Swedish System Research Articles

The safety effect of increased pedestrian protection, autonomous emergency braking for pedestrians and bicyclists on passenger cars, and speed management

This was the first retrospective study to estimate the effect of increased pedestrian protection, autonomous emergency braking, and speed management to reduce serious injuries among pedestrians and bicyclists. More specifically, the aim was to estimate the injury mitigating effects of the following interventions: AEB with pedestrian and bicyclist detection, Euro NCAP pedestrian test score, active bonnet, traffic calming at pedestrian and bicycle crossings, and additionally, the combined effect of the above-mentioned treatments. The main source of data was the Swedish traffic data acquisition system (Strada), where information of road traffic crashes between passenger cars and pedestrians or bicyclists for the period 1 January 2003–31 December 2022 was obtained. Cars with optional fitment of AEB systems were identified, and the license registration number was used to access individual car equipment lists to identify whether the vehicle was equipped with AEB with pedestrian and/or cyclist detection. Information about traffic calming at pedestrian and bicycle crossings was obtained from the Swedish Transport Administration. The injury metric used was risk of permanent medical impairment (RPMI) of at least one percent and ten percent. RPMI captures the risk of long-term medical impairment based on a diagnosed injury location and Abbreviated Injury Severity (AIS) score. The relative difference between the mean values of RPMI (mRPMI1%+ and mRPMI10%+) was calculated and tested using an independent two sample t-test which was conducted for unequal sample sizes and variance. Although many results were found to be statistically non-significant, the following results were found to be significant at least at 90% level. Pedestrian mRPMI10%+ was reduced by 44% in speed zones ≤ 50 km/h comparing the group struck by cars equipped with AEB with pedestrian detection compared to the group struck by cars without the system. For cyclists, the mRPMI10%+ was reduced by 35% in speed zones ≤ 50 km/h. For crashes within ± 20 meters from a pedestrian or bicycle crossing, the AEB system reduced 60% of pedestrians mRPMI10%+ at crossings with good safety standard compared to crossings of poor safety standard. The comparison of cars with poor performance (1–9 points) in the NCAP pedestrian test and cars with a high score (28–36 points) showed that pedestrian mRPMI10%+ was reduced by 48% across all speed limits, and by 64% including only those aged ≤ 64 years. For bicyclists, a significant reduction of cyclist mRPMI10%+ was found comparing low scoring cars to high scoring cars in ≤ 30 km/h speed limit (-73%) and across all speed limits (-36%). Including only those aged ≤ 64 years, the reduction was 49%. For the active bonnet, a significant reduction of mRPMI1%+ by 24% was observed but given that the rate of helmet wearing was higher in the group struck by cars with active bonnet, this difference cannot be attributed to an effect of an active bonnet. The STA safety rating of pedestrian and bicycle crossings showed that overall pedestrian mRPMI1%+ was reduced by 15%, while cyclists mRPMI10%+ was reduced by 32% comparing crossings of high safety level to crossings of poor safety level. The analysis of combined interventions showed that the total reduction of pedestrians and cyclists mRPMI10%+ together was 69%, from 6.4% to 2%. This paper demonstrates that a road environment with adapted infrastructure and speed, combined with passenger car technologies that improve the safety for vulnerable road users, can create significant reductions of serious (long-term) injuries among pedestrians and bicyclists.

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).

Universal health coverage and equal access in Sweden: a century-long perspective on macro-level policy

BackgroundWhen today’s efforts to achieve universal health coverage are mainly directed towards low-income settings, it is perhaps easy to forget that countries considered to have universal, comprehensive and high-performing health systems have also undergone this journey. In this article, the aim is to provide a century-long perspective to illustrate Sweden’s long and ongoing journey towards universal health coverage and equal access to healthcare.MethodsThe focus is on macro-level policy. A document analysis is divided into three broad eras (1919–1955; 1955–1989; 1989–) and synthesises seven points in time when policies relevant to overarching goals and regulation of universal health coverage and equal access were proposed and/or implemented. The development is analysed and concluded in relation to two egalitarian goals in the context of health: equality of access and equal treatment for equal need.ResultsOver the past century, macro-level policy evolved from the concept of creating access for the neediest and those reliant on wages for their survival to a mandatory insurance with equal right to healthcare for all. However, universal health coverage was not achieved until 1955, and individuals had to rely on their personal financial resources to cover the cost at the time of care utilization until the 1970s. It was not until 1983 that legislation explicitly stated that access to healthcare should be equal for the entire population (horizontal equity), while a vertical equity-principle was not added until 1997. Subsequently, ideas of free choice and privatization have gained significance. For instance, they aim to increase service access, addressing the Swedish health system’s Achilles’ heel in this regard. However, the principle of equal access for all is now being challenged by the emergence of private health insurance, which offers quicker access to services.Conclusions: brief summary and potential implicationsIt can be concluded that there is no perpetual Swedish healthcare model and various dimensions of access have been the focus of policy discussion. The discussion on access barriers has shifted from financial to personal and organizational ones. Today, Sweden still ranks high in terms of affordability and equity in international comparisons: although not as well as a decade ago. Whether this marks the beginning of a new trend intertwined with a decline in Sweden’s welfare ‘exceptionalism’, or is a temporary decline remains to be assessed in the future.

The Profit Motive in the Classroom—Friend or Foe?

ABSTRACT This study critically evaluates the Swedish school system’s shift toward marketization since the early 1990s, noting that the anticipated educational gains from increased competition and innovation have not materialized significantly. We attribute major barriers to innovation in the school quasi-market to systemic institutional flaws. These include a national curriculum that lacks a clear mission for knowledge promotion, a grading system that undermines reliable measures of student knowledge, and insufficient, complicated information obstructing user choice. If these problems were remedied, the Swedish school system could harness the potential benefits of competition and the profit motive, ushering in substantial educational gains.

Drivers of a more sustainable future food system – Lessons from Sweden

The global food sector is one of the most impactful sectors in the world, necessitating an urgent shift towards more sustainable practices. Sweden has made great progress in putting sustainability on the agenda as a strategic component of its national development strategy. Still, understanding how a full-scale sustainable food system can be achieved in practice and the drivers of such a transition remain unclear. In this study, we first empirically explore these drivers, their interdependencies and how these affect the Swedish food system's progress towards its sustainability objectives. Then, we assess which scenarios for the future food system in Sweden perform better with regard to sustainability considerations. For the first objective, we utilised the DEMATEL technique to identify and quantify the cause-and-effect relationships among these drivers. The results showed that revenue and the use of toxic materials are key drivers for food systems' sustainability in Sweden, suggesting a path for system improvement focus areas in the future. For the second objective, we applied TOPSIS as a decision-making method for assessing the sustainability of four different future scenarios for the Swedish food system. The outcomes suggest that food tech is the most sustainable scenario among the ones considered. The findings of this study will collectively aid in promoting sustainable consumption, encouraging a shift towards a more sustainable agrifood system in Sweden, a leading nation in sustainability efforts.

When fairness is an abstraction: equity and AI in Swedish compulsory education

ABSTRACT The paper emphasises the need to consider the social, political, and economic contexts within which educational systems operate and use Artificial Intelligence (AI). Focused on Swedish compulsory education, this study explores whether the use of AI envisioned by national authorities and educational technology companies contributes to unfairness. Through qualitative content analysis of Swedish policy documents and educational company reports, the study employs the concept of Relevant Social Groups to assess how diverse stakeholders perceive the risks and benefits of using AI in education regarding fairness. Three distinct groups are identified, each prioritising different forms of “efficiency” as a key value—economic, pedagogical, and accessibility-related. In conclusion, this study sheds light on the intricate interplay between fairness and the use of AI in the Swedish educational system. It also questions the concept of fairness revolving around formal equality of opportunities that separates fairness from the broader context of social justice.

Beyond academics: Links from teaching practices in Swedish schools to students’ achievements and mental health complaints

BackgroundDespite extensive research on the relationship between teaching practices and learning outcomes, limited attention has been given to their potential links with students’ mental health. AimsThis study investigates the relationships between three teaching practice types – teacher-centered, student-centered, and student-dominated – and both student mental health complaints and academic achievement. It furthers explores variations in these associations based on students’ socioeconomic status (SES). SampleThe analysis includes 4573 grade 9 students (aged 15–16 years) in the Swedish comprehensive school system. MethodsEmploying structural equation modelling techniques, we analyze a dataset comprising students’ cognitive test scores, their perceptions of classroom processes, self-reported mental health complaints, as well as register data on teacher-assigned grades and parental education. ResultsTeacher-centered practices are positively associated with academic achievements but lack robust links with mental health complaints. Conversely, student-centered practices are positively associated with academic achievements and correlate with lower mental health complaint frequencies. However, student-dominated practices demonstrate poor relationships with both mental health and academic achievements. Limited variations based on students’ social background reveal only two differing associations between low and high SES students: teacher-centered teaching shows stronger academic achievement associations for low SES students, while student-dominated teaching is more adversely linked to low SES students' mental health. ConclusionsThe results affirm the benefits of both teacher- and student-centered teaching practices for academic achievement while cautioning against excessive self-directed teaching. Importantly, the study highlights the role of instructional approaches in shaping not only academic outcomes but also students’ mental health.

Continued decline in the incidence of myocardial infarction beyond the COVID-19 pandemic: a nationwide study of the Swedish population aged 60 and older during 2015–2022

The number of myocardial infarctions declined during the early COVID-19 pandemic but mechanisms behind these declines are poorly understood. COVID-19 infection is also associated with an increased risk of myocardial infarction which could lead to higher incidence rates in the population. This study aims to shed light on the seemingly paradoxical relationship between COVID-19 and myocardial infarction occurrence on the population level by exploring long-term trends in incidence rates, case fatality, and proportion of patients dying before reaching a hospital. Our work is based on a linkage of administrative registers covering the entire population aged 60 + in Sweden. Considering both long-term trends since 2015 and seasonal variability, we compared observed incidence, case fatality, and proportions of patients hospitalized to expected values during 2020–2022. Despite more than 200 laboratory-confirmed COVID-19 cases per 1000 inhabitants by the end of 2022, incidence rates of myocardial infarction continued to decline, thus following the long-term trend observed already before 2020. During the first pandemic wave there was an additional incidence decline corresponding to 13% fewer myocardial infarctions than expected. This decline was neither accompanied by increasing case fatality nor by lower shares of patients being hospitalized. We found no increase in the population-level incidence of myocardial infarction despite large-scale exposure to COVID-19, which suggests that the effect of COVID-19 on myocardial infarction risk is not substantial. Increased pressure on the Swedish health care system has not led to increased risks or poorer outcomes for patients presenting with acute myocardial infarction.

Institutionalizing suspicion: Tracing the decline of the Swedish sickness insurance system in the 2000’s

This article presents an analysis of Swedish sickness insurance in the 2000’s, outlining cultural and structural shifts in political and institutional design. The study is based on analytic dualism and Margaret S. Archer’s morphogenetic model, which is used to create an analytical narrative focusing on political and institutional developments. The narrative identifies two distinct phases: one period of rapid cultural and structural change (morphogenesis), and one of institutionalization of the new structure (morphostasis). The narrative describes how a key element of the Swedish welfare state, sickness insurance, underwent a transition from an encompassing and generous to a strict and suspicious system, and how this was effectively solidified politically and organizationally. This is related both to a broader shift toward neoliberal and workfare policies, and to the specific socio-cultural and social interactions between agents to reform the system. The analysis provides a contribution to the literature by providing an internationally relevant empirical case of how an encompassing system has undergone a period of substantial decline, and by presenting a coherent long-term narrative which temporalizes this development into specific timepoints and phases.

Temporalities in asylum childhoods: time politics and children’s rights in Sweden’s asylum reception and resettlement

ABSTRACT The study of time and temporality can provide a critical understanding of the migration process and be analysed to understand temporal governance and migrants' lived temporal experiences. This article draws on Cwerner's understanding of time politics and Griffiths' theorisation of temporal tensions to consider how temporal governance and temporal regulations affect children's lived temporalities. The article draws on ethnographic fieldwork in the tradition of the sociology of childhood to explore children's lived experiences of time and temporalities in the Swedish asylum reception system and the resettlement process. The article shows how the children's lived experiences entailed different dimensions of time and temporalities and considers how time politics and temporal tensions affect childhood conditions. The article particularly explores children's lived experiences of the temporalities embedded in migration politics concerning school and housing. The article argues that children's lived experiences of time and temporality may contribute to an understanding of how the time politics embedded in the asylum reception system and the resettlement affects the conditions of asylum childhoods and in turn has an impact on children's rights.

Organizing for deputy principalship in Swedish school organizations: The triggers and factors shaping the process

Although constituting a significant position in the daily practices and development of many school organizations, little is known regarding how the position of the deputy principal is organized. The purpose of this paper is to explore how Swedish principals organize for the deputy principal position by focusing on the triggers and factors constituting their sensemaking of the division of responsibilities. The paper provides an additional perspective by focusing on the interpretive aspects comprising the organizing processes. The paper draws from qualitative interview data from a larger study on deputy principals’ position in the Swedish school system. The results show how principals’ sensemaking is triggered by contextual cues and reform-driven factors that together create spaces of ambiguity in relation to the organizing of the deputy principals’ position. Principals make sense of these events based on personal- and identity-oriented beliefs, as well as frameworks and perceived expectations from municipal organizers.

On the Way to Utilizing Green Hydrogen as an Energy Carrier—A Case of Northern Sweden

Low or even zero carbon dioxide emissions will be an essential requirement for energy supplies in the near future. Besides transport and electricity generation, industry is another large carbon emitter. Hydrogen produced by renewable energy provides a flexible way of utilizing that energy. Hydrogen, as an energy carrier, could be stored in a large capacity compared to electricity. In Sweden, hydrogen will be used to replace coal for steel production. This paper discusses how the need for electricity to produce hydrogen will affect the electricity supply and power flow in the Swedish power grid, and whether it will result in increased emissions in other regions. Data of the Swedish system will be used to study the feasibility of implementing the hydrogen system from the power system viewpoint, and discuss the electricity price and emission issues caused by the hydrogen production in different scenarios. This paper concludes that the Swedish power grid is feasible for accommodating the additional electricity capacity requirement of producing green hydrogen for the steel industry. The obtained results could be references for decision makers, investors, and power system operators.

Nurses' use of an advisory decision support system in ambulance services: A qualitative study.

To illuminate from the perspective of nurses in ambulance services the experiences of using a web-based advisory decision support system to assess care needs and refer patients. Inductive and descriptive approaches. Thirteen semi-structured interviews were conducted in the spring of 2020. The data were analysed through the reflexive thematic analysis. The Swedish web-based advisory decision support system (ADSS) was found to strengthen nurses' feelings of security when they assess patients' care needs, promote their competence and professional pride, and help them manage stress. However, the system also generated difficulties for nurses to adjust to the dynamic ambulance team and revealed a discrepancy between their professional roles and responsibilities to refer patients and provide self-care advice. The nurses thought that the support system facilitated their increased participation and helped them understand patients and significant others by offering transparency in assessment and decision making. Thus, the support system provides nurses with an opportunity to strengthen patients' independence through information and education. However, in the care relationship, nurses worked to overcome patients' expectations. Nurses using the ADSS increased their security while performing assessments and referrals and found new opportunities to provide information and promote understanding of their decisions. However, nursing care values can be threatened when new support systems are introduced, especially as ambulance services become increasingly protocol-driven. These findings have implications for nurses' work environments and help them maintain consistency in making medical assessments and in providing equivalent self-care advice when referring patients to the different levels of care. The findings will also impact researchers and policymakers who formulate decision support systems. Consolidated criteria for reporting qualitative research (COREQ). None.

Access to Work for Those Seeking Asylum: Concerns Arising from British and Swedish Legal Strategies

Abstract This article seeks to probe the controversial relationship between seeking asylum and the permission (or obligation) to work. In doing so, we recognise the concurrent claims that can be made for asylum and access to the labour market, problematising the concept of ‘work’ and its relationship to freedom and dignity from the perspective of international refugee law and European human rights norms alongside European Union (EU) law. We examine how British and Swedish legal systems have reflected two starkly opposed policy stances. The UK has long denied asylum seekers the financial and psychological benefits that come with work usually until refugee status is formally granted, but the Swedish system has facilitated a complementary pathway for asylum seekers whose labour can make (what is determined politically to be) a sufficient contribution to the economy. We identify the perceived benefits and failings of each strategy. In this context, we observe that the status quo in both countries is changing and even arguably converging around an illiberal consensus regarding the relationship between asylum and work, which will demand further attention and potentially legal challenges in the years to come.

Exploring cross-boundary collaboration for youth mental health in Sweden – a qualitative study using the integrative framework for collaborative governance

BackgroundYouth mental health is a major health concern in almost every country. Mental health accounts for about 13% of the global burden of disease in the 10-to-19-year age group. Still there are significant gaps between the mental health needs of young people and the quality and accessibility of available services. Collaboration between health and social service actors is a recognized way of reducing gaps in quality and access. Yet there is little scientific evidence on how these collaborations are applied, or on the challenges of cross-boundary collaboration in the youth mental health space. This study aims to explore how collaboration is understood and practiced by professionals working in the Swedish youth mental health system.MethodsWe conducted 42 interviews (November 2020 to March 2022) with health and social care professionals and managers in the youth mental health system in Sweden. Interviews explored participants’ experience and understanding of the purpose, realization, and challenges of collaboration. Data were analysed under an emergent study design using reflexive thematic analysis.ResultsThe analysis produced three themes. The first shows that collaboration is considered as essential and important, and that it serves diverse purposes and holds multiple meanings in relation to professionals’ roles and responsibilities. The second addresses the different layers of collaboration, in relation to activities, relationships, and target levels, and the third captures the challenges and criticisms in collaborating across the youth mental health landscape, but also in growing possibilities for future development.ConclusionWe conclude that collaboration serves multiple purposes and takes many shapes in the Swedish youth mental health system. Despite the many challenges, participants saw potential in further building collaboration. Interestingly our participants also raised concerns about too much collaboration. There was scepticism about collaboration directing attention away from young people to the professionals, thereby risking the trust and confidentiality of their young clients. Collaboration is not a panacea and will not compensate for an under-resourced youth mental health system.

Swedish Societal Transformation and the Question of Tax Incentives for Charitable Contributions to Civil Society1

Abstract The issue of how the Swedish welfare system should be organized in an increasingly market-driven economy has become an urgent one. The public sector’s retreat from its previous commitments through deregulation and new public management reforms, as well as the state’s ambition of highlighting non-profit actors as potential providers of welfare, can be understood as an illustration of two ongoing processes of transformation in Swedish society. The aim of this article is to place a legal doctrinal research methodology of the Swedish Income Tax Act´s incentive scheme for corporate and private donations to civil society at the intersection of these transformations (welfare and civil society). At the same time, it is in the understanding of the tax legislation and the advantages it can offer individuals, nonprofits or commercial actors, that changes can be brought about in both the patterns and our understanding of charity and giving. A question that arises in this context is whether it is meaningful to speak of a shift in the state’s control of the financing of civil society. The term nonprofit tax shift is introduced in the study to discuss this issue. The article also addresses how ideas, stances and policy initiatives are shaped and articulated in Swedish contemporary politics, including tax policy. The paper argues for the existence of a ressentiment driven discursive frontline, running parallel to the public dialogue on welfareand the role of nonprofits. Additionally, it examines whether these developments in tax policy have affected the notions of justice that were previously a significant consideration in designing the income tax system in Sweden.

Effects of pharmacological interventions on mortality in patients with Takotsubo syndrome: a report from the SWEDEHEART registry.

Takotsubo syndrome (TS) is a heart condition mimicking acute myocardial infarction. TS is characterized by a sudden weakening of the heart muscle, usually triggered by physical or emotional stress. In this study, we aimed to investigate the effect of pharmacological interventions on short- and long-term mortality in patients with TS. We analysed data from the SWEDEHEART (the Swedish Web System for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) registry, which included patients who underwent coronary angiography between 2009 and 2016. In total, we identified 1724 patients with TS among 228263 individuals in the registry. The average age was 66±14years, and 77% were female. Nearly half of the TS patients (49.4%) presented with non-ST-elevation acute coronary syndrome, and a quarter (25.9%) presented with ST-elevation myocardial infarction. Most patients (79.1%) had non-obstructive coronary artery disease on angiography, while 11.7% had a single-vessel disease and 9.2% had a multivessel disease. All patients received at least one pharmacological intervention; most of them used beta-blockers (77.8% orally and 8.3% intravenously) or antiplatelet agents [aspirin (66.7%) and P2Y12 inhibitors (43.6%)]. According to the Kaplan-Meier estimator, the probability of all-cause mortality was 2.5% after 30days and 16.6% after 6years. The median follow-up time was 877days. Intravenous use of inotropes and diuretics was associated with increased 30day mortality in TS [hazard ratio (HR)=9.92 (P<0.001) and HR=3.22 (P=0.001), respectively], while angiotensin-converting enzyme inhibitors and statins were associated with decreased long-term mortality [HR=0.60 (P=0.025) and HR=0.62 (P=0.040), respectively]. Unfractionated and low-molecular-weight heparins were associated with reduced 30day mortality [HR=0.63 (P=0.01)]. Angiotensin receptor blockers, oral anticoagulants, P2Y12 antagonists, aspirin, and beta-blockers did not statistically correlate with mortality. Our findings suggest that some medications commonly used to treat TS are associated with higher mortality, while others have lower mortality. These results could inform clinical decision-making and improve patient outcomes in TS. Further research is warranted to validate these findings and to identify optimal pharmacological interventions for patients with TS.

Outbreak of Salmonella Typhimurium linked to Swedish pre-washed rocket salad, Sweden, September to November 2022.

In September 2022, the Public Health Agency of Sweden observed an increase in domestic Salmonella Typhimurium cases through the Swedish electronic notification system, and an outbreak strain was identified with whole genome sequencing. Overall, 109 cases with symptom onset between 17 September and 24 November 2022 were reported from 20 of 21 Swedish regions. The median age of cases was 52 years (range 4-87 years) and 62% were female. A case-control study found cases to be associated with consumption of rocket salad (adjusted odds ratio (aOR) = 4.9; 95% confidence interval (CI): 2.4-10, p value < 0.001) and bagged mixed salad (aOR = 4.0; 95% CI: 1.9-8.1, p value < 0.001). Trace-back, supported by Finnish authorities who identified the Swedish outbreak strain in a Finnish cluster during the same time period, identified rocket salad, cultivated, pre-washed and pre-packed in Sweden as the likely source of the outbreak. No microbiological analyses of rocket salad were performed. Our investigation indicates that bagged leafy greens such as rocket salad, regardless of pre-washing procedures in the production chain, may contain Salmonella and cause outbreaks, posing a health risk to consumers. We emphasise the need for primary producers of leafy greens to identify possible contamination points to prevent outbreaks.

Recurrence of Atrial Fibrillation in Patients With New-Onset Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting

New-onset postoperative atrial fibrillation (POAF) occurs in approximately 30% of patients undergoing coronary artery bypass grafting (CABG). It is unknown whether early recurrence is associated with worse outcomes. To test the hypothesis that early AF recurrence in patients with POAF after CABG is associated with worse outcomes. This Swedish nationwide cohort study used prospectively collected data from the SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) registry and 3 other mandatory national registries. The study included patients who underwent isolated first-time CABG between January 1, 2007, and December 31, 2020, and developed POAF. Data analysis was performed between March 6 and September 16, 2023. Early AF recurrence defined as an episode of AF leading to hospital care within 3 months after discharge. The primary outcome was all-cause mortality. Secondary outcomes included ischemic stroke, any thromboembolism, heart failure hospitalization, and major bleeding within 2 years after discharge. The groups were compared with multivariable Cox regression models, with early AF recurrence as a time-dependent covariate. The hypothesis tested was formulated after data collection. Of the 35 329 patients identified, 10 609 (30.0%) developed POAF after CABG and were included in this study. Their median age was 71 (IQR, 66-76) years. The median follow-up was 7.1 (IQR, 2.9-9.0) years, and most patients (81.6%) were men. Early AF recurrence occurred in 6.7% of patients. Event rates (95% CIs) per 100 patient-years with vs without early AF recurrence were 2.21 (1.49-3.24) vs 2.03 (1.83-2.25) for all-cause mortality, 3.94 (2.92-5.28) vs 2.79 (2.56-3.05) for heart failure hospitalization, and 3.97 (2.95-5.30) vs 2.74 (2.51-2.99) for major bleeding. No association between early AF recurrence and all-cause mortality was observed (adjusted hazard ratio [AHR], 1.17 [95% CI, 0.80-1.74]; P = .41). In exploratory analyses, there was an association with heart failure hospitalization (AHR, 1.80 [95% CI, 1.32-2.45]; P = .001) and major bleeding (AHR, 1.92 [1.42-2.61]; P < .001). In this cohort study of early AF recurrence after POAF in patients who underwent CABG, no association was found between early AF recurrence and all-cause mortality. Exploratory analyses showed associations between AF recurrence and heart failure hospitalization, oral anticoagulation, and major bleeding.

스웨덴 경찰의 부패통제 시스템에 관한 연구

The purpose of this study is to examine the feature and implication of the control system of sweden police. The characteristic of the Swedish police's corruption control system is the balance between internal and external control devices. To summarize, first, A committee-centered decision-making structure prevents centralization of authority. Second, the Special Investigation Department of the National Police Agency maintains its fairness by appointing the head of the Swedish Prime Minister, ensuring independence of work, and exercising special authority to investigate corruption in specific public officials, including police officials. Third, Separate Public Prosecution Office and the National Anti-Corruption Unit are placed directly under the Minister of Justice and have the authority to investigate and prosecute corruption cases of specific public officials, including police officials. In particular, Separate Public Prosecution Office independently exercises the authority to investigate the legitimacy of police use of weapons. Fourth, prevent corruption of public funds by reviewing in advance the appropriateness of police budget use. Fifth, all decision-making processes related to police work and the exercise of police power are disclosed to the public. Sixth. It has a recruitment structure that hires qualified people with the character and ethics of a police officer. In addition, efforts are made to exclude corruption cartels and a culture of silence in police organizations by providing strong identity protection for whistle blowers.