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Background: People with intellectual disabilities are less physically active and suffer from ill-health more than the general population. Support staff play an important role in the person's life. This study aimed to explore the support staff's experiences regarding the feasibility of adapted web-based exercise for people with intellectual disabilities. Method: Participants with intellectual disabilities living in community-based settings were recruited for a web-based exercise study. Eight semi-structured interviews were carried out with their support staff before and after the intervention period. Results: The main theme, 'Support staff are crucial for feasibility' encompasses the importance of communication, structure, and motivation in improving physical activity for people with intellectual disabilities. Conclusion: The experiences of support staff, indicate that a web-based exercise program is feasible for the target group, and one way to overcome challenges for PA, where the role of the staff is crucial.

Classical ballet training has been criticized for prioritizing technical excellence over creativity, despite 21st century dancers needing to be strong in both aspects. The aim of this study was to investigate professional choreographers' views on (a) how ballet training inspired vs. inhibited their creativity and (b) potential gender differences in this regard. Eight choreographers (50% female) participated in semi-structured interviews, with transcripts analyzed using thematic analysis. The key theme was created from accounts of how ballet training impacted on interviewees' "Intrinsic motivation to create," fed into by experiences of "Autonomy, Variety and Opportunities." Experiences of significant autonomy thwarting were considered to have inhibited creativity; this was one of several areas of gender difference, and a reason for participants to pursue choreography rather than stay employed as dancers. In following the emergent Recommendations for schools, it is possible that Intrinsic motivation to create could be better nurtured in ballet training.

This study provides the first in-depth investigation of how perfectionism is experienced in high-level dance. Seventy-seven students (M age = 15.52, SD = 2.30) completed a perfectionism questionnaire. Next, dancers with the highest and lowest levels of perfectionistic strivings (PS) and perfectionistic concerns (PC) were recruited for interview (N = 8), as representatives of the four subtypes of perfectionism in the 2 × 2 model. Distinct profiles emerged for the four quadrants of the 2 × 2 model in relation to four key themes: "self-regulation," "achievement goals," "views on mistakes," and "role of others." Dancers with high PS displayed the highest levels of self-regulation while dancers with low PC appeared most task-oriented. Dancers with high PC reported holding less favorable views on mistakes and placed greater emphasis on the opinions of others. Importantly, PS appeared to be both helpful and hurtful. Findings are discussed in relation to theory intermixed with practical recommendations.

Leys are an important part of northern European livestock production, particularly for ruminants since monogastric animals are limited in their ability to digest the fibres of the forage. Crop fractionation methods are a promising option to make forages more beneficial for monogastric animals and decrease the amount of imported protein feed. A leaf stripping harvesting technique was evaluated at Röbäcksdalen in northern Sweden in mixed grass‐clover leys over 2 years. The PremAlfa Mini leaf stripper (Trust'ing‐Alf'ing, Nantes, France) worked well in mixed stands, harvesting on average a third of the available forage biomass, primarily in the form of leaves and soft stems from the clover plants. It proved successful in producing a forage fraction that had a significantly higher crude protein (CP) concentration (+39.1%) and lower neutral detergent fibre (aNDFom) concentration (−21.4%) than the pre‐harvest mixed sward (all significant at p <.05 level). Due to the remaining high level of aNDFom in the leaf stripper fraction, it is more suited for use as an energy source for monogastrics rather than as a protein supplement. Alternatively, the leaf stripper fraction could be used to increase digestibility and CP content in the feed rations of high producing dairy cows. [ABSTRACT FROM AUTHOR]

Severe chronic rhinosinusitis with nasal polyposis (CRSwNP) is a disabling airway disease that significantly impacts patients' lives through the severity of symptoms, the need for long-term medical treatment and the high risk of recurrence post-surgery. Biological agents targeting type 2 immune responses underlying the pathogenesis of CRSwNP have shown effectiveness in reducing polyp size and eosinophilic infiltrate, and in decreasing the need for additional sinus surgeries. However, despite recent progress in understanding and treating the disease, type 2 inflammation-driven severe CRSwNP continues to pose challenges to clinical management due to several factors such as persistent inflammation, polyp recurrence, heterogeneity of disease, and comorbidities. This article presents the findings of a scientific discussion involving a panel of ear, nose and throat (ENT) specialists and pulmonologists across Sweden and Finland. The discussion aimed to explore current management practices for type 2 inflammation-driven severe CRSwNP in the Nordic region. The main topics examined encompassed screening and referral, measurements of disease control, treatment goals, and future perspectives. The experts emphasized the importance of a collaborative approach in the management of this challenging patient population. The discussion also revealed a need to broaden treatment options for patients with type 2 inflammation-driven CRSwNP and comorbid conditions with shared type 2 pathophysiology. In light of the supporting evidence, a shift in the disease model from the presence of polyps to that of type 2 inflammation may be warranted. Overall, this discussion provides valuable insights for the scientific community and can potentially guide the future management of CRSwNP. [ABSTRACT FROM AUTHOR]

Purpose: To describe four Finnish families with epithelial recurrent erosion dystrophy (ERED) caused by the pathogenic variant c.3156C>T in collagen type XVII alpha 1 chain gene (COL17A1). Methods: Eleven affected and two unaffected individuals underwent clinical ophthalmological examination, anterior segment photography, and corneal topography. Two of them underwent phototherapeutic keratectomy (PTK). Genetic analysis included both next‐generation and Sanger sequencing. Specimens from the manual keratectomy of one patient were available for ophthalmic pathologic examination, including immunohistochemistry. Results: The common splice‐site altering synonymous variant c.3156C > T, p.(Gly1052=) in COL17A1 was confirmed in 15 individuals with ERED from the four families. Subepithelial corneal scarring grades varied and increased with age, leading to decreased best‐corrected visual acuity. PTK improved vision in 58‐ and 67‐year‐old individuals without reactivating the disease. The keratectomy specimens showed an uneven epithelium and a spectrum of basement membrane abnormalities, including breaks, fragmentation, multiplication and entrapment within the subepithelial scar, reflecting recurrent erosions. The stromal cells consisted of varying proportions of bland and activated fibroblasts and myofibroblasts, reflecting different ages of scars. The family with the largest number of known affected generations originated from Southern Sweden. Conclusion: The phenotype in the Finnish ERED families is consistent with earlier reports of the c.3156C > T variant, although the severity has varied between reports. The phenotype may be modulated by other genes. This study suggests a likely founder effect of the variant in both Finnish and Swedish populations due to their shared population histories. If vision is compromised, PTK can be considered especially in older patients. [ABSTRACT FROM AUTHOR]

Background: Nutritious and attractive school meals can improve health equality and public health. Current official guidelines and recommendations on food and nutrient composition of school meals in 3 Nordic countries; Sweden, Finland, and Iceland, are described and compared with actual practice, ie, availability of foods and nutrients in served reference meals in 3 selected areas in each country. Methods: A country comparison was made between official guidelines, and actual practice was studied in participating schools. Reference portions of school meals (N = 170) provided in 24 compulsory schools were photographed and weighed. Food and nutrient availability were compared with official guidelines in each country. Results: Emphasis of recommendations on whole-grain bread in Sweden, whole grains in Finland, and fish in Iceland were reflected in food availability. The energy content of the meals provided was lower than guidelines and there was a large variation in energy content between days. Conclusions: The guidelines regarding food availability were quite well followed, but the large variation in energy and nutrient content of provided school meals between days indicates a need for standardization.

Aim: Breath‐holding spells (BHS) are common in children, but evidence‐based clinical guidelines are lacking. We investigated a large population‐based cohort of BHS patients, to propose a refined description of typical BHS and guidelines for its management. Methods: In a cross‐sectional retrospective study, patients diagnosed with BHS in Southern Sweden 2004–2018 were recruited. Disease characteristics and diagnostic data were collected from patient medical records. Results: In total, 519 patients, mean age at diagnosis 19.8 ± 13.8 months with equal gender distribution, were included. In 48.3%, BHS had already been diagnosed after one spell. During spells, 78.0% of patients were unresponsive. For 71.5%, atonic, tonic, tonic–clonic or myoclonic seizures were reported, and 78.0% of patients had a spell lasting less than 1 min. Electroencephalography was conducted in 30.4% and Electrocardiography in 45.1%. Six children (3.8%) had a pathological electroencephalogram, four of which had concomitant epilepsy and only 0.9% of children had electrocardiogram findings suggesting pathology, none showing long QT syndrome. Conclusion: Children with BHS were frequently subjected to unnecessary diagnostic interventions. We characterise a typical presentation of BHS and propose a management‐algorithm, which is expected to reduce unnecessary usage of electroencephalography and electrocardiography. [ABSTRACT FROM AUTHOR]

Purpose: Pupils' perspective should be better taken into account when developing nutrition education at school. The purpose of this paper is to explore Nordic children's perspectives on the healthiness of meals in the context of school lunches. Design/methodology/approach: In total, 78 focus group discussions were conducted with 10-11-year-old girls and boys (n = 457) from schools in Finland, Iceland, Norway and Sweden, which were participating in the Nordic school meal project ProMeal during the school year 2013-2014. A flexible discussion guide and stimulus material in the form of 14 photographs displaying different school lunch contexts were used. The discussions were analyzed using thematic analysis. Findings: These Nordic children seem to share the adult-set aim of healthy eating in the school context as a socio-cultural norm. Although healthy eating was constructed as a rational, normative and acceptable way to eat at school, unhealthy eating was emphasized as negotiably acceptable when eaten occasionally and under certain circumstances (e.g. at special occasions). Unhealthy eating also comprised emotionally laden descriptions such as enjoyment and disgust. Practical implications: Children's conceptualizations of healthy eating are connected to nutritional, socio-cultural, emotional and normative dimensions, which should be reflected also when developing nutrition education in school. Originality/value: The need for research exploring children's experiences of, and understandings about, school lunch motivated this unique multicenter study with a large number of participating children. In the focus groups a child-oriented, photo-elicitation method was used.

Simple Summary: Overweight is a growing problem in dogs worldwide and negative health effects associated with excess body weight are common. The body condition score (BCS) scale is a time- and resource-effective method to assess if a dog is overweight, but its precision among dog owners has been found to vary. The aim of this study was to investigate dog owners' perceptions of various body compositions in dogs and evaluate if a short education on how to use the 9-point BCS scale might change these perceptions. This study included one survey and one clinical study of Swedish dog owners. In the indirect assessment based on photos, normal-weight dogs were underestimated by three-quarters of dog owners, and about half of the dog owners underestimated overweight dogs. Before receiving the standardized education, one-third of the owners underestimated the body composition of their own dogs, mainly for dogs with excess adiposity. The dog owners responded well to the practical education given and, thereafter, performed assessments comparable to veterinary health care personnel. These results indicate that perception of what an "ideal weight" dog should look like is sliding and that the ability to identify overweight dogs might be limited when owners evaluate body composition without previous education. Overweight in dogs is an increasing problem, with a prevalence of about 30% in Sweden. To prevent the negative health effects of overweight, it is important to identify and treat canine overweight. Dog owners are essential for such interventions. The aim of this study was to evaluate dog owners' perceptions of various canine body compositions via indirect assessment based on photos and direct assessment of their own dogs. A second aim was to evaluate the effect of a standardized practical education for dog owners on body condition score (BCS) assessment of their own dogs. The 9-point BCS scale was used, and two study samples were recruited: one was a survey sample where 564 dog owners assessed the BCS of dogs using photos, and one sample was a separate clinical sample where 82 dogs were assessed by their owners and by veterinary health care personnel. The initial BCS assessment by the dog owners in the clinical sample (mean ± SD) was significantly lower (4.6 ± 1.0) than the BCS assessed by the veterinary health care personnel (5.2 ± 1.1), but the owners improved significantly after receiving the standardized education (5.1 ± 1.0) (both p < 0.0001) and performed as accurately as the veterinary health care personnel (p = 0.99). The results should be verified in the broader dog owner population based on a randomized selection of participants. "Weight blindness", defined here as an underassessment of normal-weight dogs and an inability to identify overweight dogs, is likely to have a negative impact on canine overweight prevalence. Deeper knowledge about dog owners' perceptions can inform the development of new strategies to help prevent and manage canine overweight, whereof standardized practical education on BCS assessment is shown here to be one example. [ABSTRACT FROM AUTHOR]

Introduction: Professional visual artists constitute a heterogeneous vocational group, including, but not limited to painters, photographers, textile artists, and sculptors who may face exposure to workplace hazardous substances and lifestyle factors that may contribute to the development of selected cancers. The objective of this registry-based cohort study was to assess the cancer incidence among Nordic visual artists. Materials and methods: This study is based on data from the Nordic Occupational Cancer (NOCCA) project that combines census data of 15 million people from all Nordic countries and cancer registries from 1961 to 2005. For the present study we selected a cohort of visual artists from Finland, Iceland, Norway, and Sweden. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for the entire national study populations used as reference rates. Results: In male visual artists, there were statistically significant excesses in cancers of the tongue (SIR 2.91, 95% confidence interval 1.74-4.55), oral cavity (2.09, 1.26-3.27), pharynx (2.18, 1.45--3.15), testis (1.91, 1.11-3.05), renal pelvis (2.48, 1.42-4.03) and bladder (1.33, 1.14-1.55). The risk was significantly decreased for cancers of the lip (0.45, 0.18-0.93) and stomach (0.65, 0.50-0.84). In female visual artists, the only significantly increased risk was observed for breast cancer (1.29, 1.13-1.48) and the only significantly decreased risk for stomach cancer (0.43, 0.17-0.88). The incidence of lung cancer was close to the population average in both sexes. Conclusions: The non-elevated incidence of lung cancer suggests a similar prevalence of smoking between visual artists and the general population, while the elevated risk of cancers of mouth and pharynx among male visual artists is suggestive of more widespread alcohol drinking. The excess risk of urogenital cancers might be associated with exposure to solvents. NOVELTY & IMPACT The exposure of visual artists to carcinogens remains unstudied and equivocal. The current study suggests that visual artists carry an overall cancer risk that is slightly above the risk among the general population of the four Nordic countries. We observed in men over two-fold excess risks of cancers of the tongue, oral cavity, pharynx, and renal pelvis, and also a significant risk of testis and bladder cancers. [ABSTRACT FROM AUTHOR]

Disclaimer: Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of the International Agency for Research on Cancer/World Health Organization. Simple Summary: Veterinarians can be exposed to a wide range of known and suspected carcinogens through their work, however relatively few studies have investigated the cancer risk in the profession. We investigated cancer incidence in veterinarians in Denmark, Finland, Iceland, Norway, and Sweden, across more than 40 years. In all the countries, the overall cancer incidence in veterinarians was close to the incidence in the total population. There was an elevated incidence of several cancer types among male veterinarians before the 1990s but no excess cancer risk after that. Veterinary work environments have been changing, and are changing, in terms of exposure to chemical compounds, ionizing radiation from diagnostic imaging, and different pathogens, and these changes may affect the cancer profile of veterinarians. The cancer profile of veterinarians has received little research attention, despite the profession potentially being exposed to a wide range of known and suspected carcinogens. In this large-scale cohort study, we assessed cancer incidence in veterinarians in Denmark, Finland, Iceland, Norway, and Sweden, across more than 40 years (1961–2005). The cohort comprised 4708 veterinarians and 119,503 person-years at follow-up. The overall cancer incidence in veterinarians was close to the incidence in the total population in all countries and in all age groups. In male veterinarians, the standardized incidence ratios (SIR) in 1961–1990 were elevated for colon cancer (1.86, 95% confidence interval (CI) 1.39–2.44), prostate cancer (1.35, 95% CI 1.07–1.67), and especially skin melanoma (3.62, 95% CI 2.78–2.84), while there was no longer any statistically significant excess in the more recent follow-up period. Decreased SIRs were observed for lip cancer (0.11, 95% CI 0.00–0.62), laryngeal cancer (0.38, 95% CI 0.12–0.89), lung cancer (0.59, 95% CI 0.47–0.74), and stomach cancer (0.58, 95% CI 0.38–0.86), without a marked change in SIR over time. Non-significant excesses among male veterinarians were also observed in Hodgkin lymphoma (1961–1990 only), and leukaemia. This multi-country study indicates that there was an elevated incidence of several cancer types among male veterinarians before the 1990s but not after that. Some of the findings might rather be attributed to lifestyle factors and not directly to work conditions, but the excess risk of cancers of kidney and bladder, for example, might be related to work exposures. [ABSTRACT FROM AUTHOR]

Background: Alpha-chloralose (AC) is a compound known to be toxic to various animal species and humans. In 2018 and 2019 an increase in suspected cases of AC poisoning in cats related to the use of AC as a rodenticide was reported to national veterinary and chemical authorities in Finland, Norway and Sweden by veterinarians working in clinical practices in respective country. The aims of this study were to prospectively investigate AC poisoning in cats, including possible secondary poisoning by consuming poisoned mice, and to study metabolism and excretion of AC in cats through analysis of feline urine. Methods: Data on signalment, history and clinical findings were prospectively collected in Finland, Norway and Sweden from July 2020 until March of 2021 using a questionnaire which the attending veterinarian completed and submitted together with a serum sample collected from suspected feline cases of AC-poisoning. The diagnosis was confirmed by quantification of AC in serum samples. Content of AC was studied in four feline urine samples, including screening for AC metabolites by UHPLC-HRMS/MS. Bait intake and amount of AC consumed by mice was observed in wild mice during an extermination of a rodent infestation. Results: In total, 59 of 70 collected questionnaires and accompanying serum samples were included, with 127 to 70 100 ng/mL AC detected in the serum. Several tentative AC-metabolites were detected in the analysed feline urine samples, including dechlorinated and oxidated AC, several sulfate conjugates, and one glucuronic acid conjugate of AC. The calculated amount of AC ingested by each mouse was 33 to 106 mg with a mean of 61 mg. Conclusions: Clinical recognition of symptoms of AC poisoning in otherwise healthy cats roaming free outdoors and known to be rodent hunters strongly correlated with confirmation of the diagnosis through toxicological analyses of serum samples. The collected feline exposure data regarding AC show together with the calculation of the intake of bait and subsequent AC concentrations in mice that secondary poisoning from ingestion of mice is possible. The results of the screening for AC metabolites in feline urine confirm that cats excrete AC both unchanged and metabolized through dechlorination, oxidation, glucuronidation and sulfatation pathways. [ABSTRACT FROM AUTHOR]

The Baltic countries Estonia, Latvia and Lithuania are well connected to the Nordic countries Finland and Sweden on the electricity market, yet in a different position facing the transition to a low-carbon electricity system. While especially Sweden is a large electricity producer and net exporter, the Baltic countries suffer from a lack of capacity, which makes them highly dependent on trade. In addition, the present electricity mix of Estonia is very carbon intensive compared to the Nordic countries. There is a debate regarding nuclear power in Sweden. This paper explores four possible solutions for a Nordic-Baltic electricity system: with and without nuclear power in Sweden and with the current transmission network, as well as with a considerably expanded network. The impact on electricity mix, electricity prices, carbon dioxide intensity and import dependence in the Baltic countries from the EU transition to electricity systems with very low carbon dioxide emissions is investigated. The electricity and district heat market model Enerallt is used to quantify electricity prices, electricity trade and system costs. The results show that the development of the transmission network affects electricity prices and especially electricity trade in the Baltic countries. With transmission expansion, the demand weighted average prices in the Baltic countries increase from 62 €/MWh to 65 €/MWh and 70 €/MWh with and without nuclear power in Sweden, respectively. If transmission is expanded, phasing out nuclear power in Sweden can increase the revenue from electricity export by over 100% for the Baltic countries. However, significant new investment in wind power is required. [ABSTRACT FROM AUTHOR]

A growing trend in developed countries is the use of wood as fuel for domestic heating due to measures taken to reduce the usage of fossil fuels. However, this imposed another issue with the environment and human health. That is, the emission from wood burning contributed to the increased level of atmospheric particulates and the wood smoke caused various respiratory diseases. The aim of this study was to investigate the impact of wood burning on the polycyclic aromatic hydrocarbons (PAHs) in air PM 10 using known wood burning tracers, i.e. levoglucosan, mannosan and galactosan from the measurement at the urban background and residential areas in Sweden. A yearly measurement from three residential areas in Sweden showed a clear seasonal variation of PAHs during the cold season mainly from increased domestic heating and meteorology. Together, an increased sugar level assured the wood burning during the same period. The sugar ratio (levoglucosan / (mannosan + galactosan)) was a good marker for wood burning source such as the wood type used for domestic heating and garden waste burning. On the Walpurgis Night, the urban background measurement demonstrated a dramatic increase in levoglucosan, benzo[ a ]pyrene (B[ a ]P) and oxygenated PAHs (OPAHs) concentrations from the increased wood burning. A significant correlation between levoglucosan and OPAHs was observed suggesting OPAHs to be an indicator of wood burning together with levoglucosan. The levoglucosan tracer method and modelling used in predicting the B[ a ]P concentration could not fully explain the measured levels in the cold season. The model showed that the local wood source contributed to 98 % of B[ a ]P emissions in the Stockholm area and 2 % from the local traffic. However, non-local sources were dominating in the urban background (60 %). A further risk assessment estimated that the airborne particulate PAHs caused 13.4 cancer cases per 0.1 million inhabitants in Stockholm County. [ABSTRACT FROM AUTHOR]

Background: POSITIVE (i.e. maintaining and imPrOving the intrinSIc capaciTy Involving primary care and caregiVErs) is a new intervention program consisting of home-monitoring equipment and a communication platform to support treatment of frailty symptoms initially in primary care and prevent disability in older adults. Methods: The primary objectives are to estimate the potential efficacy of the POSITIVE system on improving frailty in at least one point in Fried's criteria and five points in Frailty Trait Scale. The secondary objectives are to (A) assess the recruitment, retention, drop-out rates, compliance with the intervention and the intervention mechanisms of impact; (B) evaluate the usability and acceptance of the POSITIVE system, and to get estimations on; (C) the potential efficacy of the intervention on improving the participants' physical performance, cognitive functions, mood, independency level in activities in daily living, the impact on quality of life and number of falls during the follow-up period; (D) the impact on the caregiver quality of life and caregiver burden; and (E) on the consumption of health care resources, participants' perception of health and level of care received, and healthcare professionals' workload and satisfaction. A randomised controlled, assessor-blinded pilot study design recruiting from a primary care centre in Stockholm Region will be conducted. Fifty older adults identified as pre-frail or frail will be randomised into a control or an intervention group. Both groups will receive a medical review, nutritional recommendations and Vivifrail physical exercise program. The intervention group will receive the POSITIVE-system including a tablet, the POSITIVE application and portable measurement devices. The participants receiving the POSITIVE program will be monitored remotely by a primary care nurse during a 6-month follow-up. Data will be collected at baseline, 3 and 6 months into the intervention though the platform, standardised assessments and surveys. A process evaluation as per Medical Research Council guidance will be conducted after the 6-month follow-up period. Discussion: The implications of the study are to provide estimations on the potential efficacy of the POSITIVE system in improving frailty among older adults and to provide relevant data to inform powered studies of potential efficacy and effectiveness, as well as to inform about the feasibility of the current study design. Trial registration: ClinicalTrials.gov. Registration number: NCT04592146. October 19, 2020. [ABSTRACT FROM AUTHOR]

This article focuses on Swedish public service radio (Sveriges Radio, SR) and how interviews in languages other than Swedish are given in SR. In the article, the result of a close analysis of 42 hours of broadcasting from SR is presented. All in all, a dozen languages are identified; however, English clearly dominates the radio programs besides Swedish. Pronounced differences are also found between the two public radio channels Pi (including news) and P3 (with more entertaining programs). In the latter, interviews in English are abundant - in one program English is spoken a fourth of the total broadcasting time. In addition, interviews in English are seldom translated. This indicates that a listener not understanding English will have trouble comprehending all the content published by Swedish public radio. In the article, this is discussed from the perspective of democracy and inclusion in society, since not all people in Sweden master English. [ABSTRACT FROM AUTHOR]

Background: Oilseed rape (OSR; Brassica napus L.) is a highly valued crop for food, feed and industrial use. It is primarily grown in temperate climates, and over recent decades, its area of production and profitability have increased. Concurrently, several diseases negatively impact OSR production. Diseases caused by soil-borne pathogens, pose a risk of substantial yield loss since crop rotation schemes have become narrow as the time lapse between OSR crops in a field has been shortened. The aims of this paper were to provide an overview of plant protection measures available for OSR production and to identify knowledge gaps and areas where more research is needed. Methods: This systematic map builds on a previously published protocol and follows the ROSES reporting standard. The search strategy was developed in collaboration with stakeholders and designed to cover available scientific evidence for OSR disease management in climate zones relevant for Scandinavian crop production (Dfc, Dfb, Cfb and Cfa in the Köppen-Geiger climate classification). Five scientific databases were used to identify peer-reviewed literature, complemented by additional searches performed in grey literature. Articles were screened at three stages: the title, abstract and full text. The eligible publications included studies of OSR crops, and all measures to control crop disease in agricultural fields were considered eligible interventions. The comparator was intervention and no intervention, and the yield per unit area, disease suppression or an increase in crop quality were determined to be outcomes of interventions. A basic assessment of the experimental design of each study was performed to assess its eligibility. All articles were coded based on the following categories: the location and climate zone, disease, pathogen, intervention and management method, outcome and study design. Articles not reporting original data but judged to be relevant (i.e., review papers, books and notes of registration of cultivars) were saved in a separate category called "books, reviews and reports". Review findings: A total of 4633 articles were collected through systematic searches. After duplicates were removed, 3513 articles were included in the screening process. After screening at the title and abstract levels, 897 articles were evaluated at the full text level, and 118 articles comprised the studies that met the eligibility criteria of the systematic map. The country (Canada) and region (Europe) with the largest OSR crop production areas also contributed the highest number of articles. In total, 17 different diseases were reported, with black leg (syn. Phoma stem canker) being the most studied disease. Nineteen different intervention methods or management types were examined. Cultivar resistance and pesticide application were the most studied control measures. Conclusion: We report scientific studies on plant disease protection measures for OSR based on field trials where the results are intended to be directly implemented in crop production management. The map clearly provides an overview of research progress throughout the time period chosen, and it identifies knowledge gaps regarding important diseases where only a few studies have been published, for example, diseases caused by viruses. [ABSTRACT FROM AUTHOR]

The promise of becoming a normal or even ideal citizen of the nation-state has long been central to the politics of military recruitment and retention. However, what this promise has entailed, and how the image of the soldier has been constructed, varies across time and place. This article illustrates and historicizes the emergence of a distinct soldier image, closely associated with the neoliberal ideal of responsible, active, and entrepreneurial citizenship, in the context of Sweden. The paper adopts a genealogical approach and views 'the enterprising soldier' through the contemporary history of military reforms in post-Cold War Sweden. Central to these reforms was the move from universal conscription for men to a recruitment policy that gradually came to rely on voluntarism for all, a shift that culminated in the introduction of an all-volunteer force in 2010. To illustrate the significance and potential appeal of 'the enterprising soldier', the paper exemplifies how this image has been promoted and presupposed in three sites: (1) military recruitment materials, (2) military career planning schemes, and (3) military-private sector partnership programmes. Through this genealogical endeavour, this paper contributes new insights into how the image and promise of soldiering has transformed alongside neoliberal reforms of the armed forces. [ABSTRACT FROM AUTHOR]

Little is known about the microstructural behavior of magnetite during hypervelocity impact events, even though it is a widespread accessory mineral and an important magnetic carrier in terrestrial and extraterrestrial rocks. We report systematic electron backscatter diffraction crystallographic analysis of shock features in magnetite from a transect across the 52-km-diameter ca. 380 Ma Siljan impact structure in Sweden. Magnetite grains in granitoid samples contain brittle fracturing, crystal-plasticity, and lamellar twins. Deformation twins along {111} with shear direction of <112> are consistent with spinel-law twins. Inferred bulk shock pressures for the investigated samples, as constrained by planar deformation features (PDFs) in quartz and shock twins in zircon, range from 0 to 20 GPa; onset of shock-induced twinning in magnetite is observed at >5 GPa. These results highlight the utility of magnetite to record shock deformation in rocks that experience shock pressures >5 GPa, which may be useful in quartz-poor samples. Despite significant hydrothermal alteration and the variable transformation of host magnetite to hematite, shock effects are preserved, which demonstrates that magnetite is a reliable mineral for preserving shock deformation over geologic time. [ABSTRACT FROM AUTHOR]

To extract the items most suitable for a short version of the 15-item Geriatric Depression Scale (GDS-15) in a sample of adults aged ≥ 85 years using item response theory (IRT). This population-based cross-sectional study included 651 individuals aged ≥ 85 years from the Umeå 85+/GErontological Regional DAtabase (GERDA) study. Participants were either community dwelling (approximately 70%) or resided in institutional care (approximately 30%) in northern Sweden and western Finland in 2000–2002 and 2005–2007. The psychometric properties of GDS-15 items were investigated using an IRT-based approach to find items most closely corresponding to the GDS-15 cut off value of ≥5 points. Receiver operating characteristic curves were used to compare the performance of the proposed short version with that of previously proposed short GDS versions. GDS-15 items 3, 8, 12, and 13 best differentiated respondents' levels of depressive symptoms corresponding to the GDS-15 cut off value of ≥5, regardless of age or sex, and thus comprise the proposed short version of the scale (GDS-4 GERDA). For the identification of individuals with depression (total GDS-15 score ≥ 5), the GDS-4 GERDA with a cut-off score of ≥2 had 92.9% sensitivity and 85.0% specificity. The GDS-4 GERDA could be used as an optimized short version of the GDS-15 to screen for depression among adults aged ≥ 85 years. [ABSTRACT FROM AUTHOR]

Background: Pharmacovigilance based on spontaneously reported suspected adverse events (AEs) from veterinary professionals is a powerful tool for detecting potential risks of using medicinal products. However, it is heavily dependent on the voluntary participation of veterinary professionals. Estimates suggest that over 90% of suspected AEs remain unreported. This survey was conducted to accumulate information on current practices and attitudes of Swedish veterinary professionals in relation to AE reporting and their perceptions of the accessibility of updated product safety information. Methods: Swedish veterinary professionals were surveyed using a web‐based questionnaire prepared by the Swedish Medical Products Agency (SMPA). The survey included three sections with 13 questions and was distributed via several communication channels, including the Swedish Veterinary Association. Results: The survey was answered by 412 veterinary professionals, including veterinarians and licensed veterinary nurses. The survey identified that most veterinarians comply with national legislation by reporting directly to the SMPA, but not all observed AEs are reported. Veterinary professionals indicated that it is important to have an easy and efficient reporting system, preferably directly from an electronic medical records system. Feedback is considered important. Veterinary nursing staff could potentially improve the reporting rate of suspected AEs in Sweden. The degree of knowledge relating to the reporting of AEs varies among professionals, thus impacting on reporting frequency. A single source of product safety information is mainly used, and improvements are required to enhance accessibility and distribution of updated product safety information. Conclusions: The insight gained from this survey will be used to influence attitudes and facilitate adaptations needed to fulfil the requirements of the European Union regulations. To reduce underreporting of AEs and facilitate access to updated product safety information, various approaches are required including educational interventions, new digital reporting tools and adaption of communication strategies. [ABSTRACT FROM AUTHOR]

Child sexual abuse (CSA) is a crime against human rights with severe health consequences, and suicidal actions, stress, eating disorders, and borderline disorder are common among survivors of CSA. The objective of this study was to analyze how health care consumption patterns developed among adolescent girls in the Stockholm Region, Sweden, 1 and 2 years after the first registration of CSA experience appeared in their medical record, as compared to age-matched controls without such registration. In this cohort study, number of healthcare visits, comorbidities, and prescribed drugs were collected through the Stockholm Region administrative database (VAL), for girls age 12–17 with registration of CSA experience in their medical record (n = 519) and age-matched controls (n = 4920) between 2011 and 2018. Healthcare consumption patterns remained higher among the girls with a registered CSA experience compared to the controls, both 1 and 2 years after the first CSA experience registration. Highest odds ratios (ORs) were found for suicide attempts [OR 26.38 (12.65–55.02) and 6.93 (3.48–13.49)]; stress disorders [25.97 (17.42–38.69) and 15.63 (9.82–24.88)]; psychosis [OR 19.39 (1.75–214.13) and 9.70 (1.36–68.95)], and alcohol abuse [OR 10.32 (6.48–16.44) and 6.09 (1.98–18.67)], 1 and 2 years, respectively, after the first CSA experience registration. The drug prescriptions were also significantly higher among the girls with a CSA experience registration than for the controls. The results highlight the need to systematically evaluate and develop assessment, treatment planning, and interventions offered to adolescent girls after their first CSA experience registration. [ABSTRACT FROM AUTHOR]

Background Lyme neuroborreliosis peripheral facial palsy (LNB PFP) and idiopathic PFP, Bell's palsy (BP), are the most common causes of facial palsy in borrelia-endemic areas and are clinically similar. Early treatment with corticosteroids has been shown to be effective in Bell's palsy, and antibiotics improve the outcome in LNB. However, there is a lack of knowledge on how the addition of corticosteroids to standard antibiotic treatment affects the outcome in LNB PFP. Methods This prospective, open trial with historical controls was conducted at 2 large hospitals in western Sweden between 2011 and 2018. Adults who presented with LNB PFP were included in the study group and were treated with oral doxycycline 200 mg twice daily for 10 days and prednisolone 60 mg once daily for 5 days, then tapered over 5 days. The historical controls were adult patients with LNB PFP included in previous studies and treated with oral doxycycline. Both groups underwent a follow-up lumbar puncture and were followed until complete recovery or for 12 months. Results Fifty-seven patients were included, 27 in the study group and 30 in the control group. Two patients (7%) in the study group and 6 patients (20%) in the control group suffered from sequelae at the end follow-up. There was no statistically significant difference between the groups, either in the proportion of patients with sequelae or in the decline in cerebrospinal fluid mononuclear cell count. Conclusions Adjunctive corticosteroids neither improve nor impair the outcome for patients with LNB PFP treated with doxycycline. [ABSTRACT FROM AUTHOR]

Background: Welfare technology has been launched as a concept to accelerate digital transformation in care services, but the deployment of these technologies is still hindered by organisational resistance, lack of infrastructure, and juridical and ethical issues. This paper investigates decision-making among municipal actors in the application and deployment of welfare technology from a procurement process perspective. The study explores the perceptions and negotiations involved in purchasing welfare technology at each stage of the procurement model, revealing the impact of technical, economic, juridical and ethical competence on the mapping, planning, procurement, implementation and management of welfare technology.Methods: The study presents empirical findings from qualitative interviews conducted among municipal actors in Sweden. Semi-structured interviews were gathered in 2020 among procurement managers, IT managers, and managers in social administration in three different municipalities (n = 8). Content analysis and systematic categorisation were applied resulting in the division of procurement practices into sub-categories, generic categories and main categories.Results: Challenges in the application and deployment of welfare technology occur at all stages of the procurement model. In mapping and planning, barriers are identified in the need analysis, requirement specification and market analysis. In the procurement stage, economic resources, standardisation and interoperability hinder the procurement process. Implementation and management are complicated by supplier assessment, legislation, cross-organisational collaboration and political strategy. Building on these findings, this study defines 'procurement competence' as consisting of technical, economic, juridical and ethical expertise in order to assess and evaluate welfare technology. Technical and ethical competence is needed in early stages of procurement, whereas juridical and economic competence relates to later stages of the model.Conclusions: Procurement competence is associated with the application and deployment of welfare technology in (1) assessment of the end-user's needs, (2) estimation of the costs and benefits of welfare technology and (3) management of juridical and legislative issues in data management. Economic and juridical decisions to purchase welfare technology are not value-neutral, but rather associated with socially shared understandings of technological possibilities in care provision. Optimisation of procurement processes requires a combination of capabilities to introduce, apply and deploy welfare technology that meets the demands and needs of end-users. [ABSTRACT FROM AUTHOR]

This article studies how professional elites, as exemplified by first teachers (FTs)--a new prominent position for teachers in Sweden--respond to clashes between market and professional logics, and how this affects professional control vis-à-vis clients. Based on a collaborative ethnography, findings suggest that the professional elites use different responses to the clashes between the logics. Professional control can be strengthened by FTs co-opting the market logic strategically in the interest of the profession. However, FTs sometimes also succumb to cliental influence, becoming co-opted themselves by the market logic, which weakens professional control. Tentatively, context needs to be highlighted in order to understand why different responses are used, and in this identity work and relationships to managers seem essential to create a foundation for FTs to respond in ways that increase professional control vis-àvis clients. [ABSTRACT FROM AUTHOR]

Motivation Due to the worldwide COVID-19 pandemic, new strategies had to be adopted to move from classroom-based education to online education, in a very short time. The lack of time to set up these strategies, hindered a proper design of online instructions and delivery of knowledge. Bioinformatics-related training and other onsite practical education, tend to rely on extensive practice, where students and instructors have a face-to-face interaction to improve the learning outcome. For these courses to maintain their high quality when adapted as online courses, different designs need to be tested and the students' perceptions need to be heard. Results This study focuses on short bioinformatics-related courses for graduate students at the University of Gothenburg, Sweden, which were originally developed for onsite training. Once adapted as online courses, several modifications in their design were tested to obtain the best fitting learning strategy for the students. To improve the online learning experience, we propose a combination of: (i) short synchronized sessions, (ii) extended time for own and group practical work, (iii) recorded live lectures and (iv) increased opportunities for feedback in several formats. Supplementary information Supplementary data are available at Bioinformatics online. [ABSTRACT FROM AUTHOR]

There are studies suggesting that participation in musical activities may protect from cancer. On the other hand, some musicians have a lifestyle that might increase the risk of cancer. The objective of this study was to assess the cancer pattern of musicians in four Nordic countries. This study combines census and cancer registry data from 1961 to 2005 for 13 million people from Finland, Iceland, Norway, and Sweden. Standardized incidence ratio (SIR) analyses were conducted with the cancer incidence rates for entire national populations used as reference rates. There were 11,401 male and 3105 female musicians with 2039 cancer cases. The SIR for all sites combined was 1.02 (95% confidence interval 0.97–1.07) in men and 1.04 (0.94–1.15) in women. In male musicians, there were statistically significant excesses in oropharyngeal cancer (4.36, 2.73–6.60), esophageal cancer (2.08, 1.51–2.81), liver cancer (1.81, 1.26–2.52), and skin melanoma (1.40, 1.10–1.75). The risk was decreased in lip cancer (0.13, 0.02–0.48), stomach cancer (0.66, 0.50–0.82), and lung cancer (0.77, 0.65–0.90). In female musicians, there were no statistically significant SIRs in any of the cancer types studied, but the risk of breast cancer was significantly elevated in the age category of 70+ (1.52, 1.04–2.15). The overall SIR was stable over the 45 year period of observation, but strong decreases were observed in the SIRs of esophageal cancer, liver cancer, laryngeal cancer, and skin melanoma. Musicians have characteristics of indoor workers such as low incidence of lip cancer and high incidence of skin melanoma. The low incidence of lung cancer suggests that the prevalence of smoking among musicians is lower than in the general population while the elevated risk of alcohol-related cancer types suggest that drinking is likely more common among musicians. The cancer risk for all sites combined is still similar to that of the general population in the four countries studied. [ABSTRACT FROM AUTHOR]

The aim of this article is to contribute to the literature on how stratification affects professions. Our case study is the 'first teacher reform' in Sweden, which introduced a more prominent position for some teachers. In this article, we elaborate six different first teacher types and analyse how these affect the profession. While elites are generally described as hybrids, we conclude that several of our types rather led to a de‐hybridization of roles, where managers became more administratively focused, and elites more anchored to professional tasks. We conclude that elite roles reveal various potentials in being strengthening/weakening or shattering/integrating to the profession, but, in contrast to other studies on professional elites, the majority of roles studied here are both strengthening and integrating to the profession. The study is qualitative and is based on 111 interviews, 12 weeks of shadowing and 53 observed meetings. [ABSTRACT FROM AUTHOR]

Black carbon (BC) and particle number (PN) concentrations are usually high in cities due to traffic emissions. European mitigation policies, including Euro emission standards, have been implemented to curb these emissions. We analyzed BC and PN (particle diameter D p > 4 nm) concentrations in Stockholm spanning the years 2013–2019 (BC) and 2009–2019 (PN) measured at street canyon and rooftop sites to assess the effectiveness of the implemented policies. Combining these data with inverse dispersion modeling, we estimated BC and PN emission factors (EF BC and EF PN) for the mixed fleet, reflecting real-world driving conditions. The pollutants showed decreasing trends at both sites, but PN concentrations remained high at the canyon site considering the World Health Organization (WHO) recommendations. BC concentrations declined more rapidly than PN concentrations, showing a −9.4% and −4.9% annual decrease at the canyon and −7.2% and −0.5% at the rooftop site in the years 2013–2019. The EF BC and EF PN trends showed that the mitigation strategies for reducing particulate emissions for on-road vehicles were successful over the study period. However, the introduction of biofuels in the vehicle fleet —ethanol and later rapeseed methyl ester (RME)— increased the concentrations of particles with D p < 10 nm before the adoption of particulate filters in the exhausts. Stricter Euro emission regulations, especially with diesel particulate filters (DPF) in Euro 5, 6, and VI vehicles, led to 66% decrease in EF BC and 55% in EF PN. Real-world EF BC surpassed HBEFA (Handbook Emission Factors for Road Transport) database values by 2.4–4.8 times; however, direct comparisons between real-world and HBEFA EF PN are difficult due to differences in lower cut-off sizes and measurement techniques. Our results underscore the necessity for revising the HBEFA database, updating laboratory testing methods and portable emission measuring systems (PEMS) measurements to account for liquid condensate contributions to PN measurements. [Display omitted] • Particle concentrations were measured at street canyon and rooftop sites. • Emission factors (EF) were calculated from these measurements for the mixed fleet. • Large drops in black carbon (BC) and particle number (PN) concentrations were found. • Traffic emissions largely decreased for BC (66%), but less for PN (55%). • EF BC and EF PN exceeded the values provided in the HBEFA database for Sweden. [ABSTRACT FROM AUTHOR]

• Analysis included 63 substances across 13 chemical groups in 1082 adolescents. • Socio-demographic determinants were associated with variation in chemical patterns. • Birth-country, gender, and latitude of home address were the most influential. • Lifestyle/physiological/dietary factors seemed to explain a few of the associations. Relatively little is known about the relationship between socio-demographic factors and the chemical exposome in adolescent populations. This knowledge gap hampers global efforts to meet certain UN sustainability goals. The present work addresses this problem in Swedish adolescents by discerning patterns within the chemical exposome and identify demographic groups susceptible to heightened exposures. Enlisting the Riksmaten Adolescents 2016–17 (RMA) study population (N = 1082) in human-biomonitoring, and using proportional odds ordinal logistic regression models, we examined the associations between concentrations of a diverse array of substances (N = 63) with the determinants: gender, age, participant/maternal birth country income per capita level, parental education levels, and geographic place of living (longitude/latitude). Participant/maternal birth country exhibited a significant association with the concentrations of 46 substances, followed by gender (N = 41), and longitude (N = 37). Notably, individuals born in high-income countries by high-income country mothers demonstrated substantially higher estimated adjusted means (EAM) concentrations of polychlorinated biphenyls (PCBs), brominated flame retardants (BFRs) and per- and polyfluoroalkyl substances (PFASs) compared to those born in low-income countries by low-income country mothers. A reverse trend was observed for cobalt (Co), cadmium (Cd), lead (Pb), aluminium (Al), chlorinated pesticides, and phthalate metabolites. Males exhibited higher EAM concentrations of chromium (Cr), mercury (Hg), Pb, PCBs, chlorinated pesticides, BFRs and PFASs than females. In contrast, females displayed higher EAM concentrations of Mn, Co, Cd and metabolites of phthalates and phosphorous flame retardants, and phenolic substances. Geographical disparities, indicative of north-to-south or west-to-east substance concentrations gradients, were identified in Sweden. Only a limited number of lifestyle, physiological and dietary factors were identified as possible drivers of demographic inequalities for specific substances. This research underscores birth country, gender, and geographical disparities as contributors to exposure differences among Swedish adolescents. Identifying underlying drivers is crucial to addressing societal inequalities associated with chemical exposure and aligning with UN sustainability goals. [ABSTRACT FROM AUTHOR]

Background: The prevalence of overweight and obesity is increasing in companion dogs, but little is known of these conditions in show dogs. This study assessed body condition score (BCS) of show dogs of six selected popular breeds at a major Swedish dog show event and examined the association between BCS and performance in competition. Results: At one of Sweden's largest dog shows, BCS of 120 dogs of six different breeds was assessed by trained animal healthcare personnel, using a 9-point BCS scale with conditional cut-off for overweight set to BCS ≥ 6. Prevalence of overweight in the cohort was 32% but all overweight dogs except one displayed only slight overweight (BCS 6) and no dog was assessed as obese (BCS 8–9). Prevalence of overweight differed significantly between breeds (P < 0.0001) with Labrador retrievers, Golden retrievers and French bulldogs showing the highest mean BCS (5.6–5.7) and highest prevalence of overweight (50–67%). Lean and overweight dogs received awards and higher show awards (certificates) to the same extent, and no significant association between slight overweight and performance in competition was found. Conclusions: Prevalence of overweight in Swedish show dogs was relatively high and in the same range as in the Swedish dog population as a whole. Dog owners, breeders and judges should be made aware of canine obesity problems and trained in BCS assessment, to better prevent canine overweight and associated health risks. This is particularly important for retriever and brachycephalic breeds, which showed high prevalence of slight overweight and have breed-specific health problems exacerbated by overweight. Owners and breeders of traditionally sturdy dog breeds should be informed that overweight dogs do not outperform lean dogs in competition. [ABSTRACT FROM AUTHOR]

Background: The associations between a sickness absence spell duration and patient care have been rarely studied. An assumption is that associations would differ by spell duration and by the patient care type, inpatient- or specialized outpatient, due to severity of diseases and/or conditions. We aimed to investigate sickness absence spells in various spell durations as a predictor for subsequent inpatient- and specialized outpatient care separately, and to study if familial confounding plays a role in these associations.Methods: We followed a population-based sample of Swedish twins born 1925-90 with national registers from 2001 for first incident sickness absence spell (days to calculate spell duration categorized into ≤30 days, 31-90 days, 91-180 days and ≥ 181 days), or no sickness absence, and for inpatient- and specialized outpatient care until 2013 (n = 24,975). Cox proportional hazards models were applied for hazard ratios (HR) with 95% confidence intervals (CI) while accounting for covariates and familial confounding.Results: First incident sickness absence spell across all duration categories was associated with an increased risk of inpatient- (age- and sex adjusted HR 1.28 to 6.05) or specialized outpatient care (HR 1.17-2.50), both in comparison to those without any sickness absence or the shortest sickness absence spell category (1-30 days). The associations remained statistically significant while controlling for covariates or familial confounding.Conclusions: First incident sickness absence spell increases the risk of inpatient care or specialized outpatient care regardless of the duration of the sickness absence spell. Hence, incident sickness absence spells should be noted and targeted to actions at workplaces as well as in primary and occupational health care. [ABSTRACT FROM AUTHOR]

In 2016, the Swedish Armed Forces (SAF) launched a digital Sports Club and began providing the public with fitness programmes and wellness advice. The SAF were now, in their words, 'fighting for a healthier Sweden'. By taking 'the Club' as its point of departure, this article contributes to emerging literature on military public relations in general, and digital outreach in particular. It illustrates how interactive, digital technologies enable armed forces to position themselves as both visible and useful in the everyday lives of a diversity of citizens. This presence carries considerable potential for military institutions seeking to recruit and retain soldiers and supporters for war preparations and deployments. In addition, by showing how the Club renders the SAF appealing and accessible through gendered language and imagery, which partly challenges ideas of muscular, military masculinity, this article contributes knowledge about the ways in which armed forces are (re)gendered in military marketing. [ABSTRACT FROM AUTHOR]

Recognition of impact‐induced deformation of minerals is crucial for the identification and confirmation of impact structures as well as for the understanding of shock wave behavior and crater formation. Shock deformed mineral grains from impact structures can also serve as important geochronometers, precisely dating the impact event. We investigated zircon grains from the Mien impact structure in southern Sweden with the aim of characterizing shock deformation. The grains were found in two samples of impact melt rock with varying clast content, and in one sample of suevitic breccia. We report the first documentation of so‐called "FRIGN zircon" (former reidite in granular neoblastic zircon) from Mien (pre‐erosion diameter 9 km), which confirms that this is an important impact signature also in relatively small impact structures. Furthermore, the majority of investigated zircon grains contain other shock‐related microtextures, most notably granular and microporous textures, that occur more frequently in grains found in the impact melt than in the suevitic breccia. Our findings show that zircon grains that are prime candidates for establishing a new and improved age refinement of the Mien impact structure are present in the impact melt. [ABSTRACT FROM AUTHOR]

Objective: In this study, we evaluate the efficacy of outpatient individual cognitive behavioral therapy for young adults (CBT-YA) and combined family/individual therapy for young adults (FT-YA) for anorexia nervosa (AN). Method: Participants (aged 17–24 years) with AN in Sweden were recruited and assigned to 18 months of CBT-YA or FT-YA. Treatment efficacy was assessed primarily using BMI, presence of diagnosis, and degree of eating-related psychopathology at post-treatment and follow-up. Secondary outcomes included depression and general psychological psychopathology. The trial was registered at , ISRCTN (25181390). Results: Seventy-eight participants were randomized, and seventy-four of them received allocated treatment and provided complete data. Clinical outcomes from within groups resulted in significant improvements for both groups. BMI increased from baseline (CBT-YA 16.49; FT-YA 16.54) to post-treatment (CBT-YA 19.61; FT-YA 19.33) with high effect sizes. The rate of weight restoration was 64.9% in the CBT-YA group and 83.8% in the FT-YA group. The rate of recovery was 76% in both groups at post-treatment, and at follow-up, 89% and 81% had recovered in the CBT-YA and FT-YA groups respectively. Conclusions: Outpatient CBT-YA and FT-YA appear to be of benefit to young adults with AN in terms of weight restoration and reduced eating disorder and general psychopathology. [ABSTRACT FROM AUTHOR]

Objective: Little evidence exists concerning the optimal model of inpatient care for patients with longstanding anorexia nervosa (AN). Self‐admission has been developed as a treatment tool whereby patients with a history of high healthcare utilization are invited to decide for themselves when brief admission is warranted. The aim of this study was to evaluate the impact of a self‐admission program on healthcare utilization, eating disorder morbidity, health‐related quality of life (HRQoL), and sick leave for patients with AN. Method: In this cohort study, 29 participants with AN in a Swedish self‐admission program were compared to 113 patients with longstanding illness but low previous utilization of inpatient treatment, matched based on age, illness duration, and body‐mass index (BMI). Data on healthcare utilization, eating disorder morbidity, and sick leave were obtained from national population and eating disorder quality registers. Results: Participants displayed a >50% reduction in time spent hospitalized at 12‐month follow‐up, compared to nonsignificant changes in the comparison group. A sensitivity analysis comparing participants to a moderate‐utilization comparison subgroup strengthened this observation. In contrast, the approach did not affect participants' BMI or eating disorder morbidity. Regarding HRQoL, mixed results were observed. In terms of sick leave, a beneficial but nonsignificant pattern was seen for participants. Discussion These findings indicate that self‐admission is a viable and helpful tool within a recovery model framework, even though it does not lead to symptom remission. In its proper context, self‐admission could potentially transform healthcare from crisis‐driven to pre‐emptive, and promote autonomy for severely ill patients. [ABSTRACT FROM AUTHOR]

In this article, we join the discussion about the potential consequences of welfare service privatization by examining the relationship between the privatization of welfare service delivery and public opinion about service quality in Sweden. Due to the politically polarized debate about welfare service privatization in Sweden, we also examine the extent to which individualsapos; ideological orientations influence this relationship in both local politicians and ordinary citizens. For local politicians, the results show that a higher municipal degree of privatization is generally associated with slightly lower levels of satisfaction overall with welfare services, although no such relationship exists for the public. Most importantly, however, the results indicate that political ideology constitutes an important moderator in the relationship between privatization and opinions about service quality. Local politicians and, to some extent, ordinary citizens who place themselves to the left on the ideological left–right scale tend to be less satisfied with services as the municipal degree of welfare service privatization increases. For local politicians who position themselves far to the right on the scale, the relationship between welfare service privatization and satisfaction is positive. These findings suggest that there is no clear‐cut relationship between privatization and individualsapos; opinions about services; rather, this relationship depends on the ideological predispositions of local politicians and ordinary citizens. [ABSTRACT FROM AUTHOR]

Male breast cancer (MBC) is a rare and understudied disease. There is limited evidence on association between environmental and occupational agents and MBC. Some similarities in risk factors may be shared with female breast cancer. We evaluated solvents, metals, exhaust gases and other agents in relation to MBC within the large Nordic Occupational Cancer Study (NOCCA). The study included 1469 MBC cases and 7345 controls from Finland, Iceland and Sweden, matched for the date of birth, sex and country. Cases were identified through national cancer registries. Data on occupation and other demographic indicators were collected from census records and population registries. Overall, 24 occupational exposures were assessed. Exposure estimates were assigned by linking job titles to job-exposure matrices (NOCCA-JEM). Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated by using conditional logistic regression models. Significantly decreased overall OR was observed for physical workload (OR = 0.78, 95% CI 0.67–0.91). Protective effect of physical workload was stronger by increasing exposure level with significant dose-response relationship (p-trend<0.01). Non-significantly increased ORs were observed for trichloroethylene, iron, lead, chromium, welding fumes and wood dust, and decreased ORs for asbestos, silica dust and perchloroethylene. However, these results were not consistent across all analyses. The current study showed 20–25% protective effect for physical workload at work, while no strong evidence for other agents was observed. • Male breast cancer (MBC) is a rare and understudied disease. • We assessed associations between occupational agents and MBC in the current study. • While no strong evidence was observed for other agents, physical activity at work was linked to 20–25% reduced MBC risk. [ABSTRACT FROM AUTHOR]

The relationship between perfectionism – perfectionistic strivings and perfectionistic concerns – and athletic performance is contested and inconsistent. The present study explored the possibility that one explanation for this inconsistency is the assumption that the relationship is linear. In two samples, we tested alternative non-linear relationships between perfectionism and real-world competitive athletic performance. Sample one comprised 165 Swedish track and field athletes (57 % competing in female category, 42 % in male category; M age = 16.93 years) and sample two comprised 157 British track and field athletes (55 % competing in female category, 43 % in male category; M age = 18.42 years). Testing for linear and non-linear relationships, we found a quadratic effect whereby higher perfectionistic strivings had both positive increasing (i.e., U-shape; sample 1) and positive decreasing (i.e., inverted U-shape; sample 2) relationships with performance. We conclude that there may be circumstances when perfectionistic strivings contribute to better and worse sport performance, and that this relationship can be curvilinear. • Non-linear relationships between perfectionism and sport performance were tested. • Quadratic effects were found between perfectionistic strivings and performance. • The effects were different in two separate samples of track and field athletes. • Perfectionistic strivings might contribute to both better and worse performances. [ABSTRACT FROM AUTHOR]

Background: Being involved in the care of a loved one is a desire of many next of kin. However, according to several studies of the perceptions of nursing home staff, the involvement of next of kin is not an obvious part of care. To be able to involve next of kin in care at nursing homes, the perceptions of what participation means are an important piece of knowledge. The aim of this study was therefore to describe variations in next of kin's perceptions of the meaning of participation in the care of older persons living in nursing homes. Methods: Eighteen next of kin of older persons living in ten nursing homes in Sweden were recruited for interviews. The study design was based on a phenomenographic approach, focusing on the qualitatively different ways in which a person perceives, experiences or conceptualises a phenomenon or certain aspect of reality. Results: Five categories emerged from analysis of the interviews, representing the next of kin's perceptions of the meaning of participation in the care of older persons in nursing homes: be present; communicate; monitor; do practical tasks; and to represent. The next of kin expressed meanings that belonged to more than one category, and the categories were interdependent. Conclusions: Our results indicate that there are several meanings of next of kin's perceptions of participation at nursing homes. Nursing home staff's knowledge of these perceptions is important to enable next of kin to participate according to their own preferences. [ABSTRACT FROM AUTHOR]

ABSTRACT: BACKGROUND: Nutritious and attractive school meals can improve health equality and public health. Current official guidelines and recommendations on food and nutrient composition of school meals in 3 Nordic countries; Sweden, Finland, and Iceland, are described and compared with actual practice, ie, availability of foods and nutrients in served reference meals in 3 selected areas in each country. METHODS: A country comparison was made between official guidelines, and actual practice was studied in participating schools. Reference portions of school meals (N = 170) provided in 24 compulsory schools were photographed and weighed. Food and nutrient availability were compared with official guidelines in each country. RESULTS: Emphasis of recommendations on whole‐grain bread in Sweden, whole grains in Finland, and fish in Iceland were reflected in food availability. The energy content of the meals provided was lower than guidelines and there was a large variation in energy content between days. CONCLUSIONS: The guidelines regarding food availability were quite well followed, but the large variation in energy and nutrient content of provided school meals between days indicates a need for standardization. [ABSTRACT FROM AUTHOR]

Adolescence is a period of significant physiological changes, and likely a sensitive window to chemical exposure. Few nation-wide population-based studies of chemical body burdens in adolescents have been published. In the national dietary survey Riksmaten Adolescents (RMA) 2016–17, over 13 chemical substance groups, including elements, chlorinated/brominated/fluorinated persistent organic pollutants (POPs) were analysed in blood, and in urine metabolites of phthalates/phthalate alternatives, phosphorous flame retardants, polycyclic aromatic hydrocarbons (PAHs), and pesticides, along with bisphenols and biocide/preservative/antioxidant/UV filter substances (N = 1082, ages 11–21). The aim was to characterize the body burdens in a representative population of adolescents in Sweden, and to compare results with human biomonitoring guidance values (HBM-GVs). Cluster analyses and Spearman's rank order correlations suggested that concentrations of substances with known common exposure sources and similar toxicokinetics formed obvious clusters and showed moderate to very strong correlations (r ≥ 0.4). No clusters were formed between substances from different matrices. Geometric mean (GM) concentrations of the substances were generally less than 3-fold different from those observed among adolescents in NHANES (USA 2015–16) and GerES V (Germany 2014–17). Notable exceptions were brominated diphenyl ethers (PBDEs) with >20-fold lower GM concentrations, and the biocide triclosan and ultraviolet (UV) filter benzophenone-3 with >15-fold lower mean concentrations in RMA compared to NHANES. Exceedance of the most conservative HBM-GVs were observed for aluminium (Al, 26% of subjects), perfluorooctanesulfonic acid (PFOS, 19%), perfluorooctanoic acid (PFOA, 12%), lead (Pb, 12%), MBP (dibutyl phthalate metabolite, 4.8%), hexachlorobenzene (HCB, 3.1%) and 3-phenoxybenzoic acid (PBA, pyrethroid metabolite, 2.2%). Males showed a higher proportion of exceedances than females for Pb, HCB and PFOS; otherwise no gender-related differences in exceedances were observed. A higher proportion of males than females had a Hazard Index (HI) of substances with liver and kidney toxicity and neurotoxicity >1. Industrialized countries with similarly high standards of living, with some exceptions, show comparable average body burdens of a variety of toxic chemicals among adolescents from the general population. The exceedances of HBM-GVs and HIs strongly suggests that further efforts to limit chemical exposure are warranted. • 66 biomarkers measured in blood and urine from 1082 adolescents. • Moderate-strong correlations indicate common exposure sources/toxicokinetics. • HBM guidance value exceedances of Pb, HCB and PFOS were highest among males. • Males had a higher proportion of hazard indices >1 for hepato-/nephro-/neurotoxicity. • 94% of the participants had a hazard index >1 for neurotoxic substances. [ABSTRACT FROM AUTHOR]

Background: This study investigated the associations between night work, sleep and disability pension (DP) due to musculoskeletal disorders (MSD), while controlling for several confounding factors including both genetic factors and shared family background. Methods: The study sample consisted of 27 165 Swedish twin individuals born in 1935-58 with comprehensive survey data on sociodemographic, health and lifestyle factors. Night work was assessed as years of working hours at night at least every now and then, and categorized into 'not at all, 1-10 years and over 10 years'. Data on DP with MSD (ICD-diagnoses M00-M99) were obtained from the National Social Insurance Agency. Follow-up was from the time of the interview in 1998-2003 until 2013. Information on the length and quality of sleep was available for a sub-sample of twins (n = 1684). Cox proportional hazards models were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). Results: During the follow-up, 1338 (5%) participants were granted DP due to MSD. Both 1-10 years (HR 1.33, 95% CI 1.17-1.53) and over 10 years of night work (HR 1.3995% CI 1.18-1.64) increased the risk of future DP. The associations were not affected by health, lifestyle or sleep factors. In the discordant twin pair analysis, the associations between night work and DP due to MSD attenuated. Conclusions: Night work was associated with increased risk of DP due to MSD independently from health and lifestyle factors. Familial confounding could not be ruled out. [ABSTRACT FROM AUTHOR]

Introduction: The objective of this study was to calculate costs associated with severe fear of childbirth (FOC) during pregnancy and peripartum by comparing two groups of women expecting their first child and attending an ordinary antenatal program; one with low FOC and one with severe FOC.Material and Methods: In a prospective case-control cohort study one group with low FOC [Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) sum score ≤60, n = 107] and one with severe FOC (W-DEQ ≥85, n = 43) were followed up till 3 months postpartum and included in the analysis. Medical records were assessed and medical parameters were mapped. Mean costs for healthcare consumption and sick leave during pregnancy were calculated and compared.Results: When means were compared between the groups, the group with severe FOC had more visits for psychosocial reasons (p = 0.001) and more hours on sick leave (p = 0.03) during pregnancy, and stayed longer at the maternity ward (p = 0.04). They also more seldom had normal spontaneous deliveries (p = 0.03), and more often had an elective cesarean section on maternal request (p = 0.02). Postpartum, they more often than the group with low FOC paid visits to the maternity clinic because of complications (p = 0.001) and to the antenatal unit because of adverse childbirth experiences (p = 0.001). The costs for handling women with severe FOC was 38% higher than those for women with low FOC.Conclusion: Women with severe FOC generate considerably higher perinatal costs than women with low FOC when handled in care as usual. [ABSTRACT FROM AUTHOR]

Background: Reduced lung function in patients with chronic obstructive pulmonary disease (COPD) is likely due to both environmental and genetic factors. We report here a targeted high-throughput DNA sequencing approach to identify new and previously known genetic variants in a set of candidate genes for COPD. Methods: Exons in 22 genes implicated in lung development as well as 61 genes and 10 genomic regions previously associated with COPD were sequenced using individual DNA samples from 68 cases with moderate or severe COPD and 66 controls matched for age, gender and smoking. Cases and controls were selected from the Obstructive Lung Disease in Northern Sweden (OLIN) studies. Results: In total, 37 genetic variants showed association with COPD (p < 0.05, uncorrected). Several variants previously discovered to be associated with COPD from genetic genome-wide analysis studies were replicated using our sample. Two high-risk variants were followed-up for functional characterization in a large eQTL mapping study of 1,111 human lung specimens. The C allele of a synonymous variant, rs8040868, predicting a p.(S45=) in the gene for cholinergic receptor nicotinic alpha 3 (CHRNA3) was associated with COPD (p = 8.8 x 10-3). This association remained (p = 0.003 and OR = 1.4, 95 % CI 1.1-1.7) when analysing all available cases and controls in OLIN (n = 1,534). The rs8040868 variant is in linkage disequilibrium with rs16969968 previously associated with COPD and altered expression of the CHRNA5 gene. A follow-up analysis for detection of expression quantitative trait loci revealed that rs8040868-C was found to be significantly associated with a decreased expression of the nearby gene cholinergic receptor, nicotinic, alpha 5 (CHRNA5) in lung tissue. Conclusion: Our data replicate previous result suggesting CHRNA5 as a candidate gene for COPD and rs8040868 as a risk variant for the development of COPD in the Swedish population. [ABSTRACT FROM AUTHOR]

Aims and objectives. To describe and compare the quality of recovery on discharge from hospital among patients undergoing elective hip or knee replacement. The study will also attempt to identify any predicting factors. Background. Arthroplasty is commonly used for an increasing population of patients with osteoarthritis, and the recovery process starts directly after surgery. Today's shorter hospital stay may be a challenge for the patients during the early period of recovery. It is therefore important to identify factors associated with quality of recovery at discharge from hospital. Design. A descriptive, comparative study including 12 hospitals in 5 European countries; Cyprus, Finland, Greece, Iceland and Sweden. Methods. Consecutively included patients responded on: health-related quality of life, and emotions before surgery and at hospital discharge; quality of recovery, patient satisfaction and fulfilment of knowledge expectations. Related factors and associations were analysed separately for each kind of arthroplasty. In total, 865 patients were included (hip n = 413, knee n = 452). Results. In the dimension of pain, patients undergoing hip replacement had significantly better quality of recovery compared to those undergoing knee replacement. Both patient groups experienced negative emotions before surgery that were related to poorer quality of recovery. Fulfilment of knowledge expectations has a limited effect on quality of recovery. Greater satisfaction with care predicted better quality of recovery. Conclusions. Negative preoperative emotions were related to poorer quality of recovery. For both kinds of arthroplasty, greater satisfaction with care was associated with better quality of recovery. Relevance to clinical practice. The result emphasises the need to detect patients in need of support in their preparation and recovery process, taking into account the perspective of their emotional state. [ABSTRACT FROM AUTHOR]