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Speaking with an artificial counterpart in simulated environments has been shown beneficial for foreign language learning. Still, few studies have explored how it is experienced by younger students. We report on a study of Swedish students (N = 22) speaking English with embodied conversational agents (ECAs) in everyday-life scenarios. Data were collected on students' rankings, choices, and open-response items in logbooks and questionnaires. Self-reported data on experiences were analyzed through three dimensions: cognitive, emotional, and social. Findings show that students were generally satisfied with the activity and emotionally engaged with large individual differences within the social dimension. We unpack aspects regarding social relating to the ECA, analyzing the space between experiencing the ECA as a socially distant "deadpan machine" to humanizing and relating socially.

Speaking in a foreign language is considered challenging to both teach and learn. Virtual humans (VHs), as conversational agents (CAs), provide opportunities to practise speaking skills. Lower secondary school students (N = 25) engaged in an AI-based spoken dialogue system (SDS) and interacted verbally with VHs in simulated everyday-life scenarios to solve given tasks. Our analysis is based on system-generated metrics and self-reported experiences collected through questionnaires, logbooks, and interviews. Thematic analysis resulted in seven themes, revolving around the speaking practice method, scenarios and technology, which, in combination with descriptive statistics, enabled a deeper understanding of the students' experiences. The results indicate that, on average, they found it easy, fun, and safe, but sometimes frustrating in scenarios not always relevant to their everyday lives. Factors suggested as underlying the levels of experienced frustration include technical issues and constraints with the system, such as not being understood or heard as expected. The findings suggest that lower secondary school students conversing with VHs in the SDS in an institutional educational context facilitated a beneficial opportunity for practising speaking skills, especially pronunciation and interaction in dialogues, aligning with the key principles of second language acquisition (SLA) for language development.

This article concerns knowledge negotiations as an aspect of interactional power in three-way interaction between Arabic-speaking women, Swedish-speaking midwives and interpreters in Swedish antenatal care. The notion of epistemic stance is used to investigate how all three participants negotiate knowledge, and how this affects the ongoing consultation. The data consist of audio recordings of 33 consultations, involving five midwives. Using an interaction analytical approach, the study focuses on sequences where the pregnant woman makes her voice heard, possibly challenging the midwife or the Swedish antenatal care programme. Three different ways in which the epistemic stances of the participants unfold interactionally are analysed: (1) the midwife and the pregnant woman mutually adjusting their knowledge claims; (2) the pregnant woman unsuccessfully attempting to claim knowledge; and (3) participants jointly asserting the midwife's knowledge. Importantly, all three participants wield their interactional power through various ways of negotiating knowledge, which contrasts with the idea of the interpreter as fully neutral and detached. The knowledge claims of the pregnant women and the midwives in the data are also shown to be highly dependent on the interpreters' competence and performance.

Background: As family members affect patient outcomes following open‐heart surgery, the objective was to provide updated knowledge on family involvement in to guide future interventions facilitating family involvement. Aim: The aim was to explore and describe the experiences and actions of important situations of family involvement asexpressed by patients who underwent elective open‐heart surgery in Sweden. Methodological Design and Justification: The critical incident technique (CIT) was used, which is a qualitative research method suitable for clinical problems when a phenomenon is known but the experiences and consequences of it are not. Ethical Issues and Approval: Considerations for patient integrity were made during the recruitment phase by ensuring that voluntary informed consent was obtained in two steps. Research Methods: Individual interviews were conducted with 35 patients who underwent open‐heart surgery in Sweden in 2023. Important situations were analysed according to the CIT method. Results: Two main areas emerged: Patients described important situations of family involvement as experiences of mutual dependency while also being independent individuals. These experiences led to balancing healing and risk‐taking activities as a family. The positive consequences of family involvement described by patients included improved recovery through practical help at home and emotional support. Conclusions: As complements to preserving the existing positive aspects of family involvement, social support screening, the establishment of individualised visitation policies and the provision of professional and peer support earlier can improve patient recovery following open‐heart surgery. [ABSTRACT FROM AUTHOR]

Pain and depressive symptoms are common reasons for adolescents to contact the school nurse. The aim was to describe the prevalence of pain (headache, abdominal pain, and back pain) and depressive symptoms among adolescents and to examine whether there is an association between pain and depressive symptoms. This cross-sectional survey included students (N = 639) in Sweden (median age: 16 years). Over half of the female participants (56%) and one third of male participants (33%) had weekly headaches, abdominal pain, or back pain. Almost every second girl (48%) and one in four boys (25%) had depressive symptoms (as measured by the Center for Epidemiological Studies Depression Scale, scores = 16). There was a significant association between having pain (headache, abdominal pain, or back pain) and having depressive symptoms. It is of great importance for school nurses to adequately identify and treat the cause of pain and other factors contributing to depression.

The Swedish Campaign for Nuclear Disarmament (SCND) fought the military’s plans to acquire Swedish nuclear weapons and protested the nuclear arms race, 1961–1967. This article presents SCND’s ideological orientation by focusing on temporalities. SCND saw the Second World War as a decisive event and tried to avert a crisis and a dystopia by manifesting remembrance of past nuclear detonations, and by representing a ‘desperate man’ who needed to act directly against nuclear weapons testing and research. As an opinion-forming force, SCND advocated international negotiations and rejected political initiatives regarding disarmament. Furthermore, SCND refused to take a position between West and East in the Cold War and SCND did not strive for a fundamental change of society, a utopia, which can be explained by SCND’s critique of ideology and from its temporal orientation rooted in the present. Nevertheless, the rise of imperialist-critical internationalism led to internal ideological conflicts, and the Swedish Campaign dissolved when only one of the goals was achieved: when Sweden abandoned the plans for nuclear weapons. Some members insisted on continuing the campaign to fight against not least imperialism, and SCND’s downfall in 1967 can be explained by its challenge to navigate an ideologically multifaceted landscape. [ABSTRACT FROM AUTHOR]

In this article, based on a larger research project, the ambition is to critically discuss the first collaboration between students with intellectual disabilities and the Academy of Music in Sweden. The article presents an analysis of video observations of lessons in rhythmics, related to an encounter between the students with intellectual disabilities and a group of student teachers. The theoretical and methodological framework emanates from post-structuralist and social constructionist theories. The results show that the silenced discourse, the unspoken, is constructed from the fact that the students with disabilities both are insufficiently skilled for the task as leaders in rhythmics, and less skilled than the student teachers. Finally, the silenced discourse is discussed, where assumptions of normality and issues of inclusion are addressed as well as a hegemonic discourse in the Swedish politics of education.

Swedish teacher education has undergone several reforms in recent decades aimed at incorporating teacher education into the university setting and strengthening the teaching profession. In view of earlier research that has shown how arts education in schools is ruled by dominant knowledge ideologies, the purpose of the project is to critically scrutinize current discourses related to arts learning and arts education in teacher education. The study is based on social constructionist theory and data were collected by various means, including 19 focus group interviews with teachers and students at 10 Swedish teacher education institutes. Our analysis shows that an academic discourse focusing on theory, reflection and textual production has pushed aside skills-based practice. A second discourse, characterized by subjectivity and relativism vis-a-vis the concept of quality, is also found in the material. Finally, a therapeutic discourse is articulated and legitimized based on an idea that student teachers should be emotionally balanced.

This paper reports findings from a project implementing the VL (virtual labs) site featuring flash-based animations developed at Stanford University. The main conclusion in this paper stresses the need to design for flexibility and adaptability of interactive media to better suit the specific situation teachers encounter in their everyday work, in order to allow them to build their own audiovisual presentation kits based on various available resources. Ambitious but rigid visualization products might otherwise end up not being used at all. (Contains 10 figures.)

Objective: The primary aim of this study was to describe the current practice regarding pain management in relation to tonsil surgery among Ear Nose and Throat (ENT) clinics in Sweden. The secondary aim was to determine the impact of the provider's regime of rescue analgesics on the pain related Patient Reported Outcome Measures (pain-PROMs) from the Swedish Quality Register for Tonsil Surgery (SQTS). Materials & methods: A descriptive cross-sectional study originating from a validated web-based questionnaire. The survey enrolled one respondent from each ENT clinic (47/48 participated) nationally. Pain-PROMs from the SQTS, recorded from October 2019 to October 2022, were included (8163 tonsil surgeries). Results: Paracetamol was used by all enrolled ENT clinics as preemptive analgesia. The addition of COX inhibitors was used in 40% of the clinics. Betamethasone was usually administered, to prevent pain and nausea (92%). All clinics gave postdischarge instructions on multimodal analgesia with COX inhibitors and paracetamol. Rescue analgesics were prescribed after tonsillectomy for 77% of adults, 62% of older children, 43% of young children and less often after tonsillotomy. The most frequently prescribed rescue analgesic was clonidine in children (55%) and oxycodone in adults (72%). A high proportion of patients reported contact with health care services due to postoperative pain (pain-PROMs/ SQTS). Tonsillectomy procedures were associated with the highest rates of contacts (children/adolescents 13–15%; adults 26%), while tonsillotomy were associated with lower rates, (5–7% of children/adolescents). There was no significant difference in the frequency of health care contacts due to pain regarding whether clinics routinely prescribed rescue analgesics or not after tonsillectomy. Conclusion: The Swedish analgesic regimen after tonsil surgery is good overall. Nevertheless, there is a need for increased awareness and knowledge to achieve optimal patient recovery. Pain-PROM data demonstrate the call for improvement in pain management after tonsil surgery. [ABSTRACT FROM AUTHOR]

Objectives The educational gradient in late-life health is well established. Despite this, there are still ambiguities concerning the role of underlying confounding by genetic influences and gene-environment (GE) interplay. Here, we investigate the role of educational factors (attained and genetic propensities) on health and mortality in late life using genetic propensity for educational attainment (as measured by a genome-wide polygenic score, PGSEdu) and attained education. Methods By utilizing genetically informative twin data from the Swedish Twin Registry (n = 14,570), we investigated influences of the educational measures, familial confounding as well as the possible presence of passive GE correlation on both objective and subjective indicators of late-life health, that is, the Frailty Index, Multimorbidity, Self-rated health, cardiovascular disease, and all-cause mortality. Results Using between-within models to adjust for shared familial factors, we found that the relationship between educational level and health and mortality later in life persisted despite controlling for familial confounding. PGSEdu and attained education both uniquely predicted late-life health and mortality, even when mutually adjusted. Between-within models of PGSEdu on the health outcomes in dizygotic twins showed weak evidence for passive GE correlation (prGE) in the education-health relationship. Discussion Both genetic propensity to education and attained education are (partly) independently associated with health in late life. These results lend further support for a causal education-health relationship but also raise the importance of genetic contributions and GE interplay. [ABSTRACT FROM AUTHOR]

Introduction: Although frailty is commonly considered as a syndrome of old individuals, recent studies show that it can affect younger adults, too. Whether and how frailty differs in younger adults compared to old is however unknown. To this end, we analyzed the prevalence, characteristics, and risk factors of early-life (aged <65) and late-life (aged ≥65) frailty. Methods: We analyzed individuals in the UK Biobank (N = 405,123) and Swedish Screening Across the Lifespan Twin (SALT; N = 43,641) study. Frailty index (FI) scores ≥0.21 were used to demarcate frailty. Characteristics of early-life versus late-life frailty were analyzed by collating the FI items (deficits) into domains and comparing the domain scores between younger and older frail individuals. Logistic regression was used to assess the risk factors of frailty. Results: The pooled prevalence rates of frailty were 10.3% (95% confidence interval [CI]: 2.7–32.7), 14.4% (95% CI: 4.5–37.2), 19.2% (95% CI: 2.5–68.5) in individuals aged ≤55, 55–64, 65–74, respectively. Younger frail adults (aged <65) had higher scores in immunological, mental wellbeing, and pain-related domains, whereas older frail adults (aged ≥65) had higher scores in cardiometabolic, cancer, musculoskeletal, and sensory-related domains. Higher age, female sex, smoking, lower alcohol consumption, lower education, obesity, overweight, low income, and maternal smoking were similarly associated with the risk of early-life and late-life frailty. Conclusion: Frailty is prevalent also in younger age groups (aged <65) but differs in some of its characteristics from the old. The risk factors of frailty are nevertheless largely similar for early-life and late-life frailty. [ABSTRACT FROM AUTHOR]

This article studies a previously unknown asset market in eighteenth-century Sweden. It emerged as a result of a partial default in 1719, when large amounts of recently released fiat coins were converted into government liabilities. These could only be redeemed as a customs duty on international trade, the licent. As merchants had to acquire such assets to conduct their trade, tens of thousands of transactions were carried out on a secondary market over a period of more than 45 years. Networks of local merchants bought assets from initial holders and sold them on to intermediaries or merchants, who deposited the liabilities with a newly established government agency, the Debt Office. Here, hundreds of account holders could transfer the value of their deposits between them. When a licent payment was due, the amount was deducted from the merchant's account. Prices on the liabilities were low and sometimes volatile, but the long-term trend was rising. We have distinguished three types of market participants: a small group of very active users, most of them professional dealers or brokers; merchants who traded on a regular basis as they needed to pay the licent , or when a favorable opportunity appeared; and finally, those who traded sporadically. The emergence of this market was part of a financial expansion that occurred in many European countries at the same time, the closest equivalent being the segmented default in France after the abolition of John Law's system. This study aims to broaden our understanding of eighteenth-century financial developments, which have rarely been studied in a semi-peripheral European economy. [ABSTRACT FROM AUTHOR]

Background: Many students leave compulsory school without being qualified to apply for national upper secondary school programmes. Despite efforts, the number of unqualified students in Sweden has increased. Grades from compulsory school have direct implications for students' educational futures and the requirement to qualify for an upper secondary school programme is at least the grade G (pass), in the subjects Swedish/Swedish as a second language, Mathematics, and English. Earlier research shows that the amount of physical activity, students' motor skills, and grades in Physical Education can have an impact on school achievements, but no study has examined the relationships of these factors in this particular group of students. Purpose: The aim was to study relationships between physical activity and school performance among Swedish compulsory school students who fail to achieve sufficient grades to move on to upper secondary school (about one in five students in the city of Malmo). Method: The population consisted of 389 students of which 76% (147 male, and 146 female) participated in a web inquiry. For statistical analyses of the responses, the Statistical Package for the Social Sciences program was used. Non-parametric tests (Chi-squared, Kruskal- Wallis, and Mann-Whitney) were used to study differences between groups, and Spearman's rank correlation and Pearson's product moment correlation were used for correlation analyses. Findings: The results show that less than 50% were physically active in the school subject physical education and health (PEH), and 14% never participated. Forty-five per cent were never physically active during their spare time. Twenty-nine per cent failed to reach the goals in PEH. Nine per cent (14% of boys, and 4% of girls), received the highest grade in PEH: pass with special distinction. Significant correlations were found between the level of physical activity and grade in PEH, as well as between physical activity and total grades. Grades in PEH correlated with grades in Swedish, Mathematics, and English. Students who responded that they skipped lessons once a week or more, had significantly lower grades in PEH and in total than students who never or less often skipped school lessons. Students who had good self-esteem (n =162) were significantly more physically active than those who had low self-esteem (n = 32). Their answers to the question, "How physically active were you during school year nine?" showed that they moved and became breathless and sweaty more than students who had lower self-esteem. They also did sports/ exercise significantly more both in and outside of sports clubs. Conclusion: The findings of the relatively low levels of physical activity and the significant correlation between physical activity and school performance indicate the importance of examining how schools can improve students' self-esteem and motivation to be physically active and participate in PEH and other lessons.

Ungulate species have experienced severe declines over the past centuries through overharvesting and habitat loss. Even if many game species have recovered thanks to strict hunting regulation, the genome-wide impacts of overharvesting are still unclear. Here, we examine the temporal and geographical differences in genome-wide diversity in moose (Alces alces) over its whole range in Sweden by sequencing 87 modern and historical genomes. We found limited impact of the 1900s near-extinction event but local variation in inbreeding and load in modern populations, as well as suggestion of a risk of future reduction in genetic diversity and gene flow. Furthermore, we found candidate genes for local adaptation, and rapid temporal allele frequency shifts involving coding genes since the 1980s, possibly due to selective harvesting. Our results highlight that genomic changes potentially impacting fitness can occur over short time scales and underline the need to track both deleterious and selectively advantageous genomic variation. Collection and analysis of 200 years of Swedish moose genomes reveals regional differences in genetic load, candidate regions for positive selection and an overall limited impact on human-driven bottlenecks on today's moose population. [ABSTRACT FROM AUTHOR]

This article presents an analysis of video documentation of music teaching in Swedish schools. The article is based on a larger research project, funded by The Swedish Research Council, the purpose of which has been to study how market aesthetics and students' everyday culture are applied to the teaching of music. The introduction presents a background for the study's focus on music teaching in relation to issues of student influence. Next, the theoretical and methodological starting points are presented. With discourse psychological microanalysis as a point of departure, the ideological dilemma that has emerged in the analysis of the videos is then identified and discussed. In addition, the different types of subject positions contained in the studied discursive practice are problematized. The article concludes with a discussion of a number of factors that contribute to the establishment of ideological dilemmas in school practitioners of music education. (Contains 1 note.)

Background: Studies have shown that some children do not participate in sport or exercise because they did not establish early coordination and basic motor skills while at school. Basic motor skills form significant parts of the goals for students to achieve in the Swedish school subject Physical Education and Health (PEH). Aims: The aim was to study effects of an extension of physical activity and motor training, during a period of nine years, on motor skills and marks in the school subject PEH. Furthermore, a motor training program called "Motor Development as Ground for Learning" [Motorisk Utveckling som Grund for Inlarning] (MUGI) was tested and evaluated. Method: The study is longitudinal and two groups of students were followed during nine school years. At the start of the project the students were seven years old, and 15 years old at the follow-up. An intervention group (n = 161) had one scheduled lesson of physical activity and motor training every school day. A control group (n = 102) had the school's usual two PEH lessons per week. Motor skills observations were carried out in the school years 1, 2, 3, and 9 according to the MUGI checklists. Extra motor skill training, according to the MUGI model, was given to students in the intervention group who had motor skills deficits. The method was hypothetic-deductive and two hypotheses were tested: (1) Students' motor skills will improve with extended PEH and extra motor training according to the MUGI model, and (2) boys' and girls' marks in PEH will improve with extended PEH and extra motor training in school. Findings: The results confirmed the hypothesis that students' motor skills improve with extended physical activity and motor training. After only one year the students in the intervention group had significantly better motor skills (balance and coordination) than students in the control group. These differences remained and were also found at follow-up school years 3 and 9. Differences in motor skills between boys and girls decreased with extended physical activity and extra motor training in school. Significant correlations were found between motor skills school year 2, 3, and 9 and marks in PEH school year 9. The second hypothesis was confirmed by significantly higher marks in the school subject PEH school year 9 in the intervention than in the control group. Although there were no significant differences in motor skills between boys and girls in school year 9, girls had significantly lower marks in PEH than boys. Conclusions: The school has good potential for stimulating students' development of motor skills, but two lessons of PEH per week are not enough. Differences in motor skills between boys and girls may decrease with extended physical activity and extra motor training in school. The MUGI program can be useful as a pedagogic model for observing and improving motor skills in school. (Contains 3 tables and 3 figures.)

In this article, based on the results of a larger research project funded by the Swedish Research Council (Ericsson and Lindgren 2010), the authors discuss and problematize the rock band context in music education in Swedish compulsory schools in relation to governance and knowledge formation. The empirical material on which the study is based consists of video documentation of 9th grade music education at eight schools for one semester. The intention was to make the authors' sample as strategically representative as possible. The authors covered an area of about 400 km in the western part of Sweden. They also tried to choose schools in settings with different social and cultural structures, and schools situated in both urban and rural areas. Although they cannot claim that the results of their study are generally applicable to all music teaching in Sweden, it was possible to distinguish patterns and trends common among all the schools in their study. Because they assume that similar patterns might well be found in other schools as well, the authors highlight them in order to initiate discussion and reflection on these issues. The theoretical framework of the study is presented, followed by a brief overview of the results, which is discussed in relation to questions of power and governance and the consequences for pupils' opportunities for musical learning in contemporary Swedish schools. (Contains 1 note.)

Aim: To study the value and reliability of an examination of neurological soft-signs, often used in Sweden, in the assessment of children with attention-deficit-hyperactivity disorder (ADHD), by examining children with and without ADHD, as diagnosed by an experienced clinician using the DSM-III-R. Method: We have examined interrater reliability (26 males, nine females; age range 5y 6mo-11y), internal consistency (94 males, 43 females; age range 5y 6mo-11y), test-retest reliability (12 males, eight females; age range 6-9y), and validity (79 males, 33 females; age range 5y 6mo-9y). Results: The sum of the scores for the items on the examination had good interrater reliability (intraclass correlation [ICC] 0.95) and acceptable internal consistency (Cronbach's alpha 0.76). The test-retest study also showed good reliability (ICC 0.91). There were modest associations between the examination and the assessment of motor function made by the physical education teacher (ICC 0.37) as well as from the parents' description (ICC 0.39). The examination of neurological soft-signs had a sensitivity of 0.80 and a specificity of 0.76 in predicting motor problems as evaluated by the physical education teacher. Interpretation: The reliability and validity of this examination seem to be good and can be recommended for clinical practice and research.

At the initiative of the Government of the People's Republic of China, a letter of intent concerning a joint undertaking for studying children with intellectual disability in China was formulated together with the Swedish Government's Ministry of Social Affairs in the early 1990s. The Swedish Board of Health and Welfare invited Uppsala University to set up a consulting team through the Centre for Disability Research. On the Chinese side, the task was given to China Disabled Persons' Federation (CDPF), whose overriding task is the representation of and guarding the legal rights of persons with disabilities. Under the auspice of the CDPF, researchers from China and Sweden jointly identified three areas of work: iodine deficiency, developmental screening, and rehabilitation. This article describes the project's activities within the Sino-Swedish Project, initiated in 1995. The Sino-Swedish Project was implemented in the least developed and consequently poorest western/northwestern interior parts of the country and overall work was carried out on a county-level (i.e., target areas were predominately rural albeit located in townships and villages). The experiences gained have formed the basis for further implementation throughout the country.

The aim was to study effects of an extension of physical education and motor training on motor skills, attention and cognition during a period of three years. The study has two intervention groups (n = 152) that have physical activity and motor training one lesson every school day and one control group (n = 99) that has the school's ordinary physical education two lessons per week. The method is hypothetic-deductive. The results confirm the hypothesis that children's motor skills improve with extended physical activity and motor training. The hypothesis that children's attention will improve cannot be confirmed. Although pupils in intervention groups have better attention in school year 2 than pupils in the control group, the differences do not remain in school year 3. The third hypothesis concerning academic achievements is confirmed by several results in Swedish and mathematics. The MUGI observation programme was found to be useful both as a screening and as a pedagogic instrument. (Contains 1 table and 1 figure.)

Aims: This study aimed to describe the impact of the COVID-19 pandemic on lifestyle and social activities among older adults in Sweden, with a special focus on differences between the 'younger old' (aged 77–84) and 'older old' (aged 85–109). Methods: This study is based on a nationally representative sample of older adults (aged ⩾77 years) in Sweden (SWEOLD). Data were collected between May 2021 and April 2022, when many recommendations were removed but the virus was still classified as a public health disease. We studied occurrences and differences between the two age groups in several lifestyle factors and social activities. Results: The younger old displayed larger changes in lifestyles because of the pandemic than the older old. Most changes were found in social interactions with family. Conclusions: Our results highlight the large heterogeneity within the Swedish population aged ⩾77 years, and that the younger old experienced a bigger lifestyle change than the older old. Previous activity levels might be important to consider in order to understand how regulations may affect the older population. Finally, our findings indicate large age differences in Internet use, which require attention to prevent digital exclusion of an already vulnerable group. [ABSTRACT FROM AUTHOR]

Aims: Swedish public health reports have repeatedly provided information about socio-economic inequalities in sedentary leisure time, despite that, in the interest of health equity, physical activity should be equally distributed in the population. Such public health reports, however, neither consider the intersection of multiple socio-demographic factors nor the individual heterogeneity around group averages. Drawing on intersectionality theory, this study aimed to revisit previous findings on sedentary leisure time from Swedish public health surveys and demonstrate how the analysis of individual heterogeneity and discriminatory accuracy (AIHDA) can be used for analysing complex health inequalities. Methods: Using data from Swedish national public health surveys (2004–2015), we applied the AIHDA to define 72 intersectional groups by categories of age, gender, educational achievement, migration status and household composition. We then calculated (a) the absolute and relative risk of sedentary leisure time and (b) the discriminatory accuracy (DA) of the intersectional grouping. Results: The average risk of sedentary leisure time ranged from 5.8% among native-born, highly educated, young women living alone to 41.0% among immigrated young men, living alone, with low education. The risk was higher in strata comprising immigrated people with low education and lower in strata including native-born, highly educated people. However, the DA of the grouping was poor, indicating a substantial overlap of individual risk between groups. Conclusions: Using the AIHDA and drawing on intersectionality, this study provides an improved mapping of the socio-economic distribution of sedentary leisure time in Sweden, with the poor DA suggesting universal rather than targeted physical activity interventions. [ABSTRACT FROM AUTHOR]

A study examining why some Swedish teachers use outdoor education interviewed 10 female primary school teachers. The teachers used outdoor education to know their pupils better and achieve a more relaxed teacher role. They had the curiosity and courage to create different learning environments and did not feel they needed to be experts on nature to teach outdoors. (TD)

Climate change represents a growing ecological challenge. The (sub) arctic and boreal regions of the world experience the most rapid warming, presenting an excellent model system for studying how climate change affects mammals. Moose (Alces alces) are a particularly relevant model species with their circumpolar range. Population declines across the southern edge of this range are linked to rising temperatures. Using a long-term dataset (1988–1997, 2017–2019), we examine the relative strength of direct (thermoregulatory costs) and indirect (food quality) pathways linking temperature, precipitation, and the quality of two important food items (birch and fireweed) to variation in moose calf mass in northern Sweden. The direct effects of temperature consistently showed stronger relationships to moose calf mass than did the indirect effects. The proportion of growing season days where the temperature exceeded a 20 °C threshold showed stronger direct negative relationships to moose calf mass than did mean temperature values. Finally, while annual forb (fireweed) quality was more strongly influenced by temperature and precipitation than were perennial (birch) leaves, this did not translate into a stronger relationship to moose calf weight. The only indirect path with supporting evidence suggested that mean growing season temperatures were positively associated with neutral detergent fiber, which was, in turn, negatively associated with calf mass. While indirect impacts of climate change deserve further investigation, it is important to recognize the large direct impacts of temperature on cold-adapted species. [ABSTRACT FROM AUTHOR]

Aims A short time span from symptom onset to reperfusion is imperative in ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine factors associated with patient decision time for seeking care in STEMI, particularly how symptoms were experienced and affected patient response. Methods and results A multicentre cross-sectional self-report survey study was completed at five Swedish hospitals representing geographic diversity. The 521 patients were divided into three groups based on their time to respond to symptoms: early (<20 min), intermediate (20–90 min), and late responders (>90 min). Only one out of five patients both responded early and called an ambulance within 20 min. Believing symptoms were cardiac in origin [odds ratio (OR) 2.60], male sex (OR 2.40), left anterior descending artery as culprit artery (OR 1.77), and bystanders calling an ambulance (OR 4.32) were factors associated with early response and correct action. Associated symptoms such as dyspnoea (OR 1.67) and weakness (OR 1.65) were associated with an early action (<20 min), while chest pain was not independently associated with response time. Cold sweat (OR 0.61) prevented late care-seeking behaviour as did a high symptom burden (OR 0.86). Conclusion Misinterpretation of symptoms delays correct care-seeking behaviour because patient expectations may not be aligned with the experience when stricken by Myocardial infarction. Therefore, it is imperative to continuously enhance public awareness in correct symptom recognition and appropriate care-seeking behaviour and to make efforts to educate individuals at risk for STEMI as well as their next of kin. [ABSTRACT FROM AUTHOR]

Aim: To estimate the fiscal burden for taxpayers in Sweden associated with type 2 diabetes (T2D) attributed to diabetes‐related complications in patients failing to meet HbA1c targets. Material and Methods: We developed a public economic framework to assess how changes in diabetes‐related complications influenced projected tax contributions and government disability payments for people with T2D. The analysis applied accepted disease‐modelling practices to estimate different rates of diabetes‐related complications based on an HbA1c of 6.9% (52 mmol/mol) and of 6.0% (42 mmol/mol). We adjusted the employment activity rates for those experiencing T2D‐related events, applying age‐specific earnings to estimate lifetime tax losses. Furthermore, the likelihood of receiving payments for health‐related employment inactivity was estimated. Direct healthcare costs are excluded from this analysis. Results: The estimated per person earnings loss for immediate and delayed HbA1c control was Swedish krona (SEK) 42 299 and SEK 44 157, respectively, over 10 years. The lost employment activity of people with T2D translates to lost tax revenues of SEK 23 265 and SEK 24 287 for immediate and delayed control, respectively. The estimated difference in disability payments was SEK 538. Combining the tax revenue loss and excess disability payments defines the broader fiscal costs, where we observe combined fiscal losses that favour immediate and sustained control by SEK 1560 over 10 years. Conclusions: We show that conducting fiscal analysis of diabetes interventions offers an enriched perspective capturing a range of costs that fall on government in relation to lost tax revenue and disability payments. Tax‐financed health systems may benefit from broadening the consideration of costs and benefits when evaluating new interventions and treatment practices. [ABSTRACT FROM AUTHOR]

Data from the Interplay of Genes and Environment across Multiple Studies (IGEMS) consortium were used to examine predictions of different models of gene-by-environment interaction to understand how genetic variance in self-rated health (SRH) varies at different levels of financial strain. A total of 11,359 individuals from 10 twin studies in Australia, Sweden, and the United States contributed relevant data, including 2,074 monozygotic and 2,623 dizygotic twin pairs. Age ranged from 22 to 98 years, with a mean age of 61.05 (SD = 13.24). A factor model was used to create a harmonized measure of financial strain across studies and items. Twin analyses of genetic and environmental variance for SRH incorporating age, age2, sex, and financial strain moderators indicated significant financial strain moderation of genetic influences on self-rated health. Moderation results did not differ across sex or country. Genetic variance for SRH increased as financial strain increased, matching the predictions of the diathesis–stress and social comparison models for components of variance. Under these models, environmental improvements would be expected to reduce genetically based health disparities. [ABSTRACT FROM AUTHOR]

The theory and applications of Smart Factories and Industry 4.0 are increasing the entry into the industry. It is common in industry to start converting exclusive parts, of their production, into this new paradigm rather than converting whole production lines all at once. In Europe and Sweden, recent political decisions are taken to reach the target of greenhouse gas emission reduction. One possible solution is to replace concrete in buildings with Cross Laminated Timber. In the last years, equipment and software that have been custom made for a certain task, are now cheaper and can be adapted to fit more processes than earlier possible. This in combination, with lessons learned from the automotive industry, makes it possible to take the necessary steps and start redesigning and building tomorrows automated and flexible production systems in the wood industry. This paper presents a proof of concept of an automated inspection system, for wood surfaces, where concepts found in Industry 4.0, such as industrial Internet of things (IIoT), smart factory, flexible automation, artificial intelligence (AI), and cyber physical systems, are utilized. The inspection system encompasses, among other things, of the shelf software and hardware, open source software, and standardized, modular, and mobile process modules. The design of the system is conducted with future expansion in mind, where new parts and functions can be added as well as removed. [ABSTRACT FROM AUTHOR]

This article examines female participation as a strategy for sustainable development. The increasing interest in female participation as a sustainability strategy on an international scale, underscores the need for critical examinations of this approach. Centring on contemporary Sweden as a prominent site of this development, this article investigates the municipal use of gendered design processes and gender-sensitive policies. Drawing on the study of five public spaces, this article discusses categorization and processes of inclusion/exclusion and ordination/subordination in relation to the design and use of public spaces. Central to the analysis is a recurring ambivalence identified in the material, where spaces are referred to both as spaces for girls and spaces for everyone. The authors argue that spaces can only fulfil the double demand of being for girls and for everyone if we accept that girls stay subordinated to boys in their use of public space. Drawing on an analysis of the interplay of inclusion/exclusion and ordination/subordination they propose a generalizable model of participation and public space. The article concludes by advocating for the creation of spaces for girls and the creation of spaces for everyone to be treated as two related yet separate tasks. • Public spaces designed exclusively for girls aim to address gender imbalances. • Spaces for girls are ascribed attributes like welcoming and openness. • Spaces for girls became open to all over time, revealing ambiguous intentions. • A space can be for girls and for all only if girls remain subordinate to boys. • A model combining inclusion/exclusion and ordination/subordination is introduced. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the economic and clinical burden associated with poor glycaemic control in Sweden, in people with type 2 diabetes (T2D) initiating first‐line glucose‐lowering therapy. Materials and Methods: Population data were obtained from Swedish national registers. Immediate glycaemic control was compared with delays in achieving control of 1 and 3 years, with outcomes projected over 3, 10 and 50 years in the validated IQVIA CORE Diabetes Model. Glycaemic control was defined as glycated haemoglobin (HbA1c) targets of 52, 48 and 42 mmol/mol, as recommended in Swedish guidelines, according to age and disease duration. Costs (expressed in 2019 Swedish krona [SEK]) were accounted from a Swedish societal perspective. Results: Immediate glycaemic control was associated with population‐level cost savings of up to SEK 279 million and SEK 673 million versus delays of 1 and 3 years, respectively, as well as small population‐level life expectancy benefits of up to 1305 and 2590 life years gained. Reduced levels of burden were a result of lower incidence and delayed time to onset of diabetes‐related complications. Conclusions: Even in people with T2D initiating first‐line glucose‐lowering therapy, the economic burden of poor glycaemic control in Sweden is substantial, but could be reduced by early and effective treatment to achieve glycaemic targets. [ABSTRACT FROM AUTHOR]

With accelerated land conversion and global heating at northern latitudes, it becomes crucial to understand, how life histories of animals in extreme environments adapt to these changes. Animals may either adapt by adjusting foraging behavior or through physiological responses, including adjusting their energy metabolism or both. Until now, it has been difficult to study such adaptations in free‐ranging animals due to methodological constraints that prevent extensive spatiotemporal coverage of ecological and physiological data.Through a novel approach of combining DNA‐metabarcoding and nuclear magnetic resonance (NMR)‐based metabolomics, we aim to elucidate the links between diets and metabolism in Scandinavian moose Alces alces over three biogeographic zones using a unique dataset of 265 marked individuals.Based on 17 diet items, we identified four different classes of diet types that match browse species availability in respective ecoregions in northern Sweden. Individuals in the boreal zone consumed predominantly pine and had the least diverse diets, while individuals with highest diet diversity occurred in the coastal areas. Males exhibited lower average diet diversity than females.We identified several molecular markers indicating metabolic constraints linked to diet constraints in terms of food availability during winter. While animals consuming pine had higher lipid, phospocholine, and glycerophosphocholine concentrations in their serum than other diet types, birch‐ and willow/aspen‐rich diets exhibit elevated concentrations of several amino acids. The individuals with highest diet diversity had increased levels of ketone bodies, indicating extensive periods of starvation for these individuals.Our results show how the adaptive capacity of moose at the eco‐physiological level varies over a large eco‐geographic scale and how it responds to land use pressures. In light of extensive ongoing climate and land use changes, these findings pave the way for future scenario building for animal adaptive capacity. [ABSTRACT FROM AUTHOR]

Introduction: Real-world evidence has demonstrated improved glycemic control and insulin management following introduction of smart insulin pens in a Swedish type 1 diabetes (T1D) population. To understand the implications for healthcare costs and expected health outcomes, this analysis evaluated the long-term cost-effectiveness of introducing smart insulin pens to standard-of-care T1D treatment (standard care) from a Swedish societal perspective. Methods: Clinical outcomes and healthcare costs (in 2018 Swedish krona, SEK) were projected over patients' lifetimes using the IQVIA CORE Diabetes Model to estimate cost-effectiveness. Clinical data and baseline characteristics for the simulated cohort were informed by population data and a prospective, noninterventional study of a smart insulin pen in a Swedish T1D population. This analysis captured direct and indirect costs, mortality, and the impact of diabetes-related complications on quality of life. Results: Over patients' lifetimes, smart insulin pen use was associated with per-patient improvements in mean discounted life expectancy (+ 0.90 years) and quality-adjusted life expectancy (+ 1.15 quality-adjusted life-years), in addition to mean cost savings (direct, SEK 124,270; indirect, SEK 373,725), versus standard care. A lower frequency and delayed onset of complications drove projected improvements in quality-adjusted life expectancy and lower costs with smart insulin pens versus standard care. Overall, smart insulin pens were a dominant treatment option relative to standard care across all base-case and sensitivity analyses. Conclusions: Use of smart insulin pens was projected to improve clinical outcomes at lower costs relative to standard care in a Swedish T1D population and represents a good use of healthcare resources in Sweden. [ABSTRACT FROM AUTHOR]

Hunting, an activity conceptualized as part of wildlife management partnership between the state, landowners and hunting communities, is increasingly challenged by a decreasing hunter base. This has ecological, economic and socio-cultural consequences, and the issue of hunter recruitment deserves more scholarly and political attention. In Sweden, the number of individuals taking a hunting proficiency test is high even though the number of hunters has declined during the last few decades although with a recovery the last 12 months, indicating an under-utilized source of potential new hunters. We explore in an interview study with potential new hunters in Sweden what factors affect and motivate individuals to take the hunter proficiency test and to hunt. Our thematic analysis identifies structural, institutional and individual factors influencing hunting participation, such as social networks and access to land, rendering two ideal types of new hunters. We offer suggestions to help curb the negative trend of declining hunter numbers and we identify research gaps for future studies to address. [ABSTRACT FROM AUTHOR]

In 1975, Sweden extended voting rights in local elections to immigrants without Swedish citizenship (resident aliens). In this essay, motives behind the reform are analysed and it is argued that these were based on a wish to speed up the integration of immigrants rather than on normative ideas about the nature of democracy. In fact, the reform was seen as a part of the emerging Swedish integration policy of the 1970s. The discursive construction of 'the immigrant' was another important factor. Most immigrants at the time came from other Nordic countries, and politicians saw them as culturally similar to Swedes. However, this would change after the reform was enacted as Nordic labour immigration was superseded by non-European refugee immigration and the new asylum seekers were seen as more or less 'different' to Swedes. Domestic political arguments such as these, rather than philosophical arguments, shaped the outcome of the Swedish decisions regarding voting rights for resident aliens. [ABSTRACT FROM AUTHOR]

Aim: To describe partners' experiences of living with men with a screening‐detected abdominal aortic aneurysm (AAA). Background: Diagnosis of a chronic life‐threatening disease affects the patients' as well as their partners' lives in different aspects. AAA, with rupture as the major consequence, is a life‐threatening disease that can affect the whole family. Screening programmes for AAA have been introduced in several countries to reduce the mortality rate. Although the awareness of having an AAA influences the individuals' quality of life and well‐being, it is still unclear how it affects their partners. Design: Qualitative descriptive design. Methods: Twenty‐one partners of men with AAA were purposely selected to participate in individual semi‐structured interviews between August 2017–February 2018 in Sweden. Data were transcribed and imported into NVivo‐12®. The data were analysed using qualitative content analysis. The study conforms to the COREQ checklist. Results: Three categories were identified: (a) experiencing the unexpected; (b) being reminded of fragility; and (c) balancing a changing relationship. The partners had a positive attitude towards the screening process and were pleased that their husbands were under surveillance. Nevertheless, at the same time, the diagnosis caused worries and questions. The AAA diagnosis was constantly in the minds of the partners, which sometimes affected and limited daily activities. Furthermore, ambivalent feelings towards surgical treatment were described. The partners tried to support their men and encouraged them to achieve a healthy lifestyle. Conclusion: The partners' well‐being and daily lives were impacted by the awareness of the screening‐detected AAA. Different degrees of worry were the most common reaction and were pervasive in all three categories. Relevance for clinical practice: The result highlights the need to review routines or develop new strategies to include the partners in the process of screening and offer supplementary support and information. [ABSTRACT FROM AUTHOR]

Background: Frailty is a strong predictor of adverse outcomes. However, longitudinal drivers of frailty are not well understood. This study aimed at investigating the longitudinal trajectories of a frailty index (FI) from adulthood to late life and identifying the factors associated with the level and rate of change in FI.Methods: An age-based latent growth curve analysis was performed in the Swedish Adoption/Twin Study of Aging (N = 1,842; aged 29-102 years) using data from up to 15 measurement waves across 27 years. A 42-item FI was used to measure frailty at each wave.Results: A bilinear, two-slope model with a turning point at age 65 best described the age-related change in FI, showing that the increase in frailty was more than twice as fast after age 65. Underweight, obesity, female sex, overweight, being separated from one's co-twin during childhood, smoking, poor social support, and low physical activity were associated with a higher FI at age 65, with underweight having the largest effect size. When tested as time-varying covariates, underweight and higher social support were associated with a steeper increase in FI before age 65, whereas overweight and obesity were associated with less steep increase in FI after age 65.Conclusions: Factors associated with the level and rate of change in frailty are largely actionable and could provide targets for intervention. As deviations from normal weight showed the strongest associations with frailty, future public health programs could benefit from monitoring of individuals with abnormal BMI, especially those who are underweight. [ABSTRACT FROM AUTHOR]

Albedo change during feedstock production can substantially alter the life cycle climate impact of bioenergy. Life cycle assessment (LCA) studies have compared the effects of albedo and greenhouse gases (GHGs) based on global warming potential (GWP). However, using GWP leads to unequal weighting of climate forcers that act on different timescales. In this study, albedo was included in the time‐dependent LCA, which accounts for the timing of emissions and their impacts. We employed field‐measured albedo and life cycle emissions data along with time‐dependent models of radiative transfer, biogenic carbon fluxes and nitrous oxide emissions from soil. Climate impacts were expressed as global mean surface temperature change over time (∆T) and as GWP. The bioenergy system analysed was heat and power production from short‐rotation willow grown on former fallow land in Sweden. We found a net cooling effect in terms of ∆T per hectare (−3.8 × 10–11 K in year 100) and GWP100 per MJ fuel (−12.2 g CO2e), as a result of soil carbon sequestration via high inputs of carbon from willow roots and litter. Albedo was higher under willow than fallow, contributing to the cooling effect and accounting for 34% of GWP100, 36% of ∆T in year 50 and 6% of ∆T in year 100. Albedo dominated the short‐term temperature response (10–20 years) but became, in relative terms, less important over time, owing to accumulation of soil carbon under sustained production and the longer perturbation lifetime of GHGs. The timing of impacts was explicit with ∆T, which improves the relevance of LCA results to climate targets. Our method can be used to quantify the first‐order radiative effect of albedo change on the global climate and relate it to the climate impact of GHG emissions in LCA of bioenergy, alternative energy sources or land uses. [ABSTRACT FROM AUTHOR]

The question of how voting rights should be designed in relation to national citizenship has gained attention in modern, academic debates. However, there are few empirical studies on the political agents actually involved in efforts to promote or oppose enfranchisement of expatriate citizens or resident aliens, or the arguments they have used. This essay therefore analyses debates on voting rights and citizenship in the Swedish parliament from 1921 (when Sweden adopted general suffrage) and until 2019. Initiatives promoting enfranchisement for expatriate citizens were taken by conservatives and liberals, and were opposed by socialists. Initiatives promoting enfranchisement for resident aliens were taken by socialist and green parties, and often opposed by conservatives and nationalists. The arguments used were sometimes very instrumental, and quite different from the theoretical arguments used in modern academic, normative discussions. For example, Sweden's local enfranchisement of resident aliens in 1975 was seen as an effort to promote integration and prevent segregation. [ABSTRACT FROM AUTHOR]

The collaborative ecosystem-based management of moose (Alces alces) in Sweden puts a strain on the involved stakeholders. Representatives have to cope with environmental uncertainty and social stress associated with goal conflicts. This article advanced the understanding of representatives' coping strategies in response to perceived challenges and how these coping strategies are associated with social trust, focusing upon salient value similarity. A mixed-method approach, combining a questionnaire survey (n = 624) and interviews (n = 21) among landowners and hunter representatives, was employed. Survey results showed that the presence of emotion-centered coping strategies that involve venting of negative emotions and behavioral disengagement were associated with relatively lower trust, whereas problem-solving centered coping was associated with relatively higher trust. The interviews indicated the importance of appointing group leaders who are skilled at initiating dialogue and working toward decisions and compromises, as this seemed to hinder expressions of emotion-centered coping strategies. [ABSTRACT FROM AUTHOR]

• Perceived adaptive capacity is scale dependent and varies across a system. • A psychometric approach can capture variations in adaptive capacity determinants.\ • Linking social capital is a critical determinant of perceived adaptive capacity. • A focus on social learning could help to build linking and bridging social capital. • Interventions should foster a balance between different types of social capital. In 2012 Sweden implemented a collaborative governance regime for managing moose (Alces alces). This was guided by the awareness that decentralization and stakeholder participation can help to reduce conflicts, foster systematic learning, and handle complexity. However, previous research has highlighted that there are no blueprint approaches to the governance and management of natural resources. In this case, diverse multi-use landscapes, ever-changing ungulate populations, and other external stressors (e.g. climate change, wildlife diseases) can create challenges for collaborative institutions. Adaptive capacity is therefore needed as it allows a system and the actors involved to react successfully to social-ecological changes and to develop even in times of no imminent change or risk. Using Swedish moose management as an example of a multi-level governance system, this research assesses the critical determinants of adaptive capacity across levels. We developed and applied a psychometric approach to measure actors' perceived adaptive capacity on two levels in the management system. A web-based survey was sent to Moose Management Groups (n = 765, response rate = 81 %) and Moose Management Units (n = 1,380, response rate = 71 %). Using structural equation modelling, we assessed the relative importance of governance aspects, different types of social capital, as well as human and financial capital on actors' perceived adaptive capacity. Linking and bridging social capital in the system had significant impacts on both levels. Actors felt more prepared to handle future challenges in moose management when they perceived benefits through collaborations with levels below and expressed social trust in authorities and the management level above. Besides those similarities between the two levels, fairness was a more important determinant of actors' perceived adaptive capacity on the lower management level. These results can contribute to a future improvement of the collaborative governance setting by finessing strategic interventions on different levels. Furthermore, our results illustrate the importance of scale when assessing the adaptive capacity of a system. [ABSTRACT FROM AUTHOR]

Objectives: Health economic analysis from a healthcare and societal point of view was conducted to assess the cost-effectiveness of insulin degludec (IDeg) after switching from other basal insulins in people with type 1 diabetes.Material and Methods: This was a prospective, open-label, single arm, observational follow-up from August 2013 to October 2015 of 476 consecutive patients at Danderyd Hospital (Stockholm, Sweden) who switched to IDeg from other basal insulins (99% basal insulin analogs). The IMS CORE Diabetes Model (CDM) was used to predict the cost-effectiveness of life-long treatment with IDeg vs. other basal insulins, based on a Swedish setting.Results: Mean (SD) duration of follow-up was 21.7 (6.0) weeks. Mean HbA1c decreased by 2.7 mmol/mol, mean basal insulin dose decreased by 13.1% (p < .0001), and mean bolus insulin dose decreased by 7.5% (p < .0001) after switching. Frequencies of non-severe daytime hypoglycemia and non-severe nocturnal hypoglycemia decreased by 12% (p = .0127) and 53% (p < .0001) respectively and severe hypoglycemia was reduced by 62% (p = .0225). The CDM predicted a gain in life expectancy of 0.33 years, a discounted gain in quality-adjusted life-years (QALYs) of 0.54, and lower estimated direct lifetime healthcare costs of SEK 22,757 for patients switching to IDeg. The incremental cost-effectiveness ratio (ICER) showed IDeg as dominant (i.e. higher effectiveness with a lower cost). Sensitivity analyses confirmed the results.Conclusion: Based on this prospective, real-world, follow-up and using the CDM, it was estimated that switching to IDeg from other basal insulins translated into QALY gains including improved life expectancy and health-related quality of life, as well as dominant ICER, meaning cost-savings for the healthcare system. However, the study is limited by its observational design. Extrapolation into the future is only estimated since the actual treatment effect cannot be projected with certainty. [ABSTRACT FROM AUTHOR]

Optimal management of hunted species requires an understanding of the impacts of hunting on both individual animal and population levels. Recent technological advancements in biologging enable us to obtain increasingly detailed information from free-ranging animals, covering longer periods of time, and providing the data needed to assess such impacts. In Sweden, more than 80 000 moose are harvested annually, mostly hunted with the use of baying dogs. The effects of this hunting method on animal welfare and stress are understudied. Here, we evaluated 6 real and 17 experimental hunting approaches with baying dogs [wearing global positioning system (GPS) collars] on 8 adult female moose equipped with ruminal temperature loggers, subcutaneous heart rate (HR) loggers and GPS collars with accelerometers. The obtained data were used to analyse the behavioural and physiological responses of moose to hunting with dogs. Successful experimental approaches (moose and dog were within 240 m for >10 min) resulted in higher maximum body temperature (Tb, 0.88°C higher) and a mean increase in HR of 24 bpm in moose at the day of the approach compared to the day after. The moose rested on average >90 min longer the day after the approach compared to the day of the approach. The moose travelled on average 4.2 km longer and had a 1.3 m/s higher maximum speed the day of the approach compared to the day after. Our results demonstrate that hunting with dogs increase moose energy expenditure and resting time (and consequently decrease time available for foraging) on an individual level. This could possibly affect body condition and reproduction rates if the hunting disturbances occur frequently. [ABSTRACT FROM AUTHOR]

Background: Despite advances in life expectancy, low socioeconomic status is associated with a shorter lifespan. This study was conducted to investigate socioeconomic differences in mortality by comparing preventable with non-preventable causes of death in 39 506 participants from the Swedish Twin Registry born before 1935.Methods: Childhood social class, own education, own social class and social mobility were used as separate indicators of socioeconomic status. These data were linked to the Swedish Cause of Death Register. Cause of death was categorized as preventable or non-preventable mortality according to indicators presented in the Avoidable Mortality in the European Union (AMIEHS) atlas. Using Cox proportional hazard models, we tested the association between the socioeconomic measures and all-cause mortality, preventable mortality and non-preventable mortality. Additional co-twin control analyses indicated whether the associations reflected genetic confounding.Results: The social gradient for mortality was most prominent for the adult socioeconomic measures. There was a social gradient in both preventable mortality and non-preventable mortality, but with an indication of a moderately stronger effect in preventable causes of death. In analyses of social mobility, those who experienced life-time low socioeconomic status (SES) or downward social mobility had an increased mortality risk compared with those with life-time high SES and upward social mobility. Adjustments for genetic confounding did not change the observed associations for education, social class or social mobility and mortality. In the co-twin control analyses of reared-apart twins, the association between childhood social class and mortality weakened, indicating possible genetic influences on this association.Conclusions: Our results indicate that there is an association between low adult socioeconomic status and increased mortality independent of genetic endowment. Thus, we do not find support for indirect social selection as the basis for mortality inequalities in Sweden. [ABSTRACT FROM AUTHOR]

In multi-functional mountainous landscapes worldwide, conservation of natural values is a major task. Here, pro-active policies can be a way forward. National Environmental Quality Objectives (EQO) to solve environmental problems for future generations, however, often wrestle with being too visionary and lacking specificity, which complicates their implementation. The EQO "A Magnificent Mountain Landscape" that has been adopted by the Swedish Parliament in 1999 to preserve the pristine mountain environment in Sweden, experiences all these flaws. To aid its implementation, we studied the conditions and processes needed to define, to evaluate, and to preserve its goals across the Swedish mountain chain, using one of its milestone targets (a landscape characterized by grazing) as a study system. Applying qualitative and quantitative methods, we analyzed three types of data: 1) referral responses to the governmental strategy document, 2) interviews with relevant actors, and 3) environmental monitoring data (reindeer position data). Nationally, our results suggest a need for geographical differentiation to match regional/local conditions. Regionally, difference in both perception and definition of the milestone target among the actors hinders the formulation, monitoring, and evaluation of a common goal. Next to a culture-nature divide, we found that a "within as a user" and "from the outside as an observer" perspective influenced suggested definitions. Moreover, we found a need for better defining whether the goal is maintaining current conditions or restoring previous ones. Our result supports the use of animal position data as a decision support tool to monitor and to aid evaluation of the target. Given the number of actors involved and conflicts of interests present, we suggest the application of a structured decision process to accomplish agreements on a common goal. Here, environmental monitoring data can aid a "landscape assessment step" as a natural part in the decision process to target landscape management actions resourcefully and effectively. [ABSTRACT FROM AUTHOR]

Several studies have documented the importance of optimal work situation and the general well-being of early-career researchers (ECRs) for enhancing the academic performance of universities. Yet, most studies focused on specific categories of ECRs, or on specific academic disciplines as well as on specific outcomes. With this study, we recognize the need for a broader sample encompassing different categories of ECRs across academic disciplines. In a national survey of Swedish universities, the National Junior Faculty of Sweden (NJF) collected data from ECRs in order to study the influence of work situation and well-being on perceived scientific environment. We observed that work situation and well-being are interdependent and jointly influence each other in shaping the conditions for ideal scientific environment. Importantly, we employ structural equation model (SEM) analysis to account for the endogenous relationship between work situation and personal well-being in predicting perceived scientific environment. Results from SEM indicate that support from the university, work time management, job clarity, contract length and quality of life satisfaction were related to the perceived possibility of conducting the best science. Our research also highlighted individual differences across demographic factors and contract length in the perceived work situation and the possibility of conducting the best science. [ABSTRACT FROM AUTHOR]

Introduction: Sweden has amongst the highest incidence rates of type 1 diabetes (T1D) in Europe. The high incidence and chronic nature of T1D result in high prevalence and economic burden. Improving glycemic control reduces the incidence of microvascular complications, which in turn reduces medical costs. The present study aimed to quantify the reductions in cost and improvements in quality-adjusted life expectancy with varying reductions in HbA1c in the T1D population.Methods: The IQVIA CORE Diabetes Model was used to simulate a typical Swedish population of patients with T1D experiencing HbA1c reductions from 0.1% to 0.8% (in 0.1% increments) from 7.9% at baseline. Analyses were conducted in simulated cohorts based on data from the Swedish National Diabetes Register (NDR) and in subgroups by sex, smoking status, and body mass index (BMI), with different sets of quality-of-life utilities included. Generalized least squares (GLS) models were used to test for significant differences between subgroups. Analyses were also performed to investigate the effect of the duration of HbA1c control. Analyses were run over 50 years and outcomes discounted at 3% per annum.Results: In the reference case analysis, reducing HbA1c lowered the incidence of microvascular and macrovascular complications and improved quality-adjusted life expectancy. GLS models identified a significantly larger benefit of reducing HbA1c in women over men, but found no significant differences in the magnitude of quality of life improvements with decreasing HbA1c when segregating by smoking status or BMI.Conclusions: Reducing HbA1c in a population with T1D would reduce the incidence of microvascular complications, improve life expectancy and quality of life. Larger quality-of-life benefits were observed in younger and female adult patients, but no notable differences were observed in the benefits of glycemic control in smokers versus non-smokers or in patients with low or high BMI.Funding: Novo Nordisk Scandinavia AB, Malmö, Sweden. [ABSTRACT FROM AUTHOR]

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Background: Extracorporeal membrane oxygenation (ECMO) may be a lifesaving rescue therapy in refractory, severe respiratory, and/or circulatory failure. To provide the best cost efficiency to the population served and patient outcome, ECMO therapy should be provided by specialized high volume ECMO centers. This requires dedicated transport teams to organize and perform these complex transports. Concerning adverse events and complications during these transfers, only a minimal amount of data has been published. Methods: To shed light on this matter, all medical transport records from transports on ECMO between January 2010 and June 2016 were analyzed. The data was classified in constituent groups and categorized to risk groups. Results: During the study period, 536 transports on ECMO were performed. The transport records could be identified in 514 of these cases (95.9%). In 163 (31.7%) transports 206 adverse events occurred. In 34 transports two or more adverse events passed on the same trip. No deaths occurred during transport. Sixty-five percent (134) of the complications were Patient related; the most prominent was loss of tidal volume with or without fluid flooding of the lung (n = 57, 43%). Lack of control of equipment was the most common Staff related flaw. Causes due to Equipment/technical (n = 30) could be traced to 14.6% of the events. Vehicle/transportation related complications were reported from 26 transfers, a sub-group in which 50% of the reports concerned malfunction of Ambulance utility/electrical, or Wrong ambulance size at hospital or airport. Conclusions: If transporting on ECMO high-risk or sudden threat-of-life situations are inevitable and have to be dealt with immediately, sometimes within seconds. A well-trained staff and an experienced high-volume organization are recommended. Key words: extra corporeal membrane oxygenation; ECMO, transport; adverse event; complication [ABSTRACT FROM AUTHOR]