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OBJECTIVES: Through inflammation and hyposalivation, obstructive sleep apnea (OSA) is suggested to affect periodontal status over time. Our aim was to compare the clinical and radiographic periodontal status of hypertensive patients with or without long-term presence of OSA, treated or untreated with continuous positive airway pressure treatment (CPAP). MATERIALS AND METHODS: In 2007-2009, a screening for OSA was conducted among 394 hypertensive primary care patients. Polygraphy was used to create three groups: no OSA, non-CPAP, or adherent CPAP based on the apnea hypopnea index (AHI). After 10 years, a cross-sectional sleep and periodontal examination including a clinical and radiographic examination, a questionnaire, and a matrix metalloproteinase-8 (MMP-8) chair-side test was conducted. Based on levels of alveolar bone, bleeding on probing (BoP), and probing pocket depth (PPD), patients were categorized into four periodontal stages: periodontal health/gingivitis and three periodontal disease stages. Periodontal status and periodontal stages were compared between the OSA (n = 49), non-CPAP (n = 38), or adherent CPAP (n = 34) groups. RESULTS: The 121 patients (53% women) had a median age of 71 years. No differences were seen between the OSA groups regarding median number of teeth (p = .061), teeth/implants, (p = .107), plaque index (p = .245), BoP (p = .848), PPD ≥ 4 mm (p = .561), PPD ≥ 6 mm (p = .630), presence of MMP-8 (p = .693) except for bone loss (p = .011). Among patients with stage periodontal health/gingivitis a significant difference was seen, as 70% of those were categorized as no OSA, 20% as non-CPAP, and 10% as adherent CPAP (p = .029). Differences were not seen in periodontal disease stages. CONCLUSIONS: Hypertensive patients with obstructive sleep apnea (OSA) did not have an adverse clinical periodontal status compared to patients without OSA. However, when combining radiographic and clinical status into periodontal stages, patients without OSA more

ObjectivesAnterior active rhinomanometry (AAR) is widely used in Swedish routine clinical practice to decide if septoplasty is necessary. The scientific basis for the method needs to be strengthened. Therefore, the aims were to evaluate nasal airway resistance (NAR), paradoxical reactions to pharmacological decongestion, and test-retest characteristics of the Rhino-Comp (R) AAR in healthy subjects.MethodsA prospective longitudinal design was used. AAR was performed before and after decongestion at baseline and after >= 6 months on 60 healthy volunteers. The relationships between NAR, height, weight, BMI, sex, and allergic rhinitis were evaluated by regression analyses. Descriptive statistics were used to evaluate paradoxical reactions. Test-retest and repeatability characteristics were evaluated with intra-class coefficients (ICC), Cronbachs alpha, and standard error of measurementResultsNo statistically significant differences were found between genders or nasal cavity sides. NAR was statistically significantly related to height. Short- and long-term test-retest characteristics were good with ICC and Cronbachs alpha > .75. The minimal significant difference in NAR Log10V2 values between the two measurements was 0.11 and 0.09 (long- and short-term). Paradoxical reactions to pharmacological decongestion were rare, mostly weak, and not evidently reproducible.ConclusionIn this study, we report reference data for healthy subjects, test-retest capabilities, and the minimal relevant difference between two measurements for the Rhino-Comp (R) AAR, information that is vital and necessary for the appropriate use of AAR in clinical practice. An effective method for pharmacological decongestion is described and recommended for future studies and clinical practice. Paradoxical reactions to pharmacological decongestants exist but maybe without clinical significance.Level of EvidenceNA., Funding Agencies|The SNOT 22 was used under a license agreement with Washington University, USA

All Nordic countries have set ambitious targets to achieve net-zero greenhouse gas emissions through various national goals and legislation. Carbon Capture and Storage (CCS) has a key role in strategies to achieve net-zero emissions through mitigating emissions from fossil fuels and removing CO2 permanently from the atmosphere. This project aimed to analyse regulatory aspects that are relevant for deployment of CCS-based mitigation options in a Nordic context. The report identifies similarities and differences between the Nordic countries concerning CCS regulation, barriers to CCS deployment due to regulatory frameworks, and currently ongoing regulatory development aimed at promoting responsible CCS deployment. Recommendations are provided concerning areas where further development, coordination, and capacity building might be prioritised by the Nordic countries.

Oral health is a multifaceted and changeable part of our overall health and well-being as it contributes to important everyday functions such as eating, talking, and conveying feelings. Our oral health can be affected by a range of determinants, one of which is obstructive sleep apnea [OSA] treated with continuous positive airway pressure [CPAP]. Even though xerostomia has been frequently reported upon, the possible relationship between oral health and CPAP-treated OSA is not clearly understood. The World Dental Federation [FDI] recently proposed a definition and theoretical framework of oral health, intended to be globally applicable and to move dentistry toward a more promotive approach. By using the FDI’s framework as a basis for exploration, studies in a general population can increase the understanding of different aspects of oral health and set the frame of reference for whether and how CPAP-treated OSA can be experienced to affect a person’s oral health. The overall aim of this thesis was to gain a deeper understanding of how the FDI’s theoretical framework of oral health can be applied in a general population and how oral health is experienced in a specific population of persons with increased risk for adverse oral health. The FDI’s framework was explored with empirical data from a general population (N=630) and a population of persons with experience of CPAP-treated OSA (N=18). In papers I and II, the FDI framework was tested and evaluated with quantitative methods (principal component analysis and structural equation modeling), using cross-sectional data from the Jönköping studies. In papers III and IV, qualitative methods (directed content analysis and critical incident technique) were used where personal views and experiences were explored using individual semi-structured interviews. The findings in paper I showed that factors such as dental caries, periodontal disease, experience of xerostomia, and aesthetic satisfaction can be included in the FDI’s com

Over the past two decades, the emergence of multiple carbon market segments has led to fragmentation of governance of international carbon markets. International baseline-and-credit systems for greenhouse gas mitigation have been repeatedly expected to wither away, but show significant resilience. Still, Parties to the Paris Agreement have struggled to finalize rules for market-based cooperation under Article 6, which are still being negotiated. Generally, there is tension between international top-down and bottom-up governance. The former was pioneered through the Clean Development Mechanism under the Kyoto Protocol and is likely to be utilized for the Article 6.4 mechanism, while the latter was used for the first track of Joint Implementation and will be applied for Article 6.2. Voluntary carbon markets governed bottom-up and outside the Kyoto Protocol by private institutions have recently gained importance by offering complementary project types and methodological approaches. The clear intention of some Parties to use market-based cooperation in order to reach their nationally determined contributions to the Paris Agreement have led to an ongoing process of navigating the alignment of these fragmented carbon market instruments with the implementation of nationally determined contributions and Paris Agreement's governance architecture. We discuss emerging features of international carbon market governance in the public and private domain, including political and technical issues. Fragmented governance is characterized by different degrees of transparency, centralization, and scales. We assess the crunch issues in the Article 6 negotiations through the lens of these governance features and their effectiveness, focusing on governance principles and their operationalization to ensure environmental integrity and avoid double counting.

Continuous positive airway pressure is a common and effective treatment for obstructive sleep apnea, but adherence remains an issue. Both obstructive sleep apnea and oral diseases are associated with cardiovascular diseases, and as oral dryness contributes to treatment abandonment, oral health is of importance for this patient group. The aim was therefore to explore how persons with continuous positive airway pressure-treated obstructive sleep apnea experience situations associated with their oral health, and which actions they take to manage these. An explorative and descriptive design was adopted using the critical incident technique. Based on a purposeful selection, 18 adults with long-term experience of continuous positive airway pressure-treatment were interviewed using a semi-structured interview guide. Both negative and positive situations were described. Negative situations consisted of challenges with breathing, including mouth-breathing, choking sensations, problems with night-time and daytime oral dryness, changes in the saliva composition, and deteriorating oral health. Positive situations included experiences of reduced mouth-breathing and oral dryness. The situations were often successfully managed by mimicking daytime movements, changing sleeping position, adjusting the CPAP-device and mask, increasing oral hygiene efforts, drinking water, using a humidifier or chinstrap, or contacting their oral healthcare clinic. Long-term experience of persons with continuous positive airway pressure-treated obstructive sleep apnea regard situations and actions from everyday life. Successful management can contribute to long-term adherence and decrease negative effects on oral health. More interdisciplinary collaborations could enable identification and adequate recommendations for persons who experience negative situations during their continuous positive airway pressure treatment., Funding Agencies|Jonkoping University, Sweden; International Federation of Dental Hygiene [IFDH]; Medical Research Council of Southeast Sweden [FORSS-847071, FORSS-931569]; Proxident

An increasing number of non-state actors are taking steps towards and beyond carbon neutrality and making claims about their contribution to global climate action. The voluntary use of carbon credits is one way to support more, earlier and faster climate action than what would be possible with own emission reductions alone, if high environmental and social integrity is ensured. The Nordic Dialogue on Voluntary Compensation brought together Nordic stakeholders to co-create guidance for the robust voluntary use of carbon credits in line with the long-term goals of the Paris Agreement and the UN Sustainable Development Agenda. This report summarises Nordic perspectives on best practice for the voluntary use of carbon credits and related claims, and recommendations for further Nordic cooperation in this field.

This chapter looks at enhanced direct Access (EDA), an innovative programmatic access modality for multilateral climate funds under which funding decisions are delegated to the recipient national or sub-national level. It begins by looking at historic precursors, such as the Marshall Plan in Germany, and then turns to discuss the evolution of EDA in international climate finance, and ends with conclusions on the way forward.

Introduction Oral health is part of general health, and oral diseases share risk factors with several non-communicable diseases. The World Dental Federation (FDI) has published a theoretical framework illustrating the complex interactions between the core elements of oral health (CEOHs): driving determinants, moderating factors, and general health and well-being. However, the framework does not specify which self-reported or clinical measurements to be included in the CEOHs. Objectives To explore oral health measurements relevant for a general adult population to be included in the CEOHs in the FDIs theoretical framework of oral health. Materials and methods A psychometric study was performed, using cross-sectional data from Sweden (N = 630, 54% women, mean age 49.7 years). The data set initially consisted of 186 self-reported and clinical measurements. To identify suitable measurements, the selection was discussed in different settings, including both experts and patients. Principal component analyses (PCAs) were performed to explore, reduce and evaluate measurements to be included in the three CEOHs. Internal consistency was estimated by Cronbachs Alpha. Results The validation process yielded 13 measurements (four clinical, nine self-reported) in concordance with the CEOHs. PCAs confirmed robust validity regarding the construction, predicting 60.85% of variance, representing psychosocial function (number of measurements = 5), disease and condition status (number of measurements = 4), and physiological function (number of measurements = 4). Cronbachs Alpha indicated good to sufficient internal consistency for each component in the constructs (alpha = 0.88, 0.68, 0.61, respectively). Conclusion In a Swedish general adult population, 13 self-reported and clinical measurements can be relevant to include to operationalise CEOHs in the FDIs theoretical framework., Funding Agencies|Jonkoping University, Sweden; Futurum-Academy for Health and Care, Jonkoping County Council [844881]

Introduction: The World Dental Federation (FDI) has recently proposed a new definition and theoretical framework of oral health. The theoretical framework includes 4 main components and describes the relationships amongst them. In 2020, an international work group proposed the minimum Adult Oral Health Standard Set (AOHSS) of variables to measure oral health, which was mapped onto the FDI's theoretical framework. By using an empirical data set, the proposed variables in the AOHSS and the potential interactions amongst the components of the FDI's theoretical framework can be tested. The purpose of this research was to investigate structural relations of the components of the FDI's theoretical framework of oral health based on data from a general adult population. Methods: Data from a previously conducted Swedish cross-sectional study focusing on oral health were utilised (N = 630; women, 55.2%; mean age, 49.7 years [SD, 19.2]). Variable selection was guided by the AOHSS. Structural equation modeling was used to analyse relationships amongst the components of the FDI's theoretical model (core elements of oral health, driving determinants, moderating factors, and overall health and well-being). Results: The Oral Health Impact Profile (OHIP)-14, xerostomia, and aesthetic satisfaction had statistically significant direct effects on overall health and well-being (p < .05). Driving determinants and moderating factors had statistically significant direct effects on all core elements of oral health (p < .05) except aesthetic satisfaction (p = .616). The predictors explained 24.1% of the variance of the latent variable overall health and well-being. Based on several indices, the proposed model showed acceptable model fit. Conclusions: The FDI's theoretical framework can be used to describe different components of oral health and the relationship amongst them in an adult general population. Further research based on the FDI's theoretical framework in other populations an

The Nordic Dialogue on Voluntary Compensation aims to inform Nordic and international stakeholders on using voluntary compensation of greenhouse gas emissions as part of their broader efforts towards and beyond carbon neutrality. Specifically, the Dialogue’s goal is to promote the high integrity, transparency and harmonisation of voluntary compensation, and alignment with the principles and long-term goals of the Paris Agreement and the United Nations Sustainable Development Goals. This brochure provides an overview of the goals and activities under the Nordic Dialogue on Voluntary Compensation.

Carbon dioxide removal (CDR) poses a significant and complex public policy challenge in the long-term. Presently treated as a marginal aspect of climate policy, addressing CDR as a public good is quickly becoming essential for limiting warming to well below 2 or 1.5°C by achieving net-zero emissions in time – including by mobilization of public and private finance. In this policy and practice review, we develop six functions jointly needed for policy mixes mobilizing CDR in a manner compatible with the Paris Agreement's objectives. We discuss the emerging CDR financing efforts in light of these functions, and we chart a path to a meaningful long-term structuring of policies and financing instruments. CDR characteristics point to the need for up-front capital, continuous funding for scaling, and long-term operating funding streams, as well as differentiation based on permanence of storage and should influence the design of policy instruments. Transparency and early public deliberation are essential for charting a politically stable course of action on CDR, while specific policy designs are being developed in a way that ensures effectiveness, prevents rent-seeking at public expense, and allows for iterative course corrections. We propose a stepwise approach whereby various CDR approaches initially need differentiated treatment based on their differing maturity and cost through R&D pilot activity subsidies. In the longer term, CDR increasingly ought to be funded through mitigation results-oriented financing and included in broader policy instruments. We conclude that CDR needs to become a regularly-provided public service like public waste management has become over the last century.

The study provides guidance on how countries can design NDCs and NDC implementation plans, and use the information presented therein, to promote their Article 6 readiness and enable pursuit of international cooperation under the Paris Agreement in a manner that ensures environmental integrity and promotes transformational change. At the same time, this study aims to inform public and private stakeholders how to take into account NDC targets and implementation plans when designing Article 6 cooperation, setting up related processes and implementing tools.

Carbon dioxide removals (CDR) complementing emission reduction efforts are needed to mitigate climate change. Many technological CDR options that could result in highly permanent removal of CO2 only exist as concepts or in very few pilot installations due to their high cost and lack of non-carbon revenue. By mapping the current public policy and private finance efforts toward CDR Perspectives’ experts find severe gaps. To align with expectations and existing targets, governments and private actors need to take several proactive steps to support and scale up CDR technologies. Only a systematically planned ensemble of policy instruments can ensure alignment with Paris Agreement objectives: One key challenge is to bring down the costs of technology-based options while avoiding rent-seeking. Allocating funding for research, development, and pilot activities transparently, competitively, and with continual assessment is key to ensure efficiency near-term. For effectiveness, and alignment with the long-term perspective of the Paris Agreement a gradual transition to more permanent policy instruments is then required.

This paper was developed by Perspectives Climate Research gGmbH (PCR), with inputs from the Carbon Market Mechanisms Working Group (CMM-WG) and further technical experts consulted. We thank all the working group members and technical experts as well as the numerous survey participants for their input to this paper. The CMM-WG is chaired by PCR and is funded and coordinated in close collaboration with the German Federal Ministry for the Environment, Nature Conservation and Nuclear Safety. The CMM-WG focuses on technical aspects of programmatic and upscaled crediting mechanisms in Article 6 of the Paris Agreement as well as results-based climate finance. The working group aims to facilitate a continuous dialogue on technical issues among key carbon market stakeholders.

The new discussion paper, with inputs from and for the Carbon Market Mechanisms Working Group, explores the ongoing discussions around setting crediting baselines for Article 6 market-based cooperation while securing NDC achievement and aligning carbon markets with long-term decarbonisation pathways. The authors identify opportunities for high environmental integrity but also challenges on the trade-off between dynamic baseline setting and investment security. Ein neues Diskussionspapier, mit Beiträgen von und für die Carbon Market Mechanisms Working Group, untersucht die laufenden Diskussionen um die Festlegung von Baselines für marktbasierte Kooperationen nach Artikel 6 unter Sicherstellung der Erreichung der NDCs und der Ausrichtung der Kohlenstoffmärkte auf langfristige Dekarbonisierungspfade. Die Autoren identifizieren Chancen für hohe Umweltintegrität, aber auch Herausforderungen im Hinblick auf den Kompromiss zwischen der Festlegung dynamischer Baselines und Investitionssicherheit.

This study, commissioned by the Swedish Energy Agency, analyses lessons learned and explores benefits and challenges of applying benchmarks derived from “best available technology” assessments in international market-based cooperation. While there is limited experience in international carbon markets, it is proposed as a baseline setting approach for the Article 6.4 mechanism to increase the mitigation ambition of the mechanism and the share of mitigation that is retained by the host country.