Industrial Development Center (Sweden)

Immunoglobulin G subclass deficiencies (IgGSD) are associated with recurrent respiratory tract infections. Tools to identify patients with IgGSD who benefit from immunoglobulin G replacement therapy (IgGRT) are lacking. This crossover study evaluated the number of antibiotic-demanding infections on and after up to 18 mo off IgGRT in 28 patients with IgGSD. Pneumococcal antibodies against 21 serotypes were assessed using a multiplex assay. After 12 mo on IgGRT, the frequency of infections was reduced during the following 6 mo compared with the last 6 mo without IgGRT, indicating a delayed therapeutic effect. Low levels of pneumococcal serotype-specific antibodies and lower IgG2 levels were associated with the need to restart IgGRT. In conclusion, IgGRT effectively reduces bacterial infections in IgGSD, but the benefits may take at least a year to manifest. Pneumococcal antibody profiling and IgG2 levels may help identify patients needing long-term IgGRT.

Pediatric long COVID can lead to persistent symptoms that affect the child's daily functioning and may influence family dynamics. Parents of children with chronic conditions may be at risk of experiencing challenges related to their own health, sleep, and self-esteem. Exploring the parent-child dyad may provide a deeper understanding of how long COVID impacts both individuals and their relationship. The aim of this study was to describe health, sleep quality, insomnia symptoms, and self-esteem in parents of children with long COVID, and to see how these factors are affected by the child´s disability exploring child-parent dyads and triads. This cross-sectional study, part of the interdisciplinary project POCOKIDS, included 35 parents and 26 children who completed questionnaires on long COVID symptoms, sleep quality, insomnia, and self-esteem. Parents with persistent symptoms reported poorer sleep, higher insomnia scores, and greater worry about finances, employment, social life, and their child's education than those without symptoms. Notably, parents without persistent symptoms reported lower self-esteem. Most children reported poor sleep quality, and nearly half met criteria for insomnia symptoms, with girls experiencing more sleep-related difficulties than boys. Children's self-esteem was less affected than their parents'. The findings reveal a shared psychosocial burden and underscore the need for individualized support addressing both children's and caregivers' health and emotional needs.

Creating conditions for sustainable employment is important and urgent for social care service organizations who often face challenges in the work environment and with competence supply. Based on the framework of Job Demands‐Resources theory, we investigated how organizational efforts to prioritize employee health (i.e., Psychosocial Safety Climate [PSC]) and promote conditions for quality of work (QW) relate to indicators for sustainable employment in terms of employee work engagement (WE) and organizational commitment (OC). Furthermore, we investigated if these associations in part are explained by proactive work behavior among employees (i.e., job crafting [JC]). Using a web‐based survey, self‐reports were collected from 607 municipal social care service employees. The results of regression‐based analyses (mediation analyses: PROCESS v.4.2) showed that the respective effect of PSC and QW on WE was partially mediated by JC–seeking challenges and JC–seeking resources, whereas the effect of PSC and QW on OC was found to be partially mediated by JC–seeking resources. The results contribute with insights to meet challenges in competence supply in social and elderly care services. Specifically, the results highlight that to create conditions for sustainable employment as indicated by WE and OC, organizations need to prioritize employees’ health and safety (PSC) and provide opportunities for QW and also promote precondition and possibilities for employees to engage in proactive work behavior (JC)—especially to craft and build resources at work.

Nursing staff turnover is an increasing problem for healthcare globally. In Sweden, the shortage of nurses in primary healthcare has increased significantly in recent years. This development is alarming because primary healthcare, both in Sweden and internationally, is responsible for a large part of healthcare. The aim of this study was to explore working conditions (change fatigue, leadership climate, and social support from colleagues) and characteristics of primary care nurses who are discontent with their current job, i.e., those with high turnover intentions and poor job satisfaction in Sweden. This was a cross-sectional survey of 466 registered nurses working in Swedish primary healthcare. Data were analyzed using descriptive statistics and logistic regression. The results demonstrate that 21.1% of the responding nurses are discontent with their current job and have considered quitting. Being discontent had significant associations with poor leadership climate (p < 0.001), lack of social support from colleagues (p < 0.001), change fatigue (p < 0.001), poor health (p < 0.001), and working more than 40 h per week (p=0.02). The results have implications for how healthcare organizations structure the work of nurses in primary healthcare and how they can attract and retain future staff to these workplaces.

Over the last decades, there has been much attention on air quality, especially in urban environments. A significant factor effecting the air quality in the urban environment is airborne particulate matter (PM). Long-term exposure to PM causes increased risk for heart disease, decreased lung function, exacerbation of asthma, and lung cancer. Therefore, many countries have implemented exposure limits to the concentration of ambient PM in the urban environments. The toxicity of PM is dependent on several factors such as chemical composition, shape, adsorbed materials, and particle sizes (usually divided in ultrafine, fine and coarse particles). However, the relationship between different PM properties and developing health hazards are not clear. Therefore, further studies to investigate different properties of PM may contribute to understanding the influence of PM on human health. In the present work, different novel methods to investigate sampled airborne PM and to investigate potential health effects have been used to increase the knowledge regarding street and wear particles. In study I, a sampling plan involving collecting one filter from Tapered Element Oscillating Microbalance (TEOM) monitoring stations used for Environmental monitoring each month for 20 months were developed. Particles on the filters were extracted into a suspension. TEOM particles were then studied with respect to constituents and variables that reflect their toxicity. The constituent and toxicity was found to be spatial and seasonal dependent. As a follow-up, in study II, TEOM filters from three geographical different cities were collected once a month for a year. The variation in particle mass measured with TEOM monitor, cadmium and lead contents, as well as endotoxin levels between locations and time points over the year was studied. The correlation between studied variables and biological effect was investigated. The results show that the concentration of metals and endotoxin in TEOM particles have no relationship to particle mass, while endotoxin levels coincided with pro-inflammatory response. These studies show that results from analyzing different variables on obtained particles from TEOM filters in combination with information about the ambient particle concentration, could be helpful in the evaluation of differences in the risk of breathing air at various locations. The dominant road traffic particle sources are wear particles from the road and tyre interface, and from vehicle brake pads. The particle concentrations are highest in cities with high traffic amounts and a high frequency of braking. There are a few cell studies that have investigated the toxicological and biological effect of these wear particles, but there is a lack of knowledge regarding their effect on tissue level. Furthermore, the knowledge about importance of rock materials in pavement is deficient. To mitigate these knowledge gaps, the effect of different wear particles from pavement and brake pad were tested using a model with isolated perfused rat lungs in study III. The wear particles from the pavement showed a significant decrease of tidal volume compared to unexposed controls. The largest effect were found with quartzite stone material. Wear particles from brakes instead showed a larger effect on released proinflammatory cytokines. The study shows that the toxic effect on lungs exposed to airborne particles can be investigated using repetitive measurements of tidal volume. Furthermore, the study shows that the choice of rock material in road pavements has the potential to affect the toxicity of road wear particles. This should be considered in environments where the concentrations and exposures are high. The brake particles showed a different effect than stone particles, indicating the need to differentiate wear particles from different sources in relation to health effects. In summary, the present work have investigated different aspects of airborne particles collected from streets as well as generated wear particles. These indicate different important aspects of the particles that may be of importance to better understand their health effects.

AimThe aim of this study was to explore lessons from the pandemic by registered and assistant nurses in Swedish primary health care (PHC) of potential relevance for the future operation of PHC.MethodsTwenty‐one semi‐structured interviews were conducted with registered and assistant nurses. We used a purposeful sampling strategy to achieve a diverse sample with regard to size and location of PHC centres. Data were analysed using qualitative content analysis.ResultsAnalysis yielded two categories: lessons from the pandemic pertaining to PHC personnel and patient behaviours (adaptability of the personnel; importance of hygiene and maintaining physical distance; and importance of being attentive to illness symptoms) and lessons from the pandemic related to primary healthcare work routines (effectiveness of digital job meetings; advantages of digital patient consultations; importance of keeping infectious patients separate from other patients; and the need to allow only pre‐booked patient appointments).ConclusionsThe seven sub‐categories represent seven lessons from the pandemic. The lessons generated both instrumental knowledge, which the nurses could apply in work‐related decisions, and conceptual knowledge which yielded improved understanding of problems and potential solutions for PHC.

The transmission of COVID-19 is dependent on social mixing, the basic rate of which varies with sociodemographic, cultural, and geographic factors. Alterations in social mixing and subsequent changes in transmission dynamics eventually affect hospital admissions. We employ these observations to model and predict regional hospital admissions in Sweden during the COVID-19 pandemic. We use an SEIR-model for each region in Sweden in which the social mixing is assumed to depend on mobility data from public transport utilisation and locations for mobile phone usage. The results show that the model could capture the timing of the first and beginning of the second wave of the pandemic 3 weeks in advance without any additional assumptions about seasonality. Further, we show that for two major regions of Sweden, models with public transport data outperform models using mobile phone usage. We conclude that a model based on routinely collected mobility data makes it possible to predict future hospital admissions for COVID-19 3 weeks in advance.

BackgroundAlthough figure skating attracts several hundred thousand participants worldwide, there is little knowledge about physical health and sports injuries among young skaters.ObjectiveTo describe the health status of a geographically-defined Swedish population of licensed competitive figure skaters and to examine injury determinants.DesignCross-sectional.SettingAll licensed competitive skaters in the south-eastern region of Sweden.ParticipantsIn total, 142 (36%) of 400 skaters participated, 137 (96%) of whom were girls (mean (SD) age: 12.9 (SD 3.0) years). Participating boys (n=5) were excluded from further analysis.Assessment of Risk FactorsAge, skating level, eating habits, relative energy deficiency indicators, and training habits were assessed.Main Outcome MeasurementsThe primary outcome measure was the one-year prevalence of a severe sports injury episode (time loss>21 days). The secondary outcome measure was the point prevalence of an ongoing sports injury.ResultsThe one-year prevalence of a severe sports injury episode was 31%, which in the multiple model, was associated with older age (odds ratio (OR) 1.2, 95% confidence interval (CI) 1.1–1.4; p=0.002) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p=0.014). The point prevalence of an ongoing injury episode was 19%, which was associated with older age (OR 1.4, 95% CI 1.2–1.7; p<0.001) and an increased number of skipped meals per week (OR 1.1, 95% CI 1.0–1.3; p=0.049).ConclusionsOne-third of young female Swedish competitive figure skaters had sustained a severe injury episode during the past year, and a fifth reported an ongoing episode. Older age and an increased number of skipped meals per week were associated with a sports injury episode. Further prospective studies of injury determinants among competitive figure skaters are warranted before the findings are broadly applied in intervention programs.

The incidence of cutaneous malignant melanoma (CMM) continues to increase in most countries worldwide and the majority are diagnosed with thin tumours (≤ 1 mm). The aim of the present study was to investigate the melanoma-specific survival (MSS) as well as conditional MSS (CMSS) in patients with thin CMM in Sweden. Clinical and histological parameters were obtained from the Swedish Melanoma Registry for patients diagnosed with thin CMM between 1990 and 2017. Patients were followed until the end of 2017. MSS as well as CMSS for different thickness groups were calculated using the Kaplan-Meier method and Cox regression analyses were used to calculate for survival differences between thickness groups. There were 31670 patients included for final analyses. The overall 10- and 20-year MSS for thin CMMs was 97% [95% confidence interval (CI) 97-97] and 95% (95% CI 95-96), respectively. From 0·7 mm and above, MSS decreased significantly with increasing thickness level. All thickness groups had an increased survival over time. The lowest CMSS was confirmed for men with 1·0 mm in thickness but their 10-year CMSS increased steadily over time. Women had overall better MSS as well as CMSS than men. However, the relation between MSS and CMSS was similar for both sexes. MSS was confirmed as excellent for patients with thin CMMs in Sweden. Although we could show a decreased MSS for patients with 0·7 mm thickness and above, the long-term survival and, in addition, a very favourable CMSS for those patients do not support more extended follow-up programmes than the current recommendations in Sweden.

The aim of the study was to compare how alcohol was addressed in routine healthcare practice in Sweden in 2010 and 2017, following the 2011 implementation of national drinking guidelines. Population-based cross-sectional surveys were conducted in 2010 and in 2017. Subjects were 3200 respondents in 2010 (response rate 54%) and 3000 respondents in 2017 (response rate 51%) in Sweden. Both the 2010 and 2017 surveys collected data on: socio-demographics; alcohol consumption; healthcare visits in the past 12 months and characteristics of alcohol conversations in healthcare (duration, contents, experience and effects). It was significantly more likely that respondents had a conversation about alcohol in healthcare in 2017 than in 2010 (OR = 1.49; 95% CI = 1.27-1.75; P<0.001). Conversations about alcohol in the healthcare were mostly short (<4 min), both in 2010 and 2017. The alcohol conversations in 2017 included less information about alcohol's influence on health (P = 0.002) compared with 2010. The experience of the conversation about alcohol was perceived as less dramatic in 2017 than in 2010 (P = 0.038). The results suggest that conversations about alcohol were more embedded in routine healthcare practice in Sweden in 2017 than in 2010. This development has occurred since the 2011 publication of the national guidelines. Alcohol conversations targeted also specific groups of drinkers as recommended by the guidelines. However, our study design does not allow for conclusions about the relationship between the guidelines and the changes in healthcare practice.