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Lundberg T, Falk E, Alvariza A, Åkerman E, Dahl O, Nilsson M, Anmyr L. Being between life and death-experiences of COVID-19 survivors 12 to 18 months after being treated in intensive care. Int J Qual Stud Health Well-being 2024; 19:2398223. [PMID: 39238148 PMCID: PMC11382733 DOI: 10.1080/17482631.2024.2398223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 08/26/2024] [Indexed: 09/07/2024] Open
Abstract
PURPOSE This study aims to explore the experiences of care, psychosocial support, and psychosocial wellbeing among patients treated for COVID-19 in intensive care 12 to 18 months after discharge. METHODS This study used a qualitative approach with a descriptive design. Semi-structured interviews were performed with 20 adult patients treated for COVID-19 12 to 18 months after being discharged from a university hospital in Sweden. Data were analysed using qualitative content analysis. FINDINGS The participants were severely affected by COVID-19 both during the hospital stay and afterwards. They experienced overwhelming fears and uncertainties related to their wellbeing and possibility to recover. The care was described chaotic with staff that were stressed; however, the efforts of the staff during this strenuous circumstance were still positively acknowledged. Difficulties to stay in touch with family and friends due to visiting restrictions affected the patient's psychosocial wellbeing. CONCLUSION Contracting COVID-19 in the beginning of the pandemic was a stressful event. Being seen and heard is of importance as it has the possibility to create a feeling of security and being cared for despite unclarities about treatment and illness trajectory. Accordingly, healthcare staff play an important role for the psychosocial wellbeing of patients treated for COVID-19.
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Affiliation(s)
- Tina Lundberg
- Medical Unit: Clinical Social Work, Karolinska University Hospital, Stockholm, Sweden
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Eleonora Falk
- Medical Unit: Clinical Social Work, Karolinska University Hospital, Stockholm, Sweden
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
| | - Anette Alvariza
- Department of Health Care Sciences, Marie Cederschiöld University, Stockholm, Sweden
- Department of research and development/Palliative Care, Stockholms Sjukhem, Stockholm, Sweden
| | - Eva Åkerman
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Oili Dahl
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Marie Nilsson
- Medical Unit: Clinical Social Work, Karolinska University Hospital, Stockholm, Sweden
- Academic Primary Care Center, Region Stockholm, Stockholm, Sweden
- Department of Neurobiology, Care Science and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden
| | - Lena Anmyr
- Medical Unit: Clinical Social Work, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
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Ham L, Schelin MEC, Fransen HP, Fürst CJ, van der Heide A, Korfage IJ, Raijmakers NJH, van Zuylen L, Hedman C. Death rituals and quality of life of bereaved relatives during the COVID-19 pandemic: Results of the observational CO-LIVE study. DEATH STUDIES 2024:1-10. [PMID: 39260831 DOI: 10.1080/07481187.2024.2400354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/13/2024]
Abstract
Grief is a normal reaction after the death of a loved one. Death rituals are an integral part of the mourning processes. Not being able to carry out death rituals can affect relatives' quality of life. The aim was to evaluate death rituals during COVID-19 and their association with relatives' quality of life. In a Swedish nation-wide study relatives to persons who died during the COVID-19-pandemic received questionnaires about their quality of life and how they could perform death rituals. Association between quality of life and death rituals was analyzed with linear regression. Of the 324 relatives, a minority indicated that their loved one's funeral (17%) met their wishes. Not being able to carry out the funeral as desired was significantly associated with a lower quality of life (p = 0.006). The experiences during the pandemic revealed that it is important for people to perform death rituals according to their wishes.
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Affiliation(s)
- Laurien Ham
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Maria E C Schelin
- Department of Clinical Sciences Lund, Institute for Palliative Care, Lund University, Lund, Sweden
| | - Heidi P Fransen
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Carl Johan Fürst
- Department of Clinical Sciences Lund, Institute for Palliative Care, Lund University, Lund, Sweden
| | - Agnes van der Heide
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Natasja J H Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
- Netherlands Association for Palliative Care (PZNL), Utrecht, the Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Christel Hedman
- Department of Clinical Sciences Lund, Institute for Palliative Care, Lund University, Lund, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- R&D Department, Stockholms Sjukhem Foundation, Stockholm, Sweden
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Holmlund S, Linden K, Wessberg A, Sengpiel V, Appelgren C, Lundmark L, Lindqvist M. Set aside-A qualitative study of partners' experiences of pregnancy, labour, and postnatal care in Sweden during the COVID-19 pandemic. PLoS One 2024; 19:e0307208. [PMID: 39240932 PMCID: PMC11379312 DOI: 10.1371/journal.pone.0307208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 07/01/2024] [Indexed: 09/08/2024] Open
Abstract
BACKGROUND Due to changes in Swedish maternity care during the COVID-19 pandemic, partners were often excluded from antenatal and postnatal care. AIM To explore partners' experiences of pregnancy, labour, and postnatal care in relation to the COVID-19 pandemic restrictions. METHODS A descriptive qualitative interview study with 15 partners of women who gave birth from March 2020 to March 2022. Data was collected from April to November 2022, and analysed using inductive thematic analysis. FINDINGS Two themes and six subthemes were identified. The first theme, Feelings of loss and exclusion, emphasises the expectation and desire to share the journey of becoming a parent together with the pregnant partner. When excluded from maternity care, a feeling of missing out was described which could create a sense of distance from the unborn child. The second theme, Dealing with powerlessness, relates to the fear of infection and not being able to participate during the birth, and life being adapted to restrictions. Mixed feelings regarding the restrictions were described since the reasons behind were not always perceived as clear and logical. DISCUSSION Sweden prides itself on gender equality, where partners normally are a natural part of maternity care. This likely contributed to strong feelings of exclusion when partners were prevented from participating in maternity care during the COVID-19 pandemic. CONCLUSION Partners of women giving birth during the COVID-19 pandemic were substantially affected by the restrictions within maternity care. Partners wish to be involved in pregnancy and birth and want to receive clear information as part of their preparation for parenthood. Society-including maternity care-must decide how to address these needs.
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Affiliation(s)
- Sophia Holmlund
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Wessberg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Obstetrics and Gynecology, Region Västra Goötaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Verena Sengpiel
- Department of Obstetrics and Gynecology, Region Västra Goötaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Lisa Lundmark
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Maria Lindqvist
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, Umeå, Sweden
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Atia O, Bryder N, Mendelovici A, Ledderman N, Ben-Tov A, Osooli M, Forss A, Loewenberg Weisband Y, Matz E, Dotan I, Turner D, Olén O. The Epidemiology of Inflammatory Bowel Diseases During the COVID-19 Pandemic: Comparison of Two Nationwide Cohorts. J Crohns Colitis 2024; 18:1241-1249. [PMID: 38407990 DOI: 10.1093/ecco-jcc/jjae029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/01/2024] [Accepted: 02/24/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND We aimed to explore the epidemiology of inflammatory bowel diseases [IBD] in association with the COVID-19 pandemic in two countries with different lockdown policies. METHODS We utilized nationwide IBD cohorts in Israel and Sweden to explore the incidence of IBD during the pandemic compared to 3 years prior [2017-2019]. We examined temporal trends through the presence of inflection points by Joinpoint regression analysis and reported average monthly percentage changes [AMPC]. RESULTS A total of 155 837 patients with IBD were included [Israel, 58 640; Sweden, 97 197]. The annual incidence of IBD was stable until 2019 in both countries but then decreased in Israel (AAPC -16.6% [95% confidence interval, CI, -19.9% to -10.0%]) and remained stable in Sweden (AAPC -3.5% [95% CI -11.6% to 3.7%]). When exploring the monthly incidence during the pandemic, in Israel the rate remained stable until November 2020 (AMPC 2.3% [95% CI -13.4% to 29.9%]) and then decreased sharply (AMPC -6.4% [95% CI -20.8% to 17.0%] until February 2021 and to -20.1% [95% CI -38.9% to -4.7%] from February 2021), while in Sweden, which had a less stringent lockdown policy, it decreased slightly until July 2020 (AMPC -3.3% [95% CI -21.6% to 20.3%]), but increased thereafter (AMPC 13.6% [95% CI -12.6% to 27.0%]). The change of incidence rate in Sweden occurred mainly in elderly-onset patients, the only population with significant restrictions during the pandemic. CONCLUSION The incidence of IBD decreased during the pandemic in association with lockdowns, more so in Israel, which had more stringent policies. Future studies are needed to determine the long-term effect of the pandemic on IBD.
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Affiliation(s)
- Ohad Atia
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nicklas Bryder
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Adi Mendelovici
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Amir Ben-Tov
- Kahn-Sagol-Maccabi Research and Innovation Center, Maccabi Healthcare Services, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Mehdi Osooli
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anders Forss
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Eran Matz
- Leumit Health Services, Tel-Aviv, Israel
| | - Iris Dotan
- Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Division of Gastroenterology, Rabin Medical Center, Petah Tikva, Israel
| | - Dan Turner
- Juliet Keidan Institute of Pediatric Gastroenterology Hepatology and Nutrition, The Eisenberg R&D Authority, Shaare Zedek Medical Center, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ola Olén
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Sachs' Children and Youth Hospital, Stockholm South General Hospital, Stockholm, Sweden
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Balak N, Mathiesen TI. Loss of Moral Values During Business-Like Transformations in Healthcare Services. World Neurosurg 2024; 191:149-155. [PMID: 39147024 DOI: 10.1016/j.wneu.2024.08.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Revised: 08/08/2024] [Accepted: 08/09/2024] [Indexed: 08/17/2024]
Abstract
BACKGROUND The shortcomings of business-like management systems in health care were exposed during the coronavirus disease 2019 pandemic when the need for flexibility and a rapid response to patients' needs became pressing. Almost all administrative decisions concerning the management of health care services have an ethical dimension. This research aims to investigate current debates on this subject and fill in the knowledge gaps. METHODS A systematic review was undertaken to identify neurosurgical ethical concerns related to transformations in the functioning of health care institutions; however, the data analysis is presented in a narrative format. RESULTS Two management models were identified and compared: a business/economic management model versus a medical model. Independent of the management model chosen, problems arise when a framework is adopted where measurement and proxy parameters are implemented and economic mechanisms are used for administrative steering. The proxy measures of physician performance proved to be entirely inappropriate during the pandemic. The pandemic suddenly made many management models obsolete as doctors tried to solve immediate problems according to their medical training rather than by following abstract systems for maximizing public health. The measures were largely taken in a bottom-up fashion based on physicians' training and knowledge, not in a top-down manner dictated by management. CONCLUSIONS Purely financial cost containment strategies in health care can be ineffective or even harmful. Therefore, nonfinancial control mechanisms must ensure adherence to personal and professional ethics, together with professionalism based on sound medical knowledge.
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Affiliation(s)
- Naci Balak
- Department of Neurosurgery, Istanbul Medeniyet University, Göztepe Prof. Dr. SüleymanYalçın City Hospital, Istanbul, Turkey.
| | - Tiit I Mathiesen
- Department of Neurosurgery, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Kreku R, Behndig A, Viberg A. Prioritizations in Swedish cataract surgery - when resources are limited-Exemplified by the COVID-19 pandemic. Acta Ophthalmol 2024. [PMID: 39129645 DOI: 10.1111/aos.16749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 07/29/2024] [Indexed: 08/13/2024]
Abstract
PURPOSE To study the prioritization effects of the of COVID-19 pandemic on Swedish cataract surgery using a national healthcare registry with high coverage. SETTING A study from the Swedish National Cataract Register (NCR), involving all patients undergoing cataract surgery in Sweden during 2019-2022 - before, during and after the COVID-19 pandemic. RESULTS With the pandemic outbreak, the number of cataract surgeries fell by 22% in 2020 (15 369 procedures), albeit with large regional differences (-43% to +58%). The numbers recovered in 2021, and in 2022, a new top notation was seen (n = 149 952). On a national level, the patients were younger (-0.46 years, p < 0.001), with a larger proportion of less difficult cases (p < 0.001) and the proportion of males was higher (p < 0.001) during the pandemic, but all these variables also differed substantially between different regions and clinics. CONCLUSION A national registry with high coverage can map the consequences of an event disrupting elective surgery in detail. During the COVID-19 pandemic, the impact on Swedish cataract surgery varied largely between different regions, clinics, and healthcare providers, leading to inequality in the availability of surgery. These differences likely owed to variations in healthcare policy approaches in different parts of the country. The present study shows that outcomes at one clinic or region cannot be extrapolated to larger regions under these circumstances. It actualizes the need to aim for a healthcare on equal terms, but it also shows a system that delivers care to many despite difficult times.
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Affiliation(s)
- Ruben Kreku
- Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden
- Sunderby Research Unit, Division of Ophthalmology, Department of Clinical Sciences, Umeå University, Luleå, Sweden
| | - Anders Behndig
- Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden
| | - Andreas Viberg
- Department of Clinical Sciences/Ophthalmology, Umeå University, Umeå, Sweden
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Orfanos I. Decreased incidence of urinary tract infections in febrile infants aged ≤60 days during COVID-19 pandemic. Acta Paediatr 2024; 113:1934-1939. [PMID: 38676461 DOI: 10.1111/apa.17256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/16/2024] [Accepted: 04/19/2024] [Indexed: 04/29/2024]
Abstract
AIM To investigate the incidence rate of urinary tract infections (UTIs) among febrile infants aged ≤60 days before, during, and after the COVID-19 pandemic. METHODS We conducted a retrospective study in 2 Swedish paediatric emergency departments between 2014 and 2022. We included full-term infants aged ≤60 days with fever without source. We calculated the annual incidence rate of UTI per 1000 births. RESULTS We included 1589 full-term infants with fever without source. In 2020, 89 infants were evaluated in the emergency department versus 203-259 in 2017-2019. In 2020, the incidence rate of UTI was 1.43 per 1000 births/year versus 2.18-2.37 in 2017-2019. The median age, sex, fever duration, and urine testing were similar between the years 2017 and 2020. CONCLUSION The number of febrile infants who presented to the paediatric emergency department and the incidence rate of UTIs decreased in 2020. This decrease might imply a systematic misdiagnosis of UTIs in infants with febrile viral infections. A more selective urine testing approach for febrile, previously healthy, infants should be considered to mitigate UTI misdiagnosis and its potential harmful effects.
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Affiliation(s)
- Ioannis Orfanos
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Pediatrics, Skåne University Hospital, Lund University, Lund, Sweden
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Fernemark H, Hårdstedt M, Skagerström J, Seing I, Karlsson E, Nilsen P, Schildmeijer KGI. Primary healthcare in the aftermath of the COVID-19 pandemic: a qualitative interview study in Sweden. BMJ Open 2024; 14:e085527. [PMID: 39067889 DOI: 10.1136/bmjopen-2024-085527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
OBJECTIVE To explore how primary healthcare workers in Sweden experienced and perceived the long-term impact of the pandemic on their work. DESIGN This is a descriptive qualitative study with individual semistructured interviews conducted 2 years after the onset of COVID-19. Data were analysed using an inductive thematic approach. SETTING Swedish primary healthcare units in rural and urban locations. PARTICIPANTS 29 healthcare providers (6 registered nurses, 7 assistant nurses, 8 physicians and 8 managers) in Swedish primary healthcare. RESULTS Data analysis yielded three overarching themes: (1) primary healthcare still affected by the pandemic; (2) primary healthcare changes made permanent; and (3) lessons learnt for handling future crises affecting primary healthcare. The participants experienced a high workload, even after the pandemic, and concluded that it would take years to catch up both mentally and workwise. Four lessons were learnt for future handling of crises that might affect primary healthcare: the importance of creating a cohesive primary healthcare management system to provide clarity regarding recommendations for how primary healthcare personnel should work, the need for management support at all levels, restricting and adapting the flow of information for primary healthcare and ascertaining the necessary resources if primary healthcare is to take on additional tasks. CONCLUSION Two years after the onset of the COVID-19 pandemic, primary healthcare workers in Sweden experienced that their work was still affected by the pandemic. Our findings highlight the importance of ensuring sufficient recovery time and providing opportunities for reflection on the experiences of primary healthcare personnel. This also includes preparedness for managing the heavy workload and strained energy levels of healthcare workers in the aftermath of a crisis.
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Affiliation(s)
- Hanna Fernemark
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Primary Health Care Center, Lambohov, Region Östergötland, Linköping, Sweden
| | - Maria Hårdstedt
- Vansbro Primary Health Care Center, Vansbro, Sweden
- Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden
| | - Janna Skagerström
- Research and Development Unit, Region Östergötland, Linköping, Sweden
| | - Ida Seing
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Elin Karlsson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Per Nilsen
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Halmstad University School of Health and Welfare, Halmstad, Sweden
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Magnus MC, Söderling J, Örtqvist AK, Andersen AMN, Stephansson O, Håberg SE, Urhoj SK. Covid-19 infection and vaccination during first trimester and risk of congenital anomalies: Nordic registry based study. BMJ 2024; 386:e079364. [PMID: 39019547 DOI: 10.1136/bmj-2024-079364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
OBJECTIVES To evaluate the risk of major congenital anomalies according to infection with or vaccination against covid-19 during the first trimester of pregnancy. DESIGN Prospective Nordic registry based study. SETTING Sweden, Denmark, and Norway. PARTICIPANTS 343 066 liveborn singleton infants in Sweden, Denmark, and Norway, with an estimated start of pregnancy between 1 March 2020 and 14 February 2022, identified using national health registries. MAIN OUTCOME MEASURE Major congenital anomalies were categorised using EUROCAT (European Surveillance of Congenital Anomalies) definitions. The risk after covid-19 infection or vaccination during the first trimester was assessed by logistic regression, adjusting for maternal age, parity, education, income, country of origin, smoking, body mass index, chronic conditions, and estimated date of start of pregnancy. RESULTS 17 704 (5.2%) infants had a major congenital anomaly. When evaluating risk associated with covid-19 infection during the first trimester, the adjusted odds ratio ranged from 0.84 (95% confidence interval 0.51 to 1.40) for eye anomalies to 1.12 (0.68 to 1.84) for oro-facial clefts. Similarly, the risk associated with covid-19 vaccination during the first trimester ranged from 0.84 (0.31 to 2.31) for nervous system anomalies to 1.69 (0.76 to 3.78) for abdominal wall defects. Estimates for 10 of 11 subgroups of anomalies were less than 1.04, indicating no notable increased risk. CONCLUSIONS Covid-19 infection and vaccination during the first trimester of pregnancy were not associated with risk of congenital anomalies.
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Affiliation(s)
- Maria C Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anne K Örtqvist
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynaecology, Visby County Hospital, Visby, Sweden
| | | | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women's Health, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Siri E Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Stine Kjaer Urhoj
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Statistics Denmark, Copenhagen, Denmark
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Bennet R, Rinder MR, George E, Hertting O, Luthander J, Åkefeldt SO, Hammas B, Allander T, Eriksson M. Pre-admission virus detection during the COVID-19 pandemic in children with and without symptoms of infection. Acta Paediatr 2024; 113:1679-1684. [PMID: 38445712 DOI: 10.1111/apa.17195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 03/07/2024]
Abstract
AIM Pre-admission viral screening is used only in exceptional situations such as pandemics. We therefore evaluated pre-admission screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), respiratory syncytial virus (RSV) and influenza during the COVID-19 pandemic, comparing epidemiology and clinical features of admitted children. METHODS Children were screened at a paediatric emergency department from 1 March 2020 to 30 June 2022 by nasopharyngeal sampling and polymerase chain reaction kit. We retrospectively retrieved positive results from the laboratory and scrutinised charts of admitted children. RESULTS Out of 15 927 screened children, 522, 127 and 572 were positive and admitted with RSV, influenza A or SARS-CoV-2, respectively. Of these, 29 (5.6%), 26 (24.1%) and 245 (44.8%) were incidental findings, lacking symptoms of infection. RSV and influenza A were initially absent but re-emerged in the autumn of 2021. The rate of COVID-19 rose when the Omicron variant emerged in December 2021. The median age of children with RSV was 0.3 years, of those with influenza A 6.7 years and of those with COVID-19 1.6 years. Major complications were rare. CONCLUSION Frequent incidental detections of SARS-CoV-2 likely reflected widespread presence of a mild infection. Clinically, COVID-19 was like other viral respiratory infections in children.
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Affiliation(s)
- Rutger Bennet
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Solna, Sweden
| | - Malin Ryd Rinder
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Solna, Sweden
| | - Eric George
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Solna, Sweden
| | - Olof Hertting
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Solna, Sweden
| | - Joachim Luthander
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Solna, Sweden
| | | | - Berit Hammas
- Department of Medical Microbiology, Karolinska University Hospital, Solna, Sweden
| | - Tobias Allander
- Department of Medical Microbiology, Karolinska University Hospital, Solna, Sweden
- Department of Microbiology, Tumour and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Margareta Eriksson
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Solna, Sweden
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11
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Abzhandadze T, Hoang MT, Mo M, Mostafaei S, Jurado PG, Xu H, Johnell K, Von Euler M, Eriksdotter M, Garcia-Ptacek S. COVID-19 Pandemic and Stroke Care in Patients with Dementia Compared to Other Stroke Patients. J Am Med Dir Assoc 2024; 25:105011. [PMID: 38702044 DOI: 10.1016/j.jamda.2024.03.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 05/06/2024]
Abstract
OBJECTIVES The primary objective of this study was to examine the impact of the COVID-19 pandemic on the quality of stroke care for patients with preexisting dementia, compared with patients who had only stroke. The secondary aim was to investigate how the quality of stroke care changed during the pandemic and post-pandemic periods compared with the pre-pandemic period in patients with preexisting dementia. DESIGN A registry-based, nationwide cohort study in Sweden. SETTING AND PARTICIPANTS We included patients with a first stroke between 2019 and 2022, both with and without dementia. The study periods were defined as follows: pre-pandemic (January 1, 2019, to February 29, 2020), COVID-19 pandemic (March 1, 2020, to February 24, 2022), and post-COVID-19 pandemic period (February 25, 2022, to September 19, 2022). The outcomes examined were the following quality indicators of stroke care, suggested by the national guideline of stroke care in Sweden: stroke admission site, performance of swallowing assessment, reperfusion treatment, assessment for rehabilitation, and early supported discharge. METHODS The associations were studied through group comparisons and binary logistic regressions. RESULTS Of the 21,795 patients with strokes, 1357 had documented preexisting dementia, and 20,438 had stroke without a dementia diagnosis. Throughout all study periods, a significantly lower proportion of patients with stroke with preexisting dementia, compared with stroke-only patients, received reperfusion treatment, assessments for rehabilitation, and early supported discharge from stroke units. In the subgroup of stroke patients with preexisting dementia, no significant associations were found regarding the quality indicators of stroke care before, during, and after the pandemic. CONCLUSIONS AND IMPLICATIONS Disparities in quality of stroke care were observed between stroke patients with preexisting dementia and those with only stroke during the COVID-19 pandemic. However, there were no statistically significant differences in stroke care for patients with dementia across the pandemic.
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Affiliation(s)
- Tamar Abzhandadze
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Minh Tuan Hoang
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Minjia Mo
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Shayan Mostafaei
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Pol Grau Jurado
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Hong Xu
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mia Von Euler
- Faculty of Medicine and Health, Department of Neurology and Rehabilitation, Örebro University, Örebro, Sweden
| | - Maria Eriksdotter
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Sara Garcia-Ptacek
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Stockholm, Sweden; Aging and Inflammation Theme, Karolinska University Hospital, Stockholm, Sweden
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12
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Varpula R, Äyräs O, Aabakke AJM, Klungsøyr K, Svanvik T, Kanerva J, Jonasdottir E, Mentzoni CT, Thurn L, Jones E, Fredriksson L, Pettersson K, Nyfløt LT, Vangen S, Røe K, Júlíusson PB, Källén K, Gissler M, Pyykönen A, Jakobsson M, Krebs L, Engjom HM. Early suppression policies protected pregnant women from COVID-19 in 2020: A population-based surveillance from the Nordic countries. Acta Obstet Gynecol Scand 2024; 103:1063-1072. [PMID: 38382894 PMCID: PMC11103151 DOI: 10.1111/aogs.14808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/03/2024] [Accepted: 01/17/2024] [Indexed: 02/23/2024]
Abstract
INTRODUCTION The Coronavirus 2019 Disease (COVID-19) pandemic reached the Nordic countries in March 2020. Public health interventions to limit viral transmission varied across different countries both in timing and in magnitude. Interventions indicated by an Oxford Stringency Index ≥50 were implemented early (March 13-17, 2020) in Denmark, Finland, Norway and Iceland, and on March 26, 2020 in Sweden. The aim of the current study was to assess the incidence of COVID-19-related admissions of pregnant women in the Nordic countries in relation to the different national public health strategies during the first year of the pandemic. MATERIAL AND METHODS This is a meta-analysis of population-based cohort studies in the five Nordic countries with national or regional surveillance in the Nordic Obstetric Surveillance System (NOSS) collaboration: national data from Denmark, Finland, Iceland and Norway, and regional data covering 31% of births in Sweden. The source population consisted of women giving birth in the included areas March 1-December 31, 2020. Pregnant women with a positive SARS-CoV-2 PCR test ≤14 days before hospital admission were included, and admissions were stratified as either COVID-19-related or non-COVID (other obstetric healthcare). Information about public health policies was retrieved retrospectively. RESULTS In total, 392 382 maternities were considered. Of these, 600 women were diagnosed with SARS-CoV-2 infection and 137 (22.8%) were admitted for COVID-19 symptoms. The pooled incidence of COVID-19 admissions per 1000 maternities was 0.5 (95% confidence interval [CI] 0.2 to 1.2, I2 = 77.6, tau2 = 0.68, P = 0.0), ranging from no admissions in Iceland to 1.9 admissions in the Swedish regions. Interventions to restrict viral transmission were less stringent in Sweden than in the other Nordic countries. CONCLUSIONS There was a clear variation in pregnant women's risk of COVID-19 admission across countries with similar healthcare systems but different public health interventions to limit viral transmission. The meta-analysis indicates that early suppression policies protected pregnant women from severe COVID-19 disease prior to the availability of individual protection with vaccines.
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Affiliation(s)
- Reetta Varpula
- Department of Obstetrics and Gynecology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Outi Äyräs
- Department of Obstetrics and Gynecology, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Anna J M Aabakke
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Holbæk, Holbæk, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department for Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
| | - Teresia Svanvik
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Julia Kanerva
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Jonasdottir
- Department of Obstetrics and Gynecology, Landspitali University Hospital, Reykjavik, Iceland
| | | | - Lars Thurn
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund, Sweden
| | - Elin Jones
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Lisa Fredriksson
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Karin Pettersson
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - Lill Trine Nyfløt
- Norwegian Research Center for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Siri Vangen
- Norwegian Research Center for Women's Health, Oslo University Hospital, Oslo, Norway
| | - Kjerstine Røe
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger, Norway
| | - Pétur B Júlíusson
- Department for Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
| | - Karin Källén
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences, Lund University, Lund, Sweden
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute of Health and Welfare, Helsinki, Finland
- Academic Primary Health Care Center, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Maija Jakobsson
- Department of Obstetrics and Gynecology, HUS Hyvinkää Hospital, Helsinki University, Helsinki, Finland
| | - Lone Krebs
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Obstetrics and Gynecology, Copenhagen University Hospital-Amager and Hvidovre Hospital, Copenhagen, Denmark
| | - Hilde Marie Engjom
- Department for Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department for Health Registry Research and Development, Norwegian Institute of Public Health, Bergen, Norway
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13
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Zhou M, Gebreslassie M, Ponce de Leon A, Tynelius P, Ahlqvist VH, Dahlen M, Berglind D, Lager A, Brynedal B. The influence of the COVID-19 pandemic on physical activity in Stockholm County - Evidence from time series models of smartphone measured daily steps data spanning over 3 years. Prev Med 2024; 183:107969. [PMID: 38653392 DOI: 10.1016/j.ypmed.2024.107969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND It has been reported that physical activity levels decreased during the COVID-19 pandemic. Previous studies often relied on self-reported physical activity, which has low accuracy. Studies based on objectively measured physical activity have had short data collection periods, thereby not allowing the consideration of pre-pandemic levels of physical activity or the influence over the different waves of the pandemic. METHODS In this study, we utilize smartphone-measured step data from a nonprobability sample in Stockholm County, Sweden, where measures to limit the spread of COVID-19 differed from those in many other countries. The results are based on 522 individuals and 532,739 person-days with step data spanning from 2019 to 2021. Generalized additive models were fitted for each individual, and meta-regression was used to combine the results from individual models. RESULTS Daily steps decreased during the first wave but increased during the third wave compared to individual pre-pandemic levels. The decrease in daily steps occurred primarily in young individuals and those with occupations allowing remote work. Individuals of retirement age on the contrary increased their daily steps during the same period. CONCLUSIONS This study reveal that the influence of the COVID-19 pandemic was temporary and that younger age and the possibility of working from home were associated with a decreasing trend in physical activity.
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Affiliation(s)
- Minhao Zhou
- Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden
| | - Mihretab Gebreslassie
- Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden
| | - Antonio Ponce de Leon
- Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden; Department of Epidemiology, Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Per Tynelius
- Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Viktor H Ahlqvist
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Micael Dahlen
- Center for Wellbeing, Welfare and Happiness, Stockholm School of Economics, Stockholm, Sweden
| | - Daniel Berglind
- Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden; Center for Wellbeing, Welfare and Happiness, Stockholm School of Economics, Stockholm, Sweden
| | - Anton Lager
- Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Boel Brynedal
- Center for Epidemiology and Community Medicine (CES), Region Stockholm, Stockholm, Sweden; Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
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14
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Sennfält S, Hedman C, Fürst CJ. Associations between the spread of COVID-19 and end-of-life circumstances in the non-infected population of Sweden. Scand J Public Health 2024; 52:290-298. [PMID: 38153142 PMCID: PMC11067408 DOI: 10.1177/14034948231216197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 07/15/2023] [Accepted: 11/06/2023] [Indexed: 12/29/2023]
Abstract
AIMS Since its outbreak in 2020, the COVID-19 pandemic has directly caused the premature death of millions. However, indirect consequences, such as social restrictions, have affected a far greater number. We explored the association between the spread of COVID-19 and end-of-life circumstances in the infected and non-infected population in Sweden. METHODS In this descriptive, population-based, observational study, we primarily used data from the Swedish National Registry of Palliative Care, which covers about 60% of all deaths in Sweden. We explored the association between the spread of COVID-19 and place of death, people present at death and end-of-life symptoms using regression analyses. RESULTS The study included 190,291 individuals who died in any region of Sweden from 1 January 2019 to 30 June 2022, of which 10,646 were COVID-19 cases. Correlated to the temporal and geographical spread of COVID-19, there was a greater proportion of individuals dying without the presence of their next-of-kin, and consequently more people dying alone, both in those with and without COVID-19. There was a similar pattern of a greater proportion of deaths taking place in nursing homes and in the individual's own home. However, we did not find substantial associations to reported symptoms, such as anxiety or confusion. CONCLUSIONS This study shows the profound effects of the COVID-19 pandemic on end-of-life circumstances in both the infected and non-infected population in Sweden. As we prepare for future pandemics, there is a need to develop strategies to minimise the impact on non-infected individuals.
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Affiliation(s)
- Stefan Sennfält
- Department of Neurology, Karolinska University Hospital, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Christel Hedman
- Department of Clinical Sciences, Lund University, Sweden
- Institute for Palliative Care, Lund University and Region Skåne, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Sweden
- R&D Department, Stockholms Sjukhem Foundation, Sweden
| | - Carl Johan Fürst
- Department of Clinical Sciences, Lund University, Sweden
- Institute for Palliative Care, Lund University and Region Skåne, Sweden
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15
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Hentges M, Kågesten AE, Brandén G, Kosidou K, Michielsen K, Ekström AM, Larsson EC. Effects of COVID-19 measures on access to HIV/STI testing and condoms among adults in Sweden: a cross-sectional online survey. Scand J Public Health 2024; 52:299-308. [PMID: 38166520 PMCID: PMC11067389 DOI: 10.1177/14034948231217020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 10/04/2023] [Accepted: 11/09/2023] [Indexed: 01/04/2024]
Abstract
AIMS To investigate the self-reported impact of COVID-19 measures on access to testing for HIV and other sexually transmitted infections (STIs) and condoms and factors associated with reduced access among adults in Sweden. METHODS Cross-sectional data were collected in late 2020 through a web panel with adults (18-49 years) in Sweden as part of the International Sexual Health And REproductive health survey (I-SHARE) (N=1307). The primary outcome was self-reported access to HIV/STI testing and condoms during COVID-19 measures. Logistic regression was used to assess adjusted odds ratios of experiencing reduced access to HIV/STI testing and condoms in relation to sociodemographic characteristics, changes in sexual behaviours and COVID-19-related factors. RESULTS Of the 1138 sexually active respondents, 17% wanted an HIV/STI test, and of those over half (57%) reported reduced access during the COVID-19 measures in 2020. Compared with cis-women, transgender or non-binary respondents were more likely to experience lower access to testing. Among those who usually used condoms (n=568), 23% reported hampered condom access due to COVID-19 restrictions. Reduced condom access was associated with identifying as non-cis gender and a cis-man compared with cis-woman, non-heterosexual orientation, being foreign-born and financially worried. CONCLUSIONS Findings indicate that access to HIV/STI testing and condoms among sexually active adults of reproductive age in Sweden was disrupted during the COVID-19 pandemic in 2020 with varied impact depending on sexual orientation, gender identity or socioeconomic situation. This signals the importance of ensuring equitable access to sexual and reproductive health services and commodities in future crises response.
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Affiliation(s)
- Maike Hentges
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Anna E. Kågesten
- Department of Global Public Health, Karolinska Institutet, Sweden
| | - Gunnar Brandén
- Department of Global Public Health, Karolinska Institutet, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Sweden
| | - Kyriaki Kosidou
- Department of Global Public Health, Karolinska Institutet, Sweden
- Center for Epidemiology and Community Medicine, Region Stockholm, Sweden
| | | | - Anna Mia Ekström
- Department of Global Public Health, Karolinska Institutet, Sweden
- Department of Infectious Diseases, South General Hospital, Sweden
| | - Elin C. Larsson
- Department of Global Public Health, Karolinska Institutet, Sweden
- Department of Women’s and Children’s Health, Karolinska Institutet, Sweden
- Department of Women’s and Children’s Health, Uppsala University, Sweden
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16
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Blotière PO, Maura G, Raitanen J, Pulkki J, Forma L, Johnell K, Aaltonen M, Wastesson JW. Long-term care use, hospitalizations and mortality during COVID-19 in Finland and Sweden: A nationwide register-based study in 2020. Scand J Public Health 2024; 52:345-353. [PMID: 38481014 PMCID: PMC11067386 DOI: 10.1177/14034948241235730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/02/2024] [Accepted: 02/10/2024] [Indexed: 05/04/2024]
Abstract
AIM To describe long-term care (LTC) use in Finland and Sweden in 2020, by reporting residential entry and exit patterns including hospital admissions and mortality, compared with the 2018-2019 period and community-living individuals. METHODS From national registers in Finland and Sweden, all individuals 70+ were included. Using the Finnish and Swedish study populations in January 2018 as the standard population, we reported changes in sex- and age-standardized monthly rates of entry into and exit from LTC facilities, mortality and hospital admission among LTC residents and community-living individuals in 2020. RESULTS Around 850,000 Finns and 1.4 million Swedes 70+ were included. LTC use decreased in both countries from 2018 to 2020. In the first wave (March/April 2020), Finland experienced a decrease in LTC entry rates and an increase in LTC exit rates, both more marked than Sweden. This was largely due to short-term movements. Mortality rates peaked in April and December 2020 for LTC residents in Finland, while mortality peaked for both community-living individuals and LTC residents in Sweden. A decrease in hospital admissions from LTC facilities occurred in April 2020 and was less marked in Finland versus Sweden. CONCLUSIONS During the first wave of the pandemic mortality was consistently higher in Sweden. We also found a larger decrease in LTC use and, among LTC residents, a smaller decrease in hospital admissions in Finland than in Sweden. This study calls for assessing the health consequences of the differences observed between these two Scandinavian countries as part of the lessons from the COVID-19 pandemic.
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Affiliation(s)
- Pierre-Olivier Blotière
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Géric Maura
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jani Raitanen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland
- UKK Institute for Health Promotion Research, Tampere, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jutta Pulkki
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland
| | - Leena Forma
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland
- Laurea University of Applied Sciences, Vantaa, Finland
| | - Kristina Johnell
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mari Aaltonen
- Faculty of Social Sciences (Health Sciences) and Gerontology Research Centre (GEREC), Tampere University, Tampere, Finland
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jonas W. Wastesson
- Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet & Stockholm University, Sweden
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17
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von Brömssen K, Roxberg Å, Werkander Harstäde C. Space and place for health and care - Nationalist discourses in Swedish daily press during the first year of COVID-19. Heliyon 2024; 10:e27858. [PMID: 38560119 PMCID: PMC10979052 DOI: 10.1016/j.heliyon.2024.e27858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 03/03/2024] [Accepted: 03/07/2024] [Indexed: 04/04/2024] Open
Abstract
Sweden's strategy during COVID-19 with restrictions but no firm closure of the society surprised the rest of the world and was questioned, not least by neighbouring countries. This article analyses public discourses on space and place for health and care in the Swedish daily press during the first year of the pandemic, 2020. Critical discourse analysis was conducted on daily press newspaper articles to approach issues of space, place, health and care during the COVID-10 pandemic. The findings suggest three main discourses. First, a powerful discourse on unity against the threat is articulated, urging citizens in Sweden to be loyal in the national space. Secondly, an affirming national reconstructing discourse is manifested, related to constructions of borders of national space but also in relation to places of family life and social contacts to 'flatten the curve' and stay healthy. Thirdly, later in the period the overarching discourse of the nation and its loyal citizens was torn apart and increasing tensions were articulated due to, as it appeared, the uncertain actions from the government. This study adds to the literature on a theoretical and practical level. Raising awareness on nationalist discourses in relation to place, space, health, and care could prove important in combating inequalities in the local society as well as when cooperating on an international level.
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Affiliation(s)
- K. von Brömssen
- Department of Social and Behavioural Studies, University West, Trollhättan, Sweden
| | - Å. Roxberg
- Department of Health Sciences, University West, Trollhättan, Sweden
- VID, Specialized University, Bergen, Norway
- UiT, University of Tromsø, Campus Harstad, Norway
| | - C. Werkander Harstäde
- Department of Health and Caring Sciences, Linnaeus University, Kalmar, Växjö, Sweden
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Ekberg S, Molin D, Pahnke S, Bergström F, Brånvall E, Smedby KE, Wästerlid T. Impact of the COVID-19 pandemic on lymphoma incidence and short-term survival - a Swedish Lymphoma Register Study. Acta Oncol 2024; 63:164-168. [PMID: 38591352 PMCID: PMC11332491 DOI: 10.2340/1651-226x.2024.35238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/02/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND & PURPOSE The COVID-19 pandemic posed a large challenge for healthcare systems across the world. Comprehensive data on the impact of the COVID-19 pandemic on incidence and mortality in lymphoma are lacking. PATIENTS/METHODS Using data from the Swedish lymphoma register, we compare incidence and 1-year survival of lymphoma patients in Sweden before (2017-2019) and during the pandemic (2020 and 2021). RESULTS Fewer patients were diagnosed with lymphomas during March-June 2020, but the annual incidence rates for 2020 and 2021 were similar to those of 2017-2019. A larger proportion of patients presented with stage IV disease during 2021. There were no differences in other base-line characteristics nor application of active treatment in pre-pandemic and pandemic years. One-year overall survival was not inferior among lymphoma patients during the pandemic years compared to pre-pandemic years i.e., 2017-2019. INTERPRETATION The COVID-19 pandemic had limited impact on the incidence and mortality of lymphoma in Sweden.
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Affiliation(s)
- Sara Ekberg
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Molin
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; cDepartment of Cancer Immunotherapy, Uppsala University, Uppsala, Sweden
| | - Simon Pahnke
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; cDepartment of Cancer Immunotherapy, Uppsala University, Uppsala, Sweden
| | - Fanny Bergström
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Elsa Brånvall
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Medicine, Capio St Göran Hospital, Stockholm, Sweden
| | - Karin E Smedby
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden
| | - Tove Wästerlid
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Hematology, Karolinska University Hospital, Stockholm, Sweden.
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Tiger M, Castelpietra G, Wesselhoeft R, Lundberg J, Reutfors J. Utilization of antidepressants, anxiolytics, and hypnotics during the COVID-19 pandemic. Transl Psychiatry 2024; 14:175. [PMID: 38575574 PMCID: PMC10995182 DOI: 10.1038/s41398-024-02894-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
Since the onset of the COVID-19 pandemic, there have been concerns over the mental health impact of COVID-19. This is a review of the utilization of antidepressants, anxiolytics, and hypnotics since the COVID-19 pandemic was declared on March the 11th 2020. A number of reports so far have been based on large prescription databases for administrative use at the national or regional level, but mainly in high-income countries. We found studies reporting increased prescription rates of antidepressants, anxiolytics, and hypnotics during March 2020, which has been interpreted as hoarding of such medications. In the following months, most studies of antidepressant prescription rates did not display a clear pattern of change compared with prepandemic trends. In later phases of the pandemic small increases in utilization of antidepressants, with higher than predicted prescription rates, have been the most consistent finding, especially in youth. In most high-income countries, there were increasing trends in utilization of antidepressants also before 2020, which needs to be considered when estimating utilization during the pandemic, whereas for anxiolytics and hypnotics, the prepandemic patterns of prescriptions were more varying. Overall, after March 2020 we could not find any distinct changes in the utilization of anxiolytics and hypnotics during the COVID-19 pandemic. Most studies did not contain information about the prevalence of indicated psychiatric disorders in the studied populations. More studies are needed about the long-term effects of COVID-19, particularly regarding utilization of antidepressants. Research relating antidepressant utilization with the prevalence of major depression and anxiety disorders would promote a better understanding of how well antidepressant prescription rates reflect the needs of the population.
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Affiliation(s)
- Mikael Tiger
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden.
| | - Giulio Castelpietra
- Outpatient and Inpatient Care Service, Central Health Directorate, Region Friuli Venezia Giulia, Trieste, Italy
- Department Adult 2, Centre Neuchâteloise de Psychiatrie, Marin-Epagnier, Préfargier, Switzerland
| | - Rikke Wesselhoeft
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit of Child and Adolescent Psychiatry, Institute for Clinical Research, University of Southern Denmark, Odense, Denmark
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Johan Lundberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Johan Reutfors
- Centre for Pharmacoepidemiology, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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Håkansson A, Karlsson A, Widinghoff C. Treatment seeking for gambling disorder in nationwide register data - observations around a major shift in legislation. Front Public Health 2024; 12:1293887. [PMID: 38566789 PMCID: PMC10985188 DOI: 10.3389/fpubh.2024.1293887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/16/2024] [Indexed: 04/04/2024] Open
Abstract
Background Treatment seeking for gambling disorder is known to be low and there has been a lack of longitudinal research regarding treatment opportunities. The present study aimed to assess possible changes in treatment uptake after a formal introduction of gambling disorder in social services and health care legislations, by using register data, including patient characteristics with respect to socio-demographics and comorbidities. Methods Nationwide register data were collected for the years 2005-2019, describing diagnoses in specialized out-patient health care and in in-patient hospital care. Numbers and characteristics of patients with gambling disorder were followed longitudinally. Also, a new legislation for treatment by public institutions was introduced in 2018, and data were compared for the years before and after the shift in legislation, both nationally, for each of the three major urban regions, and for the rest of the country. Comparisons were made with respect to concurrent mental health comorbidities, age and gender. Results The number of out-patient gambling disorder diagnoses increased over time, but without any significant step changes around the shift in legislation. Over time, patients were younger, became more likely to have gambling disorder as their primary diagnosis, and less likely to have mental health comorbidities, whereas gender distribution did not change. Among the smaller group of patients diagnosed in in-patient settings, mental health comorbidity increased over time. Despite gradual changes over time, no changes in demographics were seen around the actual shift in legislation, although the psychiatric comorbidity appeared to increase after this change. Conclusion After the introduction of gambling disorder in the responsibility of social services and health care settings in Sweden, the number of patients diagnosed with gambling disorder increased only modestly. Likely, further implementation of gambling disorder treatment is required in the health care services. Also, longer longitudinal studies are needed in order to understand to what extent patients not seeking health care treatment are received by municipal social services or remain outside the treatment system.
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Affiliation(s)
- Anders Håkansson
- Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Malmö Addiction Center, Malmö, Sweden
| | - Anna Karlsson
- Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
| | - Carolina Widinghoff
- Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden
- Malmö Addiction Center, Malmö, Sweden
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Tondel M, Nordquist T, Helgesson M, Svartengren M. COVID-19: incidence and mortality in Sweden comparing all foreign-born to all Swedish-born individuals in different occupations in an unvaccinated cohort of year 2020. Occup Environ Med 2024; 81:136-141. [PMID: 38267211 PMCID: PMC10958322 DOI: 10.1136/oemed-2023-108952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVES The aim was to analyse the incidence and mortality of COVID-19 in immigrants compared with Swedish born in inpatients and outpatient registers, respectively. METHODS The study population included all persons 20-88 years of age living in Sweden, 31 December 2019, including 1 676 516 foreign-born persons and 6 037 151 Swedish-born persons. The outcome was clinical cases of COVID-19 with a positive PCR test (ICD-10 U07.01) or without a positive PCR test (U07.2) from 1 January to 31 December 2020. Persons 20-64 years of age were classified with occupational titles according to the Swedish Standard Classification of Occupations. Residing municipality of each individual was coded according to the Swedish Association of Local Authorities. Relative risks (RR) were calculated by sex in 5 years age bands using Swedish born as reference. Age-adjusted RRs (adj RR) with 95% CIs were calculated in a Poisson regression model. Rural municipalities were used as the reference category. RESULTS Foreign born had consistently higher RRs in COVID-19, regardless of sex, with a peak in 50-69 years of age. Foreign born had a higher RR of death in COVID-19 above 50 years and 40 years of age in women and men, respectively. Among occupations, male drivers had the highest adj RR 4.37 (95% CI 3.45 to 5.54) and 5.09 (4.26 to 6.07) in outpatients and inpatients, respectively (U07.1). Persons living in commuting municipalities did not show any consistent increased risk for COVID-19. CONCLUSION Foreign born have a higher risk of COVID-19 compared with Swedish-born individuals at any age and occupation before vaccination began in 2021.
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Affiliation(s)
- Martin Tondel
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Tobias Nordquist
- Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
| | - Magnus Helgesson
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Caring Sciences, Health Equity and Working Life, Uppsala University, Uppsala, Sweden
| | - Magnus Svartengren
- Occupational and Environmental Medicine, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
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Elenis E, Kallner HK, Karalexi MA, Hägg D, Linder M, Fall K, Papadopoulos FC, Skalkidou A. Estrogen-modulating treatment among mid-life women and COVID-19 morbidity and mortality: a multiregister nationwide matched cohort study in Sweden. BMC Med 2024; 22:84. [PMID: 38414048 PMCID: PMC10898018 DOI: 10.1186/s12916-024-03297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/12/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND It has been repeatedly shown that men infected by SARS-CoV-2 face a twofold higher likelihood of dying, being hospitalized or admitted to the intensive care unit compared to women, despite taking into account relevant confounders. It has been hypothesized that these discrepancies are related to sex steroid hormone differences with estrogens being negatively correlated with disease severity. The objective of this study was therefore to evaluate COVID-19-related mortality and morbidity among peri- and postmenopausal women in relation to estrogen-containing menopause hormonal treatments (MHT). METHODS This is a national register-based matched cohort study performed in Sweden between January 1 to December 31, 2020. Study participants comprised women over the age of 53 years residing in Sweden. Exposure was defined as prescriptions of local estrogens, systemic estrogens with and without progestogens, progestogens alone, or tibolone. MHT users were then compared with a matched cohort of non-users. The primary outcome consisted of COVID-19 mortality, whereas the secondary outcomes included inpatient hospitalizations/outpatient visits and confirmed SARS-CoV-2 infection. Multivariable adjusted Cox regression-derived hazard ratios (HRs) were calculated. RESULTS Use of systemic estrogens alone is associated with increased COVID-19 mortality among older women (aHR 4.73, 1.22 to 18.32), but the association is no longer significant when discontinuation of estrogen use is accounted for. An increased risk for COVID-19 infection is further observed for women using combined systemic estrogens and progestogens (aHR 1.06, 1.00 to 1.13) or tibolone (aHR 1.21, 1.01 to 1.45). Use of local estrogens is associated with an increased risk for COVID-19-related death (aHR 2.02,1.45 to 2.81) as well as for all secondary outcomes. CONCLUSIONS Systemic or local use of estrogens does not decrease COVID-19 morbidity and mortality to premenopausal background levels. Excess risk for COVID-19 morbidity and mortality was noted among older women and those discontinuing systemic estrogens. Higher risk for death was also noted among women using local estrogens, for which non-causal mechanisms such as confounding by comorbidity or frailty seem to be the most plausible underlying explanations. TRIAL REGISTRATION DETAILS Not applicable.
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Affiliation(s)
- Evangelia Elenis
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- Reproduction Center, Women's Clinic, Uppsala University Hospital, Uppsala, Sweden.
| | - Helena Kopp Kallner
- Department of Clinical Sciences at Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden
| | - Maria A Karalexi
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - David Hägg
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Marie Linder
- Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Katja Fall
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | | | - Alkistis Skalkidou
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Doheny M, de Leon AP, Burström B, Liljas A, Agerholm J. Differences in Covid-19 mortality among persons 70 years and older in an integrated care setting in region Stockholm: a multi-level analysis between March 2020-February 2021. BMC Public Health 2024; 24:462. [PMID: 38355460 PMCID: PMC10865543 DOI: 10.1186/s12889-024-17904-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/26/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND In Norrtälje municipality, within Region Stockholm, there is a joint integrated care organisation providing health and social care, which may have facilitated a more coordinated response to the covid-19 pandemic compared to the otherwise decentralised Swedish system. This study compares the risk of covid-19 mortality among persons 70 years and older, in the municipalities of Stockholm, Södertälje, and Norrtälje, while considering area and individual risk factors. METHODS A population-based study using linked register data to examine covid-19 mortality among those 70 + years (N = 127,575) within the municipalities of interest between the periods March-August 2020 and September 2020-February 2021. The effect of individual and area level variables on covid-19 mortality among inhabitants in 68 catchment areas were examined using multi-level logistic models. RESULTS Individual factors associated with covid-19 mortality were sex, older age, primary education, country of birth and poorer health as indicated by the Charlson Co-morbidity Index. The area-level variables associated were high deprivation (OR: 1.56, CI: 1.18-2.08), population density (OR: 1.14, CI: 1.08-1.21), and usual care. Together, this explained 85.7% of the variation between catchment areas in period 1 and most variation was due to individual risk factors in period 2. Little of the residual variation was attributed to differences between catchment areas. CONCLUSION Integrated care in Norrtälje may have facilitated a more coordinated response during period 1, compared to municipalities with usual care. In the future, integrated care should be considered as an approach to better protect and meet the care needs of older people during emergency situations.
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Affiliation(s)
- Megan Doheny
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden.
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Aging Research Center, Tomtebodavägen 18A, plan 9, Stockholm, 171 65, Sweden.
| | - Antonio Ponce de Leon
- Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Bo Burström
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Ann Liljas
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Janne Agerholm
- Aging Research Center, Karolinska Institutet, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Aging Research Center, Tomtebodavägen 18A, plan 9, Stockholm, 171 65, Sweden
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Kennedy B, Varotsis G, Hammar U, Nguyen D, Carrasquilla GD, van Zoest V, Kristiansson RS, Fitipaldi H, Dekkers KF, Daivadanam M, Martinell M, Björk J, Fall T. Sociodemographic characteristics and COVID-19 testing rates: spatiotemporal patterns and impact of test accessibility in Sweden. Eur J Public Health 2024; 34:14-21. [PMID: 38011903 PMCID: PMC10843959 DOI: 10.1093/eurpub/ckad209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Diagnostic testing is essential for disease surveillance and test-trace-isolate efforts. We aimed to investigate if residential area sociodemographic characteristics and test accessibility were associated with Coronavirus Disease 2019 (COVID-19) testing rates. METHODS We included 426 224 patient-initiated COVID-19 polymerase chain reaction tests from Uppsala County in Sweden from 24 June 2020 to 9 February 2022. Using Poisson regression analyses, we investigated if postal code area Care Need Index (CNI; median 1.0, IQR 0.8-1.4), a composite measure of sociodemographic factors used in Sweden to allocate primary healthcare resources, was associated with COVID-19 daily testing rates after adjustments for community transmission. We assessed if the distance to testing station influenced testing, and performed a difference-in-difference-analysis of a new testing station targeting a disadvantaged neighbourhood. RESULTS We observed that CNI, i.e. primary healthcare need, was negatively associated with COVID-19 testing rates in inhabitants 5-69 years. More pronounced differences were noted across younger age groups and in Uppsala City, with test rate ratios in children (5-14 years) ranging from 0.56 (95% CI 0.47-0.67) to 0.87 (95% CI 0.80-0.93) across three pandemic waves. Longer distance to the nearest testing station was linked to lower testing rates, e.g. every additional 10 km was associated with a 10-18% decrease in inhabitants 15-29 years in Uppsala County. The opening of the targeted testing station was associated with increased testing, including twice as high testing rates in individuals aged 70-105, supporting an intervention effect. CONCLUSIONS Ensuring accessible testing across all residential areas constitutes a promising tool to decrease inequalities in testing.
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Affiliation(s)
- Beatrice Kennedy
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Georgios Varotsis
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Ulf Hammar
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Diem Nguyen
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Germán D Carrasquilla
- Novo Nordisk Foundation Center for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Vera van Zoest
- Department of Information Technology, Division of Systems and Control, Uppsala University, Uppsala, Sweden
- Department of Systems Science for Defence and Security, Swedish Defence University, Stockholm, Sweden
| | - Robert S Kristiansson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Hugo Fitipaldi
- Diabetic Complications Unit, Department of Clinical Sciences, Lund University Diabetes Centre, Lund, Sweden
| | - Koen F Dekkers
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Meena Daivadanam
- Global Health and Migration Unit, Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Mats Martinell
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
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Swall A, Hammar LM, Boström AM. Listen to the voices of nurses: the role of community chief nurses and registered nurses in the provision of care for older people in Sweden during the COVID-19 pandemic - a cross-sectional study. BMC Geriatr 2024; 24:127. [PMID: 38308241 PMCID: PMC10835959 DOI: 10.1186/s12877-023-04652-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 12/31/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND During the pandemic in Sweden, the aim was to protect older people, especially those among them who were sick, frail and vulnerable in residential care facilities. A ban was put on visits at all residential care facilities in March 2020 to prevent the spread of infection among the older people. This study aims to describe the experiences of Community Chief Nurses and Registered Nurses who provided medical and nursing care for older people in residential care facilities and home care during the first wave of the COVID-19 pandemic, and to examine factors associated with the quality of care. METHODS The study has a mixed method cross-sectional design (STROBE). Data were collected using a web-based survey that comprised two questionnaires, for Community Chief Nurses and Registered Nurses developed for the study. Data were analysed using descriptive statistics and logistic regression models, as well as qualitative content analyses. RESULTS The majority of Community Chief Nurses reported adequate opportunities to work with management to handle the COVID-19 pandemic. The Registered Nurses reported that the quality of care, as well as the person's safety, was negatively affected during the pandemic. Factors associated with good care were as follows: information-sharing; ability to comply with hygiene practices; competence in how to care for older persons with COVID-19; a physician at bedside assessing their health; and support from frontline managers. CONCLUSION The study highlights crucial facets that care organizations must address to enhance their readiness for future pandemics or disasters, ensuring the security and well-being of the older people.
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Affiliation(s)
- Anna Swall
- School of Health and Welfare, Dalarna University, Högskolan Dalarna, 791 88, Falun, Sweden.
| | - Lena Marmstål Hammar
- School of Health and Welfare, Dalarna University, Högskolan Dalarna, 791 88, Falun, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Box 833, 721 23, Eskilstuna/Västerås, Sweden
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Science and Society Karolinska Institute, Alfred Nobels Allé 23, 141 83, Stockholm, Huddinge, Sweden
- Medical Unit Aging, Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- R&D Unit, Stockholms Sjukhem, Stockholm, Sweden
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Rudman A, Boström AM, Wallin L, Gustavsson P, Ehrenberg A. The use of the evidence-based practice process by experienced registered nurses to inform and transform clinical practice during the COVID-19 pandemic: A longitudinal national cohort study. Worldviews Evid Based Nurs 2024; 21:14-22. [PMID: 38084830 DOI: 10.1111/wvn.12692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 02/09/2024]
Abstract
BACKGROUND During the COVID-19 pandemic, many registered nurses (RNs) worked on the frontline caring for severely ill patients. They did so with limited knowledge of how to treat and prevent the disease. This extreme situation puts pressure on RNs to find evidence on which to base the care of their patients. AIMS To examine: (1) the extent to which evidence-based practice (EBP) process was applied by Swedish RN cohorts 15-19 years after graduation during the pandemic, (2) whether there was any change to their EBP process from pre-pandemic to late pandemic, (3) the relationship between RNs' use of the EBP process and the duration of exposure to work situations severely affected by the COVID-19 pandemic, and (4) whether level of education, position and care setting were associated with the extent of RNs' EBP process. METHODS In 2021, the level of EBP activities was investigated among 2237 RNs 15-19 years after graduation. The scale used to measure EBP consisted of six items of the EBP process. Unpaired t-tests or one-way analysis of variance (ANOVA) were used in the analysis. RESULTS RNs used the EBP process to a moderate extent to inform and transform their clinical practice. There was a minor but significant decrease in practicing the EBP process from pre-pandemic to late in the pandemic. RNs who were most affected by the pandemic scored higher on the scale than less-affected colleagues. RNs in nonclinical positions reported more EBP activities, as did RNs in management positions. RNs working in outpatient settings reported more EBP activities than their colleagues in hospitals. LINKING EVIDENCE TO ACTION It is imperative that RNs hone their skills in EBP if they are to be prepared for future healthcare crises. Healthcare providers have a duty to facilitate the development of EBP and, in this regard, RNs in clinical positions in hospitals need particular support.
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Affiliation(s)
- Ann Rudman
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anne-Marie Boström
- Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- R&D Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Lars Wallin
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Petter Gustavsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Ehrenberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
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Forsberg T, Isaksson M, Schelin C, Lyngå P, Schandl A. Family members' experiences of COVID-19 visiting restrictions in the intensive care unit-A qualitative study. J Clin Nurs 2024; 33:215-223. [PMID: 36710394 DOI: 10.1111/jocn.16637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To describe how family members of critically ill patients experienced the COVID-19 visiting restrictions in Sweden. BACKGROUND In Sweden, the response to COVID-19 was less invasive than in many other countries. However, some visiting restrictions were introduced for intensive care units, with local variations. Although there is a growing body of literature regarding healthcare professionals' and family caregivers' perspectives on visiting restriction policies, there may be inter-country differences, which remain to be elucidated. DESIGN This study has a qualitative descriptive design. Focus group interviews with 14 family members of patients treated for severe COVID-19 infection were conducted. The interviews took place via digital meetings during the months after the patients' hospital discharge. Qualitative content analysis was used to interpret the interview transcripts. Reporting of the study followed the COREQ checklist. RESULTS Two categories-dealing with uncertainty and being involved at a distance-described family members' experiences of coping with visiting restrictions during the COVID-19 pandemic. These restrictions were found to reduce family members' ability to cope with the situation. Communication via telephone or video calls to maintain contact was appreciated but could not replace the importance of personal contact. CONCLUSIONS Family members perceived that the visiting restriction routines in place during the COVID-19 pandemic negatively influenced their ability to cope with the situation and to achieve realistic expectations of the patients' needs when they returned home. RELEVANCE TO CLINICAL PRACTICE This study suggests that, during the COVID-19 pandemic, the visiting restrictions were experienced negatively by family members and specific family-centred care guidelines need to be developed for use during crises, including the possibility of regular family visits to the ICU. PATIENT AND PUBLIC CONTRIBUTION None in the conceptualisation or design of the study.
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Affiliation(s)
- Tomas Forsberg
- Department of Anaesthesiology and Intensive Care, Stockholm, Sweden
| | - Maria Isaksson
- Department of Cardiology and Medical Intensive Care, Stockholm, Sweden
| | - Caroline Schelin
- Department of Cardiology and Medical Intensive Care, Stockholm, Sweden
| | - Patrik Lyngå
- Department of Cardiology and Medical Intensive Care, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Anna Schandl
- Department of Anaesthesiology and Intensive Care, Stockholm, Sweden
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Rimpelä A, Kesanto-Jokipolvi H, Myöhänen A, Heikonen L, Oinas S, Ahtiainen R. School and class closures and adolescent mental health during the second and later waves of the COVID-19 pandemic in Finland: a repeated cross-sectional study. BMC Public Health 2023; 23:2434. [PMID: 38057763 PMCID: PMC10702082 DOI: 10.1186/s12889-023-17342-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Since the start of the COVID-19 pandemic, several studies have shown deterioration of adolescents' mental health when comparing periods before and after the start of the pandemic when there were national school closures. Less is known of the following waves with more variation in school closures and their duration. We study here, if variation in school or class closures was related to adolescents' mental health, if the duration mattered, and if the relationships were gender sensitive. METHODS All comprehensive schools in Finland were invited to participate. Students (grades 7-9, age 13-16 years) answered digitally in November-December 2020 (n = 41,041) and April-May 2021 (n = 28,501). The responses were given anonymously. Mental health was measured by daily health complaints and moderate/severe anxiety (GAD-7, only in 2021). School and class closures were combined to a variable (yes/no). The duration of a closure was analysed in weeks. Logistic regression analysis was used. RESULTS In 2020, 14% of pupils reported a school closure and 33% in 2021. The gender-adjusted odds for daily health complaints were higher among those with the school or class closure compared to those without (OR = 1.2 (1.1-1.3) in 2020; OR = 1.3 (1.2-1.3) in 2021). For anxiety, the corresponding OR was 1.3 (1.2-1.4). Girls had higher odds for both measures than boys and the non-binary gender had the highest. A one-week increase in the duration of closure had a small effect on daily health complaints OR = 1.05 (1.02-1.09) in 2020; OR = 1.05 (1.02-1.08) in 2021) and anxiety OR = 1.05 (1.01-1.08). Gender differences in the associations of the school or class closure with mental health were negligible. CONCLUSIONS A specific negative influence of school or class closures on adolescents' mental health was seen when comparing those who had school/class closure and those who did not during the further waves of the pandemic. The duration of closure had a small effect, too. The non-binary gender had lowest mental health, but the influence of school closure on mental health was mainly similar between the genders. School closures are one of the factors in adolescents' mental health, but not the only one.
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Affiliation(s)
- Arja Rimpelä
- Faculty of Social Sciences, Department of Health Sciences, Tampere University, Tampere, Finland
- Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Heidi Kesanto-Jokipolvi
- Faculty of Social Sciences, Department of Health Sciences, Tampere University, Tampere, Finland
| | - Anna Myöhänen
- Faculty of Social Sciences, Department of Health Sciences, Tampere University, Tampere, Finland.
| | - Lauri Heikonen
- Faculty of Educational Sciences, Department of Education, University of Helsinki, Helsinki, Finland
| | - Sanna Oinas
- Faculty of Educational Sciences, Department of Education, University of Helsinki, Helsinki, Finland
- Faculty of Educational Sciences, Department of Teacher Education, University of Turku, Turku, Finland
| | - Raisa Ahtiainen
- Faculty of Educational Sciences, Department of Education, University of Helsinki, Helsinki, Finland
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Ginman B, Pahnke S, Freyhult E, Hoffman T, Kolstad L, Rönnberg B, Lundkvist Å, Hamberg Levedahl K, Enblad G, Glimelius I. Strict self-isolation did not protect Swedish cancer patients on active treatment from the risk of becoming seropositive for SARS-CoV-2. Acta Oncol 2023; 62:1707-1715. [PMID: 37729083 DOI: 10.1080/0284186x.2023.2257873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 09/06/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND Swedish recommendations to reduce the risk of COVID-19 relied on each citizen's own sense of responsibility rather than mandatory lockdowns. We studied how COVID-19-related self-isolation and anxiety correlated to SARS-CoV-2 seropositivity and PCR-positivity in patients with active cancer treatment. METHODS In a longitudinal cohort study at Uppsala University Hospital patients and cancer personnel were included between April 1st 2020 to August 1st 2020. Serological testing for SARS-CoV-2 was done every 8-12-weeks until 30 March 2021. Patients completed a survey at inclusion regarding self-reported COVID-19-related anxiety and self-isolation. RESULTS A total of 622 patients [n = 475 with solid malignancies (SM), n = 147 with haematological malignancies (HM)], and 358 healthcare personnel were included. The seropositivity rate was lower for patients than for personnel; 10.5% for SM patients, 6.8% for HM patients, and 16.2% for personnel (p = 0.005). Strict adherence to self-isolation guidelines was reported by 54% of patients but was not associated with a lower risk of becoming seropositive [OR = 1.4 (0.8-2.5), p = 0.2]. High anxiety was expressed by 32% of patients, more often by SM patients than HM patients (34% vs 25% [OR = 1.6 (1.1-2.5, p = 0.03)]). Female gender [OR = 3.5 (2.4-5.2), p < 0.001] and being born outside of Europe [OR = 2.9 (1.4-6.4), p = 0.007] were both associated with high anxiety. Patients reporting high anxiety became seropositive to a similar degree as those with low anxiety [OR = 0.7 (0.3-1.2), p = 0.2]. HM patients with PCR-positive COVID-19 were more likely than SM patients to require oxygen therapy, including non-invasive ventilation/intubation (69% vs. 26%, p = 0.005). CONCLUSION For Swedish patients on active cancer treatment, high self-assessed COVID-19-related anxiety or strict adherence to self-isolation guidelines were not associated with a lower risk of COVID-19. Patients with HM were less likely to develop serological antibody response after COVID-19 and were more likely to require advanced hospital care, but expressed less COVID-19-related anxiety than patients with SM.
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Affiliation(s)
- Beatrice Ginman
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Sweden
| | - Simon Pahnke
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Sweden
| | - Eva Freyhult
- Department of Cell and Molecular Biology, National Bioinformatics Infrastructure Sweden, Science for Life Laboratory, Uppsala, Sweden
| | - Tove Hoffman
- Department of Medical Biochemistry and Microbiology, Zoonosis Science Center, Uppsala University, Uppsala, Sweden
| | - Linda Kolstad
- Department of Medical Biochemistry and Microbiology, Zoonosis Science Center, Uppsala University, Uppsala, Sweden
| | - Bengt Rönnberg
- Department of Medical Biochemistry and Microbiology, Zoonosis Science Center, Uppsala University, Uppsala, Sweden
| | - Åke Lundkvist
- Department of Medical Biochemistry and Microbiology, Zoonosis Science Center, Uppsala University, Uppsala, Sweden
| | | | - Gunilla Enblad
- Department of Immunology, Genetics and Pathology, Cancer Immunotherapy, Uppsala University, Uppsala, Sweden
| | - Ingrid Glimelius
- Department of Immunology, Genetics and Pathology, Cancer Precision Medicine, Uppsala University, Sweden
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Peterson M, Akearok GH, Cueva K, Lavoie JG, Larsen CVL, Jóhannsdóttir L, Cook D, Nilsson LM, Rautio A, Timlin U, San Sebastián M, Gladun E, Rink E, Broderstadt AR, Dagsvold I, Siri S, Ottendahl CB, Olesen I, Zatseva L, Young RI, Chaliak AJ, Ophus E, Stoor JPA. Public health restrictions, directives, and measures in Arctic countries in the first year of the COVID-19 pandemic. Int J Circumpolar Health 2023; 82:2271211. [PMID: 37898999 PMCID: PMC10997298 DOI: 10.1080/22423982.2023.2271211] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/28/2023] [Indexed: 10/31/2023] Open
Abstract
Beginning January of 2020, COVID-19 cases detected in Arctic countries triggered government policy responses to stop transmission and limit caseloads beneath levels that would overwhelm existing healthcare systems. This review details the various restrictions, health mandates, and transmission mitigation strategies imposed by governments in eight Arctic countries (the United States, Canada, Greenland, Norway, Finland, Sweden, Iceland, and Russia) during the first year of the COVID-19 pandemic, through 31 January 2021s31 January 2021. We highlight formal protocols and informal initiatives adopted by local communities in each country, beyond what was mandated by regional or national governments. This review documents travel restrictions, communications, testing strategies, and use of health technology to track and monitor COVID-19 cases. We provide geographical and sociocultural background and draw on local media and communications to contextualise the impact of COVID-19 emergence and prevention measures in Indigenous communities in the Arctic. Countries saw varied case rates associated with local protocols, governance, and population. Still, almost all regions maintained low COVID-19 case rates until November of 2020. This review was produced as part of an international collaboration to identify community-driven, evidence-based promising practices and recommendations to inform pan-Arctic collaboration and decision making in public health during global emergencies.
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Affiliation(s)
- Malory Peterson
- Department of Human Development and Community Health, Montana State University, Helena, USA
| | | | - Katie Cueva
- Institute of Social and Economic Research (ISER), University of Alaska, Anchorage, AK, USA
| | - Josée G. Lavoie
- Ongomiizwin Research, University of Manitoba, Winnipeg, MB, Canada
| | - Christina VL Larsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Lára Jóhannsdóttir
- Environment and Natural Resources Programme, University of Iceland, Reykjavík, Iceland
| | - David Cook
- Environment and Natural Resources Programme, University of Iceland, Reykjavík, Iceland
| | - Lena Maria Nilsson
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
| | - Arja Rautio
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Ulla Timlin
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Miguel San Sebastián
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
| | - Elena Gladun
- Institute of State and Law, University of Tyumen, Tyumen, Russia
| | - Elizabeth Rink
- Department of Human Development and Community Health, Montana State University, Helena, USA
| | - Ann Ragnhild Broderstadt
- Centre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Inger Dagsvold
- Centre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | - Susanna Siri
- Centre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
| | | | - Ingelise Olesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Institute of Health and Nature, University of Greenland, Nuuk, Greenland
| | - Larisa Zatseva
- Institute of State and Law, University of Tyumen, Tyumen, Russia
| | | | | | - Emily Ophus
- Qaujigiartiit Health Research Centre, Nunavut, Canada
| | - Jon Petter A. Stoor
- Department of Epidemiology and Global Health, Lávvuo-Research and Education for Sámi Health, Umeå University, Umeå, Sweden
- Centre for Sámi Health Research, Department of Community Medicine, UiT the Arctic University of Norway, Tromsø, Norway
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Shaaban AN, Andersson F, Peña S, Caspersen IH, Magnusson C, Orsini N, Karvonen S, Magnus P, Hergens MP, Galanti MR. The Association Between Tobacco Use and Risk of COVID-19 Infection and Clinical Outcomes in Sweden: A Population-Based Study. Int J Public Health 2023; 68:1606175. [PMID: 38098982 PMCID: PMC10720900 DOI: 10.3389/ijph.2023.1606175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 11/06/2023] [Indexed: 12/17/2023] Open
Abstract
Background: The association between tobacco use and COVID-19 is controversial. During the early course of the pandemic, limited testing prevented studying a wide spectrum of clinical manifestations. Objective: To examine the potential causal association between tobacco use and COVID-19 during the second wave (1 October 2020-30 June 2021) of the pandemic in Stockholm, Sweden. Methods: A population-based cohort study was conducted in the Stockholm region of Sweden, with information on tobacco use collected prior to the pandemic. Adjusted relative risks (RR) of COVID-19 and 95% confidence intervals (CI) were calculated, contrasting current smokers and snus users to non-users of tobacco. Results: Compared with non-users of tobacco, current smokers had a lower risk of COVID-19 (RR 0.78, 95% CI = 0.75-0.81) and of hospitalisation for the disease. Current snus users had a higher risk of COVID-19. Heavy smokers and snus users had longer hospital stays than non-users of tobacco. Conclusion: Tobacco use may have a different impact on the risk of being infected with SARS-CoV-2 and the risk of developing severe clinical manifestations. Further research is needed to determine the underlying mechanisms.
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Affiliation(s)
- A. N. Shaaban
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - F. Andersson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
| | - S. Peña
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - I. H. Caspersen
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - C. Magnusson
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
| | - N. Orsini
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
| | - S. Karvonen
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | - P. Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - M. P. Hergens
- Unit for Communicable Disease Control, Stockholm, Sweden
- Infectious Diseases Unit, Department of Medicine Solna, Karolinska Institutet, Solna, Sweden
| | - M. R. Galanti
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Centre for Epidemiology and Community Medicine, Stockholm, Sweden
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Göras C, Lohela-Karlsson M, Castegren M, Condén Mellgren E, Ekstedt M, Bjurling-Sjöberg P. From Threatening Chaos to Temporary Order through a Complex Process of Adaptation: A Grounded Theory Study of the Escalation of Intensive Care during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7019. [PMID: 37947575 PMCID: PMC10649734 DOI: 10.3390/ijerph20217019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 11/01/2023] [Accepted: 11/02/2023] [Indexed: 11/12/2023]
Abstract
To ensure high-quality care, operationalize resilience and fill the knowledge gap regarding how to improve the prerequisites for resilient performance, it is necessary to understand how adaptive capacity unfolds in practice. The main aim of this research was to explain the escalation process of intensive care during the first wave of the pandemic from a microlevel perspective, including expressions of resilient performance, intervening conditions at the micro-meso-macrolevels and short- and long-term consequences. A secondary aim was to provide recommendations regarding how to optimize the prerequisites for resilient performance in intensive care. A grounded theory methodology was used. First-person stories from different healthcare professionals (n70) in two Swedish regions were analyzed using the constant comparative method. This resulted in a novel conceptual model (including 6 main categories and 24 subcategories), and 41 recommendations. The conclusion of these findings is that the escalation of intensive care can be conceptualized as a transition from threatening chaos to temporary order through a complex process of adaptation. To prepare for the future, the components of space, stuff, staff, system and science, with associated continuity plans, must be implemented, anchored and communicated to actors at all levels of the system.
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Affiliation(s)
- Camilla Göras
- Department of Caring Sciences, Faculty of Health and Occupational Sciences, University of Gävle, SE-801 76 Gävle, Sweden;
- Department of Anesthesia and Intensive Care, Falu Hospital, SE-791 31 Falun, Sweden
| | - Malin Lohela-Karlsson
- Department of Public Health and Caring Sciences, Health Services Research, Uppsala University, SE-752 37 Uppsala, Sweden;
- Centre for Clinical Research Västmanland, Uppsala University, SE-721 89 Västerås, Sweden;
| | - Markus Castegren
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, SE-171 77 Stockholm, Sweden;
- Centre for Clinical Research Sörmland, Uppsala University, SE-631 88 Eskilstuna, Sweden
| | - Emelie Condén Mellgren
- Centre for Clinical Research Västmanland, Uppsala University, SE-721 89 Västerås, Sweden;
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University Kalmar/Växjö, SE-392 31 Kalmar, Sweden;
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Petronella Bjurling-Sjöberg
- Centre for Clinical Research Sörmland, Uppsala University, SE-631 88 Eskilstuna, Sweden
- Department of Public Health and Caring Sciences, Caring Science, Uppsala University, SE-752 37 Uppsala, Sweden
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Wijkström J, Caldinelli A, Bruchfeld A, Nowak A, Artborg A, Stendahl M, Segelmark M, Lindholm B, Bellocco R, Rydell H, Evans M. Results of the first nationwide cohort study of outcomes in dialysis and kidney transplant patients before and after vaccination for COVID-19. Nephrol Dial Transplant 2023; 38:2607-2616. [PMID: 37433606 PMCID: PMC10615630 DOI: 10.1093/ndt/gfad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Patients on kidney replacement therapy (KRT) have been identified as a vulnerable group during the coronavirus disease 2019 (COVID-19) pandemic. This study reports the outcomes of COVID-19 in KRT patients in Sweden, a country where patients on KRT were prioritized early in the vaccination campaign. METHODS Patients on KRT between January 2019 and December 2021 in the Swedish Renal Registry were included. Data were linked to national healthcare registries. The primary outcome was monthly all-cause mortality over 3 years of follow-up. The secondary outcomes were monthly COVID-19-related deaths and hospitalizations. The results were compared with the general population using standardized mortality ratios. The difference in risk for COVID-19-related outcomes between dialysis and kidney transplant recipients (KTRs) was assessed in multivariable logistic regression models before and after vaccinations started. RESULTS On 1 January 2020, there were 4097 patients on dialysis (median age 70 years) and 5905 KTRs (median age 58 years). Between March 2020 and February 2021, mean all-cause mortality rates increased by 10% (from 720 to 804 deaths) and 22% (from 158 to 206 deaths) in dialysis and KTRs, respectively, compared with the same period in 2019. After vaccinations started, all-cause mortality rates during the third wave (April 2021) returned to pre-COVID-19 mortality rates among dialysis patients, while mortality rates remained increased among transplant recipients. Dialysis patients had a higher risk for COVID-19 hospitalizations and death before vaccinations started {adjusted odds ratio [aOR] 2.1 [95% confidence interval (CI) 1.7-2.5]} but a lower risk after vaccination [aOR 0.5 (95% CI 0.4-0.7)] compared with KTRs. CONCLUSIONS The COVID-19 pandemic in Sweden resulted in increased mortality and hospitalization rates among KRT patients. After vaccinations started, a distinct reduction in hospitalization and mortality rates was observed among dialysis patients, but not in KTRs. Early and prioritized vaccinations of KRT patients in Sweden probably saved many lives.
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Affiliation(s)
- Julia Wijkström
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Aurora Caldinelli
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- University of Milano-Bicocca, Department of Statistics and Quantitative Methods, Milano, Italy
| | - Annette Bruchfeld
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Alexandra Nowak
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Angelica Artborg
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Stendahl
- Department of Internal Medicine, Ryhov Hospital, Jönköping, Sweden
- Swedish Renal Register, Jönköping, Sweden
| | - Mårten Segelmark
- Swedish Renal Register, Jönköping, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Endocrinology, Nephrology and Rheumatology, Skane University Hospital, Lund, Sweden
| | - Bengt Lindholm
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Rino Bellocco
- University of Milano-Bicocca, Department of Statistics and Quantitative Methods, Milano, Italy
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Helena Rydell
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Swedish Renal Register, Jönköping, Sweden
| | - Marie Evans
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Department of Renal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Swedish Renal Register, Jönköping, Sweden
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Wang H, Churqui MP, Tunovic T, Enache L, Johansson A, Lindh M, Lagging M, Nyström K, Norder H. Measures against COVID-19 affected the spread of human enteric viruses in a Swedish community, as found when monitoring wastewater. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 895:165012. [PMID: 37353026 PMCID: PMC10284612 DOI: 10.1016/j.scitotenv.2023.165012] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/25/2023] [Accepted: 06/17/2023] [Indexed: 06/25/2023]
Abstract
The quantification of viral genomes in wastewater reflects the prevalence of viral infections within the community. Knowledge of how the spread of common enteric viruses in the community was affected by the Swedish COVID-19 interventions is limited. To investigate this, the weekly wastewater samples collected for monitoring SARS-CoV-2 throughout the COVID-19 pandemic at the Rya sewage treatment plant in Gothenburg were also analyzed for adenovirus, norovirus GII, astrovirus, and rotavirus. The amount of each viral genome was quantified by real-time-qPCR and compared with the quantity of these viral genomes in wastewater from 2017. The results showed that the winter seasonality of norovirus GII and rotavirus in wastewater observed in 2017 was interrupted shortly after the introduction of the COVID-19 interventions, and they remained at low level throughout the pandemic. The circulation pattern of astrovirus and adenovirus was less affected. When the COVID-19 restrictions were lifted in 2022, a dramatic increase was observed in the amount of norovirus GII, rotavirus, and adenovirus genomes in wastewater. The changes in abundance and seasonality of some viruses identified through wastewater monitoring were consistent with changes in the number of patients diagnosed with these viruses. These findings suggest that moderate intervention to prevent COVID-19 significantly reduced the spread of some enteric viruses in the community. The results show that wastewater monitoring is a valuable tool for detecting the spread and outbreaks of viral infections that may cause gastroenteritis also when people do not seek medical help, such as during the COVID-19 pandemic.
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Affiliation(s)
- Hao Wang
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Department of Clinical Microbiology, Region Västra Götaland, Gothenburg, Sweden.
| | - Marianela Patzi Churqui
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | - Timur Tunovic
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden
| | | | | | - Magnus Lindh
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Department of Clinical Microbiology, Region Västra Götaland, Gothenburg, Sweden
| | - Martin Lagging
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Department of Clinical Microbiology, Region Västra Götaland, Gothenburg, Sweden
| | - Kristina Nyström
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Department of Clinical Microbiology, Region Västra Götaland, Gothenburg, Sweden
| | - Heléne Norder
- Institute of Biomedicine, Department of Infectious Diseases, University of Gothenburg, Gothenburg, Sweden; Sahlgrenska University Hospital, Department of Clinical Microbiology, Region Västra Götaland, Gothenburg, Sweden
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Lindgren I, Trulsson Schouenborg A, Larsson C, Stigmar K. Perceptions of everyday life during lenient COVID-19 restrictions in Sweden- an interview study. BMC Public Health 2023; 23:1743. [PMID: 37679662 PMCID: PMC10483720 DOI: 10.1186/s12889-023-16599-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 08/23/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Both COVID-19 and its associated societal restrictions have affected individuals' health and everyday life. In Sweden, more lenient public health restrictions were implemented, with individuals asked to act responsibly in terms of reducing spread of disease. The majority of studies reporting on experiences of Covid-19 restrictions have been in the context of more substantial mandatory rules aimed at reducing social contact, therefore it is important to describe how more lenient restrictions have impacted individuals' well-being. This study aims to describe perceptions of everyday life during the first wave of the COVID-19 pandemic, perceived by individuals with no underlying medical condition, and living with more lenient public health restrictions in Sweden. METHOD The participants were recruited from individuals who originally had participated in an online survey about life satisfaction, health, and physical activity. Fifteen individuals (median age 49, range 26-76 years, seven women) in various social situations, such as living alone/cohabiting, having children at home, geographical area and size of city were interviewed. Qualitative content analysis was applied to the data. RESULTS An overall theme "Both hindrances and opportunities in important life domains were experienced within the same person during lenient Covid-19 restrictions" was derived and covered three categories: "New possibilities of flexibility in work and better health", "Life went on as usual with minor adjustments" and "Everyday life changed and became more difficult" together with eight subcategories. For most participants, both facilitating and hindering important domains in life were described. Unexpected findings were positive experiences regarding working from home, physical activities, leisure time activities and the balance between work and leisure time. In areas where only minor adjustments were made, life was perceived as going on as before. On the other hand, restrictions increased worries and were perceived to have negative effects on social participation. CONCLUSION The impact of the pandemic and lenient restrictions in Sweden on the participants´ everyday life was multifaceted. Both hindrances and opportunities in important life domains were experienced within the same person. An increased flexibility in work- and leisure activities were perceived having positive effects for health and wellbeing and led to a better balance in life.
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Affiliation(s)
- Ingrid Lindgren
- Rehabilitation and Sustainable Health, Department of Health Sciences, Lund University, Lund, Sweden.
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, Lund, Sweden.
| | - Anna Trulsson Schouenborg
- Department of Neurosurgery and Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
- Human Movement: health and rehabilitation, Department of Health Sciences, Lund University, Lund, Sweden
| | - Caroline Larsson
- Human Movement: health and rehabilitation, Department of Health Sciences, Lund University, Lund, Sweden
| | - Kjerstin Stigmar
- Human Movement: health and rehabilitation, Department of Health Sciences, Lund University, Lund, Sweden
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Heiden M, Hallman DM, Svensson M, Mathiassen SE, Svensson S, Bergström G. Mismatch between actual and preferred extent of telework: cross-sectional and prospective associations with well-being and burnout. BMC Public Health 2023; 23:1736. [PMID: 37674141 PMCID: PMC10481552 DOI: 10.1186/s12889-023-16683-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/01/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND This study aimed to determine whether telework mismatch, i.e., lack of fit between actual and preferred extent of telework, is cross-sectionally and prospectively associated with well-being and burnout. METHODS A questionnaire was sent to employees in a Swedish manufacturing company in November 2020 (baseline) and September 2021 (follow-up). It contained questions about well-being (WHO-5 Well-Being Index) and burnout (Copenhagen Psychosocial Questionnaire III), as well as the preferred extent of telework and extent of telework performed. Telework mismatch was calculated as the difference between the actual and preferred extent of telework. Change in mismatch over time was categorized as 1) less mismatch at follow-up than at baseline, 2) more mismatch at follow-up, and 3) identical levels of mismatch at baseline and follow-up. Multivariate and univariate analyses of variance were used to determine the effects of mismatch and change in mismatch over time on baseline ratings and changes in ratings of well-being and burnout. All analyses were performed with and without adjustment for age, sex, marital status, children, type of employment, commuting time and extent of telework performed. RESULTS The response rate was 39% at baseline (n = 928, 67% men, mean(SD) age: 45(11) years) and 60% at follow-up (n = 556, 64% men, mean(SD) age: 46(11) years). A cross-sectional association was found between telework mismatch and well-being, showing that employees who teleworked more than they would like reported worse well-being than those who teleworked less than they would like. No statistically significant association was found between telework mismatch and burnout. The ability of telework mismatch at baseline to predict changes in well-being or burnout over 10 months was small and non-significant. No association was found between change in telework mismatch over the 10-month period and corresponding changes in well-being or burnout. CONCLUSION Our results suggest that telework should be thoughtfully practiced in companies/organizations to avoid negative consequences for employees who already telework more than they prefer. Studies are needed to determine how long-term changes in match between preferred and actual extent of telework is associated with employee well-being, including how the association is modified by the nature of the job and the work environment.
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Affiliation(s)
- Marina Heiden
- Centre for Musculoskeletal Research, Department of Occupational Health Science and Psychology, Faculty of Health and Occupational Studies, University of Gävle, SE 801 76 Gävle, Gävle, Sweden.
| | - David M Hallman
- Centre for Musculoskeletal Research, Department of Occupational Health Science and Psychology, Faculty of Health and Occupational Studies, University of Gävle, SE 801 76 Gävle, Gävle, Sweden
| | - Malin Svensson
- Centre for Musculoskeletal Research, Department of Occupational Health Science and Psychology, Faculty of Health and Occupational Studies, University of Gävle, SE 801 76 Gävle, Gävle, Sweden
| | - Svend Erik Mathiassen
- Centre for Musculoskeletal Research, Department of Occupational Health Science and Psychology, Faculty of Health and Occupational Studies, University of Gävle, SE 801 76 Gävle, Gävle, Sweden
| | - Sven Svensson
- Centre for Musculoskeletal Research, Department of Occupational Health Science and Psychology, Faculty of Health and Occupational Studies, University of Gävle, SE 801 76 Gävle, Gävle, Sweden
| | - Gunnar Bergström
- Centre for Musculoskeletal Research, Department of Occupational Health Science and Psychology, Faculty of Health and Occupational Studies, University of Gävle, SE 801 76 Gävle, Gävle, Sweden
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Box 210, 171 77, Stockholm, Sweden
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Ågren A, Pavlidis G. Sense-Making of Loneliness and Exclusion From Social Relations Among Older Adults in Sweden. THE GERONTOLOGIST 2023; 63:1140-1148. [PMID: 36752678 PMCID: PMC10448986 DOI: 10.1093/geront/gnad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Loneliness and exclusion from social relations (ESR) are frequently addressed as public health issues for older adults. Public discourses potentially influence how loneliness and ESR are understood in society and experienced by the individual. The aim of this study was to analyze how older adults in different parts of Sweden use the discourses and concepts available to them to describe experiences of ESR and loneliness, and how these descriptions are used to construct a self-identity. RESEARCH DESIGN AND METHODS Qualitative semi-structured interviews were conducted with 30 individuals (14 men, 16 women) aged 67-87 years and living in Sweden. Emphasis was, in line with perspectives of discursive psychology, on how individuals draw on discourses to make sense of experiences. The empirical material was analyzed through an inductive process where we were open to finding concepts and themes. RESULTS Most participants emphasized the importance of not being lonely, considered achievable through maintaining an active lifestyle. "Othering" was taking place, where a general image of a "lonely" older adult was referred to when speaking about "others" loneliness. Those who expressed feelings of loneliness related these feelings to loss, being omitted, and other difficult life circumstances. DISCUSSION AND IMPLICATIONS States of ESR were discussed more comfortably than loneliness, whereas various linguistic resources were used to distance themselves from loneliness. These findings indicate the need for further studies elaborating on how older adults make sense of ESR and loneliness and what implications this has for older adults' well-being and identity making.
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Affiliation(s)
- Axel Ågren
- Department of Culture and Society, Linköping University, Campus Norrköping, Sweden
| | - George Pavlidis
- Department of Culture and Society, Linköping University, Campus Norrköping, Sweden
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Soriano-Arandes A, Brett A, Buonsenso D, Emilsson L, de la Fuente Garcia I, Gkentzi D, Helve O, Kepp KP, Mossberg M, Muka T, Munro A, Papan C, Perramon-Malavez A, Schaltz-Buchholzer F, Smeesters PR, Zimmermann P. Policies on children and schools during the SARS-CoV-2 pandemic in Western Europe. Front Public Health 2023; 11:1175444. [PMID: 37564427 PMCID: PMC10411527 DOI: 10.3389/fpubh.2023.1175444] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 06/26/2023] [Indexed: 08/12/2023] Open
Abstract
During the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), mitigation policies for children have been a topic of considerable uncertainty and debate. Although some children have co-morbidities which increase their risk for severe coronavirus disease (COVID-19), and complications such as multisystem inflammatory syndrome and long COVID, most children only get mild COVID-19. On the other hand, consistent evidence shows that mass mitigation measures had enormous adverse impacts on children. A central question can thus be posed: What amount of mitigation should children bear, in response to a disease that is disproportionally affecting older people? In this review, we analyze the distinct child versus adult epidemiology, policies, mitigation trade-offs and outcomes in children in Western Europe. The highly heterogenous European policies applied to children compared to adults did not lead to significant measurable differences in outcomes. Remarkably, the relative epidemiological importance of transmission from school-age children to other age groups remains uncertain, with current evidence suggesting that schools often follow, rather than lead, community transmission. Important learning points for future pandemics are summarized.
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Affiliation(s)
- Antoni Soriano-Arandes
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ana Brett
- Infectious Diseases Unit and Emergency Service, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Milan, Italy
| | - Louise Emilsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Isabel de la Fuente Garcia
- Pediatric Infectious Diseases, National Pediatric Center, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Despoina Gkentzi
- Department of Paediatrics, Patras Medical School, Patras, Greece
| | - Otto Helve
- Department of Health Security, Institute for Health and Welfare, Helsinki, Finland
- Pediatric Research Center, Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Kasper P. Kepp
- Section of Biophysical and Biomedicinal Chemistry, DTU Chemistry, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Maria Mossberg
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Epistudia, Bern, Switzerland
| | - Alasdair Munro
- NIHR Southampton Clinical Research Facility and Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
- Faculty of Medicine, Institute of Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Cihan Papan
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Aida Perramon-Malavez
- Computational Biology and Complex Systems (BIOCOM-SC) Group, Department of Physics, Universitat Politècnica de Catalunya (UPC·BarcelonaTech), Barcelona, Spain
| | | | - Pierre R. Smeesters
- Department of Pediatrics, University Hospital Brussels, Academic Children’s Hospital Queen Fabiola, Université Libre de Bruxelles, Brussels, Belgium
- Molecular Bacteriology Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - Petra Zimmermann
- Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
- Department of Paediatrics, Fribourg Hospital, Fribourg, Switzerland
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Täljedal T, Granlund M, Almqvist L, Osman F, Norén Selinus E, Fängström K. Patterns of mental health problems and well-being in children with disabilities in Sweden: A cross-sectional survey and cluster analysis. PLoS One 2023; 18:e0288815. [PMID: 37463139 DOI: 10.1371/journal.pone.0288815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Children with disabilities have an increased risk of mental health problems. Patterns of mental health problems and well-being may vary. AIMS To identify patterns of mental health problems and well-being in children with disabilities in Sweden, and investigate the influence of parental background (migration, education), and child cognitive level. METHOD In this cross-sectional study, cluster analysis was used to analyse parents' ratings of conduct problems, emotional symptoms, and prosocial behaviour on the Strengths and Difficulties Questionnaire (SDQ) in children with disabilities (n = 136). The influence of parental background (migration, education) and child cognitive level on cluster membership was explored through multinomial logistic regression. RESULTS Five clusters of mental health patterns emerged. Three clusters had mean ratings near or past clinical cut-off for one each of the SDQ-subscales. One cluster had difficulties on all three subscales. Greater child cognitive difficulties increased the likelihood of low prosocial behaviour (OR 2.501, p < .001) and of difficulties on all three subscales (OR 2.155, p = .006). Parental background did not influence cluster membership. CONCLUSION Children with disabilities display varying mental health patterns. Awareness of the complexity of mental health patterns among children with disabilities is important. Screening and support for emotional symptoms and prosocial behaviour deficits should be considered for children with conduct problems.
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Affiliation(s)
- Torun Täljedal
- Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital Västerås, Västerås, Sweden
- CHAP, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Mats Granlund
- CHILD Research Environment, Jönköping University, Jönköping, Sweden
- Department of Mental Health, Norway Technical and Natural Sciences University, Trondheim, Norway
| | - Lena Almqvist
- CHILD Research Environment, Jönköping University, Jönköping, Sweden
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Fatumo Osman
- CHAP, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Eva Norén Selinus
- Region Västmanland - Uppsala University, Centre for Clinical Research, Västmanland Hospital Västerås, Västerås, Sweden
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Karin Fängström
- CHAP, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Lättman K, Olsson LE, Waygood EOD, Friman M. Nowhere to go - Effects on elderly's travel during Covid-19. TRAVEL BEHAVIOUR & SOCIETY 2023; 32:100574. [PMID: 36911425 PMCID: PMC9986143 DOI: 10.1016/j.tbs.2023.100574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 12/14/2022] [Accepted: 02/16/2023] [Indexed: 06/03/2023]
Abstract
The COVID-19 pandemic has presented numerous, significant challenges for elderly in their daily life. In order to reach a deeper understanding of the feelings and thoughts of the elderly related to their possibilities to travel and engage in activities during the pandemic, this study takes a qualitative approach to exploring the views of the elderly themselves. The study focuses on experiences during the COVID-19 pandemic. A number of in-depth semi-structured interviews with elderly aged 70 and above, were conducted in June 2020. Applied Thematic Analysis (ATA) was applied, as a first stage, to investigate meaningful segments of data. In a second stage these identified segments were combined into a number of themes. This study reports the outcome of the ATA analysis. More specifically we report experiences, motivations and barriers for travel and activity participation, and discuss how these relate to the health and well-being of elderly, and vice versa. These findings highlight the strong need to develop a transport system that to a higher extent addresses the physical as well as the mental health of old people, with a particular focus on facilitating social interactions.
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Affiliation(s)
- Katrin Lättman
- Karlstad University, CTF - Service Research Center and Department of Social and Psychological Studies, SE-65188 Karlstad, Sweden
- Department of Occupational Health Science and Psychology, University of Gävle, SE-80176 Gävle, Sweden
| | - Lars E Olsson
- Karlstad University, CTF - Service Research Center and Department of Social and Psychological Studies, SE-65188 Karlstad, Sweden
| | - E Owen D Waygood
- Polytechnique Montreal, Department of Civil Geological and Mining Engineering, PO Box 6079, Montréal, QC H3C 3A7, Canada
| | - Margareta Friman
- Karlstad University, CTF - Service Research Center and Department of Social and Psychological Studies, SE-65188 Karlstad, Sweden
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Blomqvist S, Virtanen M, Westerlund H, Magnusson Hanson LL. Associations between COVID-19-related changes in the psychosocial work environment and mental health. Scand J Public Health 2023; 51:664-672. [PMID: 36964650 PMCID: PMC10040465 DOI: 10.1177/14034948231160633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 10/25/2022] [Accepted: 02/13/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND Individuals' lives have been substantially affected by the COVID-19 pandemic. We aimed to describe changes in psychosocial work environment and mental health and to investigate associations between job insecurity and mental ill-health in relation to changes in other psychosocial work factors, loneliness and financial worries. METHODS A sub-sample of individuals from the eighth Swedish Longitudinal Occupational Survey of Health answered a web-based survey in early 2021 about current and pandemic-related changes in health, health behaviours, work and private life. We investigated participants working before the pandemic (N=1231) in relation to standardised measures on depression, anxiety and loneliness, together with psychosocial work factors, in descriptive and logistic regression analyses. RESULTS While 9% reached the clinical threshold for depression and 6% for anxiety, more than a third felt more worried, lonelier or in a low mood since the start of the pandemic. Two per cent had been dismissed from their jobs, but 16% experienced workplace downsizings. Conditioning on socio-demographic factors and prior mental-health problems, the 8% experiencing reduced job security during the pandemic had a higher risk of anxiety, but not of depression, compared to employees with unaltered or increased job security. Loneliness and other psychosocial work factors explained more of the association than objective measures of job insecurity and financial worries. CONCLUSIONS Reduced job security during the COVID-19 pandemic seems to have increased the risk of anxiety among individuals with a strong labour market attachment, primarily via loneliness and other psychosocial work factors. This illustrates the potentially far-reaching effects of the pandemic on mental health in the working population.
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Affiliation(s)
- Sandra Blomqvist
- Stress Research Institute at Department of Psychology, Stockholm University, Sweden
| | - Marianna Virtanen
- School of Educational Sciences and Psychology, University of Eastern Finland, Finland
| | - Hugo Westerlund
- Stress Research Institute at Department of Psychology, Stockholm University, Sweden
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Tufvesson Stiller H, Schmitt-Egenolf M, Fohlin H, Uppugunduri S. Patient reported experiences of Swedish patients being investigated for cancer during the Covid-19 pandemic. Support Care Cancer 2023; 31:416. [PMID: 37354327 DOI: 10.1007/s00520-023-07897-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 06/21/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Patient reported experiences in individuals being investigated for cancer have been recorded in a nationwide survey in Sweden, providing an opportunity to assess the impact of the Covid-19-pandemic. MATERIAL AND METHODS Questionnaires from 45920 patients were analyzed to assess the experience of being investigated for cancer. Data from before the Covid-19-pandemic (2018-2019) was compared to data acquired during the pandemic (2020-2021), using chi-square and Wilcoxon rank sum tests. Both, patients who were cleared from suspicion of cancer and those who were diagnosed with cancer were included. RESULTS Fewer patients in total visited health services during the pandemic. However, patients that did seek help did so to a similar extent during as prior to the pandemic. Patient waiting time was perceived to be shorter during the pandemic and judged as neither too long nor too short by most patients. The emotional support to patients improved during the pandemic, whereas the support to next of kin declined. A majority of patients received the results from the investigation in a meeting with the physician. Although there was a preference for receiving results in a meeting with the physician, the pandemic has brought an increasing interest in receiving results by phone. CONCLUSION Swedish cancer healthcare has shown resilience during the Covid-19-pandemic, maintaining high patient satisfaction while working under conditions of extraordinary pressure. Patients became more open to alternatives to physical "in person" health care visits which could lead to more digital visits in the future. However, support to significant others demands special attention.
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Affiliation(s)
- Helena Tufvesson Stiller
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
- Regional Cancer Center Southeast, Linköping, Sweden.
| | | | - Helena Fohlin
- Regional Cancer Center Southeast, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Srinivas Uppugunduri
- Regional Cancer Center Southeast, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Wallberg M, Tinnerholm Ljungberg H, Björk Brämberg E, Nybergh L, Jensen I, Olsson C. Hindering and enabling factors for young employees with common mental disorder to remain at or return to work affected by the Covid-19 pandemic - a qualitative interview study with young employees and managers. PLoS One 2023; 18:e0286819. [PMID: 37285347 DOI: 10.1371/journal.pone.0286819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 05/24/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, changes in working life occurred, even in Sweden, where there was no general lockdown. The aim of this study was to examine how the COVID-19 pandemic was perceived as affecting the hindering and enabling factors among young employees with CMD to remain at or return to work, here as investigated from the perspective of young employees and managers. MATERIAL AND METHODS A qualitative design was applied with semistructured interviews with 23 managers and 25 young employees (20-29 years old). The interviews were recorded and transcribed verbatim, and the parts of the interviews related to the aim of this article were analysed using conventional content analysis. RESULTS The hindering factors were changed working conditions, decreased well-being when spending more time at home, and uncertainty. The enabling factors were decreased demands, increased balance, and well-functioning work processes. For managers it is important to be aware of warning signals indicating blurred boundaries between work and private life, to create and maintain well-functioning communication, and leave room for recovery. CONCLUSION The hindering and enabling factors can be described as two sides of the same coin. Changes in the working conditions during the pandemic led to difficulties for both young employees and managers when the margins of maneuver were insufficient.
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Affiliation(s)
- Martina Wallberg
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Helena Tinnerholm Ljungberg
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisabeth Björk Brämberg
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Nybergh
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Irene Jensen
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Olsson
- Unit of Intervention and Implementation Research for Worker Health, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
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Janson A. Unique Swedish data on young children's growth help to fill the gap identified by the World Health Organization. Acta Paediatr 2023; 112:1140-1141. [PMID: 37002727 DOI: 10.1111/apa.16771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 05/09/2023]
Affiliation(s)
- Annika Janson
- National Childhood Obesity Centre, Karolinska University Hospital, Solna, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Legeby A, Koch D, Duarte F, Heine C, Benson T, Fugiglando U, Ratti C. New urban habits in Stockholm following COVID-19. URBAN STUDIES (EDINBURGH, SCOTLAND) 2023; 60:1448-1464. [PMID: 37273493 PMCID: PMC10230291 DOI: 10.1177/00420980211070677] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
During the COVID-19 pandemic, physical distancing, mobility restrictions and self-isolation measures were implemented around the world as the primary intervention to prevent the virus from spreading. Urban life has undergone sweeping changes, with people using spaces in new ways. Stockholm is a particularly relevant case of this phenomenon since most facilities, such as day care centres and schools, have remained open, in contrast to cities with a broader lockdown. In this study, we use Twitter data and an online map survey to study how COVID-19 restrictions have impacted the use of different locations, services and amenities in Stockholm. First, we compare the spatial distribution of 87,000 geolocated tweets pre-COVID-19 and during the COVID-19 pandemic. Second, we analyse 895 survey responses asking people to identify places they 'still visit', 'use more', 'avoid' and self-report reasons for using locations. The survey provides a nuanced understanding of whether and how restrictions have affected people. Service and seclusion were found to be important; therefore, the accessibility of such amenities was analysed, demonstrating how changes in urban habits are related to conditions of the local environment. We find how different parts of the city show different capacities to accommodate new habits and mitigate the effects of restrictions on people's use of urban spaces. In addition to the immediate relevance to COVID-19, this paper thus contributes to understanding how restrictions on movement and gathering, in any situation, expose more profound urban challenges related to segregation and social inequality.
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Affiliation(s)
- Ann Legeby
- KTH Royal Institute of Technology, Sweden
| | | | - Fábio Duarte
- Massachusetts Institute of Technology, USA
- Pontifícia Universidade Católica do Paraná, Brazil
| | - Cate Heine
- Massachusetts Institute of Technology, USA
| | - Tom Benson
- Massachusetts Institute of Technology, USA
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Andersson MJ, Kenttä G, Moesch K, Borg E, Claesdotter-Knutsson E, Håkansson A. Symptoms of depression and anxiety among elite high school student-athletes in Sweden during the COVID-19 pandemic: A repeated cross-sectional study. J Sports Sci 2023; 41:874-883. [PMID: 37527354 DOI: 10.1080/02640414.2023.2241783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/20/2023] [Indexed: 08/03/2023]
Abstract
The COVID-19 pandemic precipitated numerous changes in daily life, including the cancellation and restriction of sports globally. Because sports participation contributes positively to the development of student-athletes, restricting these activities may have led to long-term mental health changes in this population. Using a repeated cross-sectional study design, we measured rates of depression using the Patient Health Questionnaire-2 and anxiety using the Generalized Anxiety Disorder-2 scale in student-athletes attending elite sport high schools in Sweden during the second wave of the pandemic (February 2021; n = 7021) and after all restrictions were lifted (February 2022; n = 6228). Depression among student-athletes decreased from 19.8% in 2021 to 17.8% in 2022 (p = .008, V = .026), while anxiety screening did not change significantly (17.4% to 18.4%, p > .05). Comparisons between classes across years revealed older students exhibited decreases in depressive symptoms, while younger cohorts experienced increases in symptoms of anxiety from 2021 to 2022. Logistic regressions revealed that being female, reporting poorer mental health due to COVID-19, and excessive worry over one's career in sports were significant predictors of both depression and anxiety screenings in 2022. Compared to times when sports participation was limited, the lifting of restrictions was associated with overall reduced levels of depression, but not anxiety.
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Affiliation(s)
- Mitchell J Andersson
- Malmö Addiction Center, Region Skåne, Clinical Sports and Mental Health Unit, Malmö, Sweden
- Faculty of Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Göran Kenttä
- Swedish Sports Confederation, Stockholm, Sweden
- Department of Physiology, Nutrition and Biomechanics, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
- School of Human Kinetics, University of Ottawa, Ottawa, Canada
| | - Karin Moesch
- Swedish Sports Confederation, Stockholm, Sweden
- Department of Sports Science, Malmö University, Malmö, Sweden
| | - Elisabet Borg
- Faculty of Social Sciences, Department of Psychology - Perception and Psychophysics, Stockholm University, Stockholm, Sweden
| | | | - Anders Håkansson
- Malmö Addiction Center, Region Skåne, Clinical Sports and Mental Health Unit, Malmö, Sweden
- Faculty of Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
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Örtqvist AK, Magnus MC, Dahlqvist E, Söderling J, Johansson K, Sandström A, Håberg SE, Stephansson O. Association between SARS-CoV-2 infection and newly diagnosed hypertension during pregnancy: prospective, population based cohort study. BMJ MEDICINE 2023; 2:e000465. [PMID: 37275554 PMCID: PMC10230329 DOI: 10.1136/bmjmed-2022-000465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/26/2023] [Indexed: 06/07/2023]
Abstract
Objective To study the association between SARS-CoV-2 infection and newly diagnosed hypertension during pregnancy. Design Prospective, population based cohort study. Setting All singleton pregnancies after 22 completed gestational weeks registered in the Swedish Pregnancy Register and the Medical Birth Registry of Norway, from 1 March 2020 to 24 May 2022. Participants 312 456 individuals available for analysis (201 770 in Sweden and 110 686 in Norway), with pregnancies that reached 42 completed gestational weeks by the end of follow-up in the pregnancy registries, excluding individuals with SARS-CoV-2 infection before pregnancy and those with a diagnosis of pre-existing hypertension or onset of hypertension before 20 gestational weeks. Main outcome measures Newly diagnosed hypertension during pregnancy was defined as a composite outcome of a diagnosis of gestational hypertension, pre-eclampsia, HELLP (haemolysis, elevated liver enzymes, low platelets) syndrome, or eclampsia, from gestational week 20 to one week after delivery. The association between SARS-CoV-2 infection and hypertension during pregnancy was investigated with a stratified Cox proportional hazard model, adjusting for maternal age, body mass index, parity, smoking, region of birth, education, income, coexisting medical conditions, previous hypertension during pregnancy, number of healthcare visits during the past year, and vaccination against SARS-CoV-2. Pre-eclampsia was also analysed as a separate outcome. Results Of 312 456 individuals available for analysis, 8% (n=24 566) had SARS-CoV-2 infection any time during pregnancy, 6% (n=18 051) had a diagnosis of hypertension during pregnancy, and 3% (9899) had pre-eclampsia. SARS-CoV-2 infection during pregnancy was not associated with an increased risk of hypertension during pregnancy (adjusted hazard ratio 0.99, 95% confidence interval 0.93 to 1.04) or pre-eclampsia (0.98, 0.87 to 1.10). The results were similar for SARS-CoV-2 infection in all gestational trimesters and in different time periods that corresponded to dominance of different variants of the SARS-CoV-2 virus. Conclusions This population based study did not find any evidence of an association between SARS-CoV-2 infection during pregnancy and an increased risk of hypertension during pregnancy or pre-eclampsia.
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Affiliation(s)
- Anne K. Örtqvist
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Visby Hospital, Visby, Sweden
| | - Maria C. Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Elisabeth Dahlqvist
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Jonas Söderling
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Kari Johansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Sandström
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
| | - Siri E. Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women’s Health, Division of Obstetrics, Karolinska University Hospital, Stockholm, Sweden
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Dhammawati F, Fagerberg P, Diou C, Mavrouli I, Koukoula E, Lekka E, Stefanopoulos L, Maglaveras N, Heimeier R, Karavidopoulou Y, Ioakimidis I. Ultra-Processed Food vs. Fruit and Vegetable Consumption before and during the COVID-19 Pandemic among Greek and Swedish Students. Nutrients 2023; 15:nu15102321. [PMID: 37242204 DOI: 10.3390/nu15102321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has impacted children's lifestyles, including dietary behaviors. Of particular concern among these behaviors is the heightened prevalence of ultra-processed food (UPF) consumption, which has been linked to the development of obesity and related non-communicable diseases. The present study examines the changes in (1) UPF and (2) vegetable and/or fruit consumption among school-aged children in Greece and Sweden before and during the COVID-19 pandemic. METHODS The analyzed dataset consisted of main meal pictures (breakfast, lunch, and dinner) captured by 226 Greek students (94 before the pandemic and 132 during the pandemic) and 421 Swedish students (293 before and 128 during the pandemic), aged 9-18, who voluntarily reported their meals using a mobile application. The meal pictures were collected over four-month periods over two consecutive years; namely, between the 20th of August and the 20th of December in 2019 (before the COVID-19 outbreak) and the same period in 2020 (during the COVID-19 outbreak). The collected pictures were annotated manually by a trained nutritionist. A chi-square test was performed to evaluate the differences in proportions before versus during the pandemic. RESULTS In total, 10,770 pictures were collected, including 6474 pictures from before the pandemic and 4296 pictures collected during the pandemic. Out of those, 86 pictures were excluded due to poor image quality, and 10,684 pictures were included in the final analyses (4267 pictures from Greece and 6417 pictures from Sweden). The proportion of UPF significantly decreased during vs. before the pandemic in both populations (50% vs. 46%, p = 0.010 in Greece, and 71% vs. 66%, p < 0.001 in Sweden), while the proportion of vegetables and/or fruits significantly increased in both cases (28% vs. 35%, p < 0.001 in Greece, and 38% vs. 42%, p = 0.019 in Sweden). There was a proportional increase in meal pictures containing UPF among boys in both countries. In Greece, both genders showed an increase in vegetables and/or fruits, whereas, in Sweden, the increase in fruit and/or vegetable consumption was solely observed among boys. CONCLUSIONS The proportion of UPF in the Greek and Swedish students' main meals decreased during the COVID-19 pandemic vs. before the pandemic, while the proportion of main meals with vegetables and/or fruits increased.
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Affiliation(s)
- Friska Dhammawati
- Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan (the IMPACT) Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, 14152 Stockholm, Sweden
| | - Petter Fagerberg
- Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan (the IMPACT) Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, 14152 Stockholm, Sweden
| | - Christos Diou
- Department of Informatics and Telematics, Harokopio University of Athens, 177 78 Athens, Greece
| | - Ioanna Mavrouli
- Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan (the IMPACT) Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, 14152 Stockholm, Sweden
| | | | - Eirini Lekka
- 2nd Obstetrics and Gynaecology Dept, Center of Woman Digital Health, Medical School, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Leandros Stefanopoulos
- 2nd Obstetrics and Gynaecology Dept, Center of Woman Digital Health, Medical School, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
- Image and Video Processing Laboratory, Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Nicos Maglaveras
- 2nd Obstetrics and Gynaecology Dept, Center of Woman Digital Health, Medical School, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | | | - Youla Karavidopoulou
- Laboratory of Medical Informatics, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece
| | - Ioannis Ioakimidis
- Innovative Use of Mobile Phones to Promote Physical Activity and Nutrition Across the Lifespan (the IMPACT) Research Group, Department of Biosciences and Nutrition, Karolinska Institutet, 14152 Stockholm, Sweden
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Sjödahl Hammarlund C, Norlander A, Brogårdh C. Experiences of People with Cardiovascular Disease during COVID-19 in Sweden: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5588. [PMID: 37107869 PMCID: PMC10139106 DOI: 10.3390/ijerph20085588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/11/2023] [Accepted: 04/18/2023] [Indexed: 05/10/2023]
Abstract
Although people with cardiovascular conditions were subjected to more rigorous restrictions during the COVID-19 pandemic, there is limited knowledge of how the restrictions affected their lives and well-being. Thus, the aim of this study was to describe how people with cardiovascular conditions experienced their life situation and physical and mental health during the second wave of the pandemic in Sweden. Fifteen participants (median age 69 years; nine women) were individually interviewed, and data were analyzed with systematic text condensation. The findings revealed that some of the participants were fearful of contracting COVID-19 as their medical condition made them vulnerable. Additionally, the restrictions changed their daily routines and their ability to take part in social activities, as well as their access to specialized outpatient care (medical check-ups and physiotherapy). Although emotional and psychological distress were present, several participants found strategies that reduced their worries, such as exercising and meeting friends outdoors. However, some had adopted a more sedentary lifestyle and unhealthy diets. These findings indicate that healthcare professionals should provide individualized support to persons with cardiovascular diseases in order to find well-functioning emotion- and problem-focused strategies aimed at improving physical and mental health during crises such as pandemics.
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Affiliation(s)
- Catharina Sjödahl Hammarlund
- Department of Health Sciences, Lund University, SE-22100 Lund, Sweden; (A.N.); (C.B.)
- The PRO-CARE Group, Faculty of Health Sciences, Kristianstad University, SE-29188 Kristianstad, Sweden
| | - Anna Norlander
- Department of Health Sciences, Lund University, SE-22100 Lund, Sweden; (A.N.); (C.B.)
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, SE-22185 Lund, Sweden
| | - Christina Brogårdh
- Department of Health Sciences, Lund University, SE-22100 Lund, Sweden; (A.N.); (C.B.)
- Department of Neurology, Rehabilitation Medicine, Memory Disorders and Geriatrics, Skåne University Hospital, SE-22185 Lund, Sweden
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Alaqra AS, Khumalo AC. Handling Public's Well-being during the COVID-19 Crisis: An Empirical Study with Municipalities' Representatives in Sweden. JMIR Form Res 2023; 7:e40669. [PMID: 37053098 PMCID: PMC10185336 DOI: 10.2196/40669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 03/13/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND COVID-19 had a significant impact on the public's health and well-being due to infections and restrictions imposed during the crisis. Recreational activities are important for the public's well-being, however comes in second in relation to the public's safety from the COVID-19 virus. In Sweden, a country with a decentralized public health and welfare system relied on less stringent approaches for handling the crisis. The limited restrictions of Sweden allowed the recreational activities to take place despite the pandemic, which could be attributed to considerations for the public's well-being. OBJECTIVE The objective of this study is to investigate municipal approaches for handling and supporting recreational activities during the COVID-19 crisis. METHODS We conducted an empirical study (qualitative and quantitative), using an online survey for data collection, with 23 participants. They were representatives holding mostly managerial roles, from 18 distinct municipalities (of 18 counties). A thematic analysis was conducted to analyze open-ended responses, and descriptive statistics was used as a method to summarize the close-ended responses. RESULTS In this study, we report on the status of municipalities during the COVID-19 pandemic. The highlighted results show a significant impact on the municipalities as a result of COVID-19, where 78.3% of participants state significant changes due to the pandemic. 88.9% indicate efforts and approaches for supporting recreational activities during COVID-19. Following national guidelines for public's health and safety is indicated by 78.3%. Information and Communications Technologies (ICTs) were considered significant for dealing with COVID-19 as per 87% of participants. Our qualitative results further show details of public's health and safety considerations, efforts to support recreational activities particularly for youth, and ICTs role and requirements. Challenges relating to the usability of ICTs were also highlighted. CONCLUSIONS Despite the critique of Sweden's lenient strategy of handling the COVID-19 crisis, our results show significant considerations for both the public's safety and well-being by the municipalities (additionally on a regional and local levels) in this study. Trusting the public with safety guidelines in addition to efforts for publics' safety, supporting public's well-being with approaches for maintaining recreational activities, and giving special care to youth, was the Swedish approach to handling the crisis. Despite having technological solutions in place, challenges using digital solutions and requirements for future development are noted. CLINICALTRIAL None.
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