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Lind, A., Cao, Y., Hesser, H., Hårdstedt, M., Jansson, S. P. O., Lernmark, Å., . . . Jendle, J. (2024). Anxiety, depression and quality of life in relation to SARS-CoV-2 antibodies in individuals living with diabetes during the second wave of COVID-19. Diabetes epidemiology and management, 13, Article ID 100194.
Open this publication in new window or tab >>Anxiety, depression and quality of life in relation to SARS-CoV-2 antibodies in individuals living with diabetes during the second wave of COVID-19
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2024 (English)In: Diabetes epidemiology and management, ISSN 2666-9706, Vol. 13, article id 100194Article in journal (Refereed) Published
Abstract [en]

Aims: The objective was to compare anxiety, depression, and quality of life (QoL) in individuals living with type 1 (T1D) and type 2 (T2D) diabetes with matched controls during the second wave of the COVID-19 pandemic.

Methods: Via randomization, individuals living with diabetes T1D (n = 203) and T2D (n = 413), were identified during February-July 2021 through health-care registers. Population controls (n = 282) were matched for age, gender, and residential area. Questionnaires included self-assessment of anxiety, depression, QoL, and demographics in relation to SARS-CoV-2 exposure. Blood was collected through home-capillary sampling, and SARS-CoV-2 Nucleocapsid (NCP) and Spike antibodies (SC2_S1) were determined by multiplex Antibody Detection by Agglutination-PCR (ADAP) assays.

Results: Younger age and health issues were related to anxiety, depression, and QoL, with no differences between the study groups. Female gender was associated with anxiety, while obesity was associated with lower QoL. The SARS-CoV-2 NCP seroprevalence was higher in T1D (8.9 %) compared to T2D (3.9 %) and controls (4.0 %), while the SARS-CoV-2 SC2_S1 seroprevalence was higher for controls (25.5 %) compared to T1D (16.8 %) and T2D (14.0 %).

Conclusions: A higher SARS-CoV-2 infection rate in T1D may be explained by younger age and higher employment rate, and the associated increased risk for viral exposure.

Place, publisher, year, edition, pages
Elsevier, 2024
Keywords
Diabetes, SARS-CoV-2, COVID-19, Anxiety, Depression, Quality of life, Virus antibodies
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-111559 (URN)10.1016/j.deman.2023.100194 (DOI)001154927400001 ()38463606 (PubMedID)2-s2.0-85182889973 (Scopus ID)
Funder
Swedish Foundation for Strategic Research, IRC15-0067
Note

This work was supported by NIH SBIR 2R44DK110005-02, Strategic Research Area Exodiab Dnr 2009-1039, and the Swedish Foundation for Strategic Research Dnr IRC15-0067.

Available from: 2024-02-14 Created: 2024-02-14 Last updated: 2024-03-19Bibliographically approved
Skagerström, J., Fernemark, H., Nilsen, P., Seing, I., Hårdstedt, M., Karlsson, E. & Schildmeijer, K. (2023). Challenges of primary health care leadership during the COVID-19 pandemic in Sweden: a qualitative study of managers' experiences. Leadership in Health Services, 36(3), 389-401
Open this publication in new window or tab >>Challenges of primary health care leadership during the COVID-19 pandemic in Sweden: a qualitative study of managers' experiences
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2023 (English)In: Leadership in Health Services, ISSN 1751-1879, E-ISSN 1751-1887, Vol. 36, no 3, p. 389-401Article in journal (Refereed) Published
Abstract [en]

Purpose: At the outbreak of the COVID-19 pandemic, health care was at the centre of the crisis. New demands made existing organizational practices and services obsolete. Primary health care had a great deal of responsibility for COVID-19-related care. The pandemic demanded effective leadership to manage the new difficulties. This paper aims to explore experiences and perceptions of managers in primary health care in relation to their efforts to manage the COVID-19 crisis in their everyday work.

Design/methodology/approach: The authors used a qualitative approach based on 14 semi-structured interviews with managers in primary health care from four regions in Sweden. The interviews were conducted during September to December 2020. Data were analysed using conventional qualitative content analysis.

Findings: Data analysis yielded three categories: lonely in decision-making; stretched to the limit; and proud to have coped. The participants felt lonely in their decision-making, and they were stretched to the limit of their own and the organization's capacity. The psychosocial working conditions in primary care worsened considerably during the pandemic because demands on leaders increased while their ability to control the work situation decreased. However, they also expressed pride that they and their employees had managed the situation by being flexible and having a common focus.

Originality/value: Looking ahead and using lessons learnt, and apart from making wise decisions under pressure, an important implication for primary health-care leaders is to not underestimate the power of acknowledging the virtues of humanity and justice during a crisis. Continuing professional education for leaders focusing on crisis leadership could help prepare leaders for future crises.

Place, publisher, year, edition, pages
Emerald Group Publishing Limited, 2023
Keywords
Health care, Leadership, Management, General practice, Crisis leadership
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-111700 (URN)10.1108/LHS-08-2022-0089 (DOI)000932156800001 ()36786773 (PubMedID)2-s2.0-85148111144 (Scopus ID)
Available from: 2024-02-19 Created: 2024-02-19 Last updated: 2024-02-19Bibliographically approved
Hårdstedt, M. & Seiler, C. (2023). Swimming-Induced Pulmonary Edema: Respiratory Pathogens as a Potential Risk Factor. Chest, 163(5)
Open this publication in new window or tab >>Swimming-Induced Pulmonary Edema: Respiratory Pathogens as a Potential Risk Factor
2023 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 163, no 5Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
American College of Chest Physicians, 2023
National Category
Occupational Health and Environmental Health
Identifiers
urn:nbn:se:oru:diva-105907 (URN)10.1016/j.chest.2023.01.001 (DOI)001001194500001 ()37164569 (PubMedID)2-s2.0-85153529094 (Scopus ID)
Note

Funding agencies:

Center for Clinical Research Dalarna-Uppsala University (CKF)

Regional Research Council Mid Sweden

Available from: 2023-05-11 Created: 2023-05-11 Last updated: 2024-03-06Bibliographically approved
Kristiansson, L., Seiler, C., Lundeqvist, D., Braman Eriksson, A., Sundh, J. & Hårdstedt, M. (2023). Symptom duration, recurrence and long-term effects of swimming-induced pulmonary edema: a 30-month follow-up study. Chest, 164(5), 1257-1267
Open this publication in new window or tab >>Symptom duration, recurrence and long-term effects of swimming-induced pulmonary edema: a 30-month follow-up study
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2023 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 164, no 5, p. 1257-1267Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Swimming-induced pulmonary edema (SIPE) has been reported to subside within 24-48 hours, but comprehensive follow-up studies on symptom duration and long-term effects are missing.

RESEARCH QUESTION: What is the symptom duration, recurrence, and long-term effects of SIPE?

STUDY DESIGN AND METHODS: A follow-up study was conducted based on 165 cases of SIPE from Sweden's largest open water swimming event with 26,125 individuals participating during 2017-2019. Data on patient characteristics, clinical findings and symptoms were collected upon admission. Telephone interviews at 10 days and 30 months were performed to explore symptom duration, recurrence of SIPE symptoms, need of medical evaluation and long-term effects of self-assessed general health and physical activity level.

RESULTS: Follow-up at 10 days was performed for 132 cases and at 30 months for 152 cases. Most of the cases were women and mean age was 48 years. At the 10-day follow-up, symptom duration >2 days after the swimming race were reported by 38%. The most common symptoms were dyspnea and cough. In patients followed for 30 months, recurrence of respiratory symptoms during open water swimming was reported by 28%. In multivariable logistic regression, asthma was independently associated with both symptom duration >2 days and recurrence of SIPE symptoms (p =0.045 and p =0.022 respectively). Most participants reported equal or improved general health (93%) and physical activity level (85%) after experiencing SIPE, but 58% had not swum in open water since the event.

INTERPRETATION: The present large cohort study challenges the established hallmark of SIPE symptom duration of <48 hours, while SIPE recurrence was in the previously reported range. At 30 months, most patients reported unchanged self-assessed general health and physical activity level. These findings add to our understanding of the course of SIPE and can provide evidence-based information to swimmers and health care professionals.

Place, publisher, year, edition, pages
American College of Chest Physicians, 2023
Keywords
Cohort, SIPE, exercise, long-term effects, recurrence, swimming-induced pulmonary edema, symptom duration
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-107029 (URN)10.1016/j.chest.2023.06.041 (DOI)001110166300001 ()37414334 (PubMedID)2-s2.0-85172253421 (Scopus ID)
Note

Financial support was provided by the Center for Research and Development, Uppsala University/Region Gavleborg and the Center for Clinical Research Dalarna-Uppsala University.

Available from: 2023-07-07 Created: 2023-07-07 Last updated: 2024-03-06Bibliographically approved
Seiler, C. & Hårdstedt, M. (2022). Response [Letter to the editor]. Chest, 162(2), e109-e109
Open this publication in new window or tab >>Response
2022 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 162, no 2, p. e109-e109Article in journal, Letter (Other academic) Published
Place, publisher, year, edition, pages
American College of Chest Physicians (ACCP), 2022
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-100554 (URN)10.1016/j.chest.2022.04.005 (DOI)000877107900015 ()35940664 (PubMedID)2-s2.0-85135547020 (Scopus ID)
Available from: 2022-08-12 Created: 2022-08-12 Last updated: 2024-03-06Bibliographically approved
Gonzalez Lindh, M., Ställberg, B., Hårdstedt, M., Malinovschi, A., Bröms, K., Lisspers, K., . . . Högman, M. (2022). Subjective swallowing symptoms in COPD - a 2-year follow up: a 2-year follow up. In: : . Paper presented at ERS (European Respiratory Society), Barcelona, Spain, Sept 2022..
Open this publication in new window or tab >>Subjective swallowing symptoms in COPD - a 2-year follow up: a 2-year follow up
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2022 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Respiratory Medicine and Allergy Cardiology and Cardiovascular Disease
Research subject
Lung Medicine; Cardiology
Identifiers
urn:nbn:se:oru:diva-111673 (URN)
Conference
ERS (European Respiratory Society), Barcelona, Spain, Sept 2022.
Available from: 2024-02-19 Created: 2024-02-19 Last updated: 2025-02-10Bibliographically approved
Seiler, C., Kristiansson, L., Klingberg, C., Sundh, J., Eriksson, A. B., Lundeqvist, D., . . . Hårdstedt, M. (2022). Swimming-induced pulmonary edema: evaluation of prehospital treatment with continuous positive airway pressure or positive expiratory pressure device. Chest, 162(2), 410-420
Open this publication in new window or tab >>Swimming-induced pulmonary edema: evaluation of prehospital treatment with continuous positive airway pressure or positive expiratory pressure device
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2022 (English)In: Chest, ISSN 0012-3692, E-ISSN 1931-3543, Vol. 162, no 2, p. 410-420Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Swimming-induced pulmonary edema (SIPE) occasionally occurs during swimming in cold open water. While optimal treatment for SIPE is unknown, non-invasive positive pressure ventilation (NPPV) is an option for prehospital treatment.

RESEARCH QUESTION: Is NPPV a feasible and safe prehospital treatment for SIPE, and which outcome measures reflect recovery after treatment?

STUDY DESIGN AND METHODS: A prospective observational study was conducted at Vansbrosimningen, Sweden's largest open water swimming event, in 2017-2019. Swimmers diagnosed with SIPE and with peripheral oxygen saturation (SpO2) ≤95% and/or persistent respiratory symptoms were eligible for the study. NPPV was administered on-site as continuous positive airway pressure (CPAP) by facial mask or as positive expiratory pressure device (PEP-device). Discharge criteria were SpO2 >95% and clinical recovery. Four outcome measures were evaluated: SpO2, crackles on pulmonary auscultation, pulmonary edema on lung ultrasound (LUS) and patient-reported respiratory symptoms.

RESULTS: Of 119 treated individuals, 94 received CPAP, 24 PEP-device and one required tracheal intubation. In total, 108 (91%) individuals were discharged after NPPV for median 10-20 minutes, 11 (9%) required hospital transfer. NPPV resulted in increased SpO2 from median 91% to 97% (p<0.0001) together with improvement of six patient-reported respiratory symptoms (median numerical rating scales 1-7 to 0-1; p<0.0001). No significant decrease in auscultation of crackles (93% vs 87%, p=0.508) or pulmonary edema on LUS (100% vs 97%, p=0.500) was seen during NPPV-treatment.

INTERPRETATION: NPPV administered as CPAP or PEP-device proved feasible and safe as prehospital treatment for SIPE with a vast majority of patients discharged on-site. SpO2 and patient-reported respiratory symptoms reflected recovery after treatment, whereas pulmonary auscultation or LUS did not.

Place, publisher, year, edition, pages
American College of Chest Physicians, 2022
Keywords
CPAP, Continuous positive airway pressure, PEP-device, SIPE, lung ultrasound, positive expiratory pressure device, swimming-induced pulmonary edema, treatment, ultrasonography
National Category
Respiratory Medicine and Allergy
Identifiers
urn:nbn:se:oru:diva-98089 (URN)10.1016/j.chest.2022.02.054 (DOI)000863173400023 ()35288117 (PubMedID)2-s2.0-85134311908 (Scopus ID)
Note

Funding agencies:

Center for Clinical Research Dalarna-Uppsala University (CKF)

Center for Research and Development

Uppsala University/Region Gävleborg(CFUG)

Ester Åsberg Lindbergs Foundation

Available from: 2022-03-21 Created: 2022-03-21 Last updated: 2024-03-06Bibliographically approved
Mathabire Rücker, S. C., Gustavsson, C., Rücker, F., Lindblom, A. & Hårdstedt, M. (2022). Transmission of COVID-19 among healthcare workers: an epidemiological study during the first phase of the pandemic in Sweden. Epidemiology and Infection, 150, Article ID e68; PII S0950268822000231.
Open this publication in new window or tab >>Transmission of COVID-19 among healthcare workers: an epidemiological study during the first phase of the pandemic in Sweden
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2022 (English)In: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 150, article id e68; PII S0950268822000231Article in journal (Refereed) Published
Abstract [en]

During the first phase of the COVID-19 pandemic in 2020, concerns were raised that healthcare workers (HCWs) were at high risk of infection. The aim of this study was to explore transmission of COVID-19 among HCWs during a staff outbreak at an inpatient ward in Sweden 1 March to 31 May 2020. A mixed methods approach was applied using several data sources. In total, 152 of 176 HCWs participated. The incidence of COVID-19 among HCWs was 33%. Among cases, 48 (96%) performed activities involving direct contact with COVID-19 patients. Contact tracing connected 78% of cases to interaction with another contagious co-worker. Only a few HCWs cases reported contact with a confirmed COVID-19 case at home (n=6; 12%) or in the community (n=3; 6%). Multiple logistic regression identified direct care of COVID-19 patients and positive COVID-19 family contact as risk factors for infection (adjusted OR 8.4 and 9.0 respectively). Main interventions to stop the outbreak were physical distancing between HCWs, reinforcement of personal hygiene routines and rigorous surface cleaning. The personal protective equipment used in contact with patients was not changed in response to the outbreak. We highlight HCW-to-HCW transmission of COVID-19 in a hospital environment and the importance of preventing droplet and contact transmission between co-workers.

Place, publisher, year, edition, pages
Cambridge University Press, 2022
Keywords
COVID-19, health care workers, infection prevention and control, personal protective equipment, Sweden
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-98213 (URN)10.1017/S0950268822000231 (DOI)000776561000001 ()35272735 (PubMedID)
Note

Funding agency:

Center for Clinical Research Dalarna-Uppsala University CKFUU-938675 CKFUU-942768

Available from: 2022-03-22 Created: 2022-03-22 Last updated: 2024-03-06Bibliographically approved
Fernemark, H., Skagerstrom, J., Seing, I., Hårdstedt, M., Schildmeijer, K. & Nilsen, P. (2022). Working conditions in primary healthcare during the COVID-19 pandemic: an interview study with physicians in Sweden. BMJ Open, 12(2), Article ID e055035.
Open this publication in new window or tab >>Working conditions in primary healthcare during the COVID-19 pandemic: an interview study with physicians in Sweden
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2022 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 2, article id e055035Article in journal (Refereed) Published
Abstract [en]

Objective: The aim of this study was to explore how the COVID-19 pandemic changed the working conditions of physicians in Swedish primary healthcare.

Design: This is a descriptive, qualitative study with individual semistructured interviews. Data were analysed using inductive content analysis. Setting Swedish primary healthcare units in both rural and urban areas.

Participants: A total of 11 primary care physicians fulfilled participation.

Results: Two main categories emerged: 'work organisation and routines' and 'psychosocial work environment', containing three and five subcategories, respectively. The pandemic enforced changes in work organisation and routines. Increased flexibility, including more patient-oriented delivery of care, and novel means of interorganisational and intraorganisational interactions were perceived as positive by physicians. The pandemic also caused several changes in physicians' psychosocial work environment. Increased workload, information overload, as well as ethical considerations and feelings of uncertainty made the work environment stressful for physicians.

Conclusions: The COVID-19 pandemic affected the working conditions of physicians in Swedish primary healthcare in numerous ways. The pandemic enforced changes in work organisation and routines for physicians in primary healthcare. Further research is needed to investigate how the pandemic will affect primary healthcare in the longer term. Learning from the pandemic is important because this will not be the last crisis that primary care and its healthcare professionals will face.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022
Keywords
COVID-19, primary care, health services administration & management
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-111671 (URN)10.1136/bmjopen-2021-055035 (DOI)000754022100063 ()35135771 (PubMedID)2-s2.0-8512428615 (Scopus ID)
Available from: 2024-02-19 Created: 2024-02-19 Last updated: 2024-02-21Bibliographically approved
Rücker, F., Hårdstedt, M., Rücker, S. C., Aspelin, E., Smirnoff, A., Lindblom, A. & Gustavsson, C. (2021). From chaos to control - experiences of healthcare workers during the early phase of the COVID-19 pandemic: a focus group study. BMC Health Services Research, 21(1), Article ID 1219.
Open this publication in new window or tab >>From chaos to control - experiences of healthcare workers during the early phase of the COVID-19 pandemic: a focus group study
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2021 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 21, no 1, article id 1219Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Coronavirus disease 2019 (COVID-19) pandemic has caused overwhelming challenges to healthcare systems worldwide. Healthcare workers (HCWs) have faced particular challenges: being exposed to the coronavirus SARS-CoV-2 and caring for patients having a new and potentially life-threatening disease. The aim of this study was to explore how HCWs in the Swedish healthcare system perceived their work situation during the first phase of the COVID-19 pandemic in 2020.

METHODS: Focus group discussions and interviews with HCWs were performed from June to October 2020 in one Swedish healthcare region. A purposeful sampling approach was used to select a variety of professions (physicians, nurses, nurse aides and cleaners) and workplaces (hospital inpatient wards, emergency department, nursing home and home care service). Qualitative content analysis was used for data analysis.

RESULTS: In total, 51 HCWs participated in eight focus group discussions and one HCW participated in an individual interview. The content analysis identified two main categories: 'Concerns about the risk of infection and transmission of infection to others', and 'Transition from chaos to managing in a new and challenging work situation'. The findings revealed how HCWs perceived working conditions, including experiences of fear for personal health, confusion and uncertainty regarding personal protective equipment and infection prevention and control (PPE/IPC), and fear of infecting others. Both fearful and appreciating attitudes were achieved from the surrounding community. Helpful strategies for transition from chaos to control were lifted i.e. present and supportive leadership, and finding comfort and strength in the working team. Both helplessness and meaningfulness were described when caring for COVID-19 patients.

CONCLUSIONS: This study provides unique insights into HCWs experiences of an extremely challenging work situation during the first phase of the COVID-19 pandemic, including feelings of stress and insecurity in a chaotic and hazardous working environment. But there is also mitigation of these challenges and even positive experiences including feelings of safety and meaningfulness. To enhance safety among HCWs in healthcare crises such as the COVID-19 pandemic, the findings highlight the importance of avoiding confusion about PPE/IPC, having a supportive healthcare leadership and ensuring accurate information provision about virus transmission to the public.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2021
Keywords
Coronavirus disease 2019, Health personnel, Infection control, Mental health, Occupational health, Patient care, Qualitative research
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-95398 (URN)10.1186/s12913-021-07248-9 (DOI)000716931500001 ()34758837 (PubMedID)2-s2.0-85118827387 (Scopus ID)
Note

Funding agencies:

Center for Clinical Research Dalarna

Uppsala University

Available from: 2021-11-12 Created: 2021-11-12 Last updated: 2024-03-06Bibliographically approved
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