The Swedish National Patient Register offers unique possibilities for identification of large cohorts, such as patients with rheumatoid arthritis (RA). Although the overall diagnostic validity in the ...register has been reported as good, the aims of this study were to a) specifically validate the RA diagnosis from contemporary outpatient specialist care in this register, and b) assess the proportion of patients identified via algorithms to define incident RA in the register who in clinical practice also have new-onset disease.
211 individuals with prevalent or incident RA in the National Patient Register were included. By extracting diagnosis-related parameters from their medical records, we determined if the patient fulfilled the 2010 ACR/EULAR- and the 1987 ACR-classification criteria for RA. We also determined whether clinical diagnosis was synchronous with disease onset as defined through register-based algorithms.
For 91% of the prevalent patients, the RA diagnosis in the National Patient Register fulfilled classification criteria or clinical diagnosis for RA. Among individuals identified with incident RA using a strict algorithm for new-onset disease, the RA diagnosis was substantiated in 91%, of whom 92% also represented new-onset disease.
The validity of the RA diagnosis in the National Patient Register was high and, by using specific algorithms, new-onset RA can be defined. These findings strengthen the notion that the National Patient Register may be used to define RA populations with high validity to allow for high-quality epidemiological studies.
Aims. We establish the mean metallicity from high-resolution spectroscopy for the recently found dwarf spheroidal galaxy Boötes I and test whether it is a common feature for ultra-faint dwarf ...spheroidal galaxies to show signs of inhomogeneous chemical evolution (e.g. as found in the Hercules dwarf spheroidal galaxy). Methods. We analyse high-resolution, moderate signal-to-noise spectra for seven red giant stars in the Boötes I dSph galaxy using standard abundance analysis techniques. In particular, we assume local thermodynamic equilibrium and employ spherical model atmospheres and codes that take the sphericity of the star into account when calculating the elemental abundances. Results. We confirm previous determinations of the mean metallicity of the Boötes I dwarf spheroidal galaxy to be -2.3 dex. Whilst five stars are clustered around this metallicity, one is significantly more metal-poor, at -2.9 dex, and one is more metal-rich at, -1.9 dex. Additionally, we find that one of the stars, Boo-127, shows an atypically high Mg/Ca ratio, indicative of stochastic enrichment processes within the dSph galaxy. Similar results have previously only been found in the Hercules and Draco dSph galaxies and appear, so far, to be unique to this type of galaxy.
•A brief summary of the history of high strength stainless steel bearings is given.•Service experience of stainless steel bearings in Sweden and elsewhere is reviewed.•Initiation of failure is ...primarily assumed related to SCC.•Service loading plus a certain wedge imperfection was sufficient for final failure.
With the innovation of elastomeric bearings in the mid-1950s steel bearings lost their interest and significance both in research and development and subsequently even in application. Steel bearings were gradually abandoned in bridges, followed by the technical literature and design standards. However, a great number of steel bearings remain today in service world-wide and will pose their particular challenges in the future. To the author’s knowledge, just in Sweden, high strength stainless steel bearings still exist in no less than some 650 bridges. In recent years, a large number of such bearings have failed with an alarmingly high frequency in Sweden during a period of six to twenty years after installation making them a serious maintenance cost issue.
After a brief summary of the history of high strength stainless steel bearings, the paper reviews service experience of such bearings in Sweden and elsewhere. Accompanying finite element analyses were performed in order to gain insight into the likely failure mechanism. Finally, this comprehensive review leads to a conclusion that identifies the causes of the failures occurred and makes some recommendations.
Although previous investigations of the stainless steel bearings have not been able to clearly identify the cause(s) of the failures occurred, it is found that the failures primarily occurred due to initiation of cracks through stress corrosion cracking followed by fatigue crack growth requiring a certain stress range and a sufficiently large number of cycles until final failure ensued through sudden and instable fracture after fatigue growth to a critical crack size.
Bariatric surgery prevents and induces remission of type 2 diabetes in many patients. The effect of preoperative glucose status on long-term health-care costs is unknown. We aimed to assess ...health-care costs over 15 years for patients with obesity treated conventionally or with bariatric surgery and who had either euglycaemia, prediabetes, or type 2 diabetes before intervention.
The Swedish Obese Subjects (SOS) study is a prospective study of adults who had bariatric surgery and contemporaneously matched controls who were treated conventionally (age 37-60 years; BMI of ≥34 in men and ≥38 in women) recruited from 25 Swedish surgical departments and 480 primary health-care centres. Exclusion criteria were identical for both study groups, and were previous gastric or bariatric surgery, recent malignancy or myocardial infarction, selected psychiatric disorders, and other contraindicating disorders to bariatric surgery. Conventional treatment ranged from no treatment to lifestyle intervention and behaviour modification. In this study, we retrieved prescription drug costs for the patients in the SOS study via questionnaires and the nationwide Swedish Prescribed Drug Register. We retrieved data for inpatient and outpatient visits from the Swedish National Patient Register. We followed up the sample linked to register data for up to 15 years. We adjusted mean differences for baseline characteristics. Analyses were by intention to treat. The SOS study is registered with ClinicalTrials.gov, number NCT01479452.
Between Sept 1, 1987, and Jan 31, 2001, 2010 adults who had bariatric surgery and 2037 who were treated conventionally were enrolled into the SOS study. In this study, we followed up 4030 patients (2836 who were euglycaemic; 591 who had prediabetes; 603 who had diabetes). Drug costs did not differ between the surgery and conventional treatment groups in the euglycaemic subgroup (surgery US$10,511 vs conventional treatment $10,680; adjusted mean difference -$225 95% CI -2080 to 1631; p=0·812), but were lower in the surgery group in the prediabetes ($10,194 vs $13,186; -$3329 -5722 to -937; p=0·007) and diabetes ($14,346 vs $19,511; -$5487 -7925 to -3049; p<0·0001) subgroups than in the conventional treatment group. Compared with the conventional treatment group, we noted greater inpatient costs in the surgery group for the euglycaemic ($51,225 vs $25,313; $22,931 19,001-26,861; p<0·0001), prediabetes ($58,699 vs $32,861; $27,152 18,736-35,568; p<0·0001), and diabetes ($61,569 vs $47,569; 18,697 9992-27,402; p<0·0001) subgroups. We noted no differences in outpatient costs. Total health-care costs were higher in the surgery group in the euglycaemic ($71,059 vs $45,542; $22,390 17,358-27,423; p<0·0001) and prediabetes ($78,151 vs $54,864; $26,292 16,738-35,845; p<0·0001) subgroups than in the conventional treatment group, whereas we detected no difference between treatment groups in patients with diabetes ($88,572 vs $79,967; $9081 -1419 to 19,581; p=0·090).
Total health-care costs were higher for patients with euglycaemia or prediabetes in the surgery group than in the conventional treatment group, but we detected no difference between the surgery and conventional treatment groups for patients with diabetes. Long-term health-care cost results support prioritisation of patients with obesity and type 2 diabetes for bariatric surgery.
AFA Försäkring and Swedish Scientific Research Council.
Skeletal muscle is a major metabolic organ and plays important roles in glucose metabolism, insulin sensitivity and insulin action. Muscle telomere length reflects the myocyte's exposure to harmful ...environmental factors. Leukocyte telomere length is considered a marker of muscle telomere length and is used in epidemiologic studies to assess associations with ageing-related diseases where muscle physiology is important. However, the extent to which leucocyte and muscle telomere length are correlated is unknown, as are their relative correlations with glucose and insulin concentrations. The purpose of this study was to determine the extent of these relationships.
Leucocyte and muscle telomere length were measured by quantitative real-time polymerase chain reaction in participants from the Malmö Exercise Intervention (n = 27) and the Prevalence, Prediction and Prevention of Diabetes-Botnia studies (n = 31). Participants in both studies were free from Type 2 diabetes. We assessed the association between leucocyte telomere length, muscle telomere length and metabolic traits using Spearmen correlations and multivariate linear regression. Bland-Altman analysis was used to assess agreement between leucocyte and muscle telomere length.
In age-, study-, diabetes family history- and sex-adjusted models, leucocyte and muscle telomere length were positively correlated (r = 0.39, 95% CI 0.15-0.59). Leucocyte telomere length was inversely associated with 2-h glucose concentrations (r = -0.58, 95% CI -1.0 to -0.16), but there was no correlation between muscle telomere length and 2-h glucose concentrations (r = 0.05, 95% CI -0.35 to 0.46) or between leucocyte or muscle telomere length with other metabolic traits.
In summary, the current study supports the use of leucocyte telomere length as a proxy for muscle telomere length in epidemiological studies of Type 2 diabetes aetiology.
Chemical pollution was monitored and assessed along the Swedish west coast. 62 of 172 analyzed organic chemicals were detected in the water phase of at least one of five monitored sites. A ...Concentration Addition based screening-level risk assessment indicates that all sites are put at risk from chemical contamination, with total risk quotients between 2 and 9. Only at one site did none of the individual chemicals exceeded its corresponding environmental threshold (PNEC, EQS). The monitoring data thus demonstrate a widespread blanket of diffuse pollution, with no clear trends among sites. Further issues critical for the environmental chemical risk assessment include the challenges to achieve sufficiently low levels of detection, especially for hormones and cypermethrin (a pyrethroid insecticide), the appropriate consideration of non-detects and the limited availability of reliable PNECs and EQS values.
•62 out of 172 analyzed compounds were detected in at least one out of five samples.•Triclosan was detected at levels exceeding its environmental threshold at 4 locations.•The risk from the combined mixture exceeded critical levels at all five locations.•The Kaplan-Meier method was used to estimate the risk contribution from non-detects.•The limit of detection was higher than the environmental threshold for 10 compounds.
Orexins/hypocretins (OX/Hcrt) are hypothalamic neuropeptides linking sleep-wakefulness, appetite and neuroendocrine control. Their role and mechanisms of action on higher brain functions, such as ...learning and memory, are not clear. We used field recordings of excitatory post-synaptic potentials (fEPSP) in acute mouse brain slice preparations to study the effects of orexins and pharmacological inhibitors of multiple kinases on long-term synaptic plasticity in the hippocampus. Orexin-A (OX-A) but not orexin-B (OX-B) induces a state-dependent long-term potentiation of synaptic transmission (LTPOX) at Schaffer collateral-CA1 synapses in hippocampal slices from adult (8- to 12-week-old) mice. In contrast, OX-A applied to slices from juvenile (3- to 4-week-old) animals causes a long-term depression (LTDOX) in the same pathway. LTPOX is blocked by pharmacological inhibition of orexin receptor-1 (OX1R) and plasticity-related kinases, including serine/threonine- (CaMKII, PKC, PKA, MAPK), lipid- (PI3K), and receptor tyrosine kinases (Trk). Inhibition of OX1R, CaMKII, PKC, PKA and Trk unmasks LTDOX in adult animals. Orexins control not only the bistability of arousal states and threshold for appetitive behaviours but, in an age- and kinase-dependent manner, also bidirectional long-term synaptic plasticity in the hippocampus, providing a possible link between behavioural state and memory functions.
Background
Web‐based interventions for pain management are increasingly used with possible benefits, but never used in addition to multimodal rehabilitation (MMR). MMR is recommended treatment for ...persistent pain in Sweden. The aim was to evaluate the effects of a self‐guided, web‐based programme added to MMR for work ability, pain, disability and health‐related quality of life.
Methods
We included 99 participants with persistent musculoskeletal pain in a randomized study with two intervention arms: (1) MMR and web‐based intervention, and (2) MMR. Data was collected at baseline, 4 and 12 months. Outcome measures were work ability, working percentage, average pain intensity, pain‐related disability, and health‐related quality of life.
Results
There were no significant effects of adding the web‐based intervention to MMR regarding any of the outcome variables.
Conclusions
This trial provides no support for adding a self‐guided, web‐based activity programme to MMR for patients with persistent musculoskeletal pain.
Significance
The comprehensive self‐guided, web‐based programme for activity, Web‐BCPA, added to multimodal treatment in primary health care had no effect on work ability, pain, disability or health‐related quality of life. Future web‐based interventions should be tailored to patients’ individual needs and expectations.
Purpose
To compare Knee Injury and Osteoarthritis Outcome Score (KOOS) and EuroQol-5D (EQ-5D) subscale scores at 2-year follow-up for patients with primary isolated ACL reconstruction with patients ...undergoing ACL reconstruction and simultaneous meniscal treatment in terms of either resection or repair in the Swedish National Knee Ligament Register (SNKLR).
Methods
All ACL reconstruction patients within the SNKLR at 2-year follow-up were reviewed. The KOOS and EQ-5D subscales were assessed in four distinct patient groups: isolated ACL reconstruction, ACL reconstruction + medial meniscus resection, ACL reconstruction + lateral meniscus resection, ACL reconstruction + medial meniscus repair, and ACL reconstruction + lateral meniscus repair. The primary analysis was conducted using linear regression with isolated ACL reconstruction designated as the reference group, and was adjusted for patient age, gender, and time from injury to surgery.
Results
The included patients consisted of 10,001 (65.0%) individuals with an isolated ACL injury, 588 (3.8%) with ACL injury plus treated with medial meniscus repair, 2307 (15.0%) with ACL injury plus treated with medial meniscus resection, 323 (2.1%) with ACL injury plus treated with lateral meniscus repair, and 2173 (14.1%) with ACL injury plus treated with lateral meniscus resection. Meniscus resection demonstrated significantly worse results with respect to the KOOS Symptoms subscale for both the medial and lateral meniscus resection groups. Medial meniscus resection also demonstrated worse results for the KOOS quality of life (QoL) subscale, while lateral meniscus resection only approached significance. Outcomes were not different between the isolated ACL reconstruction group and the meniscus repair groups.
Conclusion
Meniscus resection in addition to ACL reconstruction resulted in worse clinical outcomes than isolated ACL reconstruction patients; a result not seen within the meniscus repair group. This suggests that, when possible, meniscus repair may provide greater clinical outcomes over resection when treating a reparable meniscal tear that presents along with an ACL tear. Clinicians should consider and implement these findings for the management of future meniscus tear patients within their clinical practice.
Level of evidence
Level III.
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