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INTRODUCTION: If a family is discharged from a hospital earlier after birth, close supervision by a skilled midwife is essential. The aim was to describe mothers' overall experience receiving postnatal care in a Swedish home-based midwifery care model. METHODS: A descriptive qualitative study was conducted. Mothers meeting the inclusion criteria for a new home-based postnatal care model at a hospital in Stockholm, Sweden, were included. In total, 24 healthy mothers participated in a semi-structured telephone interview, averaging 58 minutes. Data were analyzed using thematic analysis, according to Braun and Clarke. RESULTS: The main theme explored, `The home-based postnatal care model facilitated a smooth succession into motherhood', is explained by the themes: 1) Mothers felt `not left adrift' when cared for by the home-based postnatal midwives; 2) Professional midwives with authority guided the way into motherhood; and 3) The home, a safe and secure space for new mothers. CONCLUSIONS: Mothers valued the well-structured home-based postnatal midwifery care. Important for mothers was to receive health checks, adequate information, and that midwives have a kind and individual approach to the families. Midwives play an important role for mothers in the early days after the birth of their baby.

BACKGROUND: Midwifery continuity models of care are highly recommended yet rare in Sweden, although approximately 50% of pregnant women request them. Before introducing and scaling up continuity models in Sweden, midwives' attitudes about working in continuity models must be investigated. OBJECTIVE: to investigate Swedish midwives' interests in working in midwifery continuity models of care and factors influencing the midwifery workforce's readiness for such models. METHODS: A cross-sectional online survey was utilised and information collected from a national sample of midwives recruited from two unions regarding background and work-related variables. Crude and adjusted odds ratios and logistic regression analysis were used in the analysis. RESULTS: A total of 2084 midwives responded and 56.1% reported an interest. The logistic regression model showed that respondents' ages 24-35 years (OR 1.73) or 35-45 years (OR 1.46); years of work experience 0-3 years (OR 5.81) and 3-10 years (OR 2.04); rotating between wards or between tasks (OR 2.02) and working temporary (OR 1.99) were related to interest in continuity models. In addition, working daytime only (OR 1.59) or on a two-shift schedule (OR 1.93) was associated with such interest. CONCLUSION: A sufficient number of midwives in Sweden appear to be interested in working in continuity models of midwifery care to align with women's interest in having a known midwife throughout pregnancy, birth and postpartum period. Developing strategies and continuity models that will address the preferences of women in various areas of Sweden is important for offering evidence-based maternity services.

Objective: The aim of this paper was to compare current perceptions of empowerment in their work with results from a sample of midwives recruited 2012. Design: A comparative cross-sectional cohort study of national samples of midwives in Sweden from 2012 to 2022. Participants: 475 midwives recruited from the Swedish midwifery association in 2012 and 1782 through two midwifery unions in 2022. Methods: Data were collected using a questionnaire with background information and the revised version of the Perception of Empowerment Scale (PEMS). Mean scores and domains of the PEMS were compared between the years. Findings: Midwives' perceptions of empowerment changed over time, in both directions. Their perception of their skills and education, advocating for and empowering women as well as support from the team and manager increased over the years. Midwives in 2022 were less likely to perceive that they were involved in a midwifery-led practice, and the communication with managers was rated lower. Midwives sensed a lack of professional recognition from the medical profession and their contribution to the care of birthing women. Access to resources for birthing women was perceived lower in 2022 compared to 2012. Younger age, shorter work experience and working in labour wards or postnatal wards were associated with lower perceptions of empowerment. Conclusions: Midwives need to have the authority and reality to practice midwife-led care, to receive control over their work. Good communication and recognition from the medical profession is essential to be empowered. This is important in order to maintain a healthy workforce.

INTRODUCTION: Childbirth is a life-changing event where fathers desire being involved. As fathers take a more active role, fear of childbirth can arise. The aim of this study was to explore fathers' experiences of childbirth fear during pregnancy and after the birth of their baby. METHODS: This was a qualitative longitudinal prospective study that included 14 interviews with seven fathers, one during the prenatal period, and one follow-up interview after childbirth. Data were analyzed using thematic analysis according to Braun and Clark. RESULTS: The main theme 'Being vulnerable during the transition to fatherhood' was based on the perception of childbirth as risky with threats toward the woman's and baby's health, not being able to give and receive enough support, unable to handle the unknown process of birth, and not being a good father. Helpful strategies for coping with fear were to talk about fear, to learn more about childbirth and techniques on how to handle fear, and to avoid dealing with fear. Fathers' fear of childbirth changed after the birth of their baby. Their thoughts of another childbirth did not evoke the same strong feelings of fear. Issues important for the reduction of childbirth fear were: receiving professional support, actively taking part in the childbirth process, and the partner having an uncomplicated birth. CONCLUSIONS: Fathers with childbirth fear regarded childbirth as risky, but they expressed helpful coping strategies. After the birth of their baby, they became less fearful. Quality of fear-reducing support to expectant fathers may influence how they cope with their transition into fatherhood.

Introduction Cultural doulas have a unique role in providing support to foreign-born women and improving their reproductive health. The aim was to explore cultural doulas' experiences of giving support to foreign-born women during pregnancy and after childbirth. Methods A qualitative descriptive study with an inductive approach included six cultural doulas in Sweden. Individual semi-structured interviews were conducted, and the data were analyzed with qualitative content analysis. Results The theme 'To lead the way with pride' was explored and described by the categories: A rewarding mission, A personal guide, and Makes the new society understandable. The cultural doulas gave support in the women's mother tongue, something they experienced had contributed to reducing the risk of misunderstanding between women and healthcare professionals. The cultural doulas found their work important because the support they provided to women made healthcare more available to them. Conclusions The cultural doulas felt proud when they experienced their work as meaningful and important. It was clear to them that their support and guidance had a positive impact on the women's reproductive health as well as their integration into Swedish society. Cultural doulas could play an important role in building equal maternal healthcare in Sweden.

There is evidence that continuity models of midwifery care benefit women and babies in terms of less birth interventions and higher maternal satisfaction. Studies about continuity models in a Swedish context are lacking.The aim of this study was to describe how women experience continuity of midwifery care in a Swedish rural area, and thereby provide a deeper understanding of what this care entails for women.A qualitative interview study using thematic analysis was carried out. Telephone interviews were conducted with 33 women who participated in a continuity of midwifery care project in a rural area of Sweden.The overarching theme 'a longing for a sense of security', pervaded the three main themes: 'The importance of professional midwifery care', 'Continuity of midwifery - fulfilled expectations or full of disappointments' and 'New prerequisites - acceptable to some, but not a substitute for everyone', which explains different aspects affecting the feeling of security. The endeavour to feel secure during pregnancy, birth and postpartum was a continually recurring subject that cannot be overstated.Continuity of midwifery care strengthened women's feelings of security during pregnancy, birth and postpartum. The deepened relationship developed over time was a central part of the positive aspects of the experience of continuity in midwifery care. Expectations and prerequisite circumstances are important to consider when developing and introducing new care models. Service providers and decision makers should pay attention to and prioritise this relational aspect when planning care for women during the childbearing period.

Arctic observing and data systems have been widely recognized as critical infrastructures to support decision making and understanding across sectors in the Arctic and globally. Yet due to broad and persistent issues related to coordination, deployment infrastructure and technology gaps, the Arctic remains among the most poorly observed regions on the planet from the standpoint of conventional observing systems. Sustaining Arctic Observing Networks (SAON) was initiated in 2011 to address the persistent shortcomings in the coordination of Arctic observations that are maintained by its many national and organizational partners. SAON set forth a bold vision in its 2018 – 28 strategic plan to develop a roadmap for Arctic observing and data systems (ROADS) to specifically address a key gap in coordination efforts—the current lack of a systematic planning mechanism to develop and link observing and data system requirements and implementation strategies in the Arctic region. This coordination gap has hampered partnership development and investments toward improved observing and data systems. ROADS seeks to address this shortcoming through generating a systems-level view of observing requirements and implementation strategies across SAON’s many partners through its roadmap. A critical success factor for ROADS is equitable participation of Arctic Indigenous Peoples in the design and development process, starting at the process design stage to build needed equity. ROADS is both a comprehensive concept, building from a societal benefit assessment approach, and one that can proceed step-wise so that the most imperative Arctic observations—here described as shared Arctic variables (SAVs)—can be rapidly improved. SAVs will be identified through rigorous assessment at the beginning of the ROADS process, with an emphasis in that assessment on increasing shared benefit of proposed system improvements across a range of partnerships from local to global scales. The success of the ROADS process will ultimately be measured by the realization of concrete investments in and well-structured partnerships for the improved sustainment of Arctic observing and data systems in support of societal benefit. Available here.

Active layer probing in northern Sweden, northeast Greenland, and central Svalbard indicates active layer thickening has occurred at Circumpolar Active Layer Monitoring (CALM) sites with long‐term, continuous observations, since the sites were established at these locations in 1978, 1996, and 2000, respectively. The study areas exhibit a reverse latitudinal gradient in average active layer thickness (ALT), which is explained by site geomorphology and climate. Specifically, Svalbard has a more maritime climate and thus the thickest active layer of the study areas (average ALT = 99 cm, 2000–2018). The active layer is thinnest at the northern Sweden sites because it is primarily confined to superficial peat. Interannual variability in ALT is not synchronous across this Nordic Arctic region, but study sites in the same area respond similarly to local meteorology. ALT correlates positively with thawing degree days in Sweden and Greenland, as has been observed in other Arctic regions. However, ALT in Svalbard correlates with freezing degree days, where the maritime Arctic climate results in relatively high and variable winter air temperatures. The difference in annual ALT at adjacent sites is attributed to differences in snow cover and geomorphology. From 2000 to 2018, the average rate of active layer thickening at the Nordic Arctic CALM probing sites was 0.5 cm/yr. The average rate was 1 cm/yr for Nordic Arctic CALM database sites with significant trends, which includes a borehole in addition to probing sites. This range is in line with the circum‐Arctic average of 0.8 cm/yr from 2000 to 2018. (Less)

The Circumpolar North has been changing rapidly within the last decades, and the socioeconomic systems of the Eurasian Arctic and Siberia in particular have displayed the most dramatic changes. Here, anthropogenic drivers of environmental change such as migration and industrialization are added to climate-induced changes in the natural environment such as permafrost thawing and increased frequency of extreme events. Understanding and adapting to both types of changes are important to local and indigenous peoples in the Arctic and for the wider global community due to transboundary connectivity. As local and indigenous peoples, decision-makers and scientists perceive changes and impacts differently and often fail to communicate efficiently to respond to changes adequately, we convened a meeting of the three groups in Salekhard in 2017. The outcomes of the meeting include perceptions of how the three groups each perceive the main issues affecting health and well-being and recommendations for working together better. Electronic supplementary material The online version of this article (doi:10.1007/s13280-019-01277-9) contains supplementary material, which is available to authorized users.

Background The goal of postnatal care is to provide the highest possible quality of care and medical safety with the least possible intervention in order to optimize health and wellbeing of the new family. The aim of the study was to describe mothers´ experiences in relation to a new postnatal home-based model of midwifery care. Methods The current study uses a cross-sectional mixed method design to assess a new postnatal home-based model of midwifery care in Sweden. Healthy women with an uncomplicated pregnancy and childbirth, and with a healthy baby answered an online questionnaire one week after birth. Data were collected during one year (2017–2018) and analyzed using descriptive and inferential statistics for quantitative data, and manifest content analysis for qualitative data. Findings In total, 180 mothers with one to six children were included. They were most likely to have been discharged between six and 12 h after childbirth (56%) and 90% reported that the time for their discharge was good. The postnatal check-ups included were telephone contact (100%), home visit(s) (94%) and hospital visit(s) (98%). Most mothers had a positive postnatal care experience from using the new postnatal model of midwifery care (mean VAS 8.74, Std. Deviation 1.438). For 75%, of the participants, home-based postnatal care would be preferred for their next childbirth. Conclusion Home-based postnatal care is well accepted by mothers who were discharged early after childbirth. Mothers with a positive experience of the new postnatal model of midwifery care would prefer home-based postnatal care for their next childbirth. Midwifery care should include home-based postnatal care.

Winter warming events (WWE) in the Swedish subarctic are abrupt and short-lasting (hours-to-days) events of positive air temperature that occur during wintertime, sometimes accompanied by rainfall (rain on snow; ROS). These events cause changes in snow properties, which affect the below-ground thermal regime that, in turn, controls a suite of ecosystem processes ranging from microbial activity to permafrost and vegetation dynamics. For instance, winter melting can cause ground warming due to the shortening of the snow cover season, or ground cooling as the reduced snow depth and the formation of refrozen layers of high thermal conductivity at the base of the snowpack facilitate the release of soil heat. Apart from these interacting processes, the overall impacts of WWE on ground temperatures may also depend on the timing of the events and the preceding snowpack characteristics. The frequency and intensity of these events in the Arctic, including the Swedish subarctic, has increased remarkably during the recent decades, and is expected to increase even further during the 21st Century. In addition, snow depth (not necessarily snow duration) is projected to increase in many parts of the Arctic, including the Swedish subarctic. In 2005, a manipulation experiment was set up on a lowland permafrost mire in the Swedish subarctic, to simulate projected future increases in winter precipitation. In this study, we analyse this 15-year record of ground temperature, active layer thickness, and meteorological variables, to evaluate the short- (days to weeks) and long-term (up to 1 year) impacts of WWE on the thermal dynamics of lowland permafrost, and provide new insights into the influence of the timing of WWE and the underlying snowpack conditions on the thermal response of permafrost. On the short-term, the thermal responses to WWE are faster and stronger in areas with a shallow snowpack (5-10 cm), although these responses are more persistent in areas with a thicker snowpack (>25 cm), especially after ROS events. On the long term, permafrost in areas with a thicker snowpack exhibit a more durable warming response to WWE that results in thicker active layers at the end of the season. On the contrary, we do not observe a correlation between WWE and end of season active layer thickness in areas with a shallow snowpack.

Arctic and subarctic ecosystems are experiencing substantial changes in hydrology, vegetation, permafrost conditions, and carbon cycling, in response to climatic change and other anthropogenic drivers, and these changes are likely to continue over this century. The total magnitude of these changes results from multiple interactions among these drivers. Field measurements can address the overall responses to different changing drivers, but are less capable of quantifying the interactions among them. Currently, a comprehensive assessment of the drivers of ecosystem changes, and the magnitude of their direct and indirect impacts on subarctic ecosystems, is missing. The Torneträsk area, in the Swedish subarctic, has an unrivalled history of environmental observation over 100 years, and is one of the most studied sites in the Arctic. In this study, we summarize and rank the drivers of ecosystem change in the Torneträsk area, and propose research priorities identified, by expert assessment, to improve predictions of ecosystem changes. The research priorities identified include understanding impacts on ecosystems brought on by altered frequency and intensity of winter warming events, evapotranspiration rates, rainfall, duration of snow cover and lake-ice, changed soil moisture, and droughts. This case study can help us understand the ongoing ecosystem changes occurring in the Torneträsk area, and contribute to improve predictions of future ecosystem changes at a larger scale. This understanding will provide the basis for the future mitigation and adaptation plans needed in a changing climate. Electronic supplementary material The online version of this article (10.1007/s13280-020-01381-1) contains supplementary material, which is available to authorized users.

Objective To explore and describe fathers’ experiences of a newly implemented Swedish home-based postnatal care model. Design A descriptive cross-sectional qualitative study was conducted as a part of a larger study. Setting Families who qualified to be discharged early were offered to participate in a postnatal home-based model of midwifery care by a hospital in Stockholm, Sweden. Participants and Measurements In total, 16 fathers participated in a semi-structured telephone interview, averaging 43 minutes. Data were analyzed using systematic text condensation. Findings Three major themes emerged: To decide on home- or hospital-based postnatal care – a matter of safety, To be offered professional midwifery postnatal support at home, and To be at home helped fathers to navigate parenthood. Fathers appreciated the home-based postnatal care and felt safe because of the received professional support from midwives. Key conclusions Home-based postnatal care was valued by fathers whose partner had a non-complicated vaginal birth because they felt safe in their home environment and supported by midwives. The home environment aided fathers in supporting their partners and developing a father-infant bond. Implications for practice Home-based postnatal care was valued by fathers and should be considered an option for new families. To offer home-based postnatal care may result in less overcrowded postnatal wards. Midwives need to enable fathers’ participation and support their parental role regardless of where the care takes place.

Snow and ice are defining environmental characteristics of the polar and alpine regions that are rapidly changing. They provide habitats for some biota and mediate biogeochemical processes. They also modify winter habitats. Snow insulates soil, vegetation, and animals that live under the snow, and it isolates plants from herbivores, and small herbivores from predators. Snow and ice also have physical and mechanical properties that present challenges and opportunities to some plants and animals. In addition, snow and ice affect spring and summer habitats of plants because their duration affects the timing and length of the growing/active period and because snow stores winter precipitation that is released in spring as a water supply for soil organisms and plants. Nutrients and pollutants, accumulated in winter snow, are released during the spring thaw when they have their effects on the biosphere, including on people. However, snow and ice conditions are changing during current global warming resulting in damaging events to plants and animals in many Arctic areas. On the other hand, changing vegetation is affecting snow conditions. Ice cover also provides a habitat and a platform for species such as marine mammals. It isolates marine and freshwater organisms in the water column from light, both beneficial photosynthetically active radiation and harmful ultraviolet-B. On land, permafrost exerts a major influence on biogeochemical cycling, particularly storage and release of carbon, while freeze–thaw cycles generate soil movement that selects for specifically adapted plant roots and limits agriculture.

Snow depth increases observed in some artic regions and its insulations effects have led to a winter-warming of permafrost-containing peatlands. Permafrost thaw and the temperature-dependent decomposition of previously frozen carbon (C) is currently considered as one of the most important feedbacks between the artic and the global climate system. However, the magnitude of this feedback remains uncertain because winter effects are rarely integrated and predicted from mechanisms active in both surface (young) and thawing deep (old) peat layers.Laboratory incubation studies of permafrost soils, in situ carbon flux measurements in ecosystem-scale permafrost thaw experiments, or measurements made across naturally degrading permafrost gradients have been used to improve our knowledge about the net effects of winter-warming in permafrost C storage. The results from these studies, however, are biased by imprecision in long-term (decadal to millennial) effects due to the short time scale of the experiments. Gradient studies may show longer-term responses but suffer from uncertainties because measurements are usually taken during the summer, thus ignoring the long cold season. The need for robust estimates of the long-term effect of permafrost thaw on the net C balance, which integrates year-round C fluxes sets the basis of this study.Here, we quantified the effects of long-term in situ permafrost thaw in the net C balance of a permafrost-containing peatland subjected to a 10-years snow manipulation experiment. In short, we used a peat age modelling approach to quantify the effect of winter-warming on net ecosystem production as well as on the underlying changes in surface C inputs and losses along the whole peat continuum. Contrary to our hypothesis, winter-warming did not affect the net ecosystem production regardless of the increased old C losses. This minimum overall effect is due to the strong reduction on the young C losses from the upper active layer associated to the new water saturated conditions and the decline in bryophytes. Our findings highlight the need to incorporate long-term year-round responses in C fluxes when estimating the net effect of winter-warming on permafrost C storage. We also demonstrate that thaw-induced changes in moisture conditions and plant communities are key factors to predicting future climate change feedbacks between the artic soil C pool and the global climate system.

Snow depth increases observed and predicted in the sub-arctic are of critical importance for the dynamics of lowland permafrost and vegetation. Snow acts as an insulator that protects vegetation but may lead to permafrost degradation. In the Abisko area, in northernmost Sweden, there has been an increasing trend in snow depth during the last Century. Downscaled climate scenarios predict an increase in precipitation by 1.5 - 2% per decade for the coming 60 years. The observed changes in snow cover have affected peat mires in this area as thawing of permafrost, increases in active layer thickness and associated vegetation changes have been reported during the last decades. An experimental manipulation was set up at one of these lowland permafrost sites in the Abisko area (68°20’48’’N, 18°58’16’’E) 15 years ago, to simulate projected future increases in winter precipitation and to study their effect on permafrost and vegetation. The snow cover has been more than twice as thick in manipulated plots compared to control plots and it has had a large impact on permafrost and vegetation. It resulted in statistically significant differences in mean winter and minimum ground temperatures between the control and the manipulated plots. Already after three years there was a statistically significant difference between active layer thickness in the manipulated plots compared to the control plots. In 2019, the active layer thickness in the control plots were around 70 cm whereas in the manipulated plots it was 110 cm. The increased active layer thickness has led to surface subsidence due to melting of ground ice in all the manipulated plots. The increased snow thickness has prolonged the duration of the snow cover in spring with up to 22 days. However, this loss in early season photosynthesis was well compensated for by the increased absorption of PAR and higher light use efficiency throughout the whole growing seasons in the manipulated plots. Eriophorum vaginatum is a species that has been especially favored in the manipulated plots. It has increased both in number and in size. Underneath the soil surface, the roots have also been affected. There has been a strong increase in total root length and growth in the active layer, and deep roots has invaded the newly thawed permafrost in the manipulated plots. The increased active layer thickness has also had an effect on the bacterial community composition in the newly thawed areas. According to past, century-long patterns of increasing snow depth and projections of continuing increases, it is very likely that the changes in permafrost and vegetation that have been demonstrated by this experimental treatment will occur in the future under natural conditions.

The paper focuses on analysis of macro‐ and micromorphological characteristics of relict slope deposits in Serra da Estrela (Portugal) to understand the significance of different slope processes and paleoenvironmental settings. Micromorphology is a useful sedimentology technique allowing significant advances compared to macroscopic techniques. Results show that different processes are involved in the development of the slope deposits, reflecting different environmental conditions. The main processes responsible for the emplacement of the relict slope deposits are solifluction, debris‐flow and runoff, but postdepositional changes are also present. Solifluction was identified in slope deposits between 650 and 1500 m a.s.l. The common microfeatures identified are circular arrangement of grains with a core grain, rounded vesicles, vertical grains, matrix deformations and fine‐grained deposits. Slope deposits above 1300 m a.s.l have a platy microstructure and coincide with the altitudinal range of the relict rock glaciers, indicating the elevation limit of permafrost. Below this altitude platy microstructures are less frequent. Slope deposits in north‐facing slopes were affected by frost‐induced processes in a seasonal frost regime, followed by a postdeposition illuvial phase. Debris‐flow and runoff were identified in slope deposits between 680 and 1260 m a.s.l. The common microfeatures are oblique grains, grain dumps, and coarse and fine grain lineations, and banded microstructures were identified in runoff processes. Debris‐flow deposits have a circular arrangement of grains without a core grain, identified in sediments in paraglacial and periglacial environments. The slope deposits show evidence of past periods of enhanced periglacial activity since the last glaciation until the Younger Dryas. (Less)

Introduction Individuals who are transgender often want a family and want to be validated as fathers, but may lack support in the reproductive health field. The aim of this qualitative study was to explore midwives’ perceptions regarding caring for transmen during labour and birth. Methods Five midwives were recruited from Stockholm-area hospitals, with interviews lasting 17 minutes on average. Qualitative content analysis using an inductive approach was used. Results Our findings describe the challenges midwives face when caring for transmen in childbirth, including a lack of knowledge, confusion on working with transgender, how to provide individualized support, and the complexity of childbirth. Conclusions The midwives faced challenges when caring for transmen in childbirth. Since midwives lacked knowledge regarding best practices to support transmen, they wanted to receive more education on how to care for transmen during birth.

Background The World Health Organization recommends exclusive breastfeeding for 6 months followed by continued breastfeeding with complementary food up to 2 years of age or beyond. Few women achieve this recommendation in Sweden, and they often stop breastfeeding earlier than they would like. Investigating women’s advice to healthcare professionals is important for the provision of optimal breastfeeding support. The aim of this study was to explore women’s advice to healthcare professionals regarding support for continuing to breastfeed for at least 6 months. Methods This investigation used an exploratory study design, and a purposive sample of women was recruited between 2015 and 2016 through social media platforms. The work is a follow-up of an earlier study exploring women’s perceptions of the factors that assisted them in breastfeeding for at least 6 months. Telephone interviews were conducted with 139 Swedish women who reported that they had breastfed for at least 6 months. Women were asked the question, “Do you have any advice that you would like to give to healthcare professionals regarding breastfeeding support?”. The data were analysed using content analysis. Results The theme, “Professionals need to offer women sensitive, individualized breastfeeding support to promote a positive breastfeeding experience”, describes the women’s advice based on five categories: 1) providing evidence-based care, 2) preparing expectant parents during pregnancy, 3) creating a respectful and mutual dialogue, 4) offering individual solutions to breastfeeding problems, and 5) offering practical support. Conclusions This study highlights the importance of professionals providing evidence-based breastfeeding support in a sensitive and individualized manner. This consideration is an important prerequisite to strengthening women’s self-confidence and assisting them in reaching their breastfeeding goals, which may enhance the positive nature of their breastfeeding experience.

Findings on the association between alcohol consumption and bladder cancer are inconsistent. We investigated that association in the European Prospective Investigation into Cancer and Nutrition cohort. We included 476,160 individuals mostly aged 35-70 years, enrolled in ten countries and followed for 13.9 years on average. Hazard ratios (HR) for developing urothelial cell carcinoma (UCC; 1,802 incident cases) were calculated using Cox proportional hazards models. Alcohol consumption at baseline and over the life course was analyzed, as well as different types of beverages (beer, wine, spirits). Baseline alcohol intake was associated with a statistically nonsignificant increased risk of UCC (HR 1.03; 95% confidence interval (CI) 1.00-1.06 for each additional 12 g/day). HR in smokers was 1.04 (95% CI 1.01-1.07). Men reporting high baseline intakes of alcohol (>96 g/day) had an increased risk of UCC (HR 1.57; 95% CI 1.03-2.40) compared to those reporting moderate intakes ( 6 to 24 g/day). Average lifelong alcohol intake was not associated with the risk of UCC, however intakes of spirits > 24 g/day were associated with an increased risk of UCC in men (1.38; 95% CI 1.01-1.91) and smokers (1.39; 95% CI 1.01-1.92), compared to moderate intakes. We found no association between alcohol and UCC in women and never smokers. In conclusion, we observed some associations between alcohol and UCC in men and in smokers, possibly because of residual confounding by tobacco smoking.

Since the publication of the original article, the authors noticed some errors in reference citation had been introduced throughout the paper. The following text contains excerpts from the original article and how they should appear with correct referencing. The publisher apologises for any inconvenience this has caused readers.

Source at https://doi.org/10.1017/S0032247418000645. A lasting legacy of the International Polar Year (IPY) 2007–2008 was the promotion of the Permafrost Young Researchers Network (PYRN), initially an IPY outreach and education activity by the International Permafrost Association (IPA). With the momentum of IPY, PYRN developed into a thriving network that still connects young permafrost scientists, engineers, and researchers from other disciplines. This research note summarises (1) PYRN’s development since 2005 and the IPY’s role, (2) the first 2015 PYRN census and survey results, and (3) PYRN’s future plans to improve international and interdisciplinary exchange between young researchers. The review concludes that PYRN is an established network within the polar research community that has continually developed since 2005. PYRN’s successful activities were largely fostered by IPY. With >200 of the 1200 registered members active and engaged, PYRN is capitalising on the availability of social media tools and rising to meet environmental challenges while maintaining its role as a successful network honouring the legacy of IPY.

Objectives: The objective was to investigate the prevalence of mothers who experienced pain during breastfeeding in the early postnatal period and to describe associated factors. Methods: Medical records of 987 mothers and their babies were scrutinized. Chi-square Test, McNemar's test, and relative risk with a 95% confidence interval were applied for analysis. Results: During the in-hospital postnatal stay, 19.5% mothers experienced pain during breastfeeding. At discharge, the rate was 8.8% (ρ

Permafrost warming has the potential to amplify global climate change, because when frozen sediments thaw it unlocks soil organic carbon. Yet to date, no globally consistent assessment of permafrost temperature change has been compiled. Here we use a global data set of permafrost temperature time series from the Global Terrestrial Network for Permafrost to evaluate temperature change across permafrost regions for the period since the International Polar Year (2007–2009). During the reference decade between 2007 and 2016, ground temperature near the depth of zero annual amplitude in the continuous permafrost zone increased by 0.39 ± 0.15 °C. Over the same period, discontinuous permafrost warmed by 0.20 ± 0.10 °C. Permafrost in mountains warmed by 0.19 ± 0.05 °C and in Antarctica by 0.37 ± 0.10 °C. Globally, permafrost temperature increased by 0.29 ± 0.12 °C. The observed trend follows the Arctic amplification of air temperature increase in the Northern Hemisphere. In the discontinuous zone, however, ground warming occurred due to increased snow thickness while air temperature remained statistically unchanged.

Climate-warming-induced permafrost thaw exposes large amounts of carbon and nitrogen in soil at considerable depths, below the seasonally thawing active layer. The extent to which plant roots can reach and interact with these hitherto detached, deep carbon and nitrogen stores remains unknown. We aimed to quantify how permafrost thaw affects root dynamics across soil depths and plant functional types compared with above-ground abundance, and potential consequences for plant-soil interactions. A decade of experimental permafrost thaw strongly increased total root length and growth in the active layer, and deep roots invaded the newly thawed permafrost underneath. Root litter input to soil across all depths was 10 times greater with permafrost thaw. Root growth timing was unaffected by experimental permafrost thaw but peaked later in deeper soil, reflecting the seasonally receding thaw front. Deep-rooting species could sequester

Objective The aim was to explore what concerns Swedish fathers had about parenting difficulties at two months after the birth of their baby. Methods Self-report questionnaires were used and data were analyzed with mixed methods. Results Thirty percent of the 827 fathers reported concerns about the difficulties of parenthood. The theme ‘Managing the demands of being a father’ emerged and was based on concerns about how to raise the baby, having enough money, health issues, lack of time and finding balance in the new family pattern. Financial worries, feeling less positive about expecting a baby, and self-reported poor emotional health were related to fathers who perceived parenthood as difficult. Conclusion Experienced fathers as well as new fathers expressed similar concerns about parenthood. Preparation classes for reassurance and skills coaching about child raising may provide important support for fathers. This is especially important for fathers who may have poor emotional health or who may not be feeling positive about expecting a baby. Policy-makers and health care providers should recognize that offering support for all fathers benefits not only men, but also their children, and their partners and can help encourage egalitarian practices at home and work.

Sweden has an international reputation for offering high quality maternity care, although models that provide continuity of care are rare. The aim was to explore women's interest in models of care such as continuity with the same midwife, homebirth and birth center care.A prospective longitudinal survey where 758 women's interest in models such as having the same midwife throughout antenatal, intrapartum and postpartum care, homebirth with a known midwife, and birth center care were investigated.Approximately 50% wanted continuity of care with the same midwife throughout pregnancy, birth and the postpartum period. Few participants were interested in birth center care or home birth. Fear of giving birth was associated with a preference for continuity with midwife.Continuity with the same midwife could be of certain importance to women with childbirth fear. Models that offer continuity of care with one or two midwives are safe, cost-effective and enhance the chance of having a normal birth, a positive birth experience and possibly reduce fear of birth. The evidence is now overwhelming that all women should have maternity care delivered in this way.

The decomposition of large stocks of soil organic carbon in thawing permafrost might depend on more than climate change-induced temperature increases: indirect effects of thawing via altered bacterial community structure (BCS) or rooting patterns are largely unexplored. We used a 10-year in situ permafrost thaw experiment and aerobic incubations to investigate alterations in BCS and potential respiration at different depths, and the extent to which they are related with each other and with root density. Active layer and permafrost BCS strongly differed, and the BCS in formerly frozen soils (below the natural thawfront) converged under induced deep thaw to strongly resemble the active layer BCS, possibly as a result of colonization by overlying microorganisms. Overall, respiration rates decreased with depth and soils showed lower potential respiration when subjected to deeper thaw, which we attributed to gradual labile carbon pool depletion. Despite deeper rooting under induced deep thaw, root density measurements did not improve soil chemistry-based models of potential respiration. However, BCS explained an additional unique portion of variation in respiration, particularly when accounting for differences in organic matter content. Our results suggest that by measuring bacterial community composition, we can improve both our understanding and the modeling of the permafrost carbon feedback. A correction to this article has been published. DOI: 10.1038/s41396-019-0384-1

This paper presents results from a risk assessment of recycling pre-treated bottom ash from municipal solid waste incineration as a subbase layer in certain asphalt paved constructions in Sweden. Based on a model for assessing environmental and health risks at contaminated areas, previously developed by the Swedish EPA and by the Swedish Geotechnical Institute, target values for total content and porewater concentrations were calculated. Three different construction sizes and geometries were considered; a 1 km long road of 10 and 20 m width, respectively, and an application of 100 × 300 m. Additionally, different technical solutions of the use of bottom as in road embankments were considered. Compared to risk assessments conducted in other countries, target values are generally higher, but in the same order of magnitude. Total lead concentrations in dust potentially emitted during construction and demolition of the bottom ash is identified as a critical factor. It requires particular attention when planning for or carrying out groundwork constructions with pre-treated bottom ash. As exposure to dust and bioavailaibility of lead in bottom ash are likely to be overestimated by the underlying risk model, higher target values for lead in bottom ash should be possible for the envisaged construction purposes without affecting the general risk level. As no data is available on actual dust production and deposition by constructing and demolishing subbase layers of pre-treated bottom ash, this should be a part of future studies in order to narrow down lead target values.

Northern regions have received considerable attention not only because the effects of climate change are amplified at high latitudes but also because this region holds vast amounts of carbon (C) stored in permafrost. These carbon stocks are vulnerable to warming temperatures and increased permafrost thaw and the breakdown and release of soil C in the form of carbon dioxide (CO2) and methane (CH4). The majority of research has focused on quantifying and upscaling the effects of thaw on CO2 and CH4 emissions from terrestrial systems. However, small ponds formed in permafrost wetlands following thawing have been recognized as hotspots for C emissions. Here, we examined the importance of small ponds for C fluxes in two permafrost wetland ecosystems in northern Sweden. Detailed flux estimates of thaw ponds during the growing season show that ponds emit, on average (±SD), 279 ± 415 and 7 ± 11 mmol C m−2 d−1 of CO2 and CH4, respectively. Importantly, addition of pond emissions to the total C budget of the wetland decreases the C sink by ~39%. Our results emphasize the need for integrated research linking C cycling on land and in water in order to make correct assessments of contemporary C balances.

Background Parents’ birth experiences affect bonding with their infant, which in turn may influence the child’s future health. Parents’ satisfaction with childbirth is multi-dimensional and dependent on both expectations and experiences. Increasing involvement of partners in intrapartum care may lead to an assumption that the birthing couple shares attitudes and expectations of intrapartum care. There is a limited knowledge regarding the uniformity of couples’ experiences of labour and birth. Aim To describe and compare uniformity in couples’ birth experiences of the quality of intrapartum midwifery care. Method A quantitative cross-sectional study nested within a randomised controlled trial. In total 209 healthy primiparous mothers and their partners were recruited. A quality of care index was generated from an on-line questionnaire administered as a follow-up to the randomised controlled trial. Uniformity and differences were identified regarding the coupleś experiences of birth and their preferences for intrapartum care Results A high level of uniformity between the mothers and their partners was revealed. Birth was a positive experience for 79% of partners and 73% of mothers whom were more likely to have experienced a spontaneous vaginal birth. Partners and mothers with a less positive birth experienced deficiencies regarding: being in control, receiving information about labour progress and midwife’s presence in labour room. Discussion Midwives can enhance couples’ feeling of being in control during labour and birth by being attentive, present and continuously providing adequate information and emotional support.

Several modifiable lifestyle factors, including smoking, alcohol, certain dietary factors and weight are independently associated with gastric cancer (GC); however, their combined impact on GC risk is unknown. We constructed a healthy lifestyle index to investigate the joint influence of these behaviors on GC risk within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. The analysis included 461,550 participants (662 first incident GC cases) with a mean follow-up of 11.4 years. A healthy lifestyle index was constructed, assigning 1 point for each healthy behavior related to smoking status, alcohol consumption and diet quality (represented by the Mediterranean diet) for assessing overall GC and also body mass index for cardia GC and 0 points otherwise. Risk of GC was calculated using Cox proportional hazards regression models while adjusting for relevant confounders. The highest versus lowest score in the healthy lifestyle index was associated with a significant lower risk of GC, by 51% overall (HR 0.49 95% CI 0.35, 0.70), by 77% for cardia GC (HR 0.23 95% CI 0.08, 0.68) and by 47% for noncardia GC (HR 0.53 (95% CI 0.32, 0.87), p-trends

Objective: to develop greater understanding of how expectant fathers experience their partner's labour and the subsequent birth of their baby. Design: a qualitative meta-synthesis. Data were search for in CINAHL, PubMed, Psych Info and SCOPUS. Setting: eight studies conducted in England, Malawi, Nepal and Sweden were included. Participants: 120 fathers with experiences of their partner having a spontaneous vaginal, assisted or surgical birth. Measurements and findings: 1st order themes were identified and subsequently grouped into seven 2nd order themes. Finally through a process of exploring patterns and connections seven 3rd order themes were developed which produced new insights into the men's experiences of labour and birth. This meta-synthesis revealed that most men wanted to be actively involved in their partner's labour, present at the birth and respected for what they could contribute. Men rec ognised that birth was au nique event that may be potentially challenging requiring a level of preparation. There were also men who felt pressured to attend. During the actual experience of labour men commonly expressed overwhelming feelings and inadequacy in their ability to support their partner. They particularly struggled with the ‘pain’ of labour. Midwives were subsequently identified as best placed to make a significant difference to how men perceived their experiences of labour and what they described as the life changing event of birth. Key conclusions: the expectant fathers' birth experiences were multidimensional. Many were committed to being involved during labour and birth but often felt vulnerable. Being prepared and receiving support were essential elements of positive experience as well as contributing to their ability to adequately support the labouring woman. Implications for practice: men's ability to actively prepare for, and be supported through, the labour and birth process influences their perceptions of the childbirth event as well as their sense of connection to their partner. Couples should be given opportunities to explore expectations and how these may influence their own construction of their role during the birth process. While the role of expectant fathers in labour and birth should be facilitated and supported arguably their wish not to participate should be afforded the same respect.