularemia cases (aged >10 years at time of study) in Norrbotten county between 2011 and 2021 were collected through review of electronic medical records and participant questionnaires; 415 of 784 accepted participation (52.9%). Of these, 327 were laboratory-confirmed cases (serology and/or polymerase chain reaction). A multivariable logistic regression model was used to investigate variables associated with retreatment. Median age of participants was 54 years (interquartile range [IQR], 41.5-65) and 49.2% were female. Although ulceroglandular tularemia was the predominant form (n = 215, 65.7%), there were several cases of pulmonary tularemia (n = 40; 12.2%). Inflammatory markers were largely nonspecific, with monocytosis frequently observed (n = 36/75; 48%). Tularemia was often misdiagnosed on presentation (n = 158, 48.3%), with 65 (19.9%) receiving initial inappropriate antibiotics and 102 (31.2%) retreated. Persistent lymphadenopathy was infrequent (n = 22, 6.7%), with 10 undergoing surgical interventions. In multivariable analysis of variables associated with retreatment, we highlight differences in time until receiving appropriate antibiotics (8 [IQR, 3.25-20.75] vs 7 [IQR, 4-11.25] days; adjusted P = .076), and doxycycline-based treatment regimen (vs ciprofloxacin; adjusted P = .084), although this was not significant after correction for multiple comparisons. We comprehensively summarize clinical, laboratory, and treatment outcomes of type B tularemia. Targeting tularemia requires clinical awareness, early diagnosis, and timely commencement of treatment for an appropriate duration.

Data center excess heat for mealworm farming, an applied analysis for sustainable protein production

Since Sweden joined the EU in 1995, importing food became easier and cheaper, leading to certain parts of the country, such as Norrbotten, becoming highly dependent on imports. This dependency, along with the inherent environmental impact of imports, could be significantly reduced by local farming. The environmental emissions originating from animal farming could be lowered even further by substituting the highly polluting soybean feed with, e.g., insect feed. This study examines the farming of mealworms, utilizing excess heat from a data center, part of a growing industry in Norrbotten county, as a means of alternative feedstock for animal production and a case study for industrial symbiosis. This industrial symbiosis project is in line with the EU's incentive to use other sources of protein and thus lower the EU's reliance on the import of foreign protein. Three different feeding approaches are tested, in a room heated with data center excess heat of 30 °C and at room temperature of about 20 °C. After the adult mealworms were harvested, a sample was taken to analyze their nutritional values. The results show that protein, lipid, and fiber content is 19,1 g, 12,6 g, and 2,7 g per 100 g, respectively. All amino acids except tryptophan were detected. This project concludes that it is possible to reach full-grown mealworms in about 8 weeks, which is about half the time stated in the literature.

Obesity associates with increased all-cause and cardiovascular mortality in adults with asthma

BackgroundAsthma and obesity are prevalent conditions that are increasing worldwide. Asthma is characterized by airway inflammation and bronchial variability, while obesity is a complex metabolic disorder that poses significant morbidity and mortality risks. Obesity is a risk factor for asthma and a plethora of other non-communicable diseases. ObjectiveTo compare all-cause and cause-specific mortality between obese, overweight and normal weight adults with asthma in a cohort with long-term follow-up. MethodsIndividuals from a population-based adult asthma cohort recruited in Norrbotten county, Sweden, were clinically examined between 1986 and 2001 and grouped into body mass index (BMI) categories. Underlying causes of death until December 31st, 2020 were categorized as cardiovascular, respiratory, cancer and other mortality by linking cohort data to the Swedish National Board of Health and Welfare's National Cause of Death register. Hazard ratios (HR) with 95% confidence intervals (CI) for all-cause and cause-specific mortality associated with overweight and obesity were calculated via Cox proportional hazard models. ResultsIn total, 940 individuals were normal weight, 689 overweight and 328 obese while only 13 were underweight. Obesity increased the hazard for all-cause (HR 1.26, 95% CI 1.03–1.54) and cardiovascular mortality (HR 1.43, 95% CI 1.03–1.97). Obesity was not significantly associated with respiratory or cancer mortality. Overweight did not increase the hazard of all-cause or any cause-specific mortality category. ConclusionObesity, but not overweight, was significantly associated with increased hazard of all-cause and cardiovascular mortality in adults with asthma. Neither obesity nor overweight were associated with increased hazard of respiratory mortality.

Governing the green economy in the Arctic

In Sweden’s Norrbotten County, a “green transition” driven by market demand and new normative structures is underway, creating a regional mega-project designed to put Sweden at the forefront of emerging green industries. These industries, such as carbon-neutral steel fabrication, battery production, and data center hosting, all require large amounts of energy, land, and minerals. This paper applies the regional environmental governance framework to Arctic data to examine which stakeholders have the capacity to impose their agenda on the Arctic environment and the points of conflict and collaboration during this period of accelerated growth. The paper tests the assumption that regional governance accommodates a plurality of interests. A case study examining Norrbotten County’s industrial mega-project centered around Luleå, Sweden, identifies a dominant coalition uniting government and industry that supports norms seeking to reduce greenhouse gas emissions in this region. However, the existing regional governance model does a poor job of integrating the local Indigenous Sámi preferences for land use. At the core of the difference between actors advancing the green economy and the local Sámi reindeer herders are divergent conceptions of nature and sustainability.

Erythrocytosis, thrombocytosis, and rate of recurrent thromboembolic event-A population based cohort study.

The management to reduce risk of thromboembolic complications in polycythemia vera and essential thrombocythemia are well established, but for other conditions with elevated hemoglobin, hematocrit, or platelets there are no consensus regarding treatment and follow up. To assess frequency of elevated blood values in patients with thromboembolic event, how many of these should be investigated further regarding myeloproliferative neoplasm and if the risk of recurrent event is depending on underlying condition. Retrospective cohort study of 3931 adult patients in the county of Norrbotten, Sweden, with thromboembolism during 2017 and 2018. Of the 3931 patients, 1195 had either elevated Hb, HCT, or platelets fulfilling the 2016 revised WHO criteria for PV and ET, and out of these 411 should be evaluated regarding underlying myeloproliferative neoplasms. Unexplained thrombocytosis and secondary erythrocytosis were associated with the highest rate of recurrent event as well as the most inferior restricted mean survival time. Elevated blood values are common in patients with thromboembolic event and the high risk of recurrent event and inferior restricted mean survival time in patients with unexplained thrombocytosis and secondary erythrocytosis implicates the importance of finding and managing the underlying condition.

Marginalisation through the eyes of the othered: Young adults choosing to live in rural Northern Sweden

Recent years have seen increasing debate and research into identity and belonging in rural areas. The northernmost region of Sweden, Norrland, has been identified as the rural internal other to the modern, progressive, youthful and urban Swedish state (Eriksson, 2008). Young adults are underrepresented in and often expected to leave small municipalities, but an increasing body of international research focuses on rural stayers. This study aims to investigate how young adults choosing to live in rural Northern Sweden negotiate their identity in relation to representations and Othering of Norrland and the rural. The research is based on eleven semi-structured interviews with people between 19 and 25 years old living in the counties of Norrbotten, Västerbotten and Västernorrland. The findings show that young adults are aware of prejudice and negative representations surrounding their localities. These representations are approached in different ways, either seen as true, upsetting or irrelevant. The concept of Norrland was often understood as oppressive, prejudiced or one-dimensional when used by people who do not live there. Participants perceive that they and their places do not matter to authorities at any political level and worry about losing access to public services. As an effect of stigmatisation and generalisation of rural Norrland, injustice was seen as natural and difficult to complain about. These findings are important as they give voice to people who are often made invisible and because it shows alternative reactions to rural marginalisation than radicalisation.

Kidney function in patients with bipolar disorder with and without lithium treatment compared with the general population in northern Sweden: results from the LiSIE and MONICA cohorts

The clinical relevance of lithium nephropathy is subject to debate. Kidney function decreases with age and comorbidities, and this decline might lead to attribution bias when erroneously ascribed to lithium. We aimed to investigate whether patients with bipolar or schizoaffective disorder had faster decline in estimated glomerular filtration rate (eGFR) compared with the general population, whether observed differences in the steepness of the decline were attributable to lithium, and whether such changes depended on the length of lithium exposure. In this cross-sectional cohort study, we used clinical data from the Lithium-Study into Effects and Side-effects (LiSIE) retrospective cohort study, which included patients with bipolar disorder or schizoaffective disorder whose medical records were reviewed up to Dec 31, 2017, and the WHO Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, covering a representative sample of the general population in northern Sweden aged 25-74 years. The primary outcome was the age-associated decline of creatinine-based eGFR, assessed using linear regression. We adjusted for sex and grouped for different lengths of lithium exposure (never or <1 year, 1-5 years, >5-10 years, and >10 years). For patients with moderate-to-severe kidney disease we identified the underlying nephropathy in the case records. From LiSIE, we included 785 patients (498 [63%] female and 287 [37%] male), with a mean age of 49·8 years (SD 13·2; range 25-74). From MONICA, we included 1549 individuals (800 [52%] female and 749 [48%] male), with a mean age of 51·9 years (13·8; 25-74). No ethnicity data were collected. Adjusted for duration of lithium exposure, eGFR declined by 0·57 mL/min/1·73 m2/year (95% CI 0·50-0·63) in patients with bipolar disorder or schizoaffective disorder and by 0·57 mL/min/1·73 m2/year (0·53-0·61) in the reference population. Lithium added 0·54 mL/min/1·73 m2 (0·43-0·64) per year of treatment (p<0·0001). After more than 10 years on lithium, decline was significantly steeper than in all other groups including the reference population (p<0·0001). Lithium nephropathy was judged to be the commonest cause of moderate-to-severe chronic kidney disease, but comorbidities played a role. The effect of lithium on eGFR showed a high degree of inter-individual variation. Steeper eGFR decline in patients with bipolar disorder or schizoaffective disorder can be attributed to lithium, but the trajectory of kidney function decline varies widely. Comorbidities affecting kidneys should be treated assertively as one possible means to affect the trajectory. In patients with a fast trajectory, a trade-off is required between continuing lithium to treat mental health problems and discontinuing lithium for the sake of renal health. Norrbotten County Research and Learning Fund Sweden, Visare Norr (Northern County Councils Regional Federation Fund), Swedish Kidney Foundation (Njurfonden), Swedish Kidney Association (Njurförbundet), Norrbotten section. For the Swedish translation of the Summary see Supplementary Materials section.

Institutional Determinants of Mining Projects in Canada and Sweden: Insights from the Prosperity and Kallak Cases.

Mining has proven to be a controversial form of resource development throughout the circumpolar north. This article compares two mining projects-the proposed Prosperity gold and copper mine in central British Columbia, Canada and the proposed Kallak iron ore mine in Norrbotten County in northern Sweden-that have endured long and protracted approval processes that have caused tensions and disputes between mining companies, Indigenous peoples, communities and state actors. In an effort understand the particular development paths taken by these two mining projects, this article examines the institutional determinants that structure relationships between industry, Indigenous communities and the state in Canada and Sweden. Using an historical institutionalist theoretical approach, the article focuses on the manner in which the structural features of the political systems and the environmental assessment and permitting processes in both countries have shaped the mine approval process. It also identifies particular critical junctures-important events and decisions that influenced the trajectory of the approval processes in profound and consequential ways. The article finds that institutional determinants, both historical and contemporary, have played a critical role in determining outcomes in both cases. In particular, it demonstrates the ways in which the structures of the Canadian and Swedish political systems have historically excluded Indigenous peoples from the decision-making process for resource development projects such as mines. It also shows how broader institutional contexts, as well as specific events and decisions, have complicated and politicized the mine approval processes, a situation that has heightened tensions on all sides.

Use and exchange of knowledge in the introduction of hospital-based home rehabilitation after a stroke: barriers and facilitators in change management

BackgroundThe purpose of the study was to contribute to research and practice on how the use and exchange of knowledge can facilitate change in health care, specifically methods supporting managers. The study also aimed to investigate barriers related to governance principles that may affect organizational ability to improve quality of care. To achieve the purpose, the study followed a project of hospital-based home rehabilitation after a stroke at a hospital in Norrbotten County, Sweden.MethodsSeven individual interviews were performed to obtain information from the project members and the managers involved in the project. A group interview with the team and their immediate manager were conducted after the project ended. A thematic analysis was performed to identify and present patterns that formed the results of the study.ResultsThe study shows how knowledge was identified, gathered, used, and disseminated in the project. The analysis pointed out how knowledge played an important role from two perspectives: in evidence-based practice in rehabilitation work and for change management. Knowledge exchange and learning across organizational boundaries increased the pace, efficiency, and effectiveness, but collaboration on knowledge, in the sense of joint activities based on a common purpose, only took place within the rehabilitation work. Furthermore, there were indications that governance principles, such as the distribution of financial responsibility and the requirements for official recommendations, influenced the pace of change.ConclusionsIt was shown that the exchange of knowledge and collaboration can facilitate change in health care, but that communication needs to be planned and prioritised. Readiness for change was the basis for the success of the project and for ensuring commitment among those involved. There is also a need for the management to understand how governance principles may affect the efficiency of change work.

Maternal characteristics and pregnancy outcomes in the NICE birth cohort: an assessment of self-selection bias

Background Prospective birth cohorts are essential for identifying associations between exposures and outcomes. However, voluntary participation introduces a potential bias due to self selection since the persons that chose to participate may differ in background characteristics and behaviors. Objectives To investigate potential bias due to self-selection in the N utritional impact on I mmunological maturation during C hildhood in relation to the E nvironment (NICE) birth cohort in northern Sweden. Methods Women in the NICE birth cohort (N = 621) were compared to nonparticipating pregnant women in Norrbotten County in northern Sweden who were eligible for participation (N = 4976) regarding maternal characteristics and lifestyle. Maternal characteristics and pregnancy outcomes were compared between the groups and associations between exposures (smoking, folic acid, BMI, parity, education) and pregnancy outcomes (birth weight and gestational age) were analyzed by linear regression analyses, examining any interaction with the group. Results NICE participants were more highly educated, older and more likely to cohabit than the non-participants. They more often took folic acid and multivitamin supplements and less often smoked during early pregnancy. Pregnancy outcomes (mode of delivery, gestational age at delivery, birth weight and APGAR score) did, however, not differ significantly between participants and non-participants. Smoking, BMI, education and parity affected gestational age and birth weight, but the associations were of similar magnitude in participants and non-participants, with no significant effect on the group. Conclusion Self-selection to the NICE study was evident in some factors related to lifestyle and socioeconomic characteristics but did not appear to skew pregnancy outcomes or alter well-known effects of certain lifestyle parameters on pregnancy outcomes.

Northern Sweden and Economic Development

Governments around the Circumpolar world are attempting to ensure the long-term viability of northern economies, generally by supporting the natural resource economy and seeking opportunities to promote “new economy” commercial development. The challenge is formidable, in large measure because few Arctic or sub-Arctic regions have the research capability, highly skilled personnel, venture capital, accessible markets and entrepreneurial drive necessary to compete in the global science and technology-based economy. Communities in Norrbotten County in Sweden have made significant efforts to develop contemporary economic opportunities. This essay considers efforts made by a series of northern centres—Arjeplog, Kiruna, Luleå, Skellefteå and Haparanda—to build jobs and businesses beyond traditional northern economic activities, demonstrating that creative and determined northern regions can compete successfully in the age of rapid technological transformation.

The impact of community-based prevention on quality of life-The necessity to control for general health trends the Northern Sweden MONICA study in 2014.

BackgroundThe Västerbotten intervention program (VIP), is a public health promotion program in northern Sweden with the aim of preventing cardiovascular disease. Positive effects have been reported although the evidence is not unequivocal. Since only historical controls have been used, effects from other sources than the program have largely been uncontrolled for and health related quality of life (HRQoL) has not been evaluated.PurposeBy using the neighbouring county of Norrbotten (NB) as the reference population, we compare HRQoL in Västerbotten (VB) and in NB.MethodsIn 2014 the Northern Sweden survey, Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA), examined a random sample from the two counties. HRQoL was measured with the EQ-5D-3L. In total, 1112 subjects aged 40–74 years participated, 516 in VB and 594 in NB. Differences in mean QoL between VB and NB were analysed via Student’s t-test and the Pearson chi-square test.ResultsAverage HRQoL measured by the EQ-5D-index was 0.798 in VB and 0.811 in NB, a difference of 0.013 (p = 0.2, CI -0.009 to 0.036). For subjects aged 45–54 years, the HRQoL was lower in VB than in NB, a difference of 0.048 (p = 0.041; CI 0.002 to 0.0094). Men had higher HRQoL than women, and university educated had higher HRQoL than those without university education. EQ-VAS showed similar results. Subjects from NB and from VB did not differ regarding age, gender and level of education. In NB, HRQoL decrease with age, a pattern not seen in VB.ConclusionsWe found similar levels of HRQoL in VB and in NB.

Comparison of dietary trends between two counties with and without a cardiovascular prevention programme: a population-based cross-sectional study in northern Sweden.

To compare temporal trends, over a 20-year period, in dietary habits between a county (Västerbotten) with a CVD prevention programme and a county (Norrbotten) without such a programme. Cross-sectional data from the Northern Sweden MONICA study (survey period 1994, 1999, 2004, 2009 and 2014). Dietary habits were assessed by a semi-quantitative FFQ. Counties of Norrbotten and Västerbotten, Northern Sweden. Five thousand four hundred Swedish adults (mean age 56·9 years; 51·2 % women) from Västerbotten (47 %) and Norrbotten (53 %). No differences in temporal trend for estimated percentage of energy intake from total carbohydrates, total fat, total protein and alcohol were observed between the counties (Pfor interaction ≥ 0·33). There were no between-county difference in temporal trends for overall diet quality (assessed by the Healthy Diet Score; Pfor interaction = 0·36). Nor were there any between-county differences for the intake of whole grain products, fruits, vegetables, fish, sweetened beverages or fried potatoes (Pfor interaction ≥ 0·09). Consumption of meat (Pfor interaction = 0·05) increased to a greater extent in Norrbotten from 2009 and onwards, mainly in men (sex-specific analyses, Pfor interaction = 0·04). Men in Västerbotten decreased their intake of sweets to a greater extent than men in Norrbotten (Pfor interaction < 0·01). Over a 20-year period in northern Sweden, only small differences in dietary habits were observed in favour of a county with a CVD prevention programme compared with a county without such a programme.

History, hearths and contested landscapes

According to Swedish law, reindeer grazing is allowed east of the Lapland border (Sw. Lappmarksgränsen) on a seasonal basis during winter. Today, coastal winter pastures are contested landscapes facing the claims of a number of industries other than reindeer herding. Disputes over land use and land rights have led to legal proceedings. In this context of conflicting claims, history plays out as a significant factor decisive to Sámi usufruct. This paper examines the diversity and time depth of Sámi cultural landscapes in coastal areas. The study draws on archaeological remains, historical records, place names and oral tradition among Sámi as well as local villagers in an area covering the Piteå and Älvsbyn municipalities in the south-eastern parts of the county of Norrbotten. Social and economic strategies are analysed as they have played out in the landscape. The analysis shows, that the studied area contributed to Sámi subsistence throughout the last 500 years and beyond, linking back to the indigenous population of prehistoric times.

P0284RENAL FUNCTION AFTER DISCONTINUATION OF CHRONIC LITHIUM TREATMENT: FINDINGS FROM THE LISIE RETROSPECTIVE COHORT STUDY

Abstract Background and Aims Current guidelines consider lithium a first-line treatment for bipolar disorder to prevent relapse and suicide. Lithium, however, has renal adverse effects that can accumulate over decades of treatment. Studies have found a positive association between duration of lithium use and incidence of chronic kidney disease and prevalence of end stage renal disease. When the kidney function declines the treating clinician is presented with a choice of either continuing lithium, despite the risk of renal failure, or discontinuing lithium, despite an increased risk of relapse of the underlying affective disorder. One recent study showed that concerns about reduced renal function may account for 9% of reasons for lithium discontinuation. Yet it remains unknown, whether after lithium discontinuation, decline of renal function will continue unchanged, become less steep, or whether renal function can even improve. The aim of our study was to investigate the effect of lithium discontinuation on renal function. Method A retrospective mirror-image study, examining the decline of renal function five years before and after lithium discontinuation. Our study was part of LiSIE, a retrospective cohort study of patients with bipolar disorder, schizoaffective disorder and depression in the Swedish county of Norrbotten 1997 - 2017. We included all patients who had discontinued lithium between 1997 and 2013. We excluded patients who (a) had renal diseases possibly affecting renal function acutely (e.g. glomerulonephritis) or (b) used lithium less than 90% of the 5 years of the pre-mirror period. The patients provided informed verbal consent. In accordance with the ethical approval, deceased patients were also included. Patients were followed for 5 years after lithium discontinuation, until they initiated renal replacement therapy, restarted lithium treatment or died. To evaluate renal function, we calculated eGFR by the CKD-EPI -formula from all creatinine measurements taken during out- or in-patient care in the county of Norrbotten. We censored values for episodes of acute kidney injury or values not reflective of the underlying kidney function, such as in terminal cancer and cachexia. All data was manually validated in the medical records. A mixed effects model was fitted including eGFR as dependent variable. Age, hypertension and diabetes mellitus were included as fixed effects. Results Of 1340 patients with lithium treatment 579 patients had discontinued lithium. 172 patients (55.2% women, 44.8% men) with 5335 creatinine samples were eligible for inclusion. Mean age at discontinuation was 61.5 (min. 24.5 max. 91.3). Mean duration of lithium treatment was 15.8 (min. 4.5, max. 42.5) years. 19.2% of patients had diabetes and 48.9% had hypertension diagnosed before or during the study period. There was a statistically significant change in annual decline of renal function (p&amp;lt;0.001), from -1.96 ml/min/year before (95% CI -2.22 to -1.70) and -0.22 ml/min/year (95% CI -0.50 to 0.07) after discontinuation. Diagnosed hypertension added -1.27 ml/min/year in decline of eGFR (p&amp;lt;0.001). Diabetes mellitus did not affect the decline. Conclusion Mean annual decline of renal function is significantly steeper during lithium treatment than after discontinuation. However, decline still occurs. In patients with hypertension, the decline of renal function is accelerated irrespective of lithium discontinuation. The implications for renal function in individual patients considering lithium discontinuation remain unclear. The decision of whether to discontinue lithium depends on a careful trade-off of potential psychiatric risks against potential renal benefits.

4100Exercise related sudden cardiac death in the young in Sweden 2000–2010 – a nationwide study showing decreasing incidence in competitive athletes

Abstract Background Sudden cardiac death (SCD) is uncommon, but accounts for a majority of natural, unexpected sudden death in the young population. Exercise, although clearly health promoting for the vast majority of individuals, is also historically well known as a potential trigger of SCD. Previous studies have reported varying results concerning the comparative risk of SCD in competitive athletes versus non-athletes. Purpose The aim was to study all exercise related SCD in 10–35 years old in Sweden during the 11-year period 2000–2010, regarding the frequency, etiology, prevalence of symptoms, family history and/or ECG-changes; and to estimate the SCD incidence in the young and specifically in competitive athletes and to compare it with data from the previous decade. Methods We have previously identified all cases of SCD in 1–35 years old during 2000–2010 by systematic search in the Swedish Cause of Death Registry and the database of Forensic Medicine (n=552). From this cohort, we identified 514 cases in 10–35-years old, 373 (73%) men, and 141 (27%) women. For each case, information on circumstances at death, pathogenesis, athletic activity, medical history, symptoms, substance use, and heredity was assembled from autopsy-, police- and medical records. Results Exercise-related SCD occurred in 12% (62/514), a majority being men (56/62; 90%). Two thirds were recreational athletes, one-third competitive athletes. In total, 48% had either previous cardiac disease (27%), family history (27%), symptoms (32%), or an abnormal ECG (45%) before death. The most prevalent diagnosis was sudden arrhythmic death syndrome (SADS) (15/62; 24%). Exercise-related SCD was more frequent in men with hypertrophic cardiomyopathy (p=0.0008) and arrhythmogenic right ventricular cardiomyopathy (p=0.001), compared to non-exercise related SCD. The SCD incidence in competitive athletes was 9.4/million per year in men, and 0.6/million per year in women, which was around half the incidence compared to the years 1992–99. The SCD incidence in the general population was 22.3/million per year in men and 9.6/million per year in women. However, the risk of exercise-related SCD was twice as high in competitive athletes compared to recreational athletes. Conclusions 12% of SCD cases in the young Swedish population are exercise-related, with SADS being the most common etiology. The risk of exercise-related SCD is higher for competitive athletes compared to non-athletes. Specifically, exercise seems to trigger SCD in men with ARVC and HCM. About 50% have a pre-mortal risk profile. Importantly, the incidence of SCD in competitive athletes has been approximately halved in the 2000's compared to the 1990's. Theoretically, increased awareness, safety measures and cardiac screening may all have attributed to this positive development. We advocate a uniform evaluation of all exercise-related SCD in young athletes, including optimal histology and genetic analysis at autopsy. Acknowledgement/Funding Grants from Marcus Borgström, Uppsala University, the Swedish Medical Society, and from Norrbotten County Council

Infectious Disease Outbreak Associated With Supplementary Feeding of Semi-domesticated Reindeer.

Supplementary winter feeding of semi-domesticated reindeer (Rangifer tarandus tarandus) has become more common in Sweden and Norway due to reindeer pasture fragmentation and climatic conditions. With increased corralling and feeding, often associated with animal stress, increased animal-to-animal contact, and poor hygienic conditions, an altered range of health challenges and diseases may emerge. An outbreak of three different infectious diseases appeared simultaneously in a reindeer herd in Norrbotten County, Sweden. The animals were corralled and fed silage. Several animals in poor body condition stopped eating, with drool and discoloration of the hair coat around the mouth. There were large, black, necrotic lesions on the tongue and gingiva, with holes perforating the chin, indicative of oral necrobacillosis and Fusobacterium spp. infection. Simultaneously, animals were seen with proliferative lesions in the oral mucosa and on the lips, characteristic of contagious ecthyma and Orf virus infection. Furthermore, three animals had keratoconjunctivitis suggesting exposure to cervid herpesvirus 2 (CvHV2) and possibly secondary bacterial infections. DNA specific for Fusobacterium necrophorum and ORFV was detected in relevant tissue samples. Antibodies against CvHV2 were detected in 10 of 13 diseased and in four of 11 apparently healthy reindeer. Nine animals were found dead or were euthanized during the outbreak. Health risk factors associated with feeding and corralling may severely impact animal welfare and the herder's economy, and may represent an underestimated cost when replacing natural grazing with feeding.

Chlamydia pecorum Associated With an Outbreak of Infectious Keratoconjunctivitis in Semi-domesticated Reindeer in Sweden.

Infectious keratoconjunctivitis (IKC), the most common ocular disease in ruminants worldwide, has affected semi-domesticated Eurasian reindeer (Rangifer tarandus tarandus) for over 100 years, both as individual cases and in outbreaks affecting tens to hundreds of animals. Recurrent IKC outbreaks have been affecting a semi-domesticated reindeer herd in Östra Kikkejaure (Norrbotten county, Sweden) from 2014. The latest episode of these recurrent outbreaks, in winter 2016/2017, was investigated in this study. Clinical findings were in line with previous reports of IKC in semi-domesticated reindeer and the clinical signs displayed by the affected animals (n = 30) included increased lacrimation, follicular conjunctivitis, purulent secretions around the affected eyes and corneal edema. Laboratory analyses of the samples revealed the presence of Chlamydiaceae in most samples obtained from the clinically affected animals (98.3%, n = 60), but also a high seroprevalence of cervid herpesvirus 2 (CvHV2) antibodies (56.6%, n = 53). Moraxella bovoculi was isolated from nine IKC-affected animals during the outbreak (45.0%, n = 20). All affected animals were treated with long-acting antibiotics and recovered from the disease, testing negative for the presence of Chlamydiaceae DNA by PCR 16 days and 3 months after the initial treatment. For the first time, Chlamydia pecorum was identified in semi-domesticated reindeer, and the involvement of Chlamydiaceae in a clinical outbreak of IKC is reported. The CvHV2 seroprevalence (56.6%) and the data obtained from a previous outbreak in 2014 also suggest the involvement of the reindeer alphaherpesvirus in the recurrent outbreaks.

Epidemiology of Adult Ankle Fractures: 1756 cases identified in Norrbotten County during 2009\u20132013 and classified according to AO/OTA

BackgroundThe ankle fracture is one of the most common fractures, increasing in an ageing population, but not generally seen as an osteoporotic fracture. The aim of this study was to examine the relationship between different AO/OTA classes of ankle fractures, age, sex and type of trauma.MethodsAnkle fractures, treated at any of the hospitals in Norrbotten County in Sweden between 2009 and 2013, were retrospectively identified and classified according to the AO/OTA-classification system. Information about the trauma mechanism was also obtained.ResultsIn Norrbotten County, 1756 ankle fractures in 1735 patients aged 20 years or older were identified. This gave an incidence in the county of 179 per 100,000 person-years. Of these patients, 34.6% were 65 years or older, 58.4% were women and 68.2% of the trauma leading to a fracture was defined as low-energy. In 1.5% of the cases the fractures were open. Incidences of type B fractures increased substantially with age, from 62 (95% CI 50–77) at 30–39 years of age to 158 (95% CI 131–190) in patients older than 80 years of age per 100,000 person-years. Type B fractures showed a slightly higher proportion of low-energy trauma while type C showed a lower mean age and proportion of women.ConclusionsThis study shows an incidence of 179 adult ankle fractures annually per 100,000 persons. More than two thirds of the fractures were caused by a low-energy trauma and ankle fractures are more frequent among females. Females generally have an increased incidence during their life, mainly between the ages of 30 and 60. This is in contrast to men who have more of an even distribution throughout their life. Classification according to AO/OTA reveals some heterogeneity among the classes of ankle fractures in age and gender as well as the energy involved in the trauma.