Background: As global aging accelerates, routinely assessing the functional status and morbidity burden of older patients becomes paramount. The aim of this study is to assess the validity of the comprehensive clinical and functional Health Assessment Tool (HAT) based on four cohorts of older adults (60 + years) from the Swedish National study on Aging and Care (SNAC) spanning urban, suburban, and rural areas.

Methods: The HAT integrates five health indicators (gait speed, global cognition, number of chronic diseases, and basic and instrumental activities of daily living), providing an individual-level score between 0 and 10. The tool was constructed using nominal response models, first separately for each cohort and then in a harmonized dataset. Outcomes included all-cause mortality over a maximum follow-up of 16 years and unplanned hospital admissions over a maximum of 3 years of follow-up. The predictive capacity was assessed through the area under the curve (AUC) using logistic regressions. For time to death, Cox regressions were performed, and Harrell’s C-indices were reported. Results from the four cohorts were pooled using individual participant data meta-analysis and compared with those from the harmonized dataset.

Results: The HAT demonstrated high predictive capacity across all cohorts as well as in the harmonized dataset. In the harmonized dataset, the AUC was 0.84 (95% CI 0.81–0.87) for 1-year mortality, 0.81 (95% CI 0.80–0.83) for 3-year mortality, 0.80 (95% CI 0.79–0.82) for 5-year mortality, 0.69 (95% CI 0.67–0.70) for 1-year unplanned admissions, and 0.69 (95% CI 0.68–0.70) for 3-year unplanned admissions. The Harrell’s C for time-to-death throughout 16 years of follow-up was 0.75 (95% CI 0.74–0.75).

Conclusions: The HAT is a highly predictive, clinically intuitive, and externally valid instrument with potential for better addressing older adults’ health needs and optimizing risk stratification at the population level. © The Author(s) 2024.

The advent of powered toothbrushes and associated mobile health applications provides an opportunity to collect and monitor the data, however collecting reliable and standardized data from large populations has been associated with efforts from the participants and researchers. Finding a way to collect data autonomously and without the need for cooperation imparts the potential to build large knowledge banks. A solution with Bluetooth low energy technology is designed to pair a powered toothbrush with a single-core processor to collect raw data in a real-time scenario, eliminating the manual transfer of powered toothbrush data with mobile health applications. Associating powered toothbrush with a single-core processor is believed to provide reliable and comprehensible data of toothbrush use and propensities can be a guide to improve individual exhortation and general plans on oral hygiene quantifies that can prompt improved oral wellbeing. The method makes a case for an expanded chance to plan assistant capacities to protect or improve factors that influence oral wellbeing in individuals with mild cognitive impairment. The proposed framework assists with determining various parameters, which makes it adaptable and conceivable to execute in various oral care contexts 

Background: Traditionally, assessing the degree of ossification in the epiphyseal plate for growth plate development relies on manual evaluation, which can be inefficient due to the complexities of the distal femoral epiphysis anatomy. Existing methods lack efficient detection techniques.

Method: This study proposes an AI-based decision support system, designed within a product-service system (PSS) framework, to automate ossification assessment and detection of the distal femoral epiphysis in knee magnetic resonance imaging (MRI) data. The system leverages advanced machine learning techniques, specifically two Convolutional Neural Networks (CNNs), combined with computer vision techniques. This intelligent system analyzes MRI slices to predict the optimal slice for analysis and identify variations in the degree of ossification within individual datasets.

Results: The proposed method's effectiveness is demonstrated using a set of T2-weighted gradient echo grayscale knee MRI data. The system successfully detects the complex anatomy of the distal femoral epiphysis, revealing variations in the degree of ossification ranging from completely closed/open to fully open/closed regions.

Conclusions: This study presents a robust and efficient AI-based method, integrated within a PSS framework, for measuring the degree of ossification in the distal femoral epiphysis. This approach automates ossification assessment, providing valuable insights for clinical decision-making by clinicians and forensic practitioners. The PSS framework ensures seamless integration of the AI technology into existing workflows.

Background: Older people's use of the internet is increasingly coming into focus with the demographic changes of a growing older population. Research reports several benefits of older people's internet use and highlights problems such as various forms of inequality in use within the group. There is a need for consistent measurements to follow the development and use of the internet in this group and to be able to compare groups both within and between countries, as well as follow the changes over time. Objective: The aim of this study was to create an instrument to measure an older person's perception of the benefits of their online social participation, unconnected to specific applications and services. The instrument to measure internet social participation proposed in this paper builds on social participation factors and is a multidimensional construct incorporating both social relations and societal connectedness. Methods: A short instrument for measuring social participation over the internet was created. An exploratory factor analysis (EFA) was conducted in a random selection of persons aged 65 years or older (n=193) on 10 initial items. Further validation was made by confirmatory factor analysis (CFA) in the remaining group (n=193). Results: A 1-factor solution for the social internet score was decided upon after exploratory factor analysis (EFA; based on a random sample of half the data set). None of the questionnaire items were excluded based on the EFA, as they all had high loadings, the lowest being 0.61. The Cronbach α coefficient was.92. The 1-factor solution explained 55% of the variance. CFA was performed and included all 10 questionnaire items in a 1-factor solution. Indices of goodness of fit of the model showed room for improvement. Removal of 4 questions in a stepwise procedure resulted in a 6-item model (χ26=13.985; χ2/degrees of freedom=1.554; comparative fit index=0.992; root mean square error of approximation=0.054; standardized root mean square residual=0.025). Conclusions: The proposed instrument can be used to measure digital social participation and coherence with society. The factor analysis is based on a sufficient sample of the general population of older adults in Sweden, and overall the instrument performed as expected. © Peter Anderberg, Linda Abrahamsson, Johan Sanmartin Berglund. Originally published in JMIR Aging (https://aging.jmir.org),17.05.2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Aging, is properly cited. The complete bibliographic information, a link to the original publication on https://aging.jmir.org, as well as this copyright and license information must be included.

Background: Many countries are witnessing a trend of growth in the number and proportion of older adults within the total population. In Europe, population aging has had and will continue to have major social and economic consequences. This is a fundamentally positive development where the added life span is of great benefit for both the individual and the society. Yet, the risk for the individual to contract noncommunicable diseases and disability increases with age. This may adversely affect the individual's ability to live his or her life in the way that is desired. Cognitive conditions constitute a group of chronic diseases that predominantly affects older people. Recent technology advancements can help support the day-to-day living activities at home for people with cognitive impairments. Objective: A digital platform (Support Monitoring and Reminder for Mild Dementia; SMART4MD) is created to improve or maintain the quality of life for people with mild cognitive impairment (PwMCI) and their carers. The platform will provide reminders, information, and memory support in everyday life, with the purpose of giving structure and lowering stress. In the trial, we will include participants with a diagnosed neurocognitive disorder as well as persons with an undiagnosed subjective memory problem and cognitive impairment, that is, 20 to 28 points on the Mini-Mental State Examination. Methods: A pragmatic, multicenter RCT is being conducted in Spain, Sweden, and Belgium. The targets for recruitment are 1200 dyads-split into an intervention group and a control group that are in usual care. Intervention group participants will be provided with a data-enabled computer tablet with the SMART4MD app. Its core functionalities, intended to be used daily at home, are based on reminders, cognitive supporting activities, and sharing health information. Results: Inclusion of participants started in December 2017, and recruitment is expected to end in February 2019. Furthermore, there will be 3 follow-up visits at 6, 12, and 18 months after the baseline visit. Conclusions: This RCT is expected to offer benefits at several levels including in-depth knowledge of the possibilities of introducing a holistic multilayered information and communication technology solution for this group. SMART4MD has been developed in a process involving the structured participation of PwMCI, their informal carers, and clinicians. The adoption of SMART4MD faces the challenge of this age group's relative unfamiliarity with digital devices and services. However, this challenge can also be an opportunity for developing a digital device tailored to a group at risk of digital exclusion. This research responds to the wider call for the development of digital devices which are accessible and affordable to older people and this full scale RCT can hopefully serve as a model for further studies in this field.

Background: The use of health technology by older people is coming increasingly in focus with the demographic changes. Health information technology is generally perceived as an important factor in enabling increased quality of life and reducing the cost of care for this group. Age-appropriate design and facilitation of technology adoption are important to ensure functionality and removal of various barriers to usage. Development of assessment tools and instruments for evaluating older persons' technology adoption and usage as well as measuring the effects of the interventions are of high priority. Both usability and acceptance of a specific technology or service are important factors in evaluating the impact of a health information technology intervention. Psychometric measures are seldom included in evaluations of health technology. However, basic attitudes and sentiments toward technology (eg, technophilia) could be argued to influence both the level of satisfaction with the technology itself as well as the perception of the health intervention outcome. Objective: The purpose of this study is to develop a reduced and refined instrument for measuring older people's attitudes and enthusiasm for technology based on relevant existing instruments for measuring technophilia A requirement of the new instrument is that it should be short and simple to make it usable for evaluation of health technology for older people. Methods: Initial items for the TechPH questionnaire were drawn from a content analysis of relevant existing technophilia measure instruments. An exploratory factor analysis was conducted in a random selection of persons aged 65 years or older (N=374) on eight initial items. The scale was reduced to six items, and the internal consistency and reliability of the scale were examined. Further validation was made by a confirmatory factor analysis (CFA). Results: The exploratory factor analysis resulted in two factors. These factors were analyzed and labeled techEnthusiasm and techAnxiety. They demonstrated relatively good internal consistency (Cronbach alpha=.72 and .68, respectively). The factors were confirmed in the CFA and showed good model fit (chi(2)(8)=21.2, chi(2)/df=2.65, comparative fit index=0.97, adjusted goodness-of-fit index=0.95, root mean square error of approximation=0.067, standardized root mean square residual=0.036). Conclusions: The construed TechPH score showed expected relations to external real-world criteria, and the two factors showed interesting internal relations. Different technophilia personality traits distinguish clusters with different behaviors of adaptation as well as usage of new technology. Whether there is an independent association with the TechPH score against outcomes in health technology projects needs to be shown in further studies. The instrument must also be validated in different contexts, such as other countries.

The use of the internet has considerably increased over recent years, and the importance of internet use has also grown as services have gone online. Sweden is largely an information society like other countries with high reported use amongst European countries. In line with digitalization development, society is also changing, and many activities and services today take place on the internet. This development could potentially lead to those older persons who do not use the internet or do not follow the development of services on the internet finding it difficult to take part in information and activities that no longer occur in the physical world. This has led to a digital divide between groups, where the older generations (60+), in particular, have been affected. In a large study of Sweden's adult population in 2019, 95 percent of the overall population was said to be internet users, and the corresponding number for users over 66 years of age was 84%. This study shows that the numbers reported about older peoples' internet use, most likely, are vastly overestimated and that real use is significantly lower, especially among the oldest age groups. We report that 62.4% of the study subjects are internet users and that this number most likely also is an overestimation. When looking at nonresponders to the questionnaire, we find that they display characteristics generally attributed to non-use, such as lower education, lower household economy, and lower cognitive functioning.

BACKGROUND: Loneliness is described as a public health problem and can be both a consequence of aging and a cause of ill health. Lonely older adults tend to have difficulties making new social connections, essential in reducing loneliness. Loneliness often varies over time, but established loneliness tends to persist. Maintaining good health is fundamental throughout the life course. Social connections change with aging, which can contribute to loneliness. AIM: This study aimed to investigate loneliness in relation to social factors and self-reported health among older adults. METHOD: A cross-sectional research design was used based on data from the Swedish National Study on Aging and Care, Blekinge (SNAC-B), from February 2019 to April 2021. Statistical analysis consisted of descriptive and inferential analysis. RESULTS: Of n = 394 participants, 31.7% (n = 125) stated loneliness. Close emotional connections were necessary for less loneliness. Loneliness was more common among those who did not live with their spouse or partner and met more rarely. Furthermore, seeing grandchildren and neighbors less often increased loneliness, and a more extensive social network decreased loneliness. CONCLUSION: This study underlined the importance of social connections and having someone to share a close, emotional connection with to reduce loneliness.

Background: Poor sleep is a potential modifiable risk factor for later life development cognitive impairment. The aim of this study is to examine if subjective measures of sleep duration and sleep disturbance predict future cognitive decline in a population-based cohort of 60, 66, 72 and 78-year-olds with a maximal follow up time of 18 years. Methods: This study included participants from the Swedish National Study on Ageing and Care – Blekinge, with assessments 2001–2021. A cohort of 60 (n = 478), 66 (n = 623), 72 (n = 662) and 78 (n = 548) year-olds, were assessed at baseline and every 6 years until 78 years of age. Longitudinal associations between sleep disturbance (sleep scale), self-reported sleep duration and cognitive tests (Mini Mental State Examination and the Clock drawing test) were examined together with typical confounders (sex, education level, hypertension, hyperlipidemia, smoking status, physical inactivity and depression). Results: There was an association between sleep disturbance at age 60 and worse cognitive function at ages 60, 66 and 72 years in fully adjusted models. The association was attenuated after bootstrap-analysis for the 72-year-olds. The items of the sleep scale most predictive of later life cognition regarded nightly awakenings, pain and itching and daytime naps. Long sleep was predictive of future worse cognitive function. Conclusion: Sleep disturbance was associated with worse future cognitive performance for the 60-year-olds, which suggests poor sleep being a risk factor for later life cognitive decline. Questions regarding long sleep, waking during the night, pain and itching and daytime naps should be further explored in future research and may be targets for intervention. © 2022

Background: Early diagnosis of cognitive disorders is becoming increasingly important. Limited resources for specialist assessment and an increasing demographical challenge warrants the need for efficient methods of evaluation. In response, CoGNIT, a tablet app for automatic, standardized, and efficient assessment of cognitive function, was developed. Included tests span the cognitive domains regarded as important for assessment in a general memory clinic (memory, language, psychomotor speed, executive function, attention, visuospatial ability, manual dexterity, and symptoms of depression). Objective: The aim of this study was to assess the feasibility of automatic cognitive testing with CoGNIT in older patients with symptoms of mild cognitive impairment (MCI). Methods: Patients older than 55 years with symptoms of MCI (n=36) were recruited at the research clinic at the Blekinge Institute of Technology (BTH), Karlskrona, Sweden. A research nurse administered the Mini-Mental State Exam (MMSE) and the CoGNIT app on a tablet computer. Technical and testing issues were documented. Results: The test battery was completed by all 36 patients. One test, the four-finger-tapping test, was performed incorrectly by 42% of the patients. Issues regarding clarity of instructions were found in 2 tests (block design test and the one finger-tapping test). Minor software bugs were identified. Conclusions: The overall feasibility of automatic cognitive testing with the CoGNIT app in patients with symptoms of MCI was good. The study highlighted tests that did not function optimally. The four-finger-tapping test will be discarded, and minor improvements to the software will be added before further studies and deployment in the clinic. © 2022 JMIR Publications Inc.. All right reserved.

Objective. To evaluate if the presence of periodontitis is associated with carotid arterial calcifications diagnosed on panoramic radiographs in an elderly population. Materials and methods. Study individuals were randomly selected from the Swedish civil registration database representing the aging population (60-96 years) in Karlskrona, Sweden. Bleeding on probing (BOP) and the deepest probing measurement at each tooth were registered. The proportions of teeth with a probing depth 5 mm and the proportion of teeth with bleeding on probing were calculated. Analog panoramic radiographs were taken and the proportion of sites with a distance 5 mm between the alveolar bone level and the cement-enamel junction (CEJ) were assessed. A diagnosis of periodontitis was declared if a distance between the alveolar bone level and the CEJ 5 mm could be identified from the panoramic radiographs at >10% of sites, probing depth of 5 mm at one tooth or more and with BOP at >20% of teeth. Results. Readable radiographs were obtained from 499 individuals. Carotid calcification was identified in 39.1%. Individuals were diagnosed with periodontitis in 18.4%. Data analysis demonstrated that individuals with periodontitis had a higher prevalence of carotid calcifications (Pearson (2) = 4.05 p < 0.05) and with a likelihood of 1.5 (95% CI = 1.0, 2.3, p < 0.05). Conclusions. Data analysis demonstrated a significant association between periodontitis and carotid calcification.

Objective: The present study assessed if individuals ≥ 60 years of age with periodontitis are more likely to develop stroke or ischemic heart diseases, or at a higher risk of death for 17 years. Material and methods: At baseline individuals ≥ 60 received a dental examination including a panoramic radiograph. Periodontitis was defined as having ≥ 30% sites with ≥ 5-mm distance from the cementoenamel junction to the marginal bone level. Medical records were annually reviewed from 2001 to 2018. Findings from the medical records identifying an ICD-10 code of stroke and ischemic heart diseases or death were registered. Results: Associations between periodontitis and incidence of ischemic heart disease were found in this 17-year follow-up study in all individuals 60–93 years (HR: 1.5, CI: 1.1–2.1, p = 0.017), in women (HR: 2.1, CI: 1.3–3.4, p = 0.002), and in individuals 78–96 years (HR: 1.7, CI: 1.0–2.6, p = 0.033). Periodontitis was associated with mortality in all individuals (HR: 1.4, CI: 1.2–1.8, p = 0.002), specifically in men (HR: 1.5, CI: 1.1–1.9, p = 0.006) or in ages 60–72 years (HR: 2.2, CI: 1.5–3.2, p = 0.000). Periodontitis was more prevalent among men (OR: 1.8, CI: 1.3–2.4, p = 0.000). Conclusions: Individuals with periodontitis have an increased risk for future events of ischemic heart diseases and death. Clinical relevance: Improving periodontal health in older individuals may reduce overall mortality and ischemic heart diseases. Both dental and medical professionals should be aware of the associations and ultimately cooperate. © 2021, The Author(s).

In a 5-y retrospective follow-up study in southern Sweden that initially included > 1000 individuals with previously diagnosed erythema migrans, factors that influenced the risk of reinfection with Lyme borreliosis were elucidated. The total frequency of reinfection was 4% and the number of tick bites influenced the risk of reinfection: those bitten > 10 times during the observation period had a 4-8-fold increased risk compared with those bitten < 5 times. Women manifested to a greater extent than men although both genders were bitten equally by ticks, thus indicating that women may be more susceptible to reinfection. All reinfected women were > 44 y old. The county of Kalmar including Oland was found to be highly endemic for reinfection with Lyme borreliosis. Thus the number of tick bites, gender, age and study area influenced the risk of reinfection.

In a 5 y retrospective follow-up study in southern Sweden of 708 adult individuals with erythema migrans as the single manifestation of Lyme borreliosis, the clinical outcome and the antibiotic treatment were studied. 80%, were treated with phenoxymethyl penicillin, 15% with doxycycline and 5% with other antibiotics. Phenoxymethyl penicillin and doxycycline were extremely effective: 98 and 94% of the individuals reported complete recovery without complications. Few individuals reported the development of new symptoms following treatment and none developed any late manifestation of Lyme borreliosis during the observation period. Thus, in the area studied the treatment of the early localized manifestation of Lyme borreliosis (erythema migrans) with antibiotics was extremely successful. The current Swedish recommendation to use phenoxymethyl penicillin, when no sign of disseminated infection or coinfection with other tick-borne pathogens is present, seems excellent.

Aim: The aim in this survey was to study the clinical characteristics of infections caused by Borrelia genospecies in patients with erythema migrans where Borrelial origin was confirmed by polymerase chain reaction. The aim was also to study factors influencing the clinical appearance of erythema migrans. Methods: The study was conducted in southern Sweden from May 2001 to December 2003 on patients 18 years and older attending with erythema migrans at outpatient clinics. All erythema migrans were verified by polymerase chain reaction, photographed and categorized into “annular” or “non-annular” lesions. A logistic regression model was used to analyze relations between the appearance of the erythema migrans (i.e., annular or non-annular) and factors that influenced its clinical appearances. Results: A total of 118 patients, 54 women (45.8%) and 64 men (54.2%), fulfilled the inclusion criteria. Of these patients, 74% were infected by B. afzelii, 26% by B. garinii ( p < 0.001). A total of 45% (38/85) of the erythema migrans were annular, 46% (39/85) were non-annular and 9.4% (8/85) were atypical. For men infected by B. afzelii the odds ratio of developing non-annular erythema migrans was 0.09 (95% CI: 0.03 - 0.33) in comparison with women with the same infection. Conclusions: In this prospective study of a large series of erythema migrans, where infecting genospecies were confirmed by polymerase chain reaction, the sex of patients infected with B. afzelii had a strong influence on the appearance of the rash. Patients infected by B. garinii more often had non-annular erythema migrans and a more virulent infection with more individuals presenting with fever, raised levels of C-reactive protein and seroreactivity in the convalescence sera.

Background: The aim of this study was to describe and categorize the different predominant patterns of PCR confirmed erythema migrans (EM) and to study possible correlations according to the clinical pictures and Borrelia substrains. Methods: Patients over 18 years old, seeking care with tick exposure and an EM were consecutively included during a study period of three years. We evaluated clinical and laboratory findings with regard to Borrelia burgdorferi s.l. spirochetes detected with nested Osp A PCR in skin biopsy specimens. Laboratory and serology testing were done acute, after 6 weeks and after 6 months. The patients were clinically evaluated at the initial visit and repeatedly after 14 days unitl recovery. Results: 118 patients (women=54, men=64) with a positive B. Burgdorferi s.l. PCR analysis were included. In this area totally 73.7% of the EM were caused by B. afzelii and 26.3% by B. garinii (p=0.0001). Leisons caused by B. garinii had a shorter duration from tick bite to the initial visit (p= 0.001) but there were no differences between the sizes of the EM, indicating a faster development of lesions caused by B. garinii. Patients with lesions caused by B. garinii to a greater extent had presented with fever at the initial visit (p=0.02). Also patients with B. garinii lesions to a greater extent had elevated levels of CRP at the initial visit (p=0.006). 45% of the EM were categorized as “annular”, 27% as “homogeneous”, 19% as “central erythemas” and 9% as “atypical”. The lesions caused by B. afzelii were predominately “annular” and the lesions caused by B. gaarinii were predominately “homogeneous”. Conclusions: In this study most EM were caused by B. afzelii. Leisons caused by B. garinii developed faster and the patients to a greater extent presented with fever and elevated levels of CRP at the initial visit. Leisons caused by B. garinii were mostly homogenous and by B. afzelii were mostly annular.

The aim of the present study was to investigate the long-term incidence rate of Lyme borreliosis and, additionally, to determine whether a correlation exists between climatic factors and summer-season variations in the incidence of Lyme borreliosis. Climatic variability acts directly on tick population dynamics and indirectly on human exposure to Lyme borreliosis spirochetes. In this study, conducted in primary healthcare clinics in southeastern Sweden, electronic patient records from 1997-2003 were searched for those that fulfilled the criteria for erythema migrans. Using a multilevel Poisson regression model, the influence of various climatic factors on the summer-season variations in the incidence of erythema migrans were studied. The mean annual incidence rate was 464 cases of erythema migrans per 100,000 inhabitants. The incidence was significantly higher in women than in men, 505 and 423 cases per 100,000 inhabitants, respectively (p<0.001). The summer-season variations in the erythema migrans incidence rate correlated with the monthly mean summer temperatures (incidence rate ratio 1.12; p<0.001), the number of winter days with temperatures below 0 degrees C (incidence rate ratio 0.97; p<0.001), the monthly mean summer precipitation (incidence rate ratio 0.92; p<0.05), and the number of summer days with relative humidity above 86% (incidence rate ratio 1.04; p<0.05). In conclusion, Lyme borreliosis is highly endemic in southeastern Sweden. The climate in this area, which is favourable not only for human tick exposure but also for the abundance of host-seeking ticks, influences the summer-season variations in the incidence of Lyme borreliosis.

The aim is to highlight the influence of patients’ gender on Lyme borreliosis and especially erythema migrans (EM), focusing on exposure to tick bites, epidemiology, and the clinical picture. All studies were conducted in the county of Blekinge, located in southeastern Sweden. A prospective study was conducted in 235 individuals (women, n=110; men, n=125) engaged in recreational or occupational activities focusing on exposure to tick bites. A retrospective epidemiological study evaluating 123,495 electronic patients´ records (women, n=61,712; men, n=61,783) and a prospective clinical study including 118 patients (women, n=54; men, n=64) 18 years or older seeking care for EM > 5 cm in diameter with genospecies verified by polymerase chain reaction were conducted. Results: Women 40 years or older had a 48% higher risk than men 40 years or older and 42% higher risk than women younger than 40 years of attracting tick bites (0.0188 versus 0.0127 and 0.0188 versus 0.0132 tick bites respectively per hour). Additionally they had a 96% higher risk than men younger than 40 years of attracting tick bites (0.0188 versus 0.0096). The annual incidence rate of EM in women was 506 and in men 423 cases per 100,000 inhabitants (p<0.001). Significant differences in incidence rates occurred in those 40 years or older. Odds ratios for males infected with Borrelia afzelii developing nonannular EM were 0.09 (95% confidence interval [CI] 0.03 to 0.33) in comparison with females infected by Borrelia afzelii. Conclusions: Significant gender differences in the risk of contracting tick bites, incidence rates, and clinical picture of EM have been observed. Exposure to tick bites alone may not explain these observations and further studies need to be done to clarify the biologic, immunologic, and sociological mechanisms causing these differences.

OBJECTIVE: The aim of this study was to describe the association between ischaemic heart disease (IHD), diabetes mellitus (DM) and heart failure (HF) and the prevalence of cognitive impairment. METHODS: In a cross-sectional, community-based study in Karlskrona, Sweden, 1402 participants of the Swedish National Study on Ageing and Care (60-96 y) underwent a medical examination and psychological testing including the Mini Mental State Examination (MMSE). Of these, 58% stated that they were treated for hypertension, IHD, DM or HF, or had ECG abnormalities (positive screen). RESULTS: The prevalence of cognitive impairment (MMSE score < 24) in patients treated for IHD, DM or HF was 28.5% compared to 16.1% in the population with a negative screen without cardiovascular disease or DM. After stratification by age, the difference was seen to be due to a higher prevalence of cognitive impairment in the age group 70-79 y, where 68.8% of the cognitively impaired came from the group treated for IHD, DM or HF. The odds ratio for cognitive impairment in this age group was 4.4 (95% CI 1.7-11.4), when compared to those with a negative screen as baseline. CONCLUSION: This study has shown that the patient group treated for IHD, DM or HF has a higher prevalence of cognitive impairment and a higher risk of developing early cognitive impairment between the ages of 70 and 79 y. Although this study has not provided conclusive evidence that cardiovascular disease and DM are associated with the early development of cognitive impairment, it provides incentive for further studies.

Abstract Objective. We assessed the relationships between (I) ultrasonography calcaneus T-scores (PIXI) and mandibular cortex characteristics on oral panoramic radiographs in older subjects; and (II) osteoporosis and periodontitis. Material and methods. We examined 778 subjects (53% women) aged 59-96 years. Periodontitis was defined by alveolar bone loss assessed from panoramic radiographs. Results. PIXI calcaneus T-values ≤-2.5 (osteoporosis) were found in 16.3% of women and in 8.1% of men. PIXI calcaneus T-values <-1.6 (osteoporosis, adjusted) were found in 34.2% of women and in 21.4% of men. The age of the subjects and PIXI T-values were significantly correlated in women (Pearson's r = 0.37, P < 0.001) and men (Pearson's r = 0.19, P < 0.001). Periodontitis was found in 18.7% of subjects defined by alveolar bone level ≥5 mm. Subjects with osteoporosis defined by adjusted PIXI T-values had fewer remaining teeth [mean difference 4.1, 95% confidence interval (CI) -1.1 to -6.5, P < 0.001]. The crude odds ratio (OR) of an association between the panoramic assessment of mandibular cortex erosions as a sign of osteoporosis and the adjusted T-value (T-value cut-off <-1.6) was 4.8 (95% CI 3.1-7.2, P < 0.001; Pearson χ(2) = 60.1, P < 0.001). A significant OR between osteoporosis and periodontitis was only found in women for the T-value cut-off ≤-2.5 (crude OR 1.8, 95% CI 1.1-3.3, P < 0.03). Conclusions. An association between osteoporosis and periodontitis was only confirmed in women. The likelihood that the mandibular cortex index agrees with adjusted PIXI T-values is significant.

The objective of this follow-up study was to determine the long-term outcome of strictly classified cases of neuroborreliosis treated with antibiotics. A one-year prospective population-based survey of Lyme borreliosis was conducted in southern Sweden, between 1992 and 1993. A total of 349 identified cases with suspected neuroborreliosis were followed up 5 years later. Medical records were reviewed and all participants filled in a questionnaire. Of those classified with definite neuroborreliosis 114/130 completed the follow-up, of whom 111 had completed the initial antibiotic treatment. Of the 114 patients followed up, 86 (75%) had recovered completely and 70 (61%) had recovered within 6 months. Residual neurological symptoms such as facial palsy, concentration disorder, paresthesia and/or neuropathy were reported by 28/114. No significant differences between different antibiotic treatments were observed in terms of occurrence of sequelae. To conclude, we found that 25% (95% confidence interval 17-33%) of the patients suffered from residual neurological symptoms 5 years post-treatment. However, the clinical outcome of treated neuroborreliosis is favourable as only 14/114 (12%) of the patients had sequelae that influenced their daily activity post-treatment. Early diagnosis and treatment would seem to be of great importance in order to avoid such sequelae.

The objective of this follow-up study was to determine the long-term outcome in patients treated with antibiotics for strictly classified cases of neuroborreliosis. A one-year prospective population-based survey of Lyme borreliosis was conducted in southern Sweden, 1992-1993. Totally 349 identified cases with suspected neuroborreliosis were registered. Of those, 130 were classified as definitively neuroborreliosis and followed up five years later. Medical records were reviewed and all participants filled in a questionnaire. Totally, 114/130 (88%) completed the follow-up of whom 111/114 (97%) had fulfilled the initial antibiotic treatment. Of these, 86/114 (75%) had recovered completely and 70 (61%) recovered within six months. However 28/114 (25%) suffered from remaining neurological symptoms such as facial palsy, concentration disorder, paresthesia and/or neuropathy. The longer the duration from the neurological symptoms onset to antibiotic treatment the higher was the rate of sequelae. Of those who were treated within 30 days 5/32 (16%) and of those who were treated after 30 days 16/41 (39%) respectively, reported sequelae. Women suffered significantly more from sequelae compared to men, this difference was not seen among the children. No significant differences between the different antibiotic treatments given and experience of sequelae were seen. To conclude, we found that 25% (95% CI 17% to 33%) of the patients suffered from remaining neurological symptoms five years post treatment. However, the clinical outcome of treated neuroborreliosis is favourable as only 14/114 (12%) of the patients had sequelae that influenced their daily activity post treatment and early diagnosis and treatment seems to be of great importance to possibly avoid also these cases.

We investigated a protein-based nontypeable Haemophilus influenzae (NTHi) and pneumococcal (HiP) vaccine containing pneumococcal histidine triad D (PhtD), detoxified pneumolysin (dPly), and NTHi protein D (PD) in adults. In a phase I study, 40 healthy 18- to 40-year-old subjects were randomized (2:2:1) to receive two HiP doses administered 60 days apart, with or without AS03 adjuvant (HiP-AS and HiP groups, respectively), or Engerix B (GlaxoSmithKline, Belgium) as a control. Safety, antibodies, and antigen-specific CD4+ T-cell immune responses were assessed before and until 480 days after vaccination. No serious adverse events were reported, and no subject withdrew due to an adverse event. Local and systemic symptoms were reported more frequently in the HiP-AS group than in the other two groups. The frequency and intensity of local and systemic symptoms appeared to increase after the second dose of HiP-AS or HiP but not Engerix B. Antibody geometric mean concentrations (GMCs) for PhtD, dPly, and PD increased after each dose of HiP-AS or HiP, with higher GMCs being observed in the HiP-AS group (statistically significant for anti-PD after dose 1 and anti-Ply after dose 2). GMCs remained higher at day 420 than prior to vaccination in both the HiP-AS and HiP groups. Antigen-specific CD4+ T cells increased after each dose but were unmeasurable by day 480. Two doses of an investigational PhtD-dPly-PD protein vaccine induced humoral immunity and antigen-specific CD4+ T-cell responses after each dose, with generally higher responses when the vaccine was administered with AS03. HiP combined with AS03 appeared to be more reactogenic than the antigens alone. (This study has been registered at ClinicalTrials.gov under registration no. NCT00814489.)

Background: Frail older adults are high consumers of medical care due to their age and multiple chronic conditions. Regular contact with a case manager has been proven to increase well-being of frail older adults and reduce their number of health-care visits. Skype calls through tablet PCs can offer easier communication. Objective: This paper examines frail older adults’ use of tablet computers and Skype, with their case managers.Method: Interviews were conducted on 15 frail older adults. A content analysis was used to structure and analyze the data. Results: The results indicate that tablet computers were experienced in a positive way for most frail older adults. Conflicting feelings did emerge, however, as to whether the frail elderly would adopt this in the long run. Skype needs to be tested further as to whether this is a good solution for communication with their case managers. Strong technical support and well-functioning technology are important elements to facilitate use. Conclusion: Using Skype and tablet PCs do have potential for frail older adults, but need to be tested further. © 2015 Taylor & Francis

Background The Internet and information communication technology is today considered as a means to sustain active and healthy aging, and to provide better care for the aging population. There is an increase in prevalence in older adults using the Internet, however many are still not using the Internet. This study therefore, investigated predictors in starting and stopping Internet use by older adults between 2001-2013 in Sweden and the Netherlands. These represent currently two of the highest older adult Internet users in Europe. The aim of this study was to examine, first, if there was a different starting and stopping rate in Sweden and the Netherlands; second, if the predictors age, gender, education, rural/urban living, living alone/not, cognition and functional limitations have different effects in either country. Methods A cross-national and longitudinal design was chosen. Data was used from the Longitudinal Aging study Amsterdam (LASA) and the Swedish National Study on Aging and Care (SNAC). Cox regression analyses were done to test the predictors over time with starting or stopping Internet use. An interaction term ‘variable*country’ was then considered for each variable, if significant, leading to a stratification into a multivariate model per country. Results More older adults started use in the Netherlands (19%); lower in age, normal cognitive functioning, living alone, fewer functional limitations and lower education were predictive of starting. In Sweden fewer started (10.3%), where being female was the only significant predictor of starting use. Both countries did not have many people stopping use; in the Netherlands (3%) they were younger in age and living urban, whereas in Sweden (1.7%), they had lower cognitive functioning. Conclusion Results indicate that there are differences between countries in starting use. These differences can possibly be explained by the early adoption of the Internet in Sweden. The new findings that the older adults living alone and lower educated are now going online, are positive regarding the theme of active aging. For those stopping use, the differences are more country-specific. More research is needed in order to understand better what an older adult was using the Internet for and why they stop. © 2016. Gerontechnology. All Rights Reserved.

Objectives: Maintaining good cognitive function with aging may be aided by technology such as computers, tablets, and their applications. Little research so far has investigated whether internet use helps to maintain cognitive function over time.Design: Two population-based studies with a longitudinal design from 2001/2003 (T1) to 2007/2010 (T2).Setting: Sweden and the Netherlands.Participants: Older adults aged 66 years and above from the Swedish National Study on Ageing and Care (N = 2,564) and from the Longitudinal Aging Study Amsterdam (N = 683).Measurements: Internet use was self-reported. Using the scores from the Mini-Mental State Examination (MMSE) from T1 and T2, both a difference score and a significant change index was calculated. Linear and logistic regression analysis were performed with difference score and significant change index, respectively, as the dependent variable and internet use as the independent variable, and adjusted for sex, education, age, living situation, and functional limitations. Using a meta-analytic approach, summary coefficients were calculated across both studies.Results: Internet use at baseline was 26.4% in Sweden and 13.3% in the Netherlands. Significant cognitive decline over six years amounted to 9.2% in Sweden and 17.0% in the Netherlands. Considering the difference score, the summary linear regression coefficient for internet use was-0.32 (95% CI:-0.62,-0.02). Considering the significant change index, the summary odds ratio for internet use was 0.54 (95% CI: 0.37, 0.78).Conclusions: The results suggest that internet use might play a role in maintaining cognitive functioning. Further research into the specific activities that older adults are doing on the internet may shine light on this issue. © 2019 International Psychogeriatric Association.

Older adults need to participate in the digital society, as societal and personal changes and what they do with the remaining time that they have in their older years has an undeniable effect on motivation, cognition and emotion. Changes in personality traits were investigated in older adults over the period 2019–2021. Technology enthusiasm and technology anxiety are attitudes that affect the relationship to the technology used. The changes in the score of technology enthusiasm and technology anxiety were the dependent variables. They were investigated with personality traits, age, gender, education, whether someone lives alone, cognitive function, digital social participation (DSP) and health literacy as predictors of the outcome. The Edwards-Nunnally index and logistic regression were used. The results indicated that DSP, lower age, lower neuroticism and higher education were indicative of less technology anxiety. High DSP and high extraversion are indicative of technology enthusiasm. DSP and attitude towards technology seem to be key in getting older adults to stay active online. © The Author(s) 2023.

Background: Europe has called attention to the importance of the e-inclusion of older adults. Society is indicating that the developers, websites, and devices are causing age bias in technology. This affects living independently, the values of ethical principles associated with an older person, and digital ageism: which is an age-related bias in artificial intelligence systems. Objective: This research attempts to investigate the instrument technology anxiety and enthusiasm, and assistive technology devices during the period 2019- 2021. This instrument may be a way to redress misconceptions about digital ageism. The assistive technology device that we will investigate in this study is the adoption of a service that is designed for online health consultations. Method: The participants are part of the longitudinal Swedish National Study on Aging and Care. Technology anxiety and technology enthusiasm are two factors, which aim to measure technophilia (vs technophobia) in older adults. The age range is 63 -99 years of age in 2019 T1 and 66 -101 in 2021 T2. Wilcoxon rank test was conducted to investigate technology enthusiasm, technology anxiety, and how they changed with time. An Edwards Nunnally index was then calculated for both variables to observe a significant change in score from T1 to T2. Mann Whitney U test was used to investigate the variables sex and health status with technology anxiety & technology enthusiasm in T1 & T2. Age, Cognitive function MMSE, and digital social participation were investigated through a Kruskall-Wallis test. A logistic regression was conducted with the significant variable. Results: Between 2019-2021, change in technology enthusiasm was based on less digital social participation (OR: 0.608; CI 95%: 0.476- 0.792). Technology anxiety was significantly higher due to age (OR: 1.086, CI 95%: 1.035-1.139) and less digital social participation (OR: 0.684; CI 95%: 0.522- 0.895). The want for online healthcare consultations was popular but usage was low. Conclusion: Staying active on- line and participating digitally may be a way to reduce digital ageism. However, digital ageism is a complex phenomenon, which requires different solutions in order to include older people and reduce an inaccurate categorisation of this group in the digital society.

Older adults living in rural and urban areas have shown to distinguish themselves in technology adoption; a clearer profile of their Internet use is important in order to provide better technological and health-care solutions. Older adults' Internet use was investigated across large to midsize cities and rural Sweden. The sample consisted of 7181 older adults ranging from 59 to 100 years old. Internet use was investigated with age, education, gender, household economy, cognition, living alone/or with someone and rural/urban living. Logistic regression was used. Those living in rural areas used the Internet less than their urban counterparts. Being younger and higher educated influenced Internet use; for older urban adults, these factors as well as living with someone and having good cognitive functioning were influential. Solutions are needed to avoid the exclusion of some older adults by a society that is today being shaped by the Internet.

Objectives: This paper investigated factors associated with internet usage in the Swedish older adults ranging in age from 60 to 96. Personality traits and individual characteristics have been previously noted to influence internet usage, where older adults have not been the focus population. In this study the relationships between personality, individual characteristics and internet usage were investigated. Methods: A descriptive analysis of the personality tests of a total of 1402 subjects included in the Swedish National Study on Aging and Care (SNAC) was conducted. Three variables were controlled for: sex, age and education. Descriptive statistics, Mann-Whitney and Kruskal-Wallis tests, chi square tests and a logistic regression were used in order to detect the relationships with internet usage. Results: Men differ significantly from women in the personality traits analysis. Those with higher education were more open and neuroticism was lower in the oldest older adults. Internet usage declined significantly with age and those with middle to higher education were using the internet the most. No other associations with internet use were found Conclusion: Personality traits and individual characteristics do not seem to influence the Swedish older adult and their internet usage. What one needs to account for is the age and education of the person. The more educated and the youngest cohorts were using the internet more frequently.

The increased reliance on Internet use in social functions has presumably left out a part of the population: the oldest-older adults. These are people who have not kept themselves up to date with the technological developments for various reasons. There are, however, exceptions from whom we have something to learn. This study investigates the older people in Sweden who started to use the Internet over a period of 6 years. Cognition, extraversion, openness, functional disability, household economy, sex, age and education were investigated in relation to starting to use the Internet. A chi-square test, Spearman correlation and a logistic regression analysis were conducted. It was found that higher cognition, being male and being between the ages of 60 and 80 years were determining factors in starting to use the Internet for the Swedish older adult. Our results indicate that the oldest-older adults are slow to adapt to using the Internet and more attention should be paid on how to support this group.

Efficacy against herpes zoster and immune responses to the adjuvanted recombinant zoster vaccine plateaued at high levels between 5.1 and 7.1 years (mean) post-vaccination, suggesting that its clinical benefit in older adults is sustained for at least 7 years post-vaccination. Background This ongoing follow-up study evaluated the persistence of efficacy and immune responses for 6 additional years in adults vaccinated with the glycoprotein E (gE)-based adjuvanted recombinant zoster vaccine (RZV) at age >= 50 years in 2 pivotal efficacy trials (ZOE-50 and ZOE-70). The present interim analysis was performed after >= 2 additional years of follow-up (between 5.1 and 7.1 years [mean] post-vaccination) and includes partial data for year (Y) 8 post-vaccination. Methods Annual assessments were performed for efficacy against herpes zoster (HZ) from Y6 post-vaccination and for anti-gE antibody concentrations and gE-specific CD4[2+] T-cell (expressing >= 2 of 4 assessed activation markers) frequencies from Y5 post-vaccination. Results Of 7413 participants enrolled for the long-term efficacy assessment, 7277 (mean age at vaccination, 67.2 years), 813, and 108 were included in the cohorts evaluating efficacy, humoral immune responses, and cell-mediated immune responses, respectively. Efficacy of RZV against HZ through this interim analysis was 84.0% (95% confidence interval [CI], 75.9-89.8) from the start of this follow-up study and 90.9% (95% CI, 88.2-93.2) from vaccination in ZOE-50/70. Annual vaccine efficacy estimates were >84% for each year since vaccination and remained stable through this interim analysis. Anti-gE antibody geometric mean concentrations and median frequencies of gE-specific CD4[2+] T cells reached a plateau at approximately 6-fold above pre-vaccination levels. Conclusions Efficacy against HZ and immune responses to RZV remained high, suggesting that the clinical benefit of RZV in older adults is sustained for at least 7 years post-vaccination.

The genetic polymorphism of Borrelia burgdorferi and Borrelia afzelii, two species that cause Lyme borreliosis, was estimated by sequence typing of four loci: the rrs-rrlA intergenic spacer (IGS) and the outer-membrane-protein gene p66 on the chromosome, and the outer-membrane-protein genes ospA and ospC on plasmids. The major sources of DNA for PCR amplification and sequencing were samples of the B. burgdorferi tick vector Ixodes scapularis, collected at a field site in an endemic region of the north-eastern United States, and the B. afzelii vector Ixodes ricinus, collected at a similar site in southern Sweden. The sequences were compared with those of reference strains and skin biopsy isolates, as well as database sequences. For B. burgdorferi, 10-13 alleles for each of the 4 loci, and a total of 9 distinct clonal lineages with linkage of all 4 loci, were found. For B. afzelii, 2 loci, ospC and IGS, were examined, and 11 IGS genotypes, 12 ospC alleles, and a total of 9 linkage groups were identified. The genetic variants of B. burgdorferi and B. afzelii among samples from the field sites accounted for the greater part of the genetic diversity previously reported from larger areas of the north-eastern United States and central and northern Europe. Although ospC alleles of both species had higher nucleotide diversity than other loci, the ospC locus showed evidence of intragenic recombination and was unsuitable for phylogenetic inference. In contrast, there was no detectable recombination at the IGS locus of B. burgdorferi. Moreover, beyond the signature nucleotides that specified 10 IGS genotypes, there were additional nucleotide polymorphisms that defined a total of 24 subtypes. Maximum-likelihood and parsimony cladograms of B. burgdorferi aligned IGS sequences revealed the subtype sequences to be terminal branches of clades, and the existence of at least three monophyletic lineages within B. burgdorferi. It is concluded that B. burgdorferi and B. afzelii have greater genetic diversity than had previously been estimated, and that the IGS locus alone is sufficient for strain typing and phylogenetic studies.

Partial sequencing of the 16S-23S rDNA intergenic spacer showed two to four genotypes each for Borrelia hermsii and B. turicatae, both relapsing fever agents transmitted by argasid ticks, and for B. miyamotoi and B. lonestari, transmitted by ixodid ticks. Field surveys of Ixodes ticks in Connecticut and Sweden showed limited local diversity for B. miyamotoi.

Digital health technologies such as mobile health (mHealth) are considered to have the potential to support the needs of older adults with cognitive impairment. However, the evidence for improving health with the use of mHealth applications is of limited quality. Few studies have reported on the consequences of technology use concerning the older adults' quality of life. The purpose of this study was to describe perceptions of mHealth and its impact on health-related quality of life (HRQoL) among older adults with cognitive impairment. The study was conducted using a qualitative design with a phenomenographic approach. A total of 18 older participants with cognitive impairment were interviewed. The interviews were analyzed in order to apply phenomenography in a home-care context. The results showed variations in the older adults' perceptions that were comprised within three categories of description; Require technology literacy, Maintain social interaction, and Facilitate independent living. In conclusion, the development and design of mHealth technologies need to be tailored based on older adults´ needs in order to be understood and perceived as useful in a home-care context. For mHealth to support HRQoL, healthcare should be provided in a way that encourages various forms of communication and interaction.

Background: Quality of life (QoL) is affected even at early stages in older adults with cognitive impairment. The use of mobile health (mHealth) technology can offer support in daily life and improve the physical and mental health of older adults. However, a clarification of how mHealth technology can be used to support the QoL of older adults with cognitive impairment is needed. Objective: To investigate factors affecting mHealth technology use in relation to self-rated QoL among older adults with cognitive impairment. Methods: A cross-sectional research design was used to analyse mHealth technology use and QoL in 1,082 older participants. Baseline data were used from a multi-centered randomized controlled trial including QoL, measured by the Quality of Life in Alzheimer's Disease (QoL-AD) Scale, as the outcome variable. Data were analyzed using logistic regression models. Results: Having moderately or high technical skills in using mHealth technology and using the internet via mHealth technology on a daily or weekly basis was associated with good to excellent QoL in older adults with cognitive impairment. Conclusions: The variation in technical skills and internet use among the participants can be interpreted as an obstacle for mHealth technology to support QoL.

Aim: This study aimed to identify factors affecting health-related quality of life (HRQoL) of older adults with cognitive impairment and to describe the association of these factors with different components of HRQoL. Design: A cross-sectional, descriptive research design was used. Methods: Data were collected from 247 individuals aged 60 years and older from a Swedish longitudinal cohort study. The Short-Form Health Survey-12 (SF-12) and EuroQol (EQ-5D) were used to assess HRQoL. The data were analysed using descriptive and comparative statistics. Results: The present study identified several factors that influenced HRQoL of older adults with cognitive impairment. The results of a multiple logistic regression analysis revealed that the following factors were associated with physical and mental HRQoL: dependency in activities of daily living (ADL), receiving informal care and feelings of loneliness and pain. © 2019 The Authors. Nursing Open published by John Wiley & Sons Ltd.

Objective This study aimed to analyze the oral health status of four different birth cohorts: two cohorts of 60-year-olds born in 1941-1943 and 1954-1955 and 2 cohorts of 81-year-olds born in 1920-1922 and 1933-1934. Material and methods The study was based on data from an ongoing longitudinal population project, The Swedish National Study on Aging and Care (SNAC). Oral health status was repeatedly examined clinically and radiographically in 2001-2003 and 2014-2015, including 60- and 81-year-olds, in total 412 individuals. Statistical analyses were performed using independent-samples t test and Pearson's chi(2) test. Results More individuals were dentate in 2014-2015 compared to 2001-2003 in the two age groups: 60 and 81 years (p < 0.001 for both). The mean number of teeth increased in the 60-year-olds from 24.2 to 27.0 and in the 81-year-olds from 14.3 to 20.2. The numbers of at least one intact tooth increased for both age groups (p < 0.001 and p < 0.004, respectively). In the age groups 81 years, there was an increase in having at least one PPD >= 6 mm (p < 0.016) and bone loss >= 5 mm (p < 0.029) between the two examinations. No such differences were found in the age groups of 60 years. Conclusion Over 13 years, oral health improved for both 60- and 81-year-old age groups. The most significant changes were in the 81-year-olds where oral health had improved except for periodontal status.

Objective: This study investigated oral health status in 60-year-old individuals over 12 years.

Materials and Methods: Data were obtained from The Swedish National Study on Aging and Care (SNAC). One hundred nineteen 60-year-old individuals (48% females) underwent a clinical and radiographic baseline examination (2001–2003) and follow-up examination in 2013–2015. For statistical analyses, paired t-tests and McNemar's test were performed. Statistical significance was determined at p < 0.05.

Results: At the 12-year follow-up, the mean number of teeth and the proportion of individuals having ≥ 20 teeth decreased (p < 0.001). The mean number of teeth with buccal/lingual and approximal caries lesions increased (p < 0.029 and p < 0.031). Individuals with a distance from the cement-enamel junction to the bone of ≥ 5 mm increased in total (p < 0.002) and in males (p < 0.006). The prevalence of gingivitis increased in total (p < 0.001). The prevalence of periodontitis showed a significant increase in total (p < 0.043) and in females (p < 0.039).

Conclusion: The present study indicates that oral health status in 60-year-old individuals deteriorates over 12 years. However, the deteriorations were minor in terms of tooth loss, caries lesions, and changes in periodontal status. © 2024 The Author(s). International Journal of Dental Hygiene published by John Wiley & Sons Ltd.

Background The assessment of bone age and skeletal maturity and its comparison to chronological age is an important task in the medical environment for the diagnosis of pediatric endocrinology, orthodontics and orthopedic disorders, and legal environment in what concerns if an individual is a minor or not when there is a lack of documents. Being a time-consuming activity that can be prone to inter- and intra-rater variability, the use of methods which can automate it, like Machine Learning techniques, is of value. Objective The goal of this paper is to present the state of the art evidence, trends and gaps in the research related to bone age assessment studies that make use of Machine Learning techniques. Method A systematic literature review was carried out, starting with the writing of the protocol, followed by searches on three databases: Pubmed, Scopus and Web of Science to identify the relevant evidence related to bone age assessment using Machine Learning techniques. One round of backward snowballing was performed to find additional studies. A quality assessment was performed on the selected studies to check for bias and low quality studies, which were removed. Data was extracted from the included studies to build summary tables. Lastly, a meta-analysis was performed on the performances of the selected studies. Results 26 studies constituted the final set of included studies. Most of them proposed automatic systems for bone age assessment and investigated methods for bone age assessment based on hand and wrist radiographs. The samples used in the studies were mostly comprehensive or bordered the age of 18, and the data origin was in most of cases from United States and West Europe. Few studies explored ethnic differences. Conclusions There is a clear focus of the research on bone age assessment methods based on radiographs whilst other types of medical imaging without radiation exposure (e.g. magnetic resonance imaging) are not much explored in the literature. Also, socioeconomic and other aspects that could influence in bone age were not addressed in the literature. Finally, studies that make use of more than one region of interest for bone age assessment are scarce. Copyright: © 2019 Dallora et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Background: Bone age assessment (BAA) is an important tool for diagnosis and in determining the time of treatment in a number of pediatric clinical scenarios, as well as in legal settings where it is used to estimate the chronological age of an individual where valid documents are lacking. Traditional methods for BAA suffer from drawbacks, such as exposing juveniles to radiation, intra- and interrater variability, and the time spent on the assessment. The employment of automated methods such as deep learning and the use of magnetic resonance imaging (MRI) can address these drawbacks and improve the assessment of age. Objective: The aim of this paper is to propose an automated approach for age assessment of youth and young adults in the age range when the length growth ceases and growth zones are closed (14-21 years of age) by employing deep learning using MRI of the knee. Methods: This study carried out MRI examinations of the knee of 402 volunteer subjects-221 males (55.0%) and 181 (45.0%) females-aged 14-21 years. The method comprised two convolutional neural network (CNN) models: the first one selected the most informative images of an MRI sequence, concerning age-assessment purposes; these were then used in the second module, which was responsible for the age estimation. Different CNN architectures were tested, both training from scratch and employing transfer learning. Results: The CNN architecture that provided the best results was GoogLeNet pretrained on the ImageNet database. The proposed method was able to assess the age of male subjects in the range of 14-20.5 years, with a mean absolute error (MAE) of 0.793 years, and of female subjects in the range of 14-19.5 years, with an MAE of 0.988 years. Regarding the classification of minors-with the threshold of 18 years of age-an accuracy of 98.1% for male subjects and 95.0% for female subjects was achieved. Conclusions: The proposed method was able to assess the age of youth and young adults from 14 to 20.5 years of age for male subjects and 14 to 19.5 years of age for female subjects in a fully automated manner, without the use of ionizing radiation, addressing the drawbacks of traditional methods. © 2019 Journal of Medical Internet Research. All rights reserved.

Objectives: We aimed to explore Swedish women's decision-making experiences regarding permanent contraception. Study design: In this study, we included 17 women aged 30–48 who were scheduled to undergo female permanent contraceptive procedures. We conducted semistructured interviews using two broad open-ended questions. We analyzed these data using systematic text condensation based on the principles of psychological phenomenological analysis. Results: The interviewees experienced no counseling or support from health care workers regarding permanent contraception until they specifically asked for it. Participants reported that they themselves place the responsibility of permanent contraception solely on women. Consequently, our participants described feeling hesitancy and ambivalence in the process of deciding to have the procedure. Once the decision was made and the women were on the waiting lists for surgery, they experienced relief and empowerment. Conclusions: Our findings suggest that health care providers in Sweden miss opportunities to support patient-centered decision-making regarding permanent contraception. This study indicates that women make deliberate and considered decisions regarding permanent contraception and are best positioned to know when the procedure should take place in their reproductive lives. Implication statements: Health care professionals should discuss permanent contraception as an option with all women desiring contraception to allow them to decide if that method is right for them. © 2020 Elsevier Inc.

Designing systems working in health care needs complying with the heterogeneous, overlapping, non-overlapping, competing, or even contradicting requirements expressed by the various actors of the health care complex environment, including regulatory bodies. The unification method introduced in this paper, utilized ontological struc- tures to unify heterogeneous requirements in different levels of ab- straction. Also the weighting and threshold algorithms defined upon the ontology structure allows to both prioritize the requirements and align design resources upon that priority, at the same time to enforce regulatory requirements in an easy, clear and integrated way and reject designs which cannot comply with them. Application of the method introduced in this paper is not limited to health care, but it might be applied in design for any heterogeneous environment.

Background: There are several frameworks that attempt to address the challenges of evaluation of health information systems by offering models, methods, and guidelines about what to evaluate, how to evaluate, and how to report the evaluation results. Model-based evaluation frameworks usually suggest universally applicable evaluation aspects but do not consider case-specific aspects. On the other hand, evaluation frameworks that are case specific, by eliciting user requirements, limit their output to the evaluation aspects suggested by the users in the early phases of system development. In addition, these case-specific approaches extract different sets of evaluation aspects from each case, making it challenging to collectively compare, unify, or aggregate the evaluation of a set of heterogeneous health information systems.

Objectives: The aim of this paper is to find a method capable of suggesting evaluation aspects for a set of one or more health information systems—whether similar or heterogeneous—by organizing, unifying, and aggregating the quality attributes extracted from those systems and from an external evaluation framework.

Methods: On the basis of the available literature in semantic networks and ontologies, a method (called Unified eValuation using Ontology; UVON) was developed that can organize, unify, and aggregate the quality attributes of several health information systems into a tree-style ontology structure. The method was extended to integrate its generated ontology with the evaluation aspects suggested by model-based evaluation frameworks. An approach was developed to extract evaluation aspects from the ontology that also considers evaluation case practicalities such as the maximum number of evaluation aspects to be measured or their required degree of specificity. The method was applied and tested in Future Internet Social and Technological Alignment Research (FI-STAR), a project of 7 cloud-based eHealth applications that were developed and deployed across European Union countries.

Results: The relevance of the evaluation aspects created by the UVON method for the FI-STAR project was validated by the corresponding stakeholders of each case. These evaluation aspects were extracted from a UVON-generated ontology structure that reflects both the internally declared required quality attributes in the 7 eHealth applications of the FI-STAR project and the evaluation aspects recommended by the Model for ASsessment of Telemedicine applications (MAST) evaluation framework. The extracted evaluation aspects were used to create questionnaires (for the corresponding patients and health professionals) to evaluate each individual case and the whole of the FI-STAR project.

Conclusions: The UVON method can provide a relevant set of evaluation aspects for a heterogeneous set of health information systems by organizing, unifying, and aggregating the quality attributes through ontological structures. Those quality attributes can be either suggested by evaluation models or elicited from the stakeholders of those systems in the form of system requirements. The method continues to be systematic, context sensitive, and relevant across a heterogeneous set of health information systems.

Background and Objectives

Survey-based evaluation of a system, such as measuring user’s satisfaction or patient-reported outcomes, entails a set of burdens that limits the feasibility, frequency, extendability, and continuity of the evaluation. Automating the evaluation process, that is reducing the burden of evaluators in questionnaire curation or minimizing the need for explicit user attention when collecting their attitudes, can make the evaluation more feasible, repeatable, extendible, continuous, and even flexible for improvement. An automated evaluation process can be enhanced to include features, such as the ability to handle heterogeneity in evaluation cases. Here, we represent the design of a system that makes it possible to have a semi-automated evaluation system. The design is presented and partially implemented in the context of health information systems, but it can be applied to other contexts of information system usages as well.

Method

The system was divided into four components. We followed a design research methodology to design the system, where each component reached a certain level of maturity. Already implemented and validated methods from previous studies were embedded within components, while they were extended with improved automation proposals or new features.

Results

A system was designed, comprised of four major components: Evaluation Aspects Elicitation, User Survey, Benchmark Path Model, and Alternative Metrics Replacement. All components have the essential maturity of identification of the problem, identification of solution objectives, and the overall design. In the overall design, the primary flow, process-entities, data-entities, and events for each component are identified and illustrated. Parts of some components have been already verified and demonstrated in real-world cases.

Conclusion

A system can be developed to minimize human burden, both for the evaluators and respondants, in survey-based evaluation. This system automates finding items to evaluate, creating questionnaire based on those items, surveying the users' attitude about those items, modeling the relations between the evaluation items, and incrementally changing the model to rely on automatically collected metrics, usually implicit indicators, collected from the users, instead of requiring their explicit expression of their attitudes. The system provides the possibility of minimal human burden, frequent repetition, continuity and real-time reporting, incremental upgrades regarding environmental changes, proper handling of heterogeneity, and a higher degree of objectivity.

Background:

Several models suggest how the qualities of a product or service influence user satisfaction. Models, such as the Customer Satisfaction Index (CSI), Technology Acceptance Model (TAM), and Delone and McLean Information Systems Success (D&M IS), demonstrate those relations and have been used in the context of health information systems.

Objective:

We want to investigate which qualities foster greater satisfaction among patient and professional users. In addition, we are interested in knowing to what extent improvement in those qualities can explain user satisfaction and if this makes user satisfaction a proxy indicator of those qualities.

Methods:

The Unified eValuation using ONtology (UVON) method was utilised to construct an ontology of the required qualities for seven e-health applications being developed in the FI-STAR project, a European Union (EU) project in e-health. The e-health applications were deployed across seven EU countries. The ontology included and unified the required qualities of those systems together with the aspects suggested by the Model for ASsessment of Telemedicine applications (MAST) evaluation framework. Two similar questionnaires, for 87 patient users and 31 health professional users, were elicited from the ontology. In the questionnaires, user was asked if the system has improved the specified qualities and if the user was satisfied with the system. The results were analysed using Kendall correlation coefficients matrices, incorporating the quality and satisfaction aspects. For the next step, two Partial Least Squares Structural Equation Modelling (PLS-SEM) path models were developed using the quality and satisfaction measure variables and the latent construct variables that were suggested by the UVON method.

Results:

Most of the quality aspects grouped by the UVON method are highly correlated. Strong correlations in each group suggest that the grouped qualities can be measures which reflect a latent quality construct. The PLS-SEM path analysis for the patients reveals that the effectiveness, safety, and efficiency of treatment provided by the system are the most influential qualities in achieving and predicting user satisfaction. For the professional users, effectiveness and affordability are the most influential. The parameters of the PLS-SEM that are calculated allow for the measurement of a user satisfaction index similar to CSI for similar health information systems.

Conclusions:

For both patients and professionals, the effectiveness of systems highly contributes to their satisfaction. Patients care about improvements in safety and efficiency, while professionals care about improvements in the affordability of treatments with health information systems. User satisfaction is reflected more in the users' evaluation of system output and fulfilment of expectations, but slightly less in how far the system is from ideal. Investigating satisfaction scores can be a simple, fast way to infer if the system has improved the abovementioned qualities in treatment and care.

Background

Evaluating and researching health information systems are interventions of their kind and might lead to ethical complexities and challenges. Most of those challenges are inherited from the more general fields of research and evaluation, health studies, and information systems studies. Beyond those challenges, this field has its particular traits, regarding the involved stakeholders, required values or qualities, or the process which can raise field-specific or context-specific ethical challenges.

Objectives

This paper reports and discusses some of the challenges of evaluating and researching health information systems by taking a systematic approach in finding, postulating, and analyzing them.

Method

Through a scoping review, a set of ethical challenges, regarding the evaluation and research of health information systems, were extracted. From the same set of articles, the acting entities, including stakeholders and artefacts, were identified. From a sample of seven cases of health information systems, a set of demanded impact qualities were extracted. From the literature, the evaluation stages were elicited. The acting entities, required qualities, and the evaluation stages were combined to create a three-dimensional space. The space contained the ethical challenges extracted from the scoping review and helped to postulate more items.

Results

The final list of identified items contains 20 possible ethical challenges that can be caused or raised by evaluating or researching health information systems and technologies. The ethical challenges are discussed, based on their probable stage of occurrence. The three-dimensional space and the method of populating it is proposed as an effective method in similar cases of discovering ethical challenges.

Conclusion

Evaluating or researching health information systems can raise ethical challenges, that we have identified 20 of them in this article. All the challenges were discussed, such as the actual value of evaluation, breach of privacy, risks for safety, problems with usability and accessibility, conflict of interests, problems with the informed consent, and miscommunication. The novel approach for elicitation of the ethical challenges introduced in this article might be applied in other similar studies.

Purpose of Study: To gain Swedish norm value for the Life Satisfaction Index-A (LSI-A) in a population 60–93+ years old stratified for sex and age and to relate these norm values with respect to number of chronic diseases and functional impairment. Materials and Methods: The study population included a random sample of 2656 men (45.7%) and 3159 (54.3%) women from the longitudinal national studies’ “Good Aging in Skåne” (GÅS) and SNAC-B, both part of the Swedish National Study on Aging and Care (SNAC). Data on Neugartens Life Satisfaction Index-A (LSI-A), medical history, activities of daily life (ADL) and socio-demographics were collected through structured interviews and questionnaires. Results: Men scored significantly higher than women; 28.5, sd=6.9, and 27.3, sd=6.6, respectively, out of maximum 40 points. For both genders the scores decreased with age, mean score 6.0 points, lower for men and 7.1 points lower for women between 60 and 93+ years. The highest score was noted for healthy individuals where both men and women scored 29.5 points, sd=6.2. Increased number of chronic diseases and dependency in ADLs were associated with lower LS. Conclusion: Norm values here presented may facilitate assessments and evaluation of life satisfaction in the general elder population and as reference values to clinical trials. Female sex, rising age, morbidity and impaired functional ability were all associated with impaired LS. © 2020 Elmståhl et al.

Background: Previous phase 3 studies showed that the AS01E-adjuvanted respiratory syncytial virus (RSV) prefusion F protein-based vaccine for older adults (RSVPreF3 OA) is well tolerated and efficacious in preventing RSV-associated lower respiratory tract disease in adults ≥ 60 years of age. This study evaluated lot-to-lot immunogenicity consistency, reactogenicity, and safety of three RSVPreF3 OA lots. Methods: This phase 3, multicenter, double-blind study randomized (1:1:1) participants ≥ 60 years of age to receive one of three RSVPreF3 OA lots. Serum RSVPreF3-binding immunoglobulin G (IgG) concentration was assessed at baseline and 30 days post-vaccination. Lot-to-lot consistency was demonstrated if the two-sided 95 % confidence intervals (CIs) of the RSVPreF3-binding IgG geometric mean concentration (GMC) ratios between each lot pair at 30 days post-vaccination were within 0.67 and 1.50. Solicited adverse events (AEs) within four days, unsolicited AEs within 30 days, and serious AEs (SAEs) and potential immune-mediated diseases within six months post-vaccination were recorded. Results: A total of 757 participants received RSVPreF3 OA, of whom 708 were included in the per-protocol set (234, 237, and 237 participants for each lot). Lot-to-lot consistency was demonstrated: GMC ratios were 1.06 (95 % CI: 0.94–1.21), 0.92 (0.81–1.04), and 0.87 (0.77–0.99) between the lot pairs (lot 1/2; 1/3; 2/3). For the three lots, the RSVPreF3-binding IgG concentration increased 11.84-, 11.29-, and 12.46-fold post-vaccination compared to baseline. The reporting rates of solicited and unsolicited AEs, SAEs, and potential immune-mediated diseases were balanced between lots. Twenty-one participants reported SAEs; one of these–a case of atrial fibrillation–was considered by the investigator as vaccine-related. SAEs with a fatal outcome were reported for four participants, none of which were considered by the investigator as vaccine-related. Conclusion: This study demonstrated lot-to-lot immunogenicity consistency of three RSVPreF3 OA vaccine lots and indicated that the vaccine had an acceptable safety profile. ClinicalTrials.gov: NCT05059301. © 2024 GSK

This paper presents a method for collecting core body temperature data via a temperature sensor integrated into a powered toothbrush. The purpose is to facilitate the collection of temperature data without any extended effort from the user. Twelve participants use a powered toothbrush with a temperature sensor mounted on the brush head twice daily for two months. The obtained values are compared with those from a conventional fever thermometer approved for intraoral use. The results show that the temperature sensor–integrated powered toothbrush can measure the core body temperature and provide values comparable to those provided by a traditional oral thermometer. The use of the device can facilitate disease monitoring, fertility control, and security solutions for the elderly. © 2022, The Author(s).