AIMS: In patients with sinus node disease, dual-chamber pacing (DDD) possibly results in adverse effects on the ventricular function. We have compared the incidence of cardiovascular morbidity and mortality in patients with sinus node disease and with atrioventricular (AV) synchronous pacemakers, DDD vs. atrial pacing (AAI). METHODS AND RESULTS: A nation-wide population-based cohort of 8777 patients with AAI- or DDD-mode pacemakers was followed during 12 years. The cohort was linked to national healthcare and census registers. Patients with DDD pacing and without any pre-implant admission for atrial fibrillation or flutter had an increased risk of post-implant fibrillation or flutter, in relation to corresponding AAA patients [hazard ratio (HR) = 1.30; 95% confidence interval (CI) 1.10-1.52]. A slight increase in the risk of any cardiovascular disease (HR = 1.07; CI, 1.00-1.15), and all-cause mortality (HR = 1.12; CI, 1.00-1.25), was seen among DDD patients, in relation to AAI patients, but there was no significant difference in the risk of ischaemic or unspecified stroke (HR = 1.14; CI, 0.94-1.37). Among DDD patients, the all-cause mortality did not differ from the general population [standardized mortality ratio (SMR) = 1.04; CI, 0.98-1.11]. Patients with AAI, however, had a decreased all-cause mortality risk (SMR = 0.89; CI, 0.82-0.97). CONCLUSION: Our results support AAI as the preferred mode of pacing in patients with sinus node disease, and a normal AV node function.
OBJECTIVE: To describe characteristics of patients seeking medical attention for non-urgent conditions at an emergency department (ED) and patients who use non-scheduled services in primary healthcare. DESIGN: Descriptive cross-sectional study. SETTING: Primary healthcare centres and an ED with the same catchment area in Stockholm, Sweden. PATIENTS: Non-scheduled primary care patients and non-referred non-urgent ED patients within a defined catchment area investigated by structured face-to-face interviews in office hours during a nine-week period. MAIN OUTCOME MEASURES: Sociodemographic characteristics, chief complaints, previous healthcare use, perception of symptoms, and duration of symptoms before seeking care. RESULTS: Of 924 eligible patients, 736 (80%) agreed to participate, 194 at the ED and 542 at nine corresponding primary care centres. The two groups shared demographic characteristics except gender. A majority (47%) of the patients at the primary care centres had respiratory symptoms, whereas most ED patients (52%) had digestive, musculoskeletal, or traumatic symptoms. Compared with primary care patients, a higher proportion (35%) of the ED patients had been hospitalized previously. ED patients were also more anxious about and disturbed by their symptoms and had had a shorter duration of symptoms. Both groups had previously used healthcare frequently. CONCLUSIONS: Symptoms, previous hospitalization and current perception of symptoms seemed to be the main factors discriminating between patients studied at the different sites. There were no substantial sociodemographic differences between the primary care centre patients and the ED patients.
The aim of this study was to investigate the incidence of influenza-related encephalitis in Sweden during 11.5 years. Studies from Japan report an increased incidence of influenza-related encephalitis/encephalopathy. Few other studies are available. We conducted a retrospective register-based study on the Swedish National Inpatient Register, which covers all Swedish hospitals. In 1987-1998, a total number of 14,250 hospitalized individuals had an influenza diagnosis (population incidence: 137 per million person-years). In-hospital mortality was 4.1%. Using three different approaches, only 21 cases of influenza-related encephalitis were found, corresponding to a rate of 1.5 per 1,000 hospitalized persons with an influenza diagnosis (population incidence 0.21 per million person-years). We conclude that encephalitis following influenza occurs rarely, or is an infrequently recognized, diagnosed or reported complication. The cases we studied in detail have all recovered without sequels.
BACKGROUND: Herpes simplex encephalitis (HSE) is a devastating disease. METHODS: In Sweden, a nationwide retrospective study of the incidence, morbidity, and mortality associated with HSE during the 12-year period 1990-2001 was conducted. The national inpatient register data were used, and diagnostic data from the virus laboratories were validated. RESULTS: In the study period, 638 patients hospitalized in Sweden received a primary diagnosis of HSE. Of these, 236 patients had a confirmed infection of the central nervous system due to herpes simplex virus type 1. This corresponds to an incidence of confirmed HSE due to herpes simplex virus type 1 of 2.2 cases per million population per year. Of the survivors, 87% were readmitted to the hospital. The most frequent diagnosis at readmission was epilepsy, which was found in 49 patients (21% of the 236 total patients; 24% of 203 survivors), with a median onset 9.3 months after the diagnosis of HSE. This corresponds to a 60- to 90-fold increase in risk, compared with that for the general population. Neuropsychiatric sequelae were evident in 45 (22%) of 203 surviving patients. The incidence of venous thromboembolism, including pulmonary embolism, was 5-14 times higher than that in the general population. Among patients with HSE due to herpes simplex virus type 1, the 1-year mortality was 14% (33 of 236 patients died), which was 8 times higher than expected. CONCLUSIONS: This is, to our knowledge, the first study to report long-term, nationwide follow-up data for patients with virologically confirmed HSE. There is considerable morbidity after HSE, with epilepsy being the most common diagnosis. This demonstrates the need for expanding our knowledge of the pathogenesis of HSE to direct more effective antiviral and antiinflammatory treatments.
Comment In: Clin Infect Dis. 2007 Oct 1;45(7):881-217806054
BACKGROUND: Although surgical correction for hallux valgus and other toe deformities is one of the most common procedures in foot surgery, its incidence in the general population is not well-known. MATERIALS AND METHODS: The study population comprised patients living in Sweden of a varied age group and both sexes who underwent forefoot surgery. We identified all inpatient cases from 1997 to 2000 and all ambulatory cases in 2000 registered in the National Swedish Patient Register (NSPR). Further, clinical data for the surgical treatment of hallux valgus deformity were extracted from medical records in patients treated in a geographically defined region (Stockholm). RESULTS: In total, 6956 patients with surgically treated forefoot deformities were identified from the adult population, equivalent to a cumulative incidence of 0.8 procedures per 1000 inhabitants for the whole analyzed group. There were regional variations and significant sex differences. The age distribution in both sexes was characterized by a peak in the fifth decade. Forefoot surgery was statistically more frequently performed in private clinics than in public hospitals (p