Swedish County Research Articles

Intersectional inequalities in child social-emotional health: a case for proportionate universalism

Abstract Background Social-emotional difficulties in early childhood are associated with a range of outcomes across the life course and are related to socioeconomic factors. The aim of this study was to examine intersectional inequalities in social-emotional problems in preschool children relating to their parents’ income, education and country of birth in addition to investigating the public health implications. Methods This population-based study with a repeated cross-sectional design in the Västerbotten County of Sweden used the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) for children aged 3 in child health care services over the years of 2014-2018 and socio-economic information from national population registers. The effective sample of 8,823 individuals was analyzed using additive binomial regression in combination with an analysis of individual heterogeneity and discriminatory accuracy (AIHDA) approach to estimate risk differences for social-emotional problems across 27 intersectional groups and discriminatory accuracy. Results Average risk differences generally increased in the groups where multiple dimensions of social inequality intersected, with risk differences as high as 18% (95% CI 8 to 28%) and 25% (95% CI 14 to 37%) compared to the most advantaged category. The discriminatory accuracy of all three included regression models was estimated as moderate, but improved in a slight but statistically significant way with the addition of social inequalities. Conclusions This study increases our understanding of intersectional and social inequalities in social-emotional problems in preschool children. It supports the need for universal public health policies in addition to policies targeting more vulnerable groups when addressing this issue, consistent with the concept of proportionate universalism. An intersectional research perspective including discriminatory accuracy could increase our knowledge of health inequities and improve public health effectiveness. Key messages • Intersecting dimensions of social inequalities are associated with an increased risk of social-emotional problems in children aged 3. • Universal public health policies are needed in addition to policies targeting vulnerable population groups with regards to social-emotional problems in young children.

Optimising Abdominal Aortic Aneurysm Screening of 65 Year Old Men by Exploring Risk Factor Based Targeted Screening Strategies in Light of Declining Prevalence of the Disease

A decline in abdominal aortic aneurysm (AAA) prevalence calls into question the credibility of general population screening of 65 year old men. Selectively targeting high risk individuals among this group could be more effective in preventing death from AAA rupture. This cross sectional study analysed risk factor data in a cohort of 65 year old men screened in the Swedish general population based AAA screening program, with the aim of exploring the effectiveness of hypothetical targeted screening strategies. All men attending AAA screening in four neighbouring counties in Sweden between 2006 and 2010 completed a health questionnaire on smoking habits and medical history. Abdominal aortic aneurysm was defined as measuring ≥ 30 mm. The sensitivity and specificity of different targeted screening strategies, with targeted subpopulations defined by duration of smoking with and without additional risk factors, were explored using receiver operating characteristic (ROC) curves. A total of 16 232 men were screened, with 236 (1.5%) screening detected AAAs. A strategy combining smoking, presence of coronary artery disease (CAD), or both was associated with the mathematically optimal balance between sensitivity and specificity (optimal threshold) in the ROC analysis. The optimal threshold corresponded to targeting men having smoked for thirty years or more, a history of CAD, or both, where 74.0% of all AAAs could be detected by screening 33.0% of the population, compared with general screening. Targeting men that have smoked for ten years or more indicated that 84.0% of all AAAs could be detected by screening 55.0% of the population. A simplified strategy of targeting ever smokers resulted in detecting 85.0% of all AAAs by screening 61.0% of the population. Targeted screening of men at high risk of AAA, focusing on smoking history for inclusion, may be a safe and effective alternative to general population screening.

COVID-19 quer durch die Berufsgruppen – Infektions-, Krankenhausaufenthalts- und ICU-Muster in einem schwedischen Bezirk

COVID-19 Across Professions – Infection, Hospitalisation, and ICU Patterns in a Swedish County The study, which will be published in the Journal of Occupational and Environmental Medicine and which has already been pre-published online in May 2024, is one of the few research projects on the links between COVID-19 and occupational activity that analysed data from all three waves of the pandemic and was able to draw on a particularly large data set (data from 22,000 people). Based on this data, the study determined the number of all positive infection reports, hospitalisations and intensive care unit admissions as well as deaths caused by COVID-19 for relevant occupational groups. Healthcare workers and other professions with frequent/close human contact had a significantly higher number of confirmed COVID-19 infections and a higher risk of hospitalisation than other occupational groups, especially in the first wave of the pandemic, even if this trend gradually weakened with each subsequent wave of the pandemic. Based on this finding, the authors of the study conclude that effective preventive protective measures should be implemented immediately at the beginning of a future pandemic wave for the groups of people and professions particularly affected by frequent and close occupational contact with people. The study’s analysis of data from a longer period of time makes it possible to better recognise changes in infection patterns over time. Keywords: COVID-19 – occupational activity – infection reports – hospitalisations admissions – deaths

Effects of structured contraceptive counseling in young women: Secondary analyses of a cluster randomized controlledtrial (the LOWE trial).

Unwanted pregnancy constitutes a huge health issue. Long-acting reversible contraception (LARC) are the most effective methods for preventing unwanted pregnancy, especially among young women. This study evaluates the intervention effect of structured contraceptive counseling on the choice, initiation, and use of LARC in young women. This is a secondary analysis of women aged 18-25, enrolled in a multicenter cluster randomized controlled trial performed in abortion, youth, and maternal health clinics across the Stockholm County in Sweden. Clinics were randomized (1:1) to provide structured contraceptive counseling (intervention) or standard counseling (control). Surveys were administered at the clinic visit and follow-ups at 3, 6, and 12 months. Primary outcome focused on the choice of LARC among women 18-25 years of age. Secondary outcomes included initiation, and use of LARC at 3 and 12 months, satisfaction with the counseling received and information on extended use of combined hormonal contraceptives. The study was registered at Clinicaltrials.gov (NCT03269357). From September 2017 to May 2019, 770 women aged 18-25 years from 28 clinics/clusters were recruited. There was a significant intervention effect on LARC choice (aOR 5.96, 95% CI 3.25-10.94), initiation (aOR 4.43, 95% CI 2.32-8.46), and use at 12 months (aOR 2.21, 95% CI 1.31-3.73). The odds of LARC choice at pre-booked visits were higher and more women received information about extended-use regimen for short-acting reversible contraception in the intervention group compared to the control group. The intervention package was well received, but with higher satisfaction at pre-booked compared to drop-in visits. Our study demonstrates that comprehensive structured contraceptive counseling significantly increases LARC choice, initiation and use, with high satisfaction among young participants, especially at pre-booked visits. The results highlight an approach that merits implementation to increase quality of care in contraceptive services, to enhance reproductive health for adolescents and young adults.

Parents’ perceptions of the safe environment for every kid (SEEK) model in the Swedish child health services

BackgroundThe Safe Environment for Every Kid (SEEK) model was developed to address psychosocial risk factors (financial worries, depressive symptoms, major parental stress, alcohol misuse and intimate partner violence) in the pediatric primary care setting but has not been evaluated from the parents’ perspective. To further investigate the usefulness of SEEK, it is important to explore how parents perceive the model.ObjectiveThe aim of the present study was to explore parents’ perceptions of the SEEK model as a part of regular health visits in the Child Health Services in Sweden.Participants and settingEighteen parents (13 women and five men) in two Swedish counties participated in the study.MethodsSemi-structured telephone interviews were conducted, and the resulting data were analyzed using reflective thematic analysis.ResultsThree themes were identified: Acceptance and understanding of the SEEK model in the child health services, The questionnaire as a bridge to a dialogue, and Feeling trust in the system and the child health nurse’s professional competence. Further, an overarching theme was created that encompassed a core meaning of all three themes; SEEK provides a process-oriented framework to receive support in parenting with a focus on child health.ConclusionsThe study showed that parents express both acceptance and understanding of the SEEK model and they perceive that the model provides an avenue for repeated dialogues about the family’s situation during the child’s upbringing and an opportunity to access support if needed.

Is there a need for revised guidelines in the treatment of perforated appendicitis in children? A study of risk factors for prolonged hospital stay and postoperative complications

PurposeTo study the need for revised guidelines in the treatment of children with acute perforated appendicitis (APA) by describing the clinical course of children surgically treated for APA in one county in Sweden, with focus on length of hospital stay (LOS) and risk of postoperative complications. The study also aimed to identify variation in practice, comparing a university children's hospital (UCH) to county hospitals (CH). MethodsTwo thousand children, <16 years, who had surgery for acute appendicitis 2014-2018 in four public hospitals (1 UCH and 3 CH), were identified. Patients with perforation of the appendix, n=383(19%) were selected for study and retrospective assessment of patient records. Uni and multivariable logistic regression analyses were done to identify risk factors for prolonged length of stay (PLOS) and complications. ResultsThe median LOS was 5.05 days (0.5-61.9), 6.79 (1.81-61.91) for the UCH (n=186) and 3.65 (0.54-35.65) for CH's (n=197)(p<0.0001). PLOS (=>5 days in hospital) was seen in 147 (79%) at UCH and 53(26.9%) at CH's(p<0.0001). Intra-abdominal abscess within 30 days was identified in 36 (9.4%) and surgical re-intervention was needed in 19 (5%) with no differences between hospitals. The need for readmission within 30 days was higher at CH n=22(11.4%) than at UCH n=4(2.2%), (p=0.0006). Multivariable analyses showed independent predictors of PLOS to be: male gender(OR 2.97 (1.68-5.23)), treatment at UCH(OR 10.24 (6.38-16.44)), CRP >135mg/l(OR per 50 units 1.42 (1.16-1.73)), prehospital delay>2.5 days(OR 1.22 (1.01-1.47)), delayed time to surgery(OR per 10 hours 1.74 (1.26-2.41)) extended surgery time(OR per 2 hours 4.59 (1.43-14.76)) and use of urinary catheter(OR 2.99 (1.42-6.29)). ConclusionGuidelines for treatment of childhood APA, focusing on minimizing antibiotics and facilitating early discharge, would optimize care of the patients but also the economical use of resources. Most children with APA have an uncomplicated course, but factors predicting PLOS have been identified. We found a pronounced variation in practice between the UCH and CH's, without increasing the risk of postoperative complications.

The Use of Evaluation Methods for Physiotherapy Treatment in Infants With Bronchiolitis—a Survey Study

Aims The aim of this study was to identify and describe methods that physiotherapists use to evaluate the immediate effects of their interventions for infants in hospital with acute respiratory tract infections. Methods We constructed an anonymous digital survey to physiotherapists working with infants aged 0–24 months in Sweden. The survey was distributed by e-mail and posted on web pages for seven weeks, which included a reminder. Results Replies were obtained from 88 respondents, and 52 completed surveys remained to be analyzed. All 21 counties in Sweden were represented. The most prevalent answer options were as follows: more productive/increased or decreased cough (73%), increased oxygen saturation (35%), changed secretion sounds (33%), reduced work of breathing (20%), and parental report (16%). Conclusions The physiotherapists reported to use diverse methods for evaluation of their interventions. However, to a large degree they used subjective measures, which depend on the individual clinician’s assessment and interpretation. The evaluation methods vary in psychometric properties and robustness. This study identifies the need for consensus about valid, reliable, and clinically relevant evaluation methods for this patient group.

Experience of Student Nurse Anesthetists’ Learning in the Operating Room During the COVID-19 Pandemic: A Qualitative Interview Study

PurposeThis study explores student nurse anesthetists’ (SNAs) learning in the operating room during the coronavirus 2019 pandemic. DesignAn explorative design with semistructured interviews was used. MethodsThirteen former SNAs and 12 clinical supervisors (8 of whom were included in the final analysis) were recruited from 6 counties in Sweden. Participants were purposively recruited. Inclusion criterion for former SNAs was having completed the nurse anesthesia program in the fall of 2020 to spring 2022; and for nurse anesthetists, those who have experience in supervising SNAs. The interviews were analyzed with thematic analysis. FindingsThe analysis identified one theme and five subthemes. The theme was that student learning was in focus despite an ongoing pandemic. Every learning situation contributed, and learning was triggered by the challenges. Both the SNAs and the supervisors exhibited resilience by accepting the situation and striving to do their absolute best in a nonoptimal learning environment. Over time, learning and supervision returned to normal. ConclusionsDuring the pandemic, learning was ongoing despite stress, fear, and other challenging factors. Students’ learning appears to have been prioritized. The study highlights that nurse anesthetists and SNAs were resilient, resourceful, and able to find new ways to keep learning going.

Diagnostic accuracy and radiological validation of intracerebral hemorrhage diagnosis in the Swedish Stroke Register (Riksstroke).

National quality registries for stroke care operate under the assumption that the included patients are correctly diagnosed. We aimed to validate the clinical diagnosis of spontaneous intracerebral hemorrhage (ICH) in Riksstroke (RS) by evaluating radiological data from a large, unselected ICH population. We conducted a retrospective, multicenter study including all ICH patients registered in RS between 2016 and 2020 residing in Skåne County in Sweden (1.41 million inhabitants). Radiological data from first imaging were evaluated for the presence of spontaneous ICH. Other types of bleeds were registered if a spontaneous ICH was not identified on imaging. The radiological evaluation was independently performed by one radiology fellow and one senior neuroradiologist. Between 2016 and 2020, 1784 ICH cases were registered in RS, of which 1655 (92.8%) had a radiological diagnosis consistent with spontaneous ICH. In the 129 (7.2%) remaining cases, the radiological diagnosis was instead traumatic bleed (n = 80), subarachnoid hemorrhage (n = 15), brain tumor bleed (n = 14), ischemic lesion with hemorrhagic transformation (n = 14), ischemic lesion (n = 3), or no bleed at all (n = 3). There was a higher degree of incorrect coding in the older age groups. At radiological evaluation, 92.8% of ICH diagnoses in RS were consistent with spontaneous ICH, yielding a high rate of agreement that strengthens the validity of the diagnostic accuracy in the register, justifying the use of high coverage quality register data for epidemiological purposes. The most common coding error was traumatic bleeds that were classified as spontaneous ICH.

Factors influencing outcomes in candidemia: A retrospective study of patients in a Swedish county.

Candidemia is a diverse condition and associated with a broad spectrum of clinical presentation. As mortality is high, timely diagnosis of candidemia and start of correct therapeutic treatment are essential. To investigate characteristics and factors influencing outcomes for patients with candidemia in a Swedish setting. All positive blood cultures for any Candida species in Östergötland County from 2012 to 2016 were screened. Medical records of patients fulfilling all inclusion criteria and no exclusion criteria were retrospectively reviewed to obtain data on risk factors, diagnostic and therapeutic procedures and at what wards candidemia was diagnosed. Univariate logistic regression and multivariable regression analysis were used to obtain odds ratio to determine risk factors for 30-day all-cause mortality associated with candidemia. A p-value <.05 was considered statistically significant. Of all analysed risk factors, increasing age, renal failure with haemodialysis, immunosuppressant treatment, and severity of the infection (i.e. if septic shock was present) were significantly associated with 30-day mortality in univariate analysis (p < .05). Removal of a central venous catheter or an infectious diseases consultant was associated with a significantly lower odds ratio for death at 30 days (p < .05). With multivariable analysis, age, time to start of treatment and infectious disease consultant remained significant (p < .05). In conclusion, this study provides an update of the epidemiology and outcomes of candidemia in a Swedish setting, highlighting that patients with candidemia are present at various departments and indicates the importance of an infectious disease consultant when candidemia is present.

Experiences of co-producing person-centred and cohesive clinical pathways in the national system for knowledge-based management in Swedish healthcare: a qualitative study

BackgroundWhen the 21 Swedish county councils decided to collaborate in the creation of a national system for knowledge-based management, patient participation was mandatory. Patient and next-of-kin representatives (PR) co-produced person-centred and cohesive clinical pathways together with healthcare professionals (HPR). Research on co-production in healthcare at the national level is scarce. The aim of this study is to explore experiences of patient participation from the perspectives of both PRs and HPRs when co-producing clinical pathways within the Swedish nationwide healthcare system for knowledge-based management.MethodsA qualitative study was conducted. A strategic sample of nine PRs and eight HPRs were interviewed individually between August 2022 and January 2023 using a semi-structured interview guide. We analysed data using an inductive content analysis.ResultsThree main categories were identified: (1) Finding appropriate patient representativeness; (2) Working methods that facilitate a patient perspective; and (3) Influence of the patient perspective in the clinical pathways.ConclusionsThe study demonstrates the importance of patient and next-of-kin participation in the construction of clinical pathways at the national level. The results provide a platform for further research on patient participation on the national level and add to studies on if and how patient participation on this level has an impact on how the clinical pathways are put into practice at the micro level, and the support provided at the meso level. The study contributes to the growing body of literature studying patient participation and co-production.Trial registrationRegion Örebro County ID 276,940. An advisory opinion was obtained from the Swedish Ethical Review Authority (2021-05899-01).

Nature for everyone? Planning perspectives on accessibility, disability and participation in the Swedish outdoors

ABSTRACT For older adults and people with disabilities, it can be difficult to participate in recreation due to inaccessible nature. This can lead to exclusion when it comes to outdoor experiences and health. Nature-based solutions for quality of life are hence essential. Through semi-structured interviews with Swedish municipal and county representatives, and representatives of interest organizations for people with physical disabilities, we identify challenges in the planning and management of the recreational landscape in relation to accessibility and participation. We enlighten how accessibility and social inclusion can be enhanced through planning and management to promote health through equal access to nature.

Covid-19 Across Professions-Infection, Hospitalization, and Intensive Care Unit Patterns in a Swedish County.

The aim of the study was to study infection, hospitalization, and admission to intensive care unit for COVID-19 in different occupations and pandemic waves in a Swedish county. Individual registry data of infection and hospitalization were merged with occupational data in this cross-sectional study. Infected, hospital-, and intensive care unit-admission were analyzed by occupational groups. 22,095 cases of COVID-19 from 21 February 2020 to 31 August 2022 were identified. Healthcare workers and others working in close physical proximity showed a higher rate of confirmed COVID-19 infections in all waves and higher risk for hospital admission early in the pandemic. Exposure to diseases and physical proximity played a decisive role. Workers in close-contact occupations experienced a higher rate of confirmed infections throughout the pandemic and higher hospitalization rates in the first pandemic wave, suggesting a need for more effective initial safety measures in a future pandemic.

Prevalence of high-risk HPV and cervical dysplasia in IUD users and controls: a cross sectional study

Objective To examine the prevalence of infections with high-risk human papillomavirus (HPV) and cervical dysplasia, and the clearance rate of HPV infections, in users of different kinds of intrauterine devices (IUDs) and other contraceptive methods. Methods A cross-sectional register-based study including 16,181 women aged 30–49 years participating in the screening programme for cervical cancer in a Swedish County in 2017–2018. Data on contraception from screening records was paired with the HPV test results, cytological and histological follow-up tests and subsequent HPV test. Results There was no difference in the risk of being HPV positive, or histological HSIL+, between users of copper-containing IUDs and women with no reported use of contraception. Use of levonorgestrel intrauterine system and hormonal contraception were associated with higher odds for HPV infection in age-adjusted models (aOR 1.21; 95% CI 1.04–1.41, and aOR 1.41; 95% CI 1.22–1.63, respectively) and for HSIL+ (aOR 1.45; 95% CI 1.02–2.06, and aOR 1.56; 95% CI 1.13–2.16, respectively). No significant differences were found in HPV clearance rates. Conclusions Reported use of levonorgestrel intrauterine system and hormonal contraception, but not use of copper IUD, was associated with a higher prevalence of HPV infections and histological HSIL + compared to no reported use of contraception.

Malignant hyperthermia safety - A nationwide survey of publicly funded Swedish healthcare.

Malignant hyperthermia (MH) is a rare pharmacogenetic disorder that can lead to a life-threatening reaction during general anaesthesia with triggering agents. Prompt life-saving treatment includes the immediate administration of the antidote dantrolene. This study investigated Swedish healthcare providers' awareness and adherence to guidelines and recommendations with respect to MH and whether adherence to safe MH-praxis varies with hospital care-complexity level and private versus public management form. Agreements and procurement specifications between all 21 Swedish County Councils and privately run surgical care providers were reviewed alongside with questionnaire-aided collection of information from 62 publicly funded health care providers (both privately and publicly run). No procurement requirement specification or contract contained requirements on anaesthesia or aspects of MH. All publicly run hospitals stocked dantrolene and 28 out of 52 (54%) stocked the recommended amount. Seven out of nine (78%) of the privately run institutions stocked dantrolene, and one stocked the recommended amount. Publicly run hospitals adhered to recommendations to a greater extent than privately run institutions, both with respect to stocking of dantrolene (p = .02) and to stocking the recommended amount (p = .03). Contracts between Swedish county councils and private surgical care subcontractors rarely outline expectations of standards for the safe practice of anaesthesia such as preparedness to handle a life-threatening MH reaction. Among Swedish publicly funded anaesthesia providers there is room for improvement in adherence to the EMHG guideline on dantrolene availability. Publicly run hospitals seem to have better compliance with these recommendations than privately run institutions. Raising awareness about current guidelines is important to improve safety for known and unknown MH-susceptible individuals.

A web-based pesticide risk assessment tool for drinking water protection zones in Sweden

To protect human health, wildlife and the aquatic environment, “safe uses” of pesticides are determined at the EU level while product authorization and terms of use are established at the national level. In Sweden, extra precaution is taken to protect drinking water, and permits are therefore required for pesticide use within abstraction zones. This paper presents MACRO-DB, a tool for assessing pesticide contamination risks of groundwater and surface water, used by authorities to support their decision-making for issuing such permits. MACRO-DB is a meta-model based on 583,200 simulations of the physically-based MACRO model used for assessing pesticide leaching risks at EU and national level. MACRO-DB is simple to use and runs on widely available input data. In a qualitative comparative assessment for two counties in Sweden, MACRO-DB outputs were in general agreement with groundwater monitoring data and matched or were more protective than the national risk assessment procedure for groundwater.

Pregnancy planning and neonatal outcome - a retrospective cohort study

BackgroundUnplanned pregnancy is common, and although some research indicates adverse outcomes for the neonate, such as death, low birth weight, and preterm birth, results are inconsistent. The purpose of the present study was to investigate associated neonatal outcomes of an unplanned pregnancy in a Swedish setting.MethodsWe conducted a retrospective cohort study in which data from 2953 women were retrieved from the Swedish Pregnancy Planning Study, covering ten Swedish counties from September 2012 through July 2013. Pregnancy intention was measured using the London Measurement of Unplanned Pregnancy. Women with unplanned pregnancies and pregnancies of ambivalent intention were combined and referred to as unplanned. Data on neonatal outcomes: small for gestational age, low birth weight, preterm birth, Apgar score < 7 at 5 min, and severe adverse neonatal outcome defined as death or need for resuscitation at birth, were retrieved from the Swedish Medical Birth Register.ResultsThe prevalence of unplanned pregnancies was 30.4%. Compared with women who had planned pregnancies, those with unplanned pregnancies were more likely to give birth to neonates small for gestational age: 3.6% vs. 1.7% (aOR 2.1, 95% CI 1.2–3.7). There were no significant differences in preterm birth, Apgar score < 7 at 5 min, or severe adverse neonatal outcome.ConclusionsIn a Swedish setting, an unplanned pregnancy might increase the risk for birth of an infant small for gestational age.

Trends in mental health problems among Swedish adolescents: Do school-related factors play a role?

The aim of this study is to investigate the extent to which school-related factors, such as school liking, participation in decision-making, school-related parental support, teachers' support, and school physical environment, explain trends in mental health problems. The problems considered are psychosomatic symptoms (PSS), depressive symptoms (DS), suicidal ideations (SI), and suicide attempts (SA) among Swedish adolescents of varying socioeconomic status (SES) from 2004 to 2020. We analyzed data collected through repeated cross-sectional surveys from 19,873 15-year-old students at schools in a county in Sweden. Boys and girls each constituted 50% of the participants. We fitted linear and logistic regression models to investigate associations between the school-related factors and trends in mental health problems. Increased school-related parental support and school liking were cross-sectionally associated with decreased PSS, DS and SI, with school liking also associated with decreased SA. Conducive school physical environment was also found to be cross-sectionally associated with lower PSS and DS scores. Over time, mental health problems have shown a general increase among adolescents in the low SES group and a decrease among those in the high SES group. While school-related factors explained the improvement in mental health in the high SES group, we found such association only between parental support trends in PSS and DS, along with participation and trends in SA over time among adolescents in the low SES group. The results show that school-related factors play significant roles in influencing adolescent mental health. The influence, however, varied across SES gradients over time. This suggests that working against inequities in school-related factors would help address inequities in mental health.

Implementation of the Infant-Toddler Checklist in Swedish child health services at 18 months: an observational study

BackgroundCommunication and language disorders are common conditions that emerge early and negatively impact quality of life across the life course. Early identification may be facilitated using a validated screening tool...

The Relation between Walking Capacity and Quality of Life after Stroke: A Study of Consecutive Patients in a Swedish County Hospital

The Relation between Walking Capacity and Quality of Life after Stroke: A Study of Consecutive Patients in a Swedish County Hospital