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Bakgrund: För de som överlever en stroke drabbas många av kraftiga funktionsnedsättningar. Nedsatt motorisk funktion är en av de vanligaste funktionsnedsättningarna. Spegelterapi är en relativt ny behandlingsmetod som visats ha god effekt på att återfå funktion. Det finns en kunskapslucka inom området och evidensen kring spegelterapi behöver stärkas. Där spelar litteraturöversikter en väsentlig roll för att uppdatera om det rådande evidensläget samt optimera framtida forskning. Syfte: Att undersöka evidensläget för effekterna av spegelterapi på motorisk funktion i övre extremitet hos personer med hemipares efter stroke i ett subakut och kroniskt stadium. Metod: Studien genomfördes med en litteraturstudie där randomiserade kontrollerade studier inkluderades. Sökningar genomfördes i databaserna PubMed och Cinahl. Artiklarnas enskilda risk för snedvridning granskades enligt PEDro-scale och resultatets sammanvägda tillförlitlighet granskades enligt “Bedömning tillförlitlighet systematisk översikt”. Resultat: Totalt inkluderades nio artiklar där alla bedömdes ha låg risk för snedvridning enligt PEDro-scale. Av de nio visade fem artiklar en signifikant skillnad till interventionsgruppens fördel. Den sammanvägda bedömningen gällande effekten av spegelterapi på motorisk funktion i övre extremitet visade på en låg (++) tillförlitlighet enligt “Bedömning tillförlitlighet systematisk översikt”. Konklusion: Fler än hälften av studierna visade att spegelterapi har effekt och är en säker rehabiliteringsmetod för personer med stroke och nedsatt motorisk funktion i övre extremitet. Ytterligare forskning av hög kvalitet behövs för att säkert kunna styrka dess effektivitet., Background: For those who survive a stroke, many suffer from severe disabilities. Impaired motor function function is one of the most common disabilities. Mirror therapy is a relatively new treatment method that has been shown to be effective in regaining function. There is a knowledge gap in this area, and the evidence regarding mirror therapy needs to be strengthened. Literature reviews play an essential role in updating the current state of evidence and optimizing future research. Purpose: To investigate the evidence regarding the effects of mirror therapy on motor function in the upper extremities of individuals with hemiparesis following stroke in a subacute and chronic stage. Method: The study was conducted through a literature review, including randomized controlled trials. Searches were conducted in the PubMed and Cinahl databases. The individual risk of bias of the articles was assessed using the PEDro scale, and the combined reliability of the results was assessed using the “Bedömning tillförlitlighet systematisk översikt”. Results: In total, nine articles were included, all assessed to have low risk of bias according to the PEDro scale. Of these nine, five articles demonstrated a significant advantage for the intervention group. The combined assessment regarding the effect of mirror therapy on upper extremity motor function showed low (++) reliability according to the "Bedömning tillförlitlighet systematisk översikt" Conclusion: More than half of the studies showed that mirror therapy is effective and a safe rehabilitation method for individuals with stroke and impaired motor function in the upper extremity. Further high-quality research is needed to definitively confirm its effectiveness.

Purpose: People age at different rates and the available evidence suggests that the rate of aging is partly inherited from previous generations. This heterogeneity in aging is evident already in midlife, but to what extent aging is associated with the timing of events earlier in life is not fully known. Here we aim to shed light on this topic by investigating the trade-off between reproduction and aging postulated by evolutionary theories of aging. Methods: Drawing on the inheritance of aging we use parental age at death as a proxy for aging-rates in the offspring, and study how age at first birth depends on this variable. We use data from an almost complete Swedish birth cohort comprising 92,359 individuals. Accelerated failure time models are used to estimate the association between parental age at death and age at first birth while adjusting for parental occupational class, educational attainment, and income. Results: Longer parental lifespans were consistently associated with older age at first births, both in men and women. Conclusion: Our findings suggest that aging-related processes may be interrelated with the processes underlying the timing of reproduction and are in general agreement with evolutionary theories of aging.

Magnetic resonance imaging (MRI) is a powerful imaging tool for diagnostics, which AMRA uses to segment and quantify certain anatomical regions. This thesis investigate the possibilities of using deep learning for the particular task of AMRAs segmentation, both for ordinary regions (fat and muscle regions) and injured muscles.The main approach performs muscle and fat segmentation separately, and compares results for three approaches; a full resolution approach, a down-sample approach (trained on down-sampled images) and an ensemble approach (uses voting among the 7 best networks).The results shows that deep learning segmentation is possible for the task, with satisfactory results. The down-sampled approach works best for fat segmentation, which can be related to the inconsistently over-segmented ground truth fat masks. It is therefore unnecessary with the additional resolution, which might only impair the performance. The down-sampled approach achieves better results also for muscle segmentation. Ensemble learning does in general not improve the neither the segmentation dice score nor the biomarker predictions. Injured muscles are more difficult to predict due to smaller muscles in the particular used dataset, and an increased data versatility. As a summary, deep learning shows great potential for the task. The results are overall satisfactory (mostly for a down-sampled approach), but further work needs to be done for injured muscles in order to make it clinically useful.

Kvaliteten på skolgårdar som utemiljö är mycket viktig för barn i deras vardag. En väl utformad utemiljö uppmuntrar till och möjliggör lek, vilket i sin tur är behövligt för barnens utveckling, hälsa och välmående. Detta arbete syftar till att undersöka hur lekvärden inkluderas på en nyanlagd skolgård i Uppsala kommun, vilket relateras till forskningsstudier och riktlinjer. Med hjälp av dokumentstudier undersöks kvaliteter för barns utemiljöer med relevans för skolgårdar där fokus läggs på lekvärden och grönska. En analys av Tiundaskolans skolgård görs sedan med utgångspunkt i dokumentstudierna samt en platsanalys där lekvärden och grönska inventeras. Även plan- och bygglagen samt riktlinjer för barns utemiljöer ligger till grund för analys och diskussion. Vid analysen framgick att skolgården innehåller många lekvärden men att den också är bristfällig i många avseenden, framförallt gällande tillgången till växtlighet samt skolgårdens storlek på friyta. Hårdgjorda ytor och bollplaner utgör stora delar av skolgårdens yta på bekostnad av vad som kan ge eller utgöra andra potentiella lekvärden. Slutsatsen av arbetet är att Tiundaskolans skolgård innehåller flertalet värden men att omfattande brister i utformning och kvaliteter, vad gäller framförallt ytstorlek och grönska, begränsar dess möjlighet att möta barns behov och att utgöra en god miljö för skolbarnen., The quality of school yards as outdoor spaces is of great importance for children in their everyday lives. A well designed outdoor space encourages and makes play possible, which in turn is needful to children's development, health and wellbeing. This work intends to examine how play values are included in a newly built school yard in Uppsala in Sweden. This in turn, gets related to academic studies and official guidelines. Document studies are used to survey values for children's spaces, with relevance to school yards, where focus is placed on play values and greenery. An analysis of the school yard belonging to Tiundaskolan is then carried out with the document studies as basis along with a place analysis in which play values and greenery are examined. The Swedish Planning and Building Act and official guidelines are also addressed in relation to the school yard in the analysis and discussion. The analysis showed that many play values are present while the school yard also is lacking in many ways, primarily in regards to greenery and the size of the schoolyard. Impervious surfaces and playing surfaces for ball sports cover large parts of the schoolyards area at the expense of what could otherwise contribute to other potential play values. The conclusion is that the school yard belonging to Tiundaskolan has a number of play values, but that the design and qualities are substantially lacking in regards to above all the areas size and greenery, and that this limits the possibilities to meet children's needs and compose a good environment for schoolchildren.

We read with interest the recent paper by Sariaslan et al.1 investigating the associations between childhood family income and three outcomes observed later in life: psychiatric disorders, substance misuse and violent crime arrests. The paper contains a careful analysis of a large and relevant dataset of more than 650 000 individuals born in Finland in 1986–96, who were followed from age 15, when income was assessed, until 2017 or 2018. The authors use two types of analysis in the paper: one in which differences in the outcomes are accounted for by variability in income between families (henceforth between-family analysis) and one, the so-called sibling comparison, in which outcome differences are accounted for only by income variability within families (henceforth within-family analysis). In the between-family analysis, the authors find consistent associations between a number of related estimates of childhood family income and the three outcomes (e.g. Figure 2 in the paper). However, and this is the main finding of the paper, these associations between income and the three outcomes completely disappear in the within-family analysis. From this, the authors conclude that ‘[a]ssociations between childhood family income and subsequent risks … were not consistent with a causal interpretation’.

Background: In Sweden, approximately 1000 persons per year are committed to compulsory care for substance abuse for a maximum duration of six months. People admitted to compulsory care are known to suffer high mortality risks, but whether the risk of dying is further heightened immediately after discharge is not known. Methods: Individual data from Swedish national registers were used to follow all persons discharged from a six months compulsory care episode in the period 2000–2017 (N = 7, 929). Based on a competing risks framework including re-admissions to compulsory care or imprisonment, hazard rates were estimated in five non-overlapping time windows covering the first year after discharge. Results: In total, 494 persons died during follow-up, corresponding to an overall mortality rate of 7.1 per 100 person years (95% confidence interval: 6.5, 7.8). The risk was higher for men than for women and increased with age. The risk of dying during the first two weeks after discharge was higher than during the remaining follow-up period – hazard rate ratios comparing the first two weeks with subsequent time windows were between 2.6 (1.3, 5.0) and 3.7 (2.4, 5.9). This heightened risk in close proximity to discharge was only observed for deaths due to external causes, and only for people below the median age of 36 years. Conclusions: The risk of dying immediately after discharge from compulsory care is very high, especially for younger clients, and more efforts should be made to prevent these deaths.

This article analyzes civil–military relations and the issue of civilian control through the lens of new managerialism. It illustrates that the means and mechanisms applied by governments to govern the military actually shape its organization and affect its functions in ways not always acknowledged in the civil–military debate. We start by illustrating the gradual introduction of management reforms to the Swedish Armed Forces and the growing focus on audit and evaluation. The article thereafter analyzes the consequences of these managerialist trends for the most central installation of the armed forces–its headquarters. It further exemplifies how such trends affect the work of professionals at the military units. In conclusion, managerialist reforms have not only changed the structure of the organization and the relationship between core and support functions but have also placed limits on the influence of professional judgment., Governing public professions: Performance management and professional autonomy in the police and military

This paper focuses on the professionalization project of the Swedish military and police and the interplay between profession and organization. Previous literature has suggested that the relationship between professions and organizations are crucial for understanding matters such as organizational change and the development of professional work. Against this background, we start with the assumption that the relationship between professions and organizations is an important variable also for the development and evolvement of professionalization undertakings. We start by mapping ambitions and concrete measures, undertaken from the 1990s onwards, to professionalize these two forces. Following the understanding of professionalization as the scientification of work, we study changes in officer education as well as ambitions to increase the linkage between research and the conduct of professional work. We thereafter analyze to what extent the receiving end has adopted to the input side of these reforms, by studying the importance of scientification when it comes to what knowledge base officers rely on when conducting work; the linkage between scientification and admission, promotion and the status of officers as teachers or researchers. We conclude that there is no immediate correlation between efforts to reform these professional groups and their impact on the organization. Despite similar ambitions by the state, the Swedish military and police have responded differently. We further conclude that for externally initiated professionalization reforms to have an effect, they cannot solely target the professional groups, but also the organization., Shirin Ahlbäck Öberg is noted as presenter on the conference presentation abstract page, Governing public professions: Performance management and professional autonomy in the police and military

Influenza viruses have caused disease outbreaks in human societies for a long time. Influenza often has rapid onset and relatively short duration, both in the individual and in the population. The case fatality rate varies for different strains of the virus, as do the effects on total mortality. Outbreaks related to coronavirus infections have recently become a global concern but much less is known about the dynamics of these outbreaks and their effects on mortality. In this work, disease outbreaks in Sweden, in the time period of 1860-2020, are characterized and compared to the currently ongoing COVID-19 outbreak. The focus is on outbreaks with a sharp increase in all-cause mortality. Outbreak onset is defined as the time point when death counts start to increase consistently for a period of at least 10 days. The duration of the outbreak is defined as the time period in which mortality rates are elevated. Excess mortality is estimated by standard methods. In total there were 15 outbreaks detected in the time period, the first 14 were likely caused by influenza virus infections, the last by SARS-CoV-2. The mortality dynamics of the SARS-CoV-2 outbreak is shown to be similar to outbreaks due to influenza virus, and in terms of the number of excess deaths, it is the worst outbreak in Sweden since the Spanish flu of 1918-1919.