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Wändell P, Borg K, Li X, Carlsson AC, Sundquist J, Sundquist K. The risk of post-polio syndrome among immigrant groups in Sweden. Sci Rep 2023; 13:6044. [PMID: 37055461 PMCID: PMC10098995 DOI: 10.1038/s41598-023-33240-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 04/10/2023] [Indexed: 04/15/2023] Open
Abstract
To examine the risk of post-polio syndrome (PPS) in immigrant groups using native Swedish-born individuals as referents. This is a retrospective study. The study population included all individuals aged 18 years and older registered in Sweden. PPS was defined as having at least one registered diagnosis in the Swedish National Patient Register. The incidence of post-polio in different immigrant groups, using Swedish-born individuals as referents, was assessed by Cox regression, with hazard ratios (HRs) and 99% confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, co-morbidities, and neighbourhood socioeconomic status. In total 5300 post-polio cases were registered, 2413 males and 2887 females. Fully adjusted HRs (99% CI) in immigrants versus Swedish-born were 1.77 in men (1.52-2.07) and 1.39 (1.19-1.62) in women. Statistically significant excess risks of post-polio were found in the following subgroups: men and women from Africa, HRs (with 99% CI) 7.40 (5.17-10.59) and 8.39 (5.44-12.95), respectively, and Asia, HRs 6.32 (5.11-7.81) and 4.36 (3.38-5.62) respectively, and in men from Latin America, HR 3.66 (2.17-6.18). It is of importance to be aware of risks of PPS in immigrants settled in Western countries, and that it is more common in immigrants from regions of the world where polio is still prevalent. Patients with PPS need treatment and proper follow-up until polio has been eradicated through global vaccination programs.
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Affiliation(s)
- Per Wändell
- Division of Family Medicine and Primary Care, NVS Department, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Kristian Borg
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd University Hospital, Stockholm, Sweden
| | - Xinjun Li
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Axel C Carlsson
- Division of Family Medicine and Primary Care, NVS Department, Karolinska Institutet, Alfred Nobels Allé 23, 141 83, Huddinge, Sweden.
- Academic Primary Health Care Centre, Region Stockholm, Stockholm, Sweden.
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Functional Pathology, Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Matsue, Japan
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Functional Pathology, Center for Community-Based Healthcare Research and Education (CoHRE), School of Medicine, Shimane University, Matsue, Japan
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Meiner Z, Marmor A, Jalagel M, Levine H, Shiri S, Schwartz I. Risk factors for functional deterioration in a cohort with late effects of poliomyelitis: A ten-year follow-up study. NeuroRehabilitation 2021; 49:491-499. [PMID: 34542042 DOI: 10.3233/nre-210216] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND More than 7000 patients developed poliomyelitis during the main epidemic in the fifties in Israel. In recent years, there is a further deterioration in their condition due to accelerated aging process and post-polio syndrome. OBJECTIVE To evaluate the risk factors for the progression of functional status in a cohort of patients with late effect of poliomyelitis over a period of ten years. METHODS A cross-sectional cohort study including 82 individuals with late effect of poliomyelitis evaluated over ten years. Mean age was 67±8.5 years, 52.4%were men and 79.3%were Jewish. Functional status was evaluated by activities of daily living (ADL) questionnaire. Risk factors, including general comorbidities, history of poliomyelitis infection, use of assistive devices, employment, and physical activity statuses were evaluated using specific questionnaires. RESULTS Independence in ADL functions deteriorated significantly over ten years. Older age, ethnicity, use of a wheelchair, and use of orthotic devices in childhood were risk factors for deterioration in ADL function. No correlation was found between the presence of other comorbidities or poliomyelitis parameters and worsening of ADL functions. CONCLUSIONS Late effect of poliomyelitis was associated with deterioration in ADL functions probably due to the combined effect of the initial severity of the paralytic poliomyelitis symptoms and accelerated aging.
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Affiliation(s)
- Zeev Meiner
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Anat Marmor
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Murad Jalagel
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health, Hebrew University-Hadassah, Jerusalem, Israel
| | - Shimon Shiri
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Isabella Schwartz
- Department of Physical Medicine and Rehabilitation, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Shapiro LT, Sherman AL. Medical Comorbidities and Complications Associated with Poliomyelitis and Its Sequelae. Phys Med Rehabil Clin N Am 2021; 32:591-600. [PMID: 34175017 DOI: 10.1016/j.pmr.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Survivors of poliomyelitis may experience long-term sequelae that put them at increased risk for injury, pain, cardiovascular deconditioning, and functional decline. Osteoporotic fractures and entrapment neuropathies, in particular, may result in greater impairments in one's mobility and ability to perform activities of daily living. Dysphagia may necessitate the use of compensatory swallow strategies to minimize aspiration risk. Comorbid conditions, including hypertension, dyslipidemia, obesity, and stroke, are also very prevalent in this population. Risk factor modification, including diet, exercise, and medication compliance, is essential to achieve optimal health and function among survivors of poliomyelitis.
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Affiliation(s)
- Lauren T Shapiro
- Department of Physical Medicine and Rehabilitation, University of Miami Leonard M. Miller School of Medicine, PO Box 016960 (C-206), Miami, FL 33101, USA.
| | - Andrew L Sherman
- Department of Physical Medicine and Rehabilitation, University of Miami Leonard M. Miller School of Medicine, PO Box 016960 (C-206), Miami, FL 33101, USA
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Selander H, Santos Tavares Silva I, Kjellgren F, S. Sunnerhagen K. "The car is my extra legs" - Experiences of outdoor mobility amongst immigrants in Sweden with late effects of polio. PLoS One 2019; 14:e0224685. [PMID: 31671130 PMCID: PMC6822759 DOI: 10.1371/journal.pone.0224685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/19/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The aim of the study was to describe the experience of outdoor mobility among immigrants with late effects of polio living in Sweden. There is a need to understand more about this young group of persons since they often have problems with mobility and gait, but they may also face participation restrictions due to issues associated with integration into a new community and culture. METHOD A total of 14 young immigrants with late effects of polio participated and were interviewed individually. The study used a qualitative method to explore personal experiences and the interviews were analyzed through an inductive approach, using qualitative content analysis. RESULTS The analysis led to a major theme; self-image and acceptance, that comprised a changeable process and experiences of cultural, social, and gender-specific barriers, but also of environmental and personal factors that impacted their outdoor mobility. By using a car, the participants felt they could come across as normal which also increased their self-esteem. CONCLUSIONS Independent mobility is a major enabler for ongoing employment and being able to use a car increases the chances for integration into society for young immigrants with late effects of polio. Public transport is not considered to be adequate or efficient enough due to the participants' mobility impairments, but driving can prevent involuntary isolation and facilitate participation. A car can increase quality of life but may also be a facilitator for work and reduce the demand for societal support.
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Affiliation(s)
- Helena Selander
- Rehabilitation Medicine, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
- The Swedish National Road and Transport Research Institute (VTI), Gothenburg, Sweden
| | - Iolanda Santos Tavares Silva
- Rehabilitation Medicine, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, The Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Felicia Kjellgren
- Rehabilitation Medicine, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Katharina S. Sunnerhagen
- Rehabilitation Medicine, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Sweden
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Selander H, Kjellgren F, Sunnerhagen KS. Self-perceived mobility in immigrants in Sweden living with the late effects of polio. Disabil Rehabil 2019; 42:3203-3208. [PMID: 30907167 DOI: 10.1080/09638288.2019.1585488] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: To investigate outdoor mobility of immigrants in Sweden who are living with the late effects of polio.Materials and methods: A total of 145 patients with late effects of polio born outside the Nordic region were identified at an outpatient polio clinic. Of these, 74 completed a questionnaire about their mobility and independence in daily life, self-perceived pain and depression, vocational status, mobility assistive devices/aids, transportation modes and driving. Patient characteristics were based on medical records supplied by physicians.Results: Twice as many patients had lower extremities that were affected by polio than upper extremities. This affected their use of different transport modes and caused mobility and transfer problems. Indeed, 39% needed mobility aids and help from another person to move outdoors. Those who reported dependence for outdoor mobility were more often unemployed and more often depressed.Conclusions: Many respondents reported having difficulties with transport mobility, but a large proportion, 57%, were independent and active drivers. It is important to consider outdoor mobility when planning rehabilitation for patients with late effects of polio and foreign backgrounds. In addition to psychosocial factors, dependence on mobility-related activities can lead to dependency and isolation.Implications for rehabilitationOutdoor mobility and access to transport modes are important for independence and an active life and need to be included in the rehabilitation process.Both personal and environmental factors, can contribute to mobility problems of people with foreign backgrounds, who are living with the late effects of polio.Factors such as cultural, social and gender aspects are important when planning suitable and individualized rehabilitation.
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Affiliation(s)
- Helena Selander
- Rehabilitation Medicine, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Swedish National Transport Research Institute, Gothenburg, Sweden
| | - Felicia Kjellgren
- Rehabilitation Medicine, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Rehabilitation Medicine, Department of Clinical Neuroscience, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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