Swedish Association Research Articles

Swedish Operating Room Nurses and Nurse Anesthetists' Perceptions of Competence and Self-Efficacy

To compare perceived competence and self-efficacy (SE) among Swedish operating room (OR) nurses and registered nurse anesthetists (RNAs), and to evaluate the relationship between SE and competence, gender, age, and years of experience. Comparative cross-sectional survey. Two validated questionnaires, Perceived Perioperative Competence Scale-Revised and General Self-Efficacy Scale, were sent to members of the Swedish Association of Health Professionals (n = 2,902). The response rate was 39% (n = 1,033). OR nurses showed significantly higher scores on Perceived Perioperative Competence Scale-Revised subscale foundational knowledge and leadership as well as General Self-Efficacy Scale scores compared with RNAs. The RNA group showed significantly higher empathy scores compared with OR nurses. Among the OR nurses professional development made the strongest contribution to SE and proficiency among the RNAs. These results suggest that there are differences in perceived competence and SE between OR nurses and RNAs. Gender may be an independent factor affecting SE.

Reliance on the internal auditors\u2019 work: experiences of Swedish external auditors

The purpose of this study is to explore how external auditors experience their decision to rely on internal auditors’ work. This study employs both qualitative and quantitative methods consisting of semi-structured interviews and questionnaires administered to external auditors in Sweden. Semi-structured interviews were conducted with external auditors who are working in Big 4 audit firms in Sweden and have engagements with internal audit functions. A questionnaire was administered to authorized/approved auditors, members of the Swedish Association of Certified Public Accountants (FAR). Findings indicate that external auditors use the work of internal auditors as they gain efficiency in performing their work. Nevertheless, external auditors may compromise their independence and professionalism through closer involvement with internal auditors, which may lead to uncritical evaluation and use of the reports prepared by internal auditors. At the same time, while relying on the internal auditors’ reports, external auditors appear to be conscious of the consequences for the audit quality they deliver. The study highlights the dilemma faced by external auditors in their cooperative work with internal auditors and the balance/imbalance in their opinions concerning efficiency gains, independence, professionalism and audit quality.

The caregiving phenomenon and caregiver participation in dementia.

BackgroundDementia presents barriers to the collaboration between individuals and the healthcare system. Caregivers perform multiple functions helping patients with basic and instrumental activities but also communicating and mediating the dyads’ needs within the broader social group. Interventions focusing on caregivers show that caregiver burden can be reduced, improving patient outcomes in a cost‐effective way, but the generalisation of these findings is limited by several factors such as low participation rates of caregivers in studies. There is a global push to increase patient participation in health care, but this can be difficult for patients with dementia. Caregiver participation has arisen as a substitute, but there is a lack of standardised definitions, goals and outcome measurement tools for this participation.MethodsIn 2015, the Swedish Association of Local Authorities and Regions commissioned a study on possibilities of increasing caregiver participation within the Swedish Dementia Registry (SveDem). This discussion paper updates and adapts that report, aiming to broadly summarise the caregiving phenomenon in order to provide a backdrop for clinicians seeking to understand the legal, ethical and practical considerations of caregiver participation in dementia. Relevant literature on caregiver participation is presented, and its definition, extent and practical implementation are discussed.DiscussionThe Swedish legal framework compels care providers to facilitate patient and caregiver participation in dementia and provides support to caregivers through the local level of government, but further work is needed to clarify and define the extension and form that this participation must take in clinical practice. Advanced directives are one step in extending patient participation to the period of advanced dementia.ConclusionLittle research exists on caregiver participation. There is a need to develop a framework for caregiver and patient participation to determine the extent, type and form that such participation should take in health care, research and quality initiatives pertaining to persons with dementia.

Developing Adequate Communication of Waste Footprints of Products for a Circular Economy—A Stakeholder Consultation

Relatively few consumers are conscious of the waste generated in the course of producing the goods that they consume, although most are aware of the amount of waste they dispose of. This article reports on a small-scale survey (N = 28) among stakeholders aimed at developing adequate communication of preconsumer waste footprints of consumer goods in the context of the circular economy. Life cycle assessment (LCA) practitioners and consumers assessed five methodological details of an approach for calculating and communicating a product waste footprint (PWF). Most of the respondents expressed that the guidelines described in the proposed PWF methodology are good enough for the purposes of differentiating waste and byproducts, and defining which material flow shall be accounted for. Some LCA practitioners declared that the proposed streamlined method may not be adequate for conveying the environmental significance of waste types. The respondents also expressed that the PWF concept would be primarily useful and/or needed for consumers and government, and in the contexts of improving environmental awareness of consumers, environmental policy making, visualizing waste flows in a circular economy, and improving resource efficiency in industry, and less useful/needed in a business-to-business context. The PWF has been successfully used by diverse stakeholder groups in Sweden mostly to promote sustainable production and consumption across society. A notable example is the ‘invisible waste’ (#invisiblewaste) campaign of the Swedish Waste Management Association (Avfall Sverige). The concerns of the LCA experts have therefore not held true. The symbolic power and parsimony of the PWF concept appears to be effective in sensitizing consumers towards waste issues so that circular economy strategies beyond recycling are possible to be fully realized.

Patient Perspectives on the Value of Patient Preference Information in Regulatory Decision Making: A Qualitative Study in Swedish Patients with Rheumatoid Arthritis.

BackgroundThere is increasing interest in involving patient preferences for benefits and risks in regulatory decision making. Therefore, it is essential to identify patient perspectives regarding the value of patient preference information (PPI).ObjectivesThe aim of this study was to explore how patients with rheumatoid arthritis (RA) value the use of PPI in regulatory decision making regarding medical products.MethodsRegulators and patients with RA were interviewed to gather initial insights into opinions on the use of PPI in regulatory decisions regarding medical products. The interviews were used to draft and validate the interview guide for focus groups with patients with RA. Participants were purposively sampled in collaboration with the Swedish Rheumatism Association in Stockholm and Uppsala. Each focus group consisted of three to six patients (18 in total). All interviews were audio-recorded, transcribed verbatim, and analysed using content analysis.ResultsAccording to the participants, PPI could lead to regulators considering patients’ needs, lifestyles and well-being when making decisions. PPI was important in all stages of the medical product lifecycle. Participants reported that, when participating in a preference study, it is important to be well-informed about the use of the study and the development, components, administration, and risks related to the medical products.ConclusionsPatients thought PPI could be valuable to consider in regulatory decisions. It is essential for patients to be well-informed when asked for their preferences. Research on information materials to inform patients in preference studies is needed to increase the value of PPI in regulatory decision making.Electronic supplementary materialThe online version of this article (10.1007/s40271-018-0344-2) contains supplementary material, which is available to authorized users.

‘Something that stretches during sex’

Although there is no scientific proof of a breakable membrane in the vagina, virginity controls are causing great suffering to women worldwide, and hymen (re) constructions are carried out in many countries. The hymen is called mödomshinna 'virginity membrane' in Swedish, which can reinforce the idea of a breakable membrane. In their work against female sexual oppression the Swedish Association for Sexuality Education launched a new term, vaginal corona. The aim of our study is to evaluate this initiative. By conducting a survey directed at youths and health professionals at youth clinics in Stockholm, we were able to show that knowledge of the new word had spread and that changes in the oppressive cultural beliefs connected to virginity and female sexuality in part can be connected to the word. The study thus supports the claim that initiatives aimed at changing vocabulary can be effective in changing cultural concepts. Feminist language activism initiatives are thus usable as part of feminist political work to promote women’s sexual rights and gender equality.

Strong development of research based on national quality registries in Sweden

The aim of the present paper is to describe how the use of national quality registries (NQRs) for research has evolved over the past decade in Sweden. All Swedish NQRs have reported their scientific activity (publications per year in peer-reviewed scientific journals) to the Swedish Association of Local Authorities and Regions since 2009, and the present report is based on available data from 2009–2016. The yearly number of publications of the 69 registries active in 2009 has increased from 121 to 496 in 2016. Seventeen of these registries published more than 10 papers in 2016; however, 12 NQRs did not publish any papers in 2016. An additional 77 papers were published in 2016 by the 34 NQRs started after 2009. In summary, there has been a strong development of quality registry-based research in Sweden over the last decade. However, there is still room for further increase of the use of research based on NQRs in Sweden.

Risk Factors, Mortality, and Cardiovascular Outcomes in Patients with Type 2 Diabetes

BackgroundPatients with diabetes are at higher risk for death and cardiovascular outcomes than the general population. We investigated whether the excess risk of death and cardiovascular events among patients with type 2 diabetes could be reduced or eliminated.MethodsIn a cohort study, we included 271,174 patients with type 2 diabetes who were registered in the Swedish National Diabetes Register and matched them with 1,355,870 controls on the basis of age, sex, and county. We assessed patients with diabetes according to age categories and according to the presence of five risk factors (elevated glycated hemoglobin level, elevated low-density lipoprotein cholesterol level, albuminuria, smoking, and elevated blood pressure). Cox regression was used to study the excess risk of outcomes (death, acute myocardial infarction, stroke, and hospitalization for heart failure) associated with smoking and the number of variables outside target ranges. We also examined the relationship between various risk factors and cardiovascular outcomes.ResultsThe median follow-up among all the study participants was 5.7 years, during which 175,345 deaths occurred. Among patients with type 2 diabetes, the excess risk of outcomes decreased stepwise for each risk-factor variable within the target range. Among patients with diabetes who had all five variables within target ranges, the hazard ratio for death from any cause, as compared with controls, was 1.06 (95% confidence interval [CI], 1.00 to 1.12), the hazard ratio for acute myocardial infarction was 0.84 (95% CI, 0.75 to 0.93), and the hazard ratio for stroke was 0.95 (95% CI, 0.84 to 1.07). The risk of hospitalization for heart failure was consistently higher among patients with diabetes than among controls (hazard ratio, 1.45; 95% CI, 1.34 to 1.57). In patients with type 2 diabetes, a glycated hemoglobin level outside the target range was the strongest predictor of stroke and acute myocardial infarction; smoking was the strongest predictor of death.ConclusionsPatients with type 2 diabetes who had five risk-factor variables within the target ranges appeared to have little or no excess risk of death, myocardial infarction, or stroke, as compared with the general population. (Funded by the Swedish Association of Local Authorities and Regions and others.)

Comment on Björn Sahlberg’s paper

ABSTRACTThis paper is a comment on Björn Sahlberg’s paper on the function of training analysis in the Swedish psychoanalytic association and discusses some aspects of the candidates’ personal analysis and supervision. The paper further suggests some possible sources for inspiration and perspective on organizational and educational issues, for example taking an interest in the epistemology of professions, in what the concept of ‘reflection-in-action’ could mean in the training situation, or in empirical research about the educational models and the practice of psychoanalysis.

Innovation in Swedish hotels

PurposeThe purpose of this paper is to assess innovation in the hotel sector in Sweden and to investigate how structural and organizational factors influence hotel’s likelihood of producing service/product, process, organizational and marketing innovations.Design/methodology/approachThis paper is based on responses from 174 hotels with membership in the Swedish hotel association. Responses were collected via a web-based survey.FindingsThis paper provides insights about the nature and extent of innovations in the hotel sector. Although traditionally considered rigid and non-innovative, around half of the responding hotels produced at least one type of innovation. Most common are service/product and marketing innovations. A hotel’s likelihood of innovating depends largely on structural independence (non-chain), having an explicit innovation strategy and investing in non-traditional R&D.Research limitations/implicationsBecause of the chosen design (convenience sampling), the results of this paper may lack generalizability. Therefore, future research is encouraged to test the hypotheses further.Practical implicationsManagers in the hospitality industry can influence the production of innovations in the hotel sector. By promoting flexibility, defining and communicating an innovation strategy, and engaging in non-traditional R&D activities, practitioners can better respond to the changing business environment.Originality/valueThis paper presents a systematic, and internationally recognized, method for assessing four types of innovation in the hotel sector. Its originality stems also from its approach to investigating how key structural and organizational factors, when considered in the same analysis, predict service/product, process, organizational and marketing innovations.

Prevention of Peritonitis in Patients with Peritoneal Dialysis - Effects of Regular Follow-Up of Patients' Theoretical Knowledge and Practical Skills with Focus on Infection Prophylaxis (PEPS): A Randomised Controlled Trial

Background: Prevention of peritonitis is important to peritoneal dialysis (PD) patients, since it increases the risk for PD technique failure and mortality. Patients non-compliant with the PD exchange protocol procedures more often experience peritonitis than compliant patients. We therefore assessed the effect of regular testing of the PD knowledge in patients new to PD with the primary aim to reduce time to first peritonitis. Methods: This physician-initiated, open-label, parallel group trial was undertaken at 57 centres in Scandinavia, Estonia, Latvia, the Netherlands, and the UK. Patients new to PD and able to perform PD without assistance were randomly assigned in a 1:1 ratio to a retraining or a control group using computer generated randomisation. The retraining patients underwent regular testing of PD knowledge and skills with focus on infection prophylaxis at 1, 3 and 6 months after PD start, and every 6th month thereafter up to 36 months. If they did not pass the tests, they were retrained. The controls were treated according to routines of their centres. Findings: Of 671 participants, 340 were assigned to the retraining group and 331 to the control group. The follow-up after 12, 24, and 36 months was completed by 57%, 23%, and 9% in the retraining group and 67%, 34% and 13% in the controls. 102 (30%) of participants in the retraining group and 121 (37%) of the controls experienced a first peritonitis episode. Compared with the controls, the retraining group did not have significantly longer time to first peritonitis during the study (HR 0·92 (0·71-1·19); p=0·52] or during the first year of follow-up [(HR 0·87 (0·63-1·21); p=0·41]. Interpretation: In this randomised controlled trial, we were unable to demonstrate that regular, targeted testing and retraining of patients new to PD reduced the risk of first peritonitis. Clinical Trial Number: The trial was registered with CinicalTrials.gov, number NCT01293799. Funding Statement: The Health & Medical Care Committee of The Regional Executive Board, Region West of Sweden (VGFOUREG-78061, 226521, and 383641), Baxter Healthcare Corporation (McGaw Park, IL, USA; Clinical Evidence Council grant #10CECEU1004), Swedish Society of Nephrology, The Swedish Kidney Association, The Society of Kidney Patients in West of Sweden, The John and Brit Wennerstrom Foundation, The Foundation for kidney failure, The Swedish Kidney Foundation, and Norwegian Society of Kidney Patients. Declaration of Interests: SL has received a research grant from Baxter Healthcare Corporation, that partly funded this trial. OH has received speaker´s honoraria from Baxter Healthcare Corporation and Fresenius Medical Care, investigator´s honoraria from Fresenius Medical Care and Otsuka, and personal fee for participation in an advisory board regarding hyperkalaemia from Astra Zeneca. MW has received speaker´s honoraria from Fresenius Medical Care. AP has received speaker´s honoraria from Fresenius Medical Care and Baxter Healthcare Corporation and travel grants from Baxter Medical Corporation and Gambro. Ethics Approval Statement: The study protocol (see appendix) was approved by the ethics committees in all participating countries and was in full compliance with the Helsinki Declaration.

Test of simulator-based assessment of psychomotor skill in transthoracic echo.

We developed a transthoracic echo simulator that measures technical skill in image acquisition in terms of the deviation angle between an acquired image and the anatomically correct plane for that view. We studied whether this metric reflects the clinical experience of providers. Attendees at an echo course or at the annual meeting of the Swedish Heart Association were invited to test themselves on the simulator by scanning a mannequin and acquiring four views in 15min: parasternal long axis (pLAX) in patient 1, apical four chamber and apical long axis (aLAX) in patient 2 and pLAX in patient 3. Their experience with echo was assessed from duration in years and procedure volume in the past year. Image acquisition error was assessed from the deviation angle. Of 61 participants, there were 37 physicians and 24 non-physicians (22 sonographers and two nurses). Non-physicians had higher procedure volume than physicians (850±599 versus 312±393 testsyear-1 , P<0·001); both had similar duration of experience (9±8 versus 12±11years, P=NS). The deviation angle for aLAX (55±37 degrees) was higher than for any other view (P<0·00001). aLAX was the only view whose deviation angle correlated significantly with experience and only with procedure volume (r=-0·357, P=0·008). These results demonstrate that deviation angle, a novel metric of technical skill in image acquisition, reflects clinical experience. Simulator-based testing provides objective and quantitative assessment that may be of value in the certification of trainees and for maintenance of certification.

Organizational Readiness for Change (ORC) test used in the implementation of assessment instruments and treatment methods in a Swedish National study

Organizational climate and related factors are associated with outcome and are as such of vital interest for healthcare organizations. Organizational Readiness for Change (ORC) is the questionnaire used in the present study to assess the influence of organizational factors on implementation success. The respondents were employed in one of 203 Swedish municipalities within social work and psychiatric substance/abuse treatment services. They took part in a nationwide implementation project organized by the Swedish Association of Local Authorities and Regions (SALAR), commissioned by the Swedish National Board of Health and Welfare. AimThe aims were: (a) to identify classes (clusters) of employees with different ORC profiles on the basis of data collected in 2011 and (b) to investigate ORC profiles which predicted the use of assessment instruments, therapy methods and collaborative activities in 2011 and 2013. Design and recruitmentThe evaluation study applied a naturalistic design with registration of outcome at consecutive assessments. The participants were contacted via official e-mail addresses in their respective healthcare units and were encouraged by their officials to participate on a voluntary basis. StatisticsDescriptive statistics were obtained using SPSS version 23. A latent profile analysis (LPA) using Mplus 7.3 was performed with a robust maximum likelihood estimator (MLR) to identify subgroups (clusters) based on the 18 ORC indexes. ResultsA total of 2402 employees responded to the survey, of whom 1794 (74.7%) completed the ORC scores. Descriptive analysis indicated that the respondents were a homogenous group of employees, where women (72.0%) formed the majority.Cronbach's alpha for the 18 ORC indexes ranged from α=0.67 to α=0.78. A principal component analysis yielded a four-factor solution explaining 62% of the variance in total ORC scores. The factors were: motivational readiness (α=0.64), institutional resources (α=0.52), staff attributes (α=0.76), and organizational climate (α=0.74). An LPA analysis of the four factors with their three distinct profiles provided the best data fit: Profile 3 (n=614), Profile 2 (n=934), and Profile 1 (n=246). Respondents with the most favorable ORC scores (Profile 3) used significantly more instruments and more treatment methods and had a better collaborating network in 2011 as well as in 2013 compared to members in Profile 1, the least successful profile. ConclusionIn a large sample of social work and healthcare professionals, ORC scores reflecting higher institutional resources, staff attributes and organizational climate and lower motivational readiness for change were associated with a successful implementation of good practice guidelines for the care and treatment of substance users in Sweden. Low motivational readiness as a construct may indicate satisfaction with the present situation. As ORC proved to be an indicator of successful dissemination of evidence-based guidelines into routine and specialist healthcare, it can be used to tailor interventions to individual employees or services and to improve the dissemination of and compliance with guidelines for the treatment of substance users.

Physiotherapy for Parkinson's Disease in Sweden: Provision, Expertise, and Multi-professional Collaborations.

Evidence for the positive effects of physiotherapy for persons with Parkinson's disease (PwPD) is rapidly increasing. However, little is known about the provision of physiotherapy for PwPD in everyday practice. The objective of this study was to gain insight into the nature of physiotherapeutic care for PwPD in hospitals, primary care units, and community services in Sweden. A web-based survey was sent out to 2956 members of the Swedish Association of Physiotherapists, including questions about treatment, measurement tools, multi-professional collaborations, adherence to physiotherapy guidelines, professional expertise, and needs for gaining expertise regarding PwPD. Of the 1189 physiotherapists who completed the survey, 705 were treating 1 or more PwPD per month in hospitals (21%), in primary care units (37%), and in the community (42%). Physiotherapy frequently targeted a wide range of musculoskeletal and mobility impairments; however, freezing of gait and pain were less frequently treated. Measurement tools recommended for PwPD were infrequently used, and there was a preference for single-item questions/tools compared with multi-item instruments. Collaboration with other health care professionals for the rehabilitation of PwPD was rare and was more evident in hospitals than in primary care units and the community. Adherence to physiotherapy guidelines was poor, and most respondents reported that they treated too few PwPD to retain their expertise and they perceived a need to increase their knowledge and skills about physiotherapy for PwPD. The current findings emphasize the need to strengthen expertise regarding the assessment and treatment of PwPD among physiotherapists in Sweden and to apply strategies endorsing multi-professional collaboration for PD rehabilitation.

What factors enable or hinder engagement of civil society in ecosystem management? The case of ‘pike factories’ and wetland restoration in Sweden

Engaging civil society in conservation activities is an important complementary strategy to counteract ongoing biodiversity decline and loss of ecosystem services. Since 2011, the Swedish Anglers Association (SAA) has cooperated with landowners to restore wetlands nationwide. We investigated factors that enabled or hindered civil society-led wetland restoration in Sweden through interviews and surveys with the SAA's project leaders and landowners. Principal internal and external factors contributing to the project's implementation included: flexibility and adaptive management of its leadership; support from authorities and policies; the good reputation of the SAA team; and landowners’ willingness to cooperate. The latter was linked to their feelings of environmental responsibility, the low investment required by them, and expectations of some benefits. We discuss the need to enable adaptive management in environmental management projects, adjust existing policies to their needs, and re-think funding strategies to consider the long-term nature of such projects.

Fires due to Selfignition in (MSWS) Municipal Solid Waste Storages

Growing energy demands and global emphasis on employing sustainable energy resources to meet energy requirements result in increased importance of MSW (municipal solid waste) as a valuable carbondioxide neutral fuel. There is a need to study the factors that may lead to selfignition of MSW, if stored for sufficiently longer period of time. A better understanding of these factors may help in establishing the practicle guidelines for efficient handling of MSW and to reduce the environmental and social costs caused by selfigniting fires. Its importance is evident from the fact that millions of euros are lost every year in Sweden because of spontaneous fires. These fires cause loss of valuable material and injuries to people, and they are also associated with intense environmental pollution, in particular in the form of smoke and water pollution. This study is based on a questionnaire survey among the members of the Swedish waste management association (Avfall Sverige), whose members service 95% of the Swedish population. The response to the survey was 60%. A total of 96 major surface fires have been reported in the past 10 years at storage sites. 74% of these 96 fire incidents were due to self-ignition, 11% were due to known causes other than self-ignition and 15% were due to unknown reasons. In reference to the type of storage, 50% of these 96 fire incidents took place at sites that store both household and industrial waste, 20% at sites that store only industrial waste, and 30% at sites that store household, industrial, and agricultural waste. Regarding the most frequent cause of fire at any storage site, 33% of respondents relate the fire incidents with extreme hot weather conditions, 8% of respondents report that fire incidents at their storage site are mostly an aftereffect of rainfall, 13% relate the fire incidents with cold weather in December, and 46% of respondents experienced the fire incidents throughout the whole year.&#x0D; Based on data covering the last 10 years, the average annual amount of emissions of dioxins is (upper/lower bound) TCDD 0.03/0.12 g, PAH 0.98/3.7 tons, PCB 1.66/6.31 g, Hg 16.51/62.59 g, and VOC 18/68 tons from MSW storage fires in Sweden.

Rubbers by Numbers – A Survey About Sexuality in the Nordic Countries

RFSU (the Swedish Association for Sexuality Education) was founded in 1933 and works with sexual and reproductive health and rights through information, education and advocacy. We have been surveying what people in the Nordic countries think about sex. The aim is to gain valuable data that RFSU can use in our work on sexuality education for adults and young adults and product/materials development. The survey was conducted online, via an access panel, with 4,260 people. The respondents are living in Sweden, Norway, Finland and Denmark, aged between 15 and 65, who have had sex at least once. The survey is nationally representative, taking in a cross-section of the population in the target group. The survey has five different parts; condom use in the Nordic countries, sex life of young adults, sex life of Nordic people, digital relationships, and cheating and parallel relationships. Over half state that sex is important but only 44 percent of Swedes are entirely happy with their sex life. The main reason is the infrequency of sex or the lack of a partner. For one in five Swedish women, the reason is that they don’t come often enough, and half of them have faked an orgasm at some point.

Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes

BackgroundLong-term trends in excess risk of death and cardiovascular outcomes have not been extensively studied in persons with type 1 diabetes or type 2 diabetes.MethodsWe included patients registered in the Swedish National Diabetes Register from 1998 through 2012 and followed them through 2014. Trends in deaths and cardiovascular events were estimated with Cox regression and standardized incidence rates. For each patient, controls who were matched for age, sex, and county were randomly selected from the general population.ResultsAmong patients with type 1 diabetes, absolute changes during the study period in the incidence rates of sentinel outcomes per 10,000 person-years were as follows: death from any cause, −31.4 (95% confidence interval [CI], −56.1 to −6.7); death from cardiovascular disease, −26.0 (95% CI, −42.6 to −9.4); death from coronary heart disease, −21.7 (95% CI, −37.1 to −6.4); and hospitalization for cardiovascular disease, −45.7 (95% CI, −71.4 to −20.1). Absolute changes per 10,000 person-years among patients with type 2 diabetes were as follows: death from any cause, −69.6 (95% CI, −95.9 to −43.2); death from cardiovascular disease, −110.0 (95% CI, −128.9 to −91.1); death from coronary heart disease, −91.9 (95% CI, −108.9 to −75.0); and hospitalization for cardiovascular disease, −203.6 (95% CI, −230.9 to −176.3). Patients with type 1 diabetes had roughly 40% greater reduction in cardiovascular outcomes than controls, and patients with type 2 diabetes had roughly 20% greater reduction than controls. Reductions in fatal outcomes were similar in patients with type 1 diabetes and controls, whereas patients with type 2 diabetes had smaller reductions in fatal outcomes than controls.ConclusionsIn Sweden from 1998 through 2014, mortality and the incidence of cardiovascular outcomes declined substantially among persons with diabetes, although fatal outcomes declined less among those with type 2 diabetes than among controls. (Funded by the Swedish Association of Local Authorities and Regions and others.)

Self-reported frequency of sex as self-injury (SASI) in a national study of Swedish adolescents and association to sociodemographic factors, sexual behaviors, abuse and mental health

BackgroundSex as self-injury has become a concept in Swedish society; however it is a largely unexplored area of research, not yet conceptualized and far from accepted in the research field. The use of sex as a way of affect regulation is known in the literature and has, in interviews with young women who sell sex, been compared to direct self-injury, such as cutting or burning the skin. The aim of this study was to investigate the self-reported frequency of sex as self-injury and the association to sociodemographic factors, sexual orientation, voluntary sexual experiences, sexual risk-taking behaviors, sexual, physical and mental abuse, trauma symptoms, healthcare for psychiatric disorders and non-suicidal self-injury.MethodsA representative national sample of 5750 students in the 3rd year of Swedish high school, with a mean age of 18 years was included in the study. The study was questionnaire-based and the response rate was 59.7%. Mostly descriptive statistics were used and a final logistic regression model was made.ResultsSex as self-injury was reported by 100 (3.2%) of the girls and 20 (.8%) of the boys. Few correlations to sociodemographic factors were noted, but the group was burdened with more experiences of sexual, physical and emotional abuse. Non-heterosexual orientation, trauma symptoms, non-suicidal self-injury and healthcare for suicide attempts, depression and eating disorders were common.ConclusionsSex used as self-injury seems to be highly associated with earlier traumas such as sexual abuse and poor mental health. It is a behavior that needs to be conceptualized in order to provide proper help and support to a highly vulnerable group of adolescents.

Prediction of peanut allergy in adolescence by early childhood storage protein-specific IgE signatures: The BAMSE population-based birth cohort

This study was supported by the Swedish Asthma and Allergy Research Foundation; Stockholm County Council; the Swedish Research Council of Health, Working Life and Welfare; the Swedish Research Council; the Swedish Society of Medicine; the Swedish Heart-Lung Foundation; the Swedish Cancer and Allergy Foundation; the Konsul Th Berg's Foundation, the Magnus Bergvall Foundation, the Swedish Association for Allergology, the European Commission's Seventh Framework 29 Program MeDALL (Mechanisms for the Development of Allergy) under grant agreement no. 261357, and in part by grant no. F4605 of the Austrian Science Fund (FWF).