National Board of Health and Welfare

This study examines the impact of artificial intelligence (AI) innovation and natural resource management on Pakistan's economic growth from 1990 to 2024. The time-series econometric technique, the autoregressive distributed lag (ARDL) model, was used to analyze short- and long-term relationships among economic growth, AI innovation (proxies by patent applications), total natural resource rents, and inflation. The results show that AI innovation and natural resource rents significantly contribute to economic growth, while inflation negatively affects it. These findings highlight the importance of promoting AI-driven technological advancements and sustainable resources used to achieve long-term financial resilience. Based on the results, this study recommends policies to reward AI innovation and adopt sustainable natural resource management practices, ensuring a balanced and robust pathway for economic development.

There have been 9,700 reported rape cases in Sweden year 2022, however these cases are only about 10-20% of all sexual crimes reported to police. Specialized Sexual Assault Care Centers provide comprehensive healthcare services to survivors of sexual violence operating across six regions in Sweden. The aim of this study was to conduct a demographic survey of patients treated for sexual violence and to identify and analyze inefficiencies in the care pathways for survivors of sexual violence. This study employed a mixed-methods approach, utilizing register data collected from the Swedish Patient Register, complemented by a comprehensive literature review and in-depth interviews with key stakeholders. The findings reveal that a total of 6,735 individuals received care for sexual violence between 2020 and 2022, with the majority seeking treatment during the acute stage. Notably, young women and girls comprised the vast majority of these patients. The study highlights three key challenges: 1) an uneven geographic distribution of specialized clinics, leading to inequitable access to care, particularly for children; 2) insufficient long-term care and psychosocial support, especially for vulnerable groups; and 3) fragmented care pathways that create barriers for both patients and healthcare providers in navigating the system efficiently. Healthcare for sexual violence survivors is a vital public health priority, addressing both immediate and long-term care needs while enabling systematic prevention and support services. The conclusion of this study is that there is a need for establishing specialised clinics for sexual violence in all regions and developing policies regarding care for most vulnerable patients.Key messages• Lack of cohesive healthcare pathways creates significant gaps where patients remain unaware of available care options and healthcare providers struggle to identify appropriate referral pathways.• Strengthening public health surveillance systems requires establishing specialized clinics for survivors of sexual violence and implementing support policies across all regions in Sweden.

BackgroundThe Swedish National Patient Register (NPR) is an important source of data for epidemiological research. A review in 2010 described the validity of recorded diagnoses for inpatient care, but did not include specialised outpatient care.MethodUsing systematic searches of medical literature databases (Embase, Medline), and reports from members of the Swedish Epidemiological Association, we aimed to identify all studies validating diagnoses and procedure codes in inpatient care since 2010 and all studies validating specialised outpatient care. In addition, we summarize findings from register validation work performed by the National Board of Health and Welfare.ResultsThe literature search and personal reports generated 3990 non-duplicate original studies, of which 89 were deemed relevant. Compared to data in patient charts (reference), the median positive predictive value (PPV) for diagnostic codes in the NPR was 84% (interquartile range 72–93%), but with clear differences between types of diagnoses. The median PPV for surgical procedures was 97% (86–99%). The median sensitivity of diagnoses and procedures compared to other registers and cohorts was 73% (45–80%). The completeness of the register has improved over time. Missingness originates mainly from underreporting of procedures performed by private healthcare providers, and for certain variables, e.g. medication codes.ConclusionThe NPR has good diagnostic accuracy for most diagnoses and very good for surgical procedures. The sensitivity is lower. Longitudinal comparisons of incidence or prevalence are affected by changes in completeness. Missingness is low, although it is higher among private healthcare providers and for specific variables such as drug administration.

PurposeTo study the association between the use of drugs for hypertension or heart failure, particularly diuretics, and risk of death in COVID-19.MethodsWe conducted a cohort study, based on record linked individual-based data from national registers, of all Swedish inhabitants 50 years and older (n = 3,909,321) at the start of the first SARS-CoV-2 wave in Sweden. The association between use of angiotensin-converting enzyme inhibitors (ACEI), angiotensin II receptor blockers (ARB), thiazides, loop diuretics, aldosterone antagonists, beta blocking agents and calcium channel blockers at the index date 6 March 2020, and death in COVID-19 during 7 March to 31 July 2020, was analysed using Cox-proportional hazards regression, adjusted for a wide range of possible confounders.ResultsUse of loop diuretics was associated with higher risk [adjusted hazard ratio (HR) 1.26; 95% confidence interval (95% CI) 1.17–1.35] and thiazides with reduced risk (0.78; 0.69–0.88) of death in COVID-19. In addition, lower risk was observed for ACEI and higher risk for beta-blocking agents, although both associations were weak. For ARB, aldosterone antagonists and calcium channel blockers no significant associations were found.ConclusionIn this nationwide cohort of nearly 4 million persons 50 years and older, the use of loop diuretics was associated with increased risk of death in COVID-19 during the first SARS-CoV-2 wave in Sweden. This contrasted to the decreased risk observed for thiazides. As treatment with loop diuretics is common, particularly in the elderly, the group most affected by severe COVID-19, this finding merit further investigation.

Background: SNOMED CT is a large terminology system designed to represent all aspects of healthcare. Its current form and content result from decades of bottom-up evolution. Due to SNOMED CT’s formal descriptions, it can be considered an ontology. The Basic Formal Ontology (BFO) is a foundational ontology that proposes a small set of disjoint, hierarchically ordered classes, supported by relations and axioms. In contrast, as a typical top-down endeavor, BFO was designed as a foundational framework for domain ontologies in the natural sciences and related disciplines. Whereas it is mostly assumed that domain ontologies should be created as extensions of foundational ontologies, a post-hoc harmonization of consolidated domain ontologies in use, such as SNOMED CT, is known to be challenging. Methods: We explored the feasibility of harmonizing SNOMED CT with BFO, with a focus on the SNOMED CT Clinical Finding hierarchy. With more than 100,000 classes, it accounts for about one third of SNOMED CT’s content. In particular, we represented typical SNOMED CT finding/disorder concepts using description logics under BFO. Three representational patterns were created and the logical entailments analyzed. Results: Under a first scrutiny, the clinical intuition that diseases, disorders, signs and symptoms form a homogeneous ontological upper-level class appeared incompatible with BFO’s upper-level distinction into continuants and occurrents. The Clinical finding class seemed to be an umbrella for all kinds of entities of clinical interest, such as material entities, processes, states, dispositions, and qualities. This suggests the conclusion that Clinical finding would not be a suitable upper-level class from an BFO perspective. On closer inspection of the taxonomic links within this hierarchy and the implicit meaning derived thereof, it became clear that Clinical finding classes do not characterize the entity (e.g. a fracture, allergy, tumor, pain, hemorrhage, seizure, fever) in a literal sense but rather the condition of a patient having that fracture, allergy, pain etc. This gives sense to the current characteristic of the Clinical Finding hierarchy, in which complex classes are modeled as subclasses of their constituents. Most of these taxonomic links are inferred, as the consequence of the ‘role group’ design pattern, which is ubiquitous in SNOMED CT and has often been subject of controversy regarding its semantics. Conclusion: Our analyses resulted in the proposal of (i) equating SNOMED CT’s ‘role group’ property with the reflexive and transitive BFO relation ‘has occurrent part’; and (ii) reinterpreting Clinical Findings as Clinical Occurrents, i.e. temporally extended entities in an organism, having one or more occurrents as temporal parts that occur in continuants. This re-interpretation was corroborated by a manual analysis of classes under Clinical Finding, as well as the identification of similar modeling patterns in other ontologies. As a result, SNOMED CT does not require any content redesign to establish compatibility with BFO, apart from this re-interpretation, and a suggested re-labeling. Regarding the feasibility of harmonizing terminologies with principled foundational ontologies post-hoc, our results provide support to the assumption that this does not necessarily require major redesign efforts, but rather a careful analysis of the implicit assumptions of terminology curators and users.

The association between early childhood psychosocial problems and poorer educational outcomes is well-documented, but the extent to which this association persists is less understood. The current study assessed the correlations between first-grade psychosocial functioning and educational outcomes through eighth grade in a large longitudinal sample of Chilean students. The Pediatric Symptom Checklist-Chilean (PSC-CL) and Teacher Observation of Classroom Adaptation Re-Revised (TOCA-RR) assessed psychosocial functioning for 9736 students who were screened four times from first through eighth grade through the Skills for Life program. Adjusted linear mixed effects models assessed the association between first grade PSC-CL and TOCA-RR risk and third, sixth, and eighth grade GPA and school attendance. First-grade PSC-CL and TOCA-RR risk both significantly predicted lower third, sixth, and eighth grade GPAs; all p < .001. The relationships between first-grade psychosocial functioning and later school attendance rates were less consistent but still significant at certain time points. First-grade psychosocial risk was persistently associated with lower academic performance in a longitudinal sample of Chilean students followed through elementary and middle school. Early school-based psychosocial screening and follow-up interventions have the potential to improve students' long-term educational outcomes.

Pregnancy-related factors are important for short- and long-term health in mothers and offspring. The nationwide population-based Swedish Medical Birth Register (MBR) was established in 1973. The present study describes the content and quality of the MBR, using original MBR data, Swedish-language and international publications based on the MBR.The MBR includes around 98% of all births in Sweden. From 1982 onwards, the MBR is based on prospectively recorded information in standardized antenatal, obstetric, and neonatal records. When the mother and infant are discharged from hospital, this information is forwarded to the MBR, which is updated annually. Maternal data include information from first antenatal visit on self-reported obstetric history, infertility, diseases, medication use, cohabitation status, smoking and snuff use, self-reported height and measured weight, allowing calculation of body mass index. Birth and neonatal data include date and time of birth, mode of delivery, singleton or multiple birth, gestational age, stillbirth, birth weight, birth length, head circumference, infant sex, Apgar scores, and maternal and infant diagnoses/procedures, including neonatal care. The overall quality of the MBR is very high, owing to the semi-automated data extraction from the standardized regional electronic health records, Sweden’s universal access to antenatal care, and the possibility to compare mothers and offspring to the Total Population Register in order to identify missing records. Through the unique personal identity numbers of mothers and live-born offspring, the MBR can be linked to other health registers. The Swedish MBR contains high-quality pregnancy-related information on more than 5 million births during five decades.