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The increased recognition of inter-relationships between the environmental and health effects of food has resulted in a new fast-growing research area. Development of methods for integrated analysis of environmental and nutritional impacts is essential to facilitate policy decisions and actions for sustainable food systems. Dietary quality scores is one of the methods suggested to combine environmental and nutritional assessments of foods, meals and diets. This systematic review provides an overview of how dietary quality scores are used in environmental sustainability studies of food products and diets. The review includes 24 articles applying 20 different types of dietary quality scores. We describe current approaches used to combine environmental and nutritional assessments, discuss methodological choices of importance and their impact on results, and identify research gaps that require further efforts to push the current frontier of knowledge. Based on our analysis we identify two different categories of dietary quality scores and four approaches used to integrate environmental and nutritional assessments. There is a large number of methods available to quantify a dietary quality score: which one is chosen as well as how they are combined with environmental assessments can affect the results, and hence also the conclusions of which foods that are more sustainable to eat. This is critical to understand for the set-up of studies and for the interpretation of results and drawing conclusions. Our categorization of existing methods used, how they differ, what applications they are suited for, and which methodological challenges they involve increases the understanding of what analyzes are possible today and point out areas where methods are lacking and where more research is required. Continued efforts are needed to bring about a transition to sustainable food systems that do not exceed the planets ecological limits and promote healthy populations. This systematic review provides guidance for future use and development of methods within the field of sustainable nutrition. [ABSTRACT FROM AUTHOR]

Abstract Although food production is a main driver of environmental pressure and resource use globally, food delivers critical nutrition to humans. In life cycle assessment (LCA) of foods, the dominant functional unit is mass, despite the ISO requirement that the LCA unit should reflect the actual function. Studies have used various dietary quality scores in environmental assessments of foods, but the consideration of the dietary context is largely missing. The main function, i.e., nutrient supply, is complex since the nutritional value of a food item depends on its dietary context. Moreover, overall nutritional value is a combination of multiple nutrients. The aim was to combine scientific knowledge from the fields of nutrition and LCA to generate a basis for further research. The long-term aim was to help develop methods to support sustainability-based planning and decision making by food chain stakeholders. The proposed functional unit expresses the nutrient content of individual foods in relation to the nutritional supply of the complete diet, to create a single score reflecting the nutrient quality in a given dietary context. The nutrient quality index developed was evaluated by analyzing how relationships in global warming potential (GWP) between single products differed when using as functional unit either the mass of the food product, a nutrient quality index not considering the dietary context (the Nutrient Rich Foods Index 9.3, NRF9.3) and the new dietary dependent nutrient quality index (NQI) proposed. Two dietary scenarios were explored, an average Swedish diet and a typical unhealthy diet. The products considered were: bread, apples, tomatoes, milk, hard cheese, spread and chicken fillets. The results, calculated using bread as the reference, indicated that in both dietary contexts apples, tomatoes, and hard cheese had lower NQIadjusted GWPs compared to when GWPs were calculated using mass as the functional unit. Milk's NQI-adjusted and mass-calculated GWPs differed little, while the chicken fillet GWPs were the same in the unhealthy diet and performed better in the average diet. The NRF9.3-adjusted GWPs differed from the NQI-adjusted ones for all analysed foods. The main conclusions were: 1) considering nutritional value in the LCA of foods improves our understanding of how the environmental impacts and nutritional functions of food are related; 2) the environmental performance of different products varies with dietary context; and 3) application of the NQI could help industry, authorities, and consumers improve products and diets. Highlights • A method to include nutrition in the functional unit in food LCAs was developed. • By including the dietary context single foods' nutritional quality can be captured. • The method changed the relative environmental performance between products. • The dietary context impacted the results; hence it is if of relevance. • The method needs to be developed to be more generally applicable. [ABSTRACT FROM AUTHOR]

Different approaches have been used for translation of the EAT-Lancet reference diet into dietary scores that can be used to assess health and environmental impact. Our aim was to compare the different EAT-Lancet diet scores, and to estimate their associations with all-cause mortality, stroke incidence, and greenhouse gas emissions. We did a systematic review (PROSPERO, CRD42021286597) to identify different scores representing adherence to the EAT-Lancet reference diet. We then qualitatively compared the diet adherence scores, including their ability to group individuals according the EAT-Lancet reference diet recommendations, and quantitatively assessed the associations of the diet scores with health and environmental outcome data in three diverse cohorts: the Danish Diet, Cancer and Health Cohort (DCH; n=52 452), the Swedish Malmö Diet and Cancer Cohort (MDC; n=20 973), and the Mexican Teachers' Cohort (MTC; n=30 151). The DCH and MTC used food frequency questionnaires and the MDC used a modified diet history method to assess dietary intake, which we used to compute EAT-Lancet diet scores and evaluate the associations of scores with hazard of all-cause mortality and stroke. In the MDC, dietary greenhouse gas emission values were summarised for every participant, which we used to predict greenhouse gas emissions associated with varying diet adherence scores on each scoring system. In our review, seven diet scores were identified (Knuppel et al, 2019; Trijsburg et al, 2020; Cacau et al, 2021; Hanley-Cook et al, 2021; Kesse-Guyot et al, 2021; Stubbendorff et al, 2022; and Colizzi et al, 2023). Two of the seven scores (Stubbendorff and Colizzi) were among the most consistent in grouping participants according to the EAT-Lancet reference diet recommendations across cohorts, and higher scores (greater diet adherence) were associated with decreased risk of mortality (in the DCH and MDC), decreased risk of incident stroke (in the DCH and MDC for the Stubbendorff score; and in the DCH for the Colizzi score), and decreased predicted greenhouse gas emissions in the MDC. We conclude that the seven different scores representing the EAT-Lancet reference diet had differences in construction, interpretation, and relation to disease and climate-related outcomes. Two scores generally performed well in our evaluation. Future studies should carefully consider which diet score to use and preferably use multiple scores to assess the robustness of estimations, given that public health and environmental policy rely on these estimates., Competing Interests: Declaration of interests AS, UE, and ES were all involved in constructing one of the EAT–Lancet diet scores investigated (Stubbendorff et al(8)). All other authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

The market for plant-based dairy alternatives is growing; therefore, focusing on the nutritional quality of these products is important. This study evaluates the nutritional profile of plant-based alternatives to milk, yoghurt, cheese, cream, ice cream and fat spread in the Swedish market and compares them to corresponding dairy products. The nutritional quality of organic vs non-organic and plain vs flavoured plant-based milk and yoghurt alternatives was also assessed. Nutritional data for 222 plant-based dairy alternatives were collected from the manufacturers' websites, and data for corresponding dairy products were obtained from the Swedish Food Composition Database. Plant-based dairy alternatives had higher fibre content than dairy products, while their protein content was lower, except for soy-based products. The saturated fat content of plant-based dairy alternatives was similar to or lower than dairy products, except for coconut-based yoghurt and plant-fat-based cheese. Their energy content was also similar to or lower than dairy products, except for coconut-based yoghurt, plant-based fat spread and plant-based ice cream, which contained higher energy than yoghurt, blended margarine, and ice cream, respectively. The micronutrient fortification was mainly in plant-based milk, yoghurt, and cheese alternatives; thus, compared to dairy, they had similar or higher vitamins D, B2, and B12 (except in plant-based milk alternatives), calcium and iodine content. Furthermore, organic plant-based milk and yoghurt alternatives had a lower micronutrient content (e.g., vitamins B2 and B12, iodine and calcium) except for vitamin D than non-organic varieties. Flavoured plant-based milk and yoghurt alternatives were higher in energy and total sugar than plain varieties. In summary, plant-based dairy alternatives have nutritional strengths and weaknesses compared to dairy products that should be considered when replacing dairy., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: There is a concern that pesticide residues, regularly detected in foods, might pose a health risk to the consumer, but epidemiological evidence is limited. We assessed the associations between dietary exposure to a mixture of pesticide residues and mortality., Methods: Food consumption was assessed in 68,844 participants from the Swedish Mammography Cohort and the Cohort of Swedish Men, 45-83 years at baseline (1997). Concentrations of pesticide residues detected in foods on the Swedish market (1996-1998), mainly fruits and vegetables, were obtained via monitoring programs. To assess mixture effects, we summed per food item the ratios of each single pesticide mean residue concentration divided by its acceptable daily intake to create for each participant a Dietary Pesticide Hazard Index (adjusted for energy intake and expressed per kilogram of body weight). Multivariable-adjusted Cox proportional hazards models were used to estimate hazard ratios (HR) and 95 % confidence intervals (95 %CI)., Results: During 15 years of follow-up (1998-2014), a total of 16,527 deaths occurred, of which 6,238 were caused by cardiovascular disease (CVD) and 5,364 by cancer. Comparing extreme quintiles of Dietary Pesticide Hazard Index, the highest category was inversely associated with CVD mortality HR, 0.82 (95 % CI, 0.75-0.90) and with cancer mortality HR 0.82 (95 % CI 0.75-0.91). In analyses stratified by high/low Dietary Pesticide Hazard Index, similar inverse associations were observed by increasing fruit and vegetable consumption., Conclusions: We observed no indications that dietary exposure to pesticide residue mixtures was associated with increased mortality, nor any clear indications that the benefits of fruit and vegetable consumption on mortality was compromised. Yet, our results need to be interpreted with caution., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Reliable detection and classification of bacteria and other pathogens in the human body, animals, food, and water is crucial for improving and safeguarding public health. For instance, identifying the species and its antibiotic susceptibility is vital for effective bacterial infection treatment. Here we show that phase contrast time-lapse microscopy combined with deep learning is sufficient to classify four species of bacteria relevant to human health. The classification is performed on living bacteria and does not require fixation or staining, meaning that the bacterial species can be determined as the bacteria reproduce in a microfluidic device, enabling parallel determination of susceptibility to antibiotics. We assess the performance of convolutional neural networks and vision transformers, where the best model attained a class-average accuracy exceeding 98%. Our successful proof-of-principle results suggest that the methods should be challenged with data covering more species and clinically relevant isolates for future clinical use., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: J.E. has founded and is partly engaged in the AMR diagnostics company Sysmex Astrego AB, https://www.sysmex-astrego.se. This competing interest will not alter adherence to PLOS policies on sharing data and materials., (Copyright: © 2023 Hallström et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: To assess the associations between adherence to the Swedish dietary guidelines and all-cause mortality (i.e. assessing the index' ability to predict health outcomes), as well as levels of dietary greenhouse gas emissions (GHGEs)., Design: A longitudinal study 1990-2016 within the population-based cohort Västerbotten Intervention Programme. Dietary data were based on FFQs. Diet quality was assessed by the Swedish Healthy Eating Index for Adults 2015 (SHEIA15), based on the 2015 Swedish dietary guidelines. Dietary GHGEs were estimated from life cycle assessment data including emissions from farm to industry gate. Hazard ratios (HR) and 95 % CI of all-cause mortality were evaluated with Cox proportional hazards regression, and differences in median GHGEs were tested between quintiles of SHEIA15 score using the Kruskal-Wallis one-way ANOVA test., Setting: Northern Sweden., Participants: In total, 49 124 women and 47 651 men, aged 35-65 years., Results: Median follow-up times were 16·0 years for women and 14·7 years for men, during which time 3074 women and 4212 men died. A consistent trend of lower all-cause mortality HR for both sexes with higher SHEIA15 scores was demonstrated. For women, the all-cause mortality HR was 0·81 ((95 % CI 0·71, 0·92); P = 0·001) and for men 0·90 ((95 % CI 0·81, 0·996); P = 0·041) between the quintile with the highest SHEIA15 score compared with the quintile with the lowest SHEIA15 score. A consistent trend of lower estimated dietary GHGEs among both sexes with higher SHEIA15 scores was also found., Conclusions: Adherence to Swedish dietary guidelines, estimated by SHEIA15, seems to promote longevity and reduce dietary climate impact.

Background: Interventions to improve dietary intake and reduce dietary greenhouse gas emissions (dGHGE) are urgently needed. Adolescence presents a unique time in life to promote sustainable diets. Detailed dietary data are needed to inform public health strategies aiming at improving adolescents' diet quality and reducing dGHGE., Objective: This study aimed to describe dGHGE in Swedish adolescents' diets by socio-demographic characteristics, evaluate how food groups contribute to dGHGE, and examine dGHGE in relation to diet quality., Methods: Data come from the national, school-based, cross-sectional dietary survey Riksmaten Adolescents 2016-17 of 3099 females and males attending school grades 5 (11-12 y old), 8 (14-15 y old) and 11 (17-18 y old). Participants completed 2 web-based 24-h recalls and questionnaires on lifestyle factors. dGHGE was estimated based on life cycle assessment data. Diet quality was estimated using NRF11.3 (Nutrient Rich Food Index) and SHEIA15 (Swedish Healthy Eating Index for Adolescents 2015)., Results: dGHGE were higher in males than females (medians 4.2 versus 3.8 kg CO 2 e/10 MJ, P < 0.001). In females, dGHGE were highest in grade 5 (4.0 kg CO 2 e/10MJ), whereas in males, emissions were highest in grade 11 (4.4 kg CO 2 e/10MJ), P < 0.001 for the sex/grade interaction. Overweight/obesity was positively associated with CO 2 e/10MJ, but parental education, birthplace, and degree of urbanization were not. In females, the proportion of dGHGE from animal-based foods was lowest in grade 11, whereas the proportions from plant-based foods and sweet foods/beverages were highest. In males, these proportions were similar across grades. NRF11.3 was not associated with CO 2 e/10MJ, whereas healthier eating, according to SHEIA15, was inversely associated with CO 2 e/10MJ., Conclusions: Food choices and dGHGE per calorie differ by sex in adolescents. Thus, intervention strategies to improve dietary sustainability need to be tailored differently to females and males. Diet quality should also be considered when promoting reduced GHGE diets., (Copyright © 2023 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background: Nutritional quality, and health and climate impacts are important considerations in the design of sustainable diets., Objectives: To investigate the association between diets varying in nutrient density and climate impact and MI and stroke HRs., Methods: Dietary data of 41,194 women and 39,141 men (35-65 y) who participated in a Swedish population-based cohort study were employed. Nutrient density was calculated using the Sweden-adapted Nutrient Rich Foods 11.3 index. Dietary climate impact was calculated with data from life cycle assessments, including greenhouse gas emissions from primary production to industry gate. HRs and 95% CIs for MI and stroke were assessed with multivariable Cox proportional hazards regression, comparing a least-desirable diet scenario reference group (lower nutrient density, higher climate impact) with three diet groups that varied with respect to higher/lower nutrient density and higher/lower climate impact., Results: Median follow-up time from the baseline study visit to MI or stroke diagnosis was 15.7 y for women and 12.8 y for men. The MI hazard was significantly higher for the men with diets of lower nutrient density and lower climate impact (HR: 1.19; 95% CI: 1.06, 1.33; P = 0.004), compared with the reference group. No significant association with MI was observed for any of the diet groups of women. No significant association with stroke was observed among any of the diet groups of women or men., Conclusions: The results among men suggest some adverse health effects for men when diet quality is not considered in the pursuit of more climate-sustainable diets. For women, no significant associations were detected. The mechanism underlying this association for men needs further investigation., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Nutritional quality of 142 plant-based meat analogues (PBMAs) on the Swedish market were assessed by nutritional contribution (NC) to recommended nutrient intake, three labelling systems (Keyhole, Nutri-Score, nutrition claims) and comparisons to meat references. Based on median (min-max) NC for macronutrients, PBMAs in general appeared as healthy options to meat due to higher NC per 100 g for fibre [PBMAs: 15% (1-33%) vs meat: 0% (0-2%)] and lower NC for saturated fat [PBMAs: 4% (0-59%) vs meat: 15% (1-51%)]. The NC per 100 g for salt was substantial for both PBMAs [25% (5-52%)] and meat [24% (2-55%)]. Limited data for micronutrients indicated that PBMAs are higher in iron compared to meat. Nutrition quality varied both between and within product categories. Mince, bite/fillet and nugget analogues were the main healthier categories, according to labelling systems. Bioavailability of iron, protein quality and effects of processing are important future aspects to consider.

Background: Current global food systems threaten human health and environmental sustainability. In 2019, the EAT-Lancet Commission on healthy diets from sustainable food systems defined the first global reference diet to improve both areas, but there is no consensus on how to quantify the EAT-Lancet reference diet as a diet index, and its relation to mortality has not been widely studied., Objectives: We sought to develop a new dietary index to quantify adherence to the EAT-Lancet diet and assess its association with mortality in a large, population-based Swedish cohort. We also examined food components included in the index and their individual associations with mortality., Methods: We used the Malmö Diet and Cancer cohort (n = 22,421; 45-73 years old at baseline). Dietary data were collected using a modified diet history method. The EAT-Lancet index was developed based on intake levels and reference intervals of 14 food components defined in the EAT-Lancet diet (0-3 points per component; 0-42 points in total). Associations with mortality were examined based on registers during a mean of 20 years of follow-up and were adjusted for potential confounders., Results: Divided into 5 adherence groups, the highest adherence to the EAT-Lancet diet (≥23 points) was associated with lower all-cause mortality (HR, 0.75; 95% CI, 0.67-0.85), cancer mortality (HR, 0.76; 95% CI, 0.63-0.92), and cardiovascular mortality (HR, 0.68; 95% CI, 0.54-0.84) than the lowest adherence (≤13 points). Several food components included in the index contributed to the observed reductions in mortality., Conclusions: We developed a new dietary index to investigate adherence to the EAT-Lancet diet. The findings indicate a 25% lower risk of mortality among those with the highest adherence to the EAT-Lancet diet, as defined using our index, which adds to the evidence base for the development of sustainable dietary guidelines., (© The Author(s) 2021. Published by Oxford University Press.)

Fluorescence microscopy, which visualizes cellular components with fluorescent stains, is an invaluable method in image cytometry. From these images various cellular features can be extracted. Together these features form phenotypes that can be used to determine effective drug therapies, such as those based on nanomedicines. Unfortunately, fluorescence microscopy is time-consuming, expensive, labour intensive, and toxic to the cells. Bright-field images lack these downsides but also lack the clear contrast of the cellular components and hence are difficult to use for downstream analysis. Generating the fluorescence images directly from bright-field images using virtual staining (also known as "label-free prediction" and "in-silico labeling") can get the best of both worlds, but can be very challenging to do for poorly visible cellular structures in the bright-field images. To tackle this problem deep learning models were explored to learn the mapping between bright-field and fluorescence images for adipocyte cell images. The models were tailored for each imaging channel, paying particular attention to the various challenges in each case, and those with the highest fidelity in extracted cell-level features were selected. The solutions included utilizing privileged information for the nuclear channel, and using image gradient information and adversarial training for the lipids channel. The former resulted in better morphological and count features and the latter resulted in more faithfully captured defects in the lipids, which are key features required for downstream analysis of these channels., Competing Interests: No authors have competing interests.

Background: Diets combining adequate nutritional quality and low climate impact are highly needed for human and planet health., Objectives: We aimed to 1) evaluate nutrient density indexes' ability to predict mortality, and 2) assess the effects of diets varying in nutrient density and climate impact on total mortality., Methods: Dietary data from 49,124 women and 47,651 men aged 35-65 y in the population-based prospective study Västerbotten Intervention Programme (Sweden) were used. Greenhouse gas emissions (GHGEs) were estimated using data from life cycle assessments. Fifteen variants of nutrient density indexes were evaluated and the index that best predicted mortality was used to estimate participants' nutrient density. GHGEs and nutrient density were adjusted for energy intakes. Total mortality risk was estimated by Cox proportional hazards models for 4 groups of women and men, respectively, i.e., higher nutrient density, lower climate impact (HNutr/LClim); higher nutrient density, higher climate impact (HNutr/HClim); lower nutrient density, lower climate impact (LNutr/LClim); and lower nutrient density, higher climate impact (LNutr/HClim-reference group)., Results: NRF11.3, a Sweden-adapted variant of the Nutrient Rich Foods index, was identified to have the best ability to predict mortality in the study population. Median follow-up times for women and men were 16.0 and 14.7 y, respectively. For women a significantly lower mortality risk was found for HNutr/LClim (HR: 0.87; 95% CI: 0.79, 0.96; P = 0.008) and HNutr/HClim (HR: 0.87; 95% CI: 0.78, 0.97; P = 0.011) than for LNutr/HClim. Among men LNutr/LClim had a significantly higher mortality risk (HR: 1.10; 95% CI: 1.01, 1.21; P = 0.033) than LNutr/HClim., Conclusions: Diets beneficial for both health and climate are feasible and associated with lower mortality risk in women. Further studies are needed to understand how men may transition into diets that are more sustainable from a combined health and climate perspective., (© The Author(s) 2021. Published by Oxford University Press on behalf of the American Society for Nutrition.)

The objective was to examine 10-year changes in dietary carbon footprint relative to individual characteristics and food intake in the unique longitudinal Västerbotten Intervention Programme, Sweden. Here, 14 591 women and 13 347 men had been followed over time. Food intake was assessed via multiple two study visits 1996-2016, using a 64-item food frequency questionnaire. Greenhouse gas emissions (GHGE) related to food intake, expressed as kg carbon dioxide equivalents/1000 kcal and day, were estimated. Participants were classified into GHGE quintiles within sex and 10-year age group strata at both visits. Women and men changing from lowest to highest GHGE quintile exhibited highest body mass index within their quintiles at first visit, and the largest increase in intake of meat, minced meat, chicken, fish and butter and the largest decrease in intake of potatoes, rice and pasta. Women and men changing from highest to lowest GHGE quintile exhibited basically lowest rates of university degree and marriage and highest rates of smoking within their quintiles at first visit. Among these, both sexes reported the largest decrease in intake of meat, minced meat and milk, and the largest increase in intake of snacks and, for women, sweets. More research is needed on how to motivate dietary modifications to reduce climate impact and support public health.

Objective: The objective of this study was to examine climate impact from diet across background and sociodemographic characteristics in a population-based cohort in northern Sweden., Design: A cross-sectional study within the Västerbotten Intervention Programme. Dietary data from a 64-item food frequency questionnaire collected during 1996-2016 were used. Energy-adjusted greenhouse gas emissions (GHGE) for all participants, expressed as kg carbon dioxide equivalents/day and 4184 kJ (1000 kcal), were estimated using data from life cycle analyses. Differences in background and sociodemographic characteristics were examined between participants with low and high GHGE from diet, respectively. The variables evaluated were age, BMI, physical activity, marital status, level of education, smoking, and residence., Setting: Västerbotten county in northern Sweden., Participants: In total, 46 893 women and 45 766 men aged 29-65 years., Results: Differences in GHGE from diet were found across the majority of examined variables. The strongest associations were found between GHGE from diet and age, BMI, education, and residence (all P < 0·001), with the highest GHGE from diet found among women and men who were younger, had a higher BMI, higher educational level, and lived in urban areas., Conclusions: This study is one of the first to examine climate impact from diet across background and sociodemographic characteristics. The results show that climate impact from diet is associated with age, BMI, residence and educational level amongst men and women in Västerbotten, Sweden. These results define potential target populations where public health interventions addressing a move towards more climate-friendly food choices and reduced climate impact from diet could be most effective.

Purpose: To compare the results two to three years after intervention, using either surgical or non-operative treatment., Methods: Eighty-seven patients with subacromial impingement syndrome (SAIS) were randomised into open acromioplasty (OS group), arthroscopic acromioplasty (AS group) or physiotherapy (PT group) treatment. The assessments comprised the Constant score, the Watson and Sonnabend score, the SF-36 evaluation and a clinical examination performed by an independent observer. Fifty-five patients attended the clinical follow-up., Results: The groups were comparable at baseline in terms of demographics and clinical assessments. No significant differences in terms of the clinical assessments or health-related quality of life (QoL) were found between the study groups at follow-up. The Constant score had improved significantly at follow-up in both the OS group and the AS group (p = 0.003 and 0.008, respectively). At follow-up, the OS group revealed improved strength compared with before intervention (p = 0.012). All groups revealed a significantly improved internal rotation (OSG p = 0.01, ASG p = 0.005, PTG p = 0.004). The SF-36 was significantly improved in some scales within all three groups. The Watson and Sonnabend score was significantly improved in 12/14 questions for the OS group, in 5/14 questions for the AS group and in 6/14 for the PT group (p < 0.02 OS group vs. AS group, p < 0.05 OS group vs. PT group)., Conclusion: In this randomised study, the Constant score, other clinical assessments and subjective health-related QoL revealed no significant differences between the 3 groups two to three years after intervention in patients with SAIS. The OS group showed a greater improvement over time., Level of Evidence: CT with low follow-up rate, Level II.

Background: Previous studies indicate that elevated amylose content in products from rice, corn, and barley induce lower postprandial glycaemic responses and higher levels of resistant starch (RS). Consumption of slowly digestible carbohydrates and RS has been associated with health benefits such as decreased risk of diabetes and cardiovascular disease., Objective: To evaluate the postprandial glucose and insulin responses in vivo to bread products based on a novel wheat genotype with elevated amylose content (38%)., Design: Bread was baked from a unique wheat genotype with elevated amylose content, using baking conditions known to promote amylose retrogradation. Included test products were bread based on whole grain wheat with elevated amylose content (EAW), EAW with added lactic acid (EAW-la), and ordinary whole grain wheat bread (WGW). All test breads were baked at pumpernickel conditions (20 hours, 120°C). A conventionally baked white wheat bread (REF) was used as reference. Resistant starch (RS) content was measured in vitro and postprandial glucose and insulin responses were tested in 14 healthy subjects., Results: The results showed a significantly higher RS content (on total starch basis) in breads based on EAW than in WGW (p<0.001). Lactic acid further increased RS (p<0.001) compared with both WGW and EAW. Breads baked with EAW induced lower postprandial glucose response than REF during the first 120 min (p<0.05), but there were no significant differences in insulin responses. Increased RS content per test portion was correlated to a reduced glycaemic index (GI) (r=-0.571, p<0.001)., Conclusions: This study indicates that wheat with elevated amylose content may be preferable to other wheat genotypes considering RS formation. Further research is needed to test the hypothesis that bread with elevated amylose content can improve postprandial glycaemic response.

To study the kinematics of the glenohumeral joint during the testing of the Neer and Hawkins signs, we used dynamic radiostereometry. Eighteen patients with impingement syndrome (Neer stage 2) and eleven controls were included. During testing of the Neer sign, there was no significant difference in humeral rotation and translation between patients and controls. During testing of the Hawkins sign, the center of the humeral head was positioned more laterally and superiorly in controls than in patients. The maximum amount of abduction, either relative glenohumeral rotation or as absolute rotation, was not influenced by the presence of impingement symptoms. Absence of kinematic abnormalities during the Neer maneuver and changed humeral translation in the Hawkins position suggest that the latter test is a more sensitive diagnostic tool. Our findings do not support that abnormal passive shoulder motions precede development of impingement syndrome.

Unlabelled: We used dynamic radiostereometry to study the three-dimensional kinematics of the shoulder joint during active abduction. Twenty-five patients experiencing shoulder symptoms (Neer Stage 2) for more than 18 months, without total rotator cuff tears, participated. Eight men and four women without shoulder symptoms constituted controls. The rotation of the humeral head relative to a fixed scapula and the absolute rotation of the humerus (caused by humeral, scapular, and trunk motion) were measured. The rotations were calculated in the order of abduction/adduction (anteroposterior axis), internal/external rotation (longitudinal axis), and flexion/extension (transverse axis). The absolute abduction of the humerus in our patients did not differ from controls, nor did the abduction in the glenohumeral joint. During abduction, the humeral centre displaced medially, proximally, and anteriorly. In the patient group, slightly more (1-1.5 mm) proximal translation was observed. Presence of impingement syndrome was associated with increased proximal translation of the humeral head center, which occurred in the early phase of the arc of motion., Level of Evidence: Diagnostic Level I. See Guidelines for Authors for a complete description of Levels of Evidence.