Lakartidningen最新文献

Increasing heat is the largest direct health risk associated with climate change, and urban environments exacerbate the problem through the urban heat island effect. Vulnerable groups, including the elderly, individuals with chronic illnesses, pregnant women, children, and socially disadvantaged populations, are particularly at risk. Densification policies may contribute to more sustainable cities but can at the same time increase heat exposure by limiting green spaces. While solutions like tree planting can mitigate heat, they must be balanced with competing urban development needs. Climate adaptation measures, such as urban greening, should be implemented with a justice perspective to avoid reinforcing social inequalities. Moving forward, urban planning strategies must integrate climate adaptation with public health to reduce heat-related health risks and create more sustainable, liveable cities. Green spaces not only help lower urban temperatures but also provide other health benefits such as promoting physical activity and stress relief.

The medical profession plays a crucial role in tackling the health impacts of climate change and in promoting a green transition of society and the health sector. Despite this, opportunities for action are still quite unknown within the profession, and no mandatory education is required in interns' or residents' education. Medical schools, on the contrary, both in Sweden (due to legislation) and abroad, have started integrating climate, health and sustainable healthcare into the medical curricula in line with international educational recommendations, thus preparing future generation physicians for the task. The following overview presents concrete and relevant pedagogical initiatives currently used in Sweden and abroad to enhance education and clinical implementation of climate medicine and sustainable healthcare for medical students and physicians. Furthermore, the significance of strong leadership and mandatory education is emphasized.

PROMs provide valuable information from patients about their health and health-related problems. These measures complement medical measures and are critical for developing optimized, co-produced and person-centred healthcare, as they add important perspectives, offering a holistic view of health. Valid and reliable PROMs have been developed since a long time and are increasingly used in research. Digital PROMs are today available at 1177.se but seldom utilized in clinical practice. To utilize PROMs in clinical care, healthcare professionals need to understand their value and how to analyse data and use results. Therefore, to support the increased interest to implement PROMs, this knowledge needs to be disseminated among all professionals. In order to effectively use PROMs in improvement work, we also need to address significant technical and legal obstacles. Integrating PROM data into electronic medical records should be prioritized in the ongoing development of infrastructure for health data collection.

The new ACR/EULAR classification criteria for APS differ from the previous Sydney criteria by incorporating a broader range of clinical manifestations beyond venous/arterial thromboembolism and obstetric complications. These include microvascular disease, heart valve disease and thrombocytopenia. We applied both classification systems to a cohort of 139 individuals diagnosed with primary APS in Southern Sweden. Of these, 76 met the ACR/EULAR criteria, while 78 fulfilled the Sydney criteria. Subsequently, only a marginal difference in diagnostic yield was observed between the two classification systems. However, the ACR/EULAR criteria are particularly advantageous as they provide clear definitions and encompass a broader spectrum of clinical manifestations, aligning more closely with the clinical management of patients with APS compared to the Sydney criteria.

Airborne infection is considered a significant cause of postoperative wound infections (surgical site infections - SSI). In low-income countries, the risk is elevated. A simple concept based on electrostatic air cleaning has, after extensive testing, been shown to effectively reduce the levels of particles and bacteria in the air. This has been demonstrated in laboratory environments and in simulated operating room environments at Kungälv Hospital, as well as in field studies at two hospitals in a low-income country (the Democratic Republic of the Kongo).

Medical certificates for the Swedish Migration Agency are vital documents to prove injuries or illnesses claimed in the asylum process. Our purpose is to provide guidance on the legal bases for the use of medical evidence in the asylum process. To illustrate, we give examples from our study of 74 decisions with medical certificates. Cases were identified from a random sample of 500 files from 590 000 asylum decisions made by the Swedish Migration Agency 2006-2022. Medical certificates were not unanimously taken into account in decisions. For high evidentiary value, the certificates should demonstrate the physician's competence, be based on verifiable sources and include a detailed prognosis and the effects of not receiving adequate treatment. Importantly, certificates can also be used to undermine the patient's trustworthiness if the certificate fails to prove or contradicts claims made by the applicant.

Lead extraction is safe and effective in patients with systemic and local infections with a cardiac implantable electronic device. 30-day mortality and 1-year mortality rates were 2.5% and 9.9%, respectively. Systemic infection and chronic kidney disease were independently associated with 30-day and 1-year mortality. Clinical frailty scale 5-7 correlated independently with 1-year mortality. These risk factors should be considered during pre-procedure risk stratification.

Thoracic and lumbar fractures are common injuries that can be treated either surgically or non-surgically. This study investigated if socioeconomic and demographic factors influence treatment choices in Sweden using data from the Swedish Fracture Register and other national health registers. Results showed no significant association between socioeconomic factors and treatment choices. However, patients age 50-69 years were less likely to undergo surgery, probably because of factors such as osteoporosis and increased comorbidity. The study suggests that Swedish healthcare primarily bases treatment decisions on medical factors rather than socioeconomic background. This contrasts with findings from other countries where healthcare is more influenced by socioeconomic factors.

Spinal fractures are common, and distinct epidemiological patterns are well-known.In the young to middle age, high energy trauma is the most common etiology, and men are more afflicted than women. In the geriatric population, osteoporotic vertebral fractures are common, and in this age category the women are most often affected. As vertebral fractures affect all socioeconomic groups in the society, the question arises if treatment of vertebral fractures differs according to the patient's socioeconomic status. A recent Swedish study from Uppsala, using national databases, confirmed the results from previous epidemiological studies and showed that socioeconomic factors do not influence how patients with vertebral fractures are treated in Swedish hospitals.