Years In Sweden Research Articles

Epidemiology and mortality of pelvic and femur fractures—a nationwide register study of 417,840 fractures in Sweden across 16 years: diverging trends for potentially lethal fractures

Background and purpose — Fractures of the pelvis and femur are serious and potentially lethal injuries affecting primarily older, but also younger individuals. Long-term trends on incidence rates and mortality might diverge for these fractures, and few studies compare trends within a complete adult population. We investigated and compared incidence and mortality rates of pelvic, hip, femur shaft, and distal femur fractures in the Swedish adult population. Patients and methods — We analyzed data on all adult patients ≥ 18 years in Sweden with a pelvic, hip, femur shaft, or distal femur fracture, through the Swedish National Patient Register. The studied variables were fracture type, age, sex, and 1-year mortality. Results — While incidence rates for hip fracture decreased by 18% (from 280 to 229 per 105 person-years) from 2001 to 2016, incidence rates for pelvic fracture increased by 25% (from 64 to 80 per 105 person-years). Incidence rates for femur shaft and distal femur fracture remained stable at rates of 15 and 13 per 105 person-years respectively. 1-year mortality after hip fracture was 25%, i.e., higher than for pelvic, femur shaft, and distal femur fracture where mortality rates were 20–21%. Females had an almost 30% lower risk of death within 1 year after hip fracture compared with males. Interpretation — Trends on fracture incidence for pelvic and femur fractures diverged considerably in Sweden between 2001 and 2016. While incidence rates for femur fractures (hip, femur shaft, and distal femur) decreased or remained constant during the studied years, pelvic fracture incidence increased. Mortality rates were different between the fractures, with the highest mortality among patients with hip fracture.

Effectiveness of Population-Based Service Screening with Mammography for Women Aged 70-74 Years in Sweden.

Consensus has been reached on the effectiveness of inviting women aged 50 to 69 years to mammography screening, but for older women, the evidence is scarce. The aim of this study was to estimate the marginal effectiveness of inviting women to mammography screening with an upper age limit of 74 years versus stopping at age 69 using data from the Swedish service-screening program. A cohort design was used to compare the breast cancer mortality in the period 1986 to 2012 between geographic areas and periods where women were invited to screening up to the age of 74 years (study group) with those where women were invited up to age 69 (control group). The study group and the control group were compared using the incidence-based breast cancer mortality rate ratio where only breast cancer deaths in cases diagnosed at 70 to 74 years of age were counted. After 20 years of follow-up, there were 1,040 and 1,173 breast cancer deaths in the study and the control group, respectively. The breast cancer mortality rate ratio for women invited up to age 74 versus women invited up to age 69 was 0.80 [95% confidence interval (CI): 0.75-0.85] after bias adjustments. The corresponding rate ratio for participating women was 0.73 (95% CI: 0.66-0.81). Continuing to screen women up to 74 years of age is effective compared with stopping screening at 69 years. This large long-term study will add to the knowledge of the effect of mammography screening for women 70 to 74 years.

Shortening Ambulance Response Time Increases Survival in Out-of-Hospital Cardiac Arrest.

BackgroundThe ambulance response time in out‐of‐hospital cardiac arrest (OHCA) has doubled over the past 30 years in Sweden. At the same time, the chances of surviving an OHCA have increased substantially. A correct understanding of the effect of ambulance response time on the outcome after OHCA is fundamental for further advancement in cardiac arrest care.Methods and ResultsWe used data from the SRCR (Swedish Registry of Cardiopulmonary Resuscitation) to determine the effect of ambulance response time on 30‐day survival after OHCA. We included 20 420 cases of OHCA occurring in Sweden between 2008 and 2017. Survival to 30 days was our primary outcome. Stratification and multiple logistic regression were used to control for confounding variables. In a model adjusted for age, sex, calendar year, and place of collapse, survival to 30 days is presented for 4 different groups of emergency medical services (EMS)‐crew response time: 0 to 6 minutes, 7 to 9 minutes, 10 to 15 minutes, and >15 minutes. Survival to 30 days after a witnessed OHCA decreased as ambulance response time increased. For EMS response times of >10 minutes, the overall survival among those receiving cardiopulmonary resuscitation before EMS arrival was slightly higher than survival for the sub‐group of patients treated with compressions‐only cardiopulmonary resuscitation.ConclusionsSurvival to 30 days after a witnessed OHCA decreases as ambulance response times increase. This correlation was seen independently of initial rhythm and whether cardiopulmonary resuscitation was performed before EMS‐crew arrival. Shortening EMS response times is likely to be a fast and effective way of increasing survival in OHCA.

Potential analysis of roof-mounted solar photovoltaics in Sweden

Solar photovoltaic energy, driven mostly by the residential and commercial market segments, has been growing a lot in recent years in Sweden. In response to the commitment towards sustainability goals, this paper explores the potential of roof-mounted solar photovoltaic projects. This paper focuses on: roof area estimation, potential installed capacity, and potential electricity generation, at the single municipal scale and at the national scale. The following categories of different building types have been investigated: residential buildings, industrial buildings, buildings of social function, buildings of business function, buildings of economic/agricultural function, buildings of complementary function, and buildings of other unknown functions. The analysis starts from Västerås, a typical Swedish municipality and ranking seventh among the largest cities in Sweden. An estimate of 5.74 km2 available roof area potential is calculated, by considering factors such as building purposes, roof orientations, shadows and obstacles. The total potential installed capacity is calculated, assuming the installation of commercial photovoltaic modules, and design parameters for flat roofs such as inter-row distances and tilt angles. With the inputs of meteorological parameters and geographical information, the potential yearly electricity generation is calculated. The results reveal 727, 848, and 956 MWp potential installed capacity and 626, 720, and 801 GWh annual electricity production for Västerås on pitched roofs and flat roofs with three scenarios, respectively. The extrapolation of the methodology to the entire of Sweden yields a total of 504 km2 usable roof area and 65, 75, and 84 GWp installed capacity. Finally, we reveal a new understanding of usable roof area distribution and of potential installed capacity of roof-mounted solar photovoltaic systems, which can largely help evaluate subsidy scale and solar energy policy formulation in Sweden.

Mortality in first- and second-generation immigrants to Sweden diagnosed with type 2 diabetes: a 10\xa0year nationwide cohort study

Aims/hypothesisNon-Western immigrants to Europe are at high risk for type 2 diabetes. In this nationwide study including incident cases of type 2 diabetes, the aim was to compare all-cause mortality (ACM) and cause-specific mortality (CSM) rates in first- and second-generation immigrants with native Swedes.MethodsPeople living in Sweden diagnosed with new-onset pharmacologically treated type 2 diabetes between 2006 and 2012 were identified through the Swedish Prescribed Drug Register. They were followed until 31 December 2016 for ACM and until 31 December 2012 for CSM. Analyses were adjusted for age at diagnosis, sex, socioeconomic status, education, treatment and region. Associations were assessed using Cox regression analysis.ResultsIn total, 138,085 individuals were diagnosed with type 2 diabetes between 2006 and 2012 and fulfilled inclusion criteria. Of these, 102,163 (74.0%) were native Swedes, 28,819 (20.9%) were first-generation immigrants and 7103 (5.1%) were second-generation immigrants with either one or both parents born outside Sweden. First-generation immigrants had lower ACM rate (HR 0.80 [95% CI 0.76, 0.84]) compared with native Swedes. The mortality rates were particularly low in people born in non-Western regions (0.46 [0.42, 0.50]; the Middle East, 0.41 [0.36, 0.47]; Asia, 0.53 [0.43, 0.66]; Africa, 0.47 [0.38, 0.59]; and Latin America, 0.53 [0.42, 0.68]). ACM rates decreased with older age at migration and shorter stay in Sweden. Compared with native Swedes, first-generation immigrants with ≤ 24 years in Sweden (0.55 [0.51, 0.60]) displayed lower ACM rates than those spending >24 years in Sweden (0.92 [0.87, 0.97]). Second-generation immigrants did not have better survival rates than native Swedes but rather displayed higher ACM rates for people with both parents born abroad (1.28 [1.05, 1.56]).Conclusions/interpretationIn people with type 2 diabetes, the lower mortality rate in first-generation non-Western immigrants compared with native Swedes was reduced over time and was equalised in second-generation immigrants. These findings suggest that acculturation to Western culture may impact ACM and CSM in immigrants with type 2 diabetes but further investigation is needed.Graphical abstract

Trends in older people's drinking habits, Sweden 2004-2017.

Aims:To examine if and how the drinking habits of older people aged 60–79 years in Sweden have changed during 2004–2017, with a specific focus on age groups and gender.Data and measures:A Swedish, nationally representative, repeated cross-sectional telephone survey covering the years 2004–2017 (n = 225,134) was used. Four aspects of alcohol consumption were investigated: proportion of alcohol consumers, frequency of drinking, amount per drinking occasion, and prevalence of heavy episodic drinking.Results:Three of the four measures investigated showed increases in alcohol consumption in the older age groups, particularly among women. Proportion of alcohol consumers, frequency of drinking and prevalence of heavy episodic drinking during the past month increased in most older age groups among both women and men, while the average amount per drinking occasion remained stable. Thus, total consumption in older age groups has increased over time, since the proportion of drinkers and the frequency of drinking has increased. Increases were particularly marked among women and in the age groups 70–74 and 75–79 years. In age groups below 60 years, these measures showed either declines or stability.Conclusions:There has been a steady increase in alcohol consumption across all the older age groups studied, which implies that the changing drinking habits are not isolated only to certain birth cohorts. Instead there seems to be a continuous shift in older people’s drinking habits which can be expected to continue. However, these increases are from very low levels, and older people’s drinking is still at modest levels. Public health implications must be studied further.

Lydbogsbrugere og folkebiblioteket


 
 
 The use of audiobooks has risen significantly during the last few years in Sweden, a trend reflected in increasing demands for public libraries to provide their users with these books. Digital books are by no means a new phenomenon in public libraries, but the marked interest in borrowing audiobooks and new ways of distributing have led to changes in public libraries’ digital services and a redistribution of media budgets. This article describes who the audiobook users are and which other media they use. Building on this information, the article asks what challenges the demographic data of audiobook users – such as gender, age, and level of education – may pose for public libraries. Based on a quantitative analysis of survey data from Sweden, it is concluded that audiobook use is more common among young, well-educated people with a high level of digital literacy. Subscription services appear to be more popular among audiobook users, as their sale numbers are higher than lending numbers at public libraries. Nevertheless, the conclusions are that audiobooks have a place in public libraries, as they increase the service to communities and have the potential to reach new users. However, it is unclear if public libraries are reaching new groups by offering audiobooks; although the use of digital public library services is increasing, these services are mainly used by people who are already library visitors, and the public library seems to be primarily associated with the printed book.
 
 

Immigrant Background and Crime Among Young People: An Examination of the Importance of Delinquent Friends Based on National Self-Report Data

In this article we examine whether different agents of socialization—family, school, and peers—are differentially associated with offending among different immigrant groups. Our expectation is to find that the association between delinquent friends and offending is stronger for first- and second-generation immigrants than for youths of native Swedish background. We use data from four nationally representative self-report studies of 21,504 adolescents with an average age of 15 years in Sweden. The results show that both first- and second-generation immigrants report committing more offenses than natives. The association is rather weak and the two predictors account for only a marginal amount of the variance in total offending. The results also show that the association between delinquent friends and offending is stronger for both first- and second-generation immigrants than for natives.

Highlights in this issue

Many countries have closed schools and kindergartens to minimise COVID-19, but the role that children play in transmitting the virus is unclear. Ludvigsson carried out a systematic review and concluded that children were unlikely to be the main drivers of the pandemic.1 de Niet et al2 comment on the same topic. Snapiri et al3 present a group of paediatric patients who were diagnosed with appendicitis at a later stage, due to fear of the pandemic, and report higher complications than the same period in 2019. Mastnak4 suggest in a perspective paper that some of the psychopathological problems related to the pandemic could be prevented with music therapy. Haward et al5 express concerns about assumptions that extremely premature babies are less deserving of ventilator care than adults during the pandemic. The authors also describe other unrecognised areas in paediatric ethics that require our immediate attention. There are two different indications where body position has had a great impact on active medical practice. One of them is infants and sudden infant death syndrome, which favours the supine position, and the other is adult patients with acute lung insufficiency, which favours the prone position. This is covered by three papers in this issue. Poets et al6 studied oxygenation and intermittent hypoxia in supine versus prone positions in very preterm infants and Lindahl7 comments on the findings. Lindahl also looks at how some centres have started treating adult COVID-19 patients with rapidly deteriorating lung function in the prone position. His mini-review reports that this has led to considerable improvement in oxygenation in some cases and provides some insights into the mechanisms behind this that could also be relevant for paediatric medicine.8 Kivistö et al explored trends in asthma medication dispensed to children and adolescents aged 0-19 years in Finland and Sweden from 2006 to 2017.9 The authors report that inhaled corticosteroids were 1.5 times more likely to be dispensed for children aged 0-4 years in Sweden than Finland. The prevalence of short-acting β2-adrenergic receptor agonists increased in both countries, particularly in Finland. The accompanying editorial by Wennergren10 discusses why trends in asthma medication and hospitalisation differ for children in Finland and Sweden. Readers may also be interested in the paper by Bigman,11 which reports that exclusive breastfeeding for the first 3 months of life may reduce the risk of respiratory allergies and some asthma in children when they reach 6 years of age. Examining the placentas of sick newborn infants may help to personalise their neonatal care. De Angelis et al studied sick newborn infants who were transferred from smaller neonatal care centres to the neonatal intensive care unit at a children's hospital in Genoa, Italy. They found that placentas were seldom transferred with the infants for pathological examination.12 The authors attribute this finding to insufficient understanding of the importance of placental pathology in smaller neonatal care centres, as well as suboptimal routines for storing and handling placentas. They propose steps that could overcome these barriers. Papadogiannakis comments on the paper.13 Figures 1, 3: istockphoto.com, 2: Lindahl et al, 4: Alamy

Qualitative faecal immunochemical tests (FITs) for diagnosing colorectal cancer in patients with histories of rectal bleeding in primary care: a cohort study

BackgroundRectal bleeding is considered an alarm symptom for colorectal cancer (CRC) but it is common and mostly caused by benign conditions. Qualitative faecal immunochemical tests (FITs) for occult blood have been used as diagnostic aids for many years in Sweden when CRC is suspected. The study aimed to evaluate the usefulness of FITs requested by primary care physicians for patients with and without histories of rectal bleeding, in the diagnosis of CRC.MethodsResults of all FITs requested in primary care for symptomatic patients in the Örebro region during 2015 were retrieved. Data on each patient’s history of rectal bleeding was gathered from electronic health records. Patients diagnosed with CRC within 2 years were identified from the Swedish Cancer Register. The analysis focused on three-sample FITs, the customary FIT in Sweden.ResultsA total of 4232 patients provided three-sample FITs. Information about the presence/absence of rectal bleeding was available for 2027 patients, of which 59 were diagnosed with CRC. For 606 patients with the presence of rectal bleeding, the FIT showed sensitivity 96.2%, specificity 60.2%, positive predictive value 9.8% (95% CI 6.1–13.4) and negative predictive value 99.7% (95% CI 99.2–100) for CRC. For 1421 patients without rectal bleeding, the corresponding figures were 100%, 73.6%, 8.3% (95% CI 5.6–10.9) and 100% (95% CI 99.6–100).ConclusionThe diagnostic performance of a qualitative three-sample FIT provided by symptomatic patients in primary care was similar for those with and without a history of rectal bleeding. FITs seem useful for prioritising patients also with rectal bleeding for further investigation.

Pneumococcal vaccine not cost effective at 65 years in Sweden

Pneumococcal vaccine not cost effective at 65 years in Sweden

1314-P: A Low HbA1c during the First 2 Years Correlates with a Higher Percentage of HbA1c ≤6.5% (48 mmol/mol) and Lower Percentage >8.0% (64 mmol/mol) on a Clinic Level

Background: The mean HbA1c in children and adolescents varies between countries, but there is a considerable variation also between clinics within a country. The Swedish HbA1c target in children and adolescents is ≤6.5% (48 mmol/mol). Our aim was to compare early metabolic control with percentage of patients with HbA1c ≤6.5% (A1c6.5) and >8.0% (64 mmol/mol) (A1c8) for all clinics in Sweden. Methods: In this register-based nationwide cohort with type 1 diabetes, 98% of children and adolescents <18 years in Sweden were covered. We captured HbA1c for all patients (last value recorded in 2019) and calculated the mean. We then compared the mean HbA1c of all patients with up to 2 years duration with the percentage of patients with A1c6.5 and A1c8. Results: Mean overall HbA1c was 7.0% (95% CI 7.0-7.1) (53.3 mmol/mol, 95% CI 52.6-54.0) (n=7433) and for those with 0-2 years' duration 6.6% (95% CI 6.5-6.7) (49.1 mmol/mol, (95% CI 48.2-50.0) (n=1911). The mean overall percentage of patients with A1c6.5 was 35.3% (95% CI 32.4-38.2) (n=2575) and A1c8 was 13.2 (95% CI 11.5-14.8) (n=958). The correlation between mean HbA1c 0-2 y. and A1c6.5 was -0.80 (p<0.001) and A1c8 0.48 (p=0.004). Conclusions: An intensive treatment program at the onset of diabetes resulting in a low HbA1c early on is a good investment to increase HbA1c values within target and to minimize high HbA1c values. Disclosure R. Hanas: Advisory Panel; Self; Abbott, Novo Nordisk A/S. Speaker’s Bureau; Self; Sanofi. Other Relationship; Self; AstraZeneca. L. Hanberger: None. U. Samuelsson: None. A. Svensson: None. K. Akesson: None.

Levothyroxine treatment is associated with an increased relative risk of overall and organ specific incident cancers – a cohort study of the Swedish population

High thyroid hormone values have been associated with an increased risk of incident cancers, especially breast cancer but also lung cancer and any solid cancers. We explored whether there is an increased risk of overall and cause-specific cancers in those receiving levothyroxine treatment.We included all individuals ≥ 18 years in Sweden (N = 8,573,313) on January 1 2009, and identified patients with two or more dispensed prescriptions of levothyroxine 2005–2006 (n = 253,193, 3.0 %). A cancer diagnosis in the Swedish Cancer Register 2009–2015 was used as outcome. We excluded patients with a cancer diagnosis before 2005. Cox regression was used (hazard ratios, HRs, and 95 % confidence intervals, CI) with adjustments for age, socioeconomic/neighborhood factors and co-morbidities.Totally 399,751 cases of incident cancer were identified, with a slight increased overall risk associated with levothyroxine treatment for both men, adjusted HR 1.06 (95 % CI 1.03–1.10), and women, adjusted HR 1.08 (95 % CI 1.07–1.10). For men, increased risks were found for cancers of the thyroid gland and other endocrine glands. For women, increased risks were found for cancers of the breast, endometrium, other female genitals (ovaries not included), stomach, colon, liver, pancreas, urinary bladder, skin, leukemia, and unspecified primary tumor. Unlike men, for women, no increased risk was found for cancer of the thyroid gland.In conclusions, levothyroxine treatment was associated with an excess cancer risk, including many different types of cancer, especially among women. Our results need confirmation by other studies, but levothyroxine is recommended to be prescribed only on approved indications.

Child physical abuse, declining trend in prevalence over 10years in Sweden.

To study trends in prevalence and risk factors of child physical abuse over 10years in Sweden. This study analysed responses from school surveys in 2008, 2011, 2014 and 2017 in Södermanland County, Sweden with average 5125 respondents per year, 15 and 17years old. There were identical questions on exposure to violence and risk factors including parental employment, separated parents, disability or disease, foreign background and lack of adult support. Intimate partner violence was included at three occasions. Data were analysed with bi- and multivariate models, and mean of accumulated risks were compared. Child physical abuse decreased significantly between 2008 and 2017. Repeated abuse decreased to a less degree than abuse once. In bivariate analyses, the share of risk factors declined for those exposed to physical abuse. In multiple analyses, it was found significant associations with exposure. There was and a dose-relationship between numbers of accumulated risk categories and self-reported abuse. Exposure to child physical abuse decreased substantially between 2008 and 2017. However, prevalence of abuse is still unacceptable, and the finding that prevalence of the more severe forms of CPA decreased less during the same time, draws attention to the need of ongoing efforts.

Determining the useful life of district heating pipes: Correlation between natural and accelerated ageing

District heating (DH) systems constitute a smart and environmentally friendly solution for energy distribution in the heat sector in Europe. This technique is still expanding but already faces some issues such as status assessment of the current DH networks and the development of new generation networks for low-temperature DH. Therefore, it is essential to understand the ageing behaviour of pipes under operating conditions and to find the relevant parameters that control the degradation processes. Many factors affect the deterioration of DH pipes, especially the polyurethane foam, which makes it very complex to find a reliable prediction model. Models based on a linear Arrhenius relationship using results from high ageing temperatures seem to be incorrect. For this study, 10 pipes that have been in service for many years in Sweden and Norway were evaluated. The aim was to study the impact of natural ageing on the mechanical adhesion and chemical structure of the polyurethane foam, which affects the pipe's performance. A test method developed at the Research Institutes of Sweden (RISE), called RISE plug method, was used to study the mechanical adhesion strength. In addition, Fourier transform infrared spectroscopy was used to observe any change in the chemical structure. The results were compared with previous analyses of DH pipes exposed to accelerated ageing. This information helps to provide a better comprehension of the deterioration of the current generation of pre-insulated DH pipes and to improve the accelerated ageing methods used nowadays to predict the technical lifetime of DH pipes. Our results suggest that the lifetime of DH pipes has been underestimated when using artificial ageing at relatively high temperatures. The data collected from naturally aged pipes gave confirmatory information about their physical status compared with our laboratory tests. This study also suggests that infrared analyses could be used as an early indication of the degradation of the polyurethane foam at the interface with a steel pipe.

Paediatric obesity treatment during 14 years in Sweden: Lessons from the Swedish Childhood Obesity Treatment Register-BORIS.

Treatment of paediatric obesity has been offered customarily and free of charge for more than 15 years in Sweden. The Swedish Childhood Obesity Treatment Register (BORIS) is a prospective register of children and adolescents undergoing obesity treatment. To investigate how patient characteristics and treatment efficacy has changed over 14 years on a national scale. All subjects in BORIS with data from 2004 until 2017 were included, n = 21 499. Outcomes were age and BMI SDS at treatment initiation, dropout rates and treatment outcome up to 3 years after treatment initiation. Age and BMI SDS at treatment initiation have decreased during the years (both P < .0001). Of the patients who started treatment before 2009, more than 80% had at least 1-year follow-up. This number has decreased to about 60% in 2017. Since 2004, no trend in improvement of treatment results was observed when evaluating change in either BMI SDS or proportion of obesity remission. There was no difference between the sexes. Although children in Sweden receive treatment at an earlier age, which is a major determinant of treatment success, and at a lower degree of obesity at treatment initiation, the effect of childhood obesity treatment on standard anthropometric measures has not improved over the investigated years.

Abstract P2-14-05: Adjuvant chemotherapy in elderly women with triple-negative breast cancer: Swedish registry data 2009-2017

Abstract Background: Breast cancer incidence is strongly related to age, with the highest incidence rates being in elderly women. Triple-negative breast cancer (TNBC) is an aggressive form of breast cancer associated with worse survival. Due to competing mortality risks and co-morbidities, TNBC in the elderly is often under-treated with adjuvant chemotherapy. The aim of this study was to investigate if there is a gain in both breast cancer specific survival (BCSS) and overall survival (OS) with adjuvant chemotherapy in elderly patients with TNBC. Method: Information from all patients 70 years and older diagnosed with primary TNBC during the years 2009-2017 were retrieved from the Swedish National Register for Breast Cancer, the Swedish Cause of Death Register and the Swedish Patient Register. Both a propensity score matched (PSM) model and a Cox-regression model was created examining the effect of age, tumor size, tumor grade, nodal status, co-morbidities (Charlson/Deyo) and chemotherapy treatment, on BCSS and OS. Results: Of the 1421 patients included, 428 (30.1%) received chemotherapy. The 5-year BCSS was 84% vs. 62% in favor for patients receiving chemotherapy. The 5-year OS was 80% vs. 46% in favor for patients receiving chemotherapy. When adjusting for the co-variates using PSM, the 5-year BCSS was 84% vs. 73% (p&amp;lt;0.004) and the 5-year OS was 79% vs. 62% (p&amp;lt;0.001) favoring chemotherapy. Discussion: In this PSM registry analysis including all patients ≥70 years in Sweden with TNBC during a 9-year period, we could show that there was a significant benefit in both BCSS and OS with adjuvant chemotherapy when adjusting for both age and co-morbidities. Cox multivariate regression model for breast cancer specific survivalHazard Ratiop-value95% CIChemotherapy0.6020.0020.435-0.834Age (years)1.0510.0001.030-1.072Tumor size (mm)1.0170.0001.012-1.022Stage N11.9090.0001.488-2.450Stage N24.8550.0011.978-11.916Stage N31.9060.5210.266-13.637Grade 21.0140.9790.365-2.813Grade 31.6220.3400.601-4.374Charlson score1.1940.0570.995-1.433 Citation Format: Slavica Janeva, Chenyang Zhang, Anikó Kovács, Toshima Z Parris, Anna-Karin Tzikas, Christopher M Pezzi, Riccardo A Audisio, Roger Olofsson Bagge. Adjuvant chemotherapy in elderly women with triple-negative breast cancer: Swedish registry data 2009-2017 [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-14-05.

Prognostic Impact of Menopausal Hormone Therapy in Breast Cancer Differs According to Tumor Characteristics and Treatment

This study investigated how a history of menopausal hormone therapy (MHT) impacts clinical outcomes overall and in different subgroups of breast cancer patients. The study included 814 primary breast cancer patients aged ≥50 years in Sweden (2002–2012) with follow-up until 2016. Associations between patient- and tumor characteristics, recurrences, and overall survival were analyzed in relation to MHT. After a median follow-up of 7 years, 119 recurrences, and 111 deaths occurred. Ever MHT (n = 433, 53.2%) was associated with a lower BMI, frequency of alcohol abstinence, and histological grade, higher frequency of oral contraceptive use, and lobular cancer. Overall, MHT was not associated with prognosis, but there were significant effect modifications by estrogen receptor (ER) status, node status, main histological type, and aromatase inhibitor (AI) treatment on recurrence-risk (all Pinteractions≤ 0.017). MHT conferred an increased recurrence-risk in patients with ER- tumors, adjusted Hazard Ratio (HRadj) 3.99 (95% Confidence Interval (CI) 1.40–11.33), in node-negative patients HRadj 1.88 (95% CI 1.11–3.17), and in non-AI-treated patients HRadj 1.81 (95% CI 1.01–3.24), but decreased recurrence-risk in AI-treated patients HRadj 0.46 (95% CI 0.25–0.84) and in patients with lobular cancer HRadj 0.15 (95% CI 0.04–0.64). MHT was associated with lower risk of death in node-positive patients HRadj of 0.48 (95% CI 0.27–0.86) and in AI-treated patients HRadj of 0.41 (95% CI 0.22–0.77), but not in other patients (both Pinteractions≤ 0.027). A history of MHT may have prognostic value for certain subgroups of breast cancer patients such as AI-treated or node-negative patients.

The relevance of macroeconomic conditions on concurrent and subsequent alcohol use – results from two Northern Swedish cohorts

Background: The aim of this study is to examine the relevance of macroeconomic conditions (boom vs. recession) and own labor market status on alcohol use in youth and midlife.Method: Two Northern Swedish cohorts, born in either 1965 (boom at age 21 years) or 1973 (recession at age 21 years), included all pupils attending the last grade of compulsory school in Luleå, in 1981 (n = 990) or 1989 (n = 686), respectively. Questionnaires were completed at ages 21 and 43/39 years. Alcohol use was measured as volume of consumption (cl/year) and heavy episodic drinking (HED).Results: Women aged 21 years during the boom (Cohort65) consumed less alcohol and were less likely to be heavy episodic drinkers at age 21 years compared to those who were exposed to recession at the same age (Cohort73). In men there were no such cohort differences. Women, and to some extent men, in Cohort65 increased their consumption at midlife, whereas this decreased for those in Cohort73. HED decreased in both cohorts, but the decrease was steeper in the recession cohort. Analyses stratified by labor market status revealed between-cohort differences in consumption among women who were either employed or students at baseline; but not for men. Alcohol use for those unemployed did not differ between the cohorts.Conclusions: In our study, comparing two cohorts that experienced either macroeconomic boom (1986) or recession (1994) at age 21 years in Sweden, the association between individual alcohol use and concurrent unemployment in youth was not affected by macroeconomic conditions.

Renovation Strategies for Multi-Residential Buildings from the Record Years in Sweden—Profit-Driven or Socioeconomically Responsible?

An important part of the multi-family housing stock in Sweden was built during the record years 1961–1975 and is in need of extensive renovation to be modernized. The stock is also at the center of political discussion of how to sustain ‘good housing for all’, especially in the rental sector. These renovation needs coincide with present energy targets and provides an opportunity to combine renovation with energy efficiency measures. Common for many of these buildings are that neglected maintenance has led to technical shortcomings, such as high energy use and low thermal comfort due to bad insulation, unsatisfactory air tightness and leaky windows, inefficient heating systems and insufficient ventilation, and moisture damage due to leaking building envelope and leaking pipes. However, the people living in these buildings are not willing to or cannot afford to pay the higher rents that extensive renovations would entail. Earlier research has highlighted the broader societal problem of energy renovations, but also that of housing companies’ priority of measures with short payback times, and those that give the possibility to raise rents. However, recent observations indicated a tendency towards more holistic approaches to housing renovation, and this study was initiated to investigate how public and private housing companies deal with renovation levels, rent increases and related social problems. The main conclusions are that sustainability and social responsibility are moving up on agendas in the public sector, but also, apparently, in the renovations strategies among the private companies. What is also seen is a trend moving from extensive total renovations to more tenant-adapted and step-by-step renovations. Renovation options which do not entail such large rent increases are increasingly being seen. Implications are that housing owners favor gentle renovation with reasonable rent increases of 10%–20%, which at the same time, may be a drawback for reaching energy efficiency targets.