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Objectives: While suicidal behaviour has become less prevalent in non-manual workers in recent decades, rates have increased in manual workers. We aimed to identify occupations within the construction industry with excess risk of suicide and non-fatal self-harm. Methods: This cohort of Swedish construction workers comprises 389 132 individuals examined 1971-1993 and followed 1987-2018 using national hospital and cause of death registers. More than 200 job titles were merged into 22 occupational groups. For 296 891 men alive in 1987 and active in the construction sector, survival was calculated from baseline to first event of non-fatal self-harm or suicide and censored for emigration, long-term unemployment, disability pension, retirement, death from other causes or end of follow-up. HRs with 95% CIs were obtained from multiple Cox proportional hazard regression. Results: Overall, 1618 cases of suicide and 4774 events of non-fatal self-harm were registered. Self-harm before baseline was the single largest risk factor for suicide, HR 9.3 (95% CI 7.5 to 11.6). Compared with the overall mean, labourers and rock workers had excess risk for suicide, HR 1.4 (95% CI 1.1 to 1.7) and 1.5 (95% CI 1.0 to 2.3), respectively, while electricians, clerks and foremen had reduced risk. Labourers, concrete workers, sheet metal workers, painters, glaziers and the group € other construction workers' were at increased risk for non-fatal self-harm. Almost all categories of manual workers were at increased risk for suicidal behaviour relative to clerks and foremen. Conclusions: Specific occupations within the construction sector were associated with excess risk for suicidal behaviour. Future studies should identify underlying risk factors to inform tailored interventions.

OBJECTIVE: This study examined BMI in young men and incident site-specific cancer to estimate population attributable fractions due to BMI based on projected obesity prevalence. METHODS: A population-based cohort study with measured height and weight at age 18. Cox regression models assessed linear associations for BMI and included age, year, and site of conscription as well as parental level of education as covariates. RESULTS: Primary analyses were performed in 1,489,115 men, of whom 78,217 subsequently developed cancer during a mean follow-up of 31 years. BMI was linearly associated with risk of developing all 18 site-specific cancers assessed (malignant melanoma; leukemia; myeloma; Hodgkin lymphoma; non-Hodgkin lymphoma; and cancer in the lungs, head and neck, central nervous system, thyroid, esophagus, stomach, pancreas, liver and gallbladder, colon, rectum, kidney, and bladder), in some instances evident at BMI levels usually defined as normal (20-25 kg/m2 ). Higher BMI was associated with lower risk of prostate cancer. The highest hazard ratios and population attributable fractions were seen for some gastrointestinal cancers. CONCLUSIONS: This study reports linear associations between BMI at age 18 and subsequent site-specific cancers, calling for rapid action to stem the obesity epidemic and to prepare the health care system for steep increases in cancer cases.

The risk of late complications after a brain tumor in childhood is high. Both the tumor itself and the treatments give rise to sequelae that affect daily life activities. In this registry study, we explored post-compulsory education, i.e., further education following the nine compulsory years in school, in 452 cases born 1988–1996 and diagnosed with a brain tumor before their fifteenth birthday. They were compared with 2188 individual controls who were not treated for cancer. Significantly fewer teenagers and young adults treated for brain tumors in childhood attended high school or university compared with controls, especially individuals treated for embryonal tumors or optic pathway gliomas. A significantly larger proportion of subjects treated for embryonal tumors and craniopharyngiomas attended folk high schools, a type of post-compulsory school with a more accessible learning environment. For both cases and controls, we observed a positive correlation between parental education levels and attendance in high school and university. In our previous studies we have shown that children treated for brain tumors, as a group, tend to perform worse during their last year of compulsory school compared with their peers, and the current study confirms that these differences remain over time.

Background: Survivors of pediatric brain tumors are at high risk of late complications that may affect their daily life in both short- and long-term perspectives. Methods: In this nationwide registry-based study we explored the occupational outcomes, including employment, sickness or activity compensation and parental leave, in 452 individuals in Sweden, born 1988–1996, and diagnosed with a brain tumor before their 15th birthday. Their results were compared with 2188 matched controls. Results: There were significant differences between cases and controls for all assessed variables. The cases had benefitted from sickness or activity compensation 11 times more often than controls (CI 7.90–15.83; p < 0.001) between 2005 and 2016. Controls were almost three times more likely to have an employment (OR 0.36; CI 0.28–0.47; p < 0.001) and nearly twice as likely to have been on parental leave (OR 0.56; CI 0.39–0.80; p = 0.002). Although cases treated for high-grade tumors typically fared worse than those treated for low-grade tumors, significant differences for all assessed variables were also observed for cases treated for a low-grade tumor compared with controls. Conclusions: Our findings emphasize the need for follow-up programs for all brain tumor diagnoses, not only those known to be at most risk. This is evident, for example, from the high number of cases who received sickness or activity compensation.

Background: Estimating excess mortality and years of life lost (YLL) attributed to coronavirus disease 19 (COVID-19) infection provides a comprehensive picture of the mortality burden on society. We aimed to estimate the impact of the COVID-19 pandemic on age- and sex-specific excess mortality and YLL in Sweden during the first 17 months of the pandemic. Methods: In this population-based observational study, we calculated age- and sex-specific excess all-cause mortality and excess YLL during 2020 and the first 5 months of 2021 and cause-specific death [deaths from cardiovascular disease (CVD), cancer, other causes and deaths excluding COVID-19] in 2020 compared with an average baseline for 2017–19 in the whole Swedish population. Results: COVID-19 deaths contributed 9.9% of total deaths (98 441 deaths, 960 305 YLL) in 2020, accounting for 75 151 YLL (7.7 YLL/death). There were 2672 (5.7%) and 1408 (3.0%) excess deaths, and 19 141 (3.8%) and 3596 (0.8%) excess YLL in men and women, respectively. Men aged 65–110 years and women aged 75–110 years were the greatest contributors. Fewer deaths and YLL from CVD, cancer and other causes were observed in 2020 compared with the baseline adjusted to the population size in 2020. Conclusions: Compared with the baseline, excess mortality and YLL from all causes were experienced in Sweden during 2020, with a higher excess observed in men than in women, indicating that more men died at a younger age while more women died at older ages than expected. A notable reduction in deaths and YLL due to CVD suggests a displacement effect from CVD to COVID-19.

OBJECTIVES: To assess the associations between cardiorespiratory fitness (CRF) in young men and the incidence of site-specific cancer. METHODS: A Swedish population-based cohort study with register linkage of men who underwent military conscription in 1968-2005 was undertaken. CRF was assessed by maximal aerobic workload cycle test at conscription. Cox regression models assessed linear associations and included CRF, age, year and site of conscription, body mass index and parental level of education. CRF was also categorised into low, moderate and high for facilitated interpretation and results comparing high and low CRF are reported. RESULTS: Primary analyses were performed in 1 078 000 men, of whom 84 117 subsequently developed cancer in at least one site during a mean follow-up of 33 years. Higher CRF was linearly associated with a lower hazard ratio (HR) of developing cancer in the head and neck (n=2738, HR 0.81, 95% CI 0.74 to 0.90), oesophagus (n=689, HR 0.61, 95% CI 0.50 to 0.74), stomach (n=902, HR 0.79, 95% CI 0.67 to 0.94), pancreas (n=1280, HR 0.88, 95% CI 0.76 to 1.01), liver (n=1111, HR 0.60, 95% CI 0.51 to 0.71), colon (n=3222, HR 0.82, 95% CI 0.75 to 0.90), rectum (n=2337, HR 0.95, 95% CI 0.85 to 1.05), kidney (n=1753, HR 0.80, 95% CI 0.70 to 0.90) and lung (n=1635, HR 0.58, 95% CI 0.51 to 0.66). However, higher CRF predicted a higher hazard of being diagnosed with prostate cancer (n=14 232, HR 1.07, 95% CI 1.03 to 1.12) and malignant skin cancer (n=23 064, HR 1.31, 95% CI 1.27 to 1.36). CONCLUSION: We report a number of protective associations between higher CRF in healthy young men and the subsequent hazard of site-specific cancers. These results have implications for public health policymaking, strengthening the incentive to promote health through improving CRF in youth.

BACKGROUND: Our aim was to assess associations between cardiorespiratory fitness (CRF) and body mass index (BMI) in youth and 5-year mortality after site-specific cancer diagnoses in men. METHODS: Men with cancer from a population who underwent military conscription at ages 16-25 during 1968-2005 in Sweden were included. CRF was assessed as maximal aerobic workload on a cycle ergometer test and was classified as low, moderate, or high. BMI (kg/m2 ) was classified as underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), or obesity (>30). Conscription data were linked with register data on cancer diagnosis and mortality. Analyses included CRF, BMI, date of diagnosis, and age, year, and center for conscription. RESULTS: A total of 84,621 cancer cases were included. Mean age at diagnosis was 52 years. Follow-up data were available during a mean of 6.5 years. There were linear protective associations between CRF and mortality after any cancer diagnosis (hazard ratio [HR] for high vs. low CRF 0.70), malignant skin cancer (HR 0.80), non-Hodgkin lymphoma (HR 0.78), and cancer in the lungs (HR 0.80), head and neck (HR 0.68), pancreas (HR 0.83), stomach (HR 0.78), liver (HR 0.84), rectum (HR 0.79), and bladder (HR 0.71). Overweight and/or obesity were associated with increased mortality after any cancer (HR for obesity vs. normal weight 1.89), malignant skin cancer (HR 2.03), Hodgkin lymphoma (HR 2.86) and cancer in the head and neck (HR 1.38), thyroid (HR 3.04), rectum (HR 1.53), kidney (HR 1.90), bladder (HR 2.10), and prostate (HR 2.44). CONCLUSION: We report dose-dependent associations between CRF and BMI in youth and mortality after site-specific cancer diagnoses in men. The associations with mortality could be due to both cancer inhibition and an improved tolerance to withstand cancer treatment. These results strengthen the incentive for public health efforts aimed at establishing a high CRF and normal weight in youth.

OBJECTIVE: Overweight and obesity have been identified as risk factors for severe COVID-19, however, prospective cohort studies investigating the association between overweight early in life and severity of COVID-19 are lacking. METHODS: We included 1,551,670 Swedish men, born 1950-1987, with body mass index (BMI) registered at age 18. They were followed until January 9, 2021. COVID-19 cases and comorbidities were identified through the National Patient, Intensive Care, and Cause of Death registries. Outcomes were: 1) hospitalization, 2) intensive care unit admission, and 3) death. RESULTS: We found 4,315 cases (mean age 56.4 years, SD 8.8) hospitalized due to COVID-19, of which 729 were admitted to an intensive care unit, and altogether 224 deaths. The risk for hospital admission increased with higher values of BMI (kg/m2 ), despite adjustment for comorbidities, from odds ratio (OR) 1.19 (95% CI 1.08-1.31) at BMI 22.5-25 to 1.68 (1.39-2.02) at BMI ≥30 compared to BMI 18.5-20. ORs for intensive care unit admission were 1.44 (1.13-1.84) at BMI 22.5-25 and 2.61 (1.73-3.93) at BMI ≥30. CONCLUSION: Higher BMI in early adulthood was associated with severe COVID-19 many years later with a risk increase starting already at BMI ≥22.5. This underlines the necessity of preventive actions against overweight in youth to offer protection against coming viral pandemics.

Background: Exposure to many contacts is the main risk factor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while risk of serious disease and death is chiefly determined by old age and comorbidities. Relative and population-attributable fractions (PAFs) of multiple medical and social exposures for COVID-19 outcomes have not been evaluated among older adults. Objectives: We describe the effect of multiple exposures on the odds of testing positive for the virus and of severe disease (hospital care or death) and PAFs in Swedish citizens aged 55 years and above. Methods: We used national registers to follow all citizens aged 55 years and above with respect to (1) testing positive, (2) hospitalization, and (3) death between 31 January 2020 and 1 February 2021. Results: Of 3,410,241 persons, 156,017 (4.6%, mean age 68.3 years) tested positive for SARS-CoV-2, while 35,999 (1.1%, mean age 76.7 years) were hospitalized or died (12,384 deaths, 0.4%, mean age 84.0 years). Among the total cohort, the proportion living without home care or long-term care was 98.8% among persons aged 55–64 and 22.1% of those aged 95 and above. After multiple adjustment, home care and long-term care were associated with odds ratios of 7.9 (95% confidence interval [CI] 6.8–9.1) and 22.5 (95% CI 19.6–25.7) for mortality, with PAFs of 21.9% (95% CI 20.9–22.9) and 33.3% (95% CI 32.4–34.3), respectively. Conclusion: Among Swedish residents aged 55 years and above, those with home care or long-term care had markedly increased risk for COVID-19 death during the first year of the pandemic, with over 50% of deaths attributable to these factors.

Background: We sought to determine the role of obesity in adolescent men on development of atrial fibrillation (AF) and subsequent associated clinical outcomes in subjects diagnosed with AF. Methods and Results: We conducted a nationwide, register-based, cohort study of 1 704 467 men (mean age, 18.3±0.75 years) enrolled in compulsory military service in Sweden from 1969 through 2005. Height and weight, blood pressure, fitness, muscle strength, intelligence quotient, and medical disorders were recorded at baseline. Records obtained from the National Inpatient Registry and the Cause of Death Register were used to determine incidence and clinical outcomes of AF. During a median follow-up of 32 years (interquartile range, 24-41 years), 36 693 cases (mean age at diagnosis, 52.4±10.6 years) of AF were recorded. The multivariable-adjusted hazard ratio (HR) for AF increased from 1.06 (95% CI, 1.03-1.10) in individuals with body mass index (BMI) of 20.0 to <22.5 kg/m2 to 3.72 (95% CI, 2.44-5.66) among men with BMI of 40.0 to 50.0 kg/m2, compared with those with BMI of 18.5 to <20.0 kg/m2. During a median follow-up of ≈6 years in patients diagnosed with AF, we identified 3767 deaths, 3251 cases of incident heart failure, and 921 cases of ischemic stroke. The multivariable-adjusted HRs for all-cause mortality, incident heart failure, and ischemic stroke in AF-diagnosed men with baseline BMI >30 kg/m2 compared with those with BMI <20 kg/m2 were 2.86 (95% CI, 2.30-3.56), 3.42 (95% CI, 2.50-4.68), and 2.34 (95% CI, 1.52-3.61), respectively. Conclusions: Increasing BMI in adolescent men is strongly associated with early AF, and with subsequent worse clinical outcomes in those diagnosed with AF with respect to all-cause mortality, incident heart failure, and ischemic stroke., Funding agency:Swedish state under an agreement concerning research and education of physicians ALFGBG-717211

Bakgrund: Ungdomars sexuella och reproduktiva hälsa och rättigheter (SRHR) är ett viktigt folkhälsoarbete och barnmorskan har en central roll när det kommer till att nå ungdomarna med kunskap och information. Det förefaller finnas få studier om barnmorskors uppfattningar om vad ungdomar behöver veta mer om när det kommer till deras sexuella och reproduktiva hälsa och rättigheter. Syfte: Syftet med denna studie var att beskriva barnmorskors uppfattningar om vad ungdomar behöver veta mer om inom området sexuell och reproduktiv hälsa och rättigheter. Metod: Kvalitativ intervjustudie med åtta semistrukturerade intervjuer med barnmorskor. Datamaterial analyserades med en kvalitativ innehållsanalys med induktiv ansats. Resultat: Barnmorskorna uppfattade att ungdomarna hade behov av att veta mer om kroppsutveckling. Även mer om sexuellt överförbara infektioner (STI) och preventivmedel samt att killarna behövde veta mer om deras reproduktiva ansvar. Ungdomarna behövde också veta mer om sexuella relationer och rättigheter, innefattande bland annat lagar och homosexualitet. Barnmorskorna ser idag en ökning av sexuella problem bland ungdomarna och barnmorskorna hade en gemensam uppfattning om att det beror på pornografikonsumtion. Slutsats: Barnmorskor har insikt i vad ungdomar behöver veta mer om inom SRHR. Det finns fortfarande brister i undervisning och utbildning till ungdomar inom SRHR och det är angeläget att fokusera och investera i arbeten för att stärka och främja ungdomars SRHR. Klinisk tillämpbarhet: Denna studie lyfter barnmorskors uppfattningar om vad ungdomar behöver veta mer om inom ämnet SRHR. Studien kan användas i klinisk verksamhet till förbättringsarbeten för olika yrkeskategorier som arbetar med ungdomar gällande SRHR., Background: The sexual and reproductive health and rights (SRHR) of young people is an important public health work and the midwife has a central role in reaching the young people with knowledge and information. There seem to be few studies on midwives' perceptions about what young people need to know more about when it comes to their sexual and reproductive health and rights. Purpose: The purpose of this study was to describe the views of midwives about what young people need to know more about in the area of sexual and reproductive health and rights. Method: Qualitative interview study with eight semi-structured interviews with midwives. The data material was analyzed with a qualitative content analysis with inductive approach. Result: The midwives perceived that the young people needed to know more about body development. In addition, more about sexually transmitted infections (STIs) and contraceptives and that the young men needed to know more about their reproductive responsibilities. The youth also needed to know more about sexual relations and rights, including, among other things, laws and homosexuality. The midwives today see an increase in sexual problems among young people and the midwives had a common view that this is due to pornography consumption. Conclusion: Midwives have insight into what young people need to know more about in SRHR. There are still shortcomings in education for young people within SRHR, and it is important to focus and invest in work to strengthen and promote young people's SRHR. Clinical application: This study highlights the views of midwives on what young people need to know more about in the subject of SRHR. The study can be used in clinical activities for improvement work for various occupational categories that work with young people regarding SRHR.