Hallands sjukhus Halmstad

Aims To examine the separate associations of glycemic control and chronic kidney disease with hospitalization days over one year in patients with type 2 diabetes (T2D). Materials and methods A cross-sectional study using retrospective data on T2D patients in Region Halland, Sweden, during 2020. Data from the Region Halland database included hospitalizations, emergency visits, primary care encounters, glycemic control, estimated glomerular filtration rate (eGFR), comorbidities, pharmacotherapy and healthcare encounters. Negative binomial regression was used to assess associations with healthcare utilization. Results A total of 12,689 patients participated, with an average age of 66.0 years (67.1 years for women and 65.2 years for men, p = 0.010). Higher glycated hemoglobin (HbA1c) and elevated blood glucose levels were associated with increased hospitalization days. Relative risks (RRs) for hospitalization days were higher for HbA1c 52–70 mmol/mol (RR 1.08, 95% CI 1.01–1.15) and >70 mmol/mol (RR 1.24, 95% CI 1.12–1.37). Elevated blood glucose levels ≥7.8 mmol/L had an RR of 1.17 (95% CI 1.04–1.32), while <7.8 mmol/L had an RR of 0.85 (95% CI 0.76–0.96). Patients with an eGFR between 30 and 60 mL/min had a RR of hospitalization of 1.35 (95% CI 1.26–1.44) compared to those with an eGFR >60 mL/min. For patients with an eGFR <30 mL/min, the RR of hospitalization was 3.36 (95% CI 3.00–3.77). Conclusions Both poor glycemic control and decreased kidney function were associated with higher hospitalization rates in T2D patients. These findings emphasize the need for effective management of glycemic control and renal function to reduce the healthcare burden in this patient population.

Sömnrelaterade problem och bristande sömnhygien är vanligt bland barn och ungdomar. Ibland är problemen så stora att kontakt tas med vården. De bedömningsinstrument som finns tillgängliga för att bedöma barns sömn varierar i vilka domäner av barns sömnhälsa som täcks in. Syftet med denna studie var att beskriva bedömningsinstrument för barn och ungdomar i skolåldern som inkluderar sömnproblem relaterat till beteenden, vanor och rutiner. En systematisk litteraturöversikt i form av en umbrella review resulterade i tre stycken översiktsartiklar, varav fyra bedömningsinstrument förekom i minst två (en selektion för att skapa en överblick men ändå begränsa antalet). Av de fyra instrumenten var två översatta till svenska: Sömnvanor hos barn (eng. Children’s Sleep Habits Questionnaire (CSHQ)) och Sömn, TV och datorvanor hos barn (eng. Sleep and Lifestyle Questionnaire (SLQ)); och två fanns endast på engelska: Children’s Report of Sleep Patterns (CRSP) och Adolescent Sleep Hygien Scale (ASHS). Bedömningsinstrument för barns och ungdomars sömn är viktiga för att identifiera sömnproblem och förstå påverkningsfaktorer. Områden som lyfts särskilt i de inkluderade instrumenten är sömnvanor/livsstilsfaktorer, sömnmönster och sömnhygien. Mer forskning behövs, och översättning eller utvecklandet av nya instrument anpassade till svensk kontext ses som ytterst relevant.

ABSTRACTAimDuring the COVID‐19 pandemic, Sweden chose a more open public health approach. A general concern was that this approach would affect the population negatively. We describe the Swedish national MIS‐C cohort and risk factors for severe disease defined as admission to the intensive care unit and cardiogenic shock.MethodsNationwide population‐based cross‐sectional study. All children and adolescents from 0 to 19 years of age with MIS‐C from March 2020 to August 2022 were included. Multivariable logistic regression with ICU admission and cardiogenic shock as outcomes was used to evaluate risk factors for severe disease.ResultsA total of 338 MIS‐C cases were identified; 69 patients (20%) required intensive care and 38 patients (11%) developed cardiogenic shock. Clinical findings associated with ICU admission were cardiac involvement: OR 14.00 (6.28–34.70), airway involvement: OR 6.75 (3.23–14.80), hyperinflammation: OR 3.25 (1.34–7.97), oedema: OR 2.40 (1.07–5.44) and diarrhoea: OR 2.23 (1.07–4.80). Clinical findings associated with cardiogenic shock were hyperinflammation: OR 5.10 (2.16–12.00), airway involvement: OR 4.87 (2.12–12.00), higher age (13–19 vs. 0–5 years): OR 3.85 (1.17–15.60), obesity: OR 3.55 (1.14–10.5) and diarrhoea: OR 2.48 (1.09–5.92).ConclusionIn Swedish national MIS‐C cohort, the rate of ICU admission was low and outcome excellent. Identifying risk factors for ICU admission and cardiogenic shock may facilitate early detection of risk patients.

Abstract Introduction The use of magnetic resonance imaging (MRI) in preoperative staging of breast cancer remains arbitrary. The high sensitivity together with the somewhat lower specificity of MRI provides a unique balance between finding true extent/new lesions and overdiagnostics/overtreatment. This study aims to assess a cohort of breast cancer patients examined with preoperative MRI and estimate the potential benefits and negative effects. Method This retrospective, single center cohort study included patients examined with preoperative MRI before primary surgery for breast cancer between 2019 and 2022. Result In total, 94 patients were included. Median age was 54 years, 37.2% were premenopausal and 35.1% had invasive lobular carcinoma. The detection rate of occult contralateral breast cancer was 9.6%. Reoperation rate due to positive margins was 6.4%. Bland-Altman statistics showed higher agreement between estimated extent by MRI and postoperative histopathological extent, compared to estimation by ultrasound or mammography. MRI contributed to correct change of operation method in 18.1%, but also less favorable choice of surgery in 5.3% of patients (such as unnecessary mastectomy). The total mastectomy rate was 54.3%. Unnecessary biopsies of benign lesions after MRI were performed in 11.7% of patients. Discussion In this cohort, breast MRI had a clear impact on the surgical treatment of breast cancer, affecting choice of operation method. About a fifth of patients examined with MRI received a benefit with a better management of their breast cancer, however an equally large part received less optimal diagnostics and treatment.

BackgroundAccurate risk stratification in older adults presenting to the emergency department (ED) is essential but challenging due to atypical presentations and age-related physiological changes. While vital signs are central to triage, their predictive value for short-term mortality in this population remains unclear. This study aimed to explore the association between initial vital signs and 7-day mortality among older ED patients.MethodThis retrospective cohort study included patients aged ≥ 65 years who visited two EDs in Region Halland, Sweden, during 2018. Vital signs, systolic blood pressure (SBP), heart rate (HR), peripheral oxygen saturation (SpO₂), respiratory rate (RR), body temperature, and level of consciousness (LOC), were extracted from the regional health information system. Descriptive statistics, ROC curve analysis, and logistic regression were used to assess associations between categorized vital signs and 7-day mortality, adjusting for age, sex, and comorbidity.ResultsOf 30 327 ED visits, 25 450 patients had at least one recorded vital sign. The mean age was 78 years; 50% were female. The 7-day mortality rate was 2%. ROC analysis showed limited discriminative ability of individual vital signs (AUC range: 0.49–0.70). Low SBP, high HR, low SpO₂, and impaired LOC were statistically significantly associated with mortality. Multivariable logistic regression confirmed these associations, with SBP (≤ 80 mmHg, AOR 7.79; 95% CI 3.27–18.54), high HR (> 125 bpm, AOR 6.37; 95% CI 1.26–32.16), low SpO₂ (≤ 80%, AOR 3.64; 95% CI 1.75–7.58), and impaired LOC (GCS < 13 (AOR 9.30-18.36)) showing the strongest effects.ConclusionLow SBP, elevated HR, reduced SpO₂, and impaired LOC were independently associated with short-term mortality in older ED patients, though their individual predictive performance was modest. LOC, despite being a strong predictor, was frequently missing, underscoring challenges in routine assessment. These findings highlight the need for more comprehensive, geriatric-informed triage systems that incorporate age-related physiological changes and ensure consistent evaluation of LOC. As frailty and functional status was not available in this dataset, future studies should focus on integrated models that include these factors to improve early risk identification in emergency care for older adults.Clinical trial numberNot applicable.

Objective Becoming ill with a chronic disease during young adulthood is characterized by significant physical, psychological, and psychosocial transformations. These dynamic changes can add to the complexity of managing a newly diagnosed chronic disease. The aim of this study was to explore how young adults experienced and managed the disease and daily life during the first year after being diagnosed with a chronic inflammatory joint disease (IJD). Method A qualitative interview study based on semi-structured interviews was conducted and then interpreted using qualitative content analysis, including both manifest content and interpretations of underlying latent meaning. A total of 14 young adults (eight women and six men), ranging in age from 18 to 25 years, participated in the study within 1 year of being diagnosed with a chronic IJD. Results The analysis resulted in five categories and 12 subcategories that described the young adults’ experiences during the first year after being diagnosed with chronic IJD. The five categories were: Processing towards diagnosis, Struggling with the consequences of the disease, Finding ways to manage the new situation, Needing received support, and Accepting the situation as a process. Conclusion The young adults demonstrated a strong fighting spirit as they adapted to new circumstances and found solutions to problems related to the disease. Their fighting spirit, combined with support from their significant others and healthcare professionals, helped them in this challenging time when their lifeworld was changing.

Generative Artificial Intelligence holds promising applications in dentistry, revolutionizing various aspects of patient care, treatment planning, and education. One key application is the creation of realistic 3D models of dental structures, enabling practitioners to precisely visualize and analyze complex anatomical details-particularly for patients requiring Guided Bone Regeneration (GBR) procedures before dental implants-processes that are currently manual, time-consuming, and highly skill-dependent. This paper proposes Dental GENI as a prototype plan to automate aspects of the GBR process, allowing dentists to guide the procedure and potentially achieve more consistent quality across different clinics.

Myocardial infarction (MI) is a serious condition that increases with age. It is valuable to identify the reasons why some are affected, and possibly, why different personality traits can be associated with an increased or decreased risk for myocardial infarction. This is a cross-sectional study based on wave 7 data from the Survey of Health, Ageing and Retirement in Europe (SHARE). A total of 52,231 individuals aged 50years or older were included in the study. The Big Five personality traits constituted the main exposure variables and were analyzed separately. The value of each personality trait variable was standardized. The association between each personality trait and MI was examined by logistic regression models which were used to estimate the Odds Ratios (ORs) and 95% Confidence Intervals (CIs). A total of 6336 participants reported having a MI in this study. The odds of MI were higher in individuals with greater Neuroticism (OR: 1.15, 95% CI: 1.12-1.18). Higher Conscientiousness was associated with decreased odds of MI (OR: 0.96, 95% CI: 0.94-0.99). Higher Agreeableness was associated with lower odds of MI (OR: 0.96, 95% CI: 0.94-0.99). There were no significant associations between Openness or Extraversion and the odds of MI, respectively. Higher Neuroticism was associated with increased odds of MI. Higher Agreeableness and Conscientiousness were associated with decreased odds of MI, respectively. Our study is of interest for the prevention of MI.

Access to adequate pain treatment is a fundamental right, yet international data suggest that a considerable number of children experience acute and persistent pain. Little is known about the occurrence of both acute and persistent pain in children. The incidence of persistent postoperative pain in children is an unexplored area but international studies suggest that many children experience long-term pain after surgery, with a major impact on daily life. In 4P, Persistent Postoperative Pediatric Pain, we want to estimate the incidence of acute and persistent postoperative pediatric pain. The European Society for Paediatric Anaesthesiology has developed guidelines for perioperative pain management. We aim to examine how well these guidelines are followed and whether adherence to guidelines influences the pain experienced after surgery. 4P is a prospective observational study of children aged 1-17, planned for surgery in southern Sweden 2023-2024. After agreement from all caregivers, data concerning preoperative pain, pre-emptive analgesia, perioperative management and postoperative pain will be collected. Via an electronic management software, pain will be evaluated at home (or in hospital) at 24h, 3, 6 and 12 months after surgery. We will include 1000 patients. 4P will prospectively follow a large number of children after general pediatric surgeries and evaluate the occurrence of postoperative pain, both acute (APOP) and persistent (PPOP). The study will assess pain treatment regimens and identify risk factors associated with the development of acute and persistent pediatric postoperative pain. Prospectively posted at ClinicalTrials.gov, identifier NCT06035042.