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Background Well-established associations exist between the risk of small for gestational age (SGA) and unidimensional sociodemographic factors. We investigated social inequalities in SGA risk and adopted an intersectional approach that simultaneously considers different social categories. By doing so, we could assess heterogeneities in SGA risk within unidimensional sociodemographic categories. Methods We included all live 679 694 singleton births in Sweden between 2010 and 2016. The outcome was SGA, and the exposures were age, maternal educational level, dichotomous migration status and civil status. Thirty-six possible combinations of these factors constituted the exposure in an intersectional model. We present odds ratios (ORs) with 95% confidence intervals (95% CIs) and the area under the receiver operating characteristic curve (AUC)—a measurement of discriminatory accuracy (i.e. the ability to discriminate the babies born SGA from those who are not). Results Women with low education and women born outside Sweden had ORs of 1.46 (95% CI 1.38–1.54) and 1.50 (95% CI 1.43–1.56) in unidimensional analyses, respectively. Among women aged under 25 with low education who were born outside Sweden and unmarried, the highest OR was 3.06 (2.59–3.63). The discriminatory accuracy was low for both the unidimensional model that included all sociodemographic factors (AUC 0. 563) and the intersectional model (AUC 0.571). Conclusions The intersectional approach revealed a complex sociodemographic pattern of SGA risk. Sociodemographic factors have a low accuracy in identifying SGA at the individual level, even when quantifying their multi-dimensional intersections. This cautions against interventions targeted to individuals belonging to socially defined groups to reduce social inequalities in SGA risk. [ABSTRACT FROM AUTHOR]

Prior studies have reported that heart failure typically affects elderly, multimorbid and socioeconomically deprived men. Women with heart failure are generally older, have a higher EF (ejection fraction) and have more heart failure-related symptoms than men. This study explored the disparities in the prevalence of heart failure between men and women in relation to age, multimorbidity level and socioeconomic status of the population in southern Sweden. A register-based, cross-sectional cohort study. Setting and subjects: The inhabitants from 20 years of age onwards (N = 981,383) living in southern Sweden in 2015. Main outcome measure: Prevalence and mean probability of having heart failure in both genders. CNI (Care Need Index) percentiles depend on the socioeconomic status of their listed primary healthcare centres. Men had a higher OR for HF − 1.70 (95% CI 1.65–1.75) - than women. The probability of men having heart failure increased significantly compared to women with advancing age and multimorbidity levels. At all CNI levels, the multimorbid patients had a higher prevalence of heart failure in men than in women. The disparity in the mean probability of heart failure between the most affluent and deprived CNI percentile was more apparent in women compared to men, especially from 80 years. The prevalence of heart failure differs significantly between the genders. Men had an increasing mean probability of heart failure with advancing age and multimorbidity level compared to women. Socioeconomic deprivation was more strongly associated with heart failure in women than in men. The probability of having heart failure differs between the genders in several aspects. Independently of socioeconomic status, men had a higher prevalence of heart failure than women among the multimorbid patients. The mean probability of men having heart failure increased significantly compared to women with advancing age and multimorbidity level. Socioeconomic status was more strongly associated with heart failure in women than in men. [ABSTRACT FROM AUTHOR]

Background: The use of complementary and alternative medicine (CAM) by patients is widespread. However, there is a lack of knowledge regarding the extent and details of patient CAM use in Sweden, especially in rural Sweden. The aim of this study was to estimate the extent and characteristics of CAM use among cancer patients in Region Gävleborg. Methods: A total of 631 questionnaires were distributed to which 376 responses were registered, yielding a response rate of 59.6%. Questionnaires were distributed to oncology patients at their first visit for curative treatment at the Department of Oncology, Gävle Hospital. Palliative patients were recruited at their first visit and during enrollment in palliative outpatient care in their own homes. The characteristics of the respondents were presented with standard descriptive statistics. A multivariable logistic model was fitted to calculate odds ratios (ORs) and identify potential predictors (Age, Gender, Education, Diagnosis) of CAM use post-cancer diagnosis. Results: 54% of all participants reported lifetime CAM use, 34% reported CAM use post-diagnosis. The most common CAM methods used after diagnosis are vitamins, health food preparations, herbal teas, prayer and dietary methods. The most common source of information reported is family and friends. Almost 70% of those who used CAM after their diagnosis stated that they did not discuss their use with healthcare professionals. Most patients reported that they would like some CAM modalities to be offered within conventional care regardless of their own CAM use. Conclusions: The use of CAM is common among patients with cancer in the region of Gävleborg, and previous studies show a similar use in Sweden in general. Based on the widespread use of CAM and patient interest in discussing CAM use with healthcare professionals, greater attention and focus should be placed on creating a basis for this dialogue. If we, as healthcare professionals, are to emphasise our commitment to providing patient-centred care, we must acknowledge that patients use CAM and are seeking a dialogue about CAM use in their care. [ABSTRACT FROM AUTHOR]

Background: Depression is a risk factor for type 2 diabetes (T2D) and cardiovascular disease (CVD). The aims were to explore the prevalence of depression, anxiety, antidepressant use, obesity, Hemoglobin A1c > 64 mmol/mol, life-style factors, pre-existing CVD, in patients with newly diagnosed T2D; to explore associations with depression; and to compare with Swedish general population data. Methods: Multicentre, cross-sectional study. Inclusion criteria: adults with serologically verified newly diagnosed T2D. Included variables: age, sex, current depression and anxiety (Hospital Anxiety and Depression Scale), previous depression, antidepressant use, obesity (BMI ≥ 30 and ≥ 40 kg/m2), Hemoglobin A1c, pre-existing CVD. Logistic regression analyses were performed. Results: In 1027 T2D patients, aged 18–94 years, depression was associated with age (per year) (inversely) (odds ratio (OR) 0.97), anxiety (OR 12.2), previous depression (OR 7.1), antidepressant use (OR 4.2), BMI ≥ 30 kg/m2 (OR 1.7), BMI ≥ 40 kg/m2 (OR 2.3), smoking (OR 1.9), physical inactivity (OR 1.8), and women (OR 1.6) (all p ≤ 0.013). Younger women (n = 113), ≤ 59 years, compared to younger men (n = 217) had higher prevalence of current depression (31% vs 12%), previous depression (43 vs 19%), anxiety (42% vs 25%), antidepressant use (37% vs 12%), BMI ≥ 30 kg/m2 (73% vs 60%) and BMI ≥ 40 kg/m2) (18% vs 9%), and smoking (26% vs 16%) (all p ≤ 0.029). Older women (n = 297), ≥ 60 years, compared to older men (n = 400) had higher prevalence of previous depression (45% vs 12%), anxiety (18% vs 10%), antidepressant use (20% vs 8%), BMI ≥ 30 kg/m2 (55% vs 47%), BMI ≥ 40 kg/m2 (7% vs 3%) (all p ≤ 0.048), but not of current depression (both 9%). Compared to the Swedish general population (depression (women 11.2%, men 12.3%) and antidepressant use (women 9.8%, men 5.3%)), the younger women had higher prevalence of current depression, and all patients had higher prevalence of antidepressant use. Conclusions: In patients with newly diagnosed T2D, the younger women had the highest prevalence of depression, anxiety, and obesity. The prevalence of depression in young women and antidepressant use in all patients were higher than in the Swedish general population. Three risk factors for CVD, obesity, smoking, and physical inactivity, were associated with depression. [ABSTRACT FROM AUTHOR]

Physical conditions in children and adolescents are often under reported during mainstream school years and may underlie mental health disorders. Additionally, comparisons between younger and older schoolchildren may shed light on developmental differences regarding the way in which physical conditions translate into conduct problems. The aim of the current study was to examine the incidence of psychosomatic complaints (PSC) in young and older adolescent boys and girls who also report conduct problems. A total of 3132 Swedish adolescents (age range 15–18 years, 47% boys) completed the Uppsala Life and Health Cross-Sectional Survey (LHS) at school. The LHS question scores were categorised by two researchers who independently identified questions that aligned with DSM-5 conduct disorder (CD) criteria and PSC. MANOVA assessed the effects of PSC, age, and gender on scores that aligned with the DSM criteria for CD. The main effects of gender, age, and PSC on the conduct problem scores were observed. Adolescents with higher PSC scores had higher conduct problem scores. Boys had higher serious violation of rules scores than girls, particularly older boys with higher PSC scores. Psychosomatic complaints could be a useful objective identifier for children and adolescents at risk of developing conduct disorders. This may be especially relevant when a reliance on a child's self-reporting of their behavior may not help to prevent a long-term disturbance to their quality of life. [ABSTRACT FROM AUTHOR]

Background: Cancer care trajectories are often complex, with potent multimodality treatments and multiple interactions with health care providers. Communication and coordination are challenging and the patients' responsibilities to take on more active roles in their own care are increasing. Objective: This study aimed to investigate associations between patient activation level and participation in cancer care, sociodemographic characteristics, clinical data, health‐related quality of life (HRQoL) and helpfulness of received information. Methods: In this cross‐sectional population‐based study, patients completed questionnaires on patient activation, perceived participation, HRQoL, helpfulness of received information and sociodemographic characteristics. Responses to the patient activation measures (PAMs) were classified into four levels (higher levels indicating more activation). Data on age, sex and cancer diagnosis were collected from the Swedish Cancer Register. Results: Data from 682 patients were analysed. On comparing patients at PAM levels 1 and 4, the latter reported significantly higher possibilities to influence care decisions (46.6% vs. 20.8%) and to ask questions regarding treatment and care (93.4% vs. 68.4%). Patients at PAM level 4 reported wanting to influence decision‐making to a higher extent, compared with patients at other PAM levels, and reported clinically significantly higher HRQoL. No significant differences were found regarding sociodemographic characteristics. Conclusion: We found strong associations between perceived patient participation and activation levels, with limited possibility for participation among those with lower activation levels. Patient or Public Contribution: Discussions with patient representatives have raised the importance of participation. The preliminary findings were presented and discussed in a workshop with representatives from 21 cancer patient advocacy groups. [ABSTRACT FROM AUTHOR]

Background: Current sepsis screening tools are predominantly based on vital signs. However, patients with serious infections frequently present with normal vital signs and there has been an increased interest to include other variables such as symptoms in screening tools to detect sepsis. The majority of patients with sepsis arrive to the emergency department by emergency medical services. Our hypothesis was that the presentation of sepsis, including symptoms, may differ between patients arriving to the emergency department by emergency medical services and patients arriving by other means. This information is of interest to adapt future sepsis screening tools to the population in which they will be implemented. The aim of the current study was to compare the prevalence of keywords reflecting the clinical presentation of sepsis based on mode of arrival among septic patients presenting to the emergency department. Methods: Retrospective cross-sectional study of 479 adult septic patients. Keywords reflecting sepsis presentation upon emergency department arrival were quantified and analyzed based on mode of arrival, i.e., by emergency medical services or by other means. We adjusted for multiple comparisons by applying Bonferroni-adjusted significance levels for all comparisons. Adjustments for age, gender, and sepsis severity were performed by stratification. All patients were admitted to the emergency department of Södersjukhuset, Stockholm, and discharged with an ICD-10 code compatible with sepsis between January 1, and December 31, 2013. Results: "Abnormal breathing" (51.8% vs 20.5%, p value < 0.001), "abnormal circulation" (38.4% vs 21.3%, p value < 0.001), "acute altered mental status" (31.1% vs 13.1%, p value < 0.001), and "decreased mobility" (26.1% vs 10.7%, p value < 0.001) were more common among patients arriving by emergency medical services, while "pain" (71.3% vs 40.1%, p value < 0.001) and "risk factors for sepsis" (50.8% vs 30.8%, p value < 0.001) were more common among patients arriving by other means. Conclusions: The distribution of most keywords related to sepsis presentation was similar irrespective of mode of arrival; however, some differences were present. This information may be useful in clinical decision tools or sepsis screening tools. [ABSTRACT FROM AUTHOR]

To investigate the association between a recorded procedure code for a medication review and adequate drug treatment management, and to explore factors associated with this code. Cross-sectional study; two primary health care centres, in Region Västra Götaland, Sweden. A total of 302 consecutive patients (≥65 years old, 59% female; median number of drugs: six) requiring a non-urgent consultation with a physician in October–November 2017. Adequate drug treatment management (treatment that did not require any further action), determined in consensus by two specialists in family medicine blinded to the medication review code. Adequate drug treatment management was, overall, less common in those with a recorded medication review over the last year: 63% versus 73% (p = 0.047). This negative association was evident among patients aged 65–74 years: 49% versus 74% (p = 0.003), but absent in those ≥75 years old: 67% versus 70% (p = 0.77). Recommendations from consensus included the search for additional information to be able to make a decision regarding initiation or withdrawal of a drug (n = 53), withdrawal of a drug (n = 41), or ordering a laboratory test (n = 25). Factors associated with a recorded procedure code included age above the remuneration limit of 75 years (odds ratio: 9.8; 95% confidence interval 5.0–19), type 2 diabetes (3.0 (1.5–6.2)), hypertension (2.4 (1.2–4.8)), and depression (2.5 (1.02–6.0)). The presence of a recorded medication review was not positively associated with adequate drug treatment management but was associated with the age limit for remuneration, and some chronic diseases. To improve drug treatment in older people in primary care, a remuneration system linked to recorded medication reviews has been introduced. In this study, fewer patients with than without a recorded medication review (63% versus 73%) had adequate drug treatment management. A recorded medication review was ten times more common in those ≥75 years, that is, the age limit for remuneration. Recorded codes for medication reviews were also common in those with type 2 diabetes, hypertension, and depression. [ABSTRACT FROM AUTHOR]

Background: Many ice hockey goaltending techniques force hip joints and groin muscles into extreme ranges of motion, which may increase the risk of hip and groin problems. Purpose: To explore how elite goaltenders and goaltending coaches perceive the demands of common goaltending techniques on the hip and groin region. We further explored differences in perception between goaltenders and their coaches as well as between junior (age <20 years) and senior (age ≥20 years) goaltenders. Study Design: Cross-sectional survey. Methods: We developed a model to categorize common ice hockey goaltending techniques into quantifiable units and invited elite goaltenders and coaches in Sweden to complete an online survey. Participants were asked to rate the perceived demands of each technique on the hip and groin using a Likert scale (not at all, slightly, somewhat, very, or extremely demanding). Using the chi-square test, the proportion of participants perceiving each technique as very or extremely demanding were compared between goaltenders and coaches as well as between senior and junior goaltenders. Results: We received responses from 132 goaltenders and 43 coaches. The stances most frequently perceived as very or extremely demanding were the reverse vertical horizontal post-play (40%) and the butterfly save (25%). Among transitions, movements into the post were most frequently rated as very or extremely demanding (11%–40%). Several techniques were perceived as demanding by a larger share of coaches than goaltenders (difference, 13%–46%; P <.001–.028) and a larger share of senior versus junior goaltenders (difference, 12%–20%; P =.13–.18). Conclusion: The post-play and the butterfly were the goaltending techniques most frequently perceived as demanding, and more coaches than goaltenders percieved these techniques demanding. The results of this study may inform injury prevention efforts for ice hockey goaltending. [ABSTRACT FROM AUTHOR]

Background: The aim was to investigate trends in the prevalence of obesity by age and level of education in the general population in mid-Sweden from year 2000 to 2012. Methods: A postal questionnaire was sent to a random population sample aged 25-74 years in years 2000, 2004, 2008 and 2012. The overall response rates were 67%, 65%, 60% and 53%, respectively, and the study included 29 017, 27 385, 25 910 and 24 152 respondents, respectively. Obesity (BM≥30 kg/m²) was based on self-reported weight and height. Results: The age-standardized prevalence of obesity increased from 13% to 17% in women and from 12% to 17% in men between 2000 and 2012. Obesity increased in all age groups from 2000 to 2008 and continued to increase among the middle aged (45-64 years) between 2008 and 2012. The socioeconomic gradient in obesity changed during the study period since the absolute increase in obesity was steepest at the middle educational level. In 2012, the prevalence of obesity was almost twice as high at both middle and low educational levels compared with high educational level. The 'true' prevalence of adult obesity, corrected for self-reported weight and height, was around 20% in 2012 for both men and women. Conclusion: In the majority, among the middle-aged and those with secondary education, the prevalence of obesity continued to increase even between 2008 and 2012. [ABSTRACT FROM AUTHOR]

Aims: In Sweden, alcohol abstention has increased over the last 20 years and consumption has recently decreased after a peak in 2004. To understand the dynamics of these trends the present study aims at estimating age, period and cohort (APC) effects on trends in alcohol use prevalence as well as overall and beverage-specific volume of drinking over the last three decades. Methods: APC analysis of seven cross-sectional surveys from 1979 to 2011 was conducted using cross-classified random effects models (CCREMs) by gender. The nationally representative samples comprised 77,598 respondents aged 16-80 years. Outcome measures were 30-day prevalence of alcohol use and overall as well as beverage-specific alcohol volume. Results: Trends in prevalence, overall and beverage-specific volume were significantly affected by APC. The period effects of prevalence and overall volume show a small decline after an increase up to the year 2005. Mean beer and wine volume levelled off after a peak in 2005 and volume of spirits drinking decreased constantly. Predicted alcohol prevalence rates in male cohorts (1945-1985) remained generally at the same level, while they declined in post-World War II female generations. Results point to high overall and beverage-specific consumption among cohorts born in the 1940s, 1950s and 1980s. Conclusions: High consuming cohorts of the 1940-1950s were key in rising consumption up to 2005. Progression through the life course of these cohorts, a decrease in prevalence and drinking volume in successive cohorts seem to have contributed to the recent downward trend in alcohol use in Sweden. [ABSTRACT FROM AUTHOR]

Background: Variation in prescription of antibiotics in primary care can indicate poor clinical practice that contributes to the increase of resistant strains. General Practitioners (GPs), as a professional group, are expected to have a fairly homogeneous prescribing style. In this paper, we describe variation in prescribing style within and across groups of GPs from six countries. Methods: Cross-sectional study with the inclusion of 457 GPs and 6394 sore throat patients. We describe variation in prescribing antibiotics for sore throat patients across six countries and assess whether variation in “prescribing style” - understood as a subjective tendency to prescribe - has an important effect on variation in prescription of antibiotics by using the concept of prescribing style as a latent variable in a multivariable model. We report variation as a Median Odds Ratio (MOR) which is the transformation of the random effect variance onto an odds ratio; Thus, MOR = 1 means similar odds or strict homogeneity between GPs' prescribing style, while a MOR higher than 1 denotes heterogeneity in prescribing style. Results: In all countries some GPs always prescribed antibiotics to all their patients, while other GPs never did. After adjusting for patient and GP characteristics, prescribing style in the group of GPs from Russia was about three times more heterogeneous than the prescribing style in the group of GPs from Denmark - Median Odds Ratio (6.8, 95% CI 3.1;8.8) and (2.6, 95% CI 2.2;4.4) respectively. Conclusion: Prescribing style is an important source of variation in prescription of antibiotics within and across countries, even after adjusting for patient and GP characteristics. Interventions aimed at influencing the prescribing style of GPs must encompass context-specific actions at the policy-making level alongside GP-targeted interventions to enable GPs to react more objectively to the external demands that are in place when making the decision of prescribing antibiotics or not. [ABSTRACT FROM AUTHOR]

Context: Tennis requires repetitive overhead movements that can lead to upper extremity injury. The scapula and the shoulder play a vital role in injury-free playing. Scapular dysfunction and glenohumeral changes in strength and range of motion (ROM) have been associated with shoulder injury in the overhead athlete. Objective: To compare scapular position and strength and shoulder ROM and strength between Swedish elite tennis players of 3 age categories (,14, 14-16, and .16 years). Design: Cross-sectional study. Setting: Tennis training sports facilities. Patients or Other Participants: Fifty-nine adolescent Swedish elite tennis players (ages 10-20 years) selected based on their national ranking. Main Outcome Measure(s): We used a clinical screening protocol with a digital inclinometer and a handheld dynamometer to measure scapular upward rotation at several angles of arm elevation, isometric scapular muscle strength, glenohumeral ROM, and isometric rotator cuff strength. Results: Players older than 16 years showed less scapular upward rotation on the dominant side at 908 and 1808 (P , .05). Although all absolute scapular muscle strength values increased with age, there was no change in the body-weight–normalized strength of the middle (P = .9) and lower (P = .81) trapezius or serratus anterior (P = .17). Glenohumeral internal-rotation ROM and total ROM tended to decrease, but this finding was not statistically significant (P = .052 and P = .06, respectively). Whereas normalized internal-rotator strength increased from 14 to 16 years to older than 16 years (P = .009), normalized external-rotator and supraspinatus strength remained unchanged. Conclusions: Age-related changes in shoulder and scapular strength and ROM were apparent in elite adolescent tennis players. Future authors should examine the association of these adaptations with performance data and injury incidence. [ABSTRACT FROM AUTHOR]

Objective. To study the associations between active choice of primary care provider and healthcare utilization, multimorbidity, age, and sex, comparing data from primary care and all healthcare in a Swedish population. Design. Descriptive cross-sectional study using descriptive analyses including t-test, correlations, and logistic regression modelling in four separate models. Setting and subjects. The population (151 731) and all healthcare in Blekinge in 2007. Main outcome measure. Actively or passively listed in primary care, registered on 31 December 2007. Results. Number of consultations (OR 1.31, 95% CI 1.30-1.32), multimorbidity level (OR 1.69, 95% CI 1.67-1.70), age (OR 1.03, 95% CI 1.03-1.03), and sex (OR for men 0.67, 95% CI 0.65-0.68) were all associated with registered active listing in primary care. Active listing was more strongly associated with number of consultations and multimorbidity level using primary care data (OR 2.11, 95% CI 2.08-2.15 and OR 2.14, 95% CI 2.11-2.17, respectively) than using data from all healthcare. Number of consultations and multimorbidity level were correlated and had similar associations with active listing in primary care. Modelling number of consultations, multimorbidity level, age, and sex gave four separate models with about 70% explanatory power for active listing in primary care. Combining number of consultations and multimorbidity did not improve the models. Conclusions. Number of consultations and multimorbidity level were associated with active listing in primary care. These factors were also associated with each other differently in primary care than in all healthcare. More complex models including non-health-related individual characteristics and healthcare-related factors are needed to increase explanatory power. [ABSTRACT FROM AUTHOR]

Objective. Few large-scale studies have examined the prevalence of irritable bowel syndrome (IBS) and the number of visits among IBS patients in a primary health care setting. The aim of this study was to assess the prevalence of IBS in primary health care in four Swedish counties. Another aim was to study the number of visits among the IBS patients. Design. A register-based study. Setting. A primary health care database with information on patients from 71 primary health care centres in the Swedish counties of Stockholm, Uppsala, Värmland, and Gotland. Subjects. The primary health care database contains individual-level data for 919 954 patients for the period 2001-2007. Main outcome measures. Prevalence of IBS diagnosis. Results. 10 987 patients had a diagnosis of IBS, which corresponds to a prevalence of 1.2%. IBS was most common in the 25-44 years age group (37% of IBS patients); 71% of IBS patients were female, and 81% of IBS patients visited their GP six or more times, compared with 46% of non-IBS patients. However, 95% of the IBS patients visited their GP three times or fewer for IBS. Conclusion and implications. The prevalence of IBS was low among Swedish primary health care patients. This might suggest that IBS patients are insufficiently diagnosed in Swedish primary health care. [ABSTRACT FROM AUTHOR]

Background: The prevention paradox states that a majority of alcohol-related problems in a population come from moderate drinkers because they are more numerous than heavy drinkers, although the latter have a higher individual risk of adverse outcomes. We examined the extent to which the prevention paradox applies to the relationship between alcohol consumption, heavy episodic drinking (HED) and alcohol-related problems in adolescents; an area in which studies are lacking. Methods: A total of 7288 alcohol-consuming adolescents aged 13–17 years were examined. The proportions (%) of problems related to drinking measures [the upper 10% and bottom 90% of drinkers by annual alcohol intake, and those with frequent (monthly), less frequent, and no heavy drinking episodes] were calculated. Results: The bottom 90% of consumers by annual intake accounted for a large majority of the alcohol-related problems among boys and girls at all ages. The share of problems accounted for by monthly HEDs increased with age, from ∼10% among those aged 13 years to >50% among those aged 17 years. Attributable proportions for the top 10% alcohol consumers ranged between 22% and 37%. Conclusions: Our analyses suggest that the prevention paradox is valid for adolescent boys and girls aged ≥15 years and applies to a large range of alcohol-related problems of varying severity. Our results imply that not only that prevention directed at all adolescents is essential, but also that HED should be particularly noticed. [ABSTRACT FROM PUBLISHER]

Postoperative sore throat and hoarseness are common and disturbing complications following endotracheal intubation, and women are more frequently affected by these symptoms. This study explores risk factors associated with postoperative sore throat and hoarseness in women following intubation. In this prospective cross-sectional study, 97 patients undergoing elective ear, nose, and throat surgery or plastic surgery were included. Eight different variables were analyzed to detect possible associations for the development of postoperative sore throat or hoarseness. For data analysis, the χ2 test and the odds ratio were used. Three variables were found to be significant risk factors for postoperative sore throat: age greater than 60 years (P = .01), the use of a throat pack (P = .04), and endotracheal tube No. 7.0 (size 7 mm; P = .02). The only risk factor found to be significantly associated with developing hoarseness was an endotracheal cuff pressure below 20 centimeters of water (P = .04). Larger studies are needed to confirm these risk factors. [ABSTRACT FROM AUTHOR]

The objective of this study was to analyse sociodemographic differences in medication use, health-care contacts and sickness absence among individuals with medication-overuse headache (MOH). A cross-sectional, population survey was conducted, in which 44,300 Swedes (≥15 years old) were interviewed over telephone. In total, 799 individuals had MOH. Of these, 47 % ( n = 370) only used over-the-counter medications. During the last year, 46 % ( n = 343) had made a headache-related visit to their physician and 14 % ( n = 102) had visited a neurologist. Among individuals aged <30 years, the number of days/month with headache was greater than the number of days with medication use, whereas the opposite was true for those ≥30 years. Both the proportion using prophylactic medication and the proportion having consulted a neurologist were smaller among those who only had elementary school education than among those with higher education ( p = 0.021 and p = 0.046). Those with a lower level of education also had a higher number of days/month with headache and with medication use than those with a higher educational level ( p = 0.011 and p = 0.018). The MOH-sufferers have limited contacts with health-care and preventive measures thus need to include other actors as well. Particular efforts should be directed towards those with low educational levels, and more research on medication use in relation to age is required. [ABSTRACT FROM AUTHOR]

Background/Objectives: Sleep problems and pain are common among the elderly and have been shown to affect quality of life. The objectives were to determine the prevalence of sleep problems and pain among the elderly and to compare the two factors in relation to age and gender. Design: A cross-sectional study based on baseline material collected by the Swedish National Study on Aging and Care in Blekinge (SNAC-Blekinge). Setting: The data were gathered from questionnaires distributed between the years 2001 and 2003 in the municipality of Karlskrona, Sweden. Participants: The participants comprised 1402 Swedish men and women aged 60-96. Results: Of all the participants 70 percent met the criteria for sleep problems and 62 percent indicated some experience of pain during the preceding 4 weeks. Both sleep problems and pain were more frequent among women than men and sleep problems tended to be more common with increasing age. Among the participants who experienced pain during the preciding 4 weeks 77 percent suffered from sleep problems. Conclusions: Sleep problems and pain are common among older people. Furthermore it is common to suffer from sleep problems when pain has been experienced during the preciding 4 weeks. [ABSTRACT FROM AUTHOR]

Objective. Several studies indicate that ethnicity may be a strong predictor of poor self-rated health (SRH). The aims of the present study were to investigate whether there was an association between ethnicity and poor SRH in subjects with type 2 diabetes and to determine if the association remained after adjusting for possible confounders such as age, gender employment, marital status, and education. Design. A cross-sectional study based on a patient population in the town of Södertälje. An unconditional logistic regression was performed to estimate the odds ratios (ORs) and 95% confidence intervals (95% CIs). Setting. Four primary health care centers. Subjects. A total of 354 individuals were included: Assyrian/Syrian-born (n = 173) and Swedish-born (n = 181). Results. The odds ratio for rating poor SRH for Assyrian/Syrian subjects with type 2 diabetes was 4.5 times higher (95% CI = 2.7-7.5) than for Swedish patients in a crude model. After adjusting for possible confounders, unemployed/retired people had 5.4 times higher odds for reporting poor SRH than employees (OR = 5.4; 95% CI = 2.3-12.5). Women had 1.8 times higher odds (95% CI = 1.0-3.0) for reporting poor SRH than men. In the final model poor SRH among Assyrians/Syrians decreased but still remained significant (OR=3.7; 95% CI = 2.5-6.6). Conclusions. The findings in this study are important for planning primary health care services. They highlight the crucial importance of being aware of the subjective health status of immigrants fleeing from war in the Middle East and resettling in Sweden. [ABSTRACT FROM AUTHOR]

Background: Access to and advice on Complementary and Alternative Medicine (CAM) are uncommon within Swedish conventional cancer care and little is known about cancer patients' own use of CAM. The aim of this cross-sectional study was to explore Swedish cancer patients´ patterns of CAM use, their experiences and preferences. Methods: Questionnaires were distributed consecutively to 1297 cancer patients at a university hospital's out-patient oncology units. The response rate was 58% (n = 755). Descriptive statistics were used to analyze the survey data. A logistic regression model was used to investigate the association between CAM use and gender, age and level of education. Open-ended responses were analyzed, using qualitative content analysis. Results: Lifetime CAM use was reported by 34% (n = 256), and 26% (n = 198) used CAM after cancer diagnosis. Being female, younger and having higher education predicted CAM use. Most commonly used methods were natural products including vitamins and minerals and relaxation. Main reasons for CAM use were improvement of physical, general and emotional wellbeing and increasing the body's ability to fight cancer. Satisfaction with CAM usage was generally high. Reported adverse effects were few and mild; 54% of users spent < 50 Euro a month on CAM. One third had discussed their CAM use with cancer care providers. More than half of all participants thought that cancer care providers should be able to discuss (58%) and to consider (54%) use of CAM modalities in cancer care. Conclusions: Despite limited access and advice within conventional cancer care, one fourth of Swedish cancer patients use CAM. The insufficient patient-provider dialogue diverges with most patients' wish for professional guidance in their decisions and integration of CAM modalities in conventional cancer care. Concurrent and multimodal CAM use implies challenges and possibilities for cancer care that need to be considered. [ABSTRACT FROM AUTHOR]