Erythema Migrans in Primary Health Care

Lyme borreliosis (LB) is the most common vector-borne disease in the northern hemisphere, and southern Sweden is a highly endemic area. In over 70% of the cases, LB is represented by the non-disseminated cutaneous form erythema migrans (EM). This thesis has its focus on EM from a primary health care perspective in southern Sweden, including aspects on epidemiology, the clinical picture, gender differences and the climate. In paper III, an annual mean incidence rate over 460 cases of EM per 100,000 inhabitants was found in the county of Blekinge. Over 98% of the cases were treated in primary health care and almost every second case occurred during the vacation months of July and August. In paper I, individuals in southern Sweden treated and recovered from EM were followed during a period of 5 years. Annually, 1% were 'reinfected', i.e. had a new infection with LB during the follow-up. This is significantly higher than the prevalence of LB in the area in 1992-1993 of 0.07% (p < 0.001), indicating that individuals with a former infection are at a higher risk of LB. In paper IV studying patients with EM, where genospecies were confirmed by PCR, 74% of the patients were infected with B. afzelii and 26% were infected with B. garinii. B. garinii seemed to cause more intense local and systemic inflammatory reactions than B. afzelii. Totally, 45% (38/85) of the lesions were annular, 46% (39/85) were non-annular and 9% (8/85) were atypical. An interaction between gender and genospecies was found that has not been described before. Men to a higher extent than women developed annular EM while women more often developed non-annular EM, if infected with B. afzelii. Surprisingly, time duration from tick bite to diagnosis was not found to have an effect on the clinical appearance of the EM. In paper II, antibiotic treatment of EM with pcV and doxycycline was found to be highly effective and no cases of disseminated LB were found in patients followed for 5 years. The incidence rate of EM was significantly higher in women than men (506/100,000 vs 423/100,000 p < 0.001) and especially women over 50 years were affected (paper III). Additionally, significantly more women than men were reinfected, 6% and 1%, respectively (p < 0.01). All infected women were over the age of 44 years and they were tick-bitten to the same extent as the men (paper I). Immunological differences might have an impact on, and explain, the observed gender differences. The seasonal incidence rates of EM varied considerably. Different climate factors were found to influence the EM incidence rates (paper III)

Ethnic differences in the contribution of insulin action and secretion to type 2 diabetes in immigrants from the Middle East compared to native Swedes.

We investigated insulin action (insulin sensitivity index, ISI) and insulin secretion (oral disposition indices, DIo) and studied metabolic, demographic and lifestyle-related risk factors for type 2 diabetes and insulin action, in the largest non-European immigrant group to Sweden, immigrants from Iraq and native Swedes

A family history of diabetes determines poorer glycaemic control and younger age of diabetes onset in immigrants from the Middle East compared with native Swedes.

Immigrant populations from the Middle East develop diabetes earlier than indigenous European populations; however, the underlying etiology is poorly understood. This study looked at the risk factors associated with early diabetes onset and, in non-diabetics, glycaemic control in immigrants from Iraq compared with native Swedes

High prevalence of type 2 diabetes in Iraqi and Swedish residents in a deprived Swedish neighbourhood - a population based study

Background: Immigrants from the Middle-East are at high risk of developing type 2 diabetes (T2D). The aim of the present survey was to measure, in a single deprived neighbourhood, the prevalence rates of impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and T2D in residents originating from Iraq and to compare them to those in residents born in Sweden. An additional aim was to identify metabolic, lifestyle and socioeconomic risk factors associated with IFG/IGT and T2D in these residents. Methods: The study was conducted February 1'st to March 31'st 2010. Men and women aged 45 to 65 years of Swedish or Iraqi origin, living in the neighbourhood of Rosengard, Malmo, Sweden, were randomly selected from the census register. Each participant signed a written informed consent form, underwent a physical examination and an oral glucose tolerance test (OGTT), provided blood samples and filled in a questionnaire. A total of 175 subjects participated (Swedish origin n = 79, Iraqi origin n = 96), reflecting an overall response rate of almost 60%. Results: In total, 21.9% and 19.0% of the Iraqi and Swedish participants, respectively, suffered from T2D, while 24.0% of the Iraqi participants and 25.3% of the Swedish participants had IFG/IGT. There were no significant differences in prevalence rates relating to country of origin. Obesity (BMI >= 30 kg/m(2)) and sedentary leisure time physical activity were highly prevalent in both groups, while a family history of diabetes was more prevalent in participants from Iraq (49.2%) than in those from Sweden (22.8%) (p = 0.001). Being obese or having a sedentary leisure time were, independently associated with T2D (OR 5.43 (95% CI 2.10-14.02) and 2.89 (95% CI 1.03-8.10) respectively), while economic difficulties were independently associated with IFG/IGT (OR 2.55 (95% CI 1.06-6.15)) after adjustment for the confounding effects of other common risk factors for T2D. Conclusions: This study reveals a high prevalence of T2D, independently of country of origin (Iraq or Sweden), in a socially vulnerable area and additionally presents a risk factor profile that is markedly different from that of Sweden in general

Risk of hospitalization for type 2 diabetes in first- and second-generation immigrants in Sweden: a nationwide follow-up study.

OBJECTIVES: This is the first nationwide study with the aim to analyze whether there is an association between country of birth in first-generation immigrants and hospitalization for type 2 diabetes (T2D), and to study whether any such association remains in second-generation immigrants. DESIGN: In this follow-up study, the Swedish Hospital Discharge Register was used to identify all hospital diagnoses of T2D in first- and second-generation immigrants in Sweden between January 1, 1964 and December 31, 2007. Hospitalization rate ratios standardized with regard to gender, age, geographical region, socioeconomic status, obesity, and family history of hospitalization for T2D were estimated in first- and second-generation immigrants. RESULTS: Both increased and decreased risks of hospitalization for T2D were shown for several first-generation immigrant groups. However, only second-generation immigrants with Finnish or former Yugoslavian parents had higher rates of hospitalization for T2D than the reference group. No other differences remained in the second-generation immigrants. CONCLUSIONS: The present study suggests that ethnic environmental factors may be more important than ethnic genetic factors in explaining the observed variation in hospitalization for T2D among first-generation immigrants

Ethnicity is an independent risk indicator when estimating diabetes risk with FINDRISC scores: A cross sectional study comparing immigrants from the Middle East and native Swedes.

This study sought to compare type 2 diabetes (T2D) risk indicators in Iraqi immigrants with those in ethnic Swedes living in southern Sweden

Adult-onset diabetes in Middle Eastern immigrants to Sweden : Novel subgroups and diabetic complications-The All New Diabetes in Scania cohort diabetic complications and ethnicity

Background Middle Eastern immigrants to Europe represent a high risk population for type 2 diabetes. We compared prevalence of novel subgroups and assessed risk of diabetic macro- and microvascular complications between diabetes patients of Middle Eastern and European origin. Methods This study included newly diagnosed diabetes patients born in Sweden (N = 10641) or Iraq (N = 286), previously included in the All New Diabetes in Scania cohort. The study was conducted between January 2008 and August 2016. Patients were followed to April 2017. Incidence rates in diabetic macro- and microvascular complications were assessed using cox-regression adjusting for the confounding effect of age at onset, sex, anthropometrics, glomerular filtration rate (eGFR) and HbA1c. Findings In Iraqi immigrants versus native Swedes, severe insulin-deficient diabetes was almost twice as common (27.9 vs. 16.2% p <0.001) but severe insulin-resistant diabetes was less prevalent. Patients born in Iraq had higher risk of coronary events (hazard ratio [HR] 1.84, 95% CI 1.06-3.12) but considerably lower risk of chronic kidney disease (CKD) than Swedes (HR 0.19; 0.05-0.76). The lower risk in Iraqi immigrants was partially attributed to better eGFR. Genetic risk scores (GRS) showed more genetic variants associated with poor insulin secretion but lower risk of insulin resistance in the Iraqi than native Swedish group. Interpretation People with diabetes, born in the Middle East present with a more insulin-deficient phenotype and genotype than native Swedes. They have a higher risk of coronary events but lower risk of CKD. Ethnic differences should be considered in the preventive work towards diabetes and its complications.Peer reviewe

The association between apolipoprotein M and insulin resistance varies with country of birth.

Risk of type 2 diabetes mellitus (T2DM) differs according to ethnicity. Levels of apolipoprotein M (ApoM) have been shown to be decreased in T2DM. However, its role in different ethnicities is not known. We examined the differences in plasma ApoM levels in Swedish residents born in Iraq (Iraqis) and Sweden (Swedes) in relation to T2DM and insulin resistance (IR)

Genetic frontiers for conservation:An assessment of synthetic biology and biodiversity conservation

In recent years synthetic biology has emerged as a suite of techniques and technologies that enable humans to read, interpret, modify, design and manufacture DNA in order to rapidly influence the forms and functions of cells and organisms, with the potential to reach whole species and ecosystems. As synthetic biology continues to evolve, new tools emerge, novel applications are proposed, and basic research is applied. This assessment is one part of IUCN’s effort to provide recommendations and guidance regarding the potential positive and negative impacts of synthetic biology on biodiversity conservation; it comprises a full assessment and a short synthesis report