Western Sweden Research Articles

Occupational balance and associated factors among students during higher education within healthcare and social work in Sweden: a multicentre repeated cross-sectional study

ObjectiveThe aim was to explore whether occupational balance is associated with health, health-promoting resources, healthy lifestyle and social study factors among students during higher education within healthcare and social work.DesignThe...

Physical activity on prescription for children with obesity: a focus group study exploring experiences in paediatric healthcare.

Insufficient physical activity is a growing public health concern and is closely linked to obesity in both adults and children. Swedish physical activity on prescription (PAP) is effective in increasing physical activity levels in adults, but knowledge about how PAP is used in paediatric healthcare is lacking. Therefore, this study aimed to explore experiences of working with PAP for children with obesity amongst paediatric staff and managers. Seven focus group discussions with 26 participants from paediatric outpatient clinics in western Sweden were conducted. Data were analysed both inductively and deductively, framed by the Normalization Process Theory's four core constructs: coherence, cognitive participation, collective action, and reflexive monitoring. The PAP work for children with obesity was experienced to be about helping children to become physically active, and less about losing weight. Identified barriers for using PAP were the non-uniform nature of the work and a perceived lack of guidelines. Collaboration with physiotherapists and physical activity organisers outside the organisation was identified as an important facilitator. An important contextual factor for implementing PAP is the collaboration between paediatric clinics and physical activity organisers. In the transition between these stakeholders, maintaining a family-centred approach when working with PAP was experienced as challenging. PAP is a well-known intervention that is inconsistently used for children with obesity. The intervention should include a family-centred approach for this patient group. It also needs to align better with existing collaborations with other healthcare units as well as with new forms of collaboration with physical activity organisers in the community.

Calibration of medical gamma cameras for estimation of internal contamination from 137Cs

Calibration of 22 gamma camera units was performed at 15 hospitals in southern and western Sweden to estimate 137Cs contamination in humans in a supine static geometry, with a new developed calibration protocol and phantom. The minimum detectable activities (MDAs) and the estimated committed effective doses (CEDs) were calculated for each calibration. Generic calibration factors were calculated for five predetermined groups based on the detector type and manufacturer. Group 1 and 2 included NaI-based gamma cameras from General Electrics (GEs) with a crystal thickness of 5/8′′ and 3/8′′ respectively. Group 3 and 4 included NaI-based gamma cameras from Siemens Healthineers with a crystal thickness of 3/8′′, with a similar energy window as the GE NaI-based cameras and a dual window respectively. Group 5 included semiconductor-based gamma cameras from GE with a CdZnTe (CZT) detector. The generic calibration factors were 60.0 cps kBq−1, 52.3 cps kBq−1, 50.3 cps kBq−1, 53.2 cps kBq−1 and 48.4 cps kBq−1 for group 1, 2, 3, 4, and 5 respectively. The MDAs ranged between 169 and 1130 Bq for all groups, with measurement times of 1–10 min, corresponding to a CED of 4.77–77.6 μSv. A dead time analysis was performed for group 1 and suggested a dead time of 3.17 μs for 137Cs measurements. The dead time analysis showed that a maximum count rate of 232 kcps could be measured in the calibration geometry, corresponding to a CED of 108–263 mSv. It has been shown that semiconductor-based gamma cameras with CZT detectors are feasible for estimating 137Cs contamination. The generic calibration factors derived in this study can be used for gamma cameras of the same models in other hospitals, for measurements in the same measurement geometry. This will increase the measurement capability for estimating internal 137Cs contamination in the recovery phase following radiological or nuclear events.

Awareness of somatisation disorder among Swedish physicians at emergency departments: a cross-sectional survey

BackgroundSomatisation is a highly prevalent psychiatric syndrome in both women and men, in which psychological distress is manifested in physical symptoms without a medical explanation. Many patients with somatisation disorder are high healthcare utilisers, particularly at emergency departments. Unnecessary investigations and diagnostic operations occur frequently, which cause both patient suffering and a significant burden on the healthcare system. Emergency department physicians’ awareness of somatisation and its manifestations has not previously been studied. This study aimed to investigate awareness about somatisation disorder among physicians working at emergency departments in western Sweden, and to explore differences between gender, specialty, and work experience.MethodsA web-based, cross-sectional survey consisting of six dichotomous questions about somatisation disorder was conducted, in December 2021 – January 2022, among licensed physicians of various specialties working at emergency departments in western Sweden. Descriptive analyses and comparative analyses were performed to investigate differences between gender, type of specialty, and years of practice. Data were analysed using chi2 tests and Fisher’s exact test.ResultsOf the 526 eligible physicians who received the survey, 241 responded; response rate 45.8%. The majority of the respondents (56.4%) were women, and most (35.3%) were specialised in obstetrics/gynaecology. Average years of work experience was 11.1 (SD 8.7) years. Although 71% of respondents were aware of the diagnosis, only 7% knew the diagnostic criteria and only 6% had ever diagnosed a patient with somatisation disorder. Female physicians were more aware of underlying factors than their male colleagues (55.7% vs. 38.2%; p = .010). Type of specialty or years of practice did not affect awareness.ConclusionsAwareness of somatisation disorder is low among physicians working at emergency departments in western Sweden. The findings suggest a need to increase awareness and knowledge and provide training in diagnosing the condition, to ensure correct decisions and optimal patient management. Clinical guidelines need to be developed to support diagnosis, investigation, and treatment, in Sweden as well as internationally.

Facing a new life-The healthy transition to motherhood: What individual and environmental factors are needed? A phenomenological-hermeneutic study

ObjectiveThe aim of the study was to highlight first-time mothers’ experiences of the transition to motherhood uncovering personal and environmental conditions facilitating or preventing the process of a healthy transition in a Swedish context. DesignA qualitative study with interview data analyzed using a phenomenological hermeneutic method. Setting and participantsTen recent first-time mothers were selected from three primary healthcare centers in western Sweden. FindingsFour themes emerged, and the transition could be divided into several phases, interpreted as facing a new life, while feeling unprepared for identity and existential issues. The experience of becoming a mother was described as oscillation between a loss of former identity from previous life, and on the other hand, the joy and expectations of forming a new family. The mothers had high demands of themselves, often influenced by social media and needed to value the flow of information and `let go of control` to be able to make adequate decisions. The close family of origin was invaluable in this process being able to provide confirmation in the new role, facilitating the development of their own security and self-confidence. Key conclusionsThe vulnerability expressed by new mothers shows that support from the family of origin, partners and professionals are indispensable. The desired result after the transition to motherhood is a prosperous, maturity and confident mother. The main promoting factor in this process seems to be having a safe base that can provide required support. Implications for practiceThe level of wellbeing after the transition is crucial and the possibility of a warm, responsive and secure parenting needs to be strengthened. The challenge to preventive health care will be to identify a lack of support and ensure that these mothers gain sufficient support to meet today´s demands and still feel that they are good enough mothers for their children.

Follow-up Routines Matter for Adherence to Endocrine Therapy in the Adjuvant Setting of Breast Cancer.

Endocrine therapy (ET) adherence leads to increased survival in breast cancer (BC). How follow-up should be done to maximize adherence is not known. To assess adherence to ET, factors favouring adherence to ET and effects on survival in a population-based cohort of BC patients in western Sweden. This is a retrospective study. We included 358 patients operated for oestrogen receptor-positive BC and recommended 5 years of ET, in Region Halland, Sweden, year 2015 to 2016. Demographical, clinical and pathological data and use of ET were retrieved from the electronic medical records. Patients were considered adherent if taking ET for 5 years or during the full extent of the follow-up, until termination of ET due to BC relapse or death and where renewals of prescriptions of ET covered ⩾80% of the ordinated dose. Two follow-up routines were employed, ie, routine A where patients were contacted annually by nurses and a more passive follow-up routine B where patients were only contacted by nurses at 2 years and 5 years following start of ET. Medication persistence for 4 years and more was good and similar between patients initiating aromatase inhibitor (AI) and tamoxifen (75.7% and 72.0%, respectively, P = .43). More patients initiating AIs changed ET due to side effects compared with patients initiating tamoxifen (24.3% vs 9.9%, respectively, P < .0001). Endocrine therapy adherence was better for follow-up routine B than for follow-up routine A (hazard ratio [HR] = 2.71 [1.44-5.09], P = .0027). Adherence to ET in BC is high in Western Sweden. Less regular nurse-initiated contacts between BC patients and nursesled surprisingly to a better adherence than a more regular nurse-initiated contact.

Prevalence and nature of patient-reported antiseizure medication side effects in a Swedish regional multi-center study

PurposeSide effects is one of the major clinical problems in epilepsy care. We assessed the prevalence of ASM side effects in participants in a large regional multicenter observational study in western Sweden and aimed to identify risk factors and inventory the nature of side effects with different ASM regimes. MethodsCross-sectional analysis of survey answers and clinical characteristics of 406 adult participants recruited to a regional observational study between December 2020 and March 2023. Half of the participants had been seizure free for one year. Second-generation or newer ASMs were the most common. ResultsA total of 164 (40 %, 95 %CI: 36–45) patients reported side effects. Patients reporting side effects were younger (median 41 vs 47 years, p = 0.015), had more frequently experienced a seizure in the last year (p = 0.02), and were more often on ASM polytherapy (p < 0.01). ASM polytherapy and age were significant risk factors in regression models, but the explanatory value was low. The most common side effect was tiredness followed by cognitive symptoms. ConclusionsOur findings show that side effects are still common in epilepsy care and suggests that unnecessary polypharmacy should be avoided. Apart from number or ASMs, predicting who will experience side effects is difficult and more research on individual vulnerability is needed.

Low agreement between Swedish national registers and parental questionnaires on allergic rhinitis.

Allergic rhinitis (AR) has been well documented using questionnaire-based studies. Here, we examine the agreement between parental-reported data during childhood with the emphasis on 12-year-olds and data from two national Swedish registers to determine whether register data on AR can supplement or replace questionnaire data. Data were collected from a prospective, longitudinal cohort study of children born in western Sweden in 2003. Parental questionnaires were filled out at 6 months and one, four, eight, and 12 years of age. A total of 3634 children were linked to the Swedish Prescribed Drug Register (SPDR) and the National Patient Register (NPR) using personal identity numbers. The agreement between the register and questionnaire data was estimated using Cohen's kappa with 95% confidence intervals. According to the SPDR, 9.9% (n = 360/3634) of the children were dispensed specific AR medication at 11-13 years of age compared with the 12 years questionnaire where 23% reported AR medication use during the last 12 months. The overall agreement between questionnaire and SPDR data on AR medication was slight (kappa 0.05). At 11-12 years, 1.8% (n = 65/3634) of the children received an outpatient AR diagnosis in the NPR, while 10% reported doctor-diagnosed AR in the questionnaire. The overall agreement between questionnaire and NPR data on AR diagnosis was slight (kappa 0.16). There was poor agreement between questionnaire and register data regarding AR and dispensed medication. Explanations could include over-the-counter drugs and diagnosis in primary care, which are not included in the registers.

Using various geotechnical techniques for challenging conditions at the West Link project

AbstractThe city of Gothenburg in western Sweden is currently experiencing the construction of one of the biggest infrastructure projects in the country – The West Link (Västlänken). The West Link is an 8 km double‐track railway project, of which 6 km will be through underground tunnels with two new stations, Haga and Korsvägen, and construction of a bigger Central station. The construction of the project began in May 2018 and the finalization is expected in 2026. The project is split into five different sections which were awarded and are being executed individually. The widely varied geological profile of the area consisting of weak‐to‐very weak clay and silty‐sandy‐gravelly moraine along with challenging local conditions like existing waterways, traffic routes, and buildings requires a range of soil improvements and shoring system solutions suiting the local conditions. Some techniques executed by Keller include dry deep soil mixing (DDSM) to stabilize the quick clay to facilitate excavation, jet grouting for water sealing, excavation support in addition to soil improvement purposes, uplift piles over a flowing river, drilled steel piles at the bottom of excavation pit as foundation support, drilled steel pile wall, and sheet piling. Apart from technical challenges, the West Link has strong focus on adopting sustainable solutions like methods to reduce disposal of wet masses from jet grouting. A team of experts of design and execution from different parts of the world is working together to make it a success story.

Childhood BMI trajectories predict cardiometabolic risk and stress at age 13 years. The STARS cohort

Abstract Background Research on BMI trajectory focuses mainly on childhood and adolescence, missing birth and infancy, which are also relevant in the development of cardiometabolic disease. We aimed to identify trajectories of BMI from birth throughout childhood, and to examine whether BMI trajectories predict health at age13 years; and, if so, whether differences exist among trajectories regarding timeframes during which early life BMI influences health. Methods Participants from Western Sweden (n = 1902, 44% males, 13.5±0.4 years) completed questionnaires assessing perceived stress and psychosomatic symptoms and examined for waist circumference (WC), systolic blood pressure (SBP), pulse wave velocity, and white blood cell counts (WBC). They had at least 5 retrospective measures of weight and height covering birth, infancy, childhood to early adolescence. We used group-based trajectory modeling to identify BMI trajectories and linear regression to assess associations, which are presented as estimated mean differences with 95% CI between trajectories. Results We identified three BMI trajectories: normal, moderate, and excessive gain. Differences distinguishing these trajectories were established before 2 years of age. After adjusting for sex, age, migrant background, and parental income, adolescents with excessive gain had higher WC (19.2 [18.4-20.0} cm), SBP (3.6 [2.4-4.4] mmHg), WBC (0.7 [0.4-0.9] x109/L) and stress (1.1 [0.2-1.9]) than adolescents with normal gain. Increased levels of WC (6.4 [5.8-6.9] cm), SBP (1.8 [1.0-2.5] mmHg) and stress (0.7 [0.1-1.2]) were found in adolescents with moderate gain. The observed significant positive correlation of early life BMI with SBP started approximately at age 6 years for participants with excessive gain, much earlier than for participants with normal and moderate gain, for which it started at age 12 years. Conclusions Excessive gain BMI trajectory from birth predicts cardiometabolic risk and stress in adolescents before age 13 years. Key messages • Differences distinguishing childhood BMI trajectories were established before age 2 years. • In excessive gain group, influence of early life BMI on SBP started already around age 6 years.

Range of Motion Limitations in Middle-aged Adults With Cerebral Palsy

ObjectiveTo describe limitations in range of motion (ROM) in middle-aged adults with cerebral palsy (CP), and identify associations with CP subtype, gross motor function, sex and age. DesignPopulation-based cohort study. SettingLocal and regional referral centers. ParticipantsInclusion criteria: diagnosis of CP, born 1959 to 1978 and living in the county of Västra Götaland, Sweden. In the population-based register of CP in Western Sweden, 417 subjects were identified and 139 volunteered to participate. Adults with CP, born elsewhere, who had moved into the area were invited through patient organizations and habilitation units, and eleven chose to participate. In total 150 participants, age 37-58 years (mean 48) 65 women (43%) (N=150). All CP subtypes and Gross Motor Function Classification (GMFCS) levels were represented. InterventionsNot applicable Main Outcome MeasuresPassive ROM was measured in the upper and lower extremity and was classified into 4 levels (inspired by The Spinal Alignment and Range of Motion Measure and adapted from the values of the American Academy of Orthopedic Surgeons); good=1, vs mild=2, moderate=3 or severe=4 limitation. The results were summarized to obtain a total score of the participants' ROM limitations. ResultsModerate to severe limitations were present in 98 % of the participants. There was a correlation to GMFCS level in both the upper and lower extremity (P<.001), but no correlation with age. Upper extremity limitations were most common in dyskinetic CP, lower extremity limitations were most common in dyskinetic CP and bilateral spastic CP. Men had more limitations in the lower extremity (P=.001). The most common limitation in the lower extremity was hamstrings tightness (82%) and hip abduction (80%), and in the upper extremity, limited shoulder abduction (57%). ConclusionsLimited ROM is common in adults with CP, most pronounced in shoulders, hip joints and hamstrings muscles, with no differences related to age in this age-span.

EXECUTION OF VARIOUS GEOTECHNICAL WORKS FOR CHALLENGING PROJECTS IN SWEDEN AND SLOVENIA

The city of Gothenburg in western Sweden is currently experiencing the construction of one of the biggest infrastructure projects in the country - The West Link (Västlänken). The West Link is an eight km double track railway project, of which six km will run through underground tunnels. The project is split into five different sections, which were awarded and being executed individually. The widely varied geological profile of the area consisting of weak to very weak clay (often referred as ‘quick clay’) and silty, sandy and gravelly moraine along with challenging local conditions like existing waterways, traffic routes and buildings require a range of soil improvements and shoring system solutions suiting the local conditions. Keller has been executing Dry deep soil mixing (DDSM) to stabilize the quick clay to facilitate excavation and jet grouting for water sealing and excavation support in addition to soil improvement purposes. Execution of uplift piles over a flowing river, drilled steel piles at the bottom of excavation pit as foundation support, drilled steel pile wall and sheet piling for excavation support are other examples of geotechnical solutions executed as customized to site requirements. The knowledge gained from challenging international projects is further applied to key local projects, such as those in Slovenia, where the advantages of developed geotechnical technologies and procedures are leveraged in the most effective ways. Two significant projects have recently been executed using this approach. Firstly, ground improvement works were undertaken for the new Central Correctional Facilities Project in Ljubljana, involving the use of premixed vibro concrete columns (PVCC). This project was carried out on an abandoned quarry that had been filled with construction waste over the past few decades. The second project involves landslide prevention measures, specifically the reconstruction of an existing anchored wall on a highway near Maribor. To address this, longer and higher capacity geotechnical anchors were installed at heights of up to 8 meters.

Health-related quality of life by gout severity in women and men with gout in primary care: results from a questionnaire study in Western Sweden

Objective We aimed to compare health-related quality of life (HRQoL) by gout severity, overall and by sex. Method A questionnaire was sent to patients with gout (n = 1444) identified at 12 primary care centres in Western Sweden. The questionnaire asked about comorbidities, gout-specific aspects, and HRQoL, using the RAND 36-Item Health Survey. Responders were divided into ‘mild’, ‘moderate’, or ‘severe’ gout based on the number of self-reported flares (0, 1–2, ≥ 3) during the past 12 months. Results Out of 1444 gout patients, 784 (54.3%) responded to the questionnaire. Among the respondents, 673 [560 (83.2%) men and 113 (16.8%) women] provided answers regarding the number of gout flares in the past year. Of these, 322 (47.8%), 218 (32.4%), and 133 (19.8%) were classified as having mild, moderate, and severe gout, respectively. Allopurinol use was more frequent in those with mild disease. In more severe gout, HRQoL was reduced compared to less severe gout [severe vs mild gout, mean values for physical component summary (PCS) score 39.5 vs 43.6, p = 0.002, and mental component summary (MCS) score 46.6 vs 51.1, p < 0.001]. When excluding those with a flare in the past month, the HRQoL was still worse in severe gout (vs mild), although differences were attenuated and not statistically significant for the PCS and for women. Conclusion Gout severity, defined as the number of flares during the past year, was associated with significant reductions in HRQoL.

Patient safety culture in home care settings in Sweden: a cross-sectional survey among home care professionals

BackgroundThe connection between a weak patient safety culture and adverse patient events is well known, but although most long-term care is provided outside of hospitals, the focus of patient safety culture is most commonly on inpatient care. In Sweden, more than a third of people who receive care at home have been affected by adverse events, with the majority judged to be preventable. The aim of this study was to investigate the patient safety culture among care professionals working in care at home with older people.MethodsThis cross-sectional study used a purposive sample of 66 municipal care workers, health care professionals, and rehabilitation staff from five municipal care units in two districts in western Sweden who provided care at home for older people and had been employed for at least six months. The participants completed the Hospital Survey on Patient Safety Culture (HSOPSC) self-report questionnaire, which assessed aspects of patient safety culture—norms, beliefs, and attitudes. Logistic regression analysis was used to test how the global ratings of Patient safety grade in the care units and Reporting of patient safety events were related to the dimensions of safety culture according to the staff’s professions and years of work experience.ResultsThe most positively rated safety culture dimension was Teamwork within care units (82%), which indicates good cooperation with the closest co-workers. The least positively rated dimensions were Handoffs and transitions among care units (37%) and Management support (37%), which indicate weaknesses in the exchange of patient information across care units and limited support from top-level managers. The global rating of Patient safety grade was associated with Communication openness and Management support (p < 0.01 and p = 0.03, respectively). Staff with less work experience evaluated the Patient safety grade higher than those with more work experience.ConclusionsThis study suggests that improvements are needed in care transitions and in support from top-level managers and that awareness of patient safety should be improved in staff with less work experience. The results also highlight that an open communication climate within the care unit is important for patient safety.

Scaling up community wind energy: the relevance of autonomy and community

BackgroundRenewable energy, especially wind power, is expanding rapidly in Sweden and elsewhere and has left the “niche” to become part of the mainstream energy socio-technical “regime”. However, the social innovation of community-owned wind energy is not expanding alongside. Despite its potential for an inclusive energy transition and for alleviating conflicts, community energy remains a niche phenomenon. In this article, we explore the conditions for community energy to scale up. Upscaling is sometimes regarded as alien to the spirit of community energy, but we argue that it can be positive and, assuming the existence of a “community wind energy trap”—increased market competition and decreased governmental support—even necessary for the long-term survival of community wind energy. We particularly study how two variables relate to upscaling: autonomy and community, the latter divided into communities of interest and place.ResultsA case study on four wind cooperatives and their main partners, municipal energy companies, based in western Sweden is conducted to generate a theory of how autonomy and community are related to their ambitions and capabilities to scale up their operations. The results indicate that for scaling up, autonomy is a more important factor than community, while communities of interest are more likely to scale up than communities of place. A provisional theory on possibilities for community energy to scale up is developed based on the case study results.ConclusionsEven when upscaling is the will and ambition of a community energy initiative, neither autonomy nor community alone is a guarantee for it to happen—yet in combination, the likelihood increases: with autonomy as a prerequisite for action, and community as a motivation for action. Both communities of place and of interest can act as a motivational force and mobilise resources. Yet local rootedness can be difficult to combine with upscaling beyond a certain point, while a community of interest lacks physical borders. If regulators are keen on counteracting the community energy trap, our research suggests that they need to intervene and support these initiatives—yet without intruding on their autonomy.

From church to museum and back again

In the small village of Kinnarumma in western Sweden an old wooden church was replaced by a new church buildning in the early twentieth century. The old church was de-sacralized by being moved to an open-air museum in Borås and used there for exhibitions and the storage of museum objects. The need for more church premises in the city led to the re-sacralization of the old church in 1930. The transition of Kinnarumma’s old wooden church to museum object, its museumification, was an expression of change in religious heritage, and its re-sacralization expressed an unchanged part of the same heritage.

The clinical relevance of broad mutational screening of myeloproliferative neoplasms at diagnosis.

Myeloproliferative neoplasm (MPN) is a heterogenous group of hematological malignancies including polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF). JAK2V617F is the most frequent driver mutation in all three entities, but in PMF and ET mutations in CALR and MPL are also frequent. Mutations seen in additional genes are also often the same regardless of subtype of MPN. The aim of this study was to analyze a population based MPN cohort for genetic variants with prognostic value that can guide clinical decisions. MPN patients from Western Sweden diagnosed between 2008-2013 (n=248) were screened for mutations in 54 genes associated with myeloid malignancy. Mutations in the genes SRSF2 and U2AF1 correlated significantly with impaired overall survival but did not correlate to increased risk for vascular events, neither before nor after diagnosis. Rather, mutations in these genes showed an association with disease transformation. Several recurrent gene variants with allele frequency close to 50% were confirmed to be germline. However, none of these variants was found to have an earlier onset of MPN. In conclusion, we identified gene mutations to be independent markers of impaired survival in MPN. This indicates the need for more individualized assessment and treatment of MPN patients and a wider gene mutation screening already at diagnosis. This could ensure the identification of patients with high-risk mutations early on. In addition, several genetic variants were also identified as germline in this study but gave no obvious clinical relevance. To avoid conclusions from non-informative genetic variants, a simultaneous analysis of normal cell DNA from patients at diagnosis should be considered.

Inclusion body myositis with early onset: a population-based study.

Inclusion body myositis (IBM), an inflammatory myopathy with progressive weakness without efficient treatment, typically presents after 45years of age and younger patients are sparsely studied. In a population-based study during a 33-year period, 142 patients with IBM were identified in western Sweden. Six patients fell outside the European Neuromuscular Centre 2011 criteria for IBM due to young age at symptom onset, verified by a muscle biopsy < 50years of age. These were defined as early-onset IBM and included in this study. Medical records, muscle strength, comorbidities, muscle biopsies, and nuclear- and mitochondrial DNA were examined and compared with patients with IBM and age matched controls from the same population. The median age at symptom onset was 36 (range 34-45) years and at diagnosis 43 (range 38-58) years. Four patients were deceased at a median age of 59 (range 50-75) years. The median survival from diagnosis was 14 (range 10-18) years. The prevalence December 31 2017 was 1.2 per million inhabitants and the mean incidence 0.12 patients per million inhabitants and year. The mean decline in quadriceps strength ± 1 standard deviation was 1.21 ± 0.2 Newton or 0.91 ± 0.2% per month and correlated to time from diagnosis (p < 0.001). Five patients had swallowing difficulties. All patients displayed mitochondrial changes in muscle including cytochrome c oxidase deficiency and the mitochondrial DNA mutation load was high. Early-onset IBM is a severe disease, causing progressive muscle weakness, high muscle mitochondrial DNA mutation load and a reduced cumulative survival in young and middle-aged individuals.

Antiseizure medication selection and retention for adult onset focal epilepsy in a Swedish health service region: A population-based cohort study.

Historically, approximately half of those with newly diagnosed epilepsy have responded to and tolerated the first antiseizure medication (ASM), but there are few contemporary real-world data. Third-generation ASMs have improved tolerability and are increasingly used according to prescription data. We aimed to describe current ASM selection and retention in adult onset focal epilepsy in western Sweden. A multicenter retrospective cohort study was performed at five public neurology care providers in western Sweden (nearly complete coverage in the area). We reviewed 2607 medical charts and included patients diagnosed with nongeneralized epilepsy after January 1, 2020 who had a seizure onset after age 25 years (presumed focal onset) and were started on ASM monotherapy. A total of 542 patients (median age at seizure onset = 68 years, interquartile range = 52-77) were included. Most patients received levetiracetam (62%) or lamotrigine (35%), with levetiracetam being more common among men and those with structural causes or short epilepsy duration. During follow-up (median = 471.5 days), 463 patients (85%) remained on the first ASM. Fifty-nine (18%) patients discontinued levetiracetam, and 18 (10%) ended treatment with lamotrigine (p = .010), most commonly because of side effects. In a multivariable Cox regression model, the discontinuation risk was higher for levetiracetam than lamotrigine (adjusted hazard ratio = 2.01, 95% confidence interval = 1.16-3.51). Levetiracetam and lamotrigine were the dominating first ASMs for adult onset focal epilepsy in our region, indicating good awareness of problems with enzyme induction or teratogenicity of older drugs. The most striking finding is the high retention rates, perhaps reflecting a shift toward an older epilepsy population, higher tolerability of newer ASMs, or suboptimal follow-up. The finding that treatment retention differed among patients receiving levetiracetam and lamotrigine aligns with the recent SANAD II results. It suggests lamotrigine may be underutilized in our region and that education efforts are needed to ensure it is considered the first choice more often.

Clostridioides difficile outbreak detection: Evaluation by ribotyping and whole-genome sequencing of a surveillance algorithm based on ward-specific cutoffs.

We evaluated the performance of an early-warning algorithm, based on ward-specific incidence cutoffs for detecting Clostridioides difficile transmission in hospitals. We also sought to determine the frequency of intrahospital Clostridioides difficile transmission in our setting. Diagnostic performance of the algorithm was tested with confirmed transmission events as the comparison criterion. Transmission events were identified by a combination of high-molecular-weight typing, ward history, ribotyping, and whole-genome sequencing (WGS). The study was conducted in 2 major and 2 minor secondary-care hospitals with adjacent catchment areas in western Sweden, comprising a total population of ∼480,000 and ∼1,000 hospital beds. All patients with a positive PCR test for Clostridioides difficile toxin B during 2020 and 2021. We conducted culturing and high-molecular-weight typing of all positive clinical samples. Ward history was determined for each patient to find possible epidemiological links between patients with the same type. Transmission events were determined by PCR ribotyping followed by WGS. We identified 4 clusters comprising a total of 10 patients (1.5%) among 673 positive samples that were able to be cultured and then typed by high-molecular-weight typing. The early-warning algorithm performed no better than chance; patient diagnoses were made at wards other than those where the transmission events likely occurred. In surveillance of potential transmission, it is insufficient to consider only the ward where diagnosis is made, especially in settings with high strain diversity. Transmission within wards occurs sporadically in our setting.