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Background: This ecological study of 219 regions in 11 European countries aimed to investigate the effect of the seemingly quasi-randomly assigned school winter holiday week on excess mortality associated with the COVID-19 pandemic during spring 2020. A secondary aim was to evaluate the impact of stringency and timing of the government responses to the early inflow of infected cases. Methods: Regional data on mortality week 14 – 23 in 2020 compared with the same period 2015 – 2019 were retrieved from Eurostat and national statistical agencies. Data on initial government responses were obtained from the Oxford COVID-19 Government Response Tracker. Variance-weighted least square regression was used to estimate the effect of winter holiday week and government responses with adjustment for population density and age distribution. Findings: Being a region with winter holiday exclusively in week 9 was in the adjusted analysis associated with 16 weekly excess deaths (95% CI 13 to 20) per million inhabitants, which corresponds to 38% of the excess mortality in these regions. A more stringent response implemented in week 11, corresponding to 10 additional units on the 0 – 100 ordinal scale, was associated with 20 fewer weekly deaths (95% CI 18 to 22) per million inhabitants. Interpretation: Winter holiday in week 9 was an amplifying event contributed importantly to the excess mortality observed in the study area during the spring 2020. Timely government response to the resulting early inflow of cases was associated with lower excess mortality. Funding: Swedish Research Council (Vetenskapsradet; grant no. 2019 – 00198). Declaration of Interests: The authors declare no conflicting interests. Ethics Approval Statement: The authors stated that this study was entirely based on aggregated data so no ethical approval was necessary.

Background Both age and comorbidity are established risk factors for death among those infected with COVID-19. Because they often co-exist, it is difficult to assess if age is a risk factor on its own. Methods We used administrative register data of the total Swedish population from 01/2015 until 07/2020. We stratified the population aged 70+ into three groups according to level of care (in care homes, with home care, and in independent living). Within these groups, we explored the level of excess mortality in 2020 by estimating expected mortality with Poisson regression and compared it to observed levels. We investigated if excess mortality has been of the same magnitude in the three groups, and if age constitutes a risk factor for death during the pandemic regardless of level of care. Findings Individuals living in care homes experienced the highest excess mortality (75- >100% in April, 25–50% in May, 0–25% in June, depending on age). Individuals with home care showed the second highest magnitude (30–60% in April, 15–40% in May, 0–25% in June), while individuals in independent living experienced excess primarily at the highest ages (5–50% in April, 5–50% in May, 0–25% in June). Although mortality rates increased, the age-pattern of mortality during the pandemic resembled the age-pattern observed in previous years. Interpretation We found stepwise elevated excess mortality by level of care during the first wave of the COVID-19 pandemic in Sweden, suggesting that level of frailty or comorbidities plays a more important role than age for COVID-19 associated deaths. Part of our findings are likely attributable to differences in exposure to the virus between individuals receiving formal care and those living independently, and not only different case fatality between the groups. Although age is a strong predictor for mortality, the relative effect of age on mortality was no different during the pandemic than before. We believe this is an important contribution to the discussion of the pandemic, its consequences, and which groups need the most protection. Funding This study was funded by the Swedish Research Council for Health, Working Life and Welfare (FORTE: grant 2016-07115).

Background Hip fracture is a common cause of disability and mortality among the elderly. Declining incidence trends have been observed in Sweden. Still, this condition remains a significant public health problem since Sweden has one of the highest incidences worldwide. Yet, no Swedish lifetime risk or survival trends have been presented. By examining how hip fracture incidence, post-fracture survival, as well as lifetime risk have developed between 1995 and 2010 in Sweden, this study aims to establish how the burden hip fractures pose on the elderly changed over time, in order to inform initiatives for improvements of their health. Material and Methods The entire Swedish population 60 years-old and above was followed between 1987 and 2010 in the National Patient Register and the Cause of Death Register. Annual age-specific hip fracture cumulative incidence was estimated using hospital admissions for hip fractures. Three-month and one-year survival after the first hip fracture were also estimated. Period life table was used to assess lifetime risk of hip fractures occurring from age 60 and above, and the expected mean age of the first hip fracture. Results The age-specific hip fracture incidence decreased between 1995 and 2010 in all ages up to 94 years, on average by 1% per year. The lifetime risk remained almost stable, between 9% and 11% for men, and between 18% and 20% for women. The expected mean age of a first hip fracture increased by 2.5 years for men and by 2.2 years for women. No improvements over time were observed for the 3-month survival for men, while for women a 1% decrease per year was observed. The 1-year survival slightly increased over time for men (0.4% per year) while no improvement was observed for women. Conclusions The age-specific hip fracture incidence has decreased over time. Yet the lifetime risk of a hip fracture has not decreased because life expectancy in the population has increased in parallel. Overall, survival after hip fracture has not improved.

Aims To investigate whether sleep disturbances and low psychological well-being are associated with an increased risk of autoimmune diabetes in adults (including LADA and type 1 diabetes) and type 2 diabetes. Methods We used data from the Norwegian HUNT Study ( n =53,394) and estimated the risk of developing autoimmune diabetes in adults ( n =138) and type 2 diabetes ( n =1895) between 1984 and 2008 in relation to baseline self-reported psychological well-being and sleep problems. Results Sleep disturbances and low psychological well-being were associated with an increased risk of autoimmune diabetes (hazard ratio 1.84, 95% confidence interval 1.10–3.09), primarily linked to poor sleep in men (1.83, 1.05–3.20) and low well-being in women (2.50, 1.03–6.54). Similar associations were seen with type 2 diabetes in relation to sleep problems (1.25, 1.08–1.44) in men and low well-being (1.34, 1.16–1.54), in both men and women. In autoimmune diabetes, these factors were associated with lower anti-GAD levels (177 vs. 306WHOunits/ml, p =0.04). Conclusions Our findings indicate that psychosocial factors influence the risk of autoimmune diabetes in adults, possibly through mechanisms related to insulin resistance. This supports the notion that the aetiology of autoimmune diabetes with adult onset in some respects is similar to that of type 2 diabetes.

Summary Background & aims Results of previous studies on tea consumption and incidence or prognosis of acute myocardial infarction (AMI) are conflicting. The aim of the present study was to examine the potential role of tea consumption in the previous 12 months in primary and secondary prevention of AMI. Methods We studied a total of 1340 individuals with a first non-fatal AMI and 2303 frequency matched control participants on age, gender and hospital catchment area including querying their tea consumption over the previous 12 months. The cohort of AMI cases was then followed for total and cardiac mortality and for non-fatal cardiovascular events with national registers over 8 years. Estimates of relative risks for a first AMI were based on odds ratios from unconditional logistic regression and Cox proportional hazards models were used to examine the prognostic importance of tea consumption in the cohort of cases. Results The prevalence of daily tea consumption was 20.5% among cases and 21.5% among controls. Tea consumption was associated with a lower risk for a first AMI with adjustment for matching criteria alone, with an odds ratio of 0.78 (95% confidence interval, 0.64–0.95) comparing those who consumed tea daily to those never consuming tea. However, in multivariable adjusted model there was no evidence for an association, the corresponding odds ratio was 1.08(0.86–1.36). There was also no association between tea consumption and cardiac mortality and non-fatal cardiovascular events, with a corresponding adjusted hazard ratio of 0.99(0.77–1.27). Conclusions In this epidemiological study, greater tea consumption in the previous year was associated with a lower risk of AMI. However, a clear association between tea consumption and the incidence or prognosis of AMI was not demonstrated, probably because of tea drinkers having a healthier lifestyle.

Background : There is continuing public and scientific interest in the possibility that exposure to radiofrequency (RF) electromagnetic fields (EMF) from mobile telephones or other wireless devices and applications might increase the risk of certain cancers or other diseases. The interest is amplified by the rapid world-wide penetration of such technologies. The evidence from epidemiological studies published to date have not been consistent and, in particular, further studies are required to identify whether longer term (well beyond 10 years) RF exposure might pose some health risk. Methods : The “Cosmos” study described here is a large prospective cohort study of mobile telephone users (ongoing recruitment of 250,000 men and women aged 18+ years in five European countries – Denmark, Finland, Sweden, The Netherlands, UK) who will be followed up for 25+ years. Information on mobile telephone use is collected prospectively through questionnaires and objective traffic data from network operators. Associations with disease risks will be studied by linking cohort members to existing disease registries, while changes in symptoms such as headache and sleep quality and of general well-being are assessed by baseline and follow-up questionnaires. Conclusions : A prospective cohort study conducted with appropriate diligence and a sufficient sample size, overcomes many of the shortcomings of previous studies. Its major advantages are exposure assessment prior to the diagnosis of disease, the prospective collection of objective exposure information, long-term follow-up of multiple health outcomes, and the flexibility to investigate future changes in technologies or new research questions.

Background Populations are ageing and survival from many diseases including stroke has improved substantially over the past decades. Even if stroke incidence is declining as well, at least in the population 65 years and above, there is concern that the burden of stroke will increase in the coming decades, when the population grow larger and older. However, few studies have explored how incidence, recurrence and prevalence have developed in parallel with population ageing. It needs to be further investigated whether or not the decline in incidence is large enough to compensate for the ageing of the population, and, how the incidence of recurrent stroke has developed when survival from the first stroke has improved, before we can make any clear statements of the future burden of stroke. Aim and setting In this population-based study based on Swedish register data we explore how the rate of recurrent events of stroke has developed in relation to the rate of first events. Further, how the prevalence of stroke has developed when survival has improved and the population has become older, and, finally, how the absolute number of stroke events developed. Trends are estimated for the period 1994 to 2014. Based on the findings, we discuss the future disease burden of stroke. Results We found clear declines in both incidence of first as well as recurrent stroke in Sweden between 1994 and 2014 for all ages between 60 and up to 90. For ages above 90 years the trends have remained stable. Despite improved survival of stroke the prevalence has not increased but decreased during the period, both as a proportion and as absolute number of events. Conclusion Based on the development the past 15 years in Sweden in the population 65 and older we do not find support for an increasing burden of stroke, despite an ageing population.

Existing studies of diet and adult brain tumors have been limited by small numbers in histology-specific subgroups. Dietary data from an international collaborative case-control study on adult brain tumors were used to evaluate associations between histology-specific risk and consumption of specific food groups.The study included 1548 cases diagnosed between 1984 and 1991 and 2486 control subjects from 8 study centers in 6 countries. Of the 1548 cases, 1185 were gliomas, 332 were meningiomas, and 31 were other tumor types. Dietary consumption was measured as average grams per day.We found inverse associations between some vegetable groups and glioma risk, the strongest for yellow-orange vegetables (odds ratio [OR], 0.7, 95% confidence interval [CI], 0.5-0.9 for the 4th vs. 1st quartile of consumption, p for trend0.001), and the association was limited to specific glioma subtypes. There was no association with cured meat. Non-cured meat was associated with a modest increase in glioma risk (OR, 1.3; 95% CI, 1.0-1.7 for 4th quartile vs. 1st quartile, p for trend=0.01). We also found positive associations between egg, grain, and citrus fruit consumption and glioma but not meningioma risk.Our study suggests that selected dietary food groups may be associated with adult gliomas and its subtypes but not meningiomas.

Cohort studies have suggested little effect of coffee consumption on risk of acute myocardial infarction. The effect of coffee consumption on prognosis after myocardial infarction is uncertain.In a population-based inception cohort study, we followed 1,369 patients hospitalized with a confirmed first acute myocardial infarction between 1992 and 1994 in Stockholm County, Sweden, as part of the Stockholm Heart Epidemiology Program. Participants reported usual coffee consumption over the preceding year with a standardized questionnaire distributed during hospitalization and underwent a health examination 3 months after discharge. Participants were followed for hospitalizations and mortality with national registers through November 2001.A total of 289 patients died during follow-up. Compared with intake of1 cup per day, coffee consumption was inversely associated with mortality, with multivariable-adjusted hazard ratios of 0.68 (95% confidence interval [CI] 0.45-1.02) for 1 to3 cups, 0.56 (95% CI 0.37-0.85) for 3 to5 cups, 0.52 (95% CI 0.34-0.83) for 5 to7 cups, and 0.58 (95% CI 0.34-0.98) foror =7 cups per day (P trend .06). Coffee intake was not associated with hospitalization for congestive heart failure or stroke. Candidate lipid and inflammatory biomarkers did not appear to account for the observed inverse association with mortality.Self-reported coffee consumption at the time of hospitalization for myocardial infarction was inversely associated with subsequent postinfarction mortality in this population with broad coffee intake. If confirmed in other settings, identification of relevant mechanisms could lead to an improved prognosis for survivors of acute myocardial infarction.

To find similarities that may possibly indicate novel mutations, we performed comparative genomic hybridization (CGH) analysis following degenerate oligonucleotide primed polymerase chain reaction (PCR) for DNA obtained from unique material of breast cancer that developed in monozygotic twin-pairs. Polymerase chain reaction amplification was successful in 12 samples for 11 patients, including 3 pairs. Six samples exhibited DNA copy number changes. Gains (76%) were more frequent than losses (24%). Gains or high-level amplifications in 8q were present in all but 1 of the abnormal cases. Frequent gains were detected with a minimal common overlapping region at 5p (4 cases), at 1q25-qter (3 cases), and at 20q12-qter (2 cases). The most frequent loss, detected in half of the abnormal cases, was at 1p32-pter. One twin-pair showed similar changes in 4 chromosomal locations involving loss of 1p32-pter and gains in 1q25-qter, 5, and 8q.

Upon request of the European Commission, the Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) has updated the previous opinion on "Possible effects of Electromagnetic Fields (EMF), Radio Frequency Fields (RF) and Microwave Radiation on human health" by the Scientific Committee on Toxicity, Ecotoxicity and the Environment (CSTEE) from 2001,2 with respect to whether or not exposure to electromagnetic fields (EMF) is a cause of disease or other health effects. The opinion is primarily based on scientific articles, published in English language peerreviewed scientific journals. Only studies that are considered relevant for the task are cited and commented upon in the section Scientific Rationale in the full text of the opinion.3 The opinion is divided into frequency (f) bands, namely: radio frequency (RF) (100 kHz < f

The aim of the study was to investigate the importance of diagnostic dental radiography and amalgam fillings as risk factors for tumours of the central nervous system (CNS). This population-based case-control study included subjects aged 25-74 years, living in the catchment area of the Neurosurgery Department of Uppsala University Hospital in Sweden. A total of 192 cases of glioma, 99 cases of meningioma and 42 cases of acoustic neurinoma were identified between 1987 and 1990. A control group of 343 subjects was matched on age, gender and parish. Information about dental exposure was obtained by a self-administered questionnaire and from dental records. For those who had a dental radiography at least once a year after age 25 years, a relative risk of 2.1 (95% confidence interval (CI) 1.0-4.3) was seen for meningioma, while for other subgroups of CNS tumours the relative risk was close to unity. No association was observed between the number of amalgam fillings and CNS tumours. In conclusion, there was no clear evidence that dental radiography or amalgam fillings is related to the development of tumours of the CNS.

The present study is an analysis of the mortality among a cohort of male chemists who graduated during the years 1930 to 1959. This cohort was followed-up until the end of 1977. The chemists were compared in respect of mortality with the general male population in Sweden and with a similar cohort of male architects, who graduated from the same school during the same period. It was found that both the chemists and the architects had a total mortality that was lower than that of the general male population. As regards cancer mortality, the chemists had a higher mortality than both the general population and the architects. This high cancer mortality was mainly due to an excess mortality of tumors in the lymphatic and hematopoetic systems and of brain tumors.

A tenfold increased risk for oesophageal cancer, more often localised in the upper than in the lower third of the oesophagus, was found in a 13-year follow-up of vulcanisation workers. The risk for laryngeal cancer was also significantly raised. The study was based on a record linkage between the 1960 census and the cancer registry in Sweden. The rise in oesophageal cancer cannot be explained by alcohol consumption or other factors previously known to be associated with this disease.

A study of inflammatory bowel diseases and left-handedness was published in this Journal by Seariman and Fugagli (1987). We reanalysed the data and found that left-handedness was associated with relative risk of 2.5 for Crohn's disease and 2.9 for ulcerative colitis.