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Objectives: To compare diagnostic accuracy of contrast-enhanced CT, dual-layer detector spectral CT (DL-CT), and whole-body MRI (WB-MRI) for diagnosing metastatic breast cancer. Methods: One hundred eighty-two biopsy-verified breast cancer patients suspected of metastatic disease prospectively underwent contrast-enhanced DL-CT and WB-MRI. Two radiologists read the CT examinations with and without spectral data in consensus with 3-month washout between readings. Two other radiologists read the WB-MRI examinations in consensus. Lymph nodes, visceral lesions, and bone lesions were assessed. Readers were blinded to other test results. Reference standard was histopathology, previous or follow-up imaging, and clinical follow-up. Results: Per-lesion AUC was 0.80, 0.84, and 0.82 (CT, DL-CT, and WB-MRI, respectively). DL-CT showed significantly higher AUC than CT (p = 0.001) and WB-MRI (p = 0.02). Sensitivity and specificity of CT, DL-CT, and WB-MRI were 0.66 and 0.94, 0.75 and 0.95, and 0.65 and 0.98, respectively. DL-CT significantly improved sensitivity compared to CT (p < 0.0001) and WB-MRI (p = 0.002). Per-patient AUC was 0.85, 0.90, and 0.92 (CT, DL-CT, and WB-MRI, respectively). DL-CT and WB-MRI had significantly higher AUC than CT (p = 0.04 and p = 0.03). DL-CT significantly increased sensitivity compared to CT (0.89 vs. 0.79, p = 0.04). WB-MRI had significantly higher specificity than CT (0.84 vs. 0.96, p = 0.001) and DL-CT (0.87 vs. 0.96, p = 0.02). Conclusions: DL-CT showed significantly higher per-lesion diagnostic performance and sensitivity than CT and WB-MRI. On a per-patient basis, DL-CT and WB-MRI had equal diagnostic performance superior to CT. Key Points: • Spectral CT has higher diagnostic performance for diagnosing breast cancer metastases compared to conventional CT and whole-body MRI on a per-lesion basis. • Spectral CT and whole-body MRI are superior to conventional CT for diagnosing patients with metastatic breast cancer. • Whole-body MRI is superior to conventional CT and spectral CT for diagnosing bone metastases. [ABSTRACT FROM AUTHOR]

In a living tree crown, the surface expands from year to year and the limbs of the tree thicken, as a consequence of primary and secondary growth. An epiphytic plant fixed on a bark surface is thus subject to constant and, at times, rapid successional change, to which the epiphyte must acclimate or die. These changes concern physical and chemical development in the bark substrate and changes in microclimatic conditions. Thus, the width of the tolerance range of an epiphytic species in principle defines its typical longevity. Epiphytes are distributed in a non-random fashion with respect to crown part occupied, the zone of habitation being delimited by the youngest crown position offering conditions for establishment and the position preventing further survival of the epiphytic species in question. The orchid life cycle is crucially dependent on other organisms, such as pollinating animals and symbiotic fungi, but the relationship between epiphytic orchid and phorophyte tree is currently receiving the least attention, despite the likely relevance for conservation of rare and threatened orchid species. Although many correlative studies have recorded occurrence of mature epiphytic orchids, the dynamics created by the growth of the phorophyte are often disregarded. We call for more experimental approaches, such as transplantation studies of seeds and seedlings, to reveal the still largely unknown mechanisms by which orchid distribution is biased towards certain phorophyte species, age stages and crown positions. We provide a compilation of noteworthy cases that could serve as starting points for studies into bias mechanisms. [ABSTRACT FROM AUTHOR]

Despite being the largest extant family of flowering plants, few fossils of Orchidaceae have been described, and unambiguous finds have first appeared in the last decade. Orchid pollinaria attached to insect pollinators embedded in amber are exceptional sources of information about orchids from the past but may not always be recognized by collectors and insect specialists. We here describe an orchid anther cap with pollinia and caudicular viscin threads as Succinanthera baltica gen. nov. & sp. nov. attached to a fungus gnat embedded in Baltic amber. With an age of 40–55 Myr, this is the oldest orchid fossil known at present. [ABSTRACT FROM AUTHOR]

Background: Parental self-efficacy (PSE) refers to beliefs of parents to effectively engage in behaviors that result in desired outcomes for their children. There are several instruments of PSE for promoting healthy dietary or physical activity (PA) behaviors in children. These measures typically assess PSE in relation to some quantity or frequency of behavior, for example, number of servings or times per week. However, measuring PSE in relation to contextual circumstances, for example, psychological states and situational demands, may be a more informative approach. The purpose of the present study was to develop and psychometrically evaluate a context-based PSE instrument. Methods: Swedish mothers of five-year-old children (n = 698) responded to the Parental Self-Efficacy for Healthy Dietary and Physical Activity Behaviors in Preschoolers Scale (PDAP) and a questionnaire on dietary and PA behaviors in children. Interviews were conducted to explore participant perceptions of the quality of the PDAP items. Psychometric evaluation was conducted using exploratory and confirmatory factor analyses. Spearman correlations between PSE and child behaviors were examined. Results: Twenty-seven interviews were conducted with participants, who perceived the items as highly comprehensible, relevant and acceptable. A four-factor model of a revised 21-item version of the PDAP fitted the data, with different factors of PSE for promoting healthy dietary or PA behaviors in children depending on whether circumstances were facilitating or impeding successful performance. Internal consistency was excellent for total scale (Cronbach's a = .94), and good for factors (a =. 8 4-.88). Correlations were in the expected direction: positive correlations between PSE and healthy behaviors, and negative correlations between PSE and unhealthy behaviors (all rss ≤ .32). Conclusions: Psychometric evaluation of the PDAP provided preliminary support of construct validity and internal consistency. [ABSTRACT FROM AUTHOR]

Background Low IQ has been shown to be an important risk factor for disability pension (DP) but whether the importance has changed over time remains unclear. It can be hypothesised that IQ has become more important for DP over time in parallel with a more demanding working life. The aim of this study was to investigate the relative risk of low IQ on the risk of DP before age 30 between 1971 and 2006. Methods This study covered the entire Swedish male population born between 1951 and 1976, eligible for military conscription. Information about the study subjects was obtained by linkage of national registers. Associations between IQ and DP over time were analysed by descriptive measures (mean values, proportions, etc) and by Cox proportional hazards regressions. Analyses were adjusted for educational level. Results The cohort consisted of 1 229 346 men. The proportion that received DP before the age of 30 increased over time, from 0.68% in the cohort born between 1951 and 1955 to 0.95% in the cohort born between 1971 and 1976. The relative risk of low IQ (adjusted for education) in relation to high IQ decreased from 5.68 (95% CI 4.71 to 6.85) in the cohort born between 1951 and 1955 to 2.62 (95% CI 2.25 to 3.05) in the cohort born between 1971 and 1976. Conclusions Our results gave no support to the idea that the importance of low IQ for the risk of DP has increased in parallel with increasing demands in working life. In fact, low IQ has become less important as a risk factor for DP compared with high IQ between the early 1970s and 1990s. An increased educational level over the same time period is likely to be part of the explanation. [ABSTRACT FROM AUTHOR]

Recent phylogenetic analyses confirm the monophyly of Orchidaceae as sister group to the remainder of Asparagales, and identify the sequence of early branching lineages in Orchidaceae. Orchid seedling mycorrhiza ( OSM) involving rhizoctonious fungi is distributed widely in all subfamilies, including the first branching ones, and its status as a founding event is thus supported. OSM is recognized as one element in the character syndrome that distinguishes orchid biology, and we argue that OSM was the first to evolve. We also discuss the possible evolutionary origins of OSM in Asparagales. The prevalent mycobionts suggest a derivation from a pathogenic relationship, and sister group comparison offers little support for derivation from other mycorrhizal relationships. A combination of in situ sowings and molecular identification of seedling mycobionts has established that a broad range of fungi besides rhizoctonious mycelia are presently involved in OSM, presumably evolving secondarily and often in parallel in different orchid clades. Structural features and internal patterns of mycobiont behaviour appear to have remained largely the same, implying that OSM needs only minor physiological adjustment to accommodate new mycobionts. Such modifications will have involved checkpoints for recognition/rejection and the formation/breakdown of pelotons. These physiological mechanisms are so far largely unknown. The trophic versatility of the mycobionts and the apparently easy shifts could be a main factor in the ecological adaptability of orchids and proliferation of the family. © 2014 The Linnean Society of London, Botanical Journal of the Linnean Society, 2014, 175, 313-327. [ABSTRACT FROM AUTHOR]

Background Epidemiological data have linked obesity with an increased risk of asthma, but the mechanisms responsible for this relationship remain unknown. One possible mechanism, which has received little attention, could be the effect of cholesterol metabolism on airway smooth muscle function. The present study investigated the association between airway hyperresponsiveness ( AHR) to methacholine and body mass index ( BMI) and plasma lipoproteins [low-density lipoprotein ( LDL), high-density lipoprotein ( HDL) and total cholesterol]. Methods Associations between AHR, BMI and plasma lipoproteins were assessed in a population-based cohort at ages 14 and 20 years. Results In unadjusted analyses, higher LDL cholesterol levels at age 14 were associated with AHR at age 20 in both sexes ( P < 0.05). HDL, LDL/HDL ratio and total cholesterol were not associated with AHR. In multiple regression analyses adjusted for sex, lung function, smoking and asthma, only higher levels of BMI at age 14 or 20 years were significantly associated with increased AHR at age 20 years, while neither LDL, HDL and LDL/HDL ratio nor total cholesterol were significantly associated with AHR. Conclusion We confirmed that in teenagers there is a strong association between BMI and AHR to methacholine. This association seems to be independent of the plasma lipoprotein levels at that age. [ABSTRACT FROM AUTHOR]

Background: Research on the temporal relationship of parental risk factors with offspring's suicide attempt is scarce and a life course approach has not been applied to date. We investigated the temporal relationship of parental morbidity and mortality with offspring's suicide attempt and whether any such association was modified by offspring's age at attempt. Methods: We designed a case-control study through linkage of Swedish registers. Cases comprised all individuals in Sweden born 1973-1983 with inpatient care due to suicide attempt (15-31 years of age) and with information on both biological parents (N = 15 193). Ten controls were matched to each case (National Patient register with national complete coverage). Conditional logistic and spline regressions were applied. Results: Particularly for women, most parental markers showed the strongest effect sizes if exposure was short-term (within 2 years after exposure) and related to the mother. Especially short-term exposure to maternal inpatient care due to psychiatric diagnoses had a significantly stronger effect on suicide attempt risk in women compared to men. Regarding exposure to parental inpatient care due to psychiatric diagnoses, short-term as opposed to long-term (exceeding 2 years after exposure) effects were highest during adolescence and decreased significantly with age for female and male offspring, respectively. Conclusions: Although limited by the fact that data on parental morbidity and the outcome of suicidality were based on inpatient data only, the data suggest that the high risks of suicide attempt in case of exposure to parental psychopathology and suicidal behavior particularly during adolescence and the strong short-term effects associated with maternal psychopathology for female offspring are of direct clinical importance. [ABSTRACT FROM AUTHOR]

Abstract: Boron neutron capture therapy relies on the preferential delivery of a 10B-compound to tumor cells. The BSH-biodistribution was investigated in nu/nu mice and human patients. The boron concentration was measured with prompt gamma ray spectroscopy. BSH accumulates to a very low extent not only in brain, but also in fat tissue, bone and muscle, which makes BSH an interesting drug not only for brain lesions but also for tumors located at the extremities. The differential uptake in different organs indicates a complex mechanism. [Copyright &y& Elsevier]

Background: Primary health care specialists have a key role in the management of obesity. Through understanding how they conceive the encounter with patients with obesity, treatment may be improved. The aim of this study was thus to explore general practitioners' and district nurses' conceptions of encountering patients with obesity in primary health care. Method: Data were collected through semi-structured interviews, and analysed using a phenomenographic approach. The participants were 10 general practitioners (6 women, 4 men) and 10 district nurses (7 women, 3 men) from 19 primary health care centres within a well-defined area of Sweden. Results: Five descriptive categories were identified: Adequate primary health care, Promoting lifestyle change, Need for competency, Adherence to new habits and Understanding patient attitudes. All participants, independent of gender and profession, were represented in the descriptive categories. Some profession and gender differences were, however, found in the underlying conceptions. The general staff view was that obesity had to be prioritised. However, there was also the contradictory view that obesity is not a disease and therefore not the responsibility of primary health care. Despite this, staff conceived it as important that patients were met with respect and that individual solutions were provided which could be adhered to step-by-step by the patient. Patient attitudes, such as motivation to change, evasive behaviour, too much trust in care and lack of self-confidence, were, however, conceived as major barriers to a fruitful encounter. Conclusions: Findings from this study indicate that there is a need for development and organisation of weight management in primary health care. Raising awareness of staff's negative views of patient attitudes is important since it is likely that it affects the patient-staff relationship and staff's treatment efforts. More research is also needed on gender and profession differences in this area. [ABSTRACT FROM AUTHOR]

Introduction. Limited research has been conducted on factors that may increase children's likelihood of developing negative attitudes or stereotypes about obesity. The aim of this study was to investigate predictors of children's obesity stereotypes. Methods and procedures. A nationally representative sample of 10-year-old children ( N=3 000), and their parents were requested to respond to a questionnaire in 2005. Obesity stereotypes were assessed by asking children to attribute positive and negative adjectives to boy and girl silhouette figures with average, thin and obese body sizes. Children's body esteem was also assessed, as well as parents’ belief in the controllability of body weight. Additional data were collected on parents’ and children's current body size and socio-demographic variables. Results. The study included 1 383 parent and child pairs. Children assigned on average 3.9 (standard deviation, SD=3.5) more stereotypes to a boy figure with obesity and 3.7 ( SD=3.4) more stereotypes to a girl figure with obesity than to thin and average figures. Predictors of obesity stereotypes were parental body size and parents’ beliefs concerning controllability of weight. Children's body esteem was inversely associated with boy obesity stereotypes, while only boy's body esteem showed an inverse association with girl obesity stereotypes. Discussion. Obesity stereotyping was a more salient feature among 10-year-olds having leaner parents and/or parents holding stronger beliefs about personal control over body weight. Children's perception of own body size rather than actual body size seem to be important in forming obesity stereotypes. [ABSTRACT FROM AUTHOR]

Orchid mycorrhiza probably affects about 25 000 plant species and thus roughly one tenth of all higher plants. Histologically, this symbiosis resembles other kinds of endomycorrhiza, the fungal hyphae growing within living plant cells. Considerable evidence, however, suggests that it is not a two-way exchange relationship and thus not potentially mutualistic, such as the wide-spread endomycorrhiza between plants and Glomalean fungi, known as arbuscular mycorrhiza. During the achlorophyllous seedling stage orchids are obligately dependent on the fungi; some species remain so through life, while others establish photosynthesis but to varying degrees remain facultatively dependent of /responsive to fungal infection as adults. None of the fungi involved are so far known to depend on the symbiosis with orchids. Transfer of organic carbon compounds from hyphae to the orchid has been demonstrated repeatedly, but it is not clear to what extent this takes place during a biotrophic phase while the intracellular hyphae remain intact, or during the subsequent extensive degradation of the hyphal coils. The advantage of viewing orchid mycorrhiza basically as a unilateral mycophagous relationship, in spite of hypothetical beneficial spin-offs to the mycobiont, is that it provides a conceptual framework similar to that of other parasitic or fungivore relationships; mechanisms known in such relationships could be searched for in future studies of the orchid–fungus symbiosis. These could include mechanisms for recognition, attraction and selection of fungi, physiological regulation of internal hyphal growth, breakdown, and material transfer, nutritional consequences of the plant's preference(s) and trophic changes, fungal avoidance mechanisms, and consequences at population and ecosystem levels. A whole range of possible life strategies becomes apparent that could support divergent evolution and lead to the proliferation of species that has indeed occurred in the orchid family. We outline some of the possible physiological mechanisms and ecological implications of this approach. [ABSTRACT FROM AUTHOR]

Familial clustering of suicidal behaviour and psychopathology has been reported in young suicide attempters. Most of these studies were predominantly carried out in clinical treatment settings and lacked statistical power to assess the independent and modifying influences of own and familial psychopathology and suicidal behaviour. We carried out a population-based record-linkage study with a nested case control design. The 14,440 individuals hospitalised due to suicide attempt (cases) and 144,400 matched controls were born in Sweden between 1968 and 1980 and followed up till December 31, 1999. Among the strongest independent familial risk factors for youth suicide attempt were siblings’ (OR 3.4; 2.8–4.1), maternal (OR 2.7; 2.5–3.1) and paternal (OR 1.9; 1.7–2.1) suicide attempt. Other important risk factors were familial personality and substance abuse disorders, maternal schizophrenia, non-affective psychoses and organic disorders and parental neurotic, stress-related and somatoform disorders (1.9–3.2 fold increase), and paternal (OR 1.9; 1.6–2.3) and maternal (OR 1.8; 1.3–2.4) suicide completion. Mental illnesses in index subjects, particularly substance abuse, affective and personality disorders, were the dominant determinants of suicide attempt. Strong interactions were observed between psychopathology in index subjects and familial suicidality. Familial suicide completion had a stronger effect on suicide attempt of earlier onset and on boys. Nearly half (47%) of all suicide attempts could be attributed to familial psychopathology (13%), family suicide attempt (7%) and suicide completion (1%) and own psychopathology (25%). Early recognition and adequate treatment of individual mental illness contribute to prevent youth suicide attempts. Children of parents with psychopathology and suicidal behaviour should receive early support and attention. Evaluation of familial suicidal behaviour seems to be vital for suicide risk assessment in young psychiatric inpatients. There appears to be an independent effect of familial suicidal behaviour as well as familial psychopathology on youth suicide attempt beyond the transmission of mental illness. [ABSTRACT FROM AUTHOR]

Aims: To study the hearing of 18-year-old men by using screening audiograms obtained at military conscription. Methods: The study group comprised 301,873 Swedish men belonging to six age cohorts born from 1953 to 1977 who had been screened at age 18 years from 1971 to 1995. The prevalence of mild to moderate hearing loss was investigated. Results: Of the entire study group, 13.1% had elevation of one or more pure tone thresholds. In most cases, 11.9%, the elevation was situated in the high-frequency region. High-frequency hearing loss was more common in the left ear (7.5%) than in the right ear (6.2%). The prevalence of hearing loss decreased during the period 1971 to 1981 from 15.7% to 8.3%. During the last part of the study period, 1986 to 1995, the prevalence increased from 9.8% to 16.3%. The increase included mild to moderate degrees of hearing loss with thresholds below 35 dB HL. The prevalence of threshold elevations was highest in sparsely populated areas of Sweden and lowest in large, metropolitan areas of Sweden from 1971 to 1986. During the last part of the study period the geographical differences decreased or disappeared. Conclusions: The total prevalence of hearing loss was in accordance with other reports. The frequency 6 kHz was most affected by threshold elevations. The prevalence of hearing loss decreased in the first part of the study period, and increased at the end of the study period. Hearing loss was most commonly seen in rural areas. [ABSTRACT FROM AUTHOR]

Background: The prevalence of obesity has increased threefold among Swedish men during recent decades. Knowledge from Sweden on how obese men manage in working life and become disability pensioners is sparse. The aim of this nationwide and population-based cohort study was to investigate to what extent body mass index (BMI) in young adulthood predicts later disability pension. Method: All Swedish men born 1952–59, who had their weight and height measured at age 18 years in the compulsory military conscription examinations, were followed up longitudinally from 1990 to 2001 with regard to receiving disability pension. Data on own socioeconomic position (1985), education and marital status (1990), parental socioeconomic position (1960), and education (1970) were obtained from censuses. For 366,929 men (81% of the eligible men) the hazard ratio for receiving disability pension was calculated with Cox regression controlling for own education, parental education, childhood and adult socioeconomic position, marital status, morbidity, and type of municipality. Results: Obesity in young adulthood increased the risk for disability pension later in life (1.35, 95% CI 1.19, 1.52) compared with men of normal weight. The relationship between BMI and disability pension was J-shaped with higher risks for underweight (1.14, 95% CI 1.09, 1.20) and obese men. Conclusions: Obese men in Sweden are at higher risk of receiving disability pension. The relationship between BMI and disability pension is J-shaped. An important future task is to estimate the societal costs due to disability pension of obese people. [ABSTRACT FROM AUTHOR]

The Swedish Young Male Twins Study is a population-based longitudinal twin study founded in 1997 through record-linkages of several national registers. Details on pregnancy and birth were obtained from the Swedish Medical Birth Register and used to identify 3566 male twins (1783 pairs) born in Sweden between 1973 and 1979 and resident in Sweden in 1997. A record-linkage was made between the Medical Birth Register and the Military Service Conscription Register for the years 1991 to 1999, providing information on body weight, height, blood pressure, muscle strength, cognitive ability of these twins at age 18 and 19 years. In 1998, 2002 and 2005 to 2006, the twins were surveyed on their zygosity, socioeconomic status, lifestyle factors (such as eating habits, physical activity, smoking habits, use of alcohol etc), height and weight. In 2002, additional information was collected on perceived body shape and size, and eating behavior, according to the Three-Factor Eating Questionnaire. In 2003, DNA via buccal mucosa was collected from a subset of the twins. Recent research using the Swedish Young Male Twins datasets has explored the relationships between fetal growth, body size and blood pressure in young adulthood, genetic and environmental contributions to eating behavior and physical activity, and relationships between diet and physical activity patterns with longitudinal changes in body mass index and attained waist circumference. [ABSTRACT FROM AUTHOR]

The aims of this study were to examine the genetic contribution on physical activity (PA) within a nationwide population of young adult male twin pairs from Sweden and to investigate the equal environment assumption (EEA) in relation to PA. Information on PA was collected by questionnaires in 1998 and 2002 and the impact of genetic factors was estimated by structural equation modeling (SEM). The study included 1022 pairs of twins and the best fitting SEM-model gave a heritability of 49% (95% CI, 40–56%) for total PA and all PA dimensions showed genetic contributions between 40% and 65%. Non-shared environmental factors were also important, whereas shared environmental factors did not contribute to PA behaviors. The EEA was investigated with a linear regression model, examining if the twins contact frequency predicted within-pair differences in PA, and further by a simulation study. We found no support for violation of the EEA. [ABSTRACT FROM AUTHOR]

Aims: The aims of the present study are to investigate time trends and social inequalities in mean body mass index (BMI), overweight, and obesity among 18‐year‐old men in Sweden from 1970 to 2000 and to explore whether social inequalities in these conditions have increased. Methods: A record linkage was made between the Military Service Conscription Register, Population and Housing Censuses, the Register of Education and the Register of the Total Population. All 1,748,800 males born in 1952–82 who were living in Sweden at the age of 17 years in 1969–99 were eligible for this nationwide study. The study population comprises 1,500,499 18‐year‐old men with information on BMI (86% of eligible subjects). Results: During the study period from 1970 to 2000, mean BMI increased from 20.89 kg/m 2 to 22.49 kg/m 2 , the prevalence of overweight increased from 6.6% to 13.6% and the prevalence of obesity increased from 1.0% to 3.8%. Mean BMI and the prevalence of overweight and obesity were higher among young men with low‐educated mothers than among those with high‐educated mothers. A noteworthy finding was that the socioeconomic gap increased over time. Conclusions: Between 1970 and 2000, the prevalence of overweight increased twofold and the prevalence of obesity increased fourfold in this study population. The social inequalities in overweight and obesity have steadily increased among young men in Sweden during the past three decades. [ABSTRACT FROM AUTHOR]

Aims: One aim was to disentangle how the shape and location of the BMI distribution changed among Swedish children over a 12 y period. Another aim was to identify the age during childhood when changes occurred or became manifest. Methods: Two population-based cohorts—2591 children from Stockholm born 1985–1987 and 3650 from Gothenburg born 1973–1975—were compared with respect to BMI distributions from 2 to 15 y of age. Results: Differences between the BMI distributions of the two cohorts were present from 5–6 y of age. From age 7, the children born in 1985–1987 and belonging to the upper parts of the BMI distribution, e.g. those above the 90th or 95th BMI percentiles, had much higher BMI mean values compared to their counterparts born 12 y earlier. Comparisons with respect to the 5th, 10th, 25th, 50th, 75th, 90th and 95th BMI percentiles showed that changes appeared above the 25th percentile and became increasingly pronounced in the upper parts of the BMI distributions. Conclusion: School-aged children in the rightmost parts of the BMI distributions may be more susceptible to “obesogenic” environmental exposures than those in the middle or leftmost parts. The results support the suggestion that the period of BMI rebound is critical for the development of obesity. [ABSTRACT FROM AUTHOR]

Objective To investigate the association of paternal age at conception with the risk of offspring developing schizophrenia. Design A population based cohort study. Setting Sweden. Subjects 754 330 people born in Sweden between 1973 and 1980 and still alive and resident in Sweden at age 16 years. Main outcome measures Hospital admission with schizophrenia or non-schizophrenic, non-affective psychosis. Results After adjustment for birth related exposures, socioeconomic factors, family history of psychosis, and early parental death the overall hazard ratio for each 10 year increase in paternal age was 1.47 (95% confidence interval 1.23 to 1.76) for schizophrenia and 1.12 (0.98 to 1.29) for non-schizophrenic non-affective psychosis. This association between paternal age and schizophrenia was present in those with no family history of the disorder (hazard ratio for each 10 year increase in paternal age 1.60, 1.32 to 1.92), but not in those with a family history (0.91, 0.44 to 1.89) (P = 0.04 for interaction). Conclusions Advancing paternal age is an important independent risk factor for schizophrenia. The stronger association between paternal age and schizophrenia in people without a family history provides further evidence that accumulation of de novo mutations in paternal sperm contributes to the overall risk of schizophrenia. [ABSTRACT FROM AUTHOR]

: BackgroundPrevious longitudinal studies of smoking and BMI have focused on smoking cessation. The aim of the present study was to disentangle the effects of long-term smoking on longitudinal changes and age-matched BMI differences (time period effects) in a nation-wide Swedish cohort.: MethodsMen and women (n = 4349) ages 18–73 years reported height, weight, and smoking status for a baseline survey in 1980–1981. Eight and 16 years after baseline, follow-up surveys were conducted for 3244 (75%) of the 4349 subjects. Long-term smokers and long-term nonsmokers were compared with respect to longitudinal changes and age-matched BMI differences.: ResultsFor middle-age adults, the longitudinal increases in BMI were smaller among long-term smokers than long-term nonsmokers regardless of gender. Among the elderly, the longitudinal decrease in BMI was greatest among long-term smokers. Among men, age-matched BMI differences between surveys were smaller for long-term smokers than for nonsmokers. Among women, however, age-matched BMI differences were greater for long-term smokers than for nonsmokers.: ConclusionsIn middle-age subjects, longitudinal BMI increases are smaller among smokers than nonsmokers. During old age, the BMI of smokers decreases more than that of nonsmokers. Unknown factors related to gender contribute to larger time period effects of smoking in women than in men. [Copyright &y& Elsevier]

The objective was to test the fetal origins hypothesis by examining the association between fetal growth and systolic blood pressure in a large cohort of adult male twins of known zygosity. This cohort study is based on a record linkage of routinely collected data from the Swedish Medical Birth Registry, the Swedish Military Conscription Registry and a mailed questionnaire. It comprises 886 pairs of same-sex male twins born in Sweden in 1973-79 for whom data were available on size at birth and systolic blood pressure, height and weight at age 17-19 years. Based on self-reported similarity of appearance in childhood, 384 twin pairs were classified as monozygotic (MZ), 269 as dizygotic (DZ) and 233 as of uncertain zygosity (XZ). Differences in systolic blood pressure within and between twin pairs were analysed in relation to birthweight and birthweight-for-gestational-age z-score using random effects linear models. Within twin pairs, a 1 kg difference in birthweight was associated with a difference of -1.30 mmHg in systolic blood pressure [95% confidence interval -4.15, +1.54] for MZ twins and +0.14 [-3.49, +3.76] for DZ twins; for all twins combined it was -0.21 [-2.13, +1.71]. Between twin pairs, a 1 kg difference in birthweight was associated with a difference of -2.68 mmHg in systolic blood pressure [-4.95, -0.42] for MZ twins and +0.28 [-2.35, +2.91] for DZ twins; for all twins combined -1.68 [-3.15, -0.22]. All these estimates included adjustment for age, year and conscription centre of examination, gestational age and height and weight at conscription. These results provide little support for the fetal origins hypothesis. The estimates of the within-pair effect in MZ twins and their wide confidence intervals (including zero) cannot exclude the existence of common genetic mechanisms, but are also not inconsistent with an in utero programming effect. This study highlights some methodological problems with twin studies. [ABSTRACT FROM AUTHOR]

Provides information on a study which described the protocorm and seedling mycorrhiza of Neuwiedia veratrifolia Blume. Materials and methods; Results; Discussion.

Hjern A, Rasmussen F, Johansson M, Åberg N. Migration and atopic disorder in Swedish conscripts. Pediatr Allergy Immunol 1999: 10: 209–215. © Munksgaard, 1999 We have studied asthma and allergic rhinitis prevalence in Swedish conscripts born 1973–1977 according to the military service conscription register in relation to the socio‐economic status and country of birth of the conscripts and their parents, and age when granted residency in Sweden. There was an increase in prevalence of asthma and allergic rhinitis over time in all groups irrespective of country of birth or ethnic origin. Conscripts who themselves were born in Africa, Asia, Latin America and the Mediterranean had a significantly lower risk for asthma and allergic rhinitis than Swedish‐born conscripts. The risk of atopic disorder among the foreign‐born conscripts increased with time of residency in Sweden. Conscripts with mothers from Latin America, Asia and Africa were identified as having the highest risk for atopic disorder among Swedish‐born conscripts with high socio‐economic status; the adjusted risk ratio (RR) for asthma was 2.6 (95% CI 1.7–4.0) and that for allergic rhinitis was 2.0 (1.5–2.6). The conscripts with mothers from the Mediterranean had the lowest risk for atopic disorders of the Swedish‐born conscripts with low socio‐economic status; the RR for asthma was 0.43 (0.34–0.56) and that for allergic rhinitis was 0.84 (0.76–0.93). This study demonstrates that factors related to migration and ethnicity are important determinants of atopic disorder among Swedish conscripts. [ABSTRACT FROM AUTHOR]

Epidemiological and laboratory studies have implied that the environment during early childhood is important for the risk of developing atopic disorders. In this study we analyzed the prevalence of asthma, hayfever and eczema among 1901 internationally adopted young men at the military‐induction medical examination in relation to indicators of their early childhood environment. The adopted young men who came to Sweden before 2 years of age suffered from asthma, hayfever and eczema significantly more often than those who came to Sweden between 2 and 6 years of age; the risk ratios (RR) were 1.6, 2.5 and 2.1, respectively. The young men who were born in the Far East were identified as being particularly susceptible to the development of hayfever and eczema, with RRs of 1.3 and 1.7. This study demonstrates that the environment during the first 6 years of life has a profound influence on the risk of suffering from atopic disorders as young adults. [ABSTRACT FROM AUTHOR]

Presents information on a cladistic analysis of Orchidaceae. Materials and methods; Importance of vegetative characters; Results of implied weighting analysis.

Investigates the daily copper intake on children in Sweden by studying the concentration of copper in drinking water and volumes of water consumed by children. Low concentration of copper in drinking water in households with water-pipe systems and those living in detached houses.

Studies the development of anthers in subfamilies of Orchidaceae to examine homology hypotheses for pollinium number characters. Shape revelations of the anthers as flattened or ovoid; Presence of a meristematic region of the anthers; Representation of character states of the pollinia.

Presents a study that examined ethnic differences in infant mortality rates and rates of sudden infant death syndrome among Swedish and immigrant women between 1978 and 1990 in Sweden. Methodology; Results and discussion.

Presents a study comparing the efficacy of three acellular vaccines with a United Kingdom whole-cell vaccine. The acellular vaccines being two-component, three-component, and five-component diphtheria-tetanus-pertussis (DPT) serums; Methods of enrolling babies and assigning vaccines; Findings and interpretations.

Abstract: Adult height, a marker of early-life environment, has been sporadically associated with suicide risk. We have examined adult height and attempted suicide risk in a cohort of 1,102,293 Swedish men and, in fully-adjusted analyses, found decreasing stepwise associations between height and attempted suicides by any means and most specific means. [ABSTRACT FROM AUTHOR]

Background: A higher incidence of late adverse events (LAEs) to iodinated contrast media in interleukin-2 (IL-2)-treated patients has been reported. Purpose: To assess the incidence of LAEs after administration of iodinated contrast media in patients with metastatic renal cell carcinoma (mRCC) treated with IL-2. Material and Methods: Patients were randomized to treatment with IL-2 and interferon-α with/without bevacizumab in the Danish Renal Carcinoma Group study – 1. Patients underwent a computed tomography (CT) scan at baseline, at one month, at three months, and every third month until RECIST 1.1 defined progression. LAEs due to iodinated contrast media were systematically registered according to the Common Terminology Criteria for Adverse Events classification. Results: In total, 89 patients were included and underwent a total of 507 contrast-enhanced CT scans. An overall incidence of 46 (9.1%) LAEs was observed in 38 of 89 (42.7%) patients; 3 LAEs at baseline (3.4% of all baseline scans), 39 (13.9%) LAEs during IL-2-based therapies, and 4 (2.9%) LAEs after termination of IL-based therapies. There was no difference in progression-free survival, overall survival, and treatment response in patients experiencing LAEs compared to patients without LAEs (P = 0.2, P = 0.5, and P = 0.6, respectively). Conclusion: Patients with mRCC demonstrated a higher incidence of LAEs after administration of iodinated contrast during ongoing IL-2 therapy, indicating that iodinated contrast media may cause a recall phenomenon of IL-2 toxicities in patients with mRCC. Treatment with IL-2 should not be a contraindication for contrast-enhanced scans in patients with mRCC but expertise and vigilance are required. [ABSTRACT FROM AUTHOR]

The author reflects on dynamic contrast-enhanced computed tomography (DCE-CT) for gastrointestinal stromal tumors (GISTs). The author explores the work of researchers M. Betz and colleagues regarding the combination of contrast-enhanced computed tomography (CE-CT) and DCE-CT protocol. Topics discussed include cancer treatment, lesions, and conventional chemotherapy and radiotherapy.

The author reflects on the importance of the Response Evaluation Criteria in Solid Tumor (RECIST). He states that RECIST sets of criteria on determining the impact of treatment by following changes in anatomical measurements of tumors. He adds that the development of RECIST is intended for the treatment response of solid tumors receiving systemic therapy.

The article presents the author's views on multidisciplinary approach to the treatment of colorectal liver metastases (CRLM). He says that like surgical resection, ablation of CRLM relies on level-II scientific evidence and a well-planned and conducted randomized, controlled trials (RCT). According to him, every patient with CRLM must be carefully evaluated and the optimal treatment should be chosen which very often involves a combination of surgical resection and ablation.

Objective: To investigate the associations of exercise capacity and muscle strength in late adolescence with risk of vascular disease and arrhythmia.Design: Cohort study.Setting: General population in Sweden.Participants: 1.1 million men who participated in mandatory military conscription between 1 August 1972 and 31 December 1995, at a median age of 18.2 years. Participants were followed until 31 December 2010.Main Outcomes: Associations between exercise capacity and muscle strength with risk of vascular disease and subgroups (ischaemic heart disease, heart failure, stroke, and cardiovascular death) and risk of arrhythmia and subgroups (atrial fibrillation or flutter, bradyarrhythmia, supraventricular tachycardia, and ventricular arrhythmia or sudden cardiac death). Maximum exercise capacity was estimated by the ergometer bicycle test, and muscle strength was measured as handgrip strength by a hand dynamometer. High exercise capacity or muscle strength was deemed as above the median level.Results: During a median follow-up of 26.3 years, 26 088 vascular disease events and 17 312 arrhythmia events were recorded. Exercise capacity was inversely associated with risk of vascular disease and its subgroups. Muscle strength was also inversely associated with vascular disease risk, driven by associations of higher muscle strength with lower risk of heart failure and cardiovascular death. Exercise capacity had a U shaped association with risk of arrhythmia, driven by a direct association with risk of atrial fibrillation and a U shaped association with bradyarrhythmia. Higher muscle strength was associated with lower risk of arrhythmia (specifically, lower risk of bradyarrhythmia and ventricular arrhythmia). The combination of high exercise capacity and high muscle strength was associated with a hazard ratio of 0.67 (95% confidence interval 0.65 to 0.70) for vascular events and 0.92 (0.88 to 0.97) for arrhythmia compared with the combination of low exercise capacity and low muscle strength.Conclusions: Exercise capacity and muscle strength in late adolescence are independently and jointly associated with long term risk of vascular disease and arrhythmia. The health benefit of lower risk of vascular events with higher exercise capacity was not outweighed by higher risk of arrhythmia. [ABSTRACT FROM AUTHOR]

Background: Mediastinal lymph node enlargement (MLNE) is a finding described in a subset of patients with idiopathic pulmonary fibrosis (IPF) and other interstitial lung diseases (ILDs) and is associated with accelerated disease progression and increased mortality. The cause of MLNE is still not known. Our hypothesis is that there is an association between MLNE and B-cell follicles in lung tissue, another aspect detectable in the lung tissue of patients with IPF and other ILDs. Objectives: The aim of this study was to assess if there is an association between MLNE and B-cell follicles in lung tissue in patients with IPF and other ILDs. Method: Patients having transbronchial cryobiopsies performed as part of an investigation for ILD were included in this prospective observational study. MLNE (smallest diameter ≥10 mm) were assessed in station 7, 4R, and 4L on high-resolution computed tomography scans. B-cell follicles were assessed on haematoxylin-eosin-stained specimens. Lung function, 6-minute walk test, acute exacerbation, and mortality were registered after 2 years. In addition, we investigated if the finding of B-cell follicles was consistent in patients who underwent both surgical lung biopsies (SLBs) and cryobiopsies. Results: In total, 93 patients were included for analysis (46% diagnosed with IPF, 54% diagnosed with other ILDs). MLNE was found in 26 (60%) of the IPF patients and in 23 (46%) of the non-IPF patients (p = 0.164). Diffusing capacity for carbon monoxide was significantly lower (p = 0.03) in patients with MLNE compared to patients without MLNE. B-cell follicles were found in 11 (26%) of the IPF patients and in 22 (44%) of the non-IPF patients (p = 0.064). Germinal centres were not seen in any of the patients. There was no association between MLNE and B-cell follicles (p = 0.057). No significant difference in change of pulmonary function test was seen at 2-year follow-up when comparing the patients with and without MLNE or B-cell follicles. In 13 patients, both SLBs and cryobiopsies were performed. The presence of B-cell follicles was not consistent when comparing the two different methods. Conclusion: MLNE is evident in a substantial part of patients with ILD and is associated with lower DLCO at inclusion. We could not demonstrate an association between histological B-cell follicles in biopsies and MLNE. A possible explanation for this is that the cryobiopsies might not have captured the changes we sought. [ABSTRACT FROM AUTHOR]

To explore the experiences of nurses and coordinators in the PRIMROSE childhood obesity prevention trial, and to understand the factors that might help to improve the outcome of future primary prevention of obesity. Using a qualitative approach, data were obtained by interviewing nine intervention nurses and three regional study coordinators. All participants were female. The interviews were transcribed and analysed using content analysis. Two themes emerged: The nurses experienced that it was rewarding to participate in the trial, but challenging to combine the intervention with regular work; and The study coordinators experienced that they were in a difficult position handling the conflicting needs of the research group and the nurses' commitment to usual child health care services. The importance of support, encouragement, briefer and simpler intervention, and adaptation of the training in motivational interviewing to the setting was emphasized. Stress and lack of time were major barriers to deliver the intervention as intended. Although the PRIMROSE intervention was developed in collaboration with representatives from the child health services, and additional research funding was provided to compensate for time spent working with the trial, nurses experienced stress and time constraints.. [ABSTRACT FROM AUTHOR]

Objectives: To associate the early change in DL-CT parameters and HU with survival outcomes and treatment response in patients with metastatic renal cell carcinoma (mRCC). Methods: DL-CT scans were performed at baseline and after 1 month of checkpoint immunotherapy or tyrosine kinase inhibitor therapy. Scans were reconstructed to conventional CT and DL-CT series, and used for assessment of HU, iodine concentration (IC), and the effective atomic number (Zeffective) in the combined RECISTv.1.1 target lesions. The relative changes, defined as ΔIC(combined), ΔZeffective(combined), and ΔHU(combined), were associated with progression-free survival (PFS), overall survival (OS), and objective response rate (ORR). The reduction in the sum of diameters of target lesions ≥ 30% after 1 month was associated with OS, PFS, and ORR. Results: Overall, 115 and 104 mRCC patients were included at baseline and 1 month, respectively. Median IC(combined) decreased from 2.3 to 1.2 mg/ml (p < 0.001), Zeffective(combined) from 8.5 to 8.0 (p < 0.001), and HU(combined) from 86.0 to 64.00 HU (p < 0.001). After multivariate adjustments, the largest reductions in ΔIC(combined) (HR 0.47, 95% CI: 0.24–0.94, p = 0.033) and ΔZeffective(combined) (HR = 0.43, 95% CI: 0.21–0.87, p = 0.019) were associated with favorable OS; the largest reduction in ΔZeffective(combined) was associated with higher response (OR = 2.79, 95% CI: 1.12–6.94, p = 0.027). The largest reduction in ΔHU(combined) was solely associated with OS in univariate analysis (HR 0.45, 95% CI: 0.23–0.91). Reduction in SOD ≥ 30% at 1 month was not associated with outcomes (p > 0.075). Conclusions: Early reductions at 1 month in ΔIC(combined) and ΔZeffective(combined) are associated with favorable outcomes in patients with mRCC. This information may reassure physicians and patients about treatment strategy. Key Points: • Early reductions following 1 month of therapy in spectral dual-layer detector CT-derived iodine concentration and the effective atomic number (Zeffective) are independent biomarkers for better overall survival in patients with metastatic renal cell carcinoma. • Early reduction after 1 month of therapy in the effective atomic number (Zeffective) is an independent imaging biomarker for better treatment response metastatic renal cell carcinoma. [ABSTRACT FROM AUTHOR]

A preface is presented for this issue of "Acta Radiologica."

Focuses on imaging of hilar cholangiocarcinoma or Klatskin tumor. Primary malignancy arising from the bile duct epithelium, at the confluence of the right and the left hepatic duct; Technical advances in imaging's improvement of surgical techniques have lead to that more patients are being treated with surgical resection and have improved the overall five-year survival rates after surgery to 20 percent.

This study aims to generate and also validate an automatic detection algorithm for pharyngeal airway on CBCT data using an AI software (Diagnocat) which will procure a measurement method. The second aim is to validate the newly developed artificial intelligence system in comparison to commercially available software for 3D CBCT evaluation. A Convolutional Neural Network-based machine learning algorithm was used for the segmentation of the pharyngeal airways in OSA and non-OSA patients. Radiologists used semi-automatic software to manually determine the airway and their measurements were compared with the AI. OSA patients were classified as minimal, mild, moderate, and severe groups, and the mean airway volumes of the groups were compared. The narrowest points of the airway (mm), the field of the airway (mm2), and volume of the airway (cc) of both OSA and non-OSA patients were also compared. There was no statistically significant difference between the manual technique and Diagnocat measurements in all groups (p > 0.05). Inter-class correlation coefficients were 0.954 for manual and automatic segmentation, 0.956 for Diagnocat and automatic segmentation, 0.972 for Diagnocat and manual segmentation. Although there was no statistically significant difference in total airway volume measurements between the manual measurements, automatic measurements, and DC measurements in non-OSA and OSA patients, we evaluated the output images to understand why the mean value for the total airway was higher in DC measurement. It was seen that the DC algorithm also measures the epiglottis volume and the posterior nasal aperture volume due to the low soft-tissue contrast in CBCT images and that leads to higher values in airway volume measurement. [ABSTRACT FROM AUTHOR]

Purpose. This study aimed to compare the presence and grades of intra- and extracranial carotid artery calcifications between obstructive sleep apnea (OSA) and non-OSA patients. Methods. CBCT records of 190 patients (95 OSA patients and 95 non-OSA patients) were retrospectively collected and analyzed. Patient demographic data, including age and gender for both study groups and body mass index (BMI), and apnea-hypopnea index (AHI) for OSA patients were recorded. The presence of intra- and extracranial carotid artery calcifications and the number of calcifications were noted according to the grading scale. Results. There was a significant difference in carotid artery calcifications between OSA patients and healthy individuals. A total of 56.8% of the OSA patients showed at least one carotid artery calcification, whereas 13.8% of healthy individuals showed at least one carotid artery calcification (p < 0.05). For intracranial calcifications, OSA patients showed a significantly higher prevalence than healthy individuals (p < 0.05). The results showed that as the apnea-hypopnea index increases in OSA patients, the incidence of carotid artery calcification increases simultaneously. AHI > 30 patients showed the highest percentage of calcifications. Conclusion. In conclusion, OSA patients showed a higher prevalence of calcified carotid artery calcifications than healthy individuals. The results can be interpreted as the higher AHI, the more carotid artery calcification occurs. As these lesions can be a precursor of future strokes, 3D MDCT/CBCT images should evaluate meticulously not only extracranial but also intracranially, especially in OSA patients. [ABSTRACT FROM AUTHOR]

Background: Overweight or obesity is detrimental during pregnancy. We studied time trends in the educational gradient of overweight and obesity among pregnant women. Differences in overweight and obesity by area of residence and country of birth were also examined. Methods: The study was based on the Swedish Medical Birth Register between 1992 and 2010 and included 1,569,173 singleton pregnancies. Weight and height were registered during the first visit at the antenatal-care clinic. Data on education, country of birth, and area of residence were derived from registers with national coverage. Results: In 2008-2010, 32% of Swedish nulliparous pregnant women were overweight or obese. The relative risk of obesity among lower educated women compared to women with higher education increased from 1.91 (95% confidence interval: 1.85-1.97) in 1992-1995 to 2.09 (95% confidence interval: 2.05-2.14) in 2008-2010. There was an inverse linear relationship between risks of overweight or obesity, and population density and type of residence municipality. An excessive gestational weight gain according to the American Institute of Medicine was observed among 57-63% of the overweight or obese women, but there were small differences by education. Pregnant women born in Africa, Middle East or Latin America had higher risks of being overweight or obese compared to women born in Sweden. Conclusions: The prevalence of obesity as well as the social inequalities in obesity during pregnancy increased in Sweden between 1992 and 2010. Further understanding of social inequalities and geographical differentials in health behaviours of pregnant women is needed when planning public health interventions. [ABSTRACT FROM AUTHOR]

Double fertilization and subsequent endosperm formation are two of the most important synapomorphies of the angiosperms. Endosperm is generally lacking in Orchidaceae, but Swamy reported the formation of up to ten endosperm nuclei in Vanilla planifolia in 1947. The observation was documented only by line drawings and has not been confirmed; however, assumptions about endosperm formation occurring in Orchidaceae are primarily founded on Swamy's study. The current study provides the first detailed description of embryo sac formation and early embryogeny in Vanilla since Swamy, and is the first using modern imaging techniques. Flowers of Vanilla imperialis were artificially pollinated at 1-week intervals and the resulting fruits were fixed, embedded and sectioned for light microscopy of embryo sac formation, fertilization and early development of the embryo. Three-dimensional reconstructions of embryo sacs were obtained using confocal laser scanning microscopy on fixed ovules. The mature embryo sac contains only six nuclei as a result of the arrested development of the chalazal nuclei prior to the formation of three antipodals and a polar nucleus. Fertilization was observed 7 weeks after pollination, but double fertilization and the formation of endosperm did not occur. © 2014 The Linnean Society of London, Botanical Journal of the Linnean Society, 2015, 177, 202-213. [ABSTRACT FROM AUTHOR]

Background: Early detection of lung cancer is crucial as the prognosis depends on the disease stage. Chest radiographs has been the principal diagnostic tool for general practitioners (GPs), but implies a potential risk of false negative results, while computed tomography (CT) has a higher sensitivity. The aim of this study was to describe the implementation of direct access to low-dose CT (LDCT) from general practice. Methods: We conducted a cohort study nested in a randomised study. A total of 119 general practices with 266 GPs were randomised into two groups. Intervention GPs were offered direct access to chest LDCT combined with a Continuing Medical Education (CME) meeting on lung cancer diagnosis. Results: During a 19-month period, 648 patients were referred to LDCT (0.18/1000 adults on GP list/month). Half of the patients needed further diagnostic work-up, and 15 (2.3%, 95% CI: 1.3–3.8%) of the patients had lung cancer; 60% (95% CI: 32.3–83.7%) in a localised stage. The GP referral rate was 61% higher for CME participants compared to non-participants. Conclusion: Of all patients referred to LDCT, 2.3% were diagnosed with lung cancer with a favourable stage distribution. Half of the referred patients needed additional diagnostic work-up. There was an association between participation in CME and use of CT scan. The proportion of cancers diagnosed through the usual fast-track evaluation was 2.2 times higher in the group of CME-participating GPs. The question remains if primary care case-finding with LDCT is a better option for patients having signs and symptoms indicating lung cancer than a screening program. Whether open access to LDCT may provide earlier diagnosis of lung cancer is yet unknown and a randomised trial is required to assess any effect on outcome. Trial Registration: Clinicaltrials.gov [ABSTRACT FROM AUTHOR]

Background: Some studies have suggested that overweight is associated with lower mortality, but these results may be affected by reverse causality. We analysed how body mass index (BMI) in young adulthood is associated with mortality in the general population and after the diagnoses of coronary heart disease (CHD), stroke and cancer.Methods: BMI was measured at an average age of 18 years in 734 438 Swedish men born in 1950-65. Diagnoses of CHD, stroke and cancer as well as all-cause mortality were derived from registers covering the whole population, up to 31 December 2010. The follow-up of 24.56 million person-years included 33 067 cases of mortality and 19 843 CHD, 13 578 stroke and 27 365 cancer diagnoses. Hazard ratios (HR) [with 95% confidence intervals (CI)] were estimated by the Cox proportional hazards model.Results: Higher mortality in the whole cohort (HR = 1.26, 1.21-1.32) as well as after the diagnosis of CHD (HR = 1.33, 1.09-1.63) or cancer (HR = 1.13, 1.01-1.25) was found in moderately overweight men (BMI 25.0-27.4 kg/m(2)) as compared with normal weight men (BMI 20.1-22.4 kg/m(2)); for stroke patients the result for the same BMI categories was not statistically significant (HR = 1.17, 0.94-1.45). Mortality increased with increasing weight status and was highest in obese men (BMI >30 kg/m(2)): HR = 2.17 (2.02-2.34) for the whole cohort, 2.35 (1.81-3.05) after the diagnosis of CHD, 2.08 (1.56-2.77) after stroke and 1.68 (1.40-2.01) after cancer.Conclusions: Even moderate overweight in young adulthood increases all-cause mortality and mortality after the diagnosis of CHD, stroke and cancer in men. Preventing overweight in young adulthood remains as an important public health issue. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effects of training in methods of preventing childhood obesity on self-efficacy (SE) in nurses. Methods: In a randomized, controlled trial conducted in child health services in Sweden, nurses in the intervention and control groups of the PRIMROSE prevention trial of childhood obesity were offered a 5-day workshop on dietary and physical activity interventions, and motivational interviewing. Self-efficacy for influencing parents to promote healthy dietary and physical activity behaviors in their children was measured using an 18-item instrument. Difference in SE between groups at post- assessment was analyzed using multiple linear regression analysis. Results: Compared to control nurses (n = 38), intervention nurses (n = 22) demonstrated higher SE (ß = 14.70, P < .001). Conclusions and Implications: Training in methods of preventing childhood obesity increased SE in nurses. Self-efficacy should be included as a construct in evaluations of clinical training. [ABSTRACT FROM AUTHOR]

Background: Based on prior studies spectral CT has shown a higher sensitivity for malignant lesions than conventional CT at the cost of lower specificity. For the radiologists, it also offers a higher degree of certainty in the diagnosis of benign lesions. The objective of this study was to evaluate the economic impact of spectral CT in patients suspected of occult cancer in a medical center in Denmark. Methods: This study was a secondary analysis using de-identified data from a prospective study of patients receiving a contrast-enhanced spectral CT scan. Based on suggested follow-up examinations on both spectral CT and contrast-enhanced CT, costs from a payer's perspective were determined using unit costs obtained from national databases. Results: The dataset contained 400 patients. Overall, 203 follow-up procedures were eliminated based on spectral data reading. The largest reduction in suggested follow-up procedures was found for the kidney (83%), followed by the liver (66%), adrenal glands (60%), and pancreas (42%). The total estimated costs for suggested follow-up procedures based on spectral data reading were €155,219, 25.2% (€52,384) less than that of conventional CT reading. Conclusion: Our results provide support for spectral body imaging as an advanced imaging modality for suspected occult cancer. A substantial number of follow-up diagnostic procedures could be eliminated based on spectral data reading, which would result in significant cost savings. [ABSTRACT FROM AUTHOR]