BACKGROUND: The macrophage scavenger receptor 1 (MSR1) gene on chromosome 8p22 was recently reported as a candidate gene for hereditary prostate cancer (HPC). Here, we further elucidate the role of MSR1 in both Swedish families with HPC and in a cohort of unselected prostate cancer. METHODS: DNA samples from 83 Swedish HPC families and 215 unselected population based cases of prostate cancer as well as 425 age-matched controls were genotyped. RESULTS: A total of 18 variants were identified, including 2 exonic, 7 intronic changes, and 9 changes in the 5'- or 3'-uncoding region. Of the two exonic changes, one previously reported truncation mutation was identified, a R293X nonsense mutation. This mutation was found in 2 of the 83 (2.4%) HPC families. The R293X mutation was found more frequently in men with PC (4.9%) than in unaffected men (2.7%), consistent with previous published results, however our results were not significant (P = 0.16). To additionally test for potential association of common sequence variants and increased risk for the disease, five common polymorphisms (PRO3, INDEL1, IVS5-57, P275A, INDEL7) were genotyped in the group of 215 prostate cancer cases and 425 age-matched controls. No association between any of the five common sequence variants and prostate cancer were found. CONCLUSION: Our results suggest that mutations in MSR1 gene might play a role in prostate cancer susceptibility, particularly the R293X mutation. This study warrants further investigations of the role of MSR1 in prostate cancer etiology.
Several triage methods have been developed and adopted around the world but none has been devised for specific patient populations such as older people or those with special needs. This literature review outlines the development of triage since the 1950s, briefly discusses some of the models in use around the world, including one that is used in the care of older people, and outlines the issues that should be taken into account when deciding which method to adopt.
This is a community-based sequential case series of 50 individuals who committed suicide by jumping from bridges in two regions of Sweden. Of the 50 subjects, 32 were men and 18 women, with a median age of 35 years. At least 40 had psychiatric problems. The frequency of suicide was highest during the summer months and during the weekends. A total of 27 bridges were used, with a total length of just under 9 km. Three bridges accounted for almost half of all suicides. Limiting the availability of one method of committing suicide is reported to reduce the overall suicide rate; why suicide and injury suicide preventive measures might be considered. Since this study demonstrates that few bridges attract suicide candidates, this injury mechanism needs to be acknowledged by the road system owners and included in the safety work.
Fire-related fatalities and injuries have become a growing governmental concern in Sweden, and a national vision zero strategy has been adopted stating that nobody should get killed or seriously injured from fires. There is considerable uncertainty, however, regarding the numbers of both deaths and injuries due to fires. Different national sources present different numbers, even on deaths, which obstructs reliable surveillance of the problem over time. We assume the situation is similar in other countries. This study seeks to assess the true number of fire-related deaths in Sweden by combining sources, and to verify the coverage of each individual source. By doing so, we also wish to demonstrate the possibilities of improved surveillance practices.
Data from three national sources were collected and matched; a special database on fatal fires held by The Swedish Contingencies Agency (nationally responsible for fire prevention), a database on forensic medical examinations held by the National Board of Forensic Medicine, and the cause of death register held by the Swedish National Board of Health and Welfare.
The results disclose considerable underreporting in the single sources. The national database on fatal fires, serving as the principal source for policy making on fire prevention matters, underestimates the true situation by 20%. Its coverage of residential fires appears to be better than other fires.
Systematic safety work and informed policy-making presuppose access to correct and reliable numbers. By combining several different sources, as suggested in this study, the national database on fatal fires is now considerably improved and includes regular matching with complementary sources.
Pulmonary vein isolation (PVI) is a recommended treatment for patients with atrial fibrillation, but it is unclear whether it results in a lower risk of stroke.
To investigate the proportion of patients discontinuing anticoagulation treatment after PVI in association with the CHA2DS2-VASc (congestive heart failure, hypertension, age =75 years [doubled], diabetes, stroke [doubled], vascular disease, age 65-74 years, sex category [female]) score, identify factors predicting stroke after PVI, and explore the risk of cardiovascular events after PVI in patients with and without guideline-recommended anticoagulation treatment.
A retrospective cohort study was conducted using Swedish national health registries from January 1, 2006, to December 31, 2012, with a mean-follow up of 2.6 years. A total of 1585 patients with atrial fibrillation undergoing PVI from the Swedish Catheter Ablation Register were included, with information about exposure to warfarin in the national quality register Auricula. Data analysis was performed from January 1, 2015, to April 30, 2016.
Warfarin treatment.
Ischemic stroke, intracranial hemorrhage, and death.
In this cohort of 1585 patients, 73.0% were male, the mean (SD) age was 59.0 (9.4) years, and the mean (SD) CHA2DS2-VASc score was 1.5 (1.4). Of the 1585 patients, 1175 were followed up for more than 1 year after PVI. Of these, 360 (30.6%) discontinued warfarin treatment during the first year. In patients with a CHA2DS2-VASc score of 2 or more, patients discontinuing warfarin treatment had a higher rate of ischemic stroke (5 events in 312 years at risk [1.6% per year]) compared with those continuing warfarin treatment (4 events in 1192 years at risk [0.3% per year]) (P?=?.046). Patients with a CHA2DS2-VASc score of 2 or more or those who had previously experienced an ischemic stroke displayed a higher risk of stroke if warfarin treatment was discontinued (hazard ratio, 4.6; 95% CI, 1.2-17.2; P?=?.02 and hazard ratio, 13.7; 95% CI, 2.0-91.9; P?=?.007, respectively).
These findings indicate that discontinuation of warfarin treatment after PVI is not safe in high-risk patients, especially those who have previously experienced an ischemic stroke.
Notes
CommentIn: JAMA Cardiol. 2017 Feb 1;2(2):152-154 PMID 27893050
The aim of the study was to investigate media presentations of baby boomers as future care users. The Swedish baby boomer generation, born in the 1940s, and known as the '40s generation, has been characterized as youthful and powerful, and a question investigated in the study was whether boomers are supposed to display these characteristics as care users. We analyzed 481 articles in Swedish newspapers, published between 1995 and 2012, with a qualitative content analysis. The results showed that the '40s generation was predicted to become a new breed of demanding, self-aware care users. These claims were supported by descriptions of the formative events and typical characteristics of these individuals, which were then projected onto their future behavior as care users. Such projections tended to portray contemporary care users as passive, submissive, and partly responsible for problems associated with elder care. Consequently, approaches that focus on differences between cohorts need to incorporate a constructionist dimension to highlight the problem of generationism.
The aim of this article is to explore whether ambulance clinicians in Sweden perceive their working environment to be safe.
Twenty four ambulance nurses and nine paramedics at five ambulance stations in urban and rural areas of Sweden were interviewed.
After transcripts of the interviews had been analysed, nine issues that affect how participants perceive the safety of patient care in ambulances emerged: planning before departure; use of safety belts; driving at high speeds; patient first, safety second; equipment design and placement; noise; driving styles; presence of relatives; documentation.
Ambulance personnel should have greater involvement in the design of ambulance care spaces and drivers should be given more regular training.
Department of Medicine, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden; Heart and Vascular Theme, Department of Cardiology, Karolinska University Hospital, 171 76 Stockholm, Sweden. Electronic address: kari.feldt@ki.se.
The impact of a change in mitral regurgitation (MR) following TAVR is unknown. We studied the impact of baseline MR and early post-procedural change in MR on survival following TAVR.
The SWEDEHEART registry included all TAVRs performed in Sweden. Patients were dichotomized into no/mild and moderate/severe MR groups. Vital status, echocardiographic data at baseline and within 7?days after TAVR were analyzed.
1712 patients were included. 1404 (82%) had no/mild MR and 308 (18%) had moderate/severe MR. Baseline moderate/severe MR conferred a higher mortality rate at 5-year follow-up (adjusted HR 1.29, CI 1.01-1.65, p?=?0.04). Using persistent =mild MR as the reference, when moderate/severe MR persisted or if MR worsened from =mild at baseline to moderate/severe after TAVR, higher 5-year mortality rates were seen (adjusted HR 1.66, CI 1.17-2.34, p?=?0.04; adjusted HR 1.97, CI 1.29-3.00, p?=?0.002, respectively). If baseline moderate/severe MR improved to =mild after TAVR no excess mortality was seen (HR 1.09, CI 0.75-1.58, p?=?0.67). Paravalvular aortic regurgitation (PVL) was inversely associated with MR improvement after TAVR (OR 0.4, 95%: CI 0.17-0.94; p?=?0.034). Atrial fibrillation (OR 2.1, 95% CI: 1.27-3.39, p?=?0.004), self-expanding valve (OR 3.8, 95% CI: 2.08-7.14, p?
Hogskolan I Boras School of Health Sciences, Goteborg University Faculty of Medicine, Department of Primary Health Care, Boras, Sweden. Anders.Jonsson@hb.se
INTRODUCTION: This study investigated the prevalence of post-traumatic stress symptoms among professional ambulance personnel in Sweden and investigated the question: "Does self-knowledge have influence on how well one copes with the effects of daily work exposure from such events?" Little is known about the variables that might be associated with post-traumatic stress symptoms in high-risk occupational groups such as ambulance service groups. METHODS: Data were gathered from ambulance personnel by means of an anonymous questionnaire. Survey responses of 362 ambulance personnel from the county of Västra Götaland were analyzed. A correlation was established between post-traumatic symptoms using the impact of event scale (IES-15) and the Professional Self-Description Form (PSDF). RESULTS: Of those who reported a traumatic situation, 21.5% scored > or =26 on the IES-15 subscale. Scores >26 indicate "PTSD caseness". There were significant differences on PSDF subscales between those presenting with or without post-traumatic symptoms. CONCLUSIONS: The mental health and emotional well-being of ambulance personnel appear to be compromised by accident and emergency work. The high prevalence of PTSD symptoms in ambulance personnel indicates an inability to cope with post-traumatic stress caused by daily work experiences.
