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The global burden of orofacial pain (OFP), including temporomandibular disorders (TMDs), has never been estimated due to lacking disability weights (DWs). This is a significant limitation in the World Health Organization’s goals for oral health. The present study presents DWs with directions for the development of corresponding health state descriptions. We used general population data on OFP and TMD (n > 180,000) with linked data on health-related quality of life from the Short Form Health Survey (SF-36; n > 110,000). From the SF-36 sum scores, a cumulative DW was mapped, and condition-specific DWs adjusted for common risk factors were calculated. Pain disability and related self-reported clinical characteristics were presented descriptively in a subsample of 300 individuals. In the study sample (n = 26,253, 49.9% women), participants with OFP reported significantly lower scores on the mental and physical components of the SF-36 when compared with pain-free individuals (P < 0.001), as did individuals with TMD as compared with those without TMD (P < 0.001). After adjusting for the presence of common health states, the mean DW was 0.024 (95% CI, 0.011 to 0.038) for OFP and 0.026 (95% CI, 0.016 to 0.038) for TMD. Individuals with higher pain disability reported higher pain intensity as well as increased pain catastrophizing and functional jaw limitations. Our findings demonstrate a feasible solution for estimating DW for OFP and TMD as an important step toward incorporation of these conditions into the Global Burden of Disease study and suggest a greater impact of pain than other common oral diseases. Further efforts are needed to develop lay descriptions and validate DW findings in other populations.

Background: Everyday Life Rehabilitation (ELR) is a recovery-oriented intervention that aims at improving residents’ quality of life through engagement in meaningful everyday activities. The intervention has been demonstrated to be effective in a randomized controlled trial (ClinicalTrials.gov: NCT05056415).

Method: A cost-utility analysis (CUA) was conducted using quality-adjusted life years (QALYs) derived from ReQoL-UI as the primary outcome. Both deterministic and probabilistic sensitivity analysis was used to explore critical assumptions. A budget impact analysis was used to estimate the incremental cost of scaling up ELR in routine practice.

Results: The intervention was found to be cost-effective compared to usual care, with an estimated incremental cost-effectiveness ratio (ICER) of 133 494 SEK (12 148 EUR) per QALY. Sensitivity analysis indicated that the findings were robust. The estimated average budget impact was estimated to be 10 118 SEK (921 EUR) per resident for one year of ELR. Overall, ELR demonstrated significant clinical benefits with minimal incremental costs.

Interpretation: Throughout the analysis, we have used highly conservative estimates. Despite this, the analysis concluded that the intervention has a high probability of being cost-effective. Thus, the study provides robust evidence for the value of ELR as a scalable and economically viable intervention.

Aims: The Västerbotten Intervention Programme VIsualiZation of subclinical Atherosclerosis (VIPVIZA) pragmatic randomized controlled trial (RCT) previously reported reduced cardiovascular disease (CVD) risk 3 years after colour-coded information about subclinical atherosclerosis based on carotid ultrasonography and facilitated by nurse-led motivational dialogue. This report evaluated the development of CVD risk and clinical risk factors following the 3-year follow-up, at which point the control group received their first delayed intervention and the intervention group received a repeated VIPVIZA intervention.

Methods and results: Participants (n = 3532) were recruited during 2013–2016 and randomized into two groups. Routine primary care managed preventive treatments. At the 6-year follow-up, group differences in CVD risk factors, the European Systematic Coronary Risk Evaluation 2 (SCORE2), and Framingham Risk Score (FRS) were statistically tested. Trajectories of the outcomes in both groups were graphically assessed. The participation rate after 6 years was 75.4%. No significant differences were found between groups in levels of SCORE2, FRS, clinical risk factors, anthropometrics, smoking, or diabetes—except for systolic blood pressure, which was lower in the original intervention group. Risk scores and systolic blood pressure increased in both groups in parallel, while LDL levels decreased and converged. The higher the baseline risk was, the stronger the decrease of LDL cholesterol.

Conclusion: When the delayed VIPVIZA intervention was provided to the control group after 3 years, the beneficial effect appeared similar as previously reported for the intervention group. After 6 years, any differences between groups in CVD risk were no longer seen. Cholesterol levels were greatly reduced in both groups.

Registration: The VIPVIZA trial is registered with www.clinicaltrials.gov (NCT01849575).

BACKGROUND: Despite being one of the most common chronic pain conditions, painful temporomandibular disorders (TMDs) are still not included in the Global Burden of Disease (GBD) measures of health loss. A key obstacle is the absence of a lay description that can be used to derive a disability weight reflecting the severity relative to all other diseases' consequences measured in GBD. This study aims to propose lay descriptions of painful TMDs suitable for use within the GBD framework.

METHODS: The process was guided by experts from the Institute for Health Metrics and Evaluation (IHME), USA. A structured consensus process was conducted among international experts, clinicians, and patient representatives in three steps: terminology alignment, roundtable discussions during a workshop, and outcome synthesis. After aligning terminology through introductory lectures, five groups of 8-12 participants reviewed existing lay descriptions for other pain-related disorders. In addition, they discussed lay descriptions and severity states.

RESULTS: No existing descriptions adequately captured the characteristics of painful TMDs. After consensus discussions, the proposed lay description was "Pain in the jaw, face, cheeks, or around the ears, sometimes radiating to the temples or behind the eyes. The pain may be felt as dull, sharp, tense, or stiff, making chewing, talking, or opening the mouth difficult." Duration, intensity, and frequency were identified as important dimensions linked to severity.

CONCLUSIONS: The lay description provides direction on how painful TMDs can be quantified in GBD estimates. Future studies, including those that incorporate patients' perspectives, are essential to ensure alignment with lived experiences.

OBJECTIVE: To evaluate the association between exposure to occupational biomechanical factors and the incidence of surgically treated osteoarthritis (OA) treated with arthroplasty in the hip and knee among male construction workers.

DESIGN: Longitudinal register-based cohort study.

PARTICIPANTS AND SETTING: Male construction workers (n=291 062) who participated in a national Swedish occupational health examination programme between 1971 and 1993, delivered through multiple primary-level nationwide occupational health centres.

PRIMARY AND SECONDARY OUTCOME MEASURES: Hip and knee arthroplasties performed due to OA from 1987 to 2019 were identified through linkage with the Swedish National Patient Register. Data on age, smoking habits, body mass index, job title and self-reported biomechanical exposures were collected during the health examinations. Occupational biomechanical workload was assessed using eight factors from a job-exposure matrix. Poisson regression was applied to estimate adjusted incidence rate ratios (IRRs) associated with each type of occupational biomechanical exposure.

RESULTS: The study included 10 336 cases of hip arthroplasties and 8926 cases of knee arthroplasties. All studied biomechanical risk factors were associated with an increased risk of knee OA requiring arthroplasty, especially for individuals exposed to static work in non-neutral lumbar postures (IRR 1.38, 95% CI 1.16 to 1.65) and those with a high frequency of kneeling (IRR 1.27, 95% CI 1.12 to 1.45). In contrast, only a few biomechanical factors were associated with an increased risk of hip OA requiring arthroplasty. Similar results were observed when alternative exposure measures, such as occupational group and self-reported exposure assessments, were employed.

CONCLUSIONS: Occupational workload was associated with an increased risk of knee arthroplasty due to OA, whereas the association for hip arthroplasty remains unclear.

Background: Pulmonary nodules (PNs) are clinically challenging because differentiation between benign and malignant PNs is not possible at CT detection; recurring CT examinations and invasive procedures are often required in PN follow-up.

Purpose: To investigate PN prevalence in a middle-aged population and the risk factors associated with these nodules.

Materials and Methods: In this secondary analysis of the cross-sectional population-based Swedish CArdioPulmonary bioImage Study (known as SCAPIS, from November 2013 to November 2018), participants aged 50-64 years with chest CT data were analyzed. Risk factors such as smoking history, occupational exposure (vapor, dust, gas, and fumes), and lung diseases were derived from comprehensive questionnaires. Robust Poisson regression was used to evaluate associations, adjusted for age and sex, between potential risk factors and the binary outcome of nodule presence or absence. Prevalence ratios (PRs), adjusted for age and sex, and 95% CIs were estimated.

Results: Among 29 574 participants (median age, 57.4 years; IQR, 53.7-61.2 years; 15 168 women), solid nodules sized 100-300 mm3, part-solid, and ground-glass nodules were found in 1420 (4.8%), 199 (0.7%), and 430 (1.5%), respectively. The prevalence of solid nodules among participants who never, formerly, and currently smoked was 32.5% (4713 of 14 515), 34.5% (3602 of 10 437), and 37.9% (1381 of 3644), respectively. Solid nodules sized 100-300 mm3 were associated with current smoking (PR, 1.38; 95% CI: 1.19, 1.60), chronic obstructive pulmonary disease (PR, 1.72; 95% CI: 1.17, 2.53), occupational exposure (PR, 1.31; 95% CI: 1.11, 1.54), emphysema (PR, 1.56; 95% CI: 1.31, 1.86), reticulation (PR, 1.96; 95% CI: 1.47, 2.61), and bronchiectasis (PR, 2.03; 95% CI: 1.64, 2.50). In participants who had never smoked, associations were found between solid nodules at least 100 mm3 and reticulation (PR, 2.28; 95% CI: 1.55, 3.36), reported lung disease other than asthma or chronic obstructive pulmonary disease (PR, 2.26; 95% CI: 1.49, 3.43), and bronchiectasis (PR, 2.17; 95% CI: 1.60, 2.94).

Conclusion: PN prevalence was approximately the same in a middle-aged population regardless of smoking history. In participants who had never smoked, nodules were linked to reported lung disease, reticulation, and bronchiectasis. 

Aims: To study the importance of decreasing tobacco smoking on the occurrence of larynx cancer in men and women.

Methods: The incidence rates of larynx cancer in the Swedish population between 1970 and 2021 were retrieved from the Swedish Cancer Register for ages 50–84 years, stratified for sex, age and calendar year. Data on the population’s smoking habits was retrieved from surveys and from taxation on the sale of cigarettes. The occurrence of larynx cancer was compared to smoking habits, sex and age. The time trends were compared between larynx and lung cancer.

Results: Over the years, Swedish men and women have had different smoking habits, especially older persons during the 1970s. In 1963, the prevalence of current smokers in women 50–69 years was 11%, while it was 46% in men. Around 2020, less than 10% of men and women in all age groups were current smokers. However, men had higher incidence rates of larynx cancer than women, even when their smoking habits were similar. For example, men and women 60–64 years of age in 2017–2021 had similar smoking habits during their life but the relative risk of larynx cancer in men compared to women was 3.3 (95% CI 1.7–4.8). However, pipe smoking was much more common in men.

Conclusions: The study indicates that other causes than cigarette smoking have an impact on the occurrence of larynx cancer in Sweden. Pipe smoking and occupational exposure to carcinogenic materials such as asbestos may be underlying causes of the difference in cancer risk between Swedish men and women.

Prostate cancer treatment depends on whether the cancer exists only inside the gland or within the prostate capsule or on the outside surface of the gland. The presence on the outside surface indicates migration of the cancer to adjacent organs. This study presents a novel method for detecting prostate cancer (PCa) on the surface of excised prostate glands using Raman spectroscopy and stiffness measurements. The workflow involves assessing the location and extent of PCa via MRI before surgery, followed by 3D scanning of the excised prostate. Key positions on ten excised prostates, 211 positions with 56 deemed as cancer, are measured using Raman spectroscopy and stiffness probes. The results are mapped onto a digital representation of the prostate to aid surgical decision-making. Statistical analysis of the Raman data indicates that spectra could be divided into two components, one more related to cancer and one more related to normal tissue. A stiffness parameter was calculated from resonance measurements from the stiffness probe. The Raman components and stiffness parameters were converted to z-scores. Logistic generalized linear mixed modelling revealed that the stiffness parameter was statistically associated with cancer presence in prostate regions (p = 0.009). The scanning equipment is easy to handle and makes further larger studies possible. This method holds promise for providing real-time support during surgery, reducing the need for post-surgical therapies and minimizing patient distress.

Background: The ABO blood group system has shown an association with cardiovascular disease. The susceptibility to CVD is proposed to be partly mediated by dyslipidaemia in non-O individuals. Previous studies are scarce for the RhD blood group, but we recently showed that RhD − young individuals are associated with subclinical atherosclerosis. Hence, we sought to examine whether the ABO blood groups and RhD factor are associated with dyslipidaemia.

Methods: All participants were part of the VIPVIZA study, including 3532 individuals with available plasma lipid levels. Lipids were assessed as total, LDL, HDL, remnant, non-HDL cholesterol and triglycerides. Information about ABO and RhD was retrieved by linking VIPVIZA with the SCANDAT-3 database, where 85% of VIPVIZA participants were registered.

Results: For the ABO blood groups, no significant differences in lipid levels between non-O and O individuals were seen. In 40-year-old males, RhD − individuals compared to RhD + had higher levels of non-HDL cholesterol, LDL cholesterol, and remnant cholesterol, with ratios of geometric means of 1.21 (CI95% 1.03; 1.43), 1.20 (1.02; 1.41) and 1.38 (1.00; 1.92), respectively. No differences in lipid levels depending on the RhD blood group were seen in women or the older age groups.

Conclusion: Our study indicates that younger RhD − men have increased non-HDL, LDL, and remnant cholesterol levels. Thus, the RhD blood group, but not ABO, seems to be associated with dyslipidaemia and may act as a future possible risk marker of cardiovascular disease.

Among workers performing hand-intensive tasks, musculoskeletal disorders in the upper extremities are more frequent in women than in men. However, risk assessments are generally not sex-specific, and it is not known whether exposures in regular work differ between females and males. The aim of this study was to compare measured wrist joint velocity and muscle activity between men and women performing identical tasks. Participants (28 female–male pairs) performed one of eighteen hand-intensive on-site tasks. Wrist velocity was measured using inertial units. Forearm muscle activity was measured via surface electromyography and normalized to maximal voluntary electrical activation (MVE). The 10th, 50th, and 90th percentiles and time in muscle recovery (< 0.5 %MVE) were computed. Between-sex differences were tested using the Wilcoxon signed-rank test. Wrist angular velocities did not significantly differ between sexes in any percentile (all p > 0.374). The muscle activity was significantly higher in female workers (p < 0.001–0.004), ranging from 1.3 to 2.8 times higher, and they spent less time in muscle recovery (p < 0.001). In hand-intensive tasks involving women and men, risk assessments should prioritize assessments of women to ensure protection against work-related musculoskeletal disorders for all workers.