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Background: To meet the complex needs of adults with dementia, a team-based, individualized rehabilitation approach may be required. This randomized controlled pilot trial evaluated the feasibility of a person-centred multidimensional interdisciplinary rehabilitation program for older adults with dementia, in terms of follow-up and response rates, and potential short- and long-term effects in adults with dementia on social participation, loneliness, and mental health.

Methods: Participants (mean age (SD) 78.7 (±6.6) years), were randomized to an intervention group (n = 31) or usual care (n = 30). The rehabilitation program consisted of a 20-week rehabilitation period and two follow-ups after 5 and 14 months. An interdisciplinary team performed assessments and interventions based on the individual's goals. Assessors blinded to group allocation performed structured assessments at baseline and after 5, 12, 24, and 36 months.

Results: Initially, response rates in participants with dementia were high for all assessments in the areas of social participation, loneliness, and mental health. Response rates after 12 months decreased, particularly for cognitively demanding questions with multiple-choice options in the area of social participation. Overall, there were few statistically significant differences between the groups in the outcomes over 36 months, but some of the findings seemed potentially clinically meaningful in favor of the intervention group: increased frequency of active recreation and organized social activities outside the home, as reported by both participants with dementia and caregivers or staff; as well as experienced more frequent visits to family and friends; and short-term reduction in depressive symptoms.

Conclusions: Assessments made of loneliness and mental health in this study over three years seemed feasible. It seemed cognitively demanding for participants with dementia to answer questions regarding social participation over time; therefore it seemed worthwhile to also ask informal caregivers or staff to avoid data loss. The positive findings noted during assessments and potential effects indicate that it is relevant to proceed further to an adequately powered RCT and conducted in additional geographical regions.

Background: Polycythemia vera (PV) and essential thrombocythemia (ET) are associated with a well-recognized increased risk of thrombotic events, bleeding, and all-cause mortality, but the frequency of these outcomes during treatment has rarely been assessed in large cohorts.

Methods: In this nationwide, population-based study, we analyzed 2604 PV and 3141 ET patients using multiple Swedish health care registers, covering 43 612 patient-years. Rates of arterial and venous events, major bleeding, and all-cause mortality (ACM) were evaluated across therapies.

Results: Unexpectedly, 42.3% of low-risk PV patients and 29.7% of very low/low-risk ET patients received hydroxyurea (HU) during follow-up. High-risk PV patients treated with interferon (IFN) exhibited the lowest arterial event rate (2.21 per 100 patient-years). In high-risk ET, patients with IFN therapy experienced the lowest arterial and venous event rates (1.55 and 0.44 per 100 patient-years). Advanced age and leukocytosis at diagnosis independently predicted thrombosis, bleeding, and ACM in both PV and ET. Multivariable analysis showed that HU and IFN were associated with reduced ACM risk; HU also conferred protection against thromboembolism and major bleeding.

Conclusion: This study highlights risk factors associated with complications during treatment in a real-world context and reinforces the role of HU and IFN as first-line therapies in PV and ET.

Objective: Existing literature offers fragmented insights into working life following severe perineal trauma (SPT), suggesting positive and negative implications. No research has systematically examined work ability or potential risk factors associated with impaired work ability. This study assessed and compared work ability among women with SPT more than 18 months postpartum and identified potential risk factors for impaired work ability.

Methods: An exploratory cross-sectional pilot study was conducted in Sweden. Participants were recruited via digital platforms (n = 197) and included women who sustained SPT during childbirth more than 18 months before data collection. Data were collected via an online questionnaire and analysed using multivariable logistic regression.

Results: Nearly one-third of participants reported impaired work ability. Absence of reconstructive surgery, increased life impact of pelvic floor disorders, and history of sick leave in adult life were identified as risk factors for impaired work ability.

Conclusions: The complexity of health problems following SPT may affect women’s ability to work. Given the exploratory nature and limited sample size of this pilot study, larger longitudinal studies – using national registers or multicentre recruitment – are needed to confirm the observed associations and deepen understanding of the multifaceted consequences of health problems following SPT.

Background Bilateral groin hernias comprise approximately 25% of all groin hernias, with one side often being asymptomatic/minimally symptomatic. With an increase in minimally invasive approaches, simultaneous bilateral groin hernia repair (B-GHR) is frequently performed in routine practice. However, chronic pain and recurrence remain significant postoperative concerns. This study evaluated long-term outcomes after B-GHR versus unilateral groin hernia repairs (U-GHR). Methods This nationwide population-based cohort study used prospective data from the Swedish Hernia Register, combined with a patient-reported outcome measure (PROM) questionnaire. All men and women aged ≥ 15 years with groin hernia repair registered between 1 September 2012 and 31 December 2018 were included in the study. Primary outcomes were chronic pain and patient dissatisfaction 1 year after B-GHR versus U-GHR. Secondary outcomes included reoperation for recurrence up until 2020, and risk factors for these long-term outcomes exclusively after B-GHR. Results In all, 65 749 patients provided PROM data for analysis (response rate 69.4%). Chronic pain at 1 year was reported by 16.2% of patients (27) after B-GHR and by 15.4% of patients (9232) after U-GHR. A higher proportion of women undergoing B-GHR reported increased chronic pain than men (23.0 versus 15.4%; P < 0.001). Multivariable regression analyses revealed a higher risk of chronic pain (odds ratio (OR) 1.14; P = 0.002) and patient dissatisfaction (OR 1.30; P < 0.001) after B-GHR than U-GHR. Female sex and age < 50 years were independent risk factors for chronic pain and patient dissatisfaction after B-GHR. No significant difference was observed in reoperation rates for recurrence. Conclusions B-GHR is associated with an increased risk of chronic pain and patient dissatisfaction compared with U-GHR. Women and younger patients are particularly at risk, suggesting a more cautious approach to simultaneous B-GHR in routine practice, especially in the absence of clear symptoms, and highlighting the importance of watchful waiting.

Background: Ethiopia has experienced growth in the utilization of family planning services. However, there are reports of relatively low client satisfaction across the country.

Objective: The objective of this study was to assess client and facility level predictors of satisfaction with family planning services in Ethiopia.

Method: A multi-level mixed effects logistic regression analysis was conducted on a national survey obtained from the service provision assessment 2021–22. A total of 2071 clients (level one) and 529 facilities (level two) were included.

Results: Overall, 56% of clients were highly satisfied with the family planning service they received. Findings from the random effects of the multilevel analysis show there is a significant difference in client satisfaction between facilities, with an intra-class correlation of 0.56 in the null model. At the client-level, age above 30, auditory privacy, and discussion on side effects are significantly associated with higher client satisfaction. At the facility level, having a waiting area, facilities with a quality unit and/or committee, a DHIS2 reporting system, operating for more than 20 days a month, privately owned facilities and availability of family planning guidelines are associated with higher odds of being satisfied. On the other hand, at the client level, having a primary or higher education, increasing wait time and clients asking their providers questions are associated with lower odds of being satisfied. At the facility level, having a fixed user fee significantly reduces the odds of client satisfaction.

Conclusions: Human resource and professional development training and health system strengthening is recommended.

OBJECTIVES: To investigate if beliefs about medicines affect the time to the initiation of cardiovascular preventive medications during a 3 year follow-up period.

DESIGN: A questionnaire and register-based cohort study.

SETTING: Primary care in Sweden, in which people 40, 50 and 60 years old underwent risk factor screening and individual health promotion within the Västerbotten intervention programme (VIP).

PARTICIPANTS: People at low/medium risk of cardiovascular disease (CVD) according to the risk factor screening were included in the VIsualiZation of asymptomatic Atherosclerotic disease for optimum cardiovascular prevention-a population-based Pragmatic Randomised Open Blinded End-point trial (PROBE) nested in the Västerbotten Intervention Programme (VIPVIZA), aiming at improved primary prevention of CVD. People participating in the VIPVIZA 3 year follow-up (n=3167 (89.7%)), receiving the Beliefs about medicines questionnaire (BMQ) (n=2314 (73.1%)) and with complete answers to at least one subscale in the BMQ general (n=2258 (97.6%)) were included. Moreover, only those 60 years old at baseline (n=2073 (58.7%)) and without antihypertensive and/or lipid-lowering drugs (n=1769 (50.1%)) 6 months prior to inclusion in the VIPVIZA trial were included. Accordingly, the final study population comprised 888 people without antihypertensive medicines and 1185 without lipid-lowering drugs, respectively.

MEASURES: The primary outcome was time to the binary event of initiating antihypertensives or lipid-lowering agents, identified within the time frame from inclusion in the VIPVIZA study until the study participants' 3 year follow-up visit. General beliefs about medicines were assessed according to the BMQ. Cox proportional hazards models, adjusted for sex, were conducted to investigate primary outcome. RESULTS: Participants with stronger general beliefs about medicines being overused had significantly longer time to initiation of antihypertensive drugs in the control group (HR 0.91; 95% CI 0.84 to 0.996) but not in the intervention group (HR 1.05; 95% CI 0.95 to 1.16). No significant associations were found between beliefs about medicines and initiation of lipid-lowering treatment.

CONCLUSIONS: A more negative perception of drugs being overused was significantly associated with delayed initiation of antihypertensive drug treatment. Our results suggest that the VIPVIZA intervention may overbridge negative perceptions and affect the initiation of antihypertensive medications in a positive manner.

TRIAL REGISTRATION NUMBER: NCT01849575 (date of registration: 8 May 2013).

PURPOSE: Surgery for groin hernia is one of the most common operations in the world. Therefore, research concerning the outcomes of groin hernia surgery is extremely important both for the individual patient as well as for those providing the healthcare funding. The aim of this study is to evaluate the outcomes of hernia surgery in Sweden over a 30 year time period, from 1992 to 2021.

METHODS: All groin hernia repairs in the Swedish Hernia Register between 1992 to 2021 were analyzed with emphasis on the surgical method, reoperation rate for recurrence and date of surgery, specifically 1992-2001, 2002-2011 and 2012-2021. By using personal identification numbers, a cumulative reoperation rate has been deduced for males and females separately.

RESULTS: A total of 368,502 groin hernia operations identified in the Swedish Hernia Register between 1992 to 2021 were eligible for analysis. Since the register was begun, there have been significant changes in the choice of operative techniques, from suture repair in 1992 to open anterior mesh repair around the year 2000, until today, where an increasing proportion of hernias are repaired using laparo-endoscopic techniques. There has been a reduction in the reoperation rate for recurrence in both males and females, with the most pronounced improvement being seen in females. The laparo-endoscopic technique is associated with a reduced incidence of reoperation for recurrence in females.

CONCLUSION: Groin hernia surgery in Sweden has undergone substantial changes over the past 30 years. Reoperation for recurrence has decreased significantly during recent years, especially in females.

Purpose: Annually, more than 24,000 groin hernia repairs are performed in Sweden and Denmark, approximately 12,000 of which are laparoscopic like totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) repairs. TEP is the preferred technique in Sweden, whereas TAPP is preferred in Denmark. This study aimed to assess the risk of reoperation for recurrence following TAPP, TEP, and Lichtenstein techniques.

Method: Prospectively collected data from the Danish Hernia Database and the Swedish Hernia Register were utilized for this observational register-based study. Primary groin hernia repairs utilizing TEP, TAPP, or Lichtenstein techniques between 2004 and 2020 were included. The primary outcome was the reoperation rate for recurrence analyzed using both crude reoperation rates and Cox proportional hazard regression analysis.

Results: During 17 years, 347,912 primary groin hernia repairs were performed, of which 12% were TEP, 15% TAPP, and 74% Lichtenstein repairs. In males, the risk of reoperation was higher after TEP than after TAPP (HR 1.38, 95% CI 1.27–1.5) and Lichtenstein (HR 1.44, 95% CI 1.36–1.53). In females, Lichtenstein repair had a higher risk than the laparoscopic approaches, with no significant difference between TAPP and TEP.

Conclusion: Our study demonstrated low rates of reoperation for recurrence after Lichtenstein, TEP, and TAPP repairs. In men, TEP repair is associated with an increased risk of reoperation for recurrence compared with Lichtenstein and TAPP repair. For females, the laparoscopic approaches were superior to the Lichtenstein repair. These findings emphasize the importance of international comparative studies to optimize hernia management strategies.

Background/Objectives: Emergency groin hernia repairs have consistently presented a higher risk of mortality and morbidity. This study aimed to compare both short- and long-term outcomes associated with emergency groin hernia surgery.

Methods: A nationwide, population-based cohort study was conducted using prospective collected data from the Swedish Hernia Register combined with a questionnaire assessing patient-reported chronic pain. All patients who underwent a groin hernia repair between 2012 and 2018 were eligible for inclusion. Primary outcomes included 30-day mortality, chronic pain 1-year post-surgery, 30-day postoperative complication, and bowel resection and reoperation for recurrence for emergency versus elective repairs. Risk factors for these outcomes in emergency repair were investigated.

Results: A total of 94,349 repairs were analyzed, with 5401 (5%) emergency repairs. Emergency repairs involved older patients (median age 74 vs. 65), more women (25% vs. 9%), more ASA grade III (38% vs. 12%), more femoral hernias (19% vs. 3%) and smaller defects (24% vs. 17%) compared to elective repairs. Multivariable analysis revealed increased rates and significant risks for 30-day mortality (2.7%, OR 11.61), chronic pain (20.6%, OR 1.30), 30-day postoperative complications (21.9%, OR 2.12) and bowel resection (7.8%, OR 408) compared to elective repairs. No significant difference was observed for reoperation for recurrence. Key risk factors for the outcomes following emergency repairs were higher age, higher ASA grade and femoral hernias.

Conclusions: Emergency hernia surgery continues to pose a high risk of mortality and morbidity. Elective repair should be considered in frail patients and those with potential femoral hernias.

Background: Despite the global prevalence of groin hernia repairs, there is still limited understanding regarding the impact of surgical expertise on patient outcomes, particularly since a significant portion of hernia repairs worldwide are performed by junior surgeons. This study aims to evaluate the long-term outcomes of groin hernia repairs carried out by specialist compared to those performed by resident surgeons.

Material and Methods: This observational, nationwide, population-based registry study utilized prospectively collected data from the Swedish Hernia Register as well as patient-reported outcome measures (PROM) 1 year after groin hernia surgery. Included patients were aged 15 years or older who underwent groin hernia repair between 2012 and 2018. Surgical expertise was categorized as either specialist or resident surgeon. Primary outcome was dissatisfaction and chronic pain 1 year post-surgery. Secondary outcome was reoperation for recurrence with follow-up until 2024.

Results: In total, 62 033 groin hernia repairs were analyzed, with a response rate of 70% for PROM questionnaire. Moreover, 72% of surgeries were performed by specialists and 28% by resident surgeons. Multivariable analysis revealed no significant differences. In the specialist group, 5.7% reported dissatisfaction compared to 4.5% in the resident group (odds ratio [OR] 0.92, 95% confidence interval [CI] 0.84-1.02). Chronic pain was experienced by 15.4% of specialist operated patients and 15.5% of resident operated patients (OR 1.05, 95% CI 0.99-1.12). And 2.6% of patients in the specialist group underwent reoperation for recurrence, compared to 2.3% in the resident group (hazard ratio 0.97, 95% CI 0.86-1.11).

Conclusion: Groin hernia repairs represent a significant surgical procedure for resident surgeons in training. The level of surgical expertise was not found to be associated with increased long-term complications, suggesting that resident surgeons do not affect groin hernia patients negatively.