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To examine whether extended compared to standard level of physiotherapy is feasible and has beneficial effects on physical function in ICU survivors. This prospective pilot study with a before and after design included patients discharged from ICU to a surgical ward. The comparison group were recruited between January and April 2019 and received standard level of physiotherapy. The intervention group were recruited between May and December 2019 and received extended physiotherapy, corresponding to 50% additional physiotherapist, working 4 hours per weekday. The intervention participants received an individual rehabilitation plan developed in collaboration with a ward-based physiotherapist, and an extended number of sessions provided by the extra resource included practicing individualized exercises, for example walking and stair climbing. Physical function was measured with the Chelsea Critical Care Physical Assessment tool (CPAx) at ICU discharge, during hospital stay and discharge. Group differences were analyzed using the Mann–Whitney U-test and Chi2 test. Out of 46 eligible patients, 39 (85%) fulfilled the study (comparison n = 12, intervention n = 27) and were included in the final analyses. No adverse events occurred, and the attendance rate was high (98.5%). There were no statistically significant differences between the groups regarding physical function, hospital stay, and readmissions, but there were tendencies to better outcomes in all these parameters in favor of the intervention group. Additionally, patients in the intervention group had statistically significantly higher scores in the CPAx items "transferring from bed to chair" (median 5 vs 4, p =.039) and "stepping" (median 5 vs 4, p =.005) at hospital discharge. This pilot study indicates that extended physiotherapy after ICU discharge is feasible and does not entail patient safety risks. However, determining the potential beneficial effects for the patients remains to be evaluated in a larger trial. [ABSTRACT FROM AUTHOR]

Exercise protects against somatic comorbidities and positively affects cognitive function and psychiatric symptoms in patients with severe mental illness. In forensic psychiatry, exercise is a novel concept. Staff at inpatient care facilities may be important resources for successful intervention. Little is known about staff's knowledge, attitudes and behaviors regarding exercise in forensic psychiatric care. To translate, culturally adapt and test the feasibility of the Exercise in Mental Health Questionnaire-Health Professionals Version (EMIQ-HP) in the Swedish context, and to use this EMIQ-HP-Swedish version to describe staff's knowledge, attitudes and behaviors regarding exercise. The EMIQ-HP was translated, culturally adapted, pilot-tested and thereafter used in a cross-sectional nationwide survey. Ten of 25 clinics and 239 health professionals (50.1%) participated. Two parts of the EMIQ-HP-Swedish version showed problems. Most participants considered exercise to be a low-risk treatment (92.4%) that is beneficial (99.2%). Training in exercise prescription was reported by 16.3%. Half of participants (52.7%) prescribed exercise and 50.0% of those undertook formal assessments prior to prescribing. Creation of the EMIQ-HP-Swedish version was successful, despite some clarity problems. Exercise appears to be prescribed informally by non-experts in Swedish forensic psychiatric care and does not address treatment goals. [ABSTRACT FROM AUTHOR]

Babbling is an important precursor to speech in infancy, and deviations from the typical babbling development can predict later difficulties in speech, language, and communication. This cross-sectional study aimed to investigate babbling and early speech in Swedish extremely premature infants. Samples of babbling were collected from 20 extremely premature infants (EPT group) at the corrected age of 12 months. Data collection was home-based and consisted of an audio-video recording of each infant playing with a parent. Presence of canonical babbling (CB), and three oral stop variables distinctive of typical babbling, and consonant inventory were assessed. The assessment was performed during a standardised observation of babbling. Data from the EPT group were compared to previously collected data of a reference group of 20 10-month-old infants without known medical diagnoses. The results showed that the EPT group had a lower proportion of infants producing CB, and that they used a significantly smaller consonant inventory compared to the reference group. Although not statistically significant, oral stops were less frequently found in the EPT group. The findings of a restricted consonant inventory and low proportion of CB in the EPT group are not surprising considering that the group has been found to be at risk of speech and language delay in toddlerhood. Still, further research is needed to explore whether babbling at 12 months can predict speech and language skills at an older age in extremely premature infants. [ABSTRACT FROM AUTHOR]

Recurrent respiratory papillomatosis (RRP) is a wart-like lesion mainly affecting the larynx, caused by human papillomavirus (HPV) genotypes 6 and 11. The disease affects both children and adults, and there is no cure. Surgery is the current symptom-relieving treatment; however, HPV vaccination is used as an adjuvant treatment. The aims were to study effects of HPV vaccination in RRP cases and to compare juvenile-onset to adult-onset disease and high treatment frequency (TF) to low TF cases. Medical records of RRP patients were studied from May 2006 to January 2023. Eighty-five RRP cases, tested for HPV genotypes with PapilloCheck®, were included. Vaccination- onset- and treatment analysis were performed. Twelve percent of the cases were vaccinated. The number of surgeries decreased from 2.0 to 0.8/year after HPV vaccination. Most cases had an adult-onset and less than one treatment per year. Juvenile-onset cases had a higher vaccination treatment ratio compared to adult-onset. HPV vaccination was associated with a lower number of treatments per year, supporting the use of vaccination as an adjuvant treatment. Vaccination as adjuvant treatment to surgery may lead to increased quality of life for RRP patients and saved healthcare resources. [ABSTRACT FROM AUTHOR]

The aim of this study was to describe and analyse the variety of respiratory appearances in Long COVID subjects who were not hospitalised during the acute phase of the infection. A consecutive series of 60 subjects participated x ¯ 10.8 months (SD 4.5) after the acute phase of the infection. Respiratory function was tested concerning lung volumes, expiratory flow, muscle strength, physical capacity including concurrent oxygen saturation, chest expansion, lung sounds, pain and breathing pattern. Differences between those with or without positive test and duration of symptoms more or less than 6 months were analysed with T-test, Chi-square test and Fisher's exact test. Decreased forced vital capacity was found in 6/60 (10%), and forced expiratory volume in 1 s and 7/60 (12%), low maximal inspiratory pressure in 38/58 (54%) and low maximal expiratory pressure in 10/58 (17%). Decreased physical capacity was registered in 36/52 (69%), and thoracic expansion in 26/46 (56%). Pathologic lung sounds had 15/58 (26%) and six patients desaturated during the test of physical capacity. A majority (36/58, 67%) presented pain in the ribcage. All but three patients (95%) showed a dysfunctional breathing pattern in sitting and standing. Only poor and fair correlations were found between age, duration and level of physical capacity compared to spirometry, respiratory muscle strength and thoracic expansion. Abnormal breathing pattern and respiratory movements as well as pain, and reduced lung volumes, flow, respiratory muscle strength, physical capacity and thoracic expansion may be involved in Long COVID. The breathing symptoms should therefore be looked for in a wider picture beyond spirometry and oximetry. [ABSTRACT FROM AUTHOR]

Peritonsillar abscess (PTA) can be treated with aspiration or incision for drainage, but a subsequent PTA can occur if tonsillectomy is not performed. Better understanding is needed of when tonsillectomy should be performed to avoid PTA recurrence. This study investigated the recurrence rate of PTA following aspiration or incision for drainage and evaluated the risk factors for recurrence. The medical records of 292 patients treated for PTA were reviewed. Recurrence of PTA and elective or quinsy tonsillectomy were the primary endpoints. A Cox proportional hazards regression model for PTA recurrence was constructed with sex, age, and PTA history as predictors. Young age was the only significant predictor of PTA recurrence. Patients aged 15 to 24 years had a 30-day recurrence rate of 15.5% and a total recurrence rate of 26.6%. The total recurrence rate among patients over 30 years of age was significantly less at 4.0% (Fisher's exact test, p <.05). Based on our results, tonsillectomy should be considered for PTA patients between 15 and 25 years of age and, to effectively avoid future recurrence of PTA, should be performed urgently. [ABSTRACT FROM AUTHOR]

Knowledge regarding the impact of curricula with behavioral medicine content and competencies (BMCC) on physical therapy (PT) students' clinical reasoning skills is lacking. The primary objective was to compare the clinical reasoning skills, focusing on clients' behavioral change, of entry-level PT students with or without BMCC in their curricula. The secondary objective was to compare students' attitudes and beliefs in a biomedical and biopsychosocial practice orientation. Swedish final-semester PT students (n = 151) completed the Reasoning 4 Change (R4C) instrument and the Pain Attitudes and Beliefs Scale for Physiotherapists. A blueprint was used for curricular categorization. The independent t-test was used. Students attending programs with BMCC curricula (n = 61) had superior scores compared with students without BMCC curricula (n = 90) in the following R4C variables, all of which were related to clinical reasoning focused on behavioral change: Knowledge, Cognition, Self-efficacy, Input from the client, Functional behavioral analysis, and Strategies for behavioral change. Students who did not receive BMCC curricula scored higher in the R4C contextual factors and reported a greater biomedical practice orientation than students receiving BMCC curricula. There was no difference in the biopsychosocial practice orientation between groups. Our findings support the benefit of structured entry-level PT curricula with BMCC on final-semester students' clinical reasoning skills focused on behavioral change and their level of biomedical practice orientation. Further, our findings elucidated educational opportunities to augment students' self-efficacy and strengthen their behavioral competencies in clinical reasoning. For the generalizability of the results further research in other contexts is needed. [ABSTRACT FROM AUTHOR]

Objective: To investigate early auditory prerequisites in relation to the use of canonical babbling (CB) and early consonant production in a heterogeneous group of children with hearing impairment (HI) and in comparison to controls with normal hearing (NH). Methods: Five children with unilateral or bilateral HI who used hearing aids (HA) (0;9–1;7 years) and six children with cochlear implants (CI) (0;10–2;0 years) were compared to data from 22 children with NH (0;10–1;6 years). Hearing age, type of HI and daily use of hearing technology (hours) was investigated in relation to CB ratio and consonant production. Analysis of babbling from video recordings during verbal interaction between a parent and child was independently performed by two observers. Intra- and inter-agreement were calculated. Results: Children with HI used less CB compared to children with NH. Less CB utterances and occurrences of dental/alveolar stops were found in children with HA who had a hearing age of 5 months and who used their hearing technology 5 h per day. The children with CI reached an expected CB ratio and consonant production after 8.5 months with daily fulltime use of CI. Conclusions: Even a mild hearing loss in early childhood may affect and delay the onset of important linguistic milestones like canonical babbling and consonant production. It was indicated that children with CI or HA might receive different attention and intervention services. Longer hearing age and full-time use of hearing technology may influence positively on CB ratio and consonant production in children with HI. [ABSTRACT FROM AUTHOR]

Background: In contemporary society internet and digital competencies are used to perform activities. Aim: The aim of this study is to investigate opportunities and risks of internet use as perceived by the parents of adolescents with intellectual disabilities (ID) in comparison with a national reference group of parents of adolescents. Methods: This was a cross-sectional study with group comparisons using a national survey. Analyses were carried out using Fisher's exact test and logistic regression to control for confounding factors. Results: A significantly higher proportion of parents of adolescents with ID perceive opportunities associated with internet use and playing games, and a lower proportion perceive risks with negative consequences, compared with the reference group. Significantly more parents of adolescents with ID perceive their adolescent never use smartphones and social media compared with the reference group. Fewer parents of adolescents with ID have concerns about online risks for their adolescents compared with the reference group. Conclusion and Significance: The results provide new knowledge for occupational therapists to support positive risk-taking in internet-use for adolescents with ID, in collaboration with their parents, to enable the development of digital competencies and digital participation in everyday life in a digitalised society. [ABSTRACT FROM AUTHOR]

Background: There is limited knowledge of the effects on function after ruptured distal biceps tendon repair. The purpose of this follow-up was to evaluate range of motion (ROM), strength, endurance, physical function and perceived satisfaction after surgery for ruptured distal biceps tendon and standardised physiotherapy treatment. Methods: This is a cross-sectional study of individuals assessed on average 3 years following a distal biceps tendon repair. Out of 44 patients identified, 22 participated. All had completed standardised rehabilitation postoperatively. ROM, static upper arm flexion and extension strength, and endurance were measured. The participants estimated their level of disability and satisfaction with treatment results. Results: Supination of the injured arm was significantly inferior to the non-injured arm (p <.001), but elbow flexion, extension, and pronation were not (p >.05). There were no significant differences in isometric strength in flexion and extension or endurance in pronation/supination between arms. Patients reported low level of disability (DASH score, median 0.83), with 16/22 scoring ≤10. Eighteen participants (82%) reported complete satisfaction with treatment. Conclusion: The majority of the participants had regained function with the exception of range of motion in supination. They reported no or minor disability and overall satisfaction with treatment results was high. [ABSTRACT FROM AUTHOR]

Objectives: Approximately, 1-2% of all pregnancies are ectopic; 25% of unintended pregnancies are conceived despite the use of contraception. The primary objective of our study was to explore the proportion of ectopic pregnancies (EPs) that were conceived during contraceptive use among women in Stockholm County. Secondary objectives were to establish the prevalence of contraceptive methods used at the time of EP and the intended contraceptive method after treatment completion.Methods: We performed a retrospective cohort study of 1180 women diagnosed with and treated for EP between 1 December 2013 and 30 April 2017 at all hospitals in Stockholm County. Demographic variables and contraceptive use before and after treatment were noted. Exclusion criteria were uncertainty about the diagnosis of EP in the patient records and planned treatment/follow-up outside Stockholm County.Results: A total of 222/1180 (18.8%) EPs were conceived during known contraceptive use. A total of 112/222 (50.5%) women with known use of contraception at the time of conception discontinued contraceptive use and 81/857 (9.5%) women with no prior use of contraception initiated contraceptive use. Among the 857 women, 520 (60.7%) expressed a desire to conceive. Results were compared using the Mann-Whitney U test or Fisher's exact test as appropriate.Conclusion: EP occurring during use of contraception is an unexplored problem. Contraceptive use decreased in women who were using contraception at the time of EP conception, leaving these women at risk of a subsequent unintended pregnancy. There should be more focus on contraceptive use after treatment for EP, in order to preserve fertility. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to examine how background noise and hearing aid experience affect the robust relationship between working memory and speech recognition. Design: Matrix sentences were used to measure speech recognition in noise. Three measures of working memory were administered. Study sample: 148 participants with at least 2 years of hearing aid experience. Results: A stronger overall correlation between working memory and speech recognition performance was found in a four-talker babble than in a stationary noise background. This correlation was significantly weaker in participants with most hearing aid experience than those with least experience when background noise was stationary. In the four-talker babble, however, no significant difference was found between the strength of correlations between users with different experience. Conclusion: In general, more explicit processing of working memory is invoked when listening in a multi-talker babble. The matching processes (cf. Ease of Language Understanding model, ELU) were more efficient for experienced than for less experienced users when perceiving speech. This study extends the existing ELU model that mismatch may also lead to the establishment of new phonological representations in the long-term memory. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effect of a prolonged intervention of breathing exercises with Inspiratory Resistance Positive Expiratory Pressure for one month after open cardiac surgery concerning lung function, respiratory movements and postoperative pulmonary complications. Methods: A randomised controlled trial comparing the effect of home-based breathing exercise after discharge from the hospital or stop at discharge. Eighty patients were randomly assigned to an intervention group or control group. Forced vital capacity, forced expiratory volume in the first second, peak expiratory flow, respratory movements and saturation were measured at discharge and after the intervention. At follow-up self-reported pulmonary complications were also recorded. Results: A significant increase in forced vital capacity (p =.04) was found in the intervention group compared with the control group, and there were a tendency towards significant differences also in forced expiratory volume in the first second and saturation (p =.06). Respiratory movements increased significantly after one month but there were no significant differences between groups. None of the patients reported being treated for pneumonia. Conclusion: A prolonged intervention of breathing exercise for one month after open cardiac surgery significantly increases forced vital capacity and may accelerate recovery after cardiac surgery. Clinical registration number: FoU in Sweden no 76141. [ABSTRACT FROM AUTHOR]

Objective: In non-muscle-invasive bladder cancer (NMIBC), local recurrence after transurethral resection of the bladder (TURB) is common. Outcomes vary between urological centres, partly due to the sub-optimal surgical technique and insufficient application of measures recommended in the guidelines. This study evaluated early recurrence rates after primary TURB for NMIBC before and after introducing a standardized treatment protocol. Methods: Medical records of all patients undergoing primary TURB for NMIBC in 2010 at Skåne University Hospital, Malmö, Sweden, were reviewed. A new treatment protocol for NMIBC was defined and introduced in 2013, and results documented during the first year thereafter were compared with those recorded in 2010 prior to the intervention. The primary endpoint was early recurrence at first control cystoscopy. Comparisons were made by Chi-square analysis and Fisher's exact test. Recurrence-free survival (RFS) in the two cohorts was also investigated. Results: TURB was performed on 116 and 159 patients before and after the intervention, respectively. The early recurrence rate decreased from 22% to 9.6% (p = 0.005) at the first control cystoscopy after treatment. Residual/Recurrent tumour at the first control cystoscopy after the primary TURB (i.e. at second-look resection or first control cystoscopy) decreased from 31% to 20% (p = 0.038). The proportion of specimens containing muscle in T1 tumours increased from 55% to 94% (p < 0.001). RFS was improved in the intervention group (HR = 0.65, CI = 0.43–1.0; p = 0.05). Conclusions: Introduction of a standardized protocol and reducing the number of surgeons for primary treatment of NMIBC decreased the early recurrence rate from 22% to 9.6% and lowered the recurrence incidence by 35%. [ABSTRACT FROM AUTHOR]

Alleged child sexual abuse against preschool-aged children is often considered one of the most challenging cases for a prosecutor to handle. The aim of the current study was to examine differences between prosecuted and discontinued cases of alleged sexual abuse of preschool-aged children. Data from Swedish criminal cases of alleged sexual abuse of children ages 2-6 issued from 2010 to 2014 were analyzed (N = 130). Prosecuted cases were more likely to contain forensic evidence (documentation of abuse, corroborative DNA evidence, or a corroborative medical examination), or a confession from the suspect, while such evidence was not available in any discontinued case. Furthermore, cases where the child was older, where the prosecutor had decided to conduct an interview with the child, and where there was more than one alleged victim were more likely to be prosecuted. Factors that were associated with a decreased likelihood of prosecution were ongoing custody disputes between parents, foster care placements prior to the abuse, and if the report concerned a boy. Boys and younger children were also less likely to be interviewed. The results suggest that prosecution of sexual abuse cases involving preschool-aged children remains difficult and that there is room for improvements in these investigations. [ABSTRACT FROM AUTHOR]

Background/aims: Community-based day centres in Sweden are well-established arenas for psychiatric rehabilitation, but little is known of the attendees’ perception of the quality of the service provided. The aim of the study was thus to describe and investigate the quality of the services in community-based day centre for people with psychiatric disabilities. Methods: A sample of 218 attendees in 14 community-based day centre services in Sweden completed the Quality in Psychiatric Care - Daily Activities (QPC-DA). Results: The results showed that people with psychiatric disabilities perceived the quality of community-based day centre services as high. Most notably, quality of service was rated higher by those with lower educational level, had waited shorter time to attend the centre, and had better mental and physical health. However, particularly aspects of a secluded environment and participation (information) may be areas with potential for improvement. Conclusion/significance: From an occupational science perspective, the results adhere to the importance of occupational balance, with periods of rest/privacy during the time at the centre. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of this prospective study was to determine the prevalence of exocrine pancreatic insufficiency (EPI) in people living with HIV (PLHIV) on suppressive antiretroviral therapy (ART). Methods: PLHIV ≥18 years of age and on ART for >6 months and with HIV RNA <50 copies/mL plasma were included. Faecal elastase-1 measurement was performed on a single stool sample, serum markers of malnutrition were collected, and participants answered a short questionnaire about gastrointestinal symptoms. Participants with EPI and symptoms were offered pancreatic enzyme replacement therapy (PERT), and the result of this therapy was also evaluated. Results: Of 100 participants, 32% had EPI (faecal elastase-1<200 lg/g) and 20% severe EPI (faecal elastase-1<100 lg/g). We did not find any correlation between self-reported symptoms and degree of EPI. Twelve out of the 32 participants with EPI accepted to start PERT. Nine out of 12 (75%) reported improvement or became asymptomatic within 14 days. Conclusion: EPI is common in PLHIV on effective ART. We could, however, not find a correlation between gastrointestinal symptoms and the presence of EPI. Assessment of pancreatic exocrine function could be considered in PLHIV particularly in those with gastrointestinal discomfort, since there is a possible gain in treating them with relief of symptoms and improved quality of life. The effects of PERT in PLHIV on effective ART need further study. [ABSTRACT FROM AUTHOR]

Background: People who inject drugs (PWID) are the driving force of the hepatitis C virus (HCV) epidemic. Still, treatment is scarcely offered and the awareness of HCV status in PWID is poor. Prevention includes clean needles, syringes and other paraphernalia. HCV awareness was investigated in 1500 PWID in a needle exchange program (NEP) in Stockholm, Sweden, together with HCV prevalence, and time to HCV infection after start of injection drug use. Methods: 1500 PWID in the Stockholm NEP were consecutively enrolled. At baseline, awareness of the individual pre-test HCV status was measured followed with tests for anti-HCV and HCV RNA if anti-HCV was positive. Results: Mean age of participants was 39 years and the mean time of injection drug use 18 (0–51) years. The overall anti-HCV prevalence was 82% whereof 76% were HCV RNA positive. Within 4 years after start of injection drug use 50% of the participants were anti-HCV positive. Self-awareness of HCV status was low. Hence, 32% who believed that they never have encountered HCV were anti-HCV positive, and 24% were HCV RNA positive. For those who reported not being aware of their HCV status 62% were anti-HCV positive, and 47% were HCV RNA positive. Conclusion: The very high prevalence of chronic HCV in PWID in Stockholm indicates that both measures for prevention with increased awareness of HCV, and a higher antiviral treatment utilisation in combination need to be implemented in order to reduce the HCV prevalence and combat the HCV epidemic. [ABSTRACT FROM AUTHOR]

Objective:To study if a modified triage system at an Emergency Department (ED) combined with educational efforts resulted in reduced time to antibiotics and decreased length of hospital stay (LOS) for patients with severe infection. Methods:A retrospective, observational study comparing patients before and after the start of a new triage model at the ED of a University Hospital. After the implementation of the model, patients with fever and abnormal vital signs were triaged into a designated sepsis line (Sepsis Alert) for rapid evaluation by the attending physician supported by a infectious diseases (IDs) specialist. Also, all ED staff participated in a designated sepsis education before Sepsis Alert was introduced. Medical records were evaluated for patients during a 3-month period after the triage system was started in 2012, and also during the corresponding months in 2010 and 2014. Results:A total of 1837 patients presented with abnormal vital signs. Of these, 221 patients presented with fever and thus at risk of having severe sepsis. Among patients triaged according to the new model, median time to antibiotics was 58.5 at startup and 24.5 minutes at follow-up two years later. This was significantly less than for patients treated before the new model, 190 minutes. Also, median LOS was significantly decreased after introduction of the new triage model, from nine to seven days. Conclusions:A triage model at the ED with special attention to severe sepsis patients, led to sustained improvements of time to antibiotic treatment and LOS. [ABSTRACT FROM PUBLISHER]

Background: Extracorporeal membrane oxygenation (ECMO) may be a lifesaving rescue therapy in refractory, severe respiratory, and/or circulatory failure. To provide the best cost efficiency to the population served and patient outcome, ECMO therapy should be provided by specialized high volume ECMO centers. This requires dedicated transport teams to organize and perform these complex transports. Concerning adverse events and complications during these transfers, only a minimal amount of data has been published. Methods: To shed light on this matter, all medical transport records from transports on ECMO between January 2010 and June 2016 were analyzed. The data was classified in constituent groups and categorized to risk groups. Results: During the study period, 536 transports on ECMO were performed. The transport records could be identified in 514 of these cases (95.9%). In 163 (31.7%) transports 206 adverse events occurred. In 34 transports two or more adverse events passed on the same trip. No deaths occurred during transport. Sixty-five percent (134) of the complications were Patient related; the most prominent was loss of tidal volume with or without fluid flooding of the lung (n = 57, 43%). Lack of control of equipment was the most common Staff related flaw. Causes due to Equipment/technical (n = 30) could be traced to 14.6% of the events. Vehicle/transportation related complications were reported from 26 transfers, a sub-group in which 50% of the reports concerned malfunction of Ambulance utility/electrical, or Wrong ambulance size at hospital or airport. Conclusions: If transporting on ECMO high-risk or sudden threat-of-life situations are inevitable and have to be dealt with immediately, sometimes within seconds. A well-trained staff and an experienced high-volume organization are recommended. Key words: extra corporeal membrane oxygenation; ECMO, transport; adverse event; complication [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the effects of written instructions (WIs) versus physiotherapist-supervised rehabilitation on patient-rated ankle function, satisfaction and physical activity ability after an acute ankle sprain. Thirty-nine patients with an acute ankle sprain, recruited from an emergency department, received WIs on functional rehabilitation (WI group). The patients were evaluated six weeks and three months after their injury with the disease-specific Foot and Ankle Outcome Score (FAOS). The patients also rated how satisfied they were with their ankle and physical activity ability using visual analogue scales. The results from the WI group were compared with a group of patients (n = 33) who received physiotherapist-supervised rehabilitation in a previous study (PT group). We found that compared with the PT group, the WI group had significantly worse scores in all of the FAOS subscales six weeks after the injury, and in three of five subscales three months after the injury. They also rated significantly lower satisfaction and significantly lower physical activity ability at both follow-ups. In conclusion, physiotherapist-supervised rehabilitation was more effective than WIs on improving patient-rated ankle function, satisfaction and physical activity ability after an acute ankle sprain. [ABSTRACT FROM PUBLISHER]

Purpose:We investigated whether active video gaming (AVG) could bring about regular, enjoyable, physical exercise in children treated for brain tumours, what level of physical activity could be reached and if the children’s physical functioning improved. Methods:Thirteen children, aged 7–17 years, were randomised to either AVG or waiting-list. After 10–12 weeks they crossed-over. Weekly Internet coaching sessions were used to sustain motivation and evaluate enjoyment. Energy expenditure (EE) levels were measured as Metabolic Equivalent of Task (MET), using a multisensory activity monitor. Single-blinded assessments of physical functioning were done, using the Bruininks–Osteretsky Test of Motor Performance, second edition, evaluating participants before and after the intervention period, as well as comparing the randomisation groups after the first period. Results:All patients completed the study. AVG sessions (mean duration 47 minutes) were performed on 72% of all days. Mean EE level during AVG sessions was 3.0 MET, corresponding to moderate physical activity. The Body Coordination score improved by 15% (p = 0.021) over the intervention period. Conclusions:In this group of childhood brain tumour survivors, home-based AVG, supported by a coach, was a feasible, enjoyable and moderately intense form of exercise that improved Body Coordination.Implications for RehabilitationChildhood brain tumour survivors frequently have cognitive problems, inferior physical functioning and are less physically active compared to their healthy peers.Active video gaming (AVG), supported by Internet coaching, is a feasible home-based intervention in children treated for brain tumours, promoting enjoyable, regular physical exercise of moderate intensity.In this pilot study, AVG with Nintendo Wii improved Body Coordination. [ABSTRACT FROM AUTHOR]

Aims:Privileged access interviewing (PAI) has traditionally been used to reach illicit drug users and other ‘hidden’ populations. How PAI data compare to other self-reported data have seldom been discussed. We compare data from patients in opioid substitution treatment (OST), gathered through PAI and researcher interviews, respectively, to investigate whether PAIs and researchers are reaching comparable populations, and whether differences in answers are due to the sensitive nature of the questions. Methods:Structured interviews were conducted with 368 patients from nine OST clinics in three Swedish cities. 237 interviews were carried out by researchers, and 131 by nine PAIs (OST patients). Data were analyzed with χ2test, Fisher’s exact test,t-test and logistic regression analysis. Results:PAIs and researchers recruited comparable populations, with few differences in terms of individual, treatment and social factors. However, self-reported behaviors revealed several significant differences. Alcohol consumption and drinking to intoxication was more commonly reported among patients interviewed through PAI (p < 0.001 andp = 0.001, respectively). Furthermore, the PAI group reported selling medication (p < 0.001 last month,p < 0.001 during treatment episode) and snorting buprenorphine (p = 0.010 last month,p = 0.001 during treatment episode) more frequently. Conclusions:PAI is a useful method in studies of illicit drug use and a valuable complement to more traditional interviewing methods. Specifically as regards revelations of a sensitive or controversial nature, PAI seems to produce different results than researcher interviews, and possibly also more truthful responses. PAI may have considerable potential as a data-gathering method also when studying other, more easily accessible populations. [ABSTRACT FROM AUTHOR]

Objective: To investigate the association between positive blood alcohol level (BAL) and functional outcome in patients suffering severe traumatic brain injury. Study design: The brain trauma registry of an academic trauma centre was queried for patients admitted between January 2007 and December 2011. All patients (≥ 18 years) with a neurosurgical intensive care length of stay beyond 2 days were included. Patient demographics, clinical characteristics, injury profile, laboratory test and outcomes were abstracted for analysis. Primary outcome was unfavourable functional outcome defined as Glasgow Outcome Score (GOS) ≤ 3. Multivariable regression models were used for analysis. Results: Of the 352 patients, 39% were BAL (+) at admission. Patients with (+) BAL were significantly younger with less co-morbidities. The cohorts exhibited no significant difference in the severity of the intra-cranial injury and the use of intra-cranial monitoring or surgical interventions. Further, the groups presented no difference in in-hospital mortality (p= 0.1) or 1-year mortality (p= 0.5). There was a worse long-term functional outcome in (–) BAL patients compared to their BAL (+) counterparts after adjustment for confounders (GOS ≤ 3: AOR = 2.0, 95% CI = 1.1–3.5,p= 0.02). Conclusion: Positive BAL on admission is associated with a better long-term functional outcome in patients suffering severe traumatic brain injury. [ABSTRACT FROM PUBLISHER]

Background:Bone and joint infections remain a clinical challenge with potentially serious consequences. Nevertheless there is a lack of studies with strict criteria for diagnosis and etiology. The primary aim of this study was to determine the causative agents in orthopaedic infections using strict diagnostic criteria for infection and etiology. The secondary aim was to assess the timing of post-operative infections in relation to pathogens and to compare causative bacteria in different parts of the body. Methods:A retrospective registry study of 363 consecutive cases of bone and joint infections was performed. Microbiological data on sampling and culture results were registered. Results:Staphylococcus aureusdominated in both operated (45%) and non-operated (44%) patients, followed in frequency by coagulase-negative staphylococci (CoNS) in operated patients (11%) and beta-haemolytic streptococci in non-operated patients (16%) (p < 0.001). There were no polymicrobial infections in non-surgical cases (p < 0.001). For operated patients, Gram-negative bacilli were observed in 6%, almost exclusively isolated from the lower extremity.Propionibacterium spp.was the most common finding after spinal surgery. In 90/363 (25%), the agent responsible for the infection could not be defined according to the strict criteria used. Conclusion:S. aureusdominated as etiological agent in all bone and joint infections, including operated patient given peri-operative prophylaxis. Improved timing of antibiotic prophylaxis seen after the introduction of the Swedish national project PRISS may have changed this. The number of infections with uncertain etiology was high, stressing the importance of more studies on diagnostics, as well as strict diagnostic algorithms. [ABSTRACT FROM PUBLISHER]

Conclusions Patients with symptomatic perforations of the nasal septum had a high prevalence of S. aureus in the nasal mucosa. Pulsed field gel electrophoresis (PFGE) analysis revealed a high genetic heterogeneity of S. aureus among both patients and controls. This indicates that presence of different strains of S. aureus can maintain a chronic inflammation in symptomatic nasal septal perforations. Objective The purpose of this study was to investigate the microbial flora around nasal septal perforations in patients having severe symptoms regarding bleeding, obstruction, and crustation associated with their perforation. Methods Twenty-five patients with untreated symptomatic nasal septal perforations were included. For culture, swabs around the perforations were collected. Bacteria were identified with standard laboratory techniques including a MALDI-TOF mass spectrometer. Epidemiological analysis was done using PFGE protocols. Bacteriological data were compared with data from a healthy control group. Results Staphylococcus aureus was present in the mucosa surrounding the nasal perforation significantly more often (p < 0.0001) in the patients (88%) compared to a control group (13%). Corynebacterium spp. and Propionibacterium spp. were significantly more frequently identified in the control group. The PFGE analysis of S. aureus strains revealed a high genetic heterogeneity and no specific S. aureus genotypes were associated with septal perforation. [ABSTRACT FROM AUTHOR]

Few studies have investigated the incidence of injuries in kayakers. The aim was to study the prevalence of shoulder pain in competitive flatwater kayakers and to evaluate any differences in range of motion or scapula stability of the shoulder joint among kayakers with or without the history of shoulder pain. Thirty-one kayakers were participated in the study, and a questionnaire including background data was used. Shoulder range of motion was measured with a goniometer, and the participants were observed for scapula dyskinesis in flexion and abduction. Of the participating kayakers, 54.8% (n = 17) had experienced shoulder pain. Kayakers who had experienced shoulder pain showed a significantly lower degree of internal rotational range of motion versus kayakers with no reported shoulder pain, with a mean degree of internal rotation in the right shoulder 49.3 vs 60.0 (P = 0.017) and the left shoulder 51.9 vs 66.0 (P = 0.000). Kayakers who had experienced shoulder pain were also observed with a scapular dyskinesis (n = 15 of 17 kayakers) to a significantly higher degree (P = 0.001) than kayakers with no reported shoulder pain. Findings suggest that screening for scapular dyskinesis and testing for rotational range of motion in the shoulder joint is essential in order to treat and maybe prevent shoulder pain in kayakers. [ABSTRACT FROM PUBLISHER]

BackgroundAlthough it is acknowledged that exercising self-determination in daily activities affects older people’s health and well-being, few studies have focused on the explanatory factors for self-determination in daily life.ObjectiveTo investigate explanatory factors for self-determination in the context of community-dwelling older persons.Method: This cross-sectional study combined two sets of data that included community-dwelling persons 80 years and older (n = 456). A bivariate logistic regression was performed to analyse the association of self-determination and a set of explanatory factors.ResultsThe final bivariate logistic regression model revealed five explanatory factors that were significantly associated with perceiving reduced self-determination: high education (OR = 2.83), frailty (OR = 2.70), poor self-rated health (OR = 2.54), dissatisfaction with physical health (OR = 6.50), and receiving help from public homecare service (OR = 2.46).ConclusionSeveral explanatory factors related to the ageing body and environmental aspects were associated with reduced self-determination. To help older people maintain self-determination, healthcare professionals should consider using a person-centred and capability approach to care. [ABSTRACT FROM PUBLISHER]

Conclusion: ECT can be a safe curative mono modality treatment, especially in tongue cancer. The future role for ECT in head and neck cancer needs to be further investigated. Introduction: Electrochemotherapy (ECT) is a cancer treatment modality that uses electroporation to increase the intracellular accumulation of hydrophilic chemotherapeutic drugs, especially bleomycin. Objectives: To report the 5-year local tumor control, safety of treatment and survival after ECT, and the 1-year quality-of-life (QoL) data. Materials and methods: Nineteen patients with primary head and neck cancer were included and treated with ECT with curative intent. All except one patient had squamous cell carcinoma (SCC). Radiotherapy (RT) was performed in all patients with SCC and tumor infiltration ≥5 mm. The EORTC H&N 35 questionnaire was used at baseline and 12 months after treatment. The Wilcoxon signed rank test and McNemar's test were used for paired data and Mann Whitney U-test and Fishers exact test were used for independent data (sub-group comparison). Results: There were no local recurrences in the follow-up period. Thirteen patients were treated with adjuvant RT. The six patients that were treated with ECT alone were tumor-free and alive 5 years after treatment. There was one serious adverse event reported; aspiration after treatment of a tongue base tumor. The tumor-specific 5-year survival was 75%. The QoL outcome 1 year after ECT showed a significant increase in problems with senses (taste, smell), speech, mouth opening and xerostomia. The QoL outcome also showed worse outcome in the smoking patients regarding speech, in the patients receiving adjuvant RT regarding mouth dryness and swallowing and in the patients with non-tongue oral cavity cancer regarding need for painkillers. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate the extent and pattern of internal missing data in physiotherapy assessments of children with cerebral palsy (CP), regarding passive range of motion (PROM) and spasticity (measured using the modified Ashworth scale, MAS). Methodology: Data from 2936 children were included. Extent and pattern of missing data of PROM and MAS were related to Gross Motor Function Classification System (GMFCS) level, CP subtype, age and gender. The material was divided into groups and the proportions of the different variables were compared. Chi-squared statistics were used to assess differences in proportions. Major findings: The extent of missing data of PROM and MAS was small (6.2%). The frequency of missing data of MAS was larger than for PROM and varied according to GMFCS level and age. Principal conclusion: The extent of missing data in this study can be considered small and thus would not influence the generalizability of findings for PROM and MAS. It is, however, advisable to report the degree of missing data, especially if data concern PROM and MAS from children GMFCS level I, GMFCS level III, children from the age group 1-5 years and adolescents aged 13-20 years. [ABSTRACT FROM AUTHOR]

Purpose: Personality disorders (PDs) are associated with significant distress, disability, and cause great difficulties in life. PDs have been suggested to influence adaptation after major burns, but the potential relationship has not been fully elucidated. This study aimed to describe the prevalence of PDs in 107 patients with major burn injury, and to identify the impact of PDs on perceived patient outcome assessed as health-related quality of life (HRQoL) one year after burn. Methods: One burn-specific instrument (Burn Specific Health Scale-Brief (BSHS-B)) and two generic instruments (EuroQol Five Dimensions and Short Form 36 Health Survey) were used, and Psychiatric Axis I and II disorders were assessed one year post burn. Results: This study identified an above normal prevalence of PDs among individuals afflicted by burn, and participants with PD had a significantly larger lifetime burden of Axis I disorders compared to participants without PD. Participants with PDs scored significantly lower than those without PD in the BSHS-B domain Skin involvement, and the effect of having a PD was related to the subscale Treatment regimens. There was no relationship between the presence of PD and generic HRQoL. Conclusions: An implication of these observations is that special rehabilitation efforts including more tailored interventions must be offered to these patients to ensure that the obstacles they perceive to caring for themselves in this respect are eliminated. [ABSTRACT FROM AUTHOR]

Client violence toward social workers has been recognized as a serious problem, and major concern has been raised with regard to its impacts on social workers' practice and physical and psychological health. There is recognition among researchers and policy-makers that it is time for the international social work community to develop conventions and agreements to address this issue globally. A cross-cultural study between Sweden and Iran was conducted to compare and contrast levels of violence between the two countries. Prevalence of violence was 72% in Sweden and 68% in Iran. Iranian social workers show a significantly higher increase in general mental health problems regarding client violence compared to Swedish social workers. Despite differences in rules and regulations between Sweden and Iran, client violence was found to be common in the two countries. Preventive policies for detecting potential violence situation are good but not enough. We suggest taking actions on building trust and supportive structures within organisations. [ABSTRACT FROM AUTHOR]

During 2009 - 2011, we reported that the oral and cervical prevalence of human papillomavirus (HPV) was high by international standards at 9.3% and 74%, respectively, in youth aged 15 - 23 years attending a youth clinic in Stockholm. After gradual introduction of public HPV vaccination during 2007 - 2012, between 2013 and 2014, when 73% of the women were HPV-vaccinated, but not necessarily before their sexual debut, oral HPV prevalence had dropped to 1.4% as compared with 9.3% in 2009 - 2011 (p 0.00001). Cervical HPV prevalence was high and common cervical high-risk types were HPV51, 56, 59, 73, 16, 39, 52, and 53. However, it was shown that HPV16, 31, and 70 were significantly less common among HPV-vaccinated women than among those who had not received the vaccine. [ABSTRACT FROM AUTHOR]

Background: Primary immune deficiency (PID) due to humoral defects is associated with recurrent respiratory tract infections (RTIs). Reliable clinical warning signs of PID would facilitate early diagnosis and thereby reduce long-term complications. The aim of the present study was to evaluate the accuracy of the warning sign, 'four or more antibiotic-treated RTIs annually for 3 or more consecutive years,' for detecting PID among adults in a primary health-care setting. Methods: Fifty-three cases with 'four or more antibiotic-treated RTIs annually for 3 or more consecutive years' were selected from a Swedish primary health-care registry of RTIs. In addition, 66 age- and sex-matched controls were selected having a maximum of one antibiotic-treated RTI during the period covered by the study. Levels of immunoglobulin (Ig) IgG, IgA, IgM, IgG subclasses, and IgG antibodies against Haemophilus influenzae and Streptococcus pneumoniae as well as the inflammatory markers, C-reactive protein, interleukin (IL)-6 and IL-8 were determined. Results: IgG subclass deficiencies (IgGsd) were found in 5/53 (9.4%) of the cases and in 7/66 (10.6%) controls. The most frequent deficiency was IgG3sd and this was found in three participants in the case group and seven in the control group. The mean level of IgG3 was lower in the control group (p = 0.02). The mean level of IL-8 was lower in the case group (p = 0.02). Conclusion: The results show that physicians working in primary health care cannot solely rely on the frequency of antibiotic-treated RTIs as a warning sign for the detection of common humoral immune deficiencies. [ABSTRACT FROM AUTHOR]

Diversion—the practice of patients selling or sharing their medication—is a much debated problem of opioid substitution treatment. Regular diversion by patients was studied at 11 opioid substitution treatment programs in the south of Sweden. Using quantitative and qualitative data, it was investigated whether those patients differ from other patients, their motives for and means of diversion, and who the recipients are. Regular diverters are a small, yet heterogeneous group. Continued illicit drug use, however, stands out as a common risk factor. Pecuniary need and a desire to help friends are other important motives. The client base mainly consists of people from the regular diverters’ own drug milieus. [ABSTRACT FROM PUBLISHER]

Objective. To evaluate the safety and cost-effectiveness of point-of-care troponin T testing (POCT-TnT) for the management of patients with chest pain in primary care. Design. Prospective observational study with follow-up. Setting. Three primary health care (PHC) centres using POCT-TnT and four PHC centres not using POCT-TnT in south-east Sweden. Patients. All patients ≥ 35 years of age, contacting one of the PHC centres for chest pain, dyspnoea on exertion, unexplained weakness and/or fatigue, with no other probable cause than cardiac, were included. Symptoms must have commenced or worsened during the previous seven days. Main outcome measures. Emergency referral rates, diagnoses of acute myocardial infarction (AMI) or unstable angina (UA), and costs were collected for 30 days after the patient sought care at the PHC centre. Results. A total of 196 patients with chest pain were included: 128 in PHC centres with POCT-TnT and 68 in PHC centres without POCT-TnT. Fewer patients from the PHC centres with POCT-TnT (n = 32, 25%) were emergently referred to hospital than from centres without POCT-TnT (n = 29, 43%; p = 0.011). Eight patients (6.2%) from PHC centres with POCT-TnT were diagnosed with AMI or UA compared with six patients (8.8%) from centres without POCT-TnT (p = 0.565). Two patients with AMI or UA were classified as missed cases from PHC centres with POCT-TnT and there were no missed cases from PHC centres without POCT-TnT. SKr290 000 was saved per missed case of AMI or UA. Conclusion. The use of POCT-TnT in primary care may be cost saving but at the expense of missed cases. [ABSTRACT FROM AUTHOR]

Conclusion: Neck dissection (ND) may not be warranted for those patients with complete response in the neck. Human papillomavirus (HPV)-positive or -negative tumour does not affect this recommendation. Objectives: Treatment of tonsillar cancer varies considerably worldwide, although non-surgical treatment, e.g. radiotherapy (RT), possibly combined with chemotherapy (CRT), is gradually coming to be regarded as the first line of therapy. However, the optimal treatment of nodal disease remains controversial, and the fundamental question is if and when to perform ND. Methods: We performed a retrospective analysis of all patients with tonsillar cancer treated in the Stockholm area between 2000 and 2006. An analysis of node-positive tumours was done and the neck specimen was investigated for the presence of viable tumour cells after RT. A sub-analysis of HPV status was also carried out. Results: Following complete response after RT, 2% of patients showed viable cells in the neck specimen, compared with 60% in patients who did not show complete response. HPV-positive tumours had the same proportion of viable tumour cells in the neck specimen as HPV-negative tumours. [ABSTRACT FROM AUTHOR]

Little is known about how to support a lifestyle change for persons with acquired brain injury (ABI), who have poor health compared with the rest of the population. This study investigates whether the Health Profile Assessment (HPA) combined with individual support in individually adjusted interventions could affect the lifestyle of persons with ABI. This longitudinal prospective and quasi-experimental study has a before and after design. HPA aims to improve health habits, perceived health and physiological measurements. In addition, this study includes interventions based on individual goals and actions decided on by the participants. The intervention process was supported through various communication methods such as Motivational Interviewing (MI) and Transactional Analyses (TA). The studied group ( n = 25) included persons with cognitive impairments due to ABI who were considered for outpatient rehabilitation at a specialized facility at a university hospital in south-eastern Sweden. Results at follow-up showed significant improvements in physical activity, perceived health and diet. Significant improvements were also shown in sagittal abdominal diameter, waist circumference, body mass index (BMI) and physical fitness. Consequently, this study describes a method that successfully supported lifestyle changes in persons with ABI. [ABSTRACT FROM AUTHOR]

Conclusion: In four Nordic countries, peritonsillar abscess (PTA) patients are treated rather differently. Objectives: To study how such patients are treated in those countries. Methods: The 81 chief physicians of otorhinolaryngology departments of all central hospitals in Denmark ( n = 15), Norway ( n = 19), Sweden ( n = 27), and Finland ( n = 20) received a multiple-choice questionnaire. Results: A total of 73 physicians (90%) replied. The largest differences arose in treating patients with intravenous versus per oral antibiotics, and treating as inpatients versus outpatients. In Finland, 50% of PTA patients aged >16 years were treated as inpatients and 50% as outpatients, whereas the respective quotas in Sweden were 9 and 91%, Norway 19 and 81%, and Denmark 33 and 67%. Of Finnish physicians, 30% treated their patients primarily with oral antibiotics, 70% with intravenous antibiotics; in Sweden 91 vs 9%, Norway 53 vs 47%, and Denmark 18 vs 82%. In Denmark, almost all patients were operated on immediately, whereas in the other three countries, especially Sweden, operations more often were performed after a recovery period. Combining metronidazole with penicillin or cephalosporins was most common in Denmark: 58% reported usage, compared with 30% in Finland, 16% in Norway, and 4% in Sweden. [ABSTRACT FROM AUTHOR]

Conclusion: No statistically significant 5-year survival difference was seen in patients with oral and oropharyngeal squamous cell carcinoma (OOPSCC) between high-risk HPV-positive and -negative groups in this population-based study. Objectives: To see if the formerly observed higher risk for recurrence or second primary tumour (SPT) in high-risk HPV-positive patients with OOPSCC corresponds to worse survival. Methods: A total of 128 consecutive, previously untreated patients with OOPSCC, who were part of a population-based case-control study in southern Sweden during 2000-2004, were included. A mouthwash sample was collected and exfoliated cells were collected with cotton-tipped swabs from the tonsillar fossa and the tumour. Specimens were analysed for HPV DNA using nested polymerase chain reaction (PCR). Disease-specific survival (DSS) and DSS difference between HPV-negative and HPV-positive patients were calculated. The relationship between age, stage, high-risk HPV status and DSS was assessed. Oral and oropharyngeal tumours were assessed separately. Results: Mean DSS in months was 80.7/68.6 (high-risk HPV-negative/high-risk HPV-positive) for oral cavity tumours ( p = 0.18) and 67.6/78.3 (high-risk HPV-negative/high-risk HPV-positive) for oropharyngeal tumours ( p = 0.47). For oral cavity tumours, age, T status, N status and stage all showed significant differences in DSS. For oropharyngeal tumours, no significant difference regarding DSS was found. [ABSTRACT FROM AUTHOR]

We followed up the psychosocial situation two years after diabetes diagnosis in patients (n= 82) aged 18–65 years, with psychosocial problems (PSP;n= 27) or not (NPSP;n= 55). We used a social questionnaire, the Hospital Anxiety and Depression scale (HAD), the Sense of Coherence scale (SOC), and the General Coping Questionnaire (GCQ). The PSP group had a more difficult situation with more strained economy, lower social support, more anxiety and depression, and lower SOC on both occasions. Being in the PSP group predicted experiencing a strong negative influence of the disease at follow-up. Regarding coping strategies, “problem focusing” decreased in both PSP and NPSP over time. “Social trust” and “intrusion” decreased only in NPSP. Otherwise the coping pattern was unchanged, with PSP showing lower scores on “self-trust” and “minimization” and higher scores on “protest,” “isolation,” and “intrusion.” The most influenced areas at follow-up in the PSP group were work, relationship to partner and economy, and in the NPSP leisure-time activities, sexual life and work. Our findings underline the need to identify patients with psychosocial problems early. [ABSTRACT FROM AUTHOR]

Objective. To explore how well physicians and patients predict sick-listing duration and the correspondence between their respective predictions. To study possible gender differences concerning prediction accuracy. Design. Prospective observational study. Setting. Two medium-sized primary care centres (PCC) in western Sweden. Subjects. GPs at the PCCs and attending patients sick-listed for > 14 days. Main outcome measures. Sick-listing duration; patients' and GPs' predictions of the total duration of the individual patient's sick-listing. Results. A total of 127 patients (93 women, 34 men, mean age 45 years) and 10 GPs participated in the study. Neither the GPs nor the patients were able to predict the interval until return to work with high accuracy. The GPs' and the patients' perceptions concurred in only 26% of cases. There was a significant difference in the correspondence between the GPs' and patients' respective predictions of sick-listing duration compared with the actual duration. GPs' predictions were more accurate for medium-length duration (1.5-6 months), while patients' predictions were more accurate for long-duration (> 6 months) sick-listing. Patients with less education predicted long duration of sick-listing more accurately than those with more education. There was no significant difference between male and female patients' accuracy of prediction, or between GPs' accuracy of prediction of male vs. female patients' sick-listing duration. Conclusions. Prediction of total sick-listing duration was hard for both GP and patient; their respective predictions corresponded in only one-quarter of the cases. No gender differences were observed in the accuracy of prediction. [ABSTRACT FROM AUTHOR]

With the aim to better understand the association between asthma/allergy and psychological distress, it was hypothesized that levels of stress, exhaustion, anxiety, depression, and health worries for environmental pollution would be higher in allergic asthma, allergic rhinitis, and atopic dermatitis than in non-allergic asthma and in referents without asthma or allergy. Taking part in the population-based Västerbotten Environmental Health Study (aged 18–79 years), 76 respondents reported a physician-based diagnosis of allergic asthma, 86 reported non-allergic asthma, 190 reported allergic rhinitis, and 46 reported atopic dermatitis as the only form of asthma/allergy. A group of 2876 respondents without an asthma/allergy diagnosis constituted as referents. The participants responded to the Perceived Stress Scale, the Shirom-Melamed Burnout Questionnaire, the Hospital Anxiety and Depression Scale, and the Environmental Pollution subscale of the Modern Health Worries Scale. Levels of stress, exhaustion, and anxiety were higher in allergic asthma and atopic dermatitis than in non-allergic asthma, allergic rhinitis, and among referents, and there was a strong tendency of such group differences for depression and health worries. The results imply that stress reduction and treatment of negative affect may in certain cases be fruitful interventions in patients with atopy. [ABSTRACT FROM PUBLISHER]

Primary objective: The consequences of pre-morbid factors in adults with severe traumatic brain injury have not been widely addressed. This study aimed to determine whether being unemployed or on sick leave before injury influences long-term health-related quality-of-life (HRQoL) and functioning in patients with severe traumatic brain injury. Subjects: Fifty-one consecutive patients were studied; aged 16-65 years, with severe traumatic brain injury who were admitted to Sahlgrenska University Hospital, Gothenburg, from 1999-2002. Methods: The patients were assessed once, 2-11 years after trauma. Data from the time of injury were combined into a validated prognostic model to adjust for injury severity. Data on sick leave and unemployment before injury were gathered from the Swedish social insurance agency. Outcomes were measured with the Short Form-36 Health Survey, the Glasgow Outcome Scale-Extended, and a self-report questionnaire specifically designed for this study to measure functioning. Results: In a multivariate analysis, a history of sick leave/unemployment predicted a worse long-term global outcome, more problems with personal activities of daily living and worse HRQoL. Conclusion: These results should be considered when refining outcome predictions and optimizing rehabilitation interventions for patients with severe traumatic brain injury. [ABSTRACT FROM AUTHOR]

This study examined mortality and predictors of death in 1,396 primary amphetamine users (85% males) who were interviewed with the Addiction Severity Index in the Swedish criminal justice system during 2000-2006 and followed through 2008. Forty-nine clients deceased (standardized mortality ratio 4.1 [3.0-5.4]), at least 84% of deaths were violent or drug-related (12% suicides), and Cox regression analysis indicated that death was associated with frequent use of sedatives and less frequent use of amphetamine. No female deaths were observed; death and male gender were associated in binary analysis. Implications for diagnostics and treatment are discussed. [ABSTRACT FROM AUTHOR]

Clinical experience suggests that people with psychosis generally show a diverging substance use pattern compared with other people with ‘dual disorders’. The aim of this study was to describe substance use patterns in individuals with psychosis and relate these to substance use patterns in persons with other kinds of psychiatric disorders in combination with substance abuse. A wider aim was to contribute to a deeper understanding of interactions between mental illness and substance use. Two groups were recruited, one with persons diagnosed with psychotic disorders and one with people with other (mainly anxiety- and affective-) disorders. All participants also had substance-related problems. The participants completed the questionnaires Alcohol Use Disorders Identification Test and Drug Use Disorders Identification Test, and information about socio-demographic and care-related characteristics was collected. Group differences were calculated. The participants with psychosis scored significantly lower on most questions concerning affective/cognitive aspects of drug use, such as longing, guilt and experience of failing in relation to alcohol and drugs. They also showed fewer indications of alcohol dependence. A possible interpretation is that the findings reflect group differences in mentalization and affect-regulation relevant to both substance use and psychiatric illness. This may have implications for theoretical understanding of dual disorders as well as for psychotherapeutic treatment. [ABSTRACT FROM PUBLISHER]

Objective. To study the effects on sick leave from an early multidisciplinary assessment at a primary health care centre. Design. Randomized controlled trial. Setting. Patients who saw GPs at a primary health care centre in mid-Sweden and asked for a sickness certificate for psychiatric or musculoskeletal diagnoses were invited to participate. Patients included were sick-listed for less than four weeks; 33 patients were randomized either to an assessment within a week by a physiotherapist, a psychotherapist, and an occupational therapist or to 'standard care'. The therapists used methods and tools they normally use in their clinical work. Main outcome measure. Proportion of patients still sick-listed three months after randomization, total and net days on sick leave, and proportion who were on part-time sick leave. Results. At follow-up after three months, in contrast to the pre-trial hypothesis, there was a trend toward a higher proportion of patients still sick-listed in the intervention group (7/18) as compared with the control group (3/15). The intervention group also had significantly longer sick-listing periods (mean 58 days) than the control group (mean 36 days) (p = 0.038). The proportion of patients who were part time sick-listed was significantly higher in the intervention group (10/18) than in the control group (2/15) (p = 0.027). Conclusions. In this study an early multidisciplinary assessment was associated with longer periods on sick leave and more individuals on part-time sick leave. [ABSTRACT FROM AUTHOR]

Background: Pregnancy-related low back and pelvic pain is a worldwide problem. A large proportion of women still experience disabling daily back pain 2 years after childbirth, resulting in major changes in activities and general well-being. In spite of this, the source of pain and effective treatment are uncertain. Objective: To evaluate the short-term effects on function of a single corticosteroid injection treatment to the ischiadic spine in women with persistent pregnancy-related pelvic pain (PPPP). Methods: Thirty-six women were allocated to injection treatment with slow-release triamcinolone and lidocain or saline and lidocain, given once at the sacrospinous ligament insertion on the ischiadic spine bilaterally with follow-up at 4 weeks. Outcome measures were Disability Rating Index (DRI), self-rated functional health (SF-36), gait speed and endurance (6MWT), and strength and endurance of trunk muscles (isometric trunk extensor and flexor tests). Results: Women in the triamcinolone group showed significantly improved DRI ( p = 0.046), 6MWT ( p = 0.016), and isometric trunk extensor tests ( p = 0.004), as compared with the saline group. Close co-variation was shown between improved function and reduced pain intensity. Conclusions: Improved function was achieved among women with PPPP after a single injection treatment with slow-release corticosteroid. The effect was positively correlated to the reduced pain intensity. [ABSTRACT FROM AUTHOR]

Objectives:The aim of this population-based study was to investigate the usefulness of the Geriatric Depression Scale 15-item version (GDS-15) to assess depressive symptoms among very old people with differing levels of cognitive function. Methods:The 834 participants were aged 85 and over. Feasibility of GDS-15 was evaluated as the proportion of people who completed the scale. Concurrent criterion validity was evaluated by calculating correlations between GDS-15 and Philadelphia Geriatric Center Morale Scale (PGCMS). PGCMS measures psychological wellbeing which is closely related with depressive symptoms. Correlations were calculated within groups according to cognitive function assessed with Mini-Mental State Examination (MMSE); 0–4, 5–9, 10–14, 15–19, 20–24, 25–27, and 28–30, using Pearson's two-sided correlation and compared using Fisher r-to-z transformation. Internal consistency of the GDS-15 was evaluated by calculating Cronbach's α in each group. Results:In total, 651 (78%) of the 834 participants completed the GDS-15. For the two MMSE-groups with scores of <10, the proportion who completed GDS-15 were 1% and 42%, respectively, compared to 65–95% in the MMSE-groups with scores of ≥10. Cronbach's α in each MMSE-group ranged from 0.636 (MMSE 28–30) to 0.821 (MMSE 5–9). The level of correlation between GDS-15 and PGCMS did not significantly differ between MMSE-groups with scores of 5–27 compared to the MMSE-group with scores of 28–30. Conclusions:The GDS-15 seems to have an overall usefulness to assess depressive symptoms among very old people with an MMSE score of 10 or more. More studies are needed to strengthen the validity of GDS-15 among older people with MMSE scores of 10–14. For older people with MMSE scores lower than 10, there is a need to develop and validate other measurements. [ABSTRACT FROM PUBLISHER]

Lifetime experience of selling sex among adolescents was investigated together with sociodemographic correlates, parent–child relationship, and the existence of people to confide in. Changes over time regarding the selling of sex were investigated through a comparison of data from 2004 and 2009. This study was carried out using 3,498 adolescents from a representative sample of Swedish high school students with a mean age 18.3 years. Of these adolescents, 1.5% stated that they had given sexual services for reimbursement and both male and female buyers existed. The adolescents who had sold sex had a poorer parent–child relationship during childhood and had fewer people to confide in about problems and worries. Changes over time were found especially regarding the Internet as a contact source and also immigrant background. [ABSTRACT FROM PUBLISHER]