Years In Sweden Research Articles

Age at first intercourse, number of partners and sexually transmitted infection prevalence among Danish, Norwegian and Swedish women: estimates and trends from nationally representative cross-sectional surveys of more than 100000 women.

Sexual behavior at the population level impacts on public health. Recent representative sexual behavior data are lacking. Cross-sectional surveys in 2005 and 2012 on women age 18-45years randomly selected from the general population in Denmark (n=40804), Norway (n=30331) and Sweden (n=32114). Median (interquartile range) age at first intercourse was 16 (15-18)years in Denmark, 17 (16-18)years in Norway, and 17 (15-18)years in Sweden. Women in the most recent birth cohort had sexual debut at the lowest age, and were most likely to have sexual debut before the legal age of consent. Proportions with debut age ≤14 years among women born 1989-1994 vs 1971-1976, odds ratio (95% confidence interval) were: 18.4% vs 10.9%, 1.95 (1.74-2.18) in Denmark, 12.9% vs 6.3%, 2.38 (2.01-2.82) in Norway, 17.8% vs 11.4%, 1.75 (1.55-1.98) in Sweden. Median (interquartile range) number of lifetime sexual partners was 6 (3-10) in Denmark, 5 (2-10) in Norway, and 6 (3-11) in Sweden. The proportion of women reporting >10 sexual partners was also highest in the most recent survey. The percentage with odds ratio (95% confidence interval) in 2012 vs 2005 surveys were: 24.9% vs 22.8%, 1.13 (1.07-1.18) for Denmark; 23.8% vs 19.8%, 1.27 (1.19-1.34) for Norway; and 28.3% vs 23.8%, 1.31 (1.24-1.38) for Sweden. Similarly, the proportion of women reporting ever having had a sexually transmitted infection among women age <30 years were: 29.4% vs 26.4%, 1.21 (1.13-1.31) in Denmark, 28.9% vs 25.0%, 1.20 (1.10-1.31) in Norway, and 29.4% vs 22.2%, 1.45 (1.33-1.58) in Sweden. Scandinavian women reported lower age at first intercourse in younger birth cohorts. Moreover, they reported more lifetime sexual partners and a higher prevalence of ever having a sexually transmitted infection in 2012 than in 2005. Our findings may inform the interpretation of trends in outcomes associated with sexual health, and public health policies.

Varying social roles and networks on a family farm: Evidence from Swedish immigrant letters, 1880s to 1930s

Abstract The present study investigates patterns of language use in the ego documents written by three Swedish immigrants: Nils Blomberg (born in 1839), Mathilda Blomberg, (b. 1863), and Anton Blomberg (b. 1885), their eldest son. The empirical foundation of the investigation is a set of 32 family letters sent over a period of nearly fifty years (1885–1934) from the rural Smoky Valley in Kansas to Mathilda’s home village in Östergötland, Sweden. We analyze the writers’ lexis, discourse patterning (formulaic versus free-flowing), and re-current topics, and the social roles and networks that are manifest in their correspondence. The three writers continued to correspond in the Swedish language over the years. Our diachronic analysis of their lexis and discourse patterning reveals individual variation across the authors’ production. For example, Mathilda’s correspondence contains some evidence of heritage Swedish (i.e. Swedish that has diverged from the home country, due to geographical separation and language contact with English). Across her lifespan, Mathilda integrates some vocabulary for plants, places, and jobs that diverges from the lexis she recalls from her early years in Sweden, and she draws attention to this lexical divergence for the sake of her readers. Anton, a childhood bilingual in Swedish and English, systematically translates English lexis to Swedish in letters, presumably with the goal to bring his Kansas experiences closer to his Swedish relatives. In particular, the letters, especially those by Mathilda, reveal not only how the individuals communicate information about their social roles in rural Kansas, but also their desires to maintain the networks connecting their family farm in the U.S. to Mathilda’s home village in Sweden.

Suicide risk among refugees compared with non-refugee migrants and the Swedish-born majority population.

It has been hypothesised that refugees have an increased risk of suicide. To investigate whether risk of suicide is higher among refugees compared with non-refugee migrants from the same areas of origin and with the Swedish-born population, and to examine whether suicide rates among migrants converge to the Swedish-born population over time. A population-based cohort design using linked national registers to follow 1 457 898 people born between 1 January 1970 and 31 December 1984, classified by migrant status as refugees, non-refugee migrants or Swedish-born. Participants were followed from their 16th birthday or date of arrival in Sweden until death, emigration or 31 December 2015, whichever came first. Cox regression models estimated adjusted hazard ratios for suicide by migrant status, controlling for age, gender, region of origin and income. There were no significant differences in suicide risk between refugee and non-refugee migrants (hazard ratio 1.28, 95% CI 0.93-1.76) and both groups had a lower risk of suicide than Swedish born. During their first 5 years in Sweden no migrants died by suicide; however, after 21-31 years their suicide risk was equivalent to the Swedish-born population (hazard ratio 0.94, 95% CI 0.79-1.22). After adjustment for income this risk was significantly lower for migrants than the Swedish-born population. Being a refugee was not an additional risk factor for suicide. Our findings regarding temporal changes in suicide risk suggest that acculturation and socioeconomic deprivation may account for a convergence of suicide risk between migrants and the host population over time. None.

Linked seasonal outbreaks of Salmonella Typhimurium among passerine birds, domestic cats and humans, Sweden, 2009 to 2016.

In 2016, an outbreak of Salmonella Typhimurium (STm) with multilocus variable-number tandem repeat analysis (MLVA) profiles historically associated with passerine birds (2-[11-15]-[3-4]-NA-212) occurred among passerines, cats and humans in Sweden. Our retrospective observational study investigated the outbreak and revisited historical data from 2009–16 to identify seasonality, phylogeography and other characteristics of this STm variant. Outbreak isolates were analysed by whole-genome single nucleotide polymorphism (SNP) typing. The number of notified cases of passerine-associated STm among passerines, cats and humans per month and county, and their MLVA profiles, were compared to birdwatchers’ counts of passerines. Seasonal trend decomposition and correlation analysis was performed. Outbreak isolates did not cluster by host on SNP level. Passerine-associated STm was seasonal for birds, cats and humans, with a peak in March. Cases and counts of passerines at bird feeders varied between years. The incidence of passerine-associated STm infections in humans was higher in the boreal north compared with the southern and capital regions, consistent with passerine population densities. Seasonal mass migration of passerines appears to cause STm outbreaks among cats certain years in Sweden, most likely via predation on weakened birds. Outbreaks among humans can follow, presumably caused by contact with cats or environmental contamination.

Epilepsy in second-generation immigrants: a cohort study of all children up to 18 years of age in Sweden.

Our purpose was to study the association between country of birth and incident epilepsy in second-generation immigrants in Sweden. The study population included all children (n=4023149) aged up to 18years in Sweden. Epilepsy was defined as at least one registered diagnosis of epilepsy in the National Patient Register. The incidence of epilepsy, using individuals with Swedish-born parents as referents, was assessed by Cox regression, expressed in hazard ratios (HRs) and 95% confidence interval (95% CI). All models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, neighbourhood socioeconomic status and comorbid conditions, also using data from the Total Population Register. A total of 26310 individuals had a registered epilepsy event, i.e. 6.5/1000 (6.6/1000 amongst boys and 6.3/1000 amongst girls). After adjustment, the risk of epilepsy was lower than in children of Swedish-born parents. Amongst girls the significant HR was 0.85 (95% CI 0.81-0.88), but in boys only when adjusting also for comorbidity (HR0.96, 95% CI 0.92-0.99). Amongst specific immigrant groups, a higher incidence of epilepsy was observed amongst boys with parents from Turkey and Africa, but not when adjusting for comorbidity, and a lower risk was observed in many other groups (boys with parents from Latvia, girls with parents from Finland, Iceland, Southern Europe, countries from the former Yugoslavia, and Asia). The risk of epilepsy was lower in second-generation immigrant children compared to children with Swedish-born parents, but with substantial differences between different immigrant groups.

Persistent emotional distress after a first-time myocardial infarction and its association to late cardiovascular and non-cardiovascular mortality.

Patients with symptoms of depression and/or anxiety - emotional distress - after a myocardial infarction (MI) have been shown to have worse prognosis and increased healthcare costs. However, whether specific subgroups of patients with emotional distress are more vulnerable is less well established. The purpose of this study was to identify the association between different patterns of emotional distress over time with late cardiovascular and non-cardiovascular mortality among first-MI patients aged <75 years in Sweden. We utilized data on 57,602 consecutive patients with a first-time MI from the national SWEDEHEART registers. Emotional distress was assessed using the anxiety/depression dimension of the European Quality of Life Five Dimensions questionnaire two and 12 months after the MI, combined into persistent (emotional distress at both time-points), remittent (emotional distress at the first follow-up only), new (emotional distress at the second-follow up only) or no distress. Data on cardiovascular and non-cardiovascular mortality were obtained until the study end-time. We used multiple imputation to create complete datasets and adjusted Cox proportional hazards models to estimate hazard ratios. Patients with persistent emotional distress were more likely to die from cardiovascular (hazard ratio: 1.46, 95% confidence interval: 1.16, 1.84) and non-cardiovascular causes (hazard ratio: 1.54, 95% confidence interval: 1.30, 1.82) than those with no distress. Those with remittent emotional distress were not statistically significantly more likely to die from any cause than those without emotional distress. Among patients who survive 12 months, persistent, but not remittent, emotional distress was associated with increased cardiovascular and non-cardiovascular mortality. This indicates a need to identify subgroups of individuals with emotional distress who may benefit from further assessment and specific treatment.

213-OR: Lowering HbA1c during the First 2 Years Predicts a Lower Long-Term HbA1c on a Clinic Level

Background: Mean HbA1c in children and adolescents varies between countries, but there is a considerable variation also between clinics within the same country. It has been difficult to characterize factors that contribute to this difference. We aimed to compare early metabolic control with long-term mean HbA1c in clinics within Sweden. Methods: The Swedish pediatric diabetes quality registry (SWEDIABKIDS) covers 98% of children and adolescents &amp;lt; 18 years in Sweden. We captured overall mean HbA1c for 36/42 clinics (6 had less than 20 patients with &amp;lt; 2 years’ duration) and compared with HbA1c over the first 2 years of diabetes. Values with &amp;lt; 3 months’ duration were not included as these are affected by glucose levels before diagnosis. Results: Mean overall HbA1c for all 42 clinics was 54.6 (95% CI 53.3-55.9) mmol/mol (7.1%, 95% CI 7.0-7.3) and over the first 2 years for the 36 clinics 50.1 (95% CI 48.0-52.2) mmol/mol (6.7%, 95% CI 6.5-6.9). The correlation for the 36 clinics was r=0.677 (p&amp;lt;0.001). R2 was 0.458, i.e., 45.8% of the variation in overall HbA1c was explained by HbA1c during the first 2 years of diabetes. Conclusions: An intensive education program at the onset of diabetes resulting in a low HbA1c early on is a good investment for the long-term metabolic control. Mean HbA1c during the first 2 years will be a good variable to measure the effectiveness and success on a clinic level of new implementations in diabetes treatments. Disclosure R. Hanas: Advisory Panel; Self; Insulet Corporation. Speaker's Bureau; Self; Novo Nordisk A/S. Other Relationship; Self; AstraZeneca. L. Hanberger: None. U. Samuelsson: None. K. Åkesson: Speaker's Bureau; Self; Novo Nordisk A/S.

No Evidence for Increased Brain Tumour Incidence in the Swedish National Cancer Register Between Years 1980-2012.

The main objective of this study was to evaluate if there was an increased incidence of brain tumours between years 1980-2012, a time period when mobile phone usage has increased substantially. From the Swedish Cancer Registry, cases of meningiomas, low-grade gliomas (LGG) and high-grade gliomas (HGG) were identified in patients between 1980-2012. Direct age-standardised incidence rates were used to calculate incidence trends over time. A total of 13,441 cases of meningiomas, 12,259 cases of high-grade gliomas and 4,555 cases of LGG were reported to the register during the study period. The results suggest that there may be a negative development in the trend for LGG of -0,016 cases per 100,000 and year, corresponding to a mean reduction of approximately 1% per year. The present study was not able to demonstrate an increased incidence of glioma during the past 30 years in Sweden.

Antidepressant prescription patterns and CNS polypharmacy with antidepressants among children, adolescents, and young adults: a population-based study in Sweden

This study examines trends in antidepressant drug dispensations among young people aged 0–24 years in Sweden during the period 2006–2013, as well as prescription patterns and central nervous system (CNS) polypharmacy with antidepressants. Using linkage of Swedish national registers, we identified all Swedish residents aged 0–24 years that collected at least one antidepressant prescription (here defined as antidepressant users) between 1 January 2006 and 31 December 2013 (n = 174,237), and categorized them as children (0–11 years), adolescents (12–17 years), and young adults (18–24 years). Prevalence of antidepressant dispensation rose from 1.4 to 2.1% between 2006 and 2013, with the greatest relative increase in adolescents [by 97.8% in males (from 0.6 to 1.3%) and by 86.3% in females (from 1.1 to 2.1%)]. Most individuals across age categories were prescribed selective serotonin reuptake inhibitors, received their prescriptions from psychiatric specialist care, and had treatment periods of over 12 months. Prevalence of CNS polypharmacy (dispensation of other CNS drug classes in addition to antidepressants) increased across age categories, with an overall increase in prevalence from 52.4% in 2006 to 62.1% in 2013. Children experienced the largest increase in polypharmacy of three or more psychotropic drug classes (4.4–10.1%). Anxiolytics, hypnotics, and sedatives comprised the most common additional CNS drug class among persons who were prescribed antidepressants. These findings show that the dispensation of antidepressants among the young is prevalent and growing in Sweden. The substantial degree of CNS polypharmacy in young patients receiving antidepressants requires careful monitoring and further research into potential benefits and harms.

A missed opportunity? Lack of knowledge about sexual and reproductive health services among immigrant women in Sweden

ObjectivePoor sexual and reproductive health (SRH) among immigrant women is often related to limited access, or suboptimal use of healthcare services. This study investigates the knowledge about and use of sexual and reproductive healthcare services among immigrant women in Sweden. MethodA cross-sectional study of 288 immigrant women. A structured questionnaire was distributed among immigrants speaking Arabic, Dari, Somali or English registered at Swedish language schools for immigrants. Data collection took place in 19 strategically selected schools in Sweden. Descriptive statistics, chi-square tests, and logistic regressions were used for the analysis. ResultsAbout one-third of the immigrant women reported lack of knowledge of where to go for contraceptive counselling. Experiencing lack of emotional social support and not having had children was associated with this lack of knowledge. An even higher proportion (56%) lacked knowledge of where to go to be HIV tested, and this was associated with not having participated in a health examination. Almost 25% stated that their culture kept them back from using contraception. ConclusionLack of knowledge of where to turn for contraceptive counselling and HIV testing among immigrant women participating in Swedish language schools for immigrants could be considered as a missed opportunity, as all citizens in Sweden have free access to these services. New health policies and strategies should aim to increase knowledge of SRH services among immigrants. Swedish language schools could play an important role in increasing knowledge of SRH-related information as many new immigrants become students during their first years in Sweden.

Atopic dermatitis, educational attainment and psychological functioning: a national cohort study.

Atopic dermatitis (AD) might adversely affect academic performance, possibly through influences on psychological functioning such as stress resilience. To investigate the association of atopic dermatitis with stress resilience, cognitive function and educational attainment. We used data from a national cohort of men who underwent a military conscription examination at ages 17-20 years in Sweden between 1969 and 1976. All potential conscripts met a physician who assessed current or previous history of AD. Stress resilience was measured by a psychologist using a semistructured interview. The conscription assessment included a written cognitive function test. The highest level of education achieved was identified through record linkage. The study population included 234 715 men, 1673 (0·7%) of whom had a diagnosis of AD. AD was associated with a greater risk of low stress resilience [adjusted relative risk ratio (RRR) 1·60, 95% confidence interval (CI) 1·38-1·86]. AD was associated with higher cognitive function (β-coefficient 0·15, 95% CI 0·05-0·24) and higher educational level (RRR 1·29, 95% CI 1·13-1·47). However, adjustment for socioeconomic characteristics of the family of origin attenuated the magnitude of the associations and eliminated the statistical significance (β-coefficient 0·06, 95% CI -0·03 to 0·15; RRR 1·16, 95% CI 1·00-1·35). Swedish men with AD had lower stress resilience in late adolescence but did not have lower cognitive function or poorer educational attainment. The lower stress resilience associated with AD is consistent with an increased risk of possible long-term adverse health outcomes.

Maternal Hypertensive Disorders of Pregnancy and Offspring Risk of Hypertension: A Population-Based Cohort and Sibling Study.

BACKGROUNDWomen with a history of hypertensive disorders of pregnancy (HDP) are at increased risk of hypertension, cardiovascular disease, and type 2 diabetes. Offspring from pregnancies complicated by HDP also have worse cardiometabolic status in childhood and young adulthood, but the offspring risk of clinical hypertension in adulthood is largely unknown.METHODSWe studied 13,893 first-born adult offspring (49.4% female) who attended a structured population-based primary care visit (The Västerbotten Health Survey) at age 40 years in Sweden between 1994 and 2013. Data on maternal HDP were collected from a population-based birth register. We investigated the association between maternal HDP and the risk of adult offspring hypertension and worse cardiometabolic risk factor status utilizing multivariable poisson and linear regression models. We also conducted a sibling comparison, which inherently accounted for familial factors shared by siblings (N = 135).RESULTSOffspring participants of women with HDP (N = 383, 2.8%) had increased relative risk of hypertension (1.67, 95% confidence interval: 1.38, 2.01) and also higher mean body mass index, systolic blood pressure, diastolic blood pressure, and worse 2-hour 75 g oral glucose tolerance test result at age 40 years. No difference was observed for serum cholesterol. Point estimates for the cardiometabolic risk factors were attenuated in the sibling analyses.CONCLUSIONOffspring born to mothers with a history of HDP are on an adverse cardiometabolic trajectory and should be considered as concomitant targets for primordial prevention of hypertension in the maternal post-pregnancy period.

El forjamiento de “lo latinoamericano” en moldes editoriales: sobre el caso rumano en el período 2004–2015

Building on studies that underpinned the way Latin American literature has been seen through editorial lenses in recent years in Sweden (Alvstad in Transl Stud 1(5):78–94, 2012) and Italy (Carini in Castilla Estudios de Literatura 6:314–335, 2015), the current article aims at capturing the specificity of the Romanian editorial discourse vis-a-vis Latin American literature between 2004 and 2015. In this sense, it analyzes the paratext of relevant works of the publishing houses Humanitas and Rao. By paying special attention to the way in which the paratextual dimension articulates the “local vs. global” tension, it attempts to find out the degree to which the paratextual discourse of the two publishing houses is imbued with Eurocentric patterns of thinking. In broader terms, the current article hopes to contribute to a better understanding of the recent dynamics of the Latin American literature mediation on European grounds and plea at the same time for a closer focus on Central and Eastern Europe.

Heart failure in immigrant groups: a cohort study of adults aged 45 years and over in Sweden

Objective. An increased risk of being diagnosed with coronary heart disease or atrial fibrillation has been shown among different immigrant groups. However, less is known on the risk of being diagnosed with congestive heart failure (CHF). Design. We studied CHF in immigrants including all adults ≥45 years in Sweden (n = 3,274,119) from 1998 to 2012. CHF was defined as at the first event registered in the National Patient Register. Risk of incident CHF in immigrant groups compared to the Swedish-born population was assessed by Cox regression, stratified by sex, adjusting for age, socio-demographic status, and co-morbidities. Results. During a mean follow-up of 14 years in total, a total of 302,340 (9.2%) events of CHF were registered. We found the following: higher incidence in men from Bosnia, Iraq, Lebanon, Russia and Africa; among women from Bosnia, Iraq, Lebanon, Turkey, Central Europe and Finland; lower incidence in men from Iceland, Latin America, Southern Europe, Norway and Western Europe; and among women from Iceland, Southern Europe, Norway, Denmark and Western Europe. Conclusion. It is important to be aware of the increased incidence of CHF in some immigrant groups, especially from countries and areas where the immigrants have been refugees, in order to enable for a timely diagnosis, treatment of and prevention of CHF and its debilitating complications.

Repeated measures of body mass index and waist circumference in the assessment of mortality risk in patients with myocardial infarction

Aims: Weight loss is recommended for myocardial infarction (MI) patients with overweight or obesity. It has, however, been suggested that obese patients have better prognosis than normal-weight patients have, but also that central obesity is harmful. The aim of this study was to examine associations between repeated measures of body mass index (BMI) and waist circumference (WC), and all-cause mortality.Methods and results: A total of 14,224 MI patients aged <75 years in Sweden between the years 2004 and 2013 had measurements of risk factors at hospital discharge. The patients’ BMI and WC were recorded in secondary prevention clinics two months and one year after hospital discharge. We collected mortality data up to 8.3 years after the last visit. There were 721 deaths. We used anthropometric measures at the two-month visit and the change from the two-month to the one-year visit. With adjustments for risk factors and the other anthropometric measure the hazard ratio (HR) per standard deviation in a Cox proportional hazard regression model for mortality was 0.64 (95% confidence interval [CI] 0.56–0.74) for BMI and 1.55 (95% CI 1.34–1.79) for WC, and 1.43 (95% CI 1.17–1.74) for a BMI decrease from month two to one year of more than 0.6 kg/m2. Low BMI and high WC were associated with the highest mortality.Conclusion: High WC is harmful regardless of BMI in MI patients. Reduced BMI during the first year after MI is, however, associated with higher mortality, potentially being an indicator of deteriorated health.

Health-related quality of life experiences in children and adolescents born with esophageal atresia: A Swedish-German focus group study.

Esophageal atresia (EA) is a rare malformation of the esophagus, which needs surgical treatment. Survival rates have reached 95%, but esophageal and respiratory morbidity during childhood is frequent. Child and parent perspectives and cultural and age-specific approaches are fundamental in understanding children's health-related quality of life (HRQoL) and when developing a pediatric HRQoL questionnaire. We aimed to increase the conceptual and cross-cultural understanding of condition-specific HRQoL experiences among EA children from Sweden and Germany and investigate content validity for an EA-specific HRQoL questionnaire. Eighteen standardized focus groups (FGs) with 51 families of EA children aged 2-17years in Sweden (n=30 families) and Germany (n=21 families) were used to explore HRQoL experiences, which were content analyzed into HRQoL domains. The Swedish HRQoL domains were analyzed first and used as framework to evaluate HRQoL content reported in the German FGs. HRQoL experiences were then categorized as physical, social, and emotional HRQoL burden or resource. One thousand nine hundred eight HRQoL statements were recorded. All nine EA-specific HRQoL domains identified in the Swedish FGs (eating, social relationships, general life issues, communication, body issues, bothersome symptoms, confidence, impact of medical treatment, and additional difficulties due to concomitant anomalies) were recognized in the FGs held in Germany, and no additional EA-specific HRQoL domain was found. The HRQoL dimensions referenced physical burden (n=655, 34.5%), social burden (n=497, 26.0%), social resources (n=303, 15.9%), emotional burden (n=210, 11.0%), physical resources (n=158, 8.3%), and emotional resources (n=85, 4.5%). This first international FG study to obtain the EA child and his or her parents' perspective on HRQoL suggests Swedish-German qualitative comparability of the HRQoL domains and content validity for a cross-cultural EA-specific HRQoL questionnaire. EA children make positive and negative HRQoL experiences, but prominently related to physical and social burden, which underlines appropriate follow-up care and future research.

The increased trend of non-drinking alcohol among adolescents: what role do internet activities have?

BackgroundRecently, an increased trend toward non-drinking among adolescents has been observed in several countries. The aim of the present study is to evaluate a common suggestion in literature, that adolescents do not drink alcohol because they spend more time on the internet, monitored at home, by examining associations between internet activities (social media/chatting and computer gaming) and non-drinking.MethodsA health questionnaire was distributed to all 9th graders (15–16 years) in a mid-sized Swedish county in 2008, 2010 and 2012. In total, 7089 students returned the questionnaire.ResultsIn contrast to the suggestion, no association was found between total time spent on computers and non-drinking. Social media/chatting was robustly associated with a decreased probability of non-drinking across the three survey years. On the other hand, computer gaming during weekends only (OR = 1.74, CI = 1.13–2.69) or both on weekdays and weekends increased the probability of non-drinking (OR = 1.82, CI = 1.31–2.54) in 2012 only. However, neither social media/chatting nor computer gaming was associated with the increased trend of non-drinking from 2008 to 2012.ConclusionsInternet activities were in general not associated with non-drinking among adolescents aged 15–16 years in Sweden. Although, a weak positive association between computer gaming and non-drinking was found in 2012, this effect benefited the vast majority of the boys. The larger alcohol use among those with extensive social media use/chatting may indicate that these online platforms are arenas where adolescents are exposed for positive alcohol preferences and alcohol advertising without parental supervision.

Experiences and reflections of Somali unaccompanied girls on their first years in Sweden: a follow-up study after two decades

PurposeUnaccompanied asylum-seeking children (UASC) from Somalia are one of the largest groups of UASC in Europe and Sweden. The current study is a follow-up of a Swedish study conducted in 1999, where unaccompanied asylum-seeking girls (UASG) from Somalia were interviewed. In 2013, UASG from the 1999 study were interviewed again, as adults who have settled and found a new life in Sweden. The purpose of this paper is to explore how these women experienced their transition into the Swedish society.Design/methodology/approachA qualitative research design using semi-structured interviews was adopted for this descriptive study. Thematic analysis was used to analyze the data.FindingsUASG need support from different groups of adults, ranging from the staff at the group homes to community members, including countrymen, to establish a good life in their new country. The UASG need understanding and knowledgeable staff that can support them through the initial period, when they do not have their parents close to them. All actors in the supporter network need more knowledge about the difficulties in war situations. Former UASC can assist newcomers as well as being informants to authorities in a new country. Both parties involved need to be open and willing to learn from each other.Research limitations/implicationsUASG who consider themselves successful in being integrated into the Swedish society were interviewed and, therefore, the study mainly describes aspects that promote integration.Originality/valueThere are limited follow-up studies on how UASG have experienced their life after almost two decades in the new country.

Benzodiazepine prescribing for children, adolescents, and young adults from 2006 through 2013: A total population register-linkage study.

BackgroundPharmacoepidemiological studies have long raised concerns on widespread use of benzodiazepines and benzodiazepine-related drugs (BZDs), in particular long-term use, among adults and the elderly. In contrast, evidence pertaining to the rates of BZD use at younger ages is still scarce, and the factors that influence BZD utilisation and shape the different prescribing patterns in youths remain largely unexplored. We examined the prevalence rates, relative changes in rates over time, and prescribing patterns for BZD dispensation in young people aged 0–24 years in Sweden during the period January 1, 2006–December 31, 2013, and explored demographic, clinical, pharmacological, and prescriber-related attributes of BZD prescribing in this group.Methods and findingsThrough the linkage of 3 nationwide Swedish health and administrative registers, we collected data on 17,500 children (0–11 years), 15,039 adolescents (12–17 years), and 85,200 young adults (18–24 years) with at least 1 dispensed prescription for a BZD during 2006–2013, out of 3,726,818 Swedish inhabitants aged 0–24 years. Age-specific annual prevalence rates of BZD dispensations were adjusted for population growth, and relative changes in rates were calculated between 2006 and 2013. We analysed how BZD dispensation varied by sex, psychiatric morbidity and epilepsy, concurrent dispensation of psychotropic medication, type of dispensed BZD, and type of healthcare provider prescribing the BZD. Prescribing patterns were established in relation to duration (3 months, >3 to ≤6 months, or >6 months), dosage (<0.5 defined daily dosage [DDD]/day, ≥0.5 to <1.5 DDD/day, or ≥1.5 DDD/day), and “user category” (“regular users” [≥0.5 to <1.5 DDD/day for ≥1 year], “heavy users” [≥1.5 DDD/day for ≥1 year], or otherwise “occasional users”). Multinomial regression models were fitted to test associations between BZD prescribing patterns and individual characteristics of study participants. Between 2006 and 2013, the prevalence rate of BZD dispensation among individuals aged 0–24 years increased by 22% from 0.81 per 100 inhabitants to 0.99 per 100 inhabitants. This increase was mainly driven by a rise in the rate among young adults (+20%), with more modest increases in children (+3%) and adolescents (+7%). Within each age category, overall dispensation of BZD anxiolytics and clonazepam decreased over time, while dispensation of BZD hypnotics/sedatives, including Z-drugs, showed an increase between 2006 and 2013. Out of 117,739 study participants with dispensed BZD prescriptions, 65% initiated BZD prescriptions outside of psychiatric services (92% of children, 60% of adolescents, 60% of young adults), and 76% were dispensed other psychotropic drugs concurrently with a BZD (46% of children, 80% of adolescents, 81% of young adults). Nearly 30% of the participants were prescribed a BZD for longer than 6 months (18% of children, 31% of adolescents, 31% of young adults). A high dose prescription (≥1.5 DDD/day) and heavy use were detected in 2.6% and 1.7% of the participants, respectively. After controlling for potential confounding by demographic and clinical characteristics, the characteristics age above 11 years at the first BZD dispensation, lifetime psychiatric diagnosis or epilepsy, and concurrent dispensation of other psychotropic drugs were found to be associated with higher odds of being prescribed a BZD for longer than 6 months, high dose prescription, and heavy use. Male sex was associated with a higher likelihood of high dose prescription and heavy use, but not with being prescribed a BZD on a long-term basis (> 6 months). The study limitations included lack of information on actual consumption of the dispensed BZDs and unavailability of data on the indications for BZD prescriptions.ConclusionsThe overall increase in prevalence rates of BZD dispensations during the study period and the unexpectedly high proportion of individuals who were prescribed a BZD on a long-term basis at a young age indicate a lack of congruence with international and national guidelines. These findings highlight the need for close monitoring of prescribing practices, particularly in non-psychiatric settings, in order to build an evidence base for safe and efficient BZD treatment in young persons.

Incidence, recurrence and prevalence of stroke in an ageing population

Background Populations are ageing and survival from many diseases including stroke has improved substantially over the past decades. Even if stroke incidence is declining as well, at least in the population 65 years and above, there is concern that the burden of stroke will increase in the coming decades, when the population grow larger and older. However, few studies have explored how incidence, recurrence and prevalence have developed in parallel with population ageing. It needs to be further investigated whether or not the decline in incidence is large enough to compensate for the ageing of the population, and, how the incidence of recurrent stroke has developed when survival from the first stroke has improved, before we can make any clear statements of the future burden of stroke. Aim and setting In this population-based study based on Swedish register data we explore how the rate of recurrent events of stroke has developed in relation to the rate of first events. Further, how the prevalence of stroke has developed when survival has improved and the population has become older, and, finally, how the absolute number of stroke events developed. Trends are estimated for the period 1994 to 2014. Based on the findings, we discuss the future disease burden of stroke. Results We found clear declines in both incidence of first as well as recurrent stroke in Sweden between 1994 and 2014 for all ages between 60 and up to 90. For ages above 90 years the trends have remained stable. Despite improved survival of stroke the prevalence has not increased but decreased during the period, both as a proportion and as absolute number of events. Conclusion Based on the development the past 15 years in Sweden in the population 65 and older we do not find support for an increasing burden of stroke, despite an ageing population.