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Background Chronic stress and depression are potential risk factors for mild cognitive impairment and dementia, including Alzheimer disease. The aim was to investigate whether any such risk is additive. Methods Cohort study including 1 362 548 people (665 997 women, 696 551 men) with records in the Region Stockholm administrative healthcare database (VAL). Exposure was a recorded ICD-10 diagnosis of chronic stress, depression, or both, recorded in 2012 or 2013. Outcome was a diagnosis of Alzheimer disease, other dementia, or mild cognitive impairment recorded from 2014 through 2022. Odds ratios with 99% confidence intervals (CI) adjusted for age, sex, neighborhood socioeconomic status, diabetes, and cardiovascular disorders were calculated. Results During the exposure period, 4 346 patients were diagnosed with chronic stress, 40 101 with depression, and 1 898 with both. The average age at baseline was around 40 years in all groups. In the fully adjusted model, the odds ratio of Alzheimer disease was 2.45 (99% CI 1.22–4.91) in patients with chronic stress, 2.32 (99% CI 1.85–2.90) in patients with depression, and 4.00 (99% CI 1.67–9.58) in patients with chronic stress and depression. The odds ratio of mild cognitive impairment was 1.87 (99% CI 1.20–2.91) in patients with chronic stress, 2.85 (99% CI 2.53–3.22) in patients with depression, and 3.87 (99% CI 2.39–6.27) in patients with both. When other dementia was analyzed, the odds ratio was significant only in patients with depression, 2.39 (99% CI 1.92–2.96). Conclusions Documented chronic stress increased the risk of mild cognitive impairment and Alzheimer disease. The same was seen with depression. The novel finding is the potential additive effect of chronic stress to depression, on risk of MCI and AD.

The aim of the present study was to investigate the predictive ability for lung cancer of symptoms reported in an adaptive e-questionnaire, separately for never smokers, former smokers, and current smokers. Consecutive patients referred for suspected lung cancer were recruited between September 2014 and November 2015 from the lung clinic at the Karolinska University Hospital, Stockholm, Sweden. A total of 504 patients were later diagnosed with lung cancer (n = 310) or no cancer (n = 194). All participants answered an adaptive e-questionnaire with a maximum of 342 items, covering background variables and symptoms/sensations suspected to be associated with lung cancer. Stochastic gradient boosting, stratified on smoking status, was used to train and test a model for predicting the presence of lung cancer. Among never smokers, 17 predictors contributed to predicting lung cancer with 82% of the patients being correctly classified, compared with 26 predictors with an accuracy of 77% among current smokers and 36 predictors with an accuracy of 63% among former smokers. Age, sex, and education level were the most important predictors in all models.

We aimed to investigate whether different measures of obesity could similarly predict atrial fibrillation, and whether the atrial fibrillation risk associated with obesity is dependent on presence of metabolic syndrome. We performed our study in a population-based longitudinal cardiovascular study, comprising 1 924 men and 2 097 women, aged 60 years, from Stockholm. Body mass index, waist circumference, sagittal abdominal diameter and components of metabolic syndrome (systolic- and diastolic blood pressure, fasting glucose, triglycerides, high-density lipoprotein-cholesterol) were recorded at baseline. Participants were classified by their body mass index (normal weight, overweight or obese), waist circumference (normal, semi-elevated or elevated), and according to presence of metabolic syndrome. Atrial fibrillation risk was estimated by Cox proportional hazards regression models, adjusted for common atrial fibrillation risk factors, expressed as HR and 95% CI. During a mean follow-up of 13.6 years, 285 incident atrial fibrillation cases were recorded. One standard deviation increment of each obesity measure was associated with increased atrial fibrillation risk as: body mass index 1.25 (1.12 - 1.40), waist circumference 1.35 (1.19 - 1.54) and sagittal abdominal diameter 1.28 (1.14 - 1.44). Compared to normal weight subjects without metabolic syndrome, increased atrial fibrillation risk was noted for overweight subjects with metabolic syndrome, 1.67 (1.16 - 2.41), obese subjects without metabolic syndrome, 1.75 (1.11 - 2.74) and obese subjects with metabolic syndrome, 1.92 (1.34 - 2.74). Compared to subjects with normal waist circumference without metabolic syndrome, subjects with elevated waist circumference and metabolic syndrome suffered increased atrial fibrillation risk, 2.03 (1.44 - 2.87). Body mass index, waist circumference and sagittal abdominal diameter could similarly predict atrial fibrillation. Obesity was associated with an increased atrial fibrillation risk regardless of metabolic syndrome, whereas overweight and elevated waist circumference was associated with increased atrial fibrillation risk only if metabolic syndrome was present.

Emerging evidence suggests that bidirectional lung–kidney crosstalk may influence outcomes, but this has not been systematically evaluated in unselected emergency department populations. We therefore examined the association between peripheral oxygen saturation (SpO₂), estimated glomerular filtration rate (eGFR), and 30‑day mortality, and tested whether the prognostic association of oxygenation with mortality differs across levels of kidney function (and vice versa), using an SpO₂×eGFR interaction term to model effect modification We analyzed 12,651 adults with complete data on SpO₂, creatinine-derived eGFR, lactate, C-reactive protein (CRP), RETTS triage, and prespecified covariates from the Skåne Emergency Medicine (Skåne 17/18) cohort (2017–2018). We fitted multivariable logistic regression models including SpO₂ and eGFR (Model 1) and then added an SpO₂×eGFR interaction term (Model 2). Nested models were compared using a likelihood-ratio test, and discrimination was compared using AUROC (DeLong test) based on model-predicted probabilities. In a predefined subgroup with arterial blood gases ( n  = 3,068), we evaluated eGFR in relation to PaO₂/FiO₂ (P/F). In the full cohort, SpO₂ and eGFR were significantly correlated. Adding the SpO₂×eGFR interaction term improved model fit versus the main-effects model (LRT ΔDeviance = 15.77, p  = 7.17 × 10⁻⁵), but discrimination was essentially unchanged (AUROC 0.744 vs. 0.745; ΔAUROC 0.0009; 95% CI − 0.00227 to 0.00046; DeLong p  = 0.193). In the interaction model, higher SpO₂ and eGFR were associated with lower 30-day mortality (OR 0.81, 95% CI 0.77–0.85; OR 0.85, 95% CI 0.80–0.91), and the interaction term indicated stronger protection when both were higher (OR 0.90, 95% CI 0.86–0.95). Exploratory subgroup analyses suggested the interaction effect was most pronounced among patients presenting with chest pain. SpO₂ and eGFR showed evidence of interaction in relation to 30-day mortality. Although adding the interaction term improved model fit, it did not meaningfully improve discrimination compared to main model (without interaction). This suggests that, in unselected ED populations, measuring and interpreting SpO₂ and eGFR remains clinically useful, whereas explicitly modeling their interaction is unlikely to add substantial predictive benefit.

Background The C-reactive protein/albumin ratio (CAR) seems to mirror disease severity and prognosis in several acute disorders particularly in elderly patients, yet less is known about if CAR is superior to C-reactive protein (CRP) in the general population. Methods Prospective study design on the UK Biobank, where serum samples of CRP and Albumin were used. Cox regression analyses were conducted to assess all-cause and cardiovascular mortality, myocardial infarction, ischemic stroke, and heart failure over a follow-up period of approximately 12.5 years. The Cox model was adjusted for established cardiovascular disease (CVD) risk factors, including age, sex, smoking habits, physical activity level, BMI level, systolic blood pressure, LDL-cholesterol, statin treatment, diabetes, and previous CVD, with hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Analyses were also stratified by sex, CRP level (< 10 and ≥ 10 mg/ml) and age (< 60 and ≥ 60 years). Results In total, 411,506 individuals (186,043 men and 225,463 women) were included. In comparisons between HRs for all adverse outcomes, the results were similar or identical for CAR and CRP. For example, both CAR and CRP, adjusted HRs for all-cause mortality were 1.13 (95% CI 1.12–1.14). Regarding CVD mortality, the adjusted HR for CAR was 1.14 (95% CI 1.12–1.15), while for CRP, it was 1.13 (95% CI 1.11–1.15). Conclusions Within this study CAR was not superior to CRP in predictive ability of mortality or CVD disorders. Clinical trial registration number Not applicable (cohort study).

Research on how the COVID-19 pandemic, societal restrictions, and healthcare services barriers have impacted patients with hypertension is limited. This study aimed to evaluate trends in alcohol-related disorders, other alcohol-associated conditions, and deaths among patients with hypertension during the pandemic (March 2020–Feb 2022) compared to the pre-pandemic period (March 2018–Feb 2020) in Region Stockholm, Sweden. This exploratory descriptive time series analysis was conducted among adults diagnosed with hypertension between 2015 and 2018. Data were obtained from the Swedish National Patient Register (specialist care) and the Stockholm Region’s primary care database. The quarterly period prevalence of diagnoses or cumulative incidence of acute diagnoses and deaths was presented. The study included 168,963 patients with hypertension (57% females). Overall, no profound shifts in alcohol-related disorders or mortality were observed during the pandemic. However, noteworthy trends were: alcohol-related disorder diagnoses in primary care increased among females (3.2/1000 compared to 2.8–3.1/1000 pre-pandemic), while rates of alcohol dependency decreased in specialist care, particularly among males (3.5–4.1/1000 compared to 4.1–5.1/1000 pre-pandemic). Alcohol-related disorders and deaths remained higher in males than in females during both periods. Among other alcohol-associated conditions, cardiovascular disease prevalence increased in both sexes in primary care and in male patients in specialist care, whereas mental illness decreased in both sexes. This study highlights the need for continued prevention of hazardous alcohol use among patients with hypertension and monitoring of cardiovascular risk factors. Further research on hypertensive patients is needed, as the pandemic-related health impacts may not become apparent until many years later.

Improving accuracy and timeliness for osteoporosis diagnosis could help prevent fragility fractures, morbidity, and mortality for older individuals. Osteoporosis is an often silent health condition, especially as regards vertebral fractures, and WHO issued a call to action for primary care to lead efforts in screening, assessing, and managing diseases such as osteoporosis. We used a machine learning method, Stochastic Gradient Boosting (SGB), to identify what diagnoses in a primary care setting predict a new osteoporosis diagnosis, using a sex- and age-matched case–control design. Cases of new osteoporosis (ICD-10 code: M80, M81, M82) were identified across all outpatient care settings during 2012–2019. We included individuals aged ≥ 40 years old, stratified by sex and age-groups 40–65 years and > 65 years old. Controls were sampled from outpatients that did not have osteoporosis at any time during 2010–2019. Using the SGB model, we ranked the most important diagnoses related to newly diagnosed osteoporosis, presented as the normalized relative influence (NRI) score with a corresponding odds ratio of marginal effects (OR ME ) of being newly diagnosed with osteoporosis. A train-test approach was used to develop the model, with the performance evaluated using area under the curve (AUC). In total , we included 30,741 patients with osteoporosis aged ≥ 40 years. AUC was high, > 0.899 for all age and sex stratas. The number of visits to primary care in the year prior to the osteoporosis diagnosis contributed with the most predictive information for all age and sex stratas. For all age groups several other factors also showed high NRI and OR ME and among them many unspecific diagnoses such as Dorsalgia showed high NRI, (2.6–9.0%) and other painful musculoskeletal disorders. However, our study also showed that the diagnosis of Hypertension had a very high NRI for patients aged > 65 years but not in patients 40–65 years of age. In this AI study, including only diagnoses from patients seen in primary health care centres, we found that the number of consultations in primary care had high predictive information as well unspecific diagnoses including muscle and skeletal pain predicted high risk for osteoporosis in all age groups.

To examine the risk of post-polio syndrome (PPS) in immigrant groups using native Swedish-born individuals as referents. This is a retrospective study. The study population included all individuals aged 18 years and older registered in Sweden. PPS was defined as having at least one registered diagnosis in the Swedish National Patient Register. The incidence of post-polio in different immigrant groups, using Swedish-born individuals as referents, was assessed by Cox regression, with hazard ratios (HRs) and 99% confidence intervals (CI). The models were stratified by sex and adjusted for age, geographical residence in Sweden, educational level, marital status, co-morbidities, and neighbourhood socioeconomic status. In total 5300 post-polio cases were registered, 2413 males and 2887 females. Fully adjusted HRs (99% CI) in immigrants versus Swedish-born were 1.77 in men (1.52–2.07) and 1.39 (1.19–1.62) in women. Statistically significant excess risks of post-polio were found in the following subgroups: men and women from Africa, HRs (with 99% CI) 7.40 (5.17–10.59) and 8.39 (5.44–12.95), respectively, and Asia, HRs 6.32 (5.11–7.81) and 4.36 (3.38–5.62) respectively, and in men from Latin America, HR 3.66 (2.17–6.18). It is of importance to be aware of risks of PPS in immigrants settled in Western countries, and that it is more common in immigrants from regions of the world where polio is still prevalent. Patients with PPS need treatment and proper follow-up until polio has been eradicated through global vaccination programs.

Objective Primary care is the base in many health care systems, and to identify the most registered diagnoses in primary care is a way to identify the overall health care use and needs in society. We estimated the rates of the 30 most common diagnoses in primary health care and their male to female ratio. Research design and methods This was a study including inhabitants 18 years and older out of all 2.3 million inhabitants living in Region Stockholm, Sweden. Data on all healthcare appointments from primary care during 2019–2021 were extracted from the Stockholm County Council data warehouse known as VAL. Primary care data were analyzed by underlying population and age. In 2019, only physical visits were available, but during 2021 digital visits were included. For the specific diagnoses, physical and digital visits were merged. Results The five most common diagnoses in primary care were: essential hypertension (I10), myalgia (M79), type 2 diabetes (E11), dorsalgia (M54), and pain in joint (M25). The female-to-male ratios were higher for 27 of the 30 most common diagnoses, for example stress reaction (F43), malaise and fatigue (R53), and headache (R51). Chronic ischaemic heart disease (I25), Type 2 diabetes (E11), and Atrial fibrillation (I48) were more common in men. Conclusions Most of the common diagnoses in primary care are more often registered in women than in men. The higher presence of diagnoses of pain and mental illness seems to mirror the higher sick leave among women in recent years.

Fibroblast growth factor-23 (FGF23), a regulator of mineral metabolism, has been linked to cardiovascular disease in chronic kidney disease. As community-based data of the longitudinal association between FGF23 and cardiovascular events are lacking, we investigated a possible relationship in 727 men of the Uppsala Longitudinal Study of Adult Men population-based cohort (mean age 77 years). During a median follow-up of 9.7 years, 110 participants died of cardiovascular causes. In Cox regression models adjusted for age and established cardiovascular risk factors, higher serum FGF23 was associated with a significantly increased risk for cardiovascular mortality (hazard ratio (HR) per increased s.d. of 1.36). This relationship remained significant, albeit attenuated, after adjustment for glomerular filtration rate (GFR) (HR 1.21). FGF23 was also associated with all-cause mortality, although the association was weaker than that with cardiovascular mortality, and it was nonsignificant in fully adjusted multivariate models. Spline analysis suggested a log-linear relationship between FGF23 and outcome. Participants with a combination of high FGF23 (>60pg/ml), low GFR (<60ml/min), and micro-/macro-albuminuria (albumin/creatinine ratio above 3mg/ml) had an almost eightfold increased risk compared with participants without these abnormalities. Thus, a higher FGF23 level is associated with an increased cardiovascular mortality risk in the community. Clinical trials are needed to determine whether FGF23 is a modifiable risk factor.