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Based on a discrete choice experiment with 336 consumers, this study investigated whether the consumer propensity to choose a simplified European Union (EU) vs. non-EU denomination of origin for beef, instead of a specific country-of-origin (COO) denomination, depends upon the amount and type of credence information provided to the individual. The likelihood of choosing the EU/non-EU denomination of origin depended on the total number of other labelling credence attributes provided and also on the type of detailed credence attributes present in the choice. The presence of cues relating to animal welfare and far-reaching traceability had the highest likelihood of influencing the choice of the EU/non-EU denomination of origin. The compensatory qualities of each credence attribute in relation to the EU/non-EU origin denomination thus differed.

Decreased lumbar spine trabecular bone score (TBS), a dual-energy X-ray absorptiometry (DXA)-derived image texture measurement, is a risk factor for major osteoporotic fracture (MOF) and hip fracture (HF) independent of 10-year fracture probability estimated using FRAX. We determined how often applying the TBS adjustment to fracture probability altered treatment qualification. Using a population-based registry containing all clinical DXA results for Manitoba, Canada, we identified 34,316 women with baseline spine and hip DXA, FRAX-based fracture probability measurements (computed with femoral neck bone mineral density), lumbar spine TBS, and minimum 5 years of observation (mean 8.7 years). Population-based health services data were used to identify incident non-traumatic MOF and HF in 3503 and 945 women, respectively. Baseline MOF and HF probabilities were estimated using FRAX before and after applying the TBS adjustment. Risk recategorization was assessed using net reclassification improvement (NRI) for individual FRAX-based intervention criteria and three national clinical practice guidelines (CPGs) (US National Osteoporosis Foundation, Osteoporosis Canada, and UK National Osteoporosis Guideline Group). Overall, proportions of women reclassified with the TBS adjustment to FRAX were small (less than 5%) with more than 90% of the reclassification occurring close to the intervention threshold. For women close to an intervention cut-off reclassification, rates ranged from 9.0% to 17.9% and were < 1% otherwise. There was a small but significant improvement in overall NRI for all individual FRAX-based intervention criteria (range 0.007 to 0.018) and all three national CPGs (range 0.008 to 0.011). NRI was larger in women below age 65 years (up to 0.056 for hip fracture). In summary, a small but significant improvement in MOF and HF risk assessment was found by using lumbar spine TBS to adjust FRAX probability. An improvement in risk reclassification was observed for CPGs from three different countries, with almost all of the benefit found in individuals close to an intervention threshold. © 2017 American Society for Bone and Mineral Research.

In this report we aim to analyse the economic and environmental impacts of Pillar I direct payments, and to demonstrate alternative instruments that are better suited to achieve CAP objectives. The instruments—a targeted payment to land at risk of abandonment and a tax on mineral fertilisers—were selected on the basis of the Polluter Pays and Provider Gets Principles. We do this using two state‐of‐the‐art agricultural economic simulation models. The first model, CAPRI, is used to quantify the large‐scale or aggregate impacts for individual countries, the EU and the world. The other model, AgriPoliS, is used to quantify the fine‐scale or farm and field level impacts in a selection of contrasting agricultural regions, to consider the potential influence of the large spatial variability in agricultural and environmental conditions across the EU. The results show that direct payments are keeping more farms in the sector and more land in agricultural use than would otherwise be the case, and thus avoiding land abandonment, principally in marginal regions. Particularly the area of grassland is substantially higher, because it is generally less productive than arable land and hence more dependent on direct payments for keeping it in agricultural use. The magnitudes of the impacts of direct payments on land use therefore vary strongly across regions due to spatial variability in productivity: marginal regions with large areas of less productive land are heavily influenced by direct payments, while regions with large areas of relatively productive land are hardly affected, because this land would be farmed in any case. By keeping more farmers in the sector longer, direct payments are slowing structural change, which can hamper agricultural development. However the potential benefits of faster structural change vary considerably among our study regions. In relatively productive regions direct payments are hindering development, because too many farmers are staying in the sector and preventing the consolidation of land in larger farms, which would improve their competitiveness and increase farm profits. On the contrary, the mass departure of farms that is currently avoided, will not lead to the same general benefits in marginal regions. Instead of freed land being absorbed by remaining farms, large areas of relatively unproductive land are abandoned without payments. This land is unprofitable to maintain in agricultural land use, even if integrated into larger farms, because current market prices are too low to motivate farming it. Consequently direct payments pose a serious goal conflict: the avoidance of land abandonment on the one hand, which can have negative impacts on public goods, and restricting agricultural development on the other hand. Once again this goal conflict is rooted in the spatial variability of agricultural conditions in the EU. Maintaining extensively managed farmland, particularly semi‐natural pastures, is central for conservation of biodiversity and preservation of the cultural landscape. Therefore direct payments are contributing to the provisioning of these public goods, but principally in marginal areas. Further, abandonment of land can reduce its agricultural productivity due to erosion or afforestation. Thus, direct payments are contributing to food security by preserving the productive potential of land for the future, but only marginal land since relatively productive land is farmed in any case. Production of agricultural commodities is affected to a lesser degree by direct payments than land use per se. Nevertheless, food exports from the EU are higher and imports lower as a consequence of direct payments. However, the additional supply generated by direct payments also lowers output prices, which reduces the profitability of commodity production; thereby partially offsetting the additional revenues from direct payments. The higher agricultural output brought about by direct payments causes higher levels of environmentally damaging greenhouse‐gas emissions, nutrient surpluses and pesticide use. The higher greenhouse‐gas emissions for the EU are, to some extent, moderated by lower emissions in the rest of the world. Nevertheless, the net effect of direct payments is higher global emissions of greenhouse gases. The environmental impacts of higher nutrient surpluses and pesticide inputs are less conclusive, since these depend also on spatial factors, i.e., where the emissions occur. Although EU‐scale and regional emissions are higher due to direct payments, agricultural production is less intensive generally, on account of the lower output prices. Analysing the net effects of these two opposing forces requires additional biophysical modelling at relevant spatial scales, such as watersheds or landscapes, which is beyond the scope of this study. Pillar I direct payments generate a significant transfer of income to farmers and land owners who are not necessarily farmers; 40 billion euro annually. Of this transfer a substantial proportion goes to farmers in relatively productive regions and, further, to a minority of farmers that need them least. In relatively productive regions payments are not needed for continued agricultural production and preservation of farmland, but instead rather fuel higher land and rental prices, which hampers structural change. On the contrary, the need for support is greatest in marginal regions, because some form of payment to marginal land is needed to avoid its abandonment and the loss of associated public goods. Finally, the direct payments even come at the cost of lower market returns for farmers due to slower structural change (smaller and less competitive farms) and lower output prices (due to greater EU output). On the other hand the lower output prices lead to somewhat lower food prices, but at the greater cost of financing the direct payments. Our main conclusion is that Pillar I direct payments are generating serious goal conflicts due to spatial variability in conditions across the EU. On the one hand these payments are contributing to the provisioning of public goods by preserving marginal agricultural land. On the other hand they are hampering agricultural development, primarily in relatively productive regions. Payments to relatively productive land that would be farmed any way not only inflate land values (capitalisation) but also slow structural change, which are both likely to hinder agricultural development and hence the competitiveness of the EU on the global market. The direct payments also increase environmental pressure; by subsidising land use generally and the associated production, they are incapable of controlling environmentally damaging emissions, which is also in conflict with broad CAP objectives. The goal conflict arises because direct payments are universal, a payment principal that does not consider spatial variability in the EU and the associated trade‐offs in regard to development and environmental effectiveness. Our analysis considered two alternative policy instruments that have the potential to curb the identified goal conflicts associated with direct payments, by applying the Polluter Pays and Provider (of public goods) Gets Principles at appropriate spatial scales. Replacing direct payments with a payment targeted on marginal land (and associated public goods) prevents land abandonment at a lower cost, by avoiding payments to relatively productive land that is farmed in any case. This also allows surviving farms in regions with relatively productive land to compensate for lost direct payments through expansion and associated scale economies, as well as higher output prices. This instrument therefore finances the provisioning of public goods without adverse effects on development and the efficiency of agricultural production. The EU‐wide tax on mineral fertiliser demonstrates that this instrument has the potential to reduce nutrient surpluses. Since direct payments cause higher levels of polluting emissions, policy instruments targeting emissions at relevant spatial scales are needed to achieve cost‐effective abatement. Overall we find that Pillar I direct payments are not addressing the diversity of challenges facing European agriculture. In fact our quantitative analysis indicates that the potential for the current system to meet these challenges is seriously impaired by goal conflicts and spatial variability across the EU. A better policy requires that instruments are targeted on desired outcomes and designed according to sound principles, specifically the Polluter Pays and Provider Gets Principles. These principles would ensure that farmers are provided with appropriate incentives to i) generate public goods that otherwise would be underprovided; ii) mitigate environmentally damaging emissions at the lowest possible cost to society; and iii) continually strive to improve environmental performance. Such instruments are also fairer and promote a more competitive or viable agricultural sector by not obstructing structural change and hence agricultural development.

Studien ämnar till att undersöka anledningarna till samt resultatet av att yoga har blivit så populärt i Sverige, sett till sekulariseringsprocessen i Sverige idag, att det som ett resultat bidragit till att det erbjuds som en hälsofrämjande träningsform till skolpersonal på en gymnasieskola i Sverige. Vi har därför undersökt lärares och skolpersonals upplevelser av personalyoga, främst kundaliniyoga, som ett verktyg för stresshantering och tittat på yogans religiösa bakgrund. Sex kvalitativa intervjuer, där både lärare, skolpersonal och yogainstruktör blivit intervjuade har genomförts, transkriberats och analyserats. Resultatet visade att samtliga respondenter ansåg att yoga fungerar stressreducerande men endast en av de sex respondenterna ansåg att yoga var religiös utövning. Nästan alla respondenter var dock medvetna om att yoga har religiösa rötter i hinduism och buddhism, men samtidigt ansåg samtliga respondenter att målet med personalyogan endast var avkoppling i hälsofrämjande syfte. Utifrån resultatet har vi dragit slutsatsen att respondenterna är påverkade av sekulariseringsprocessen i Sverige samt att synen på yoga har gått från en mer religiös handling till en allt mer filosofisk väg och förhållningssätt i västvärlden.

Information om vilket land maten kommer ifrån finns i allt större utsträckning i livsmedelsbutiken men för restauranger finns det inget krav att informera gästerna om matens ursprung. Vår analys visar att restaurangbesökares efterfrågan av ursprungs-information är begränsad och främst gäller kött. Vår slutsats är att det bör vara frivilligt, snarare än tvingande, för restauranger att tillhandahålla ursprungsinformation. Ett problem som framkommer är att konsumenternas förståelse av den befintliga obligatoriska ursprungsmärkningen av livsmedel är låg. En anledning kan vara att lagstiftningen är komplex och att ursprungskriterierna omfattar flera led av produktionskedjan.

Summary This systematic review identified assessment guidelines for osteoporosis that incorporate FRAX. The rationale for intervention thresholds is given in a minority of papers. Intervention thresholds (fixed or age-dependent) need to be country-specific. Introduction In most assessment guidelines, treatment for osteoporosis is recommended in individuals with prior fragility fractures, especially fractures at spine and hip. However, for those without prior fractures, the intervention thresholds can be derived using different methods. The aim of this report was to undertake a systematic review of the available information on the use of FRAX® in assessment guidelines, in particular the setting of thresholds and their validation. Methods We identified 120 guidelines or academic papers that incorporated FRAX of which 38 provided no clear statement on how the fracture probabilities derived are to be used in decision-making in clinical practice. The remainder recommended a fixed intervention threshold (n = 58), most commonly as a component of more complex guidance (e.g. bone mineral density (BMD) thresholds) or an age-dependent threshold (n = 22). Two guidelines have adopted both age-dependent and fixed thresholds. Results Fixed probability thresholds have ranged from 4 to 20 % for a major fracture and 1.3–5 % for hip fracture. More than one half (39) of the 58 publications identified utilised a threshold probability of 20 % for a major osteoporotic fracture, many of which also mention a hip fracture probability of 3 % as an alternative intervention threshold. In nearly all instances, no rationale is provided other than that this was the threshold used by the National Osteoporosis Foundation of the USA. Where undertaken, fixed probability thresholds have been determined from tests of discrimination (Hong Kong), health economic assessment (USA, Switzerland), to match the prevalence of osteoporosis (China) or to align with pre-existing guidelines or reimbursement criteria (Japan, Poland). Age-dependent intervention thresholds, first developed by the National Osteoporosis Guideline Group (NOGG), are based on the rationale that if a woman with a prior fragility fracture is eligible for treatment, then, at any given age, a man or woman with the same fracture probability but in the absence of a previous fracture (i.e. at the ‘fracture threshold’) should also be eligible. Under current NOGG guidelines, based on age-dependent probability thresholds, inequalities in access to therapy arise especially at older ages (≥70 years) depending on the presence or absence of a prior fracture. An alternative threshold using a hybrid model reduces this disparity. Conclusion The use of FRAX (fixed or age-dependent thresholds) as the gateway to assessment identifies individuals at high risk more effectively than the use of BMD. However, the setting of intervention thresholds needs to be country-specific.

Previous prospective cohort studies have shown that serum levels of sex steroids and sex hormone‐binding globulin (SHBG) associate with nonvertebral fracture risk in men. The predictive value of sex hormones and SHBG for vertebral fracture risk specifically is, however, less studied. Elderly men (aged ≥65 years) from Sweden and Hong Kong participating in the Osteoporotic Fractures in Men (MrOS) study had baseline estradiol and testosterone analyzed by gas chromatography–mass spectrometry (GC‐MS) and SHBG by immunoradiometric assay (IRMA). Incident clinical vertebral fractures (n = 242 cases) were evaluated in 4324 men during an average follow‐up of 9.1 years. In a subsample of these men (n = 2256), spine X‐rays were obtained at baseline and after an average follow‐up of 4.3 years to identify incident radiographic vertebral fractures (n = 157 cases). The likelihood of incident clinical and radiographic vertebral fractures was estimated by Cox proportional hazards models and logistic regression models, respectively. Neither serum estradiol (hazard ratio [HR] per SD increase = 0.93, 95% confidence interval [CI] 0.80–1.08) nor testosterone (1.05, 0.91–1.21) predicted incident clinical vertebral fractures in age‐adjusted models in the combined data set. High serum SHBG, however, associated with increased clinical vertebral fracture risk (1.24, 1.12–1.37). This association remained significant after further adjustment for FRAX with or without bone mineral density (BMD). SHBG also associated with increased incident radiographic vertebral fracture risk (combined data set; odds ratio [OR] per SD increase = 1.23, 95% CI 1.05–1.44). This association remained significant after adjustment for FRAX with or without BMD. In conclusion, high SHBG predicts incident clinical and radiographic vertebral fractures in elderly men and adds moderate information beyond FRAX with BMD for vertebral fracture risk prediction. © 2015 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Sammanfattning Förståelsen kring ett hälsosamt åldrande blir alltmer viktig i ett samhälle där gruppen äldre väntas öka under kommande år. Trots att sambandet mellan välmående och självmedkänsla är dokumenterat finns inga kända studier som undersökt sambandet i en svensk, äldre population. I föreliggande studie utforskades sambandet mellan livstillfredsställels och självmedkänsla med deltagare från en svensk, nationell studie om åldrande och omsorg, kallad the Swedish National study on Aging and Care – SNAC. Även könsskillnader i de båda variablerna undersöktes. Resultaten visade att skillnader mellan kvinnor och män gällande livstillfredsställelse var obefintlig medan män skattade sig högre på självmedkänsla. Ett positivt samband mellan livstillfredsställelse och självmedkänsla fastställdes i gruppen. Självmedkänsla och ålder visade sig vara betydande för att predicera ett hälsosamt åldrande. Abstract The understanding of a successful aging is getting more important since the group of older adults is expected to grow over the next years. Even if the relationship between well-being and self-compassion is documented, no known studies have been made to investigate the relationship in a Swedish population of older adults. In this study the relationship between life-satisfaction and self-compassion was explored with participants from the Swedish National study on Aging and Care – SNAC. Furthermore the difference between women and men was also studied. The results showed no differences between men and women in life-satisfaction, but men valued themselves to have more self-compassion than women did. A positive relationship between life-satisfaction and self-compassion was confirmed. Self-compassion and age proved to be of importance for predicting a successful aging.

Objectives To investigate the role of a fall risk assessment, using the Downton Fall Risk Index (DFRI), in predicting fall‐related injury, fall‐related head injury and hip fracture, and death, in a large cohort of older women and men residing in Sweden. Design Cross sectional observational study. Setting Sweden. Participants Older adults (mean age 82.4 ± 7.8) who had a fall risk assessment using the DFRI at baseline (N = 128,596). Measurements Information on all fall‐related injuries, all fall‐related head injuries and hip fractures, and all‐cause mortality was collected from the Swedish Patient Register and Cause of Death Register. The predictive role of DFRI was calculated using Poisson regression models with age, sex, height, weight, and comorbidities as covariates, taking time to outcome or end of study into account. Results During a median follow‐up of 253 days (interquartile range 90–402 days) (>80,000 patient‐years), 15,299 participants had a fall‐related injury, 2,864 a head injury, and 2,557 a hip fracture, and 23,307 died. High fall risk (DFRI ≥3) independently predicted fall‐related injury (hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 1.39–1.49), hip fracture (HR = 1.51, 95% CI =1.38–1.66), head injury (HR = 1.12, 95% CI = 1.03–1.22), and all‐cause mortality (HR = 1.39, 95% CI = 1.35–1.43). DFRI more strongly predicted head injury (HR = 1.29, 95% CI = 1.21–1.36 vs HR = 1.08, 95% CI = 1.04–1.11) and hip fracture (HR = 1.41, 95% CI = 1.30–1.53 vs HR = 1.08, 95% CI = 1.05–1.11) in 70‐year old men than in 90‐year old women (P < .001). Conclusion Fall risk assessment using DFRI independently predicts fall‐related injury, fall‐related head injury and hip fracture, and all‐cause mortality in older men and women, indicating its clinical usefulness to identify individuals who would benefit from interventions.

This thesis is a compilation of four papers in which mathematical reasoning is examined in various contexts, in which mathematics is an integral part. It is known from previous studies that a focus on rote learning and procedural mathematical reasoning hamper students’ learning of mathematics. The aims of this thesis are to explore how mathematical reasoning affects upper secondary students’ possibilities to master the physics curricula, and how real-life contexts in mathematics affect students’ mathematical reasoning. This is done by analysing the mathematical reasoning requirements in Swedish national physics tests; as well as by examining how mathematical reasoning affects students’ success on the tests/tasks. Furthermore, the possible effect of the presence of real-life contexts in Swedish national mathematics tasks on students’ success is explored; as well as if the effect differs when account is taken to mathematical reasoning requirements. The framework that is used for categorising mathematical reasoning, distinguishes between imitative and creative mathematical reasoning, where the latter, in particular, involves reasoning based on intrinsic properties. Data consisted of ten Swedish national physics tests for upper secondary school, with additional student data for eight of the tests; and six Swedish national mathematics tests for upper secondary school, with additional student data. Both qualitative and quantitative methods were used in the analyses. The qualitative analysis consisted of structured comparisons between representative student solutions and the students’ educational history. Furthermore, various descriptive statistics and significance tests were used. The main results are that a majority of the physics tasks require mathematical reasoning, and particularly that creative mathematical reasoning is required to fully master the physics curricula. Moreover, the ability to reason mathematically creatively seems to have a positive effect on students’ success on physics tasks. The results indicate additionally, that there is an advantage of the presence of real-life context in mathematics tasks when creative mathematical reasoning is required. This advantage seems to be particularly notable for students with lower grades.

The purpose of this study was to explore the approach of the personal in residential care homes, legal guardians and Refugee secretaries consider as effective in their efforts to care for and guide unaccompanied boys in the Swedish society. With the help of qualitative method and semi-structured interviews, we have taken note of eleven informants’ perspective on what approach they believe to be essential in the work of integration process with unaccompanied boys. We used Empowerment and the Swedish Integration Board´s proposal on indicators of integration as a theoretical base. The results show among other things, that our informants believe the keys to integration in Sweden for the unaccompanied youth are the Swedish language, education and a stable social network. The view of the approach varied but all informants were founded in empowerment and cooperation between social workers and the boys who were facing the integration process. Syftet med denna uppsats var att utforska vilka arbetssätt som HVB-personal, gode män och flyktingsekreterare ser som verksamma i arbetet med att stödja ensamkommande pojkar i deras integrationsprocess. Med hjälp av kvalitativ metod och semistrukturerade intervjuer har vi tagit del av elva informanters perspektiv på vilka arbetssätt de själva tycker är betydelsefulla i arbetet med dessa pojkar. Som teoretisk utgångspunkt har vi i analysen utgått från empowerment samt Integrationsverkets förslag på indikatorer för integration. Resultatet visar bl.a. att informanterna anser att nycklarna till integration för pojkarna var det svenska språket, utbildning samt ett stabilt socialt nätverk. Synen på arbetssätt varierade men alla grundades i empowerment och ett samarbete mellan berörda aktörer och de pojkar som stod inför integrationsprocessen.

A position paper of the National Bone Health Alliance recently recommended that diagnostic criteria for osteoporosis be redefined. We review the merits and demerits of this proposal and argue that the operational bone mineral density (BMD)-based definition be retained while clarity is brought to bear on the distinction between diagnostic and intervention thresholds.

This thesis examines the role of violence and harassment towards staff in Swedish public libraries as well as the preventative measures used by the libraries. A link to a web survey was distributed to 60 libraries and answered by 38 respondents. The study included regular public libraries and public libraries integrated with school libraries. The survey regarded their situation in 2012. Three questions were used as a starting point:- What sort of problems exist in Swedish public libraries concerning violence and harassment towards library staff?- How do Swedish public libraries seek to prevent violence and harassment towards their staff and how could this preventative work be further evolved?- Is there a difference between the two types of libraries with reference to the problems with workplace violence and the preventative measures taken?The answers of the survey were structured and analyzed by using different theories and approaches to crime prevention and thereafter compared with the outcomes of another study on crime in a library setting. The results of the study showed that although the problems with violence and harassment were limited, quite a wide range of preventative measures were already in use. The integrated libraries in the study were less affected by these problems and used fewer security measures than the regular public ones.

Several recent studies suggest that obesity may be a risk factor for fracture. The aim of this study was to investigate the association between body mass index (BMI) and future fracture risk at different skeletal sites. In prospective cohorts from more than 25 countries, baseline data on BMI were available in 398,610 women with an average age of 63 (range, 20-105) years and follow up of 2.2 million person-years during which 30,280 osteoporotic fractures (6457 hip fractures) occurred. Femoral neck BMD was measured in 108,267 of these women. Obesity (BMI ≥ 30 kg/m(2) ) was present in 22%. A majority of osteoporotic fractures (81%) and hip fractures (87%) arose in non-obese women. Compared to a BMI of 25 kg/m(2) , the hazard ratio (HR) for osteoporotic fracture at a BMI of 35 kg/m(2) was 0.87 (95% confidence interval [CI], 0.85-0.90). When adjusted for bone mineral density (BMD), however, the same comparison showed that the HR for osteoporotic fracture was increased (HR, 1.16; 95% CI, 1.09-1.23). Low BMI is a risk factor for hip and all osteoporotic fracture, but is a protective factor for lower leg fracture, whereas high BMI is a risk factor for upper arm (humerus and elbow) fracture. When adjusted for BMD, low BMI remained a risk factor for hip fracture but was protective for osteoporotic fracture, tibia and fibula fracture, distal forearm fracture, and upper arm fracture. When adjusted for BMD, high BMI remained a risk factor for upper arm fracture but was also a risk factor for all osteoporotic fractures. The association between BMI and fracture risk is complex, differs across skeletal sites, and is modified by the interaction between BMI and BMD. At a population level, high BMI remains a protective factor for most sites of fragility fracture. The contribution of increasing population rates of obesity to apparent decreases in fracture rates should be explored.

Although increasing body weight has been regarded as protective against osteoporosis and fractures, there is accumulating evidence that fat mass adversely affects skeletal health compared with lean mass. We examined skeletal health as a function of estimated total body lean and fat mass in 40,050 women and 3600 men age ≥ 50 years at the time of baseline dual-energy X-ray absorptiometry (DXA) testing from a clinical registry from Manitoba, Canada. Femoral neck bone mineral density (BMD), strength index (SI), cross-sectional area (CSA), and cross-sectional moment of inertia (CSMI) were derived from DXA. Multivariable models showed that increasing lean mass was associated with near-linear increases in femoral BMD, CSA, and CSMI in both women and men, whereas increasing fat mass showed a small initial increase in these measurements followed by a plateau. In contrast, femoral SI was relatively unaffected by increasing lean mass but was associated with a continuous linear decline with increasing fat mass, which should predict higher fracture risk. During mean 5-year follow-up, incident major osteoporosis fractures and hip fractures were observed in 2505 women and 180 men (626 and 45 hip fractures, respectively). After adjustment for fracture risk assessment tool (FRAX) scores (with or without BMD), we found no evidence that lean mass, fat mass, or femoral SI affected prediction of major osteoporosis fractures or hip fractures. Findings were similar in men and women, without significant interactions with sex or obesity. In conclusion, skeletal adaptation to increasing lean mass was positively associated with BMD but had no effect on femoral SI, whereas increasing fat mass had no effect on BMD but adversely affected femoral SI. Greater fat mass was not independently associated with a greater risk of fractures over 5-year follow-up. FRAX robustly predicts fractures and was not affected by variations in body composition.

Med denna studie vill vi få en ökad förståelse för vilka förutsättningar det finns i förskolans fysiska miljö till att stimulera barns grovmotorik. Vi vill också få insikt i hur pedagoger förstår möjligheter och hinder i den fysiska miljön. I vårt arbete har vi tagit stöd av ett sociokulturellt perspektiv, då sampelet mellan pedagogernas förhållningssätt och den fysiska miljön är det centrala i arbetet med barns grovmotoriska utveckling. I undersökningen använde vi kvalitativ intervju med semistrukturerade frågor, när vi intervjuade fyra pedagoger på en förskola. Genom observation med ett strukturerat observationsunderlag, undersökte vi hur förskolans fysiska miljö nyttjas. Utifrån resultat och analys kom vi fram till att inte enbart en anpassad fysisk miljö kan stimulera barns grovmotoriska utveckling, utan pedagogens förhållningssätt är lika betydelsefullt. Ett framtida forskningsområde kan vara att studera pedagogens förhållningssätt under observation, vad som verkligen sker under en längre tid i verksamheten.

Although the optimal requirement of vitamin D for skeletal health in the general community is controversial, vitamin D deficiency impairs bone mineralization and increases bone turnover via secondary hyperparathyroidism, thus accelerating bone loss and increasing fracture risk. Support for a role of vitamin D deficiency in the epidemiology of hip fracture is found in the seasonal variation of hip fracture incidence that is reported in several studies. If the association were causal, then the incidence and amplitude of the seasonal variation in hip fracture risk should vary by latitude. We addressed this hypothesis by examining the incidence of hip fracture in men and women aged 50 years or more from Sweden (latitudes 55 to 69°) between 1987 and 2009. In order to reduce double counting, only one fracture in a period of a year was counted per individual. Men contributed 104,888 fractures in 33,313,065 person years and women 264,362 fractures in 38,387,660 person years. The effects of season and latitude were examined by Poisson regression. As expected, hip fracture rates were higher in women than in men. After adjustment for age, season and population density, hip fracture incidence increased by 3.0% (95% CI: 2.7–3.2%) per degree increase in latitude for men and by 1.9% (95% CI: 1.8–2.1%) for women. There was a marked seasonal variation of hip fracture with the highest risk in February and lower by 37.5% in men and by 23.5% women during the summer. There were significant interactions of amplitude of the seasonal variation with latitude (p < 0.001 for both men and women), indicating that seasonal variation during the year was more pronounced in the north of Sweden than in the south. The associations found with latitude and season is consistent with a role of vitamin D in hip fracture causation.

It is unknown how responsive the Fracture Risk Assessment (FRAX) tool is to osteoporosis treatment (OTX) or whether it can serve as a target for “goal-directed” treatment. We studied 11,049 untreated women aged ≥ 50 years undergoing baseline and follow-up DXA examinations in Manitoba, Canada. We identified clinical risk factors, intervening OTX based on medication possession ratios (MPR), and incident fractures. FRAX scores for major osteoporotic and hip fractures were computed for each scan using the most current (updated) FRAX inputs. Over 4 years, median FRAX scores showed an increase of 1.1% for major fractures and 0.3% for hip fractures, including women highly adherent to OTX (0.6% and 0.1% increases). Few (2.2%) highly adherent women had a decrease in major fracture probability exceeding 4%, whereas 9.0% had a decrease in hip fracture probability exceeding 1%. Compared with untreated women, OTX was associated with a higher dose-dependent likelihood of attenuating the expected increase in major fracture risk: adjusted odds ratios (aOR) 2.3 (95% confidence interval [CI] 1.8–2.9) for MPR

UNLABELLED: The worldwide uptake of FRAX is described. INTRODUCTION: The aim of this report was to determine the usage of FRAX worldwide over a 1-year period from 1 May 2012. METHODS: The number of FRAX calculations from each country was assessed over a 1-year period and expressed as calculations per million of the population aged 50 years or more. Countries were colour coded according to usage to populate a world map. RESULTS: Over the index year, there were estimated to be 2,391,639 calculations sourced from 173 counties. Uptake was high in North America, the Antipodes and most countries of Europe; intermediate in Latin America and the Middle East; and very low in Africa and much of South East Asia. CONCLUSIONS: It is expected that the comparative data will encourage the development of new FRAX models and the uptake of FRAX into assessment guidelines.