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The prevalence of iron deficiency (ID) is 26-44 percent among young girls in Sweden. Their level of iron intake is lower than the recommended daily intake. Meat has the highest bioavailability of iron. As the consumption of meat is declining, especially amongst women, meat substitutes are increasing. A new study shows that the absorption of the iron indicated on the nutritional information labels of meat substitutes is impaired by high levels of phytates in the products.  Fatigue, headache and reduced cognitive function are symptoms of ID. ID during pregnancy renders the mother ill-equiped for hemorrhage during delivery and increases the risk for pre-term birth and low birth weight. Serum hemoglobin is not sufficient to diagnose iron deficiency without anemia. Ferritin is a cheap test, which should be used more. Regulation of menstrual bleeding and dietary advice should complement the replenishment of iron stores through iron therapy to avoid a negative iron balance.

We report a sudden increase in the number of cases of C. canimorsus bacteremia during 3 months in 2022 at Östersund Hospital, Sweden. Prior to these cases, the most recent one in the region occurred in 2015. Among the five cases, one suffered from meningitis and one was diagnosed as endocarditis. Dog contact was present in all cases, although dog bites could only be verified in two. Improved diagnostics could not be an explanation to the surge, since the analysis method for blood culture had been the same since 2015. No corresponding increase was noted nationally, according to the Public Health Agency of Sweden. The isolates have been included in the ongoing global study with the aim to explore Capnocytophaga in humans and animals using comparative genomics and genome wide association studies. The study is supported by several ESCMID (European Society of Clinical Microbiology and Infectious Diseases) study groups.

Epilepsy surgery should be considered for individuals with drug-resistant focal epilepsy. The pre-surgical evaluation is highly multi-disciplinary and performed by a team consisting of neurologists, neurophysiologists, neurosurgeons, neuroradiologists, neuropsychologists, biomedical scientists, speech-language pathologists and nursing staff. The evaluation comprises of a meticulous medical history with focus on seizure semiology, a 3 Tesla MRI, ictal video-EEG, neuropsychological evaluation and sometimes also MEG, nTMS, fMRI, PET or SISCOM/ictal SPECT. Occasionally, invasive monitoring with intracranial electrodes is necessary. Surgical options in treatment of epilepsy range from open resections of epileptogenic areas to focal ablations and neurostimulation. There is evidence of epilepsy surgery being an effective treatment in carefully selected cases. Epilepsy surgery seems underutilized in Sweden and referrals for epilepsy surgery work-up need to increase.

A recent meta-analysis reported a prevalence rate of 2.2% for older adults (> 50 years) with symptom levels indicating an ADHD diagnosis, but a rate of only 0.23% for the proportion with a clinical diagnosis. Thus, ADHD symptoms are relatively frequent among older adults, but few have a formal diagnosis. The few studies of older adults that exist suggest that ADHD in older adulthood is associated with the same cognitive deficits, comorbid disorders and impairments in daily life functioning (e.g. poor working memory, depression, psychosomatic comorbidity and poor quality of life) as found in younger adults with this disorder. Evidence based treatments for children and younger adults (pharmacotherapy, psychoeducation and group-based therapy) are most likely also effective treatment options for older adults, but research is lacking. In summary, increased knowledge is needed to allow access to diagnostic assessment and treatment for older adults with clinically significant ADHD symptom levels.

Drug mortality has increased in Sweden during the 2000s. The vast majority of deaths are opioid overdoses. The National Board of Health and Welfare recommends that the antidote naloxone and a brief overdose education should be offered to people who are at risk of opioid overdose. A retrospective registry study of 193 forensically examined fatal opioid overdoses in Skåne showed that over 80 percent occurred in private residences, most often the deceased's own home. Other people were present in just over 40 percent of the 193 deaths, but usually in another room or asleep. In most cases, the witnesses were friends, partners, parents, or other people close to the deceased. Naloxone programs should be expanded to include family members and other persons who are close to opioid users, and who therefore may witness or be present early in case of an overdose.

A national multidisciplinary working group was assigned by the Swedish Association of Local Authorities and Regions to create a person-centered clinical pathway for sepsis in adults. This clinical pathway has been approved for implementation in the Swedish healthcare system. It focuses on three interventions: a sepsis alert for patients with instable vital signs and suspected sepsis in the emergency department, the correct discharge coding of sepsis according to ICD-10 codes, and a structured patient follow-up after hospital discharge. Quality indicators will be registered and monitored electronically. A health-economic analysis indicates that the clinical pathway will not drive additional costs for the healthcare system.

In the past decade, immunotherapy with checkpoint inhibitors has revolutionized the field of oncology. Checkpoint inhibitors have been approved for several types of cancer and thousands of patients in Sweden now receive oncological immunotherapy annually. Immune-related side effects are common and can occur in almost any organ. These side effects are different from those that occur with traditional oncological treatments. The side effects are usually mild, but can be serious and even lethal. In a short time, health care providers have had to readjust to be able to handle these side effects. Early and correct diagnosis of immune-related side effects, proper management and a multidisciplinary approach is crucial. Here, we give an overview of the presentation, diagnosis and treatment of immune-related side effects, with emphasis of those occurring in gastrointestinal organs, lungs and kidneys.

Six Swedish hospitals (four university hospitals and two regional hospitals) participated in a pan-European quality assurance project regarding acute management of seizures. Three hundred consecutive emergency department (ED) visits for unprovoked epileptic seizure were assessed (50 per participating hospital). Patients were generally seen by a physician in a timely manner and the quality of the medical care was good. Eyewitness statements were sought in 72% of visits after a first seizure. There is room for improvement regarding documentation of exposure to alcohol or illicit drugs and information about driving of motor vehicles, which was only documented in a minority of cases. Only 56% of patients with known epilepsy had seen a neurologist in the year before their ED visit, indicating shortcomings in the provision of epilepsy care.

MM-ARG, the Swedish maternal maternity mortality group within SFOG (Swedish Society of Obstetrics and Gynecology) has, since 2008, surveyed and analysed maternal deaths in Sweden with the aim to find and give feedback on lessons learned to the medical professions.  MM-ARG consists of obstetricians, midwives and anesthetists and the strength of the working model is that the profession itself takes responsibility for the scrutiny.  A summary of 67 known maternal deaths from 2007‒2017 is presented. Direct causes of death are dominated by hypertensive disease/preeclampsia, followed by thromboembolic disease, sepsis and obstetric bleeding. Indirect death, where a known or unknown underlying disease is exacerbated by pregnancy, is dominated by cardiovascular disease. This review shows that the diagnostics and clinical management could be improved. Besides obstetrics/gynecology, maternal mortality affects other specialties and thus holds important lessons to many.

A working group representing the Swedish Society for Infectious Diseases, the Swedish Society for Anaesthesiology and Intensive Care, the Swedish Society for Emergency Medicine, and the Swedish Intensive Care Registry have reached consensus on how to adopt the new sepsis definition, Sepsis-3, in Sweden. The recommendation is to implement the new definitions and diagnostic criteria for sepsis and septic shock, but not the use of the new screening tool for sepsis, quick-SOFA, as it needs prospective validation and since it is not clear if quick-SOFA is more useful than the currently used general triage and early warning score systems. The group recommends the use of the sfollowing ICD-10 codes: R65.1 for sepsis and R57.2 for septic shock.

Personality disorders - description, definition and diagnosis Personality disorders are common, associated with a poor quality of life, functional limitations, worse health, and often remain undiagnosed. The aetiology is complex, with the influence of both genetic and environmental factors. A person centred approach based on empathic understanding is important for the diagnostic and therapeutic alliance. In case of conceivable comorbidity, the relative influence of all possible comorbid conditions shall be evaluated to avoid an excessive number of comorbid diagnoses. A detailed and carefully taken history is crucial for a valid diagnosis and for assessment of severity.

The main purpose was to study the prehospital and early intrahospital treatment of patients with traumatic brain injury (TBI) in the county of Västerbotten 2011-2012. In total, 162 patients were included. The main finding was that a large proportion of TBI patients were older men who fell in the same or from a different level. Older patients had higher mortality and had to wait longer for diagnostic imaging compared to younger patients. Furthermore, most patients were initially relatively unaffected by the injury and around 1/5 of the patients were transported to hospital by private transport. Finally, we observed that most patients were admitted to hospital and computer tomography scan of the head was performed within 4 hours.

The purpose of this study was to examine medical interns' experiences of being a female versus a male physician in various work situations. The population consisted of interns within Umeå health care district (n=38). Data was collected using a questionnaire with open-ended questions that were analysed with qualitative content analysis. Our results revealed that the participants experienced different expectations on female and male practitioners from both patients and staff. We also found distinct experiences of discrimination of female practitioners in areas such as patient and staff conduct, service, division of labour and employment. Our conclusion is that there is a need to promote gender equality within the health care system as well as to strengthen research and education regarding gender in medicine.

Hyperacusis is defined as unusual intolerance to ordinary environmental sounds, and is commonly reported in the general population and in association with a range of medical conditions. These include neurological deficits (e.g. migraine), psychiatric conditions (e.g. depression), and several ear, nose and throat diagnoses such as tinnitus, noise-induced hearing loss, and middle ear malfunctions. However, extreme sensitivity to noise has also been studied from a public health perspective, but with a focus on noise sensitivity in general. In this review a distinction is proposed between three different aspects of the experience of hyperacusis. The first is the sensitivity, with the pain sensations reported in association with sounds. The second is the annoyance, which can be unrelated to loudness, but still cause marked distress. The third aspect deals with the fear of being harmed by sounds, which promotes avoidance and the unmotivated use of ear protection. The natural course of hyperacusis is largely unknown and there are no published randomized outcome studies on the available treatment options for the condition. In this paper we propose that cognitive behavioral therapy, presented in a multidisciplinary setting, could be a useful treatment. This treatment includes relaxation methods, advice regarding sound, and gradual exposure to everyday sounds.

The variations in response to pharmacotherapy can in part be explained by genetic factors. Pharmacogenetics, a term coined in the 1950's, describes these relationships. Great technological advances in molecular biology and computational sciences, crowned by the sequencing of the human genome, have brought forth the current interest in pharmacogenetics. Continued technological developments may lead to the understanding of the molecular mechanisms behind complex diseases like cardiovascular disease, and holds the promise of individualized pharmacotherapy. The article gives a background to the field, with emphasis on antihypertensive therapy, and prospects for the future.