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The aims of the study were to estimate the prevalence of body dysmorphic symptoms in a sample of children and adolescents with obsessive-compulsive disorder, possible clinical correlates and whether BDD symptoms predict poorer treatment outcomes after cognitive behavioral therapy. The study included 269 children and adolescents with OCD, aged 7–17 years, from Denmark, Sweden, and Norway, who were treated with 14 weekly sessions of manualized, exposure-based CBT. Twenty-one patients (7.8%) had BDD symptoms. BDD symptoms were associated with older age (p = 0.003) and a higher prevalence of comorbid anxiety disorders (p = 0.025). In addition, patients with BDD symptoms endorsed a greater number of OCD symptoms than did those without BDD symptoms. Having symptoms of BDD did not affect the CBT outcome on OCD. The results of the study suggest that CBT for OCD is equally effective for those with and without comorbid BDD symptoms. [ABSTRACT FROM AUTHOR]

The first aim of this study was to explore whether children with obsessive compulsive disorder (OCD) and subclinical autistic traits can be differentiated from children with OCD without these traits based on clinical OCD-related characteristics, distinct OCD symptom patterns, and type of comorbidity. The second aim was to investigate whether autistic traits predict immediate and long-term outcome of exposure-based cognitive behavioral therapy (CBT) in pediatric OCD. The participants in this study were a total of 257 children and adolescents aged 7–17 years, recruited from Denmark, Norway, and Sweden as a part of the Nordic long-term OCD treatment study (NordLOTS). Inclusion criteria were an OCD diagnosis based on DSM-IV criteria and a Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) total severity score of 16 or higher. No children with a diagnosis on the autism spectrum were included. An Autism Spectrum Screening Questionnaire (ASSQ) cut-off score of ≥ 17 was used to define the group of OCD patients with autistic traits and all participants were treated with 14 weekly sessions of manualized CBT. Comorbid attention-deficit/hyperactivity disorder and tic disorders, subclinical internalizing and externalizing symptoms, lower insight into OCD symptoms, more indecisiveness and pervasive slowness, and ordering/arranging OCD symptoms were found to be significantly associated with having OCD with autistic traits. No difference was found between the groups on treatment outcomes. Results suggest that children and adolescents with OCD and autistic traits portray a different clinical profile than those without these traits, but that CBT is equally effective for those with and without autistic traits. [ABSTRACT FROM AUTHOR]

Objective: Sweden is an international exception in its public health response to the COVID-19 pandemic, with a higher number of deaths, albeit not pediatric, compared with other Nordic countries. The objective of this study was to investigate what worries children and adolescents living in Sweden expressed in relation to the pandemic.Methods: Using an anonymous web-survey, 1,047 children (4-12 years; N = 717) and adolescents (13-18 years; N = 330) responded to five background and four open-ended questions, one of which was: Is there anything that you are worried about when it comes to 'Corona'? The responses were coded using manifest content analysis. Interrater reliability was .95, assessed on the code level.Results: Worry was common (77%); mostly (60%) related to disease or death of elderly relatives, parents, the child him/herself or general worry for the elderly/risk groups. Existential worry (15%) comprised worries about the future, including economy and worries about the world perishing or the contagion becoming uncontrollable. A developmental trajectory was evident in the nature of responses. Adolescents' worries about the future included missing out on their youth and employment. They also worried about society (6%), for example, the future of democracy and the world economy. There was no indication of socioeconomic status or geographic area (urban vs. rural) affecting the presence of worrisome thoughts.Conclusions: Worry about "Corona" was common. Universal preventative mental health intervention is warranted and could be conducted in the school setting. Intervention could be tailored by age, covering discussion on financial aspects with adolescents. [ABSTRACT FROM AUTHOR]

Background: Treatment with beta-blockers is currently recommended after myocardial infarction (MI). The evidence relies on trials conducted decades ago before implementation of revascularization and contemporary medical therapy or in trials enrolling patients with heart failure or reduced left ventricular ejection fraction (LVEF ≤ 40%). Accordingly, the impact of beta-blockers on mortality and morbidity following acute MI in patients without reduced LVEF or heart failure is unclear.Methods/design: The Danish trial of beta-blocker treatment after myocardial infarction without reduced ejection fraction (DANBLOCK) is a prospective, randomized, controlled, open-label, non-blinded endpoint clinical trial designed to evaluate the efficacy of beta-blocker treatment in post-MI patients in the absence of reduced LVEF or heart failure. We will randomize 3570 patients will be randomized within 14 days of index MI to beta-blocker or control for a minimum of 2 years. The primary endpoint is a composite of all-cause mortality, recurrent MI, acute decompensated heart failure, unstable angina pectoris, or stroke. The primary composite endpoint will be assessed through locally reported and adjudicated endpoints supplemented by linkage to the Danish national registers. A number of secondary endpoints will be investigated including patient reported outcomes and cardiovascular mortality. Data from similar ongoing trials in Norway and Sweden will be pooled to perform an individual patient data meta-analysis.Discussion: DANBLOCK is a randomized clinical trial investigating the effect of long-term beta-blocker therapy after myocardial infarction in patients without heart failure and reduced LVEF. Results from the trial will add important scientific evidence to inform future clinical guidelines.Trial Registration: Clinicaltrials.gov, NCT03778554. Registered on 19 December 2018. European Clinical Trials Database, 2018-002699-42, registered on 28 September 2018. [ABSTRACT FROM AUTHOR]

Background: The post-colonoscopy colorectal cancer (PCCRC) rate is a key quality indicator for colonoscopy. Previously published PCCRC rates have been difficult to compare owing to differences in methodology. The primary aim of this study was to compare Danish PCCRC rates internationally and to calculate Danish PCCRC rates using the World Endoscopy Organization (WEO) consensus method for future comparison. The secondary aim was to identify factors associated with PCCRC.Methods: National registries were used to examine the risk of PCCRC. The Danish 3-year rate of PCCRC (PCCRC-3yr) was calculated using previously published methods from England, Sweden, and the WEO. Poisson regression analysis was performed to identify factors associated with PCCRC.Results: The Danish PCCRC-3yr was significantly higher than the rate in the English NHS (relative risk [RR] 1.12, 95 % confidence interval [CI] 1.05 - 1.19) and Sweden (RR 1.15, 95 %CI 1.06 - 1.24). The Danish PCCRC-3yr based on the WEO consensus method fell from 22.5 % in 2001 to 7.9 % in 2012. The multivariable Poisson regression model found PCCRC to be significantly associated with diverticulitis (RR 3.25, 95 %CI 2.88 - 3.66), ulcerative colitis (RR 3.44, 95 %CI 2.79 - 4.23), hereditary cancer (age < 60 years: RR 7.39, 95 %CI 5.77 - 9.47; age ≥ 60 years: RR 3.81, 95 %CI 2.74 - 5.31), and location in the transverse (RR 1.57, 95 %CI 1.28 - 1.94) and ascending colon (RR 1.85, 95 %CI 1.64 - 2.08).Conclusions: The PCCRC-3yr was higher in Denmark than in comparable countries. Differences in colonoscopist training, background, and certification are possible contributing factors. A review of colonoscopist training and certification in Denmark, and continuous audit and feedback of colonoscopist performance may reduce PCCRC-3yr. [ABSTRACT FROM AUTHOR]

Hoarding, common in pediatric obsessive–compulsive disorder (OCD), has specific clinical correlates and is associated with poor prognosis. However, there are few studies of hoarding in pediatric OCD. This study estimates the occurrence of hoarding symptoms in a sample of children and adolescents with OCD, investigating possible differences in demographic and clinical variables between pediatric OCD with and without hoarding symptoms. Furthermore, the study investigates whether hoarding symptoms predict poorer treatment outcomes after cognitive behavioral therapy (CBT). The study sample comprised 269 children and adolescents with OCD, aged 7–17 years, from Denmark, Sweden, and Norway, who were all included in the Nordic long-term obsessive–compulsive disorder Treatment Study. All had an OCD diagnosis according to the DSM-IV and were treated with 14 weekly sessions of manualized, exposure-based CBT. Hoarding symptoms and OCD severity were assessed with the Children's Yale–Brown Obsessive–Compulsive Scale and group differences in treatment outcome were analyzed using linear mixed-effect modelling. Seventy-two patients (26.8%) had one or more symptoms of hoarding. Comorbid tic disorders (p = 0.005) and indecision (p = 0.024) were more prevalent among those with hoarding symptoms than those without hoarding symptoms. In addition, youth with hoarding symptoms had a different OCD symptom profile. Having symptoms of hoarding did not affect CBT outcome (p = 0.933). Results from the study suggest that CBT is equally effective for those with and without hoarding-related OCD. [ABSTRACT FROM AUTHOR]

During the post-war area, Sweden's crofts, which, ever since the second half of the 19th century, had been increasingly regarded as an outmoded form of small farming and had been vacated by their tenants in favour of jobs in the expanding towns and cities and industries, began to attract interest outside the agricultural sector, e.g. within the local heritage movement. This article sets out to investigate the great interest shown in crofts by the local heritage movement since the 1960s and to place that interest in a societal context, with a view to understanding what made it possible for crofts to become one of the movement's flagships. Special attention is paid to the significance of the material qualities of crofts in this connection. Through a study, influenced by discourse analysis, of both croft inventories by local heritage societies and of documents from the movement's central agencies, the article discusses the manifestations assumed by involvement with crofts, what that involvement is based on and what consequences it may have had. One conclusion drawn is that the croft-related activity of the local heritage movement has been informed by a notion of good crofters and bad crofts. Crofts were the homes of industrious people who, in the sweat of their brows and by dint of deprivation, built up the Swedish welfare state, and this inspired the movement with feelings of respect and pride. For this reason crofts became important to observe and preserve, both cognitively and materially speaking, Involvement with crofts, as manifested by all the hundreds of inventory texts which have been produced, has resulted in certain values and properties becoming embedded or accentuated in the crofts. With the passing of time, interest in crofts has become naturalised: one must take an interest in them, and they must be preserved. The fact of many crofts having vanished made them all the more important to highlight. The movement's commitment has focused on documenting and making visible the physical aspect of the existence of crofts, and the lessons to be learned from personal experiences of croft environments are frequently highlighted. Through the inventories and visits to croft sites, a journey through time could begin, offering chances of experiencing other periods of history and bearing those experiences with one back to present-day society. The analysis points the importance of the link between the spirit of the post-war age, with the labour movement's harvest time and material prosperity and welfare in Sweden on the one hand, and dedication to the crofts, these dwelling places closely bound up with material poverty, plain living and decay, on the other. Interest in crofts can be seen as part of an increased popular interest in the cultural heritage. If, though, we take as our starting point which people initiated, controlled and carried out the croft inventories, this worm's eye perspective becomes a retrospect which above all emanated from a top-down, externalising perspective on crofters' lives. [ABSTRACT FROM AUTHOR]

The underlying structure of obsessive-compulsive disorder (OCD) remains to be confirmed in child and adolescent populations. In this paper we report the first factor analytic study of individual OCD items from Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). OCD symptoms were assessed using the CY-BOCS symptom checklist in a sample of 854 patients with OCD (7-18 years of age) recruited from clinics in five countries. Pooled data were subjected to exploratory and confirmatory factor analysis (CFA) to identify the optimal factor structure. Various models were tested for age and gender subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination/cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores on factor two than males. The OCD symptom structure in children and adolescents is consistent across age and gender and similar to results from recent child and adolescents although hoarding may not be a separate factor. Our three-factor structure is almost identical to that seen in early studies on adults. Common mental disorders had specific patterns of associations with the different factors. [ABSTRACT FROM AUTHOR]

Background: The Nordic countries are welfare states that also have been claimed to be in the forefront in developing health promotion, in relation to theory, research, policy and practice. This scoping review was performed by members of the Nordic Health Promotion Research Network with the objectives to collect and identify the scope and theoretical basis of doctoral (PhD) dissertations on health promotion in a Nordic context. Methods: Searches for dissertations, published 2008-2018, were performed in several databases in Denmark, Finland, Iceland, Norway, and Sweden. Those labelled ‘‘health promotion’’ present in titles, abstract or key words were included in the scoping review. Data was extracted based on a common template including title, aims, university, individual-national level, setting, type of study and collaboration. Results: The search strategy had to be modified to include manual searches at university sites as no national data base was available. In total, 353 health promotion dissertations had been published at 41 different universities. Most dissertations were Swedish (193), while 56 came from Denmark, 53 from Norway and 51 from Finland, but non from Iceland. The main content was lifestyle (28%), mental or psychosocial health (14%), critical health promotion (8%), empowerment (7%) or refugee and immigrants (5%). The most common approach was settings (31%), including health care setting (14%), followed by societal (28%) and individual (28%) approaches. Mixed methods approach was most common research method (45%) followed by quantitative (32%) and qualitative methods (23%). Large country variations were seen in the health promotion. Conclusions: Health promotion research in the Nordic countries can be characterised by focusing on lifestyle, settings approach, and primarily using a mixed methods approach. However, there are large variations between different health promotion PhDs, also including dissertations on critical health promotion and empowerment. Key messages: · Analysis of PhD dissertations can contribute to more comprehensive insight in disciplinary development. The research training will have implications for the future public health workforce. · The Nordic collaboration enabled an extensive scoping review of PhD dissertations on health promotion research in the Nordic countries and shows what has characterized the field of research. [ABSTRACT FROM AUTHOR]

Objective Defective Goblet cells have been proposed to be involved in necrotizing enterocolitis (NEC). The aim was to study the expression of the Goblet cell marker REG4 and its potential involvement in NEC in preterm infants with and without NEC. Study Design Seventy histologically intact intestinal biopsies were studied: 43 were collected during surgery due to NEC (NEC group: 26.5 ± 3.0 weeks' gestational age [wGA]), and 27 from individuals who underwent surgery due to other conditions (Control group; 36.1 ± 4.5 wGA). The tissue samples were immunohistochemically stained for REG4. REG4 expression was quantified with a semiautomated digital image analysis and with clinical data compared between the groups. Results REG4 expression was lower in the NEC group than in the Control group (p = 0.035). Low REG4 expression correlated to the risk of NEC (p = 0.023). In a multivariable logistic regression analysis including GA and REG4 expression for NEC risk, only GA (p < 0.001) and not REG4 expression (p = 0.206) was associated with NEC risk. Conclusion This study concludes that Goblet cell dysfunction may be involved in NEC development, as low expression of the Goblet cell marker REG4 was related to an increased NEC risk in preterm infants. Maturity could however not be excluded as a potential confounder for REG4 expression. Key Points REG4 is a specific Goblet cell marker not yet studied in NEC. REG4 was quantified in intestinal biopsies from infants with and without NEC. REG4 expression was lower in infants with NEC, and expression seems to be maturity dependent. [ABSTRACT FROM AUTHOR]

The coronavirus 2019 (Covid-19) pandemic has affected both the private and public lives of people worldwide. Countries have chosen different strategies to reduce the spread of infection, including school closures and distance learning. This study aimed to describe school nurses' perceptions about the wellbeing of students during the Covid-19 pandemic in Sweden. Interviews in five focus groups and one individual were conducted with 17 school nurses in Sweden. The interviews were analyzed using a qualitative content analysis. According to the school nurses' perceptions, students were concerned about spreading infection, becoming infected themselves, their academic performances, and longing for socialization. The change in the school situation involved a slower pace and less anxiety for some students, more or less physical activity, and an increase in screen time. [ABSTRACT FROM AUTHOR]

Objectives. This study aimed to describe work-, lifestyle-, and health-related factors among ambulance personnel, and to analyse differences between women and men. Methods. The cross-sectional study (N = 106) included self-reported and objective measures of work, lifestyle, and health in 10 Swedish ambulance stations. The data collection comprised clinical health examination, blood samples, tests of physical capacity, and questionnaires. Results. A high proportion of the ambulance personnel reported heavy lifting, risk of accidents, threats and violence at work. A low level of smoking and alcohol use, and a high level of leisure-time physical activity were reported. The ambulance personnel had, on average, good self-rated health, high work ability and high physical capacity. However, the results also showed high proportions with risk factors for cardiovascular disease (CVD), e.g., high blood pressure, and high levels of blood lipids. More women than men reported high work demands. Furthermore, women performed better in tests of physical capacity and had a lower level of CVD risk factors. Conclusions. Exposure to work-related factors that might affect health was common among ambulance personnel. Lifestyle- and health-related factors were somewhat contradictory, with a low proportion reporting lifestyle-related risk factors, but a high proportion having risk factors for CVD. [ABSTRACT FROM AUTHOR]

Copyright of Vatten is the property of Foreningen Vatten and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Background Acquired loss of the largest von Willebrand factor multimers is a common hemostatic disturbance in patients with aortic valve stenosis (AS), resulting in impaired platelet adhesion and increased bleeding risk. AS is also associated with atherosclerosis and myocardial infarction (MI). Our aim was to study the clinical outcomes associated with AS in MI patients treated with dual antiplatelet therapy (DAPT) in a nationwide hospital-based register study. Methods Based on nationwide hospital discharge registers from Sweden (2005–2010) and Denmark (2005–2015), we calculated 1-year incidence rates and hazard ratios of bleeding, recurrent MI, and all-cause mortality in MI patients with and without AS treated with DAPT. Results from both countries were also combined in a meta-analysis. Results We included 50,460 MI patients from Sweden and 50,307 MI patients from Denmark, of which 3% had AS. The bleeding rates (per 100 person-years) in Sweden and Denmark were 3.2 and 3.3 among patients without AS vs. 9.2 and 8.3 among patients with AS. All-cause mortality rates were 7.1 vs. 28.7 in Sweden and 5.8 vs. 30.7 in Denmark among patients without and with AS, respectively. Patients with AS had an increased risk of bleeding, recurrent MI and all-cause mortality. Combined results from both countries were similar for bleeding (hazard ratio 1.59 [0.98–2.59]), recurrent MI (1.78 [1.25–2.54]), and all-cause mortality (1.76 [1.26–2.47]). Conclusion AS was associated with an increased risk of bleeding, recurrent MI and mortality after MI when treated with DAPT. Individualized selection of antiplatelet therapy may be warranted in this high-risk population. Highlights • Bleeding was more common in AS patients treated with DAPT after MI. • Recurrent MI and all-cause mortality were more frequent in AS patients. • Patients with AS represent a group with high risk after incident MI. [ABSTRACT FROM AUTHOR]

Copyright of Praehistorische Zeitschrift is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: This study compares hearing outcomes of two prosthesis materials, bone and titanium, used in ossiculoplasty., Design: This retrospective nationwide registry-based study uses data systematically collected by the Swedish Quality Registry for Ear Surgery (SwedEar)., Setting: The data were obtained from clinics in Sweden that perform ossiculoplasty., Participants: Patients who underwent ossiculoplasty using either bone or titanium prostheses were registered in SwedEar between 2013 and 2019., Main Outcome Measures: Hearing outcome expressed as air-bone gap (ABG) gain., Results: The study found no differences between bone and titanium for ABG or air conduction (AC) for either partial ossicular replacement prostheses (PORP) or total ossicular replacement prostheses (TORP). In a comparison between PORP and TORP for ABG and AC outcomes, regardless of the material used, PORP showed a small advantage, with an additional improvement of 3.3 dB (95% CI [confidence interval], 0.1-4.4) in ABG and 2.2 dB (95% CI, 1.7-4.8) in AC. In secondary surgery using TORP, titanium produced slightly better results for high-frequency pure tone average. The success rate, a postoperative ABG ≤20 dB, was achieved in 62% of the operations for the whole group., Conclusion: Both bone and titanium used to reconstruct the ossicular chain produce similar hearing outcomes for both PORP and TORP procedures. However, titanium may be a preferable option for secondary surgeries involving TORP. The success rate, a postoperative ABG ≤20 dB, is consistent with other studies, but there is room for improvement in patient selection criteria and surgical techniques., (© 2024 The Author(s). Clinical Otolaryngology published by John Wiley & Sons Ltd.)

Abstract: A number of papers have provided insight into frequencies of violence‐related trauma, especially skull trauma, in Northern European skeletal assemblages dating to the Neolithic and Bronze Age. Although the cases are often well described, they lack further discussion about the consequences of skull trauma for the injured individual and the implications for the surrounding society, especially considering severe skull trauma leading to traumatic brain injuries. In this paper, we address questions of trauma and care for one individual associated with the Swedish–Norwegian Battle Axe Culture who suffered from 2 severe ante mortem skull traumas probably leading to brain injuries. These questions are addressed using the Web‐based application and analytic tool Index of Care. We found that daily care, both short term with basic needs such as nutrition and grooming and long term with cognitive impairments, was available in the Neolithic society. Considering the frequent number of ante mortem skull trauma in the Neolithic and Bronze Age skeletal assemblages, traumatic brain injury was probably a common phenomenon. We argue that the care provided was a necessity for survival and maintenance of a socially sustainable society. [ABSTRACT FROM AUTHOR]

Background: In Sweden, older people in residential care had the highest mortality rates, followed by those who received home care, during the coronavirus disease 2019 (COVID-19) pandemic. Staff working in the care of older people assumed responsibility for preventing the spread of the virus despite lacking the prerequisites and training. This study aimed to investigate the psychosocial work environment during the COVID-19 pandemic among staff in the care of older people and examine the factors associated with staff's perceptions of the clarity of instructions and the ability to follow them. Methods: A cross-sectional study design was employed using a web survey. The staff's perceptions of their psychosocial environment were analysed using descriptive statistics. The association between organisational and individual factors, as well as the degree of clarity of the instructions and the staff's ability to follow them, were assessed using multivariate (ordinal) regression analysis. Results: The main findings show that perceptions of the clarity and adaptability of the instructions were primarily correlated with organisational factors, as higher responses (positive) for the subscales focusing on role clarity, support and encouragement in leadership at work were associated with the belief that the instructions were clear. Similarly, those indicating high job demands and high individual learning demands were less likely to report that the instructions were clear. Regarding adaptability, high scores for demands on learning and psychological demands were correlated with lower adaptability, while high scores for role clarity, encouraging leadership and social support, were associated with higher adaptability. Conclusions: High job demands and individual learning demands were demonstrated to decrease the staff's understanding and adoption of instructions. These findings are significant on an organisational level since the work environment must be prepared for potential future pandemics to promote quality improvement and generally increase patient safety and staff health. [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown an increased risk for atrial fibrillation and atrial flutter (AF) in people with type 2 diabetes and prediabetes. It is unclear whether this increase in AF risk is independent of other risk factors for AF. Objective: To investigate the association between diabetes and different prediabetic states, as independent risk factors for the onset of AF. Methods: We performed a population‐based cohort study in Northern Sweden, including data on fasting plasma glucose, oral glucose tolerance test, major cardiovascular risk factors, medical history, and lifestyle factors. Participants were divided into six groups depending on glycemic status and followed through national registers for AF diagnosis. Cox proportional hazard model was used to assess the association between glycemic status and AF, using normoglycemia as reference. Results: The cohort consisted of 88,889 participants who underwent a total of 139,661 health examinations. In the model adjusted for age and sex, there was a significant association between glycemic status and development of AF in all groups except the impaired glucose tolerance group, with the strongest association for the group with known diabetes (p‐value <0.001). In a model adjusted for sex, age, systolic blood pressure, body mass index, antihypertensive drugs, cholesterol, alcohol, smoking, education level, marital status, and physical activity, there was no significant association between glycemic status and AF. Conclusions/interpretation: The association between glycemic status and AF disappears upon adjustment for potential confounders. Diabetes and prediabetes do not appear to be independent risk factors for AF. [ABSTRACT FROM AUTHOR]

Background: Heart failure (HF) and cancer are common diseases among the elderly population. Many chronic diseases, including diabetes mellitus (DM), share risk factors and increase the incidence of HF and cancer. The aim of this study was to investigate if there was an association between HF and the prevalence of haematologic- and solid malignancies. Methods: The study population was comprised of almost one million adults living in southern Sweden in 2015. All participants were divided into seven age groups from 20 and onwards, and 10 percentiles according to their socioeconomic status (SES). All data concerning diagnoses from each consultation in both primary- and secondary health care were collected during 18 months. The prevalence of haematologic and solid malignancies was measured separately for men and women, age groups, SES and multimorbidity levels. Multivariable logistic regression was used to determine the associations between HF and the probability of having haematologic- and solid malignancies in more complex models including stratifying variables. Results: People with HF had a higher prevalence of haematologic- and solid malignancies than the general population, but a lower prevalence of solid malignancies than the multimorbid population. The people with HF had an increased OR for haematologic malignancies, 1.69 (95% CI 1.51–1.90), and solid malignancies, OR 1.21 (95% CI 1.16–1.26), when adjusted for gender and age. In more complex multivariate models, multimorbidity explained the increased OR for haematologic- and solid malignancies in people with HF. Increasing socioeconomic deprivation was associated with a decreased risk for solid malignancies, with the lowest risk in the most socioeconomically deprived CNI-percentile. Conclusions: HF was shown to be associated with malignancies, especially haematologic malignancies. Multimorbidity, however, was an even more important factor for both haematologic- and solid malignancies than HF in our study, but not socioeconomic deprivation. Further research on the interactions between the chronic conditions in people with HF is warranted to examine the strength of association between HF and malignancies. [ABSTRACT FROM AUTHOR]

Objective: Pre‐eclampsia and gestational diabetes mellitus (GDM) are two common pregnancy complications that affect birth outcomes and are associated with a long‐term risk of cardiovascular disease (CVD). The aims of this study were to investigate if the pre‐eclampsia association with CVD is independent of GDM and modified by body mass index (BMI) or GDM. Design: Case–control study. Setting: Sweden. Population: Cases were women with a first CVD event between 1991 and 2008 and a previous pregnancy who were matched with controls without CVD (1:5) by year of birth, age and region of birth. Methods: Conditional logistic regression was used to evaluate the associations of GDM, pre‐eclampsia and maternal BMI with CVD adjusted for potential confounders and effect modifications with interaction tests. Main outcome measures: CVD. Results: There were 2639 cases and 13 310 controls with complete data. Pre‐eclampsia and GDM were independent risk factors for CVD (adjusted odds ratio [aOR] 2.59, 95% CI 2.12–3.17 and aOR 1.47, 95% CI 1.04–2.09, respectively). After stratifying by maternal BMI, the adjusted association of pre‐eclampsia with CVD did not differ notably between BMI groups: normal weight (aOR 2.65, 95% CI 1.90–3.69), overweight (aOR 2.67, 95% CI 1.52–4.68) and obesity (aOR 3.03, 95% CI 0.74–12.4). Similar findings were seen when stratifying on GDM/non‐GDM. Conclusions: Pre‐eclampsia and GDM are independent risk factors for later CVD and having both during pregnancy is a major risk factor for later CVD. The association between pre‐eclampsia and CVD is not modified by BMI. Effective CVD preventive programs for high‐risk women are urgently needed in order to improve women's long‐term health. [ABSTRACT FROM AUTHOR]

Site index and stand age are important variables in forestry. Site index describes the growing potential at a given location, expressed as the height that trees can attain at a given age under favorable growing conditions. It is traditionally used to classify forests in terms of future timber yield potential. Stand age is used for the planning of management activities such as thinning and harvest. SI has previously been predicted using remote sensing, but usually relying on either very short time series or repeated ALS acquisitions. In this study, site index and forest stand age were predicted from time series of interferometric TanDEM-X data spanning seven growth seasons in a hemi-boreal forest in Remningstorp, a test site located in southern Sweden. The goal of the study was to see how satellite-based radar time series could be used to estimate site index and stand age. Compared to previous studies, we used a longer time series and applied a penetration depth correction to the phase heights, thereby avoiding the need for calibration using ancillary field or ALS data. The time series consisted of 30 TanDEM-X strip map scenes acquired between 2011 and 2018. Established height development curves were fitted to the time series of TanDEM-X-based top heights. This enabled simultaneous estimation of both age and site index on 91 field plots with a 10 m radius. The RMSE of predicted SI and age were 6.9 m and 38 years for untreated plots when both SI and age were predicted. When predicting SI and the age was known, the RMSE of the predicted SI was 4.0 m. No significant prediction bias was observed for untreated plots, while underestimation of SI and overestimation of age increased with the intensity of treatment. [ABSTRACT FROM AUTHOR]

In a stable population of 250 000, the diagnosis of congestive cardiomyopathy could be firmly established in fifty-nine cases during a period of 8 years. This gives an incidence of the disease of 3/100 000/year. If cases disclosed at post-mortem during the same period are included, the frequency of the disease will equal 5/100 000/year.

Background: The Occupational Depression Inventory (ODI) was recently devised to assess depressive symptoms that individuals specifically attribute to their work. One purpose of the ODI is to overcome limitations in current assessments of job-related distress. This study aimed to validate the Swedish version of the ODI. Methods: The study involved 365 individuals employed in Sweden. In addition to the ODI, the study included the Satisfaction with Life Scale, the Effort-Reward Imbalance Questionnaire, the Demand-Control-Support Questionnaire, the GAD-2, and the PHQ-9. We inquired into the factorial validity, dimensionality, scalability, test-score reliability, criterion validity, convergent validity, discriminant validity, and measurement invariance of the ODI. Results: Exploratory structural equation modeling bifactor analysis indicated that the ODI's Swedish version meets the requirements for essential unidimensionality (e.g., explained common variance = 0.872). Measurement invariance held across sexes, age groups, and occupational categories. The instrument exhibited strong scalability (e.g., H = 0.662). The observed total scores thus accurately ranked respondents on the latent continuum underlying the scale. The ODI's total-score reliability was high (e.g., McDonald's ω = 0.929). Speaking to the instrument's criterion validity, we found occupational depression to correlate, in the expected direction, with various work (e.g., job support) and nonwork (e.g., general anxiety) variables. Occupational depression showed large correlations with effort-reward imbalance (r = 0.613) and demand-control imbalance (r = 0.566) at work. Multiple regression analyses supported these associations further. As expected, we observed both a degree of convergent validity and a degree of discriminant validity when examining the ODI against the PHQ-9, an attribution-free measure of depression. Discussion: This study indicates that the ODI performs well within the Swedish context, consistent with the findings obtained in other linguistic and geographic contexts. The ODI promises to help researchers, practitioners, and public health decision-makers address job-related distress more effectively. [ABSTRACT FROM AUTHOR]

Ambulance personnel in emergency medical services are exposed to physical demands and stress during work, and an increased prevalence of ill health has been observed in this group. The aim was to compare hair cortisol concentration (HCC) among Swedish ambulance personnel with HCC in a population-based reference sample, to analyse differences between women and men, and differences due to work-related factors. Samples of hair 1 cm closest to the skin (5–10 mg) were collected and analysed for cortisol by radioimmunoassay. Moreover, the participants responded to a questionnaire regarding their work environment. The HCC among the ambulance personnel did not differ from the HCC in the population-based reference sample (median 19.2 vs. 22.2 pg/mg, p = 0.319), nor were there statistically significant differences between women and men. Furthermore, no associations were found between HCC and physical and psychosocial work demands, work stress, or rest and recovery from work. However, occupational balance was positively correlated with HCC (rp = 0.240; p = 0.044). The association remained statistically significant after adjustment for sex, age, hair bleaching, and corticosteroid treatment in a linear regression model. This study adds knowledge regarding HCC among ambulance personnel, and thus contributes to the overall picture of work environment and health for this group. [ABSTRACT FROM AUTHOR]

BACKGROUND: Appearance and body language are key components of non-verbal communication and play an important role in the service and marketing sector. OBJECTIVE: The aim was to explore experiences and perceptions of appearance issues related to work among employees in the marketing sector in Sweden. METHODS: Interviews were conducted with 15 marketing and communication employees (five males, ten females), at multinational companies and a university. Thematic analyses were conducted, and content was organised in two themes with sub-themes: 1. Appearance from a resource perspective (Appearance benefits; Physical activity resources; Age benefits). 2. Appearance from a demand perspective (Adaptation to gender roles; Investment in appearance; Adaptation to situation and culture). RESULTS: The findings showed that appearance was perceived as a resource for professionalism, work engagement and career in various ways. Appearance-related issues were not considered on organisational work level, but employees perceived unspoken demands to look good and appropriate to represent the company brand. The employees spent a considerable amount of time, money, and effort on appearance. CONCLUSION: Appearance creates dualistic questions and points out several dilemmas that the individual struggle to solve, which creates stress in work. The character of unspoken demands on appearance and absent communication on organisational level make the stress-coping strategies complicated and the stress coping is mostly left for the individual to handle. A gender difference shows that compared to men, women more often experience negative stress generated by appearance-related issues in work. Education and actions at the managerial level of companies are needed. [ABSTRACT FROM AUTHOR]

Aims: The aim of this study was to investigate associations between psychosocial work exposure and the presence of biological and imaging biomarkers of cardiovascular disease. Methods: This cross-sectional study was conducted in a sub-cohort of the Swedish CArdioPulmonary bioImage Study (SCAPIS). Psychosocial exposure was evaluated with the job demand–control model, and analysed according to the standard categorization: high strain, active, passive and low strain (reference). Biomarkers (blood pressure, high-density lipoprotein (HDL) and low-density lipoprotein (LDL) cholesterol, coronary artery calcification (CAC) and metabolic syndrome) were measured, or derived through measurements, from clinical examinations. Gender-specific prevalence ratios (PRs) and 95% confidence intervals (CIs) were calculated with regression models and adjusted for age, education, smoking, physical activity, general life stress and body mass index (BMI). Results: The analyses included 3882 participants (52.5% women). High strain (high demands–low control) was linked to increased PR for low HDL cholesterol in women, adjusted for all covariates (PR 1.76; 95% CI 1.25–2.48). High strain was also related to moderately increased PR for metabolic syndrome in men, after adjustments for all covariates except BMI (PR 1.25; 95% CI 1.02–1.52). In addition, passive work (low demands–low control) was associated with diastolic hypertension in women (fully adjusted: PR 1.29; 95% CI 1.05–1.59). All relationships between psychosocial factors and LDL cholesterol or CAC (both genders), or hypertension (men), were non-significant. Conclusions: Poor psychosocial job conditions was associated with the presence of low HDL cholesterol and diastolic hypertension in women, and metabolic syndrome in men. These findings contribute to the knowledge of potential pathways between stressful work and coronary heart disease. [ABSTRACT FROM AUTHOR]

Copyright of Acta Oto-Laryngologica is the property of Taylor & Francis Ltd and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Variations in prevalence and incidence of systemic lupus erythematosus (SLE) within a geographically defined area of central Sweden over a time period of 14 years were examined. Longitudinal differences in disease activity, laboratory test results, and damage accrual were investigated. Methods: Adults (aged ≥18 years) residing in Östergötland County between 2008 and 2021 (mean adult population: 357,000 citizens) with confirmed SLE were identified and followed prospectively until death, December 31, 2021, or emigration. We estimated annual incidence per 100,000 inhabitants stratified by sex and age. Linear regression with year of diagnosis as the outcome assessed whether each clinical measurement at diagnosis varied over time. Results: Prevalence on December 31, 2021, was 71.5 of 100,000 (87% female). One hundred twenty‐six new cases were identified during the study period, yielding a mean annual incidence of 3.0 of 100,000 inhabitants; this was higher in females (4.8/100,000) than in males (1.2/100,000). Mean age at diagnosis was 43.7 years (SD 17.3). Age at diagnosis and disease activity measures increased over the calendar year of diagnosis (P < 0.05) whereas disease manifestations, including lupus nephritis, did not vary significantly. Accrual of organ damage was demonstrated over time since diagnosis and stratified by sex, lupus nephritis, and corticosteroid‐related damage. Approximately 40% developed damage within 5 years. Conclusion: SLE prevalence and incidence estimates remained constant over 14 years, and disease phenotypes at SLE onset were similar. SLE was diagnosed also among older individuals with a smaller female‐to‐male ratio. Estimates of prevalence and incidence were comparable to previous Scandinavian reports but lower than observed in registry data from the US and the UK. [ABSTRACT FROM AUTHOR]

Background: Fatigue has a detrimental impact on health-related quality of life and functioning in patients with Crohn's disease (CD). We aimed to confirm the relevance and importance of fatigue, establish the content validity of the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F), qualitatively explore meaningful change in fatigue experience, and assess the measurement properties of the FACIT-F in patients with moderate-to-severe CD. Methods: This was a mixed-methods observational study consisting of a cross-sectional qualitative interview (Part A) and a longitudinal 2-week daily diary pilot study (Part B) in participants aged ≥ 18 years with a clinical diagnosis of moderate-to-severe CD. Part A included open-ended questions related to the participant's overall experiences with CD, fatigue, and impact on daily activities and a cognitive debriefing of several patient-reported outcomes (PROs), including the FACIT-F. Part B consisted of participants completing an electronic daily diary that included the FACIT-F and other PROs for 14 days. Item performance, test–retest reliability, and construct validity were assessed at baseline (Day 1), Day 7, and Day 14. Results: Thirty-five participants (mean age 45.1 years; 65.7% female) completed an interview (Part A). Ninety-one percent of the interview participants reported fatigue as a symptom attributed to CD. Participants indicated that fatigue had a major impact on their daily activities (e.g., recreation/ hobbies, work/school, yard work and housework), social activities, and emotional health. The FACIT-F was well understood by the interview participants. Seventy-six participants (mean age 41.9 years; 66% female) completed at least the Day 1 diary entry (Part B). Potential floor and ceiling effects were observed for several FACIT-F items, but test–retest reliability and construct validity were all strong and within the ranges hypothesized a priori. Conclusions: The interviews indicate that fatigue is a frequent and bothersome symptom experienced by most patients with moderate-to-severe CD and support the content validity of the FACIT-F in this population. Daily diary study results indicate that the FACIT-F scale demonstrates adequate reliability and validity among patients with CD. These study findings suggest that the FACIT-F would be a reliable, valid, and useful measure of fatigue in patients with moderate-to-severe CD. [ABSTRACT FROM AUTHOR]

Objective: To (1) examine the time to first full return-to-work (RTW), and (2) investigate whether psychosocial work factors and work-home interference are associated with time to first full RTW after sick leave due to common mental disorders (CMDs). Methods: The cohort study comprised 162 employees on sick leave due to CMDs participating in a two-armed cluster-randomised controlled trial in Sweden. Baseline data consisted of a web-based questionnaire and follow-up data of repeated text messages every fourth week for 12 months. The time to first full RTW was estimated using the Kaplan–Meier Estimator. Parametric Weibull survival models with interval-censored outcomes were used to determine associations between psychosocial work factors and work-home interference with time to first full RTW. In a post hoc analysis, time-interval differences in associations for 0– ≤ 6- versus > 6–12 months were tested. Results: During the 12-month follow-up, n = 131 (80.9%) reported a first full RTW. The median time to this RTW was 16 weeks (95% CI 12; 20). High psychological job demands, high emotional job demands, high work-to-home interference (WHI), and low social job support were independently associated with a longer time to first full RTW. Time-interval differences were found for job control and emotional job demands. Conclusions: Psychosocial work demands and WHI are associated with a longer time to RTW after sick leave due to CMDs. Work organisations and rehabilitation practices should include accommodations for high psychological and emotional job demands during RTW, as well as pay attention to the risk of spill-over of high job demands into employees' private lives. [ABSTRACT FROM AUTHOR]

Aim: To explore the perceptions of the COVID‐19 pandemic, as expressed in the drawings of Swedish children aged 4–6 years. Methods: We analysed 91 drawings with associated descriptions submitted to the Swedish Archive of Children's Art from April 2020 to February 2021. Results: The visual and text analysis resulted in three themes. First, illustrating the virus and embodying the danger showed that young children understood the invisible enemy, combining realistic elements of the virus particle with fantasies of the 'virus monster' that needs to be fought off. Second, life has changed for the worse describes the profound effect the pandemic had on young children's lives also in Sweden, with comparatively mild restrictions and no school closures. Third, the virus spreads across the world, affects people and infects their bodies conveys young children's understanding of the pandemic as an existential challenge affecting the whole world. Children displayed surprisingly high levels of health literacy related to COVID‐19, including contagion routes and the importance of hand hygiene. Conclusion: The drawings of Swedish children aged 4–6 years demonstrated the profound, practical and emotional effects of the pandemic on their lives. Drawings also illuminated young children's level of health literacy regarding COVID‐19. [ABSTRACT FROM AUTHOR]

Aims: General psychosocial stress and job strain have been related to blood pressure (BP) with conflicting results. This study sought to explore the contribution of several lifestyle factors in the relation between general psychosocial stress, job strain and BP. Methods: This cross-sectional study investigated the association of general stress and job strain with systolic BP (SBP) and diastolic BP in a sample of 9441 employed individuals from the EpiHealth cohort. General stress was measured by the Perceived Stress Scale. Job strain was assessed with the Job Content Questionnaire, assessing two dimensions of job strain: psychological job demand and decision latitude. Linear regression and sensitivity analysis were performed. Results: At the uncorrected model, general stress, job demand and decision latitude were all inversely associated with SBP. After further adjustment for lifestyle and health parameters, only general stress was associated with SPB (β coefficient: −0.103; 95% confidence interval −0.182 to 0.023). Conclusions: General stress is associated with lower SBP independently of lifestyle in middle-aged adults. Our findings point towards a major contribution for job-unrelated stressors in determining SBP and support the pivotal role of lifestyle behaviours and health status in modulating the effect of stress on BP, calling for a careful selection of confounders. [ABSTRACT FROM AUTHOR]

Four species of Bacidina (Ramalinaceae, Lecanorales, Ascomycota) are described as new to science from northern Europe (mainly Swedish material): Bacidina ferax S.Ekman, Bacidina lignicola S.Ekman, Bacidina maculans S.Ekman and Bacidina populnea S.Ekman. Another two species are resurrected from synonymy: Bacidina caerulea (Körb.) S.Ekman (based on Bacidia caerulea Körb.) and Bacidina circumpallens (Nyl.) S.Ekman (based on Lecidea circumpallens Nyl.). An additional four combinations are made: Bacidina friesiana (Hepp) S.Ekman (based on Biatora friesiana Hepp), Bacidina subfuscula (Nyl.) S.Ekman (based on Lecidea subfuscula Nyl.), Bacidina tarandina (Nyl.) S.Ekman (based on Lecidea tarandina Nyl.) and Bacidina tenella (Kullh.) S.Ekman (based on Bacidia tenella Kullh.). The morphology, distribution and nomenclature of all 28 species of Bacidina currently known from Scandinavia (Sweden, Norway, Denmark) are treated and an identification key is provided. In addition, Bacidina friesiana is discussed (for comparison with B. caerulea) even if it is not currently known from Scandinavia. Two of the treated species (B. epithallina ined., B. parasitica ined.) are parasites on cyanolichens but are not formally introduced here because of the scarcity of available material. Bilimbia arceutinoides Anzi is reduced to synonymy with Bilimbia sabuletorum (Schreb.) Arnold and Lecidea luteola var. chlorotica Ach. is reduced to synonymy with Bacidia rubella (Hoffm.) A.Massal. It is concluded that despite the present work, the diversity of the genus Bacidina remains insufficiently understood, at least in Scandinavia. [ABSTRACT FROM AUTHOR]

Aims: Unmet needs exist in the diagnosis and treatment of heart failure (HF) in the elderly population. Our aim was to analyse and compare data of diagnostics and management of very elderly patients (aged ≥85 years) compared with younger patients (aged 18–84 years) with HF in Sweden. Methods: Incidence of ≥2 HF diagnosis (ICD‐10) was identified from primary/secondary care in Uppsala and Västerbotten during 2010–2015 via electronic medical records linked to data from national health registers. Analyses investigated the diagnosis, treatment patterns, hospitalizations and outpatient visits, and mortality. Results: Of 8702 patients, 27.7% were ≥85 years old, women (60.2%); most patients (80.7%) had unknown left ventricular ejection fraction; key co‐morbidities comprised anaemia, dementia, and cerebrovascular disease. More very elderly patients received cardiovascular disease (CVD)‐related management after diagnosis in primary care (13.6% vs. 6.5%; P < 0.0001), but fewer patients underwent echocardiography (19.3% vs. 42.9%; P < 0.0001). Within 1 year of diagnosis, very elderly patients were less likely to be hospitalized (all‐cause admissions per patient: 1.9 vs. 2.3; P < 0.0001; CVD‐related admissions per patient: 1.8 vs. 2.1; P = 0.0004) or prescribed an angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) plus a β‐blocker (45.2% vs. 56.9%; P < 0.0001) or an ACEI/ARB plus a β‐blocker plus a mineralocorticoid receptor antagonist (15.4% vs. 31.7%; P < 0.0001). One‐year mortality was high in patients ≥85 years old, 30.5% (CI: 28.3‐32.7%) out of 1797 patients. Conclusions: Despite the large number of very elderly patients with newly diagnosed HF in Sweden, poor diagnostic work‐up and subsequent treatment highlight the inequality of care in this vulnerable population. [ABSTRACT FROM AUTHOR]

Aims: This study aims to determine the familial incidence of dilated (DCM) and hypertrophic cardiomyopathy (HCM) in first‐degree, second‐degree, and third‐degree relatives of affected individuals. Methods and results: In this population‐based multigenerational cohort study, full‐siblings, half‐siblings, and cousin pairs born to Swedish parents between 1932 and 2015 were included, and register‐based DCM and HCM diagnoses among relatives were ascertained. Adjusted odds ratios (ORs) for DCM and HCM were calculated for relatives of individuals with DCM and HCM compared with relatives of individuals without DCM and HCM for reference. Total study population included 6 334 979 subjects and consisted of 5 577 449 full‐siblings, 1 321 414 half‐siblings, and 3 952 137 cousins. Overall, 10 272 (0.16%) unique individuals were diagnosed with DCM and 3769 (0.06%) with HCM. Of these, 7716 (75.12%) and 2375 (63.01%) were males, respectively. Familial risk ORs for DCM were 5.35 [95% confidence intervals (CI): 4.85–5.90] for full‐siblings, 2.68 (95% CI:1.86–3.87) for half‐siblings, and 1.72 (95% CI:1.12–2.64) for cousins of affected individuals. The ORs for HCM were 42.44 (95% CI:37.66–47.82) for full‐siblings, 32.70 (95% CI:21.32–50.15) for half‐siblings, and 36.96 (95% CI:29.50–46.31) for cousins of affected individuals. In sex‐stratified analysis, relatives of affected females were found more likely to be affected than were relatives of affected males, with stronger aggregation observed for HCM. Conclusions: Familial risk of HCM and DCM is high and associated with genetic resemblance, with strongest aggregations observed in relatives of affected females with HCM, whereas this association was distinctly attenuated for DCM. The finding of a Carter effect, more pronounced in HCM, suggests a multifactorial threshold model of inheritance. [ABSTRACT FROM AUTHOR]

In the late 1750s, the Swedish botanist Engelbert Jörlin (1733–1810), one of Carl Linnaeus' students wrote his dissertation Plantae tinctoriae on more than one hundred dye plants. The article presents a systematic study on these dyeing materials and reflects the knowledge in the mid-18th century. His dissertation focused on domestic plants that could be suitable instead of expensive imported trade goods and was published during the Age of Utility (1719–1771). The Latin text of Jörlin's dissertation was first converted into a digital version by the 'Noscemus General Model' from Transkribus and then translated into English. The current scientific names were obtained from various biological websites. The dyestuffs were assigned to four groups: native and applied in Sweden (A); imported trade products (B); native to Sweden with potential use for dyeing (C); non-native and used abroad (D). They were mainly applied for dyeing textiles, less frequently for pharmaceuticals, cosmetics (make-up), inks and artists' pigments. In his dissertation, Jörlin refers to scriptures from antiquity, Latin botanical literature from the 16th and 17th centuries but especially to the publications of Carl Linnaeus. [ABSTRACT FROM AUTHOR]

Simple Summary: Early onset of colorectal cancer (EOCRC) is increasing in developed countries. The aim was to investigate autoimmune and metabolic conditions as risk factors for EOCRC. We investigated preexisting autoimmune and metabolic diagnoses of 2626 EOCRC patients in Sweden, diagnosed in 2007–2016, together with 15,756 controls matched for birth year, sex, and county. Comorbid diagnoses were collected from the National Patient Register. A history of metabolic disease nearly doubled the incidence of EOCRC, and presence of inflammatory bowel disease (IBD) was associated with a sixfold increased incidence of EOCRC. Patients with both IBD and metabolic disease had a lower incidence of EOCRC compared with IBD patients without metabolic condition. Non-IBD autoimmune disease was not associated with an increased incidence of EOCRC. IBD and metabolic disease are risk factors for EOCRC and should be considered in screening guidelines. Incidence of early-onset (<50 years) colorectal cancer (EOCRC) is increasing in developed countries. The aim was to investigate autoimmune and metabolic conditions as risk factors for EOCRC. In a nationwide nested case–control study, we included all EOCRC cases in Sweden diagnosed during 2007–2016, together with controls, matched for birth year, sex, and county. Information on exposure of autoimmune or metabolic disease was collected from the National Patient Register and Prescribed Drugs Registry. Hazard ratios (HR) as measures of the association between EOCRC and the exposures were estimated using conditional logistic regression. In total, 2626 EOCRC patients and 15,756 controls were included. A history of metabolic disease nearly doubled the incidence hazard of EOCRC (HR 1.82, 95% CI 1.66–1.99). A sixfold increased incidence hazard of EOCRC (HR 5.98, 95% CI 4.78–7.48) was seen in those with inflammatory bowel disease (IBD), but the risk increment decreased in presence of concomitant metabolic disease (HR 3.65, 95% CI 2.57–5.19). Non-IBD autoimmune disease was not statistically significantly associated with EOCRC. IBD and metabolic disease are risk factors for EOCRC and should be considered in screening guidelines. [ABSTRACT FROM AUTHOR]

Background: β-blockers are widely used for treating cardiac conditions and are suggested for the treatment of anxiety and aggression, although research is conflicting and limited by methodological problems. In addition, β-blockers have been associated with precipitating other psychiatric disorders and suicidal behaviour, but findings are mixed. We aimed to examine associations between β-blockers and psychiatric and behavioural outcomes in a large population-based cohort in Sweden. Methods and findings: We conducted a population-based longitudinal cohort study using Swedish nationwide high-quality healthcare, mortality, and crime registers. We included 1,400,766 individuals aged 15 years or older who had collected β-blocker prescriptions and followed them for 8 years between 2006 and 2013. We linked register data on dispensed β-blocker prescriptions with main outcomes, hospitalisations for psychiatric disorders (not including self-injurious behaviour or suicide attempts), suicidal behaviour (including deaths from suicide), and charges of violent crime. We applied within-individual Cox proportional hazards regression to compare periods on treatment with periods off treatment within each individual in order to reduce possible confounding by indication, as this model inherently adjusts for all stable confounders (e.g., genetics and health history). We also adjusted for age as a time-varying covariate. In further analyses, we adjusted by stated indications, prevalent users, cardiac severity, psychiatric and crime history, individual β-blockers, β-blocker selectivity and solubility, and use of other medications. In the cohort, 86.8% (n = 1,215,247) were 50 years and over, and 52.2% (n = 731,322) were women. During the study period, 6.9% (n = 96,801) of the β-blocker users were hospitalised for a psychiatric disorder, 0.7% (n = 9,960) presented with suicidal behaviour, and 0.7% (n = 9,405) were charged with a violent crime. There was heterogeneity in the direction of results; within-individual analyses showed that periods of β-blocker treatment were associated with reduced hazards of psychiatric hospitalisations (hazard ratio [HR]: 0.92, 95% confidence interval [CI]: 0.91 to 0.93, p < 0.001), charges of violent crime (HR: 0.87, 95% CI: 0.81 to 0.93, p < 0.001), and increased hazards of suicidal behaviour (HR: 1.08, 95% CI: 1.02 to 1.15, p = 0.012). After stratifying by diagnosis, reduced associations with psychiatric hospitalisations during β-blocker treatment were mainly driven by lower hospitalisation rates due to depressive (HR: 0.92, 95% CI: 0.89 to 0.96, p < 0.001) and psychotic disorders (HR: 0.89, 95% CI: 0.85 to 0.93, p < 0.001). Reduced associations with violent charges remained in most sensitivity analyses, while associations with psychiatric hospitalisations and suicidal behaviour were inconsistent. Limitations include that the within-individual model does not account for confounders that could change during treatment, unless measured and adjusted for in the model. Conclusions: In this population-wide study, we found no consistent links between β-blockers and psychiatric outcomes. However, β-blockers were associated with reductions in violence, which remained in sensitivity analyses. The use of β-blockers to manage aggression and violence could be investigated further. In a population-based cohort study of 1.4 million individuals in Sweden, Dr. Yasmina Molero and colleagues investigate the associations between β-blockers and psychiatric and behavioural outcomes. Author summary: Why was this study done?: β-blockers are primarily cardiac medications that are widely used for treating anxiety and are also suggested for the management of clinical depression and aggression, although research on efficacy is conflicting and limited by small samples and methodological problems. β-blockers have been linked to an increased risk of suicidal behaviour, but findings are inconclusive. More evidence using large samples and appropriate designs is needed on real-world effects on mental health and behavioural outcomes in people taking β-blockers. What did the researchers do and find?: We examined a population-based cohort of 1,400,766 persons in Sweden who had been treated with β-blockers using a within-individual design; i.e., we compared individuals to themselves during medication and non-medication periods to account for background factors that may confound associations. Periods on β-blocker treatment were associated with an 8% lower risk of being hospitalised due to a psychiatric disorder, a 13% lower risk of being charged with a violent crime by the police, and an 8% increased risk of being treated for suicidal behaviour or suicide mortality. Reduced associations with violent charges were consistent across sensitivity analyses, while associations with suicidal behaviour and psychiatric hospitalisations varied by specific psychiatric diagnoses, past psychiatric problems, and cardiac severity. What do these findings mean?: The widespread use of β-blockers to manage anxiety is not supported in this real-world study that examined presentations of anxiety in secondary care. Studies using other designs (e.g., randomised controlled trials) are needed to better understand the role of β-blockers in the management of aggression and violence. If findings on violence are confirmed by studies that use other designs, β-blockers could be considered to manage aggression and hostility in individuals with psychiatric conditions. [ABSTRACT FROM AUTHOR]

University students experience a distinct working environment in the context of completing their studies. In line with existing research into the connection between workplace environment and stress, it is rational to believe that such study environments can affect the level of stress that students experience. However, few instruments have been developed for measuring this. The aim of this study was to validate a modified instrument based on the Demand-Control-Support (DCS) model among students at a large university in southern Sweden to determine its utility for assessing the psychosocial properties of the study environment. Data from a survey performed at a Swedish university in 2019, which generated 8960 valid cases, was used. Of these cases, 5410 studied a course or programme at bachelor level, 3170 a course or programme at master level, and 366 a combination of courses and programmes on the two levels (14 missing). A 22-item DCS-instrument for students was used comprising four scales: Psychological workload (demand) with nine items, Decision latitude (control) with eight items, supervisor/lecturer support with four items, and colleague/student support with three items. Construct validity was examined using exploratory factor analysis (EFA) and internal consistency using Cronbach's alpha. The results of the exploratory factor analysis of the Demand-Control components support a 3-dimension solution with dimensions corresponding to psychological demands, skill discretion, and decision authority in the original DCS model. Cronbach's alpha coefficients were acceptable for Control (0.60) and Student Support (0.72) and very good for the Demand and Supervisor Support scales (0.81 and 0.84, respectively). The results suggest that the validated 22-item DCS-instrument is a reliable and valid tool for assessing Demand, Control, and Support elements of the psychosocial study environment among student populations. Further research is necessary to examine the predictive validity of this modified instrument. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on individuals' mental health. This study aimed to investigate how negative emotions toward the COVID-19 pandemic, including feeling anxious, depressed, upset, and stressed, were associated with COVID-19 vaccine acceptance in Sweden. The study is a cross-sectional online survey conducted between 21–28 May 2021, using three nested hierarchical logistic regression models to assess the association. The study included 965 unvaccinated individuals, 51.2% (n = 494) of whom reported their intention to get vaccinated. We observed graded positive associations between reported negative emotions and vaccine acceptance. Individuals who experienced economic stress had lower odds of vaccine acceptance while having a positive opinion of the government's response to COVID-19 was associated with higher odds of being vaccine-acceptant. In conclusion, unvaccinated individuals experiencing negative emotions about the pandemic were more willing to get the vaccine. On the contrary, those with a negative opinion about the government's response, and those that had experienced economic stress were less likely to accept the immunization. [ABSTRACT FROM AUTHOR]

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BACKGROUND: Recruiting and retaining managers has become increasingly difficult in recent years, primarily because of a pressured work situation. A better understanding of managers' work situation is required, and of the support they need. OBJECTIVE: The purpose of the study is to increase the understanding of managers' psychosocial work environment and health by investigating individuals as they enter or leave a managerial position. METHODS: Longitudinal questionnaire data from 1971 individuals distributed across four groups were used: individuals who 1) entered or 2) left a managerial position between measuring points, and those who remained employed as 3) managers or 4) non-managers at both measuring points. RESULTS: Demands increased between the measuring points for those who entered a managerial position. Their resources and health were, however, rated higher than non-managers already before the transition. Demands decreased for those who left a managerial position, while their resources remained higher than non-managers. Health did not change by changing position. CONCLUSION: This study contributes to knowledge of what happens when someone enters or leaves a managerial position and increases the understanding of differences between managers and non-managers. Organizations should develop supportive strategies through talent management programs to help build resources in employees and future managers. Support should also aim to reduce the increased level of demands in newly hired managers. [ABSTRACT FROM AUTHOR]

Background: Societal development and a competitive corporate climate have resulted in increased emphasis on performance management (PM) but also sustainability and health challenges in working life. Opportunities for employee well-being, development and performance are thus highly relevant for organisations and society. PM includes a manager-employee dialogue process and is identified as a complex challenge when combined with employee development and well-being. Managers have a key role in PM, and research in collaboration with practitioners in specific contexts is needed. An exploratory study, focusing on managers' experience of dialogues between managers and employees in practice, was therefore conducted in collaboration with an inter-municipal corporation company in southern Sweden. Methods: A qualitative study with an inductive design, supported by semi-structured focus group interviews, was chosen based on the exploratory character of the study. Thirty-five managers were approached in the company and 15, of varying age and managerial experience, agreed to participate. Staff Development Dialogues (SDD) were used in the company PM model to facilitate employee development, performance, and well-being. Data was analysed using conventional qualitative content analysis to obtain new insights without using pre-set classifications. Results: The analysis resulted in three categories of SDD experiences: SDD in a business context; Managers in relation to SDD; and Employees in relation to SDD. The findings revealed varying SDD experiences as well as approaches, and analytical themes were considered in relation to the organisational context and the specific SDD content and process. The study showed the importance of SDD adaptation and a well-being perspective in the dialogues was related to relational aspects and the manager-employee approach to SDDs. Discussion: The findings confirm the complexity and challenges of PM including development and well-being. Adaptation to specific departments as well as employees is important, and using the same PM strategy throughout an organisation can be questioned. The identified link between a relational approach and a well-being perspective indicates a missed opportunity for systematic workplace health promotion. Strengthening the well-being perspective can, thus, improve the quality of an SDD model, which in turn can facilitate the creation of sustainable workplaces and better fulfilment of employers' health-related obligations for systematic work environment management. [ABSTRACT FROM AUTHOR]

Mining and the permitting process for mineral projects in Sweden has been criticised as inadequately safeguarding the rights of Indigenous reindeer herding Sámi, who hold usufruct rights to more than half the country's territory. There have been calls for Sweden to ratify the Indigenous and Tribal Peoples Convention (ILO 169) and to change its Mineral Law. This paper evaluates the extent of protection of Sámi rights — and not only those engaged in reindeer herding — in Sweden's minerals permitting process. It also considers the implications if changes were made to align this process with the Indigenous-rights framework. The paper demonstrates that reindeer herding Sámi are, broadly, treated similar to landowners in the mineral projects permitting process. However, there is discrimination when it comes to being able to have a share in the benefits of a project: impacted reindeer herders have no such option whereas landowners do. Also, the permitting processes do not consider social and cultural impacts, nor are there obligations for the state to be sufficiently involved in consultation processes. Addressing the identified shortcomings would require only small changes to the Mineral Law and/or to its application and would be possible with only limited impacts on mining because the sector is not a significant user of land whilst it creates large economic values. However, extending those changes (to give parity between landowners and Sámi rights holders) in other important economic sectors which use more extensive land areas, would entail a considerable transfer of resources and associated power. Furthermore, changing the Mineral Law specifically would mean little in terms of safeguarding the rights of the majority of Sami who do not engage in reindeer herding. This suggests that calls for changes to mineral-related legislation to resolve indigenous land right issues are mis-directed or at least insufficient, and that other type of legislative change is required, fundamentally including resolving how extensive and strong the Sámi's rights to land should be. [ABSTRACT FROM AUTHOR]

We investigate the importance of adult children and/or cohabitation with a partner for older hip fracture patients' probability of independent living, public home care use and hospital readmission. Data from 35,066 Swedish hip fracture patients between 2012 and 2017, aged 65 years, and living at home at the time of the fracture in the Swedish Registry for Hip Fracture Patients and Treatment were linked with national registers. We applied adjusted logistic regression models and Cox proportional hazard models. In total, 959 (4.0%) women and 817 (7.3%) men had no adult children, 13,384 (56.0%) women and 3,623 (32.5%) men had no cohabiting partner and 2,780 (11.6%) women and 1,389 (12.5%) men neither had a cohabiting partner nor adult children. In comparison with women and men who had both a cohabiting partner and adult children, those without a cohabiting partner (i.e. only adult children) and those who neither had a cohabiting partner nor adult children had significantly lower probabilities of returning home (at discharge and after 4 months). They also had a greater probability of both receiving home care and having an increase in the amount of home care they receive. Having a close next of kin and hospital readmission were not associated. In conclusion, absence of a close next of kin, specifically a cohabiting partner, reduces the chance of return to independent living and increases the use of home care after a hip fracture hospitalisation. The findings highlight the importance of family support for older adults living situation after a hip fracture. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this paper is to identify the role of the principal in establishing a whole school approach for health and wellbeing. Two questions are asked: (1) What do successful Swedish principals do when they take on a whole school approach? (2) How do these results relate to previous research on successful school leadership? Design/methodology/approach: This paper focuses on the complexity of organisational processes and considers the role of successful leadership in managing a whole school approach to health promotion. It presents findings from two different but interlinked projects, and draws on document studies and interviews with principals, student health team members and teachers in Sweden. Findings: This paper argues that successful school leaders are crucial in establishing a whole school approach, because of the work they do to synchronise the health-promoting activities in schools. The study identifies four aspects of coordination that need to be enacted simultaneously when leading health-promoting processes. The fifth aspect identified is that a whole school approach is not limited to the school, but the whole local school context, i.e. a synchronisation between different system levels. Originality/value: Although limited in scale, this paper reports key findings that could have practical implications for school leaders. The study suggests that successful school leadership research needs to use a health-promoting lens in order to make leadership practices health-promoting practices. It also proposes extended comparative research from different fields and contexts. [ABSTRACT FROM AUTHOR]

Aims Early defibrillation is critical for the chance of survival in out-of-hospital cardiac arrest (OHCA). Drones, used to deliver automated external defibrillators (AEDs), may shorten time to defibrillation, but this has never been evaluated in real-life emergencies. The aim of this study was to investigate the feasibility of AED delivery by drones in real-life cases of OHCA. Methods and results In this prospective clinical trial, three AED-equipped drones were placed within controlled airspace in Sweden, covering approximately 80 000 inhabitants (125 km2). Drones were integrated in the emergency medical services for automated deployment in beyond-visual-line-of-sight flights: (i) test flights from 1 June to 30 September 2020 and (ii) consecutive real-life suspected OHCAs. Primary outcome was the proportion of successful AED deliveries when drones were dispatched in cases of suspected OHCA. Among secondary outcomes was the proportion of cases where AED drones arrived prior to ambulance and time benefit vs. ambulance. Totally, 14 cases were eligible for dispatch during the study period in which AED drones took off in 12 alerts to suspected OHCA, with a median distance to location of 3.1 km [interquartile range (IQR) 2.8–3.4). AED delivery was feasible within 9 m (IQR 7.5–10.5) from the location and successful in 11 alerts (92%). AED drones arrived prior to ambulances in 64%, with a median time benefit of 01:52 min (IQR 01:35–04:54) when drone arrived first. In an additional 61 test flights, the AED delivery success rate was 90% (55/61). Conclusion In this pilot study, we have shown that AEDs can be carried by drones to real-life cases of OHCA with a successful AED delivery rate of 92%. There was a time benefit as compared to emergency medical services in cases where the drone arrived first. However, further improvements are needed to increase dispatch rate and time benefits. Trial registration number ClinicalTrials.gov Identifier: NCT04415398. [ABSTRACT FROM AUTHOR]

Background: The response of small business managers to an external event such as the pandemic can have a profound effect on the work environment, health and well-being for themselves and their employees. Previous research on small business managers during the pandemic has mainly focused on traditional pathogenic effects, and there is a lack of studies looking at the issue from a salutogenic health promotion perspective. The aim of this study is to explore whether a sense of coherence and general resistance resources were experienced by small business managers in Sweden and Norway during the Covid-19 pandemic. Methods: A qualitative design was applied through exploratory interviews with 16 managers of small businesses in Sweden and Norway. A content analysis of the interviews was conducted using the sense of coherence concept by Aaron Antonovsky, with the three main components of comprehensibility, meaningfulness and manageability acting as a conceptual framework for the analysis process. Results: Within the three main sense-of-coherence categories, six general resistance resources were identified as being important for the managers to handle uncertainty during the pandemic. These were understanding rules and regulations, social support, optimism, proactivity, problem-solving and flexibility and cooperation. Conclusions: The small business managers handled the pandemic in a way that worked well in their contexts, and the pandemic generally did not have a negative effect on their businesses or themselves. A salutogenic approach, through which the managers focused on identifying and using resources, was an important factor for managing stressors and adversity during the pandemic. Hence, the concept of salutogenesis may be used as an intervention to foster better health in small businesses, both at a personal and organisational level in order to handle future challenges effectively. [ABSTRACT FROM AUTHOR]