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Aim: To investigate the prevalence of attention‐deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in a population‐based birth cohort and correlate the findings with prenatal and perinatal factors. We hypothesized that children born preterm, having experienced preeclampsia or maternal overweight, would have an increased risk of ADHD or ASD. Method: A Swedish cohort of 2666 children (1350 males, 1316 females) has been followed from birth with parental and perinatal data. The National Board of Health and Welfare's registries were used to collect data regarding perinatal status and assigned diagnoses at the age of 12 years. Results: The prevalence of ADHD and ASD was 7.6% and 1.1% respectively. Maternal obesity early in pregnancy resulted in a three‐fold increased risk of ADHD in the child. Similarly, paternal obesity resulted in a two‐fold increased risk. The association was significant also when adjusted for sex, preterm birth, smoking, and lower educational level. The prevalence of ASD was too low for statistically relevant risk factor analyses. Interpretation: Our results corroborate earlier findings regarding prevalence and sex ratio for both ADHD and ASD. Maternal body mass index and preterm birth were correlated with an ADHD diagnosis at the age of 12 years. [ABSTRACT FROM AUTHOR]

Objective: The longitudinal variations in serum levels of the hormone osteocalcin is largely unknown during infancy and early childhood. Our aim was to establish reference limits for total serum osteocalcin during specific time points from birth until 5 years of age and present those in the context of sex, breastfeeding practices and gestational age (GA). Design: Blood samples from 551 Swedish children were analysed at birth, 4, 12, 36 and 60 months of age. Total serum osteocalcin was measured using the IDS‐iSYS N‐MID Osteocalcin assay technique. Information about the mother, birth, anthropometrics and a food diary were collected. Results: Sex‐specific and age‐specific reference limits were established for the five time points. The median osteocalcin levels over time were 40.8, 90.0, 67.8, 62.2 and 80.9 μg/L for boys and 38.1, 95.5, 78.3, 73.9 and 92.6 μg/L for girls. Lower GA was associated to higher osteocalcin at birth, and ongoing breastfeeding was associated to higher osteocalcin levels. Conclusion: Osteocalcin followed a wavelike pattern with low levels in the umbilical cord and a postnatal peak during the first year which then declined and rose again by the age of five. Knowledge of this wavelike pattern and association to factors as sex, breastfeeding and GA may help clinicians to interpret individual osteocalcin levels and guide in future research. [ABSTRACT FROM AUTHOR]

Background: The transition from student to doctor is often depicted as a struggle in the literature, and previous research has focused on interventions to minimise difficulties in transitioning from undergraduate to postgraduate training. In considering this transition as a potential transformative experience, we intend to produce new insights into how junior doctors experience the transition to clinical work. The aim of this study was to explore medical interns' conceptualisations of the transition from student to doctor through studying the Swedish medical internship, which serves as a bridge between undergraduate and postgraduate studies. The research question was formulated as follows: How do medical interns perceive the meaning of the medical internship? Methods: The data were collected through in‐depth interviews with 12 senior medical interns in western Sweden. The transcribed interviews were analysed using a phenomenographic approach, which resulted in four qualitatively varying ways of perceiving the meaning of the internship, organised hierarchically in a phenomenographic outcome space. Results: The interns perceived the meaning of the internship as an opportunity to work and learn in an authentic setting (internship as in‐service training) and in a protected environment (internship as a space). The internship guaranteed a minimum level of competence (internship as a quality marker) and allowed the interns to gain new insights into themselves and their world (internship as an eye‐opener). Discussion: Being allowed to be learners in a protected space seemed pivotal for the interns to develop into competent, confident and independent practitioners. The medical internship studied here could be viewed as a meaningful transition into new ways of experiencing, allowing for an increased understanding of oneself and the world. This study adds to the scientific literature on what constitutes a transformative transition. Transitioning from student to doctor isn't just a struggle; it's a transformative experience. This study delves into how medical interns in Sweden perceive this journey. It's not just training; it's a journey of self‐discovery, competence, and confidence. [ABSTRACT FROM AUTHOR]

Objective: To determine whether a tight control (TC) regime with monthly consultations to the physician for the first 6 months, could increase remission rate and improve reported pain of patients with early rheumatoid arthritis (RA). Methods: In this single‐centre, TC study, with monthly visits to the physician, a cohort of 100 patients with early RA was consecutively included. They were compared with a reference cohort of 100 patients from the same clinic that had been conventionally managed. The patients were followed for 2 years. Results: The patients in the TC cohort had lower 28‐ joints disease activity score (DAS28) at three, six, 12 and 24 months, compared with the conventionally managed cohort, p ≤ 0.001. At 12 months, 71% in the TC cohort versus 46% in the conventional cohort were in remission (DAS28 < 2.6) and at 24 months 68% versus 49% respectively, p < 0.05. The TC cohort reported less pain at three, six, 12 and 24 months, p < 0.001. Multiple logistical regression analyses adjusted for, respectively, age, disease duration, pharmacological treatment, DAS28 and visual analogue scale pain at inclusion, revealed that participation in the TC cohort had an independent positive association with remission at 12 and 24 months and with acceptable pain at 24 months. Conclusion: The intensive follow‐up schedule for patients with early RA improved remission and led to improvement in reported pain and physical function. The positive effect of a TC regime in early disease may be due to increased empowerment, developed by meeting health professionals frequently. [ABSTRACT FROM AUTHOR]

Aim: We previously reported that consuming milk cereal drinks at six months of age was associated with a high body mass index (BMI) at 12 and 18 months. This study examined the association between daily consumption at 12 months of age and BMI at the age of five.Methods: We followed up 1870/2666 (70%) children recruited at birth in 2007-2008 for the Swedish longitudinal population-based Halland Health and Growth Study a mean of 5.09 ± 0.28 years. Feeding practices were obtained from parental questionnaires, and anthropometric data were collected by child health nurses.Results: At five years, 11.6% were overweight and 2.3% were obese. Milk cereal drinks were consumed by about 85% and 10% at one and five years of age, respectively. Consumption at 12 months was associated with almost double the risk of being overweight at five years of age (adjusted odds ratio 1.94, 95% confidence interval 1.08-3.50). Other risk factors were a family history of obesity, low paternal educational level and paternal smoking.Conclusion: Consuming milk cereal drinks daily at 12 months was associated with a twofold risk of being overweight at five years. These findings may affect the counselling guidelines used at child healthcare centres. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to investigate how visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) volumes were associated with metabolic risk factors in 7-year-old children.Methods: A total of 81 children (52% girls) from a Swedish birth cohort were studied. At 6 years of age, anthropometric data, fasting insulin, glucose, cholesterol, and blood pressure were collected on 53 children with normal weight and 28 children with overweight or obesity, and insulin resistance was estimated. At 7 years of age, magnetic resonance imaging quantified VAT and SAT. Sex and regression analyses were conducted.Results: SAT was more strongly associated with metabolic risk factors than VAT. The associations between VAT and metabolic risk factors were stronger in girls (P < 0.05). When VAT was adjusted for birth weight and maternal BMI and education, it accounted for 51% of insulin variance (β = 11.72; P = 0.001) but only in girls. The key finding of this study was that adjusted SAT accounted for 63% of the fasting insulin variance in girls (β = 2.76; P < 0.001). Waist circumference was the best anthropometric marker for insulin resistance.Conclusions: Insulin resistance was associated with abdominal adipose tissue and its associated metabolic risk factors in children as young as 7 years old. [ABSTRACT FROM AUTHOR]

Aim: The aim of the present study was to examine body mass index (BMI) and waist-to-height ratio (WHtR) growth patterns from birth until five years regarding their ability to predict overweight or obesity in children at five years of age.Methods: Population-based longitudinal birth cohort study of 1540 children from the south-west region of Sweden, recruited at the first visit to the child health care centres in 2007-2008. The children were followed for five years and classified into two weight groups according to the 2012 International Obesity Task Force criteria. BMI and WHtR standard deviation scores (SDS) were analysed with Student's t-tests and multiple logistic regression models.Results: BMI-SDS and WHtR-SDS growth patterns were from an early age different in children with overweight or obesity, compared to in children with normal weight or underweight. Overweight or obesity was significantly predicted by BMI-SDS at 0-1 month (p < 0.001), ΔBMI-SDS between 0-1 and 12 months (p < 0.001) and between 18 and 48 months (p < 0.001), but not by WHtR-SDS, except for a negative association between 18 and 48 months in the boys (p = 0.040).Conclusion: Overweight or obesity at five years could be predicted by early BMI-SDS growth patterns, and WHtR-SDS did not add to the predictivity with regard to BMI-SDS. [ABSTRACT FROM AUTHOR]

Aim: Metabolic syndrome represents a cluster of risk factors for cardiovascular disease, and we investigated whether otherwise healthy 6-year-olds showed metabolic alterations.Methods: This study followed up a representative Swedish population-based cohort of full-term infants recruited on the maternity ward at Hallands Hospital Halmstad, Sweden, from 2008 to 2011. They were examined at a mean of 6.6 years of age (range 6.5-6.9) using various measures for signs of metabolic syndrome.Results: One key measure showed that 55 (26%) of the 212 children had one or more risk factors for metabolic syndrome requiring action. The 37 who were obese (3%) or overweight (14%) were significantly more likely to be insulin resistant than the normal weight group (28% versus 5%, p < 0.001) and have high triglycerides (8% versus 0%, p < 0.001). Children with high waist circumferences had higher systolic (p = 0.01) and diastolic (p = 0.02) blood pressure than those with normal waist circumferences. Waist circumference identified children at high risk of metabolic syndrome better than body mass index.Conclusion: A significant percentage of 6-year-old children showed abnormal metabolic profiles, including insulin resistance, which increased their risk of cardiovascular disease. Waist circumference was a stronger marker for metabolic alterations than body mass index. [ABSTRACT FROM AUTHOR]

Background: Telephone helplines are useful for improving patients' access to healthcare services and reducing the need for frequent face‐to‐face contact with healthcare professionals. Little is known about how people who phone a helpline perceive the encounter. Objectives: The aims of the present study were to describe the variation in how callers perceive their encounter with a rheumatology telephone helpline. Methods: The study had a descriptive, qualitative design and used a phenomenographic approach, comprising 27 semi‐structured telephone interviews with callers to Rheuma Direct, a rheumatology telephone helpline with specially trained nurses. The callers comprised 22 women and five men, aged 22–89 years (mean 54 years). Results: The callers phoned Rheuma Direct when they had problems obtaining answers to questions on the internet or from healthcare professionals. Three descriptive categories emerged: constructive dialogue, specialized competence and applicability. The callers perceived that it was a constructive dialogue when they were able to discuss their concerns with someone, received emotional support, felt reassured and were satisfied with the information provided. They perceived specialized competence when the nurses were experienced and skilful, the advice provided complemented previously received information and when they had more knowledge after the call. The callers perceived that Rheuma Direct had applicability because it was easy to access and they could make different choices before, during and after the telephone call. Conclusions: Callers to a rheumatology telephone helpline perceived it as a valuable complement to other sources of information, and felt that it could provide them with the tools to manage their disease better, as well as future contacts with healthcare professionals. [ABSTRACT FROM AUTHOR]

Aim: This study examined whether the parents of children who were overweight at two and five years of age perceived their children as being too heavy and related the findings to sociodemographic factors.Methods: The data collection included parental questionnaires and anthropometric data from a longitudinal birth cohort of 2666 children born in the south-west region of Sweden in 2007-2008.Results: We found that 14.9 and 11.8% of the children were considered overweight or obese at the age of two and five, but 96.4 and 87.1% of their parents perceived their weight to be just about right at these ages. The difference was statistically significant (p < 0.001). Parents who were overweight themselves and had a low educational level were associated with a higher probability of misperception: at two years of age, the odds ratio was 2.75 (95% confidence interval 1.80-4.21), and at the age of five, it was 1.92 (1.24-2.97).Conclusion: Most parents did not perceive that their overweight children weighed too much, but their judgement improved as the child got older. Parents who were overweight or had a low educational level were more likely to misperceive their child's weight. Health Care professionals need to be aware of this gap in perception. [ABSTRACT FROM AUTHOR]

Background With an increasing number of patients with osteoarthritis (OA) and rheumatoid arthritis (RA) in primary care, our aim was to investigate arthritis-related practice in physiotherapy and to study adherence to evidence-based care. Methods Seventy physiotherapists (PTs) working in primary care were emailed a questionnaire to investigate current practice and the number of roles assumed by PTs, the degree of confidence, educational needs and adherence to national guidelines in managing patients with OA or RA. Interventions supported by national guidelines were compared with reports of treatment modalities in the questionnaire. Results Sixty-four (91%) PTs responded, and they reported a higher degree of confidence in assessment, treatment and education of patients with OA than for those with RA ( p < 0.001). The total number of roles assumed by the PTs was higher in the management of OA than for RA ( p < 0.001). PTs who assumed a greater number of roles also reported a stronger degree of confidence in assessing OA ( p = 0.036). Those who assumed fewer roles also reported less confidence in RA treatment ( p = 0.045). Recommendations in the guidelines were followed by the majority of PTs for eight of 11 treatment modalities in OA and for six of six in RA. Conclusions PTs reported a lower degree of confidence and the assumption of fewer roles in managing patients with RA compared with OA. There was good adherence to the national guidelines for almost all the treatment modalities listed. Even so, the results indicate a need for education, especially in chronic inflammatory arthritis care. [ABSTRACT FROM AUTHOR]

Objective Research concerning spinal mobility in axial spondyloarthritis (axSpA) has focused on ankylosing spondylitis (AS), and data on the clinical diagnosis of undifferentiated spondyloarthritis (USpA) are limited. The objective was to study differences in spinal mobility between axSpA subgroups AS and USpA, including gender differences. Methods A total of 183 patients with axSpA from a rheumatology clinic were included in the study. The earliest recorded spinal mobility measures (cervical rotation/flexion/extension/lateral flexion, tragus-to-wall distance, vital capacity, chest expansion, thoracic flexion, thoracolumbar flexion, lateral spinal flexion, lumbar flexion and intermalleolar distance) were obtained by specialized physiotherapists. Differences between subgroups were analysed using analysis of covariance, controlled for gender and disease duration. Results In the USpA group ( n = 57), the mean [standard deviation (SD)] age was 41.6 (11.4) years, and disease duration was 13 (10.6) years, with 54% men. In the AS group ( n = 126), the mean (SD) age was 48.4 (13.5) years, and disease duration 24.6 (13.3) years, with 77% men. Spinal mobility was less restricted in USpA versus AS patients ( p ≤ 0.05), with a median (interquartile range) tragus-to-wall distance of 11 (10-12) cm versus 13 (11.3-18.5) cm; thoracolumbar flexion 9 (7-10) cm versus 6.5 (4-9) cm; lateral spinal flexion 29 (25-36) cm versus 21.3 (12-31) cm; lumbar flexion 4.5 (3.5-5.0) cm versus 3.5 (2.0-4.5) cm and intermalleolar distance 113 (102-121) cm versus 101 (86-114) cm. There were no differences between the subgroups in cervical mobility, vital capacity, chest expansion or thoracic flexion, and there were few gender differences, besides anthropometric measures. Conclusion Patients with USpA and AS had similar cervical and chest mobility, while thoracic and lumbar mobility were more severely restricted in AS. There were few gender differences in either subgroup. Further studies, to understand the full impact of USpA on spinal mobility, are needed. Copyright © 2016 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Aim Infant feeding affects growth, obesity and life-long health. This study examined the impact of dietary patterns on body mass index (BMI) at 12 and 18 months. Methods We followed a cohort of 2666 children recruited in 2007-2008. Feeding practices were obtained from parental questionnaires and anthropometric data collected by child health nurses. Results At 6 months, 58.3% of the infant were breastfed, but only 1.6% exclusively. Many had begun eating solids (91.8%), porridge (87.7%) or milk cereal drink (46.6%). Bottle-feeding at 4 months was not a risk factor for a high BMI (>1 SD) at 12 or 18 months. Milk cereal drink at six months increased the risk of a high BMI at 12 and 18 months, respectively (OR 1.58, 95% CI 1.12-2.22, and 1.52, 1.07-2.17). Milk cereal drink use was increased by low parental education and maternal obesity and reduced by troubled sleep and parental group participation. Conclusion Formula at 4 months did not predict a high BMI at 12 or 18 months. Milk cereal drink use at 6 months was a risk factor for a high BMI at 12 and 18 months. The choice of milk cereal drink was influenced by parental factors, especially educational levels. [ABSTRACT FROM AUTHOR]

In this study, patients' experiences of a nurse-led rheumatology clinic for those undergoing biological therapy are discussed. The study had an explorative design, based on a qualitative content analysis with an inductive approach. Strategic sampling was used in order to achieve variations in experiences of a nurse-led clinic. Interviews were conducted with 20 participants, and the analysis resulted in the theme 'the nurse-led rheumatology clinic provided added value to patient care'. The participants' experiences of the encounter with the nurse led to a sense of security (due to competence and accessibility), familiarity (due to confirmation and sensitivity), and participation (due to exchange of information and involvement). Replacing every second visit to a rheumatologist with one to a nurse added value to the rheumatology care, making it more complete. Nurses and rheumatologists complemented each other, as they approached patients from different perspectives. This study suggests that a nurse-led rheumatology clinic adds value to the quality of care for patients in rheumatology units. [ABSTRACT FROM AUTHOR]

Objective To study patient-reported physical activity in patients with spondylarthritis (SpA) and possible differences in physical activity patterns between the SpA subtypes and sexes. Methods In 2009, a questionnaire including inquiries concerning physical activity was sent to patients with a SpA diagnosis (n = 3,711). The World Health Organization (WHO) global recommendations of physical activity for health requiring 150 minutes of moderate-intensity physical activity (MI-PA) or 75 minutes of vigorous-intensity physical activity (VI-PA) per week were used as recommended levels. Standardized risk ratios (RRs) were calculated by using physical activity data from the Swedish population. The association within the SpA group between sex, age, disease-related variables, anxiety, and depression and meeting recommended levels of MI-PA and VI-PA (dependent variables) was studied with multivariate analysis. Results A total of 2,167 patients with SpA (48% men, mean ± SD age 55 ± 14 years) responded to the questionnaire. Sixty-eight percent of the patients met the WHO recommendations, more frequently in women than in men (70% versus 66%). The recommendations were more often met in the SpA group (RR 1.09, 95% confidence interval [95% CI] 1.04-1.15) compared with the Swedish population. There was a tendency for young women to meet the WHO recommendations less often than the Swedish population (RR 0.94, 95% CI 0.63-1.25). Different factors were found to influence whether the patients were exercising with a moderate or vigorous intensity. Conclusion Seven of 10 patients with SpA met the WHO recommendations of physical activity for health, but we found sex and disease subtype differences. This information can be useful in clinical practice when coaching patients to have a healthier lifestyle. [ABSTRACT FROM AUTHOR]

Introduction Empowerment is a central concept in both rheumatology and diabetes care. A Swedish empowerment instrument for patients with rheumatic diseases has not been created before now. The aim of the present study was to determine the psychometric properties of the Swedish Rheumatic Disease Empowerment Scale, SWE-RES-23, such as construct validity, internal consistency reliability, inter-item correlations and discriminant validity. Methods The already existing instrument, the Swedish Diabetes Empowerment Scale (SWE-DES-23), was adapted for use in patients with rheumatic diseases. The adapted instrument was called the SWE-RES-23. In 2009, 260 patients with rheumatic diseases from a rheumatology unit in Sweden completed the instrument. Construct validity was tested by using exploratory factor analysis. Internal consistency reliability was tested by the use of Cronbach's α-coefficient. In order to determine unidimensionality of the empowerment subscales, inter-item correlations were calculated. To establish discriminant validity, an item about self-perceived health from the Short Form (SF) 36 was used in addition to the SWE-RES-23. Results The exploratory factor analysis resulted in five factors (empowerment subscales) with eigenvalues >1, explaining 64.1% of the total variance: Goal achievement and overcoming barriers to goal achievement; Self-knowledge; Managing stress; Assessing dissatisfaction and readiness to change; and Support for caring. Cronbach's α values ranged from 0.59 to 0.91, and the value for the total score was 0.92. Conclusion The results support the possibility of adapting the SWE-DES-23 for use in patients with rheumatic diseases. The SWE-RES-23 shows acceptable psychometric properties, in terms of construct validity and internal consistency reliability. To validate the SWE-RES-23 fully, further studies are needed, with a focus on test-retest correlations. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is associated with many benefits for both mother and child. Initiation rates are high in Sweden. Recently a slight decline is seen. Aim: The aim of this study was to assess factors associated with discontinuation of breastfeeding during the first 4 weeks. Method: A population-based longitudinal birth cohort study recruiting from 2007 to 2008 in south-western Sweden. At the first visit to the child health centre, parents were asked to complete a questionnaire. Also, the infants' height, weight, head and waist circumference were collected. Response rate was 69.2%. Results: Twenty-seven per cent of mothers had breastfeeding problems. In a multivariate analysis, there was a negative correlation between breastfeeding and use of pacifier (OR 3.72; CI 2.09-6.63), maternal smoking (OR 2.09; CI 1.08-4.05) and breastfeeding problems (OR 2.54; CI 1.73-3.71). Breastfeeding problems were correlated with poor sucking technique (OR 2.96; CI 2.14-4.07), support from maternity ward (OR 2.56; CI 2.05-3.19) and perceived poor weight gain (OR 1.37; CI 1.00-1.86). Conclusion: Many mothers reported breastfeeding problems that are associated with an early cessation. This is preventable with support, but the timing is crucial. To promote breastfeeding, the support from the child health centres must be tailored with the maternal perspective in mind. [ABSTRACT FROM AUTHOR]

Objective To study the rate of common comorbidities and cardiovascular disease in patients with ankylosing spondylitis (AS) compared with the general population seeking health care. Methods This cohort study included 935 subjects (67% men) ages ≥20 years diagnosed with AS and the adult background population in Southern Sweden. During 2004 to 2007 we recorded the occurrence of physicians' diagnostic codes for a select number of comorbidities commonly associated with AS and cardiovascular disease and risk factors. We obtained standardized morbidity-rate ratios (SMRs) by dividing the observed morbidity rate in AS patients by the expected rate based on the corresponding rate of the disease in the general population of the county seeking health care. Results The highest SMRs were found for uveitis (34.35, 95% confidence interval [95% CI] 28.55-40.98) and inflammatory bowel disease (9.28, 95% CI 7.07-11.97). Also, we found increased SMRs for ischemic heart diseases (2.20, 95% CI 1.77-2.70), hypertension (1.98, 95% CI 1.72-2.28), and diabetes mellitus (1.41, 95% CI 1.10-1.78). Furthermore, the SMRs for psoriasis, osteoporosis, and atrioventricular blocks were also statistically significantly elevated. Conclusion Inflammatory diseases affecting the eye and the digestive system were the most notable comorbidities in AS patients, but the rate for cardiovascular disease was also high. Using comprehensive longitudinal population-based register data is a promising tool to evaluate the excess consultation rate and total burden of rheumatic disease on patients and society. [ABSTRACT FROM AUTHOR]

Background: Pain, stiffness and functional restriction of the joints are the main problems experienced by patients with inflammatory rheumatic conditions. The majority of patients with rheumatic diseases require several drugs every day. Adherence is highest among patients who have repeatedly been given drug information by a nurse from the start of the treatment. When developing patient information, it is essential to utilize patients' experiences. Objectives: The purpose of this study was to describe variations in how patients with rheumatic diseases perceive drug information given by a rheumatology nurse. Methods: The study had a descriptive qualitative design with a phenomenographic approach. Fifteen inpatients with rheumatic diseases who had received a new drug agreed to take part in the study and were interviewed. Results: Three descriptive categories emerged: autonomy, power and security. Autonomy was based on patients' experiences of taking responsibility and participating. Power meant gaining knowledge and being motivated to take the drug. Security involved trust, experiencing care and access to a rheumatology nurse. Conclusions: For patients with a rheumatic disease, drug information from a rheumatology nurse gave them autonomy, power and security. These factors could explain why information from a nurse increases adherence to drug treatment. [ABSTRACT FROM AUTHOR]

Background: Patients' perspective of the causes and consequences of rheumatoid arthritis (RA) can conflict with that of healthcare professionals and lead to misunderstanding, difficulties in management and a poorer outcome. Objectives: The aim of this study was to describe the variation in how patients' conceive the cause of their RA. Methods: An open written question from the Epidemiological Investigation of Rheumatoid Arthritis (EIRA) study, aimed at patients recently diagnosed with RA, was answered by 38 strategically selected patients during 2003 and analysed using the phenomenographic approach. Results: Two descriptive categories and six concepts emerged: the category ‘consequences beyond personal control’ comprised not having a clue, being exposed to climatic change, being genetically exposed and unexpected effects of events; the category ‘overloaded circumstances’ involved work and family-related strain. Consequences beyond personal control implied that the patients could not prevent the disease and expressed their lack of understanding as to why they contracted it. Overloaded circumstances were described as strained situations that were both work and family related and could be influenced by the patient. Conclusions: The patient's perspective of the cause of their RA includes aspects that complement the current pathogenetic models and should therefore be considered in the management of the disease. When dealing with rheumatic diseases, it is necessary to be aware of the patient's perspectives in order to new management strategies. In addition to epidemiological studies, further studies of patients' own experience are needed in order to achieve a more tailored care model. Copyright © 2009 John Wiley & Sons, Ltd [ABSTRACT FROM AUTHOR]

Aim: To establish new reference values for measurements of waist circumference and waist-to-height ratio in preschool children. Methods: A population-based, cross-sectional study of 4502 children aged 0–5 years derived from child health care in a Swedish county. Measurements of weight, height and waist circumference were recorded using a standardized procedure. Results: New reference values for waist circumference and waist-to-height ratio for preschool children are presented. Reference charts were constructed and are presented. Waist circumference increased with age (r = 0.80, p < 0.001). After adjustment to the individual height, expressed as waist-to-height ratio, there was an inverse correlation to age during the first 5 years of age (r = −0.87, p < 0.001). Conclusion: The new reference values for waist circumference and waist-to-height ratio for Swedish preschool children enable future identification of new risk populations for childhood obesity. For clinicians, new reference charts for these two variables are provided for practical use. [ABSTRACT FROM AUTHOR]

Background: Pain, stiffness and functional restriction of the joints are the main problems for many patients with inflammatory rheumatic conditions. When conventional drugs fail to delay the development of the disease, the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of intravenous infusions and thus the patient is obliged to attend a clinic in order to receive his/her medication, which can affect everyday life as well as independence. It is therefore important to focus on the patient perspective. Aim: The aim of this study was to describe variations in how patients with rheumatic conditions conceive their dependence on a nurse for the administration of their intravenous anti-TNF therapy. Method: The study had a descriptive qualitative design with a phenomenographic approach. Interviews were conducted with 20 patients. Result: Three descriptive categories and seven sub-categories emerged: Dependence that affords security (encountering continuity, encountering competence and obtaining information); Dependence that creates involvement (being allowed influence and being given freedom); Dependence that invigorates (obtaining relaxation and encountering the environment). Conclusion: The patients had not reflected on the fact that they were dependent on a nurse for the administration of their intravenous anti-TNF therapy, which may be due to their possibility to influence the treatment. The patients' needs should constitute the basis for the nurse's role in the provision of care. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

The Paleoproterozoic part of the Fennoscandian Shield is composed of crustal components formed in different tectonic settings and generally separated by well-defined shear zone systems. An anomalous transitional boundary has been investigated by integrating structural analysis and geochronology with published geophysical data. The nature of this boundary is interpreted to be a consequence of an apparent stacking in the lower and middle crust initiating 1.87-1.86 Ga dextral shear along the Gävle-Rättvik Zone (GRZ) and adjacent shear zones, resulting in an arcuate northern boundary of the Bergslagen province. This boundary coincides with geophysical anomalies and temporal and metamorphic breaks. Owing to continuous convergence the pure-shear overprint component increased on the GRZ and caused a shift of dextral shear to the Hagsta Gneiss Zone with recorded shear at 1809 ± 2 Ma. Most likely, both these structures are related to coeval shear zones farther to the east as a part of an ∼1500 km long crustal, or possibly terrane, boundary. [ABSTRACT FROM AUTHOR]

The polyphase, 15-30 km wide and >200 km long Storsjön-Edsbyn Deformation Zone (SEDZ) apparently separates two major Paleoproterozoic provinces in central Sweden. Four main phases of deformation have been recognized along the zone; associated high-strain rocks are characterized by their mineralogy, microstructures, kinematic patterns, magnetic signatures, and relative ages. The mineral and stretching lineations are consistently steeply to moderately plunging. Analysis of mesoscopic shear zone populations of different generations suggests that most displacements are compatible with north-south to northeast-southwest bulk regional shortening. The structural analysis suggests that the main ductile deformation along the SEDZ was due to dextral transpression with a steep coaxial component. Field evidence combined with published age data constrain the main deformation to the time interval circa 1.7-1.3 Ga. Synkinematic titanite from a ductile protomylonite in the SEDZ yields an U-Pb age of 1674 ± 6 Ma. The combined results imply transpressive deformation broadly synchronous with, and spatially related to, volcanism and plutonism in a continental margin magmatic arc setting. [ABSTRACT FROM AUTHOR]