Abstract Background Atrial fibrillation (AF) is a major risk factor for atherothrombotic complications but is often asymptomatic and undiagnosed. This study aimed to develop a machine learning model to distinguish between individuals with low and high risk of AF, using routinely collected diagnostic data from Swedish primary health care. Methods Cases (n = 42,607, aged ≥ 45 years) with diagnosed new onset AF and controls (n = 427,169) matched by age and sex. Machine learning models stratified for age (45–69 and ≥ 70 years) and sex were developed using stochastic gradient boosting, based on number of primary health care visits during the year before the index AF diagnosis, age, and ICD-10 codes from electronic medical records 2014–2019. Performance was evaluated by AUC, sensitivity and specificity, and key predictors ranked by normalized relative influence (NRI) and odds ratios for marginal effects. Results The most influential predictors were the number of visits (NRI: 29.9–46.3%) and age (NRI: 6.2–15.9%), followed by risk factors for AF such as heart failure, hypertension, and cardiac arrhythmias. Model AUC ranged from 0.77 to 0.79 across subgroups. Sensitivity was 0.76–0.80, and specificity 0.58–0.66, with higher sensitivity in older groups and higher specificity in younger ones. The models correctly identified 95–98% of individuals without known AF. Conclusions The models show good predictive ability, effectively ruling out low-risk patients while identifying known risk factors. With AUC values comparable to more complex models, our approach using only visit frequency, age, and diagnoses may support initial risk assessment in primary health care for identifying individuals at risk of AF.

Abstract Background Individuals with diabetes have an increased risk of cardiovascular disease, infection, hospitalization, and premature mortality. However, less is known about how diabetes shapes the broader pattern of emergency department (ED) presentations, acute care use, clinical complexity, and short-term mortality in an unselected ED population. We aimed to describe ED presentation patterns and outcomes among individuals with and without diabetes in a large regional cohort. Methods We conducted a population-based cohort study including all adult ED visits to nine hospitals in Region Skåne, Sweden, between 2017 and 2018. ED visits for patients with a registered diabetes diagnosis ( n = 60,654) were compared with those without diabetes ( n = 502,800). We analysed ED visit frequency, recurrent ED use, arrival by ambulance, triage priority, length of stay, comorbidity burden, presenting complaints, and mortality after ED presentation. Results The most common presenting complaints were broadly similar in both groups, with dyspnoea, chest pain, and abdominal pain among the leading causes of ED presentation. However, diabetes visits were characterized by greater acute care complexity. Compared with visits by individuals without diabetes, visits by individuals with diabetes more often involved a previous ED visit within 90 days, higher triage priority, ambulance arrival, longer ED stay, and substantially higher comorbidity burden. Early mortality after ED presentation was also higher among individuals with diabetes and occurred at younger ages, particularly among men. Mortality diagnoses differed between groups, with cardiovascular causes more prominent among individuals with diabetes. Conclusions In this large population-based ED cohort, individuals with diabetes presented with broadly similar symptom categories as those without diabetes, but with markedly greater clinical complexity, higher acuity, recurrent acute care use, and earlier mortality. Diabetes in emergency care may therefore identify a patient group with substantial multimorbidity, reduced physiological reserve, and increased vulnerability during acute illness.

Abstract 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.

Introduction:Patients with chronic kidney disease (CKD) have an increased risk of cardiovascular morbidity. Circulating endostatin is associated with both cardiovascular morbidity and impaired kidney function in the general population, but the utility of endostatin as a prognostic marker for CKD progression and mortality in patients with CKD is not well studied. The aim was to study association between serum endostatin and mortality, and also kidney function decline in a cohort of CKD patients (Salford Kidney Study [SKS]). Methods:Analyses were performed on baseline and annual follow-up samples from 970 adults in the SKS cohort with CKD stage 3-5. Association with mortality was studied using Cox proportional hazard models adjusted for age, gender, systolic and diastolic blood pressure, smoking status, diabetes mellitus, prior cardiovascular disease, creatinine-based estimated glomerular filtration rate (eGFR), and urine protein-to-creatinine ratio (uPCR). Associations between endostatin and eGFR decline were studied with linear regression analyses. eGFR decline was defined as the percentage difference between baseline eGFR and follow-up eGFR (median follow-up, 6.2 years). Results:Median age of the cohort was 66 years, with a median eGFR of 30 mL/min/1.73 m2. Multivariate Cox regression models revealed an association between higher endostatin levels and mortality with adjustments for established cardiovascular risk factors (HR: 1.14; CI: 1.02-1.28; p = 0.02) but was attenuated and nonsignificant after adjustments for baseline eGFR and uPCR. Baseline levels of endostatin were associated with eGFR decline but were nonsignificant after adjustments for baseline eGFR and uPCR. Changes of endostatin concentrations during the study were significantly associated with eGFR decline in all models (regression coefficient 0.0023% decrease per month [95% confidence intervals 0.0012-0.0034, p < 0.001]). Conclusion:The clinical utility of plasma endostatin for risk prediction in CKD patients seems limited. Importantly, longitudinal changes of endostatin were significantly associated with eGFR decline. The clinical relevance of this warrants further studies.

BACKGROUND:Young athletes and adolescents with high cardiorespiratory fitness appear to have a higher risk of atrial fibrillation (AF), but the extent to which this reflects causal effects or shared genetic, behavioral, and environmental factors remains uncertain. METHODS:This cohort study with sibling control analysis comprised Swedish men who participated in mandatory military conscription examinations from 1972 to 1995 and completed cardiorespiratory fitness testing. The outcomes were AF and non-AF cardiovascular disease (CVD; eg, stroke and ischemic heart disease), defined as a composite end point of diagnosis or death in the National Patient Register and the Cause of Death Register, until December 31, 2023. Flexible parametric survival models estimated standardized cumulative risk differences (RDs) by deciles of fitness. RESULTS:Among 1 124  049 men (mean age, 18.3 years), 45 179 (4.0%) had a first AF event and 96 404 (8.6%) had a first non-AF CVD event at a median age of 54.8 and 54.4 years. In population-wide analysis controlling for measured confounders, compared with the lowest decile of fitness, the highest decile had a small excess in AF that exceeded the reduction in non-AF CVD during early adulthood, whereas the reduction in non-AF CVD became larger from 45 years of age onwards. In full-sibling comparisons controlling for shared familial factors, the age-dependent trade-off disappeared entirely, leaving no age window with a net cardiovascular disadvantage. Already from 35 years of age, the reduction in non-AF CVD was larger (RD, -0.11% [95% CI, -0.21% to -0.01%]) than the excess in AF (RD, 0.06% [95% CI, -0.01% to 0.12%]). By 65 years of age, the gap further widened, with an even larger reduction in non-AF CVD (RD, -3.91% [95% CI, -5.40% to -2.42%]) compared with the excess in AF (RD, 2.30% [95% CI, 1.15% to 3.45%]). CONCLUSIONS:High adolescent cardiorespiratory fitness is associated with a small excess in AF risk during early adulthood that is outweighed by larger reductions in non-AF CVD after controlling for familial confounders. These findings support population-level efforts to improve youth cardiorespiratory fitness and provide reassurance about the safety and benefits of high fitness levels.

Background Sex differences in valvular heart diseases have been examined but rarely using a nationwide, comprehensive approach. Objectives The aim of this study was to analyze the risk of different types of valvular heart diseases among males and females in Sweden. Methods This was a nationwide Swedish study of all individuals (N = 9,984,758; 4,969,472 males and 5,015,286 females). Valvular heart diseases were defined as at least 1 registered diagnosis in the National Patient Register between January 1, 1998, and December 31, 2018. Cox regression analysis was used to estimate HRs with 95% CIs of incident valvular heart diseases in males vs females. The Cox regression models were adjusted for age, comorbidities, and sociodemographic factors. Results There were 111,315 male cases and 107,527 female cases, corresponding to overall incidence rates per 100,000 person-years of 68.6 (95% CI: 67.5-69.8) among males and 51.3 (95% CI: 50.6-51.9) among females. The HRs (with 95% CI) for males compared to females were for rheumatic mitral valve disorders 0.50 (0.46-0.53), for rheumatic aortic valve disorders 1.08 (0.99-1.18), for rheumatic tricuspid valve disorders 0.61 (0.57-0.66), for nonrheumatic mitral valve disorders 1.08 (1.06-1.10), for nonrheumatic aortic valve disorders 1.25 (1.24-1.27), for nonrheumatic tricuspid valve disorders 0.72 (0.68-0.77), and for pulmonary valve disorders 0.82 (0.75-0.90). Conclusions We observed certain sex differences, with, in general, a higher incidence rate among males of valvular heart disease diagnoses, but a lower risk of specific valve disorders. The underlying factors for the sex differences are unclear and need further investigation.

This nationwide cohort study compared recurrent osteoporotic fracture risk in first- and second-generation immigrants to native Swedes. First- and second-generation immigrant men had lower risks; first- and second-generation immigrant women had similar risks to native Swedes. Variations were observed by region of origin, suggesting differences in fracture susceptibility among immigrant groups. To analyse the risk of a recurrent osteoporotic fracture in immigrants using Swedish-born individuals with Swedish-born parents as referents. A nationwide open cohort study including individuals ≥ 50 years of age at baseline (N = 296,118) with a previous fracture. Immigrants were classified as first- or second-generation immigrants, i.e. foreign-born or Swedish-born individuals with at least one foreign-born parent. Osteoporotic fractures were defined as at least one registered diagnosis of fractures in the hip, humerus, forearm, vertebrae, or pelvis in the National Patient Register between January 1, 2010, and December 31, 2018. Logistic regression analysis estimated odds ratios (ORs) with 95

BACKGROUND:Chronic back pain is a major cause of disability and a socioeconomic burden. Previous studies on back pain have suggested a moderately increased risk for cardiovascular mortality in elderly women, but evidence in elderly men is lacking. We investigated the association between continuous chronic back pain for more than a year and incident cardiovascular events in a cohort of elderly men. METHODS:The Uppsala Longitudinal Study of Adult Men (ULSAM), a community-based cohort of elderly men (mean age, 71 years; n=1,024), was used to investigate the association between continuous back pain lasting more than one year and incident cardiovascular events (defined as a composite of coronary heart disease, cerebrovascular disease or cardiovascular mortality). RESULTS:During up to 20 years follow-up, 504 individuals developed a cardiovascular event. In Cox proportional-hazards models adjusted for a large number of established cardiovascular risk factors, socioeconomic factors, and lifestyle factors (age, systolic blood pressure, antihypertensive treatment, high- and low-density lipoprotein-cholesterol, triglycerides, lipid-lowering treatment, glomerular filtration rate, urinary albumin excretion, body mass index, diabetes, diabetes medication, insulin-sensitivity, C-reactive protein, educational level, smoking, physical activity) continuous chronic back pain was robustly associated with a more than 70 % increased risk for cardiovascular events (multivariable hazard ratio 1.71, 95 % confidence intervals 1.23-2.37, p<0.001). CONCLUSIONS:Continuous chronic back pain for more than a year is a risk factor for cardiovascular events in elderly men. Our findings confirm previous evidence, highlighting chronic pain as a clinically relevant and under-recognized risk factor for cardiovascular disease that warrants consideration in future clinical guidelines.

OBJECTIVE:Thyroid hormone treatment is the standard therapy for hypothyroidism, particularly in women. Concerns have been raised that exogenous thyroid hormone use may increase breast cancer risk, but evidence remains inconclusive. This study aimed to systematically review and synthesize observational evidence on the association between thyroid hormone treatment and breast cancer risk in women. DESIGN:We conducted a systematic review and meta-analysis of observational studies. METHODS:MEDLINE, EMBASE, and Web of Science were searched from January 1976 to February 2025. Eligible studies assessed breast cancer incidence in adult women receiving thyroid hormone treatment versus non-users. Pooled ORs were calculated. Findings from cohort studies reporting hazard ratios were synthesized qualitatively. Heterogeneity, publication bias, and certainty of evidence were assessed. PROSPERO ID:CRD42022348966. RESULTS:Four case-control studies including 221,254 women receiving thyroid hormone treatment and 4,385,666 controls were included in the prespecified primary OR-based meta-analysis. In the primary random-effects meta-analysis, thyroid hormone treatment showed a possible epidemiological signal with breast cancer risk (OR 1.43, 95% CI: 0.90-2.28; I2 = 94.3%), although the confidence interval crossed unity and heterogeneity was substantial. Formal assessment of publication bias was performed but should be interpreted cautiously given the small number of included studies. The certainty of evidence was rated as low due to heterogeneity, serious inconsistency and imprecision. CONCLUSIONS:Thyroid hormone treatment was associated with a possible epidemiological signal for breast cancer in observational studies; however, the primary pooled estimate was not statistically significant and should be interpreted as hypothesis-generating because of substantial heterogeneity and residual confounding. Further well-designed prospective studies are required before causal or clinical inferences can be made.

AIMS:To study differences in cardiovascular prevention and hypertension management in primary care in men and women, with comparisons between public and privately operated primary health care (PHC). METHODS:We used register data from Region Stockholm on collected prescribed medication and registered diagnoses, to identify patients aged 30 years and above with hypertension. Age-adjusted logistic regression was used to calculate odds ratios (ORs) with 99% confidence intervals (99% CIs) using public PHC centers as referents. RESULTS:In total, 119,267 patients with a registered hypertension diagnosis at their primary care center were included; 58,239 men and 61,028 women. In terms of co-morbidities and medications, there were some differences between privately and publicly run PHC: registered diagnosis of dementia, which was higher at private PHC, age-adjusted OR 1.80 (1.24-2.69). For lifestyle counseling, privately run PHC had a higher rate of registered counseling for tobacco 1.17 (1.06-1.29), physical activity 1.13 (1.06-1.17), unhealthy diet 1.08 (1.04-1.13), and counseling according to highest prioritized level of advice stated by national guidelines 1.14 (1.09-1.18). Differences in comorbidities between men and women were found, with higher frequencies of coronary heart disease, congestive heart failure, atrial fibrillation, stroke, diabetes, and gout among men. Regarding antihypertensive treatment, women received less treatment of calcium channel blockers and ACE inhibitors, but more of angiotensin receptor blockers. CONCLUSIONS:These findings highlight the need for targeted preventive efforts in PHC, especially for male patients, to address disparities in cardiovascular health outcomes. Small differences in preventive measures between public and privately run PHC suggest generally consistent care across healthcare ownership models.

To evaluate a simplified version of the Clinical Frailty Scale (SCFS) among older adults presenting to the emergency department (ED) with acute dyspnea. In this retrospective single-center cohort study, we included patients from the Acute Dyspnea Study (ADYS) cohort. Severity of illness was assessed using the Medical Emergency Triage and Treatment System (METTS). SCFS was operationalized using existing data on municipal care services from the ADYS database and divided into three levels. SCFS 1: Not frail patients with no need for municipal care services, SCFS 2: Patients with municipal care services, including home care, and SCFS 3: Patients with residence in a short-term care facility or nursing home. The primary outcome was 90-day mortality and hospitalization. Multivariable Cox and logistic regression analyses were used to assess associations between SCFS and outcome variables. SCFS criteria were met in 35.2

Background and aims: Environmental and genetic factors predispose to cardiovascular disease. Some firstgeneration immigrants have a higher cardiovascular risk in Sweden, while less is known about secondgeneration immigrants. We aimed to analyze the risk of acute myocardial infarction (AMI) among secondgeneration immigrants in Sweden. Methods: We included all individuals 18 years of age and older in Sweden, n = 4,580,967. AMI was defined as at least one registered diagnosis in the National Patient Register between January 1, 1998, and December 31, 2018. Cox regression analysis was used to estimate the relative risk (hazard ratio = HR) with 99 % confidence interval (CI) of incident AMI with adjustments made for age, sociodemographics, and comorbidities, and also subdivided into two age groups, i.e., 18-54 years and >= 55 years. Results: A total of 158,815 AMI events were registered. Fully adjusted models showed HRs (99 % CI) in secondgeneration immigrants for men 1.05 (1.01-1.08), and for women 0.99 (0.94-1.05). A marginally higher MI risk was found only among men with parents from the Nordic countries in the fully adjusted model, HR 1.05 (1.01-1.10), and a lower risk only among women with parents from Asian countries, HR 0.47 (0.30-0.75). No significant overall differences in AMI risk were seen in older and younger second-generation immigrants. Conclusions: The overall risk of AMI was similar for most groups of men and women with foreign-born parents compared to native-born Swedes. Our findings suggest that environmental factors may be more important than genetic factors, but further studies are needed to quantify these risks concerning AMI.

Patients with diabetes admitted to emergency care face a higher risk of complications, including prolonged hospital stays, admissions to the intensive care unit and mortality. To develop a machine learning (ML) model to predict 30-day mortality in patients with diabetes admitted to the emergency department (ED). A cohort study utilizing data from all nine ED’s in Region Skåne 2017 to 2018. Totally 74,611 patient visits, representing 34,280 unique patients aged > 18 years with diabetes or hyperglycemia (glucose were > 11 mmol/L). The analysis focused on four groups, men and women aged 40–69 and ≥ 70 years. Stochastic gradient boosting was employed to develop a model predicting 30-day mortality. Variable importance was assessed using normalized relative influence (NRI) scores. Variables in certain hospitals were used to train the models, and the models were tested in other hospitals. Key predictors included laboratory values (pH, base excess, pCO2, standard bicarbonate, oxygen saturation, lactate, CRP, and leukocytes), as well as age, triage category, and time to doctor consultation. The sensitivity of the models ranged from 86–97

PURPOSE:To analyse risk of osteoporotic fractures in foreign-born individuals migrating to Sweden at different ages, compared to Swedish-born individuals. METHODS:This was a nationwide open cohort study including individuals ≥30 years of age at baseline (N = 4,715,081). Foreign-born individuals were divided as having arrived to and being registered in Sweden from the ages 0-30 years of age or >30 years of age. Osteoporotic fractures were defined as at least one registered diagnosis of fractures in the hip, humerus, forearm, vertebrae, or pelvis, in the National Patient Register between January 1, 1998, and December 31, 2018. Cox regression analysis was used to estimate relative risk (hazard ratios (HR) with 99 % confidence intervals (CI)) of incident osteoporotic fractures in foreign-born compared to Swedish-born individuals. Cox regression models were stratified by sex and adjusted for age, co-morbidities, and sociodemographic status. RESULTS:Totally 304,462 fractures (men n = 82,992, and women n = 221,470) were registered, with hip fractures dominating (54.0 % among men, 42.6 % among women). Fully adjusted HRs (99 % CI) were for foreign-born men registered at the age 0-30 years 0.81 (0.78-0.85) and 0.73 (0.69-0.78) for foreign-born men above 30 years, respectively. The corresponding risk for foreign-born women registered at the age 0-30 years was 0.92 (0.90-0.95) and 0.84 (0.80-0.88) for foreign-born women registered above 30 years. CONCLUSIONS:We found slightly different risks of osteoporotic fractures among immigrants, but with no statistically significant interaction between risks for those being registered in Sweden at the age above 30 years vs those registered until this age. SUMMARY:In this national study of osteoporotic fractures in foreign-born individuals, the fracture risk did not differ by age at immigration.

BACKGROUND:Associations between high physical activity (PA) levels and incident atrial fibrillation (AF) is found in some earlier studies. We aim to study the association between levels of PA and AF in two cohorts. METHODS:We used data from the Uppsala Longitudinal Study of Adult Men (ULSAM) study, initiated in 1970, included men aged 50 years, with 2202 included in the study. Examinations were reiterated three times, with follow-up after in median 33 years, with 3.8-6.0% on the highest PA level. We also used data from the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS; with women 50%); mean age 70 years, baseline 2001-2004, median follow-up 15 years, with 961 included in the study, with 4.8% on the highest PA level. Cox regression analysis with hazard ratios (HRs) was used to study association between PA levels and incident AF, adjusted for CV risk factors: systolic blood pressure, LDL- and HDL-cholesterol, BMI, diabetes, and smoking. RESULTS:Totally, in ULSAM 504 men during 59,958 person-years at risk, and in PIVUS 204 individuals during a follow-up of 11,293 person-years experienced an AF. Neither in ULSAM, PIVUS, nor in the meta-analysis of both cohorts, individuals with the highest PA level showed an increased AF risk, compared to individuals with lowest level of PA. CONCLUSIONS:The benefits of PA in community dwelling individuals for its benefits to mental, metabolic, and cardiovascular health should guide public recommendations, rather than a possible risk of AF. LAY SUMMARY:We studied the risk of incident atrial fibrillation at various levels of physical activity in two cohorts and found no statistically significant increased risk after adjusting for cardiovascular risk factors (systolic blood pressure, LDL- and HDL-cholesterol, BMI, diabetes, and smoking).

BACKGROUND AND AIMS:Good Selenium (Se) status predicts favorable prognoses for various diseases and a reduced overall mortality. The primary objective of the study was to determine whether Selenium status, i.e. Selenoprotein P (SeP) levels, is associated with risk of 90-day mortality in elderly patients with acute dyspnea at the Emergency Department (ED). METHODS AND RESULTS:Patients presenting with dyspnea were enrolled from the ED at the University Hospital in Malmö between 2013 and 2018. Cox regression analyses were conducted to evaluate hazard ratios (HRs) for 90-day mortality. This analysis was performed in two steps. Model A included adjustments for age and sex with 95 % confidence intervals (95 % CI) for individual factors such as SeP levels, the Medical Emergency Triage and Treatment System - Adult (METTS-A), BMI levels, comorbidities, and smoking status. Model B was a multivariate analysis with 99 % confidence intervals (99 % CI), incorporating age, sex, and statistically significant factors from Model A, including SeP levels, BMI, heart failure, anemia, and stroke. A lower concentration of SeP was independently associated with a higher risk of death within 90 days. In the continuous model of SeP, the HR was 0.798 (99 % CI 0.678-0.940). When comparing the lowest quartile to the highest quartile of SeP, the HR was 2.462 (99 % CI 1.240-4.891). CONCLUSION:Low SeP concentrations were found to predict 90-day mortality in ED patients presenting with dyspnea. The assessment of SeP levels could serve as a valuable tool in the initial evaluation of elderly patients in the ED.

BACKGROUND:Joint pain and chronic back pain are highly prevalent in the aging population and have a large impact on life quality. As the underlying mechanisms are not fully understood, this exploratory cross-sectional study aimed to discover proteins and pathways associated with these two pain conditions in Swedish 70-year-old men. METHODS:Plasma proteins (n = 720) were measured in participants from the Uppsala Longitudinal Study of Adult Men (ULSAM; n = 931) using Olink target panels. Participants self-reported current joint pain or continuous back pain during the past year. We used logistic regression with multiple testing adjustments and RIDGE regression (selecting ~10% highest-ranking proteins) to identify proteins associated with either joint or chronic back pain, which were then investigated for clusters and pathway enrichments. RESULTS:Out of 931 subjects with protein data, 131 reported joint pain and 31 reported chronic back pain. We identified 19 (significant after multiple testing adjustment) and 25 (nominally significant) highest-ranking proteins associated with joint and chronic back pain, respectively. Enriched pathways included immune responses, inflammation, lipid, coagulation and rheumatoid arthritis pathways. Similar pathways were found for both joint and chronic back pain, even though only two proteins were associated with both these pain conditions. CONCLUSIONS:This exploratory proteomics study provides support for systemic inflammation as a common underlying mechanism for joint and chronic back pain. Although similar pathways were found for both pain conditions, the selected proteins differed. Nevertheless, caution is advised due to low sample size and validation in larger studies including both women and men is needed. SIGNIFICANCE STATEMENT:Logistic and RIDGE regression analyses indicated that joint pain and chronic back pain were associated with different proteins, which were enriched for similar inflammatory pathways.

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. 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. 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. 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.

The study aimed to investigate if primary health care centers (PHCCs) offering nurse-managed hypertensive care differ from PHCCs with other types of hypertension care regarding blood pressure levels and other key indicators. In this cross-sectional study of the hypertension care given in PHCCs in Stockholm County (now called Region Stockholm), we included all 227 PHCCs in the region. To assess the extent of nurses' involvement in the PHCCs hypertension care, a questionnaire was distributed to all PHCCs in Region Stockholm. Data on blood pressure levels was collected from a primary health care quality system (Primary Care Quality). Data on key indicators regarding follow-up was obtained from the Region Stockholm database on follow-up (LUD). Blood pressure levels and LUD-data were then analyzed with regards to whether the PHCC had nurse-managed hypertension care or not. Our analysis comprised 119 267 patients diagnosed with hypertension registered in any of the regions 227 PHCCs. Of the 81 PHCCs that responded to the questionnaire, 55 reported having nurse-managed hypertension care, and 26 were classified as having non-nurse managed hypertension care, while 146 were classified as unknown type of hypertension care. There were no differences in patients reaching desired blood pressure levels between nurse-managed and non-nurse-managed hypertension care. Nurse-led hypertension care units were on par with the other types of PHCCs. Thus, nurse-led hypertension care seems to be as safe and effective as other types of hypertension care in PHCCs.