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This article explores both the church understood as a function, and the church understood as a body. The functional view has been dominant in the West ever since the Reformation. That view perceives the church, ever since its origin, as one of many groups of those who believe in Jesus and as communities of interpretation in which the sacraments are the religious markers. The church as a body expresses a unique communion with him who is the object of faith and imitation. This organic view is deeply rooted in the first generations of Christians. Exegetical study of the church as a function has applied sociology as an auxiliary discipline. This article claims that this approach does not do justice to the church understood as a body. The characteristic criteria of psychology and psychiatry for the concept of identity can contribute to a richer understanding. The post-modem criticism of the concept of identity is discussed in this article and the alternative concepts of «belonging» and «selfhood», which are suggested here, provide further perspectives on the church, understood both as a body and as a function.

Comprehensive genetic and clinical care of families with monogenic cardiovascular diseases requires competences from different medical specialties. Genetic assessment, cascade screening, risk estimation, treatment and follow-up is difficult to cover. Fourteen years ago, a center for cardiovascular diseases was created in our hospital, to improve the care of families with monogenic cardiovascular diseases. At our center, clinical geneticists, cardiologists, angiologists, pediatric cardiologists and genetic counselors work together in a seamless organization, while still having different clinic affiliations. A key feature of this organization are the family outpatient clinics, where the proband and his/her relatives at genetic risk are invited to take part. When the family or relatives live in other parts of the country, they are invited to participate through video conference.  In this paper we report our experiences and working routines from more than 300 families and 2000 individuals.

Recent technical developments and early clinical examples support that precision medicine has potential to provide novel diagnostic and therapeutic solutions for patients with complex diseases, who are not responding to existing therapies. Those solutions will require integration of genomic data with routine clinical, imaging, sensor, biobank and registry data. Moreover, user-friendly tools for informed decision support for both patients and clinicians will be needed. While this will entail huge technical, ethical, societal and regulatory challenges, it may contribute to transforming and improving health care towards becoming predictive, preventive, personalised and participatory (4P-medicine).

Complex diseases represent a number of common disorders such as allergic conditions, cardiovascular, metabolic and chronic inflammatory diseases. These diseases are caused by a combination of genetic, environmental and lifestyle factors. This complex etiology creates challenges when it comes to diagnostics, follow-up programs and treatment. Although exact disease mechanisms are yet to be elucidated for most complex diseases, key genetic determinants have been mapped and omics profiling has unraveled involved pathways. Using this wealth of data, precision medicine applications have started to appear also for common, complex diseases. In this article, we review current precision medicine applications from a clinical point of view and outline briefly a roadmap ahead for further clinical implementation of precision medicine in complex diseases.

The Swedish National Guidelines for Bone and Joint Infections were revised during 2018. The work was carried out on behalf of the Swedish Society for Infectious Diseases. The study group consists of senior consultants in infectious diseases, supported by specialists in orthopedic surgery, clinical microbiology and allergology when needed. The study group emphasizes that implant associated infections are challenging and requires multidisciplinary cooperation, including, but not limited to, specialists in orthopedic surgery, infectious diseases, clinical microbiology and radiology for optimal treatment results. All aspects of the clinical management are equally important; selecting the optimal antibiotic prophylaxis in arthroplasty as well as fracture surgery, early diagnosis of infection, adequate treatment, follow-up, and finally a structured evaluation of outcome. Profound and updated knowledge of treatment of biofilm related infection is necessary to achieve optimal results in patients with implant-associated infections. Future challenges include improved decision support for combining surgical treatment with selection of proper antibiotics, as well as management of antibiotic resistance, drug-drug interactions and adverse effects of antibiotic treatment.

Preterm delivery in Sweden constitutes 5.7 % of all deliveries, which is among the lowest rates in the world. There has not been any increase in the proportion of iatrogenic preterm deliveries during the last decades.The main hypothesis concerning the causality of preterm delivery is still that of the ascending infection from the vagina to the uterus and inflammation resulting in contractions, rupture of membranes and delivery. The mechanisms behind parturition at term are still elusive and this is also true for preterm delivery. The genetic contribution to preterm delivery is about 25-30 %. The first genes that are associated with preterm delivery and gestational duration have recently been published. Huge progress has been made in care of preterm born infants. Sweden has among the lowest rates of mortality and morbidity in the world, especially in the lowest gestational weeks. New modes of care, family-centered care and hospital-assisted home care, have empowered the parents and reduced the cost for care.

Due to a low level of understanding of mechanisms involved in spontaneous preterm delivery there is a lack of reliable biomarkers. Existing biomarkers have a low positive predictive value but a high negative predictive value. Use of tests with high negative predictive value will reduce unnecessary interventions and hospitalization of women with threatening preterm delivery. When given to the right pregnant women, antenatal corticosteroid treatment are still the most important obstetrical intervention and reduces both neonatal mortality and short- and long-term morbidity.Several ongoing national Swedish multicenter studies may increase the understanding of the roles of cervical length, preeclampsia screening and magnesium sulfate dosage in the context of preterm delivery in a Nordic setting. Major development has been achieved in prediction and prevention of preterm preeclampsia at the cost of a 10% screen positive rate.

Swedish guidelines for the management of adrenal incidentalomas  Adrenal incidentalomas are seen in about five percent of abdominal CT examinations, and in most cases represent non-hormone-producing adrenocortical adenomas, but hormone-producing or malignant lesions occur. Revised Swedish guidelines for the evaluation and management of adrenal incidentalomas based on recently published European guidelines are presented. The importance of a thorough radiological, clinical and biochemical initial evaluation is emphasized. Long-term biochemical follow-up is not recommended and use of CT contrast medium »washout« calculation is omitted. No radiological evaluation or follow-up indicated for adrenal incidentalomas <1 cm size. For patients with diagnosed lipid rich adenomas (≤ 10 HU) 1-4 cm in size no radiological follow-up is suggested after initial evaluation.

New regulations concerning EHEC/VTEC Hemolytic Uremic Syndrome (HUS) is the most severe complication to an infection with EHEC (enterohemorrhagic E. coli), also called VTEC (verocytotoxin-producing E. coli). Risk of severe complications such as HUS is an important reason why the Swedish Communicable Diseases Act (Smittskyddslag. 2004:168) includes infection with EHEC. With very few exceptions, only EHEC with the stx2 gene is associated with HUS. According to the law, persons working with unpackaged foods, infants or severely immunocompromised patients, and children attending preschool can be suspended awaiting negative test results for EHEC. Symptom free carriers of EHEC-infection only harbouring the stx1 gene and without an epidemiological association to HUS need not be suspended from work or preschool.

Early or delayed onset of oral anticoagulant therapy in patients with acute ischemic stroke with atrial fibrillation is an unsolved issue. Retrospectively, 294 patient records at two hospitals were scrutinized according to a protocol consisting of 20 items regarding choice of therapy (warfarin or NOAC), time for onset of therapy, CT findings of bleeding, capacity to swallow, and occurrence of clinical deterioration during the acute phase. Out of 249 patients who survived the acute phase, 116 (47%) patients were given a new prescription of warfarin or NOAC at discharge, while 43 (17 %) continued with anticoagulant therapy already prescribed before the onset of stroke. The median value for new prescriptions in relation to stroke admission was 5 days. The pattern was similar for warfarin and NOAC. Patients in whom anticoagulant therapy was started early were characterized by good capacity to swallow and no signs of bleeding on initial CT. The question »early or delayed onset of oral anticoagulant therapy after acute ischemic stroke with atrial fibrillation« needs to be tested in a randomized clinical trial.

In this article, results from a series of studies on the relationships between socioeconomic factors and stroke processes (stroke unit care, acute reperfusion treatment, secondary prevention with oral anticoagulants and statins) and outcomes (long-term survival, return to work and risk of suicide and suicide attempts) are summarized. The overall pattern is that acute and secondary prevention interventions and prognosis are better in patients with a high compared with a low level of education, better in people with high than low income, better in people who are cohabitant than single. As to country of birth, a more complex pattern has emerged. Unmeasured confounding may possibly explain part of the difference, but the socioeconomic gradients remain after adjustment for multiple potential confounders, leaving the possibility that there is an element of unconscious discrimination in stroke care.

Shermer's neck was first described in 1983 in an ultra-distance cyclist and it is often associated with neck pain (in our patient diplopia as first symptom) and exhaustion and impaired neck motor function with inability to extend the neck against gravity. The diplopia, for the first time described in connection with Shermer's neck, was accentuated when elevating the eyes and looking at distance, most likely reflecting exhaustion in the elevator muscles of the eye. Shermer's neck usually appears after 800 km of non-stop bike racing. Risk factors include former neck injuries, staying low in aerobars for a long time, and wearing helmet light/cameras. Prevention includes neck strength training, muscle stretching, raising of handle bars and different kinds of chin support. The most important treatment is rest and not riding a bike. In our patient the diplopia was normalized after 4 hours of sleep. It can take 2-14 days to regain full neck motor function. The possibility of developing Shermer's neck and diplopia (»Berglund's diplopia«) must be taken into account when many untrained individuals participate in popular shorter races over about 300 km.

Identifying individuals at risk of future suicide or suicide attempts is of clinical importance. Instruments have been developed to facilitate the assessment of the risk of future suicidal acts. A systematic review was conducted using the standard methods of the Swedish Council on Health Technology Assessment (SBU). The ability of the instrument to predict risk for future suicide/suicide attempt was assessed at follow up. The methodological quality of eligible studies was assessed; studies with moderate or low risk of bias were analysed in accordance with GRADE. None of the included studies provided scientific evidence to support that any instrument had sufficient accuracy to predict future suicidal behaviour. There is strong evidence to support that the SAD PERSONS Scale has very low sensitivity; most persons who make future suicidal acts are not identified.

Primary aldosteronism is the most common cause of secondary hypertension with an estimated prevalence of 5-13 % among patients with hypertension. The most common causes are aldosterone producing adrenal adenoma and idiopathic adrenal hyperplasia. Patients with primary aldosteronism have a higher prevalence of cardiovascular morbidity and mortality compared to patients with essential hypertension. An effective treatment is available for patients with primary aldosteronism, with mineralocorticoid receptor antagonists in bilateral, and minimal invasive adrenal surgery in unilateral disease, which emphasizes the importance of early detection, adequate diagnostic work-up and treatment. In this paper we give a short review of the etiology, pathophysiology, co-morbidities, screening, diagnostic work-up, treatment, and treatment outcomes of primary aldosteronism.

Patients with schizophrenia have a higher mortality than the general population. The risk of obesity, diabetes mellitus and cardiovascular disease is twice as high as in people without psychotic disorders. There are differences in emergency care as well as in secondary prevention in cardiovascular disorders and diabetes. The reason for the increased morbidity and mortality is most likely both inadequate diagnostic procedures and inadequate treatment interventions. Pharmacologic antipsychotic treatment can have negative metabolic side effects. Guidelines for identifying metabolic effects are described. Psychiatrists are advised to collaborate with specialists in internal medicine, paediatrics or general practice.

Primary aldosteronism is the cause of hypertension in 5-10% of the hypertensive population. Almost half of all patients with primary aldosteronism have unilateral disease, i.e. the dominating aldosterone production derives from one of the adrenal glands, and the rest have bilateral disease. The treatment of choice for patients with unilateral disease is unilateral laparoscopic/retroperitoneoscopic adrenalectomy. One-third of patients with unilateral disease have normal adrenal glands on imaging studies or changes in both of the adrenal glands. Similarly, 30% of patients with bilateral excessive aldosterone production have radiological evidence of adenoma in only one of the adrenal glands. Adrenal vein sampling should be considered mandatory in patients with primary aldosteronism prior to surgical treatment.

Tourette syndrome is a hereditary tic disorder. The symptoms consist of compulsory movements and vocalizations. Stress has an aggravating effect on tics. Unfortunately tics are easily mistaken for oppositional and defiant behavior. Tourette syndrome is most frequently seen with psychiatric comorbidity. Tics are best treated with low arousal techniques, which may be supplemented with pharmacotherapy.

Thoracic aortic aneurysms and dissections (TAAD) can be divided into three different main categories. 1. Inherited syndromes predisposing to TAAD such as Marfan syndrome, Ehlers-Danlos syndrome type IV and Loeys-Dietz syndrome (less than 5% of all TAAD). 2. Familial TAAD (FTAAD) with more than one affected family member (20 % of all TAAD). Inheritance shows an autosomal dominant pattern and there are no features of known syndromes. 3. Sporadic forms of TAAD with no family history or features of syndromic forms. FTAAD present earlier in life and dissections occur in smaller diameter than in sporadic cases. The underlying genetic cause can be found in about 20 % of the inherited cases. The pathogenesis seems to be an involvement of the transforming growth factor β (TGFβ) signaling pathway or a dysfunction of the smooth muscle cell contraction. The role of β-blockers for aneurysm prevention is uncertain and there are on-going studies comparing angiotensin receptor blockers and β-blockers.