Sweden

Background: Bipolar disorders (BP) are frequently diagnosed and treated as pure depression initially; accurate diagnosis often being delayed by 8 to 10 years. In prospective studies, the presence of hypomanic symptoms in adolescence is strongly predictive of later bipolar disorders. As such, an instrument for self-assessment of hypomanic symptoms might increase the detection of suspected and of manifest, but under-treated, cases of bipolar disorders. Methods: The multi-lingual hypomania checklist (HCL-32) has been developed and is being tested internationally. This preliminary paper reports the performance of the scale in distinguishing individuals with BP (N = 266) from those with major depressive disorder (MDD; N = 160). The samples were adult psychiatry patients recruited in Italy (N = 186) and Sweden (N = 240). Results: The samples reported similar clinical profiles and the structure for the HCL-32 demonstrated two main factors identified as bactive/elatedQ hypomania and brisk-taking/irritableQ hypomania. The HCL-32 distinguished between BP and MDD with a sensitivity of 80% and a specificity of 51%. Limitations: Although the HCL-32 is a sensitive instrument for hypomanic symptoms, it does not distinguish between BP-I and BP-II disorders. 0165-0327/$ -see front matter D Conclusions: Future studies should test if different combinations of items, possibly recording the consequences of hypomania, can distinguish between these BP subtypes. D

Neurodevelopmental disorders affect a substantial minority of the general population. Their origins are still largely unknown, but a complex interplay of genetic and environmental factors causing disturbances of the central nervous system's maturation and a variety of higher cognitive skills is presumed. Only limited research of rather small sample size and narrow scope has been conducted in neurodevelopmental disorders using a twin-differences design. The Roots of Autism and ADHD Twin Study in Sweden (RATSS) is an ongoing project targeting monozygotic twins discordant for categorical or dimensional autistic and inattentive/hyperactive-impulsive phenotypes as well as other neurodevelopmental disorders, and typically developing twin controls. Included pairs are 9 years of age or older, and comprehensively assessed for psychopathology, medical history, neuropsychology, and dysmorphology, as well as structural, functional, and molecular brain imaging. Specimens are collected for induced pluripotent (iPS) and neuroepithelial stem cells, genetic, gut bacteria, protein-/monoamine, and electron microscopy analyses. RATSS's objective is to generate a launch pad for novel surveys to understand the complexity of genotype-environmentphenotype interactions in autism spectrum disorder and attention-deficit hyperactivity disorder (ADHD). By October 2013, RATSS had collected data from 55 twin pairs, among them 10 monozygotic pairs discordant for autism spectrum disorder, seven for ADHD, and four for other neurodevelopmental disorders.

Tourism is often identified as able to provide opportunities for indigenous populations. In northern Sweden, correspondingly tourism has been proposed to create employment opportunities and help preserve Sámi indigenous culture. Although there are numerous studies on the topic, they are lacking in a time dimension and comprehensiveness. Often they are based on limited case studies and narratives of those members of the indigenous population who have engaged in new activities successfully. Therefore, this work aims to investigate on a national scale how widespread are tourism occupations among reindeer herders and what are some of the characteristics of those engaged in them. This paper uses detailed census and population register data containing personal and professional information on reindeer herders in Sweden and their families spanning 50 years. The findings suggest that involvement in tourism is more common among reindeer herders than farmers. Moreover, involvement in tourism is highly gendered with women being more likely to be engaged in it. Findings also show that the type of tourism professions people are engaged in is more a result of the available geographical resource than an inherent inclination among reindeer herders to work with specific ields such as nature-based attractions.

Research on blockchain technology implementation within civil engineering is quickly emerging. The use of blockchain for the integration of the material and economic flows within construction supply chain – thus creating a new digital business model for the related actors – to enhance a construction project’s production, logistics management, and constructability, has been only scarcely investigated. In this paper, this shortage is documented through a comprehensive literature review. Then, the potential of Swedish independent third-party logistics consultants as a fertile ground for such a digital business model, is examined. Finally, conclusions about the pursuance of this potential paradigm shift are drawn.

Funding models influence provision and development of palliative care services. As palliative care integrates into mainstream health care provision, opportunities to develop funding mechanisms arise. However, little has been reported on what funding models exist or how we can learn from them. To assess national models and methods for financing and reimbursing palliative care. Initial literature scoping yielded limited evidence on the subject as national policy documents are difficult to identify, access and interpret. We undertook expert consultations to appraise national models of palliative care financing in England, Germany, Hungary, Republic of Ireland, New Zealand, The Netherlands, Norway, Poland, Spain, Sweden, Switzerland, the United States and Wales. These represent different levels of service development and a variety of funding mechanisms. Funding mechanisms reflect country-specific context and local variations in care provision. Patterns emerging include the following: Pr...

A control scheme on BVDV was launched in Sweden in 1993 with the aim to prevent spread of the infection between herds, to eliminate virus from infected herds and, ultimately, to eradicate BVDV from Sweden. At the start it was voluntary and fully financed by the affiliated farmers. The estimated prevalence of infected herds was 40%. After 11 years there were only 205 (0.9%) herds still under clearance. Measures perceived to be of importance in concluding the scheme are subsidies on costs for analyses, gradually making regulations for contacts between herds and prevention of indirect infection stricter and also to eventually make the scheme compulsory.

Background. The aim of this study was to explore difficulties at work from anaesthetists' own perspective and to examine how anaesthetists handle and cope with situations that are perceived as difficult and potentially stressful. Methods. Two sets of interviews were conducted with 19 specialist anaesthetists in Sweden. The first set of interviews aimed at finding how the anaesthetists experienced difficulties at work. It consisted of in-depth interviews based on one open-ended question. We analysed the interviews with a phenomenological method, looking for themes in anaesthetists' descriptions of difficulties at work. In the second set, the interviews were semi-structured with open-ended questions, based on themes found in the first interview set. These interviews aimed at exploring how the interviewees described their ways of handling difficulties and how they coped with potentially stressful situations. Results. Analysis of the first set of interviews resulted in five themes, describing how the anaesthetists experienced difficulties at work. All interviewees talked about difficulties related to more than one of the themes. The second set of interviews revealed two main categories of ways of handling difficulties. First, problem solving consisted of descriptions of methods for handling difficult situations which aimed at solving problems, and second, coping strategies described ways of appraising potentially stressful situations that minimized stress, despite the problem not being solved. Conclusions. The anaesthetists interviewed in this study maintained that they enjoyed work and could see no external obstacles to doing a good job. They had arrived at a reconciliation of their work with its inherent difficulties and problems. Getting access to their coping strategies might help young anaesthetists to come to terms with their work.

Sleep Duration and Central Obesity-Theorell-Haglöw et al SLEEP DURATION IN THE GENERAL POPULATION HAS DECREASED FROM 8.5 H TO 7.2 H OVER THE LAST 30 YEARS. 1,2 IN ADDITION, SLEEP COMPLAINTS ARE common, especially in women. 3 Parallel to the decrease in sleep duration, the prevalence of obesity has increased, with several studies finding associations between the two conditions. 4-7 An inverse relationship between self-reported sleep duration and obesity has been found in adult men and women, as well as in children. 8 Short sleep duration has also been found to predict weight gain and obesity later in life. 5,6 Previous studies have primarily focused on self-reported sleep duration in relation to obesity. 4-7,9-13 Self-reported sleep is a subjective measure in contrast to polysomnography, which allows for detailed analysis of sleep quantity and quality. Further, earlier studies have examined the association between sleep and body mass index (BMI), whereas the association between sleep and central obesity is less clear. Central obesity is a stronger risk factor than BMI for cardiovascular disease, type 2 diabetes mellitus, 14 and mortality. 15 Therefore, finding the underlying causes of central obesity and potentially modifiable risk factors is important. Recently, an association between measured sleeping time and waist circumference in elderly men has been reported, 16 but no data are available for women or younger populations. Furthermore, the role of sleep architecture is less clear. The aim of this study was therefore to use polysomnog-raphy to analyze potential associations between sleep duration, sleep stages, and central obesity in a population-based sample of women aged 20-70 years. By analyzing measured sleep duration and time spent in different sleep stages with polysomnography, this study may enhance our knowledge about the relationships between sleep duration, sleep stages, and central obesity in women. METHODS The two-phased, population-based study "Sleep and Health in Women" was conducted between 2000 and 2004. In the first phase, randomly selected women (aged ≥ 20 years) from the population registry of the city of Uppsala, Sweden were sent a questionnaire on sleep disturbances and somatic disorders. A total of 7,051 women responded, giving a response rate of 71.6%. Based on their response to a question on snoring, the participants were categorized into non-snorers (n = 6,515) and snorers (n = 518). In the second phase of the study a sample of 400 women, aged < 70 years (n = 6,112), were selected from the responders in the first phase. Of the 400 women, 230 were selected randomly from the snorers and 170 were selected randomly from the whole group. Such a sampling scheme was employed because one aim of the project "Sleep and Health in women" was to study the association between sleep-disordered breathing and glucose metabolism. Both phases of the study have been described in detail previously. 17,18 A flow chart of the study design is depicted in Figure 1. The women filled in questionnaires that included questions on somatic disease, medication, snoring, daytime sleepiness, physical activity, tobacco use, and alcohol consumption. The participants' physical activity was analyzed by 4 questions adopted from a questionnaire used in a large population-based study on the relationship between physical activity and mortality in women. 19 Based on the responses from 6 questions assessing smoking habits, 18 the participants were categorized as SHORT SLEEP DURATION AND CENTRAL OBESITY IN WOMEN

This qualitative study used the grounded theory method to investigate district nurses&#39; experiences of caring for leg ulcers in accordance with clinical guidelines at seven primary health care centres in Stockholm, Sweden. Group interviews were conducted with 30 nurses. The results describe how district nurses strive to stay on track in order to follow clinical guidelines and remain motivated despite prolonged wound treatment and feelings of hopelessness. Three main obstacles to following the guidelines were found. District nurses used compensating strategies so the obstacles would not lead to negative consequences. If the compensating strategies were insufficient, perceived prolonged wound treatment and feelings of hopelessness could result. District nurses then used motivating strategies to overcome these feelings of hopelessness. Sometimes, despite the motivating strategies, treatment in accordance with guidelines could not be achieved. With some patients, district nurses had ...

In a population-based case-referent study of urothelial cancer in Stockholm during 1985-87, information was obtained from 80% of 320 identified male cases and 79% of 363 selected male referents. Industrial exposures were assessed for each subject by an industrial hygienist on the basis of questionnaire data. Exposure to benzene (any annual dose) gave a relative risk (with 95% confidence interval) of 2.0 (I .&3.8). The highest risk was seen for a high annual dose. Subjects exposed to both diesel and petrol exhausts (moderatelhigh annual dose) had a relative risk of . However, adjusting for benzene changed the relative risk to 5. I (0.6-43.6). It might be rewarding to consider whether benzene from petrol confounds the associations previously suggested between exhausts and urothelial cancer. Exposure to polychlorinated biphenyls (PCB) gave a relative risk of 3.3 (0.618.4).

Previous studies have lacked sufficient power to assess associations between early-life socioeconomic position and adult cause-specific mortality. The authors examined associations of parental social class at age 0-16 years with mortality among 1,824,064 Swedes born in 1944-1960. Females and males from manual compared with nonmanual childhood social classes were more likely to die from smoking-related cancers, stomach cancer, respiratory disease, cardiovascular disease, and diabetes. Males from manual compared with nonmanual social classes were more likely to die from unintentional injury, homicide, and alcoholic cirrhosis. The association with stomach cancer was little affected by adjustment for parental later-life and own adult social class or education. For other outcomes, educational attainment resulted in greater attenuation of associations than did adjustment for adult social class. Early-life social class was not related to suicide or to melanoma, colon, breast, brain, or lym...

13 Concerns over exposure to airborne particulate matter (PM) are on the rise. 14 Contemporary monitoring of PM is done on the basis of interpolating a mass of PM by 15 volume (μg/m 3 ) but has the drawback of not taking the chemical nature of PM into 16 account. Here we propose a method of collecting PM at its emission source and 17 employing automated analysis with scanning electron microscopy associated with EDS-18 analysis together with light scattering to discern the chemical composition, size 19 distribution, and time and space resolved structure of PM emissions at an intensely 20 trafficated roundabout in Sweden. Multivariate methods (PCA, ANOVA) indicate that 21 the technogenic marker Fe follows roadside dust in spreading from the road, and 22 depending on time and location of collection, a statistically significant difference can be 23 seen, adding a useful tool to the repertoir of detailed PM monitoring and risk assessment 24 of local emission sources. 25 26 Comment [v1]: Reference still missing Comment [29942]: Olika stavningar Comment [29943]: Olika stavningar

We report a family with autosomal dominant centronuclear (myotubular) myopathy caused by a novel mutation, p.A618D, in dynamin 2 (DNM2). The 64-year-old mother and 26-year-old daughter had neonatal onset with hypotonia and weak suckling, followed by improvement, then slowly progressive muscle weakness and respiratory restriction. Muscle biopsy showed radial sarcoplasmic strands around the frequent central nuclei. Electrophysiology revealed predominantly myopathic patterns without peripheral nerve involvement. Centronuclear myopathy with neonatal onset caused by a DNM2 mutation in the C-terminal part of the pleckstrin homology domain may have a favorable prognosis and follow a course similar to adult-onset centronuclear myopathy. We advise respiratory follow-up in these patients.

Hypohidrotic ectodermal dysplasia (HED) is a genetic disorder characterized by defective development of teeth, hair, nails and eccrine sweat glands. Both autosomal dominant and autosomal recessive forms of HED have previously been linked to mutations in the ectodysplasin 1 anhidrotic receptor (EDAR) protein that plays an important role during embryogenesis. The coding DNA sequence of the EDAR gene was analyzed in two large Swedish three-generational families with autosomal dominant HED. A non-sense C to T mutation in exon 12 was identified in both families. This disease-specific mutation changes an arginine amino acid in position 358 of the EDAR protein into a stop codon (p.Arg358X), thereby truncating the protein. In addition to the causative mutation two polymorphisms, not associated with the HED disorder, were also found in the EDAR gene. The finding of the p.Arg358X mutation in the Swedish families is the first corroboration of a previously described observation in an American f...

There has been concern that the availability of alternative less harmful forms of nicotine might inhibit smoking cessation and/or encourage those who would not otherwise have smoked to do so. The plausibility of such effects can be best assessed by looking at population trends in use of smoking in relation to alternatives. This paper looks at the relationships between snus use and smoking in Sweden. Analyses are based on a data set for the period January 2003 to February 2011 from a long-term study covering nationally representative samples of the Swedish population aged 18-79, with a total study population of 60,675 individuals. Questionnaires made it possible to identify detailed tobacco use categories and use trajectories. The results showed that uptake of snus use is much more common in males than females. Those who began daily tobacco use using snus were much less likely to subsequently take up smoking than those who had not, both among males (17.6% vs. 45.9%), and females (8.2% vs. 40.2%). Further, among those who started using snus after starting as smokers, 76.3% of men and 71.6% of women had stopped smoking completely, including 31.5% of the men and 28.6% of the women who had quit all forms of tobacco. Indeed, those who were primary snus users were also more likely to have quit altogether than those who only ever smoked. Snus was also reported as the most common smoking cessation aid among men and yielded higher success rates than nicotine replacement therapy and other alternatives. As conclusions, snus has both contributed to decreasing initiation of smoking and, when used subsequent to smoking, appears to facilitate smoking cessation. All these effects suggest that the availability and use of snus has been a major factor behind Sweden's record-low prevalence of smoking and the lowest level of tobacco-related mortality among men in Europe.

In this introductory essay, we build on the articles in this special issue to provide a novel theoretical framework for the understanding of current and future trends in the digitalisation of teaching and learning in Nordic higher education (HE). We highlight three key elements. Context is critical and should be systematically expanded to include not only the immediate context of the virtual and blended classroom, but also the broader organisational and national contexts within which digital learning takes place. The involvement of individual actors, higher education institutions and national policy-making agencies in the development and implementation of digitalisation policy ideas and practices is also shaped by multiple mediations, which include the mediating role of technology itself, but also of other human, organisational and policy actors, ideas and practices. Finally, digitalisation of HE teaching and learning can lead to a variety of gradual or more radical digital transformations, operating at multiple scales and with multiple potential positive or negative effects. This framework helps put into focus the key question of how to go about searching for a flexible set of "Nordic characteristics" that might affect digitalisation of teaching and learning in the Nordic region, albeit in uneven and diverse ways. While it is too early to provide a systematic analysis of the impact of the rapid digitalisation of Nordic HE teaching and learning spurred by the Covid-19 pandemic, we make some preliminary observations that offer this emerging theoretical framework as a way to assess these trends both before and after the pandemic.

Wastewater treatment sludge contains valuable nutrients, yet represents a residue problem due to the amount of heavy metals, which is one of the factors preventing the use of sludge as fertilizer. In Sweden, the government has a declared aim of closing the ecocycles of nutrients to arable land, while at the same time the existing limit values are among the lowest in the world. This paper focuses on the opportunities for Swedish wastewater utilities (WWUs) to manage and reduce sources of heavy metals in order to get sludge approved and recycled.

Background: National, regional and local activities to improve patient safety in Sweden have increased over the last decade. There are high ambitions for improved patient safety in Sweden. This study surveyed health care professionals who held key positions in their county council's patient safety work to investigate their perceptions of the conditions for this work, factors they believe have been most important in reaching the current level of patient safety and factors they believe would be most important for achieving improved patient safety in the future. Methods: The study population consisted of 218 health care professionals holding strategic positions in patient safety work in Swedish county councils. Using a questionnaire, the following topics were analysed in this study: profession/occupation; number of years involved in a designated task on patient safety issues; knowledge/overview of the county council's patient safety work; ability to influence this work; conditions for this work; and the importance of various factors for current and future levels of patient safety.

This article discusses how large lottery winnings are experienced and used by the winners. The study draws on a survey of 420 Swedish winners, which is analysed against the background of previous research from the USA and Europe. The analyses show that winners are cautious about realizing any dreams of becoming someone else somewhere else. This result contradicts theories suggesting that identities are being liquefied by the commercially driven consumer culture in affluent Western societies. In contrast, the article concludes that winners generally try to stay much the same, but on a somewhat higher level of consumption.

Spatial patterning of ecosystems can be explained by several mechanisms. One approach to disentangling the influence of these mechanisms is to study a patterned ecosystem along a gradient of environmental conditions. This study focused on hummock-hollow patterning of peatlands. Previous models predicted that patterning in drainage-dominated peatlands is driven by a peat-accumulation mechanism, reflected by higher nutrient availability in hollows relative to hummocks. Alternatively, patterning in evapotranspiration (ET)-dominated peatlands may be driven by a nutrient-accumulation mechanism, reflected by reversed nutrient distribution, namely, higher nutrient availability in hummocks relative to hollows. Here, we tested these predictions by comparing nutrient distributions among patterned peatlands in maritime (Scotland), humid temperate (Sweden), and humid continental (Siberia) climates. The areas comprise a climatic gradient from very wet and drainage-dominated (Scotland) to less wet and ET-dominated (Siberia) peatlands. Nutrient distribution was quantified as resource contrast, a measure for hummock-hollow difference in nutrient availability. We tested the hypothesis that the climatic gradient shows a trend in the resource contrast; from negative (highest nutrient availability in hollows) in Scotland to positive (highest nutrient availability in hummocks) in Siberia. The resource contrasts as measured in vegetation indeed showed a trend along the climatic gradient: contrasts were negative to slightly positive in Scotland, positive in Sweden, and strongly positive in Siberia. This finding corroborates the main prediction of previous models. Our results, however, also provided indications for further model development. The low concentrations of nutrients in the water suggest that existing models could be improved by considering both the dissolved and adsorbed phase and explicit inclusion of both nutrient-uptake and nutrient-storage processes. Our study suggests that future climate change may affect the ecosystem functioning of patterned peatlands by altering the contribution of pattern-forming mechanisms to redistribution of water and nutrients within these systems.

Biosecurity measures are important tools to maintain animal health in pig herds. Within the MINAPIG project, whose overall aim is to evaluate strategies to raise pigs with less antimicrobial use, biosecurity was evaluated in medium to large farrow-to-finish pig herds in Sweden. In 60 farrow-to-finish herds with more than 100 sows, the biosecurity level was evaluated using a previously developed protocol (BioCheck). In a detailed questionnaire, internal and external biosecurity was scored in six subcategories each. An overall score for biosecurity was also provided. Information regarding production parameters as well as gender and educational level of personnel working with the pigs was also collected. Descriptive statistics were used to examine the recorded data. The median scores for external and internal biosecurity were 68 and 59, respectively, where 0 indicates total absence of biosecurity and 100 means maximal possible biosecurity. The subcategories for external and internal bi...

Physical and psychological health and social relations in patients with prolonged musculoskeletal disorders The purpose of this study was to describe and analyse the relationship between physical and psychological health and social relations in patients with prolonged musculoskeletal disorders in primary care. Seventy-eight patients ± 64 women and 14 men ± were included in the study. Data from a semi-structured interview called addiction severity index (ASI), frequently used in psychiatric and drug abuse research and a visual analogue scale (VAS) symptom list as well were analysed using principal component analysis (PCA). The analysis gave a two-dimensional model with four poles of related variables characterizing the whole group. The ®rst dimension consisted of one pole charac-terized by present psychiatric symptoms and many somatic symptoms. The second pole on this dimension was characterized by well-being, having work and feeling satisfaction with life. One pole on the second dimension was characterized by severe physical problems, related to sick leave and disability pension. The opposite pole on this dimension was characterized by severe psychiatric symptoms earlier in life and present relationship problems with family and other people. The ASI-instrument was considered to be relevant for describing important problem areas in patients with prolonged musculoskeletal disorders.

Background and purpose: Some types of radiation therapy have been associated with an increased risk of cardiac mortality and morbidity in patients with early-stage breast cancer. A relationship has been observed between cardiac radiation dose-volume and the level of excess risk of cardiac mortality. However, relatively few data are available on the morbidity from myocardial infarction associated with adjuvant radiotherapy.

Deep-water oxygen concentrations in the Baltic Sea are influenced by eutrophication, but also by saltwater inflows from the North Sea. In the last two decades, only two major inflows have been recorded and the lack of major inflows is believed to have resulted in a long-term stagnation of the deepest bottom water. Analyzing data from 1970 to 2000 at the basin scale, we show that the estimated volume of water with oxygen, <2 mL L -1 , was actually at a minimum at the end of the longest so-called stagnation period on record. We also show that annual changes in dissolved inorganic phosphate water pools were positively correlated to the area of bottom covered by hypoxic water, but not to changes in total phosphorus load, thus addressing the legacy of eutrophication on a basinwide scale. The variations in phosphorus pools that have occurred during the past decades do not reflect any human action to reduce inputs. The long residence time and internally controlled variation of the large P pool in the Baltic Sea has important implications for management of both N and P inputs into this eutrophicated enclosed basin.

Objective. To estimate the nationwide incidence of rheumatoid arthritis (RA) in Sweden, including its variation across age, sex, geography, and demography, and to describe the sensitivity of register-based incidence estimates to different RA case definitions. Methods. Incident RA patients were identified using the Swedish National Patient Register. In the base case, incident RA was defined as first-ever inpatient or nonprimary outpatient care visit listing an RA diagnosis in 2006 -2008, with a second visit listing RA within 1 year. Patients prescribed disease-modifying antirheumatic drugs more than 6 months prior to the first visit listing RA were not regarded as incident. The robustness of this definition was evaluated by more liberal and strict criteria, and by penetration of antirheumatic treatment. individuals were identified as incident RA patients. The overall incidence was 41 per 100,000 (56 for women, 25 for men). The incidence increased with age and peaked in the 70 -79 years age group for both women and men. The age-and sex-standardized incidences were lower in densely populated areas and in individuals with high educational level. No geographic trends were noted. More liberal and strict definitions of RA only altered the observed incidence by approximately 14%. Conclusion. The overall nationwide register-based incidence of RA was robust across different case definitions. In a country with universal access to care, RA displayed demographic and socioeconomic, but no geographic, variations in incidence, and peaks at an older age than most commonly reported, with no difference in peak age at RA onset between sexes.

j Abstract Background The aim of this study was to investigate the prevalence of self-reported social phobia in a community sample of Swedish adolescents in junior high school, at the risk-period for developing social phobia. Of particular interest was to investigate gender differences in prevalence across ages. Prevalence of sub-threshold social phobia was also studied. Methods Students in grades 6-8 (aged 12-14) from seventeen schools in five Swedish municipalities were screened by means of a self-report questionnaire, the social phobia screening questionnaire-for children (SPSQ-C). Results Data from a sample of 2,128 students were analysed and showed a point-prevalence rate of 4.4% (95%CI 3.5-5.2) and a significant gender difference (6.6% girls vs.

Background: The costs of care for patients with Alzheimer's disease are correlated with key measures of disease severity. This relationship is important in the economic evaluation of new treatments and is used to translate treatment efficacy into effects on costs through economic modeling. We aimed to identify what measures of disease severity are the most important predictors of societal costs of care and whether their relationship differs across countries. Methods: Interviews were conducted with 1222 patient and caregiver pairs residing in the community or in residential care settings in Spain, Sweden, United Kingdom, and the United States. Assessments included costs of care (Resource Utilization in Dementia) and key disease severity measures: cognitive function (Mini-Mental State Examination), ability to perform Activities of Daily Living (ADL-ability, Disability Assessment for Dementia [DAD]), and behavioral symptoms (Neuropsychiatry Inventory (NPI)-severity). Results: ADL-ability was the most important predictor of societal costs of care of communitydwelling patients in all countries. A one-point decrease in DAD resulted in a 1.4% increase in costs of care in Spain, United Kingdom, and the United States on average, and a 2% increase in Sweden. This translated into a 45% increase from a standard deviation decrease in DAD on average. NPIseverity and Mini-Mental State Examination were also significant predictors but with lesser effect. Although mean costs of care differed across countries, the important predictors were the same. Conclusion: ADL-ability is the most important predictor of societal costs of care in community dwellings irrespective of country and should therefore be central in the economic evaluation of Alzheimer's disease therapies.

Summary: This article discusses the Swedish discourse on futures studies in the late
1960s and early 1970s. It focuses on the futures discourse of the group appointed by
the Prime Minister, Olof Palme, in 1967 under the chairmanship of Alva Myrdal.
The Swedish futures discourse focused on futures studies as a democratic means of
reform in defence of the Swedish model and ‘‘Swedish’’ values of solidarity and
equality, in opposition to an international futurology dominated by the Cold War
and dystopic narratives of global disaster. The article suggests that the creation of
Swedish futures studies, culminating in a Swedish institute for futures studies, can
be seen as a highpoint of postwar planning and the Swedish belief in the possibility
of constructing a particularly Swedish future from a particularly Swedish past.

Background: Interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT) are both evidence-based treatments for major depressive disorder (MDD). Several head-to-head comparisons have been made, mostly in the United States. In this trial, we compared the two treatments in a small-town outpatient psychiatric clinic in Sweden. The patients had failed previous primary care treatment and had extensive Axis-II comorbidity. Outcome measures were reduction of depressive symptoms and attrition rate. Methods: Ninety-six psychiatric patients with MDD (DSM-IV) were randomized to 14 sessions of CBT (n = 48) or IPT (n = 48). A noninferiority design was used with the hypothesis that IPT would be noninferior to CBT. A three-point difference on the Beck Depression Inventory-II (BDI-II) was used as noninferiority margin. Results: IPT passed the noninferiority test. In the ITT group, 53.5% (23/43) of the IPT patients and 51.0% (24/47) of the CBT patients were reliably improved, and 20.9% (9/43) and 19.1% (9/47), respectively, were recovered (last BDI score <10). The dropout rate was significantly higher in CBT (40%; 19/47) compared to IPT (19%; 8/43). Statistically controlling for antidepressant medication use did not change the results. Conclusions: IPT was noninferior to CBT in a sample of depressed psychiatric patients in a community-based outpatient clinic. CBT had significantly more dropouts than IPT, indicating that CBT may be experienced as too demanding. Since about half the patients did not recover, there is a need for further treatment development for these patients. The study should be

G protection in the 39 Gripen aircraft is provided by a full coverage anti-G suit, a pressure-breathing system, and anti-G straining maneuvers (AGSM). The purpose was to study (1) the interaction of pressure breathing and AGSM while wearing an anti-G suit; and (2) the G-protective properties of the anti-G suit alone and in combination with the pressure-breathing system. During rapid onset rate G-time profiles (&lt; or =9 G), 10 subjects were investigated in 5 conditions: (I) sitting relaxed, without any G-protective garment; (II) sitting relaxed and wearing an anti-G suit; (III) sitting relaxed, wearing an anti-G suit, and pressure breathing; IV) wearing an anti-G suit and performing AGSM; and V) wearing an anti-G suit, pressure breathing, and performing AGSM. In supplementary experiments (n=9), the share of the anti-G suit protection afforded by the abdominal bladder was investigated. G tolerance was 3.4 Gz (range: 2.8-4.3) in condition I, &gt; or = 6.5 Gz (4.5-9.0) in II, &gt; or ...

The co-occurrence of autoimmune diseases such as rheumatoid arthritis (RA) and type 1 diabetes mellitus (DM) has been reported in individuals and families. In this study, the strength and nature of this association were investigated at the population level in a Swedish case-control cohort. Methods. For this case-control study, 1,419 patients with incident RA diagnosed between 1996 and 2003 were recruited from university, public, and private rheumatology units throughout Sweden; 1,674 matched control subjects were recruited from the Swedish national population registry. Sera from the subjects were tested for the presence of antibodies to cyclic citrullinated peptide (anti-CCP), rheumatoid factor (RF), and the 620W PTPN22 allele. Information on a history of diabetes was obtained by questionnaire, telephone interview, and/or medical record review. The prevalence of type 1 DM and type 2 DM was compared between patients with incident RA and control subjects and further stratified for the presence of anti-CCP, RF, and the PTPN22 risk allele. Results. Type 1 DM was associated with an increased risk of RA (odds ratio [OR] 4.9, 95% confidence interval [95% CI] 1.8-13.1), and this association was specific for anti-CCP-positive RA (OR 7.3, 95% CI 2.7-20.0), but not anti-CCP-negative RA. Further adjustment for the presence of PTPN22 attenuated the risk of anti-CCP-positive RA in patients with type 1 DM to an OR of 5.3 (95% CI 1.5-18.7). No association between RA and type 2 DM was observed. Conclusion. The association between type 1 DM and RA is specific for a particular RA subset, anti-CCPpositive RA. The risk of developing RA later in life in patients with type 1 DM may be attributed, in part, to the presence of the 620W PTPN22 allele, suggesting that this risk factor may represent a common pathway for the pathogenesis of these 2 diseases. Autoimmune diseases such as rheumatoid arthritis (RA) and type 1 diabetes mellitus (DM) have been observed to co-occur within individuals and families (1-4). Although the exact etiologies of RA and type 1 DM are unknown, they are likely attributable to a combination of genetic susceptibility and interactions between environmental risk factors and genes. Thus far, one established genetic risk factor is shared by RA and type 1 DM: the 620W allele of the protein tyrosine phosphatase N22 gene (PTPN22) (5-9). Other genes involved in the pathogenesis of RA and type 1 DM have

The horse industry in Sweden has rapidly expanded in recent years. This increasing number of horses implies a greater need for more farriers. Shoeing a horse is hard physical work, and includes awkward work postures and repetitive movements. It is well known that hard physical work increases the risk of injuries and musculoskeletal problems. The risk is especially high for musculoskeletal disorders when certain movements are constantly repeated. Heavy or repeated unilateral loads lead to considerable stress on the muscles, which can lead to rupture and fatigue that can cause long term problems. A case study showed that farriers worked 75% of their work time with their backs in bent positions (often more than 70 degrees). Farriers are also exposed to risk factors in their physical environment like dust, noise and poor lighting. Risk of kicks and bites, eye injuries and burns are other factors that make their work environment hazardous. There are only a few studies available that have...