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  • 1. Berglund, Lukas
    et al.
    Liu, Cecilia
    Adami, Johanna
    Palme, Mårten
    Stockholm University, Faculty of Social Sciences, Department of Economics.
    Qureshi, Abdul Rashid
    Felländer-Tsai, Li
    Decreasing incidence of knee arthroscopy in Sweden between 2002 and 2016: a nationwide register-based study2023In: Acta Orthopaedica, ISSN 1745-3674, E-ISSN 1745-3682, Vol. 94, p. 26-31Article in journal (Refereed)
    Abstract [en]

    Background and purpose: Several randomized trials have demonstrated the lack of effect of arthroscopic lavage as treatment for knee osteoarthritis (OA). These results have in turn resulted in a change in Swedish guidelines and reimbursement. We aimed to investigate the use of knee arthroscopies in Sweden between 2002 and 2016. Patient demographics, regional differences, and the magnitude of patients with knee OA undergoing knee arthroscopy were also analyzed.

    Patients and methods: Trends in knee arthroscopy were investigated using the Swedish Hospital Discharge Register (SHDR) to conduct a nationwide register-based study including all adults (>18 years of age) undergoing any knee arthroscopy between 2002 and 2016.

    Results: The total number of knee arthroscopies performed during the studied period was 241,055. The annual surgery rate declined in all age groups, for males and females as well as patients with knee OA. The incidence dropped from 247 to 155 per 105 inhabitants. Over 50% of arthroscopies were performed in metropolitan regions.

    Conclusion: We showed a dramatic decline in knee arthroscopy. There is variability in the surgery rate between males and females and among the regions of Sweden.

  • 2. Carfi, A.
    et al.
    Liperoti, R.
    Fusco, D.
    Giovannini, S.
    Brandi, V.
    Vetrano, Davide Liborio
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI). Catholic University of the Sacred Heart, Italy.
    Meloni, E.
    Mascia, D.
    Villani, E. R.
    Gravina, E. Manes
    Bernabei, R.
    Onder, G.
    Bone mineral density in adults with Down syndrome2017In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 28, no 10, p. 2929-2934Article in journal (Refereed)
    Abstract [en]

    Summary

    This study analyzed data of bone mineral density (BMD) from a large cohort of adults with Down syndrome (DS). BMD was found to decrease with age more rapidly in these subjects than in the general population, exposing adults with DS to an increased risk of osteoporosis and bone fracture.

    Introduction

    Down syndrome (DS) in adulthood presents with a high prevalence of osteoporosis. However, in DS, bone mineral density (BMD) can be underestimated due to short stature. Furthermore, the rate of age-related decline in BMD and its association with gender in DS has been rarely evaluated or compared with the general population. The present study is aimed at assessing the variation of BMD with age and gender in a sample of adults with DS and to compare these data with those of the general population, after adjusting for anthropometric differences.

    Methods

    Adults with DS, aged 18 or older, were assessed dual-energy-X-ray-absorptiometry (DXA) at the femoral neck and at the lumbar spine. They were compared with the general population enrolled in the National Health and Nutrition Examination Survey (NHANES) 2009-2010 dataset. Bone mineral apparent density (BMAD) was calculated for each individual.

    Results

    DXA was evaluated in 234 subjects with DS (mean age 36.93 +/- 11.83 years, ranging from 20 to 69 years; 50.4% females). In the lumbar spine both mean BMD (DS 0.880 +/- 0.141 vs. NHANES 1.062 +/- 0.167, p < 0.001) and BMAD (DS 0.138 +/- 0.020 vs. NHANES 0.152 +/- 0.020, p < 0.001) were significantly lower in the DS sample than in the NAHNES cohort. The same trend was observed at the femoral neck in both BMD (DS 0.658 +/- 0.128 vs. NHANES 0.835 +/- 0.137, p < 0.001) and BMAD (DS 0.151 +/- 0.030 vs. NHANES 0.159 +/- 0.028, p < 0.001). Age was associated with lower femoral neck BMAD in both samples; importantly, this association was significantly stronger in the DS sample. In the lumbar spine region, no significant association between BMAD and age could be observed in both samples.

    Conclusions

    Adults with DS have lower bone mineral density compared to the general population and they experience a steeper decline with age. Early screening programs are needed in DS population.

  • 3.
    Halonen, Jaana I.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. University of Copenhagen, Denmark.
    Virtanen, Marianna
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Finnish Institute of Occupational Health, Finland.
    Leineweber, Constanze
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Rod, Naja H.
    Westerlund, Hugo
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Magnusson Hanson, Linda L.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Associations between onset of effort-reward imbalance at work and onset of musculoskeletal pain: analyzing observational longitudinal data as pseudo-trials2018In: Pain, ISSN 0304-3959, E-ISSN 1872-6623, Vol. 159, no 8, p. 1477-1483Article in journal (Refereed)
    Abstract [en]

    Existing evidence of an association between effort-reward imbalance (ERI) at work and musculoskeletal pain is limited, preventing reliable conclusions about the magnitude and direction of the relation. In a large longitudinal study, we examined whether the onset of ERI is associated with subsequent onset of musculoskeletal pain among those free of pain at baseline, and vice versa, whether onset of pain leads to onset of ERI. Data were from the Swedish Longitudinal Occupational Survey of Health (SLOSH) study. We used responses from 3 consecutive study phases to examine whether exposure onset between the first and second phases predicts onset of the outcome in the third phase (N = 4079). Effort-reward imbalance was assessed with a short form of the ERI model. Having neck-shoulder and low back pain affecting life to some degree in the past 3 months was also assessed in all study phases. As covariates, we included age, sex, marital status, occupational status, and physically strenuous work. In the adjusted models, onset of ERI was associated with onset of neck-shoulder pain (relative risk [RR] 1.51, 95% confidence interval [CI] 1.21-1.89) and low back pain (RR 1.21, 95% CI 0.97-1.50). The opposite was also observed, as onset of neck-shoulder pain increased the risk of subsequent onset of ERI (RR 1.36, 95% CI 1.05-1.74). Our findings suggest that when accounting for the temporal order, the associations between ERI and musculoskeletal pain that affects life are bidirectional, implying that interventions to both ERI and pain may be worthwhile to prevent a vicious cycle.

  • 4. Hengelbrock, Johannes
    et al.
    Höhle, Michael
    Stockholm University, Faculty of Science, Department of Mathematics. Federal Institute for Quality Assurance and Transparency in Healthcare (IQTIG), Germany.
    Evaluating quality of hospital care using time-to-event endpoints based on patient follow-up data2019In: Health Services & Outcomes Research Methodology, ISSN 1387-3741, E-ISSN 1572-9400, Vol. 19, no 4, p. 197-214Article in journal (Refereed)
    Abstract [en]

    Revisions of hip and knee arthroplasty implants and cardiac pacemakers pose a large medical and economic burden for society. Consequently, the identification of health care providers with potential for quality improvements regarding the reduction of revision rates is a central aim of quality assurance in any healthcare system. Even though the time span between initial and possible subsequent operations is a classical time-to-event endpoint, hospital-specific quality indicators are in practice often measured as revisions within a fixed follow-up period and subsequently analyzed by traditional methods like proportions or logistic regression. Methods from survival analysis, in contrast, allow the inclusion of all observations, i.e. also those with early censoring or events, and make thus more efficient and more timely use of the available data than traditional methods. This may be obvious to a statistician but in an applied context with historic traditions, the introduction of more complicated methods needs a clear presentation of their added value. We demonstrate how standard survival methods like the Kaplan-Meier estimator and a multiplicative hazards model outperform traditional methods with regard to the identification of performance outliers. Following that, we use the proposed methods to analyze 640,000 hip and knee replacement operations with about 13,000 revisions between 2015 and 2016 in more than 1200 German hospitals in the annual evaluation of quality of care. Based on the results, performance outliers are identified which are to be further investigated qualitatively with regard to their provided quality of care and possible necessary measures for improvement. Survival analysis is a sound statistical framework for analyzing data in the context of quality assurance and survival methods outperform the statistical methods that are traditionally used in this area.

  • 5. Idrees, M.
    et al.
    Sohail, Ayesha
    Javed, Sana
    Stockholm University, Faculty of Science, Department of Biochemistry and Biophysics. Stockholm University, Science for Life Laboratory (SciLifeLab). Comsats University Islamabad, Pakistan.
    Forecasting the critical role of intermittent therapies for the control of bone resorption2019In: Clinical Biomechanics, ISSN 0268-0033, E-ISSN 1879-1271, Vol. 68, p. 128-136Article in journal (Refereed)
    Abstract [en]

    Background: Osteoporosis is a chronic metabolic disease characterized by an imbalance of bone resorption and formation, leading to bone fragility and increased susceptibility to fracture. Parathyroid hormone is approved therapy for the treatment of osteoporosis.

    Methods: The intermittent therapy of parathyroid hormone requires accurate administration. Meta-analysis is conducted to draw a clear picture of the impact of intermittent therapy and dose rates relative to time, on the osteoporotic patients. A novel mathematical model is presented in this article synchronised with the parametric values, depicted from meta-analysis.

    Findings: Results obtained from the mathematical model are in close agreement with the results obtained from the clinical trials. The model can be used to forecast the drug potency and dosage rates, to control the vicious cycle of osteoporosis.

    Interpretations: The intermittent administration of parathyroid hormone, rather than the continuous administration, is more effective, furthermore it is also concluded that a mathematical model, linked with the extensive literature of clinical trials, using meta-analysis can help in drug administration and future clinical studies of drug development.

  • 6. Meyer, Anna C.
    et al.
    Ek, Stina
    Drefahl, Sven
    Stockholm University, Faculty of Social Sciences, Department of Sociology.
    Ahlbom, Anders
    Hedström, Margareta
    Modig, Karin
    Trends in Hip Fracture Incidence, Recurrence, and Survival by Education and Comorbidity: A Swedish Register-based Study2021In: Epidemiology, ISSN 1044-3983, E-ISSN 1531-5487, Vol. 32, no 3, p. 425-433Article in journal (Refereed)
    Abstract [en]

    Background: Hip fractures are common and severe conditions among older individuals, associated with high mortality, and the Nordic countries have the highest incidence rates globally. With this study, we aim to present a comprehensive picture of trends in hip fracture incidence and survival in the older Swedish population stratified by education, birth country, and comorbidity level.

    Methods: This study is based on a linkage of several population registers and included the entire population over the age of 60 living in Sweden. We calculated age-standardized incidence rates for first and recurrent hip fractures as well as age-standardized proportions of patients surviving 30 and 365 days through the time period 1998 to 2017. We calculated all outcomes for men and women in the total population and in each population stratum.

    Results: Altogether, we observed 289,603 first hip fractures during the study period. Age-standardized incidence rates of first and recurrent fractures declined among men and women in the total population and in each educational-, birth country-, and comorbidity group. Declines in incidence were more pronounced for recurrent than for first fractures. Approximately 20% of women and 30% of men died within 1 year of their first hip fracture. Overall, survival proportions remained constant throughout the study period but improved when taking into account comorbidity level.

    Conclusions: Hip fracture incidence has declined across the Swedish population, but mortality after hip fracture remained high, especially among men. Hip fracture patients constitute a vulnerable population group with increasing comorbidity burden and high mortality risk.

  • 7. Paanalahti, Kari
    et al.
    Wertli, Maria M.
    Held, Ulrike
    Åkerstedt, Torbjörn
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Holm, Lena W.
    Nordin, Margareta
    Skillgate, Eva
    Spinal pain—good sleep matters: a secondary analysis of a randomized controlled trial2016In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 25, no 3, p. 760-765Article in journal (Refereed)
    Abstract [en]

    Purpose

    The estimated prevalence of poor sleep in patients with non-specific chronic low back pain is estimated to 64 % in the adult population. The annual cost for musculoskeletal pain and reported poor sleep is estimated to be billions of dollars annually in the US. The aim of this cohort study with one-year follow-up was to explore the role of impaired sleep with daytime consequence on the prognosis of non-specific neck and/or back pain.

    Methods

    Secondary analysis of a randomized controlled trial, including 409 patients.

    Results

    Patients with good sleep at baseline were more likely to experience a minimal clinically important difference in pain [OR 2.03 (95 % CI 1.22–3.38)] and disability [OR 1.85 (95 % CI 1.04–3.30)] compared to patients with impaired sleep at one-year follow-up.

    Conclusion

    Patients with non-specific neck and/or back pain and self-reported good sleep are more likely to experience a minimal clinically important difference in pain and disability compared to patients with impaired sleep with daytime consequence.

  • 8. Siviero, Paola
    et al.
    Marseglia, Anna
    Stockholm University, Faculty of Social Sciences, Aging Research Center (ARC), (together with KI).
    Biz, Carlo
    Rovini, Augusto
    Ruggieri, Pietro
    Nardacchione, Roberto
    Maggi, Stefania
    Quality of life outcomes in patients undergoing knee replacement surgery: longitudinal findings from the QPro-Gin study2020In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 21, no 1, article id 436Article in journal (Refereed)
    Abstract [en]

    Background: Many patients report postoperative pain, limited improvement in physical function and poor quality of life (QOL) after knee replacement surgery. Our study uses baseline predictors of change to investigate the QOL of patients with knee osteoarthritis 3-months after knee replacement surgery.

    Methods: A prospective observational study was designed to evaluate patients (n = 132) scheduled for uni-compartmental or total knee replacement surgery who were assessed at baseline (preoperatively) and 3-months after. Physical and mental endpoints based on the component scores of the SF-12 and on the Western Ontario and McMaster Universities Arthritis (WOMAC) index were used to investigate patients' QOL. Generalised estimating equation methodology was used to assess patients' baseline characteristics (age, sex, education, body mass index (BMI), comorbidity, depressive symptoms, cognitive impairment, smoking/alcohol and type of surgery), the study endpoints and their changes over a 3-month post-surgery period. Stratified analyses by rehabilitation status after discharge were performed.

    Results: Longitudinal data analysis showed that the baseline factors associated with improvement in general QOL at the 3-month post-surgery assessment were higher BMI, a high comorbidity, total (as opposed to unicompartmental) knee replacement and low education level. Data analysis of the patients who underwent rehabilitation after discharge revealed that the current smokers' physical QOL worsened over time. The general QOL was unchanged over time in the presence of depressive symptomatology.

    Conclusions: These findings underline the importance of using comprehensive assessment methods to identify factors affecting functionality and QOL, and developing interventions to improve the health/wellbeing of patients after knee replacement.

  • 9. Venkadesan, Madhusudhan
    et al.
    Yawar, Ali
    Eng, Carolyn M.
    Dias, Marcelo A.
    Stockholm University, Nordic Institute for Theoretical Physics (Nordita). Aalto University, Finland; Aarhus University, Denmark.
    Singh, Dhiraj K.
    Tommasini, Steven M.
    Haims, Andrew H.
    Bandi, Mahesh M.
    Mandre, Shreyas
    Stiffness of the human foot and evolution of the transverse arch2020In: Nature, ISSN 0028-0836, Vol. 579, p. 97-100Article in journal (Refereed)
    Abstract [en]

    The transverse tarsal arch, acting through the inter-metatarsal tissues, is important for the longitudinal stiffness of the foot and its appearance is a key step in the evolution of human bipedalism. The stiff human foot enables an efficient push-off when walking or running, and was critical for the evolution of bipedalism(1-6). The uniquely arched morphology of the human midfoot is thought to stiffen it(5-9), whereas other primates have flat feet that bend severely in the midfoot(7,10,11). However, the relationship between midfoot geometry and stiffness remains debated in foot biomechanics(12,13), podiatry(14,15) and palaeontology(4-6). These debates centre on the medial longitudinal arch(5,6) and have not considered whether stiffness is affected by the second, transverse tarsal arch of the human foot(16). Here we show that the transverse tarsal arch, acting through the inter-metatarsal tissues, is responsible for more than 40% of the longitudinal stiffness of the foot. The underlying principle resembles a floppy currency note that stiffens considerably when it curls transversally. We derive a dimensionless curvature parameter that governs the stiffness contribution of the transverse tarsal arch, demonstrate its predictive power using mechanical models of the foot and find its skeletal correlate in hominin feet. In the foot, the material properties of the inter-metatarsal tissues and the mobility of the metatarsals may additionally influence the longitudinal stiffness of the foot and thus the curvature-stiffness relationship of the transverse tarsal arch. By analysing fossils, we track the evolution of the curvature parameter among extinct hominins and show that a human-like transverse arch was a key step in the evolution of human bipedalism that predates the genus Homo by at least 1.5 million years. This renewed understanding of the foot may improve the clinical treatment of flatfoot disorders, the design of robotic feet and the study of foot function in locomotion.

  • 10. Westgaard, Rolf Harald
    et al.
    Mork, Paul Jarle
    Loras, Havard Wuttudal
    Riva, Roberto
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lundberg, Ulf
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Trapezius activity of fibromyalgia patients is enhanced in stressful situations, but is similar to healthy controls in a quiet naturalistic setting: a case control study2013In: BMC Musculoskeletal Disorders, E-ISSN 1471-2474, Vol. 14, p. 97-Article in journal (Refereed)
    Abstract [en]

    Background: Muscle activity and pain development of fibromyalgia (FM) patients in response to mental stress show inconsistent results, when compared to healthy controls (HCs). A possible reason for the inconsistent results is the large variation in stress exposures in different studies. This study compares muscle responses of FM patients and HCs for different modes and levels of imposed stress, to elucidate features in stress exposures that distinguish stress responses of FM patients from HCs. Methods: Upper trapezius (clavicular and acromial fibers), deltoid, and biceps surface electromyographic (sEMG) activity was recorded in FM patients (n=26) and HCs (n=25). Heart rate (HR) was recorded and used as indicator of autonomic activation. Tests included inspiratory breath holding (sympathetic activation procedure), mental stress tests (color-word test and backward counting; 28 min), instructed rest prior to stress test (30 min TV watching), and controlled arm movement. sEMG and HR was also recorded during an unrestrained evening stay at a patient hotel. The 5-min period with lowest trapezius muscle activity was determined. Pain (shoulder/neck, low back pain) and perceived tension were scored on VAS scales at the start and the end of the stress test and at bedtime. Results: Trapezius sEMG responses of FM patients were significantly higher than HCs during sympathetic activation, mental stress, and instructed rest, but similar during arm movement and unrestrained evening activity. HR of FM patients and HCs was similar during mental stress and in the evening, including the 5-min period with lowest trapezius activity. Muscle activity of FM patients during the stress test (with shoulder/neck pain development) and the evening stay (no pain development) was similar. Conclusions: FM patients show elevated muscle activity (in particular trapezius activity) in situations with imposed stress, including sympathetic activation, and putative anticipatory stress. Muscle activity and HR were similar to HCs in instructed arm movement and in a situation approaching low-stress daily living. Pain development of FM patients during the stress test may be due to activation of several stress-associated physiological systems, and not obviously caused by muscle activity in isolation.

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