Nordic Project Research Articles

Skills4 Health Literacy– Nordic project promoting capacity building on health literacy and dementia

Abstract Background An increasing proportion of the population is living with dementia and need health- and social care. People with limited health literacy have difficulties with accessing, understanding, appraising, and applying health information to promote and maintain health. Knowledge about how to promote health literacy is limited among health- and social care providers although such knowledge is important to be able to work person-centered and to reduce the risk of unequitable health and health care. As a response to this, the Erasmus+ project Skills 4 Health Literacy is conducted in the period 2022-2025. The project's overall aim is to meet the needs of higher education institutions in training future and current health and social care professionals, through digital education technologies, to promote health literacy capacity-building when supporting persons at risk of dementia to deliver relevant and personalized interventions. Methods A review of research, policies, and curriculums, and four focus group discussions and 14 individual interviews with experts from with a wide range of social and health care sites in Denmark, Finland, Norway, and Sweden. Results We developed a competence profile for health- and social care workers highlighting which knowledge, skills, and abilities they need to promote and take health literacy into account when working with people at risk of dementia and relatives to those. Thereafter, we developed, and pilot tested health literacy courses (1 classroom-based, 1 traditional online and 1 MOOC) based on this competence profile, in three of the Nordic countries. Conclusions There is a need for health literacy training among health- and social care workers in the Nordic countries. This project suggests a consensus-build competency profile to further develop the capacity building within health and social care and dementia with regards to health literacy training. Key messages • Health- and social care workers in the Nordics who meet elderly need training in health literacy. • A competence profile and health literacy courses have been developed to meet those needs.

Norwegian higher education futures

AbstractThe paper deals with the future of Norwegian higher education as part of a Nordic project on higher education futures. To identify future scenarios for Norwegian higher education (HE), the paper uses the theoretical lens of historical institutionalism to focus on scenario building. Like in the other Nordic countries, Norwegian HE and research are characterized by easily accessible and free public HE provision, high participation rates, and a high level of investment in HE and research. However, the question is this: If we look back at the development of Norwegian HE the last decades, to what extent can we expect present developments to persist and to what extent can we expect more or less sharp breaks and deviations from past and present developments? Departing from an institutionalist position, two historically grounded visions and related scenarios are identified: an academic excellence scenario and a national service scenario. The scenarios reflect tensions between different visions of the shape, emphasis, and orientation of HE and research. The empirical focus is on the developments of HE along five dimensions: growth, systemic integration, academic drift, labor market relevance, and governance. First, the conceptual approach is presented, outlining the use of scenarios and an institutionalist approach to thinking about the future of HE. Secondly, the paper outlines the five trends regarding past and ongoing developments. Third, some ideas about future developments are outlined, before the conclusion is drawn.

Testing Open Science Tools

Data management plans (DMP) are an intrinsic part of planning for and implementing openness in scientific research. DMPs contain integral information on research projects: IT requirements, legal and ethical considerations and strategies for opening data. However, all too often, the DMP is seen as a chore drawn up at the request of external funders rather than a tool adopted for the benefit of project members. Similarly, the information gathered into DMPs is rarely utilised by other stakeholders such as institutional research services, nor linked to external parties such as data repositories. Machine-actionable DMPs aim to change this landscape by offering better guidance and support for researchers preparing their plans, and facilitating a research data management system that allows data and information to be shared across institutions and repositories. In fact, one of the recommendations of the EOSC Nordic project, which studied FAIR incentives and expected impact in the Nordics, Baltics and EOSC, was the implementation of machine-actionable DMPs for seamless information workflow and supporting FAIR adoption in everyday research work. Tools such as Data Stewardship Wizard and Argos do this by taking researchers through a set of simple structural questions on research data management from which answers are exported into funder templates resulting in downloadable DMP documents. These machine-actionable online tools transform tick-the-box answers that are easy to fill in into full-text DMPs that comply with funder requirements. This poster introduces a pilot project testing the Data Stewardship Wizard and localising its Knowledge Template to the needs of Aalto University. It presents the project’s findings and stages, including the process of creating a template for the Research Council of Finland DMPs and testing the tool with researchers. In doing so, it examines machine-actionable DMPs from a practice-based perspective and comments on the process of institutional implementation.

PriSUD-Nordic-Diagnosing and Treating Substance Use Disorders in the Prison Population: Protocol for a Mixed Methods Study.

BackgroundA large proportion of the prison population experiences substance use disorders (SUDs), which are associated with poor physical and mental health, social marginalization, and economic disadvantage. Despite the global situation characterized by the incarceration of large numbers of people with SUD and the health problems associated with SUD, people in prison are underrepresented in public health research.ObjectiveThe overall objective of the PriSUD (Diagnosing and Treating Substance Use Disorders in Prison)-Nordic project is to develop new knowledge that will contribute to better mental and physical health, improved quality of life, and better life expectancies among people with SUD in prison.MethodsPriSUD-Nordic is based on a multidisciplinary mixed method approach, including the methodological perspectives of both quantitative and qualitative methods. The qualitative part includes ethnographic fieldwork and semistructured interviews. The quantitative part is a registry-based cohort study including national registry data from Norway, Denmark, and Sweden. The national prison cohorts will comprise approximately 500,000 individuals and include all people imprisoned in Norway, Sweden, and Demark during the period from 2000 to 2019. The project will investigate the prison population during three different time periods: before imprisonment, during imprisonment, and after release.ResultsPriSUD-Nordic was funded by The Research Council of Norway in December 2019, and funding started in 2020. Data collection is ongoing and will be completed in the first quarter of 2022. Data will be analyzed in spring 2022 and the results will be disseminated in 2022-2023. The PriSUD-Nordic project has formal ethical approval related to all work packages.ConclusionsPriSUD-Nordic will be the first research project to investigate the epidemiology and the lived experiences of people with SUD in the Nordic prison population. Successful research in this field will have the potential to identify significant areas of benefit and will have important implications for ongoing policy related to interventions for SUD in the prison population.International Registered Report Identifier (IRRID)DERR1-10.2196/35182

Current State of DNA Barcoding of Sciaroidea (Diptera)-Highlighting the Need to Build the Reference Library.

Simple SummaryDNA barcoding is a method by which a specific region of the mitochondrial genome is used to quantify genetic distances within and between animal species. Most DNA barcodes of the world are assembled on the Barcode of Life online database BoldSystems (BOLD). There, machine-generated barcode index numbers (BINs) are automatically assigned to clusters of specimens thought to represent species. I review the current state of DNA barcoding of the superfamily Sciaroidea, a diverse insect group consisting of close to 16,000 described fly species in eight families. To date, over 1.2 million specimens of Sciaroidea have been barcoded and the 56,648 assigned BINs on BOLD already represent 3.5 times the number of described species. Still, 95% of the BINs have currently no associated scientific name and very little effort has been put into building a quality-checked reference library where named species are linked to the BINs on BOLD. In the Nordic region, however, substantial progress is made towards building a complete reference library. While DNA barcoding has tremendous potential for advancing the knowledge for many diverse groups of insects, its potential will never be fully reached absent more engagement of trained taxonomists to build voucher collections, curate the reference libraries, and describe new species.DNA barcoding has tremendous potential for advancing species knowledge for many diverse groups of insects, potentially paving way for machine identification and semi-automated monitoring of whole insect faunas. Here, I review the current state of DNA barcoding of the superfamily Sciaroidea (Diptera), a diverse group consisting of eight understudied fly families where the described species in the world makes up some 10% (≈16,000 species) of all Diptera. World data of Sciaroidea were extracted from the Barcode of Life online database BoldSystems (BOLD) and contrasted with results and experiences from a Nordic project to build the reference library. Well over 1.2 million (1,224,877) Sciaroidea specimens have been submitted for barcoding, giving barcode-compliant sequences resulting in 56,648 so-called barcode index numbers (BINs, machine-generated proxies for species). Although the BINs on BOLD already represent 3.5 times the number of described species, merely some 2850 named species (described or interim names, 5% of the BINs) currently have been assigned a BIN. The other 95% remain as dark taxa figuring in many frontier publications as statistics representing proxies for species diversity within a family. In the Nordic region, however, substantial progress has been made towards building a complete reference library, currently making up 55% of all named Sciaroidea BINs on BOLD. Another major source (31%) of named Sciaroidea BINs on BOLD comes from COI sequences mined from GenBank, generated through phylogenetic and integrative studies outside of BOLD. Building a quality reference library for understudied insects such as Sciaroidea requires heavy investment, both pre sequence and post sequence, by trained taxonomists to build and curate voucher collections, to continually improve the quality of the data and describe new species. Only when the BINs are properly calibrated by a rigorously quality-checked reference library can the great potential of both classical taxonomic barcoding, metabarcoding, and eDNA ecology be realized.

Analyzing alpha emitting isotopes of Pu, Am and Cm from NPP water samples: an intercomparison of Nordic radiochemical laboratories

Radioanalytical methods for the determination of isotopes of Pu, Am and Cm in water samples from nuclear power plants were compared and further developed in a Nordic project (Optimethod) through two intercomparison exercises among Nordic laboratories. With this intercomparison, the analytical performance of some laboratories was improved by modification of the analytical method and adopting new techniques. The obtained results from the two intercomparisons for alpha emitting transuranium isotopes are presented, and the lessons learnt from these intercomparison exercises are discussed.

12.M. Workshop: Health and integration of young refugees in Nordic Welfare countries – an equity perspective

Abstract Objectives The workshop is based on results from the Nordic project CAGE (Coming of Age in Exile) and aims at creating a better understanding of how health, education and employment jointly play a role in the process of integration among young refugees. Results on patterns and trends regarding education, employment and health across the Nordic countries based on the unique Nordic register data will be presented along with analyses of Nordic health reception policies as well as qualitative studies on educational and labour market policies and practices related to young refugees in Norway and Finland. The Nordic countries are sharing quite similar general welfare schemes and other cultural and historical roots, but at the same time displaying different integration policies. By comparisons of some of the differences between otherwise similar countries we can identify possible effects of policy decisions and disentangle some of the complex processes forming the health and welfare trajectories of the young refugees that have arrived during recent decades. Nordic CAGE researchers have collaborated since 2015 in studies on similarities and differences between national health and welfare policies with a focus on their significance for refugee health and integration; these results have served as a framework for generating hypotheses and interpreting findings from studies on the different trajectories of the young refugees. Results from time and cohort analyses of comparable register data from each country have been further explained through the policy studies as well as the qualitative studies focusing on the experiences and perceptions of key actors involved in the integration processes. The workshop will include 5 short presentations (45 minutes in total) - the first introducing and motivating the focus on the interactive dynamics of health, education and employment followed by 4 presentations based on new evidence from the CAGE project. The participants will be invited to discuss the learnings from the Nordic results in an international perspective and their implications for integration policies for different groups of refugees in Europe (15 minutes). Presentations: Integration of refugees: the interactive dynamics of health, education and employment - a Nordic project, by Signe S Jervelund, 9 min.Educational trends, patterns of employment and selected health indicators among young refugees: results from a Nordic comparative analysis based on register data, by Andrea Dunlavy, 10 min.A healthy start: A comparative analysis of health reception policies for asylum-seeking and refugee children in the Nordic countries, by Camilla Michaëlis, 8 min.Young refugees' pathways in(to) education - Teacher and student voices: challenges, opportunities and dilemmas, by Ketil Eide and Hans A. Hauge, 9 min.Two-way labour market integration? Perspectives on youth with a refugee background and employers in Finland, by Eveliina Lyytinen, 9 min. Key messages Welfare policies related to refugees need to take into account the interrelations between inclusive health care, successful education and entrance into the labour markets. Multidisciplinary, international comparative studies can provide important new evidence on the role of different migration policies for the health and social trajectories of young refugees.

Nätverk - en förutsättning för pedagogisk utveckling?

The importance of networking is often emphasized in higher education teaching and learning. In this article we discuss significant networks and their impact on pedagogical development. We also share our experience of working in different kinds of networks. We focus on a Nordic project with the aim to develop digital learning objects in co-creation between librarians, students and teachers.

Photosynthetic active radiation (PAR) in the Nordic countries and the relative flux density method

The Norwegian University of Life Sciences (NMBU) started global radiation (G) measurements in 1949. PAR measurements started in 1978 as part of a Nordic project. The project terminated in 1981, but the measurements continued at NMBU. We have used the data from the Nordic project’s seven stations and the long time series from NMBU to investigate the limitations of using the relative flux density method for the estimation of PAR from G. The yearly mean value of the relative flux density PAR/G at NMBU is 0.48 with a standard deviation of 0.02. The monthly mean values of PAR/G show a seasonal variation, with its maximum (0.50) in late summer and minimum in the winter months (0.45). The seasonal variation corresponds to 15% difference in relative cloud cover. Data from the original Nordic project gave the opportunity to investigate the usability of the relative flux density method in the Nordic area. The flux ratio for July was generally larger than the ratio for September or October, even though the differences are small and not statistically significant. In trying to explain this, one obvious candidate is the cloud cover. In the lack of cloud data, time records of global radiation were used to select fair weather and overcast days. For all stations, fair days show higher flux ratios and overcast days show lower flux ratios. Neglect of cloud cover may lead to an error in the calculation of PAR from the simple formula PAR = constant G of the order of 10%.

Singing Our Place

The article describes a year-long exploration of the human voice and song and sound as a way to connect with the world and ourselves. The exploration was part of Teater Vivas’ Nordic project ‘Singing Our Place’, which investigates connections between modern people and our surroundings through singing our places together. The author shares her experiences with interactive singing performances and community plays and she shares the questions she has explored through the artistic work: Does singing have anything to do with our relationship with our environment? Can we get to know our landscapes by singing? Can we make a new connection to ourselves and our surroundings through singing? What is the song of your favorite place like? What is the song of your body like? What is the sound of our Future on our common planet?We live in a time of great change and challenges. The climate is changing, our places are changing and we must debate whether our way of living in the world also demands a change. Is it possible in modern societies to consider singing as a way of knowing and relating to our places and our common world in new ways? Are we still able to listen? To our surroundings and ourselves? Or have we become unable to hear and give voice to the Earth, to Life and to what ties us together? The Nordic project ‘Singing Our Place’ travelled to Tuva, Nepal, Mexico, Scandinavia, Iceland and Greenland. The project invited people to express their experience of their places and surroundings trough singing new improvised songs. We live in times of plastic, pollution, noise, conflicts, isolation and fear of the future. The article offers us a sounding vision. Can we sing new paths?

Creating “Opportunity-Rooms” for Inclusion through Popular Education

In this paper, we take a closer look at five Norwegian initiatives from the Nordic project Folkbildning Norden, which is intended to contribute to a better reception of immigrants. Our question is in what way these initiatives provide “opportunity-rooms” for inclusion. The initiatives underline the recognition of lifelong and life-wide learning by linking informal and formal elements of learning—where the “free and voluntary” are tightly coupled with the “useful and necessary”. All the initiatives create inclusion through involvement, networking, trust, belonging, and language learning. The initiatives tell us that different “opportunity rooms” might be important gateways for inclusion in various social contexts. The initiatives also allow for a further discussion about possible advantages and potential of the voluntary sector regarding increasing immigrants’ opportunities for inclusion into the society.

How Does the European Recovery Target for Construction & Demolition Waste Affect Resource Management?

The revised EU Waste Framework Directive (WFD) includes a 70 % target for recovery of construction and demolition (C&D) waste. In order to study the potential change in the resource management of the main C&D waste fractions, as a consequence of fulfilling the WFD target, a Nordic project (ENCORT-CDW) has been performed. Waste fractions studied included asphalt, concrete, bricks, track ballast, gypsum-based construction materials and wood. Recovery scenarios were identified and estimations were made regarding expected savings of primary materials, impact on transport, and pollution and emissions. For wood waste, the main differences between re-use, material recycling and energy recovery were evaluated in a carbon footprint screening based on life cycle assessment methodology. The study concluded that the EU recovery target does not ensure a resource efficient and environmentally sustainable waste recovery in its present form since: It is very sensitive to how the legal definitions of waste and recovery are interpreted in the Member States. This means that certain construction material cycles might not count in the implementation reports while other, less efficient and environmentally safe, recovery processes of the same material will count.It is weight-based and consequently favours large and heavy waste streams. The result is that smaller flows with equal or larger resource efficiency and environmental benefit will be insignificant for reaching the target.It does not distinguish between the various recovery processes, meaning that resource efficient and environmentally safe recovery cannot be given priority.Improved knowledge on C&D waste generation and handling, as well as on content and emissions of dangerous substances, is required to achieve a sustainable recovery.

The Contribution of Different Patterns of Teachers’ Interactions to Young Children’s Experiences of Democratic Values During Play

Developing a sense of belonging and experiences about the value of community are important democratic values that children may learn during play in preschool. Through the different ways that teachers’ interact with children during play, children can learn about democratic values. This study is part of a Nordic project on values education in early childhood education and care settings and data from this project are used in the analyses. The data consisted of video observations from informal play situations in seven Norwegian preschools, with children aged from 18 to 36 months. The nature of practitioners’ interactions with the children was explored in the analyses. There were different ways that practitioners interacted during dyadic and group interactions, and they communicated different values about belonging and community. The findings showed that group interactions can safeguard children’s opportunities to experience democratic practices in a more comprehensive manner than are available to children in dyadic interactions. It is important that practitioners are aware how different ways of interacting with children in play situations, either in dyadic interactions or group interactions, may result in different values being conveyed to children about democracy.

How to create and terminate a school of public health.

The famous preamble to the Constitution of the World Health Organization (WHO) from 1948, stating that health is not only the absence of disease, has been one of the most influential political statements of our time. The follow-up, reaching a position where health is viewed as instrumental to a good life and not as a goal in itself, as set out in the Ottawa Charter of 1986, has likewise been of the utmost importance for the global development of public health, as well as developing the concept of health promotion. The focus on public health sparked by the WHO was paralleled by expansion of the academic interest in the topic, beginning in the USA and successively adopted around the world. In the Nordic countries the pioneering of an academic platform for public health studies and research began in 1953. This was later followed by a stepwise expansion to a full academic institution with postgraduate studies, work-related training, research and development. From the start, the resultant institution called the Nordic School of Public Health (NHV) was a joint Nordic project financed by the Nordic governments. The NHV became a leader in public health studies in Nordic countries and also a role model for the development of an academic community. A large campus and a select and erudite staff, together with thousands of students, paved the way for the NHV having a major impact on public health policy in Nordic countries. One effect of this was increasing awareness of the need for systematic policy supporting public health research and, with this, the founding of institutions of public health in all of the separate Nordic countries. Ironically, the impact made by the NHV in spreading the idea of public health as an important part of academic study has made the NHV superfluous. It is true that courses and programmes in public health are now available at most universities in the five Nordic countries, but they are directed at young students fresh from high school. There is no institution that offers a broad and high-quality postgraduate education and training in public health, adapted to the special needs of mid-career professionals in a multi-professional and internordic setting. With the NHV closing, a research institute focusing public health in a Nordic context will disappear, as will an internationally leading School of Public Health, a centre of excellence and relevance in public health, which has evaluated, assessed and promoted the goals and evaluated the success of the Nordic welfare societies.

Pesticide residues in food of plant origin from Southeast Asia – A Nordic project

Fruits and vegetables from Souteast Asia were analysed for the presence of pesticide residues. A total of 721 samples of 63 different commodities were collected in 2011. The products were imported to Denmark, Finland, Norway and Sweden from ten countries; about 80% were imported from Thailand. The reason for the increased control for certain food products from Southeast Asia was that the official control had revealed many products with too high levels of pesticide residues. In 60% of the samples we did not find any residues, while 28% had residues below or at the MRLs. Results above the MRLs were found in 12% of the samples. In comparison 6% of surveillance samples from third countries and 1.5% of surveillance samples from the EU and EFTA countries exceeded the MRL in the EU monitoring program in 2011. The estimated acute intake was higher than 100% of the ARfD in several samples and some of the products were assessed to represent possible acute health risk for consumers.

Democracy, caring and competence: values perspectives in ECEC curricula in the Nordic countries

The aim of the study is to explore how Nordic Early Childhood Education and Care policies frame values education in preschools with a special focus on the values of democracy, caring and competence. The study is part of a larger Nordic project, Values education in Nordic preschools: Basis of education for tomorrow, the aim of which is to explore values education from various perspectives, policy levels, institutional levels and personal levels. The study applies Habermas’s theoretical ideas of communicative actions, lifeworld, and the system. Here the focus is on the system level, namely, values in national curriculum guidelines that serve as the basis of pedagogical practices in preschools in the Nordic countries. Thematic research analysis described by Braun and Clarke inspired the qualitative analysis of the documents. In addition, a quantitative language-based approach was applied to the study. Keywords related with democratic, caring and competence values were selected. The findings reveal different dimensions and meanings of the three value fields, such as democracy as being and/or becoming; care as fulfilment of basic needs and an ethical relationship; and competence values as learning for sociality and academic skills.

Cross-Border Collaboration in History among Nordic Students: A Case Study about Creating Innovative ICT Didactic Models

Gransoverskridande Nordisk Undervisning/Utdanelse (GNU, meaning Cross-Border Nordic Education), the larger Nordic project, under which this case study was carried out, aims at developing innovative ...

Comparative analysis of façade regulations in the Nordic countries

This paper presents a comparison of Nordic fire safety requirements of facades. A reference building was chosen as a four-story residential building. The requirements were analysed with focus on what fire safety objectives they represent, and what type of pre-accepted solutions that were used. The results reveal large differences in the Nordic building regulations concerning facades. The differences occur both with regards to performance objectives, criteria and acceptable solutions. Current European methods are not sufficient to characterise the requirements needed for fire safety of facades. There is a need to develop new common verification methods, as well as better data and research, to improve requirements and to reach conformity. INTRODUCTION/BACKGROUND Fire safety in facades has been under the spotlight in recent years due to several significant fires. Also, new facade designs challenge the traditional pre-accepted fire safety solutions and therefore call for new verification methods. In the European perspective, several countries have used large-scale methods to evaluate facades, whereas the European standardization has not yet agreed on a common verification method. This paper demonstrates the lack of commonly agreed verification methods by comparing the building legislation and regulations in the Nordic countries. The Nordic comparison is interesting because of the many similarities, with yet a great spread in resulting regulations. In this context, current practice in Sweden is discussed. The Nordic countries share a history of collaboration for the area of building regulations. This goes back to work done by NKB (Nordic Committee on Building Regulations) that started in the sixties. However, there are still large differences in the regulations. These differences can present a barrier of trade for products and services. The construction products directive (CPD), and now the construction products regulation (1), CPR, and the resulting European harmonization of testing and classes for fire safety has mitigated some of these differences. However, the testing and classification methods do not cover all fire safety aspects relevant to facades. It would be reasonable to assume that climate, occupant behaviour etc. would be quite similar in the Nordic countries, which also would give ground for similar regulation of fire safety of facades (and other areas). By identifying differences and analysing these from a fire risk perspective, further steps may be taken to adequately regulate fire safety of facades. In 2008, another Nordic project analysed differences in classifications in the Nordic countries but no deeper studies of facades were conducts. The conclusions in the final report still revealed that there

Improving Quality Assurance with CDIO Self-Evaluation

The main goal of the Nordic project Quality Assurance in Higher Education was to develop and implement a self-evaluation model in the participating Higher Education Institutes (HEIs) to support their quality assurance work and continuous curriculum development. Furthermore, the project aimed at strengthening the cooperation of HEIs in quality assurance (QA) and disseminating good practices of QA. The framework of development is based on the CDIO approach and the CDIO self-evaluation process. The main results are a detailed definition of the self-evaluation process, well-documented self-evaluations of the participating degree programmes, and the identification of the main development areas and actions in each participating degree programme. Furthermore, the project has increased the partners’ understanding of other partners and their challenges. Finally, quality assurance has been enhanced in each participating programme and new ideas and support for quality assurance work in other higher education institutes have been produced.

Looking good and judging gazes: The relationship between body ideals, body satisfaction and body practices among Norwegian men and women

This article compares how people with normal bodies and bodies that deviate from dominant media-depicted body ideals, live with and accept their bodies. Media images of ideal bodies encompass judging gazes. These gazes affect and discipline people and may make it challenging for them to accept their bodies. The data material is part of the interdisciplinary Nordic project called “Beauty comes from within: looking good as a challenge in health promotion”. Based on 20 interviews with Norwegian men and women, of whom 10 have particular appearance-related problems, the article discusses the relationship between the media-depicted body ideals, descriptions by informants of what a good-looking body is, body satisfaction and body practices. The article shows resonance between how people describe good-looking bodies and satisfaction or not with own bodies. Women express more dissatisfaction with their bodies than men, but the article shows that many have strategies for trying to accept their bodies as they are. The comparative perspective highlight that the people having deviant bodies, more than those with normal bodies, balance the idea of “being myself” with the idea of “doing the best out of my (bodily) situation”. Most interestingly, they show that it is harder to accept handicaps that are changeable, like overweight, than harelips, deformed legs and skin injuries. As such, overweight becomes a double burden.