Swedish Case Research Articles

Candidate genetic loci modifying the colorectal cancer risk caused by lifestyle risk factors

Objective: 65-70% of colorectal cancer (CRC) cases are considered sporadic; they arise under the influence of environmental factors in individuals lacking a family history of CRC. Low-risk genetic variants are believed to contribute to CRC risk, in tandem with lifestyle factors. Design: 616 non-familial Swedish CRC cases with at least 1 of the following five risk factors: smoking, excessive alcohol consumption, physical inactivity, adherence to an unhealthy diet, and excess body weight were included in this study. A control group consisting of 1642 healthy individuals was used. Cases and controls were genotyped from blood samples at the Centre for Inherited Disease Research at Johns Hopkins University within the Colorectal Transdisciplinary Study (CORECT) research collaboration, using the Illumina Infinium® OncoArray-500 K BeadChip. Five separate genome-wide haplotype association analyses were performed, one for each risk factor. Logistic regression models were employed to estimate associations between haplotypes (exposure) and CRC (outcome) in cases with lifestyle risk factors versus controls. Haplotypes with an odds ratio (OR) >1 were considered candidate risk markers, denoting an area of interest in the genome. A significance threshold of p < 5×10-8 was used. Results: We found 17 haplotype regions significantly associated with CRC in cases vs controls. Several regions included genes linked to inflammation and tumor promotion. Conclusion: We concluded that having certain genetic variants was associated with an increased risk of CRC compared to healthy controls among cases with known lifestyle risk factors. The interplay of lifestyle and genetic risk factors calls for further elucidation.

Monkeypox 2024 outbreak: Fifty essential questions and answers.

As the world still vividly recalls the previous monkeypox (mpox) outbreak that impacted over 120 countries worldwide with more than 99,000 cases in 2022, we are now facing a second wave of infections from the monkeypox virus (MPXV), characterized by an exponential increase in cases. The current 2024 outbreak has already recorded more than 20,000 cases in Africa, marking a dramatic escalation compared to previous outbreaks. The predominance of the newly identified clade Ib variant, first detected in the Democratic Republic of the Congo (DRC) and now identified across multiple African nations and beyond, underscores its enhanced transmissibility and potential for international spread, evidenced by cases in Sweden and Thailand. The World Health Organization (WHO) declared on August 14, 2024, the current mpox outbreak a Public Health Emergency of International Concern (PHEIC), calling for heightened global public health measures. The ongoing pattern of unusual, frequent, and extensive outbreaks of mpox with potential global implications poses significant questions. This review addresses, in the format of 50 questions and answers, the 2024 mpox outbreak, detailing its characteristics, epidemiological data, and impact compared to previous outbreaks. It comprehensively explores critical questions related to MPXV virological characteristics, immunological response, clinical manifestations, epidemiology, diagnostics, and available treatments. The review also documents the significant and evolving challenges posed by the current mpox outbreak, highlighting its scale, spread, and public health response.

The Investigation of Online Child Sexual Abuse Cases in Sweden

The Investigation of Online Child Sexual Abuse Cases in Sweden

A Framework for Upgrading Contaminated Urban Land and Soil by Nature-Based Solutions: Demonstration with a Swedish Case

To move towards a circular economy and to meet the upcoming EU soil health legislation, both contaminated land and contaminated soil should be acknowledged as fragile and valuable resources to be restored and recycled to provide essential ecosystem services to humans. Underused, often contaminated land can be returned to beneficial use as urban greenspace (UGS) with the help of gentle remediation options (GROs). GROs are plant-, fungi-, bacteria-, and soil amendments-based risk management mechanisms that can also simultaneously improve soil functions and the provision of ecosystem services. This study (i) presents a framework including tools and methods for exploring opportunities for transforming brownfields to UGS using GROs to deal with soil contamination, (ii) demonstrates its application for a case study site in Gothenburg, Sweden, and (iii) presents stakeholders’ views on the suggested framework. This framework can support the transition of brownfields to UGS while recycling both land and soil and increasing the market value of the site and its surroundings. Stakeholders found the suggested framework useful but identified some challenges for its practical implementation, mainly associated with financial aspects and the existing practice and level of knowledge. Stakeholders also identified the need for additional practical tools to (a) make predictions about the time required for GROs to reach acceptable risk levels, (b) monetize non-market benefits such as ecosystem services for communicating benefits to decision-makers, and (c) provide support for plant and soil amendment selection for various GROs and contaminants.

Discourse(s) of inclusion in adult education curricula – the case of Sweden

ABSTRACT This article explores historical shifts in the discourse of inclusion in the policy of Swedish Municipal Adult Education (SMAE). Drawing on Foucauldian concepts of discourse, governmentality, and subjectivity, a critical discourse analysis was conducted on the so far three existing curricula for SMAE. A positive shift in language use was established in the three historical discourses revealed in the analysis. However, the three discourses share a common feature of understanding inclusion through the perspective of ‘deficit’ and ‘othering’, as well as governing through a controlling exercise of state’s power through different demands of responsibility. The findings point to the need of a new understanding of inclusion in SMAE in which diversity and individual characteristics for learning are central concepts.

A Genome-Wide Association Study (GWAS) of Takotsubo syndrome

Abstract Background Takotsubo syndrome (TS) is an acute cardiac condition of unknown etiology characterized by transient regional systolic dysfunction of the left and/or right ventricle. Several studies have suggested the importance of genetics; however, studies are limited and have presented conflicting results. Purpose To identify potential genetic risk variants associated with TS. Methods A case-control GWAS in three steps; I) A discovery study with Swedish takotsubo cases (n=260) and age- and sex-matched controls without heart disease from the UK Biobank (n=3034), II) A replication study of Swedish takotsubo cases (n=250) and sex- and age-matched Swedish controls without myocardial infarction from the Swedish coronary angiography and angioplasty register (n=229), III) A Meta-analysis of study I-II with extended controls from the UK-biobank (n=5161). Genotyping was performed using the Axiom® UK Biobank Genotyping Array including 820 000 single nucleotide polymorphisms (SNPs). After applying filters and QC control around 480 000 SNPs remained with a Bonferroni corrected p-value 1*10^-7, minor allele frequency (MAF 1.5-2%), Hardy-Weinberg (HWE) 10^-6. QC, filtering and analysis were performed in PLINK 1.9 and R v 4.0. Results In the discovery (I) 1490 SNP:s fulfilled a significance level of <10^-4, of which 36 SNP:s replicated (II) with a significance level of <10^-2, 11 reached a significance level of 10^-7 in the meta-analysis (III). One of the 36 SNP:s, rs1614887, replicated (II) with a significance level of 10^-3. This SNP is an intron variant in the butyrophilin subfamily 2 member A2 gene, a glycoprotein receptor involved in lipid, fatty-acid and sterol metabolism highly expressed in the heart. Of the 11 SNP:s with a significance level of 10^-7 in the meta-analysis (III) several risk variants were associated with psoriasis. Conclusions This is the largest GWAS of takotsubo syndrome performed so far, identifying one candidate gene and several potential risk variants. Further research of genetic risk variants in TS is warranted.

Participatory topological mapping: A novel approach for exploring and communicating situated knowledge of complex socio-ecological systems

Land use change impacts on Sámi reindeer husbandry are well-documented, but existing maps often fail to capture socio-ecological relationships between herders, reindeer and nature. Conventional Geographic Information Systems (GIS) simplify these relationships, lacking local context and excluding valuable knowledge due to their rigid structure. This paper introduces participatory topological mapping, a low-tech, knowledge co-production method that allows communities to share geospatial insights without advanced software. Combining hand-drawn maps with a standardised topological structure facilitates the visualisation of geographical relationships and dynamic land use systems from a local perspective. Developed and assessed through a Swedish case study in collaboration with Vittangi and Malå reindeer herding communities, the method aims to reduce barriers to knowledge exchange and enhance dialogue between Indigenous knowledge-holders, researchers and decision-makers. The paper discusses the authors’ experiences with participatory topological mapping, emphasising its potential and limitations for knowledge exchange. The method is advocated for broader use, recognising its value in articulating concerns about land use change beyond research settings and reindeer husbandry. Participatory topological mapping enables knowledge-holders to control the map and its narrative, deciding what is included or excluded. The maps and accompanying stories are valuable sources for documenting, sharing and analysing local perspectives on landscapes and the effects of land use change. The method treats mapping as a social process with the potential to affect how we understanding the world. When thoughtfully applied, it offers a valuable avenue for knowledge co-production, fostering deeper engagement, supporting informed decision-making and empowering communities.

Policy risks in the biogas sector – the case of Sweden

Policy is decisive to stimulate biogas expansion; but policy-related factors may also inhibit the development. This study explores policy risks in the Swedish biogas sector and identifies strategies to mitigate these risks. The study is based on three workshops and a survey with participation of biogas stakeholders. The findings reveal that two major policy risks significantly impact the Swedish biogas sector: the ‘lack of long-term strategies’ and the ‘long and complicated permitting processes.’ ‘Limitations of permitted feedstocks’ and ‘limited system perspective—benefits of circular economy and sustainable food system’ are also among the most probable risks. More clearly defined roles for authorities at different administrative levels and the promotion of life cycle perspectives are critical to mitigate these risks. The research emphasizes that both EU and national governments play vital roles in reducing policy risks through predictable and long-term biogas strategies. Without these interventions, the potential of the Swedish biogas sector may remain underutilized.

Public right of access to private land: examples and considerations

ABSTRACT Public right of access, everyman’s or everyone's right, freedom to roam, right of public access to the wilderness and the right to roam are terms used for concepts that give people an independent right of access to forest land and rural areas for recreational or passage purposes. Access is not a self-evident right nor are the practices in different countries resolved alike. In this paper, we review how the public right of access is resolved in different countries, with a focus on cases in Sweden and Finland. We highlight problems that arise when the right of access enables extensive use of the land by the public and may make everyone’s right prone to features related to the tragedy of the commons. We find that the code regarding public access depends largely on cultural, historical, and political differences and thus has no international or unambiguous definition as to what it includes or should include. The concept has worked considerably well throughout time but, as the original reasons for the right have waned and recreational use and demand have increased, the question has been raised whether everyone’s right should be redefined to prevent complications between users and landowners.

Whole system impacts of decarbonising transport with hydrogen: A Swedish case study

This study aims to carry out a techno-economic analysis of different hydrogen supply chain designs coupled with the Swedish electricity system to study the inter-dependencies between them. Both the hydrogen supply chain designs and the electricity system were parameterized with data for 2030. The supply chain designs comprehend centralised production, decentralised production, a combination of both, and with/without seasonal variation in hydrogen demand. The supply chain design is modelled to minimize the overall cost while meeting the hydrogen demands. The outputs of the supply chain model include the hydrogen refuelling stations' locations, the electrolyser's locations and their respective sizes as well as the operational schedule. The electricity system model shows that the average electricity prices in Sweden for zones SE1, SE2, SE3 and SE4 will be 4.28, 1.88, 8.21, and 8.19 €/MWh respectively. The electricity is mainly generated from wind and hydropower (around 42% each), followed by nuclear (14%), solar (2%) and then bio-energy (0.3%). In addition, the hydrogen supply chain design that leads to a lower overall cost is the decentralised design, with a cost of 1.48 and 1.68 €/kgH2 in scenarios without and with seasonal variation respectively. The seasonal variation in hydrogen demand increases the cost of hydrogen, regardless of the supply chain design.

Categorization, identification, and analysis of barriers to market growth in biogas solutions – The case of Sweden

Market growth for biogas solutions is important for climate change mitigation since it enables both effective waste management and a reduction of fossil fuel use. The aim of this paper is twofold. First, based on a discussion on previous research, a categorization of barriers to market growth in biogas solutions is developed. Second, the categorization is used to identify and analyze barriers within the Swedish market. The results show that market growth in Sweden has been reduced by the presence of multiple barriers such as regulatory uncertainties related to taxes and public policy instruments, lack of public funding, lengthy permit and planning processes, increased competition from electrification, lack of communication about biogas benefits, lobbying against biofuels, too high a price on biogas, and fierce competition from fossil fuels. The paper concludes with a discussion of contributions and the managerial and policy implications.

Governance dynamics and local autonomy in large-scale governmental funding: The case of Sweden’s campaign to improve equity

This article analyses the Swedish case of the government’s funding for equity, which annually provides over 600 million euros to improve equity. Being one of the largest funding schemes ever for work towards educational equity it also provides full autonomy for local education authorities (LEAs) to use the money at their discretion. By studying local decisions through interviews and analysing applications and plans in nine cases, we deepen our understanding of governance relations between state, LEAs and schools. Our findings show that funding is used mostly for general purposes, rather than for specific measures to improve equity. Dynamics of governance that mitigate improvements in equity are also found. LEAs take advantage of their position as receivers and distributors of the funding to local schools, deciding what equity is and how to invest in improving it, rather than passing funds to their school units and let them decide on its use.

Climate Change Mitigation through Civil Procedure? Justiciability in Two Nordic Climate Cases

Abstract Although the phenomenon of climate change litigation has flourished in certain European countries, it has so far been limited in the Nordic countries. A reason might be that the Nordic countries do not have a strong tradition of judicial review or rights-based litigation. The role of the courts was long considered to be less about controlling that the legislature lived up to constitutional and international obligations, than ensuring the realisation in practice of the substantive law, by resolving concrete disputes. Through the analysis of issues of justiciability in one Norwegian and one Swedish climate case, this article discusses the role of the judiciary in climate cases. It is argued that the cases illustrate a tension between on the one hand the right to access to a court and judicial review, and on the other, a more limited and traditional understanding of the role of the court, which focuses on the resolution of concrete disputes. At the same time, the cases are considered to indicate that climate change litigation can bring about change in the judicial interpretation of procedural law.

How Family Dynamics Shape Income Inequality Between Families With Young Children: The Case of Sweden, 1995–2018

How Family Dynamics Shape Income Inequality Between Families With Young Children: The Case of Sweden, 1995–2018

External facilitators’ practical work for school improvement: de-professionalising or developing improvement capacity?

AbstractThis article explores external facilitation for school improvement; more specifically, it examines the practical work of external facilitators. It is based on a Swedish case in which facilitators at the Swedish National Agency for Education support low-performing schools. The article aims to develop knowledge about how external facilitators in their practical work both promote and prevent developed understanding and improvement capacity. Based on observations and documents, facilitators’ endeavours and critical situations in their work to support school improvement are identified. The findings show five different endeavours to promote development of understanding and improvement capacity. However, they also show how taking ownership, simplification, and model focus, three of five identified recurring critical situations, prevent such development. The conclusion is that there are several aspects for external facilitators to balance to promote school improvement and turn around low-performing schools. When planning for external facilitation, it is important to consider how the facilitators’ practical work can be adapted to the local contexts of those who are facilitated in order to promote their ownership of the processes. Without balance and adaptation, external facilitation can lead to deprofessionalisation instead of development of improvement capacity.

Are frail populations more vulnerable to temperature-related mortality? The case of Sweden, 2001-2020

Are frail populations more vulnerable to temperature-related mortality? The case of Sweden, 2001-2020

Understanding collaboration beyond contracting: the relationship between inter-organizational collaboration and hard/soft control

PurposeThis paper aims to extend insights about the relationship between inter-organizational collaboration and approaches to control from the perspective of decision-makers. We investigate the relationship between approaches to control and intended forms of integration between actors responsible for solving the complex problem of integrated person-centered care for elderly with diverse and significant needs.Design/methodology/approachThe empirical study is based on a content analysis of contractual agreements. We have analyzed a total of 118 collaboration agreements and associative documents between all Swedish regions and municipalities.FindingsThe study shows that intended integration is subject to remarkable variation in intended forms of inter-organizational collaboration in this Swedish case. The paper illustrates that decision-makers’ intentions with proposed collaboration in each given context are important for the chosen approach to control. Regardless of intended forms of integration, our study suggests that an imminent soft approach to control is expressed alongside limited signs of hard control. Various forms of intended integration can be managed by the two approaches simultaneously insofar as the agreements appear to have a two-sided purpose.Originality/valueOur paper proposes an empirically driven taxonomy of intended forms of integration initiatives. The taxonomy provides resources for studies about how collaboration can be managed when it is stipulated by national legislation but local self-governance gives actors considerable freedom to decide on how to organize and manage services. By presenting the taxonomy and relating this to approaches of control, our iterative study builds on and adds to a recent stream of research arguing that the relationship between collaboration and approaches to control may by fuzzier and more complex than originally thought.

Frostbite injuries related to recreational nitrous oxide use: incidence, management, and complications in a Swedish case series

Background: Nitrous Oxide (N2O) use in the recreational setting has been increasing in Sweden and Europe and therefore also related injuries. We aimed to investigate incidence, management, and surgical outcomes of frostbite injury (FI) related to N2O use. Material and MethodAll patients in a 22-month period, 2021-2022 presenting with FI related to N2O abuse from two plastic surgery clinics (one national burn centre) were identified. Data regarding patient comorbidity, mechanism of injury, initial management, treatment, and follow up were investigated. Complications following surgery were categorized into minor (treated in outpatient setting), and major (requiring reoperation). Results: In total 9 patients were identified, and 5 patients gave consent and were included. Direct contact with gas canister was the most common injury mechanism (n=4). All but one patient contracted full thickness injuries, and these four patients later required surgical intervention. The medial thigh was the most common area of injury. Outpatient clinic visits were common (mean 4.8 visits/patient). Surgical complications were common, and all operated patients were diagnosed with a minor complication and half of them also with a major complication (wound dehiscence and scar contracture). Conclusion: Frostbite injuries arising from recreational N2O are complex and often requiring surgical intervention and leading to complications. With the increasing incidence of N2O abuse in Sweden, further research is crucial to address emerging public health concerns and optimize treatment strategies for these distinctive injuries.

How to maintain environmental integrity when using state support and the VCM to co-finance BECCS projects - a Swedish case study

How to maintain environmental integrity when using state support and the VCM to co-finance BECCS projects - a Swedish case study

The Privatization of Protest: Demobilization and the Emergence of Political Violence in the Aftermath of Local Protest Campaigns

The processual approach to political violence suggests a close link between nonviolent and violent tactical repertoires. Yet in doing so it excludes cases where violence appears to appear in the absence of public protest activity. This article traces how political violence emerges in the aftermath of local protest campaigns against migrant accommodation. Developing the concept of the privatization of protest, the article shows how the demobilization of protest contributes to a process where grievances are reframed into private frustrations rather than objects of political contention. Transformed as such, persistent patterns of intermittent political violence can sometimes grow out of private interactions, even in the absence of any consistent public protest. Applying the conceptual apparatus of frames, emotions, opportunities and to a paired process tracing of episodes of protest against Swedish migrant accommodation in 2007-2008 and 2012-2017, the article maps the causal mechanisms that create facilitative conditions for violence, sometimes long after the decline of nonviolent protest. Extending its discussion beyond the case of Sweden, it links the processual approach to adjacent discussions on the link between micro- and meso-level causes of political violence.