Years In Sweden Research Articles

Limited critical and communicative health literacy is related to poorer health among older adults

Abstract Background Health literacy-related challenges are expected to increase with age due to a discrepancy between individual capacity and health care demands. Knowledge about associations between health literacy and age-related health outcomes among older adults is scarce. This is important to address and promote optimal health in older adults. The study aims to investigate the association between health literacy and health status among older adults and explore differences between the younger old and the oldest old adults. Methods Cross-sectional study using SWEOLD population-based data from 2022, a national representative sample of people 77+ years in Sweden. Univariate and multivariate logistic regression analysis assessed associations between communicative- and critical health literacy and health outcomes. Models were adjusted for age, sex, and socioeconomic status, and stratified by age. Results Significant adjusted associations were found between inadequate and problematic health literacy and less than good self-rated health (OR 2.64, 95%CI: 1.61-4.33; 2.11, 95%CI: 1.40.3.17), and requiring assistance with medicine management (OR 5.26, 95%CI: 2.67-10.38, 2.14, 95%CI 1.08-4.22). Among the younger old (77-84 years) inadequate and problematic HL was associated with having lifestyle-related conditions (OR 1.77, 95%CI: 1.07-2.93, 2.75, 95%CI: 1.33-2.71). Among the oldest old (85+), inadequate health literacy was associated with higher likelihood of poor activities of daily living (ADL) (OR 4.48, 95%CI: 1.99-10.07) and frailty (OR 3.51, 95%CI: 1.43-8.47). Level of frailty increases earlier in age for individuals with limited HL than among those with sufficient HL. Conclusions Limited health literacy is a prevalent issue in the older population and is associated with negative health-related outcomes. To mitigate development of poor health and frailty and to promote healthy ageing, care organisations need to meet the needs of this population in a health literacy friendly way. Key messages • Limited health literacy among the older population is associated with several negative health-related outcomes. • Care organisations need to work actively to mitigate the development of poor health while promoting healthy aging among the older population in a health literacy-friendly and age sensitive manner.

Trends in heart failure mortality in Sweden between 1997 and 2022.

Data from US have shown a reversal in the improvement of heart failure (HF)-related mortality over the last ~10 years. It is unknown whether these trends generalize to European universal healthcare systems. We assessed temporal trends in (i) HF-related mortality in the overall national population; and (ii) all-cause mortality following an incident HF diagnosis, overall and stratified by ejection fraction (EF), in Sweden between 1997 and 2022. Annual mortality rates with a HF diagnosis as underlying cause were extracted from the Cause of Death Register. All-cause mortality following incident HF was assessed in two HF cohorts derived from the National Patient Register (NPR) and the Swedish HF Registry (SwedeHF). Temporal trends were presented as average annual percentage change (AAPC). Between 1997 and 2022, age-adjusted HF-related mortality in the general population declined from 33.4 to 23.8 per 100 000 individuals (AAPC -2.15%, p < 0.001). In the HF cohort from NPR (n = 423 092), all-cause mortality at 1, 3, and 5 years following a first diagnosis of HF was 25%, 46%, and 58%, respectively, in 2022; 1-year mortality declined (AAPC -1.10%, p < 0.001) over time regardless of age or sex. In SwedeHF (n = 63 753), the decline in 1-year mortality was less steep with increasing EF (AAPC -2.64%, p < 0.001; -2.30%, p = 0.062; and -2.16%, p = 0.032 in EF <40%, 40-49%, and ≥50%, respectively). Heart failure-related mortality has declined over the last ~25 years in Sweden. All-cause mortality in patients with HF has also declined, more in HF with reduced than preserved EF, mirroring the different availability of life-saving treatments across the EF spectrum.

Adaptability, stability, and productivity of potato breeding clones and cultivars at high latitudes in Europe

The aim of potato breeding is to release cultivars that exhibit high and stable performance across the target population of environments. The objective of this research was therefore to investigate the use of various methods (site regression [SREG], coefficient of variation and regression deviation [σ2δ]) for determining the adaptability and stability of productive and quality traits in the Nordic region of Europe. The multi-environment trials included 256 breeding clones and released cultivars grown by EU farmers at three distinct testing sites over two years in Sweden. There was significant (P < 0.001) variation in tuber yield, starch percentage and reducing sugars in the tuber flesh among the breeding clones and cultivars, testing environments and the genotype by environment interaction (GEI). The environments were very diverse, as revealed by the SREG biplots and particularly for the GEI patterns noted in terms of their productive and quality characteristics. The percentage of stable high-tuber yielding germplasm was greater for breeding clones (23%) than for released European cultivars (2%), thus revealing the advantage of potato breeding in the target population of environments. SLU 1415001 and SLU 1314015 were the most promising breeding clones due to their stable high tuber yield. This characteristic was best for the starch potato cultivars, although none of them exhibited a significant different σ2δ. ‘Talent’ shows an almost stable good performance among low reducing sugar cultivars and breeding clones, which are often unstable in terms of their scoring across environments. Neither a breeding clone nor a cultivar was at the top for stable tuber yield, tuber flesh starch or reducing sugars in the tuber flesh, which shows the challenge faced by potato breeding while addressing the needs of different markets.

Melanoma Incidence and Mortality Trends in Sweden.

Over the past decades, many global regions have experienced a steady increase in the incidence of cutaneous melanoma. However, more recently, a downward trend has been observed in the younger age groups in Australia and the US. Yet, in Europe, none of the countries have reported any significant decline in melanoma incidence for any age group. To assess melanoma incidence and mortality trends in Sweden, with a focus on individuals younger than the average age of melanoma onset. This cohort study used data on the national population from the Swedish Melanoma Registry and the Swedish Cancer Registry, which cover more than 99% of all primary invasive cutaneous melanomas diagnosed in the country. All patients diagnosed from 1990 to 2022 were included. Incidence and mortality rates per 100 000 inhabitants were calculated for each year and shown as average annual rates for every 5-year period from 1990 to 2022. Joinpoint regression models were used to evaluate statistical significance of temporal trends and points of change. There were 34 800 primary invasive cutaneous melanomas (19 582 [56.3%] in females and 15 218 [43.7%] in males) reported in 33 324 individuals younger than 60 years (median [IQR] age, 48 [36-58] years) from 1990 to 2022. A consistent rise in melanoma incidence was observed among those 50 to 59 years old. The age groups from 20 to 29 years, 30 to 39 years, and 40 to 49 years showed an incidence peak in 2013 to 2015 followed by stable or significantly declining rates until 2022. In patients younger than 20 years, melanoma incidence remained low with no significant trends. There was also a significant decline in melanoma mortality among 30- to 59-year-old individuals, but not in those 60 years and older. The findings of this cohort study showed a significant recent downward trend in both melanoma incidence and melanoma mortality in the age group 30 to 49 years in Sweden. The reasons for these declines are unclear but may include UV protection, public health campaigns, changing population demographics, and the introduction of effective melanoma treatment. None of these possibilities were evaluated; further study is needed.

Evolution of Home Mechanical Ventilation in Sweden Over 27 Years: Changing Trends in Incidence, Prevalence, and Patient Characteristics - The Population-Based DISCOVERY Study

BackgroundHome mechanical ventilation (HMV), non-invasive ventilation (NIV) or invasive ventilation (IV) outside a hospital setting is a key treatment to improve outcomes in chronic hypoventilation. Research questionWhat are the temporal trends observed over 27 years in Sweden regarding the incidence, prevalence, diagnostic spectrum, and patient characteristics associated with HMV? Study design and methodsNational, population-based, longitudinal analysis of the DISCOVERY study of patients initiating HMV between 1996 and 2022. Time trends stratified by the underlying diagnosis group (lung disease, predominantly chronic obstructive pulmonary disease (COPD), restrictive thoracal diseases (RTD), obesity hypoventilation syndrome (OHS), neuromuscular diseases (NMD), amyotrophic lateral sclerosis (ALS), and other neurological disorders) were analysed using linear regression models. ResultsWe included 10,555 patients ≥16 years (aged 63±15 years, 50 % women). Between 1996-98 and 2020-22, the HMV incidence increased threefold to 7/100,000, and the prevalence sixfold to 33/100,000. The most common indication for incident HMV shifted from RTD (35% in 1996-98 to 3% in 2020-22) to lung disease (14 to 31%), OHS (23 TO 33%), and ALS (4 TO 14%) by 2020-22 (p<0.001). The proportion of women increased from 47% to 54% (p<0.013, and the age at initiation of HMV increased from 58±15 to 66±14 years (p<0.001). Lung function measured as vital capacity at treatment start increased significantly in all diagnosis groups except for OHS, where both VC and forced expiratory volume in 1 second (FEV1) decreased. In the registry's first and last three-year periods, the proportion of patients ventilated invasively decreased from 10% to 2% (p<0.001). ConclusionIn 27 years to 2022, the incidence and prevalence of HMV in Sweden have increased markedly, patient demography has changed, and IV has decreased. The average age of patients initiated on HMV has increased, but treatment is started earlier in the disease trajectory.

Not attending preschool was linked to challenges in peer relationships.

There is limited research on the impact of preschool attendance on socio-emotional problems. This study aimed to investigate the association between not attending preschool and emotional and behavioural problems among children aged 3-5 years in Sweden. We analysed cross-sectional data from 9395 children, rated by both parents or by one parent. The dependent variable, emotional and behavioural problems, was measured using the Strengths and Difficulties Questionnaire (SDQ). Preschool attendance served as the independent variable. Single and multiple logistic regression analyses were conducted. Only 1.2% of children did not attend preschool. Single logistic regression models, using SDQ subscales with scores at or above the cut-off point as outcomes, showed that not attending preschool was associated with peer relationship problems, rated by mothers, and with peer relationship problems and overall difficulties, rated by fathers. These associations remained significant when controlling for covariates. Children with parents born outside Sweden or with lower educational levels had higher odds of experiencing peer relationship problems and overall difficulties. Children who do not attend preschool are at heightened risk of experiencing peer relationship problems. It is important to ensure that children who may benefit most from preschool education receive adequate support.

Lignin extraction in chemical pulp mills: The role of flexible operation

Lignin extracted from black liquor in chemical pulp mills can potentially replace fossil carbon feedstocks in fuels and materials, thereby increasing the economic and environmental added values of woody biomass. However, since lignin extraction reduces the electricity generation of the mill, the added value depends on the characteristics of the electricity market in which the mill operates. In this study, a model mill is exposed to two different electricity price profiles: the low and steady prices of south-central Sweden in Year 2019; and the high and volatile prices of the same region in Year 2022. For the model mill, investments in lignin extraction designed to increase pulp production are economically viable and have low levels of sensitivity to electricity price levels and price volatility. The viability of lignin extraction without increased pulp production depends on the relationship between the electricity and lignin prices. With stable electricity prices, or steady mill operation, a rule-of-thumb holds that for lignin extraction to be viable, the lignin price (€/t) must be 1.8-times the average electricity price (€/MWh) plus 40 €/t for the supply of chemicals. With volatile electricity prices and flexible operation of the recovery boiler, the mill can shift the loss in electricity sales to low-price hours, thereby saving 15–70 % of the operational costs of lignin extraction, as compared to steady operation. This effect can be further enhanced by increasing the capacity of the lignin extraction process or extending the size of the black liquor storage tank. The proposed flexibility measures allow the market-integrated pulp mill to export lignin to replace fossil carbon supplies in other sectors, while supporting the electricity system during hours with high demand and low supply.

Sex ratio at birth across 100 years in Sweden and risk of cardiovascular disease and all-cause mortality – a national register study

The human sex ratio at birth (SRB) undergoes temporary changes around a mean proportion of 0.51 male births. SRB has been well studied for historical, geographical, and secular trends, but until now not linked to health outcomes in the total population, e.g. for cardiovascular disease (CVD) or mortality during follow-up of birth cohorts. We used linkage analysis based on national registers in Sweden that cover all births from 1900 to 2016. SRB at birth was calculated by every 10-year birth cohort in all survivors living in 1997 for a follow-up analysis of risk of CVD and mortality with data from national registers. When the highest quartile of SRB was used as reference, a slightly increased risk of fatal CVD (HR 1.03 (95% confidence intervals, CI): 1.02–1.04), non-fatal CVD (HR 1.01; 95%CI: 1.01–1.02) and mortality (HR 1.02; 95%CI, 1.01–1.03) was found after full adjustments in men belonging to the lowest SRB quartile. A similar pattern was also found for fatal CHD in women. in the lowest SBR quartile compared to the highest, HR 1.03 (95%CI: 1.02–1.05). In conclusion, in birth cohorts with a relatively lower than expected number of males born, long-term adverse health effects were observed with slightly increased cardiovascular risk and total mortality at the population level. This could indicate that men belonging to so-called “culled cohorts” in a developed country during the 20th century are characterized by a slightly increased risk that could reflect negative early life influences and environmental exposures in pregnant women resulting in selective loss of male embryos or fetuses. In a public health perspective SRB could be of some importance to monitor as an aspect of birth statistics linked to relatively minor population health effects.

Vulvovaginal candidiasis and type 2 diabetes: A nationwide retrospective cohort study.

To examine whether vulvovaginal candidiasis (VVC) precedes type 2 diabetes and to quantify the possible time period between VVC and subsequent diabetes. We conducted a nationwide retrospective primary healthcare study including 1 838 929 women aged 35-65 years in Sweden (2007-2018). Cox regression models were used to examine associations between VVC and type 2 diabetes, while controlling for possible confounders. Propensity-score-weighted analysis was also conducted. The incidence rate of diabetes per 1000 person-years was 3.06 (95% confidence interval [CI] 3.05-3.08) in women without preceding VVC and 4.05 (95% CI 3.86-4.24) in women with preceding VVC. The incidence rate was particularly high in women aged 55 years and older with VVC: 9.56 (95% CI 8.01-11.11). Women with VVC had a hazard ratio (HR) of 1.41 (95% CI 1.28-1.55) for diabetes compared to women without VVC in the multivariable-adjusted model. The corresponding HR was 1.63 (95% CI 1.53-1.74) in propensity-score-weighted analysis. Women with prior VVC also seemed to have a stronger risk of diabetes with older age, particularly after the age of 55 years. The mean (range) time between VVC and subsequent diabetes was 0.57 (0-2) years, depending on the age of the woman. We found temporal associations between VVC and diabetes. The findings demonstrate that the presence of VVC may indicate a future diagnosis of diabetes, especially in women aged 55 years and older. This knowledge could be valuable for clinicians when treating women with VVC.

Psychometric validation of the Montgomery–åsberg Depression Rating Scale – Youth (MADRS-Y) in a clinical sample

Background Depression in adolescence is a serious major global health problem with increasing rates of prevalence. Measures of depression that are valid for young people are clearly needed in clinical contexts. Methods The study included 577 patients from child and adolescent psychiatry (n = 471) and primary care (n = 106) aged 12–22 years in Sweden (Mage=16.7 years; 76% female). The reliability and validity for Montgomery–Åsberg Depression Rating Scale – Youth (MADRS-Y) were investigated. To confirm the latent structure, we used a single-factor confirmatory factor analysis (CFA). A Kruskal–Wallis test was performed to test total score differences between diagnostic groups. Using Spearman’s rho correlations, we examine whether single items in the MADRS-Y correlate with suicidal ideation measured by The Suicidal Ideation Questionnaire-JR (SIQ-JR). Results The internal consistency using McDonald’s coefficient omega was excellent. The CFA of the 12-item MADRS-Y supported a one factor structure. Evidence of convergent and discriminant validity was shown. There was a significant difference in MADRS-Y scores across diagnostic groups, with higher results for depressive disorders. A strong correlation with suicidal ideation was found for two items. Conclusions The results support MADRS-Y as a brief, reliable, and valid self-report questionnaire of depressive symptoms for young patients in a clinical setting.

Long-term Mortality and Hospital Readmissions Among Survivors of Sepsis in Sweden: A Population-Based Cohort Study.

Survivors of sepsis may experience long-term risk of increased morbidity and mortality, but estimations of cause-specific effects beyond 1 year after a sepsis episode are lacking. This nationwide population-based cohort study linked data from national registers to compare patients aged ≥18 years in Sweden admitted to an intensive care unit from 2008 to 2019 with severe community-acquired sepsis. Patients were identified through the Swedish Intensive Care Registry, and randomly selected population controls were matched for age, sex, calendar year, and county of residence. Confounding from comorbidities, health care use, and socioeconomic and demographic factors was accounted for by using entropy-balancing methods. Long-term mortality and readmission rates, total and cause specific, were compared for 20 313 patients with sepsis and 396 976 controls via Cox regression. During the total follow-up period, 56% of patients with sepsis died, as opposed to 26% of the weighted controls. The hazard ratio for all-cause mortality was attenuated with time but remained elevated in all periods: 3.0 (95% CI, 2.8-3.2) at 2 to 12 months after admission, 1.8 to 1.9 between 1 and 5 years, and 1.6 (95% CI, 1.5-1.8) at >5 years. The major causes of death and readmission among the sepsis cases were infectious diseases, cancer, and cardiovascular diseases. The hazard ratios were larger among those without underlying comorbidities. Severe community-acquired sepsis was associated with substantial long-term effects beyond 1 year, as measured by mortality and rehospitalization. The cause-specific rates indicate the importance of underlying or undetected comorbidities while suggesting that survivors of sepsis may face increased long-term mortality and morbidity not explained by underlying health factors.

The Increased Burden of Morbidity Over the Life-Course Among Patients with COPD: A Register-Based Cohort Study in Sweden.

Patients with a diagnosis of chronic obstructive pulmonary disease (COPD) often have other chronic disorders. This study aims to describe the life-course pattern of morbidity in patients with COPD. Among all residents aged 50-90 years in Sweden in 1997, people with a hospital COPD diagnosis were identified using Swedish national registers (1997-2018). Each patient with COPD was matched by sex, birthyear and county of residency with up to five COPD-free controls. Other chronic disease diagnoses were identified during 1987-2018. Conditional logistic regression calculated risk of diseases diagnosed prior to first COPD diagnosis, producing odds ratios (OR) and 95% confidence intervals (95% CI). Cox regression estimated risk of diagnoses after first COPD diagnosis, producing hazard ratios (HR) and 95% CI. Among 2,706,814 individuals, 225,159 (8.3%) had COPD. The nested case-control sample included 223,945 COPD-cases with 1,062,731 controls. Prior to first COPD diagnosis, future COPD patients had higher risks than controls for most examined conditions. Highest risks were seen for chronic heart failure (OR = 3.25, 3.20-3.30), peripheral arterial disease (OR = 3.12, 3.06-3.18) and lung cancer (OR = 12.73, 12.12-13.37). Following the COPD diagnosis, individuals with COPD had higher risks of most conditions than individuals without COPD. Chronic heart failure (HR = 3.50, 3.46-3.53), osteoporosis (HR = 3.35, 3.30-3.42), depression (HR = 2.58, 2.53-2.64) and lung cancer (HR = 6.04, 5.90-6.18) predominated. The risk of vascular dementia was increased after COPD diagnosis (HR = 1.53, 1.48-1.58) but not Alzheimer's disease. Accumulation of chronic morbidity may precede COPD. Following the diagnosis, an increased burden of cardiovascular disease and cancer is to be expected, but subsequent depression, osteoporosis, and vascular dementia should also be noted. Management strategies for patients with COPD should consider the higher-than-average risk of multimorbidity.

Factors influencing antibiotic prescribing for respiratory tract infections in primary care – a comparison of physicians with different antibiotic prescribing rates

Background There has been a notable decrease in antibiotic prescribing in the last thirty years in Sweden. Little is known about factors influencing antibiotic prescribing over several years. Objective To compare primary care physicians who, over time, reduced their antibiotic prescribing for respiratory tract infections with those who remained either high or low prescribers regarding potentially influencing factors. Design and setting A register-based study including all RTI visits in primary care in Region Kronoberg, Sweden 2006–2014. The data were divided into three 3-year periods. Subjects The data comprised all physicians who had diagnosed at least one RTI for each of the three-year periods. The antibiotic prescribing rate adjusted for the patients’ sex and age group was calculated for each physician and period, and based on the change between the first and the third period, the physicians were divided into three prescriber groups: The High Prescribing Group, the Decreasing Prescribing Group, and the Low Prescribing Group. Main outcome measures For the three prescriber groups, we compared factors influencing antibiotic prescribing such as the characteristics of the physicians, their use of point-of-care tests, their choice of diagnoses, and whether the patients returned and received antibiotics. Results The High Prescribing Group ordered more point-of-care tests, registered more potential bacterial diagnoses, prescribed antibiotics at lower C-reactive protein levels, and prescribed antibiotics more often despite negative group A Streptococci test than in the Low Prescribing Group. The Decreasing Prescribing Group was between the High Prescribing Group and the Low Prescribing Group regarding these variables. The lower prescription rate in the Low Prescribing Group did not result in more return visits or new antibiotic prescriptions within 30 days. Conclusion Point-of-care testing and its interpretation differed between the prescriber groups. Focus on interpreting point-of-care test results could be a way forward in antibiotic stewardship.

COVID-19 mortality among immigrants by duration of residence in Sweden: a population-based cohort study.

Explanations for the disproportional COVID-19 burden among immigrants relative to host-country natives include differential exposure to the virus and susceptibility due to poor health conditions. Prior to the pandemic, immigrants displayed deteriorating health with duration of residence that may be associated with increased susceptibility over time. The aim of this study was to compare immigrant-native COVID-19 mortality by immigrants' duration of residence to examine the role of differential susceptibility. A population-based cohort study was conducted with individuals between 18 and 100 years old registered in Sweden between 1 January 2015 and 15 June 2022. Cox regression models were run to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Inequalities in COVID-19 mortality between immigrants and the Swedish-born population in the working-age group were concentrated among those of non-Western origins and from Finland with more than 15 years in Sweden, while for those of retirement age, these groups showed higher COVID-19 mortality HRs regardless of duration of residence. Both age groups of immigrants from Africa and the Middle East showed consistently higher COVID-19 mortality HRs. For the working-age population: Africa: HR<15: 2.46, 95%CI: 1.78, 3.38; HR≥15: 1.49, 95%CI: 1.01, 2.19; and from the Middle East: HR<15: 1.20, 95%CI: 0.90, 1.60; HR≥15: 1.65, 95%CI: 1.32, 2.05. For the retirement-age population: Africa: HR<15: 3.94, 95%CI: 2.85, 5.44; HR≥15: 1.66, 95%CI: 1.32, 2.09; Middle East: HR<15: 3.27, 95%CI: 2.70, 3.97; HR≥15: 2.12, 95%CI: 1.91, 2.34. Differential exposure, as opposed to differential susceptibility, likely accounted for the higher COVID-19 mortality observed among those origins who were disproportionately affected by the pandemic in Sweden.

Risk of unemployment and work disability among refugee and non-refugee migrants with incident psychotic disorders in Sweden and Denmark.

Unemployment and work disability are common among individuals with non-affective psychotic disorders (NAPDs) but it is unknown whether rates differ among migrants and native-born individuals. The present study aimed to compare the risk of these outcomes during the first 5 years of illness in non-refugee migrants, refugees and native-born individuals with NAPDs in Sweden and Denmark-two countries with different immigration policies and models of early psychosis care. Using national registers, we identified all individuals aged 18-35 years in Sweden and Denmark who received an incident NAPD diagnosis between 2006 and 2013 (N = 6750 and 8320, respectively). Cohorts were followed for 5 years to determine the days of unemployment and sickness absence (analyzed using zero-inflated negative binomial models) and the time to receipt of disability pension (analyzed using complementary log-log models). Relative to their native-born peers, refugees and non-refugee migrants in Sweden and non-refugee migrants in Denmark were significantly less likely to have zero unemployment days (OR range: 0.54-0.72) and all migrant groups experienced more unemployment days (IRR range: 1.26-1.37). Results were largely unchanged after adjustment for sociodemographic and clinical factors. In the adjusted model, both Swedish migrant groups and refugees in Denmark were more likely to experience zero sickness absence days than native-born individuals (OR range: 1.48-1.56). Only refugees in Denmark were at greater risk of disability pension. Non-refugee migrants and refugees with NAPDs in both Sweden and Denmark are particularly vulnerable to experiencing unemployment. Targeted interventions may help to reduce these disparities and promote long-term work ability among migrant groups.

Children’s perspectives on the relations between home and school

The aim of the article is to shed light on children’s perspectives of the relations between home and school. The study is based on 52 interviews with children aged 12-13 years in Sweden about their knowledge and notions of the relations between their parents and teachers, and what they perceive their own role to be in this context. The study reveals that the children’s understandings are drawing on both ideas of connectedness and autonomy to different actors characterised by a vertical or horizontal frame and that generational and institutional power are important in their understanding of the relations. The results reveals the different ways in which children talk about home-school relations, namely as (1) an asymmetric vertical “keep-apart-relation” characterised by institutional power, generational power and children’s autonomy and power and (2) a horizontal relation that is characterised by a symmetric power relation between the actors, i.e. they think that the parties to some extent sometimes have an equal influence in the relation. In addition, the study indicates that children adopt different strategies in relation to the adults. The children’s accounts show that they reproduce and also resist the social order and structure.

Dramatic improvements in survival in women and men with acute myocardial infarction over 30 years: a nationwide cohort study

Abstract Background Treatment of myocardial infarction (MI) has improved over the last decades due to the implementation of early revascularization and medical therapies for secondary prevention. The impact of these treatment changes on survival in women and men has not been documented over a 30-year perspective. Purpose The aim of this study was to assess implementation of new treatment strategies and their effects on changes in long-term outcomes in all patients with MI in Sweden over 30 years. Methods In SWEDEHEART, the Swedish register for coronary heart disease, we investigated treatments and outcomes and their associations in patients admitted with MI between 1991-2021. Patients were stratified in 2-year blocks, starting with a 3-year block for 1991-1993. Primary outcome was 1-year risk of cardiovascular (CV) mortality. Effect of treatments on outcome was assessed comparing observed event rates with event rates standardized by logistic regression accounting for differences in baseline characteristics and treatment. Results A total of 433,524 cases with MI were hospitalized between 1991-2021. Between 1991-1993 and 2020-2021, treatment with reperfusion and revascularization increased from 34.7% to 77.3%; in-hospital PCI from 1.8% to 73.8 %; dual antiplatelet therapy (DAPT) from 0.0% to 73.8%; statins from 3.0% to 91.7%; beta-blockers from 66.4% to 88.3%; and renin-angiotensin-system (RAS) inhibitors from 21.6% to 81.6% (Figure 1A). During the same period, the rates of 1-year CV mortality decreased from 24.1% to 8.3%. For women, CV mortality decreased from 28.9% to 10.3% and for men from 21.7% to 7.3%. When comparing observed with standardized event rates, most of the mortality improvement was explained by the implementation of early revascularization with PCI (Figure 1B). Conclusions In this unique nationwide cohort of patients with MI over 30 years, there was a gradual implementation of revascularization and novel medical treatment. Concurrently, there was a gradual absolute reduction in 1-year risk of CV mortality with 16 percentage points, which was similar in women and men. Most of the improvement in survival was related to implementation of early revascularization strategies. Figure 1 (A) Temporal trends in treatment and (B) crude and standardized rates of cardiovascular mortality within 1 year in patients with myocardial infarction over 30 years in Sweden.

Long-term sickness absence among adults with ADHD: the role of psychosocial working conditions

Abstract Background Symptoms of Attention-deficit/hyperactivity disorder (ADHD) do not only occur during childhood but often persist into adulthood and affect individuals’ ability to work. Adults with ADHD compared to those without ADHD are at a higher risk of negative labour market outcomes, such as long-term sickness absence (LTSA). Identifying modifiable factors in the workplace such as psychosocial working conditions may be a plausible strategy to lower this risk. This study aimed to investigate the effect modification of job control and job demands on the risk of LTSA among adults with ADHD. Methods The study population consisted of around 3.7 million individuals aged 20-60 years in Sweden in 2009. Of them, 0.3% had a diagnosis of ADHD extracted from the national patient registers. LTSA was defined as having one sick-leave spell of 90 days or more between 2010-2020. Job control and job demands were measured using job exposure matrices. Multivariable Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of LTSA among adults with ADHD compared to those without. Stratified analysis was conducted to test the effect modification by job demand-control status. Results During the follow-up, 812,971 (22%) adults had LTSA. Both men and women with a diagnosis of ADHD were at a higher risk of LTSA (HR 1.75, 95% CI 1.68-1.82 and HR 1.61, 95% CI 1.55-1.68, respectively) compared to those without ADHD, after adjusting for demographics, previous LTSA, and other mental and somatic disorders. The increased risk of LTSA among adults with ADHD was present regardless of the levels of job control, job demands and job demand-control categories (HRs ranged from 1.55 to 2.10). Conclusions Adults with a diagnosis of ADHD have a higher risk of LTSA and job demand-control status does not seem to substantially modify this risk. Future studies identifying factors in the workplace that may potentially help prevent LTSA among adults with ADHD are highly warranted. Key messages • Adults with ADHD have a higher risk of LTSA regardless of the job demand-control status. • There is an urgent need to identify factors that may help improve the work ability of this population.

Income mortality paradox by immigrants’ duration of residence in Sweden: a population register-based study

BackgroundStudies have shown that, compared with the general native population, immigrants display weaker or absent income gradients in mortality. The aim of this study is to examine the extent to...

Effects of the COVID-19 pandemic on the physical activity and screen time habits of children aged 11-13 years in Sweden.

Physical activity (PA), exercise, sedentary behavior and screen time are lifestyle factors that have been shown to significantly impact child health in different ways. These lifestyle factors were affected to different degrees by global restrictions during the COVID-19 pandemic. We investigated PA and screen time in a cohort of Swedish children in both 2019 and 2021, before and during the pandemic. Adolescents born in 2008 in Halland, Sweden, and included in a previous longitudinal birth cohort study were invited to take part in follow-up questionnaires about PA, screen time and COVID-19. A total of 1041 children aged 11 (in 2019) and 13 years (in 2021) replied and 777 of them answered on both occasions. Most children (42.1%) reported that their leisure time PA was unchanged from 2019 to 2021. Compared to unchanged PA 33.9% exercised more often (p = 0.011) and 23.9% exercised less (p < 0.001), both differences statistically significant. Roughly, 43.2% of boys and 34.9% of girls in 2021 exercised so that they became breathless or broke a sweat at least 4 times a week not counting physical education in school, corresponding figures for 2019 were 38.2% for boys and 35.2% for girls. The majority of children were able to continue attending leisure time sports clubs during the pandemic, but participation decreased from 88.3% to 76.3% from 11 to 13 years of age. Most reported that sports club routines changed during the pandemic, but only 40.9% reported fewer practice opportunities. Attending a sports club gave greater protection against loss of PA during the pandemic than not belonging to one (41.0% vs. 23.2%, p < 0.001). The majority (71.1%) of children spent more time on screens in 2021 than 2019, with a mean increase of 9.4 h (95% CI 8.6 to 10.2 h) from 20.7 to 30.1 hours per week (p < 0.001) during the study. Swedish children largely maintained their levels of PA during the pandemic at 13 years of age and these were possibly safeguarded by the comparably mild pandemic restrictions in Sweden in 2021. However, they did increase their screen time between 11 and 13 years of age.