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Background Stimulating activities are associated with a decreased risk of dementia. However, the extent to which this reflects a protective effect of activity or non-participation resulting from dementia is debated. We investigated the association of stimulating leisure-time activity in late adulthood with the risk of dementia across up to two decades' follow-up. Methods We used data from five prospective cohort studies from Finland and Sweden. Mental, social, outdoor, consumptive and physical leisure-time activities were self-reported. Incident dementia was ascertained from clinical diagnoses or healthcare and death registers. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Results Of the 33 263 dementia-free individuals aged ≥50 years at baseline, 1408 had dementia during a mean follow-up of 7.0 years. Active participation in mental (HR: 0.52, 95% CI: 0.41 to 0.65), social (HR: 0.56 95% CI: 0.46 to 0.72), outdoor (HR: 0.70, 95% CI: 0.58 to 0.85), consumptive (HR: 0.67, 95% CI: 0.53 to 0.94) and physical (HR: 0.62, 95% CI: 0.51 to 0.75) activity, as well as variety (HR: 0.54, 95% CI: 0.43 to 0.68) and the overall frequency of activity (HR: 0.41, 95% CI: 0.34 to 0.49) were associated with a reduced risk of dementia in <10 years' follow-up. In ≥10 years' follow-up all associations attenuated toward the null. Conclusion Stimulating leisure-time activities are associated with a reduced risk of dementia in short-term but not long-term follow-up. These findings may reflect a reduction in leisure-time activity following preclinical dementia or dilution of the association over time. [ABSTRACT FROM AUTHOR]

Background: Despite a good prognosis, survivors of differentiated thyroid cancer (DTC) may have reduced health-related quality of life (HRQOL) many years after treatment, and it is unclear how suppression of thyroid-stimulating hormone (TSH) may contribute to HRQOL. This study investigated changes in HRQOL in the 5 years following DTC treatment, the association between HRQOL and TSH suppression, and how HRQOL compares to the general population. Methods: In this nationwide prospective cohort study, 487 patients with DTC were identified between 2012 and 2017 from all Swedish hospitals treating patients with DTC. Patients treated with total thyroidectomy and planned for radioiodine answered the Swedish version of the Short Form-36 Health Survey (SF-36) and a study specific questionnaire at treatment and after 1, 3, and 5 years. Summary measures for physical and mental QOL were derived from the SF-36, and TSH values were collected from patient records. To study changes in HRQOL over time, linear mixed models were fitted on multiply imputed data, with all patients and measurement points included in the model. Results: In total, 351 patients consented to participate in the study. In the 5 years following DTC treatment, physical QOL did not change significantly with time, while mental QOL improved by on average 0.61 (p < 0.001) per year. TSH levels were not predictive of either physical or mental QOL, or their change over time. At 5 years, there was a significant difference in physical and mental QOL compared with the Swedish general population, but effect sizes were small (Cohen's d = 0.29 and −0.21, respectively). The SF-36 domains general health, vitality, social functioning, and mental health were lower at 5 years compared with the general population (difference 8.7–13.3), and these differences were clinically significant. Conclusions: The mental component of HRQOL improves over time following DTC treatment. HRQOL in patients with DTC is not explained by TSH suppression. Although overall differences in physical and mental HRQOL compared with the general population were small 5 years after treatment, several specific psychosocial HRQOL domains were clinically meaningfully reduced. Psychosocial health issues should be screened for during DTC follow-up. [ABSTRACT FROM AUTHOR]

There is little knowledge of how organizational and social work environmental conditions impact workers' perceptions of occupational balance. The aim of the present study was to investigate organizational and social work environmental conditions as predictors of Swedish occupational therapists' perceptions of occupational balance. This prospective study collected data twice, with a one-year interval, and used a web survey. The present study included 1835 participants. Logistic regression analysis was used to analyze the work predictors of occupational balance. A reasonable workload, high control, and high reward predicted high occupational balance. Having no children living at home, a satisfactory financial situation, and being physically active also predicted high occupational balance. A reasonable workload, high control and high reward predicted occupational balance among the occupational therapists. All these factors may be of importance for a sustainable working life for occupational therapists. This knowledge can support occupational therapists in the development of interventions at the work place, with focus on the workload and the resources (control and reward), to promote employees' occupational balance. [ABSTRACT FROM AUTHOR]

Background: The place of death of cancer patients is an important aspect of end-of-life care. However, little research has been conducted regarding factors that may influence the preferred and actual place of death in cancer patients and whether the patients die at their preferred place of death. In this study, we aimed to investigate the preferred and actual place of death for palliative cancer patients, and factors influencing these variables. Methods: Patients diagnosed with cancer and admitted to a palliative care team across three Swedish cities between 2019 and 2022 were asked for participation. Participants completed a questionnaire capturing sociodemographic data and preferred place of death. Further data regarding age, sex, and cancer type were collated at inclusion, and the actual place of death recorded for those deceased by 5-May-2023. Results: The study included 242 patients. A majority (79%) wanted to die at home which was the actual death location for 76% of the patients. When the place-of-death decision was made by the patient alone, 75% chose home, compared to 96% when decided jointly with relatives-a statistically significant variation (p = 0.0037). For the patients who wanted to die at home, 80% actually died at home, with insignificant disparities among subgroups. Conclusions: Most palliative cancer patients in this Swedish cohort preferred and achieved death at home. Involving relatives in decision-making may influence the preferred place of death, however larger studies are needed to comprehensively assess factors affecting the preferred and actual place of death in different subgroups of patients., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: The potential utility of inflammatory and hemodynamic plasma biomarkers for the prediction of incident lower extremity arterial disease (LEAD), carotid artery stenosis (CAS), isolated atherosclerotic disease without concomitant abdominal aortic aneurysm (AAA), and isolated AAA without concomitant atherosclerotic disease has not yet been integrated in clinical practice. The main objective of this prospective study was to find predictive plasma biomarkers for cardiovascular disease and to evaluate differences in plasma biomarker profiles between asymptomatic and symptomatic CAS, as well as between isolated atherosclerotic disease and isolated AAA., Methods: Blood samples collected at baseline from participants in the prospective Malmö Diet and Cancer study (MDCS) cardiovascular cohort (n = 5550 middle-aged individuals; baseline 1991-1994) were used for plasma biomarker analysis. Validation of each incident cardiovascular diagnosis was performed by random sampling. Cox regression analysis was used to calculate hazard ratios (HRs) per one standard deviation increment of each respective log-transformed plasma biomarker with 95% confidence intervals (CI)., Results: Adjusted lipoprotein-associated phospholipase A2 (Lp-PLA 2 ) activity (HR 1.33; CI 1.17-1.52) and mass (HR 1.20; CI 1.05-1.37), C-reactive protein (CRP) (HR 1.55; CI 1.36-1.76), copeptin (HR 1.46; CI 1.19-1.80), N-terminal pro-B-type natriuretic peptide (N-BNP) (HR 1.28; 1.11-1.48), and cystatin C (HR 1.19; 95% 1.10-1.29) were associated with incident symptomatic LEAD. Adjusted N-BNP (HR 1.59; CI 1.20-2.11), mid-regional proadrenomedullin (HR 1.40; CI 1.13-1.73), cystatin C (HR 1.21; CI 1.02-1.43), and CRP (HR 1.53; CI 1.13-1.73) were associated with incident symptomatic but not asymptomatic CAS. Adjusted HR was higher for Lp-PLA 2 (mass) for incident isolated AAA compared to for isolated atherosclerotic disease., Conclusions: Plasma biomarker profile data support that subclinical vascular inflammation and cardiovascular stress seem to be relevant for the development of atherosclerotic disease and AAA.

Aim: The aim of this study was to explore the temporal development of beliefs about health, illness and health care in migrant women with gestational diabetes (GD) born in Asia residing in Sweden, and the influence on health-related behaviour in terms of self-care and seeking care. Background: Migrant Asian women are a high-risk group for developing GD. Adapting to the culture in the new society and the healthcare system, being diagnosed with GD and becoming a mother is demanding. The question is whether Asian migrants' patterns of beliefs and behaviour change over time, as no previous study has been revealed on this topic. Method: Qualitative prospective exploratory study. Semi-structured interviews were held on three occasions: during pregnancy and three and fourteen months after delivery, with women born in Asia, diagnosed with GD. Data were analysed with qualitative content analysis. Findings: There was a temporal change of beliefs influencing health-related behaviour, showing a rising curve in risk awareness. An increasing number of persons described developing a healthy diet/lifestyle based on initial advice and shifted focus from the child to worries about the woman's health and risk of developing type 2 diabetes and being unable to care for the child/family. Also, the number of women perceiving GD as a transient condition decreased and more believed it would last forever. Beliefs about health care were unchanged, the healthcare model was perceived working well but information about GD and follow-ups was requested even after delivery, and competent staff was expected. Health professionals' beliefs about the seriousness of GD influence patients' beliefs and need to be considered. Migrant women need support with adequate information, based on their individual beliefs, to continue develop a sustainable healthy lifestyle even after giving birth, to promote health and prevent type 2 diabetes. [ABSTRACT FROM AUTHOR]

Background: The Oslo Sport Trauma Research Centre Questionnaire on Health Problems (OSTRC-H) has become a popular tool to monitor health status in athletes. Originally developed for adult athletes, the tool is today also being used in adolescent athletes. However, little is known on the suitability of the questionnaire for the adolescent age group and the methodological implications of applying the tool to prospectively monitor illness and injury. To address this gap in methodological knowledge, the aim of this study is to outline and discuss the adaption and application process of the OSTRC-H to adolescent football players.Method: The adaption process included a slightly modified back-translation method to translate the questionnaire. The application process included a web-based version of the Swedish OSTRC-H sent out once a week over 23 weeks to 115 adolescent football players aged 10-19 attending two football schools in Sweden. The response rate and prevalence of health problems over 23 weeks were calculated as feasibility indicators. Additionally, comprehensibility questions were added to the questionnaire in the end of the study.Result: No major disagreement was found between the original and translated versions of the questionnaire. However, significant changes to the wording of the questions and answer categories were necessary to adapt it to adolescents. A visual body figure was also added. The average weekly response rate was 38% (SD 13.5). To increase this rate, questionnaire data was gathered retrospectively through telephone and email contact with the participants and their parents, elevating the response rate to 53% (SD 15.5). The adolescents experienced the questionnaire as easy to understand and to cover all relevant health problems.Conclusion: Our study demonstrates the importance of adapting the questionnaire to the adolescent target group through translation, pre-tests, adjustments of wording and the facilitation of answering the questionnaire using a visual body figure. The study further shows the importance of keeping close and personal contact with the participants, their parents, teachers, and coaches throughout data collection. Future studies should take into account the age group and study context when adapting and applying the OSTRC-H to adolescents. [ABSTRACT FROM AUTHOR]

Context: Athletes participating in sport are exposed to a high injury risk. Previous research has found a great number of risk factors (both physiological and psychological) that could increase injury risk. One limitation in previous studies is that few have considered the complex interaction between psychological factors in their research design. Objective: To study whether personality, stress, and coping predicted injury occurrence in an elite soccer population based on a hypothesized model. Design: Prospective. Participants: 56 (n = 38 male, n = 18 female) Swedish Premiere League soccer players were selected based on convenience sampling. Intervention: Participants completed 4 questionnaires including the Swedish Universities Scales of Personality, Life Events Survey for Collegiate Athletes, and Brief COPE during the initial questionnaire administration. Subsequent to the first meeting, participants also completed the Hassle and Uplift Scale once per wk for a 13-wk period throughout the competitive season. Main Outcome Measures: A path analysis was conducted examining the influence of personality traits (ie, trait anxiety), state-level stressors (ie, negative-life-event stress and daily hassles), and coping on injury frequency. Results: Results of the path analysis indicated that trait anxiety, negative-life-event stress, and daily hassle were significant predictors of injury among professional soccer players, accounting for 24% of the variance. Conclusion: The findings highlight the need for athletes, coaches, and medical practitioners to attempt to reduce state-level stressors, especially daily hassles, in minimizing injury risk. Educating and training athletes and coaches in proactive stress-management techniques appears warranted. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to investigate fibre, and plant foods, and its association with AAA risk. Methods: In this prospective cohort study, Malmö Diet and Cancer Study, baseline data collection was carried out 1991–1996. The study participants' (n = 26,133) dietary habits were extensively recorded at baseline. The specific diagnosis of AAA in the in-hospital registry was found valid in 95%. The association between plant foods, such as cereals and types of vegetables, and AAA was assessed by using Cox regression analysis expressed as hazard ratios (HR) with 95% confidence intervals (CI). Results: A high intake of fibre was independently associated with AAA risk (HR per quintile 0.87, 95% CI 0.79–0.97). High intake of vegetables (HR 0.91, 95% CI 0.84–0.98), specifically leaf vegetables (HR 0.87, 95% CI 0.81–0.94), and fruits and berries (HR 0.89, 95% CI 0.82–0.96), citrus (HR 0.91, 95% CI 0.85–0.98) and non-citrus fruits (HR 0.87, 95% CI 0.81–0.95) were independently associated with a decreased AAA risk. Conclusions: A high intake of fruits and berries and vegetables, in particular leaf vegetables, are associated with a decreased risk of developing AAA. [ABSTRACT FROM AUTHOR]

Background: Familial breast cancer risk studies usually overlook the dynamic nature of family history.Methods: The authors assessed the effect of incorporating the timing of cancer diagnosis events into the assessment of familial risks of breast cancer in first-degree and second-degree relatives in a nationwide cohort study of 5,099,172 women (follow-up was between 1958-2015). Family history was assessed using 3 approaches: 1) as a static variable (ever having a relative with breast cancer); 2) as accumulative history; and 3) as a dynamic variable (time-dependent variable).Results: For women aged <50 years, familial risk was mostly higher when family history was assessed as a dynamic variable compared with using a static or accumulative family history. For example, the cumulative risk of receiving a breast cancer diagnosis until age 50 years for women with a history of breast cancer in 1 first-degree relative was 2.6% (95% CI, 2.5%-2.7%) using the static method, 2.4% (95% CI, 2.3%-2.4%) using the accumulative method, and 3.1% (95% CI, 3.0%-3.2%) using the dynamic method. Relative risk in women aged <50 years with a breast cancer diagnosis in a sister was 1.40-fold (95% CI, 1.31-fold to 1.48-fold) using the static method, 1.66-fold (95% CI, 1.57-fold to 1.76-fold) using the accumulative method, and 2.28-fold (95% CI, 2.07-fold to 2.51-fold) using the dynamic method.Conclusions: The results of the current study demonstrated that assessing family history as static, accumulative, or dynamic results in different familial risk estimates. The answer as to which method to use for family history assessment depends on the implications of the study, with the dynamic method appearing to be better suited for risk stratification studies, the accumulative method being the most convenient in practice and the least favored for risk prediction, and the static method being suitable for etiological impact and risk attribution studies. [ABSTRACT FROM AUTHOR]

Aim: The impact of the anti-inflammatory potential of diet on risk of heart failure (HF) and the potential modification of this association by smoking, a trigger of systemic inflammation, has not been previously investigated. We examined the association between anti-inflammatory potential of diet and risk of HF taking into account smoking status.Methods and Results: The study population included the Cohort of Swedish Men (40 514 men) and the Swedish Mammography Cohort (34 809 women), age 45-83 years, without HF, ischaemic heart disease, or cancer at baseline. Anti-inflammatory potential of diet was estimated using an anti-inflammatory diet index (AIDI; 0-16 scores). Cox proportional hazard regression models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) adjusted for HF risk factors. Over a mean follow-up of 14.9 years (1 119 110 person-years, 1998-2014), 8161 new HF diagnoses (4443 in men, 3718 in women) were identified. Compared to the lowest quintile of the AIDI (scores ≤4), the HRs for men and women in the highest quintile (scores ≥8) were 0.92 (95% CI 0.84-1.02; P-trend = 0.02) and 0.86 (95% CI 0.78-0.96; P-trend = 0.001), respectively. An inverse association between the AIDI and HF incidence was observed in current and ex-smokers but not in never-smokers (P-interaction = 0.046). Comparing extreme quintiles, the HRs were 0.86 (95% CI 0.74-1.00; P-trend = 0.007) in current smokers, 0.81 (95% CI 0.71-0.92; P-trend = 0.001) in ex-smokers, and 0.95 (95% CI 0.86-1.06; P-trend = 0.10) in never-smokers.Conclusion: These results suggest that adherence to a diet with high anti-inflammatory potential may be associated with lower HF incidence in current and ex-smokers. [ABSTRACT FROM AUTHOR]

Background: There is still a lack of knowledge on long-term effects of surgical and non-surgical weight-lowering treatments. BASUN is a prospective study with 10 years of follow-up that will observe the effects and consequences of surgical and medical treatment of obesity. The aims are to cover areas where data on long-term outcomes are lacking, e.g., nutritional deficiencies, substance abuse, psychiatric health, as well as patient-reported outcomes. Methods: BASUN is a cohort study that recruited study persons with obesity (BMI ≥ 35 kg/m2) referred to the Regional Obesity Centre of Region Västra Götaland. The interventions were Roux-en-Y gastric bypass (RYGB) or Sleeve gastrectomy (SG), or 12 months of structured, multi-professional medical treatment (MT), including very low energy diet, followed by diet and pharmaceutical treatment. The study is not randomized, but based on patients preferences and multidisciplinary assessments. The study persons are examined at baseline, 2, 5, and 10 years with blood tests, measurements and questionnaires. The recruitment period lasted from May 2015 to November 2017. Results: One thousand one hundred twenty-seven patients were included (74% female). Three hundred eighty-two patients were accepted for medical treatment, 589 for surgical treatment (388 RYGB and 201 SG) and 156 patients left the study without treatment, leaving a final study population of 971 patients. There were slight differences between the treatment groups with regards to age and BMI. Pharmaceutical treatments, level of education, smoking and marital status were not significantly different between the groups. Conclusion: This study will follow 971 obese subjects in clinical practice treated with the best surgical or medical methods currently available. It has the potential to evaluate outcomes usually not reported in short-term studies, and to assist in identifying factors that are of importance for the choices of treatment. The main limitations are non-randomization and differences in baseline characteristics. The large number of participants and the length of the prospective follow-up are major strengths of the study. BASUN is designed to identify both early and late benefits and adverse events of treatment of obesity. Trial registration: This trial was prospectively registered on March 03, 2015; NCT03152617. [ABSTRACT FROM AUTHOR]

Background: Hypothermia is a common problem in the surgical context and can lead to serious consequences for the patient and increased costs for society. Aims: To study day-surgery patients' peripheral and core temperatures during the preoperative phase. Methods: In total, 50 day-surgery patients participated in the study. Two sets of measurements of temperatures were made: core temperature and peripheral temperatures (two measuring points on the upper body and lower extremities respectively) were measured on arrival at the day-surgery unit, as well as on arrival at the operating theatre. The data were normally distributed and a paired t-test was used for statistical analysis. Findings: Peripheral temperatures had significant changes, with measuring points on the upper body decreasing and measuring points on the lower extremities increasing in temperature. The results show no significant change in core temperature. Conclusion: The measurements show that 28% of the patients were below recommended preoperative temperature on arrival at the operating theatre. Further research is needed to study the development of body temperature perioperatively as well as at what point reheating interventions should be introduced. [ABSTRACT FROM AUTHOR]

Aim: Investigate the feasibility of identifying a well-defined treatment group and a comparable reference group in clinical register data. Background: There is insufficient knowledge on how to avert neck/back pain from turning chronic or to impair work ability. The Swedish Government implemented a national multimodal rehabilitation (MMR) programme in primary care intending to promote work ability, reduce sick leave and increase return to work. Since randomised control trial data for effect is lacking, it is important to evaluate existing observational data from clinical settings. Methods: We identified all unique patients with musculoskeletal pain (MSP) diagnoses undergoing the MMR programme in primary care in the Skåne Health care Register (n = 2140) during 2010–2011. A reference cohort in primary care (n = 56 300) with similar MSP diagnoses, same ages and the same level of sick leave before baseline was identified for the same period. The reference cohort received ordinary care and treatment in primary care. The final study group consisted of 603 eligible MMR patients and 2874 eligible reference patients. Socio-economic and health-related baseline data including sick leave one year before up to two years after baseline were compared between groups. Findings: There were significant socio-economic and health differences at baseline between the MMR and the reference patients, with the MMR group having lower income, higher morbidity and more sick leave days. Sick leave days per year decreased significantly in the MMR group (118–102 days, P < 0.001) and in the reference group (50–42 days, P < 0.001) from one year before baseline to two years after. Conclusions: It was not feasible to identify a comparable reference group based on clinical register data. Despite an ambitious attempt to limit selection bias, significant baseline differences in socio-economic and health were present. In absence of randomised trials, effects of MMR cannot be sufficiently evaluated in primary care. [ABSTRACT FROM AUTHOR]

We aimed to examine the extent to which concerns about falling are associated with the risk of injurious falls in older adults, and to explore the role of balance impairment in this association. Prospective study with a 5-year follow-up. Participants were 1281 people, aged ≥60 years (62.5% women), from the Swedish National Study on Aging and Care in Kungsholmen. Data on injurious falls during 5 years of follow-up was obtained from national registers. Cox and Laplace regression models were applied to examine injurious falls in relation to concerns about falling (binary variable), balance impairment (one-leg balance test), or an indicator variable with 4 mutually exclusive categories based on the presence of concerns about falling and balance impairment. There was no statistically significant association between concerns about falling and injurious falls in the total sample when adjusting for covariates. We found significant interactions of concerns about falling with balance impairment and age (<70 vs ≥80 years), so that the association between concerns about falling and injurious falls was more evident in people with better balance and the younger-old participants (P <.05). Having only concerns about falling [hazard ratio (HR) 2.06, 95% CI 1.22, 3.48], only balance impairment (HR 2.22, 95% CI 1.38, 3.56), or both (HR 2.35, 95% CI 1.45, 3.82) were associated with an increased risk of injurious falls compared to those with neither concerns about falling nor balance impairment. Our results suggest that concerns about falling may increase the risk of injurious falls, especially among younger-old people or those without objective balance impairment. [ABSTRACT FROM AUTHOR]

Introduction: Our aim was to investigate the accuracy of postmortem fetal magnetic resonance imaging (MRI) compared with fetal autopsy in second trimester pregnancies terminated due to fetal anomalies. A secondary aim was to compare the MRI evaluations of two senior radiologists.Material and Methods: This was a prospective study including 34 fetuses from pregnancies terminated in the second trimester due to fetal anomalies. All women accepted a postmortem MRI and an autopsy of the fetus. Two senior radiologists performed independent evaluations of the MRI images. A senior pathologist performed the fetal autopsies. The degree of concordance between the MRI evaluations and the autopsy reports was estimated as well as the consensus between the radiologists.Results: Thirty-four fetuses were evaluated. Sixteen cases were associated with the central nervous system (CNS), five were musculoskeletal, one cardiovascular, one was associated with the urinary tract, and 11 cases had miscellaneous anomalies such as chromosomal aberrations, infections and syndromes. In the 16 cases related to the CNS, both radiologists reported all or some, including the most clinically significant anomalies in 15 (94%; CI 70%-100%) cases. In the 18 non-CNS cases, both radiologists reported all or some, including the most clinically significant anomalies in six (33%; CI 5%-85%) cases. In 21 cases (62%; CI 44%-78%), both radiologists held opinions that were consistent with the autopsy reports. The degree of agreement between the radiologists was high, with a Cohen's Kappa of 0.87.Conclusions: Postmortem fetal MRI can replace autopsy for second trimester fetuses with CNS anomalies. For non-CNS anomalies, the concordance is lower but postmortem MRI can still be of value when autopsy is not an option. [ABSTRACT FROM AUTHOR]

Temporomandibular disorders (TMDs) are common, but many patients with such disorders go undetected and under‐treated. Our aim was to evaluate the outcome of using a screening tool (5 yr after it was first implemented), on the clinical decision‐making for patients with TMDs. Adults who attended for a dental check‐up at the Public Dental Health Services in Västerbotten, Sweden, answered three screening questions (3Q/TMD) on frequent jaw pain, pain on jaw function, and catching/locking of the jaw. The dental records of a random sample of 200 individuals with at least one positive response to 3Q/TMD (3Q screen‐positive patients) and 200 individuals with all negative responses (3Q screen‐negative patients) were reviewed for TMD‐related treatment decisions. A clinical decision related to TMD was absent in 45.5% of 3Q screen‐positive patients. Treatment of TMDs was associated with a positive response to the screening question on jaw pain (OR = 6.7, 95% CI: 3.2–14.0) and was more frequent among 3Q screen‐positive patients (24%) than among 3Q screen‐negative patients (2%; OR = 15.5, 95% CI: 5.5–43.9), just as a female examiner was associated with more frequent treatment of TMDs (OR = 3.1, 95% CI: 1.2–8.4). The results indicate under‐treatment of TMD within general dental practice and that male clinicians are less likely to initiate TMD treatment. [ABSTRACT FROM AUTHOR]

There is evidence that derangement in serum electrolytes like sodium and potassium is associated with increased morbidity and mortality among hospitalized critically ill patients, but their role in the context of cancer survival remains poorly understood. We sought to investigate the association of pre-diagnostic serum sodium and potassium with risk of overall, cancer-specific, and cardiovascular (CV) death among 11,492 men diagnosed with prostate cancer (PCa) from the Swedish AMORIS study. Multivariable Cox proportional hazards regression was used to assess the risk of death by clinical categories of pre-diagnostic serum sodium and potassium. During a mean follow-up of 5.7 years, 1649 men died of PCa. Serum levels of sodium were not indicative of PCa-specific or CV death. A weak positive association was found between pre-diagnostic higher serum potassium (> 5 mEq/L) and overall death [HR: 1.26 (95% CI: 1.01-1.59)] as compared to low/normal levels of clinical cut-offs. The current study did not find strong evidence for a role of electrolytes in PCa mortality. To further disentangle the potential role of electrolytes in cancer development, future studies should use repeated measurement of serum electrolytes.This research project was reviewed and approved by the Stockholm Ethical Committee (Dnr 2010/1:7). [ABSTRACT FROM AUTHOR]

Aims: The aim of the present study was to investigate associations between occupational gender composition, psychosocial work factors and mild to severe depression in Swedish women and men with various educational backgrounds. Methods: The study included 5560 participants from two waves of the Swedish Longitudinal Occupational Survey of Health, an approximately representative sample of the Swedish working population. Odds ratios (OR) and 95% confidence intervals of mild to severe depression in 2014 were estimated for five strata of occupational gender composition with >20-40%, >40-60%, >60-80% and >80-100% women, using 0-20% women as the reference. Analyses were stratified by gender and education. Job strain, organisational injustice, poor social support and effort-reward imbalance in 2012 were added in separate models, and changes in OR of mild to severe depression for strata of occupational gender composition were evaluated. Results: Among women, the odds of mild to severe depression did not vary by occupational gender composition. Among men with low to intermediate education, the odds were higher in the stratum with >80-100% women, and among men with high education, the odds were higher in strata with >20-40% and >60-80% women. Psychosocial work factors affected the odds ratios of mild to severe depression, but most of the variation remained unexplained. Conclusions: Odds of mild to severe depression appeared to vary by occupational gender composition among Swedish men but not women. This variation seemed only to a small extent to be explained by psychosocial work factors. [ABSTRACT FROM AUTHOR]

Background: Psychosocial work factors can affect depressive moods, but research is inconclusive if flexibility to self-determine working hours (work-time control, WTC) is associated with depressive symptoms over time. We investigated if either sub-dimension of WTC, control over daily hours and control over time off, was related to depressive symptoms over time and examined causal, reversed-causal, and reciprocal pathways.Methods: The study was based on four waves of the Swedish Longitudinal Occupational Survey of Health which is a follow-up of representative samples of the Swedish working population. WTC was measured using a 5-item index. Depressive symptoms were assessed with a brief subscale of the Symptom Checklist. Latent growth curve models and cross-lagged panel models were tested.Results: Best fit was found for a model with correlated intercepts (control over daily hours) and both correlated intercepts and slopes (control over time off) between WTC and depressive symptoms, with stronger associations for control over time off. Causal models estimating impacts from WTC to subsequent depressive symptoms were best fitting, with a standardised coefficient between -0.023 and -0.048.Limitations: Results were mainly based on self-report data and mean age in the study sample was relatively high.Conclusion: Higher WTC was related to fewer depressive symptoms over time albeit small effects. Giving workers control over working hours - especially over taking breaks and vacation - may improve working conditions and buffer against developing depression, potentially by enabling workers to recover more easily and promoting work-life balance. [ABSTRACT FROM AUTHOR]

Aim: to explore the natural course of blood pressure development and its relation to mortality in a nursing home cohort. Methods: a cohort of 406 nursing home residents in south east Sweden was followed prospectively for 30 months. Participants were divided into four groups based on systolic blood pressure (SBP) at baseline. Data were analysed using a Cox regression model with all-cause mortality as the outcome measurement; paired Student t-tests were used to evaluate blood pressure development over time. Results: during follow-up, 174 (43%) people died. Participants with SBP < 120mmHg had a hazard ratio for mortality of 1.56 (95% confidence interval, 1.08-2.27) compared with those with SBP 120-139mmHg, adjusted for age and sex. Risk of malnutrition or present malnutrition was most common in participants with SBP < 120 mmHg; risk of malnutrition or present malnutrition estimated using the Mini Nutritional Assessment was found in 78 (71%). The levels of SBP decreased over time independent of changes in anti-hypertensive medication. Conclusions: in this cohort of nursing home residents, low SBP was associated with increased all-cause mortality. SBP decreased over time; this was not associated with altered anti-hypertensive treatment. The clinical implication from this study is that there is a need for systematic drug reviews in elderly persons in nursing homes, paying special attention to those with low SBP. [ABSTRACT FROM AUTHOR]

To investigate the association between serum calcium and risk of breast cancer using a large cohort and a systematic review with meta-analysis. From the Swedish Apolipoprotein Mortality Risk (AMORIS) Study we included 229,674 women who had baseline measurements of serum total calcium and albumin. Multivariable Cox regression was used to assess the association between total and albumin-corrected calcium and breast cancer risk. For the systematic review, an electronic search of MEDLINE and EMBASE databases was performed to identify other prospective cohorts assessing the relationship between serum calcium and breast cancer risk. We pooled the results of our AMORIS cohort with other eligible studies in a meta-analysis using a random effects model. I2 test was used to assess heterogeneity. In the AMORIS study, 10,863 women were diagnosed with breast cancer (mean follow-up: 19 years). We found an inverse association between total serum calcium and breast cancer when comparing the fourth quartile to the first quartile (HR: 0.94, 95% CI: 0.88-0.99, p value for trend 0.04) and similar results using albumin-corrected calcium. In the systematic review, we identified another two prospective cohorts evaluating pre-diagnostic serum total calcium and breast cancer. Combining these studies and our findings in AMORIS in a meta-analysis showed a protective effect of serum calcium against breast cancer, with a summary RR of 0.80 (95% CI: 0.66-0.97). No substantial heterogeneity was observed. Our findings in AMORIS and the meta-analysis support an inverse association between serum calcium and breast cancer risk, which warrants mechanistic investigations. [ABSTRACT FROM AUTHOR]

Purpose: Self-rated health (SRH) is a well-established measure within social epidemiology. However, most studies on SRH tend to be amongst the general population, where SRH has been found to be lower in women than in men. Few studies have specifically investigated patterns of SRH just within an employed population. The purpose of this study was to (1) investigate whether there are gender differences in reporting suboptimal SRH in an employed Swedish population and (2) study whether these differences could be explained by socio-economic, work-, health- and/or lifestyle-related factors. Methods: This study is cross-sectional analysis of data from the 2008 wave of Swedish Longitudinal Occupational Survey of Health, a nationally representative cohort of the Swedish working population. This study includes the responses of 9,756 employed individuals. Logistic regression analyses were performed. Results: After adjusting for age, income and working hours (full vs. part time), men had significantly higher odds of suboptimal SRH than women OR 1.38 (95 % CI 1.22-1.55). With stepwise inclusion of health factors such as long-standing disease, sleep quality and fatigue, the OR for men increased to 1.65 (95 % CI 1.44-1.89). Gender differences in reporting suboptimal SRH were attenuated to 1.29 (95 % CI 1.11-1.51) with the inclusion of lifestyle factors. However, they remained significant after inclusion of all explanatory variables. Conclusions: In contrast to findings in general population studies, our results show that men in employment have higher odds of suboptimal SRH than their female counterparts. As SRH is an important indicator of health with a strong association with mortality, an excess risk of suboptimal SRH amongst employed men shows that more attention should be paid to men's health in the workplace. [ABSTRACT FROM AUTHOR]

Aim: To examine social capital across life and functional somatic symptoms in middle-age, according to life-course models of cumulative risk and sensitive periods. Methods: Data from the 26-year prospective study the Northern Swedish Cohort enabled complete case analyses on 940 individuals (451 women and 489 men) participating in questionnaire surveys at ages 16, 21, 30 and 42. Social capital was operationalized at the individual level, comprising items on social participation, social influence and social support. Functional somatic symptoms were a summary measure of self-reported physical symptoms, palpitation and sleeping difficulties occuring during the 12 months prior to the data collection. Linear regression was used as the main statistical method, examining the relationship between functional somatic symptoms at age 42 and social capital across life. Results: Lower levels of social capital accumulated over the life course were associated with higher levels of functional somatic symptoms at age 42, for both women and men. Social capital was, especially among adolescent men, related to functional somatic symptoms at age 42, independently of social capital later in life and baseline material circumstances. Conclusions: The health impact of poor social capital may be due to accumulation across the life course and to adolescence being a particularly sensitive period. It is relevant for preventive work to acknowledge effects of social capital throughout life. [ABSTRACT FROM PUBLISHER]

Background Aspirin (ASA) use has been associated with improved breast cancer survival in several prospective studies. Methods We conducted a nested case-control study of ASA use after a breast cancer diagnosis among women using Swedish National Registries. We assessed prospectively recorded ASA exposure during several different time windows following cancer diagnosis using conditional logistic regression with breast cancer death as the main outcome. Within each six-month period of follow-up, we categorized dispensed ASA doses into three groups: 0, less than 1, and 1 or more daily doses. Results We included 27,426 women diagnosed with breast cancer between 2005 and 2009; 1,661 died of breast cancer when followed until Dec 31, 2010. There was no association between ASA use and breast cancer death when exposure was assessed either shortly after diagnosis, or 3-12 months before the end of follow-up. Only during the period 0-6 months before the end of follow-up was ASA use at least daily compared with non-use associated with a decreased risk of breast cancer death: HR (95% CI) = 0.69(0.56-0.86). However, in the same time-frame, those using ASA less than daily had an increased risk of breast cancer death: HR (95% CI) = 1.43(1.09-1.87). Conclusions Contrary to other studies, we did not find that ASA use was associated with a lower risk of death from breast cancer, except when assessed short term with no delay to death/end of follow-up, which may reflect discontinuation of ASA during terminal illness. [ABSTRACT FROM AUTHOR]

BACKGROUND: Symptoms from the eyes are common among computer users. Knowledge is scarce about these problems, however. OBJECTIVES: The aim was to study risk-factors, incidence and persistence of eye-symptoms among professionally active computer users. METHODS: This was a questionnaire based prospective study where 1283 males and females from different professions and companies answered a baseline questionnaire about individual factors and working conditions, e.g. duration of daily computer work, comfort of screen work, psychosocial factors. Subjects were at baseline and 10 follow-ups asked about the number of days with eye-symptoms during the preceding month. RESULTS: The incidence-rate of symptoms persisting minimum three days was 0.38/person-year. A multivariate Hazard-ratio model showed significant associations with extended continuous computer work, tasks with high demands on eye-hand coordination, low level of control, visual discomfort, female sex and nicotine use. Eye-symptoms at baseline was a strong risk factor for new symptoms. CONCLUSION: The incidence of eye-symptoms among professional computer users is high and related to both individual and work-related factors. The organization of computer work should secure frequent breaks from near-work at the computer screen. The severity of vision-related problems could in field studies be quantified by asking for the persistence of symptoms. [ABSTRACT FROM AUTHOR]

The effect of office type on sickness absence among office employees was studied prospectively in 1852 employees working in (1) cell-offices; (2) shared-room offices; (3) small, (4) medium-sized and (5) large open-plan offices; (6) flex-offices and (7) combi-offices. Sick leaves were self-reported two years later as number of (a) short and (b) long (medically certified) sick leave spells as well as (c) total number of sick leave days. Multivariate logistic regression analysis was used, with adjustment for background factors. A significant excess risk for sickness absence was found only in terms of short sick leave spells in the three open-plan offices. In the gender separate analysis, this remained for women, whereas men had a significantly increased risk in flex-offices. For long sick leave spells, a significantly higher risk was found among women in large open-plan offices and for total number of sick days among men in flex-offices. Practitioner Summary:A prospective study of the office environment's effect on employees is motivated by the high rates of sick leaves in the workforce. The results indicate differences between office types, depending on the number of people sharing workspace and the opportunity to exert personal control as influenced by the features that define the office types. [ABSTRACT FROM PUBLISHER]

The aim was to investigate the changes in sustainable working life over 10-13 years of follow-up and the effect of baseline night work. Data from the Swedish national registers were used to define sustainable working life. Survey data in the 1998-2003 "SALT" with 34,680 twins or in the 2004-2006 "STAGE" with 19,637 twins were utilized to assess night work at baseline. Group-based trajectory and multinomial regression models were applied. The results of the SALT cohort yielded five trajectory solutions: stable sustainable working life (40%), stable lack of sustainable working life (25%), later decreasingly sustainable working life (15%), increasingly sustainable working life (14%), and early decreasingly sustainable working life (7%). In the STAGE cohort, four trajectories were detected: stable sustainable working life (83%), decreasingly sustainable working life (7%), stable lack of sustainable working life (5%), and increasing sustainable working life (5%). Night work was associated with the decreasing or increasing sustainable working life in the trajectory groups. To conclude, the largest parts of both cohorts followed trajectories of stable sustainable working lives. Night work was associated with both the trajectories of decreasing and increasing sustainable working lives.

The article evaluates the Prediction of Falls in Rehabilitation Settings Tool (Predict FIRST) and motor function that can be used to predict falls. During the first six weeks after stroke, 21 percent of the patients fell at least once. It also concludes that even though Predict FIRST is capable of predicting falls among people with recent onset of stroke, there is some underestimation of risk of falling.

Aims and objectives. To explore the development over time of beliefs about health, illness and health care in migrant women with gestational diabetes mellitus born in the Middle East and living in Sweden and to study the influence on self-care and care seeking. Background. With today's extensive global migration, contact with the new society/health care confronts the migrant's culture of origin with the culture of the host country. The question is whether immigrants' patterns of beliefs about health, illness and health-related behaviour change over time, as no previous studies have been found on this topic. Design. A qualitative prospective exploratory study. Methods. Semi-structured interviews, with 14 women (28-44 years), on three occasions: during pregnancy in gestational weeks 34-38 and three and 14 months after delivery. Results. There was a U-shaped development of beliefs, from focusing on worries about the baby's health during pregnancy and trying to comply with advice from health professionals, particularly a healthy diet, through regression to dietary habits (more sugar, less fibre) and lifestyle held before being diagnosed with gestational diabetes mellitus three months after delivery, back to a healthy diet/lifestyle and worries 14 months after delivery but then focusing on their own risk, as mothers, of developing type 2 diabetes and being unable to care for the child. Over time, the number of persons perceiving gestational diabetes mellitus as a transient condition decreased. Respondents lacked information about gestational diabetes mellitus, diet and follow-ups. Conclusion. Beliefs changed over time and influenced health-related behaviour. Beliefs about the seriousness of gestational diabetes mellitus among healthcare staff/care organisation influence the development of patients' beliefs and need to be considered in planning care. Relevance to clinical practice. Pregnancy should be used as an opportunity to provide complete information about gestational diabetes mellitus and future health risks. This should continue after delivery and wishes for regular follow-ups should be met. [ABSTRACT FROM AUTHOR]

Lundin A, Lundberg I, Allebeck P, Hemmingsson T. Psychiatric diagnosis in late adolescence and long-term risk of suicide and suicide attempt. Objective: To investigate the associations between psychiatric diagnosis in late adolescence in an unselected population and subsequent suicide attempt and suicide during 36-year follow-up. Method: A total of 49 321 Swedish men conscripted for compulsory military training in 1969/1970, born 1949-1951, were screened for psychiatric disorder and, if detected, diagnosed by a psychiatrist according to ICD-8. Data on suicides and suicide attempts 1971-2006 were collected in national registers. Results: At conscription examination, 11.7% of the cohort received a psychiatric diagnosis. Among those, increased risks of suicide 1971-2006 [HR = 2.7 (2.2-3.2), 624 cases] and suicide attempt 1973-2006 [HR = 3.5 (3.1-4.0), 1170 cases] were found. The increased relative risks persisted during the follow-up period 19-36 years after examination [1989-2006 suicide HR = 2.1 (1.6-2.7), 308 cases, and 1989-2006 suicide attempt HR = 2.6 (2.1-3.1), 484 cases]. The dominant diagnostic groups, neurosis and personality disorder, were significantly associated with suicide and suicide attempt in the early as well as the late follow-up period. Conclusion: Psychiatric diagnoses made in late adolescence predicted subsequent suicide and suicide attempt over a 36-year follow-up period. The increased relative risks were not limited to young adulthood but were also evident 18-36 years after conscription examination. [ABSTRACT FROM AUTHOR]

The article offers information on the study conducted by researchers including Francisco B. Ortega, Idoia Labayen, and Jonatan R. Ruiz on the benefit of maintaining physical fitness in early stages of life to avoid the risk of becoming overweight later. The study aimed at determining possible factors in childhood that can cause obesity during teenage. A survey conducted by European Association for the Study of Obesity revealed that most of the overweight children belong to European Union countries.

Enlarged subcutaneous abdominal adipocytes have been shown to predict incidence of type 2 diabetes (T2D) in the Pima population of Arizona (USA). We investigated the role of subcutaneous abdominal adipocyte size (AAS), as well as femoral adipocyte size (FAS), as predictors of T2D in a population-based Swedish cohort. In 1974-1975, a sample of 1302 middle-aged women underwent a health examination, including anthropometry and evaluation of parental medical history. In addition, body composition (total body potassium and total body water), AAS and FAS (adipose tissue needle biopsy) were assessed in a sub-sample of 245 women. Incidence of T2D was followed until 2001, with 36 cases eligible for inclusion in this analysis. Women developing T2D had larger AAS at baseline vs, women remaining healthy (age/heredity-adjusted hazard ratio for increase of AAS by 1 SD [AAS-HR] 1.91; P<0.001). Further adjustment for both body fat percentage and waist-to-height ratio (WHtR) indicated a robust association. For FAS, the corresponding associations were consistently weaker. WHtR retained a strong predictive association independent of AAS and FAS (WHtR-HR 2.6 and 2.7, respectively; P<0.001). To conclude, in addition to the amount and distribution of body fat in women, subcutaneous adipocyte size, particularly in the abdominal region, predicts incidence of T2D in later life. [ABSTRACT FROM AUTHOR]

To examine the fatty acid composition of erythrocyte membranes, in relation to obesity indexes and breast cancer risk. A nested case­control study. The Malmö Diet Cancer cohort, Sweden. Among women 50 y or older at baseline (n=12 803), incident breast cancer cases (n=237) were matched to controls (n=673) on age and screening date. DFA and EFA from fish and milk, and DFA and EFA linoleic acid, show significant positive associations. Relations are negative between indexes of obesity and ‘milk’ EFA, but positive between indexes of obesity and indexes of delta9- and delta6- desaturase enzyme activity. No significant relations were observed between EFA and breast cancer risk. Similar to other studies, dietary fish and milk fatty acids, and linoleic acid, are related to the corresponding EFA. Breast cancer risk was not significantly related to EFA in this study. However, the findings suggest positive relations between body mass index, body fat per cent and indexes of desaturase activity, and negative relations between central obesity and milk EFA. The Swedish Cancer Society, the Swedish Medical Research Council, the European Commission, the Swedish Dairy Association and the City of Malmö. [ABSTRACT FROM AUTHOR]

The Swedish male senior national football team was followed prospectively between 1991 and 1997. During these 6 years, the team played 73 official matches and had three training camps. The senior author (J. E.) attended 57 of these matches and the three training camps and these matches and training camps, are included in the present study. Exposure to football was recorded individually for each player. The team physician examined all injuries. Total exposure was 7245 h (6235 training and 1010 match hours) and there were 71 injuries (40 training and 31 match injuries). Five (16%) of the match injuries were major, with more than 4 weeks of absence from football. The injury incidence during training was 6.5/1000 h and the injury risk during matchplay was 30.3/1000 h. A significantly higher injury incidence was found for matches lost compared to matches won or drawn (52.5 vs. 22.7/1000 h, P=0.026). No statistically significant difference for injury was found between competitive matches and friendly matches. No difference was found between home and away matches or matches on neutral ground. The risk for injury when playing in a national team compares with previously reported figures for professional football at a high level. [ABSTRACT FROM AUTHOR]

The long-term development of injury risk in Swedish male elite football was studied. Two prospective cohort studies from seasons 1982 and 2001 were compared with respect to exposure to football, injury incidence and injury severity. The mean number of training sessions during the season had increased by 68% between 1982 and 2001 (142 vs. 238, P<0.001), whereas teams played more matches in 1982 (49 vs. 41, P=0.02). The total exposure to football had increased by 27%. Three out of four players incurred an injury in both seasons. In 2001, players suffered more training injuries due to an increased training exposure. Accounting for risk exposure, there was no difference in injury incidence or severity between the two seasons. The incidence was 8.3 injuries/ 1000 h of total exposure (4.6 in training and 20.6 in matches) in 1982, compared to 7.8 1000 h−1 (5.2 in training and 25.9 in matches) in 2001. Major injuries accounted for 9% of all injuries, corresponding to an incidence of 0.8 /1000 h of football, in both seasons. A trend from semi-professionalism to full professionalism in Swedish elite football was seen during the last two decades. The injury risk did not change over the same period. [ABSTRACT FROM AUTHOR]

A representative sample comprising 1418 women from five age strata was examined by means of panoramic radiography. The prevalence of impacted teeth and the frequency and type of pathology associated with the impacted teeth were assessed. About 8% of the total sample had one or more impacted teeth. Among those, pathological conditions were found in 16%. Most were moderate and consisted in most cases of a slightly widened follicle or resorption of the crown. A new examination 12 yr later revealed unchanged conditions in 85% of the cases. The changes that had occurred were generally small. [ABSTRACT FROM AUTHOR]

Dietary intake as initially estimated by means of a 24-h recall has been related to the incidence of ischemic heart disease, stroke, and overall mortality during a 12-yr follow-up period in a prospective study of 1462 women representative of the general population. Energy intake was inversely correlated to the 12-yr incidence of myocardial infarction. The correlation was independent of age, indices of obesity, smoking habits, serum cholesterol, serum triglycerides, diabetes, systolic blood pressure, and physical activity. No correlation was found between dietary intake and incidence of stroke or overall mortality, nor was any correlation found between end-points and intake of fish, energy percentage of fat, protein, and carbohydrates. These observations suggest that suboptimal intake of nutrients may be an important factor in the pathogenesis of ischemic heart disease. [ABSTRACT FROM AUTHOR]

Background: The development of obesity is most likely due to a combination of biological and environmental factors some of which might still be unidentified. We used a machine learning technique to examine the relative importance of more than 100 clinical variables as predictors for BMI., Methods: BASUN is a prospective non-randomized cohort study of 971 individuals that received medical or surgical treatment (treatment choice was based on patient's preferences and clinical criteria, not randomization) for obesity in the Västra Götaland county in Sweden between 2015 and 2017 with planned follow-up for 10 years. This study includes demographic data, BMI, blood tests, and questionnaires before obesity treatment that cover three main areas: gastrointestinal symptoms and eating habits, physical activity and quality of life, and psychological health. We used random forest, with conditional variable importance, to study the relative importance of roughly 100 predictors of BMI, covering 15 domains. We quantified the predictive value of each individual predictor, as well as each domain., Results: The participants received medical (n = 382) or surgical treatment for obesity (Roux-en-Y gastric bypass, n = 388; sleeve gastrectomy, n = 201). There were minor differences between these groups before treatment with regard to anthropometrics, laboratory measures and results from questionnaires. The 10 individual variables with the strongest predictive value, in order of decreasing strength, were country of birth, marital status, sex, calcium levels, age, levels of TSH and HbA1c, AUDIT score, BE tendencies according to QEWPR, and TG levels. The strongest domains predicting BMI were: Socioeconomic status, Demographics, Biomarkers (notably TSH), Lifestyle/habits, Biomarkers for cardiovascular disease and diabetes, and Potential anxiety and depression., Conclusions: Lifestyle, habits, age, sex and socioeconomic status are some of the strongest predictors for BMI levels. Potential anxiety and / or depression and other characteristics captured using questionnaires have strong predictive value. These results confirm previously suggested associations and advocate prospective studies to examine the value of better characterization of patients eligible for obesity treatment, and consequently to evaluate the treatment effects in groups of patients., Trial Registration: March 03, 2015; NCT03152617 ., (© 2021. The Author(s).)

Objective: Smoking is a strong risk factor for the development of abdominal aortic aneurysm (AAA). It was hypothesised that a Mediterranean diet via its anti-oxidative properties would decrease the risk of AAA, particularly among smokers., Methods: The study population included the Cohort of Swedish Men (45 072 men) and the Swedish Mammography Cohort (36 632 women), aged 45 - 83 years at baseline. A modified Mediterranean Diet (mMED) score, including eight food groups, was calculated based on a food frequency questionnaire. Cox proportional hazard models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs)., Results: During 17.5 years of follow up (1 427 841 person-years), 1 781 AAA cases (1 496 in men, 285 in women; 1 497 non-ruptured, 284 ruptured) were ascertained via Swedish registers. The mMED score was inversely associated with AAA incidence in men (per each one point increment in mMED score HR 0.96, 95% CI 0.93 - 1.00) and in women (HR 0.83, 95% CI 0.77 - 0.90), for non-ruptured (HR 0.95, 95% CI 0.92 - 0.99; in men with infrarenal aortic diameter ≥ 30 mm HR 0.90, 95% CI 0.81 - 1.00) and for ruptured AAA (HR 0.81, 95% CI 0.70 - 0.93). In current and ex-smokers with low (< 20) and moderate (20 - 39.9) pack-years of smoking, a statistically significant inverse association was observed. HRs for each one point increment in the mMED score in current smokers were 0.83 (95% CI 0.75 - 0.91) and 0.90 (95% CI 0.84 - 0.97), respectively; in ex-smokers 0.89 (95% CI 0.81 - 0.97) and 0.93 (95% CI 0.85 - 1.01), respectively. No association was observed among current or ex-smokers with ≥ 40 pack-years; HRs 1.02 (95% CI 0.91 - 1.13) and 0.95 (95% CI 0.83 - 1.10), respectively., Conclusion: Adherence to the Mediterranean diet was associated with a reduced AAA risk in current and ex-smokers with low pack-years of smoking., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Aim: No previous studies have been found focusing on the long-term development of beliefs about health, illness and healthcare in migrant women with gestational diabetes mellitus (GDM). The aim of this study was to explore this and the influence on health-related behaviour (i.e. self-care and care seeking) in migrant women from the Middle East living in Sweden seven years after delivery., Background: GDM is increasing, particularly in migrant women. The risk of adverse outcomes of GDM for health can be improved by interventions reducing blood glucose and lifestyle modifications which medicalise the woman's pregnancy due to intensive follow-up and demanding self-care. The reactions might have an enduring impact on the women's long-term psychological and physical health and adoption of preventive health behaviours., Method: Qualitative exploratory study. Semi-structured follow-up interviews 7 years after delivery with women previously interviewed in gestational weeks 34-38 and 3 and 14 months after delivery. Data analysed with qualitative content analysis., Findings: Health meant freedom from illness, feeling well and living long to be able to care for the children. The present situation was described either positively, changing to a healthier lifestyle, or negatively, with worries about being affected by type 2 diabetes. Beliefs changed among the majority of women, leading to a healthier lifestyle, and they looked positively back at the time when diagnosed and their reactions to it. With few exceptions, they were confident of being aware of future health risks and felt responsible for their own and their children's health/lifestyle. None except those diagnosed with type 2 diabetes had been in contact with healthcare since the last follow-up a year after delivery. Yet, they still would like and need a healthcare model delivering more information, particularly on developing a healthy lifestyle for children, and with regular check-ups also after the first year after delivery.

Purpose: Occupational stress and obesity are both increasing in prevalence, but prospective findings relating these conditions are inconsistent. We investigated if baseline as well as prolonged exposure to high job demands and low decision latitude were associated with major weight gain (≥ 10% of baseline weight) in 3872 Swedish women and men examined three times over 20 years in the population-based Västerbotten Intervention Program., Methods: Anthropometry was measured and participants completed questionnaires on job strain, diet, and other lifestyle factors. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI), adjusting for confounders., Results: Adjusting for age, baseline low decision latitude was associated with major weight gain over 10- and 20-year OR (95% CI) 1.16 (1.00-1.33) and 1.29 (1.13-1.47), respectively (both sexes combined). After adjustment for diet quality and other confounders, the effect over 20 years remained 1.30 (1.13-1.50). Sex modified the effect of prolonged exposure to high job demands over at least 10 years (interaction p = 0.02), showing that high job demands was a risk factor of major weight gain over 20 years in women [1.54 (1.14-2.07)], but not in men [0.87 (0.63-1.19)]. Neither diet nor other lifestyle factors explained these associations., Conclusions: In conclusion, low decision latitude predicted major weight gain in women and men. In women, the results suggest an additional contribution to major weight gain from high job demands.

Aims: Literature suggests an association between loneliness and mortality for both males and females. Yet, the linkage of loneliness to mortality is not thoroughly examined, and need to be replicated with a long follow-up time. This study assessed the association between loneliness and mortality, including associations to gender, in 1363 adult swedes., Methods: This community-based prospective cohort study from the Swedish Lundby Study included 1363 individuals of whom 296 individuals (21.7%) were identified as lonely with use of semi-structured interviews in 1997. The cohort was followed until 2011 and survival analyses were used to estimate the relative risk of death., Results: Death occurred with an incidence rate of 2.63 per 100 person-years and 2.09 per 100 person-years for lonely and non-lonely individuals, respectively. In crude analysis, loneliness was associated with a significant increased mortality risk of 27% compared with non-lonely individuals [hazard ratio (HR) 1.27; 95% CI 1.01-1.60]. Unadjusted, lonely females had a significant increased risk (HR 1.76; 95% CI 1.31-2.34) and adjusted insignificant increased mortality risk of 27% (HR 1.27; 95% CI 0.92-1.74), compared with non-lonely females. Lonely males were found to have an adjusted significant decreased risk of mortality (HR 0.50; 95% CI 0.32-0.80), compared with non-lonely males., Conclusions: Findings suggest an association between loneliness and increased risk of mortality and that gender differences may exist, which have not been previously reported. If replicated, our results indicate that loneliness may have differential physical implications in some subgroups. Future studies are needed to further investigate the influence of gender on the relationship.

Background: The associations between an anti-inflammatory diet and both all-cause and cause-specific mortality have been studied previously; however, the influence of an anti-inflammatory diet on survival time has not been investigated. Moreover, the potential modification of these associations by smoking status remains unclear., Objective: The aims of this study were to examine the associations between an anti-inflammatory diet index (AIDI) and all-cause and cause-specific mortality, to determine the association between the AIDI and differences in survival time and to assess effect modification by smoking status., Methods: The study population included 68 273 Swedish men and women (aged 45-83 years) at baseline. The anti-inflammatory potential of the diet was estimated using the validated AIDI, which includes 11 potential anti-inflammatory and five potential pro-inflammatory foods. Cox proportional hazards and Laplace regression were used to estimate hazard ratios and differences in survival time., Results: During 16 years of follow-up (1 057 959 person-years), 16 088 deaths [5980 due to cardiovascular disease (CVD) and 5252 due to cancer] were recorded. Participants in the highest versus lowest quartile of the AIDI had lower risks of all-cause (18% reduction, 95% CI: 14-22%), CVD (20%, 95% CI: 14-26%) and cancer (13%, 95% CI: 5-20%) mortality. The strongest inverse associations between the highest and lowest quartiles of AIDI and risk of mortality were observed in current smokers: 31%, 36% and 22% lower risks of all-cause, CVD and cancer mortality, respectively. The difference in survival time between current smokers in the lowest AIDI quartile and never smokers in the highest quartile was 4.6 years., Conclusion: Adherence to a diet with high anti-inflammatory potential may reduce all-cause, CVD and cancer mortality and prolong survival time especially amongst smokers., (© 2018 The Association for the Publication of the Journal of Internal Medicine.)

Background: Previous research suggests that sleep problems may be an important predictor for chronic widespread pain (CWP). With this study we investigated both sleep problems and fatigue as predictors for the onset of CWP over a 5-year and an 18-year perspective in a population free from CWP at baseline., Methods: To get a more stable classification of CWP, we used a wash-out period, including only individuals who had not reported CWP at baseline (1998) and three years prior baseline (1995). In all, data from 1249 individuals entered the analyses for the 5-year follow-up and 791 entered for the 18-year follow-up. Difficulties initiating sleep, maintaining sleep, early morning awakening, non-restorative sleep and fatigue were investigated as predictors separately and simultaneously in binary logistic regression analyses., Results: The results showed that problems with initiating sleep, maintaining sleep, early awakening and non-restorative sleep predicted the onset of CWP over a 5-year (OR 1.85 to OR 2.27) and 18-year (OR 1.54 to OR 2.25) perspective irrespective of mental health (assessed by SF-36) at baseline. Also fatigue predicted the onset of CWP over the two-time perspectives (OR 3.70 and OR 2.36 respectively) when adjusting for mental health. Overall the effect of the sleep problems and fatigue on new onset CWP (over a 5-year perspective) was somewhat attenuated when adjusting for pain at baseline but remained significant for problems with early awakening, non-restorative sleep and fatigue. Problems with maintaining sleep predicted CWP 18 years later irrespective of mental health and number of pain regions (OR 1.72). Reporting simultaneous problems with all four aspects of sleep was associated with the onset of CWP over a five-year and 18-yearperspective, irrespective of age, gender, socio economy, mental health and pain at baseline. Sleep problems and fatigue predicted the onset of CWP five years later irrespective of each other., Conclusion: Sleep problems and fatigue were both important predictors for the onset of CWP over a five-year perspective. Sleep problems was a stronger predictor in a longer time-perspective. The results highlight the importance of the assessment of sleep quality and fatigue in the clinic.

Background: Aortic valve stenosis (AS) is the most common indication for cardiac valve surgery; untreated AS is linked to high mortality. The etiological background of AS is unknown. Previous human studies were typically based on case-control studies. Biomarkers identified in prospective studies could lead to novel mechanistic insights., Methods: Within a large population survey with blood samples obtained at baseline, 334 patients were identified who later underwent surgery for AS (median age [interquartile range], 59.9 [10.4] years at survey and 68.3 [12.7] at surgery; 48% female). For each case, 2 matched referents were allocated. Plasma was analyzed with the multiplex proximity extension assay for screening of 92 cardiovascular candidate proteins. Conditional logistic regression models were used to assess associations between each protein and AS, with correction for multiple testing. A separate set of 106 additional cases with 212 matched referents was used in a validation study., Results: Six proteins (growth differentiation factor 15, galectin-4, von Willebrand factor, interleukin 17 receptor A, transferrin receptor protein 1, and proprotein convertase subtilisin/kexin type 9) were associated with case status in the discovery cohort; odds ratios ranged from 1.25 to 1.37 per SD increase in the protein signal. Adjusting the multivariable models for classical cardiovascular risk factors at baseline yielded similar results. Subanalyses of case-referent triplets (n=133) who showed no visible coronary artery disease at the time of surgery in the index person supported associations between AS and growth differentiation factor 15 (odds ratio, 1.40; 95% confidence interval, 1.10-1.78) and galectin-4 (odds ratio, 1.27; 95% confidence interval, 1.02-1.59), but these associations were attenuated after excluding individuals who donated blood samples within 5 years before surgery. In triplets (n=201), which included index individuals with concurrent coronary artery disease at the time of surgery, all 6 proteins were robustly associated with case status in all sensitivity analyses. In the validation study, the association of all but 1 (interleukin 17 receptor A) of these proteins were replicated in patients with AS with concurrent coronary artery disease but not in patients with AS without coronary artery disease., Conclusions: We provide evidence that 5 proteins were altered years before AS surgery and that the associations seem to be driven by concurrent atherosclerotic disease.

Aims/hypothesis: Excessive weight is a risk factor for type 2 diabetes, but its role in the promotion of autoimmune diabetes is not clear. We investigated the risk of latent autoimmune diabetes in adults (LADA) in relation to overweight/obesity in two large population-based studies., Methods: Analyses were based on incident cases of LADA (n = 425) and type 2 diabetes (n = 1420), and 1704 randomly selected control participants from a Swedish case-control study and prospective data from the Norwegian HUNT Study including 147 people with LADA and 1,012,957 person-years of follow-up (1984-2008). We present adjusted ORs and HRs with 95% CI., Results: In the Swedish data, obesity was associated with an increased risk of LADA (OR 2.93, 95% CI 2.17, 3.97), which was even stronger for type 2 diabetes (OR 18.88, 95% CI 14.29, 24.94). The association was stronger in LADA with low GAD antibody (GADA;

Background: Gestational diabetes (GDM) is associated with health risks for both mother and child, and is particularly relevant to migrant women and women of African origin. With today's extensive global migration, contact with the new society and health system confronts the migrant's culture of origin with the culture of the host country. The question is whether immigrants' patterns of beliefs about health, illness, and health-related behaviour change over time, as no previous studies have been found on this topic. The purpose was to explore development over time, during and after pregnancy, of beliefs about health, illness and healthcare in migrant women with GDM born in Africa living in Sweden, and study the influence on self-care and care seeking., Methods: Qualitative prospective study. Semi-structured interviews, with 9 women (23-40 years), on three different occasions: during pregnancy (gestational weeks 34-38), and 3 and 14 months after delivery managed at an in-hospital diabetes specialist clinic in Sweden., Results: Beliefs were rather stable over time and mainly related to individual and social factors. GDM was perceived as a transient condition as health professionals had informed about it, which made them calm. None, except one, expressed worries about relapse and the health of the baby. Instead women worried about being unable to live an ordinary life and being bound to lifestyle changes, particularly diet, developing diabetes and needing insulin injections. Over time knowledge of appropriate diet improved, although no advice was experienced given by the clinic after delivery. The healthcare model was perceived as well functioning with easy access but regular follow-ups were requested as many (decreasing over time) were unsure whether they still had GDM and lacked information about GDM and diet. During pregnancy information was also requested about the healthcare system before/after delivery., Conclusions: Beliefs changed to a limited extent prospectively, indicated low risk awareness, limited knowledge of GDM, irrelevant worries about future health, and being unable to live a normal life, associated with problematic lifestyle changes. Beliefs about the seriousness of GDM in health professionals influenced patients' beliefs and health-related behaviour. The healthcare organisation urgently needs to be improved to deliver appropriate and timely information through competent staff.

Background: Students' motivation and ways of engaging in their schoolwork are important for their performance, including passing exams. Attendance at learning activities has also been argued to be of major importance, although no causal relationship with passing exams has been established in nursing education., Objectives: The aim of this study was to describe the impact of attendance at nonmandatory learning activities on attainment, in terms of passing or failing of exams, in nursing education courses including both mandatory and non-mandatory activities., Design: A prospective quantitative design., Setting: The nursing education programme at a Swedish university., Participants: Nursing students (n=361) from two courses and four classes within the nursing programme., Methods: Attendance was registered at every non-mandatory teaching activity by asking the students to note their attendance on a list. Data such as sex, age, and whether the students had passed the exam were also collected for each course and each semester separately., Results: Increased participation was associated with an increasing proportion of students passing the exam. The chance of passing the exam increased by 13% for every additional learning occasion attended. Logistic regression showed an OR of 5.4 for an attendance of 100%., Conclusions: An increase in attendance gave a higher proportion of exam passes. Encouraging students to attend non-mandatory learning activities could be of value, and potentially contribute to an increased graduation rate for nursing students., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objectives: Little is known on long-term consequences of poor social relationships in adulthood. The study aimed to examine associations between social relationships at age 30 and internalising symptoms at age 42., Methods: Data was drawn from four waves of the Northern Swedish cohort (n = 1001, 94 % response rate). The outcome internalising symptoms was measured by a composite index of depressiveness and anxiety. A cumulative measure was constructed to reflect various aspects of social relationships. Multivariate ordinal logistic regressions were used, controlling for socioeconomic indicators and previous level of internalising symptoms., Results: An accumulation of poor social relationships indicators at age 30 is related to internalising symptoms at age 42 in women (OR 1.30; CI 1.11-1.52) and men (OR 1.17; CI 1.02-1.36). The associations remained significant after adjustment for covariates., Conclusions: Poor quality of social relationships at age 30 can predict internalising symptoms 12 years later in both men and women even when previous mental health as well as financial disadvantage is accounted for. More research is required to further examine pathways and mechanisms as well as suitable interventions.