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Season of birth has been shown to correlate with many aspects of somatic and mental disorders, development and social adaptation (so-called ‘birth-date effects’). In a sample of young Swedish men, corresponding roughly to a one-year birth cohort, the results of intelligence tests, psychologists’ ratings of psychological function, school achievement, body height, weight and self-reported health during childhood, were found to be correlated with month of birth, and – more strongly – father’s socioeconomic status. The results were more favourable for men who were born during March–May (the period of highest birth rate), and whose fathers were of higher socioeconomic status, than for those born in November and December (the period of lowest birth rate), and whose fathers were in the lower socioeconomic group. It seems reasonable to conclude, from this study and previously reported findings, that these so-called ‘birth-date effects’ are determined by varying and often interacting biological and psychosocial factors. Among these factors, the light-induced entrainment of circadian and annual rhythms in the fetus and/or infant seems to be of pivotal importance. The organization of children into one-year age classes therefore produces an unfair lack of equality of possibilities. [ABSTRACT FROM AUTHOR]

Background: The detrimental impacts of adverse childhood experiences (ACEs) on health have been extensively studied, mainly focusing on the effects of ACEs on adults. However, there is a dearth of studies exploring their influences on adolescents., Objective: This study aims to investigate the associations between ACEs and psychological distress among Swedish adolescents., Participants and Setting: At the end of 2020, 1561 Swedish adolescents (15-19-years-old) participated in an electronic survey. The survey encompassed questions about alcohol and drug use problems within the students' families, questions about the students' experiences of physical and psychological abuse, and the administration of the Brief Symptom Inventory to assess their mental health., Methods: Descriptive and comparative non-parametric statistics were applied., Results: Nearly half of the study population reported experiencing one or more ACEs. Exposure to any ACE was significantly associated with a higher level of psychological distress. Of the ACEs examined, the experience of psychological abuse was the most substantial risk factor for psychological distress (with medium effect sizes of ε 2 between 0.07 and 0.12 on each domain and a large effect size of ε 2  = 0.14 on the General Severity Index scale). There was a positive correlation (r = 0.36) between the number of ACEs experienced and worsened mental health., Conclusions: The significant impacts of any ACE, the cumulative number of ACEs, and, particularly, psychological abuse on adolescent mental health are discussed. To further enhance the understanding of these associations and identify effective interventions to prevent and mitigate the negative impact of ACEs on mental health, additional research is warranted., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This cohort study used prospectively collected data from the Swedish national quality registry, SwedAD, to investigate weight gain as a possible side effect of dupilumab treatment for atopic dermatitis. Patients on dupilumab were compared with patients on other systemic medications, e.g., methotrexate, cyclosporine, or Janus kinase inhibitors, and possible risk factors for weight change during treatment with dupilumab were analysed. All patients aged 18 years or above, included in SwedAD between March 2018 and April 2023, who initiated systemic treatment at or after inclusion and had data on weight at baseline and at least 1 follow-up weight measurement were included (n  =  157). After 2 years on dupilumab, patients had a mean weight gain of 1.6 kg (p = 0.007, 95% confidence interval [CI] 0.4-2.7). In the multivariable analysis, controlling for age at start, sex, asthma, and body mass index at start, dupilumab was associated with higher weight gain than other systemic treatments (3.3 kg, p = 0.005 [95% CI 1.0-5.6]). Asthma was associated with weight loss; male sex tended to be associated with weight gain.

Study Objectives: Shift work, insufficient sleep, and poor sleep quality at young age have been associated with increased risk of multiple sclerosis (MS). This study aimed to investigate the potential interaction between aspects of inadequate sleep (short sleep, phase shift, and poor sleep quality) during adolescence and HLA-DRB1*15:01 in relation to MS risk., Methods: We used a Swedish population-based case-control study (1253 cases and 1766 controls). Participants with different sleep patterns during adolescence and HLA-DRB1*15:01 status were compared regarding MS risk by calculating odds ratios with 95% confidence intervals (CI) using logistic regression models. Additive interaction between aspects of inadequate sleep and HLA-DRB1*15:01 status was assessed by calculating the attributable proportion due to interaction (AP) with 95% CI., Results: Short sleep duration (<7 hours/night) during adolescence acted synergistically with HLA-DRB1*15:01, increasing the risk of MS (AP 0.38, 95% CI: 0.01 to 0.75, p = .04). Similarly, subjective low sleep quality during adolescence interacted with HLA-DRB1*15:01 regarding risk of MS (AP 0.30, 95% CI: 0.06 to 0.56, p = .03), whereas phase shift did not significantly influence the risk of the disease, irrespective of HLA-DRB1*15:01 status., Conclusions: Our findings underscore the importance of addressing inadequate sleep during adolescence, particularly in the context of the HLA-DRB1*15:01 allele, as it appears to amplify the risk of subsequently developing MS., (© The Author(s) 2024. Published by Oxford University Press on behalf of Sleep Research Society.)

Objective: This study aimed to evaluate the effect of orthognathic surgery on quality of life among Swedish patients., Materials and Methods: Patients subjected to orthognathic surgery due to dentofacial deformity (DFD) and registered in the National Register of Orthognathic Surgery (NROK) in Sweden between 2017 and 2020 were eligible for inclusion in this study. The Swedish-validated Orthognathic Quality of Life Questionnaire (S-OQLQ) was used to evaluate patient quality of life before and after surgery. The S-OQLQ measured each patient's subjective experience regarding social aspects., Results: Eighty-four participants were included in this cohort study, including 45 men (mean age 24.7 years), 48 women (mean age 23.4 years), and eight patients who stated no gender. Women generally graded several aspects of the S-OQLQ higher than men, including facial aesthetics p = 0.029), oral function (p < 0.001), and awareness of facial deformity (p = 0.0054). For all domains of the questionnaire (social, facial aesthetics, function, and awareness), a significant improvement was seen 6-24 months after surgery (p < 0.001). Women rated improvement of function and awareness of facial deformity higher than men (p < 0.001 and p = 0.039, respectively)., Conclusion: Quality of life aspects of orthognathic surgery have a strong impact on the treatment outcome. Although functional impairment is often considered a major indication for surgery, the social and aesthetic influence of DFD is highly rated by patients, whereas pain is not an issue before or after treatment., (© 2024 The Author(s). Clinical and Experimental Dental Research published by John Wiley & Sons Ltd.)

Background: Large register-based studies have reported an association between head trauma and increased risk of multiple sclerosis (MS). We aimed to investigate possible interactions between head trauma and MS-associated HLA genes in relation to MS risk., Methods: We used a Swedish population-based case-control study (2807 incident cases, 5950 matched controls with HLA genotypes available for 2057 cases, 2887 controls). Subjects with and without a history of self-reported head trauma were compared regarding MS risk, by calculating ORs with 95% CIs using logistic regression models. Additive interaction between head trauma, HLA-DRB1*1501 and absence of HLA-A*0201 , was assessed by calculating the attributable proportion (AP) due to interaction., Results: A history of head trauma was associated with a 30% increased risk of subsequently developing MS (OR 1.34, 95% CI 1.17 to 1.53), with a trend showing increased risk of MS with increasing number of head impacts (p=0.03). We observed synergistic effects between recent head trauma and HLA-DRB1*15:01 as well as absence of HLA*02:01 in relation to MS risk (each AP 0.40, 95% CI 0.1 to 0.7). Recent head trauma in individuals with both genetic risk factors rendered an 18-fold increased risk of MS, compared with those with neither the genetic risk factors nor a history of head trauma (OR 17.7, 95% CI 7.13 to 44.1)., Conclusions: Our findings align with previous observations of a dose-dependent association between head trauma and increased risk of MS and add a novel aspect of this association by revealing synergistic effects between recent head trauma and MS-associated HLA genes., Competing Interests: Competing interests: EJ has nothing to disclose. LA reports grants from Swedish Research Council, grants from Swedish Research Council for Health Working Life and Welfare, grants from Swedish Brain Foundation, during the conduct of the study. PS and IK have nothing to disclose. TO has received lecture/advisory board honoraria, and unrestricted MS research grants from Biogen, Novartis, Sanofi and Merck. AKH has nothing to disclose., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Purpose: Quality of care and the mental and physical health of nurses are interlinked. The COVID-19 pandemic has imposed an extremely high burden on health care. This study aimed to: 1) describe professional quality of life of registered nurses (RN) working in the pediatric and neonatal care units during the COVID-19 pandemic in Sweden, 2) compare professional quality of life between RNs with and without a Master's degree in specialist nursing pediatric care (MSc), and 3) compare differences in professional quality of life associated with the nursing experience (years)., Design and Methods: This study adopted a cross-sectional survey design. The PROQoL®-5-questionnaire was administered as a web survey to 160 RNs at four pediatric wards and two neonatal units of two hospitals in Sweden., Results: Seventy-one RNs responded to the survey. Overall, they reported a sufficient professional quality of life. RNs with an MSc suffered significantly lower secondary traumatic stress levels. Experienced RNs reported significantly higher compassion satisfaction and lower occupational burnout., Conclusion: Higher education and longer experience are beneficial for nurses' professional quality of life when working in pediatric care units., Practical Implications: Results from this study highlights the importance of offering RN education in pediatric care at master level and supporting novice nurses, to prevent negative professional well-being outcomes in pediatric care, because the health of nurses is of utterly importance when crisis such as a pandemic hits the world. The findings also suggest that the conditions for professional quality of life could improve through activities such as self-care, time for reflection, better working hours, competence-adjusted salary, and educational opportunities., Competing Interests: Declaration of Competing Interest The Authors declare that there is no conflict of interest., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Spring wheat is an economically important crop for Scandinavia and its cultivation is likely to be affected by climate change. The current study focused on wheat yield in recent years, during which climate change-related yield fluctuations have been more pronounced than previously observed. Here, effects of the environment, together with the genotype and fungicide treatment was evaluated. Spring wheat multi-location trials conducted at five locations between 2016 and 2020 were used to understand effects of the climate and fungicides on wheat yield. The results showed that the environment has a strong effect on grain yield, followed by the genotype effect. Moreover, temperature has a stronger (negative) impact than rainfall on grain yield and crop growing duration. Despite a low rainfall in the South compared to the North, the southern production region (PR) 2 had the highest yield performance, indicating the optimal environment for spring wheat production. The fungicide treatment effect was significant in 2016, 2017 and 2020. Overall, yield reduction due to fungal diseases ranged from 0.98 (2018) to 13.3% (2017) and this reduction was higher with a higher yield. Overall yield reduction due to fungal diseases was greater in the South (8.9%) than the North zone (5.3%). The genotypes with higher tolerance to diseases included G4 (KWS Alderon), G14 (WPB 09SW025-11), and G23 (SW 11360) in 2016; G24 (SW 11360), G25 (Millie), and G19 (SEC 526-07-2) in 2017; and G19 (WPB 13SW976-01), G12 (Levels), and G18 (SW 141011) in 2020. The combined best performing genotypes for disease tolerance and stable and higher yield in different locations were KWS Alderon, SEC 526-07-2, and WPB 13SW976-01 with fungicide treatment and WPB Avonmore, SEC 526-07-2, SW 131323 without fungicide treatment. We conclude that the best performing genotypes could be recommended for Scandinavian climatic conditions with or without fungicide application and that developing heat-tolerant varieties for Scandinavian countries should be prioritized., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Nehe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To investigate the association between surgeon volume and urinary incontinence after radical prostatectomy., Methods: A total of 8326 men in The National Prostate Cancer Register of Sweden (NPCR) underwent robot-assisted radical prostatectomy (RARP) between 2017 and 2019 of whom 56% (4668/8 326) had responded to a questionnaire one year after RARP. The questionnaire included the question: 'How much urine leakage do you experience?' with the response alternatives 'Not at all', 'A little', defined as continence and 'Moderately', 'Much/Very much' as incontinence. Association between incontinence and mean number of RARPs/year/surgeon was analysed with multivariable logistic regression including age, Charlson Comorbidity Index (CCI), PSA, prostate volume, number of biopsy cores with cancer, cT stage, Gleason score, lymph node dissection, nerve sparing intent and response rate to the questionnaire., Results: 14% (659/4 668) of the men were incontinent one year after RARP. There was no statistically significant association between surgeon volume and incontinence. Older age (>75 years vs . < 65 years, OR 2.29 [95% CI 1.48-3.53]), higher CCI (CCI 2+ vs. CCI 0, OR 1.37 [95% CI 1.04-1.80]) and no nerve sparing intent (no vs . yes OR 1.53 [95% CI 1.26-1.85]) increased risk of incontinence. There were large differences in the proportion of incontinent men between surgeons with similar annual volumes, which remained after adjustment., Conclusions: The lack of association between surgeon volume and incontinence and the wide range in outcome between surgeons with similar volumes underline the importance of individual feedback to surgeons on functional results.

Background: Some studies have suggested that teachers are particularly at risk for mental health problems but the research in this area has not been conclusive. This study aims to compare the risk of being diagnosed with depression for different types of teachers in Sweden, both with each other and with the rest of the population, using register data., Methods: Just over 3 million individuals age 30-60 were included of which 256,166 were teachers. The exposure variable was the occupation held in 2005 and the outcome was any diagnosis of depression during the follow up period of 2006 to 2016. The data was analyzed using Cox proportional hazard regression., Results: Around 5 % of women and 3 % of men developed depression during the follow up. For women, teachers had a decreased risk of developing depression compared to non-teachers, but this association was no longer present after adjusting for common covariates including education. For men, teachers had an increased risk of depression both before and after adjustment (HR 1.27 95% CI 1.22-1.32). When comparing different kinds of teachers to university teachers, several types of teachers including primary and special education teachers had an increased risk among men while primary and secondary teachers had a decreased risk among women., Conclusion: The increased risk of depression in male teachers is a result that requires further exploration in terms of occupational differences between male and female teachers., (© 2022. The Author(s).)

Background: Each year 13 000 patients undergo cholecystectomy in Sweden, and routine intraoperative cholangiography (IOC) is recommended to minimize bile duct injuries. The risk of requiring endoscopic retrograde cholangiopancreatography (ERCP) following cholecystectomy for common bile duct (CBD) stones where IOC is omitted and in patients with CBD stones left in situ is not well known., Methods: Data were retrieved from the population-based Swedish Registry of Gallstone Surgery and ERCP between 1 January 2009 and 10 December 2019. Primary outcome was risk for postoperative ERCP for retained CBD stones., Results: A total of 134 419 patients that underwent cholecystectomy were included and 2691 (2.0 per cent) subsequently underwent ERCP for retained CBD stones. When adjusting for emergency or planned cholecystectomy, preoperative symptoms suggestive of CBD stones, sex and age, there was an increased risk for ERCP when IOC was not performed (hazard ratio (HR) 1.4, 95 per cent c.i. 1.3 to 1.6). The adjusted risk for ERCP was also increased if CBD stones identified by IOC were managed with surveillance (HR 5.5, 95 per cent c.i. 4.8 to 6.4). Even for asymptomatic small stones (less than 4 mm), the adjusted risk for ERCP was increased in the surveillance group compared with the intervention group (HR 3.5, 95 per cent c.i. 2.4 to 5.1)., Conclusion: IOC plus an intervention to remove CBD stones identified during cholecystectomy was associated with reduced risk for retained stones and unplanned ERCP, even for the smallest asymptomatic CBD stones., (© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.)

Background and Objective: Few studies have investigated the association between surgical volume and outcome of robot-assisted radical prostatectomy (RARP) in an unselected cohort. We sought to investigate the association between surgical volume with peri-operative and short-term outcomes in a nation-wide, population-based study group., Methods: 9,810 RARP's registered in the National Prostate Cancer Register of Sweden (2015-2018) were included. Associations between outcome and volume were analyzed with multivariable logistic regression including age, PSA-density, number of positive biopsy cores, cT stage, Gleason score, and extent of lymph node dissection., Results: Surgeons and hospitals in the highest volume group compared to lowest group had shorter operative time; surgeon (OR 9.20, 95% CI 7.11-11.91), hospital (OR 2.16, 95% CI 1.53-3.06), less blood loss; surgeon (OR 2.58. 95% CI 2.07-3.21) hospital (no difference), more often nerve sparing intention; surgeon (OR 2.89, 95% CI 2.34-3.57), hospital (OR 2.02, 95% CI 1.66-2.44), negative margins; surgeon (OR 1.90, 95% CI 1.54-2.35), hospital (OR 1.28, 95% CI 1.07-1.53). There was wide range in outcome between hospitals and surgeons with similar volume that remained after adjustment., Conclusions: High surgeon and hospital volume were associated with better outcomes. The range in outcome was wide in all volume groups, which indicates that factors besides volume are of importance. Registration of surgical performance is essential for quality control and improvement., Competing Interests: RAG has received lecture fees from IPSEN and Astellas. All other authors report no competing interest in any stage of this research work. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Background: Organized PSA testing for asymptomatic men aged 50-74 years will be implemented in Sweden to reduce opportunistic testing in groups who will not benefit. The aim of this study was to describe the opportunistic PSA testing patterns in a Swedish region before the implementation of organized PSA testing programs., Method: We included all men in the Uppsala-Örebro health care region of Sweden who were PSA tested between 1 July 2012 and 30 June 2014. Information regarding previous PSA testing, prostate cancer diagnosis, socioeconomic situation, surgical procedures and prescribed medications were collected from population-wide registries to create the Uppsala-Örebro PSA cohort (UPSAC). The cohort was divided into repeat and single PSA testers. The background population used for comparison consisted of men 40 years or older, living in the Uppsala-Örebro region during this time period., Results: Of the adult male population in the region, 18.1% had undergone PSA testing. Among men over 85 years old 21% where PSA tested. In our cohort, 62.1% were repeat PSA testers. Of men with a PSA level ≤1µg/l 53.8% had undergone repeat testing. Prostate cancer was found in 2.7% and 4.8% of the repeat and single testers, respectively., Conclusion: Every fifth man in the male background population was PSA tested. Repeated PSA testing was common despite low PSA values. As repeated PSA testing was common, especially among older men who will not be included in organized testing, special measures to change the testing patterns in this group may be required.

Objective: Long-term information on lifestyle changes among prostate survivors is lacking. In this nationwide, population-based study we investigated the prevalence of lifestyle changes, factors associated with lifestyle changes and associations between lifestyle changes and general quality of life., Methods: All men registered in the National Prostate Cancer Register of Sweden diagnosed in 2008 with low-risk prostate cancer at age 70 years or younger were sent a questionnaire. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals for factors potentially associated with lifestyle change., Results: Out of 1288, 1720 men (75%) were responded. A total of 279 (22%) reported a positive lifestyle change regarding diet or exercise. Poor functional outcomes after treatment was associated with exercising less (OR 1.6, 95% CI 1.2-2.1) and less interest in social activities and relationships (OR 1.8, 95% CI 1.5-2.1). Men who exercised more (OR 7.9, 95% CI 4.4-14) and men who had an increased interest in relationships and social activities (OR 5.2, 95% CI 2.1-13) reported higher general quality of life., Conclusions: A considerable proportion of men reported making positive lifestyle changes after the prostate cancer diagnosis. The time after diagnosis may be a teachable moment that facilitates lifestyle interventions. Poor functional outcomes after treatment may reduce the willingness to engage in positive lifestyle change, which need be considered when supporting men after treatment. Men who made a positive lifestyle change, regardless of whether it was exercise or regarding relationships and social activities more often reported a high level of general quality of life., (© 2020 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.)

The number of national reference populations that are whole-genome sequenced are rapidly increasing. Partly driving this development is the fact that genetic disease studies benefit from knowing the genetic variation typical for the geographical area of interest. A whole-genome sequenced Swedish national reference population (n = 1000) has been recently published but with few samples from northern Sweden. In the present study we have whole-genome sequenced a control population (n = 300) (ACpop) from Västerbotten County, a sparsely populated region in northern Sweden previously shown to be genetically different from southern Sweden. The aggregated variant frequencies within ACpop are publicly available (DOI 10.17044/NBIS/G000005) to function as a basic resource in clinical genetics and for genetic studies. Our analysis of ACpop, representing approximately 0.11% of the population in Västerbotten, indicates the presence of a genetic substructure within the county. Furthermore, a demographic analysis showed that the population from which samples were drawn was to a large extent geographically stationary, a finding that was corroborated in the genetic analysis down to the level of municipalities. Including ACpop in the reference population when imputing unknown variants in a Västerbotten cohort resulted in a strong increase in the number of high-confidence imputed variants (up to 81% for variants with minor allele frequency < 5%). ACpop was initially designed for cancer disease studies, but the genetic structure within the cohort will be of general interest for all genetic disease studies in northern Sweden., Competing Interests: The authors have declared that no competing interests exist.

Background: Gendered patterns of physical activity behaviours may help explaining health inequalities between men and women. However, evidence on such patterns in the working population is sparse. This study aimed at documenting and comparing compositions of sitting, standing and moving at work and during leisure among male and female office workers of different age., Methods: Sitting (including lying), standing and moving were measured using accelerometry for, on average, four working days in 55 male and 57 female Swedish office workers. Behaviours were described in terms of time spent in four exhaustive categories: sitting in short (< 30 min) and long (≥30 min) bouts, standing, and moving. In a compositional data analysis approach, isometric log-ratios (ilr) were calculated for time sitting relative to non-sitting, time in short relative to long sitting bouts, and time in standing relative to moving. Differences between genders (men vs. women), domains (work vs. leisure), and according to age were examined for each ilr using ANOVA., Results: At work, time spent sitting in short bouts, sitting in long bouts, standing, and moving was, on average, 29, 43, 21 and 7% among men, and 28, 38, 26 and 7% among women. Corresponding proportions during leisure were 34, 27, 27 and 13% among men and 28, 27, 32 and 13% among women. Men spent more time sitting relative to non-sitting ([Formula: see text] =0.04, p = 0.03) than women, and less time standing relative to moving ([Formula: see text] =0.07, p = 0.01). At work compared to during leisure, both genders spent more time sitting relative to non-sitting ([Formula: see text] =0.47, p < 0.01); within sitting more time was spent in long relative to short sitting bouts ([Formula: see text] =0.26, p < 0.01), and within non-sitting, more time was spent standing than moving ([Formula: see text] =0.12, p < 0.01). Older workers spent less of their non-sitting time moving than younger workers ([Formula: see text] =0.07, p = 0.01)., Conclusion: Male office workers spent more time sitting relative to non-sitting than female workers, and more time moving relative to standing. Both genders were sitting more at work than during leisure. Older workers moved less than younger. These workers could likely benefit from interventions to reduce or break up prolonged sitting time, preferably by moving more.

Introduction: Women generally report more work-related musculoskeletal complaints than men and have higher rates of sickness absence, even within occupations. One likely reason is that work tasks within the occupation are gendered, that is, women and men have different tasks, even when sharing the same job title. Retail is an appealing sector for studying working conditions and work environment in a gender context. The prevalence of work-related complaints is high, physical loads may differ considerably between tasks and the distribution of tasks is likely gendered. The overall aim of this study in retail is to examine factors at the organisational and individual level that may, in a gender perspective, explain working conditions, work tasks, workloads and musculoskeletal health., Methods and Analyses: Data will be collected in two grocery stores, each with 50-70 workers, at two occasions interspersed by about 1 year. In each of these four waves, data collection will include a web-based questionnaire to all workers addressing, for example, work tasks, psychosocial factors, fatigue and pain; semistructured interviews with managers and approximately 10 workers addressing, for example, competences and decision levels; and technical measurements of postures, movements and heart rate in about 30 workers. The study is novel in combining an organisational gender perspective addressed through qualitative methods with a quantitative analysis of tasks, workload and health. The design allows an examination of both how genders may differ, and why they may differ, as well as analyses of the extent to which gendered working conditions change over time in the two participating stores., Ethics and Dissemination: Approval of the study by the Swedish Ethical Review Authority (reference number 2017/404) has been obtained. This work will be disseminated by publication of peer-reviewed papers in scientific journals, presentations at scientific conferences and in meetings with representatives from Swedish retail, including unions and employers' organisations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Knowledge about factors influencing choice of and adherence to active surveillance (AS) for prostate cancer (PC) is scarce. We aim to identify which factors most affected choosing and adhering to AS and to quantify their relative importance., Design, Setting and Participants: In 2015, we sent a questionnaire to all Swedish men aged ≤70 years registered in the National Prostate Cancer Register of Sweden who were diagnosed in 2008 with low-risk PC and had undergone prostatectomy, radiotherapy or started on AS., Outcome Measurements and Statistical Analysis: Logistic regression was used to calculate ORs with 95% CIs for factors potentially affecting choice and adherence to AS., Results: 1288 out of 1720 men (75%) responded, 451 (35%) chose AS and 837 (65%) underwent curative treatment. Of those starting on AS, 238 (53%) diverted to treatment within 7 years. Most men (83%) choose AS because 'My doctor recommended AS'. Factors associated with choosing AS over treatment were older age (OR 1.81, 95% CI 1.29 to 2.54), a Charlson Comorbidity Index >2 (OR 1.50, 95% CI 1.06 to 2.13), being unaccompanied when notified of the cancer diagnosis (OR 1.45, 95% CI 1.11 to 1.89). Men with a higher prostate-specific antigen (PSA) at the time of diagnosis were less likely to adhere to AS (OR 0.26, 95% CI 0.10 to 0.63). The reason for having treatment after initial AS was 'the PSA level was rising' in 55% and biopsy findings in 36%., Conclusions: A doctor's recommendation strongly affects which treatment is chosen for men with low-risk PC. Rising PSA values were the main factor for initiating treatment for men on AS. These findings need be considered by healthcare providers who wish to increase the uptake of and adherence to AS., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: To develop and validate a nomogram that identifies men for whom bone scan is unnecessary. Material and methods: The study datasets were derived from the National Prostate Cancer Register (NPCR) of Sweden. All men in the NPCR ≤80 years of age who were diagnosed with intermediate- or high-risk prostate cancer and who had pretreatment bone imaging ( 99m Tc MDP scintigraphy, plain x-ray, computed tomography, magnetic resonance imaging, and/or positron emission tomography fused with computed tomography) were included. Men diagnosed from 2015-2016 formed a development dataset and men diagnosed in 2017 formed a validation dataset. Outcome was metastasis on bone imaging as registered in NPCR. Multivariable logistic regression was used to develop a nomogram. Results: In the development dataset 482/5084 men (10%) had bone metastasis, the corresponding percentage in the validation dataset was 282/2554 (11%). Gleason grade group, clinical T stage, and prostate-specific antigen were included in the final model. Discrimination and calibration were satisfactory in both the development (AUC 0.80, 95% CI 0.78-0.82) and validation dataset (AUC 0.80, 95% CI, 0.77-0.82). Compared with using the EAU guidelines' recommendation for selecting men for imaging, using the nomogram with a cut-off at 4% chance of bone metastasis, would have avoided imaging in 519/2068 men (25%) and miss bone metastasis in 10/519 (2%) men in the validation dataset. Conclusion: By use of our nomogram, bone scans of men with prostate cancer can be avoided in a large proportion of men.

The fresh-water cyanobacterium Microcystis is known to form blooms world-wide, and is often responsible for the production of microcystins found in lake water. Microcystins are non-ribosomal peptides with toxic effects, e.g. on vertebrates, but their function remains largely unresolved. Moreover, not all strains produce microcystins, and many different microcystin variants have been described. Here we explored the diversity of microcystin variants within Microcystis botrys , a common bloom-former in Sweden. We isolated a total of 130 strains through the duration of a bloom in eutrophic Lake Vomb, and analyzed their microcystin profiles with tandem mass spectrometry (LC-MS/MS). We found that microcystin producing (28.5%) and non-producing (71.5%) M. botrys strains, co-existed throughout the bloom. However, microcystin producing strains were more prevalent towards the end of the sampling period. Overall, 26 unique M. botrys chemotypes were identified, and while some chemotypes re-occurred, others were found only once. The M. botrys chemotypes showed considerable variation both in terms of number of microcystin variants, as well as in what combinations the variants occurred. To our knowledge, this is the first report on microcystin chemotype variation and dynamics in M. botrys . In addition, our study verifies the co-existence of microcystin and non-microcystin producing strains, and we propose that environmental conditions may be implicated in determining their composition.

Background: A systematic repeat biopsy is recommended for men starting on active surveillance for prostate cancer, but the optimal number and distribution of cores are unknown., Objective: To evaluate an extensive repeat transrectal biopsy with anterior sampling in men starting on active surveillance., Design, Setting, and Participants: Randomised multicentre trial. From 2012 to 2016, 340 Swedish men, aged 40-75yr, with recently diagnosed low-volume Gleason grade group 1 prostate cancer were included., Intervention: Either an extensive transrectal biopsy with anterior sampling (median 19 cores) or a standard transrectal biopsy (median 12 cores)., Outcome Measurements and Statistical Analysis: Primary outcome measure: Gleason grade group ≥2 cancer., Secondary Outcomes: Cancer in anteriorly directed biopsy cores and postbiopsy infection. Nonparametric statistical tests were applied., Results and Limitations: Gleason grade group ≥2 cancer was detected in 16% of 156 men who had an extensive biopsy and in 10% of 164 men who had a standard biopsy, a 5.7% difference (95% confidence interval [CI]-0.2% to 13%, p=0.09). There was a strong linear association between prostate-specific antigen (PSA) density and cancer in the anteriorly directed biopsy cores. The odds ratios for cancer in the anteriorly directed cores were for any cancer 2.2 (95% CI 1.3-3.9, p=0.004) and for Gleason grade group ≥2 cancer 2.3 (95% CI 1.2-4.4, p=0.015) per 0.1-ng/ml/cm 3 increments. Postbiopsy infections were equally common in the two groups. A limitation is that magnetic resonance imaging was not used., Conclusions: The trial did not support general use of the extensive transrectal repeat biopsy template, but cancer in the anteriorly directed cores was common, particularly in men with high PSA density. The higher the PSA density, the stronger the reason to include anterior sampling at a systematic repeat biopsy., Patient Summary: This trial compared two different templates for transrectal prostate biopsy in men starting on active surveillance for low-risk prostate cancer. Cancer was often found in the front part of the prostate, which is not sampled on a standard prostate biopsy., (Copyright © 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Introduction: Radical prostatectomy (RP) is a common surgical procedure with a risk of postoperative erectile dysfunction and urinary incontinence. There is a need for data on RP as a basis for quality assurance and benchmarking., Methods: In 2015, prostatectomies in Sweden (PiS) form was implemented in the National Prostate Cancer Register (NPCR) of Sweden with data on pre-, peri- and post-operative variables., Results: Out of all radical prostatectomies performed in 2016 in Sweden, 3096/3881 (80%) were registered in PiS. A total of 2605 (84%) were robot-assisted radical prostatectomy (RARP) and 491 (16%) were RRP (retropubic radical prostatectomy). RARP was performed by 91 surgeons of whom 47% operated more than 25 RP/year; and RRP was performed by 69 surgeons of whom 10% performed more than 25 RP/year. RARP had a longer operative time (median operating time: RARP 155 minutes [IQR 124-190]; RRP 129 minutes [IQR 105-171]; P < .001) but was associated with smaller bleeding (median intraoperative blood loss: RARP 100 mL [IQR 50-200], RRP 700 mL [IQR 500-1100]; P < .001)., Conclusions: We report on a nationwide, population-based register with transparent reporting of data on the performance of radical prostatectomy. These data are needed as a basis for quality assurance with comparisons of results from individual surgeons and hospitals., (© 2019 The Authors. Journal of Surgical Oncology Published by Wiley Periodicals, Inc.)

Aim: To study the sleep development and sleep characteristics in children at different obesity risks, based on parental weight, and also to explore their weekday-weekend sleep variations and associated family factors., Methods: A total of 145 children participating in a longitudinal obesity prevention project were included, of which 37 had normal-weight parents (low obesity risk), and 108 had overweight/obese parents (high obesity risk). Sleep diaries at ages 1 and 2 years were used to study sleep development in children at different obesity risks. Objectively assessed sleep using an accelerometer at 2 years of age was used to analyse weekday-weekend sleep variations., Results: There was no difference in sleep development from age 1 to age 2 among children at different obesity risks, but more children in the high-risk group had prolonged sleep onset latency and low sleep efficiency. At 2 years of age, children in the high-risk group had more weekday-weekend variation in sleep offset (mean difference 18 min, 95% confidence interval (CI) 4-33 min), midpoint of sleep (mean difference 14 min, 95% CI 3-25 min) and nap onset (mean difference 42 min, 95% CI 10-74 min) than children in the low-risk group, after adjusting for other family factors. However, no difference could be detected between groups in weekday-weekend variation in sleep duration., Conclusions: Unfavourable sleep characteristics, as well as more variation in sleep schedules, have been observed in children at high obesity risk. While the differences were relatively small, they may reflect the unfavourable sleep hygiene in families at high obesity risk., (© 2018 The Authors. Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Background: Some studies suggest that gonadotropin-releasing hormone (GnRH) agonists are associated with higher risk of adverse events than antiandrogens (AAs) monotherapy. However, it has been unclear whether this is due to indication bias., Objective: To investigate rates of change in comorbidity for men on GnRH agonists versus AA monotherapy in a population-based register study., Design, Setting, and Participants: Men with advanced nonmetastatic prostate cancer (PCa) who received primary AA (n=2078) or GnRH agonists (n=4878) and age- and area-matched PCa-free men were selected from Prostate Cancer Database Sweden 3.0. Increases in comorbidity were measured using the Charlson Comorbidity Index (CCI), from 5yr before through to 5yr after starting androgen deprivation therapy (ADT)., Outcome Measures and Statistical Methods: Multivariable linear regression was used to determine differences in excess rate of CCI change before and after ADT initiation. Risk of any incremental change in CCI following ADT was assessed using multivariable Cox regression analyses., Results and Limitations: Men on GnRH agonists experienced a greater difference in excess rate of CCI change after starting ADT than men on AA monotherapy (5.6% per yr, p<0.001). Risk of any new CCI change after ADT was greater for GnRH agonists than for AA (hazard ratio, 1.32; 95% confidence interval, 1.20-1.44)., Conclusions: Impact on comorbidity was lower for men on AA monotherapy than for men on GnRH agonists. Our results should be confirmed through randomised trials of effectiveness and adverse effects, comparing AA monotherapy and GnRH agonists in men with advanced nonmetastatic PCa who are unsuitable for curative treatment., Patient Summary: Hormone therapies for advanced prostate cancer can increase the risk of other diseases (eg, heart disease, diabetes). This study compared two common forms of hormone therapy and found that the risk of another serious disease was higher for those on gonadotropin-releasing hormone agonists than for those on antiandrogen monotherapy., (Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Whole-genome sequencing is a promising approach for human autosomal dominant disease studies. However, the vast number of genetic variants observed by this method constitutes a challenge when trying to identify the causal variants. This is often handled by restricting disease studies to the most damaging variants, e.g. those found in coding regions, and overlooking the remaining genetic variation. Such a biased approach explains in part why the genetic causes of many families with dominantly inherited diseases, in spite of being included in whole-genome sequencing studies, are left unsolved today. Here we explore the use of a geographically matched control population to minimize the number of candidate disease-causing variants without excluding variants based on assumptions on genomic position or functional predictions. To exemplify the benefit of the geographically matched control population we apply a typical disease variant filtering strategy in a family with an autosomal dominant form of colorectal cancer. With the use of the geographically matched control population we end up with 26 candidate variants genome wide. This is in contrast to the tens of thousands of candidates left when only making use of available public variant datasets. The effect of the local control population is dual, it (1) reduces the total number of candidate variants shared between affected individuals, and more importantly (2) increases the rate by which the number of candidate variants are reduced as additional affected family members are included in the filtering strategy. We demonstrate that the application of a geographically matched control population effectively limits the number of candidate disease-causing variants and may provide the means by which variants suitable for functional studies are identified genome wide., Competing Interests: The authors have declared that no competing interests exist.

Objective: To describe study design and procedures for a prospective randomized trial investigating whether radical prostatectomy (RP) ± radiation improves cause-specific survival in comparison with primary radiation treatment (RT) and androgen deprivation treatment (ADT) in patients with locally advanced prostate cancer (LAPC)., Materials and Methods: SPCG-15 is a prospective, multi-centre, open randomized phase III trial. Patients are randomized to either standard (RT + ADT) or experimental (RP with extended pelvic lymph-node dissection and with addition of adjuvant or salvage RT and/or ADT if deemed necessary) treatment. Each centre follows guidelines regarding the timing and dosing of postoperative RT and adjuvant treatment such as ADT The primary endpoint is cause-specific survival. Secondary endpoints include metastasis-free and overall survival, quality-of-life, functional outcomes and health-services requirements. Each subject will be followed up for a minimum of 10 years., Results: Twenty-three centres in Denmark, Finland, Norway and Sweden, well established in performing RP and RT for prostate cancer participated. Each country's sites were coordinated by national coordinating investigators and sub-investigators for urology and oncology. Almost 400 men have been randomized of the stipulated 1200, with an increasing rate of accrual., Conclusions: The SPCG-15 trial aims to compare the two curatively intended techniques supplying new knowledge to support future decisions in treatment strategies for patients with LAPC The Scandinavian healthcare context is well suited for performing multi-centre long-term prospective randomized clinical trials. Similar care protocols and a history of entirely tax-funded healthcare facilitate joint trials.

Introduction: Excessive gestational weight gain, regardless of initial BMI, is associated with perinatal risks for both mother and offspring and contributes to obesity in women. Studies report that healthcare professionals find it difficult to communicate about weight and pregnant women perceive healthcare professionals as unconcerned, leaving many women uninformed about weight recommendations and risks. We aimed to explore how midwives approach communication about gestational weight gain recommendations, and to characterize communication barriers and facilitators., Methods: Seventeen midwives from different areas in Sweden were interviewed by a therapist using semi-structured interviews. Interviews were transcribed verbatim and analysed by three researchers using latent content analysis. Recurrent themes were identified and formulated., Results: The main theme identified in the latent part of the analysis was "midwives use avoidant behaviours to cope with fear of inflicting worries, shame or feelings of guilt in pregnant women". Avoidant behaviours include: adjusting weight recommendations, toning down risks and avoid talking about weight. Subthemes identified were (I) Conflicting responsibilities in midwives' professional identity (II) Perceived deficiencies in the working situation., Conclusion: Midwives' empathy and awareness of weight stigma strongly affects communication about weight with pregnant women, and midwives' use of avoidant behaviours constitutes salient information barriers. More research is needed on whether gestational weight guidelines and weighing routines for all women, resources for extra visits, training in specific communication skills and backup access to other professions can facilitate for midwives to initiate and communicate about healthy gestational weight development, enabling more pregnant women to make well-informed lifestyle choices., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Men with prostate cancer experience adjuvant androgen deprivation therapy (ADT) differently., Objective: To evaluate the effect of ADT on quality of life (QoL), patients' experience of clinical check-ups, and differences in cancer information as explanatory factors., Design, Setting, and Participants: A study-specific questionnaire was sent to all men randomized in the SPCG-4 trial to radical prostatectomy (RP) or watchful waiting (WW) still alive (400/695) and a control group of 281 men., Intervention: ADT., Outcome Measurements and Statistical Analysis: Self-assessed QoL, worry at clinical check-ups, and amount of information received. Estimated relative risks with associated 95% confidence intervals (CI) for risk comparisons between groups using a log-binomial regression., Results and Limitations: The SPCG-4 men had median follow-up of 12.2 yr and median age of 77.0 yr; 26% in the RP group and 40% in the WW group received ADT treatment. High QoL for men without ADT was 36% for the RP group, 44% for the WW group, and 45% for the control group. High QoL for men with ADT was 30% for the RP group and 20% for the WW group. Among men with ADT, those in the WW group received significantly less information about the disease than men in the RP group. Receiving no or little information about prostate cancer was reported by 17% of patients in the RP group and 39% in the WW group among men receiving ADT (relative risk 0.44, 95% CI 0.22-0.89). At clinical check-ups, men treated with ADT had significantly higher levels of worry, regardless of study group, than men without ADT. Limitations include the lack of longitudinal data and a low number of men receiving ADT in the RP group., Conclusions: Men on WW without ADT reported high QoL comparable to that for men without prostate cancer. ADT treatment in the WW group was associated with the lowest scores for all psychological parameters, and these men reported that they were least informed about prostate cancer and its consequences., Patient Summary: Good communication and information from caregivers are associated with less negative psychological effects at prostate cancer progression., (Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Information about how men with prostate cancer (PC) experience their medical care and factors associated with their overall satisfaction with care (OSC) is limited., Objective: To investigate OSC and factors associated with OSC among men with low-risk PC., Design, Setting, and Participants: Men registered in the National Prostate Cancer Register of Sweden as diagnosed in 2008 with low-risk PC at the age of ≤70 yr who had undergone radical prostatectomy (RP), radiotherapy (RT), or started on active surveillance (AS) were invited in 2015 to participate in this nationwide population-based survey (n=1720)., Outcome Measurements and Statistical Analysis: OSC data were analysed using ordinal logistic regression. Odds ratios (ORs) were calculated for comparisons between the highest and lowest possible response categories., Results and Limitations: A total of 1288 men (74.9%) responded. High OSC was reported by 958 (74.4%). Factors associated with high OSC were high participation in decision-making (OR 4.18, 95% confidence interval [CI] 2.61-6.69), receiving more information (OR 11.1, 95% CI 7.97-15.6), high-quality information (OR 7.85, 95% CI 5.46-11.3), access to a nurse navigator (OR 1.80, 95% CI 1.44-2.26), and better functional outcomes (defined as 25 points higher on the EPIC-26 questionnaire; OR 1.34, 95% CI 1.21-1.48). OSC was not affected by whether a doctor or specialist nurse conducted follow-up (OR 0.84, 95% CI 0.66-1.07). These findings were similar across treatment groups. Men who had undergone RP or RT reported high OSC more often than men on AS (78.2% vs 84.0% vs 72.6%), high participation in decision-making (70.5% vs 64.5% vs 49.2%), and having received more information (40.5% vs 45.8% vs 28.6%), and were less likely to believe they would die from PC (3.8% vs 3.9% vs 8.0%). Limitations include the nonrandomised retrospective design and potential recall bias., Conclusions: Information and participation in decision-making, as well as access to a nurse navigator, are key factors for OSC, regardless of treatment. Men on AS need more information about their treatment and need to participate more in decision-making. OSC was as high among men who had nurse-led follow-up as among men who had doctor-led follow-up., Patient Summary: Information about how men with low-risk prostate cancer experience their medical care is limited. In this nationwide population-based study we found that information and participation in decision-making as well as access to a nurse navigator are key factors for satisfaction regardless of treatment. Men who are being closely watched for prostate cancer without immediate curative treatment need more information than they now receive and need to participate more in decision-making than they currently do., (Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Background: Children undergoing cancer therapy are at risk for infectious complications that require hospitalization and antimicrobial therapy. Host factors such as age and underlying disease may predict the risk of severe infections in these children. To describe the increased morbidity due to infections in children with cancer, we characterized the antibiotic use during the infectious complications in a national cohort of children 7-16 years of age with cancer., Procedure: Data on infectious complications were prospectively collected from the medical records of all newly diagnosed children with cancer, aged 7-16 years, in Sweden between 2004 and 2006. An episode of infection was defined as a period of time when oral or intravenous antimicrobial treatment was prescribed because of symptoms of infection., Results: A total of 230 infectious episodes occurred in 80 of the 101 patients. Pathogens were isolated in 15% of the blood cultures that showed a predominance of Gram-positive bacteria. Intravenous broad-spectrum antibiotics with cephalosporins and carbapenems were mostly used as single drugs but also in combination with aminoglycosides and glycopeptide. The median treatment length varied between 6 and 11 days depending on cancer diagnosis., Conclusion: Our data demonstrate that infectious complications contribute significantly to morbidity in children with cancer aged 7-16 years. At the time of this survey, antibiotic prescription patterns varied and cephalosporins and carbapenems were mostly used. With increasing antibiotic resistance, a more stringent antibiotic stewardship with less use of cephalosporins and carbapenems should be encouraged for children with cancer. Data on prescription patterns should be incorporated as a quality measurement in pediatric cancer care., (© 2017 Wiley Periodicals, Inc.)

Background and Aims: Barley kernel based products have been shown to induce benefits on blood glucose regulation, cardio-metabolic risk markers and appetite regulating hormones in a time perspective of 11-16 h after intake. The mechanisms have been assigned to gut fermentation of indigestible carbohydrates. The purpose of the present study was to evaluate if the modulatory effects of barley on markers of metabolic- and appetite regulation are affected by a dietary background including a mixture of commercially available probiotics., Methods: Barley kernel bread was included in the normal diet of 21 healthy subjects in two 4-day intervention periods; with (BB-pro) or without (BB) dietary supplement with a combination of probiotics (Bifidobacterium animalis DN-173 010, Lactobacillus reuteri DSM 17938, and Lactobacillus plantarum 299v). A white wheat flour based bread was included as a reference product (WWB-ref) in a separate 4-day bread intervention period. A cross-over design was applied concerning BB- and WWB-ref; the BB-pro intervention was last in the test sequence. The BB-pro intervention was preceded by 10 days priming with probiotics. The 4 day BB- and WWB-ref intervention periods included dietary supplementation with placebo, and the interventions were preceded with 10 days priming with the placebo. The day after each intervention period, blood samples were collected at fasting and postprandially after a standardized breakfast (0-210 min) for determination of markers of glucose metabolism (blood glucose, serum (s-) insulin), inflammation (s-IL-6, s-IL-18, s-CRP, PAI-1), and concentrations of gut derived hormones involved in satiety and glucose homeostasis (plasma (p-) PYY, p-GLP-1) and intestinal barrier integrity (p-GLP-2). Breath hydrogen was determined as a marker of colonic fermentation., Results: Four days intervention with BB, in comparison to WWB-ref, lowered blood glucose response after a subsequent standardized breakfast (0-210 min, P < 0.05). BB and BB-pro interventions increased p-GLP-1 (0-120 min, P < 0.05) and breath H 2 (0-210 min, P < 0.05). BB-pro intervention, in comparison to BB and WWB-ref, increased levels of s-PAI-1 (P < 0.05), and p-GLP-2 (0-210 min, P < 0.05) after the standardized breakfast., Conclusions: With the exception of increased p-GLP-2 and an unexpected increase in s-PAI-1 concentrations, co-ingestion of a mixture of probiotics did not affect the metabolic outcome of BB; neither positively nor importantly negatively. The study was registered at: ClinicalTrials.gov, register number NCT01718418 (www.clinicaltrials.gov/ct2/show/NCT01718418)., (Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Introduction: To determine time spent at different physical activity intensities, accelerometers need calibration. The aim of this study was to develop and cross-validate intensity thresholds for the Actigraph GT3X+ accelerometer for wrist and hip placement in four-year-old children., Methods: In total 30 children (49 months, SD 3.7) were recruited from five preschools in Stockholm. Equipped with an accelerometer on the wrist and another on the hip, children performed three indoor activities and one free-play session while being video recorded. Subsequently, physical activity intensity levels were coded every 5th second according to the Children's Activity Rating Scale. Receiver Operating Characteristic (ROC) curves was used to develop wrist and hip intensity thresholds, the upper threshold for sedentary, and lower threshold for moderate-to-vigorous physical activity (MVPA), for the vertical axis (VA) and for the vector magnitude (VM). A leave-one-out method was used to cross-validate the thresholds., Results: Intensity thresholds for wrist placement were ≤ 178 (VA) and ≤ 328 (VM) for sedentary and ≥ 871 (VA) and ≥ 1393 (VM) counts/5 seconds for MVPA. The corresponding thresholds for hip placement were ≤ 43 (VA) and ≤ 105 (VM) for sedentary and ≥ 290 (VA) and ≥ 512 (VM) for MVPA. The quadratic weighted Kappa was 0.92 (95% CI 0.91-0.93) (VA) and 0.95 (95% CI 0.94-0.96) (VM) for the wrist-worn accelerometer and 0.76 (98% CI 0.74-0.77) and 0.86 (95% CI 0.85-0.87) for the hip-worn., Conclusion: Using wrist placement and the VM when measuring physical activity with accelerometry in 4-year-old children is recommended., Competing Interests: The authors have declared that no competing interests exist.

Background: National statistics have shown that only about 40% of asylum seekers actually attend the optional health assessment offered upon their arrival in Sweden, but the reasons for this have not been fully explored. Health assessments for newly arrived asylum seekers have become a regular practice in most EU countries, but what is performed, how it is organized and whether it is mandatory or not varies between countries., Aim: The aim of the study was to explore and improve our understanding of how former asylum seekers from Eritrea perceived and experienced the health assessment during their asylum-seeking process., Methods: We used a qualitative research approach guided by grounded theory. Semi-structured interviews were conducted with 11 former asylum seekers from Eritrea. Data were analysed based on constant comparative analysis., Findings: The asylum seekers expressed feelings of ambiguity and mistrust and felt that they were seen only as objects by the Swedish healthcare system during their asylum-seeking process. Poor communication and inability to overcome language and cultural barriers seemed to be the most important findings in the narratives. The core category was defined as 'A state of limbo - in transition between two contexts'., Conclusions: There are reasons to believe that these issues with communication negatively affected both the quality of the health assessment and the number of asylum seekers attending the health assessment. Improved communication by the authorities towards the asylum seekers is, therefore, of vital importance., (© 2015 the Nordic Societies of Public Health.)

Aim: The aims of this study were to describe the characteristics of peripheral venous catheters (PVCs), including dwell time and reasons for removal, and explore predictors for PVC-related complications., Methods: We included PVCs in 2032 children - 484 neonatal and 1548 paediatric - from 12 inpatient units. Data were retrieved from the patient record system, and predictors for complications were explored using logistic regression analyses., Results: Just over one-third (35.4%) of the PVCs were removed due to complications, in particular infiltration and occlusion (51.9 and 48.4/1000 PVC days, respectively). PVC survival time was shorter in neonatal than paediatric patients (4 versus 5 days), and infiltration was more frequent in neonatal patients (92.8 versus 38.7/1000 PVC days). Infiltration was associated with younger age (odds ratio 0.97) for neonatal patients and with younger age (OR 0.96), insertion in the bend of the arm (OR 1.48) or ankle (OR 2.81) for paediatric patients. Occlusion was, both for neonatal and paediatric patients, associated with longer dwell time (OR 1.32 and 1.22 respectively), insertion in the ankle (OR 5.00 and 3.51) or foot (OR 3.47 and 1.99)., Conclusion: PVC-related complications, particularly infiltration and occlusion, were more common in hospitalised children but decreased with the child's age., (©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Background: Genotyping of Pseudomonas aeruginosa (P.a) is used for surveillance at our CF clinic., Methods: P.a from 1999 to 2012 were analysed, using pulsed-field gel electrophoresis (PFGE) and multiple-locus variable number of tandem repeats analysis (MLVA)., Results: Among 232 isolates from 104 patients, we identified 78 unique strains, of which 56 were isolated from individual patients. The B-clone was isolated from 13 patients and the camp transmission clone J-strains from 8 patients at the start of the study. There was no indication of transmission within the clinic. PFGE and MLVA clone identification was in 91% agreement. For patients who provided more than 2 P.a isolates, similar strains were identified over time for 45/49 chronically- and for 6/16 intermittently-colonized patients despite, periods of no detectable P.a after eradication therapy., Conclusions: Analyses revealed high genotypic diversity, acceptable outcome of eradication therapy and no indication of cross-infection at the CF centre., (Copyright © 2014 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.)

Objective: To calibrate the Actigraph GT3X+ accelerometer for wrist-worn placement in young preschoolers by developing intensity thresholds for sedentary, low- and high-intensity physical activity. Furthermore, to cross-validate the developed thresholds in young preschoolers., Methods: Actigraph GT3X+ was used to measure physical activity during structured activities and free play in 38 children (15-36 months). Activity was video recorded and scored into sedentary, low- and high-intensity physical activity based on Children's Activity Rating Scale (CARS) and combined with accelerometer data using a 5 s epoch. Receiver operating characteristic analysis was used to develop intensity thresholds in 26 randomly selected children. The remaining 12 children were used for cross-validation., Results: Intensity thresholds for sedentary were ≤89 vertical counts (Y) and ≤221 vector magnitude (VM) counts per 5 s and ≥440 Y counts and ≥730 VM counts per 5 s for high-intensity physical activity. Sensitivity and specificity were 60-100% for the developed intensity thresholds. Strong correlations (Spearman rank correlation 0.69-0.91) were found in the cross-validation sample between the developed thresholds for the accelerometer and CARS scoring time in all intensity categories., Conclusion: The developed intensity thresholds appear valid to categorize sedentary behaviour and physical activity intensity categories in children 2 years of age., (© 2014 The Authors. Pediatric Obesity © 2014 International Association for the Study of Obesity.)

The aim was to compare self-rated independence in childhood cancer survivors 5 years after diagnosis with corresponding ratings during initial cancer treatment and those in a comparison group. A further aim was to determine whether and how certain clinical and demographic variables affected self-rated independence. Self-rated independence, a dimension included in the health-related quality of life (HRQoL) measure DISABKIDS Chronic Generic Measure (DCGM-37), was assessed in a Swedish cohort of survivors (n = 63, aged 12-22 years) and compared with ratings during initial cancer treatment and those in an age-matched comparison group (n = 257). Potential predictors of self-rated independence were estimated using multiple regression analysis. Survivors rated their independence significantly higher 5 years after diagnosis than during initial cancer treatment and higher than the comparison group. Neither demographic nor clinical variables (age, sex, diagnosis, initial cancer treatment) predicted self-rated independence 5 years post diagnosis. Five years after diagnosis, survivors of childhood cancer appear to have reached a satisfactory level of independence. However, survivors are likely to experience complications over the longer term, and therefore continued follow-up is warranted to follow possible changes in self-reported independence.

Acute myeloid leukemia (AML) survival rates in younger patients have improved considerably since the 1970s. In order to evaluate the impact of AML and its treatment on fertility and family situation in adult long-term survivors, we used the Swedish population-based registries to identify 161 adult patients diagnosed with AML within the Leukemia Group of Middle Sweden (LGMS) 1973-2003, who survived for more than 5 years and were alive in 2010. Ninety-eight patients (61 %) completed a questionnaire including items on reproductive concerns, family situation, and infertility-related distress. After excluding women >45 years and/or postmenopausal women and men >55 years, 22 women and 38 men were included in the final analysis. Nine of the women (41 %) tried to conceive after treatment, but only three succeeded. Five (83 %) of the unwillingly childless women reported "a moderate" or "a lot" of distress caused by this. Among men in the same age group, all six who wanted children after treatment succeeded. None of the men 46-55 years old cryopreserved their sperm or tried to father a child. Among patients who wanted children after AML treatment, 46 % of the women and 40 % of the younger men reported that they were not, or not fully, informed about fertility-related issues. In contrast, among men 46-55 years, none reported they would have wanted more information. Infertility among young female AML survivors thus remains an important clinical issue, and there is a need for improved clinical counseling and education in this area.

Background: It is known that registered nurses' (RNs') work context is related to their use of research and that it can affect nurse and patient satisfaction, as well as the outcomes of care. However, little is known about the relationship between work context and nurses' adherence to clinical practice guidelines. The aim of this study was to describe RNs' adherence to a clinical practice guideline (CPG) on the management of peripheral venous catheters (PVCs), their perceptions of work context, and how nurses' work context and characteristics relate to guideline adherence., Methods: This cross-sectional survey was conducted at a large pediatric university hospital in Sweden. Data were collected through a questionnaire on RNs' adherence to components of a CPG and by using the Alberta Context Tool to assess the nurses' perceptions of work context, including leadership, culture, feedback processes, and other organizational characteristics., Results: Work context--in the form of structural and electronic resources, information sharing activities, and feedback processes--was in different ways associated with the adherence to the CPG components. The RNs' adherence on unit level varied: half the units demonstrated complete adherence on disinfection of hands, whereas a majority of the units reported less than 70% adherence on the use of disposable gloves and the daily inspection of a PVC site., Linking Evidence to Action: Our findings indicate that components in one CPG might require diverse implementation strategies because they are linked to different contextual factors., (© 2014 Sigma Theta Tau International.)

Introduction: Despite the high prevalence of erectile dysfunction (ED) in men with prostate cancer, little is known about the use of ED drugs. Also, the possible influence of socioeconomic factors on ED drug use has not been studied previously., Aim: The aim of this study was to examine determinants and patterns of ED drug use before and after diagnosis in men with localized prostate cancer., Methods: Using a nationwide population-based cohort, 25,390 men with localized prostate cancer diagnosed between 2006 and 2009 and 126,944 control men were identified and followed for filled ED drug prescriptions over a 3-year period, ranging from 1 year before and up to 2 years after diagnosis., Main Outcome Measures: The main outcome measure was the proportion of men with at least one filled ED drug prescription after diagnosis., Results: The number of men using ED drugs increased markedly following diagnosis. Men who underwent radical prostatectomy had the strongest increase, with a cumulative proportion of 74% for at least one filled prescription within the first 2 years after diagnosis. The corresponding proportion was 33% in men treated with radiotherapy, 21% in men on active surveillance, 10% in men on watchful waiting, and 8% in control men. Among men who underwent prostatectomy, usage attenuated over time. Determinants of postdiagnostic use were young age at diagnosis, high income, high education, and a low- or intermediate-risk cancer., Conclusion: Although drugs for ED are commonly prescribed after diagnosis, use among most men is transient and influenced by socioeconomic status. Posttreatment counseling and affordable ED drugs are likely to reduce treatment dropout and disparities in use and help improve sexual health and quality of life in men with prostate cancer., (© 2014 International Society for Sexual Medicine.)

Being in work or the equivalent is an important goal after allo-SCT and is used as an indicator of recovery. The aim was to elucidate occupational status and factors associated with work among SCT survivors. Adults in working age with a haematological disease (n=177) were followed up within a median of 8 (range 28) years post allo-SCT. Predictors of not being in work at all or working part-time because of sick leave, disability pension or early old-age pension were analyzed using logistic regression analyses. At diagnosis, 82% of the participants were working full-time and 2% were on sick leave or old-age pension. At follow-up, 52% were working full-time, 27% were working part-time and 17% were on sick leave, disability pension or old-age pension. Not working at all was associated with multi-morbidity (P=0.01) and poorer health (P=0.00). Working part-time was associated with a higher age at diagnosis (P=0.00), being a woman (P=0.03), being born abroad (P=0.03) and multi-morbidity (P=0.00). In conclusion, the majority of survivors were in paid work at follow-up; however, a substantial number were not working or worked part-time.

Objectives: To develop and validate a new tool intended for measuring self-reported professional competence among both nurse students prior to graduation and among practicing nurses. The new tool is based on formal competence requirements from the Swedish Board of Health and Welfare, which in turn are based on WHO guidelines., Design: A methodological study including construction of a new scale and evaluation of its psychometric properties., Participants and Settings: 1086 newly graduated nurse students from 11 universities/university colleges., Results: The analyses resulted in a scale named the NPC (Nurse Professional Competence) Scale, consisting of 88 items and covering eight factors: "Nursing care", "Value-based nursing care", "Medical/technical care", "Teaching/learning and support", "Documentation and information technology", "Legislation in nursing and safety planning", "Leadership in and development of nursing care" and "Education and supervision of staff/students". All factors achieved Cronbach's alpha values greater than 0.70. A second-order exploratory analysis resulted in two main themes: "Patient-related nursing" and "Nursing care organisation and development". In addition, evidence of known-group validity for the NPC Scale was obtained., Conclusions: The NPC Scale, which is based on national and international professional competence requirements for nurses, was comprehensively tested and showed satisfactory psychometrical properties. It can e.g. be used to evaluate the outcomes of nursing education programmes, to assess nurses' professional competences in relation to the needs in healthcare organisations, and to tailor introduction programmes for newly employed nurses., (© 2013.)

Aim: To explore the simultaneous impact of parental adiposity and education level on infant growth from birth to 12 months, adjusting for known early-life risk factors for subsequent childhood obesity., Methods: Baseline data for 197 one-year-old children and their parents, participating in a longitudinal obesity intervention, were used. Obesity risk groups, high/low, were defined based on parental body mass index (n = 144/53) and parental education (n = 57/139). Observational data on infant growth between 0 and 12 months were collected. The children's relative weight (body mass index standard deviation score) at 3, 6 and 12 months and rapid weight gain 0-6 months were analysed in regression models, with obesity risk as primary exposure variables, adjusting for gestational weight gain, birth weight, short exclusive breastfeeding and maternal smoking., Results: Relative weight at 3, 6 and 12 months was associated with low parental education but not with parental adiposity. No significant associations were observed with rapid weight gain. None of the early-life factors could explain the association with parental education., Conclusion: Low parental education level is independently associated with infant growth, whereas parental obesity does not contribute to a higher weight or to rapid weight gain during the first year., (©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Lung infection with Pseudomonas aeruginosa is common in lung transplant recipients and may lead to severe complications. Bacteriological surveillance aims to detect transmission of microbes between hospital environment and patients. We sought to determine whether genotyping of P. aeruginosa isolates could improve identifications of pathways of infection. From 2004 to 2009, we performed genotyping with multiple-locus variable number of tandem repeats analysis (MLVA) and pulsed-field gel electrophoresis (PFGE) of P. aeruginosa isolates cultured from lung transplant recipients at Sahlgrenska University Hospital, Gothenburg. During a small outbreak in 2008, cultivation and genotyping of isolates from sink and drains samples from the hospital ward were performed. Pseudomona aeruginosa from 11/18 patients were genotyped to unique strains. The remaining seven patients were carriers of a P. aeruginosa strain of cluster A genotype. Pseudomona aeruginosa was isolated in 4/8 water samples, typed by MLVA also as cluster A genotype and confirmed by PFGE to be similar or identical to the isolates from four transplanted patients. In conclusion, genotyping of isolates revealed a clonal relationship between patient and water isolates, indicating in-hospital transmission of P. aeruginosa. We suggest genotyping with MLVA for rapid routine surveillance, with the PFGE method used for extended, confirmatory analyses., (© 2013 APMIS. Published by John Wiley & Sons Ltd.)

The clinical demonstration is an established way of bridging the disciplinary content in preclinical and clinical courses. In dentistry, however, clinical demonstrations have often been perceived as less rewarding due to the restricted visual access to the details of the treatment. This study investigated a course in endodontics at the University of Gothenburg, Sweden, in which traditional clinical demonstrations were replaced by instructor-led seminars that enabled students to follow and discuss broadcasted root canal treatments. Two cameras provided overviews of the operating room, whereas a third camera attached to a surgical microscope offered a magnified view of procedures carried out in the inner parts of teeth. The hypothesis was that this arrangement would increase the students' sense of the clinical relevance of basic scientific knowledge. Two focus group interviews were designed to explore the students' perceptions of this change. The students expressed that the video-based seminars offered ample opportunities to integrate theoretical and clinical understanding. The major reasons were that the visualization displayed procedures on a sufficiently detailed level; instructors demonstrated clinical reasoning in situ and provided the context necessary for understanding procedures; and the interactive format encouraged discussions on the generalizability of knowledge beyond the specific case.

Black currant berries contain many biochemical compounds with proven or potential human health benefits. We studied the content of total and single polyphenols, ascorbic acid, soluble sugars, and titratable acidity for two advanced selections and three cultivars of black currant at two distant locations in Sweden (south: 56°06'N; north: 65°21'N) over a 3 year period. Regression analyses revealed the effect of genotype to be considerably larger than that of location and year. However, significant effects of location, year, and interactions were also revealed. A principal component analysis nevertheless separated the genotypes. The content of ascorbic acid, total phenols, total anthocyanins, and soluble sugars was highest in berries from the south, whereas the content of phenolic acids and titratable acidity was highest in berries from the north. The results show that selection of cultivars and production sites are important for cultivation of high-quality black currant raw material for health-promoting products.

Objective: Only a minority of patients with low-risk prostate cancer needs treatment, but the methods for optimal selection of patients for treatment are not established. This article describes the Study of Active Monitoring in Sweden (SAMS), which aims to improve those methods., Material and Methods: SAMS is a prospective, multicentre study of active surveillance for low-risk prostate cancer. It consists of a randomized part comparing standard rebiopsy and follow-up with an extensive initial rebiopsy coupled with less intensive follow-up and no further scheduled biopsies (SAMS-FU), as well as an observational part (SAMS-ObsQoL). Quality of life is assessed with questionnaires and compared with patients receiving primary curative treatment. SAMS-FU is planned to randomize 500 patients and SAMS-ObsQoL to include at least 500 patients during 5 years. The primary endpoint is conversion to active treatment. The secondary endpoints include symptoms, distant metastases and mortality. All patients will be followed for 10-15 years., Results: Inclusion started in October 2011. In March 2013, 148 patients were included at 13 Swedish urological centres., Conclusions: It is hoped that the results of SAMS will contribute to fewer patients with indolent, low-risk prostate cancer receiving unnecessary treatment and more patients on active surveillance who need treatment receiving it when the disease is still curable. The less intensive investigational follow-up in the SAMS-FU trial would reduce the healthcare resources allocated to this large group of patients if it replaced the present standard schedule.

Background: The strength of and relationship between the fundamental elements context, evidence and facilitation of the PARIHS framework are proposed to be key for successful implementation of evidence into healthcare practice. A better understanding of the presence and strength of contextual factors is assumed to enhance the opportunities of adequately developing an implementation strategy for a specific setting. A tool for assessing context-The Context Assessment Index (CAI)-was developed and published 2009. A Swedish version of the instrument was developed and evaluated among registered nurses. This work forms the focus of this paper., Purpose: The purpose of this study was to translate the CAI into Swedish, adapt the instrument for use in Swedish healthcare practice and assess its psychometric properties., Methods: The instrument was translated and back-translated to English. The feasibility of items and response scales were evaluated through think aloud interviews with clinically active nurses. Psychometric properties were evaluated in a sample of registered nurses (n = 373) working in a variety of healthcare organisations in the Stockholm area. Item and factor analyses and Cronbach's alpha were computed to evaluate internal structure and internal consistency., Result: Sixteen items were modified based on the think aloud interviews and to adapt the instrument for use in acute care. A ceiling effect was observed for many items and the originally identified 37 item five-factor model was not confirmed. Item analyses showed an overlap between factors and indicated a one-dimensional scale., Discussion: The Swedish version of the CAI has a wider application than the original instrument. This might have contributed to the differences in factor structure. Different opportunities for further development of the scale are discussed., Conclusions: Further evaluation of the psychometric properties of the CAI is required., (© 2012 The authors. World Views on Evidence-Based Nursing © Sigma Theta Tau International.)

Introduction: In Sweden, means-tested social assistance serves as a temporary, last resort safety net. However, increasing numbers of people are receiving it for longer periods and about a third has assistance for more than a year. The aim of this study was to explore the ways social assistance recipients manage long lasting adversity and their roles as active, rather than passive, agents in this process, using a resilience perspective., Method: The study is based on thirteen in-depth interviews with long-term social assistance recipients from diverse areas in Stockholm County. The interviews were guided by narrative inquiry to interpret and construct stories of experiences and are part of a larger qualitative study exploring experiences of living on social assistance in Sweden., Results: Experiences of cumulative adversity during many years compounded recipients' difficulties in finding ways out of hardship. They had different strategies to deal with adversities, and many had underlying "core problems", including mental health problems, which had not been properly resolved. Recipients' showed resistance in adverse situations. Some made attempts to find ways out of hardship, whereas others struggled mainly to achieve a sense of mastering life. They received important support from individual professionals in different authorities, but mostly the help from the welfare system was fragmented., Conclusions: Social assistance recipients in this study demonstrated agency in ways of managing long lasting difficulties, sometimes caused by "core problems", which were often accumulated into complex difficulties. Resilience was about keeping going and resisting these difficulties. To find ways out of social assistance required help from different welfare agencies and professionals and was hindered by the fragmentation of services. This study shows that there is a need for more long-term personalised, comprehensive support, including interventions both to increase individual well-being and self-esteem and to open up opportunities for education and employment. Adequate benefit levels and overall quality of welfare services such as health and social care, day care and schools, are of major importance for those in greatest need.