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BackgroundLow grip strength and gait speed are associated with mortality. However, investigation of the additional mortality risk explained by these measures, over and above other factors, is limited.AimWe examined whether grip strength and gait speed improve discriminative capacity for mortality over and above more readily obtainable clinical risk factors.MethodsParticipants from the Health, Aging and Body Composition Study, Osteoporotic Fractures in Men Study, and the Hertfordshire Cohort Study were analysed. Appendicular lean mass (ALM) was ascertained using DXA; muscle strength by grip dynamometry; and usual gait speed over 2.4-6 m. Verified deaths were recorded. Associations between sarcopenia components and mortality were examined using Cox regression with cohort as a random effect; discriminative capacity was assessed using Harrell's Concordance Index (C-index).ResultsMean (SD) age of participants (n = 8362) was 73.8(5.1) years; 5231(62.6%) died during a median follow-up time of 13.3 years. Grip strength (hazard ratio (95% CI) per SD decrease: 1.14 (1.10,1.19)) and gait speed (1.21 (1.17,1.26)), but not ALM index (1.01 (0.95,1.06)), were associated with mortality in mutually-adjusted models after accounting for age, sex, BMI, smoking status, alcohol consumption, physical activity, ethnicity, education, history of fractures and falls, femoral neck bone mineral density (BMD), self-rated health, cognitive function and number of comorbidities. However, a model containing only age and sex as exposures gave a C-index (95% CI) of 0.65(0.64,0.66), which only increased to 0.67(0.67,0.68) after inclusion of grip strength and gait speed.ConclusionsGrip strength and gait speed may generate only modest adjunctive risk information for mortality compared with other more readily obtainable risk factors.

The 2019 European Working Group on Sarcopenia in Older People (EWGSOP2) and the Sarcopenia Definitions and Outcomes Consortium (SDOC) have recently proposed sarcopenia definitions. However, comparisons of the performance of these approaches in terms of thresholds employed, concordance in individuals and prediction of important health-related outcomes such as death are limited. We addressed this in a large multinational assembly of cohort studies that included information on lean mass, muscle strength, physical performance and health outcomes. White men from the Health Aging and Body Composition (Health ABC) Study, Osteoporotic Fractures in Men (MrOS) Study cohorts (Sweden, USA), the Hertfordshire Cohort Study (HCS) and the Sarcopenia and Physical impairment with advancing Age (SarcoPhAge) Study were analysed. Appendicular lean mass (ALM) was ascertained using DXA; muscle strength by grip dynamometry; and usual gait speed over courses of 2.4-6 m. Deaths were recorded and verified. Definitions of sarcopenia were as follows: EWGSOP2 (grip strength

Generalization is one of the core aspects of algebraic thinking, and research literature points to the importance of objectification when generalizing mathematical discourses. To increase the field's understanding of the objectification process in various algebra discourses, our study analyses Grade 6 teachers' use of words, symbols, routines and narratives when they introduce various algebraic concepts. Our results show that there exist instances of objectification in the teachers' discourses, but these are all implicit, which can make them difficult for students to notice. Thus, teachers need to be made more aware of the importance of making the objectification process explicit. Furthermore, our results show that instances of objectification are tightly connected to the use of formal algebraic symbols. This highlights the importance of the transition from concrete/iconic to formal/arbitrary representations. [ABSTRACT FROM AUTHOR]

Research has identified several aspects that influence students' transition to mathematics studies at university, but these aspects have often been studied separately. Our study contributes to the field's understanding of the transition between upper secondary and university mathematics by taking a multifaceted perspective not previously explored. We analyse experiences and attainment in mathematics of 154 engineering students with respect to known aspects of this transition, and our results show that it is important to consider several aspects together in order to understand the full complexity of the transition. It is revealed that students with previous experiences of university studies, when compared with new first year undergraduates, perceive a larger difference between studying mathematics at the upper secondary level and university. Our results also show that the engineering students enrolled in distance programmes experience larger differences between secondary and tertiary levels than engineering students enrolled in campus programmes. Furthermore, our analyses show that students' success in mathematics is related to their perceptions of the rift experienced in the transition. In all, our results highlight the importance of taking a student perspective in the development of explanatory and useful models of students' transition between upper secondary and university mathematics. [ABSTRACT FROM AUTHOR]

Summary: It is widely recognised that young people in out-of-home care are often involved in a complex process of culminating disadvantage and exclusion. Investing in the core ingredients of social inclusion (participation and interpersonal relationships) while still in care can counterbalance ongoing exclusion processes. In this article, we explore how early work experiences (before the age of 18) can play a role in this. Findings: A thematic analysis was performed on interview data from 74 young adults in six countries. Several elements promote community participation (gaining financial autonomy, gaining a feeling of independence, and being able to contribute as a worker) and help to develop a sense of belonging (striving for normality and building long-lasting social connections). Early work experiences also contribute to personal growth (building capabilities and shaping the future). Applications: This article highlights how early work experiences have the potential to promote social inclusion for out-of-home care-experienced young people and serve as gateway experiences for both educational and work trajectories. Entry into the world of work should not be postponed until the age of 18. Caregivers can play a role in motivating young people to work while still being in care and helping them to find a job. The experiences gained during these early work experiences can also have a place in the care process. [ABSTRACT FROM AUTHOR]

Objectives: Severe chronic obstructive pulmonary disease affects and changes the lives of both affected persons and next of kin. There is a need for support and a sense of coherence to manage the life situation and minimize the symptom and caregiver burden. The aim of this study was to diverge or converge views of symptom burden, caregiver burden, the need for support, and sense of coherence in persons with chronic obstructive pulmonary disease and their next of kin to gain a deeper and broader knowledge and understanding. Methods: A mixed methods study with data from interviews and four validated questionnaires from persons affected by chronic obstructive pulmonary disease in GOLD stages III and IV and their next of kin. Results: Questionnaires from 112 persons affected by chronic obstructive pulmonary disease, and 71 next of kin, together with 25 and 21 interviews, show that; there is a difference between estimated symptoms and caregiver burden and experiences expressed in their own words. There is also a defect regarding meaningfulness, comprehensibility, and manageability affecting daily life. Symptoms and caregiver burden, together with the sense of coherence, strengthen the need for support. Discussion: The complexity of the life situation leads to a need for supportive interventions to strengthen internal and external resources. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate the prevalence of three sarcopenia definitions and their associations with fracture risk in older Swedish women when adjusted for fracture risk assessment (FRAX)-based risk factors; 2,883 women with a mean age of 77.8 years were included. Sarcopenia was defined based on the Sarcopenia Definitions and Outcomes Consortium (SDOC; low handgrip strength [kg] and gait speed (m/s)), revised European Working Group on Sarcopenia in Older People (EWGSOP2; low appendicular lean mass index, appendicular lean mass [ALM]/height; kg/m2], and hand grip strength [kg]), and Asian Working Group for Sarcopenia (AWGS; low ALM (kg), and hand grip strength [kg]) definitions. Femoral neck T -score was obtained from dual-energy X-ray absorptiometry. All fractures, confirmed by X-ray or medical record review, were subsequently categorized as major osteoporotic fractures (MOFs) and hip fractures. Deaths were verified through regional registers. The total follow-up time was 6.4 ± 1.3 (mean ± SD) yr. Cox regression (hazard ratios [HR] and 95% CIs) analyses were performed with adjustment for age, FRAX variables, and femoral neck T -score. Sarcopenia prevalence was 4.5% (n  = 129) according to SDOC, 12.5% (n  = 360) for EWGSOP2, and 10.3% (n  = 296) defined by AWGS. Individuals with sarcopenia defined by SDOC had a higher mortality risk than individuals without sarcopenia (HR: 3.41; 95% CI: 2.51, 4.62) after adjusting for age and FRAX variables. Sarcopenia according to EWGSOP2 and AWGS was not associated with an increased fracture risk after adjusting for age and FRAX variables. Individuals with sarcopenia defined by SDOC had a higher risk for any fractures (HR: 1.48; 95% CI: 1.10, 1.99) and MOF (HR: 1.42; 95% CI: 1.03, 1.98) compared with individuals without sarcopenia after adjusting for clinical risk factors used in FRAX. In conclusion, sarcopenia defined by SDOC, incorporating muscle function/strength, was the only sarcopenia definition associated with fracture risk in older women. [ABSTRACT FROM AUTHOR]

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.

This article draws attention to the relevance of young care leavers' exercise of agency as one possible key ingredient in overcoming barriers to engagement in work. Several previous studies show difficulties in entering adult life, both in relation to higher and further education as well as entrance into work life. The article analyses interviews with young adults from six countries, who have spent at least part of their childhood and youth in out‐of‐home care and the results indicate that the care leavers have the ability to make plans and set up goals for the future that they in many cases are able to achieve or at least are striving for over time. In many instances, they show a strong motivation, for example, to educate themselves pursuing their goals. To support this transition of young care leavers, it is important to listen to 'successful' cases such as the ones presented. [ABSTRACT FROM AUTHOR]

Reducing greenhouse gas emissions from agriculture is crucial to reach global and regional climate targets. However, the efficiency of unilateral climate policies aimed at taxing emissions might be hampered by carbon leakage. One way to eliminate leakage is to implement a global carbon tax. In this article, we study the effects of a carbon tax in agriculture on GHG emissions by simulating five policy scenarios using the CAPRI model; (i) an EU tax, (ii) an EU tax complemented with a border carbon adjustment mechanism (BCA), (iii) a global tax, (iv) a global tax scaled by GDP per capita, and (v) a low global tax at 1/10 of the tax level in the other scenarios. For the global scenarios, we also analyse the impact on food consumption and nutrient intake. We find that a global tax of EUR 120 per ton CO2-eq could reduce global agricultural emissions by 19%, but also jeopardizes food security in some parts of the world. A global tax at 1/10 of that rate (EUR 12) achieves a 3.2% reduction. In contrast, a unilateral EU tax of EUR 120 per ton CO2-eq, accompanied with a BCA, reduces global agricultural emissions by only 0.15%. A unilateral carbon tax in the EU causes significant emission leakage. This result depends strongly on differences in emission intensities between regions and on consumer preferences. A EUR 12 global carbon tax achieves a considerably larger global emission reduction than a EUR 120 unilateral EU carbon tax accompanied with a border carbon adjustment. A global carbon tax differentiated by GDP per capita is less effective than a uniform global carbon tax, as producers with higher emission intensities tend to get lower tax rates. Other ways of taking equity into account should be sought when designing climate policies in the agricultural sector. [ABSTRACT FROM AUTHOR]

Context: Anemia and decreasing levels of hemoglobin (Hb) have previously been linked to increased fracture risk, but the added value to FRAX, the most utilized fracture prediction tool worldwide, is unknown. Objective: To investigate the association between anemia, Hb levels, bone microstructure, and risk of incident fracture and to evaluate whether Hb levels improve fracture risk prediction in addition to FRAX clinical risk factors (CRFs). Methods: A total of 2778 community-dwelling women, aged 75-80 years, and part of a prospective population-based cohort study in Sweden were included. At baseline, information on anthropometrics, CRFs, and falls was gathered, blood samples were collected, and skeletal characteristics were investigated using dual-energy x-ray absorptiometry and high-resolution peripheral quantitative computed tomography. At the end of follow-up, incident fractures were retrieved from a regional x-ray archive. Results: The median follow-up time was 6.4 years. Low Hb was associated with worse total hip and femoral neck bone mineral density (BMD), and lower tibia cortical and total volumetric BMD, and anemia was associated with increased risk of major osteoporotic fracture (MOF; hazard < ratio 2.04; 95% CI 1.58-2.64). Similar results were obtained for hip fracture and any fracture, also when adjusting for CRFs. The ratio between 10-year fracture probabilities of MOF assessed in models with Hb levels included and not included ranged from 1.2 to 0.7 at the 10th and 90th percentile of Hb, respectively. Conclusion: Anemia and decreasing levels of Hb are associated with lower cortical BMD and incident fracture in older women. Considering Hb levels may improve the clinical evaluation of patients with osteoporosis and the assessment of fracture risk. [ABSTRACT FROM AUTHOR]