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Purpose: The aim of this study was to validate the Ethos Brief Index (EBI) in patients with Restless Legs Syndrome (RLS)., Methods: A cross-sectional design, including 788 subjects with RLS (65% women, 70.8 years, SD 11.3) from the Swedish RLS Association, was used. A postal survey was sent out to collect data regarding socio demographics, comorbidities, and RLS-related treatment data. Questionnaires included were EBI, the Restless Legs Syndrome-6 Scale (RLS-6), Restless Legs Syndrome-Quality of Life questionnaire (RLSQoL), the Insomnia Severity Index (ISI), and the Epworth Sleepiness Scale (ESS). The validity and reliability of the EBI were investigated using Rasch and confirmatory factor analysis (CFA) models. Measurement invariance, unidimensionality, and differential item functioning (DIF) across age and gender groups, as well as insomnia, daytime sleepiness, RLS-related QoL and RLS severity were assessed., Results: The results supported the unidimensionality of the EBI in the CFA (i.e., explaining 61.5% of the variance) and the Rasch model. The reliability of the EBI was confirmed using composite reliability and Cronbach's alpha. No DIF was identified for gender, age, insomnia, daytime sleepiness, RLS severity or RLS-related QoL., Conclusion: The EBI showed good validity and reliability and operated equivalently for male and female patients with RLS. Accordingly, healthcare professionals can use the EBI as a psychometrically sound tool to explore and identify patient-centered problems related to the whole life situation., (© 2024. The Author(s).)

Objectives: This study investigated the relationship between biological maturation and success in adolescence and adulthood in male Swedish ice hockey players., Methods: Anthropometric records of players in certified ice hockey high schools between 1998 and 2017 were retrieved (n = 4787). The database was complemented with records of Swedish junior national teams (U16, U18, U20) and National Hockey League (NHL) appearances. Biological maturation was recorded as a percentage of adult height (%AH), and selection probabilities were estimated using a generalised linear mixed effects model. Biological age was determined by comparing players with age-matched growth reference values. Categories of %AH, standard deviation z-scores and biological age offset describing early, on-time and late maturation were created., Results: A total of 217 players had played on the U16 national team (junior success), and 96 reached the NHL (adult success). The difference [95% confidence interval (CI)] in baseline %AH between players with junior versus adult success was - 0.75 (- 0.39, - 1.11). Looking at age-offset categories in junior success, 30% of players were early maturing and 19% of players were late maturing, showing a bias towards early maturation (p < 0.01). In contrast, more late-maturing players (40%) achieved adult success than early-maturing players (25%), and NHL players had significantly later maturation [%AH: - 0.48 (- 0.80, - 0.16)] than non-NHL players., Conclusion: This unique 20-year analysis shows that junior success in male ice hockey is positively related to early maturation, while adult success is inversely related to advanced maturation. Ice hockey organisations should implement maturation assessments to optimise the development of both late- and early-matured players., (© 2024. The Author(s).)

Introduction: Multiple sclerosis (MS) is a chronic autoimmune disease with a substantial impact on quality of life and functional capability. The prognosis of MS has changed over time due to the development of increasingly effective therapies. As the knowledge and perceptions of persons living with chronic conditions increasingly have been acknowledged, it has become important to understand lived experiences with a focus on everyday events and experiences as a way of knowing and interpreting the world. Exploring context-specific lived experiences as a source of knowledge about the disease and care may contribute to more precision in designing care services. The aim of this study was to explore the lived experience of persons living with MS in a Swedish context., Materials and Methods: A qualitative interview study was conducted with both purposeful and random sampling strategies, resulting in 10 interviews. Data were analyzed using inductive thematic content analysis., Results: The analysis generated 4 overarching themes with 12 subthemes, the 4 themes were: perspectives on life and health, influence on everyday life, relations with healthcare, and shared healthcare processes. The themes are concerned with the patients' own perspectives and context as well as medical and healthcare-related perspectives. Patterns of shared experiences were found, for example, in the diagnosis confirmation, future perspectives, and planning and coordination. More diverse experiences appeared concerning relations with others, one's individual requirements, symptoms and consequences, and knowledge building., Conclusion: The findings suggest a need for a more diverse and coproduced development of healthcare services to meet diverse needs in the population with greater acknowledgement of the person's lived experience, including consideration of the complexity of the disease, personal integrity, and different ways of knowing. Findings from this study will be further explored together with other quantitative and qualitative data., (© 2023 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Background: The burden of disease for persons with multiple sclerosis (MS) and society is changing due to new treatments. Knowledge about the total need for care is necessary in relation to changing needs and new service models., Objective: The aim of this study was to describe the contact patterns for MS patients, calculate costs in health care, and create meaningful subgroups to analyze contact patterns., Methods: All patients diagnosed with MS at Ryhov Hospital were included. All contacts in the region from January 1, 2018, until September 30, 2019, were retrieved from the hospital administrative system. Data about age, sex, contacts, and diagnosis were registered. The cost was calculated using case costing, and costs for prescriptions were calculated from medical files., Results: During the 21-month period, patients (n = 305) had 9628 contacts and 7471 physical visits, with a total cost of $7,766,109. Seventeen percent of the patients accounted for 48% of the visits. The median annual cost was $7386 in the group with 10 or fewer visits, compared to $22,491 in patients with more than 50 visits., Conclusion: There are considerable differences in the utilization of care and cost between patients with MS in an unselected population, meaning that the care needs to be better customized to each patient's demands., (© 2022 The Authors. Brain and Behavior published by Wiley Periodicals LLC.)

Objectives: Study the proportion of patients affected by involuntary childlessness who are denied fertility treatment and the reasons behind this in a publicly funded healthcare system., Design: Survey study using prospectively collected information by healthcare professionals., Setting: Two university-affiliated fertility clinics in Sweden., Participants: Single women and couples in heterosexual and homosexual relationships seeking fertility evaluation and treatment between November 2017 and April 2018 (943 individual cases)., Primary and Secondary Outcome Measures: Number and proportion of individuals who were either denied, delayed or granted fertility treatment directly. Furthermore, the reasons behind delaying or completely withholding treatment., Results: The majority of those seeking evaluation were heterosexual couples (75%), while 14% were single women and 7.5% were same-sex couples. The great majority of those undergoing evaluation were granted treatment either directly (85%) or after in-depth evaluation (7.5%), while 7.5% were denied treatment. Among those who were denied treatment, there were a greater proportion of single women and couples seeking treatment with donated gametes. Among heterosexual couples, gamete origin was not associated with treatment refusal. Although age did not differ between those granted and denied treatment, a higher body mass index (in both recipient and partner, when applicable) was observed among those being refused treatment. Fertility specialists in Sweden focused their assessment on parental factors that may indirectly entail a risk of harm to the future child, such as medical and psychiatric conditions of the individuals involved, their financial constraints and other social reasons, substance abuse and female obesity., Conclusion: Being single or receiving treatment with donated gametes can both be reasons for withholding fertility treatment. Although difficult to operationalise, parenting assessment in Sweden is employed interchangeably in treatments with donated gametes (legally mandated assessment) and even autologous gametes (non-legally mandated assessment)-making evident a need for clear official policy guidelines regulating these assessments and the provision of treatment., Competing Interests: Competing interests: EE has received lecture fee from Gideon Richter outside the submitted work., (© 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.)

Aim: We investigated socio-economic and geographical determinants of hospital care for viral gastroenteritis in young children., Method: This is a register-based study in a national birth cohort of 752 078 children 0-5 years of age in Sweden during 2006-2012. Hazard ratios (HR) of time to first admission and first episode of outpatient emergency department (ED) care with a diagnosis of viral gastroenteritis were estimated with Cox regression., Results: The adjusted HRs for hospital admission with a diagnosis of viral gastroenteritis were increased when the mother was below 25 years at the birth of the child, 1.30 (95% CI: 1.24-1.35), had a short (<=9 years) education, 1.18 (95% CI: 1.12-1.23), a psychiatric disorder, 1.34 (95% CI: 1.30-1.39), and/or when parents were born outside Europe, 1.23 (95% CI: 1.18-1.29). In contrast, the disposable income of the family was only marginally associated with such hospital admissions. The pattern of HRs for outpatient ED hospital care was similar. Hospital care incidences for viral gastroenteritis differed considerably between Swedish counties., Conclusion: Parental indicators associated with a lower level of health literacy increase the risk for hospital care due to gastroenteritis in young children. Information about oral rehydration should be provided in ways that are accessible to these parents., (©2018 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Cryptic prey coloration typically bears a resemblance to the habitat the prey uses. It has been suggested that coloration which visually matches a random sample of the background maximizes background matching. We studied this previously untested hypothesis, as well as another, little studied principle of concealment, disruptive coloration, and whether it could, acting in addition to background matching, provide another plausible means of achieving camouflage. We presented great tits (Parus major) with artificial background-matching and disruptive prey (DP), and measured detection times. First, we studied whether any random sample of a background produces equally good crypsis. This turned out to not be the case. Next, we compared the DP and the best background-matching prey and found that they were equally cryptic. We repeated the tests using prey with all the coloration elements being whole, instead of some of them being broken by the prey outline, but this did not change the result. We conclude that resemblance of the background is an important aspect of concealment, but that coloration matching a random visual sample of the background is neither sufficient nor necessary to minimize the probability of detection. Further, our study lends empirical support to the principle of disruptive coloration.

Long stretches of sea and desert often interrupt the migration routes of small songbirds, whose fat reserves must be restored before these can be crossed as they provide no opportunity for refuelling. To investigate whether magnetic cues might enable inexperienced migratory birds to recognize a region where they need to replenish their body fat, we caught and held thrush nightingales (Luscinia luscinia) in Sweden just before their first migration and exposed them to a magnetic field simulating that at a migratory stopover in northern Egypt, before the Sahara Desert. We found that this magnetic field stimulated the birds to extend their fat-deposition period, indicating that magnetic cues may help small migratory birds to confront large ecological barriers.