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Aim: We aimed to estimate the risk of hearing impairment in children and adolescents with foreign-born parents, compared to natives. Methods: A nationwide study of 1,923,590 (51.4% boys) individuals aged 0–17 years of age in Sweden. Hearing impairment was defined as at least one registered diagnosis in the National Patient Register between 1 January 1998 and 31 December 2015. We used Cox regression analysis to estimate relative risk (hazard ratios with 99% confidence intervals) of incident hearing impairment in children with foreign-born parents compared to Swedish-born natives. Cox regression models were stratified by sex and adjusted for age, co-morbidities and socioeconomic status. Results: A total of 20,514 cases (53.7% boys) with extended sensorineural hearing impairment were registered, also including noise-induced hearing impairment and that from other causes, and 6172 cases (50.0% boys) with conductive hearing impairment. The risk of extended sensorineural hearing impairment was higher in boys with parents from Asia, especially from Iraq, fully adjusted HR (99% CI) 1.30 (1.17–1.4), and lower in boys with parents from Nordic countries, South Europe, and North America. Conclusion: The risk of extended sensorineural hearing impairment was higher in boys with parents from Asia, in particular Iraq. (Less)

Congestive heart failure (CHF) is the most important cause of death in patients with atrial fibrillation (AF). We aimed to study the association between cardiovascular drugs in AF patients and incident CHF. The study population included all adults (n = 120 756) aged ≥45 years diagnosed with AF in Sweden diagnosed for the period 1998‐2006. Outcome was incident congestive heart failure (follow‐up 2007‐2015) in AF patients. Associations between treatment with cardiovascular pharmacotherapies and CHF were evaluated using Cox regression to estimate hazard ratios (HRs) with 95% CIs, after adjustment for age, sociodemographic variables, and comorbidities. During a mean 5.3 years (SD 3.0) of follow‐up, there were 28 257 (23.4%) incident cases of CHF. Treatment with beta‐1‐selective and non‐selective beta‐blockers and statins was associated with lower risks of incident CHF in men, HR, (95% CI); 0.90, (0.87‐0.94); 0.90, (0.84‐0.97), and 0.94, (0.90‐0.99), respectively. Only beta‐1‐selective beta‐blockers were protective in women 0.94 (0.91‐0.98). Treatment with loop diuretics, potassium‐saving agents, ACE inhibitors, and angiotensin receptor blockers was associated with a higher risk of CHF. For men, treatment with heart‐active calcium channel blockers also led to a higher risk of CHF. In conclusion, we found that beta‐blockers, in particular, but also statins were associated with lower risk of incident CHF in patients with AF.

Aim: To compare incidence of urolithiasis in second-generation immigrant children aged 0-17 years to children of Swedish-born parents. Methods: A nationwide study of individuals residing in Sweden. Urolithiasis was defined as having at least one registered diagnosis of urolithiasis in the Swedish National Patient Register between January 1, 1998 and December 31, 2015. Cox regression analysis was used to estimate the relative risk (hazard ratios (HR) with 95% confidence intervals (CI)) of incident urolithiasis compared to individuals with Swedish-born parents. The models were stratified by sex and adjusted for age, co-morbidities and sociodemographic status of parents. Results: Totally, 1653 incident cases of urolithiasis were registered, 658 boys and 995 girls, with a mean annual incidence per 100 000 person-years for children with Swedish-born parents of 4.0 (95% CI 3.7-4.3) in boys and 6.7 (95% CI 6.2-7.2) in girls, and for children with foreign-born parents of 5.3 (95% CI 5.1-5.4) in boys and 7.2 (95% CI 6.9-7.4) in girls. The fully adjusted HRs of urolithiasis in second-generation immigrants were non-significant, in boys (1.20, 95% CI 0.99-1.46) and girls (0.95, 95% CI 0.80-1.12). Conclusion: The risk of urolithiasis in second-generation immigrants was not significantly different from that of children with Swedish-born parents. (Less)

BACKGROUND Obesity and lack of physical activity are frequently reported in persons with intellectual disability (ID) or autism spectrum disorder (ASD). We hypothesised a higher prevalence of diabetes and hypertension in this population. METHOD We used administrative data for all primary and specialist outpatient and inpatient healthcare consultations for people with at least one recorded diagnosis of diabetes mellitus, hypertension or obesity from 1998 to 2015. Data were drawn from the central administrative database for Stockholm County, Sweden. It was not possible to separate data for type 1 and type 2 diabetes. We stratified 26 988 individuals with IDs or ASD into three groups, with Down syndrome treated separately, and compared these groups with 1 996 140 people from the general population. RESULTS Compared with the general population, men and women with ID/ASD had 1.6-3.4-fold higher age-adjusted odds of having a registered diagnosis of obesity or diabetes mellitus, with the exception of diabetes among men with Down syndrome. A registered diagnosis of hypertension was only more common among men with ID/ASD than in the general population. CONCLUSIONS Diabetes and blood pressure health screening, along with efforts to prevent development of obesity already in childhood, are necessary for individuals with IDs and ASD. We believe that there is a need for adapted community-based health promotion programmes to ensure more equitable health for these populations.

Aim To evaluate the impact of an educational intervention on the preparedness of district nurses at primary healthcare centres to encounter women exposed to intimate partner violence. Methodological design An observational quasi-experimental study. Participants were divided into an intervention group (n = 117) and a control group (n = 204), both from the eastern part of Sweden. A group of nurses from across Sweden (the ‘national group,’ n = 217) was also recruited. The Violence Against Women Health Care Provider Survey was used pre- and 1 year postintervention to measure the intervention's impact. This survey, which measured preparedness, included eight factors: practitioner preparedness, self-confidence, lack of control, comfort following disclosure, professional support, practice pressures, abuse inquiry and consequences of asking. anova, the paired Wilcoxon test, the Mann–Whitney U test and the Kruskal–Wallis test were used to analyse the data. Findings Pre-intervention preparedness was equal in all three groups. In the intervention group, preparedness related to the factor practitioner lack of control increased (p = 0.003), but a comparison of change between the intervention and control groups showed no significant intervention effect (p = 0.069). Conclusions The results indicate that the intervention had a low impact on district nurses’ preparedness. The educational intervention must be adjusted; a main focus of changes should be the addition of continuing postintervention supervision and support.

OBJECTIVE: To study association between country of birth and incident epilepsy in second-generation immigrants in Sweden.METHODS: Study population included all children (n=4,023,149) aged up to 18 years of age in Sweden. Epilepsy was defined as at least one registered diagnosis of epilepsy in the National Patient Register. The incidence of epilepsy, using individuals with Swedish-born parents as referents, was assessed by Cox regression, expressed in hazard ratios (HRs) and 95% confidence intervals (95% CI). All models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, neighbourhood socioeconomic status and comorbid conditions, also using data from the Total Population Register.RESULTS: A total of 26,310 individuals had a registered epilepsy event, i.e. 6.5/1000 (6.6/1000 among boys and 6.3/1000 among girls). After adjustment, the risk of epilepsy was lower than in children of Swedish-born parents. Among girls, the significant HR was 0.85 (95% CI, 0.81-0.88) but in boys only when adjusting also for co-morbidity (HR = 0.96, 0.92-0.99). Among specific immigrant groups, a higher incidence of epilepsy was observed among boys with parents from Turkey and Africa, but not when adjusting for co-morbidity, and a lower risk in many other groups (boys with parents from Latvia, girls with parents from Finland, Iceland, Southern Europe, countries from the former Yugoslavia, and Asia).SIGNIFICANCE: Risk of epilepsy was lower in second-generation immigrant children compared to children with Swedish-born parents, however, with substantial differences between different immigrant groups. This article is protected by copyright. All rights reserved.

AIMS AND OBJECTIVES: To improve the understanding of district nurses' experiences of encountering women exposed to intimate partner violence. BACKGROUND: Intimate partner violence is a public health issue that influences all aspects of affected women's lives; it is thus of great relevance to identify intimate partner violence. District nurses in primary health care in Sweden encounter women of all ages and are therefore in a unique position to identify intimate partner violence and provide nursing care. However, studies indicate that several barriers have kept nurses from identifying intimate partner violence. Consequently deeper understanding of district nurses' encounters with women exposed to intimate partner violence is needed. DESIGN: A qualitative study using grounded theory method. METHODS: Interviews with 11 district nurses in primary health care in Sweden. RESULTS: The hesitation process is central in these encounters. Several barriers to asking and factors that facilitated asking impacted the hesitation process. Under the influence of these factors, district nurses moved from being unaware that identifying intimate partner violence was their professional responsibility, to becoming ambivalent about asking, to starting to prepare themselves to ask about intimate partner violence. The presence of factors that facilitated asking finally made district nurses feel prepared, and then they decided to ask women about intimate partner violence. CONCLUSIONS: The concept of managing the hesitation process could be used to be incorporated in continuing education and training. Barriers and facilitators concerning organisational factors found in this study may be specific to the Swedish health care system, but the concept of the hesitation process is applicable in similar contexts and perhaps to other issues about which it is difficult to ask. RELEVANCE TO CLINICAL PRACTICE: This study illuminates the importance of a supportive work environment in reducing district nurses' hesitation to ask about intimate partner violence and to propose continuing education, training and supervision for district nurses regarding intimate partner violence. Language: en

Aim To investigate the changes in prevalence and incidence of pharmacologically and non-pharmacologically treated diabetes in Sweden during 2005 to 2013. Methods We obtained data on gender, date of ...

Aim This article investigates attitudes towards and awareness of research and use of research findings among primary healthcare nurses, determinants of attitudes and evaluation of psychometric properties of an instrument measuring nurses' attitudes. Background The production of new knowledge is ongoing and the amount of research of relevance for health care has increased, but there remains a gap between what is known and what is done in practice. To enhance evidence-based practice and patient safety, the use of research findings needs to be encouraged and promoted. Method An explanatory study using a cross-sectional survey was conducted in 2005–2006. The survey included items about background data and the instrument attitudes towards and awareness of research and development in nursing. 1054 nurses participated in the study. Factor analyses and Cronbach's alpha were used to evaluate internal structure and internal consistency of the instrument. Result The nurses generally held positive attitudes towards research. Although most of the nurses reported using research in practice, 37% claimed that they never or rarely used research findings. Half of the respondents perceived they had the ability to analyse scientific reports/articles. This ability and research use were significant determinants of attitudes. Factor analysis of the scale resulted in a three-factor solution, which differs from the seven-factor structure previously identified by the originators of the instrument. Conclusion Our results support the view that implementation of research is a complex process involving several factors. The different factor structure identified suggests that further work is needed on this instrument.

Background Physical activity remains a valuable prevention for metabolic disease. The effects of Nordic walking on cardiovascular risk factors were determined in overweight individuals with normal or disturbed glucose regulation. Methods We included 213 individuals, aged 60 ± 5.3 years and with body mass index (BMI) of 30.2 ± 3.8 kg/m2; of these, 128 had normal glucose tolerance (NGT), 35 had impaired glucose tolerance (IGT) and 50 had type 2 diabetes mellitus (T2DM). Participants were randomized to unaltered physical activity or to 5 h per week of Nordic walking with poles, for a 4-month period. Dietary habits were unaltered. BMI, waist circumference, blood pressure, glucose tolerance, clinical chemistry, maximal oxygen uptake (peak VO2) and self-reported physical activity (questionnaire) were assessed at the time of inclusion and after 4 months. The participants in the exercise-intervention group kept a walking diary. Results In the NGT exercise group, self-reported physical activity increased markedly, and body weight (−2.0 ± 3.8 kg), BMI (−0.8 ± 1.4 kg/m2) and waist circumference (−4.9 ± 4.4 cm) (mean ± SD) decreased. Exercise power output (12.9 ± 9.9 W) and peak VO2 (2.7 ± 2.8 mL/kg/min) increased in the IGT exercise group. More cardiovascular risk factors were improved after exercise intervention in people with NGT compared with those with IGT or T2DM. Exercise capacity improved significantly in all three groups of participants who reported at least 80% compliance with the scheduled exercise. Conclusions Nordic walking improved anthropometric measurements and exercise capacity. However, unsupervised Nordic walking may not provide a sufficient increase in exercise intensity to achieve ultimate health-promoting benefits on the cardiovascular parameters assessed in this study, particularly for those with disturbed glucose regulation. Copyright © 2012 John Wiley & Sons, Ltd.

The purpose of this study was to investigate how tactile massage (TM), short term and over time, affects blood glucose, stress hormones and well-being in women with type 2 diabetes mellitus, at a primary health care centre in the South Western Health Care Region of Stockholm. The study was carried out as a pilot. Women aged 35 years and older with type 2 diabetes were included in the study. Eleven participants completed the study and eight patients retained their diabetes treatment. The patients received tactile, whole-body massage for 60 minutes once a week for 10 weeks. Before the massage treatments, one week after and 12 weeks after that, blood samples were taken, body measurements were made and questionnaires were completed (n=11). The results for all patients (n=11) showed decreases in blood glucose in connection with the massage treatments (p

The study examines internal item/scale structure and concurrent validity of a newly developed 48-item questionnaire [General Coping Questionnaire (GCQ)] that measures 10 aspects of coping with chronic illness (self-trust, problem-reducing actions, change of values, social trust, minimization, fatalism, resignation, protest, isolation and intrusion). The tests were performed in two independent samples of persons with diabetes mellitus. The first sample consisted of 119 subjects with type I diabetes and the second sample of 184 subjects with type II diabetes. Concurrent validity was examined by comparisons with measures of health-related quality of life (SF-36), a measure of metabolic control (HbA1c) and incidence of diabetic complications. The item/scale structure was found to be similar and very good in both samples. The 10 dimensions correlated as expected with the measure of mental health, although the ‘negative’ dimensions of the GCQ correlated higher compared with the ‘positive’ dimensions. Weaker relations with metabolic control were also found in one of the samples. These tests provide further evidence that GCQ is a well-structured, relevant and reliable instrument for assessing coping reactions in chronic somatic conditions. Copyright © 2012 John Wiley & Sons, Ltd.