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The purpose of the study was to evaluate whether students with intellectual disabilities (ID) can improve their arithmetic skills by participating in an arithmetic intervention programme, theoretically founded on explicit instruction (EI) and administered via an application developed for tablet computers. The intervention study used a randomised controlled trial design (RCT) (n = 30, aged 10-16, 13 females) and lasted for up to 12 weeks. The results show that the intervention group significantly improved in arithmetic fact fluency compared to the controls and the effects remained six months after the intervention. The effects were larger for subtraction than for addition, and this difference remained six months later. These results suggest that mathematics applications based on explicit instruction can be an effective way of teaching arithmetic facts to youth with mild ID.

The intention of the study was to examine the effects of a fraction intervention in a whole-class environment. The intervention aimed to enhance students' conceptual fraction knowledge, with a major focus on fraction magnitude understanding. This study included 120 fifth-grade students in standard classroom settings. Utilizing a cluster randomized controlled trial design, students were divided into either an intervention group (n = 64) or a control group (n = 56). Students in the intervention condition received a series of seven 35-minute lessons. Students in the control condition received "treatment as usual". Both post-test and delayed post-test results revealed that students in the intervention group performed significantly better than those in the control group on fraction concepts, with a stronger effect in measurement aspects compared to part-whole aspects. The intervention group also outperformed the control group on fraction arithmetic on both post-tests, while no significant difference was observed on fraction word problems.

The study set out to explore different mathematical difficulties among 877 second-grade children and to test the effect of memorization versus conceptual practices with number combinations. It used a latent profile analysis of baseline measurements of digit writing speed, number combination fluency, multidigit calculation, and number sense skills to identify six latent classes: three mathematical learning difficulty classes, two typical classes, and one high-achieving class. The memorization practice produced superior improvement for all classes of students except the high-achievers class. These results suggest that memorization practice with basic number combinations should not be considered poor teaching practice. It is important for teachers to incorporate practices with number combinations that focus on speed and memorization, even for children who struggle with mathematics.

Background: Children's numerical and arithmetic skills differ greatly already at an early age. Although research focusing on accounting for these large individual differences clearly demonstrates that mathematical performance draws upon several cognitive abilities, our knowledge concerning key abilities underlying mathematical skill development is still limited. Aims: First, to identify key cognitive abilities contributing to children's development of early arithmetic skills. Second, to examine the extent to which early arithmetic performance and early arithmetic development rely on different or similar constellations of domain-specific number abilities and domain-general cognitive abilities. Sample: In all, 134 Swedish children (M[subscript age] = 6 years and 4 months, SD = 3 months, 74 boys) participated in this study. Method: Verbal and non-verbal logical reasoning, non-symbolic number comparison, counting knowledge, spatial processing, verbal working memory and arithmetic were assessed. Twelve months later, arithmetic skills were reassessed. A latent change score model was computed to determine whether any of the abilities accounted for variations in arithmetic development. Results: Arithmetic performance was supported by counting knowledge, verbal and non-verbal logical reasoning and spatial processing. Arithmetic skill development was only supported by spatial processing. Conclusions: Results show that young children's early arithmetic performance and arithmetic development are supported by different cognitive processes. The findings regarding performance supported Fuchs et al.'s model ("Dev Psychol, 46," 2010b, 1731) but the developmental findings did not. The developmental findings align partially to Geary et al.'s ("J Educ Psychol, 109," 2017, 680) hypothesis stating that young children's early arithmetic development is more dependent on general cognitive abilities than number abilities.

Abstract Background The aim of this study was to contribute to the theoretical development within the field of labour market effects on mental health during life by integrating Bronfenbrenner’s ecological model with mainly earlier theoretical work on life-course theory. Methods An integrative review was performed of all 52 publications about labour market conditions in relation to mental health from the longitudinal Northern Swedish Cohort study. Inductive and deductive qualitative content analysis were performed in relation to Bronfenbrenner’s ecological framework combined with life-course theories. Results The following nine themes were identified: 1. Macroeconomic recession impairs mental health among young people. 2. The mental health effects on individuals of youth unemployment seem rather insensitive to recession. 3. Small but consistent negative effect of neighbourhood unemployment and other work-related disadvantaged on individuals’ mental health over life. 4. Youth unemployment becomes embodied as scars of mental ill-health over life. 5. Weak labour market attachment impairs mental health over life. 6. Bidirectional relations between health and weak labour market attachment over life. 7. Macrolevel structures are of importance for how labour market position cause poor health. 8. Unequal gender relations at work impacts negatively on mental health. 9. The agency to improve health over life in dyadic relations. Unemployment in society permeates from the macrolevel into the exolevel, defined by Bronfenbrenner as for example the labour market of parents or partners or the neighbourhood into the settings closest to the individual (the micro- and mesolevel) and affects the relations between the work, family, and leisure spheres of the individual. Neighbourhood unemployment leads to poor health among those who live there, independent of their employment status. Individuals’ exposure to unemployment and temporary employment leads to poorer mental health over the life-course. Temporal dimensions were identified and combined with Bronfenbrenner levels into a contextual life-course model Conclusion Combining the ecosocial theory with life-course theories provides a framework for understanding the embodiment of work-related mental health over life. The labour market conditions surrounding the individual are of crucial importance for the embodiment of mental health over life, at the same time as individual agency can be health promoting. Mental health can be improved by societal efforts in regulations of the labour market.

Mastering traditional algorithms has formed mathematics teaching in primary education. Educational reforms have emphasized variation and creativity in teaching and using computational strategies. These changes have recently been criticized for lack of empirical support. This research examines the effect of teaching two differently structured written calculation methods on teaching arithmetic skills (addition) in grade 2 in Sweden with respect to students' procedural, conceptual and factual knowledge. A total of 390 students (188 females, 179 males, gender not indicated for 23) were included. The students attended 20 classes in grade 2 and were randomly assigned to one of two methods. During the intervention, students who were taught and had practiced traditional algorithms developed their arithmetic skills significantly more than students who worked with the decomposition method with respect to procedural knowledge and factual knowledge. These results provided no evidence that the development of students' conceptual knowledge would benefit more from learning the decomposition method compared to traditional algorithm.

Abstract Fishing has the potential to influence the life‐history traits of exploited populations. However, our understanding of how fisheries can induce evolutionary genetic changes remains incomplete. The discovery of large‐effect loci linked with ecologically important life‐history traits, such as age at maturity in Atlantic salmon (Salmo salar), provides an opportunity to study the impacts of temporally varying fishing pressures on these traits. A 93‐year archive of fish scales from wild Atlantic salmon catches from the northern Baltic Sea region allowed us to monitor variation in adaptive genetic diversity linked with age at maturity of wild Atlantic salmon populations. The dataset consisted of samples from both commercial and recreational fisheries that target salmon on their spawning migration. Using a genotyping‐by‐sequencing approach (GT‐seq), we discovered strong within‐season allele frequency changes at the vgll3 locus linked with Atlantic salmon age at maturity: fishing in the early season preferentially targeted the vgll3 variant linked with older maturation. We also found within‐season temporal variation in catch proportions of different wild Atlantic salmon subpopulations. Therefore, selective pressures of harvesting may vary depending on the seasonal timing of fishing, which has the potential to cause evolutionary changes in key life‐history traits and their diversity. This knowledge can be used to guide fisheries management to reduce the effects of fishing practices on salmon life‐history diversity. Thus, this study provides a tangible example of using genomic approaches to infer, monitor and help mitigate human impacts on adaptively important genetic variation in nature.

IntroductionDrawing upon the framework of life course epidemiology, this study aligns with research on the mental health consequences of significant social transitions during early adulthood. The focus is on the variation in initial labour market attachment and the development of depressiveness, assuming that a firm attachment is associated with decreasing depressiveness.MethodsThe baseline investigation of the studied cohort (n = 1,001) took place during their final year of compulsory schooling at age 16. Follow-up surveys were conducted at ages 18, 21, 30, and 43. Depressiveness was measured with a five-item score. Multiple trajectory analysis, incorporating five labour market statuses observed over seven half-year periods from ages 18 to 21, was employed to categorize the cohort into six distinct groups. Among these, ‘All-time education,’ ‘From education to employment,’ ‘Education and employment,’ and ‘From employment to education’ were considered to demonstrate firm labour market attachment. Meanwhile, ‘Active labour market policy’ and ‘Unemployment’ represented less firm attachment.ResultsThe trajectory of depressive symptoms among the total cohort from age 16 to age 43 exhibited a ‘broken stick’ pattern, reaching its lowest point at age 21. This pattern was evident in all groups classified as having a firm attachment. A substantial decrease in depressiveness was also observed in the relatively weakly attached ‘Active labour market policy’ group, whereas no ‘broken stick’ pattern emerged in the ‘Unemployment’ group. The disparities in the levels of depressiveness observed at age 21 remained relatively stable across the measurements at ages 30 and 43.DiscussionThe results were as expected, except for the observed improvement in mental health within the ‘Active labour market policy’ group. Supported labour market attachment during emerging adulthood can enhance mental well-being similarly to regular mainstream attachment. In terms of policy recommendations, the consistently high levels of depressiveness within the ‘Unemployment’ group underscore the importance of reducing long-term and repeated unemployment in young age. The findings regarding the ‘Active labour market policy’ provide evidence of the intervention’s benefits. While the primary goal of these measures is to create jobs for the unemployed, they also include elements that contribute to participants’ mental health.

Objectives Better understanding of societal factors associated with COVID-19 vaccination can have important implications for public health policy to increase uptake.Methods This study investigated sociodemographic determinants of COVID-19 vaccine uptake with ≥2 doses vs 0 doses, and ≥3 doses vs 2 doses, among adults (≥18 years) in a general population from Sweden followed from 27 December 2020 (n=1 064 548 at the present cross-section—12 June 12 2022). Associations between individual-level and area-level sociodemographic factors and vaccine uptake were modelled with logistic regression, with average marginal effects and estimated proportion vaccinated subsequently estimated.Results Being vaccinated with ≥2 doses vs 0 doses was positively associated with education (tertiary vs primary, OR 1.5, 95% CI 1.3 to 1.7), household disposable income (Q5 vs Q1, OR 2.3; 95% CI 1.9 to 2.7), comorbidities (≥2 doses vs none, OR 1.9, 95% CI 1.8 to 1.9) and residential area type (affluent socioeconomic conditions vs poor, OR 2.0, 95% CI 1.6 to 2.4). Whereas, being born outside Sweden was associated with a lower uptake (low and middle-income countries vs Swedish born, OR 0.6, 95% CI 0.5 to 0.7). The associations were generally similar when comparing booster vs remaining on only two doses. From these ORs, there were consistent differences in the estimated proportion vaccinated both for ≥2 doses and booster vaccination. Absolute changes in percentage vaccinated between affluent and poor areas were largely similar across individual country of birth, income and education, both for at least two doses and for the booster doses.Conclusions COVID-19 vaccine uptake was associated with higher sociodemographic classifications both at the individual level and area level. The predicted proportion vaccinated increased with more affluent socioeconomic conditions and concurrent increases in individual household income were the strongest indicators. This sociodemographic selection showed consistency with respect to entering (obtaining ≥2 doses) and remaining (obtaining at least one booster dose) in the vaccination programme.

Abstract Juvenile salmonids often experience high mortality rates during migration and bird predation is a common source of mortality. Research suggests that hatchery‐reared salmonids are more prone to predation than wild salmonids, and that Atlantic salmon (Salmo salar) experience lower predation than Sea trout (Salmo trutta), yet telemetry studies have displayed equivocal results. Here, using a large data set on passive integrated transponder (PIT) tagged hatchery‐reared and wild juveniles of Atlantic salmon and Sea trout (25,769 individuals) we investigate predation probability by piscivorous birds (mainly Great Cormorants Phalarocorax carbo) on salmonids originating from River Dalälven in Sweden. Bird colonies and roosting sites were scanned annually (2019–2021), and the temporal dynamics of bird predation on salmonids released in 2017–2021 was assessed. Hatchery‐reared trout was clearly most susceptible to cormorant predation (0.31, 90% credibility interval [CRI] = 0.14–0.53), followed by wild trout (0.19, 90% CRI = 0.08–0.37), hatchery‐reared salmon (0.13, 90% CRI = 0.07–0.23), and wild salmon (0.08, 90% CRI = 0.04–0.14), in subsequent order. This order in predation probability was consistent across all studied tag‐ and release‐years, suggesting that the opportunistic foraging of cormorants affects the overall survival of juvenile salmonids, but that the inherent predation risk between different salmonid types differs systematically.

Background Universities can be understood as work-like environments for students, with similar risks and expectations regarding psychosocial environment. Limited research has examined this study environment from a Demand-Control-Support perspective with regard to sexual harassment. Understanding this environment is key to designing protective measures. This study aimed to examine the association between individual and psychosocial study environment characteristics and exposure to sexual harassment among students at Lund University, Sweden. Methods This cross-sectional study utilised data from an online survey conducted among students. Questions on background characteristics, exposure to sexual harassment while at university and psychosocial study environment as measured by a Demand-Control-Support-instrument were used. Bivariate, and multivariable logistic regressions were used, together with Population Attributable Fractions (PAF), and synergy indexes (SI). Results High demands and low control were independently associated with higher odds of being exposed to sexual harassment among both females and males (OR 1.41, OR 1.26 and OR 1.55, OR1.34, respectively). When adjusting for background characteristics, high study strain (combination of high demands and low control) was associated with exposure to sexual harassment among both female and male respondents (aOR 1.67 and 1.98 respectively) and could account for PAF of 14% and 15% of study environment sexual harassment for females and males, respectively. Low lecturer support was associated with higher odds for sexual harassment among females (aOR 1.19) but not males. Little evidence was found for a buffering effect of student support on high strain and sexual harassment (SI 0.7). Conclusion Working to reduce situations of high strain study environments could be an effective strategy for reducing sexual harassment in university settings. Improving support from lecturers could also modify this relationship, but more research is required to identify causal pathways underlying this result.

Introduction In low-income countries the utilisation of sexual and reproductive health and rights (SRHR) services is influenced by healthcare practitioners’ knowledge, attitudes and practices. Despite awareness of the potential problems due to ingrained biases and prejudices, few approaches have been effective in changing practitioners’ knowledge, attitudes and practices concerning SRHR in low-income countries. Objectives 1) To assess whether participating in an SRHR international training programme (ITP) changed healthcare practitioners’ SRHR knowledge, SRHR attitudes and SRHR practices and 2) examine associations between trainees’ characteristics, their SRHR work environment and transfer of training. Methods A pre- and post-intervention study, involving 107 trainees from ten low-income countries, was conducted between 2017 and 2018. Paired samples t-test and independent samples t-test were used to assess differences between trainees’ pre- and post-training scores in self-rated SRHR knowledge, attitudes, knowledge seeking behaviour and practices. Linear regression models were used to examine association between trainees’ baseline characteristics and post-training attitudes and practices. Results Trainees’ self-rated scores for SRHR knowledge, attitudes and practices showed statistically significant improvement. Baseline high SRHR knowledge was positively associated with improvements in attitudes but not practices. High increases in scores on knowledge seeking behaviour were associated with higher practice scores. No statistically significant associations were found between scores that measured changes in SRHR knowledge, attitudes and practices. Conclusion The findings indicate that the ITP was effective in improving trainees’ self-rated scores for SRHR knowledge, attitudes and behaviours (practices). The strongest association was found between improvement in SRHR knowledge seeking behaviour and the improvement in SRHR practices. This suggests that behaviour intention may have a central role in promoting fair open-minded SRHR practices among healthcare practitioners in low-income countries.

Background University students experience a distinct working environment in the context of completing their studies. In line with existing research into the connection between workplace environment and stress, it is rational to believe that such study environments can affect the level of stress that students experience. However, few instruments have been developed for measuring this. Objective The aim of this study was to validate a modified instrument based on the Demand-Control-Support (DCS) model among students at a large university in southern Sweden to determine its utility for assessing the psychosocial properties of the study environment. Methods Data from a survey performed at a Swedish university in 2019, which generated 8960 valid cases, was used. Of these cases, 5410 studied a course or programme at bachelor level, 3170 a course or programme at master level, and 366 a combination of courses and programmes on the two levels (14 missing). A 22-item DCS-instrument for students was used comprising four scales: Psychological workload (demand) with nine items, Decision latitude (control) with eight items, supervisor/lecturer support with four items, and colleague/student support with three items. Construct validity was examined using exploratory factor analysis (EFA) and internal consistency using Cronbach’s alpha. Results The results of the exploratory factor analysis of the Demand-Control components support a 3-dimension solution with dimensions corresponding to psychological demands, skill discretion, and decision authority in the original DCS model. Cronbach’s alpha coefficients were acceptable for Control (0.60) and Student Support (0.72) and very good for the Demand and Supervisor Support scales (0.81 and 0.84, respectively). Conclusions The results suggest that the validated 22-item DCS-instrument is a reliable and valid tool for assessing Demand, Control, and Support elements of the psychosocial study environment among student populations. Further research is necessary to examine the predictive validity of this modified instrument.

Abstract Background Sexual harassment (SH) in the workplace is prevalent and associated with poor health. Universities are large workplaces with complex formal and informal power relations, which may influence the prevalence of SH. Although employees and students share the university context, few studies on SH have included both groups. The overall aim of the study was to investigate SH among employees and students at a large Swedish public university regarding types of harassment, prevalence in different groups, characteristics of the perpetrators, and the circumstances in which it occurs. Methods A cross-sectional analysis was performed, based on a web-based survey with 120 items that was sent out to all staff, including PhD students (N = 8,238) and students (N = 30,244) in November 2019. The response rate was 33% for staff and 32% for students. Exposure to SH was defined as having experienced at least one of ten defined SH behaviors during their work or studies. Results Among women, 24.5% of staff and 26.8% of students reported having been exposed to SH. The corresponding figures were 7.0% and 11.3% for male staff and students and 33.3% and 29.4% for non-binary individuals among staff and students. Unwelcome comments, suggestive looks or gestures, and ‘inadvertent’ brushing or touching were the three most common forms of reported harassment, both among staff and students. Attempted or completed rape had been experienced by 2.1% of female and 0.6% of male students. Male and female perpetrators were reported by about 80% and 15%, respectively, of exposed participants. Among staff most reported events occurred during the everyday operation of the university, while among students the majority of the events took place during social events linked to student life. When exposed to a perpetrator from the same group (staff or students), women reported more often being in a subordinate power position in relation to the perpetrator. Conclusions The results indicate that sexual harassment is common in the university context, and interventions and case management routines of events should consider power relations between victim and perpetrator, as well as the various contexts within which sexual harassment takes place.

OBJECTIVE: This study aimed to examine the effects of low-quality employment trajectories on severe common mental disorders (CMD) according to Swedish and foreign background. METHODS: In this longitudinal study based on Swedish population registries (N=2 703 687), low- and high-quality employment trajectories were the main exposures observed across five years (2005–2009), with severe CMD as outcome variable (2010–2017). Adjusted hazard ratios (HR) were calculated by means of Cox regression models and stratified according to Swedish and foreign background [first-generation (i) EU migrants, (ii) non-EU migrants, (iii) second-generation migrants, (iv) Swedish-born of Swedish background] and sex. The reference group was Swedish-born of Swedish background in a constant high-quality employment trajectory. RESULTS: Second-generation migrants had an increased risk of CMD compared to Swedish-born of Swedish background when following low-quality employment trajectories [eg, male in constant low-quality HR 1.54, 95% confidence interval (CI) 1.41–1.68]. Female migrant workers, especially first-generation from non-EU countries in low-quality employment trajectories (eg, constant low-quality HR 1.66, 95% CI 1.46–1.88), had a higher risk of CMD compared to female Swedish-born of Swedish background. The risk for CMD according to employment trajectories showed little differences between first- and second-generation migrants. CONCLUSION: Low-quality employment trajectories appear to be determinants of risk for CMD in association with Swedish or foreign background of origin and sex. Our study shows a higher risk for severe CMD in second-generation and non-EU migrant compared to Swedish-born of Swedish background in constant low-quality employment. Further qualitative research is recommended to understand the mechanism behind the differential mental health impact of low-quality employment trajectories according to foreign background.

Abstract The impact of the composition of blends comprising low‐density polyethylene (LDPE), isotactic polypropylene (PP) and a styrenic copolymer additive on the thermomechanical properties as well as the direct‐current (DC) electrical and thermal conductivity is investigated. The presence of 5 weight percent (wt%) of the styrenic copolymer strongly reduces the amount of PP that is needed to enhance the storage modulus above the melting temperature of LDPE from 40 to 24 wt%. At the same time, the copolymer improves the consistency of the thermomechanical properties of the resulting ternary blends. While both the DC electrical and thermal conductivity strongly decrease with PP content, the addition of the styrenic copolymer appears to have little influence on either property. Evidently, PP in combination with small amounts of a styrenic copolymer not only allows to reinforce LDPE at elevated temperatures but also functions as an electrical conductivity‐reducing additive, which makes such thermoplastic ternary formulations possible candidates for the insulation of high‐voltage power cables.

Abstract Background Swimming ability among children in the city of Malmö, Sweden is strongly affected by socioeconomic differences. We investigated to what extent mediating health and lifestyle factors, such as children’s eating, sleeping and physical activity habits, as well as the characteristics of the social and working environment at both school and home, could explain the socioeconomic gradient in swimming ability. Methods Our study population included children who started their first-grade school-year in 2012 or 2013 at any of the public primary schools of Malmö, Sweden. Cross-sectional, self-reported questionnaire-based data about health status and swimming ability in the fourth grade (age 10) were included from the Pupil Health Database (ELSA) for 3468 children. Results Children’s self-reported swimming ability was strongly associated with both individual- and school-based sociodemographic variables. Nine health, lifestyle and environmental variables were identified as potential mediators and included in the final model. Four of these variables, “Activity”, “Outdoor time”, “Social relationships at home and on the free time”, and “Positivity about future”, were significantly and positively associated with children’s ability to swim. Conclusions Social support, optimism for the future and an active lifestyle were positively associated with children’s swimming skills; however, compared to the socioeconomic factors, these health- and lifestyle factors contributed very little. It is possible, that interventions concerning children’s swimming ability in lower socioeconomic neighbourhoods, should in addition to children’s swimming lessons, target the whole families with the goal of increasing their possibilities for socialising and engaging in different kinds of recreational activities.

Background The global community has committed to achieving universal access to sexual and reproductive health and rights (SRHR) services, but how to do it remains a challenge in many low-income countries. Capacity development is listed as a means of implementation for Agenda 2030. Although it has been a major element in international development cooperation, including SRHR, its effectiveness and circumstances under which it succeeds or fails have limited evidence. Objective The study sought to examine whether improvement in team capacity of SRHR practitioners resulted in improved organisational effectiveness and/or improved SRHR outcomes in low-income countries. Methods The study involved 99 SRHR interventions implemented in 13 countries from Africa and Asia. Self-reported evaluation data from healthcare practitioners who participated in a capacity development international training programme in SRHR was used. The training was conducted by Lund University in Sweden between 2015 and 2019. Logistic regression models were used to examine the association between improved team capacity, improved organizational effectiveness and improved SRHR outcomes, for all the 99 interventions. Adoption of new SRHR approaches (guidelines and policies), media engagement, support from partner organisations and involvement of stakeholders were assessed as possible confounders. Results Improved team capacity, support from partner organisations and media engagement were positively associated with improved organisational effectiveness. Improved team capacity was the strongest predictor of organisational effectiveness even after controlling for other covariates at multivariate analysis. However, adopting new SRHR approaches significantly reduced organisational effectiveness. Furthermore, support from partner organisations was positively associated with increased awareness of and demand for SRHR services. Conclusions Successful implementation of capacity development interventions requires an enabling environment. In this study, an SRHR training programme aiming at improving team capacity resulted in an improvement in organisational effectiveness. Support from partner organisations and media engagement were key enablers of organisational effectiveness.

Objectives The credit market has expanded rapidly, increasing the risk of over-indebtedness among those who lack secure employment or adequate income, an issue of concern in the COVID-19 aftermath. We investigated the role of over-indebtedness for developing poor mental health, and whether this impact is modified by age, gender, educational level or being in precarious employment.Methods This is a cohort study using data from the Swedish Scania Public Health Cohort, based on individuals randomly selected from the general adult population in Scania, southern Sweden, initiated in 1999/2000 (response rate 58%) with follow-ups in 2005 and 2010. Over-indebtedness was assessed by combining information on cash margin and difficulty in paying household bills. Mental health was assessed by General Health Questionnaire-12. Those with poor mental health at baseline were excluded, and the analyses were further restricted to vocationally active individuals with complete data on main variables, resulting in 1256 men and 1539 women.Results Over-indebtedness was more common among women, among persons with a low educational level, born abroad and with a precarious employment at baseline. The age-adjusted incidence rate ratio (IRR) for poor mental health in 2010 among individuals exposed to over-indebtedness in 1999/2000 or 2005 was 2.2 (95% CI 1.7 to 2.8). Adjusting for educational level, country of origin and precarious employment in 1999/2000 or 2005, yielded an IRR of 2.0 (95% CI 1.6 to 2.6). An interaction analysis indicated that a high level of education may act synergistically with over-indebtedness, regarding poor mental health among men.Conclusions Over-indebtedness was related to unfavourable societal power relations, regarding social class, gender and foreign birth. Precarious employment was independently linked to poor mental health and may also mediate the effect by over-indebtedness. The COVID-19 pandemic might entail increased over-indebtedness, which should be acknowledged in policies aiming at buffering social effects of the pandemic.

This article explores sustainable development from a gastronomic perspective. Humanistic perspectives on food offered by gastronomy are explored as an asset in cultivating self-awareness capacities needed for sustainable transformations of society. The purpose is to explore how gastronomes can cultivate understandings and explanations of sustainability to be conveyed to individuals via meals. In semi-annually recurring dialogic interviews, four university-educated gastronomes cultivated their understandings and explanations of sustainability, and modeled how these could be communicated to other individuals. The dialogues gradually brought the ideas of the researcher and the participants toward a common explanation of the potential ways gastronomic competency could advance sustainable development. The results highlight two ways of understanding gastronomic sustainability: functionally as practical communication, and formally as a cultural issue. Based on H.G. Gadamer’s idea of bildung as hermeneutic interpretation, we argue that self-awareness is a process which is rooted in how knowledge is interpreted, understood, and explained by the individual. Practical participation in culturally influenced meals makes gastronomy a bridge between individual and societal issues, whereby gastronomic competencies can cultivate sustainable commitment, judgment, and community. In this way, gastronomic sustainability represents an approach to sustainable development that, significantly, also involves the cultivation of sustainable meaning.

This study examined cognitive precursors of hierarchical mathematical development. Six-year-old children (n = 258) were assessed on number skills, cognitive skills, and arithmetic 1 year prior to school entry. Skills in advanced arithmetic and advanced mathematics were assessed in Grades 3 and 6, respectively. Path analyses were computed and provided longitudinal evidence for a hierarchy of mathematics. During development, the reliance on prior skills at lower, most proximal levels becomes increasingly important in order to acquire and succeed at later and higher levels of mathematics. The study extends the Fuchs et al. (2010b) model as the mechanisms underlying 3 different hierarchical levels of mathematics all involve an interplay between domain-specific number abilities (i.e., sequence knowledge, digit comparison) and general cognitive abilities (i.e., logical reasoning, phonological awareness, working memory). The constellation of domain-specific number and domain-general cognitive mechanisms subserving mathematics at different hierarchical levels showed a high degree of similarity. However, the importance of number abilities decreases during development, whereas the importance of general cognitive abilities remains approximately equal across levels of mathematical learning. Early symbolic number skills (i.e., counting sequence knowledge, digit comparison) are subserved by general cognitive mechanisms such as working memory, phonological awareness, and rapid automatic naming processes.

OBJECTIVES: This study aimed to explore multidimensional operationalizations of precarious employment (PE) in Swedish register data using two approaches: (i) a typological approach and (ii) a dimensional, summative scale approach. It also examined the distribution of sociodemographic and occupational characteristics of precarious employees in Sweden. METHOD: Register data was retrieved on individuals and their employers in the Swedish workforce. Five items corresponding to three dimensions of PE were operationalized: contractual relationship insecurity, contractual temporariness, multiple jobs/sectors, income level, and lack of unionization. First, latent class analysis was applied and a typology of six employment types emerged. Second, a summative scale was constructed by scoring all PE-items. RESULTS: Three types of PE were found using the typological approach, which were characterized by direct employment, solo self-employment and multiple job holding, respectively. The summative scale score ranged between -10 and +2 (average: -1.8). Particularly poor scores were seen for solo self-employed, multiple job holders/multiple sectors, and low income. Female gender, young age, low education and foreign origin were prone to precariousness. PE was more frequent among certain economic sectors and occupations. CONCLUSIONS: Using an existing register of labor market data, two operationalizations of PE were constructed and rendered promising for exposure assessment. Hence, the operationalizations could be of interest for countries with similar data structure. Both approaches highlighted precarious combinations of employment conditions and pointed towards the existence of a wide continuum of precariousness on the labor market. Etiological studies and research assessing trends over time are needed to validate these findings.

Abstract Background Precarious employment is a risk factor for poor mental health, particularly among young adults. Knowledge about how young people maintain their mental health while in a precarious employment situation is scarce. The aim of the study was to explore the meaning of precarious employment for young adults in Sweden and their strategies for maintaining good mental health. Methods In-depth interviews were conducted with 15 individuals (9 men and 6 women) aged 20–39 years in a precarious employment situation. Contact persons at union offices and at specific job-coaching organizations collaborating with the Swedish public employment agency in the city of Malmö were gate openers to reach informants. Analysis was based on constructivist grounded theory, implying an emergent design where data collection and analysis go hand in hand. Results All informants had completed secondary school in Sweden, and one third had studied at the university level. A majority currently had jobs; however, they were mostly employed on an hourly basis and only a few had temporary full-time jobs. The analysis resulted in a core category “Diverting blame to stay sane,” which summarized an emergent coping process involving individual resources and resources represented by the individuals’ social capital. The developed theoretical model contained four main categories, “Facing reality,” “Losing control,” “Adapting,” and “Fighting back,” related to the core category. Conclusions The results implied a process where the challenges created by loss of employment-based rights required a coping process where the individual’s social capital plays an important role. However, social capital is to a large extent determined by contextual factors, underlining the strong health equity aspect of precarious employment.

Summary: Background: The aim is to identify trajectories of precarious employment (PE) over time in Sweden to examine associations of these with the subsequent risk of myocardial infarction (MI) and stroke. Methods: This is a nation-wide register-based cohort study of 1,583,957 individuals aged 40 to 61 years old residing in Sweden between 2003-2007. Trajectories of PE as a multidimensional construct and single PE components (contractual employment relationship, temporariness, income levels, multiple job holding, probability of coverage by collective agreements) were identified for 2003-2007 by means of group-based model trajectories. Risk Ratios (RR) for MI and stroke according to PE trajectories were calculated by means of generalized linear models with binomial family. Findings: Adjusted estimates showed that constant PE and borderline PE trajectories increased the risk of MI (RR: 1·08, CI95%:1·05-1·11 and RR:1·13, CI95%: 1·07-1·20 respectively) and stroke (RR:1·14, CI95%: 1·10-1·18 and HR:1·24, CI95%: 1·16-1·33 respectively) among men. A higher risk of stroke in men was found for the following unidimensional trajectories: former agency employees (RR:1·32, CI95%:1·04-1·68); moving from high to a low probability of having collective agreements (RR: 1·10, CI95%:1·01-1·20). Having constant low or very low income was associated to an increased risk of MI and Stroke for both men and women. Interpretation: The study findings provide evidence that PE increases the risk of stroke and possibly MI. It highlights the importance of being covered by collective bargaining agreements, being directly employed and having sufficient income levels over time. Funding: The Swedish Research Council for Health, Working Life and Welfare, no. 2019-01226.

Objective We investigate recent trends in income inequalities in mortality and the shape of the association in Sweden. We consider all-cause, preventable and non-preventable mortality for three age groups (30–64, 65–79 and 80+ years).Design and setting Repeated cross-sectional design using Swedish total population register data.Participants All persons aged 30 years and older living in Sweden 1995–1996, 2005–2006 and 2016–2017 (n=8 084 620).Methods Rate differences and rate ratios for all-cause, preventable and non-preventable mortality were calculated per income decile and age group.Results From 1995 to 2017, relative inequalities in mortality by income increased in Sweden in the age groups 30–64 years and 65–79 years. Absolute inequalities increased in the age group 65–79 years. Among persons aged 80+ years, inequalities were small. The shape of the income–mortality association was curvilinear in the age group 30–64 years; the gradient was stronger below the fourth percentile. In the age group 65–79 years, the shape shifted from linear in 1995–1996 to a more curvilinear shape in 2016–2017. In the oldest age group (80+ years), varied shapes were observed. Inequalities were more pronounced in preventable mortality compared with non-preventable mortality. Income inequalities in preventable and non-preventable mortality increased at similar rates between 1995 and 2017.Conclusions The continued increase of relative (ages 30–79 years) and absolute (ages 65–79 years) mortality inequalities in Sweden should be a primary concern for public health policy. The uniform increase of inequalities in preventable and non-preventable mortality suggests that a more complex explanatory model than only social causation is responsible for increased health inequalities.

Purpose: Perceived support from co-workers and managers is important for many organizational outcomes. However, the benefit of competence support from colleagues and school management on personal teacher efficacy has not been investigated. The purpose of this paper is twofold: first, to investigate the impact of competence support from colleagues and the school management on growth in teacher efficacy and second, to investigate cultural differences (Canada and Sweden). Design/methodology/approach: The authors administered an inventory measuring support for competence and personal teacher efficacy to over 400 teachers in Canada and Sweden at 27 schools, at two times. Time 1 took place at the first week of a fall semester and Time 2 at the end of the same semester. Findings: Structural equation modeling revealed that competence support from colleagues predicted growth in teacher efficacy, whereas competence support from school management did not. No differences in these relations emerged between Canadian and Swedish teachers. Practical implications: The findings have implications for how schools organize teachers in teacher teams so that competence support from co-workers is promoted. Originality/value: This study is the first cross-cultural study to empirically show that teachers' self-efficacy is significantly benefitted by competence support from their teacher peers.

Abstract About one third of global edible food is lost or wasted along the supply chain, causing the wastage of embedded natural and economic resources. Life cycle methodologies can be applied to identify sustainable and viable prevention and valorization routes needed to prevent such inefficiencies. However, no systemic approach has been developed so far to guide practitioners and stakeholders. Specifically, the goal and scoping phase (e.g. problem assessed or system function) can be characterized by a large flexibility, and the comparability between food waste scenarios could be not ensured. Within the Horizon2020 project Resource Efficient Food and dRink for the Entire Supply cHain, this study aimed to provide practitioners with guidance on how to combine life cycle assessment and environmental life cycle costing in the context of food waste. Recent literature was reviewed to identify relevant methodological aspects, possible commonly adopted approaches, main differences among studies and standards and protocols, main challenges, and knowledge gaps. Basing on this review, an analytical framework with a set of recommendations was developed encompassing different assessment situations. The framework intends to provide a step by step guidance for food waste practitioners, and it is composed of a preliminary section on study purpose definition, three decision trees—respectively on assessment situation(s), costing approach, and type of study (footprint vs. intervention)—and two sets of recommendations. Recommendations can be applied to all levels of the food waste hierarchy, stating a generic order of preference for handling food chain side flows. This consistent and integrated life cycle approach should ensure a better understanding of the impact of specific interventions, thus supporting informed private and public decision making and promoting the design of sustainable and cost-efficient interventions and a more efficient food supply chains.

Aiming to compare capability across persons with impairments using and not using assistive products and persons without impairments in Bangladesh for 16 different functionings, we contrast two sets of self-reported cross-sectional data from eight districts of Bangladesh: (i) data from persons with hearing impairment not using hearing aids, persons with hearing impairment using hearing aids and persons without impairments (N = 572); and (ii) data from persons with ambulatory impairment not using manual wheelchairs, persons with ambulatory impairment using manual wheelchairs and persons without impairments (N = 598). Kruskal–Wallis tests were used to compare levels of capability across the three groups in each data set. Results showed that, for all functionings in both data sets, the levels of capability were statistically significantly highest for persons without impairments. Compared to persons with hearing impairment not using hearing aids, persons with hearing impairment using hearing aids scored higher in all functionings, with statistical significance at the .05 level for 12 of them. Persons with ambulatory impairment using manual wheelchairs scored higher than persons with ambulatory impairment not using manual wheelchairs for 11 of the functionings, but none of the comparisons between the two groups were significant at the .05 level. Assistive products—hearing aids more than manual wheelchairs—enhance capabilities but do not fully equalize opportunities between people with and without impairments.

Objectives Levels, trends or changes in socioeconomic mortality differentials are typically described in terms of means, for example, life expectancies, but studies have suggested that there also are systematic social disparities in the dispersion around those means, in other words there are inequalities in lifespan variation. This study investigates changes in income inequalities in mean and distributional measures of mortality in Denmark, Finland, Norway, and Sweden over two decades.Design Nationwide register-based study.Setting The Danish, Finnish, Norwegian and Swedish populations aged 30 years or over in 1997 and 2017.Main outcome measures Income-specific changes in life expectancy, lifespan variation and the contribution of ‘early’ and ‘late’ deaths to increasing life expectancy.Results Increases in life expectancy has taken place in all four countries, but there are systematic differences across income groups. In general, the largest gains in life expectancy were observed in Denmark, and the smallest increase among low-income women in Sweden and Norway. Overall, life expectancy increased and lifespan variation decreased with increasing income level. These differences grew larger over time. In all countries, a marked postponement of early deaths led to a compression of mortality in the top three income quartiles for both genders. This did not occur for the lowest income quartile.Conclusion Increasing life expectancy is typically accompanied by postponement of early deaths and reduction of lifespan inequality in the higher-income groups. However, Nordic welfare societies are challenged by the fact that postponing premature deaths among people in the lowest-income groups is not taking place.

A meal consists of both tangible and intangible dimensions. Menus and photos may be the only documentation from a meal, but experiences are rarely saved beyond memory. The aim of this study is to design a method for documenting intangible aspects of the professional experience of a meal craftsman, based on the memories associated with the files in an archive. By sorting the archive according to a specific process of documentation we managed to revive and document also the intangible aspects of these meals. In order to access the intangible aspects, a version of the Socratic method of dialogue was developed and used. This is exemplified by a case. The dialogues reunited intangible aspects from the memories of the designer, such as motives and drivers, with the tangible archive documents.

Background: Office blood pressure (OBP) is used for diagnosing and treating hypertension but ambulatory blood pressure measurement (ABPM) associates more accurately with patient outcome. BP control is important in secondary prevention but it is unknown whether the use of APBM improves BP-control in this setting. Our objective was to investigate whether physician awareness of ABP after percutaneous coronary intervention (PCI) improved BP-control. Methods: A total of 200 patients performed ABPM before and after their PCI follow-up visit. Patients were randomized to open (O) or concealed (C) ABPM results for the physician at the follow-up visit. The change in ABP and antihypertensive medication in relation to baseline ABP was compared between the two groups. Results: The average OBP (O and C: 128/76 mmHg) and ABP (O: 123/73 mmHg, C: 127/74 mmHg) was well controlled and did not change between the first and second measurement. A slight increase in systolic ABP during night time was observed in the open arm compared to the concealed arm. Among patients with high ABP (>130/80 mm Hg) at baseline more patients in the C compared to O group remained with a high ABP at the end of study 34/44 (77%) vs 19/34 (56%), p = 0.045. There was a positive correlation between baseline systolic ABP and ABP change in both the O (r = 0.41, p

Background: Developing sufficient mathematical skills is a prerequisite to function adequately in society today. Given this, an important task is to increase our understanding regarding the cognitive mechanisms underlying young people's acquisition of early number skills and formal mathematical knowledge. Aims: The purpose was to examine whether the pathways to mathematics model provides a valid account of the cognitive mechanisms underlying symbolic-number processing and mathematics in adolescents. The pathways model states that the three pathways should provide independent support to symbolic-number skill. Each pathway's unique contribution to formal mathematics varies depending on the complexity and demand of the tasks. Sample: The study used a sample of 114 adolescents (71 girls). Their mean age was 14.60 years (SD = 1.00). Methods: The adolescents were assessed on tests tapping the three pathways and general cognitive abilities (e.g., working memory). A structural equation path analysis was computed. Results: Symbolic-number comparison was predicted by the linguistic pathway, the quantitative pathway, and processing speed. The linguistic pathway, quantitative pathways, and symbolic-number comparison predicted arithmetic fact retrieval. The linguistic pathway, working memory, visual analogies, and symbolic-number comparison predicted percentage calculation. Conclusions: There are both similarities and differences in the cognitive mechanisms underlying arithmetic fact retrieval and percentage calculation in adolescents. Adolescents' symbolic-number processing, arithmetic fact retrieval, and percentage calculation continue to rely on the linguistic pathways, whereas the reliance upon the spatial pathway has ceased. The reliance upon the quantitative pathway varies depending on the task.

BackgroundIn cohorts with voluntary participation, participants may not be representative of the underlying population, leading to distorted estimates. If the relevant sources of selective participation are observed, it is however possible to restore the representativeness by reweighting the sample to resemble the target population. So far, few studies in epidemiology have applied reweighting based on extensive register data on socio-demographics and disease history, or with self-reported data on health and health-related behaviors.MethodsWe examined selective participation at baseline and the first two follow-ups of the Scania Public Health Cohort (SPHC), a survey conducted in Southern Sweden in 1999/2000 (baseline survey; n = 13,581 participants, 58% participation rate), 2005 (first follow-up, n = 10,471), and 2010 (second follow-up; n = 9,026). Survey participants were reweighted to resemble the underlying population with respect to a broad range of socio-demographic, disease, and health-related characteristics, and we assessed how selective participation impacted the validity of associations between self-reported overall health and dimensions of socio-demographics and health.ResultsParticipants in the baseline and follow-up surveys were healthier and more likely to be female, born in Sweden, middle-aged, and have higher socioeconomic status. However, the differences were not very large. In turn, reweighting the samples to match the target population had generally small or moderate impacts on associations. Most examined regression coefficients changed by less than 20%, with virtually no changes in the directions of the effects.ConclusionOverall, selective participation with respect to the observed factors was not strong enough to substantially alter the associations with self-assessed health. These results are consistent with an interpretation that SPHC has high validity, perhaps reflective of a relatively high participation rate. Since validity must be determined on a case-by-case basis, however, researchers should apply the same method to other health cohorts to assess and potentially improve the validity.

Background: Sexual and Reproductive Health and Rights (SRHR) is a concept of human rights applied to sexuality and reproduction. Suboptimal access to SRHR services in many low-income countries results in poor health outcomes. Sustainable development goals (3.7 and 5.6) give a new impetus to the aspiration of universal access to high-quality SRHR services. Indispensable stakeholders in this process are healthcare practitioners who, through their actions or inactions, determine a population’s health choices. Often times, healthcare practitioners’ SRHR decisions are rooted in religious and cultural influences. We seek to understand whether religious and cultural influences differ significantly according to individuals’ characteristics and work environment. Objective: The purpose of this study was to examine the role of healthcare practitioners’ individual characteristics and their work environment in predicting normative SRHR attitudes and behaviours (practices). We hypothesized that religion and culture could be significant predictors of SRHR attitudes and practices. Methods: A quantitative cross-sectional study of 115 participants from ten low-income countries attending a capacity-building programme at Lund University Sweden was conducted. Linear regression models were used to assess for the predictive values of different individual characteristics and workplace environment factors for normative SRHR attitudes and SRHR practices. Results: Self-rated SRHR knowledge was the strongest predictor for both normative SRHR attitudes and normative SRHR practices. However, when adjusted for other individual characteristics, self-rated knowledge lost its significant association with SRHR practices, instead normative SRHR attitudes and active knowledge-seeking behaviour independently predicted normative SRHR practices. Contrary to our hypothesis, importance of religion or culture in an individual’s life was not correlated with the measured SRHR attitudes and practices. Conclusion: Healthcare practitioners’ cultural and religious beliefs, which are often depicted as barriers for implementing full coverage of SRHR services, seem to be modified by active knowledge-seeking behaviour and accumulated working experience with SRHR over time.

Little is known about the interaction between job control and social support at work on common mental disorders. To examine whether there is a synergistic interaction effect between job control and social support at work on general psychological distress and whether it differs by the level of job demands.About 1,940 male and female workers from the Malmö Shoulder and Neck Study were chosen for this cross-sectional study. Job control, social support at work, and job demands were measured by the Swedish version of the Job Content Questionnaire, and general psychological distress was assessed by the General Health Questionnaire.A significant excessive risk increase for general psychological distress was observed when workers had both low job control and low social support at work in both men and women. The synergistic effect was stronger in women, when job demands were low (Rothman’s synergy index was 2.16 vs. 1.51 when job demands were high). However, in male workers, while a strong synergistic effect between job control and social support at work was found when job demands were low (synergy index was 9.25), there was an antagonistic effect when job demands were high (synergy index was 0.52).There was a synergistic interaction effect between job control and social support at work on general psychological distress, but the synergistic effect or its effect size differed by the level of job demands and gender. An atomic, additive approach to the risk assessment of the psychosocial work characteristics on common mental disorders could be misleading or lead to a risk underestimation.

Purpose: Atrial fibrillation (AF) is associated with an increased risk for cardiovascular morbidity and mortality, not entirely explained by thromboembolism. The underlying mechanisms for this association are largely unknown. Similarly, high blood pressure (BP) increases the risk for cardiovascular events. Despite this the interplay between AF and BP is insufficiently studied. The purpose of this study was to examine and quantify the beat-to-beat blood pressure variability in patients with AF in comparison to a control group of patients with sinus rhythm. Materials and methods: We studied 33 patients - 21 in atrial fibrillation and 12 in sinus rhythm - undergoing routine coronary angiography. Invasive blood pressure was recorded at three locations: radial artery, brachial artery and ascending aorta. Blood pressure variability, defined as average beat-to-beat blood pressure difference, was calculated for systolic and diastolic blood pressure at each site. Results: We observed a significant difference (p