Decreased incidence of Guillain-Barré syndrome during the COVID-19 pandemic : a retrospective population-based study

The Author(s). Published by S. Karger AG, Basel.Background: Guillain-Barré syndrome is an immune-mediated acute inflammatory polyneuropathy that is associated with various triggers, including certain infections and vaccines. It has been suggested that both SARS-CoV-2 infection and vaccination may be triggering factors for Guillain-Barré syndrome, but evidence remains equivocal. Here, we conducted a population-based incidence study of Guillain-Barré syndrome spanning the 3 years immediately prior to and the 2 years during the pandemic. Methods: Cases were identified by searching a regional diagnostic database for the ICD-10 code for Guillain-Barré syndrome. Individuals who fulfilled the Brighton criteria for Guillain-Barré syndrome were included. Information on clinical presentation, laboratory values, and vaccination status were retrieved from medical records. We calculated the incidence immediately prior to and during the pandemic. Results: The Guillain-Barré syndrome incidence rate was 1.35/100,000 person-years for the pre-pandemic period and 0.66/100,000 person-years for the pandemic period (incidence rate ratio: 0.49; p = 0.003). Three cases were temporally associated with SARS-CoV-2 infection and 1 case each to the AstraZeneca and Pfizer-BioNTech COVID-19 vaccines. Conclusions: Our results show that the incidence of Guillain-Barré syndrome decreased during the pandemic. This is most likely due to decreased prevalence of triggering infections due to social restrictions. Our findings do not support a causal relationship between Guillain-Barré syndrome and COVID-19.Peer reviewe

Variation in plasma calcium analysis in primary care in Sweden - a multilevel analysis

<p>Abstract</p> <p>Background</p> <p>Primary hyperparathyroidism (pHPT) is a common disease that often remains undetected and causes severe disturbance especially in postmenopausal women. Therefore, national recommendations promoting early pHPT detection by plasma calcium (P-Ca) have been issued in Sweden. In this study we aimed to investigate variation of P-Ca analysis between physicians and health care centres (HCCs) in primary care in county of Skaraborg, Sweden.</p> <p>Methods</p> <p>In this cross sectional study of patients' records during 2005 we analysed records from 154 629 patients attending 457 physicians at 24 HCCs. We used multilevel logistic regression analysis (MLRA) and adjusted for patient, physician and HCC characteristics. Differences were expressed as median odds ratio (MOR).</p> <p>Results</p> <p>There was a substantial variation in number of P-Ca analyses between both HCCs (MOR_HCC1.65 [1.44-2.07]) and physicians (MOR_physician1.95 [1.85-2.08]). The odds for a P-Ca analysis were lower for male patients (OR 0.80 [0.77-0.83]) and increased with the number of diagnoses (OR 25.8 [23.5-28.5]). Sex of the physician had no influence on P-Ca test ordering (OR 0.93 [0.78-1.09]). Physicians under education ordered most P-Ca analyses (OR 1.69 [1.35-2.24]) and locum least (OR 0.73 [0.57-0.94]). More of the variance was attributed to the physician level than the HCC level. Different mix of patients did not explain this variance between physicians. Theoretically, if a patient were able to change both GP and HCC, the odds of a P-Ca analysis would in median increase by 2.45. Including characteristics of the patients, physicians and HCCs in the MLRA model did not explain the variance.</p> <p>Conclusions</p> <p>The physician level was more important than the HCC level for the variation in P-Ca analysis, but further exploration of unidentified contextual factors is crucial for future monitoring of practice variation.</p

Availability and costs of medicines for the treatment of tuberculosis in Europe

To evaluate the access to comprehensive diagnostics and novel antituberculosis medicines in European countries. We investigated the access to genotypic and phenotypic Mycobacterium tuberculosis drug susceptibility testing and the availability of antituberculosis drugs and calculated the cost of drugs and treatment regimens at major tuberculosis treatment centres in countries of the WHO European region where rates of drug-resistant tuberculosis are the highest among all WHO regions. Results were stratified by middle-income and high-income countries. Overall, 43 treatment centres from 43 countries participated in the study. For WHO group A drugs, the frequency of countries with the availability of phenotypic drug susceptibility testing was as follows: (a) 75% (30/40) for levofloxacin, (b) 82% (33/40) for moxifloxacin, (c) 48% (19/40) for bedaquiline, and (d) 72% (29/40) for linezolid. Overall, of the 43 countries, 36 (84%) and 24 (56%) countries had access to bedaquiline and delamanid, respectively, whereas only 6 (14%) countries had access to rifapentine. The treatment of patients with extensively drug-resistant tuberculosis with a regimen including a carbapenem was available only in 17 (40%) of the 43 countries. The median cost of regimens for drug-susceptible tuberculosis, multidrug-resistant/rifampicin-resistant tuberculosis (shorter regimen, including bedaquiline for 6 months), and extensively drug-resistant tuberculosis (including bedaquiline, delamanid, and a carbapenem) were €44 (minimum-maximum, €15-152), €764 (minimum-maximum, €542-15152), and €8709 (minimum-maximum, €7965-11759) in middle-income countries (n = 12) and €280 (minimum-maximum, €78-1084), €29765 (minimum-maximum, €11116-40584), and €217591 (minimum-maximum, €82827-320146) in high-income countries (n = 29), respectively. In countries of the WHO European region, there is a widespread lack of drug susceptibility testing capacity to new and repurposed antituberculosis drugs, lack of access to essential medications in several countries, and a high cost for the treatment of drug-resistant tuberculosis

Rifapentine access in Europe: growing concerns over key tuberculosis treatment component

[No abstract available]Support statement: C. Lange is supported by the German Center of Infection Research (DZIF). All other authors have no funding to declare for this study. Funding information for this article has been deposited with the Crossref Funder Registry

Elevated calcium concentration, is it dangerous? Long-term follow-up in primary care

Background and aims: Patients with hypercalcaemia are relatively common in primary care; the most frequent causes are primary hyperparathyroidism (pHPT) and cancer. Many patients with pHPT have such discrete symptoms that they are difficult to detect without a calcium analysis. To increase the detection of pHPT, more calcium analyses are recommended by Swedish authorities. The aim of this thesis was to study the care of patients with elevated calcium concentrations and to investigate factors contributing to the variation in calcium analyses between physicians and health care centres (HCC) in primary care. Material and Methods: First, we investigated all patients with elevated calcium concentrations (n=142) at Tibro HCC between the years 1995−2000. In the following studies, HCC patients with normal calcium concentrations were used as controls. Both groups were offered an examination after 10 years with new blood analyses and questions concerning diseases, medication and quality of life. In the last study, the variation in the ordering of calcium analyses between 457 physicians and 24 HCCs was investigated through a multilevel analysis. Results: In the first study we tried to survey the underlying causes in patients with elevated calcium concentrations; however, no cause was found in 70 % of the patients. pHPT and cancer were among the most common diagnoses. At follow-up, 88 % of the patients with elevated calcium concentrations turned out to have an underlying disease. Many women had pHPT, while men showed an increased mortality from cancer. Patients with elevated calcium concentrations had poorer quality of life and increased health care utilisation than patients with normal calcium concentrations. There were large differences in the number of calcium analyses ordered, both between physicians and HCCs. A patient’s likelihood of an analysis could increase 2.5 times if both the physician and the HCC were changed. Physicians in education ordered more and locums fewer calcium analyses than the average general practitioner

Problem vid migration av applikationer från Visual Basic 6 till Visual Basic .net vid användande av ett migrationsverktyg

Arbetet bygger på att de informationssystem som används idag men som blir allt äldre och därigenom inte klarar de krav som ställs på dem. Detta medför att informationssystemen måste migreras till modernare plattformar, då företagen dels inte klarar sig utan dess nuvarande funktionalitet och dels måste vidareutveckla systemen. Detta arbete tar upp olika sätt som detta kan genomföras på och vilka problem som kan komma att uppstå när detta sker. För att kunna undersöka detta så genomfördes ett antal migrationer. Språken som migrationen kommer att ske mellan är Visual Basic 6 och Visual Basic .net. Migrationerna kommer att ske med hjälp av ett migrationsverktyg, samt ett ramverk som i arbetet skräddarsys för just arbetets typ av migrationer. Det arbetet kommer fram till är att det sker problem vid användande av ett verktyg och även att det inte ger tillräckligt med respons på vad som gått snett under migrationerna

Digital Rebellion : Design project educating as well as criticizing misogynistic content on the internet, focusing on the social media app TikTok

Digital rebellion is a design project that is meant to educate as well as criticize misogynistic content on the internet, with focus on the social media app TikTok. It is meant to engage in conversation surrounding feminism, toxic masculinity, misogyny, and social sustainability for users somewhat familiar with the context but accessible for individuals who might not be. TikTok is a feeding ground for unsolicited opinions, without a good foundation you can quickly get buried under them. Digital rebellion highlights feminist methods on the app with the purpose to combat problematic content with humor. How feminism as a movement has used humor and continue to use it to keep the fire burning for future generations

Quantify and mimic the feedback through the steering wheel during specific driving conditions: Reproducing the steering feel in a conventional steering system in a Steer-by-Wire system

The mobility industry is going through a transformation where mechanical-connected steering system is replaced with wired-connected steering system, called Steer-by-Wire. Steer-by-Wire steering feedback is set by a Electronic Control Unit. Based on this transformation Polestar’s dynamic department wants to create steering feedback in the coming Steer-by-Wire cars that mimic the feedback felt in a mechanical steering system during some specific conditions. This thesis aim is therefore to create software that creates feedback that mimics the mechanical system during these conditions: • Driving over crest while turning • Driving on a dashed road marking • Driving across rutted roads • Driving with front or rear axle saturated The method starts with logging the sensors data from the car which should be con verted to Steer-by-Wire when it is driving through the specific conditions to see how they could be detected. Then a car with a mechanically connected system is driven through the same conditions to see what the desired feedback should be. The result is a Simulink model consisting of several functions, a main feedback function that sets the basic feedback and additional functions that are connected to the specific conditions. The main feedback function has promising results. The functions that detect driving over crest while turning, dashed road marking and axle saturation show potential. These functions detect the situations and output the aimed feedback. For rutted road conditions, no solution for a function has been found. In addition to the functions detecting the situation there are two functions for friction coefficient estimation to enable change of feedback in the steering wheel with available friction. These functions only show reasonable values when close to limit handling or steady state

The modelling of an anaerobic digestion plant and a sewage plant in the ORWARE simulation model

A simulation model, called ORWARE (ORganic WAste REsearch model), has been developed for evaluation of handling alternatives for organic waste. The model deals with both source separated solid organic waste and liquid organic waste i.e. wastewater. Included are transport for collection, incineration, landfilling, anaerobic digestion, composting, transportation of residuals and spreading on arable land. The model is intended for simulation of handling scenarios for organic waste and calculates emissions to air, water, recirculation to arable land and energy turnover. The flows in the model are described by a variable vector of 43 substances, including e. g. plant nutrients, heavy metals and some organic priority pollutants. The construction of the models for anaerobic digestion, sewage plant, sewage system and spreading of residuals included in ORWARE, are described in detail. The anaerobic digestion model is a continuous, single stage, mixed tank reactor (C.S.T.R.) operating under mesophilic conditions. The gas production is related to the retention time and the maximum degradation ratio and first order rate constant, for the organic components fat, protein and three classes of carbohydrates respectively. The combustion of the gas in a stationery engine is also included. The sewage plant model includes mechanical, biological and chemical treatment of the wastewater, and anaerobic digestion and dewatering of the sewage sludge. The separation of sludge is based on the suspended solids and water separated in the respectively treatment processes with data primarily from the plant in Uppsala. Separation of the remaining substances included in the vector is principally modelled from assumptions of the substances to be attached to the suspended solids or soluble in water. Sewage systems included are conventional systems and vacuum systems. The model deals with leakage and energy consumption. Alternatives in ORWARE are also urine separation and kitchen disposers for transporting and treating the solid organic waste in a sewage plant. These alternatives changes the substrate composition and water quantity sent to the sewage plant. The model for spreading of residuals includes three types of spreaders, depending on the residues water content. It models energy consumption and emissions from the tractor

KORANEN OCH ÖVERSÄTTNING. En historisk-litterär studie

This essay aims to study three Swedish translations of the Qurʾān; Crusenstople from 1843, Zetterstéen from 1917 and Bernström from (1998)2005, and to make a comparision between them with the focus on how each of them has handled the litteral phenomenon hapax in sūrat al-Nisāʾ. The questions that the essay aims to deal with are first whether there really is a difference between the three translations as far as the phenomenon hapax is concerned, and second whether theese possible differences affect the readers understanding of the message of the text to the degree that it poses a problem. The conclusion that is reach within the frame of this essay is that the main differences between the three translations depend on their different chioces of translation methods and hence that it is not possible to say that one of them is more correct than the other, considering their different puroposes with and techniques for the translation process. The essay can not find that the difficulty in the translation of the litteral phenomenon hapax poses a problem as far as the hapaxes that are dealt with in this essay are concerned