Search

Objective To study symptom panorama in students, to identify undiagnosed iron deficiency, and to evaluate any changes in symptoms and laboratory test results after treatment with iron supplementation. Design Descriptive and prospective, interventional study. Setting Healthcare in upper secondary school. Intervention Treatment with iron supplementation for a period of 3 months. Subjects Students in the first grade of one upper secondary school. Main outcome measures Frequency of iron deficiency related to symptoms measured by a questionnaire (30 questions) on symptoms related to quality of life and 9 questions about diet and exercise. Results Iron deficiency was diagnosed in 12% of the students (two or more abnormal laboratory tests) and in 61% of the students one or more laboratory tests were abnormal. Symptoms of vertigo/dizziness were significantly more common in students with iron deficiency. After iron supplementation there was a significant increase in s-ferritin levels and a decrease in s-transferrin levels, with an accompanying significant reduction of the symptom scores of vertigo/dizziness, irritability, depressive symptoms, and indisposition. Conclusions Symptoms of vertigo/dizziness were significantly more common in students with iron deficiency. Iron supplementation reduced the symptoms of vertigo/dizziness, irritability, depressive symptoms, and indisposition. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to explore how health care providers at youth clinics (YCs) in Sweden engage with, focus on, and navigate across the mental health youth space, while upholding the core bedrock principle of "youth-centeredness"., Methods: Qualitative interviews were conducted with 21 health care professionals working in three YCs located in three different regions of Sweden. Data were analysed using reflexive thematic analysis informed by the work of Braun and Clarke., Results: The three themes were: 1) "youth mission-at the core of the YCs" work and challenged by a stronger involvement in mental ill health'; 2) "YCs" unique and complementary role in the youth mental health system: a holistic perspective, team work, and a focus on normalization', and 3) "Caught between a rock and a hard place: to treat at a care level that is not optimal for the young users" needs or to refer within an unreliable system'., Conclusion: This study reflects the individuality and key features of YCs, their widening roles within the mental health sphere, and the challenges faced in maintaining and expanding the characteristic "youth-centred" approach while expanding their work with mental health.

In Swedish school health services, local initiatives have been taken to use physical activity on prescription (PAP) to encourage physically inactive children to become more active. Previous research shows that interprofessional collaboration plays a crucial role in promoting physical activity in children, as well as in promoting health in schools. However, there is a lack of knowledge about PAP for children in the school setting, including how medical and educational staff can work together to encourage children who have been recommended PAP. Therefore, this study aims to explore the perceived facilitators and barriers concerning interprofessional collaboration regarding physical activity on prescription in the school setting, as viewed from the professionals' perspectives. Semi-structured interviews were conducted with 21 professionals who work with the method in school settings. The data were analyzed using Reflexive Thematic Analysis. The results reveal both barriers and facilitators for interprofessional collaboration on PAP in the school setting, as perceived by professionals. Organizational and structural obstacles within school institutions hinder collaboration, while a shared commitment to PAP, characterized by consensus-building, acts as a facilitating factor. PAP for children in a school setting is still an unexplored area and further research is required., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Wiklund, Vikman, Wiklund and Hedenborg.)

School nurses are in a key position to promote children's physical activity. They engage all children in health dialogues and use different approaches to inform children about physical activity and motivate them to change their physical activity level. In a school context, it is important to explore and problematize school nurses' views of children's physical activity and the influence of these views on their professional practice in the school health service. Identifying and problematizing school nurses' views of physical activity would enable them to create improved guidelines and equivalent ways of working in the future. Therefore, this study aims to discursively explore Swedish school nurses' views on school children's physical activity and its promotion and elucidate them through a discursive framework based on sensitizing concepts. This study uses a qualitative research design with a constructivist grounded theory approach. Semi-structured interviews were conducted with 24 school nurses. The analysis resulted in a core category describing how school nurses use intertwined views to lead children from sedentarity to physical activity. Furthermore, the school nurses' practices were identified in three categories: fostering everyday movement as a tool for health, battling children's sedentarity under difficult conditions, and promoting everyday movement and compensating for unequal access. The results indicate that school nurses lack common and clear guidelines for their mission to promote physical activity to children, which may lead to inequality in access to physical activity for children and young people., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Wiklund, Wiklund, Vikman and Hedenborg.)

Background: During the first year postpartum, about 25 per cent of Swedish women with severe perineal trauma (SPT), i.e., a third- or fourth-degree perineal laceration at childbirth, are unsatisfied with their healthcare contacts. Further, there is a lack of research on the more long-term experiences of healthcare encounters among women with persistent SPT-related health problems. This study explores how women with self-reported persistent SPT-related health problems experience their contact with healthcare services 18 months to five years after childbirth when the SPT occurred., Methods: In this descriptive qualitative study, a purposive sample of twelve women with self-reported persistent health problems after SPT were individually interviewed from November 2020 - February 2022. The data was analysed using inductive qualitative content analysis., Results: Our results showed a paradoxical situation for women with persistent health problems due to SPT. They struggled with their traumatised body, but healthcare professionals rejected their health problems as postpartum normalities. This paradox highlighted the women's difficulties in accessing postpartum healthcare, rehabilitation, and sick leave, which left them with neglected healthcare needs, diminished emotional well-being, and loss of financial and social status. Our results indicated that these health problems did not diminish over time. Consequently, the women had to search relentlessly for a 'key person' in healthcare who acknowledged their persistent problems as legitimate to access needed care, rehabilitation, and sick leave, thus feeling empowered., Conclusions: Our study revealed that women with persistent SPT-related health problems experienced complex health challenges. Additionally, their needs for medical care, rehabilitation, and sick leave were largely neglected. Thus, the study highlights an inequitable provision of SPT-related healthcare services in Sweden, including regional disparities in access to care. Hence, the authors suggest that Swedish national guidelines for SPT-related care need to be developed and implemented, applying a woman-centered approach, to ensure equitable, effective, and accessible healthcare., (© 2024. The Author(s).)

Background: Youth mental health is a major health concern in almost every country. Mental health accounts for about 13% of the global burden of disease in the 10-to-19-year age group. Still there are significant gaps between the mental health needs of young people and the quality and accessibility of available services. Collaboration between health and social service actors is a recognized way of reducing gaps in quality and access. Yet there is little scientific evidence on how these collaborations are applied, or on the challenges of cross-boundary collaboration in the youth mental health space. This study aims to explore how collaboration is understood and practiced by professionals working in the Swedish youth mental health system., Methods: We conducted 42 interviews (November 2020 to March 2022) with health and social care professionals and managers in the youth mental health system in Sweden. Interviews explored participants' experience and understanding of the purpose, realization, and challenges of collaboration. Data were analysed under an emergent study design using reflexive thematic analysis., Results: The analysis produced three themes. The first shows that collaboration is considered as essential and important, and that it serves diverse purposes and holds multiple meanings in relation to professionals' roles and responsibilities. The second addresses the different layers of collaboration, in relation to activities, relationships, and target levels, and the third captures the challenges and criticisms in collaborating across the youth mental health landscape, but also in growing possibilities for future development., Conclusion: We conclude that collaboration serves multiple purposes and takes many shapes in the Swedish youth mental health system. Despite the many challenges, participants saw potential in further building collaboration. Interestingly our participants also raised concerns about too much collaboration. There was scepticism about collaboration directing attention away from young people to the professionals, thereby risking the trust and confidentiality of their young clients. Collaboration is not a panacea and will not compensate for an under-resourced youth mental health system., (© 2024. The Author(s).)

Immunotherapy is revolutionizing cancer therapy. The rapid development of new immunotherapeutic strategies to treat solid tumors is posing new challenges for preclinical research, demanding novel in vitro methods to test treatments. Such methods should meet specific requirements, such as enabling the evaluation of immune cell responses like cytotoxicity or cytokine release, and infiltration into the tumor microenvironment using cancer models representative of the original disease. They should allow high-throughput and high-content analysis, to evaluate the efficacy of treatments and understand immune-evasion processes to facilitate development of new therapeutic targets. Ideally, they should be suitable for personalized immunotherapy testing, providing information for patient stratification. Consequently, the application of in vitro 3-dimensional (3D) cell culture models, such as tumor spheroids and organoids, is rapidly expanding in the immunotherapeutic field, coupled with the development of novel imaging-based techniques and -omic analysis. In this paper, we review the recent advances in the development of in vitro 3D platforms applied to natural killer (NK) cell-based cancer immunotherapy studies, highlighting the benefits and limitations of the current methods, and discuss new concepts and future directions of the field., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Carannante, Wiklund and Önfelt.)

Objective: To measure changes in regional lung perfusion using CT angiography in mechanically ventilated, anesthetized ponies administered pulsed inhaled nitric oxide (PiNO) during hypotension and normotension., Animals: 6 ponies for anesthetic 1 and 5 ponies for anesthetic 2., Procedures: Ponies were anesthetized on 2 separate occasions, mechanically ventilated, and placed in dorsal recumbency within the CT gantry. Pulmonary arterial, right atrial, and facial arterial catheters were placed. During both anesthetics, PiNO was delivered for 60 minutes and then discontinued. Anesthetic 1: hypotension (mean arterial pressure < 70 mmHg) was treated using dobutamine after 30 minutes of PiNO delivery. Following the discontinuation of PiNO, dobutamine administration was discontinued in 3 ponies and was continued in 3 ponies. The lung was imaged at 30, 60, and 105 minutes. Anesthetic 2: hypotension persisted throughout anesthesia. The lung was imaged at 30, 60, and 90 minutes. At all time points, arterial and mixed venous blood samples were analyzed and cardiac output (Q˙t) was measured. Pulmonary perfusion was calculated from CT image analysis., Results: During PiNO delivery, perfusion to well-ventilated lungs increased if ponies were normotensive, leading to increased arterial oxygenation, reduced alveolar dead space, and reduced alveolar to arterial oxygen tension gradient. When PiNO was stopped and dobutamine administration continued, alveolar dead space and venous admixture increased, in contrast to when dobutamine and PiNO were both discontinued., Clinical Relevance: If PiNO is administered to mechanically ventilated, anesthetized ponies with concurrent hypotension and low Q˙t, this must be supported to achieve favorable redistribution of pulmonary perfusion to improve pulmonary gas exchange.

Background: In Sweden, persistent physical and psychological health problems occur in about three in ten women who sustain severe perineal trauma (SPT) during childbirth. As most Swedish women work outside the home, the question of if and how SPT-related morbidity influences working life needs exploration. This study aims to qualitatively explore how women with persistent SPT-related morbidities experience and conceptualise their problems concerning working life. Further, we theorise the findings by applying Simone de Beauvoir's feminist framework of immanence and transcendence as well as authentic and inauthentic life., Methods: Ten interviews with women recruited via a Swedish social media community for perineal trauma were analysed according to Charmaz's constructivist approach to grounded theory., Results: The theoretical model and related core category 'Negotiating the ambiguity of an (in)authentic working life' reflected the women's negotiations of immanence as 'the silent covert object' versus transcendence as the 'the resourceful overt subject'. The model also mirrored the conflict of (in)authenticity in working life. An inauthentic working life was experienced when women were denied their subjectivity at work or constructed themselves as subjects in denial of their SPT. On the other hand, women who acknowledged their SPT and were constructed as subjects by 'others' achieved an authentic working life despite SPT., Conclusions: The conflicting gendered process of 'the silent covert object' versus 'the resourceful overt subject' problematised women's vulnerability at work. Aspects that enable subjectification and transcendence are essential for policymakers, employers, healthcare services, and society to eradicate the taboo of SPT and create a working environment characterised by understanding, support, and flexibility. Further, access to adequate care, sick leave, and occupational rehabilitation are essential. Such measures support transcendence towards an authentic working life and, consequently, a more gender-equal working environment that does not deprive women of career opportunities due to a physical ailment., (© 2023. The Author(s).)

Here, we present a methodology based on multiplexed fluorescence screening of two- or three-dimensional cell cultures in a newly designed multichambered microwell chip, allowing direct assessment of drug or immune cell cytotoxic efficacy. We establish a framework for cell culture, formation of tumor spheroids, fluorescence labeling, and imaging of fixed or live cells at various magnifications directly in the chip together with data analysis and interpretation. The methodology is demonstrated by drug cytotoxicity screening using ovarian and non-small cell lung cancer cells and by cellular cytotoxicity screening targeting tumor spheroids of renal carcinoma and ovarian carcinoma with natural killer cells from healthy donors. The miniaturized format allowing long-term cell culture, efficient screening, and high-quality imaging of small sample volumes makes this methodology promising for individualized cytotoxicity tests for precision medicine., Competing Interests: B.Ö. is a consultant, has ownership in Vycellix, and receives research funding from Affimed., (© 2022 The Authors.)

Background: Sweden has provided around 300 youth clinics (YCs) to address the health needs of young people since the 1970s. During the last few years, and as part of an effort to strengthen mental healthcare for young people, YCs' role in the provision of mental healthcare has been widely debated. With such debates as background, the aim of this study is to analyse Swedish YCs' responses to the mental (ill) healthcare needs of young people, from the perspective of national level stakeholders., Methods: We used thematic analysis of interviews with eight national level stakeholders in the field of youth mental health in Sweden. Building upon the concept of biomedicalization we examined the discourses on mental (ill) health, healthcare and youth that such responses reproduce., Results: YCs engage in the three simultaneous, but at times contradictory, responses of protecting, managing and bending boundaries. Remaining true to their mission as a health-promotion service compels them to protect their boundaries and limit the type of mental health issues they address. However, the perceived malfunctioning of specialized services has led them to bend these boundaries to allow in more young people with severe mental health problems. Caught between protecting and bending boundaries, the response of managing boundaries to decide who should be allowed in and who should be sent elsewhere has emerged as a middle-way response. However, it is not free from conflicts., Conclusion: Building upon the concept of biomedicalization, this study poses two questions. The first relates to whether it is possible to support young people and their health without reinforcing discourses that represent young people as collectively at risk, and if so how this can be done. The second relates to the provision of mental healthcare for young people, and the need to identify conditions for integrating diagnosis and treatment within YCs, without hindering their holistic and youth-centred approach., (© 2022. The Author(s).)

Background: Individuals describe both short and long term consequences after an anterior cruciate ligament (ACL) injury. Functional impairments are well documented while psychological, social and contextual factors need to be further investigated. By the use of a qualitative method incorporating a biopsychosocial lens, we aimed to explore individuals' experiences of living and coping with an ACL rupture with a specific focus on experiences significant to overall life, activity in daily living and physical activity more than one year after injury., Methods: Twelve participants were chosen strategically by a purposive sampling. Four men and eight women (19-41 years) with an ACL rupture 2-25 years ago, were included. Semi-structured interviews were used and analysed with qualitative content analysis., Results: The results consisted of one overarching theme: 'A strenuous process towards regaining balance' which built on three categories 'Disrupted knee', 'Disrupted me' and 'Moving forward with new insights'. The overarching theme captures the participants' experiences of a strenuous process towards regaining both physical and mental balance in the aftermath of an ACL injury. The results illuminate how participants were forced to cope with a physically 'disrupted knee', as well as facing mental challenges, identity challenges and a 'disrupted me'. By gradual acceptance and re-orientation they were moving forward with new insights - although still struggling with the consequences of the injury., Conclusions: Individuals with an ACL injury experience both physical, psychological, and social challenges several years after injury. In addition to the functional impairments, diverse psychological, social and contextual 'disruptions' and struggles may also be present and influence the rehabilitation process. It is important that physiotherapists identify individuals who face such challenges and individually tailor the rehabilitation and support. A biopsychosocial approach is recommended in the clinical practice and future studies focusing on psychosocial processes in the context of ACL rehabilitation are warranted., (© 2022. The Author(s).)

Background: In the current study, the approach of 'utopia as method' was combined with the concept 'landscapes of care' to explore collective imaginaries of caring landscapes in relation to young people living in rural northern Sweden, while focusing specifically on what such landscapes should ideally look like, and how various strategies could help to realise the visions., Methods: The research was conducted using a modified concept mapping methodology comprising three phases of data collection and analysis. This facilitated the integration of tacit knowledge and utopian visions of young people, professionals and policymakers living and working in various parts of northern Sweden., Results: The results indicated that caring landscapes should: 'provide services responsive to young people's wishes and needs', 'be organised around values of safety, equity and youth participation', and 'rework metro-centredness' in order to care for, with and about rural youth., Conclusions: The findings can be viewed as an imaginary reconstitution of communities in rural northern Sweden, but also as hypothetical building blocks to be used for developing caring landscapes and a 'good countryside' where young people have the possibility to live a good life in decent health., (© 2021. The Author(s).)

Droplets with a liquid perfluoropentane core and a cellulose nanofiber shell have the potential to be used as drug carriers in ultrasound-mediated drug delivery. However, it is necessary to understand their mechanical properties to develop ultrasound imaging sequences that enable in vivo imaging of the vaporization process to ensure optimized drug delivery. In this work, the compressibility of droplets stabilized with cellulose nanofibers was estimated using acoustophoresis at three different acoustic pressures. Polyamide particles of known size and material properties were used for calibration. The droplet compressibility was then used to estimate the cellulose nanofiber bulk modulus and compare it to experimentally determined values. The results showed that the acoustic contrast factor for these droplets was negative, as the droplets relocated to pressure antinodes during ultrasonic actuation. The droplet compressibility was 6.6-6.8 ×10-10 Pa-1, which is higher than for water (4.4×10-10 Pa-1) but lower than for pure perfluoropentane (2.7×10-9 Pa-1). The compressibility was constant across different droplet diameters, which was consistent with the idea that the shell thickness depends on the droplet size, rather than being constant.

Introduction: Strengthening first-line mental healthcare services for youth remains a priority for the Swedish government. The government is currently investigating how different sectors involved can be strengthened, but evidence is scarce. Youth clinics play a key role in these discussions, being one of the most trusted services for youth. However, analysis of organisational functions and coordination with other services is important to strengthen youth clinics' role in first-line mental healthcare. This study investigates these challenges and aims to analyse the integration of mental healthcare within youth clinics to identify strategies to strengthen first-line mental healthcare for youth in Sweden., Methods and Analysis: This study adopts a health policy and systems approach. In the first phase, a formative realist evaluation is conducted to ascertain what works in terms of integrating mental healthcare services within youth clinics, for what type of youth subpopulations and under what circumstances. National-level stakeholders will be interviewed to elicit the programme theory that explains how the intervention is supposed to work. The programme theory will then be tested in three-five cases. The cases will be comprised of youth clinics and their stakeholders. Quantitative and qualitative information will be gathered, including via visual methodologies and questionnaires. The second phase includes a concept mapping study, engaging stakeholders and young people to build consensus on strategies to strengthen the integration of mental healthcare into youth clinics., Ethics and Dissemination: The Swedish Ethical Review Authority has approved the study (2019-02910 and 2020-04720). The results will be published in open-access peer-reviewed journals and presented at scientific conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)

Multicellular tumor spheroids (MCTSs) can serve as in vitro models for solid tumors and have become widely used in basic cancer research and drug screening applications. The major challenges when studying MCTSs by optical microscopy are imaging and analysis due to light scattering within the 3-dimensional structure. Herein, we used an ultrasound-based MCTS culture platform, where A498 renal carcinoma MCTSs were cultured, DAPI stained, optically cleared and imaged, to connect nuclear segmentation to biological information at the single cell level. We show that DNA-content analysis can be used to classify the cell cycle state as a function of position within the MCTSs. We also used nuclear volumetric characterization to show that cells were more densely organized and perpendicularly aligned to the MCTS radius in MCTSs cultured for 96 h compared to 24 h. The method presented herein can in principle be used with any stochiometric DNA staining protocol and nuclear segmentation strategy. Since it is based on a single counter stain a large part of the fluorescence spectrum is free for other probes, allowing measurements that correlate cell cycle state and nuclear organization with e.g., protein expression or drug distribution within MCTSs., (© 2021. The Author(s).)

This article explores fathering practices among Syrian refugee families in Sweden. Syrian refugees provide an example of people who migrated because of a single major event: the war in Syria. The article examines the impact of the COVID-19 pandemic on fathering practices. The Swedish COVID-19 strategy differed from those adopted in many other countries. Lockdowns were minimal and were not stringently enforced, based on the assumption that individuals would trust the authorities and would take personal responsibility for complying with their guidelines and recommendations. Previous research suggests that migrants and other vulnerable groups were not always well informed about the public policies introduced prior to and during the pandemic. The article draws on empirical data from a wider research project on the family lives of Syrian migrants in Sweden. The authors present their findings from an analysis of eleven ethnographically informed semi-structured interviews, carried out before and during the pandemic, with married fathers who had been living in Sweden for several years. In this article, they focus on three cases representing fathers with varied educational backgrounds and employment histories. These families had in common what are considered by Swedish standards to be overcrowded living conditions; they were forced to accept close family proximity, both physically and emotionally, as they no longer had the supportive networks they were used to in Syria. The three fathers were found to rely more heavily on information provided by the people with whom they were in contact in Sweden than on policies and recommendations from the authorities. These findings confirmed that the previous experiences among refugees of shifting policies regarding migration and integration had lowered their trust in government. They had learnt that they needed to rely on mutual dependency not only between spouses, but also between parents and children., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Wissö and Bäck-Wiklund.)

Background: Exercise is an effective intervention to prevent falls in older adults; however, long-term adherence is often poor. To increase adherence, additional support for behavior change has been advocated. However, consistency in the reporting of interventions using behavior change techniques is lacking. Recently, a classification system has been developed to increase consistency in studies using behavior change techniques within the self-determination theory., Objective: This study aimed to explore expressions of self-determination among community-dwelling older adults using a self-managed digital fall prevention exercise program comprising behavior change support (the Safe Step program), which was developed in co-creation with intended users., Methods: The qualitative study design was based on open-ended responses to questionnaires, and individual and focus group interviews. A deductive qualitative content analysis was applied using the classification system of motivation and behavior change techniques as an analytical matrix, followed by an inductive analysis. Twenty-five participants took part in a feasibility study and exercised in their homes with the Safe Step program for 4 months. The exercise program was available on computers, smartphones, and tablets, and was fully self-managed., Results: In the deductive analysis, expressions of support were demonstrated for all three basic human psychological needs, namely, autonomy, competence, and relatedness. These expressions were related to 11 of the 21 motivation and behavior change techniques in the classification system. The inductive analysis indicated that autonomy (to be in control) was valued and enabled individual adaptations according to different rationales for realizing exercise goals. However, the experience of autonomy was also two-sided and depended on the participants' competence in exercise and the use of technology. The clarity of the program and exercise videos was seen as key for support in performance and competent choices. Although augmented techniques for social support were requested, support through relatedness was found within the program., Conclusions: In this study, the Safe Step program supported the establishment of new exercise routines, as well as the three basic human psychological needs, with autonomy and competence being expressed as central in this context. Based on the participants' experiences, a proposed addition to the classification system used as an analytical matrix has been presented., Trial Registration: ClinicalTrials.gov NCT02916849; https://clinicaltrials.gov/ct2/show/NCT02916849., (©Beatrice Pettersson, Rebecka Janols, Maria Wiklund, Lillemor Lundin-Olsson, Marlene Sandlund. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 30.07.2021.)

In cancer research and drug screening, multicellular tumor spheroids (MCTSs) are a popular model to bridge the gap between in vitro and in vivo. However, the current techniques to culture mixed co-culture MCTSs do not mimic the structural architecture and cellular spatial distribution in solid tumors. In this study we present an acoustic trapping-based core-shell MCTSs culture method using sequential seeding of the core and shell cells into microwells coated with a protein repellent coating. Scaffold-free core-shell ovarian cancer OVCAR-8 cell line MCTSs were cultured, stained, cleared and confocally imaged on-chip. Image analysis techniques were used to quantify the shell thickness (23.2 ± 1.8 µm) and shell coverage percentage (91.2 ± 2.8%). We also show that the shell thickness was evenly distributed over the MCTS cores with the exception of being slightly thinner close to the microwell bottom. This scaffold-free core-shell MCTSs formation technique and the analysis tools presented herein could be used as an internal migration assay within the MCTS or to form core-shell MCTS co-cultures to study therapy response or the interaction between tumor and stromal cells.

Commensal meals seem to be related to a better nutritional and metabolic health as well as an improved quality of life. The aim of this paper was to examine to what extent research was performed using the search term commensality related to assessment of timing of meals. A scoping review was performed, where 10 papers were identified as specifically addressing the assessment of timing of commensality of meals. Time use studies, questionnaires, and telephone- and person-to-person interviews were used for assessing meal times in relation to commensality. Four of the studies used a method of time use registration, and six papers used interviews or questionnaires. Common meals with family members were the most common, and dinners late at night were often preferred for commensal activities among the working population. In conclusion, the family meal seemed to be the most important commensal meal. It is clear from the collected papers and from previous systematic reviews that more studies of commensal meals in general and about timing aspects in particular and in relation to nutritional health are essential to provide a solid background of knowledge regarding the importance of timing in relation to commensal meals.

This scoping review focuses on the assessment of commensality in research and attempts to identify used methods for performing research on commensality. It reflects a multidisciplinary research field and draws on findings from Web of Science Core Collection, up to April 2019. The empirical material consisted of 61 studies, whereof most were qualitative research, and some were of quantitative character, including very few dietary surveys. The findings show nine papers categorized as using quantitative approaches, 52 papers were categorized as qualitative. The results show a wide variety of different ways to try to find and understand how commensality can be understood and identified. There seems to be a shift in the very concept of commensality as well as some variations around the concept. This paper argues the need to further investigate the importance of commensality for health and wellbeing, as well as the need to gather data on health and health-related behaviors, living conditions and sociodemographic data in parallel. The review shows the broad-ranging areas where commensality is researched, from cultural and historical areas to ethnographic or anthropological areas over to dietary assessment. To complement large dietary surveys with methods of assessing who you are eating with in what environment should be a simple way to further our knowledge on the circumstances of meal intake and the importance of commensality. To add 24-h dietary recall to any study of commensality is another way of identifying the importance of commensality for dietary quality. The use of mixed methods research was encouraged by several authors as a good way forward in the assessment of commensality and its importance.

Acoustic trapping is a promising technique for aligning particles in two-dimensional arrays, as well as for dynamic manipulation of particles individually or in groups. The actuating principles used in current systems rely on either cavity modes in enclosures or complex arrangements for phase control. Therefore, available systems either require high power inputs and costly peripheral equipment or sacrifice flexibility. This work presents a different concept for acoustic trapping of particles and cells that enables dynamically defined trapping patterns inside a simple and inexpensive setup. Here, dynamic operation and dexterous trapping are realized through the use of a modified piezoelectric transducer in direct contact with the liquid sample. Physical modeling shows how the transducer induces an acoustic force potential where the conventional trapping in the axial direction is supplemented by surface displacement dependent lateral trapping. The lateral field is a horizontal array of pronounced potential minima with frequency-dependent locations. The resulting system enables dynamic arraying of levitated trapping sites at low power and can be manufactured at ultra-low cost, operated using low-cost electronics, and assembled in less than 5 min. We demonstrate dynamic patterning of particles and biological cells and exemplify potential uses of the technique for cell-based sample preparation and cell culture.

Background: This study emerges as a response to the lack of youth perspectives when it comes to discussions about access to and experiences of health and social services in rural areas. It subsequently contributes to the literature by positioning young people at the centre of this debate, and by taking a more holistic approach to the topic than is typically the case. Specifically, based on the idea that a good life in proper health for young people may be contingent on notions of care that are bounded up in multi-layered social and spatial environments, the aim of this study was to explore what characterises 'landscapes of care' for rural youth., Methods: In this qualitative study, the participants included young people and professionals residing in five diverse areas across the northern Swedish 'peripheral' inland. Individual interviews (16 in total) and focus group discussions (26 in total) were conducted with 63 youth aged 14-27 years and with 44 professionals operating across sectors such as health centres, school health, integration units, youth clinics and youth clubs. Following an emergent design and using thematic analysis, we developed one main theme, 'landscapes of care and despair', comprising the two themes: '(dis)connectedness' and 'extended support or troubling gaps'., Results: The findings illustrate how various health-promoting and potentially harmful aspects acting at structural, organisational and interpersonal levels contributed to dynamic landscapes characterised simultaneously by care and despair. In particular, our study shows how rural youths' feelings of belongingness to people and places coupled with opportunities to participate in society and access practical and emotional support appear to facilitate their care within rural settings. However, although the results indicate that some in the diverse group of rural youth were cared for and about, a negative picture was painted in parallel. These aspects of despair included youths' senses of exclusion and marginalisation, degrading attitudes towards them and their problems, as well as recurrent gaps in the provision and practices of care., Conclusions: To gain a more comprehensive understanding about the health of rural youth, this study highlights the benefits investigating 'care-ful' and 'uncaring' aspects bounded up in dynamic and multi-layered landscapes.

This co-creation study aimed to develop a smartphone self-test application for balance and leg strength in collaboration between older adults and the research team. The paper describes older participants' preferences for, and their contribution to, the application design. Technology to assess movements is available in smartphones with built-in sensors, and one of the challenges is to develop a valuable self-test for older adults. The participants contributed to the design of the application's instructions and user interface. Multiple data collection methods were used: user-test with Think aloud method, mock-ups, homework assignment as co-researcher, audio and video recordings. Qualitative content analysis with a deductive-inductive approach was used, guided by the Optimized Honeycomb model for user experience (UX) as a categorization matrix. The analysis resulted in 17 subcategories within the seven facets of the UX Honeycomb model (findable, accessible, usable, desirable, credible, useful, and valuable), and describes the older participants' preferences and experiences. The main results were participants' desire to know why, to get clear and appropriate information, and expectations of the self-test to be useful. It was feasible and valuable to develop the self-test application in co-creation with the intended user-group, in order to get direct feedback and suggestions for the development., Competing Interests: The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Background: Sweden has nearly 300 youth clinics that have been offering services since the 1970s. However, no evaluation has been done to assess their youth-friendliness. This study aims to assess: i) to what extent youth clinics are perceived as youth-friendly by the young people using them; and ii) if the level of youth friendliness is equally perceived across different sociodemographic groups of users., Methods: The four northernmost counties of Sweden were included in the study. Of the total identified 22 youth clinics, 20 participated by giving out questionnaires to the youth after their visits to the respective youth clinics. In total 1110 youth participated in the study and answered questions according to the World Health Organization's criteria of accessibility, equity, respect, privacy and confidentiality, no judgement, and quality. Means and frequencies were calculated, and t-test and ANOVA were used to compare means by sociodemographic variables., Results: Participants perceived the youth clinics as very youth friendly across the measured domains, with scores as high as 4.8 and 4.9 (of a maximum of 5). Youth clinics were perceived in a similar way regardless of gender, but other sociodemographic factors influenced some of the domains, especially ethnic background., Conclusions: The perception of youth friendliness in youth clinics was very high. Nonetheless, younger users; users who did not categorize themselves as either heterosexual, homosexual, or bisexual; users with trans-experiences; and users with non-Swedish backgrounds gave youth clinics lower scores for certain domains.

We investigate cell-particle secondary acoustic radiation forces in a plain ultrasonic standing wave field inside a microfluidic channel. The effect of secondary acoustic radiation forces on biological cells is measured in a location between a pressure node and a pressure anti-node and the result is compared with theory by considering both compressibility and density dependent effects. The secondary acoustic force between motile red blood cells (RBCs) and MCF-7 cells and fixed 20 µm silica beads is investigated in a half-wavelength wide microchannel actuated at 2 MHz ultrasonic frequency. Our study shows that the secondary acoustic force between cells in acoustofluidic devices could play an important role for cell separation, sorting, and trapping purposes. Our results also demonstrate the possibility to isolate individual cells at trapping positions provided by silica beads immobilized and adhered to the microchannel bottom. We conclude that during certain experimental conditions, the secondary acoustic force acting on biological cells can dominate over the primary acoustic radiation force, which could open up for new microscale acoustofluidic methods., Competing Interests: The authors declare no conflict of interest.

A method is presented for measurements of secondary acoustic radiation forces acting on solid particles in a plain ultrasonic standing wave. The method allows for measurements of acoustic interaction forces between particles located in arbitrary positions such as in between a pressure node and a pressure antinode. By utilizing a model that considers both density- and compressibility-dependent effects, the observed particle-particle interaction dynamics can be well understood. Two differently sized polystyrene micro-particles (4.8 and 25 μm, respectively) were used in order to achieve pronounced interaction effects. The particulate was subjected to a 2-MHz ultrasonic standing wave in a microfluidic channel, such as commonly used for acoustophoresis. Observation of deflections in the particle pathways shows that the particle interaction force is not negligible under this circumstance and has to be considered in accurate particle manipulation applications. The effect is primarily pronounced when the distance between two particles is small, the sizes of the particles are different, and the acoustic properties of the particles are different relative to the media. As predicted by theory, the authors also observe that the interaction forces are affected by the angle between the inter-particle centerline and the axis of the standing wave propagation direction.