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Sammanfattning Sverige framhålls ofta som ett föregångsland gällande personlig assistans (PA) och mänskliga rättigheter. Forskning visar dock att bedömningen av rätten till PA styrs av en medicinsk förståelse av funktionshinder och av ekonomiska snarare än funktionshinderpolitiska mål. Nedskärningar har medfört att antalet med statlig assistansersättning har minskat. Syftet med artikeln är att belysa de motstridiga upplevelserna av att ha PA i dagens Sverige. Det handlar om att å ena sidan kunna påverka sina livsvillkor, vara delaktig och utöva självbestämmande och å andra sidan om avsaknad av kontroll och makt över myndigheters beslut och omprövning av rätten till PA. Artikeln baseras på en deltagarbaserad forskningscirkel där bl.a. assistansanvändare och deras företrädare var medforskare. Resultatet belyser de komplexa sambanden mellan ett personligt utformat stöd och möjlighet att forma tillvaron. PA tillskrivs en avgörande och grundläggande betydelse för vardag, relationer, arbetsliv och hälsa. Kontakter med myndigheter väcker maktlöshet och bristande kontroll. Rädslan för att mista assistansen är påtaglig. Artikeln bidrar med kunskap om de sociala aspekterna av funktionshinder och om hur politiska reformer och nedskärningar gör avtryck i människors liv. Detta är angelägen kunskap då PA i en svensk kontext har blivit en fråga om behov snarare än mänskliga rättigheter.

Frågor kring breddad rekrytering och breddat deltagande utgör en del av den sociala dimensionen av högre utbildning och är ett prioriterat område för det europeiska samarbetet. 2017 års förslag om att ändra i högskolelagen och vidga lärosätenas uppdrag till att aktivt främja ett brett deltagande gav upphov till en debatt bland såväl politiker som företrädare för lärosäten, vilken synliggjorde flera utmaningar, förhoppningar och farhågor. Föreliggande reflektion tar avstamp i denna debatt och fördjupar sig i frågor kring breddat deltagande för studenter med funktionsnedsättning. Syftet med reflektionen är att diskutera och reflektera kring vad breddat deltagande för denna målgrupp innebär och vilka krav det ställer på resurser, tillgänglighet, bemötande och attityder samt på högskolepedagogisk kompetensutveckling, kunskap om funktionsnedsättning och funktionshinder samt inkluderande pedagogik. Utgångspunkten för reflektionen är svensk forskning och pågående utvecklingsarbete om breddat deltagande för studenter med funktionsnedsättning samt författarnas erfarenhetsbaserade kunskaper om högskolepedagogisk undervisning och kompetensutveckling.

Knut Hamsun’s polemic about the Norwegian Nansen cult round 1889 (on the occasion of Fridtjof Nansen’s ski crossing of Greenland), which he published in a newspaper article titled “Meditations on Nansen” (“Nansen-Betragtninger”), was mainly directed against the public enthusiasm for sportive records as a typical modern trend, whose pointless absurdity Hamsun shows in an incisive and specifically provocative way. His critique is primarily aimed at a kind of hero worship that in his opinion is out of all proportion to the uselessness of the expedition’s results. Thus, “a daredevil, well finished adventure, a breakneck act, a sports affair, a lucky strike,” as he outlines Nansen’s venture, becomes the basis for a mass hysteria whose driving forces are invested in the signatures of modernity. The fascination of crossing the line and of extreme forms of progress in “both sports and science”, their entanglement as an example for the “proliferation of hybrids” (Latour 1993), and the contingent dimension of success stories are symptoms of modernity that Hamsun is polemically engaged with. In conclusion, I investigate to what extent Hamsun ironically refers to these symptoms in his novel Editor Lynge (Redakteur Lynge, 1893). My argument is supported by the assumption that Hamsun’s vehement denunciation of such tendencies is owed to the fact that he himself is embroiled in them.

In this study we examined whether developmental changes in using verbal self-cueing for task-goal maintenance are dependent on the amount of task practice and task-sequencing demands. To measure task-goal maintenance we applied a switching paradigm in which children either performed only task A or B in single-task blocks or switched between them on every second trial in mixed-task blocks. Task-goal maintenance was determined by comparing the performance between both blocks (mixing costs). The influence of verbal self-cueing was measured by instructing children to either name the next task aloud or not to verbalize during task preparation. Task-sequencing demands were varied between groups whereas one group received spatial task cues to support keeping track of the task sequence, while the other group did not. We also varied by the amount of prior practice in task switching while one group of participants practiced task switching first, before performing the task naming in addition, and the other group did it vice versa. Results of our study investigating younger (8-10 years) and older children (11-13 years) revealed no age differences in beneficial effects of verbal self-cueing. In line with previous findings, children showed reduced mixing costs under task-naming instructions and under conditions of low task-sequence demands (with the presence of spatial task cues). Our results also indicated that these benefits were only obtained for those groups of children that first received practice in task switching alone with no additional verbalization instruction. These findings suggest that internal task-cueing strategies can be efficiently used in children but only if they received prior practice in the underlying task so that demands on keeping and coordinating various instructions are reduced. Moreover, children benefitted from spatial task cues for better task-goal maintenance only if no verbal task-cueing strategy was introduced first.

To what extent does musical practice change the structure of the brain? In order to understand how long-lasting musical training changes brain structure, 20 male right-handed, middle-aged professional musicians and 19 matched controls were investigated. Among the musicians, 13 were pianists or organists with intensive practice regimes. The others were either music teachers at schools or string instrumentalists, who had studied the piano at least as a subsidiary subject, and practiced less intensively. The study was based on T1-weighted MR images, which were analyzed using Deformation Field Morphometry. Cytoarchitectonic probabilistic maps of cortical areas and subcortical nuclei as well as myeloarchitectonic maps of fiber tracts were used as regions of interest to compare volume differences in the brains of musicians and controls. In addition, maps of voxel-wise volume differences were computed and analyzed.Musicians showed a significantly better symmetric motor performance as well as a greater capability of controlling hand independence than controls. Structural MRI-data revealed significant volumetric differences between the brains of keyboard players, who practiced intensively and controls in right sensorimotor areas and the corticospinal tract as well as in the entorhinal cortex and the left superior parietal lobule. Moreover, they showed also larger volumes in a comparable set of regions than the less intensively practicing musicians. The structural changes in the sensory and motor systems correspond well to the behavioral results, and can be interpreted in terms of plasticity as a result of intensive motor training. Areas of the superior parietal lobule and the entorhinal cortex might be enlarged in musicians due to their special skills in sight-playing and memorizing of scores. In conclusion, intensive and specific musical training seems to have an impact on brain structure, not only during the sensitive period of childhood but throughout life.

Introduction: The use of e-cigarettes has grown in popularity worldwide. From their manufacturing, use, and disposal, the environmental impacts of e-cigarettes present a novel public health concern that needs to be urgently investigated. However, very limited studies have focused on the subject matter. The present study aims to review available studies to identify the environmental impacts of e-cigarettes., Methods: In this scoping review, we undertook a search in two databases (PubMed and Web of Science) from inception until 21 March 2023, and a gray literature search in Google Scholar. Reference lists of publications included in the scoping review were screened manually for additional relevant publications. Scientific publications that were in English and focused on the potential impacts of e-cigarettes on the environment were included., Results: A total of 693 publications were identified, of which 33 were subjected to full-text review and 9 publications were finally included in the review. The impacts on air quality, water, land use, and animals, water and energy consumption, with associated environmental impacts, increased pollution and emissions due to greater e-cigarette production, having harmful and toxic components, creating pollution and waste issues, and global environmental impacts due to manufacturing and importing ingredients and components from low- and middle-income countries, were identified as the environmental impacts of e-cigarettes., Conclusions: Despite the emphasis on the environmental threat of e-cigarettes, there are limited scientific studies on the environmental impacts of the e-cigarette life cycle. Considering the rapid expansion of e-cigarette usage, there is an urgent need for a rigorous assessment of their life-cycle environmental burden of the various potential health, environmental, and other consequences., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2023 Ngambo G. et al.)

Background: Strong scientific evidence affirms that climate change is now a public health emergency. Increasingly, climate litigation brought against governments and corporations utilizes international human rights, environmental and climate laws and policies to seek accountability for climate-destructive and health-harming actions. The health impacts of climate change make litigation an important means of pursuing justice and strategically challenging legal systems. Yet there is scant documentation in the literature of the role that public health has played in climate litigation and the legal weight public health narratives are given in such contexts. Therefore, we assessed to what extent courts of law have used public health harm in legal adjudication and sought to provide practical recommendations to address barriers to positioning legal arguments in public health-centric frames., Methods: We reviewed legal databases to identify all publicly reported, documented, cases of climate litigation filed in any country or jurisdiction between 1990 and September 2020. For the 1641 cases identified, we quantified the frequency of cases where health concerns were explicitly or implicitly raised., Findings: Case numbers are trending upwards, notably in high income countries. Resolution remains pending in over half of cases as the majority were initiated in the past three years. Cases were primarily based in climate and human rights law and brought by a wide range of groups and individuals predominantly against governments. About half of the decided cases found in favour for the plaintiffs. Based on this, we selected the 65 cases that were directly linked to public health. We found economic forces and pricing of health risks play a key role, as courts are challenged by litigants to adjudicate on the responsibility for health impacts., Conclusions: While courts of law are receptive to public health science, significant legal reform is needed to enhance leveraging of public health evidence in legal judgements of climate litigation cases. The integration of a public health mandate into a new eco-centric legal paradigm will optimize its potential to promote human well-being-the core objective underpinning both international law, human rights, and public health. Existing legal doctrines and practices can be enhanced to increase the weight of public health arguments in climate legal action and consequently ensure legal rulings in climate litigation prioritize, protect and promote public health., Competing Interests: The authors have declared that no competing interests exist.

Climate plays an important role in human health and it is well established that climate change can have very significant impacts in this regard. In partnership with The Lancet and the MJA, we present the inaugural Australian Countdown assessment of progress on climate change and health. This comprehensive assessment examines 41 indicators across five broad sections: climate change impacts, exposures and vulnerability; adaptation, planning and resilience for health; mitigation actions and health co-benefits; economics and finance; and public and political engagement. These indicators and the methods used for each are largely consistent with those of the Lancet Countdown global assessment published in October 2017, but with an Australian focus. Significant developments include the addition of a new indicator on mental health. Overall, we find that Australia is vulnerable to the impacts of climate change on health, and that policy inaction in this regard threatens Australian lives. In a number of respects, Australia has gone backwards and now lags behind other high income countries such as Germany and the United Kingdom. Examples include the persistence of a very high carbon-intensive energy system in Australia, and its slow transition to renewables and low carbon electricity generation. However, we also find some examples of good progress, such as heatwave response planning. Given the overall poor state of progress on climate change and health in Australia, this country now has an enormous opportunity to take action and protect human health and lives. Australia has the technical knowhow and intellect to do this, and our annual updates of this assessment will track Australia's engagement with and progress on this vitally important issue.

The scientific relationship between atmospheric CO2 and global temperatures has been understood for over a century. Atmospheric concentrations of CO2 due to burning of fossil fuels have contributed to 75% of the observed 1°C rise in global temperatures since the start of the industrial era (about 1750). Global warming is associated with intensifying climatic extremes and disruption to human society and human health. Mitigation is vital for human health as continued current emission rates are likely to lead to 4°C of warming by 2100. Further escalation of Australia's hot and erratic climate will lead to more extreme climate-related disasters of heatwaves, droughts, fires and storms, as well as shifts in disease burdens.

Human activity is having multiple, inter-related effects on ecosystems. Greenhouse gas emissions persisting along current trajectories threaten to significantly alter human society. At 0.85 °C of anthropogenic warming, deleterious human impacts are acutely evident. Additional warming of 0.5 °C-1.0 °C from already emitted CO₂ will further intensify extreme heat and damaging storm events. Failing to sufficiently address this trend will have a heavy human toll directly and indirectly on health. Along with mitigation efforts, societal adaptation to a warmer world is imperative. Adaptation efforts need to be significantly upscaled to prepare society to lessen the public health effects of rising temperatures. Modifying societal behaviour is inherently complex and presents a major policy challenge. We propose a social systems framework for conceptualizing adaptation that maps out three domains within the adaptation policy landscape: acclimatisation, behavioural adaptation and technological adaptation, which operate at societal and personal levels. We propose that overlaying this framework on a systems approach to societal change planning methods will enhance governments' capacity and efficacy in strategic planning for adaptation. This conceptual framework provides a policy oriented planning assessment tool that will help planners match interventions to the behaviours being targeted for change. We provide illustrative examples to demonstrate the framework's application as a planning tool.

Human thermoregulation and acclimatization are core components of the human coping mechanism for withstanding variations in environmental heat exposure. Amidst growing recognition that curtailing global warming to less than two degrees is becoming increasing improbable, human survival will require increasing reliance on these mechanisms. The projected several fold increase in extreme heat events suggests we need to recalibrate health protection policies and ratchet up adaptation efforts. Climate researchers, epidemiologists, and policy makers engaged in climate change adaptation and health protection are not commonly drawn from heat physiology backgrounds. Injecting a scholarly consideration of physiological limitations to human heat tolerance into the adaptation and policy literature allows for a broader understanding of heat health risks to support effective human adaptation and adaptation planning. This paper details the physiological and external environmental factors that determine human thermoregulation and acclimatization. We present a model to illustrate the interrelationship between elements that modulate the physiological process of thermoregulation. Limitations inherent in these processes, and the constraints imposed by differing exposure levels, and thermal comfort seeking on achieving acclimatization, are then described. Combined, these limitations will restrict the likely contribution that acclimatization can play in future human adaptation to global warming. We postulate that behavioral and technological adaptations will need to become the dominant means for human individual and societal adaptations as global warming progresses.

This exploratory study describes the experiences arising from exposure to extreme summer heat, and the related health protection and promotion issues for working people in Australia. Twenty key informants representing different industry types and occupational groups or activities in Australia provided semi-structured interviews concerning: (i) perceptions of workplace heat exposure in the industry they represented, (ii) reported impacts on health and productivity, as well as (iii) actions taken to reduce exposure or effects of environmental heat exposure. All interviewees reported that excessive heat exposure presents a significant challenge for their industry or activity. People working in physically demanding jobs in temperatures>35°C frequently develop symptoms, and working beyond heat tolerance is common. To avoid potentially dangerous health impacts they must either slow down or change their work habits. Such health-preserving actions result in lost work capacity. Approximately one-third of baseline work productivity can be lost in physically demanding jobs when working at 40°C. Employers and workers consider that heat exposure is a 'natural hazard' in Australia that cannot easily be avoided and so must be accommodated or managed. Among participants in this study, the locus of responsibility for coping with heat lay with the individual, rather than the employer. Heat exposure during Australian summers commonly results in adverse health effects and productivity losses, although quantification studies are lacking. Lack of understanding of the hazardous nature of heat exposure exacerbates the serious risk of heat stress, as entrenched attitudinal barriers hamper amelioration or effective management of this increasing occupational health threat. Educational programmes and workplace heat guidelines are required. Without intervention, climate change in hot countries, such as Australia, can be expected to further exacerbate heat-related burden of disease and loss of productivity in many jobs. In light of projected continued global warming, and associated increase in heat waves, more attention needs to be given to environmental heat as a human health hazard in the Occupational Health and Safety arena. Without adoption of effective heat protective strategies economic output and fitness levels will diminish. Health protection and promotion activities should include strategies to reduce heat exposure, limit exposure duration, ensure access to hydration, and promote acclimatization and fitness programmes, and reorientate attitudes towards working in the heat., (© The Author (2013). Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Individuals living in hot climates face health risks from hyperthermia due to excessive heat. Heat strain is influenced by weather exposure and by individual characteristics such as age, sex, body size, and occupation. To explore the population-level drivers of heat strain, we developed a simulation model that scales up individual risks of heat storage (estimated using Myrup and Morgan's man model "MANMO") to a large population. Using Australian weather data, we identify high-risk weather conditions together with individual characteristics that increase the risk of heat stress under these conditions. The model identifies elevated risks in children and the elderly, with females aged 75 and older those most likely to experience heat strain. Risk of heat strain in males does not increase as rapidly with age, but is greatest on hot days with high solar radiation. Although cloudy days are less dangerous for the wider population, older women still have an elevated risk of heat strain on hot cloudy days or when indoors during high temperatures. Simulation models provide a valuable method for exploring population level risks of heat strain, and a tool for evaluating public health and other government policy interventions.

Although the implications of climate change for public health continue to be elucidated, we still require much work to guide the development of a comprehensive strategy to underpin the adaptation of the health system. Adaptation will be an evolving process as impacts emerge. The authors aim is to focus on the responses of the Australian health system to health risks from climate change, and in particular how best to prepare health services for predicted health risks from heat waves, bushfires, infectious diseases, diminished air quality, and the mental health impacts of climate change. In addition, the authors aim to provide some general principles for health system adaptation to climate change that may be applicable beyond the Australian setting. They present some guiding principles for preparing health systems and also overview some specific preparatory activities in relation to personnel, infrastructure, and coordination. Increases in extreme weather-related events superimposed on health effects arising from a gradually changing climate will place additional burdens on the health system and challenge existing capacity. Key characteristics of a climate change-prepared health system are that it should be flexible, strategically allocated, and robust. Long-term planning will also require close collaboration with the nonhealth sectors as part of a nationwide adaptive response.

The rapid rise in extreme heat events in Australia recently is already taking a health toll. Climate change scenarios predict increases in the frequency and intensity of extreme heat events in the future, and population health may be significantly compromised for people who cannot reduce their heat exposure. Exposure to extreme heat presents a health hazard to all who are physically active, particularly outdoor workers and indoor workers with minimal access to cooling systems while working. At air temperatures close to (or beyond) the core body temperature of 37°C, body cooling via sweating is essential, and this mechanism is hampered by high air humidity. Heat exposure among elite athletes and the military has been investigated, whereas the impacts on workers remain largely unexplored, particularly in relation to future climate change. Workers span all age groups and diverse levels of fitness and health status, including people with higher than "normal" sensitivity to heat. In a hotter world, workers are likely to experience more heat stress and find it increasingly difficult to maintain productivity. Modeling of future climate change in Australia shows a substantial increase in the number of very hot days (>35°C) across the country. In this article, the authors characterize the health risks associated with heat exposure on working people and discuss future exposure risks as temperatures rise. Progress toward developing occupational health and safety guidelines for heat in Australia are summarized.

Population health is a function of social and environmental health determinants. Climate change is predicted to bring significant alterations to ecological systems on which human health and livelihoods depend; the air, water, plant, and animal health. Agricultural systems are intrinsically linked with environmental conditions, which are already under threat in much of southern Australian because of rising heat and protracted drying. The direct impact of increasing heat waves on human physiology and survival has recently been well studied. More diffusely, increasing drought periods may challenge the viability of agriculture in some regions, and hence those communities that depend on primary production. A worst case scenario may herald the collapse of some communities. Human health impacts arising from such transition would be profound. This article summarizes existing rural health challenges and presents the current evidence plus future predictions of climate change impacts on Australian agriculture to argue the need for significant augmentation of public health and existing health policy frameworks. The article concludes by suggesting that adaptation to climate change requires planning for worst case scenario outcomes to avert catastrophic impacts on rural communities. This will involve national policy planning as much as regional-level leadership for rapid development of adaptive strategies in agriculture and other key areas of rural communities.

Public health educational pathways in Australia have traditionally been the province of Universities, with the Master of Public Health (MPH) recognised as the flagship professional entry program. Public health education also occurs within the fellowship training of the Faculty of Public Health Medicine, but within Australia this remains confined to medical graduates. In recent years, however, we have seen a proliferation of undergraduate degrees as well as an increasing public health presence in the Vocational Education and Training (VET) sector.Following the 2007 Australian Federal election, the new Labour government brought with it a refreshing commitment to a more inclusive and strategic style of government. An important example of this was the 2020 visioning process that identified key issues of public health concern, including an acknowledgment that it was unacceptable to allocate less than 2% of the health budget towards disease prevention. This led to the recommendation for the establishment of a national preventive health agency (Australia: the healthiest country by 2020 National Preventative Health Strategy, Prepared by the Preventative Health Taskforce 2009).The focus on disease prevention places a spotlight on the workforce that will be required to deliver the new investment in health prevention, and also on the role of public health education in developing and upskilling the workforce. It is therefore timely to reflect on trends, challenges and opportunities from a tertiary sector perspective. Is it more desirable to focus education efforts on selected lead issues such as the "obesity epidemic", climate change, Indigenous health and so on, or on the underlying theory and skills that build a flexible workforce capable of responding to a range of health challenges? Or should we aspire to both?This paper presents some of the key discussion points from 2008 - 2009 of the Public Health Educational Pathways workshops and working group of the Australian Network of Public Health Institutions. We highlight some of the competing tensions in public health tertiary education, their impact on public health training programs, and the educational pathways that are needed to grow, shape and prepare the public health workforce for future challenges.