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

Consensus statements can be very influential in medicine and public health. Some of these statements use systematic evidence synthesis but others fail on this front. Many consensus statements use panels of experts to deduce perceived consensus through Delphi processes. We argue that stacking of panel members toward one particular position or narrative is a major threat, especially in absence of systematic evidence review. Stacking may involve financial conflicts of interest, but nonfinancial conflicts of strong advocacy can also cause major bias. Given their emerging importance, we describe here how such consensus statements may be misleading, by analyzing in depth a recent high-impact Delphi consensus statement on COVID-19 recommendations as a case example. We demonstrate that many of the selected panel members and at least 35% of the core panel members had advocated toward COVID-19 elimination (Zero-COVID) during the pandemic and were leading members of aggressive advocacy groups. These advocacy conflicts were not declared in the Delphi consensus publication, with rare exceptions. Therefore, we propose that consensus statements should always require rigorous evidence synthesis and maximal transparency on potential biases toward advocacy or lobbyist groups to be valid. While advocacy can have many important functions, its biased impact on consensus panels should be carefully avoided.

Fall incidents are a significant health problem for people with intellectual disabilities (ID) and physical activity improves balance capacity and can prevent the risk of falling. The Special Olympics Healthy Athletes® offers health screenings and education to athletes with ID. The aim of this cross-sectional study was to explore whether Special Olympics athletes have better balance capacity than non-athletes with ID. During the Special Olympics Sweden Invitational Games 2020, athletes and non-athletes participated in the Healthy Athletes programme. The results of athletes (n=47) and non-athletes (n=25) for balance tests (i.e. single leg stance, functional reach and timed sit-to stand test) and health markers (i.e. blood pressure and body mass index) were analysed. Athletes showed higher balance capacity, more physical activity at moderate intensity and a lower body mass index and diastolic blood pressure compared to non-athletes. However, the balance capacity of both athletes and non-athletes with ID were low, lower than for people without ID. From this study, Special Olympics athletes showed higher physical activity on moderate intensity and higher balance capacity which can decrease the risk of fall incidents compared to non-athletes.

The Swedish Library Act stipulates the libraries responsibility to pay specific attention to people with impairments. However, no explicit definition of impairments or disability is offered. Findings in previous disability research show that using the term disability without connection to a theoretical framework leads to an understanding of disability as a phenomenon simply caused by the impairments of individuals rather than aspects of the environment. In the everyday usage disability is thereby commonly determined by visually overt signifiers as wheelchairs or hearing aids. “Invisible” impairments and social or relational aspects of disability is seldom accounted for. In this study, ten randomly selected present public library plans were analyzed through a discourse analysis, focusing on how disability is perceived in the plans. Findings show that disability is predominantly understood as a phenomenon caused by impairments connected to individuals and that these individuals usually come in second place when library services are planned and designed. Furthermore, the design of library services is also depicted as something that could cause disability, especially aspects of the physical environment and alternative formats to facilitate reading are in focus. The acknowledgement of attitudinal or relational aspects of disabilities were not visible in the plans that were analyzed. The overall emerging picture is thus a traditional view of what libraries and library use are, as well as a traditional view of what causes disability. Nevertheless, the responsibility to pay specific attention to people with disabilities is evident and a strong connection to human rights is thereby visible.

Summary: The relationship between self-reported falls and fracture risk was estimated in an international meta-analysis of individual-level data from 46 prospective cohorts. Previous falls were associated with an increased fracture risk in women and men and should be considered as an additional risk factor in the FRAX® algorithm. Introduction: Previous falls are a well-documented risk factor for subsequent fracture but have not yet been incorporated into the FRAX algorithm. The aim of this study was to evaluate, in an international meta-analysis, the association between previous falls and subsequent fracture risk and its relation to sex, age, duration of follow-up, and bone mineral density (BMD). Methods: The resource comprised 906,359 women and men (66.9% female) from 46 prospective cohorts. Previous falls were uniformly defined as any fall occurring during the previous year in 43 cohorts; the remaining three cohorts had a different question construct. The association between previous falls and fracture risk (any clinical fracture, osteoporotic fracture, major osteoporotic fracture, and hip fracture) was examined using an extension of the Poisson regression model in each cohort and each sex, followed by random-effects meta-analyses of the weighted beta coefficients. Results: Falls in the past year were reported in 21.4% of individuals. During a follow-up of 9,102,207 person-years, 87,352 fractures occurred of which 19,509 were hip fractures. A previous fall was associated with a significantly increased risk of any clinical fracture both in women (hazard ratio (HR) 1.42, 95% confidence interval (CI) 1.33–1.51) and men (HR 1.53, 95% CI 1.41–1.67). The HRs were of similar magnitude for osteoporotic, major osteoporotic fracture, and hip fracture. Sex significantly modified the association between previous fall and fracture risk, with predictive values being higher in men than in women (e.g., for major osteoporotic fracture, HR 1.53 (95% CI 1.27–1.84) in men vs. HR 1.32

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

Importance Cardiovascular risk factors in youth have been associated with future cardiovascular disease (CVD), but conventional observational studies are vulnerable to genetic and environmental confounding. Objective To examine the role of genetic and environmental factors shared by full siblings in the association of adolescent cardiovascular risk factors with future CVD. Design, Setting, and Participants This is a nationwide cohort study with full sibling comparisons. All men who underwent mandatory military conscription examinations in Sweden between 1972 and 1995 were followed up until December 31, 2016. Data analysis was performed from May 1 to November 10, 2022. Exposures Body mass index (BMI), cardiorespiratory fitness, blood pressure, handgrip strength, and a combined risk z score in late adolescence. Main Outcomes and Measures The primary outcome was fatal or nonfatal CVD, as recorded in the National Inpatient Register or the Cause of Death Register before 2017. Results A total of 1 138 833 men (mean [SD] age, 18.3 [0.8] years), of whom 463 995 were full brothers, were followed up for a median (IQR) of 32.1 (26.7-37.7) years, during which 48 606 experienced a CVD outcome (18 598 among full brothers). All risk factors were associated with CVD, but the effect of controlling for unobserved genetic and environmental factors shared by full siblings varied. In the sibling analysis, hazard ratios for CVD (top vs bottom decile) were 2.10 (95% CI, 1.90-2.32) for BMI, 0.77 (95% CI, 0.68-0.88) for cardiorespiratory fitness, 1.45 (95% CI, 1.32-1.60) for systolic blood pressure, 0.90 (95% CI, 0.82-0.99) for handgrip strength, and 2.19 (95% CI, 1.96-2.46) for the combined z score. The percentage attenuation in these hazard ratios in the sibling vs total cohort analysis ranged from 1.1% for handgrip strength to 40.0% for cardiorespiratory fitness. Consequently, in the sibling analysis, the difference in cumulative CVD incidence at age 60 years (top vs bottom decile)

Objectives: To examine whether moderate-to-vigorous physical activity (MVPA) modifies the association between sedentary time and mortality and vice versa, and estimate the joint associations of MVPA and sedentary time on mortality risk. Methods: This study involved individual participant data analysis of four prospective cohort studies (Norway, Sweden, USA, baseline: 2003-2016, 11 989 participants ≥50 years, 50.5% women) with hip-accelerometry-measured physical activity and sedentary time. Associations were examined using restricted cubic splines and fractional polynomials in Cox regressions adjusted for sex, education, body mass index, smoking, alcohol, study cohort, cardiovascular disease, cancer, and/or diabetes, accelerometry wear time and age. Results: 6.7% (n=805) died during follow-up (median 5.2 years, IQR 4.2 years). More than 12 daily sedentary hours (reference 8 hours) was associated with mortality risk only among those accumulating <22 min of MVPA per day (HR 1.38, 95% CI 1.10 to 1.74). Higher MVPA levels were associated with lower mortality risk irrespective of sedentary time, for example, HR for 10 versus 0 daily min of MVPA was 0.85 (95% CI 0.74 to 0.96) in those accumulating <10.5 daily sedentary hours and 0.65 (95% CI 0.53 to 0.79) in those accumulating ≥10.5 daily sedentary hours. Joint association analyses confirmed that higher MVPA was superior to lower sedentary time in lowering mortality risk, for example, 10 versus 0 daily min of MVPA was associated with 28-55% lower mortality risk across the sedentary time spectrum (lowest risk, 10 daily sedentary hours: HR 0.45, 95% CI 0.31 to 0.65). Conclusions: Sedentary time was associated with higher mortality risk but only in individuals accumulating less than 22 min of MVPA per day. Higher MVPA levels were associated with lower mortality risk irrespective of the amount of sedentary time.

Alternative media can be a positive force in democratic societies, contributing to journalistic diversity and contributing to dialogue. However, there are an increasing number of actors that challenge, criticise and question journalism by establishing their own channels for communication, spreading disinformation and propaganda. These actors often position themselves as anti-establishment and thus challenge mainstream journalistic agenda-setting and credibility in certain groups. Research shows that news media can play a role in normalising racism in society (e.g., Pollack 2021; Ekman & Krzyżanowski 2021). Furthermore, the internet has proven to be an important arena for disseminating far right discourse into public debate and political actors with racist views have benefitted from online platforms for seeking, obtaining and spreading information (Titley 2019; Åkerlund 2022; Ekman 2015). Research further shows that affect and emotion are crucial for political engagement and aid in creating a sense of belonging and recognition (Ahmed 2014; Ekman 2023). The aim of this study is to gain understanding of how racist imaginaries are shaped and circulated through posts on the social media pages of five Swedish alternative media, and how these are contributing to a form of digital racism (Ekman 2023). Drawing on Ahmed’s concept of ‘cultural politics of emotion’, social media posts constitute ‘objects of feeling’ which people feel love, anger, pity, or fear towards (2014, pp. 8–9). These emotions can be collective or individual, established historically and culturally, and are manifest in responses to events in what Ahmed calls ‘emotional economies’ (Ahmed in Gregg & Seigworth 2010, pp. 29– 51). This study explores the characteristics, compositions and constitution of the mediated emotions of political expression embedded in social media posts, together with comments and interactions from followers/users while investigating the sociocultural, economic, and political