Lakartidningen [JOURNAL]
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200 papers
[Access to health data for research].
Gedeborg R, Holm L, Stattin P
Lakartidningen · 2026 Jun · PMID 42374799 · Publisher ↗
Secondary use of individual-level health data for research is cost-efficient but challenging. In the PCBase Xtend project, we collected PSA values, biopsy reports, MRI results, and chemotherapy data from all 21 regions a...
Secondary use of individual-level health data for research is cost-efficient but challenging. In the PCBase Xtend project, we collected PSA values, biopsy reports, MRI results, and chemotherapy data from all 21 regions and private healthcare providers in Sweden. The process required 46 applications over a period of almost 4 years and revealed major variability in IT systems, administrative routines, and costs. The time to data delivery ranged from weeks to years. Early quality checks were essential to correct errors in the data extraction. Despite challenges, >11 million PSA values, 550 000 prostate biopsies, 170 000 MRI results, and >6 million drug administrations could be added to PCBase for use in epidemiological studies of prostate cancer. Better administrative routines, data extraction integrated in IT systems, incentives for data migration, and national support structures are needed to improve access to health data for research.
[CANVAS and RFC1-related disease - a broad clinical spectrum from cough and neuropathy to cerebellar ataxia].
Andrén K, Paucar M, Thonberg H
Lakartidningen · 2026 Jun · PMID 42290619 · Publisher ↗
CANVAS (Cerebellar Ataxia, Neuropathy and Vestibular Areflexia Syndrome) is an autosomal recessive disorder caused by a pentanucleotide expansion in the RFC1 gene. It is likely the most common cause of autosomal recessiv...
CANVAS (Cerebellar Ataxia, Neuropathy and Vestibular Areflexia Syndrome) is an autosomal recessive disorder caused by a pentanucleotide expansion in the RFC1 gene. It is likely the most common cause of autosomal recessive ataxia in Sweden. The genetic basis of the disease was identified in 2019. The condition is slowly progressive with onset in mid-adulthood, typically beginning with sensory neuropathy, followed by progressive postural imbalance due to sensory and cerebellar ataxia and vestibular areflexia. Chronic cough is a common feature and may precede the neurological symptoms by years or even decades. Other typical findings include oscillopsia, dysarthria and autonomic dysfunction. Milder forms exist, with isolated neuropathy with or without chronic cough. We present two cases: one with the full CANVAS syndrome, and one with neuropathy associated with RFC1-related disease.
[Choosing wisely in Swedish neuroradiology].
Fällmar D, Björkman-Burtscher I, Blystad I
Lakartidningen · 2026 Jun · PMID 42281330 · Publisher ↗
The concept »Choosing wisely« was initiated in the United States in 2012, and is being implemented in many countries. The Swedish Society of Medicine decided to join the movement in 2020 under the Swedish name »Kloka kli...
The concept »Choosing wisely« was initiated in the United States in 2012, and is being implemented in many countries. The Swedish Society of Medicine decided to join the movement in 2020 under the Swedish name »Kloka kliniska val« (KKV). At the time of writing, some but far from all national medical specialty societies have published advice on choosing wisely adapted to Swedish conditions. This article presents a list of five wise imaging choices from the Swedish Society for Neuroradiology (SFNR), together with a few comments and an encouragement for other national societies to join in.
[Asthma among athletes - prevalence, diagnosis and treatment].
Lahti A, Andersson P, Lindman I
Lakartidningen · 2026 Jun · PMID 42272237 · Publisher ↗
Asthma is more common among athletes than in the general population. The diagnosis can be difficult to detect as objective examinations such as resting spirometry often remain normal and are masked by the athletes' good...
Asthma is more common among athletes than in the general population. The diagnosis can be difficult to detect as objective examinations such as resting spirometry often remain normal and are masked by the athletes' good cardio-pulmonary capacity, as well as overlapping with what is expected in a normal training response. Evaluation should include exercise testing and provocation in a real training environment. Training environments involving cold and dry air, as well as inhalation of chlorine compounds from pool water, can trigger asthmatic symptoms. Both over- and under-treatment occurs, which makes careful diagnosis and monitoring of prescribed treatment important. With proper treatment, athletes can train and compete on equal terms, and it is important to encourage physical activity among people with asthma.
[Minimally invasive surgery for colorectal cancer was introduced in a safe and well controlled manner].
Agger E, Tiefenthal M, Larsson C … +6 more , Odensten C, Axelsson L, Hager J, Bihl P, Prytz M, Matthiessen P
Lakartidningen · 2026 Jun · PMID 42266069 · Publisher ↗
The present nationwide population-based study compared minimally invasive surgery (MIS) with open surgery (OPEN) for colorectal cancer during a period when MIS was introduced in Sweden. The primary analyses demonstrated...
The present nationwide population-based study compared minimally invasive surgery (MIS) with open surgery (OPEN) for colorectal cancer during a period when MIS was introduced in Sweden. The primary analyses demonstrated that MIS was not inferior compared with OPEN regarding short-term outcome for patients operated 2012-2018, nor for long-term outcome assessed as overall survival with surgery performed 2010-2016. In secondary analyses employing Cox regression models, several short-term advantages for MIS were demonstrated, such as lower early mortality, shorter hospital stay and decreased reoperation rate. Regarding long-term outcome, with adjustment for potential statistical confounders, overall survival was better with MIS as compared with OPEN both for colon and rectal cancer, with a relative decrease in risk for overall 5-year mortality by 13% and 12 %, respectively. The authors conclude that MIS was introduced in a safe and well controlled manner, and suggest that MIS should be equally offered to all suitable patients across Sweden.
[Modified Valsalva maneuver induced an asymptomatic polymorphic ventricular tachycardia].
Arshad A, Hägglund C, Scorza R
Lakartidningen · 2026 May · PMID 42204901 · Publisher ↗
Paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal re-entry tachycardia (AVNRT), are commonly treated with vagal maneuvers. The modified Valsalva maneuver, combining forced expiration with...
Paroxysmal supraventricular tachycardias (PSVT), including atrioventricular nodal re-entry tachycardia (AVNRT), are commonly treated with vagal maneuvers. The modified Valsalva maneuver, combining forced expiration with postural change, has shown higher success rates. A 44-year-old woman with recurrent PSVT underwent a modified Valsalva maneuver under ECG monitoring. The maneuver induced a 10-second asymptomatic polymorphic VT that resolved spontaneously. Echocardiography and labs were normal, and electrophysiology confirmed AVNRT. The patient was successfully treated with cryoablation. The modified Valsalva maneuver is generally safe. However, in rare cases it can induce ventricular tachycardia through autonomic, hemodynamic, or re-entry-related mechanisms. The modified Valsalva maneuver remains a first-line treatment for PSVT, but initial use should be ECG monitored. If polymorphic VT or other ventricular arrhythmias occur during the maneuver, further electrophysiological evaluation is warranted, and ablation should be considered for confirmed PSVT.
[New therapies and ongoing clinical trials in Alzheimer's disease].
Andersen P, Bonnard A, Börjesson Hanson A … +1 more , Kivipelto M
Lakartidningen · 2026 May · PMID 42159020
Clinical trials in Alzheimer's disease focus on disease-modifying therapies with targeted approaches addressing underlying pathology. Immunotherapies against amyloid-beta with monoclonal antibodies such as lecanemab and...
Clinical trials in Alzheimer's disease focus on disease-modifying therapies with targeted approaches addressing underlying pathology. Immunotherapies against amyloid-beta with monoclonal antibodies such as lecanemab and donanemab have shown promise in reducing amyloid plaque burden and modestly preserving cognition and function in early-stage patients. Tau-targeted therapies, including vaccines, antibodies, and antisense oligonucleotides, have indicated good tolerability in early studies. Additionally, anti-inflammatory strategies and different neurotransmitters are being explored. As of early 2025, over 180 clinical trials are ongoing, targeting various disease mechanisms and stages, including preclinical and at-risk populations. Increased knowledge of pathophysiology, clinical presentation, genetics, and biomarkers has over time provided a broader foundation for the development of Alzheimer's therapy. However, there is still a significant need for better implementation of this knowledge in clinical practice.
[Brain imaging in cognitive disorders - from diagnosis to treatment and monitoring].
Granberg T, Blystad I, Fällmar D … +3 more , Savitcheva I, van Westen D, Westman E
Lakartidningen · 2026 May · PMID 42157624
Brain imaging is essential in the diagnostic workup of cognitive disorders. Computed tomography (CT) is usually the first-line method due to accessibility and patient comfort, whereas magnetic resonance imaging (MRI) off...
Brain imaging is essential in the diagnostic workup of cognitive disorders. Computed tomography (CT) is usually the first-line method due to accessibility and patient comfort, whereas magnetic resonance imaging (MRI) offers higher diagnostic precision and is required before anti-amyloid therapy. MRI adds value by detecting microvascular pathology, enabling volumetric analysis, and ensuring safe monitoring of amyloid-related imaging abnormalities (ARIA). National Swedish MRI protocols and structured reporting templates support harmonized diagnostics and follow-up. Nuclear medicine methods are useful for complex cases to assess glucose metabolism, amyloid burden or dopamine transport function. With emerging treatment options for Alzheimer's disease, standardized imaging and close collaboration across specialties are essential for upscaling diagnostic routines and for safe and efficient care.
[Alzheimer's disease and other neurocognitive disorders - epidemiology and new diagnostic criteria].
Borgh Skillbäck T, Palmqvist S, Eriksdotter M … +2 more , Skoog I, Kern S
Lakartidningen · 2026 May · PMID 42153497
Neurocognitive disorders are progressive conditions leading to brain atrophy and functional decline, representing the third leading cause of death in Sweden after cardiovascular disease and cancer. Approximately 150 000...
Neurocognitive disorders are progressive conditions leading to brain atrophy and functional decline, representing the third leading cause of death in Sweden after cardiovascular disease and cancer. Approximately 150 000 individuals live with a dementia diagnosis, with Alzheimer's disease (AD) comprising two-thirds of cases, followed by vascular cognitive impairment. Diagnosis is usually initiated in primary care through patient history, cognitive testing, laboratory analyses, and brain imaging, while more advanced assessments in specialist clinics may include cerebrospinal fluid or blood biomarkers. Traditionally, diagnoses in Sweden have relied on ICD-10, emphasizing cognitive decline affecting daily life. Recently, biomarker-based frameworks such as NIA-AA and IWG have redefined AD either as a purely biological entity (NIA-AA) or as a clinico-biological construct (IWG). While these are primarily used in research, they highlight the importance of integrating biological markers with clinical evaluation. Preventive strategies remain crucial, as pathological processes can precede symptoms by decades.
[New blood-based biomarkers for Alzheimer's disease].
Palmqvist S, Tengzelius R, Schöll M … +3 more , Nägga K, Mattsson-Carlgren N, Zetterberg H
Lakartidningen · 2026 May · PMID 42153492
Blood-based biomarkers, particularly plasma p-tau217, have rapidly improved the detection of Alzheimer's disease pathology and can in some settings replace cerebrospinal fluid analysis or amyloid PET in clinical diagnost...
Blood-based biomarkers, particularly plasma p-tau217, have rapidly improved the detection of Alzheimer's disease pathology and can in some settings replace cerebrospinal fluid analysis or amyloid PET in clinical diagnostics. Clinically available assays now achieve high accuracy, especially when using a two-cutoff approach that classifies results as negative, intermediate, or positive, thereby supporting their use for confirming or ruling out disease. Implementation is likely to be straightforward in specialized clinics but more challenging in settings without prior biomarker experience or access to confirmatory testing for intermediate results, such as primary care.
[Prevention of cognitive impairment - from research to implementation].
Mangia Lasche F, Matton A, Karlsson P … +1 more , Kivipelto M
Lakartidningen · 2026 May · PMID 42153378
Risk reduction and prevention of cognitive impairment and dementia have been highlighted as crucial to curb the expected rise of cases. Nearly half of all dementia cases can be linked to modifiable lifestyle, health and...
Risk reduction and prevention of cognitive impairment and dementia have been highlighted as crucial to curb the expected rise of cases. Nearly half of all dementia cases can be linked to modifiable lifestyle, health and environmental factors, and encouraging evidence from multimodal interventions addressing many of these factors has shown the potential for brain health promotion. The FINGER trial outlined a successful multidomain intervention paradigm, reporting cognitive and additional health benefits in older adults at increased risk for dementia via a combination of healthy diet, physical activity, cognitive and social stimulation, and monitoring of cardiometabolic disorders. Global adaptation and enhancement of this multidomain model is promoted via the World-Wide FINGERS global network of trials for risk reduction of dementia, connecting researchers and clinics in over 70 countries with over 50 trials in different populations, cultures, and socioeconomic settings. Forthcoming preventive strategies will increasingly rely on tailored interventions based on individual risk profiles, including precision prevention and a combination of non-pharmacological and pharmacological interventions. In parallel, implementation activities in communities and clinical settings have been successfully developed in the Nordics (e.g., Swedish FINGER network of municipalities) and across Europe (e.g., Brain Health Services). Sustainability and success of these efforts rely on intersectoral collaboration and policy frameworks, which are being updated (e.g., Swedish national strategy for dementia) to effectively support prevention across the at-risk continuum of dementia.
[Health economic aspects of dementia].
Wimo A, Jönsson L
Lakartidningen · 2026 May · PMID 42145110
The societal costs of dementia in Sweden are very high: about SEK 90-100 billion per year. A purely demographic projection to 2050 gives a cost increase of about 80%. In addition to the costs, dementia also entails a los...
The societal costs of dementia in Sweden are very high: about SEK 90-100 billion per year. A purely demographic projection to 2050 gives a cost increase of about 80%. In addition to the costs, dementia also entails a loss of life expectancy for those with dementia and of quality of life for those affected and their relatives. At present, it is not possible to assess whether the antibody treatment against Alzheimer's disease is cost-effective in Sweden because no price is yet available. Blood-based biomarkers for Alzheimer's disease and other diagnostic methods, if included in the pricing basis for new drugs, can be a valuable addition to cost-effectiveness analyses.
[Changes in the diagnostic panorama after the Patient Choice Reform - a retrospective study of diagnosis registrations in Swedish primary health care].
Kohnke H, Ribman B, Zielinski A … +2 more , Beckman A, Ohlsson H
Lakartidningen · 2026 May · PMID 42108859
In 2010, the Patient Choice Reform of Swedish primary health care established free entry for private primary health care providers and strengthened patient choice. Following the reform, an overall increase in primary hea...
In 2010, the Patient Choice Reform of Swedish primary health care established free entry for private primary health care providers and strengthened patient choice. Following the reform, an overall increase in primary health care utilization has been recorded. As quality aspects of the reform remain understudied, the aim of this study was to identify the diagnoses with the greatest increase in registrations in primary health care over a five-year period following the reform. The study is a retrospective analysis of administrative register data from Region Skåne, Sweden. Of identified diagnosis groups, there was an overrepresentation of diagnoses related to mental health issues. Identified diagnoses were more common in the younger part of the population. The findings of this study align with previous research indicating increased utilization of primary health care services for minor symptoms. However, the results may also reflect changes in diagnostic routines.
[Funnel plot].
Lundgren F, Troëng T
Lakartidningen · 2026 May · PMID 42100916
A funnel plot indicates whether result deviations are real or due to chance. Other methods are needed to determine whether deviating results are due to quality deficiencies or other factors. A funnel plot can easily show...
A funnel plot indicates whether result deviations are real or due to chance. Other methods are needed to determine whether deviating results are due to quality deficiencies or other factors. A funnel plot can easily show whether there are performance deviations in individual units or groups of units.
[Persistent very high levels of P-cobalamin caused by formation of immune complexes, macro-B12].
Wiklund L, Hadi M, Hammarsten O
Lakartidningen · 2026 May · PMID 42080313
Supranormal plasma levels of cobalamin may result from formation of immune complexes of cobalamin bound to transcobalamin, referred to as macro-B12. Two patients with very high levels of B12, 3800 pmol/l and above 4400 p...
Supranormal plasma levels of cobalamin may result from formation of immune complexes of cobalamin bound to transcobalamin, referred to as macro-B12. Two patients with very high levels of B12, 3800 pmol/l and above 4400 pmol/l, were investigated. PEG precipitation decreased B12 levels to 175 pmol/l and 191 pmol/l, respectively. Employing protein G spin columns decreased levels by 92 procent and 87 procent, proving that the high levels of B12 were caused by formation of IgG-immune complexes. Macro-B12 may obscure underlying deficit of B12, since immune complex-bound holotranscobalamin is biologically inactive. Supranormal levels of vitamin B12 have been associated with myeloproliferative diseases, lymphoid malignancies, various types of cancer and hepatic and renal disease. In clinical literature it is recommended that supranormal levels of B12 (>1000 pmol/l) are investigated for malignancy or other underlying disease, but further research could define the conditions and clinical advantages of such investigations.
[From fragility fracture to secondary prevention - no standardized care pathways].
Ek S, Hedström M, Sääf M … +2 more , Wolf O, Modig K
Lakartidningen · 2026 Apr · PMID 42057561
To better understand the shortcomings and underlying causes in secondary fracture prevention, it is important to consult the different healthcare professionals involved in fracture care. As a first step, orthopedic surge...
To better understand the shortcomings and underlying causes in secondary fracture prevention, it is important to consult the different healthcare professionals involved in fracture care. As a first step, orthopedic surgeons at Swedish orthopedic clinics were approached. The aim was to gain insight into how these clinics perceive and manage patients with fragility fractures and suspected underlying osteoporosis. We found considerable variation in how orthopedic departments in Sweden initiate secondary prevention following fragility fractures. Referral to primary care is the most common approach, though other measures are also used. Despite national recommendations, no consensus exists on standardized procedures, and collaboration within the fracture liaison service is often perceived as insufficient. Many clinics lack a fracture coordinator, a role intended to ensure coordinated care for these patients. The findings highlight the need to follow established guidelines and strengthen cooperation across different levels of care to achieve more equitable treatment for patients with fragility fractures and suspected underlying osteoporosis.
[Experiences and approach to identifying women subjected to intimate partner violence].
Thurezon E, Brune C, Liljas A
Lakartidningen · 2026 Apr · PMID 42053437
Intimate partner violence (IPV) is a global public health issue and poses a substantial threat to women's health and well-being. The healthcare sector has an important role in identifying and responding to this, yet ofte...
Intimate partner violence (IPV) is a global public health issue and poses a substantial threat to women's health and well-being. The healthcare sector has an important role in identifying and responding to this, yet often the violence goes unnoticed. This study aims to examine general practitioners' (GPs) approach to identifying women exposed to IPV. Qualitative semi-structured interviews including fictive scenarios were conducted with 11 GPs (3 men) from 10 primary care clinics and analysed thematically. Findings showed that participating GPs considered IPV important to identify, yet reported variations in how and when to do so. Trust in the patient-doctor relationship and collegiality were further emphasized. Some reflected upon their own prejudices related to socioeconomic status and cultural background as a barrier to ask about IPV, a finding of importance from an equity perspective. Lack of adherence to guidelines and routines was also highlighted. Directed efforts to increase competencies, improve routines and provide support are recommended.
[Intimate partner violence a challenge for healthcare].
Simmons J, Kastbom L
Lakartidningen · 2026 Apr · PMID 42052726
Intimate partner violence (IPV) is a pervasive public health problem and a human rights violation, affecting approximately 35% of women and 21% of men in Sweden. IPV is strongly associated with adverse health outcomes an...
Intimate partner violence (IPV) is a pervasive public health problem and a human rights violation, affecting approximately 35% of women and 21% of men in Sweden. IPV is strongly associated with adverse health outcomes and often constitutes an underlying reason for health care visits. Despite this, many practitioners hesitate to address IPV, because of insufficient knowledge and lack of clear referral protocols. However, an increasing number of national and regional guidelines provide practical support for asking about IPV and making appropriate referrals. While healthcare professionals carry significant responsibility in responding to IPV, this is not a task we face alone. Numerous societal resources are available, including healthcare services, social services, and non-governmental organizations, all working to support individuals affected by IPV.
[Losartan - an appropriate antihypertensive drug in patients with gout].
Anker D, Peterson M
Lakartidningen · 2026 Apr · PMID 42046462
Gout is common, and the prevalence in Sweden is approximately 2%, predominantly men. Of these, 74% also have hypertension. Acute attacks are treated with anti-inflammatory agents. In patients with recurrent disease and h...
Gout is common, and the prevalence in Sweden is approximately 2%, predominantly men. Of these, 74% also have hypertension. Acute attacks are treated with anti-inflammatory agents. In patients with recurrent disease and high urate levels, urate-lowering treatment is indicated. The first-line treatment is xanthine oxidase inhibitors. Some other drugs lower urate levels, such as Losartan, while beta-blockers and thiazides increase them. Thus, a subsequential question is whether Losartan is sufficient as urate-lowering treatment in patients with gout and hypertension. A PubMed search yielded six relevant articles: two RCTs, two non-randomized studies, and two systematic reviews. The overall results show significant urate-lowering effect, on average 50 µmol/L. Consequently, Losartan is not sufficient as the only urate-lowering treatment for most patients. Switching to Losartan from other blood pressure-lowering drugs reduces urate levels among patients with hypertension and gout.
[Mosquitoes, climate change and new diseases].
Lindström A, Lilja T, Eklöf D … +1 more , Waldeck M
Lakartidningen · 2026 Apr · PMID 42029018
Climate change affects all organisms, including mosquitoes. Shorter, milder winters and prolonged vegetation period are expected to increase mosquito populations, thereby heightening the risk of mosquito-borne disease tr...
Climate change affects all organisms, including mosquitoes. Shorter, milder winters and prolonged vegetation period are expected to increase mosquito populations, thereby heightening the risk of mosquito-borne disease transmission. West Nile fever exemplifies a disease that has expanded northward in recent decades, now endemic in Germany as far as the Baltic Sea coast. Additionally, mosquito species are shifting their geographical distribution. For instance, Culex modestus, known for transmitting West Nile virus, was first identified in Sweden in 2016. Invasive species like Aedes albopictus are also expanding with concurrently autochthonous transmissions of Dengue fever to humans in Europe. In 2023, two Aedes albopictus introductions were recorded in Sweden, likely occur-ring regularly, though no established populations have been confirmed. Malaria, once widespread in Sweden during the 18th and 19th centuries, disappeared, yet reintroduction due to climate change seems highly unlikely. Swedish health care must be prepared to diagnose Dengue and Chikungunya in travelers to southern Europe as well as for the emergence of West Nile virus in southernmost Sweden.
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