Zeitschriftenartikel: „Skåne county“

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Melander, Eva, Hans-Bertil Hansson, Sigvard Mölstad, Kristina Persson und Håkan Ringberg. „Limited Spread of Penicillin-Nonsusceptible Pneumococci, Skåne County, Sweden“. Emerging Infectious Diseases 10, Nr. 6 (Juni 2004): 1082–87. http://dx.doi.org/10.3201/eid1006.030488.

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Högberg, Anders. „The Voice of the Authorized Heritage Discourse: A Critical Analysis of Signs at Ancient Monuments in Skåne, Southern Sweden“. Current Swedish Archaeology 20, Nr. 1 (10.06.2021): 131–67. http://dx.doi.org/10.37718/csa.2012.12.

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The study presents an investigation of a regional authorized heritage discourse, represented by the County Administrative Board on signs set up at an- cient monuments and sites in the province of Skåne in southern Sweden. The starting point is a critical analysis of layout, texts and illustrations to ascertain the narratives conveyed by the signs. The results show that slightly less than half of the studied signs work well according to the criteria set up for the study. The result also demonstrates that more than half of the studied signs do not work well according to these cri- teria. Those that work well give detailed information about the ancient monument or site. The signs that do not work well give inadequate information and risk excluding a majority of the people who read them. The latter signs confirm what so many other discourse analyses have shown, that the authorized heritage dis- course to a large extent still privileges the perspectives of a white, middle-class male. The former signs, that is, those that are judged to work well in terms of the criteria applied in this study, show that the authorized heritage discourse does not only offer something that privileges the perspectives of that white, middle class male, but also has the ability to offer narratives with other perspectives.

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Andréll, Cecilia, Josef Dankiewicz, Lizbet Todorova, Knut Olanders und Hans Friberg. „Effects of fire-fighters as first responders in out-of-hospital cardiac arrest: A study of a selective dispatch system in Skåne County, Sweden“. Resuscitation 130 (September 2018): e133. http://dx.doi.org/10.1016/j.resuscitation.2018.07.284.

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Mohammad, Aladdin J., und Thomas Mandl. „Takayasu Arteritis in Southern Sweden“. Journal of Rheumatology 42, Nr. 5 (15.03.2015): 853–58. http://dx.doi.org/10.3899/jrheum.140843.

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Objective.To study the epidemiology and clinical characteristics of Takayasu arteritis (TA) in southern Sweden.Methods.The study area is situated in Skåne, the southernmost county in Sweden (total population December 2011: 983,419, 50.5% women). Patients were identified using clinical registries in all the 5 hospitals and private rheumatology clinics within the study area between the years 1997 and 2011. The diagnosis of TA was confirmed by medical records review. Only patients fulfilling the 1990 American College of Rheumatology classification criteria were included.Results.Thirteen patients (all women) were identified. The median age at diagnosis was 23 years [interquartile range (IQR) 16–38]. Ten patients were diagnosed between 1997 and 2011. The annual incidence rate was estimated to 0.7/million inhabitants (95% CI 0.3–1.2) and 1.5/million among women (95% CI 0.6–2.4). Patients were followed for a median of 9 years (IQR 4–17.5). As of January 1, 2012, all 13 patients were alive and living within the study area. The point prevalence per million inhabitants was 13.2 (95% CI 6.0–20.4), and 26.2 among women (95% CI 11.9–40.4). Subclavian arteries were the most commonly affected vessels. Organ damage was common, affecting all patients. Seven pregnancies resulting in 5 live births and 2 abortions were registered after the diagnosis of TA.Conclusion.The incidence of TA in Sweden is comparable to recently reported rates from other European studies, while the prevalence is higher than previously reported. The prognosis of TA is good, but the rate of damage is high.

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Saleh, Muna, Carl Turesson, Martin Englund, Peter A. Merkel und Aladdin J. Mohammad. „Visual Complications in Patients with Biopsy-proven Giant Cell Arteritis: A Population-based Study“. Journal of Rheumatology 43, Nr. 8 (01.06.2016): 1559–65. http://dx.doi.org/10.3899/jrheum.151033.

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Objective.To study the clinical and laboratory characteristics of patients with biopsy-proven giant cell arteritis (GCA) with visual complications, and to evaluate the incidence rate of visual complications in GCA compared to the background population.Methods.Data from 840 patients with GCA in the county of Skåne, Sweden, diagnosed between 1997 and 2010, were used for this analysis. Cases with visual complications were identified from a diagnosis registry and confirmed by a review of medical records. The rate of visual complications in patients with GCA was compared with an age- and sex-matched reference population.Results.There were 85 patients (10%) who developed ≥ 1 visual complication after the onset of GCA. Of the patients, 18 (21%) developed unilateral or bilateral complete visual loss. The mean age at diagnosis was 78 years (± 7.3); 69% were women. Compared with patients without visual complications, those with visual complication had lower C-reactive protein levels at diagnosis and were less likely to have headache, fever, and palpable abnormal temporal artery. The use of β-adrenergic inhibitors was associated with visual complications. The incidence of visual complications among patients with GCA was 20.9/1000 person-years of followup compared to 6.9/1000 person-years in the reference population, resulting in a rate ratio of 3.0 (95% CI 2.3–3.8).Conclusion.Ten percent of patients with GCA developed visual complications, a rate substantially higher than that of the general population. Patients with GCA who had visual complications had lower inflammatory responses and were more likely to have been treated with β-adrenergic inhibitors compared with patients without visual complications.

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Mohammad, Aladdin J., Jan-Åke Nilsson, Lennart TH Jacobsson, Peter A. Merkel und Carl Turesson. „Incidence and mortality rates of biopsy-proven giant cell arteritis in southern Sweden“. Annals of the Rheumatic Diseases 74, Nr. 6 (17.01.2014): 993–97. http://dx.doi.org/10.1136/annrheumdis-2013-204652.

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ObjectivesTo study the epidemiology and mortality in patients with biopsy-proven giant cell arteritis (GCA) in southern Sweden.MethodsThe study area was the County of Skåne. Patients with a positive temporal artery biopsy between 1997 and 2010 were identified using a regional register and a structured review of all histopathology reports. Standardised mortality ratios (SMR) were calculated using data for the Swedish population as the reference.ResultsThere were 840 patients with biopsy-proven GCA (626 women). The annual incidence rate per 100 000 inhabitants aged ≥50 years was 14.1 (95% CI 13.1 to 15.0); 7.7 (6.7 to 8.7) for men and 19.6 (18.1 to 21.1) for women, without seasonal variations. The incidence increased with age, with estimates of 2.0, 11.8, and 31.3 per 100 000 in the age groups 50–60, 61–70, 71–80 years, respectively (p<0.001). The age-standardised and sex-standardised incidence rate decreased from 15.9/100 000 in 1997–2001 to 13.3/100 000 in 2007–2010 (p=0.026). Two hundred and seventy-nine patients (207 women) died during the observation period. Mortality was significantly increased over the first 2 years after GCA diagnosis (SMR 1.52 (95% CI 1.20 to 1.85)), but not with longer follow-up. The estimated excess mortality was greater in women and in patients aged ≤70 years at diagnosis.ConclusionsIn this large population-based study of biopsy-proven GCA from southern Sweden, the incidence of GCA may have decreased over time. Short-term mortality was increased, in particular among those diagnosed at ≤70 years of age, but long-term survival was not impaired.

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Olofsson, Tor, Martin Englund, Tore Saxne, Anna Jöud, Lennart T. H. Jacobsson, Pierre Geborek, Saralynn Allaire und Ingemar F. Petersson. „Decrease in sick leave among patients with rheumatoid arthritis in the first 12 months after start of treatment with tumour necrosis factor antagonists: a population-based controlled cohort study“. Annals of the Rheumatic Diseases 69, Nr. 12 (06.08.2010): 2131–36. http://dx.doi.org/10.1136/ard.2009.127852.

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ObjectiveTo investigate the effect of tumour necrosis factor (TNF) antagonist treatment of patients with rheumatoid arthritis (RA) on sick leave (SL) and disability pension (DP) in a population-based setting in southern Sweden.MethodsAll patients with RA in the South Swedish Arthritis Treatment Group register living in the county of Skåne (population 1.2 million), who started their first treatment with a TNF antagonist between January 2004 and December 2007 and were 18–58 years at treatment start (n=365), were identified. For each patient with RA, four matched reference subjects from the general population were randomly selected. Data were linked to the Swedish Social Insurance Agency register and the point prevalence of SL and DP as well as days of SL and DP per month were calculated from 360 days before until 360 days after treatment start.ResultsAt treatment start 38.6% of the patients with RA were registered for SL. During the first 6 months this share dropped to 28.5% (decrease by 26.2%, p<0.001). This level remained stable throughout the first treatment year. Comparing patients with RA to the reference group the relative risk of being on SL was 6.6 (95% CI 5.2 to 8.5) at initiation of anti-TNF treatment and 5.2 (95% CI 4.0 to 6.8) 1 year after that. The corresponding figures for DP were 3.4 (95% CI 2.7 to 4.2) and 3.2 (95% CI 2.7 to 3.9).ConclusionsThere was a marked decline in SL during the first 6 months of TNF antagonist treatment in patients with RA in southern Sweden, maintained throughout the first year, which was not offset by a corresponding increase in DP.

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Arthursson, Victoria, Roberto Rosén, Jenny M. Norlin, Katarina Gralén, Ervin Toth, Ingvar Syk, Henrik Thorlacius und Carl-Fredrik Rönnow. „Cost comparisons of endoscopic and surgical resection of stage T1 rectal cancer“. Endoscopy International Open 09, Nr. 10 (16.09.2021): E1512—E1519. http://dx.doi.org/10.1055/a-1522-8762.

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Abstract Background and study aims Management of T1 rectal cancer is complex and includes several resection methods, making cost comparisons challenging. The aim of this study was to compare costs of endoscopic and surgical resection and to investigate hypothetical cost scenarios for the treatment of T1 rectal cancer. Patients and methods Retrospective population-based cost minimization study on prospectively collected data on T1 rectal cancer patients treated using endoscopic submucosal dissection (ESD), transanal endoscopic microsurgery (TEM), open, laparoscopic, or robotic resection, in Skåne County, Sweden (2011–2017). The hypothetical cost scenarios were based on the distribution of high-risk features of lymph node metastases in a national cohort (2009–2017). Results Eighty-five patients with T1 RC undergoing ESD (n = 16), TEM (n = 17), open (n = 35), laparoscopic (n = 9), and robotic (n = 8) resection were included. ESD had a total 1-year cost of 5165 € and was significantly (P < 0.05) less expensive compared to TEM (14871€), open (21 453 €), laparoscopic (22 488 €) and robotic resection (26 562 €). Risk factors for lymph node metastases were seen in 68 % of 779 cases of T1 rectal cancers included in the national cohort. The hypothetical scenario of performing ESD on all T1 RC had the lowest total 1-year per patient cost compared to all other alternatives. Conclusions This is the first study analyzing total 1-year costs of endoscopic and surgical methods to resect T1 rectal cancer, which showed that the cost of ESD was significantly lower compared to TEM and surgical resection. In fact, based on hypothetical cost scenarios, ESD is still justifiable from a cost perspective even when all high-risk cases are followed by surgery in accordance to guidelines.

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Blomstedt, Kristina, Helena Nilsson und Anders Johansson. „The public’s perception of prehospital emergency care in the County of Skane, southern Sweden“. International Emergency Nursing 21, Nr. 2 (April 2013): 136–42. http://dx.doi.org/10.1016/j.ienj.2012.05.004.

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Ahmad Kiadaliri, Aliasghar, Aleksandra Turkiewicz und Martin Englund. „Educational inequalities in falls mortality among older adults: population-based multiple cause of death data from Sweden“. Journal of Epidemiology and Community Health 72, Nr. 1 (03.11.2017): 68–70. http://dx.doi.org/10.1136/jech-2017-209616.

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BackgroundFalls are the leading cause of fatal injuries among elderly adults. While socioeconomic status including education is a well-documented predictor of many individual health outcomes including mortality, little is known about socioeconomic inequalities in falls mortality among adults. This study aimed to assess educational inequalities in falls mortality among older adults in Sweden using multiple cause of death data.MethodsAll residents aged 50‒75 years in the Skåne region, Sweden, during 1998‒2013 (n=566 478) were followed until death, relocation outside Skåne or end of 2014. We identified any mention of falls on death certificates (n=1047). We defined three levels of education. We used an additive hazards model and Cox regression with age as time scale adjusted for marital status and country of birth to calculate slope and relative indices of inequality (SII/RII). We also computed the population attributable fraction of lower educational attainment. Analyses were performed separately for men and women.ResultsBoth SII and RII revealed statistically significant educational inequalities in falls mortality among men in favour of high educated (SII (95% CI): 15.5 (9.8 to 21.3) per 100 000 person-years; RII: 2.19 (1.60 to 3.00)) but not among women. Among men, 34% (95% CI 19 to 46) of falls deaths were attributable to lower education.ConclusionsThere was an inverse association between education and deaths from falls among men but not women. The results suggest that individual’s education should be considered in falls reduction interventions.

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Merriam, Daniel. „Carolus Linnaeus: The Swedish Naturalist and Venerable Traveler“. Earth Sciences History 23, Nr. 1 (01.01.2004): 88–106. http://dx.doi.org/10.17704/eshi.23.1.g94rq3lg277pgmh6.

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Carolus Linnaeus (Carl von Linné) (1707-1778) lived during and helped establish the Swedish golden years of science in the early and mid Eighteenth Century (other notables of the time included Emanuel Swedenborg, Anders Celsius, Pehr Kalm, Axel Cronstedt, Daniel Tilas, Johan Wallerius, and Torbern Bergman). Although known best for his contributions to botany, he was a natural scientist of the first class and made contributions to many fields, including geology. His contributions to geology, however, are not well known. Obtaining his medical degree in Harderwijk (Holland) in 1735, he had opportunity to visit the savants of the day on the continent and in England making contacts that lasted a lifetime. But Linnaeus was a believer in having scientists see their own country first and admonished his fellow workers to learn about Sweden "… [and not to] cross the stream for water, and waste … money endeavoring to learn in a foreign country what … might have [been] acquired at home"—good advice even today. He practiced what he preached and during his lifetime made five notable resor (=journeys) in Sweden: Lappland (1732), Dalarna (1734), Öland and Gotland (1741), Västergötland (1746), and Skåne (1749). These field excursions were recorded, not in the scientific language of the day, Latin, but in Swedish and thus were not widely read outside the country. As was his custom, he recorded everything noted on the journeys. Later, through his earlier contacts via the post and his apostles (students), he kept abreast of happenings all over the globe.

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Abrahamsson, Cecilia, Ewa Carin Ekberg, Thor Henrikson, Maria Nilner, Bo Sunzel und Lars Bondemark. „TMD in Consecutive Patients Referred for Orthognathic Surgery“. Angle Orthodontist 79, Nr. 4 (01.07.2009): 621–27. http://dx.doi.org/10.2319/060408-293.1.

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Abstract Objective: To answer the question whether temporomandibular disorders (TMD) were more common in a group of individuals referred for orthognathic surgery than in a control group. The null hypothesis was that neither the frequency of signs and symptoms of TMD or diagnosed TMD would differ between the patient group and a control group. Materials and Methods: A sample of 121 consecutive patients referred for orthognathic surgery at the Department of Oral Maxillofacial Surgery, Malmö University Hospital, Sweden, was interviewed and examined regarding signs and symptoms of TMD and headaches. A control group was formed by 56 age- and gender-matched individuals attending the Department of Oral Diagnosis, Faculty of Odontology, Malmö University, Sweden, and Public Dental Health Clinic in Oxie, County of Skane, Sweden. TMD diagnoses were used according to Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Results: The patient group showed more myofascial pain without limited opening, disc displacement with reduction, and arthralgia according to RDC/TMD than the control group. The patient group also had more symptoms and signs of TMD in general. Conclusions: The null hypothesis was rejected because patients who were to be treated with orthognathic surgery had more signs and symptoms of TMD and higher frequency of diagnosed TMD compared with the matched control group.

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Waight, Tod E., Simon H. Serre, Sebastian H. Næsby und Tonny B. Thomsen. „The ongoing search for the oldest rock on the Danish island of Bornholm: new U-Pb zircon ages for a quartzrich xenolith and country rock from the Svaneke Granite“. Bulletin of the Geological Society of Denmark 65 (31.08.2017): 75–86. http://dx.doi.org/10.37570/bgsd-2017-65-06.

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Previous geochronological studies on the Danish island of Bornholm have not identified any rocks older than c. 1.46 Ga. New LA-ICP-MS U-Pb zircon ages are presented for a xenolith within, and the country rock gneiss adjacent to, the Svaneke Granite on Bornholm. The xenolith is fine-grained and quartz-rich and was likely derived from either a quartz-rich sedimentary protolith or a hydrothermally altered felsic volcanic rock. The relatively fine-grained felsic nature of the country rock gneiss and the presence of large zoned feldspars that may represent phenocrysts suggest its protolith may have been a felsic volcanic or shallow intrusive rock. A skarn-like inclusion from a nearby locality likely represents an originally carbonate sediment and is consistent with supracrustal rocks being present at least locally. Zircon data from the xenolith define an upper intercept age of 1483 ± 12 Ma (2σ, MSWD = 2.5) with a poorly defined lower intercept age of 474 ± 250 Ma, and a weighted average 207Pb/206Pb age of 1477.9 ± 4.6 Ma; both these ages are older than the host Svaneke Granite (weighted average 207Pb/206Pb age of 1465.0 ± 4.8 Ma). Zircons from the gneiss define an upper intercept age of 1477.7 ± 6.8 Ma when anchored at 0 Ma, and a weighted average 207Pb/206Pb age of 1475.4 ± 6.6 Ma which overlaps statistically with the Svaneke Granite age. These ages are currently the oldest ages determined for in situ rocks on Bornholm. Evidence for substantially older basement lithologies (e.g. 1.8 Ga as observed in southern Sweden) remains absent. The zircons display clear oscillatory zoning, have Th/U typical of magmatic zircons and in some cases preserve inherited cores, all of which suggest that the ages are robust and do not represent resetting due to incorporation within or intrusion by the Svaneke Granite. Inherited zircons are not common; they have ages (c. 1.6–1.8 Ga) that are similar to those observed in other felsic basement lithologies on Bornholm. These new results suggest that prior to intrusion of the Svaneke Granite, the upper crust on Bornholm was dominated, at least locally, by lithologies similar in composition to the currently exposed felsic basement. The protoliths to the two samples investigated here must have been buried to mid-crustal depths over a relatively short time period (c. 10 Ma) prior to intrusion of the Svaneke Granite. This suggests a dynamic tectonic environment and is consistent with evidence for broadly simultaneous magmatism and deformation in basement rocks at 1.46 Ga in southern Scandinavia and burial and metamorphism of sediments in southern Skåne.

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Herrero Morant, A., G. Suárez Amorín, L. Sanchez Bilbao, C. Álvarez Reguera, D. Martínez-López, J. L. Martín-Varillas, P. Setien Preciados et al. „AB1215 EPIDEMIOLOGY AND CLINICAL PHENOTYPE OF BEHÇET’S DISEASE IN A WELL-DEFINED POPULATION OF NORTHERN SPAIN“. Annals of the Rheumatic Diseases 79, Suppl 1 (Juni 2020): 1898.2–1899. http://dx.doi.org/10.1136/annrheumdis-2020-eular.4694.

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Background:Considerable epidemiological variations in prevalence of Behçet’s disease (BD) have been reported. These disparities may either reflect geographical differences, methodological artifacts, changes over time or random fluctuations. In Spain, published BD’s epidemiological studies are scarce.Objectives:To study epidemiological and clinical domains of BD in a well-defined population of Northern Spain, as well as, to compare results with other regions.Methods:We included all consecutive 111 patients, diagnosed of definitive or possible BD by expert rheumatologists between 1980 and 2019. Two Classification criteria were applied: a) International Study Group (ISG) for BD(Lancet. 1990; 335:1078-80), and b) International Criteria for BD (ICBD)(J Eur Acad Dermatol Venereol. 2014; 28:338-47). In addition, a literature review of Medline publications was carried out.Results:In our study, prevalence was higher than in most European populations regardless of the diagnostic criteria applied. Incidence was low (expert opinion: 0.021, ICBD: 0.016, ISG: 0.012). Mean age at onset (36.8±13.2) and gender distribution (55.9% females) were similar to other countries. Pathergy test was performed in 9% of patients giving low results (25.2%). Clinical domains’ frequency was in line with other regions except vascular and gastrointestinal involvement, which were lower. (TABLE)Conclusion:BD’s prevalence in Northern Spain is higher than in most European populations. These differences likely reflect a combination of true geographic variation, methodological artifacts as well as the easy access to Public Health System and its efficiency. In contrast, clinical phenotypes are similar to other regions.TABLEDiagnostic criteria and study periodn cases / population sizeMean age at onset and sex (%females)Prevalence (over 100000) / incidenceOral / genital ulcers (%)Skin lessions/ pathergy test (%)Ocular involvement (%)Joint involvement (%)Neurobehcet/ Vascular/ Gastrointestinal involvement (%)Herrero, A et al. Southern Europe (Cantabria, Spain)Expert opinion, ISG, ICBD / 1980-2019111 (expert opinion) / 86 (ICBD) / 65 (ISG) / 58107836.8±13.2/ 55.919.1 (expert opinion), 14.8 (ICBD), 11.2 (ISG) / 0.021 (expert opinion), 0.016 (ICBD), 0.012 (ISG)99 / 53.168.4 / 25. 235.168.518 / 10 / 4.5Calamia, K. T. et al. North America (Minnesota, USA)ISG / 1960-200513 / NR31 / 305.2 / 0.38100 / 6285 / NR624623 / 23 / NRAltenburg, A. et al. Northern Europe (Berlin, Germany)ISG and ABD classification tree / 1961-2005590 / 339134426 / 584.9 / 1 (estimated)98.5 / 63.762.5 / 33.758.15310.9 / 22.7 / 11.6Mohammad, A. et al. Northern Europe (Skane County, Sweden)ISG / 1997-201040 / 80931730.5 / 334.9 / 0.2100 / 8088 / NR53400 / 20 / NRMahr, A. et al. Southern Europe (Seine-Saint-Denis County, France)ISG / 200379 / 109441227.6 / 437.1 / NR100 / 8090 / 20515910 / NR / 10Salvarani, C. et al. Southern Europe (Reggio Emilia, Italy)ISG, 1988-200518 / 48696133 / 503.7 / 0.24100 / 78100 / NR565011 / 6 / NRAzizlerli, G. et al. Middle East (Istambul, Turkey)ISG / prevalence study101 / 23986NR / 48.542 / NR100 / 70.2Not globally reported / 69.327.7Not globally reportedNR / Not globally reported / NRDavatchi, F. et al. Middle East (Iran nationwide)Expert opinion / 1975-20187641 / NR25.6 / 44.280 / NR97.5 / 64.462.2 / 50.455.638.13.9 / 8.9 / 6.8Krause, I. et al. Middle East (Galilee, Israel)ISG / 15 years (not specific years have been reported)112 / 73700030.6 / 4715.2 / NRNR / 6841 / 44.4587011.6 / Not globally reported / NRNishiyama, M. et al. Asia (Japan nationwide)1987 JCBD / 19913316 / NR35.7 / 50.6NR / NR98.2 / 73.287.1 / 43.869.156.911 / 8.9 / 15.5Disclosure of Interests:Alba Herrero Morant: None declared, Guillermo Suárez Amorín: None declared, Lara Sanchez Bilbao: None declared, Carmen Álvarez Reguera: None declared, David Martínez-López: None declared, José Luis Martín-Varillas Grant/research support from: AbbVie, Pfizer, Janssen and Celgene, Speakers bureau: Pfizer and Lilly, Patricia Setien Preciados: None declared, M. Cristina Mata Arnaiz: None declared, Rosalía Demetrio-Pablo: None declared, Miguel Ángel Gordo Vega: None declared, Miguel Á. González-Gay Grant/research support from: AbbVie, MSD and Roche, Speakers bureau: AbbVie, MSD and Roche, Ricardo Blanco Grant/research support from: Abbvie, MSD and Roche, Consultant of: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen and MSD, Speakers bureau: Abbvie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD

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Sanchez-Bilbao, L., G. Suárez-Amorín, C. Álvarez-Reguera, A. Herrero-Morant, D. Martínez-López, J. L. Martín-Varillas, M. C. Mata Arnaiz, R. Demetrio-Pablo, M. A. González-Gay und R. Blanco. „AB0399 EPIDEMIOLOGY OF BEHÇET DISEASE IN A NORTHERN SPANISH HEALTH REGION“. Annals of the Rheumatic Diseases 80, Suppl 1 (19.05.2021): 1227.2–1228. http://dx.doi.org/10.1136/annrheumdis-2021-eular.3577.

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Background:Behçet disease (BD) is a systemic and potentially severe disease. Its incidence varies widely worldwide. In Spain, published BD’s epidemiological studies are scarce.Objectives:In a well-defined Northern Spanish population-based cohort, the aim of this study was a) to estimate epidemiological variations, b) clinical domains and c) to compare our results with other regions.Methods:Study of unselected all consecutive patients diagnosed with definitive or possible BD by expert rheumatologists between 1980 and 2020 in our health region. Two classification criteria were applied: a) International Study Group (ISG) for BD [1], and b) International Criteria for BD (ICBD) [2]. In addition, a literature review of Medline publications was carried out.Results:In this study, from a total of 120 patients diagnosed with BD by expert opinion (58 women/62 men), 96 met ICBD and 59 ISG criteria. Mean age of the cohort at diagnosis was 37.6±13.8 years similar to other countries, as well as sex distribution.Prevalence was higher than in most European populations regardless the diagnostic criteria applied: expert opinion (20.6), ICBD (16.5) or ISG (10.1) (TABLE 1). Incidence was lower (expert opinion: 0.022, ICBD: 0.018, ISG: 0.011). Clinical domains’ frequency was in line with other regions except vascular and gastrointestinal involvement, which were lower.TABLE 1.Diagnostic criteria and study periodn cases / population sizeMean age at onset and sex (%female)Prevalence (over 100000) / incidenceOral / genital ulcers (%)Skin lessions/ pathergy test (%)Ocular involve ment (%)Joint involve ment (%)Neurobehcet/ Vascular/ Gastrointestinalinvolvement (%)Sánchez. L et al. Southern Europe (Cantabria, Spain)Expert opinion, ISG, ICBD / 1980- 2020120 (expert opinion) / 96 (ICBD) / 59 (ISG) / 58164137.6 ±13.8/ 48.320.6 (expert opinion), 16.5 (ICBD), 10.1 (ISG) / 0.022 (expert opinion), 0.018 (ICBD), 0.011 (ISG)94.2 / 59.263.3 / 25. 241.66510.8 / 11.6 / 6.6Calamia, K. T. et al. North America (Minnesota, USA)ISG / 1960-200513 / NR31 / 305.2 / 0.38100 / 6285 / NR624623 / 23 / NRAltenburg, A. et al. Northern Europe (Berlin, Germany)ISG and ABD classification tree / 1961-2005590 / 339134426 / 584.9 / 1 (estimated)98.5 / 63.762.5 / 33.758.15310.9 / 22.7 / 11.6Mohammad, A. et al. Northern Europe (Skane County, Sweden)ISG / 1997-201040 / 80931730.5 / 334.9 / 0.2100 / 8088 / NR53400 / 20 / NRMahr, A. et al. Southern Europe (SeineSaint-Denis County, France)ISG / 200379 / 109441227.6 / 437.1 / NR100 / 8090 / 20515910 / NR / 10Salvarani, C. et al. SouthernEurope (Reggio Emilia, Italy)ISG, 1988-200518 / 48696133 / 503.7 / 0.24100 / 78100 / NR565011 / 6 / NRAzizlerli, G. et al. Middle East (Istambul, Turkey)ISG / prevalence study101 / 23986NR / 48.542 / NR100 / 70.2Not globally reported / 69.327.7Not globally reportedNR / Not globally reported / NRDavatchi, F. et al. Middle East (Iran nationwide)Expert opinion / 1975-20187641 / NR25.6 / 44.280 / NR97.5 / 64.462.2 / 50.455.638.13.9 / 8.9 / 6.8Krause, I. et al. Middle East (Galilee, Israel)ISG / 15 years (not specific years have been reported)112 / 73700030.6 / 4715.2 / NRNR / 6841 / 44.4587011.6 / Not globally reported / NRNishiyama, M. et al. Asia (Japan nationwide)1987 JCBD / 19913316 / NR35.7 / 50.6NR / NR98.2 / 73.287.1 / 43.869.156.911 / 8.9 / 15.5JCBD: Japanese diagnostic Criteria of Behçet’s Disease; n: number of cases; NR: Not ReportedConclusion:BD’s prevalence in Northern Spain is higher than in most European populations. These differences likely reflect a combination of true geographic variation, methodological artifacts as well as the easy access to Public Health System and its efficiency. In contrast, clinical phenotypes are similar to other regions.References:[1]Lancet. 1990; 335:1078-80[2]J Eur Acad Dermatol Venereol. 2014; 28:338-47Disclosure of Interests:Lara Sanchez-Bilbao: None declared, Guillermo Suárez-Amorín: None declared, Carmen Álvarez-Reguera: None declared, Alba Herrero-Morant: None declared, David Martínez-López: None declared, José Luis Martín-Varillas: None declared, M. Cristina Mata Arnaiz: None declared, Rosalía Demetrio-Pablo: None declared, Miguel A González-Gay Speakers bureau: AbbVie, Pfizer, Roche, Sanofi, Celgene and MSD., Grant/research support from: AbbVie, MSD, Jansen and Roche, Ricardo Blanco Speakers bureau: AbbVie, Pfizer, Roche, Bristol-Myers, Janssen, Lilly and MSD., Grant/research support from: AbbVie, MSD and Roche.

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Dell’isola, A., A. Kiadaliri, A. Turkiewicz, V. Hughes, K. Magnusson, J. Runhaar, S. M. A. Bierma-Zeinstra und M. Englund. „AB0678 RATES OF SURGICAL PROCEDURES OF THE KNEE AND HIP DURING THE “FIRST WAVE” OF COVID 19 IN SWEDEN“. Annals of the Rheumatic Diseases 80, Suppl 1 (19.05.2021): 1372.1–1372. http://dx.doi.org/10.1136/annrheumdis-2021-eular.2494.

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Background:Many countries imposed lockdowns in March 2020, in anticipation of the “first wave” of COVID-19 and the massive healthcare resources required to meet its acute medical needs. Sweden adopted a different strategy to contain the epidemic, opting for non-binding recommendations. Nonetheless, elective and acute surgical procedures in health care may have been affected.Objectives:To investigate the effect of the “first-wave” of COVID-19 and the government’s response in Sweden on the rates of total joint replacements (TJR), arthroscopies, and fracture surgeries of the knee and hip.Methods:We used register data for the entire population of Skåne, the southernmost region in Sweden with 1.3 million inhabitants (13% of the total Swedish population). We identified all residents aged ≥18 years who between 1st January 2015 and 31st November 2020 underwent any of the following surgical procedures of the knee or hip: TJR (TJR due to fracture excluded), arthroscopy, and surgery due to fracture (including TJR). To demarcate pre-event and post-event periods, we established a differentiation point corresponding to mid-March 2020, the timepoint at which the the Swedish Public Health Agency began recommending social distancing, working from home, distance learning for secondary schools and universities,. At the aggregate level, we modelled the number of surgeries per 10,000 adults from January 2015 up to September 2020. We did an interrupted time-series (ITSA) analysis using segmented ordinary least-squares regression to estimate changes in the levels and trends of surgical procedures compared to pre-COVID-19 levels, adjusting for seasonal variations. The month of March was treated as a “phase-in” period to give time for the new recommendations to be implemented. In addition, we estimated the absolute and relative difference (with its 95% confidence interval [CI]) between the predicted and the counterfactual scenario in the monthly number of surgeries from April 2020, where the counterfactual is the rate of surgery that would have been expected if COVID-19 had not happened. To account for the possibility that other co-occurring events may be responsible for the observed changes, we assessed changes in the number of surgeries due to fractures, which are normally treated as emergencies that cannot be cancelled or rescheduled, and thus should be less affected, at least by policies at the hospital level.Results:We identified a total of 20,831 TJRs, 12,156 arthroscopies and 15,041 fracture surgeries of the knee or hip over the study period. The monthly rate of surgeries and ITSAs are presented in Figure 1, with the pre-COVID period starting from February 2019 for readability (Figure 1). The results suggest that in April 2020, there was a decrease of 2.08 (95%CI 1.81; 2.35) TJRs per 10,000 adults which corresponds to a decrease of 74% (95%CI 65%; 85%) when compared to the counterfactual scenario. This was followed by a positive trend signifying a monthly increase of 0.36 (95%CI 0.31; 0.40) TJRs per 10,000 adults. The rate of arthroscopies followed a similar pattern with a decrease of 0.55 (95%CI 0.39; 0.71) arthroscopies per 10,000 adults in April, which corresponds to a 49% decrease (95%CI 28%; 63%) followed by a positive trend signifying a monthly increase of 0.11 (95%CI 0.07; 0.15) arthroscopies per 10,000 adults. The rate of surgery due to knee or hip fractures showed no decrease in April and was followed by a negative trend signifying a monthly decrease of 0.03 (95%CI 0.002; 0.04) surgeries per 10,000 adults.Conclusion:In Sweden, we observed a marked decrease in the number of typical elective knee and hip surgeries such as TJRs and arthroscopies, following the government’s response to Covid-19. We then observed a slow but steady recovery that brought the rates of procedures towards expected levels by Fall 2020, before the “second wave” hit the country. The number of acute fracture surgeries showed no sharp drop, instead showing a steady and slow decline potentially due to reduction in commuting and in physical activities linked to recommendations of socialDisclosure of Interests:None declared

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Andersson, Lisa, Anders Håkansson, Jonas Berge und Björn Johnson. „Changes in opioid-related deaths following increased access to opioid substitution treatment“. Substance Abuse Treatment, Prevention, and Policy 16, Nr. 1 (10.02.2021). http://dx.doi.org/10.1186/s13011-021-00351-4.

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Abstract Background Opioid-related mortality is high and increasing in the Western world, and interventions aimed at reducing opioid-related deaths represent an important area of study. In Skåne County, Sweden, a patient choice reform resulted in increased access to opioid substitution treatment (OST). In addition, a gradual shift towards less restrictive terms for exclusion from OST has been implemented. The aim of this study was to assess the impact of these policy changes on opioid-related deaths. Methods Detailed data on opioid-related deaths in Skåne during the 2 years prior to and following the policy change were obtained from forensic records and from health care services. Data on overdose deaths for Skåne and the rest of Sweden were obtained using publicly available national register data. Time periods were used as the predictor for opioid-related deaths in the forensic data. The national level data were used in a natural experiment design in which rates of overdose deaths were compared between Skåne and the rest of Sweden before and after the intervention. Results There was no significant difference in the number of deaths in Skåne between the data collection periods (RR: 1.18 95% CI:0.89–1.57, p= 0.251). The proportion of deaths among patients enrolled in OST increased between the two periods (2.61, 1.12–6.10, p= 0.026). There was no change in deaths related to methadone or buprenorphine in relation to deaths due to the other opioids included in the study (0.92, 0.51–1.63, p= 0.764). An analysis of national mortality data showed an annual relative decrease in unintentional drug deaths in Skåne compared to the rest of Sweden following the onset of the reform (0.90, 0.84–0,97, p= 0.004). Conclusions Opioid-related deaths, as assessed using forensic data, has not changed significantly in Skåne following a change to lower-threshold OST. By contrast, national level data indicate that the policy change has been associated with decreased overdose deaths. The discrepancy between these results highlights the need for more research to elucidate this issue. The result that more patients die during ongoing OST following an increase in access to treatment underlines the need for further preventive interventions within the OST treatment setting.

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Troberg, Katja, Pernilla Isendahl, Marianne Alanko Blomé, Disa Dahlman und Anders Håkansson. „Protocol for a multi-site study of the effects of overdose prevention education with naloxone distribution program in Skåne County, Sweden“. BMC Psychiatry 20, Nr. 1 (07.02.2020). http://dx.doi.org/10.1186/s12888-020-2470-3.

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Abstract Background Continuously high rates of overdose deaths in Sweden led to the decision by the Skåne County to initiate the first regional take-home naloxone program in Sweden. The project aims to study the effect of overdose prevention education and naloxone distribution on overdose mortality in Skåne County. Secondary outcome measures include non-fatal overdoses and overdose-related harm in the general population, as well as cohort-specific effects in study participants regarding overdoses, mortality and retention in naloxone program. Methods Implementation of a multi-site train-the-trainer cascade model was launched in June 2018. Twenty four facilities, including opioid substitution treatment units, needle exchange programs and in-patient addiction units were included for the first line of start-up, aspiring to reach a majority of individuals at-risk within the first 6 months. Serving as self-sufficient naloxone hubs, these units provide training, naloxone distribution and study recruitment. During 3 years, questionnaires are obtained from initial training, follow up, every sixth month, and upon refill. Estimated sample size is 2000 subjects. Naloxone distribution rates are reported, by each unit, every 6 months. Medical diagnoses, toxicological raw data and data on mortality and cause of death will be collected from national and regional registers, both for included naloxone recipients and for the general population. Data on vital status and treatment needs will be collected from registers of emergency and prehospital care. Discussion Despite a growing body of literature on naloxone distribution, studies on population effect on mortality are scarce. Most previous studies and reports have been uncontrolled, thus not being able to link naloxone distribution to survival, in relation to a comparison period. As Swedish registers present the opportunity to monitor individuals and entire populations over time, conditions for conducting systematic follow-ups in the Swedish population are good, serving the opportunity to study the impact of large scale overdose prevention education and naloxone distribution and thus fill the knowledge gap. Trial registration Naloxone Treatment in Skåne County - Effect on Drug-related Mortality and Overdose-related Complications, NCT 03570099, registered on 26 June 2018.

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Bläckberg, Anna, Therese de Neergaard, Inga-Maria Frick, Pontus Nordenfelt, Rolf Lood und Magnus Rasmussen. „Lack of Opsonic Antibody Responses to Invasive Infections With Streptococcus dysgalactiae“. Frontiers in Microbiology 12 (27.04.2021). http://dx.doi.org/10.3389/fmicb.2021.635591.

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IntroductionStreptococcus dysgalactiae can cause severe recurrent infections. This study aimed to investigate antibody responses following S. dysgalactiae bacteraemia and possible development of protective immunity.Materials and MethodsPatients with S. dysgalactiae bacteraemia in the county of Skåne between 2017 and 2018 were prospectively included. Acute and convalescent sera were obtained. All isolates were emm typed and enzyme-linked immunosorbent assay (ELISA) was utilised to analyse specific antibody responses to bacteria and antigens. Bactericidal- and phagocytosis assays were applied to further establish antibody function.ResultsSixteen patients with S. dysgalactiae bacteraemia were included of whom one had recurrent episodes of bacteraemia. Using ELISA with S. dysgalactiae isolates and mutants, development of IgG antibodies was demonstrated in few patients. Type-specific antibodies were demonstrated in one patient when recombinant M proteins as antigens, were applied. The type-specific serum mediated a small increase in phagocytosis but did not facilitate increased killing of the S. dysgalactiae isolate, carrying that M protein, in blood or by phagocytic cells.ConclusionS. dysgalactiae bacteraemia sometimes results in increased levels of antibodies to the infecting pathogen. We did not find evidence that these antibodies are effectively opsonising. Apparent failure to produce opsonising antibodies might partially explain why S. dysgalactiae can cause recurrent invasive infections in the same host.

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„Coping with autonomy: Managers’ responses to the pendulum between activity-based and fixed reimbursement systems in Swedish hospital care“. American Journal of Management 18, Nr. 5 (30.12.2018). http://dx.doi.org/10.33423/ajm.v18i5.250.

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Governance and management in publicly funded services includes the processes that governments use to ensure that the activities of organizations involved in the delivery of public services are in line with those expected. In hospital care, the reimbursement model is viewed as an important tool to motivate providers to act in the interest of the funding body. The purpose of this study was to analyse consequences of a change from activity-based funding (ABF) to global budgeting for the governance and management of hospitals in a Swedish county council. The paper furthers previous research by illustrating how managers at different levels and in different hospital types adopt different strategies to cope with the increased autonomy inherent to the budget model. A single case study with an explorative onset was used to study different levels of management and cover different specialties in the county council Region Skåne (RS). The main source of data is semi-structured interviews with managers at different levels of the health care organisation. A key result is that shifting reimbursement system had potentially large consequences for the processes of management and governance. The results suggest that a reform aimed at increased professional autonomy may have different effects depending on the way that managers handle the change and that such differences may be attributable to type of hospital. i.e. university versus non-university hospitals. Two potential strategies for managers to cope with a change from variable ABF to fixed global budgets have been identified: One is to compensate for the low level of detail in assignments by continuing or even increasing the use of other coercive controls. Another is to adapt and align other controls with the new reimbursement model and focus on more enabling types of governance and management overall.

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Berthold, Elisabet, Bengt Månsson und Robin Kahn. „Outcome in juvenile idiopathic arthritis: a population-based study from Sweden“. Arthritis Research & Therapy 21, Nr. 1 (28.10.2019). http://dx.doi.org/10.1186/s13075-019-1994-8.

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Abstract Background As the treatment arsenal for children with juvenile idiopathic arthritis (JIA) has expanded during the last decades, follow-up studies are needed on children diagnosed in the era of biological treatment to evaluate if this has improved the outcome. Our aim was to study the epidemiology and outcome of JIA in southern Sweden using a population-based cohort of children with a validated diagnosis of JIA collected over 9 years. Methods Potential cases of JIA between 2002 and 2010 were collected after a database search, using the ICD codes M08-M09. The study area was Skåne, the southernmost county of Sweden (population 1.24 million; 17.6% aged < 16 years). The JIA diagnosis was validated and subcategorized through medical record review based on the criteria defined by the International League of Associations for Rheumatism (ILAR). Parameters on disease activity and pharmacologic treatment were recorded annually until the end of the study period (December 31, 2015). Results In total, 251 cases of JIA were confirmed. The mean annual incidence rate for JIA was estimated to be 12.8/100,000 children < 16 years, with the highest age-specific annual incidence at the age of 2 years (36/100,000). Oligoarthritis was the largest subgroup (44.7%), and systemic JIA was the smallest subgroup (2.8%). Methotrexate was the most common disease-modifying anti-rheumatic drug prescribed (60.6%). Tumor necrosis factor alpha inhibitors were used as treatment for 23.9% of the children. Only 40.0% of the follow-up years, with a median follow-up time of 8 years, were free of arthritis or uveitis. Uveitis occurred in 10.8% of the children (8.0% chronic uveitis), and the need for joint corrective orthopedic surgery was 9.2%. Conclusions The incidence of JIA in this well-defined, population-based cohort is slightly lower than in previously published studies from Scandinavia. The need for orthopedic surgery and the presence of uveitis are diminished compared to studies with patients diagnosed more than 20 years ago. Children with JIA however still experience disease activity more than 50% of the time. In conclusion, we still have long-term challenges in the care for children with JIA, in spite of state-of-the-art treatment.

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Månsson, Tomas, Marieclaire Overton, Mats Pihlsgård und Sölve Elmståhl. „Impaired kidney function is associated with lower cognitive function in the elder general population. Results from the Good Aging in Skåne (GÅS) cohort study“. BMC Geriatrics 19, Nr. 1 (Dezember 2019). http://dx.doi.org/10.1186/s12877-019-1381-y.

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Abstract Background A possible connection on vascular basis between impaired kidney function and cognitive dysfunction has been suggested in previous studies. Contradictory results regarding specific cognitive domains have been reported. The aim for this study was to investigate the association between kidney function and specific cognitive domains. Methods In this cross-sectional design, data from the general population based cohort study “Good aging in Skåne” (GÅS) was used. The sample included 2931 subjects ages 60 to 93 randomly selected from the southern part of Sweden. Estimated glomerular filtration rate (eGFR) for both creatinine and cystatine C was calculated using the chronic kidney disease epidemiology collaboration (CKD-EPI) equation. The subjects underwent a test battery of neuropsychological tests assessing global cognitive function, learning and memory, language, complex attention, executive function, perceptual motor and meta-memory. Adjustments were made for age, sex, education and country of origin. Results After adjustment for demographic variables, impaired kidney function was associated with 0.41 points worse result in MMSE, 0.56 points worse result in recognition, 0.66 points worse result in word fluency, 0.45 points worse result in digit cancellation, 0.99 points worse result in pattern comparison, and 3.71 s longer time to finish TMT B-A. Associations to cognitive function was also noted for mildly impaired kidney function defined as eGFR 45- < 60 ml/min/1,73m2. No association was found between kidney function and meta-memory. Conclusions Impaired kidney function as well as the severity of impaired kidney function is associated with impairment in learning and memory, language, complex attention, executive function and global cognitive function, but not meta-memory.

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Kiadaliri, Ali, Margarita Moreno-Betancur, Aleksandra Turkiewicz und Martin Englund. „Educational inequalities in all-cause and cause-specific mortality among people with gout: a register-based matched cohort study in southern Sweden“. International Journal for Equity in Health 18, Nr. 1 (28.10.2019). http://dx.doi.org/10.1186/s12939-019-1076-1.

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Abstract Background Gout is the most common inflammatory arthritis with a rising prevalence around the globe. While educational inequalities in incidence and prevalence of gout have been reported, no previous study investigated educational inequality in mortality among people with gout. The aim of this study was to assess absolute and relative educational inequalities in all-cause and cause-specific mortality among people with gout in comparison with an age- and sex-matched cohort free of gout in southern Sweden. Methods We identified all residents aged ≥30 years of Skåne region with doctor-diagnosed gout (ICD-10 code M10, n = 24,877) during 1998–2013 and up to 4 randomly selected age- and sex-matched comparators free of gout (reference cohort, n = 99,504). These were followed until death, emigration, or end of 2014. We used additive hazards models and Cox regression adjusted for age, sex, marital status, and country of birth to estimate slope and relative indices of inequality (SII/RII). Three cause-of-death attribution approaches were considered for RII estimation: “underlying cause”, “any mention”, and “weighted multiple-cause”. Results Gout patients with the lowest education had 1547 (95% CI: 1001, 2092) more deaths per 100,000 person-years compared with those with the highest education. These absolute inequalities were larger than in the reference population (1255, 95% CI: 1038, 1472). While the contribution of cardiovascular (cancer) mortality to these absolute inequalities was greater (smaller) in men with gout than those without, the opposite was seen among women. Relative inequality in all-cause mortality was smaller in gout (RII 1.29 [1.18, 1.41]) than in the reference population (1.46 [1.38, 1.53]). The weighted multiple-cause approach generally led to larger RIIs than the underlying cause approach. Conclusions Our register-based matched cohort study showed that low level of education was associated with increased mortality among gout patients. Although the magnitude of relative inequality was smaller in people with gout compared with those without, the absolute inequalities were greater reflecting a major mortality burden among those with lower education.

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Lundström, Ingemar, und Kenth Hasselgren. „Uptake of metals in willow biomass plantations fertilised with sewage sludge“. Linnaeus Eco-Tech, 09.05.2019, 79–91. http://dx.doi.org/10.15626/eco-tech.2003.009.

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Despite the main part of the sewage sludge (biosolids) production in Sweden meets thehigh quality requirements set up for recycling in agriculture, amounts of sludge spread totraditional crops are decreasing. This is mainly due to the negative attitude within thefood industry to sludge use. However, sludge managers gradually develop other routes ofsludge disposal.For instance, sludge fertilisation of willow (Salix spp.) plantations for biofuel productionhas increased in recent years. The increase can be described by the fact that the willowfarmers measure positive effects after sludge application and/or because willow isexcluded from the food industry business.The primary project objective is to clarify the practical extent of uptake of heavy metalsin Salix wood through direct measurements of commercial willow plantations fertilisedwith biosolids. Some 20 plantations in SkAne and Orebro counties (south Sweden) wereincluded in the investigation.In general, uptake rates of metals in the Salix crop were high compared to traditionalagricultural crops. Uptake of Cd in Salix stems was greatly exceeding (ca 10 times) theapplication of Cd with sludge (general sludge type and application rates), also includingatmospheric deposition of Cd. This means that a willow crop fertilised with sludge couldwork as a biological filter for remediation of Cd contaminated land. Uptake of Zn in Salixwas fairly well balanced with the Zn application with sludge, whereas for other metalsuptake in Salix wood was lower than the amount added with biosolids.Sludge from the Swedish wastewater treatment plants can potentially supply the futurewillow-to-energy plantations (I 00 000's of hectares) in the country with full amounts ofphosphorus and with parts of the other nutrient requirements. Further, application ofbiosolids increases the content of organic matter in the soil.

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Andersen, Bror Just. „Effekter av program i skolen for å forebygge psykiske plager“. Norsk Epidemiologi 20, Nr. 1 (07.03.2011). http://dx.doi.org/10.5324/nje.v20i1.1291.

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Mellom 15 og 20% av alle ungdommer i Norge har psykiske problemer som går ut over deres fungeringsevne. Mellom 4 og 7% har så alvorlige plager at de trenger behandling. Mange tør ikke dele problemene med andre. VIP er et forebyggende program innenfor psykisk helse for elever i videregående skole. Målsetningen er å øke kunnskap om og evne til å gjenkjenne tegn på psykiske problemer og lidelser, og å senke terskelen for å søke hjelp. Vi vurderer her graden av måloppnåelse. Utvalget er 880 elever i Akershus der intervensjonen har blitt gjennomført, sammenliknet med 811 elever fra Vestfold fylke som ikke hadde intervensjonen. Opplysningene er innhentet gjennom spørreskjema før intervensjonen (t0), og 1 (t1), 6, 12 og 24 måneder etter intervensjonen. Ved hvert tidspunkt ble kunnskapen målt i prosent av maksimum skåre på et sett av indekser. Effektstørrelsen på de enkelte indeksene er estimert i (a) forskjeller i forbedring av prosentskåre og (b) Cohens d. Fra t0 til t1 hadde intervensjonsgruppen signifikant bedre kunnskapsutvikling innenfor ”kjennskap til psykiske lidelser” (10,2% flere prosentenheter framgang, Cohens d = 0,58), ”generell kunnskap om psykisk helse” (4,4% - 0,30), ”evne til kopling av symptomer til diagnoser” (3,1% - 0,34), ”kunnskap om hjelpeapparatet innenfor psykisk helse generelt” (11,6% - 0,51) og ”kunnskap om nærmiljøets hjelpeapparat innenfor psykisk helse” (11,3% - 0,74). Sammenliknet med effektstørrelsene i andre, tilsvarende studier (mellom 0,01 og 0,3 i Norge og mellom 0,26 og 0,57 i internasjonale undersøkelser) synes effekten av VIP å være god. Tatt i betraktning at kunnskap forvitrer og glemmes over tid, gjenstår det likevel å se om VIP-programmet får varige effekter av en størrelsesorden som er tilfredsstillende, sett i forhold til det programmet koster. Effects of programs in school for preventing mental problems -English Summary : Between 15 and 20% of all young people in Norway have mental problems that impact their daily functioning. Between 4 and 7% have problems that need treatment. Many of those who have problems do not dare to share them with others. VIP is a preventive program in mental health in Norway targeted at students in secondary school. It aims at increasing understanding and recognition of mental problems and illness and at lowering thresholds for help seeking. We assess the degree of achievement of these goals. A sample of 880 students in a county where the program had been implemented was compared with a sample of 811 students in a county where the program had not yet been implemented. Data was collected through questionnaires prior to intervention (t0) and at 1 (t1), 6, 12 and 24 months after intervention. At each time, knowledge was measured as percentages of top scores on a set of indices. Effect sizes on the various indices are estimated in terms of (a) differences in improvements of percentage scores and (b) Cohen’s d. From t0 to t1, the intervention group showed significantly greater progress in “knowledge of mental disorders” (10.2 percentage units greater progress, Cohen’s d = 0.58), “general knowledge of mental health” (4.4%, 0.30), “ability to link symptoms to diagnosis” (3.1%, 0.34), “general knowledge of mental health services” (11.6%, 0.51), and “knowledge of specific community help facilities” (11.3%, 0.74). Compared with effect sizes from similar studies (between 0.01 and 0.30 in Norway and between 0.26 and 0.57 in international surveys), the effect sizes of VIP lie in the higher end of the scale. However, considering that knowledge to some extent is forgotten over time, it remains to be seen if the VIP program has a satisfactory lasting effect compared to its costs.

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Fretland, Steinar, und Øystein Krüger. „Regionale sykelighetsforskjeller i Nord-Trøndelag fylke belyst med tall fra ulike datakilder“. Norsk Epidemiologi 8, Nr. 1 (28.10.2009). http://dx.doi.org/10.5324/nje.v8i1.429.

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SAMMENDRAGNord-Trøndelag fylke inndeles i to sykehusområder, Namdal i nord/nordvest og Innherred i sør. Det ertidligere påvist høyere sykehusforbruk i Namdal enn i Innherred. En undersøkelse fra 80-tallet tydet på atforhold i primærhelsetjenesten forklarte noen av disse forskjellene: større stabilitet blant primærlegene ogbedre samarbeid mellom første- og andrelinjetjenesten i Innherred kunne forklare lavere sykehusforbruk i detteområdet. Forhold knyttet til geografi, næringsstruktur og befolkningssammensetning så ikke ut til å spillenoen vesentlig rolle. Formålet med denne undersøkelsen var å kartlegge eventuelle forskjeller i sykelighetmellom befolkningene i Namdal og Innherred. For å beskrive sykdomsmønstre i fylket har vi hentet data frabefolkningsundersøkelser i fylket, fra sykehusstatistikk, fra registrering hos primærleger, fra kreftregisteret,fra meldingssystemet for infeksjonssykdommer, fra dødsårsaksregisteret, fra fylkets trygdekontor og fraFylkeslegen. Det var høyere forekomst av hjertesykdom og høyere nivåer for risikofaktorer for hjertesykdom(målte gjennomsnittlige kolesterolverdier, høyt blodtrykk, daglig røyking og infarktrisk-skåre) i Namdal enn iInnherred. Regionale ulikheter i sykelighet registrert ved Helseundersøkelsen i Nord-Trøndelag (HUNT) blebekreftet av tilsvarende forskjeller ved innleggelser i sykehus for en rekke sykdommer.Fretland S, Krüger Ø. Regional differences in disease morbidity in Nord-Trøndelag county.Nor J Epidemiol ENGLISH SUMMARYPrevious research has revealed that the population-adjusted number of hospital admissions through manyyears has been higher in Namdal than in Innherred hospital region. This was not explained by differences inpopulation age or sex distributions, but was to some extent associated with the level of primary health care.The aim of this study was to investigate if there were differences in morbidity between the two hospitalregions. We have used different sources to collect information about the disease patterns: The Nord-Trøndelag Health Survey, data from general practitioners in the county, the Cancer Registry of Norway, theNational Institute of Public Health, the hospital registers in the county of Nord-Trøndelag, the National DeathRegister, the public insurance company and from the County Health Office. There was a substantially higheroccurrence of heart disease and risk factors for heart disease (levels of cholesterol and blood pressure, cigarettesmoking and infarction risk score) in Namdal than in Innherred hospital region. The regional differencesin coronary heart disease were clearly confirmed in hospital admission data, and also for several otherdiseases: stroke, asthma, rheumatoid arthritis, Bechterew's disease and arm and hip fractures –1998; 8 (1): 73-78.

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