Swedish Centres Research Articles

Translating glycated hemoglobin A1c into time spent in glucose target range: A multicenter study.

Approximately 90% of children and adolescents with type 1 diabetes in Sweden use continuous glucose monitoring (CGM), either as real-time CGM or intermittently scanned CGM to monitor their glucose levels. Time in target range (TIT) is an easily understandable metric for assessing glycemic control. The aim of this study was to examine the relation between TIT and hemoglobin A1c (HbA1c). Subjects were recruited from three diabetes care centers in Sweden. Glucose data were collected for 133 children and adolescents with type 1 diabetes through CGM using Diasend. Subjects with registration time over 80% were included in the analysis. HbA1c was collected from SWEDIABKIDS, the Swedish pediatric diabetes quality registry. TIT was defined as 3.9 to 7.8 mmol/L (70-140 mg/dL) and time in range (TIR) as 3.9 to 10 mmol/L (70-180 mg/dL). During the period of 60 days, 105 subjects provided complete data for analysis. Mean age was 12.2 (±3.3) years, mean HbA1c was 53.9 (±8.2) mmol/mol or 7.1% (±0.7%). Mean sensor glucose value was 8.6 (±1.3) mmol/L, mean coefficient of variation was 42.2% (±7.2%), mean TIT was 40.9% (±SD 12.2%), and mean TIR was 60.8% (±13.1%). There was a significant nonlinear relation between TIT during 60 days and HbA1c, R2 = 0.69. This study suggests a nonlinear relation between time spent in glucose target range and HbA1c. The finding implies that time spent in TIT could be a useful metric in addition to HbA1c to assess glycemic control.

Compensating for unequal childhoods: practitioners’ reflections on social injustice in leisure-time centres

ABSTRACT In Sweden and other countries, children's everyday lives and educational opportunities depend on their living conditions and class backgrounds. The current study examined the manifestation of issues of social injustice and unequal childhoods in the daily practices of leisure-time centres in Sweden. The empirical data were derived from the written reflections of practitioners enrolled in a continuing education course. The results indicate that leisure-time centres play an important role by compensating for unequal childhoods and other inequalities in the society. The practitioners discussed the importance of the centres’ maintaining supplies of clothing and equipment for children who lack these essentials for participation in outdoor activities. This compensation for unequal childhoods was also expressed through the provision of a free snack every afternoon and free meals during excursions.

Patient choice and provider competition – Quality enhancing drivers in primary care?

Patient choice of provider and provider competition have been introduced with the claim that they would lead to improved quality. For this to occur, certain conditions must be fulfilled on both the demand and the supply side. However, supply side-mechanisms – with provider behaviour as central – have been largely neglected in the literature, especially in primary care markets. In this article, we focus on provider behaviour and explore if and how choice and competition function as quality enhancing drivers in Swedish primary care. We explore this through semi-structured interviews with 24 managers and physicians at 13 Swedish primary healthcare centres, conducted from May 2016 to February 2017. The analysis draws on assumptions that for enhanced quality, providers must receive information on patients' choices, analyse it and respond accordingly. One conclusion is that Swedish primary care providers lack information on patients' choices and ‘exits’, which makes it difficult for providers to respond to patients' choices. Furthermore, it is questionable whether choice and competition stimulate enhanced clinical quality. At the same time, choice and competition seems to make providers more aware of accessibility concerns and of their reputation, which they may be stimulated to improve. The article contributes evidence on supply side-mechanisms, and encourages clarification of ‘quality’ in this respect, both on the political arena as well as in theoretical models.

The association between gout and cardiovascular disease in patients with atrial fibrillation.

Gout is a sign of a disturbed metabolism and associated with atrial fibrillation (AF) and other cardio-vascular diseases. Our aim was to study associations between gout and cardiovascular co-morbidities in patients with AF. The study population included all adults (n=12,283) ≥45 years diagnosed with AF visiting 75 primary care centers in Sweden 2001-2007. Logistic regression was used to calculate odds ratios with 95% confidence intervals (CIs) for the associations between prevalent gout and cardiovascular co-morbidities. In subsamples we studied incident congestive heart failure (CHF) and ischemic stroke (IS), excluding patients with earlier registered specific diagnosis, using Cox regression (to estimate hazard ratios (HR) with 95% CIs). Gout was significantly and positively associated with CHF, obesity and diabetes among men and women, and among men also with hypertension and coronary heart disease. Prevalent gout was negatively associated with incident IS (HR and 95% CI: 0.64, 0.49-0.82; 0.50, 0.39-0.64) in both full model (adjusted for sex, age, socio-economic factors and comorbidities) and CHA2DS2-VASc model (adjusted for CHA2DS2-VASc, sex and age). Adding gout to full model increased Harrell's C by 1% in CHA2DS2-VASc model. In this clinical setting we found gout to be associated with most cardiometabolic diseases except cerebrovascular diseases, and with decreased risk of IS, with gout adding significantly to the predictive value compared to CHA2DS2-VASc without gout included.

Calls made to the Poisons Information Centre reveal need for improved risk management of cleaning agents in the workplace

Purpose. This study aimed to investigate chemical injuries caused by cleaning agents and disinfectants by reviewing poison control data. Methods. We performed a 5-year retrospective analysis of calls to the Swedish Poisons Information Centre (PIC) concerning occupational use of cleaning agents and disinfectants. In addition, callers for 17 new cases were interviewed. Results. Out of 8240 occupationally related cases handled by the PIC during 2010–2014, 24% concerned cleaning agents and disinfectants (N = 1983). Of these, one-third were classified as major risk cases, generally due to potential for corrosive eye and skin injuries. The most frequent type of workplace was restaurants and caterers. However, information about occupation was only identifiable for 30% of the cases. Follow-up interviews exemplify how limited awareness of safety data sheets and disregard of protective equipment may contribute to health-related outcomes such as absence at work. Conclusions. Management and prevention strategies for cleaning agents should be improved. PIC records hold relevant information both for designing interventions and for future research on occupational health and safety management. We suggest that systematic collection by the PIC of information on occupation and age would further improve the usefulness for occupational injury surveillance purposes.

Parents act as intermediary users for their children when using assistive technology for cognition in everyday planning: Results from a parental survey

ABSTRACT Assistive Technology for Cognition (ATC) is employed by children with and without disabilities. However, how the ATC is used in everyday life has not been studied. The current study investigated ATC-usage in everyday planning in three groups: 1) children qualifying for Swedish habilitation centers (ID/ASD), 2) children with disability not qualifying for habilitation service (ADHD), and 3) children with typical development (TD). A parental survey was conducted (n = 192) and answers were analyzed with statistical tests and inductive thematic text analysis. Results showed that all groups used ATC, most in the Habilitation group and least in the TD group. According to parents, ATC supported cognitive functions in all groups, but it became evident that the parents were responsible for planning by setting up the ATC, whilst the children merely executed the plans. This was linked to several limitations, for example the design was not appropriately adapted for these groups. The implications for the practitioners are 1) evaluate the users’ cognitive abilities and choose an ATC suitable for that individual rather focusing on the diagnosis, and 2) follow up usage to see if it is the parent or the child that are using the ATC.

Healthcare staff's evaluation of a walk-in centre at a healthcare centre in an immigrant-dense area.

To evaluate a walk-in centre at a healthcare centre in an immigrant-dense area where a high proportion of the patients have limited language ability in Swedish, from the perspective of healthcare personnel. Increased global migration results in higher vulnerability in migrants, with the risk of increased morbidity and mortality. Migrants' health often deteriorates, which can be attributed to an increased level of stress and adaptation to a new lifestyle. Therefore, immigrants are at higher risk of being affected by, for example, cardiovascular diseases and diabetes. This requires access to good health care. A qualitative exploratory study was conducted, using semi-structured interviews. Content analysis was used in the analysis process. Semi-structured interviews were held with 15 purposively sampled doctors and nurses, working at a healthcare centre in Sweden. Data were collected during autumn 2017. The study was performed in accordance with COREQ. Working at the walk-in centre involved caring for everything from basic to advanced health problems and meant a high pace that required stress-resistant personnel. The walk-in centre was described as both promoting and threatening patient safety. The personnel had several ideas on how to develop the walk-in centre. A walk-in centre can be seen as a necessity related to issues of ensuring patient safety and delivering care for everyone in an immigrant-dense area. However, it cannot be the only form of care offered, as it seems not be adapted to certain groups, such as people with disabilities and the elderly. The findings emphasise that a walk-in centre is a way to increase accessibility for the entire population and offer equal care for all, even if it involves challenges that need to be addressed.

Keeping up with thekladdkaka: Kindness and coercion in Swedish immigration detention centres

Unlike many of its neighbouring North European countries, Sweden has historically been reluctant to expand its use of immigration detention. Likewise, and similar to its use of prisons, it is a state that often favours architectural ‘softness’ in the structure and regime of detention. However, as this article contends, its reputation for hospitality and welfare is in contrast with the very existence of such spaces. Reflecting on interviews with detention custody officers and governors in two such centres, I demonstrate how ‘hard’ approaches to control are instead supplemented with dualistically ‘kind’ and coercive measures to obtain their ultimate agenda: the deportation of the unwanted immigrant Other. Considering the harms inherent to imprisonment, I argue that – although preferable to harsher conditions enacted by various other states – the negative impacts of confinement cannot be eradicated by ‘soft’ approaches, but rather require the eradication of border confinement itself.

Health effects of direct triaging to physiotherapists in primary care for patients with musculoskeletal disorders: a pragmatic randomized controlled trial.

Background:Physiotherapists and general practitioners (GPs) both act as primary assessors for patients with musculoskeletal disorders in primary care. Previous studies have shown that initial triaging to physiotherapists at primary healthcare centres has advantages regarding efficiency in the work environment and utilization of healthcare. In this study, we aimed primarily to determine whether triaging to physiotherapists affects the progression of health aspects over time differently than traditional management with initial GP assessment. The secondary aim was to determine whether triaging to physiotherapists affects patients’ attitudes of responsibility for musculoskeletal disorders.Methods:This was a pragmatic trial where both recruitment and treatment strategies were determined by clinical, not study-related parameters, and was initiated at three primary care centres in Sweden. Working-age patients of both sexes seeking primary care for musculoskeletal disorders and nurse assessed as suitable for triaging to physiotherapists were randomized to initial consultations with either physiotherapists or GPs. They received self-assessment questionnaires before the initial consultation and were followed up at 2, 12, 26 and 52 weeks with the same questionnaires. Outcome measures were current and mean (3 months) pain intensities, functional disability, risk for developing chronic musculoskeletal pain, health-related quality of life and attitudes of responsibility for musculoskeletal conditions. Trends over time were analysed with a regression model for repeated measurements.Results:The physiotherapist-triaged group showed significant improvement for health-related quality of life at 26 weeks and showed consistent but nonsignificant tendencies to greater reductions of current pain, mean pain in the latest 3 months, functional disability and risk for developing chronic pain compared with traditional management. The triage model did not consistently affect patients’ attitudes of responsibility for musculoskeletal disorders.Conclusions:Triaging to physiotherapists for primary assessment in primary care leads to at least as positive health effects as primary assessment by GPs and can be recommended as an alternative management pathway for patients with musculoskeletal disorders.ClinicalTrials.gov identifier:NCT148611.

Diseases and causes of death among alpacas in Sweden: a retrospective study

BackgroundDue to increasing popularity in Sweden during the last decade, alpacas are frequently encountered by practising veterinarians and pathologists. Knowledge regarding their health and diseases under Swedish conditions is, however,...

Fixotek: Implementing and Testing Urban Reuse and Repair Centers in Sweden

The Fixotek project is testing if dedicated community spaces in residential areas could help encourage residents to fix, lend, swap and recycle consumer products, thereby preventing waste generation and recovering resources locally. Four Fixoteks have been developed, in districts with different socioeconomic conditions in Gothenburg, offering regular open hours and events. The idea has been very well received by the community, with differences in how easily it has been taken up in some of the locations. Two of the Fixoteks engage local volunteers and have developed closer to local initiatives, while in the other two more efforts are needed to engage the local community. Non the less, the locations have allowed residents to reuse and repair beyond what was possible before. The project has been implemented with a multi-stakeholder consortium, which has given it a holistic approach to the implementation, but makes decision taking slow.

The V-Dem Measurement Model: Latent Variable Analysis for Cross-National and Cross-Temporal Expert-Coded Data​

This material is based upon work supported by the National Science Foundation (SES-1423944, PI: Daniel Pemstein), Riksbankens Jubileumsfond (Grant M13-0559:1, PI: Staffan I. Lindberg), the Swedish Research Council (2013.0166, PI: Staffan I. Lindberg and Jan Teorell), the Knut and Alice Wallenberg Foundation (PI: Staffan I. Lindberg), and the University of Gothenburg (E 2013/43); as well as internal grants from the Vice-Chancellor’s office, the Dean of the College of Social Sciences, and the Department of Political Science at University of Gothenburg. Marquardt acknowledges research support from the Russian Academic Excellence Project ‘5-100.’ We performed simulations and other computational tasks using resources provided by the Notre Dame Center for Research Computing (CRC) through the High Performance Computing section and the Swedish National Infrastructure for Computing (SNIC) at the National Supercomputer Centre in Sweden (SNIC 2016/1-382, SNIC 2017/1-406 and 2017/1-68). We specifically acknowledge the assistance of In-Saeng Suh at CRC and Johan Raber and Peter Mu nger at SNIC in facilitating our use of their respective systems.

Family talk intervention in paediatric oncology: a pilot study protocol

IntroductionThere is evidence that families with a child diagnosed with cancer need psychosocial support throughout the illness trajectory. Unfortunately, there is little research into psychosocial interventions for such families, especially...

Revolution! Svenska erfarenheter från Ryssland

Abstract: Review of Revolution! Swedish experiences from RussiaBirgitte Beck Pristed reviews Revolution! Swedish experiences from Russia, edited by Alexander Husebye, with contributions by Bengt JAngfeldt, Ulrika Knutson, Martin Kragh, Benito Peix Geldart, Gunnar Åselius. The volume is issued by the Swedish Center for Business History on the occasion of the 100th anniversary of the Russian Revolution and examines the postrevolutionary fate of Swedish entrepreneurs and their extensive business activities in Russia.

Swedish School-age Educare Centres and German All-day Schools – A Bi-national Comparison of Two Prototypes of Extended Education

In Sweden and in Germany, an extensive system of extended education programmes and activities has been established within the last decades. Prototypic examples of this development are school-age educare centres in Sweden and all-day schools in Germany. In this article a bi-national comparison, aiming to find some similarities and differences by means of historical background, current questions of student learning, staff professionalism, and research findings, is presented. It can be shown that, though Swedish school-age educare centres and German all-day schools are based on pedagogical roots reaching back to the end of the 19th and the beginning of the 20th century, their historical developments are quite different. Whilst in Sweden the school-age educare idea became entrenched in the society and the collective beliefs about the necessity of learning outside the classroom, in Germany the all-day school model never prevailed. That only changed in the beginning of the 21st century when PISA showed that the German education system was not performing very well. Based on the different developments over time, both models established different features. With regard to student learning, the Swedish model is more oriented towards fostering creativity and imagination, whilst the German model is more oriented towards curricular learning. One difference concerning the students are that in Germany the all-day school embrace both children and youths up to the end of secondary-II level (up to 18/19 years), in Sweden young people older than 13 years old cannot participate in the school-age educare. In Sweden educators working outside of the classroom are academically trained in quite the same way as classroom teachers, whilst in Germany there is no such common regulation. Based on the more curricular learning centred view in Germany, some large scale effectivity studies were conducted within the last decade. Such comprehensive research programs are lacking in Sweden. We will give a short overview of some main research findings and discuss future research topics.

Effect of Levothyroxine Treatment on Incident Dementia in Adults with Atrial Fibrillation and Hypothyroidism.

Background and ObjectiveThe possible adverse or positive effects of levothyroxine treatment among patients with atrial fibrillation have been debated. Atrial fibrillation, levothyroxine treatment, and dementia are common among older adults, yet little is known about the effects of levothyroxine on the development of dementia.MethodsThe study population included all adults (n = 12,057) aged ≥ 45 years with a diagnosis of atrial fibrillation at 75 primary care centers in Sweden during 2001–2007 without an earlier recorded dementia diagnosis. Patients with a diagnosis of hypothyroidism and levothyroxine prescription (n = 756; 180 men and 576 women), or with a prescription without this diagnosis (n = 415, 100 men and 315 women), were compared to patients without a diagnosis and prescription (n = 10,886). Cox regression was performed, with hazard ratios and 95% confidence intervals, with outcome defined as dementia of all causes until 31 December, 2010.ResultsDuring a mean 5.7 years (standard deviation 2.4 years) of follow-up, a total of 749 patients with atrial fibrillation (6.2%) were diagnosed with dementia. Women with hypothyroidism and a levothyroxine prescription showed lower hazard ratios (0.61; 0.41–0.90) in adjusted Cox regression models (age, socioeconomic factors, co-morbidity, and warfarin treatment). Levothyroxine prescription without hypothyroidism was non-significant.ConclusionsWe found that women with atrial fibrillation with levothyroxine treatment and hypothyroidism have a lower risk of incident dementia than women with atrial fibrillation without levothyroxine treatment and no hypothyroidism. The results should be confirmed in larger studies.Electronic supplementary materialThe online version of this article (10.1007/s40261-018-0740-3) contains supplementary material, which is available to authorized users.

Metastatic papillary renal cell carcinoma in the era of targeted therapy – a retrospective study from three European academic centres

Background: Metastatic papillary renal cell carcinoma (mPRCC) is understudied. The disease is often aggressive and specific treatment options are lacking.Patients and methods: mPRCC patients (n = 86) referred to three academic centres in Sweden and Germany in the years 2005–2015 were retrospectively identified from medical records. Statistical analyses included Kaplan–Meier curves and calculation of Cox proportional hazards, generating hazard ratios with 95% confidence intervals. The aim of the study was to evaluate overall survival (OS) of mPRCC patients treated outside of clinical trials in the era of targeted agents (TA) and to identify clinically useful prognostic factors.Results: Median OS of all mPRCC patients was 11.2 months. TA were used in 77% of the patients and associated with younger age and better Eastern Cooperative Oncology Group performance status (PS). Brain metastases were common (28%). Patients with synchronous or metachronous metastases had similar OS. Variables independently associated with risk of death included age ≥60 years, worse PS and ≥3 metastatic sites. The MSKCC criteria did not provide additional prognostic information. A subgroup analysis of TA-treated patients revealed an association of lymph node metastasis with risk of death in addition to the other prognostic factors.Conclusion: OS in mPRCC remained short in the era of targeted agents. Age, PS, and number of metastatic sites provided independent prognostic information.

Older Age Predicts Worse Function 1 Year After an Acute Achilles Tendon Rupture: A Prognostic Multicenter Study on 391 Patients.

Background:There is limited evidence regarding the patient-related factors that influence treatment outcomes after an acute Achilles tendon rupture.Purpose/Hypothesis:The purpose of this study was to determine the predictors of functional and patient-reported outcomes 1 year after an acute Achilles tendon rupture using a multicenter cohort and to determine patient characteristics for reporting within the top and bottom 10% of the Achilles tendon Total Rupture Score (ATRS) and heel-rise height outcomes. The hypothesis was that older age, greater body mass index (BMI), and female sex would lead to inferior outcomes.Study Design:Cohort study; Level of evidence, 2.Methods:Patients were selected by combining 5 randomized controlled trials from 2 different centers in Sweden. Functional outcomes were assessed using validated heel-rise tests (height, number of repetitions, total work, and concentric power) for muscular endurance and strength, and the relationship between injured and uninjured legs was calculated as the limb symmetry index (LSI). Patient-reported outcomes were measured using the ATRS. All outcomes were collected at the 1-year follow-up. Independent predictors included were patient sex, smoking, BMI, age, and surgical versus nonsurgical treatment.Results:Of the 391 included patients, 307 (79%) were treated surgically. The LSI of heel-rise height at the 1-year follow-up decreased by approximately 4% for every 10-year increment in age (beta, –3.94 [95% CI, –6.19 to –1.69]; P = .0006). In addition, every 10-year increment in age resulted in a 1.79-fold increase in the odds of being in the lowest 10% of the LSI of heel-rise height. Moreover, a nonsignificant superior LSI of heel-rise height was found in patients treated surgically compared with nonsurgical treatment (beta, –4.49 [95% CI, –9.14 to 0.16]; P = .058). No significant predictor was related to the ATRS. Smoking, patient sex, and BMI did not significantly affect the 1-year results for the LSI of the heel-rise tests.Conclusion:Older age at the time of injury negatively affected heel-rise height 1 year after an Achilles tendon rupture. Irrespective of age, a nonsignificant relationship toward the superior recovery of heel-rise height was seen in patients treated surgically. None of the factors studied affected patient-reported outcomes.

Researcher identities and practices inside centres of excellence

Many science support mechanisms aim to combine excellent research with explicit expectations of societal impact. Temporary research centres such as ‘Centres of Excellence’ and ‘Centre of Excellence in Research and Innovation’ have become widespread. These centres are expected to produce research that creates future economic benefits and contributes to solving society’s challenges, but little is known about the researchers that inhabit such centres. In this paper, we ask how and to what extent centres affect individual researchers’ identity and scientific practice. Based on interviews with 33 researchers affiliated with 8 centres in Sweden and Norway, and on institutional logics as the analytical framework, we find 4 broad types of identities with corresponding practices. The extent to which individuals experience tensions depend upon the compatibility and centrality of the two institutional logics of excellence and innovation within the centre context. Engagement in innovation seems unproblematic and common in research-oriented centres where the centrality of the innovation logic is low, while individuals in centres devoted to both science and innovation in emerging fields of research or with weak social ties to their partners more frequently expressed tension and dissatisfaction.

The Presence of Pedagogy and Care in Leisure-time Centres’ Local Documents: Leisure-time Teachers’ Documented Reflections

MANY COUNTRIES OFFER younger school children school-age child care. However, the governance, organisation and practical activities and its relation to education and care differs within and between countries. In Scandinavia, the concept of Educare acknowledges the need for emotional, social and intellectual aspects of the holistic view of learning. The Swedish leisure-time centres (LTC) designed for younger school children have, by tradition, an identity that strongly relates to aspects of care. This study aims to gain knowledge of leisure-time teachers’ (LTT) reflections on how pedagogy and care appear in LTCs’ local documents. After examining the written reflections of 22 groups of LTTs involved in a professional development course, it can be argued that care is fundamental to the LTC activities; however, this notion is simultaneously challenged by neoliberal tendencies.