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Purpose: Three human papillomavirus (HPV) vaccines are available against up to nine HPV types. In Sweden, from 2012, Gardasil was offered to 10−12 year old girls through the school-based vaccination program, and as catchup vaccination for women up to 26 years. To obtain a baseline, and follow HPV vaccination effects, during 2008−2018, cervical and oral HPV prevalence were followed at a youth clinic in Stockholm, and in 2013 for comparison oral HPV prevalence was examined in high-school youth in a middle-sized county in Sweden. Methods: In this review, we discuss all our data with cervical and oral mouthwash samples that were collected and tested for 24−27 HPV types by a bead-based multiplex assay from 2008. Results: Compared with 2008−2011, with ~ 35% HPV16 and > 60% high risk (HR) HPV cervical prevalence at the youth clinic, a decrease of vaccine HPV types was observed between 2013 and 2018, with e.g., HPV16 falling to 5% in catchup vaccinated women and 15−18% in nonvaccinated women. Most common cervical HR-HPV types were HPV39, 51, 52, 56, and 59 together accounting for ~ 10% of cervical cancer, and where only HPV52 is included in Gardasil-9. At baseline 2009−2011, oral HPV prevalence was ~ 10% in unvaccinated youth at the youth clinic, but after 2013 it dropped to < 2% at the youth clinic and high schools. Conclusion: To conclude, Gardasil HPV types have decreased, but it is still important to follow remaining HR-HPV types and cancer development, since there is an ongoing increase in the incidence of HPV-associated tonsillar and base of tongue cancer, and cervical cancer in Sweden. [ABSTRACT FROM AUTHOR]

Background: Tonsillar and base of tongue squamous cell carcinoma (TSCC/BOTSCC) has increased. In Stockholm, the proportion of human papillomavirus (HPV)‐positive cases and the incidence of TSCC rose between 1970 and 2006 then stabilized. Here, HPV‐prevalence, and TSCC/BOTSCC incidence 2000‐2016, in Stockholm and Sweden were followed. Methods: Incidence data for 2000‐2016 were obtained from the Swedish Cancer Registry. TSCC/BOTSCC biopsies, 2013‐2016 from Stockholm, were examined for HPV DNA and p16INK4a, or data obtained from medical reports. For cases 2000‐2012, data were available from previous studies. Results: The incidence of TSCC/BOTSCC has continued to rise in Stockholm and Sweden 2000‐2016, especially after 2008. HPV DNA and p16INK4a analysis was determined for 795 Stockholm cases from 2000 to 2016, with 72% being HPV DNA and p16INK4a positive 2013‐2016, and 70% positive 2000‐2016. Conclusion: During 2000‐2016, especially after 2008, the incidence of TSCC/BOTSCC has continued to increase in Stockholm and Sweden, with an HPV‐prevalence of approximately 70% in Stockholm. [ABSTRACT FROM AUTHOR]

Aim: This study aimed to follow the impact of human papillomavirus (HPV) catch-up and vaccination on the very high cervical HPV-prevalence in women at a youth clinic in central Stockholm during the period 2008–2018. Background: 2008–2010, cervical HPV-prevalence (69.5%) and HPV16 prevalence (34.7%) were high in non-vaccinated women at a youth clinic in Stockholm. 2013–2015, after the introduction of the quadrivalent-Gardasil® HPV-vaccine, HPV16 and HPV6 prevalence had decreased. Here, cervical HPV-prevalence was investigated 10 years after primary sampling. Material and Methods: 2017–2018, 178 cervical swabs, from women aged 15–23 years old, were tested for 27 HPV types by a bead-based multiplex method. HPV-prevalence data were then related to vaccination status and age and compared to HPV-prevalence in 615 samples from 2008 to 2010 and 338 samples from 2013 to 2015 from the same clinic, and to HPV types in 143 cervical cancer cases during 2003–2008 in Stockholm. Results: The proportion of vaccinated women increased from 10.7% (2008–2010) to 82.1% (2017–2018). The prevalence of all 27 HPVs, all high-risk HPVs (HR-HPVs) and the combined presence of the quadrivalent-Gardasil® types HPV16, 18, 6, and 11, was lower in vaccinated compared to unvaccinated women (67.4 vs. 93.3%, p = 0.0031, 60.1 vs. 86.7%, p = 0.0057 and 5.8 vs. 26.7%, p = 0.002, respectively). Furthermore, HPV16 prevalence in non-vaccinated women 2017–2018 was lower than that in 2008–2010 (16.7 and 34.7%, respectively, p = 0.0471) and similar trends were observed for HPV18 and 11. In both vaccinated and non-vaccinated women, the most common non-quadrivalent-Gardasil® vaccine HR-HPV types were HPV39, 51, 52, 56, and 59. Together they accounted for around 9.8% of cervical cancer cases in Stockholm during 2003–2008, and their prevalence tended to have increased during 2017–2018 compared to 2008–2010. Conclusion: Quadrivalent-Gardasil® vaccination has decreased HPV-vaccine type prevalence significantly. However, non-vaccine HR-HPV types remain high in potentially high-risk women at a youth clinic in Stockholm. [ABSTRACT FROM AUTHOR]

During 2009 - 2011, we reported that the oral and cervical prevalence of human papillomavirus (HPV) was high by international standards at 9.3% and 74%, respectively, in youth aged 15 - 23 years attending a youth clinic in Stockholm. After gradual introduction of public HPV vaccination during 2007 - 2012, between 2013 and 2014, when 73% of the women were HPV-vaccinated, but not necessarily before their sexual debut, oral HPV prevalence had dropped to 1.4% as compared with 9.3% in 2009 - 2011 (p 0.00001). Cervical HPV prevalence was high and common cervical high-risk types were HPV51, 56, 59, 73, 16, 39, 52, and 53. However, it was shown that HPV16, 31, and 70 were significantly less common among HPV-vaccinated women than among those who had not received the vaccine. [ABSTRACT FROM AUTHOR]

This paper gives a brief description of the service delivery system for assistive technology used in daily life (AT) in Sweden, and includes discussion on present changes and trends. In Sweden the responsibility for provision of AT is shared between counties/regions and municipalities. The greater part of the cost for prescribed AT is paid by taxes. Each county/region and municipality decides on its fees and assortment of AT; there are no national guidelines or coordination. The prescription process is part of the rehabilitation process, where assessment of needs precedes prescription. In 2007 the Swedish government commissioned a programme in which trials with a voucher system were conducted in three counties and eight municipalities. The trials were evaluated and interviewed users expressed that the voucher system increased their participation in the process and that they experienced more satisfaction when they had purchased the AT on their own. The voucher system has been criticized by some users; notably by the main user organisation for persons with hearing impairments. During the past ten years, the range of AT that can be prescribed has been reduced and users have to buy some types of AT as consumer products on the private market. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) causes cervical, head, and neck cancers. We studied 483 patients at a youth clinic in Stockholm, Sweden, and found oral HPV prevalence was 9.3% and significantly higher for female youth with than without cervical HPV infection (p = 0.043). Most oral HPV types matched the co-occurring cervical types. [ABSTRACT FROM AUTHOR]

Aim To combine clinical and molecular markers into an algorithm for predicting outcome for individual patients with human papillomavirus (HPV) DNA/p16 INK4a positive tonsillar and base of tongue squamous cell carcinoma (TSCC and BOTSCC). Background Head-neck cancer treatment has become more intensified, comprising not only surgery and radiotherapy, but also induction/concomitant chemotherapy and targeted therapy. With less treatment, 3-year disease free survival (DFS) is 80% for HPV-positive TSCC and BOTSCC. An 85–100% 3-year DFS is observed for HPV + TSCC and BOTSCC with absence of HLA class I, or CD44 expression, or high CD8 + tumour-infiltrating lymphocyte (TIL) counts suggesting that therapy could be tapered for many if patients could be identified individually. Patients and methods Patients treated curatively, with HPV DNA/p16 INK4a positive tumours examined for HLA class I and II, CD44 and CD8 + TILs, were included. An L1-regularised logistic regression was used to evaluate the effect of the biomarker data, age, stage, diagnosis, smoking and treatment on 3-year risk of death or relapse on a training cohort of 197 patients diagnosed 2000–2007 and validated on a cohort of 118 patients diagnosed 2008–2011. Results The variables finally included in the model were HLA class I, CD8 + TILs, age, stage and diagnosis (TSCC or BOTSCC). The model showed acceptable discrimination and calibration. The discriminative ability of the model did not diminish after validation (AUC = 0.77). Conclusion To our knowledge, this is the first model to utilise information from several markers to predict an individual probability of clinical outcome for patients with HPV DNA/p16 INK4a positive tumours. [ABSTRACT FROM AUTHOR]

Phosphorus (P) is an essential element for life and limits productivity in many terrestrial and aquatic ecosystems. Histosols contain a large amount of P because of their high content of organic matter and effective adsorption processes. Climate warming promotes the degradation of permafrost and increases decomposition leading to unprecedented geochemical changes in Carbon (C) and Nitrogen (N) cycles. To assess the effect of permafrost thaw on P cycling, we determined available P, Hedley P fractions and phosphatase activity across a thawing gradient in a palsa mire complex at Stordalen (Abisko, 68ºN, Sweden). We analysed three site types in a space-for-time approach (palsa, transition zone and collapsed palsa) at four different depths (5-10, 40-45, 70-75 and 95-100 cm). Available or relatively labile P were higher in surface samples compared to deep peat in the palsa and collapsed sites. The main P fraction of these samples was organic P and P bound to Iron (Fe) and Aluminum (Al) (NaOH-Porg), which made up between 40 and 70% of total P. The collapsed palsa sites had a lower proportion of P in these fractions and higher organic and inorganic available P, as well as phosphatase activity -specially in surface samples- suggesting that increased temperature, microbial activity and redox changes contribute to transforming Fe-Al bound P into other forms. Total P (TP) in deep layers (>50 cm) is dramatically reduced (between 15 and 30%) after permafrost thaw. In contrast, in surface samples (5-10 cm) TP increased by 60% suggesting an important change in the depth profile of this nutrient related to permafrost disappearance. The described changes indicate a major increase in P availability for plant and microbes after permafrost thaw, and a lower storage capacity for P in deep peat layers. P mobilization in subarctic peatlands after permafrost thaw may thus result in lower surface N/P ratios, and changes in ecosystem productivity and C fixing capacity. Permafrost thaw and associated changes in hydrology and underground circulation in areas with discontinuous permafrost may play an important role in the release of P and its interaction with C, N, Al and Fe cycles. [ABSTRACT FROM AUTHOR]

Subarctic permafrost peatlands are particularly sensitive to climate warming. The progressive degradation of permafrost in these ecosystems promotes the decomposition of old organic matter in deep soil layers and re-activates the cycling of C and nutrients. Several studies reported that thawing of permafrost in subarctic peatlands increases nitrogen (N) availability for plants and microbes, ecosystem productivity as well as CH4 and CO2 emissions. Very little is known, however, about phosphorus (P) availability after permafrost degradation and about possible changes of C:N:P ratios in soil and vegetation. In June 2018 we collected soil samples from several palsas (peat mounds with a permafrost core) at Stordalen (Abisko, 68ºN, Sweden). We sampled at four different depths: two above the active layer (5-10 and 40-45 cm) and two in the permafrost (70-75 and 95-100 cm). We incubated the samples at 0.1 °C (thaw front temperature) and 10.5 °C (summer rooting zone soil temperature) over 120 days, similar to the length of the growing season. These two temperatures simulated slow vs. fast thawing of permafrost, which are associated with a deepening of the active layer or with a complete disappearance of the permafrost, respectively. We determined total C, N and P, available P, Hedley P and available N from pre-incubation and incubated samples. The availability of P was highest near the surface of the palsa in pre-incubation samples, and lower at deeper layers; the N:P ratio was consistently higher at deeper layers. The samples exposed to 10.5°C showed a very significant increase in N and P availability and a decrease in N:P ratio. Our results indicate that in intact, oligotrophic palsa the relative availability of P might be higher than that of N, whereas the opposite may apply after permafrost thawing. Such shift in relative nutrient availability is crucial to understand changes in stoichiometry in the soil and vegetation, in ecosystem productivity, C fixation and ecosystem functioning when palsas in subarctic mires collapse by permafrost thaw. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) infection is one of the most common sexually transmitted diseases. To define the HPV-associated microbial community among a high vaccination coverage population, we carried out a cross-sectional study with 345 young Swedish women. The microbial composition and its association with HPV infection, including 27 HPV types, were analyzed. Microbial alpha-diversity was found significantly higher in the HPV-infected group (especially with oncogenic HPV types and multiple HPV types), compared with the HPV negative group. The vaginal microbiota among HPV-infected women was characterized by a larger number of bacterial vaginosis-associated bacteria (BVAB), Sneathia, Prevotella, and Megasphaera. In addition, the correlation analysis demonstrated that twice as many women with non-Lactobacillus-dominant vaginal microbiota were infected with oncogenic HPV types, compared with L. crispatus-dominated vaginal microbiota. The data suggest that HPV infection, especially oncogenic HPV types, is strongly associated with a non-Lactobacillus-dominant vaginal microbiota, regardless of age and vaccination status.