Back and neck pain: Patterns in healthcare consultations

Musculoskeletal disorders are very common and affects the individual by pain and functional impairment, and the society through work disability and healthcare utilisation. To what extent is less studied. Routinely collected healthcare registers is a potential resource for epidemiological studies of musculoskeletal disorders. Skåne region, as opposed to nationally in Sweden, has healthcare registers, covering all care including primary care. he overall aim of this thesis was to incorporate healthcare registers in the epidemiological research of consultation prevalence, healthcare consultation and sick leave patterns in patients with musculoskeletal disorders. he thesis comprises four studies in which the Skåne Healthcare Register was linked with national registers on sick leave, prescribed drugs, and socioeconomic status. Additionally, the thesis include a comparative study between data from the Skåne Healthcare Register with that of an United Kingdom (UK) consultation database. he main variables under study are in Paper I–III disease, consultations, and sick leave and in Paper IV education, income, and work status. he consultation prevalence of low back pain was estimated to 3–4% in the Skåne region while the figure was larger in the UK. People having low back pain had increased levels of healthcare consultations in general, and more pain diagnoses in particular. People diagnosed with whiplash associated neck injury had higher healthcare consultation rates already three years before the neck injury and the postinjury consultation level was associated with the preinjury consultation levels. Low socioeconomic status was associated with being diagnosed with chronic pain. It was feasible to use routinely collected databases in the studies of the burden of disease from musculoskeletal disorders, thus potentially also for other public health disorders. While there are vast potentials with register data, it is also important to bear in mind limitations due to e.g., missing data and misclassification which may introduce bias. My main findings indicate a need for early interventions after initial pain and neck injury to prevent the pain to becoming chronic. Stratification-based management is especially suggested

Decrease in sick leave among patients with rheumatoid arthritis in the first 12 months after start of treatment with tumour necrosis factor antagonists: a population-based controlled cohort study.

OBJECTIVE: /st> To investigate the effect of tumour necrosis factor (TNF) antagonist treatment of patients with rheumatoid arthritis (RA) on sick leave (SL) and disability pension (DP) in a population-based setting in southern Sweden. METHODS: /st> All patients with RA in the South Swedish Arthritis Treatment Group register living in the county of Skåne (population 1.2 million), who started their first treatment with a TNF antagonist between January 2004 and December 2007 and were 18-58 years at treatment start (n=365), were identified. For each patient with RA, four matched reference subjects from the general population were randomly selected. Data were linked to the Swedish Social Insurance Agency register and the point prevalence of SL and DP as well as days of SL and DP per month were calculated from 360 days before until 360 days after treatment start. RESULTS: /st> At treatment start 38.6% of the patients with RA were registered for SL. During the first 6 months this share dropped to 28.5% (decrease by 26.2%, p There was a marked decline in SL during the first 6 months of TNF antagonist treatment in patients with RA in southern Sweden, maintained throughout the first year, which was not offset by a corresponding increase in DP

Population-based consultation patterns in patients with shoulder pain diagnoses

Background: To assess the annual consultation prevalence and new onset consultation rate for doctor-diagnosed shoulder pain conditions. Methods: We identified all residents in the southernmost county in Sweden who received a shoulder pain diagnosis during 2006 (ICD-10 code M75). In subjects who did not consult due to such disorders during 2004 and 2005, we estimated the new onset consultation rate. The distribution of specific shoulder conditions and the length of the period of repeated consultation were calculated. Results: Annual consultation prevalence was 103/10 000 women and 98/10 000 men. New onset consultation rate was 80/10 000 women (peak in age 50-59 at 129/10 000) and 74/10 000 men (peak in age 60-69 at 116/10 000). About one fifth of both genders continued to consult more than three months after initial presentation, but only a few percent beyond two years. Rotator cuff - and impingement syndromes were the most frequent diagnoses. Conclusion: The annual consultation prevalence for shoulder pain conditions (1%) was similar in women and men, and about two thirds of patients consulted a doctor only once. Impingement and rotator cuff syndromes were the most frequent diagnoses

Landstinget i Kalmar läns Traineeprogram 2006-2007 : Utvärderingsrapport

September 2006 startade Landstinget i Kalmar län sitt första interna Traineeprogram i syfte att skapa ett fundament av lämpliga ledarkandidater respektive potentiella chefer inom landstinget. Det drygt ettåriga programmet påbörjades av 27 deltagare, med olika profession, från olika delar av länet. Programmet innefattade dels moment inom Landstinget i Kalmar län såsom praktik, mentorskap, interna och externa föreläsningar, dels moment på Handelshögskolan BBS, Högskolan i kalmar, såsom föreläsningar, teori och projektarbeten. Landstinget i Kalmar län gav vid årsskiftet 2006/2007 eHälsoinstitutet i uppdrag att utvärdera Traineeprogrammet med avseende på upplägg och innehåll. Datainsamlingen utfördes i enkätform med eHälsoinstitutets webbaserade enkätsystem. Data samlades in vid tre tillfällen, februari 2007, juni-augusti 2007 och december 2007. Utvärderingen visar att deltagarna uppskattade att de fått möjlighet att delta i Traineeprogrammet. Deltagarna var nöjda med programmets upplägg och innehåll. Flertalet lovordade kursen som hölls av BBS. Under programmets gång var deltagarna mindre positiva till mentorsdelen och praktikdelen, som har fungerat i varierande grad för olika deltagare. Flertalet deltagare uppgav oklarheter i syftet med dessa delar. Deltagarna efterfrågade även tydlighet i det övergripande syftet med programmet; vad kommer programmet att leda till med avseende på framtida chefsuppdrag? Flertalet deltagare uppgav att en stor bonus med programmet var att ha skapat nya nätverk med medarbetar på olika förvaltningar och kliniker inom landstinget.Traineeprogrammet för ledarskapsutbildning - Utvärderin

Analys och kompletteringar av Landstingets resultat i Öppna jämförelser

Sveriges Kommuner och Landsting presenterade 2007 tillsammans med Socialstyrelsen den andra rapporten med Öppna jämförelser (ÖJ) inom den svenska hälso- och sjukvården. Huvudsyftet med ÖJ är att göra Sveriges hälso- och sjukvård öppen för insyn. Ett andra syfte är att stimulera landsting och kommuner att analysera sin verksamhet, lära av varandra, förbättra kvaliteten och effektivisera verksamheten. Vidare ska kommuner och landsting kunna ta reda på vilka insatser och arbetsmetoder som ger goda resultat genom att de jämför sina prestationer. Underlaget för rapporten består av olika indikatorer inom olika områden som ska ge en bild över hälso- och sjukvårdsläget i Sverige. Indikatorerna består av fyra olika huvudgrupper; medicinska, patienterfarenheter, tillgänglighet samt kostnader. I denna rapport behandlas enbart de medicinska indikatorerna. För varje indikator finns det i Kalmar län en kontaktperson. Denna kontaktperson har ansvar för att kommentera de aktuella resultaten i anslutning till att den årliga rapporten publiceras. Som ett led i Landstinget i Kalmar läns förbättringsarbete gavs eHälsoinstitutet, tillsammans med Folkhälsocentrum uppdraget att tydliggöra och underlätta tolkning av 2007 års ÖJ.Öppna jämförelser i Kalmar läns landstin

Susceptibility to COVID-19 after High Exposure to Perfluoroalkyl Substances from Contaminated Drinking Water: An Ecological Study from Ronneby, Sweden

There is concern that immunotoxic environmental contaminants, particularly perfluoroalkyl substances (PFAS), may play a role in the clinical course of COVID-19 and epidemiologic studies are needed to answer if high-exposed populations are especially vulnerable in light of the ongoing pandemic. The objective was, therefore, to determine if exposure to highly PFAS-contaminated drinking water was associated with an increased incidence of COVID-19 in Ronneby, Sweden, during the first year of the pandemic. We conducted an ecological study determining the sex- and age-standardized incidence ratio (SIR) in the adult population relative to a neighboring reference town with similar demographic characteristics but with only background levels of exposure. In Sweden, COVID-19 is subject to mandatory reporting, and we retrieved aggregated data on all verified cases until 3 March 2021 from the Public Health Agency of Sweden. The SIR in Ronneby was estimated at 1.19 (95% CI: 1.12; 1.27). The results suggest a potential link between high PFAS exposure and susceptibility to COVID-19 that warrants further research to clarify causality

Tattoos as a risk factor for malignant lymphoma: a population-based case–control studyResearch in context

Summary: Background: The popularity of tattoos has increased dramatically over the last few decades. Tattoo ink often contains carcinogenic chemicals, e.g., primary aromatic amines, polycyclic aromatic hydrocarbons, and metals. The tattooing process invokes an immunologic response that causes translocation of tattoo ink from the injection site. Deposition of tattoo pigment in lymph nodes has been confirmed but the long-term health effects remain unexplored. We used Swedish National Authority Registers with full population coverage to investigate the association between tattoo exposure and overall malignant lymphoma as well as lymphoma subtypes. Methods: We performed a case–control study where we identified all incident cases of malignant lymphoma diagnosed between 2007 and 2017 in individuals aged 20–60 years in the Swedish National Cancer Register. Three random age- and sex-matched controls per case were sampled from the Total Population Register using incidence density sampling. We assessed exposure through a questionnaire in 2021, and data on potential confounders were retrieved from registers. We used multivariable logistic regression to estimate the incidence rate ratio (IRR) of malignant lymphoma in tattooed individuals. Findings: The study population consisted of 11,905 individuals, and the response rate was 54% among cases (n = 1398) and 47% among controls (n = 4193). The tattoo prevalence was 21% among cases and 18% among controls. Tattooed individuals had a higher adjusted risk of overall lymphoma (IRR = 1.21; 95% CI 0.99–1.48). The risk of lymphoma was highest in individuals with less than two years between their first tattoo and the index year (IRR = 1.81; 95% CI 1.03–3.20). The risk decreased with intermediate exposure duration (three to ten years) but increased again in individuals who received their first tattoo ≥11 years before the index year (IRR = 1.19; 95% CI 0.94–1.50). We found no evidence of increasing risk with a larger area of total tattooed body surface. The risk associated with tattoo exposure seemed to be highest for diffuse large B-cell lymphoma (IRR 1.30; 95% CI 0.99–1.71) and follicular lymphoma (IRR 1.29; 95% CI 0.92–1.82). Interpretation: Our findings suggested that tattoo exposure was associated with an increased risk of malignant lymphoma. More epidemiologic research is urgently needed to establish causality. Funding: The Swedish Research Council for Health, Working Life and Welfare