Search

During the 2015–2016 El Niño, the Amazon basin released almost one gigaton of carbon (GtC) into the atmosphere due to extreme temperatures and drought. The link between the drought impact and recovery of the total carbon pools and its biogeochemical drivers is still unknown. With satellite-constrained net carbon exchange and its component fluxes including gross primary production and fire emissions, we show that the total carbon loss caused by the 2015–2016 El Niño had not recovered by the end of 2018. Forest ecosystems over the Northeastern (NE) Amazon suffered a cumulative total carbon loss of ∼0.6 GtC through December 2018, driven primarily by a suppression of photosynthesis whereas southeastern savannah carbon loss was driven in part by fire. We attribute the slow recovery to the unexpected large carbon loss caused by the severe atmospheric aridity coupled with a water storage deficit during drought. We show the attenuation of carbon uptake is three times higher than expected from the pre-drought sensitivity to atmospheric aridity and ground water supply. Our study fills an important knowledge gap in our understanding of the unexpectedly enhanced response of carbon fluxes to atmospheric aridity and water storage deficit and its impact on regional post-drought recovery as a function of the vegetation types and climate perturbations. Our results suggest that the disproportionate impact of water supply and demand could compromise resiliency of the Amazonian carbon balance to future increases in extreme events.

Abstract Background Emergency medical services (EMS) personnel must rapidly assess and transport patients with time-sensitive conditions to optimise patient outcomes. Serum lactate, a valuable in-hospital biomarker, has become more accessible in EMS settings through point-of-care (POC) testing. Although POC lactate levels are valuable in specific patient groups, its broader application in EMS remains unclear. This study assessed the additional predictive value of POC lactate levels in a general adult EMS population. Methods This prospective observational study (March 2018 to September 2019) involved two EMS organisations in Västra Götaland, Sweden. Patients were triaged using the Rapid Triage and Treatment System (RETTS). POC lactate levels were measured using StatStrip Xpress devices. Non-consecutive patients who received EMS and were aged 18 years and above were available for inclusion if triaged into RETTS levels: red, orange, yellow, or green if respiratory rate of ≥ 22 breaths/min. Outcomes were adverse outcomes, including a time-sensitive diagnosis, sequential organ failure assessment (SOFA) score ≥ 2, and 30-day mortality. Statistical analyses included descriptive statistics, imputation, and regression models to assess the impact of the addition of POC lactate levels to a base model (comprising patient age, sex, presence of past medical conditions, vital signs, pain, EMS response time, assessed triage condition, and triage level) and a RETTS triage model. Results Of 4,546 patients (median age 75 [57, 84] years; 49% male), 32.4% had time-sensitive conditions, 12.5% met the SOFA criteria, and 7.4% experienced 30-day mortality. The median POC lactate level was 1.7 (1.2, 2.5) mmol/L. Patients with time-sensitive conditions had higher lactate levels (1.9 mmol/L) than those with non-time-sensitive conditions (1.6 mmol/L). The probability of a time-sensitive condition increased with increasing lactate level. The addition of POC lactate marginally enhanced the predictive models, with a 1.5% and 4% increase for the base and RETTS triage models, respectively. POC lactate level as a sole predictor showed chance-only level predictive performance. Conclusions Prehospital POC lactate assessment provided limited additional predictive value in a general adult EMS population. However, it may be beneficial in specific patient subgroups, emphasizing the need for its judicious use in prehospital settings.

Research on school improvement has accumulated an extensive list of factors that facilitate turnarounds at underperforming schools. Given that context or resource constraints may limit the possibilities of putting all of these factors in place, an important question is what is necessary and sufficient to turn a school around. We use qualitative comparative analysis (QCA) of 77 Swedish schools studied over 12 years to answer this question. Our core finding is that there is no "silver bullet" solution. Instead, there are several distinct combinations of factors that can enable school turnaround. The local school context is essential for which combinations of factors are necessary and sufficient for school turnaround. We discuss implications for research on school improvement and education policy.

AIMS – To study the prevalence of cannabis use and drug-related problems among European adolescents and the utility of the prevention paradox. METHODS – Survey data from the European School Survey Project on Alcohol and Other Drugs (ESPAD) in 2007 in the 27 countries with information about drug use and drug-related problems was used. We analysed the proportion of all drug-related problems that occurred in a high risk group and among others who had used cannabis in the previous 12 months. The cut-off for the high risk group was chosen to include 10-15 % of the most frequent cannabis users. RESULTS – The high risk groups accounted for a substantial, but a minority, of drug-related problems among boys as well as girls. A minority of those who had used cannabis reported any drug-related problem. The proportion of adolescents with drug-related problems and the average number of problems increased with frequency of cannabis use. CONCLUSIONS – We find support for policy measures of more general character, supported by the prevention paradox. However, this does not exclude a policy supporting frequent drug users if they can be identified

Abstract Background Dietary habits strongly influence health, with poor diets contributing to numerous deaths annually. Addressing this requires improved dietary habits and consistent monitoring thereof. In northern Sweden, a validated food frequency questionnaire (FFQ) has been used for decades, but trends show that its ability to accurately measure intake has diminished. With changing eating habits and food supply, updating the FFQ was crucial, leading to the development of FFQ2020. This study assessed FFQ2020’s relative validity using 24-hour recalls and evaluated its reproducibility. Methods Participants were recruited from one of the northern-Sweden population-based health screenings and by advertising. Food intake was registered in an electronic food frequency questionnaire (FFQ2020) (test instrument) and reference data were obtained by six repeated electronic 24-hour dietary recalls (24HDR). Intakes of single foods were aggregated into food groups and healthy diet index scores, and daily energy and nutrient intakes were estimated. Results from the two methods were described and tested in univariate analyses and correlation tests, Bland Altman plots, cross-classification validity, and intra-class correlation analyses. Results Totally, 628 adults were invited to participate in the study. Of these, 320 joined, and 244 completed at least four 24HDRs. The median intakes in food groups, as well as the mean index scores and estimated nutrient intakes, were largely similar between the FFQ2020 and 24HDR recordings. The correlation coefficients between the two assessments ranged from 0.253 to 0.693 for food groups, 0.520 to 0.614 for diet indices, and 0.340 to 0.629 for energy and nutrients. Intra-class correlation coefficients indicated at least good reproducibility for intakes of food groups, diet index scores, and nutrients. Generally, Bland-Altman plots did not reveal any gross systematic disagreement between the two methods for any of the assessments. However, there were single observations located outside the upper or lower 95% confidence interval (CI) limits for the difference between FFQ2020 and the 24HDR recordings. Conclusion In concert, the results suggest that the relative validity and reproducibility of FFQ2020 are acceptable for trend analyses and group comparisons in large-scale studies but also that extended reference periods would improve the precision of less frequently consumed foods.

Abstract Current research on metabolic disorders and diabetes relies on animal models because multi-organ diseases cannot be well studied with standard in vitro assays. Here, we have connected cell models of key metabolic organs, the pancreas and liver, on a microfluidic chip to enable diabetes research in a human-based in vitro system. Aided by mechanistic mathematical modeling, we demonstrate that hyperglycemia and high cortisone concentration induce glucose dysregulation in the pancreas-liver microphysiological system (MPS), mimicking a diabetic phenotype seen in patients with glucocorticoid-induced diabetes. In this diseased condition, the pancreas-liver MPS displays beta-cell dysfunction, steatosis, elevated ketone-body secretion, increased glycogen storage, and upregulated gluconeogenic gene expression. Conversely, a physiological culture condition maintains glucose tolerance and beta-cell function. This method was reproducible in two laboratories and was effective in multiple pancreatic islet donors. The model also provides a platform to identify new therapeutic proteins, as demonstrated with a combined transcriptome and proteome analysis.

Abstract Life’s Essential 8 (LE8) is a score that includes modifiable risk factors for cardiovascular disease. Four health behaviors (diet, physical activity, nicotine exposure and sleep health) and four health factors (non-HDL cholesterol, blood glucose, blood pressure and body mass index) are included. These modifiable risk factors promote inflammation, and inflammation is one of the biological mechanisms of cardiovascular disease development. Thus, we examined the relationship between cardiovascular health measured by LE8 and low-grade inflammation measured by high-sensitivity C-reactive protein (hs-CRP) in the cross-sectional population-based Swedish CArdioPulmonary bioImage Study (SCAPIS). The study consisted of 28,010 participants between 50 and 64 years (51.5% women, mean age 57.5 years). All individual LE8 components were assigned a score between 0 (unhealthy) and 100 (healthy) points, and a global score was calculated. The association between LE8 scores and high-risk hs-CRP (defined as > 3.0 mg/L) was analyzed using adjusted logistic regression with spline analyses. There was a strong, dose response and inverse association between LE8 scores and levels of hs-CRP. Thus, those with a low LE8 score (= 50.0 points) had 5.8 higher (95% confidence interval [CI] 5.2–6.4) odds ratio (OR) of having high hs-CRP as compared to those with a high LE8 score (= 80.0 points). In conclusion, our findings show strong inverse associations between LE8 scores and levels of hs-CRP.

Abstract Background Cardiovascular disease (CVD) is a major global health issue, primarily caused by atherosclerosis. Psychological factors may play a role in the development and progression of CVD. However, the relationship between psychological factors and atherosclerosis is complex and poorly understood. This study, therefore, aimed to examine the association of psychological factors with (i) coronary and carotid atherosclerosis and (ii) cardiovascular health according to Life’s Essential 8, in a large Swedish cohort. Methods This study utilized data from the Swedish CArdioPulmonary bioImage Study (SCAPIS), a large population-based project including individuals aged 50 to 65 years. Several psychological factors were analysed: general stress, stress at work, financial stress, major adverse life events, locus of control, feeling depressed, and depression. Coronary atherosclerosis was assessed as the degree of stenosis by coronary computed tomography angiography (CCTA) and coronary artery calcification (CAC) scores. Carotid atherosclerosis was examined using ultrasound. In addition, cardiovascular health was examined using the Life’s Essential 8 concept created by the American Heart Association, which includes four health behaviors and four health factors. Associations were examined through binomial logistic regression (atherosclerosis variables) and linear regression (Life’s Essential 8). Results A total of 25,658 participants were included in the study. The presence of financial stress, higher locus of control, and depression was weakly associated with increased odds of CCTA stenosis, CAC ≥ 1 and the presence of carotid plaques (all odds ratios: 1.10–1.21, 95% CI: 1.02–1.32) after adjusting for sex, age, and study site. However, these associations were attenuated and not statistically significant after additional adjustments for socioeconomic factors and health behaviors. Conversely, we observed inverse associations between the worst category for all psychological factors and cardiovascular health according to Life’s Essential 8 score (all standardized β-Coefficient ≤-0.033, p

The Total Carbon Column Observing Network (TCCON) measures column-average mole fractions of several greenhouse gases (GHGs), beginning in 2004, from over 30 current or past measurement sites around the world using solar absorption spectroscopy in the near-infrared (near-IR) region. TCCON GHG data have been used extensively for multiple purposes, including in studies of the carbon cycle and anthropogenic emissions, as well as to validate and improve observations from space-based sensors. Here, we describe an update to the retrieval algorithm used to process the TCCON near-IR solar spectra and to generate the associated data products. This version, called GGG2020, was initially released in April 2022. It includes updates and improvements to all steps of the retrieval, including but not limited to the conversion of the original interferograms into spectra, the spectroscopic information used in the column retrieval, post hoc air mass dependence correction, and scaling to align with the calibration scales of in situ GHG measurements. All TCCON data are available through https://tccondata.org/ (last access: 22 April 2024) and are hosted on CaltechDATA (https://data.caltech.edu/, last access: 22 April 2024). Each TCCON site has a unique DOI for its data record. An archive of all the sites' data is also available with the DOI https://doi.org/10.14291/TCCON.GGG2020 (Total Carbon Column Observing Network (TCCON) Team, 2022). The hosted files are updated approximately monthly, and TCCON sites are required to deliver data to the archive no later than 1 year after acquisition. Full details of data locations are provided in the “Code and data availability” section.

Abstract During the 2015–2016 El Niño, the Amazon basin released almost one gigaton of carbon (GtC) into the atmosphere due to extreme temperatures and drought. The link between the drought impact and recovery of the total carbon pools and its biogeochemical drivers is still unknown. With satellite‐constrained net carbon exchange and its component fluxes including gross primary production and fire emissions, we show that the total carbon loss caused by the 2015–2016 El Niño had not recovered by the end of 2018. Forest ecosystems over the Northeastern (NE) Amazon suffered a cumulative total carbon loss of ∼0.6 GtC through December 2018, driven primarily by a suppression of photosynthesis whereas southeastern savannah carbon loss was driven in part by fire. We attribute the slow recovery to the unexpected large carbon loss caused by the severe atmospheric aridity coupled with a water storage deficit during drought. We show the attenuation of carbon uptake is three times higher than expected from the pre‐drought sensitivity to atmospheric aridity and ground water supply. Our study fills an important knowledge gap in our understanding of the unexpectedly enhanced response of carbon fluxes to atmospheric aridity and water storage deficit and its impact on regional post‐drought recovery as a function of the vegetation types and climate perturbations. Our results suggest that the disproportionate impact of water supply and demand could compromise resiliency of the Amazonian carbon balance to future increases in extreme events.

Abstract Background Chronic active antibody-mediated rejection (caAMR) in kidney transplants is associated with irreversible tissue damage and a leading cause of graft loss in the long-term. However, the treatment for caAMR remains a challenge to date. Recently, tocilizumab, a recombinant humanized monoclonal antibody directed against the human interleukin-6 (IL-6) receptor, has shown promise in the treatment of caAMR. However, it has not been systematically investigated so far underscoring the need for randomized controlled studies in this area. Methods The INTERCEPT study is an investigator-driven randomized controlled open-label multi-center trial in kidney transplant recipients to assess the efficacy of tocilizumab in the treatment of biopsy-proven caAMR. A total of 50 recipients with biopsy-proven caAMR at least 12 months after transplantation will be randomized to receive either tocilizumab (n = 25) added to our standard of care (SOC) maintenance treatment or SOC alone (n = 25) for a period of 24 months. Patients will be followed for an additional 12 months after cessation of study medication. After the inclusion biopsies at baseline, protocol kidney graft biopsies will be performed at 12 and 24 months. The sample size calculation assumed a difference of 5 ml/year in slope of estimated glomerular filtration rate (eGFR) between the two groups for 80% power at an alpha of 0.05. The primary endpoint is the slope of eGFR at 24 months after start of treatment. The secondary endpoints include assessment of the following at 12, 24, and 36 months: composite risk score iBox, safety, evolution and characteristics of donor-specific antibodies (DSA), graft histology, proteinuria, kidney function assessed by measured GFR (mGFR), patient- and death-censored graft survival, and patient-reported outcomes that include transplant-specific well-being, adherence to immunosuppressive medications and perceived threat of the risk of graft rejection. Discussion No effective treatment exists for caAMR at present. Based on the hypothesis that inhibition of IL-6 receptor by tocilizumab will reduce antibody production and reduce antibody-mediated damage, our randomized trial has a potential to provide evidence for a novel treatment strategy for caAMR, therewith slowing the decline in graft function in the long-term. Trial registration ClinicalTrials.gov NCT04561986. Registered on September 24, 2020

Bromine activation (the production of Br in an elevated oxidation state) promotes ozone destruction and mercury removal in the global troposphere and commonly occurs in both springtime polar boundary layers, often accompanied by nearly complete ozone destruction. The chemistry and budget of active bromine compounds (e.g., Br2, BrCl, BrO, HOBr) reflect the cycling of Br and affect its environmental impact. Cyanogen bromide (BrCN) has recently been measured by iodide ion high-resolution time-of-flight mass spectrometry (I− CIMS), and trifluoro methoxide ion time-of-flight mass spectrometry (CF3O− CIMS) during the NASA Atmospheric Tomography Mission second, third, and fourth deployments (NASA ATom), and could be a previously unquantified participant in active Br chemistry. BrCN mixing ratios ranged from below the detection limit (1.5 pptv) up to as high as 36 pptv (10 s average) and enhancements were almost exclusively confined to the polar boundary layers in the Arctic winter and in both polar regions during spring and fall. The coincidence of BrCN with active Br chemistry (often observable BrO, BrCl and O3 loss) and high CHBr3/CH2Br2 ratios imply that much of the observed BrCN is from atmospheric Br chemistry rather than a biogenic source. Likely BrCN formation pathways involve the heterogeneous reactions of active Br (Br2, HOBr) with reduced nitrogen compounds, for example hydrogen cyanide (HCN/CN−), on snow, ice, or particle surfaces. Competitive reaction calculations of HOBr reactions with Cl−/Br− and HCN/CN− in solution, as well as box model calculations with bromine chemistry, confirm the viability of this formation channel and show a distinct pH dependence, with BrCN formation favored at higher pH values. Gas-phase loss processes of BrCN due to reaction with radical species are likely quite slow and photolysis is known to be relatively slow (BrCN lifetime of ∼ 4 months in midlatitude summer). These features, and the lack of BrCN enhancements above the polar boundary layer, imply that surface reactions must be the major loss processes. The fate of BrCN determines whether BrCN production fuels or terminates bromine activation. BrCN reactions with other halogens (Br−, HOCl, HOBr) may perpetuate the active Br cycle; however, preliminary laboratory experiments showed that BrCN did not react with aqueous bromide ion (< 0.1 %) to reform Br2. Liquid-phase reactions of BrCN are more likely to convert Br to bromide (Br−) or form a C–Br bonded organic species, as these are the known condensed-phase reactions of BrCN and would therefore constitute a loss of atmospheric active Br. Thus, further study of the chemistry of BrCN will be important for diagnosing polar Br cycling.

Abstract Despite the general consensus that the warming over the high latitudes northern forests (HLNF) has led to enhanced photosynthetic activity and contributed to the greening trend, isolating the impact of temperature increase on photosynthesis and greenness has been difficult due to the concurring influence of the CO2 fertilization effect. Here, using an ensemble of simulations from biogeochemical models that have contributed to the Trends in Net Land Atmosphere Carbon Exchange project (TRENDY), we identify an emergent relationship between the simulation of the climate-driven temporal changes in both gross primary productivity (GPP) and greenness (Leaf Area Index, LAI) and the model’s spatial sensitivity of these quantities to growing-season (GS) temperature. Combined with spatially-resolved observations of LAI and GPP, we estimate that GS-LAI and GS-GPP increase by 17.0 ± 2.4% and 24.0 ± 3.0% per degree of warming, respectively. The observationally-derived sensitivities of LAI and GPP to temperature are about 40% and 71% higher, respectively, than the mean of the ensemble of simulations from TRENDY, primarily due to the model underestimation of the sensitivity of light use efficiency to temperature. We estimate that the regional mean GS-GPP increased 28.2 ± 5.1% between 1983–1986 and 2013–2016, much larger than the 5.8 ± 1.4% increase from the CO2 fertilization effect implied by Wenzel et al. This suggests that warming, not CO2 fertilization, is primarily responsible for the observed dramatic changes in the HLNF biosphere over the last century.

Abstract Background To combat the opioid crisis, interventions targeting the opioid prescribing behaviour of physicians involved in the management of patients with chronic non-cancer pain (CNCP) have been introduced in clinical settings. An integrative synthesis of systematic review evidence is required to better understand the effects of these interventions. Our objective was to synthesize the systematic review evidence on the effect of interventions targeting the behaviours of physician opioid prescribers for CNCP among adults on patient and population health and prescriber behaviour. Methods We searched MEDLINE, Embase, and PsycInfo via Ovid; the Cochrane Database of Systematic Reviews; and Epistemonikos. We included systematic reviews that evaluate any type of intervention aimed at impacting opioid prescriber behaviour for adult CNCP in an outpatient setting. Results We identified three full texts for our review that contained 68 unique primary studies. The main interventions we evaluated were structured prescriber education (one review) and prescription drug monitoring programmes (PDMPs) (two reviews). Due to the paucity of data available, we could not determine with certainty that education interventions improved outcomes in deprescribing. There is some evidence that PDMPs decrease the number of adverse opioid-related events, increase communication among healthcare workers and patients, modify healthcare practitioners’ approach towards their opioid prescribed patients, and offer more chances for education and counselling. Conclusions Our overview explores the possibility of PDMPs as an opioid deprescribing intervention and highlights the need for more high-quality primary research on this topic.

The Arctic Monitoring Assessment Program (AMAP) is tasked with monitoring and assessing the status of environmental contaminants in the Arctic, documenting levels and trends, and producing science-based assessments. The objectives of this paper are to present the current levels of persistent organic pollutants (POPs) across the Arctic, and to identify trends and knowledge gaps as detailed in the most recent AMAP Human Health Assessment Report. Many Arctic populations continue to have elevated levels of these contaminants, and the highest levels of POPs were observed in populations from Greenland, Faroe Islands, and Nunavik (Canada), as well as populations in the coastal Chukotka district (Russia) for legacy POPs only. Concentrations of most POPs are declining in Arctic populations in regions where time trends data exist, although the declines are not consistent across all regions. The exceptions are per- and polyfluoroalkyl substances, with concentrations of some long-chain PFAS such as perfluorononanoic acid increasing in populations in Nunavik, Greenland and Sweden. This paper provides a more extensive summary of levels of contaminants in adults, pregnant women, and children across the Arctic than previous AMAP human health assessments, particularly for levels of long-chain PFAS, which are currently under consideration for inclusion in the Stockholm Convention.

The 2021 Arctic Monitoring Assessment Program (AMAP)’s Human Health Assessment report presents a summary of the presence of contaminants in human populations across the circumpolar Arctic and provides an update to the previous assessment released in 2015. The primary objective of this paper is to summarise some of these findings by describing the current levels of metals across the Arctic, including key regional and temporal trends based on available national data and literature, and highlight knowledge gaps. Many Arctic populations continue to have elevated levels of these contaminants, and the highest levels of mercury (Hg) were observed in populations from Greenland, Faroe Islands, and Nunavik (Canada). Still, concentrations of several metals are declining in Arctic populations in regions where time trends data exist, although the declines are not consistent across all regions. The 2021 AMAP human health assessment report and this paper provide an extensive summary of levels of metals and trace elements in adults, pregnant women, and children across the Arctic.

Arctic populations are amongst the highest exposed populations to long-range transported contaminants globally, with the main exposure pathway being through the diet. Dietary advice is an important immediate means to address potential exposure and help minimize adverse health effects. The objective of this work is to enable easier access to dietary advice and communication guidance on contaminants with a focus on the Arctic. This manuscript is part of a special issue summarizing the Arctic Monitoring and Assessment Programme’s Assessment 2021: Human Health in the Arctic. The information was derived with internet searches, and by contacting relevant experts directly. Results include risk communication efforts in European Arctic countries, effectiveness evaluation studies for several Arctic countries, experience of social media use, and the advantages and challenges of using social media in risk communication. We found that current risk communication activities in most Arctic countries emphasize the importance of a nutritious diet. Contaminant-related restrictions are mostly based on mercury; a limited amount of dietary advice is based on other contaminants. While more information on effectiveness evaluation was available, specific information, particularly from Arctic countries other than Canada, is still very limited.

There is such a vast proliferation of scientific theories of consciousness that it is worrying some scholars. There are even competitions to test different theories, and the results are inconclusive. Consciousness research, far from converging toward a unifying framework, is becoming more discordant than ever, especially with respect to theoretical elements that do not have a clear neurobiological basis. Rather than dueling theories, an integration across theories is needed to facilitate a comprehensive view on consciousness and on how normal nervous system dynamics can develop into pathological states. In dealing with what is considered an extremely complex matter, we try to adopt a perspective from which the subject appears in relative simplicity. Grounded in experimental and theoretical observations, we advance an encompassing biophysical theory, MaxCon, which incorporates aspects of several of the main existing neuroscientific consciousness theories, finding convergence points in an attempt to simplify and to understand how cellular collective activity is organized to fulfill the dynamic requirements of the diverse theories our proposal comprises. Moreover, a computable index indicating consciousness level is presented. Derived from the level of description of the interactions among cell networks, our proposal highlights the association of consciousness with maximization of the number of configurations of neural network connections ―constrained by neuroanatomy, biophysics and the environment― that is common to all consciousness theories.

IntroductionThe Norwegian Directorate of Health approved the Norwegian Hearing Register for Children in 2022. The main objective of the register is to improve the quality of treatment for children with permanent hearing loss, by measures, follow-ups and monitoring the quality and results of the health care system.MethodsInclusion criteria are children who do not pass universal newborn hearing screening and/or children with permanent hearing loss 20 dB in at least one ear. Data are registered at the Ear, Nose and Throat departments at inclusion and at follow-ups at the age of 3, 6, 10, and 15 years. The register collects information about the child within a holistic perspective. The key elements of the register are (a) data concerning newborn hearing screening; (b) data concerning hearing, medical information, hearing amplification and intervention (c) patient reported outcome measures registered by caregivers using three questionnaires; Pediatric Quality of Life Inventory, Strengths and Difficulties Questionnaire and Parents’ Evaluation of Aural/Oral Performance of Children.ResultsThe register has established four quality indicators regarding newborn hearing screening and early intervention (a) the rate of false positive neonatal screens; (b) testing for congenital cytomegalovirus within 3 weeks of age for children who do not pass newborn hearing screening; (c) audiological evaluation to confirm the hearing status no later than 3 months of age and (d) initiated intervention within 3 months after confirmation of hearing status.DiscussionThe register will include the total population of hearing impaired children over long time periods. Thus, the register enables each hospital to monitor their quality indicator scores continuously and compare them with national levels in real time. This facilitates and accelerates identification of improvement areas in the hospitals and will be an important contributor for quality improvement in NHS, diagnostics and hearing intervention for children in Norway. In addition, data from the register will be a unique source for research, and study designs with a long follow-up time can be applied.

This study explores how traffic safety implementation at local level in line with the 2030 Agenda for Sustainable Development is characterised. By investigating interactions between traffic safety and other sustainability goals (synergies), as well as identifying contradictions between goals and conflicting interests (challenges), the study aims to pinpoint the main enablers for implementing traffic safety as part of sustainability. The emphasis lies on local authorities in Sweden representing a mature traffic safety context when viewed globally. To delve into this issue, interviews were conducted with 37 municipal employees from the city of Gothenburg, encompassing diverse roles that exemplify the significant influence Swedish local authorities wield in shaping traffic safety: as road manager and planner, in maintenance and construction phases, as employer and purchaser, and as influencer of behaviour. The study reveals several synergies between traffic safety and other sustainability goals, as well as contradictions between goals and conflicting interests posing challenges to traffic safety implementation. Main enablers for implementation of traffic safety as part of sustainability at the local level concern, for example, an integrated approach on strategic level where traffic safety could be handled as either a prerequisite (e.g. for active mobility) or a framework condition (e.g. for green cars). The necessity to bridge gaps between strategic and operational levels is also emphasised. Contradicting goals and interests are inevitable and must be managed. The study identifies the traffic strategy and strategic analyses, in the European context referred to as Sustainable Urban Mobility Planning, as a platform for traffic safety implementation as part of sustainability. Such platform highlights implementation areas in common for different target areas. The significance of integrating traffic safety in relevant activities and processes, alongside fostering horizontal collaborations across target areas, becomes apparent when striving to embed traffic safety in a wider sustainability context. While Swedish municipalities may not always recognize traffic safety as part of the sustainability agenda, existing platforms within municipalities serve as a foundation for adopting an integrated approach to traffic safety implementation. However, there is a need for a central coordinating function to ensure robust leadership in integrating traffic safety as a vital component of sustainability.

Background: The dietary habits among snus users are largely unknown and have not been accounted for in observational studies on the health effects of snus use. Aim: To examine whether snus users eat unhealthier than never tobacco users. Methods: A total of 3,397 male participants, examined between 1994 and 2014 in the Northern Sweden Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, were included. Snus use and dietary habits were self-reported using questionnaires, from which intakes of different food groups, macronutrients, and a healthy diet score (HDS) were calculated (the latter as a proxy for overall diet quality). The association between snus use and dietary habits was examined by quantile regression models. Results: In the multivariable-adjusted model, current snus users had a lower HDS (median difference: −0.86 [95% confidence interval: −1.32, −0.40]) than never tobacco users. Snus users also consumed fewer weekly servings of fruits and berries (median difference: −1.03 [−1.65, −0.40]), and their estimated percentage of energy intake consisted of less carbohydrates (median difference: −1.43 [−2.12, −0.74]) and of more total fat (median difference: 0.99 [0.30, 1.67]), saturated fat (median difference: 0.67 [0.29, 1.05]), monounsaturated fat (median difference: 0.44 [0.20, 0.68]), trans fat (median difference: 0.03 [0.01, 0.06]), and alcohol (median difference: 0.21 [0.02, 0.40]). Conclusion: We observed that snus users had an unhealthier diet than never tobacco users. Future studies on the association between snus use and health outcomes should, therefore, consider diet as a potential confounder.

Abstract Background Non-adherence in the general population to preventive guidelines on cardiovascular disease calls for an interdisciplinary approach acknowledging psychological factors of relevance for risk communication and lifestyle modification. Evidence is building up regarding the advantage of sharing arterial imaging evidence of subclinical atherosclerosis with asymptomatic individuals, but there is limited understanding of how this relates to mechanisms of importance for behavioural change. Longitudinal studies on associations between patients’ reactions and lifestyle modification are missing. The population-based randomized controlled trial VIPVIZA investigates the impact of pictorial information about subclinical atherosclerosis, added to traditional risk factor-based communication. The intervention includes a personalized, colour-coded and age-related risk communication strategy and a motivational conversation, and has been shown to reduce cardiovascular disease risk. Methods In the present study we assessed cognitive and emotional reactions to the intervention, and how these reactions are associated to lifestyle modification. The participants’ evaluation of the risk communication was assessed in the intervention group (n = 1749). Lifestyle modification was assessed with a lifestyle index based on physical activity, diet, smoking and alcohol consumption at baseline and after 3 years. Associations between cognitive and emotional response and lifestyle modification were tested with analyses of covariance in a subset of participants (n = 714–857). Results The intervention increased understanding of personal CVD risk, the possibility to influence the risk, and how to influence the risk. Severity of atherosclerosis was associated with emotional reactions, but emotions of strong negative valence were uncommon. Cognitive response and emotional arousal evoked by the intervention were positively associated with lifestyle modification, whereas negative emotions in isolation were not. High level of cognitive response in combination with high level of emotional arousal was found to be most beneficial for lifestyle modification. Conclusions The results demonstrate the potential of communicating asymptomatic atherosclerosis with a pictorial, colour-coded and age-related strategy, also including a motivational conversation. Furthermore, the results show the importance of CVD risk communication evoking engagement, and that an interaction between cognitive and emotional reactions might be central for sustained lifestyle modification. Our results also indicate that, in an asymptomatic population, atherosclerosis screening may strengthen disease prevention and health promotion. Trial registration ClinicalTrials.gov identifier: NCT01849575. Registration date 08/05/2013.