Swedish Register Research Articles

The impact of socioeconomic status on glioma survival: a retrospective analysis

Abstract Purpose Although sociodemographic factors such as socioeconomic status (SES), travel time to health care, cohabitation status, and region of residence are observed to influence incidence and survival for several types of cancers, it is unclear whether similar effects have been observed in patients with glioma. This study investigates whether these factors affect survival for glioma patients. Methods In this retrospective study, the Swedish National Quality Registry for Brain Tumors was used to identify 1,276 patients with glioma WHO grade I–IV for whom data were deposited between 2009 and 2013. The RISK North database, which links data from the National Cancer Quality Register with citizen demographic data from the Longitudinal Integration Database for Health Insurance and Labor Market Studies (LISA), the Total Population Registry (TPR), and the Geography Database (GD), was utilized to assess survival in patients with glioma in relation to education level, cohabitation status, travel time to regional hospitals, and region of residence. Results In the multivariable analysis, longer survival was observed among WHO grade III-IV glioma patients with higher education level (middle school (ref) HR: 1, high school HR: 0.81 CI [0.67–0.98], p = 0.033; university/college HR: 0.81 CI [0.66–1.00], p = 0.048). Survival was not associated with travel time, cohabitation status, or region of residence in the multivariable survival analysis. Conclusion Low education level was associated with reduced survival for patients with glioma WHO grade III and IV in multivariable survival analyses, but no differences in survival were found in relation to travel time, cohabitation status, or region of residence.

Repurposing of phosphodiesterase-5 inhibitor sildenafil as a therapeutic agent to prevent gastric cancer growth through suppressing c-MYC stability for IL-6 transcription

Phosphodiesterase-5 (PDE5) inhibitors have shown promise as anti-cancer agents in malignancies. However, their specific effects on gastric cancer (GC) and the underlying mechanisms remain elusive. Our aim was to investigate this by combining evidence from population-based studies with data obtained from in vivo and in vitro experiments. By combing a couple of nationwide Swedish registers, GC patients who received PDE5 inhibitors were compared to matched controls while adjusting for confounding factors. The anti-tumor effect and mechanism of the PDE5 inhibitor sildenafil were evaluated via using tumor cells, patient-derived tumor organoids and xenograft animal models in GC. A total of 161 Swedish GC patients from a nationwide population-based cohort who received post-diagnostic PDE5 inhibitors demonstrated lower cancer-specific mortality compared to the controls (HR = 0.66, 95% CI = 0.47-0.92, P = 0.016). Functionally, the PDE5 inhibitor sildenafil exhibited the suppressive ability to prevent oncogenic growth in GC. Mechanistically, sildenafil restrained GC growth by directly activating PKG through PDE5 inhibition for regulating c-MYC expression via its phosphorylation and ubiquitination degradation, thereby suppressing c-MYC stability for IL-6 transcription within the downstream IL-6/JAK/STAT3 signalling pathway. The PDE5 inhibitor sildenafil may serve as a promising adjuvant for GC therapy if further randomized clinical trials confirm its efficacy.

Surgery for primary ventral hernias and risk of postoperative pain, nausea: a population-based register study

PurposeThe aim of this study was to evaluate risk factors for postoperative pain and nausea after open repair for primary ventral hernias.MethodA population-based registry study was conducted based on data assembled from the Swedish national ventral hernia repair register between January 2016 and December 2021and cross-matched with the Swedish perioperative register.ResultsAltogether 2064 open ventral hernia repairs were registered, including 816 (39.5%) performed on women. Of these, 91 (4.4%) were registered to suffer postoperative nausea or vomiting (PONV) and 403 (19.5%) postoperative pain (PP). In both univariable and multivariable logistic regression analyses, significant predictors of postoperative nausea and pain included male gender, which was associated with lower odds of both postoperative nausea (multivariable OR: 0.30, 95% CI: 0.18–0.49, P < 0.001) and postoperative pain (multivariable OR: 0.60, 95% CI: 0.44–0.83, P = 0.002). Additional predictors of postoperative nausea included emergency surgery (multivariable OR: 4.08, 95% CI: 1.10-15.08, P = 0.035), operative time > 40 min (multivariable OR: 4.15, 95% CI: 2.24–7.69, P < 0.001). Conversely total intravenous anesthesia was associated with lower incidence of PONV (multivariable OR: 0.40, 95% CI: 0.22–0.74, P = 0.003). Other factors, such as age, BMI, smoking status, ASA classification, hernia size, surgery type, operative time, and anesthesia type, were not significantly associated with postoperative pain after adjusting for other variables.ConclusionPostoperative nausea and vomiting (PONV) are significantly reduced with total intravenous anesthesia (TIVA) compared to inhalation anesthesia, with no notable difference in postoperative pain between the two methods.

Associations of Atopic Dermatitis in Late Adolescence with Occupation, Mental Health, Income from Work and Marital Status: A National Longitudinal Study.

The main aim of this study was to evaluate longitudinal associations between atopic dermatitis (AD) in late adolescence and occupational socioeconomic group, labour market participation, income from work, and marital status later in adult life. Using Swedish population-based registry data a total of 205,394 men were included, born between 1952 and 1956 in Sweden and who underwent military conscription examination including assessment of atopic dermatitis (AD) and AD severity. The associations between AD and AD severity in late adolescence and labour market participation, income from work, marital status, and medication for anxiety and depression later in adult life were examined. In this study, men with AD in adolescence, especially those with severe AD, more often had a prescription for antidepressants or anxiolytics at the age of 50-57 years (unadjusted HR 1.55, 95% CI 1.32-1.81). Interestingly, despite increased risk of poorer mental health, AD was not found to be associated with a disadvantage in terms of occupational socioeconomic group, income from work, and unemployment benefits. Individuals with mild AD showed a lower risk of holding routine and lower technical jobs compared with men without AD. Persons with AD in late adolescence seem not to differ regarding registered partnerships and marital status compared with those without AD.

From keywords to key embeddings – contrasting French and Swedish web registers using multilingual deep learning

Abstract The pervasiveness of the internet has given web language use a central role in society. However, the lack of multilingual corpora and scalable methods has led to the focus on English in web language research. To address this gap, the present paper sets itself in the register research tradition and explores French and Swedish web registers from a cross-linguistic angle. Methodologically we combine keyword analysis with multilingual deep learning, suggesting an approach that enables computational comparisons across languages. Specifically, we extract keywords for French and Swedish web registers, then associate the keywords with fastText word embeddings, and finally, cluster these key embeddings. The findings indicate that there are topical and functional clusters, and they are linguistically motivated and multilingual. The same clusters occur within the same registers in both languages pointing to shared topical and functional similarities – the registers are strikingly similar. The dissimilarities, in contrast, indicate that certain registers like Narrative blogs are to some extent different in French and Swedish. Moreover, grammatical specificities such as the location of adjectives explain some dissimilarities.

Cohabitation and Mortality Across the Life Course: A Longitudinal Cohort Study with Swedish Register-Based Sibling Comparisons

Research has shown that married individuals live longer lives than unmarried women and men. A smaller number of studies have included non-marital cohabitation and have found that their mortality falls between the married and other unmarried groups. There are indications that the cohabiting population is diverse in terms of mortality risk, yet very little is known about how the association is related to age and stages of the life course. Sweden is a forerunner in family trends, and this is the first study that examines cohabitation and mortality in a Swedish context. Using Swedish register data for the years 2012–2017, we investigated how different partnership statuses are related to mortality for men and women at different ages (N = 5,572,011). We also examine whether the association between cohabitation and mortality is similar after accounting for family-of-origin effects through the use of a sibling comparison design. Our findings confirmed the notion of cohabiters as a diverse group whose relative mortality risk differs depending on the timing of cohabitation. Never-married cohabiters had a mortality risk similar to married couples at younger ages and a gradually increased risk with age. Divorced and widowed cohabiters exhibited an age gradient in the opposite direction. Future research should consider how the context of cohabitation changes across the life course.

Improved outcomes after groin hernia surgery in Sweden between 1992 and 2021: Swedish Hernia Register

PurposeSurgery for groin hernia is one of the most common operations in the world. Therefore, research concerning the outcomes of groin hernia surgery is extremely important both for the individual patient as well as for those providing the healthcare funding. The aim of this study is to evaluate the outcomes of hernia surgery in Sweden over a 30 year time period, from 1992 to 2021.MethodsAll groin hernia repairs in the Swedish Hernia Register between 1992 to 2021 were analyzed with emphasis on the surgical method, reoperation rate for recurrence and date of surgery, specifically 1992–2001, 2002–2011 and 2012–2021. By using personal identification numbers, a cumulative reoperation rate has been deduced for males and females separately.ResultsA total of 368,502 groin hernia operations identified in the Swedish Hernia Register between 1992 to 2021 were eligible for analysis. Since the register was begun, there have been significant changes in the choice of operative techniques, from suture repair in 1992 to open anterior mesh repair around the year 2000, until today, where an increasing proportion of hernias are repaired using laparo-endoscopic techniques. There has been a reduction in the reoperation rate for recurrence in both males and females, with the most pronounced improvement being seen in females. The laparo-endoscopic technique is associated with a reduced incidence of reoperation for recurrence in females.ConclusionGroin hernia surgery in Sweden has undergone substantial changes over the past 30 years. Reoperation for recurrence has decreased significantly during recent years, especially in females.

1-year data on patient-reported outcome is enough after surgery for degenerative cervical myelopathy: a cohort study from the Swedish Spine register.

Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Repeated follow-ups after surgery are resource consuming. The aim was to examine whether patient-reported outcome measures (PROMs) change after the first year. The purpose of this study was to investigate whether it is necessary to obtain follow-up data from patients more than 1 year after surgery for DCM. We included individuals treated surgically for DCM in the Swedish Spine registry (Swespine), with available preoperative, 1-, and 2-year PROMs, primarily the European Myelopathy Scale (EMS) and secondarily the Neck Disability Index (NDI), and the European Quality of life Visual Analogue Scale (EQ-VAS). A tertiary analysis included available 5-year data. Median, interquartile range (IQR), and Bland-Altman plots were used to compare PROM data at different follow-up time points. 642 individuals had baseline, 1-, and 2-year follow-up data, of whom 347 also had 5-year data. EMS was 14 (12-16) preoperative, 15 (12-17) at the 1-year follow-up, and 15 (12-17) at the 2-year follow-up. Corresponding data for NDI was 38 (24-50), 25 (12-42), and 26 (12-42) and for EQ-VAS 50 (30-60), 60 (42-77), and 60 (40-75). Similar findings were seen in individuals who also had 5-year data. Bland-Altman plots indicated good agreement between 1- and 2-year data, and between 1- and 5-year data and were without proportional bias. In individuals treated for DCM no clinically meaningful change in PROMs occurred after the 1-year follow-up.

Implementation of guideline-recommended therapies in heart failure with reduced ejection fraction according to heart failure duration: An analysis of 55 581 patients from the Swedish Heart Failure (SwedeHF) Registry.

Guidelines recommend immediate initiation of all four class I guideline-directed medical therapies, renin-angiotensin system inhibitors (RASI) or angiotensin receptor-neprilysin inhibitors (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA) and sodium-glucose cotransporter 2 inhibitors (SGLT2i) following the diagnosis of heart failure (HF) with reduced ejection fraction (HFrEF). The extent to which this occurs in new-onset HFrEF is unclear. We assessed guideline-recommended therapies during the first year following a HFrEF diagnosis. The Swedish HF Registry was linked to additional national registries. In patients with HFrEF (ejection fraction <40%), clinical characteristics and HF treatment from when they were available and recommended in guidelines were assessed according to time from HF diagnosis (<3, 3 to <6, 6-12 and >12 months). Of 55 581 patients with HFrEF enrolled between 2000 and 2021, 54%, 5.8%, 4.8% and 36% had an HF duration of <3, 3 to <6, 6-12 and >12 months, respectively. Patients with shorter HF duration were younger, had lower New York Heart Association class and had fewer cardiovascular comorbidities. Within 3 months, 3 to <6 months, 6-12 months and >12 months from HF diagnosis, 93%, 92%, 90% and 89% were on RASI or ARNI, 9.8%, 17%, 19% and 22% on ARNI alone, 35%, 43%, 44% and 46% on MRA, 92%, 92%, 92% and 91% on beta-blockers, and 26%, 30%, 19% and 28% on SGLT2i, respectively. Additionally, 18% received cardiac resynchronization therapy/implantable cardioverter-defibrillator >12 months after diagnosis. Most patients received RASI and beta-blockers in the first months following HFrEF diagnosis. Use of ARNI, MRA and SGLT2i was limited, both in the early and later time periods. Our findings suggest that strategies to improve guideline-directed use of HFrEF therapies remain urgently needed.

Infective endocarditis caused by Gemella – a retrospective registry-based study

Purpose Infective endocarditis (IE) is diagnosed using the Duke criteria, which were updated in 2023. In the Duke-ISCVID 2023 criteria, Gemella was recognised as a typical IE pathogen. This study investigates the impact of this change and compares the clinical characteristics of Gemella IE to IE caused by other pathogens. Methods Data on IE caused by Gemella species and other pathogens was retrieved from the Swedish Registry of Infective Endocarditis (SRIE). Clinical characteristics of Gemella IE were compared to episodes of IE caused by non-beta haemolytic streptococci, by Staphylococcus aureus and by enterococci. Results In the SRIE, 29 episodes of Gemella IE were identified among a total of 7677 registered episodes, corresponding to 0.4% of all cases. The most common species were Gemella morbillorum (47%) and Gemella bergerii (27%). The proportion of episodes meeting the criteria for definite IE increased from 13 (45%) with the modified Duke criteria to 21 (72%) with the Duke-ISCVID criteria. Median age of patients with Gemella IE was 70 years, 40% were females and 90% hade native valve IE. One third of the patients underwent heart valve surgery and only one patient (3%) died. Many clinical aspects of IE caused by Gemella resembled those of IE caused by non-beta haemolytic streptococci. Conclusions Gemella IE is a rare condition and shares several characteristics with IE caused by non-beta haemolytic streptococci. The prognosis of IE caused by Gemella appears to be relatively favourable.

Young age and return to play increase the likelihood of subsequent ACL reconstruction in football players: Data from the Swedish National Knee Ligament Registry.

To compare football players who have undergone one anterior cruciate ligament (ACL) reconstruction (ACLR) with those who have undergone a subsequent ACLR (revision or contralateral) regarding (1) demographics, (2) football-related factors and (3) injury-specific data. Players who voluntarily completed a football-specific questionnaire available at the Swedish National Knee Ligament Registry website between April 2017 and September 2020 at the time of their primary ACL injury were included in the study. The questionnaire covered demographics, football-related activities and injury-specific factors. Subsequent ACLR registrations within 4 years of the primary ACLR were identified in December 2023. Data on game participation post-primary ACLR were retrieved from the Swedish Football Association's administrative system in September 2022. A total of 992 football players (66% men) were included, of whom 99 (10%) were registered for subsequent ACLRs. Univariable analysis showed that the following factors significantly increased the odds of a subsequent ACLR: female sex, younger age, a lower weight and body mass index, fewer years played, use of knee control exercises during warm-up, more likely to plan a return to football, more game participation registered following the primary ACLR, and shorter time between injury and ACLR. Multivariable logistic regression analysis indicated that the odds of undergoing subsequent ACLR decreased significantly with each additional year of age (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.83‒0.92, p < 0.01). Players using knee control exercises during warm-up (OR, 1.71; 95% CI, 1.08‒2.72, p = 0.02), planning to return to football (OR, 2.74; 95% CI, 1.27‒5.91, p = 0.01), and participating in games after primary ACLR (OR, 1.81; 95% CI, 1.13‒2.91, p = 0.01) increased the odds of undergoing a subsequent ACLR. Younger age and returning to play after an ACLR significantly increase the likelihood of undergoing a subsequent ACLR in football players. Level IV.

Desmoplastic melanoma in Sweden in 2009-2022: Apopulation-based registry study demonstrating distinctive tumour characteristics, incidence and survival trends.

Desmoplastic melanoma (DM) is a rare subtype, accounting for less than 5% of primary cutaneous invasive melanomas. DM often arises in chronically sun-exposed skin, in older individuals. While the incidence of cutaneous melanoma has increased globally, trends specific to DM are less documented and studies on survival outcomes for DM are inconsistent. To study patient and tumour characteristics, incidence trends and survival outcomes of desmoplastic melanoma in comparison with other melanoma subtypes using data from the population-based Swedish Melanoma Registry (SweMR). Clinicopathological variables were obtained from SweMR, for patients diagnosed with invasive cutaneous melanomas diagnosed in Sweden from 2009 to 2022. Incidence rates of DM per 100,000 inhabitants were calculated. DM cases were identified and survival outcomes were compared across DM, superficial spreading melanoma (SSM), nodular melanoma (NM) and lentigo maligna melanoma (LMM). Survival was analysed using Kaplan-Meier and Cox regression methods. Among 48,945 invasive melanomas, 388 (0.8%) were identified as DM. The incidence ranged between 0.1 and 0.4 cases per 100,000, without a evident rise, beside a certain peak in 2019-2020 in the men. DM had compared to other melanoma subtypes the thickest primary tumours (p < 0.001). When adjusting for baseline prognostic factors, DM patients had an improved melanoma-specific survival (HR 0.36, 95% CI 0.26-0.49). No significant improvement in survival was observed for DM diagnosed in 2015-2022 compared to those diagnosed in 2009-2014 (adjusted HR 0.99, 95% CI 0.45-2.14), whereas other subtypes showed an improvement (adjusted HR 0.74, 95% CI 0.68-0.80). In contrast to the rising incidence of other melanoma subtypes, the incidence of DM has remained more stable over recent years. Despite presenting with adverse prognostic features, survival from DM is superior when adjusting for these factors. However, the introduction of anti-PD-1 therapy has not significantly improved survival for DM patients.

Epidemiology and outcomes of alpha-1 antitrypsin deficiency in Sweden 2002-2020: A population-based cohort study of 2286 individuals.

To estimate the incidence, prevalence, and outcomes of patients with diagnosed alpha-1-antitrypsin deficiency (AATD) in Sweden, 2002-2020. The Swedish National Patient Registry was utilized to identify patients with a first diagnosis of AATD between 2002 and 2020. Each patient was matched with up to 10 comparators from the general population. AATD incidence and prevalence were estimated. Causes of death and rates of mortality, transplantation, lung disease, liver cirrhosis, and previous neonatal cholestasis were estimated. The incidence rate of AATD was 1.83 (95% confidence interval [CI] 1.58-2.11) per 100,000 person-years and the total prevalence was 21.04 (95%CI=20.17-21.94) per 100,000 persons at the end of 2020. Mortality was 3.55 times higher (95%CI=3.15-3.99) for patients with AATD. Rates of liver-(hazard ratio [HR]=22.95, 95%CI=12.61-41.75), lung-(HR=12.09, 95%CI=8.87-16.47), and cardiovascular (HR=1.90, 95%CI=1.45-2.90) related death were higher in patients with AATD. The cumulative incidence after 10 years of follow-up was 1.69% (95%CI=1.15-2.41) for liver transplantation and 4.14% (95%CI=3.20-5.26) for lung transplantation. About 20% of patients were estimated to be alive without lung disease or liver cirrhosis 20 years after an AATD diagnosis. Neonatal cholestasis codes were found in 3.0% of AATD patients and 0.5% of comparators (odds ratio 6.28, 95%CI=3.81-10.36). In this population-based cohort study on AATD in Sweden, an increasing incidence was observed, and significantly higher rates of death from liver, lung, and cardiovascular causes compared to the general population were found. Only a minority of diagnosed AATD patients were estimated to be free of liver cirrhosis and lung disease after 20 years.

Medications and cognitive decline in Alzheimer's disease: Cohort cluster analysis of 15,428 patients.

Medications for comorbid conditions may affect cognition in Alzheimer's disease (AD). To explore the association between common medications and cognition, measured with the Mini-Mental State Examination. Cohort study including persons with AD from the Swedish Registry for Cognitive/Dementia Disorders (SveDem). Medications were included if they were used by ≥5% of patients (26 individual drugs). Each follow-up was analyzed independently by performing 100 Monte-Carlo simulations of two steps each 1) k-means clustering of patients according to Mini-Mental State Examination at follow-up and its decline since previous measure, and 2) Identification of medications presenting statistically significant differences in the proportion of users in the different clusters. 15,428 patients (60.38% women) were studied. Four clusters were identified. Medications associated with the best cognition cluster (relative to the worse) were atorvastatin (point estimate 1.44 95% confidence interval [1.15-1.83] at first follow-up, simvastatin (1.41 [1.11-1.78] at second follow-up), warfarin (1.56 [1.22-2.01] first follow-up), zopiclone (1.35 [1.15-1.58], and metformin (2.08 [1.35-3.33] second follow-up. Oxazepam (0.60 [0.50-0.73] first follow-up), paracetamol (0.83 [0.73-0.95] first follow-up), cyanocobalamin, felodipine and furosemide were associated with the worst cluster. Cholinesterase inhibitors were associated with the best cognition clusters, whereas memantine appeared in the worse cognition clusters, consistent with its indication in moderate to severe dementia. We performed unsupervised clustering to classify patients based on their current cognition and cognitive decline from previous testing. Atorvastatin, simvastatin, warfarin, metformin, and zopiclone presented a positive and statistically significant associations with cognition, while oxazepam, cyanocobalamin, felodipine, furosemide and paracetamol, were associated with the worst cluster.

Degree of Preoperative Bilateral Hearing Affects Patient-Reported Outcome in Primary Stapedotomy.

To investigate whether degree of asymmetric hearing impairment influences patient-reported outcome measures and objective hearing results in primary stapedotomy. Register study. Data from the Swedish Quality Register for Otosclerosis Surgery consisting of 90% of stapes operations performed in Sweden. The 984 patients eligible for inclusion were categorized on the basis of preoperative hearing impairment: unilateral, bilateral asymmetric, or bilateral symmetric. Pure-tone audiometry and patient-reported outcome measures were analyzed, and Glasgow benefit plots were constructed. Ordinal logistics regression analyses were performed to adjust for factors influencing PROMs associated with degree of asymmetric hearing. Over 90% of patients across all groups reported improved or much improved hearing ability post-surgery. Ninety-five percent of patients who rated their hearing as worse or much worse after surgery had an air-conductive gain of <20 dB PTA4. Individuals with unilateral hearing impairment were more likely to report lower satisfaction with hearing function and daily life activities after surgery compared with those with bilateral hearing impairment, especially bilateral symmetric hearing impairment. In terms of hearing function, the bilateral symmetric hearing impairment group showed a significant decrease in the log odds of reporting lower satisfaction with a coefficient of -0.71 (95% confidence interval, -1.13 to -0.33), whereas the bilateral asymmetric hearing impairment group showed a nonsignificant decrease with a coefficient of -0.14 (95% confidence interval, -0.41 to 0.14) compared with the unilateral hearing impairment group. Tinnitus was more frequent in those with unilateral hearing impairment. Those with preoperative unilateral hearing impairment were more likely to express lower satisfaction with the results, compared with patients with bilateral impairment. Our findings suggest that the degree of bilateral hearing impairment should be considered in preoperative counseling, to better align with patient expectations regarding the benefit of surgery. An estimated air-conductive gain of at least 20 dB PTA4 was favorable for patient satisfaction.

Adverse Outcomes After Cemented and Cementless Primary Elective Total Hip Arthroplasty in 60,064 Matched Patients: A Study of Data From the Swedish Arthroplasty Register.

The choice between cemented and cementless fixation in primary elective total hip arthroplasty (THA) remains a subject of ongoing debate. However, comparisons between the two are subject to limited adjustments for patient characteristics, diagnoses, and surgical factors, as well as by limited outcome time endpoints. Our study aimed to compare the effect of femoral fixation on safety and implant survival outcomes in matched patients. Using propensity score techniques, we matched patients undergoing cemented (n = 101,523) and cementless (n = 52,996) primary elective THA in the Swedish Arthroplasty Register (SAR) based on age, sex, American Society of Anesthesiologists (ASA)grade, body mass index (BMI), hospital type, and pre-operative diagnosis between 2008 and 2018. We used both regression and survival models for 30, 60, and 90 days, as well as one and two years, to compare outcomes, including mortality, revision, and periprosthetic femoral fracture necessitating revision surgery. There were 30,032 cementless femoral fixations one-to-one matched with cemented ones using the Gradient Boosting Machine (GBM) modeling to estimate the propensity score. Regression analyses showed that cementless fixation had lower mortality outcomes (OR [odds ratio] 0.73, 95% CI [confidence interval] 0.69 to 0.78, P < 0.001), but significantly worse revision (OR 1.51, 95% CI 1.38 to 1.65, P < 0.001) and periprosthetic femoral fracture (OR 2.40, 95% CI 1.92 to 2.99, P < 0.001). Kaplan-Meier survival models showed statistically significant lower mortality risks for uncemented fixation at the 2-year interval (HR [hazard ratio] 0.82, 95% CI 0.71 to 0.94, P = 0.006), but not at earlier endpoints. Revision and periprosthetic femoral fractures were both higher for cementless rather than cemented fixation. This study found no significant differences in early mortality between cemented and cementless femoral implants. However, cementless fixation was associated with increased risks of revision and periprosthetic femoral fractures. These findings emphasize the importance of considering implant choice in the context of individual patient characteristics and surgical priorities to optimize outcomes in total hip arthroplasty.

Obesity Affects Disease Activity and Progression, Cognitive Functioning, and Quality of Life in People With Multiple Sclerosis.

While obesity is a known risk factor of the development of multiple sclerosis (MS), its impact on MS disease progression remains unclear. We aimed to investigate the influence of body mass index (BMI) on disease activity and progression, cognitive performance, and health-related quality of life in patients with MS. Patients from an incident population-based case-control study (n = 3,249) were categorized based on BMI status at diagnosis and followed up after diagnosis through the Swedish MS registry. Outcomes included changes in the Expanded Disability Status Scale (EDSS), Multiple Sclerosis Impact Scale 29, and Symbol Digit Modalities Test. The mean follow-up time was 10.6 years (SD 6.1). Linear mixed models were used to analyze long-term changes while Cox regression models assessed the risk of 24-week confirmed disability worsening, time to reach EDSS score 3 and EDSS score 4, the appearance of new lesions on MRI, patient-reported physical and psychological worsening, and processing speed worsening. Obesity, compared with healthy weight, was associated with a 0.02-point faster annual increase in the EDSS score (β for EDSS score x time 0.02, 95% CI 0.00-0.04). In addition, obesity was linked to a higher risk of reaching EDSS score 3 (HR 1.43, 95% CI 1.17-1.75) and EDSS score 4 (HR 1.40, 95% CI 1.07-1.73) and an increased risk of physical and psychological worsening. New lesions on MRI were more frequent among those with overweight and obesity, compared with those with healthy weight (HR 1.21, 95% CI 1.02-1.44 and HR 1.29, 95% CI 1.03-1.62, respectively). Among those who had not changed BMI group during follow-up, the associations between obesity and unfavorable outcomes became more pronounced, and the HR of cognitive disability worsening was 1.51 (95% CI 1.09-2.09) among those with obesity, compared with nonobese participants. In participants with MS, obesity was associated with faster disease progression, poorer health-related quality of life, and more rapid cognitive decline. Both overweight and obesity were associated with higher MRI activity.

Evaluating ADHD medication trial representativeness: a Swedish population-based study comparing hypothetically trial-eligible and trial-ineligible individuals.

Randomised controlled trials (RCTs) evaluating ADHD medications often use strict eligibility criteria, potentially limiting generalisability to patients in real-world clinical settings. We aimed to identify the proportion of individuals with ADHD who would be ineligible for medication RCTs and evaluate differences in treatment patterns and clinical and functional outcomes between RCT-eligible and RCT-ineligible individuals. We used multiple Swedish national registries to identify individuals with ADHD, aged at least 4 years at the age of diagnosis, initiating pharmacological treatment between Jan 1, 2007, and Dec 31, 2019, with follow-up up to Dec 31, 2020. Hypothetical RCT ineligibility was established using exclusion criteria from the international MED-ADHD dataset, including 164 RCTs of ADHD medications. Cox models evaluated differences in medication switching and discontinuation within 1 year between eligible and ineligible individuals. Quasi-Poisson models compared eligible and ineligible individuals on rates of psychiatric hospitalisations, injuries or accidents, and substance use disorder within 1 year of initiating ADHD medications. People with lived experience of ADHD were not involved in the research and writing process. Of 189 699 individuals included in the study cohort (112 153 men and boys [59%] and 77 546 women and girls [41%]; mean age 21·52 years [SD 12·83; range 4-68]) initiating ADHD medication, 53% (76 477 [74%] of 103 023 adults [aged >17 years], 12 658 [35%] of 35 681 adolescents [aged 13-17 years], and 10 643 [21%] of 50 995 children [aged <13 years]) would have been ineligible for RCT participation. Ethnicity data were not available. Ineligible individuals had a higher likelihood of treatment switching (hazard ratio 1·14, 95% CI 1·12-1·16) and a decreased likelihood of medication discontinuation (0·96, 0·94-0·98) compared with eligible individuals. Individuals ineligible for RCTs had significantly higher rates of psychiatric hospitalisations (ncidence rate ratio 9·68, 95% CI 9·57-9·78) and specialist care visits related to substance use disorder (14·78, 14·64-14·91), depression (6·00, 5·94-6·06), and anxiety (11·63, 11·56-11·69). Individuals ineligible for ADHD medication trials face higher risks of adverse outcomes. This study provides the first empirical evidence for the limited generalisability of ADHD RCTs to real-world clinical populations, by applying eligibility criteria extracted from a comprehensive dataset of RCTs to a large real-world cohort. Triangulating evidence from RCTs and real-world studies is crucial to inform rigorous evidence-based treatment guidelines. National Institute of Healthcare and Research, European Union's Horizon 2020, and Swedish Research Council.

Using Time in Tight Glucose Range as a Health-Promoting Strategy in Preschoolers With Type 1 Diabetes.

Children who develop diabetes in their first years of life risk being exposed to many decades of hyperglycemia, hence having a high risk of early complications and premature death. An additional age-dependent risk is that dysglycemia, especially hyperglycemia, negatively affects the developing brain. In evaluating the outcome of insulin treatment at an individual and group level, cutoff thresholds for glucose values are needed. Time in tight range (TITR) was defined as a measurement of time spent in a state of normoglycemia. The International Society of Pediatric and Adolescent Diabetes recommended that for preschoolers with type 1 diabetes (T1D), either >70% of time with glucose in range 70-180 mg/dL (3.9-10 mmol/L) or >50% of time in a tighter range 70-140 mg/dL (TITR) can be used as continuous glucose monitoring targets. In Sweden, over the past two decades, pediatric diabetes teams set glycemic targets to 70-140 mg/dL (3.9-7.8 mmol/L). Swedish registry data show that >50% of children <7 years old have >50% TITR. The purpose of this review is to share and discuss international knowledge and experiences of working with TITR as a health-promoting strategy in preschoolers with T1D on a structural and individual level. We conclude that as insulin treatment improves, a reasonable goal is to strive for as much time in a state of normoglycemia as possible, and this can easily be explained to families of children with diabetes. For children with access to an experienced health care team and diabetes technologies a currently realistic target can be at least half of the time in normoglycemic range, i.e., TITR >50%.

Emotional Distress in Younger (

Research has shown that younger patients who have had a myocardial infarction (MI) experience more emotional distress than their older counterparts. In this study, we aimed to compare emotional distress 2 months post-MI (follow-up 1) between younger (<55) vs older (≥55) patients in Sweden, and investigate its impact on working status and 4 secondary preventive goals 1 year after MI (follow-up 2). Data (N = 50 213) from the SWEDEHEART National Quality Registers for Cardiac Care, which covers approximately 90% of all MIs in Sweden, were used. After adjusting for confounders, logistic regression analyses showed that younger patients who had experienced an MI had higher odds of experiencing emotional distress than older patients at follow-up 1 (adjusted odds ratio [AOR], 1.59; 95% confidence interval [CI], 1.52-1.67) and follow-up 2 (AOR, 1.47; 95% CI, 1.40-1.55). Emotional distress at follow-up 1 was associated with lower odds of working (AOR, 0.60; 95% CI, 0.53-0.67) and achieving smoking and physical activity goals (AOR, 0.76; 95% CI, 0.67-0.86; AOR, 0.83; 95% CI, 0.76-0.91) at follow-up 2. However, emotional distress was not associated with achieving goals for low-density lipoproteins or systolic blood pressure at follow-up 2. Younger patients experienced emotional distress more often after a first-time MI than their older counterparts, and their distress predicted long-term lower levels of returning to work and achievement of smoking and physical activity goals. The results highlight the importance of identifying younger patients who have had an MI and are experiencing emotional distress, and offering them interventions targeting distress.