Search

To investigate the individual and the joint effect of impaired fetal growth and adult health behaviors on the risk of cardiovascular diseases (CVDs). A total of 15,618 individuals were included from three sub-cohorts of the Stockholm Public Health Cohort. Data on participants' birthweight and gestational age were retrieved from the Medical Birth Register. Data on the diagnoses of CVDs were extracted from the Swedish National Patient Register and the Cause of Death Register. Data on health behaviors were identified from self-reported questionnaires, and health behavioral profile was defined based on the recommendations of the American Health Association. The associations of fetal growth and health behaviors with the risk of CVDs were analyzed using Cox proportional hazard model. Individuals born small for gestational age (SGA) had a higher risk of CVDs than those born appropriate for gestational age (AGA), and the adjusted hazard ratio (HR) and 95% confidence interval (CI) was 1.88 (1.44, 2.47). Participants born SGA and having poor health behavioral profile in adulthood had a higher risk of CVDs than those born AGA and having ideal health behaviors with adjusted HR (95% CI) being 3.58 (1.95, 6.56). Impaired fetal growth was associated with an increased risk of CVDs in adulthood, and the risk was highest in individuals with both impaired fetal growth and poor health behaviors in adulthood. Conclusions Impaired fetal growth was associated with an increased risk of CVDs in adulthood, and the risk was highest in individuals with both impaired fetal growth and poor health behaviors in adulthood. [ABSTRACT FROM AUTHOR]

Background: To determine social and sex differences in psychosocial functioning and psychiatric comorbidity among adolescents with depression.Methods: A cohort-based study in Stockholm, Sweden. Adolescents who turned 13 years during 2001-2007, were followed in registers until they turned 18 in 2005-2011, (n = 169,262). In the current study, those with depression at age 13-17 were included (n = 6,439).Results: Adolescents with parents with low (OR=1.5, CI 1.1-2.2) education were more likely to have low psychosocial functioning. Those with parents with low education and low household income were more likely to have comorbid internalizing (OR=1.3, CI 1.0-1.7/1.3, CI 1.0-1.7) and externalizing disorders (OR=2.5, CI 1.5-4.0/2.4, CI 1.4-4.2). Adolescents with parents born outside the Nordic countries were more likely to have comorbid externalizing disorders (OR=1.6, CI 1.1-2.4). No social differences were evident in relation to family receipt of unemployment benefits. Social differences were found for both girls and boys in relation to psychosocial functioning and comorbidity but the magnitude of social differences in depression with comorbidity was overall larger for boys than girls.Limitations: The findings of the current study can only be generalized to adolescents that have sought care for and been diagnosed with depression, within a setting similar to this study, e.g. with free access to care.Conclusion: Adolescents with depression and with more disadvantaged social circumstances in the childhood run a higher risk of psychiatric comorbidity and low psychosocial functioning, which can indicate a lengthy clinical course and poorer response to treatment. Both boys and girls follow this path but partly in different kinds of psychiatric comorbidity. [ABSTRACT FROM AUTHOR]

• From among all road fatalities during the 10-year period 2010–2019, 12% of the crashes were suicide (male-to-female ratio 4.3) and 29% attributable to acute disease (male-to-female ratio 8.7). • In 9% of acute disease-triggered crashes another road user was injured. • About half of the crashes were attributed to a manoeuvre performed by the older driver him or herself (male-to-female ratio 3.8). • In the main, there were no remarkable changes in the relative proportion of those circumstances/triggers over time. • The promotion of mobility and safety of drivers must include all triggers of road deaths, not least among older drivers. Road traffic fatalities among drivers result not only from erroneous driving manoeuvres. They can also be triggered by poor mental or physical health like suicidal acts and acute disease attacks, the latter being more frequent with age. There are few studies comprising all the different triggers of fatal crashes among older drivers and on how these triggers evolve over time. This Swedish national study aims to investigate this, considering drivers 50+ years. For the period 2010–2019, data on non-commercial car drivers aged 50 and older were extracted from the Swedish Transport Administration's in-depth studies of fatal crashes, compiled in a register encompassing all road traffic fatalities. The crash triggers reported were classified as suicide, acute disease, own manoeuvre (single or other type of crash), external, and undetermined. Total and annual frequencies were presented by crash trigger, overall and stratified by sex and age groups. In total, 762 fatalities were identified and with 709 of them, it was possible to classify the crash trigger: 12% resulting from suicide; 29% from acute disease; 49% from the driver's own manoeuvre; and 10% from an external crash trigger. Suicides increased from 9% in average 2010–2014 to 15% in 2015–2019 while acute disease decreased (from 32% to 27%). The overall male-to-female ratio was 4.5, and as high as 8.7 for acute disease. The relative importance of each trigger varied with age with, for instance, acute disease being more frequent in the two younger age groups; 31% for 50–64 and 52% for 65–79 years old drivers, while own manoeuvre was more prominent for drivers aged 80 and older (23%). The distribution of the four different triggers of road traffic fatalities varies only slightly over time and, a majority are triggered by the driver's own manoeuvre. However, a substantial proportion, about four out of ten, are triggered by a health condition, of which some are suicide but the major part an acute disease, mainly cardiovascular. In some instances, such crashes can be harmful to other road users. Having in mind the need for safety and mobility of older drivers and the protection of all road users, there is a need for the promotion of road safety policies that encompass a wider range of measures to help reducing the likelihood of fatal and severe crashes to happen e.g., targeting incapacitated drivers. [ABSTRACT FROM AUTHOR]

Green areas might provide an inviting setting and thereby promote physical activity. The objective of this study was to determine whether moving to different green area surroundings was followed by changes of physical activity. Data from a large population-based cohort of adults in Stockholm County responding to surveys in 2010 and 2014 were analysed (n = 42611). Information about walking/cycling and exercise were self-reported and living area greenness data were satellite-derived (NDVI, Normalized Difference Vegetation Index). Multinomial logistic regression analyses were performed separately for changes in levels of walking/cycling and exercise (decrease, stable, increase). Greenness was defined as a change in NDVI quartile to less green, same, or greener. Odds ratio's (OR) with 95% confidence intervals (CI) were presented adjusted for gender, age, education and area-based income. Contrary to what we hypothesized, those moving to a greener area were more likely to decrease their levels of walking/cycling (OR = 1.42, CI = 1.28-1.58), whereas those moving to a less green area were more likely to increase their walking/cycling (OR = 1.26, CI = 1.13-1.41). Exercise behaviour showed another pattern, with people being more likely to decrease exercise both when moving to a greener (OR = 1.25, CI = 1.22-1.38) and to a less green area (OR = 1.22, CI = 1.09-1.36). Studying subpopulations based on sociodemographic characteristics did not aid to clarify our results. This cohort study with repeated measurements did not support the currently available cross-sectional studies showing a strong positive relation between greenness and physical activity. Nevertheless, our findings have shown spatial patterns related to green areas and physical activity which imply a need for place-specific health policies. [ABSTRACT FROM AUTHOR]

• Co-ownership or rental of motorcycles was associated with an elevated risk of RTIs. • Long working hours significantly mediate the association of the risk of RTIs among co-owned motorcycle taxi drivers. • Risky driving behaviours mediated the associations of the risk of RTIs among rented motorcycle taxi drivers. Rapid growth in the use of motorcycle taxis in low-and-middle-income countries has been associated with an increased risk of road traffic injuries (RTIs). This study aimed to examine the association between types of motorcycle ownership, such as self-ownership, rental or shared ownership, and the risk of RTIs among Tanzanian motorcycle taxi drivers. Furthermore, we investigated whether the risky driving behaviours, number of working hours and motorcycle conditions mediate the association between types of motorcycle ownership and risk of RTIs. The study included 164 cases of motorcycle taxi drivers with RTIs resulting in hospitalisation and 400 controls of motorcycle taxi drivers randomly selected from parking stages. The results show that motorcycle taxi drivers who co-own or rent their motorcycles were two to three times more likely to have RTIs than those who self-own their motorcycles after adjusting for age, education, marital status and the number of dependents. Mediation analysis shows that risky driving behaviours have a greater indirect effect on the risk of RTIs among motorcycle taxi drivers who rent their motorcycles, while the number of working hours had a significantly higher mediation effect on the risk of RTIs among motorcycle taxi drivers who co-own their motorcycles. This study shows that co-ownership or rental of motorcycles is associated with a higher risk of RTIs. Risky driving behaviours and the number of working hours are found to be important mediators. Further research on tailored approaches to improve and promote the safety of motorcycle taxi drivers' working conditions is needed. [ABSTRACT FROM AUTHOR]

Highlights: [•] We reviewed the evidence relating the use of analgesics with RTCs in senior drivers. [•] Only nine studies of medium and high quality fulfilled the inclusion criteria. [•] Evidence was weak in terms of number of studies, control of confounders, and consistency of results. [•] The explorative meta-analysis on opioids showed a marginal positive effect. [•] This can be attributed to poor adjustment of key confounders (e.g. concomitant illnesses, use of alcohol and other psychoactive medications). [ABSTRACT FROM AUTHOR]

• Not adjusting for low driving mileage as a confounder may lead to an overestimation of the effect of polypharmacy on road traffic crashes. • The magnitude of confounding by low driving mileage on the effect of polypharmacy on RTCs was 16%. • An adjusted increase of the odds of RTCs of at least 60% is associated with a statistical power of about 80%. Unmeasured confounding can lead to biased interpretations of empirical findings. This paper aimed to assess the magnitude of suspected unmeasured confounding due to driving mileage and simulate the statistical power required to detect a discrepancy in the effect of polypharmacy on road traffic crashes (RTCs) among older adults. Based on Monte Carlo Simulation (MCS) approach, we estimated 1) the magnitude of confounding of driving mileage on the association of polypharmacy and RTCs and 2) the statistical power of to detect a discrepancy from no adjusted effect. A total of 1000 studies, each of 500000 observations, were simulated. Under the assumption of a modest adjusted exposure-outcome odds ratio of 1.35, the magnitude of confounding bias by driving mileage was estimated to be 16% higher with a statistical power of 50%. Only an adjusted odds ratio of at least 1.60 would be associated with a statistical power of about 80% This applied probabilistic bias analysis showed that not adjusting for driving mileage as a confounder can lead to an overestimation of the effect of polypharmacy on RTCs in older adults. Even considering a large sample, small to moderate adjusted exposure effects were difficult to be detected. [ABSTRACT FROM AUTHOR]

• Vaccine coverage differs by healthcare worker occupation, where physicians have highest coverage. • Sweden born have the highest and immigrants born in Europe have the lowest coverage. • Healthcare workers' vaccine hesitancy is an occupational hazard and a risk of nosocomial infection. Globally SARS-CoV-2 vaccine coverage varies among healthcare workers. Based on Swedish registers, data on vaccination status as of 31 October 2021 were analysed for all adults aged 35–64 years, 3 861 565 individuals, in Sweden by healthcare worker occupation group and region of birth. For both men and women vaccination coverage decreased in a graded manner by healthcare worker group with physicians having the highest coverage (96%), followed by registered nurses, licensed practical nurses, and nurse aides. Coverage also differed by region of birth for all groups of healthcare workers and non-healthcare workers with those born in Sweden with Sweden born parents having the highest coverage, and those born outside Sweden but within EU the lowest. The difference in vaccine coverage by region of birth among healthcare workers, regardless of whether it results from socioeconomic inequalities or sociocultural beliefs, puts them at a great occupational hazard and increased risk of nosocomial transmission. [ABSTRACT FROM AUTHOR]

Abstract: Background: The association between substance abuse, particularly alcohol abuse, and violence has been well established. However, since substance abuse co-occurs with several other risk factors for violence, the causal link between substance abuse and violence and the extent to which the acute influence of alcohol, illicit drugs, benzodiazepines, and anabolic androgenic steroids have a triggering effect on violent behavior are more uncertain. Methods: Case-crossover design was used based on data from structured face to face interviews with remand prisoners (n =194; 172 men, 22 women) suspected of violent crimes. Main outcome measure: odds ratio (OR 95% CI) for a violent crime, 24h after exposure to different substances, compared to periods of no exposure was calculated using conditional logistic regression and a Mantel–Haenszel estimator with confidence intervals for sparse data. Results: Intake of alcohol (OR 6.41 CI 4.24–9.67) and large doses of benzodiazepines (OR 36.32 CI 7.14–183.65) triggered interpersonal violence. Stratified analyses of possible effect modifiers were sex, conduct/behavioral problems, trauma experiences; psychiatric vulnerability did not reveal any substantial differences. Conclusion: Influences of alcohol and unusually high doses of benzodiazepines are proximal risk factors for violent crime. Improved knowledge of short-term (and dose-related) risk factors may contribute to treatment planning and risk assessment of violence. [Copyright &y& Elsevier]

Background: Various invasive medical procedures might induce bacteremia and, hence, act as triggers for infective endocarditis. However, empirical data in humans on the potential dangers of invasive medical procedures in this regard are very sparse. Due to lack of sufficient data, it is currently debated whether the risk for endocarditis with medical procedures is substantial or rather negligible.Objectives: The purpose of this nationwide case-crossover study was to quantify the excess risk for infective endocarditis in association with invasive medical and surgical procedures.Methods: The authors identified all adult patients treated for endocarditis in hospitals in Sweden between January 1, 1998, and December 31, 2011. The authors applied a case-crossover design and compared the occurrence of invasive medical procedures 12 weeks before endocarditis with a corresponding 12-week time period exactly 1 year earlier. The authors considered all invasive nondental medical procedures except for those that are likely to be undertaken due to endocarditis or sepsis or due to infections that could possibly lead to endocarditis.Results: The authors identified 7,013 cases of infective endocarditis during the study period. Among others, several cardiovascular procedures, especially coronary artery bypass grafting; procedures of the skin and management of wounds; transfusion; dialysis; bone marrow puncture; and some endoscopies, particularly bronchoscopy, were strongly associated with an increased risk for infective endocarditis.Conclusions: This study suggests that several invasive nondental medical procedures are associated with a markedly increased risk for infective endocarditis. [ABSTRACT FROM AUTHOR]

Although some studies have shown the average side effects of cardiovascular medication, the short-term effect after newly initiated cardiovascular medications has not been studied in any detail. We aim to determine the effect of newly initiated cardiovascular medications resulting in unintentional poisoning and to identify those at high risk. A case-crossover design was used. From the Swedish National Patient Register, a total of 9,354 persons aged ≥ 50 and hospitalized with a first event of unintentional poisoning between July 2006 and September 2018 were identified. Through linkage to the Prescribed Drug Register, exposure to newly initiated cardiovascular medication during the case period (1–28 days prior to the onset date of unintentional poisoning) was compared with that in a corresponding control period (113–140 days prior to the onset date). Conditional logistic regression was used to determine the associations in total, for different time periods as well as by age, sex, underlying comorbidity, and use of other medications. Newly initiated cardiovascular medications were associated with a higher risk of unintentional poisoning, especially during the first week after initiation (odds ratio [OR]=1.39), (95% confidence interval [CI]=1.08–1.79). The risk of unintentional poisoning was comparable across age groups, sex, underlying comorbidities, and medications with OR (95% CI) ranging from 1.15 (0.75–1.74) to 2.00 (1.15–3.47). This large population-based case-crossover study showed that newly initiated cardiovascular medication is associated with an increased risk of unintentional poisoning, particularly during the first week after initiation. The risk is comparable across age, sex, underlying comorbidity, and medications. [Display omitted] • Newly initiated cardiovascular drugs increase the risk of unintentional poisoning. • The risk is particularly high during the first week after initiation. • The risk is comparable across age, sex, underlying comorbidity, and burden of other medications. [ABSTRACT FROM AUTHOR]

To determine the association between geriatric syndromes and any specific incident chronic health conditions among older community-dwellers. Population-based cohort study over a median follow-up period of 43 months. Participants from the Lifelines Cohort Study aged 60 years and older without presence of the studied chronic health conditions at baseline (n = 9094). Baseline assessment took place between November 2006 and December 2013 and included information on socioeconomic (age, sex, level of education and income), social contact, and health-related factors [eg, self-rated health, body mass index, chronic health conditions, and health behavior (alcohol consumption and smoking)]. Participants also reported the presence of geriatric syndromes (ie, included falls, incontinence, vision impairment, hearing impairment, depressive symptoms, and frailty at baseline). Three follow-up questionnaires were used to examine the incidence of any and specific chronic health conditions (ie, pulmonary and cardiovascular diseases, diabetes, cancer, and neurological diseases). Cox regression was used to analyze the longitudinal associations between geriatric syndromes and incident chronic health conditions. Older community-dwelling individuals with at least one geriatric syndrome (44.7%, n = 4038) had an increased risk of developing any new chronic health condition [hazard ratio (HR) 1.35; 95% confidence interval (CI) 1.21–1.51]. The association was attenuated but remained significant after adjustment for socioeconomic factors, social contact, health status, and health behavior (HR 1.27; 95% CI 1.12–1.43). Analyses for specific chronic health conditions showed that compared with older community-dwellers without geriatric syndromes, those with geriatric syndromes had an increased risk to develop a cardiovascular health condition (HR 1.42; 95% CI 1.13–1.79) or diabetes (HR 1.53; 95% CI 1.11–2.11). They had no increased risk to develop pulmonary conditions, cancer, or neurological conditions. The presence of geriatric syndromes is associated with incident chronic health conditions, specifically cardiovascular conditions and diabetes. Increased awareness is needed among older people with geriatric syndromes and their physicians. Comprehensive assessments of geriatric syndromes may help to prevent or at least delay the development of chronic health conditions. [ABSTRACT FROM AUTHOR]

• Medical impairment was associated with increased road traffic crash in drivers 65+. • Strongest associations were found for epilepsy, and substance abuse and dependence. • Strong association, but very low prevalence was found for ADHD and autism. • Dementia and kidney disease showed no association to road traffic crashes. Several medical conditions are known to impair sensory, cognitive and motor functions and are associated with road traffic crashes (RTC). For the drivers of today, we lack updated knowledge on how driving-impairing conditions are associated with RTCs, across all driving-impairing conditions in a given population. We aim to determine this among older drivers in Sweden. A national, population register-based, matched case-control study comparing acknowledged driving-impairing health conditions among all older drivers (65 years or older) involved in an injurious RTC in the period 2011–2016 (n = 13,701) with those of controls: older drivers not involved in any RTC (n = 26,525) matched to the cases by age, sex and residential area. The medical conditions, extracted from the National Patient Register from 1997 up until date of RTC, were identified based on ICD-10 diagnosis codes and categorized into the 13 groups of medical conditions listed in the Swedish driver's license regulations. Conditional logistic regression was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals. Unadjusted ORs for RTC were increased for all conditions. After taking the other 12 medical conditions into account, the ORs remained significant in 11 out of the 13. A strong association was found for the group "ADHD and autism spectrum disorders" (OR 2.79, CI 1.47–5.30), although with very low prevalence among cases (0.2%). Moderate associations were found for three conditions with a case prevalence between 1.3% and 8.5%: epilepsy and seizure disorders (OR 1.53, CI 1.25–1.89), substance abuse and dependence (OR 1.45, CI 1.29–1.63), psychological diseases and mental disorders (OR 1.28, CI 1.18–1.39) and for one condition with a case prevalence of 14.7%, diabetes (OR 1.28, CI 1.20–1.36). In Sweden, in the current generation of older drivers, acknowledged driving-impairing medical conditions at the national and European levels remain a concern. After adjustment for one another, all but 2 of the conditions are associated with RTCs albeit to varying degrees and more pronounced in the age group 65–79 compared to 80 or older. To promote and sustain older people's mobility, addressing this issue will require a blend of interventions where, hopefully, technological and infrastructural innovations may help counteracting individual health-related shortcomings. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Health risk behaviors tend to cluster in young people, not least among young drivers. Less is known about the health risk profile of young unlicensed drivers. This study investigates health risk behaviors among young unlicensed drivers compared to both their licensed and driving peers, and their non-driving peers. Methods: High school students participating in the Youth Risk Behavior Surveillance System in Montana (US) and age-eligible to have a driver''s license were studied (n =5985), categorized according to their self-reported car driving and license practice (licensed driving, unlicensed driving, and non-driving). Ten health risk behaviors, of which four were related to car riding/driving, were considered. Multinomial logistic regression was used to compile sex-specific odds ratios (with 95% confidence intervals) of adopting those behaviors using licensed drivers as a reference and adjusting for age and race/ethnicity. Results: Health risk behaviors tended to be more common among unlicensed drivers than other groups, although some behaviors were prevalent in all groups (i.e., alcohol use and lack of seat belt use). As a consequence, for both male and female students, there was a significant association between unlicensed driving and most health risk behaviors, except for being involved in a physical fight and riding with a drinking driver among female students. Conclusions: Young unlicensed drivers are more likely than licensed drivers to adopt several health risk behaviors both in car driving/riding or otherwise, in particular alcohol use and cigarette smoking. This challenges any simplistic approach as unlicensed driving in youth is not an isolated act suggesting public health and traffic safety initiatives. [Copyright &y& Elsevier]