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1.
Ups J Med Sci ; 1282023.
Article in English | MEDLINE | ID: covidwho-20235891

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) mRNA vaccines are associated with an increased risk of myocarditis using hospital discharge diagnoses as an outcome. The validity of these register-based diagnoses is uncertain. Methods: Patient records for subjects < 40 years of age and a diagnosis of myocarditis in the Swedish National Patient Register were manually reviewed. Brighton Collaboration diagnosis criteria for myocarditis were applied based on patient history, clinical examination, laboratory data, electrocardiograms, echocardiography, magnetic resonance imaging and myocardial biopsy. Poisson regression was used to estimate incidence rate ratios, comparing the register-based outcome variable to validated outcomes. Interrater reliability was assessed by a blinded re-evaluation. Results: Overall, 95.6% (327/342) of cases registered as myocarditis were confirmed (definite, probable or possible myocarditis according to Brighton Collaboration diagnosis criteria, positive predictive value 0.96 [95% CI 0.93-0.98]). Of the 4.4% (15/342) cases reclassified as no myocarditis or as insufficient information, two cases had been exposed to the COVID-19 vaccine no more than 28 days before the myocarditis diagnosis, two cases were exposed >28 days before admission and 11 cases were unexposed to the vaccine. The reclassification had only minor impact on incidence rate ratios for myocarditis following COVID-19 vaccination. In total, 51 cases were sampled for a blinded re-evaluation. Of the 30 randomly sampled cases initially classified as either definite or probably myocarditis, none were re-classified after re-evaluation. Of the in all 15 cases initially classified as no myocarditis or insufficient information, 7 were after re-evaluation re-classified as probable or possible myocarditis. This re-classification was mostly due to substantial variability in electrocardiogram interpretation. Conclusion: This validation of register-based diagnoses of myocarditis by manual patient record review confirmed the register diagnosis in 96% of cases and had high interrater reliability. Reclassification had only a minor impact on the incidence rate ratios for myocarditis following COVID-19 vaccination.


Subject(s)
COVID-19 Vaccines , COVID-19 , Humans , COVID-19 Vaccines/adverse effects , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , Reproducibility of Results , Sweden/epidemiology , Biopsy
2.
BMC Public Health ; 23(1): 1026, 2023 05 31.
Article in English | MEDLINE | ID: covidwho-20235181

ABSTRACT

BACKGROUND: The COVID-19 pandemic has impacted on public health in several ways. The aim of the study was to investigate changes in lifestyle, adiposity, and cardiometabolic markers among young adults in Sweden during the COVID-19 pandemic and their determinants. METHODS: The study included 1 004 participants from the population-based birth cohort BAMSE. Anthropometrics, body composition (bioelectric impedance analyses), pulse, and blood pressure were measured before (December 2016-May 2019; mean age 22.6 years) and during (October 2020-June 2021; mean age 25.7 years) the COVID-19 pandemic. Lifestyle changes during the pandemic were assessed through a questionnaire. RESULTS: All measures of adiposity (weight, BMI, body fat percentage, trunk fat percentage) and cardiometabolic markers (blood pressure, pulse) increased during the study period (e.g., body fat percentage by a median of + 0.8% in females, p < 0.001, and + 1.5% in males, p < 0.001). Male sex, non-Scandinavian ethnicity, BMI status (underweight and obesity), and changes in lifestyle factors, e.g., decreased physical activity during the pandemic, were associated with higher increase in BMI and/or adiposity. CONCLUSION: Lifestyle factors, adiposity and cardiometabolic markers may have been adversely affected among young adults in Sweden during the COVID-19 pandemic compared with the preceding years. Targeted public health measures to reduce obesity and improve healthy lifestyle are important to prevent future non-communicable diseases.


Subject(s)
COVID-19 , Cardiovascular Diseases , Female , Male , Humans , Young Adult , Adult , Adiposity , Pandemics , Sweden/epidemiology , COVID-19/epidemiology , Obesity , Life Style , Cardiovascular Diseases/epidemiology , Body Mass Index , Risk Factors
3.
Nutrients ; 15(10)2023 May 16.
Article in English | MEDLINE | ID: covidwho-20234869

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.


Subject(s)
COVID-19 , Food Services , Child , Humans , Male , Female , Vegetables , Fruit , Greece/epidemiology , Pandemics , Sweden/epidemiology , Food, Processed , COVID-19/epidemiology , Students , Diet , Feeding Behavior
4.
Viruses ; 15(4)2023 03 24.
Article in English | MEDLINE | ID: covidwho-2321574

ABSTRACT

Influenza D virus (IDV) has been detected in bovine respiratory disease (BRD) outbreaks, and experimental studies demonstrated this virus's capacity to cause lesions in the respiratory tract. In addition, IDV-specific antibodies were detected in human sera, which indicated that this virus plays a potential zoonotic role. The present study aimed to extend our knowledge about the epidemiologic situation of IDV in Swedish dairy farms, using bulk tank milk (BTM) samples for the detection of IDV antibodies. A total of 461 and 338 BTM samples collected during 2019 and 2020, respectively, were analyzed with an in-house indirect ELISA. In total, 147 (32%) and 135 (40%) samples were IDV-antibody-positive in 2019 and 2020, respectively. Overall, 2/125 (2%), 11/157 (7%) and 269/517 (52%) of the samples were IDV-antibody-positive in the northern, middle and southern regions of Sweden. The highest proportion of positive samples was repeatedly detected in the south, in the county of Halland, which is one of the counties with the highest cattle density in the country. In order to understand the epidemiology of IDV, further research in different cattle populations and in humans is required.


Subject(s)
Cattle Diseases , Influenza, Human , Thogotovirus , Animals , Cattle , Humans , Milk , Sweden/epidemiology , Influenza, Human/epidemiology , Farms , Antibodies , Cattle Diseases/diagnosis , Enzyme-Linked Immunosorbent Assay/veterinary
5.
Int J Circumpolar Health ; 82(1): 2213909, 2023 12.
Article in English | MEDLINE | ID: covidwho-2322844

ABSTRACT

The aim of this population-based cross-sectional study was to assess the prevalence of healthcare avoidance during the COVID-19 pandemic and its associated factors among the Sámi population in Sweden. Data from the "Sámi Health on Equal Terms" (SámiHET) survey conducted in 2021 were used. Overall, 3,658 individuals constituted the analytical sample. Analysis was framed using the social determinants of health framework. The association between healthcare avoidance and several sociodemographic, material, and cultural factors was explored through log-binomial regression analyses. Sampling weights were applied in all analyses. Thirty percent of the Sámi in Sweden avoided healthcare during the COVID-19 pandemic. Sámi women (PR: 1.52, 95% CI: 1.36-1.70), young adults (PR: 1.22, 95% CI:1.05-1.47), Sámi living outside Sápmi (PR: 1.17, 95% CI: 1.03-1.34), and those having low income (PR: 1.42, 95% CI:1.19-1.68) and experiencing economic stress (PR: 1.48, 95% CI: 1.31-1.67) had a higher prevalence of healthcare avoidance. The pattern shown in this study can be useful for planning future pandemic responses, which should address healthcare avoidance, particularly among the identified vulnerable groups, including the active participation of the Sámi themselves.


Subject(s)
COVID-19 , Pandemics , Young Adult , Humans , Female , Sweden/epidemiology , Prevalence , Cross-Sectional Studies , COVID-19/epidemiology , Delivery of Health Care , Norway/epidemiology
6.
Ann Rheum Dis ; 81(3): 433-439, 2022 03.
Article in English | MEDLINE | ID: covidwho-2313184

ABSTRACT

OBJECTIVES: To estimate absolute and relative risks for seasonal influenza outcomes in patients with inflammatory joint diseases (IJDs) and disease-modifying antirheumatic drugs (DMARDs). To contextualise recent findings on corresponding COVID-19 risks. METHODS: Using Swedish nationwide registers for this cohort study, we followed 116 989 patients with IJD and matched population comparators across four influenza seasons (2015-2019). We quantified absolute risks of hospitalisation and death due to influenza, and compared IJD to comparators via Cox regression. We identified 71 556 patients with IJD on active treatment with conventional synthetic DMARDs and biological disease-modifying antirheumatic drugs (bDMARDs)/targeted synthetic disease-modifying antirheumatic drug (tsDMARDs) at the start of each influenza season, estimated risks for the same outcomes and compared these risks across DMARDs via Cox regression. RESULTS: Per season, average risks for hospitalisation listing influenza were 0.25% in IJD and 0.1% in the general population, corresponding to a crude HR of 2.38 (95% CI 2.21 to 2.56) that decreased to 1.44 (95% CI 1.33 to 1.56) following adjustments for comorbidities. For death listing influenza, the corresponding numbers were 0.015% and 0.006% (HR=2.63, 95% CI 1.93 to 3.58, and HR=1.46, 95% CI 1.07 to 2.01). Absolute risks for influenza outcomes were half (hospitalisation) and one-tenth (death) of those for COVID-19, but relative estimates comparing IJD to the general population were similar. CONCLUSIONS: In absolute terms, COVID-19 in IJD outnumbers that of average seasonal influenza, but IJD entails a 50%-100% increase in risk for hospitalisation and death for both types of infections, which is largely dependent on associated comorbidities. Overall, bDMARDs/tsDMARDs do not seem to confer additional risk for hospitalisation or death related to seasonal influenza.


Subject(s)
Antirheumatic Agents/immunology , Arthritis, Rheumatoid/virology , COVID-19/mortality , Hospitalization/statistics & numerical data , Influenza, Human/mortality , Aged , Arthritis, Rheumatoid/drug therapy , COVID-19/immunology , Female , Humans , Influenza A virus/immunology , Influenza, Human/immunology , Male , Middle Aged , Proportional Hazards Models , Risk , SARS-CoV-2/immunology , Seasons , Sweden/epidemiology
7.
Emerg Infect Dis ; 29(6): 1240-1243, 2023 06.
Article in English | MEDLINE | ID: covidwho-2315020

ABSTRACT

We performed 2 surveys during 2022 to estimate point prevalences of SARS-CoV-2 infection compared with overall seroprevalence in Sweden. Point prevalence was 1.4% in March and 1.5% in September. Estimated seroprevalence was >80%, including among unvaccinated children. Continued SARS-CoV-2 surveillance is necessary for detecting emerging, possibly more pathogenic variants.


Subject(s)
COVID-19 , Child , Humans , COVID-19/epidemiology , Prevalence , SARS-CoV-2 , Sweden/epidemiology , Seroepidemiologic Studies
8.
Scand J Public Health ; 51(5): 764-768, 2023 Jul.
Article in English | MEDLINE | ID: covidwho-2312724

ABSTRACT

AIMS: This study aimed to describe the impact of the COVID-19 pandemic on lifestyle and social activities among older adults in Sweden, with a special focus on differences between the 'younger old' (aged 77-84) and 'older old' (aged 85-109). METHODS: This study is based on a nationally representative sample of older adults (aged ⩾77 years) in Sweden (SWEOLD). Data were collected between May 2021 and April 2022, when many recommendations were removed but the virus was still classified as a public health disease. We studied occurrences and differences between the two age groups in several lifestyle factors and social activities. RESULTS: The younger old displayed larger changes in lifestyles because of the pandemic than the older old. Most changes were found in social interactions with family. CONCLUSIONS: Our results highlight the large heterogeneity within the Swedish population aged ⩾77 years, and that the younger old experienced a bigger lifestyle change than the older old. Previous activity levels might be important to consider in order to understand how regulations may affect the older population. Finally, our findings indicate large age differences in Internet use, which require attention to prevent digital exclusion of an already vulnerable group.


Subject(s)
COVID-19 , Humans , Aged , COVID-19/epidemiology , Sweden/epidemiology , Pandemics , Life Style
9.
BMC Med Educ ; 23(1): 249, 2023 Apr 17.
Article in English | MEDLINE | ID: covidwho-2292190

ABSTRACT

BACKGROUND: The COVID-19 pandemic has had an unprecedented impact on societies and health care services worldwide, including the clinical training of psychology interns. Some of the pandemic-related restrictions were in breach of the internship requirements, increasing the risk of failed internships and a shortage of new health care professionals. This situation needed to be assessed. METHODS: Web-based surveys were administered to clinical psychology interns in Sweden 2020 (n = 267) and 2021 (n = 340), as well as to supervisors in 2020 (n = 240). The supervisors also provided information about their interns (n = 297). RESULTS: Risk factors for a prolonged internship, such as pandemic-related absence from work (12.4% in 2020 and 7.9% in 2021), unqualified work (0% in 2020, 3% in 2021), and change in internship content were low. However, remote interactions using digital services increased. Face-to-face patient contacts decreased significantly from 2020 to 2021 (Χ2 = 5.17, p = .023), while remote work and remote supervision increased significantly (Χ2 = 53.86, p < .001 and Χ2 = 8.88, p = .003, respectively). Still, the content in patient contacts and supervision was maintained. Most interns reported no difficulties with remote supervision or supervision in personal protective equipment. However, of the interns who reported difficulties, role-play and skills training in remote supervision were perceived as significantly harder (Χ2 = 28.67, p < .001) than in supervision using personal protective equipment. CONCLUSIONS: The present study indicates that clinical training of psychology interns in Sweden could proceed despite a societal crisis. Results suggest that the psychology internship was flexible in the sense that it could be realized in combined face-to-face and remote formats without losing much of its value. However, the results also suggest that some skills may be harder to train in remote supervision.


Subject(s)
COVID-19 , Internship and Residency , Psychology, Clinical , Humans , Pandemics , Sweden/epidemiology , COVID-19/epidemiology
10.
Scand J Public Health ; 51(5): 754-758, 2023 Jul.
Article in English | MEDLINE | ID: covidwho-2298906

ABSTRACT

OBJECTIVES: The aim is to compare Sweden, Denmark, Finland and Norway regarding government response to the COVID-19 pandemic in mid-March-June 2020 using the Oxford Government Response Tracker. STUDY DESIGN: Descriptive longitudinal ecological study. METHODS: Descriptive analysis of time series data. RESULTS: Sweden displayed a far lower response index in March. By late April indexes were similar. In May-June, response indexes were lower in Finland and Norway than in Sweden. The average response index in mid-March-June was similar in Sweden, Finland and Norway. CONCLUSIONS: The government response in the four countries indicates that timing of response was essential. Sweden's slow and weak initial government response in March-April was followed by less loosening of government response in May-June compared with, especially, Finland and Norway, which resulted in similar average government response in mid-March-June for the three countries. As a comparison, COVID-19 mortality per capita was 10 times higher in Sweden than in Finland and Norway, and five times higher than in Denmark during the same period.


Subject(s)
COVID-19 , Pandemics , Humans , COVID-19/epidemiology , Scandinavian and Nordic Countries/epidemiology , Sweden/epidemiology , Finland/epidemiology , Norway/epidemiology , Denmark/epidemiology
11.
BMJ Open ; 13(4): e070670, 2023 04 24.
Article in English | MEDLINE | ID: covidwho-2297328

ABSTRACT

INTRODUCTION: Adopting a social determinants of health perspective, this project aims to study how disproportionate COVID-19 mortality among immigrants in Sweden is associated with social factors operating through differential exposure to the virus (eg, by being more likely to work in high-exposure occupations) and differential effects of infection arising from socially patterned, pre-existing health conditions, differential healthcare seeking and inequitable healthcare provision. METHODS AND ANALYSIS: This observational study will use health (eg, hospitalisations, deaths) and sociodemographic information (eg, occupation, income, social benefits) from Swedish national registers linked using unique identity numbers. The study population includes all adults registered in Sweden in the year before the start of the pandemic (2019), as well as individuals who immigrated to Sweden or turned 18 years of age after the start of the pandemic (2020). Our analyses will primarily cover the period from 31 January 2020 to 31 December 2022, with updates depending on the progression of the pandemic. We will evaluate COVID-19 mortality differences between foreign-born and Swedish-born individuals by examining each mechanism (differential exposure and effects) separately, while considering potential effect modification by country of birth and socioeconomic factors. Planned statistical modelling techniques include mediation analyses, multilevel models, Poisson regression and event history analyses. ETHICS AND DISSEMINATION: This project has been granted all necessary ethical permissions from the Swedish Ethical Review Authority (Dnr 2022-0048-01) for accessing and analysing deidentified data. The final outputs will primarily be disseminated as scientific articles published in open-access peer-reviewed international journals, as well as press releases and policy briefs.


Subject(s)
COVID-19 , Emigrants and Immigrants , Adult , Female , Humans , Sweden/epidemiology , Social Factors , Social Determinants of Health , Observational Studies as Topic
12.
Int J Environ Res Public Health ; 20(8)2023 04 20.
Article in English | MEDLINE | ID: covidwho-2303910

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.


Subject(s)
COVID-19 , Cardiovascular Diseases , Humans , Female , Aged , COVID-19/epidemiology , Pandemics , Sweden/epidemiology , Cardiovascular Diseases/epidemiology , Mental Health
13.
BMJ Open ; 13(4): e069037, 2023 04 28.
Article in English | MEDLINE | ID: covidwho-2302567

ABSTRACT

OBJECTIVES: To explore how cardiorenal disease (CRD; heart failure and/or chronic kidney disease) impacted mortality in men and women hospitalised for COVID-19 during the first three waves of the pandemic in Sweden in comparison to previous influenza outbreaks. DESIGN: A registry-based, retrospective, case-control study. SETTING: Hospital care in Sweden. PARTICIPANTS: All patients in Sweden with a main hospital diagnosis of COVID-19 (January 2020-September 2021) or influenza (January 2015-December 2019) with previous CRD were identified in registries and compared with a reference group free from CRD but with COVID-19 or influenza. PRIMARY OUTCOME MEASURE: Associated risk of all-cause death during the first year was analysed using adjusted Cox proportional hazards models. RESULTS: In COVID-19 patients with and without prior history of CRD (n=44 866), mean age was 79.8 years (SD 11.8) and 43% were women. In influenza patients (n=8897), mean age was 80.6 years (SD 11.5) and 45% were women. COVID-19 versus influenza was associated with higher mortality risk during the first two COVID-19 waves (HR 1.53; 95% CI 1.45 to 1.62, p<0.001 and HR 1.52; 95% CI 1.44 to 1.61, p<0.001), but not in the third wave (HR 1.07; 95% CI 0.99 to 1.14, p=0.072). CRD was an independent risk factor for all-cause death after COVID-19 in men and women (men: 1.37; 95% CI 1.31 to 1.44, p<0.001; women: 1.46; 95% CI 1.38 to 1.54, p<0.001). At ages <70 years, women with CRD had a similar mortality rate to men with CRD, while at ages ≥70 years, the mortality rate was higher in men. CONCLUSIONS: Outcome after COVID-19 is worse if CRD is present. In women at ages <70 years, the presence of CRD attenuates the protective effect of female sex. COVID-19 was associated with higher mortality risk than influenza during the first two pandemic waves.


Subject(s)
COVID-19 , Heart Failure , Influenza, Human , Renal Insufficiency, Chronic , Male , Humans , Female , Aged , Aged, 80 and over , Retrospective Studies , Case-Control Studies , Sweden/epidemiology , Influenza, Human/complications , Influenza, Human/epidemiology , Pandemics , COVID-19/epidemiology , Renal Insufficiency, Chronic/epidemiology , Heart Failure/epidemiology , Registries
14.
Sci Rep ; 13(1): 5469, 2023 04 04.
Article in English | MEDLINE | ID: covidwho-2286990

ABSTRACT

To establish the impact of COVID-19 on the pre-test probability for VTE in patients with suspected VTE. This was a retrospective, observational, cross-sectional study of patients 18 years and older undergoing diagnostic tests for VTE in an integrated healthcare system covering a population of 465,000 during the calendar year of 2020. We adjusted for risk factors such as age, sex, previous VTE, ongoing anticoagulant treatment, malignancy, Charlson score, ward care, ICU care and wave of COVID-19. In total, 303 of 5041 patients had a positive diagnosis of COVID-19 around the time of investigation. The prevalence of VTE in COVID-positive patients was 10.2% (36/354), 14.7% (473/3219) in COVID-19 negative patients, and 15.6% (399/2589) in patients without a COVID-19 test. A COVID-positive status was not associated with an increased risk for VTE (crude odds ratio 0.64, 95% CI 0.45-0.91, adjusted odds ratio 0.46, 95%CI 0.19-1.16). We found no increased VTE risk in COVID-positive patients. This indicates that COVID-19 status should not influence VTE workup.The study was pre-registered on May 26, 2020 at ClinicalTrials.gov with identifier NCT04400877.


Subject(s)
COVID-19 , Venous Thromboembolism , Humans , Venous Thromboembolism/epidemiology , Venous Thromboembolism/etiology , Retrospective Studies , Cross-Sectional Studies , COVID-19/complications , COVID-19/epidemiology , Sweden/epidemiology , Risk Factors , Delivery of Health Care
15.
Acta Anaesthesiol Scand ; 67(6): 788-796, 2023 Jul.
Article in English | MEDLINE | ID: covidwho-2283682

ABSTRACT

BACKGROUND: Mortality due to acute hypoxemic respiratory failure (AHRF) in patients with coronavirus disease-19 (COVID-19) differs across units, regions, and countries. These variations may be attributed to several factors, including comorbidities, acute physiological derangement, disease severity, treatment, ethnicity, healthcare system strain, and socioeconomic status. This study aimed to explore the features of patient characteristics, clinical management, and staffing that may be related to mortality among three intensive care units (ICUs) within the same hospital system in South Sweden. METHODS: We retrospectively analyzed ICU patients with COVID-19 and AHRF in Region Jönköping County, Sweden. The primary outcome was the 90-day mortality rate. We used univariate and multivariable logistic regression analyses to investigate the relationship of predictors with outcomes. RESULTS: Between March 15, 2020, and May 31, 2021, 331 patients with AHRF and COVID-19 were admitted to the three ICUs. There were differences in disease severity, treatments, process-related factors, and socioeconomic factors between the units. These factors were related to 90-day mortality. After multivariable adjustment, age, severity of acute respiratory distress syndrome, and the number of nurses per ICU-bed independently predicted 90-day mortality. CONCLUSION: Age, disease severity, and nurse staffing, but not treatment or socioeconomic status, were independently associated with 90-day mortality among critically ill patients with AHRF due to COVID-19. We also identified variations in care related processes, which may be a modifiable risk factor and warrants future investigation.


Subject(s)
COVID-19 , Respiratory Insufficiency , Humans , Retrospective Studies , Sweden/epidemiology , Intensive Care Units , Respiratory Insufficiency/therapy
16.
Scand J Public Health ; 51(5): 673-681, 2023 Jul.
Article in English | MEDLINE | ID: covidwho-2281000

ABSTRACT

BACKGROUND: The burden of COVID-19 disease can be measured in terms of disability-adjusted life years (DALYs), which is composed of two components: the years of life lost through premature death (YLL) and the number of years lived with disability (YLD), adjusted for level of disability. This study measured DALYs due to COVID-19 in Sweden and compared it to the burden of other diseases. METHODS: The methodology used in the calculation of DALYs was based on the Global Burden of Disease guidelines. The number of patients diagnosed with mild/moderate, severe or critical COVID-19 and/or post-COVID-19 condition between March 2020 and October 2021 was extracted from national registries and used for YLD calculations. In addition, the numbers of death due to COVID-19 in different age groups were used for the YLL calculation. RESULTS: During the study period, 152,877 DALYs were lost to COVID-19 in Sweden, 99.3% of which was attributed to YLL. Loss of DALYs occurred mainly among the elderly, with 66.8% of DALYs attributed to individuals >70 years old. Compared to other diseases, the burden of COVID-19 in 2020 ranked as the eighth leading cause of DALY lost. CONCLUSIONS: Similar to other countries, the burden of COVID-19 in Sweden was concentrated mainly among the elderly, who contributed most of the DALY lost due to premature mortality. Yet, DALY loss remained lower for COVID-19 than for several other diseases. The contribution of YLD to DALYs lost was minimal. However empirical data on the occurrence and disability of post-COVID-19 condition are scarce, and YLD may therefore be underestimated.


Subject(s)
COVID-19 , Disabled Persons , Humans , Aged , Disability-Adjusted Life Years , Quality-Adjusted Life Years , Sweden/epidemiology , COVID-19/epidemiology , Cost of Illness
17.
BMC Health Serv Res ; 23(1): 202, 2023 Feb 28.
Article in English | MEDLINE | ID: covidwho-2278764

ABSTRACT

BACKGROUND: In pandemics, it is critical to find a balance between healthcare demand, and capacity, taking into consideration the demands of the patients affected by the pandemic, as well as other patients (in elective or emergency care). The purpose of this paper is to suggest conceptual models for the capacity requirements at the emergency department, the inpatient care, and intensive care unit as well as a model for building staff capacity in pandemics. METHODS: This paper is based on a qualitative single case study at a middle-sized hospital in Sweden. The primary data are collected from 27 interviewees and inductively analyzed. RESULTS: The interviewees described a large difference between the immediate catastrophe scenario described in the emergency plan (which they had trained for), and the reality during the COVID-19 pandemic. The pandemic had a much slower onset and lasted longer compared to, for example, an accident, and the healthcare demand fluctuated with the societal infection. The emergency department and inpatient care could create surge capacity by reducing elective care. Lower inflow of other emergency patients also helped to create surge capacity. The number of intensive care beds increased by 350% at the case hospital. At the same time, the capacity of the employees decreased due to infection, exhaustion, and fear. The study contributes to knowledge of conceptional models and key factors affecting the balance between demand and capacity. CONCLUSION: The framework suggests conceptual models for balancing surge capacity during a pandemic Health care practitioners need to provide assumptions of the key factors to find the balance between the demand and capacity corresponding to the reality and maintain the delivery of high-quality healthcare services.


Subject(s)
COVID-19 , Pandemics , Humans , Sweden/epidemiology , COVID-19/epidemiology , Hospitals , Health Facilities
18.
Euro Surveill ; 28(13)2023 03.
Article in English | MEDLINE | ID: covidwho-2253423

ABSTRACT

BackgroundThe current SARS-CoV-2 pandemic has highlighted a need for easy and safe blood sampling in combination with accurate serological methodology. Venipuncture for testing is usually performed by trained staff at healthcare centres. Long travel distances to healthcare centres in rural regions may introduce a bias of testing towards relatively large communities with closer access. Rural regions are therefore often not represented in population-based data.AimThe aim of this retrospective cohort study was to develop and implement a strategy for at-home testing in a rural region of Sweden during spring 2021, and to evaluate its role to provide equal health care for its inhabitants.MethodsWe developed a sensitive method to measure antibodies to the S-protein of SARS-CoV-2 and optimised this assay for clinical use together with a strategy of at-home capillary blood sampling.ResultsWe demonstrated that our ELISA gave comparable results after analysis of capillary blood or serum from SARS-CoV-2-experienced individuals. We demonstrated stability of the assay under conditions that reflected temperature and humidity during winter or summer. By assessment of capillary blood samples from 4,122 individuals, we could show both feasibility of the strategy and that implementation shifted the geographical spread of testing in favour of rural areas.ConclusionImplementation of at-home sampling enabled citizens living in remote rural areas access to centralised and sensitive laboratory antibody tests. The strategy for testing used here could therefore enable disease control authorities to get rapid access to information concerning immunity to infectious diseases, even across vast geographical distance.


Subject(s)
COVID-19 , SARS-CoV-2 , Humans , COVID-19/diagnosis , COVID-19/epidemiology , Retrospective Studies , Sweden/epidemiology , COVID-19 Testing , Antibodies, Viral
19.
PLoS One ; 18(3): e0283344, 2023.
Article in English | MEDLINE | ID: covidwho-2265372

ABSTRACT

OBJECTIVE: To analyse if the health progression of geriatric Covid-19 survivors three months after an acute Covid-19 infection was worse than in other geriatric patients. Specifically, we wanted to see if we could see distinct health profiles in the flow of re-admitted Covid-19 patients compared to re-admitted non-Covid-19 controls. DESIGN: Matched cohort study. SETTING AND PARTICIPANTS: Electronic medical records of geriatric patients hospitalised in geriatric clinics in Stockholm, Sweden, between March 2020 and January 2022. Patients readmitted three months after initial admission were selected for the analysis and Covid-19 survivors (n = 895) were compared to age-sex-Charlson comorbidity index (CCI)-matched non-Covid-19 controls (n = 2685). METHODS: We assessed using binary logistic and Cox regression if a previous Covid-19 infection could be a risk factor for worse health progression indicated by the CCI, hospital frailty risk score (HFRS), mortality and specific comorbidities. RESULTS: The patients were mostly older than 75 years and, already at baseline, had typically multiple comorbidities. The Covid-19 patients with readmission had mostly had their acute-phase infection in the 1st or 2nd pandemic waves before the vaccinations. The Covid-19 patients did not have worse health after three months compared to the matched controls according to the CCI (odds ratio, OR[95% confidence interval, CI] = 1.12[0.94-1.34]), HFRS (OR[95%CI] = 1.05[0.87-1.26]), 6-months (hazard ratio, HR[95%CI] = 1.04[0.70-1.52]) and 1-year-mortality risk (HR[95%CI] = 0.89[0.71-1.10]), adjusted for age, sex and health at baseline (the CCI and HFRS). CONCLUSIONS AND IMPLICATIONS: The overall health progression of re-hospitalized geriatric Covid-19 survivors did not differ dramatically from other re-hospitalized geriatric patients with similar age, sex and health at baseline. Our results emphasize that Covid-19 was especially detrimental for geriatric patients in the acute-phase, but not in the later phase. Further studies including post-vaccination samples are needed.


Subject(s)
COVID-19 , Humans , Aged , COVID-19/epidemiology , Cohort Studies , Sweden/epidemiology , Hospitalization , Comorbidity , Retrospective Studies
20.
BMC Public Health ; 23(1): 380, 2023 02 23.
Article in English | MEDLINE | ID: covidwho-2262629

ABSTRACT

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic had a huge impact on daily life, even in countries such as Sweden where the restrictions were relatively mild. This paper assesses the effects of the COVID-19 pandemic restrictions on physical activity (PA) patterns, screen time, and sleep among Swedish adolescents. The exposures explored include gender, parental education, anthropometrics, and cardiovascular fitness (CVF). METHODS: Cohort data were collected from September 26th to December 6th, 2019, and from April 12th to June 9th, 2021. Participants were 13-14 years-old (7th graders) at baseline with 585 participating at both baseline and follow-up. At both baseline and follow-up PA and sedentary time were measured with accelerometers, and sleep and screen time with questionnaires. The exposure variables (gender, parental education, anthropometrics and CVF) were collected at baseline. Multilevel linear regression analyses were performed. RESULTS: Moderate-to-vigorous-physical activity (MVPA) remained unchanged while light physical activity (LiPA) decreased and sedentary time increased. Sleep duration decreased and screen time increased. Girls, adolescents with overweight/obesity (BMI and percent body fat), and those with lower CVF at baseline had less favourable changes in PA patterns, sleep and screen time. CONCLUSIONS: Although no significant (α = 0.05) changes were seen in MVPA, both LiPA and sedentary time as well as sleep and screen time changed in unfavourable ways. More intense activities are often organised and seem to have withstood the pandemic, while less intense activities decreased. Some groups were more vulnerable and will need directed intervention in the post-pandemic period as well as when future pandemics hit.


Subject(s)
COVID-19 , Screen Time , Female , Humans , Adolescent , Cohort Studies , Sweden/epidemiology , Pandemics , COVID-19/epidemiology , Exercise , Sleep
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