Evidence regarding statin adherence among patients with hypertension in primary care is limited. We assessed statin adherence in Swedish primary care and examined associations between patient characteristics and adherence. In this retrospective register-based cohort study from a large Swedish region, data from all primary health care centres were linked to data on comorbidities, dispensed drugs, and socioeconomic factors. Patients with hypertension who initiated statin therapy in 2012-2015 were included. Adherence during two years after initiation was measured using the proportion of days covered (PDC). Explainable machine learning with XGBoost and SHAP values identified baseline characteristics associated with adherence. Associations were estimated using adjusted multilevel regression and presented as odds ratios (ORs) and median odds ratio (MOR).Among 30 497 patients (mean age 66 years; 48% women), the mean two-year PDC was 73.2%, while 60.2% achieved adequate adherence (PDC >80%). Adequate adherence differed by indication (P <0.001): 54.0% in primary prevention, 61.3% in diabetes without cardiovascular disease, and 65.5% in secondary prevention. The five most important characteristics associated with adequate adherence according to SHAP values were dispensed antithrombotic therapy (OR 1.38, 95% CI 1.26-1.50), primary health care centre (MOR 1.16, 95% CI 1.12-1.20), 10-year increase in age (OR 1.14, 95% CI 1.12-1.17), initiation with atorvastatin (OR 1.33, 95% CI 1.24-1.44), and countries of birth outside Sweden (OR range 0.73-0.78). Only 60% of patients achieved adequate statin adherence, which varied substantially by indication. Patient- and provider-level factors identified could guide targeted interventions to optimize preventive cardiovascular care.
To improve care for community-dwelling older individuals, Swedish primary care has implemented nurse-led elderly care units targeting this group. To explore how primary care nurses working in elderly care units view their role regarding medication safety and gain their perspectives on the work model. This was a qualitative focus group study with 14 strategically sampled primary care nurses working at elderly care units. Data were collected through three focus groups and two individual interviews between September 2024 and June 2025, audio-recorded and transcribed verbatim. Content analysis was applied, and the person-centred nursing framework was used to interpret the results. Triangulation and reflexivity were pursued, and an audit trail was maintained to ensure trustworthiness. Five categories emerged (1), diverse conditions for elderly care units (2), preventing and managing drug-related problems (3), bridging the gap - a vital function for medication safety (4), the comprehensive geriatric perspective, and (5) perceptions of the nurse's role. This study found that nurses in elderly care units recognize their potentially significant role in medication safety. Their comprehensive geriatric perspective enables them to impede or intervene on drug-related problems, compensate for fragmented care and resolve issues as a central coordinator. However, the absence of guidelines leads to inconsistent and inequitable care, insights important for further development of the work model.
Congenital uterine anomalies (UA) result in an increased risk for infertility and miscarriage but there are few population-based studies investigating the prevalence and associations between UA and pregnancy and perinatal outcomes. This nationwide cohort study includes 599 840 singleton births of primiparas from ≥22 gestational weeks in Sweden between 2010-2022. The risk for adverse pregnancy and perinatal outcomes was compared between women diagnosed with/or treated for UA and those without diagnoses for UA. Logistic regression was used to calculate adjusted odds ratios (aOR) with 95% confidence intervals (CI). There were 1101 (0.2%) women diagnosed with UA. Compared with no UA, UA were associated with an increased risk of preterm birth <34 weeks (aOR 9.10 CI [7.64-10.83]), breech presentation (aOR; 25.46 95% CI [22.59-28.70]), placental abruption (aOR; 5.09 95% CI [3.23-8.03]), emergency caesarean section (aOR: 2.96 [(2.60-3.3]), manual removal of placenta, (aOR:1.73 [1.29-2.33]) and infant small for gestational age (aOR; 2.60 95% CI [(2.11-3.21)]) but not with oligohydramnios, uterine rupture or chorioamnionitis. UA was associated with an increased risk of adverse perinatal and intrapartum outcomes, including, preterm birth, infant being small for gestational age, emergency caesarean section and maternal complications including bleeding and manual removal of the placenta. These findings highlight the importance of awareness of these pregnancies in clinical practice to support appropriate monitoring during pregnancy and intrapartum management. Women with congenital uterine anomalies face substantially higher risks of adverse pregnancy and birth outcomes in a nationwide Swedish cohort of primiparas. These findings add crucial knowledge to guide tailored antenatal and intrapartum care for women with known uterine anomalies.
The specific circumstances under which autism spectrum disorder could meet the legal standards severe mental disorder (SMD; the core Swedish legal concept underpinning sentencing to forensic psychiatric care) in criminal court cases are unclear. To explore which neurocognitive and contextual factors that have been emphasized in the assessment of SMD in cases of autism spectrum disorder. A randomized sample (N = 20) was derived from a data set of forensic psychiatric evaluations (FPEs) conducted between 2016 and 2018 on violent offenders with autism. Qualitative content analysis was used separately for offenders who did (n = 10) and did not (n = 10) meet the standard for SMD. A dimensional approach to autism-associated features was commonly used within SMD decision-making, including overall statements that autism was considered severe enough, or not, for SMD. Certain types of autism-associated features were more prominent in the SMD group, contributing to autism being considered more severe. Examples were very low psychosocial functioning, fixation on violence, few or rigid coping strategies, impaired central coherence/metacognition. Pronounced degree of idiosyncratic/atypical worldview, feelings of anxiety, insecurity, fear, or desperation were also emphasized in the SMD group. Degree of compulsive behavior could also be highlighted in the SMD group, particularly if it was considered associated with severe anxiety when routines were broken or certain stimulus was perceived. Emphasized characteristics in the no SMD group included antisocial traits, complex and/or vague psychopathology, substance abuse, intact reality monitoring, and the ability to integrate multiple perspectives. Degree of autism-symptomatology and global/psychosocial functional impairment were considered both in the SMD and no SMD groups' FPEs. The no SMD group was often described as not exhibiting sufficiently marked autism-functioning, a lower degree of psychiatric symptomatology in general, and a motivation for the crime which is not considered clearly related to a non-normative perception of reality due to autism. The vagueness in when autism severity was considered "sufficient" for SMD, emphasizes the importance of further in-depth studies to inform the development and implementation of standards or guidelines to support experts in their decision-making.
This meta-analysis integrates data from 182 runoff events across 15 Swedish sites representing diverse land uses and seasonal conditions to identify and prioritize metals of concern in urban areas. Using a data-driven risk assessment, we compared concentrations and environmental risks of 20 metal(loid)s against international databases and regulatory thresholds, evaluating both acute and chronic effects while accounting for bioavailability for seven metals. Event- and site-level analyses revealed large temporal and spatial variability in concentrations and risks, reflecting differences in emission sources, land-use characteristics, and seasonal hydrological and physicochemical conditions. Spatially, "Parking/Road", "Main Road/Highway", and "Mixed Urban" catchments were the most influential for metal concentrations and associated risks. Seasonally, snowmelt was characterized by higher total concentrations and associated total-based acute/chronic risk quotients, primarily associated with elevated TSS and pH during snowmelt. In contrast, stormwater showed higher dissolved concentrations and potentially resulting in greater dissolved- and bioavailable-based risks during stormwater events. These contrasting pathways highlight the need for dynamic, chemistry-dependent management strategies, while acknowledging variabilities related to sampling approaches and regulatory thresholds. Overall, Zn, Cu, Al, Fe, and Co ranked as the highest-risk metals, followed by Mn, V, Ba, and Ni. Effective mitigation, therefore, requires site- and season-specific control through combining targeted source reduction, solids management, and treatment adapted to metal speciation and runoff chemistry.
Despite reduced graft failure rates reported in randomized controlled trials comparing anterior cruciate ligament reconstruction (ACL-R) with and without lateral extra-articular tenodesis (LET), the impact of LET on postoperative patient-reported outcomes (PROs) remains poorly defined. To compare short-term PROs, as well as anterior cruciate ligament (ACL) revision rates and clinical failure rates (defined as Knee injury and Osteoarthritis Outcome Score [KOOS] Quality of Life [QoL] value <44) between patients undergoing primary ACL-R with and without concomitant LET. Cohort study; Level of evidence, 3. Data were extracted from the Swedish Knee Ligament Registry for all patients undergoing primary ACL-R between January 1, 2005, and June 25, 2025. Patients who underwent ACL-R + LET were matched to patients who underwent ACL-R without LET using 1:4 matching based on age, sex, body mass index, graft type, time from injury to reconstruction, and concomitant meniscal and cartilage injury status. The primary outcomes were KOOS values at the 1- and 2-year follow-ups.Secondary outcomes included revision ACL-R and clinical failure within 1 and 2 years. Categorical variables were compared using Fisher exact or chi-square tests, continuous variables were compared using Fisher nonparametric permutation tests, and within-group KOOS changes were compared using Wilcoxon signed-rank tests. Adjusted 1- and 2-year KOOS Symptoms comparisons for baseline differences and outcomes were interpreted relative to published minimal clinically important difference thresholds. After matching, the final cohort consisted of 870 patients: 174 in the ACL-R + LET group and 696 in the ACL-R group. There were no significant between-group differences in KOOS4 (mean of the Symptoms, Pain, Sports and Recreation, and QoL subscales) scores at the 1-year (77.7 ± 15.2 for ACL-R + LET vs 78.8 ± 14.9 for ACL-R) or 2-year (79.9 ± 16.7 for ACL-R + LET vs 80.7 ± 13.4 for ACL-) follow-up (P > .5). Both groups demonstrated significant within-group improvements in KOOS4 scores from baseline through the 2-year follow-up (all P≤ .002). ACL revision rates at 2 years were 2.3% and 2.4% in the ACL-R + LET and ACL-R groups, respectively. Rates of clinical failure at 2 years were similar between groups (25.5% for ACL-R + LET vs 25.6% for ACL-R; P > .99). In this matched-cohort registry study, the addition of LET to primary ACL-R did not demonstrate superior short-term PROs at 1 or 2 years postsurgery.
This paper examines the historical trajectory and contemporary transformation of Euroscepticism and populism within the Swedish political landscape. Sweden became a full member of the European Union (EU) in 1995. However, while traditional parties such as the Centre Party, the Liberal Party, and the Christian Democrats continue to advocate for European integration and supranational cooperation, the emergence of populist movements has significantly altered the national discourse. The research highlights a critical shift from traditional, sovereignty-based Euroscepticism to a modern form of populism driven by neoliberal economic shifts, migration challenges, and domestic security concerns. A focal point of this analysis is the rise of the Sweden Democrats (SD), which entered parliament in 2010 and achieved a historic breakthrough in the 2022 general elections. As the second-largest party, the SD now exerts substantial influence over socio-economic and migration policies through the Tidö agreement with the governing coalition. The analysis concludes that Sweden currently faces a dualistic future. First path is characterized by a "soft" Euroscepticism focused on environmental and human rights reforms, and the second path is defined by far-right extremism that challenges the fundamental principles of the EU. The transformative impact of the SD suggests that Swedish populism is no longer a peripheral phenomenon but a central force reshaping both national identity and EU affairs. Since joining the European Union in 1995, Sweden’s relationship with the bloc has been defined by a complex tug-of-war between international cooperation and national scepticism. Swedish politics is currently split between Europhile (pro-EU) and Eurosceptic (anti-EU or critical) forces. The pro-EU Parties such as the Centre Party, Liberal Party, and Christian Democrats advocate for deeper integration, focusing on free trade, environmental standards, and collective security. However, the Eurosceptic and populist parties such as the Left Party and the Sweden Democrats (SD) have historically challenged the EU’s authority. The most significant shift in Swedish politics occurred in the 2000s with the emergence of the SD. The party entered parliament in 2010 and became the second-largest political force in 2022. Unlike traditional Euroscepticism, which was often based on sovereignty, modern Swedish populism is driven by concerns over neoliberal economics, migration, and rising crime. Today, Sweden stands at a crossroads. One path leads toward a “soft” Euroscepticism that seeks to reform the EU based on human rights and the environment. The other path, driven by far-right momentum, moves toward nationalistic policies that fundamentally challenge the EU’s founding principles. The SD’s current role as a key government supporter ensures that their transformative influence on migration and socio-economic policy will remain a central feature of Swedish and European affairs for years to come. The present country report was prepared as part of the EUPopLink COST Action ( Andreadis & Vasilopoulou, 2014) following the EUPopLink Theoretical Framework and guidelines ( Lorimer et al., 2026).
Women with premenstrual disorder (PMD) display heightened sensitivity to hormonal changes and may be at risk for psychiatric disorders during other hormonally dynamic periods such as pregnancy and postpartum. While PMD has been linked to perinatal depression, associations with the full spectrum of perinatal psychiatric disorders (PNPDs), including anxiety and psychosis, remain largely unexplored. This study aimed to investigate whether a history of PMD is associated with increased risk of a first-onset PNPD. Nationwide register-based cohort study from 2003 to 2020. Swedish national and regional population and healthcare registers. 1 052 977 women with 1 799 010 pregnancies recorded in the Swedish Medical Birth Register. Individuals with PMD prior to pregnancy were identified through clinical diagnoses or prescribed medications in Swedish healthcare registers. First-onset PNPDs diagnosed from pregnancy start to 12 months postpartum were identified through Swedish healthcare registers. PNPDs were categorised into eight subgroups: depression, anxiety, stress-related disorders, bipolar disorder, psychosis, alcohol use disorder, drug use disorder and other. Multivariable logistic regression models were used to estimate ORs and 95% CIs, adjusting for demographic and clinical covariates. Sibling analyses were also conducted to address potential familial confounding. Among the 1 052 977 women included, 13 382 women (1.3%), corresponding to 17 514 (1%) pregnancies, had a diagnosis of PMD prior to pregnancy. In the type-specific analysis, an increased likelihood was found for all subtypes of disorders, except for perinatal psychosis. The strongest associations were observed for bipolar disorder (adjusted OR 3.98, 95% CI 3.15 to 5.04), followed by perinatal depression (adjusted OR 2.74, 95% CI 2.56 to 2.94). Associations were present in both antepartum and postpartum periods and were stronger among women without psychiatric history. Sibling comparisons showed attenuated but statistically significant associations. Our findings highlight that women with a history of PMD face an increased likelihood of developing PNPDs, particularly depression and bipolar disorder, both during pregnancy and postpartum. Given frequent perinatal healthcare contact, these findings may help inform targeted risk identification and early intervention strategies.
Cutaneous T-cell lymphoma is a chronic disease with a highly heterogeneous and unpre-dictable clinical course, and the impact on psychological resilience is still unknown. The primary aim was to investigate psychological resilience in cutaneous T-cell lymphoma patients over time and to relate it to dermatology-related quality of life (QoL) metrics. Psychological investigations were evaluated in 45 patients with mycosis fungoides included in the BIO-MUSE study. Psychological resilience was assessed using the Connor-Davidson Resilience Scale (CD-RISC), and dermatology-associated QoL was assessed with the Dermatology Life Quality Index (DLQI) and numeric rating scales for itch and sleep disorders. The resilience of the mycosis fungoides patients was further compared to a Swedish general population cohort comprising more than 2,500 individuals. This study demonstrates that mycosis fungoides patients in the BIO-MUSE cohort, where 39 of 45 cases had early-stage disease, exhibit a high and stable resilience over 1 year of the disease. The CD-RISC score is higher than in a Swedish general population cohort and in a subgroup of that cohort with psoriasis or eczema. Furthermore, the DLQI was consistently low, indicating a higher QoL in the BIO-MUSE cohort than in published data for similar patient populations.
People living with dementia are more vulnerable, which increases the risk of harm during a missing episode. Although national guidelines exist for dementia care there are no specific standards for preventing, managing, or following up on missing episodes among people living with dementia in care settings. This study aimed to describe and analyse current local documents and checklists used in elderly care and home care services in Swedish municipalities, focusing on prevention and preparedness for missing episodes, and to identify key areas for improvement. A multiple document case study was conducted using materials from one county council and eight municipalities, including care homes and home care services, examining instructions, checklists, and routines for situations where a person living with dementia is at risk of going missing or has gone missing, one or several times. Findings revealed substantial gaps in all participants documents, particularly regarding the updates of the documents, lack of preventive measures except technical solutions, delays of police notification due to inadequate instructions in case of a missing incident, limited understanding of risks and of police procedures as well as insufficient collaboration, Moreover, the decision to contact the police could be delayed for several hours and, in some cases, even days. Neither the resident nor their next of kin were actively involved in any preventive activities or risk assessments. Local guidelines and checklists in Swedish elderly- and home care services demonstrated substantial deficiencies in the prevention and preparedness of missing episodes involving persons living with dementia. Fundamental elements of preparedness were also lacking, including knowledge‑based collaboration with the police. Taken together, the findings suggest that admission to elderly care with exclusive emphasis on voluntariness and freedom does not necessarily increase safety for persons living with dementia. Safety and person‑centred care should be understood as mutually reinforcing rather than competing objectives. Not applicable.
This study aimed to evaluate methylphenidate-associated body mass index (BMI) changes and treatment discontinuation across weight status groups in children and adolescents, using real-world data. We used data from the BMI Epidemiology Study (BEST) Gothenburg cohort linked to the Swedish National Prescribed Drug Register. We included children (< 18 years) initiating methylphenidate, with BMI measurements available at baseline and one year. A subgroup also had BMI measurements at two years. We analysed changes in standardized BMI (zBMI) by baseline weight status and evaluated the impact of dosing and drug discontinuation. Methylphenidate treatment was associated with significant zBMI reduction across all weight status groups in the first treatment year, with the largest decrease observed in those with obesity (-0.5 SD, p = 0.01). Higher dose increases, younger age, and female sex were associated with larger zBMI reductions. During the first year, obesity prevalence decreased from 10.4% to 5.7% (p < 0.001), while underweight increased from 6.6% to 13.1% (p < 0.001). Individuals with underweight or normal weight had higher odds of discontinuation, compared with those with overweight or obesity (OR = 1.73, p = 0.004). In the second year, zBMI and weight status remained largely stable. In conclusion, in this real-world setting, methylphenidate was associated with BMI reductions across all weight status groups during the first treatment year. The greatest reduction was seen in individuals with obesity. For those continuing treatment the second year, BMI remained stable.
Opioid use continues to cause harm and fatalities worldwide, despite ongoing preventive efforts. Early administration of the antidote naloxone can reverse potentially fatal opioid overdoses. Naloxone distribution programmes have increased survival across regions; however, additional efforts are needed to reduce opioid overdose mortality. One approach is to expand naloxone availability within communities. The feasibility trial RESPONDER (REgion Skåne Preventing Overdose deaths through Naloxone Distribution with Emergency Runners) introduces a unique smartphone alerting system with community first responders (CFRs) dispatched to suspected opioid overdoses, in addition to the dispatch of regular emergency medical services (EMS). The aim is to investigate if trained CFRs can successfully recognise and reverse overdoses caused by opioids, prior to EMS arrival. The CFRs will be equipped with nasal naloxone and introduced to a novel naloxone algorithm during a study-specific course prior to participation. The course will offer practical training in basic life support and first aid, and it will also assess competence in the low-arousal approach, as well as the legal and ethical aspects of being a CFR.Main outcomes of the trial are feasibility, acceptability and safety. The trial will be performed in the region of Skåne, Sweden, between 1 September 2025 and 31 August 2027, with every CFR followed for up to 12 months. The trial has been approved by the Swedish Ethical Review Authority (file number 2024-05887-01). Written informed consent is required from participating CFRs. This is also required of overdose survivors to allow the collection of clinical data from hospital records.Information regarding the project and recruitment will be disseminated via social media, news media, through the healthcare region's communication channels and within public transportation hubs. Outcomes and analyses will be submitted to peer-reviewed journals. NCT07079241.
Staphylococcus aureus (S. aureus) can cause life-threatening infections, with colonization often preceding infection. Understanding the determinants of S. aureus carriage may improve infection prevention. While smoking has been associated with S. aureus carriage, studies on smokeless tobacco products remain scarce. This study aimed to investigate whether the use of snuff (Swedish snus), a smokeless tobacco product, is associated with S. aureus carriage in adolescents. We used data from Fit Futures 1, a population-based cross-sectional study including 1,038 participants (93% attendance). A total of 457 boys and 443 girls had data on snuff use and two nasal and throat swab cultures for S. aureus carriage assessment. Snuff use was defined as occasional or daily use. Logistic regression analysis was used to examine the association between snuff use and S. aureus carriage, with odds ratios (ORs) adjusted for known risk factors. Snuff use was associated with a 64% higher odds of nasal carriage (95% CI = 1.18-2.26; carriage defined as one or two positive nasal cultures) compared to non-use. In sex-stratified analyses, this association was observed only among girls, with an adjusted OR of 1.62 (95% CI = 1.03-2.55; carriage defined as two positive nasal cultures) and an adjusted OR of 1.99 (95% CI = 1.25-3.16; carriage defined as one or two positive nasal cultures). Among girls using snuff, the adjusted OR for S. aureus throat carriage was 1.66 (95% CI 1.06-2.59; carriage defined as two positive throat cultures) compared to non-users. We identified an association between snuff use and S. aureus nasal and throat carriage among adolescent girls. Girls who used snuff had higher odds of S. aureus nasal (62%) and throat (66%) carriage compared to female non-users. Futures longitudinal studies are needed to clarify whether the observed associations reflect casual relationships.
Like adults, many children and adolescents spend several hours each day engaged in screen-based activities. This has raised concerns among adults, and the consequences of screen use are the subject of intense research and public debate. Despite growing research interest, there is currently a lack of evidence-based interventions available to families experiencing negative consequences related to their child's screen use. The aim of this study was to explore parents' perceptions of the consequences of their children's screen use, as well as the type of support they seek in response. Through collaboration with schools in a medium-sized Swedish city, eleven participants with children aged 12-17 were recruited. Semi-structured interviews were conducted, transcribed, and analyzed using thematic analysis. The analysis resulted in three main themes: Consequences of children's screen use, A problem for the whole society, and Need of support on family and individual level, along with a total of nine subthemes. Our conclusion is that, according to parents, screen use among children is a complex phenomenon that calls for broad and systemic responses. While consequences for the child are primarily observed at the microsystem level-affecting relationships, health, and development-parents also express expectations for change at higher societal levels. Taken together, our findings underscore the need for multi-level interventions that combine structural measures with accessible, family-oriented support strategies aimed at promoting healthy digital habits in children and adolescents.
Previous studies suggest an increased risk of new-onset type 2 diabetes (T2D) following SARS-CoV-2 infection, which may be subject to detection bias from increased health care contacts among the infected. We aimed to assess the causal effect of SARS-CoV-2 infection on new-onset T2D using a test-negative design and negative control outcomes. We included all individuals aged ≥ 18 years registered in Sweden on 1 February 2020 without prior T2D who ordered a SARS-CoV-2 test through the Swedish healthcare service between 1 February 2020 and 28 February 2022 (N = 3,175,958). A test-negative design was applied, matching infected individuals with up to five controls based on birth year, sex, region, vaccination status, and test date. Cox proportional hazards models estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association between infection and new-onset T2D. The influence of COVID-19 severity was assessed using stratified Cox regression. Negative control outcomes anaemia, chronic kidney disease, and thyroid disorder were used to evaluate detection bias. SARS-CoV-2 infection was associated with a 12% (HR 1.12, 95% CI 1.04-1.20) increase in T2D risk, driven by elevated incidence during weeks 1-4 post-infection. Increased risk was concentrated among individuals hospitalized (HR 3.60, 95% CI 2.71-4.78) or admitted to intensive care (HR 4.85, 95% CI 2.60-9.05). Negative control outcomes showed similar patterns. Our findings do not support a causal effect of SARS-CoV-2 infection on new-onset T2D. Instead, observed increases appear largely attributable to increased detection of early-phase, sub-clinical T2D cases during hospitalization or intensive care.
The impact of current pet exposure on children with allergic asthma is not yet fully understood. This study aimed to investigate the association between cat exposure and asthma outcomes in children with established asthma and allergy. A population-based cohort study using Swedish national health, sociodemographic, and quality registers was conducted. We included 30 277 children aged 4-17 years (born 2006-2020), with validated diagnoses of asthma and allergy, who had asthma care during the two years preceding exposure assessment. Cat exposure was defined as parental cat ownership recorded in the National Cat Register in 2023. Asthma outcomes, assessed during 2023-2024, included: asthma exacerbation and moderate-to-severe asthma. In a subset with available data (n = 1428), Forced Expiratory Volume in 1 Second (FEV1) and asthma control test (ACT) were evaluated. Odds ratios (ORs) were adjusted for sex, age, initial asthma severity, baseline airway allergy severity, parental asthma and allergy, population density, parental birth country, and socioeconomic status. Of the study population (median age: 9.5 years, 39% females), 9.4% (n = 2,862) had cat exposure. Initial asthma severity was comparable between the cat-exposed and non-exposed groups (19.5% vs. 20.6% with moderate-to-severe asthma). Asthma exacerbation occurred in 3.3% of the cat-exposed group vs. 3.5% of the non-exposed group (adjusted OR: 1.12, 95% CI: 0.90-1.39). Moderate-to-severe asthma was observed in 9.6% vs. 10.1% (adjusted OR: 0.96, 0.84-1.10). No significant differences were found in ACT or FEV₁ z-scores. Within the cat-exposed group, no association between the number of cats, cat sex, or age and asthma outcomes was observed. In this cohort of children with asthma and allergy, no association between cat exposure and asthma exacerbations, severity, lung function, or asthma control was observed. These findings suggest that cat exposure may not adversely affect asthma outcomes in this population.
Heart failure with preserved ejection fraction (HFpEF) is closely linked to aging and cardiometabolic risk factors and frequently coexists with obstructive sleep apnea (OSA). We aimed to investigate the prevalence and clinical correlates of an HFpEF-like phenotype in a revascularized coronary artery disease (CAD cohort), focusing on OSA and its severity. A total of 435 patients with preserved left ventricular ejection fraction from the RICCADSA cohort were included. OSA was defined as apnea-hypopnea index (AHI) ≥ 15 events/h. HFpEF-like phenotype was defined by ≥ 2 of the following: elevated filling pressures (E/e' ≥ 15), left atrial enlargement, increased left ventricular mass index, elevated pulmonary artery systolic pressure (≥ 35 mmHg), and elevated NT-proBNP (≥ 125 pg/mL). Multivariable logistic regression analyses included age, sex, obesity, hypertension, diabetes, and OSA status. Additional models evaluated AHI and oxygen desaturation index (ODI) as continuous variables and assessed the impact of excluding body mass index (BMI). Mean age was 63.6 ± 8.6 years and BMI 28.1 ± 4.1 kg/m2; 69.9% met HFpEF-like criteria. Age and obesity were independently associated with HFpEF-like phenotype, whereas categorical OSA was not. AHI and ODI were not independently associated after adjustment; however, in models excluding BMI, both AHI (OR 1.019, 95% CI 1.005-1.033) and ODI (OR 1.030, 95% CI 1.010-1.050) were significant predictors. HFpEF-like phenotype is highly prevalent in CAD and primarily associated with aging and adiposity. The relationship between OSA severity and cardiac remodeling appears dependent on obesity, underscoring the interplay between cardiometabolic and sleep-related factors. The RICCADSA trial is registered at ClinicalTrials.gov (NCT00519597) and in the Swedish national research registry (FoU i Sverige-Research and Development in Sweden; registration no. VGSKAS-4731; April 29, 2005).
Central venous catheters (CVCs) are essential in modern healthcare. Insertion of a CVC promotes a hypercoagulable environment, in part through activation of the intrinsic coagulation pathway. We have previously shown that blood obtained from newly inserted CVCs demonstrates immediate coagulation activation, with differences between samples collected directly after insertion and after flushing of the catheter. The aim of this randomised trial is to compare early coagulation activation between four commonly used CVCs and to assess whether the different CVCs demonstrate different degrees of coagulation activation. This is a single-centre, randomised, parallel-group trial where adult patients (≥18 years) with a clinical indication for a two-lumen CVC will be eligible for inclusion. Participants will be randomised in a 1:1:1:1 ratio to receive one of four commercially available CVCs. The calculated sample size is 88 participants. Two blood samples will be obtained from each newly inserted CVC, the first obtained from the initial backflow of blood within seconds after insertion and the second after flush and discard. Samples will be analysed using rotational thromboelastometry with the non-activated thromboelastometry (ROTEM NATEM) and plasma-based coagulation assays. The primary outcome is the between-group comparison of the change in ROTEM NATEM clotting time between the two samples. Secondary outcomes include within-group and overall cohort comparisons of changes in clotting time. Additional secondary outcomes are between-group, within-group and overall cohort comparisons of changes in other ROTEM NATEM parameters, including clot formation time, alpha angle and maximum clot firmness, and changes in plasma-based coagulation markers, including prothrombin time-international normalised ratio, activated partial thromboplastin time, Factor VII, Factor XII and thrombin-antithrombin complex concentration. The results may help identify catheter materials that are less prone to activate coagulation and support in the selection and development of CVCs. This study has been approved by the Swedish Ethical Review Authority (#2022-00265-0). Written informed consent will be obtained from all participants before inclusion. The results will be published in a peer-reviewed journal and presented at scientific meetings. NCT07014722.
This perspective report examines temporal trends in concussion rates in relation to changes in permitted physical contact in the Swedish Women's Hockey League (SDHL). Over three seasons, the league gradually allowed more physical play, culminating in the current permission of body checking from the 2022/2023 season. Contrary to traditional assumptions, reported concussion rates declined during a period of progressively increased permitted physical contact. However, these observational findings should be interpreted with caution, as multiple contextual factors may have influenced the results. Also, the results do not establish a causal relationship between body checking policy and concussion incidence and rather than supporting immediate policy change, the findings highlight the need for continued monitoring and further research into how rules, education, and player behavior interact to influence concussion risk.