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Introduction: The Swedish Register of Palliative Care (SRPC) is a national quality register that collects data about end-of-life care from healthcare providers that care for dying patients. Data are used for quality control and research. Data are mainly collected with an end-of-life questionnaire (ELQ), which is completed by healthcare staff after the death of a patient. A previous validity assessment of the ELQ showed insufficient validity in some items including symptom relief. The aim of this study was to examine the validity of the revised ELQ. Materials and methods: Data from 100 consecutive patients’ medical records at two specialised palliative care units were used to complete new ELQs, which were then compared to the ELQ registrations from the SRPC for the same patients. The level of agreement was calculated for each ELQ item. To account for the possibility of the agreement occurring by chance, Cohen’s kappa was calculated for suitable items. To examine the extent of registration mistakes when transferring the paper form to the web, the original paper versions of the ELQ filled out at the units were compared to data from the ELQs reported to the SRPC. Results: Level of agreement between ELQ registrations from the SRPC and the new ELQs based on the medical records varied between 0.55 and 1.00, where 24 items showed level of agreement above 0.80 and 9 items showed level of agreement below 0.80. Cohen’s kappa with 95% confidence intervals was calculated for 24 items. The kappa values showed that two items had poor agreement, four fair agreement, 11 moderate agreement, five good agreement and two very good agreement. The level of agreement varied between 0.93 and 1.00 when comparing the ELQ registrations in the SRPC and the paper forms. Conclusion: The revised ELQ contains more items with high levels of agreement between registrations in the SRPC and notes in the patients’ medical records when compared to the previous version. Validating issues around symptom assessment remains a challenge in our model of quality assessment. [ABSTRACT FROM AUTHOR]

Polyarthritis and rash caused by Sindbis virus (SINV), was first recognised in northern Europe about 50 years ago and is known as Ockelbo disease in Sweden and Pogosta disease in Finland. This mosquito-borne virus occurs mainly in tropical and sub-tropical countries, and in northern Europe it is suggested to cause regularly reoccurring outbreaks. Here a seven-year cycle of SINV outbreaks has been referred to in scientific papers, although the hypothesis is based solely on reported human cases. In the search for a more objective outbreak signal, we evaluated mosquito abundance and SINV prevalence in vector mosquitoes from an endemic area in central Sweden. Vector mosquitoes collected in the River Dalälven floodplains during the years before, during, and after the hypothesised 2002 outbreak year were assayed for virus on cell culture. Obtained isolates were partially sequenced, and the nucleotide sequences analysed using Bayesian maximum clade credibility and median joining network analysis. Only one SINV strain was recovered in 2001, and 4 strains in 2003, while 15 strains were recovered in 2002 with significantly increased infection rates in both the enzootic and the bridge-vectors. In 2002, the Maximum Likelihood Estimated infection rates were 10.0/1000 in the enzootic vectors Culex torrentium/pipiens, and 0.62/1000 in the bridge-vector Aedes cinereus, compared to 4.9/1000 and 0.0/1000 in 2001 and 0.0/1000 and 0.32/1000 in 2003 Sequence analysis showed that all isolates belonged to the SINV genotype I (SINV-I). The genetic analysis revealed local maintenance of four SINV-I clades in the River Dalälven floodplains over the years. Our findings suggest that increased SINV-I prevalence in vector mosquitoes constitutes the most valuable outbreak marker for further scrutinising the hypothesized seven-year cycle of SINV-I outbreaks and the mechanisms behind. [ABSTRACT FROM AUTHOR]

Self-rated health (SRH) accounts comprehensively for many health domains. The aim of this paper was to investigate time trends and associations between age-comparative self-rated health and some known determinants in a general population aged 24–34 years. Population-based cross-sectional surveys were performed in 1990, 1994, 1999, 2004, 2009 and 2014 in Northern Sweden. Out of 3500 invited persons, 1811 responded. Comparative SRH was measured on a three-grade ordinal scale by the question: “How would you assess your general health condition compared to persons of your own age?” with the alternatives “better/worse/similar”. Over the period 1990 to 2014, the percentage of women rating comparative SRH as “worse” increased steadily, from 8.5% in 1990 reaching 20% in 2014 (p for trend 0.007). Among men, this pattern was almost the opposite, with increasing proportions rating “better” (p for trend <0.000). Time trends for physical activity in leisure time; length of education; Body Mass Index; anxiety; depressive emotions and satisfaction with economy showed a similar pattern for men and women. Factors that might contribute to the development of time trends for comparative SRH are discussed. [ABSTRACT FROM AUTHOR]

Background: In light of the opioid epidemic in the United States, there is growing concern about the use of opioids in Sweden as it may lead to misuse and overuse and, in turn, severe public health problems. However, little is known about the distribution of opioid use across different demographic and socioeconomic dimensions in the Swedish general population. Therefore, we applied an intersectional Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), to obtain an improved mapping of the risk heterogeneity of and socioeconomic inequalities in opioid prescription receipt. Methods and findings: Using data from 6,846,106 residents in Sweden aged 18 and above, we constructed 72 intersectional strata from combinations of gender, age, income, cohabitation status, and presence or absence of psychological distress. We modelled the absolute risk (AR) of opioid prescription receipt in a series of multilevel logistic regression models distinguishing between additive and interaction effects. By means of the Variance Partitioning Coefficient (VPC) and the area under the receiver operating characteristic curve (AUC), we quantified the discriminatory accuracy (DA) of the intersectional strata for discerning those who received opioid prescriptions from those who did not. The AR of opioid prescription receipt ranged from 2.77% (95% CI 2.69–2.86) among low-income men aged 18–34, living alone, without psychological distress, to 28.25% (95% CI 27.95–28.56) among medium-income women aged 65 and older, living alone, with psychological distress. In a model that conflated both additive and interaction effects, the intersectional strata had a fair DA for discerning opioid users from non-users (VPC = 13.2%, AUC = 0.68). However, in the model that decomposed total effects into additive and interaction effects, the VPC was very low (0.42%) indicating the existence of small interaction effects for a number of the intersectional strata. Conclusions: The intersectional MAIHDA approach aligns with the aims of precision public health, through improving the evidence base for health policy by increasing understanding of both health inequalities and individual heterogeneity. This approach is particularly relevant for socioeconomically conditioned outcomes such as opioid prescription receipt. We have identified intersections of social position within the Swedish population at greater risk for opioid prescription receipt. [ABSTRACT FROM AUTHOR]

How pervasive is labor market discrimination against immigrants and what options do policymakers and migrants have to reduce it? To answer these questions, we conducted a field experiment on employer discrimination in Sweden. Going beyond existing work, we test for a large range of applicant characteristics using a factorial design. We examine whether migrants can affect their employment chances—by adopting citizenship, acquiring work experience, or signaling religious practice—or whether fixed traits such as country of birth or gender are more consequential. We find little systematic evidence that immigrants can do much to reduce discrimination. Rather, ethnic hierarchies are critical: callback rates decline precipitously with the degree of ethno-cultural distance, leaving Iraqis and Somalis, especially if they are male, with much reduced employment chances. These findings highlight that immigrants have few tools at their disposal to escape ethnic penalties and that efforts to reduce discrimination must address employer prejudice. [ABSTRACT FROM AUTHOR]

Introduction: The rapid rise in trade and use of NPS and the lack of information concerning their potential toxicity pose serious challenges to public health authorities across the world. Policy measures towards NPS taken so far have a special focus on their legal status, while the implementation of a public health strategy seems to be still missing. The aim of this study is to perform a general assessment of NPS-related policy (including regulatory measures and public health strategies) implemented by six European countries: Portugal, the Netherlands, Czech Republic, Poland, the United Kingdom and Sweden. Methods: Six EU countries were included in this scoping review study. Drug policies (including legal responses and public health strategies) were analysed. UNODC drug policy classification system was used as a benchmark, while path dependency approach was used for data analysis; a net of inter-dependencies between international, EU and national policies was highlighted. Results and discussion: The countries included in this study can be placed in a wide spectrum according to their formulation of drug policy, from Portugal and the UK that have specific legal responses to NPS but have differently focused on harm reduction strategies at one end, to Sweden whose drug-free society goal is not translated into a specific regulation of NPS at the other end. Conclusion: The findings of the study reveal limited development towards harmonisation of national drug policies–particularly with regard to NPS. To tackle the challenge presented by NPS, EU Member states have formulated legislation and public health strategies independently. National approaches to NPS are therefore in line with their already existing drug policies, reflecting cultural values towards substance abuse and national political interests, while the homogenization at an international level has so far mostly been focused on law enforcement and drugs use preventive strategies. [ABSTRACT FROM AUTHOR]

Previous research has reported evidence of intergenerational transmissions of neighbourhood status and social and economic outcomes later in life. Research also shows neighbourhood effects on adult incomes of both childhood and adult neighbourhood experiences. However, these estimates of neighbourhood effects may be biased because confounding factors originating from the childhood family context. It is likely that part of the neighbourhood effects observed for adults, are actually lingering effects of the family in which someone grew up. This study uses a sibling design to disentangle family and neighbourhood effects on income, with contextual sibling pairs used as a control group. The sibling design helps us to separate the effects of childhood family and neighbourhood context from adult neighbourhood experiences. Using data from Swedish population registers, including the full Swedish population, we show that the neighbourhood effect on income from both childhood and adult neighbourhood experiences, is biased upwards by the influence of the childhood family context. Ultimately, we conclude that there is a neighbourhood effect on income from adult neighbourhood experiences, but that the childhood neighbourhood effect is actually a childhood family context effect. We find that there is a long lasting effect of the family context on income later in life, and that this effect is strong regardless the individual neighbourhood pathway later in life. [ABSTRACT FROM AUTHOR]

The high prevalence of intimate partner violence against women (IPVAW) in countries with high levels of gender equality has been defined as the “Nordic paradox”. In this study we compared physical and sexual IPVAW prevalence data in two countries exemplifying the Nordic paradox: Sweden (N = 1483) and Spain (N = 1447). Data was drawn from the European Union Agency for Fundamental Rights Survey on violence against women. To ascertain whether differences between these two countries reflect true differences in IPVAW prevalence, and to rule out the possibility of measurement bias, we conducted a set of analyses to ensure measurement equivalence, a precondition for appropriate and valid cross-cultural comparisons. Results showed that in both countries items were measuring two separate constructs, physical and sexual IPVAW, and that these factors had high internal consistency and adequate validity. Measurement equivalence analyses (i.e., differential item functioning, and multigroup confirmatory factor analysis) supported the comparability of data across countries. Latent means comparisons between the Spanish and the Swedish samples showed that scores on both the physical and sexual IPVAW factors were significantly higher in Sweden than in Spain. The effect sizes of these differences were large: 89.1% of the Swedish sample had higher values in the physical IPVAW factor than the Spanish average, and this percentage was 99.4% for the sexual IPVAW factor as compared to the Spanish average. In terms of probability of superiority, there was an 80.7% and 96.1% probability that a Swedish woman would score higher than a Spanish woman in the physical and the sexual IPVAW factors, respectively. Our results showed that the higher prevalence of physical and sexual IPVAW in Sweden than in Spain reflects actual differences and are not the result of measurement bias, supporting the idea of the Nordic paradox. [ABSTRACT FROM AUTHOR]

The aim of this article is to provide a detailed description of the SWEDE-I cohort, a prospective study designed to investigate work-related risk factors for transmission of viral infections. A total of 2,237 subjects aged 25–64, working and residing in Eskilstuna (central Sweden), enrolled in the study in August 2011. They filled in five detailed questionnaires including information on demography, personal characteristics, work tasks, work place, contact patterns, family structure, health status, physical activity and diet. During a 9-month follow-up period, the participants self-reported—via internet or telephone—any onset of fever, upper respiratory tract infection, or gastroenteritis immediately as they occurred. For each disease episode, the participants were asked to submit a self-sampled nasal swab for viral diagnosis. In total, 1,733 disease reports were recorded and 1,843 nasal swabs were received, of which 48% tested positive for one or more of 14 analyzed viruses. The cohort has been used to date to study diet, sleep and physical activity as determinants for upper respiratory tract infections. Analyses of contact patterns and occupational circumstances as risk factors for the transmission of infections are ongoing. The SWEDE-I study should be seen as a first pioneering effort to provide new insight in the epidemiology and prevention of viral infections. Potential joint collaborations can be discussed with the principal investigators. [ABSTRACT FROM AUTHOR]

Introduction: The reported prevalence rate of violence varies considerably between studies, even when conducted in similar populations. The reasons for this are largely unknown. This article considers the effects of nonresponse bias on the reported prevalence rate of interpersonal violence. We also single out violence perpetrated in intimate relationships and compare our results to previous Swedish studies. The aim was to explore the reasons for the large discrepancies in the prevalence rates found between studies. Material and method: This is a cross sectional study of a random population sample. The NorVold Abuse Questionnaire (NorAQ), covering emotional, physical, and sexual violence, was answered by 754 men (response rate 35%) and 749 women (response rate 38%). Nonresponse bias was investigated in six ways, e.g., findings were replicated in two samples and we explored non-responders’ reasons for declining participation. Also, the prevalence rate of intimate partner violence was compared to four previous studies conducted in Sweden, considering the methodological differences. Results and discussion: The only evidence of nonresponse bias found was for differences between the sample and the background population concerning the sociodemographic characteristics. However, the magnitude of that effect is bleak in comparison with the large discrepancies found in the prevalence rates between studies concerning intimate partner violence, e.g., emotional violence women: 11–41% and men: 4–37%; sexual and/or physical violence women: 12–27% and men: 2–21%. Some of the reasons behind these differences were obvious and pertained to differences in the definition and operationalization of violence. However, a considerable proportion of the difference could not easily be accounted for. Conclusion: It is not reasonable that so little is known about the large discrepancies in the prevalence rate for what is supposedly the same concept, i.e., intimate partner violence. This study is a call for more empirical research on methods to investigate violence. [ABSTRACT FROM AUTHOR]

Background: The objective of the present study was to evaluate effectiveness, complications and cost-effectiveness of any surgical or non-surgical treatment for radius or ulna fractures in elderly patients. Secondary objectives were to analyze present treatment traditions of distal radius fractures (DRF) in Sweden and to calculate resource usage for its treatment. Methods and findings: The assessment contains a systematic review of clinical and health economic studies comparing treatment options for radius or ulna fractures. The results regarding the effectiveness of the treatments are summarized in meta-analyses. In addition, the assessment contains a cost analysis for different treatment options commonly used for DRF care, and an analysis of registry data on the incidence and treatment of DRF. In total 31 randomized controlled trials were included in meta-analyses. When comparing functional outcome for plate fixation versus non-surgical treatment for DRF, there were no clinically important differences at one-year follow-up (mean difference [MD], -3.29, 95% CI, -7.03; 0.44). Similar results were found when comparing plating and percutaneous methods with respect to functional outcome (standardized mean difference [SMD], -0.07, 95% CI, -0.21; 0.07) and grip strength (MD, -3.47, 95% CI, -11.21; 4.28). There were no differences for minor complications, (risk difference [RD], -0.01, 95% CI, -0.07; 0.05) whereas major complications were less common for the percutaneous group, (RD, 0.02, 95% CI, 0.02; 0.03). Given the low number of studies, the evidence above was rated as moderate certainty. The cost for plate fixation versus plaster cast was estimated to 1698 compared to 137 US dollars. For DRF, plate fixation increased in Sweden between 2005 and 2013, and was the most common surgical method in 2013. Conclusions: Surgical treatment of moderately displaced distal radius fractures in elderly patients offers no clear benefit compared to non-surgical treatment. Plating procedures have become more common during the second millennium and involve higher costs and higher risk of major complications than percutaneous options. [ABSTRACT FROM AUTHOR]

Objectives: Cultural behaviors are theoretically linked to future life chances but empirical literature is scant. We use heavy metal as an example of cultural identities due to its high salience. We first assess the social morphology of metal preferences in terms of socio-economic and socio-structural positions, and then asses the short term outcomes of being a heavy metal fan on education and health behaviors. Methods: The analysis was based on a representative random stratified sample of 23-year-olds of native Swedish, Iranian, and Yugoslavian background in contemporary Sweden (n = 2,232). Linear probability models with multiple imputation were used to calculate preferences for metal music and the association of metal preferences with subsequent outcomes. Results: In contrast to many prior studies, we find that the preference for heavy metal is not structured by social background or neighborhood context in Swedish adolescents. Poor school grades tend to make them more prone to like metal, but net of previous grades, social background, personality, personal network, and neighborhood characteristics, metal fans have substantially lower transition rates into higher education. Discussion: The study suggest that metal preferences appears rather unsystematically with few important predictors, and is linked to lower education attainments in the short run. While these findings are specific to heavy metal as a certain type of culture and to Swedish adolescents, we suggest that they are indicative of how cultural consumption may play a role for life-chances. [ABSTRACT FROM AUTHOR]

Objectives: Precarious employment (PE) is a social determinant of poor health of workers. However, this population usually lack a sampling frame, making it challenging to identify the characteristics of this group. Web-based respondent driven sampling (webRDS) recruits individuals online through the social network and can provide population estimates. This study aims to assess the performance of webRDS in a population of workers with PE. Method: WebRDS was used for recruitment and data collection in the PRecarious EMployment In Stockholm (PREMIS) study. Cross-sectional questionnaire data was collected between November 2016 and May 2017. Eligible participants were living and/or working in Stockholm County, 18–65 years old, had a personal identification number and were currently employed. WebRDS performance was assessed by the total sample size, length of recruitment chains, sample composition, sample proportions and estimated RDSII population proportions with confidence intervals. Results: The webRDS process resulted in a sample of 358 recruits and a total sample of 415 participants, recruited over 1–15 waves. Of the participating seeds and recruits, 60% and 48%, respectively, successfully recruited at least one peer. The sample composition stabilized for all variables assessed. The sample proportions and RDSII estimates differed by 1–8% and the confidence intervals included the sample proportions for all variables except one. Conclusions: WebRDS successfully recruited a sufficient sample of workers with precarious employment from which population estimates could be made. Future studies should consider implementing webRDS on a national level in order to further study this population. [ABSTRACT FROM AUTHOR]

It is important to estimate the duration-distance relation in cycle commuting in the general population since this enables analyses of the potential for various public health outcomes. Therefore, the aim is to estimate this relation in the Swedish adult population of 2015. For that purpose, the first step was to establishit for adult male and female cycle commuters in Greater Stockholm, Sweden. Whether or not the slopes of these relations needed to be altered in order to make them representative of the general population was evaluated by comparing the levels of maximal oxygen uptake in samples of commuter cyclists and the population. The measure used was the maximal oxygen uptake divided by both the body weight and a cycle weight of 18.5 kg. The body weights in the population samples were adjusted to mirror relevant levels in 2015. Age adjustments for the duration–distance relations were calculated on the basis of the maximal oxygen uptake in the population samples aged 20–65 years. The duration-distance relations of the cycle commuters were downscaled by about 24–28% to mirror levels in the general population. The empirical formula for the distance (D, km) was based on duration (T, minutes) · speed (km/min) · a correction factor from cycle commuter to the general population · age adjustment (A, years). For the males in the general population the formula was: D = T · 20.76 km/h · 0.719 · (1.676–0.0147 · A). For females, the formula was: D = T · 16.14 km/h · 0.763 · (1.604–0.0129 · A). These formulas, combined with distributions of route distances between home and work in the population, enable realistic evaluations of the potential for different public health outcomes through cycle commuting. [ABSTRACT FROM AUTHOR]

In 2012, human papillomavirus (HPV) vaccination was introduced free of charge in the Swedish national school-based vaccination programme for 10-12-year-old girls, and as catch-up vaccination for young women. In Sweden, there is an ongoing discussion about including boys in the national vaccination programme. Few studies are undertaken about adolescents’ knowledge, beliefs and HPV vaccination status in relation to socioeconomic status and sexual experience. Thus, the aim was to examine HPV catch-up vaccination status in adolescents in relation to 1) socioeconomic factors, 2) beliefs and knowledge about HPV prevention, and 3) sexual behaviour. The Health Belief Model was used as a theoretical framework. Upper secondary school students (n = 832) aged 16, randomly chosen from a larger sample, were invited to participate in conjunction with the general health interview with the school nurse. A total of 751/832 (90.3%), girls (n = 391, 52%) and boys (n = 360, 48%) completed the questionnaire. HPV vaccination was associated with ethnicity and the mothers’ education level; i.e. girls with a non-European background and girls with a less educated mother were less likely to have received the vaccine (p<0.01 and p = 0.04 respectively). Vaccinated girls perceived HPV infection as more severe (p = 0.01), had more insight into women’s susceptibility to the infection (p = 0.02), perceived more benefits of the vaccine as protection against cervical cancer (p<0.01) and had a higher intention to engage in HPV-preventive behaviour (p = 0.01). Furthermore, boys and girls were almost equally sexually experienced, although fewer girls had used condom during first intercourse with their latest partner (p = 0.03). Finally, HPV vaccinated girls were less likely to have unprotected sex (p<0.01). In summary, catch-up HPV vaccination among young girls was associated with a European background and high maternal education level, as well as more favourable beliefs towards HPV prevention and less sexual risk-taking. Further preventive measures should therefore be directed at the migrant population. [ABSTRACT FROM AUTHOR]

Objective: In Sweden, previous favourable trends in blood cholesterol levels have recently levelled off or even increased in some age groups since 2003, potentially reflecting changing fashions and attitudes towards dietary saturated fatty acids (SFA). We aimed to examine the potential effect of different SFA intake on future coronary heart disease (CHD) mortality in 2025. Methods: We compared the effect on future CHD mortality of two different scenarios for fat intake a) daily SFA intake decreasing to 10 energy percent (E%), and b) daily SFA intake rising to 20 E%. We assumed that there would be moderate improvements in smoking (5%), salt intake (1g/day) and physical inactivity (5% decrease) to continue recent, positive trends. Results: In the baseline scenario which assumed that recent mortality declines continue, approximately 5,975 CHD deaths might occur in year 2025. Anticipated improvements in smoking, dietary salt intake and physical activity, would result in some 380 (-6.4%) fewer deaths (235 in men and 145 in women). In combination with a mean SFA daily intake of 10 E%, a total of 810 (-14%) fewer deaths would occur in 2025 (535 in men and 275 in women). If the overall consumption of SFA rose to 20 E%, the expected mortality decline would be wiped out and approximately 20 (0.3%) additional deaths might occur. Conclusion: CHD mortality may increase as a result of unfavourable trends in diets rich in saturated fats resulting in increases in blood cholesterol levels. These could cancel out the favourable trends in salt intake, smoking and physical activity. [ABSTRACT FROM AUTHOR]

Background: In 2006, a study investigating knowledge and attitudes regarding antibiotic use and resistance in Sweden, indicated high level of knowledge but also areas in need of improvement. Objective: (i) To provide an update on the knowledge and attitudes to antibiotic use and resistance of the Swedish population, and (ii) to identify which groups within the population are in particular need of improved knowledge or attitudes. Methods: A questionnaire was sent by post in 2013 to 2,500 randomly-selected individuals aged 18–74, living in Sweden. Latent class analyses were conducted to group respondents based on their responses. The association between socio-demographic characteristics and the probability of belonging to each latent class was assessed. Results: The response rate was 57%. Ninety-four per cent of the responders knew that bacteria could become resistant to antibiotics and the majority answered correctly to the questions regarding antibiotic resistance development. The respondents expressed confidence in doctors who decided not to prescribe antibiotics. Three latent classes related to ‘knowledge regarding antibiotic use and resistance’, two regarding ‘attitudes towards antibiotic accessibility and infection prevention’ and three regarding ‘attitudes towards antibiotic use and effects’ were revealed. Men, younger and more educated people were more knowledgeable but males had a less restrictive attitude. Respondents with high levels of knowledge on antibiotics were more likely to have appropriate restrictive attitudes to antibiotics. Conclusion: Knowledge on antibiotic use and resistance is maintained high and has improved in Sweden compared to 2006. People with lower education and elderly are especially in need of improved knowledge about antibiotic use and resistance. [ABSTRACT FROM AUTHOR]

Aim: Describe polio patients visiting a polio clinic in Sweden, a country where vaccination was introduced in 1957. Design: A consecutive cohort study. Patients: Prior polio patients. Methods: All patients (n = 865) visiting the polio clinic at Sahlgrenska University Hospital, Gothenburg Sweden, between 1994 and 2012 were included in this study. Data at first visit regarding patient characteristics, polio classification, data of electromyography, origin, assistive devices and gait speed as well as muscle strength were collected for these patients. Twenty-three patients were excluded because no polio diagnosis could be established. A total of 842 patients with confirmed polio remained in the study. Results: More than twenty percent of the patients were from countries outside the Nordic region and considerably younger than those from the Nordic region. The majority of the emigrants were from Asia and Africa followed by Europe (outside the Nordic region). Of all patients included ninety-seven percent (n = 817) had polio in the lower extremity and almost 53% (n = 444) had polio in the upper extremity while 28% (n = 238) had polio in the trunk, according to clinical classification of polio. Compared with a sample of the normal population, the polio patients walked 61–71% slower, and were 53–77% weaker in muscle strength of the knee and foot as well as grip strength. Conclusion: The younger patients with polio emigrating from countries with different cultures may lead to a challenge for the multi professional teams working with post-polio rehabilitation and are of importance when planning for the care of polio patients the coming years. [ABSTRACT FROM AUTHOR]

Background: The Swedish school-based vaccination programme offers HPV vaccine to girls born ≥1999 in 5-6th grade. In 2012, all counties introduced free-of-charge catch-up vaccination campaigns targeting girls born 1993–1998. Varying vaccine uptake in the catch-up group by December 2012 suggested that some implementation strategies were more successful than others. In order to inform future vaccination campaigns, we assessed the impact of different implementation strategies on the county-level catch-up vaccine uptake. Methods: We conducted an ecological study including all Swedish counties (n = 21), asking regional health offices about the information channels they used and where vaccination of the catch-up target group took place in their counties. The uptake of ≥1 dose by 30 September 2014 was estimated using data from the voluntary national vaccination register. We investigated associations between counties’ catch-up vaccine uptake, information channels and vaccination settings by calculating incidence rate ratios (IRR) and 95% confidence intervals (CI), using negative binomial regression models. Results: County level catch-up vaccine uptake varied between 49–84%. All counties offered vaccination through primary health care settings. Apart from this eight (34%) also offered the vaccine in some of their schools, four (19%) in all their schools, and two (10%) in other health care centres. The information channels most frequently used were: information at the national on-line health care consulting web-page (100%), letter/invitations (90%), and advertisement (81%). Counties offering vaccination to girls in all schools and counties offering vaccination in some of their schools, reached higher vaccine uptake compared to counties not offering vaccination in any of their schools (all schools adjusted IRR: 1.3, 95% CI: 1.1–1.5, some schools adjusted IRR: 1.2, 95% CI: 1.1–1.3). Conclusion: Counties offering HPV vaccination to catch-up groups in schools reached the highest vaccine uptake. No information channel explained differences in county-level vaccine uptake. Our findings suggest that catch-up vaccination outside the national vaccination program can reach a high uptake at the population level if it is implemented primarily with an organized delivery (e.g. in schools). [ABSTRACT FROM AUTHOR]

Background: In late 2007, some Swedish County Councils started 7-valent pneumococcal conjugate vaccine (PCV7) implementation for children, and PCV7 was included in the national immunization program in 2009. By 2010, both PCV10 and PCV13 were licensed, and the selection of vaccine was subject to County Councils tenders. This study investigated the impact of the order of PCV introduction into vaccination programs on the incidence of all-cause pneumonia hospitalizations in children <2 years-old. Methods: Using population-based data from the publicly available National Inpatient Registry, the incidence of inpatient pneumonia (ICD-10 J12-J18) hospitalizations by County Councils among children <2 years old was identified between 1998 and 2012. Incidence rate ratios (IRR; 95% CI) were calculated during the nationwide implementation of PCV7 and then between County Councils, as based on the higher-valent vaccine chosen for a program. Results: There was a lower risk of all-cause pneumonia hospitalization among <2 year-old children following the introduction of PCV7, as compared to the pre-PCV7 period (0.77; 0.63–0.93). A decreased risk of all-cause pneumonia was also observed in the County Councils that followed the order PCV7 then PCV13 (0.82; 0.66–1.01), while no trend was observed in County Councils with a program in the order PCV7 then PCV10 (1.03; 0.82–1.30). When comparing the higher-valent vaccines, there was a 21% (0.79; 0.66–0.96) lower risk for childhood pneumonia hospitalization in County Councils finally using PCV13 as compared to the experience in County Councils that ultimately adopted PCV10. Conclusions: Among children <2 years-old, all-cause pneumonia hospitalizations were significantly reduced by 23% one to two years after introduction of PCV7 vaccination in Sweden. In those County Councils that next introduced PCV13, a further decline in all-cause pneumonia hospitalization was observed, in contrast to those County Councils that followed with PCV10; this 21% lower risk for childhood pneumonia hospitalization was statistically significant. [ABSTRACT FROM AUTHOR]