Introduction: Despite movements like “Me Too” and refined laws, many young people in Sweden still experience sexual violence. The changing nature and severity of these assaults are of significant interest, especially due to common long-term effects like post-traumatic stress disorder (PTSD). Understanding these trends can help healthcare providers support victims and develop effective prevention strategies. This study aimed to examine changes in the severity of physical violence and injury during sexual assaults over the past decade among women aged 16–29 in Stockholm, Sweden, with a particular focus on trends in non-fatal strangulation and its associated factors.

Material and methods: This retrospective study analyzed data from the Emergency Clinic for Rape Victims at South General Hospital, which centralizes care for sexual assault victims in Region Stockholm, Sweden. A final sample of 1074 records of women aged 16–29 was included in the analysis (299 in 2012, 391 in 2017, and 384 in 2022). Data were analyzed using descriptive and regression analysis to assess adjusted odds ratios (AORs) and 95% confidence intervals (CIs).

Results: Most victims experienced physical violence during sexual assault (65.3% in 2012, 68.1% in 2017 and 67.6% in 2022). In 2022, there was an increase in hitting (13.7% to 21.7%, p = 0.008), multiple physical violence (28.4% to 37.7%, p = 0.012), and severe physical violence (15.1% to 28.9% p < 0.001) compared to 2012. Non-fatal strangulation rose significantly from 8.2% in 2012 to 24.5% in 2022 (p < 0.001), with adjusted AORs of 2.2 (95% CI: 1.2, 3.9) in 2017 and 3.3 (95% CI: 1.9, 5.8) in 2022 compared to 2012. Factors linked to non-fatal strangulation included assaults in a home environment (AOR = 1.8, 95% CI: 1.2, 2.8), vaginal penetration along with another sexual act (AOR = 2.9, 95% CI: 1.6, 5.1), and blunt force (AOR = 5.9, 95% CI: 4.0, 8.5). Genital injuries also increased significantly from 25.2% in 2012 to 37.6% in 2022.

Conclusions: This study highlights a rise in severe physical violence in sexual assaults, involving non-fatal strangulation and an increased presence of genital injuries. Findings underscore the need for thorough medical follow-up and nationally representative research to inform prevention and understand associated violence dynamics.

Background: The COVID-19 pandemic strained health systems worldwide, diverting resources and disrupting routine healthcare services. These disruptions may lead to health risks from delayed or reduced care. Health system resilience (HSR) – a critical factor in maintaining health services during crises – refers to a system’s ability to anticipate, prepare for, absorb, respond to, recover from, and adapt to disruptions. To be effective, HSR must also be equitable, ensuring that all socioeconomic groups have access to healthcare services during crises. Sweden’s approach, which relied on public adherence to government recommendations rather than enforcing restrictions, presents a unique case for studying HSR. Aim: This study aims to evaluate aspects of HSR in Sweden during the COVID-19 pandemic by analysing changes in essential health service utilisation across different phases of the pandemic, and by examining sociodemographic differences in utilisation by education and sex. Method: This study utilises interrupted time series analysis to evaluate changes in healthcare service utilisation across various levels of the Swedish health system with stratification by education and sex. Primary care was measured through diabetes diagnoses, emergency care through appendicitis cases, inpatient care through hospital admission for inflammatory bowel disease (IBD), and cancer diagnostics through diagnosis rates. Data were obtained from various population based Swedish health registries through the SWECOV project. Results: The findings highlight varying degrees of disruptions and resilience across different sectors. Emergency care, primary care, and symptom-based cancer diagnosis showed signs of recovery after an initial drop, whereas cancer screening, was more affected. In the case of inpatient care for IBD, the number of admissions declined, though the length of hospital stays remained unchanged. Education level did not impact healthcare utilisation for most indicators, and differences between men and women were generally small. Conclusion: The Swedish HSR during the COVID-19 pandemic was challenged but remained intact in most healthcare sectors. The health system on different levels also managed to a large degree cater for the diagnoses covered in this study, largely independent of educational level and sex. As data availability increases with time further research will help gain a deeper understanding of the outcomes of the pandemic on health services unrelated to COVID-19, including the role of education in influencing healthcare utilisation.

Research on sexual violence often overlooks men, with limited studies focusing on male victims. A deeper understanding of this issue is essential for providing evidence-based healthcare and effective support for male victims. Therefore, this study aims to (a) describe the characteristics of sexual violence among male victims seeking emergency care at Sweden's largest sexual assault center and (b) examine whether the occurrence of injuries and the severity of violence differ according to victim characteristics, assault characteristics, and the victim's relationship to the assailant. This retrospective study analyzed 245 anonymized medical and forensic records of men who visited Stockholm's sexual assault center, Sweden, from 2015 to 2022. The severity of violence was assessed with an adapted NorVold Abuse Questionnaire. Descriptive and inferential statistics were used to analyze the data. In our dataset, 92% of victims experienced severe acts of sexual violence, and 27% faced severe physical violence during the assault. Assaults by a group were associated with increased severity of physical violence in the adjusted model (adjusted odds ratio [AOR] = 3.9, 95% CI [1.2, 12.5]). Additionally, 65% of victims sustained extragenital injuries, which were linked to being assaulted by a known assailant (AOR = 5.8 [1.4, 24.9]), the victim being under the influence of substances during the assault (AOR = 2.5 [1.0, 6.4]), and exposure to moderate/severe physical violence (AOR = 6.6 [2.5, 17.1]). Regarding the victim's mental health history, 24% reported having a neuropsychiatric diagnosis and 48% reported a psychiatric disorder. Additionally, 45% had a history of prior sexual assault. Our study suggests that the men who sought post-assault care frequently reported experiencing physical violence during the sexual assault, particularly in cases involving multiple assailants. The high prevalence of self-reported mental illness, neuropsychiatric diagnoses, and prior sexual assault among these individuals underscores the need for psychosocial support for this patient group.

Mobile phones significantly improve access to healthcare, public health services, and disease surveillance globally. However, challenges related to reachability and accessibility persist, especially when individuals change or drop telephone numbers affecting continuity in public health interventions such as HIV follow-ups and vaccine reminders. We explored trends in phone ownership, changes in mobile phone numbers, associated factors, and the time it takes to better understand how these might affect the ability of phone-based public health services to reach targeted recipients. We used data from the Rakai Community Cohort Study, a population-based prospective open cohort in rural Uganda. Between 2010 and 2020, data on phone ownership and individuals' phone numbers were collected for six consecutive visits. We assessed trends in phone ownership using descriptive statistics. Factors associated with the number of times individuals changed their phone numbers were assessed using a Poisson multivariable regression model. We used Anderson Gill Cox proportional hazards regression to evaluate the time-to-change of phone numbers. In total 41,922 participants contributed 97,034 visits. A majority (61.8%) of participants owned a mobile phone at some point from 2010 to 2020. Phone ownership increased over the study period from 51.2% in 2010 to 68.2% in 2020 (p < 0.001). Phone ownership was lower among women participants (versus men; adjPR = 0.81; 95% CI 0.78-0.83) and younger persons < 25 years (versus ≥ 25 years; adjPR = 0.69; 95% CI 0.65-0.72), but there were no differences by HIV serostatus. The rate of change in phone numbers was significantly lower among women participants (adjusted prevalence ratio [adjIRR] = 0.88; 0.83-0.95) and those with secondary education or above (versus primary or none; adjIRR = 0.92; 95% CI 0.87-0.98). In contrast, it was higher among young persons aged 15-24-years old (versus 45 + years; adjIRR = 2.52; 95% CI 2.13-2.76), those living in lake Victoria fishing communities (versus trading centers, adjIRR = 1.28; 95% CI 1.17-1.40), persons with lower SES (versus higher SES; adjIRR:1.30; 95% CI 1.19-1.42), and persons living with HIV (versus HIV negative participants; adjIRR = 1.11; 95% CI 1.03-1.20). In this Ugandan cohort, mobile phone ownership increased over time, although by 2020 nearly 30% of the population still did not own a phone, and participants frequently changed phone numbers. Being a man, living with HIV, and lower socioeconomic status were all associated with changing phone numbers, a community peer system to maintain contact with these groups may be required to supplement phone-based initiatives.

Background: Clostridioides difficile infection (CDI) causes a major burden to individuals and society, yet the impact may vary depending on age, sex, underlying comorbidities and where CDI was acquired (hospital or community). Methods: This Swedish nationwide population-based cohort study (2006–2019) compared all 43,150 individuals with CDI to their 355,172 matched controls (first year and entire follow-up). Negative binomial regression models compared the cumulated length of stay, number of in-hospital admissions, outpatient visits and prescriptions after the first CDI episode expressed as incidence rate ratios (IRR) and 95% confidence intervals for the entire follow-up. Results: Overall, 91.6% of CDI cases were hospital acquired, and 16.8% presented with recurrence(s); 74.8%of cases were ≥ 65 years and 54.2% were women. Compared to individuals without CDI, in-hospital stay rates were 18.01 times higher after CDI (95% CI 17.40–18.63, first-year: 27.4 versus 1.6 days), 9.45 times higher in-hospital admission (95% CI 9.16–9.76, first-year: 2.6 versus 1.3 hospitalisations), 3.94 times higher outpatient visit (95% CI 3.84–4.05, first-year: 4.0 versus 1.9 visits) and 3.39 times higher dispensed prescriptions rates (95% CI 3.31–3.48, first-year: 25.5 versus 13.7 prescriptions). For all outcomes, relative risks were higher among the younger (< 65 years) than the older (≥ 65 years), and in those with fewer comorbidities, but similar between sexes. Compared to those without recurrence, individuals with recurrence particularly showed a higher rate of hospital admissions (IRR = 1.18, 95% 1.12–1.24). Compared to community-acquired CDI, those with hospital-acquired CDI presented with a higher rate of hospital admissions (IRR = 7.29, 95% CI 6.68–7.96) and a longer length of stay (IRR = 7.64, 95% CI 7.07–8.26). Conclusion: CDI was associated with increased health consumption in all affected patient groups. The majority of the CDI burden could be contributed to hospital-acquired CDI (~ 9/10), older patients (~ 3/4) and those with multiple comorbidities (~ 6/10 Charlson score ≥ 3), with 1/5 of the total CDI burden contributed to individuals with recurrence. Yet, relatively speaking the burden was higher among the younger and those with fewer comorbidities, compared to their peers without CDI.

Background: Despite numerous risk factors and serious consequences, little is known about metabolic dysfunction-associated steatotic liver disease (MASLD) at population level in Africa.

Aim: The aim of the study was to estimate the prevalence and risk factors of MASLD in people living with and without HIV in Uganda.

Methods: We collected data from 37 communities in South Central Uganda between May 2016 and May 2018. We estimated MASLD prevalence using the fatty liver index and advanced liver fibrosis using the dynamic aspartate-to-alanine aminotransferase ratio. We collected additional data on sociodemographics, HIV and cardiovascular disease (CVD) risk factors. We used multivariable logistic regression to determine the association between HIV, CVD risk factors and MASLD.

Results: We included 759 people with HIV and 704 HIV-negative participants aged 35–49. MASLD prevalence was 14% in women and 8% in men; advanced liver fibrosis prevalence was estimated to be <1%. MASLD prevalence was more common in women (15% vs. 13%) and men (9% vs. 6%) with HIV. Being female (odds ratio [OR] = 2.1; 95% confidence interval [CI] = 1.4–3.3) was associated with a higher odds of MASLD after adjustment for confounders; HIV infection was borderline associated with MASLD (OR = 1.4; 95% CI: 1.0–2.0).

Conclusions: In a relatively young cohort in Uganda, 14% of women and 8% of men had MASLD. There was an indication of an association between HIV and MASLD in multivariable analysis. These data are the first to describe the population-level burden of MASLD in sub-Saharan Africa using data from a population-based cohort.

BACKGROUND: Growing evidence indicates that gender-based violence (GBV) increased during COVID-19. We investigated self-reported impact of the pandemic on GBV at community, household and intimate partner (IPV) levels among young people and its associations with psychosocial wellbeing, i.e., COVID-related stressors and mental health.

METHODS: Cross-sectional data were drawn from a survey with young people ages 13-24 (N = 536) living with HIV (YPLWH) and without HIV (YPLWoH), in peri-urban Cape Town, South Africa. The survey, conducted February-October 2021, examined the impact of the initial lockdown on experience and perceived changes in GBV at each level, and pandemic-related psychosocial wellbeing. Descriptive statistics and binomial and multinomial regression analyses were conducted to illustrate exposure and perceived changes in GBV since lockdown, and their association with COVID-related stress factors (e.g., social isolation, anxiety about COVID), mental health (e.g., depression, anxiety), and other risk factors (e.g., age, gender, socioeconomic status) by HIV status.

RESULTS: Participants were 70% women with mean age 19 years; 40% were living with HIV. Since lockdown, YPLWoH were significantly more likely than YPLWH to perceive community violence as increasing (45% vs. 28%, p < 0.001), and to report household violence (37% vs. 23%, p = 0.006) and perceive it as increasing (56% vs. 27%, p = 0.002) (ref: decreasing violence). YPLWoH were also more likely to report IPV experience (19% vs. 15%, p = 0.41) and perception of IPV increasing (15% vs. 8%, p = 0.92). In adjusted models, COVID-related stressors and common mental health disorders were only associated with household violence. However, indicators of economic status such as living in informal housing (RRR = 2.07; 95% CI = 1.12-3.83) and food insecurity (Community violence: RRR = 1.79; 95% CI = 1.00-3.20; Household violence: RRR = 1.72; 95% CI = 1.15-2.60) emerged as significant risk factors for exposure to increased GBV particularly among YPLWoH.

CONCLUSIONS: Findings suggest that for young people in this setting, GBV at community and household levels was more prevalent during COVID-19 compared to IPV, especially for YPLWoH. While we found limited associations between COVID-related stressors and GBV, the perceived increases in GBV since lockdown in a setting where GBV is endemic, and the association of household violence with mental health, is a concern for future pandemic responses and should be longitudinally assessed.

Objective: To assess whether different forms of cognitive social capital increased the relative probability of testing for sexually transmitted infections (STIs) among young men living in Stockholm, Sweden.

Methods: A population-based cross-sectional study was conducted in 2017 with men aged 20–29 years living in Stockholm County, Sweden (n = 523). The main outcome was STI testing patterns (never tested, tested only within a 12-month period, tested only beyond a 12-month period, repeatedly tested). The main exposure were two forms of cognitive social capital: social support (having received help, having someone to share inner feelings with) and institutionalized trust (in school, healthcare, media). Data were analyzed using weighted multivariable multinomial logistic regression to obtain adjusted weighted relative probability ratio (aRPR).

Results: After adjusting for confounding factors, receiving help (aRPR: 5.2, 95% CI: 1.7–16.2) and having someone to share inner feelings with (aRPR: 3.1, 95% CI: 1.2–7.7) increased the relative probabilities of young men testing for STIs, but only for those testing beyond a 12-month period. Trust in media increased the relative probability of STI testing for those testing only within a 12-month period (aRPR: 2.6, 95% CI: 1.1–6.1) and for those testing repeatedly (aRPR: 3.6, 95% CI: 1.5–8.8).

Conclusion: Young men in Stockholm County exhibit distinct STI testing patterns. Social support and trust in media were factors that increased the probability of being tested for STIs, with this effect varying according to the young men's STI testing pattern. Further studies are required to explore how trust in media might promote STI testing in this population.

In this paper we examine the application of the Least Absolute Deviations (LAD) method for ridge-type parameter estimation of Seemingly Unrelated Regression Equations (SURE) models. The methodology is aimed to deal with the SURE models with non-Gaussian error terms and highly collinear predictors in each equation. Some biasing parameters used in the literature are taken and the efficiency of both Least Squares (LS) ridge estimation and the LAD ridge estimation of the SURE models, through the Mean Squared Error (MSE) of parameter estimators, is evaluated.

In stochastic frontier analysis, the conventional estimation of unit inefficiency is based on the mean/mode of the inefficiency, conditioned on the composite error. It is known that the conditional mean of inefficiency shrinks towards the mean rather than towards the unit inefficiency. In this paper, we analytically prove that the conditional mode cannot accurately estimate unit inefficiency, either. We propose regularized estimators of unit inefficiency that restrict the unit inefficiency estimators to satisfy some a priori assumptions, and derive the closed form regularized conditional mode estimators for the three most commonly used inefficiency densities. Extensive simulations show that, under common empirical situations, e.g., regarding sample size and signal-to-noise ratio, the regularized estimators outperform the conventional (unregularized) estimators when the inefficiency is greater than its mean/mode. Based on real data from the electricity distribution sector in Sweden, we demonstrate that the conventional conditional estimators and our regularized conditional estimators provide substantially different results for highly inefficient companies.