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Multilingual children living in areas with low socioeconomic status (SES) are at an increased risk of having speech, language and communication needs (SLCN). Many multilingual children with SLCN in Sweden have insufficient basic vocabulary knowledge in the majority language, preventing them from achieving the school's learning goals. However, there is a lack of studies of interventions that could improve vocabulary development in this group, and that can be delivered in an everyday educational setting. This pilot study evaluates the effect of a school-based vocabulary group intervention, which combines elements from shared book reading and the Lexicon Pirate method, on vocabulary skills. A non-randomised pretest-posttest control group design was used. Eighteen six- to seven-year-old multilingual children attending preschool class in low SES areas either received intervention (n = 9) or were included in a control group (n = 9). The intervention group participated in 12 intervention sessions over six weeks. Word knowledge, semantic fluency, and comprehension of semantic relations were assessed pre- and post-intervention. Results revealed that children in the intervention group demonstrated significant gains in knowledge of both trained and untrained words, compared to the control group. No effects were found on semantic fluency or comprehension of semantic relations.

Hypertension affects more than one billion people worldwide. Here we identify 113 novel loci, reporting a total of 2,103 independent genetic signals (P

Societal Impact Statement Can modern breeding technologies, such as genome editing, contribute to reduced pesticide usage? This question has been accentuated by a recent legal proposal to exempt genome‐edited plants from the strict regulations applied to classical genetically modified (GM) crops within the European Union (EU). Using official statistics on crop cultivation and pesticide usage for two example crops commonly grown in Sweden, we calculate that cereal farmers collectively could save up to 70 million € in pesticide usage for wheat alone and that a late blight‐resistant potato could reduce pesticide usage by over 80% provided that the EU legislation is amended. Summary The European Commission has set goals to reduce the use of chemical pesticides, and one way to meet these goals in the agricultural sector is to breed disease‐resistant crops. Here, we ask whether modern breeding technologies, for example, genome editing using site‐directed nucleases, can contribute to these goals. This question has been accentuated by recent legal proposals in the European Union (EU) and several other jurisdictions worldwide to exempt genome‐edited plants from the strict regulations often applied to classical genetically modified (GM) crops. Using official statistics on crop cultivation and pesticide usage for two example crops commonly grown in Sweden (wheat and potato), we show that cereal farmers collectively could potentially save up to 70 million € in pesticide usage for wheat alone and that a late blight‐resistant potato could reduce pesticide usage by over 80% provided that the EU legislation is amended. Given the immense potential of genome‐edited crops, we further discuss details in the legal proposal currently being negotiated in the EU on the so‐called new genomic techniques that includes both genome editing and targeted insertions of cisgenes. Although promising, we argue that several technical limitations in the legal proposal will, if implemented, hamper the development of disease‐resistant crops and make the suggested legislation less future‐proof.

Abstract The respiratory system, including the lungs, is essential for terrestrial life. While recent research has advanced our understanding of lung development, much still relies on animal models and transcriptome analyses. In this study conducted within the Human Developmental Cell Atlas (HDCA) initiative, we describe the protein-level spatiotemporal organization of the lung during the first trimester of human gestation. Using high-parametric tissue imaging with a 30-plex antibody panel, we analyzed human lung samples from 6 to 13 post-conception weeks, generating data from over 2 million cells across five developmental timepoints. We present a resource detailing spatially resolved cell type composition of the developing human lung, including proliferative states, immune cell patterns, spatial arrangement traits, and their temporal evolution. This represents an extensive single-cell resolved protein-level examination of the developing human lung and provides a valuable resource for further research into the developmental roots of human respiratory health and disease.

Background: The spread of sexually transmitted infections (STIs) is an ongoing public health challenge, and awareness of risk factors is essential for designing effective preventive interventions. This study aimed to assess self-reported STI occurrences and identify risk factors and sexual behaviors associated with STIs among female university students. Methods: This is a cross-sectional, online questionnaire study, including 384 female university students seeking contraceptive counseling at a gynecology clinic in Uppsala, Sweden, and reporting having had sex. Associated risk factors and behaviors were assessed by comparing those who reported STIs and those who did not. Results: The mean age of participants was 22.8 years. Seventy-eight (20%) had contracted at least one STI, with seven (9%) experiencing multiple infections. Seventy-three (94%) reported first-date sexual activity without a condom among STI experienced. Chlamydia trachomatis was the most common STI pathogen (68% of all infections), followed by Herpes simplex virus (18%) and Mycoplasma genitalium (13%). Behavioral factors associated with self-reported STIs were first-date sexual activity without a condom, not using condom at first intercourse, younger age at first intercourse, a higher number of sexual partners overall and in the last 12 months, experience of anal sex, dating app usage, and regretting sexual activity after substance use (P < 0.003 for all). Conclusions: Condom use was low among the respondents, and STIs were common regardless of the high level of education in this group. Contraceptive counseling needs to highlight the importance of condom use in addition to contraceptive efficacy. It is also essential to consider the specific risk factors and behaviors prevalent among young adults to reduce the spread of STIs.

Abstract Background Neuroblastoma (NB) is a heterogeneous embryonal malignancy and the deadliest tumor of infancy. It is a complex disease that can result in diverse clinical outcomes. In some children, tumors regress spontaneously. Others respond well to existing treatments. But for the high-risk group, which constitutes approximately 40% of all patients, the prognosis remains dire despite collaborative efforts in basic and clinical research. While its exact cellular origin is still under debate, NB is assumed to arise from the neural crest cell lineage including multipotent Schwann cell precursors (SCPs), which differentiate into sympatho-adrenal cell states eventually producing chromaffin cells and sympathoblasts. Methods To investigate clonal development of neuroblastoma cell states, we performed haplotype-specific analysis of human tumor samples using single-cell multi-omics, including joint DNA/RNA sequencing of sorted single cells (DNTR-seq). Samples were also assessed using immunofluorescence stainings and fluorescence in-situ hybridization (FISH). Results Beyond adrenergic tumor cells, we identify subpopulations of aneuploid SCP-like cells, characterized by clonal expansion, whole-chromosome 17 gains, as well as expression programs of proliferation, apoptosis, and a non-immunomodulatory phenotype. Conclusion Aneuploid pre-malignant SCP-like cells represent a novel feature of NB. Genetic evidence and tumor phylogeny suggest that these clones and malignant adrenergic populations originate from aneuploidy-prone cells of migrating neural crest or SCP origin, before lineage commitment to sympatho-adrenal cell states. Our findings expand the phenotypic spectrum of NB cell states. Considering the multipotency of SCPs in development, we suggest that the transformation of fetal SCPs may represent one possible mechanism of tumor initiation in NB with chromosome 17 aberrations as a characteristic element.

The optical, physical, and chemical properties of aerosol particles have been previously studied in the United Arab Emirates (UAE), but there is still a gap in the knowledge of particle sources and in the horizontal and vertical transport of aerosol particles and their precursors in the area. To investigate how aerosol particle and SO2 concentrations at the surface responded to changes in horizontal and vertical transport, we used data from a 1-year measurement campaign at a background site where local sources of SO2 were expected to be minimal. The measurement campaign provided a combination of in situ measurements at the surface and the boundary layer evolution from vertical and horizontal wind profiles measured by a Doppler lidar. The diurnal structure of the boundary layer in the UAE was very similar from day to day, with a deep, well-mixed boundary layer during the day transitioning to a shallow nocturnal layer, with the maximum boundary layer height usually being reached around 14:00 local time. Both SO2 and nucleation-mode aerosol particle concentrations were elevated for surface winds coming from the east or western sectors. We attribute this to oil refineries located on the eastern and western coasts of the UAE. The concentrations of larger cloud condensation nuclei (CCN)-sized particles and their activation fraction did not show any clear dependence on wind direction, but the CCN number concentration showed some dependence on wind speed, with higher concentrations coinciding with the weakest surface winds. Peaks in SO2 concentrations were also observed despite low surface wind speeds and wind directions unfavourable for transport. However, winds aloft were much stronger, with wind speeds of 10 m s−1 at 1 km common at night and wind directions favourable for transport; surface-measured concentrations increased rapidly once these particular layers started to be entrained into the growing boundary layer, even if the surface wind direction was from a clean sector. These conditions also displayed higher nucleation-mode aerosol particle concentrations, i.e. new particle formation events occurring due to the increase in the gaseous precursor.

Abstract Objective A growing body of evidence suggests patients with late‐onset seizures are at an increased risk of stroke, but the potential for reducing cardiovascular morbidity through risk factor screening and management is unknown. We aim to determine whether individuals with new‐onset unprovoked seizures after middle age should undergo vascular risk assessment. The long follow‐up needed to assess stroke risk and the known benefit of vascular risk factor modification make a standard RCT logistically and ethically challenging. Instead, we propose and have developed a protocol for a cluster project assessing the effect of vascular risk factor screening in an intervention trial as well as a cohort study. Methods Participating neurology clinics will implement standard cardiovascular risk factor assessment into the routine evaluation for individuals aged ≥50 years attending their first specialized consultation after an unprovoked seizure, excluding those with progressive brain disease. The project has two interlinked components: a prospective single group trial, in which risk factor assessment is performed and subsequent management is followed for one year; and a register‐based cohort study examining the long‐term effects of the intervention on a system level by comparing patients attending initial consultations in the 2 years after start of the study, with patients seen in the four preceding years at the same clinics. Analysis The primary outcome of the intervention trial is the proportion of patients receiving subsequent pharmacological treatment. The primary outcome of the cohort study is the incidence of acute stroke in the Swedish Stroke Register. Ethics and Dissemination Swedish Ethical Review Authority approval (which is valid for 2 years only) will be sought when funding is obtained. The results will be disseminated through peer‐reviewed scientific publications. Registration Details The study will be registered at clinicaltrials.gov. Plain Language Summary A first seizure in a middle‐aged or older person indicates a higher risk of stroke. It is not known whether investigating and treating blood pressure, blood cholesterol, or similar risk factors after a first seizure is an effective way to prevent stroke. A traditional clinical study would need too many patients and it would be unethical not to treat the control group. We have designed a study in which participating neurology departments change their practice to test and treat vascular risk factors. Patients are then compared to historic controls using registered data.

Abstract The aim of this study was to investigate how self-rated health (SRH) reflects ongoing ill-health and how SRH is associated with previous ill-health and/or predicts future ill-health such as burnout, disturbed sleep, and somatic symptoms. The study used two waves from the population-based Västerbotten Environmental and Health Study in which 2 336 adult persons participated by answering a questionnaire at two time points three years apart. Hierarchical and logistic regression analyses were conducted, thus treating all variables both continuously (degree) and categorically (case). The analyses were performed both cross-sectionally and longitudinally. The results showed bidirectionality between suboptimal SRH and burnout, disturbed sleep and somatic severity caseness. Moreover, degree of poor SRH was more likely to occur simultaneously to high degrees of burnout and somatic severity than to degree of poor sleep quality. Also, caseness of burnout, disturbed sleep and somatic severity increased the risk of simultaneous suboptimal SRH. Finally, the results showed that degree of burnout three years earlier, predicted degree of poor SRH, and that degree of poor SRH predicted degree of sleep three years later. In conclusion, in a population-based, normal adult sample there is a bidirectional relationship between suboptimal SRH and caseness of burnout, disturbed sleep quality and somatic symptoms, but not between degree of these symptoms. The results can have implications for health care meeting patients complaining about poor general health.

Abstract The healthy lifestyle index (HLI), defined as the unweighted sum of individual lifestyle components, was used to investigate the combined role of lifestyle factors on health-related outcomes. We introduced weighted outcome-specific versions of the HLI, where individual lifestyle components were weighted according to their associations with disease outcomes. Within the European Prospective Investigation into Cancer and Nutrition (EPIC), we examined the association between the standard and the outcome-specific HLIs and the risk of T2D, CVD, cancer, and all-cause premature mortality. Estimates of the hazard ratios (HRs), the Harrell’s C-index and the population attributable fractions (PAFs) were compared. For T2D, the HR for 1-SD increase of the standard and T2D-specific HLI were 0.66 (95% CI: 0.64, 0.67) and 0.43 (0.42, 0.44), respectively, and the C-index were 0.63 (0.62, 0.64) and 0.72 (0.72, 0.73). Similar, yet less pronounced differences in HR and C-index were observed for standard and outcome-specific estimates for cancer, CVD and all-cause mortality. PAF estimates for mortality before age 80 were 57% (55%, 58%) and 33% (32%, 34%) for standard and mortality-specific HLI, respectively. The use of outcome-specific HLI could improve the assessment of the role of lifestyle factors on disease outcomes, thus enhancing the definition of public health recommendations.

Abstract Background Studies indicate that brain clearance via the glymphatic system is impaired in idiopathic normal pressure hydrocephalus (INPH). This has been suggested to result from reduced cerebrospinal fluid (CSF) turnover, which could be caused by a reduced CSF formation rate. The aim of this study was to determine the formation rate of CSF in a cohort of patients investigated for INPH and compare this to a historical control cohort. Methods CSF formation rate was estimated in 135 (75 ± 6 years old, 64/71 men/women) patients undergoing investigation for INPH. A semiautomatic CSF infusion investigation (via lumbar puncture) was performed. CSF formation rate was assessed by downregulating and steadily maintaining CSF pressure at a zero level. During the last 10 min, the required outflow to maintain zero pressure, i.e., CSF formation rate, was continuously measured. The values were compared to those of a historical reference cohort from a study by Ekstedt in 1978. Results Mean CSF formation rate was 0.45 ± 0.15 ml/min (N = 135), equivalent to 27 ± 9 ml/hour. There was no difference in the mean (p = 0.362) or variance (p = 0.498) of CSF formation rate between the subjects that were diagnosed as INPH (N = 86) and those who were not (N = 43). The CSF formation rate in INPH was statistically higher than in the reference cohort (0.46 ± 0.15 vs. 0.40 ± 0.08 ml/min, p = 0.005), but the small difference was probably not physiologically relevant. There was no correlation between CSF formation rate and baseline CSF pressure (r = 0.136, p = 0.115, N = 135) or age (-0.02, p = 0.803, N = 135). Conclusions The average CSF formation rate in INPH was not decreased compared to the healthy reference cohort, which does not support reduced CSF turnover. This emphasizes the need to further investigate the source and routes of the flow in the glymphatic system and the cause of the suggested impaired glymphatic clearance in INPH.

Abstract Imbalances in electrolyte concentrations can have severe consequences, but accurate and accessible measurements could improve patient outcomes. The current measurement method based on blood tests is accurate but invasive and time-consuming and is often unavailable for example in remote locations or an ambulance setting. In this paper, we explore the use of deep neural networks (DNNs) for regression tasks to accurately predict continuous electrolyte concentrations from electrocardiograms (ECGs), a quick and widely adopted tool. We analyze our DNN models on a novel dataset of over 290,000 ECGs across four major electrolytes and compare their performance with traditional machine learning models. For improved understanding, we also study the full spectrum from continuous predictions to a binary classification of extreme concentration levels. Finally, we investigate probabilistic regression approaches and explore uncertainty estimates for enhanced clinical usefulness. Our results show that DNNs outperform traditional models but model performance varies significantly across different electrolytes. While discretization leads to good classification performance, it does not address the original problem of continuous concentration level prediction. Probabilistic regression has practical potential, but our uncertainty estimates are not perfectly calibrated. Our study is therefore a first step towards developing an accurate and reliable ECG-based method for electrolyte concentration level prediction—a method with high potential impact within multiple clinical scenarios.

Background: Older adults of low- and middle-income countries (LMICs) have a higher prevalence of mental health disorders compared to high-income countries, which can be attributed to a combination of social factors (such as isolation and loss of spouse), declining physical well-being, and the cumulative impact of life stressors, all of which contribute to an increased vulnerability in mental health. Objectives: The objective of this study was to determine the pooled prevalence of mental health disorders among older adults in LMICs and to identify community-based mental health intervention measures to tackle mental health problems in LMICs. Methods: Articles will be retrieved from databases such as PubMed, Scopus, and Cochrane Central using MeSH terms, keywords, and text words for each concept. Preprint search servers (MedRx, Cogprints, IndiaRxiv, medRxiv, and SSRN) will also be accessed. Data analysis will be conducted as per guidelines provided in the Handbook of Cochrane Systematic Review. RevMan version 5.4 software will be used for pooled analysis. Expected outcome: This systematic review will be able to identify the pooled prevalence of mental health among older adults and will also identify the evidence-based mental health intervention measures in community settings among older adults of LMICs.

Abstract The Cervical Screening Cohort enrols women screened for human papillomavirus (HPV) and cervical abnormalities within the capital region of Sweden from the organised screening program and the non-organised testing of cervical samples. The cohort started in 2011 and has enrolled more than 670,000 women, contributing with more than 1.2 million biobanked samples. The cohort is systematically updated with individual-level data from the Swedish National Cervical Screening Registry (NKCx). Key variables include birthdate, sampling date, cytological, histopathological and HPV analysis results, and invitation history. Each sampling and subsequent clinical follow-up is sequentially registered, allowing for longitudinal analyses of screening results and associated results of the clinical workup. The cohort is ideal for longitudinal, long-term follow-up studies due to its validated documentation and registry-derived information. From the data, it is possible to penetrate important human health mechanisms. The data are available as open-data and GDPR-compliant. Samples are available after getting the required permissions. Results will help researchers understand factors that increase cancer risk and other diseases.

Abstract Aims This study aimed to characterize a contemporary population with subtypes of incident or prevalent heart failure (HF) based on reduced (HFrEF), mildly reduced, or preserved (HFpEF) left ventricular ejection fraction (LVEF) and to assess how outcomes, healthcare, treatments, and healthcare costs vary between each subtype of incident HF. Methods and results Using Swedish data from the CardioRenal and Metabolic disease Heart Failure (CaReMe HF) study, updated to cover a more recent time period, this population‐based study characterized patients from Stockholm County, Sweden, with incident HF (patients with a first HF diagnosis between 1 January 2015 and 31 December 2019) or prevalent HF (patients with a first HF diagnosis before 1 January 2020). Patients with incident HF had LVEF measured by echocardiography within ±90 days of their first HF diagnosis, and patients with prevalent HF within 5 years prior to the index date. The 13 375 patients with prevalent HF (39.2% women, mean age 73.9 years) had multiple comorbidities (cardiovascular diseases, chronic kidney disease, diabetes, and cancer). These were already highly prevalent at the time of the first HF diagnosis in the 8042 patients with incident HF (40.5% women, mean age 72.3 years). Patients with incident HFpEF received less specialist HF care at outpatient secondary care facilities following their first HF diagnosis than those with incident HFrEF. Patients with HFrEF had higher risks of complications and exerted a higher burden, in terms of care for and costs of HF, on the healthcare system. Conclusions This study of contemporary patients with incident HF demonstrates that those with HFpEF and HFrEF differ considerably in terms of clinical presentation, prognosis, and care, highlighting a potential to improve HF outcomes.

BackgroundThe full spectrum of side effects from COVID-19 vaccinations and infections, including milder symptoms or health effects that do not lead to health care visits, remains unknown. Person-centered self-reporting of symptoms may offer a solution. Monitoring patient-reported outcomes over time will vary in importance for different patients. Individuals have unique needs and preferences, in terms of both communication methods and how the collected information is used to support care. ObjectiveThis study aims to describe how Symptoms, a system for person-centered self-reporting of symptoms and health-related quality of life, was utilized in investigating COVID-19 vaccine side effects. We illustrate this by presenting data from the Symptoms system in newly vaccinated individuals from the RECOVAC (Register-based large-scale national population study to monitor COVID-19 vaccination effectiveness and safety) study. MethodsDuring the COVID-19 pandemic, newly vaccinated individuals were identified as the ideal population to query for milder symptoms related to COVID-19 vaccinations and infections. To this end, we used posters in observation areas at 150 vaccination sites across the Västra Götaland region of Sweden, inviting newly vaccinated individuals to use a novel digital system, Symptoms. In the Symptoms system, users can track their symptoms, functioning, and quality of life as often as they wish, using evidence-based patient-reported outcome measures and short numeric rating scales. These scales cover a prespecified list of symptoms based on common COVID-19 symptoms and previously reported vaccine side effects. Participants could also use numeric rating scales for self-defined symptoms if their symptom was not included on the prespecified list. ResultsA total of 731 people created user accounts and consented to share data for research between July 21, 2021, and September 27, 2022. The majority of users were female (444/731, 60.7%), with a median age of 38 (IQR 30-47) years. Most participants (498/702, 70.9%) did not report any of the comorbidities included in the questionnaire. Of the 731 participants, 563 (77.0%) reported experiencing 1 or more symptoms. The most common symptom was pain at the injection site (486/563, 86.3%), followed by fatigue (181/563, 32.1%) and headache (169/563, 30.0%). In total, 143 unique symptoms were reported. Of these, 29 were from the prespecified list, while the remaining 114 (79.7%) were self-defined entries in the symptom field. This suggests that the flexibility of the self-directed system—allowing individuals to decide which symptoms they consider worth tracking—may be an important feature. ConclusionsSelf-reported symptoms in the Symptoms system appeared to align with previously observed post–COVID-19 vaccination symptoms. The system was relatively easy to use and successfully captured broad, longitudinal data. Its person-centered and self-directed design seemed crucial in capturing the full burden of symptoms experienced by users.

Artikkelissani analysoin visuaalisen historian ja sukupuolentutkimuksen teorioista sekä sotilassosiologiasta käsin sitä, minkälainen kuva suomalaisesta jatkosodan aikaisesta rajajääkäristä välittyy sotilaiden yksityisten albumeiden visuaalisten narratiivien sekä toisaalta TK-kuvien jermukuvissa aikakautena vallinneen miesihanteen näkökulmasta. Tutkin sitä, minkälaista sotilasidentiteettiä TK-kuvien osittaista sotilasstereotypiaa purkanut ohjesäännön vastainen pukeutuminen, jermuilu, sodan ajan epävirallisissa kuvissa rakensi. Tarkastelen jermukuvia kuvagenrenä armeijan virallisen ja epävirallisen organisaation leikkauspinnassa. Jermuilmiö kuvissa näyttäytyy sosiaalisena erontekona upseeriston ja rintamamiesten välillä, vastakulttuuriksi luokiteltavana kenttämuotina. Jermukuvien voidaan nähdä syntyneen tilannesidonnaisena huumorina osana rintaman pienoisyhteiskunnan sosiaalisia pienryhmiä. Kuvat rakentavat tietoisesti sotilasidentiteettiä ja osallistuvat välillisesti kansallisidentiteettien rakentamiseen. Jermuilmiö osoittaa säröä mutta myös mikrotason vuorovaikutusta armeijan virallisen ja epävirallisen organisaatiokulttuurin välillä. Se rakentaa upseeriston ja TK-kuvaajien osin vaaliman ihannesotilaan muotokuvan rinnalle vaihtoehtoista maskuliinisuutta, sankaruutta ja sotilasidentiteettiä. Ryhmäkiinteyttä vahvistaessaan huumorin keinon se on saattanut jopa kasvattaa joukon suorituskykyä. Artikkelini valottaa osaltaan maskuliinisuuden, emootioiden ja poliittisten ideologioiden leikkauspintaa ja valokuvan käyttöä sekä sosiaalisten identiteettien rakentamisen välineenä että historiantutkimuksen lähteenä. Maskuliinisuutta ja sankaristereotypiaa rakentavat kuvat asettuvat osaksi nationalistista diskurssia ja kollektiivista identiteettiä, kun taas sitä purkavat kuvat rikkovat lineaarista kansallista narratiivia; molemmilla oli funktio sotilaan mentaalisen selviämisen kannalta. Lisäksi kun rajajoukkoja voidaan perustellusti tarkastella suorituskykyisinä erikoisjoukkoina, jermuilmiö niiden kuvissa rakentaa kuvaa eräänlaisesta jermueliitistä. Drawing on visual history, gender theory, and military sociology, my interdisciplinary article examines the self-image of Finnish border jaegers during the Continuation War in the visual narratives of private photo collections, compared to the partially stereotypical heroism in the propaganda photos. I regard the so called jermu ('undisciplined soldier') photos as a genre that occurred in the intersection of the official and unofficial organisation cultures of the army, indicating social distinction between officers and frontier soldiers, thus including aspects of counterculture. They played a role in the context-dependent humour in the social groups on the front and participated in the construction of soldierly and national identities. Jermus as a phenomenon constructs alternative masculinity, heroism and Finnishness alongside the portrait of the ideal soldier. By means of humour it has relieved the reality on the front. Strengthening the unit cohesion, it may even have increased the military performance of the troop. My article shedlights the intersection of masculinity, emotions and political ideologies as well as the use of photography as a means of constructing social identities and as a historical source. The jermu photos participated and challenged in the national discourse, construcing an image of border troops as a jermu elite.