Rates In Sweden Research Articles

No widening socioeconomic gap within a general decline in Swedish breastfeeding.

To study potential socioeconomic differences within the general decline in breastfeeding over time. Data was collected for 51 415 infants born 2004-2010 from the databases of statistics of the Preventive Child Health Care Services in Uppsala and Orebro counties in Sweden and socioeconomic indicators from Swedish national registers. Breastfeeding data (breastfed/not breastfed) from 1 week, 4 months and 6 months of age were used as the main outcome variables. Educational level of the mother was defined as the highest level on a three-grade scale, low, medium and high. Family type was defined as whether the mother was single or married/cohabiting. Family disposable income was divided into quartiles where quartile 1 included the 25% children in families with the lowest incomes. Analyses were conducted by logistic regression models using the methodology of generalized estimating equations (GEE). An exchangeable correlation structure was used to control for the dependence among infants with the same mother. Breastfeeding rate in Sweden has declined gradually since the late 1990s. The results indicated that overall breastfeeding rates over the study period were influenced by socioeconomic status in a gradient manner but no widening socioeconomic gap was detected. Rather the interaction analyses showed a narrowing socioeconomic gap over the study period between high and low educational level and single versus cohabiting mothers at 4 months. The narrowing socioeconomic gap between the educational level categories was also detectable at 6 months. No increase in socioeconomic gap was detected within the general decline in Swedish breastfeeding. However, there are reasons to maintain and strengthen the overall breastfeeding supportive measures including extended support for vulnerable groups.

The national wealth of Sweden, 1810–2014

ABSTRACTThis study presents a new database, the Swedish National Wealth Database, which contains annual data on private, public, and national wealth and sectoral saving rates in Sweden over the past two centuries. The paper reviews previous investigations of national wealth, compares their estimates with the ones presented here and discusses method approaches and measurement problems. The main results from data series are presented for assets and liabilities and their subcomponents, for the private and public domestic and foreign sectors. By complementing the past literature with its traditional focus on economic flow variables to understand long-run economic developments, this new database offers potentially new perspectives on a number of important issues in Sweden's economic history.

Swedish surgical outcomes study (SweSOS): An observational study on 30-day and 1-year mortality after surgery.

The European Surgical Outcomes Study (EuSOS) revealed large variations in outcomes among countries. In-hospital mortality and ICU admission rates in Sweden were low, going against the assumption that access to ICU improves outcome. Long-term mortality was not reported in EuSOS and is generally poorly described in the current literature. To describe the characteristics of the Swedish subset of EuSOS and identify predictors of short and long-term mortality after surgery. An observational cohort study. Six universities and two regional hospitals in Sweden. A cohort of 1314 adult patients scheduled for surgery between 4 April and 11 April 2011. 30-day and 1-year mortality. A total of 303 patients were lost to follow-up, leaving 1011 for analysis; 69% of patients were classified as American Society of Anesthesiologists' physical status 1 or 2, and 68% of surgical procedures were elective. The median length of stay in postanaesthesia care units (PACUs) was 175 min (interquartile range 110-270); 6.6% of patients had PACU length of stay of more than 12 h and 3.6% of patients were admitted to the ICU postoperatively. Thirty-day mortality rate was 1.8% [95% confidence interval (CI) 1.0-2.6] and 8.5% (CI 6.8-10.2) at 1 year (n = 18 and 86). The risk of death was higher than in an age and sex-matched population after 30 days (standardised mortality ratio 10.0, CI 5.9-15.8), and remained high after 1 year (standardised mortality ratio 3.9, CI 3.1-4.8). Factors predictive of 30-day mortality were age, American Society of Anesthesiologists' physical status, number of comorbidities, urgency of surgery and ICU admission. For 1-year mortality, age, number of comorbidities and urgency of surgery were independently predictive. ICU admission and long stay in PACU were not significant predictors of long-term mortality. Mortality rate increased almost five-fold at 1 year compared with 30-day mortality after surgery, demonstrating a significantly sustained long-term risk of death in this surgical population. In Sweden, factors associated with long-term postoperative mortality were age, number of comorbidities and surgical urgency.

Teen Fathers: Our Hidden Patients

CURRENT ISSUES IN NP PRACTICE Christine Berte, EdD, APRN-BC “Do you have any children?” This question is an accepted part of a patient’s social history. But, at what age do we begin asking? And who do you ask this question? Teen mothers become apparent through objective physical changes, and have many support systems offered to them as a result of public policies and service programs. However, what about our patients who are teen fathers? They display no outward physical signs associated with pregnancy and parenting, yet have a myriad of complex issues that impact both their day-to-day function and their long-term development. They are invisible to providers and society. Kiseliea and Kiseliea report approximately 180,000 male adolescents father a child annually in the United States. The teen birth rate in the United States remains among the highest in Western industrialized nations, more than 3 times the rate in Canada and nearly 7 times the rate in Sweden. These adolescent parents, most of whom are unmarried, present with behaviors that put them at risk for a variety of health, social, and economic issues. The demographics most prevalent in the prediction of teen fathers include poverty, involvement in gang activity, illegal behavior, poor school performance or dropping out of school, and substance use. Other psychosocial issues include past history of physical or sexual abuse, a disconnect or troubled relationship with 1 or both parents, psychiatric illness, and a family that has gone through many transitions of structure along with poor supervision of the teen’s activities. Being an adolescent parent makes overcoming the constraints of poverty and incomplete education much more difficult. Adolescent fathers must transition quickly into adulthood. They need services that will enable them to become involved, responsible parents while continuing their progress toward their own future goals, with the first one usually graduation from high school.

Regional variations in cholecystectomy rates in Sweden: impact on complications of gallstone disease

Objective There are considerable variations in cholecystectomy rates between countries, but it remains unsettled whether high cholecystectomy rates prevent future gallstone complications by reducing the gallstone prevalence. The aims of this study were to investigate the regional differences in cholecystectomy rates and their relation to the incidence of gallstone complications.Material and methods Nation-wide registry-based study of the total number of cholecystectomies in Sweden between 1998 and 2013. Data were obtained from the Swedish Inpatient Registry covering the entire population and subdivided for by the 21 different counties. Indications for the procedure were prospectively collected during the years 2006–2013 in the National Registry for Gallstone Surgery and ERCP. The detailed demography of the total number of patients undergoing cholecystectomy and its relation to the respective indications were analysed by linear regression.Results The annual rates of cholecystectomy in the Swedish counties ranged from 100 to 207 per 100,000 inhabitants, with a mean of 157 (95% CI 145–169). The majority of cholecystectomies were done in females based on the indication biliary colic, with a peak incidence in younger ages. Cholecystectomies performed due to gallstone complications, pancreatitis and cholecystitis, were mainly carried out in the older age groups. No significant relationship could be demonstrated between cholecystectomy rates in the different regions and the respective incidences of gallstone complications. Conclusions There are wide regional variations in cholecystectomy rates in Sweden. The present study does not give support that frequent use of cholecystectomy in uncomplicated gallstone disease prevents future gallstone complications.

A test for robust detection of residual spatial autocorrelation with application to mortality rates in Sweden

Background: When analyzing data collected with a geographical dimension it is important to be able to test for spatial autocorrelation. The presence of spatial autocorrelation might unveil ignored explanatory variables or just be a factor necessary to consider when further analyzing the data.Objectives: The aim of this paper is to propose a new test that works well for detecting spatial autocorrelation, which is robust against heteroscedasticity and useful regardless of the underlying distribution. The new test is then used to investigate if the mortality rates in the aging Swedish population show spatial autocorrelation as an example of its use.Methods: We derive such a test assuming the mean function for the model is known and perform simulations for this case and for residuals to investigate its finite sample performance, especially how the nominal rejection size is kept.Results: In the simulations we show that our test works well if there is no heteroscedasticity and also under difficult situations such as heteroscedasticity with structure, given that sufficient number of observations are available. This study finds no autocorrelation of mortality rates in Swedish municipalities in the age group 64–75 in year 2006.

Trends of HIV-1 incidence with credible intervals in Sweden 2002-09 reconstructed using a dynamic model of within-patient IgG growth.

HIV-1 is a lifelong disease, often without serious symptoms for years after infection, and thus many infected persons go undetected for a long time. This makes it difficult to track incidence, and thus epidemics may go through dramatic changes largely unnoticed, only to be detected years later. Because direct measurement of incidence is expensive and difficult, several biomarker-based tests and algorithms have been developed to distinguish between recent and long-term infections. However, current methods have been criticized and demands for novel methods have been raised. We developed and applied a biomarker-based incidence model, joining a time-continuous model of immunoglobulin G (IgG) growth (measured by the IgG-capture BED-enzyme immunoassay) with statistical corrections for both sample size and unobserved diagnoses. Our method uses measurements of IgG concentration in newly diagnosed people to calculate the posterior distribution of infection times. Time from infection to diagnosis is modelled for all individuals in a given period and is used to calculate a sample weight to correct for undiagnosed individuals. We then used a bootstrapping method to reconstruct point estimates and credible intervals of the incidence of HIV-1 in Sweden based on a sample of newly diagnosed people. We found evidence for: (i) a slowly but steadily increasing trend in both the incidence and incidence rate in Sweden; and (ii) an increasing but well-controlled epidemic in gay men in Stockholm. Sensitivity analyses showed that our method was robust to realistic levels (up to 15%) of BED misclassification of non-recently infected persons as early infections. We developed a novel incidence estimator based on previously published theoretical work that has the potential to provide rapid, up-to-date estimates of HIV-1 incidence in populations where BED test data are available.

An Exponential Melanoma Trend Model

The present study investigated whether whole population exposure to radiation introduced by radio broadcasting and cell phone systems might explain recent increases in melanoma trends in Nordic countries or not. Trends were modeled using a single exponential function of the time each age group has been living in the new environment since an environmental change took place. The results clearly show that melanoma incidences started to increase exponentially by the time lived as an adult since 1955 and that a second trend break occurred in 1997. We searched best fit between calculated and reported age-standardized rates by parameter variation, and compared calculated with reported age-specific rates without further parameter adjustments. Local variations of breast cancer, lung cancer and all cancers together significantly correlated with corresponding local melanoma rates in Sweden. Increasing cancer trends since around 1997 seem related to a population covering environmental change effective from early 90’s. We conclude that this exponential trend model can be a useful tool in understanding responses to sudden environmental changes.

Does online collaboration with customers drive innovation performance?

Purpose– The purpose of this paper is to explore the relationship between the actual usage of online methods for collaboration with customers and firms’ innovation performance. Drawing on theories of knowledge flows and knowledge creation, this study analyses the results of customer collaboration in the online mode in comparison to the offline mode.Design/methodology/approach– The data for the econometric analysis comes from managers of 102 so-called “gazelles”, knowledge-intensive service firms that were characterized by exceptionally stable growth rates in Sweden during 2010 and 2011.Findings– This study confirms the significance of information and communication technology (ICT)-supported collaboration with customers for a firm’s innovation performance. Interacting with customers using online methods has a positive effect on companies’ innovation output. Besides, knowledge-intensive service companies demonstrate more extensive though less intensive use of online channels for collaborating with customers compared to offline methods.Research limitations/implications– The data for this study has typical limitations resulting from the collection method of web-surveying. Future research should refine the findings of this study using various measures of firms’ innovation performance.Practical implications– Firms should be more receptive towards online methods of collaboration with customers because using such strategy can increase their probability to introduce service innovations. The insights from this study are especially valuable for companies in knowledge-intensive service industries because the sample consist of companies that can be regarded as successful cases.Originality/value– This study is one of the first that addresses the issue of the impact of collaborative technologies on innovation performance. The sample of steady-growing gazelle companies adds value to the results.

Hodgkin lymphoma – a survey of children and adolescents treated in Sweden 1985–2009

Background. Hodgkin lymphoma (HL) in children constitutes approximately 30% of all pediatric lymphomas in Sweden. The chance of cure is high, but the frequency of late effects has been considerable. Over recent years, efforts have been made to reduce treatment with maintained survival.Material and methods. All patients 0–17 years, identified in the Swedish Childhood Cancer Register as diagnosed between 1985 and 2009, were included. The material was analyzed using descriptive statistics and for survival estimates the Kaplan-Meier method was used.Results. Three hundred and thirty-four patients were identified during this time period. The median age was 14 years. Male sex was over-represented, especially in lower age groups and in nodular lymphocyte predominant Hodgkin lymphoma (NLPHL). In nodular sclerosis and in age group 15–17 years, female sex dominated. Most of the cases presented in stages I or II. B-symptoms were present in 38% of cHL, but only in 7% of NLPHL. The number of patients receiving radiotherapy has been significantly reduced during the period studied. The relapse rate in cHL was 10 ± 2% and in NLPHL 16 ± 7%. The relapse rate was significantly higher in cHL stage IIB compared to other stages in the same therapy group. In cHL 6% died, and in NLPHL 0%. The 5-, 10- and 20-year overall survival estimates in cHL were 96 ± 1%, 95 ± 1% and 90 ± 3%, respectively, with no significant difference when comparing different treatment regimens and time periods. The 5- and 10-year overall survival after relapse in cHL was 81 ± 8% and 75 ± 10%, respectively.Conclusion. During the period studied there is no indication of a decline in survival despite changes in treatment. Survival rates in Sweden are high, and even after relapse chances of cure are high. We were not able to identify any characteristics specific for the group of patients that did not survive.

Smoking rate and periodontal disease prevalence: 40-year trends in Sweden 1970-2010.

To investigate the relationship between smoking rate and periodontal disease prevalence in Sweden. National smoking rates were found from Swedish National Statistics on smoking habits. Based on smoking rates for the years 1970-2010, periodontal disease prevalence estimates were calculated for the age bracket 40-70 years and smoking-associated relative risks between 2.0 and 20.0. The impact of smoking on the population was estimated according to the concept of population attributable fraction. The age-standardized smoking rate in Sweden declined from 44% in 1970 to 15% in 2010. In parallel with the smoking decline the calculated prevalence estimate of periodontal disease dropped from 26% to 12% assuming a 10-fold smoking-associated relative risk. Even at more moderate magnitudes of the relative risk, e.g. 2-fold or 5-fold, the prevalence decrease was quite tangible, suggesting that the current prevalence in Sweden is about 20-50% of the level 40 years ago. The population attributable fraction, estimating the portion of the disease that would have been avoided in the absence of smoking, was 80% in 1970 and 58% in 2010 at a ten-fold relative risk. Calculated estimates of periodontal disease prevalence are closely related to real changes in smoking rate. As smoking rate drops periodontal disease prevalence will drop.

Inflation perceptions and expectations in Sweden – Are media reports the missing link?

We analyze the interrelation between consumers' quantitative inflation perceptions and expectations as well as actual inflation rates in Sweden. The role of media reports about inflation is emphasized. Structural vector error correction models show stable cointegration between actual, perceived and expected inflation. Impulse responses and forecast error variance decompositions suggest strong interaction between perceived and expected inflation, with a lesser role for actual inflation. Media effects are generally small, but imply an asymmetric reaction of inflation expectations and perceptions to news on increasing vs. decreasing inflation. Thus, to anchor inflation expectations, central banks should explore better communication channels to inform consumers about actual inflation.

Inflation perceptions and expectations in Sweden – Are media reports the missing link?

AbstractWe analyze the interrelation between consumers' quantitative inflation perceptions and expectations as well as actual inflation rates in Sweden. The role of media reports about inflation is emphasized. Structural vector error correction models show stable cointegration between actual, perceived and expected inflation. Impulse responses and forecast error variance decompositions suggest strong interaction between perceived and expected inflation, with a lesser role for actual inflation. Media effects are generally small, but imply an asymmetric reaction of inflation expectations and perceptions to news on increasing vs. decreasing inflation. Thus, to anchor inflation expectations, central banks should explore better communication channels to inform consumers about actual inflation.

Why Paul Krugman Lost His Temper with the Swedish Riksbank?

Paul Krugman recently attacked the Swedish Riksbank for its monetary policy that it has caused a deflationary process because it raised its key interest rate in 2010 and 2011 and by this triggered unnecessarily a deflationary process afterwards. He used the term sadomonetarist for this kind of policy. This response on his accusation of the author of this paper is that Krugman has overdone his challenge of the monetary policy of the Riksbank. He has not looked sufficiently at the empirical facts of the past development in Sweden. In particular at the real GDP growth and the inflation performance it was from the standard approach reasonable to increase interest rates in Sweden after a very strong rebound of Swedish growth in 2010 with 6,6% and further strong economic growth afterwards. Inflation predictions have never been a simple problem due to the multitude of channels through which monetary policy influences economic development. Therefore it is always easy afterwards to claim that policy makers should have done better. However, this is only true ex post by ignoring the uncertainty about the future. Furthermore Sweden has experienced a significant deceleration of its inflation rate, i.e. disinflation, but not deflation for a couple of years. This might, however, be caused by external factors like a global slowdown in economic growth and a recession in the Euro area in particular. If unforeseen by the Swedish Riksbank probably due to overoptimistic forecasts of the EU-Commission, this is caused by a forecasting error, but it is not caused by a monetary policy error. A deflationary spiral is even now not in sight in Sweden. The risk of a global deflation has its origins elsewhere in the global economy.

Comparison of breastfeeding in rural areas of Sweden and Australia – a cohort study

Breastfeeding rates in Sweden and Australia appears to be decreasing in both countries. National statistics shows that 87% of infants in Sweden and 73% in Australia receive any breastfeeding two months of age. To compare women's experiences of breastfeeding in Sweden and Australia and to identify factors associated with breastfeeding two months after birth. A cohort study in two rural hospitals in mid Sweden (n=300) and north-eastern Victoria in Australia (n=91) during 2007-2009. Participants responded to questionnaires in mid pregnancy and two months after birth. Crude and adjusted odds ratios with a 95% confidence interval were used to detect differences between women in both cohorts. Women in Sweden (88.3%) were more likely to report any breastfeeding of the baby two months after birth (OR 2.41; 95% CI: 1.33-4.38) compared to women in Australia (75.8%) but were less satisfied with breastfeeding support and information. The most important factor associated with breastfeeding at two months postpartum for the Swedish women was to have received sufficient information about breastfeeding on the postnatal ward (OR 2.3; 95% CI 1.41-4.76) while for the Australian women receiving the best possible help when breastfeeding for the first time was most important (OR 4.3; 95% CI 1.50-12.46). The results indicate that Swedish women were more likely than their Australian counterparts to breastfeed the baby two months after birth. The findings demonstrated the importance of sufficient information and help when breastfeeding is initiated.

Mental Disorders Increase Vulnerability to Homicide

Back to table of contents Previous article Next article Clinical and Research NewsFull AccessMental Disorders Increase Vulnerability to HomicideLeslie SinclairLeslie SinclairSearch for more papers by this authorPublished Online:19 Apr 2013https://doi.org/10.1176/appi.pn.2013.4a16AbstractMore effective prevention of violent death among people with mental illness requires a better understanding of the risks of homicidal death, in addition to suicide and accidents.The perpetration of homicide and other violence by people with mental disorders has been studied for decades, but the risk of such people being victims of homicide has received little attention. Researchers at Stanford University recently teamed with the Center for Primary Health Care Research at Lund University in Malmö, Sweden, to determine whether people with mental disorders are at an increased risk of being victims of homicide. The strong risk for homicidal death among those with mental illness does not seem to be explained by comorbid substance use and warrants further investigation.justasc/Shutterstock.comCasey Crump, M.D., Ph.D., lead author of the study and a clinical assistant professor in the Department of Medicine at Stanford School of Medicine, and colleagues performed a nationwide cohort study of all people aged 17 or older who were living in Sweden on January 1, 2001 (n=7,253,516), identifying 615 homicide deaths during eight years of follow-up, including 141 among people who had been diagnosed with a mental illness.After adjusting for gender and age, having been diagnosed with any mental disorder was associated with more than a sevenfold risk of being a victim of homicidal death, compared with people without a mental disorder. The risk of homicidal death was strongest (approximately 16-fold higher risk) among those with substance use disorders, but it was also increased among those with personality disorders, depression, anxiety disorders, or schizophrenia and did not seem to be explained by comorbid substance use, the researchers noted.Men had twice the risk of being victims of homicide, and the risk was more than twice as high among people who were divorced or never married, compared with those who were married or cohabitating. Other independent risk factors included low education level, low income, being unemployed, and living in large cities rather than in medium-sized cities or small towns.The researchers noted that the homicide rate in Sweden (1.1 per 100,000 person years) is much lower than that of the United States (7.0 per 100,000 person years), and it is in the United States, they said, “where our findings are likely to have a larger public-health impact.”In an accompanying editorial, a group from the Centre for Mental Health and Risk, part of the Institute of Brain, Behaviour, and Mental Health at the University of Manchester in Manchester, U.K., noted that the study had much valuable information to offer to clinicians. “A key implication of these new findings is that clinicians should assess risk for the full array of adverse outcomes that may befall people with mental health problems. This would include being a victim of violence as well as committing it, abuse and bullying, suicidal behavior, accidental drug overdoses, and other major adverse events linked with intoxication or impulsivity. These risks go together, and people with mental illness, as well as their families, should receive advice on avoiding various types of harm,” wrote Roger Webb, Ph.D., Jenny Shaw, Ph.D., and Louis Appleby, F.R.C.Psych. Webb is a senior research fellow in psychiatric epidemiology, Shaw is a professor of forensic psychiatry, and Appleby is a professor of psychiatry at the center. Their editorial also pointed out future directions for further study, calling for direct comparison of patients’ risk of committing homicide with the risk of being a victim of it, as well as evaluation of how much of the risk of being a victim is a consequence of illness itself and therefore has the potential for prevention by mental health treatment. They also noted the need for analysis of the role hospitalization might play, saying “we know that discharged psychiatric patients and released prisoners are especially likely to take their own lives immediately after their return to the community. We need to know whether this heightened vulnerability on leaving institutional settings relates to being at risk from other people.”The study was supported by grants from the National Institute on Drug Abuse, the Swedish Research Council, and the Anna Lindh Foundation. ■“Mental Disorders and Vulnerability to Homicidal Death: Swedish Nationwide Cohort Study” is posted at http://www.bmj.com/content/346/bmj.f557. ISSUES NewArchived

Real World Effectiveness of Population-Based Roll Out of Human Papillomavirus Vaccination Against Rates of Genital Warts

Nordic countries or elsewhere where similar registry linkage studies may be possible—such an analysis would indeed be relevant and informative in considering the total number of administered doses. HPV vaccination coverage rates in Sweden from 2006 to 2010 (approximately 4 years after introduction) were approximately 30% for both the youngest cohorts of girls and women aged 13 to 17 and 18 to 19 years, with relatively high completion rates of the three-dose series among those who initiated vaccination (approximately 80%). Sweden has an HPV vaccination registration system (SVEVAC) overseen by the Swedish Institute for Communicable Disease Control, as well as a national registry for drug prescriptions at the National Board of Health and Welfare. Because HPV vaccines must be prescribed by a health-care professional to be subsidized before implementation of a school-based program, Leval and colleagues likely captured close to 100% of the administered HPV vaccinations (at least in the group aged 13–17 years) through registry linkages when combining these two databases. Given these estimates of HPV vaccination initiation and that coverage rates were higher among residents whose parent(s) had higher education status, further efforts are needed to ensure broader HPV vaccination coverage of the entire Swedish female population, particularly for young girls at the highest future risk of cervical cancer—daughters of parents of relatively low educational

Suicide mortality trends in the Nordic countries 1980–2009

Background and aim: The Nordic countries provide a suitable setting for comparing trends in suicide mortality. The aim of this report is to compare suicide trends by age, gender, region and methods in Denmark, Finland, Iceland, Norway and Sweden 1980–2009. Methods: Suicide statistics 1980–2009 were analyzed for men and women aged 15 years and above and the age group 15–24 years. Regional suicide rates in 2009 were presented in maps. Results: The suicide rates across the Nordic countries declined from 25–50 per 100,000 in 1980 to 20–36 in 2009 for men and from 9–26 in 1980 to 8–11 in 2009 for women. The rates in Finland were consistently higher than those of the other countries. A significant increase of suicides in young women in Finland and Norway and a lack of a decline among young women in Sweden were noted. The male– female ratio of suicide converged to approximately 3:1 across the region during the study period. Rural areas in Finland, Norway and Sweden saw the highest suicide rates, whereas the rates in the capital regions of Denmark, Norway and Sweden were lower than the respective national rates. Conclusions: We hold that the overall decline of suicide rates in the Nordic countries reflects the socio-economic development and stability of the region, including the well-functioning healthcare. The increasing rates in Finland and Norway and the unchanged rate in Sweden of suicide in young women are an alarming trend break that calls for continued monitoring.

Pilot evaluation of anterior dynamic ultrasound screening for developmental dysplasia of the hip in an Australian regional hospital

Developmental Dysplasia of the Hip (DDH) is the most common notifiable musculoskeletal birth defect in South Australia (SA). Despite routine screening by physical examination of the hips in the neonatal period and at 6 weeks of age, the risk of late diagnosis is increased in rural areas. It is assumed this is due to the examining doctors' reduced clinical expertise. Introducing Anterior Dynamic Ultrasound (ADUS) has reduced the late detection rates in Sweden to almost zero, and may benefit Australian infants in rural areas if routine screening was introduced. This study reports on a small implementation pilot in a SA regional hospital where volunteer postnatal mothers consented to their babies having ADUS examinations. The pilot was evaluated by collecting results of physical examination, ADUS, and surveying parental impressions of the screening test. Hips of 86 infants underwent ADUS during the implementation pilot. Parents' perceptions were mainly very positive and indicated ADUS was an accessible and acceptable screening test. Of the hips scanned, three were found to have maximum movement of the femoral head of >3 mm and were deemed to demonstrate increased laxity. Four hips described as loose or mobile on clinical examination were found to be within normal limits of maximum mobility on ADUS. This study has demonstrated that a larger scale implementation project would be feasible in regional Australia, and would enable researchers to better understand how to reduce the late diagnosis rate of DDH in rural areas.

Thrombolytic Therapy Rates and Stroke Severity

We tested the hypothesis that higher proportions of patients with minor stroke being treated with thrombolysis contribute to increasing overall rates of thrombolysis. We included 1743 ischemic stroke patients (age 18-80 years) treated with thrombolysis, recorded in the Swedish stroke register Riks-Stroke between 2007 and 2010. Minor stroke was defined as National Institutes of Health Stroke Scale score ≤ 5. The proportion with minor stroke among patients treated with thrombolysis increased from 22.1% in 2007 to 28.7% in 2010 (P=0.021). The rate of increase did not differ significantly between men and women, age groups, or hospital types (university hospitals, other large hospitals, or community hospitals). Hospitals with high proportions of thrombolysis patients with minor stroke were more likely to have high thrombolysis frequencies (R=0.55; P<0.001). In recent years, an increase in the proportion of patients with minor stroke treated with thrombolysis has contributed to rising overall thrombolysis rates in Sweden. At the hospital level, high rates of thrombolysis are associated with a high proportion of minor stroke being treated.