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Dyspnoea is one of the emergency department's (ED) most common and deadly chief complaints, but frequently misdiagnosed and mistreated. We aimed to design a diagnostic decision support which classifies dyspnoeic ED visits into acute heart failure (AHF), exacerbation of chronic obstructive pulmonary disease (eCOPD), pneumonia and \"other diagnoses\" by using deep learning and complete, unselected data from an entire regional health care system. In this cross-sectional study, we included all dyspnoeic ED visits of patients ≥ 18 years of age at the two EDs in the region of Halland, Sweden, 07/01/2017-12/31/2019. Data from the complete regional health care system within five years prior to the ED visit were analysed. Gold standard diagnoses were defined as the subsequent in-hospital or ED discharge notes, and a subsample was manually reviewed by emergency medicine experts. A novel deep learning model, the clinical attention-based recurrent encoder network (CareNet), was developed. Cohort performance was compared to a simpler CatBoost model. A list of all variables and their importance for diagnosis was created. For each unique patient visit, the model selected the most important variables, analysed them and presented them to the clinician interpretably by taking event time and clinical context into account. AUROC, sensitivity and specificity were compared. The most prevalent diagnoses among the 10,315 dyspnoeic ED visits were AHF (15.5%), eCOPD (14.0%) and pneumonia (13.3%). Median number of unique events, i.e., registered clinical data with time stamps, per ED visit was 1,095 (IQR 459-2,310). CareNet median AUROC was 87.0%, substantially higher than the CatBoost model´s (81.4%). CareNet median sensitivity for AHF, eCOPD, and pneumonia was 74.5%, 92.6%, and 54.1%, respectively, with a specificity set above 75.0, slightly inferior to that of the CatBoost baseline model. The model assembled a list of 1,596 variables by importance for diagnosis, on top were prior diagnoses of heart failure or COPD, daily smoking, atrial fibrillation/flutter, life management difficulties and maternity care. Each patient visit received their own unique attention plot, graphically displaying important clinical events for the diagnosis. We designed a novel interpretable deep learning model for diagnosis in emergency department dyspnoea patients by analysing unselected data from a complete regional health care system.

Background Evidence is limited for the association between parental income during childhood and adolescence and the subsequent risk of drug use disorder (DUD) in the second generation and whether the association is modified by region of origin. Identifying the association and effect modification by immigrant background and region of origin would provide an important knowledge base to consider tailored policies. Methods We used nationwide longitudinal Swedish data on 1,137,721 non-immigrants and 293,636 s-generation individuals who turned 15 years of age between 2005 and 2020. Cox proportional hazard models were used to examine the associations between parental income and DUD by immigrant background and region of origin. Parental income was assessed in ranked percentiles based on family disposable income when the study individuals were 14 years of age. In addition, accumulated exposure and critical periods of low parental income were assessed at the ages 0–4, 5–9, and 10–14. DUD was assessed using medical/legal registers 2005–2020 when the study individuals were between 15 and 25 years old. Results Higher parental income was associated with a decreased risk of DUD, while the association was weaker in the second generation, such as in those from Asia, Africa, and Middle East or North Africa (MENA) in males, and Latin America or Caribbean, Africa, and MENA in females. Accumulated exposure to low parental income was associated with an increased risk of DUD, while the association was weaker in the second generation, such as in those from MENA. Conclusions Financial security in early life may lower the subsequent risk of DUD. However, the associations varied by immigrant background and region of origin.

The events of September 8, 1978, in Iran, commonly known as 'Black Friday', have long been portrayed as a mass killing of peaceful protesters by the Shah's regime, with widely cited death tolls ranging from several hundred to several thousand. However, this article presents a comprehensive reassessment of the incident at Jaleh Square in Tehran, arguing that the dominant narrative is rooted more in disinformation and misinformation than verifiable fact. Drawing on official records from the Imperial Iranian Government, post-revolutionary data compiled by the Islamic Republic's own Martyrs Foundation, the article establishes that approximately 58-64 people were killed in the incident thus contradicting inflated figures disseminated by opposition groups, amplified by Western media, and institutionalized in scholarly literature. The article further examines how disinformation campaigns, journalistic failures, and ideological biases contributed to the construction and persistence of the 'massacre' narrative, which continues to serve the Islamic Republic's political agenda to this day. Through this case study, the article underscores the need for critical scrutiny in reporting and historiography, particularly when unverified claims shape national memory and influence political legitimacy.

Dyspnea is a common and diagnostically challenging symptom in the emergency department (ED), particularly among older adults with multimorbidity. Traditional risk stratification tools often perform poorly in this population. Galectin-3 (Gal-3), a biomarker of inflammation and fibrosis, may reflect biological aging and resilience, potentially improving early mortality risk assessment. To evaluate the independent association between Gal-3 and 30-day mortality in patients presenting with acute dyspnea; to assess its utility for identifying patients at low risk of short-term mortality; and to determine its incremental value in improving prediction of 30-day mortality when added to clinical risk models. Retrospective observational study based on the Acute Dyspnea Study (ADYS). The study included 763 adult ED patients with acute dyspnea. Gal-3 was measured as NPX (Normalized Protein Expression) values using the Olink proximity extension assay, and NT-proBNP was measured using standard laboratory methods. The primary outcome was 30-day all-cause mortality. Multivariable logistic regression and Cox regression analyses were performed, with internal validation by bootstrap resampling. Predictive performance was evaluated using ROC curves, AUC, and the Youden index, and incremental value was assessed by AUC comparison and net reclassification improvement (NRI). Among the 763 patients, 49 (6.4%) died within 30 days. Gal-3 NPX was independently associated with 30-day mortality (OR 1.97; 95% CI: 1.16-3.36; p = 0.013). Although Gal-3 NPX alone demonstrated moderate discrimination (AUC 0.69), relatively low Gal-3 NPX levels within the cohort effectively ruled out short-term mortality, with a negative predictive value of 96%. Adding Gal-3 NPX to the clinical model modestly improved predictive performance (AUC increased from 0.803 to 0.819; NRI 0.028), primarily by enhancing identification of low-risk patients. Gal-3 NPX was independently associated with 30-day mortality in patients with acute dyspnea. Although its addition yielded only a modest, non-significant improvement in overall risk prediction, Gal-3 may be useful for ruling out short-term mortality, supporting its potential role as a negative prognostic marker in the ED setting.

Background Understanding the heterogeneity of opioid overdose fatalities is critical to developing effective preventive interventions. This study examines patterns of care contacts among people who subsequently died from opioid overdose. The aim was to identify distinct groups of deceased individuals, based on their contacts with different care agencies in their last year of life. Methods A retrospective registry study was conducted in Skåne, Southern Sweden. All recorded opioid overdose fatalities during the study period were included, n  = 191. Latent class analysis was used to identify patterns of care contacts in the last year of life. Results Three distinct classes were identified: “Few care contacts,” with limited interaction with any services; “Social service contacts,” comprising individuals who predominantly had contacts with the social services and, to a lesser extent, with prison and probation services; and “Numerous care contacts,” with extensive contacts with both healthcare and social services. The “few care contacts” class comprises about half of the population. This is an important finding, since this group has not been clearly visible in previous research. The analysis indicates significant gaps in service provision, particularly regarding substance use treatment and mental health support. Conclusions Using a person-centred approach, this article offers a novel way of analysing care contacts among people who subsequently died from opioid overdose. The identification of distinct groups, particularly a large group of people with minimal contact with the community care system, highlights the need for more targeted outreach and support work. Developing targeted interventions in emergency and inpatient care settings may provide an opportunity to reach the group with few care contacts.

ObjectiveThe aim of this study was to assess associations between endostatin levels and short-term mortality in unsorted acute hospitalised dyspnoea patients with or without congestive heart failure (CHF), adjusted for common cardiovascular risk factors.Design, setting and participantsIn this prospective observational study, 723 hospitalised patients who visited the emergency department at Skåne University Hospital, Sweden, between 2013 and 2018 were included. Of these, 276 had a history of CHF. The association between endostatin levels and 1 month and 3-month mortality was evaluated, stratified by whether patients had a history of CHF or not.ResultsPatients with prior CHF had higher endostatin levels, higher short-term mortality and were more likely to have CHF as discharge diagnosis. In a fully adjusted model, endostatin was independently associated with 3-month mortality (HR=1.01 per 1 ng/mL increment of endostatin; 95% CI 1.00 to 1.02; p=0.016). No evidence of association was identified with 1-month mortality.ConclusionsEndostatins are potential biomarkers for 3 months’ mortality in patients hospitalised with CHF seeking emergency care with acute dyspnoea. Further studies are needed in different settings to assess the predictive value of endostatins in patients with CHF.

Elite Para athletes report a high incidence of sports injuries, illnesses and other health issues. Despite this, there are few prevention programmes in Para sport, and many of the existing prevention programmes are not adapted to Para athletes. To improve the success of preventive measures, it has been suggested that sports safety work should facilitate health promotion, including athlete health education. Therefore, the overarching aim of this project is to evaluate an accessible health promotion web platform as part of a complex intervention that aims to improve knowledge of athlete health in Para sport. In this protocol, the development, future implementation and evaluation of the intervention are described. To inform the implementation and use of such interventions, it is recommended to involve end users in the development and implementation process. Therefore, a participatory design process, including athletes and the sports organisation, was used to develop an accessible health promotion web platform. To evaluate this complex intervention, a process evaluation combining quantitative evaluation assessing causal pathways with qualitative methods assessing multifaceted pathways will be used. The primary outcomes are injury/illness incidence, athlete health parameters, health literacy and user behaviour. A cohort of elite Para athletes (n=150) from Sweden and South Africa will be invited to participate. This project will be the first that aims to improve athlete health in Para sport through pragmatic and accessible health promotion. It is a boundary-crossing project that will be conducted in a real-world sport setting, including athletes with different socioeconomic backgrounds.

Forensic pathologists are frequently confronted with questions about whether an injury is likely to have been inflicted by an assault or be self-inflicted. However, little is known of the epidemiological variables that might be applicable to differentiate between homicides and suicides in deaths caused by single stab injuries to the trunk. Using the Swedish forensic autopsy register, we identified 94 homicides and 45 suicides between 2010 and 2021 in which death followed a single stab injury to the trunk. We extracted characteristics from the cases and performed statistical analyses using the Mann-Whitney U test, Chi-square test and logistic regression model. Victims of homicides were younger than suicide victims (median age 33 years vs. 52 years, p < 0.05), and males were in the majority in both groups (93% vs. 82%). In numerous homicide victims, stab wounds were placed in the back and in axillar regions, unlike in suicides victims in which the stabs were all placed on the medial part of the anterior trunk. Vertical entrance wounds in the skin combined with a medially running injury channel (n = 13) showed a positive predictive value of 100% (95% CI 75.3–100) for homicide, although the sensitivity was low. Homicides were conclusively associated with an outdoor death scene (OR 19.0, 95% CI 7.6–47.1), injury to thoracic bone/cartilage (OR 3.8, 95% CI 1.6–9.0), influence of alcohol (OR 7.1, 95% Cl 2.9–17.7) and illicit drugs (OR 4.3, 95% CI 1.5–11.9). The observed forensic characteristics of stab injuries could be used as a tool when assessing the manner of death in single stabs. Further research on variables associated with manner of death are needed and we suggest also including characteristics of surviving victims in such analyses. •Homicide victims were predominately young males and often found outdoors.•All suicidal stabs were located on the medial part of the anterior trunk.•Homicidal stabs were scattered on all sides of the trunk.•Alcohol and illicit narcotics were more often proved in homicides.

Distinguishing between homicide and suicide in cases of single stab injuries to the trunk can be challenging, particularly in the absence of clear contextual information. This study aims to address this issue by developing the MODSIT score (Manner of Death in Stab Injuries to the Trunk)—an evidence-based scoring system designed to standardise forensic manner of death assessments. We developed four score models based on: 1) autopsy findings alone; 2) autopsy findings and toxicology; 3) autopsy findings, toxicology, and circumstances at the death scene; and 4) autopsy findings, toxicology, death scene circumstances, and demographics. The diagnostic performance of the models was evaluated through Receiver Operating Characteristic (ROC) curve analysis. Model 3, including autopsy findings, toxicology, and circumstances at the death scene, established the best diagnostic performance (AUC 0.99, 95 % CI 0.97–1.00). The optimal cut-off of 2 score points showed 91.8 % sensitivity and 97.6 % specificity for predicting homicide, and cut-off of –1 point showed 85.7 % sensitivity and 98.8 % specificity for predicting suicide. The score needs to be validated in other populations to confirm its generalisability. The MODSIT score has the potential to become a valuable tool for evidence-based forensic practice. ●The MODSIT score combines variables to assess manner of death in single stabs.●Four score models were created, showing good to excellent diagnostic performance.●The higher the score point, the greater the specificity for homicide.●The lower the score point, the greater the specificity for suicide.●The score could be used in forensic casework once validated in other populations.