Scania Research Articles

Regional forest green infrastructure planning and collaborative governance: A case study from southern Sweden

Green Infrastructure (GI) is a strategically planned network delivering and enhancing diverse ecosystem services whilst preventing further biodiversity loss. Although not mandatory for EU members to implement GI, it is increasingly advocated as a tool for landscape planning. In 2016, the Swedish Government mandated the County Administrative Boards (CABs) to design regional GI plans using a collaborative process. This study explored the GI collaborative process in the region of Scania in southern Sweden, focusing on forest as an important component of Swedish landscapes. We interviewed 14 different stakeholders who participated in the process, and analysed the preconditions, inner workings and outcomes of collaborative GI planning. Despite remarkably different expectations, the perceived outcomes were consistent. Most stakeholders perceived the process as mainly informational rather than deliberative and, in general, use of the GI plan was limited. Despite successful finalisation of the plan, collaboration as a long-term process has not been achieved, which may limit the realisation of activities that foster GI. Scania’s GI planning illustrates the defects of top-down approaches with insufficient resources, failing to address the stakeholders’ trust and positioning. A lack of inclusivity and deliberation undermine the legitimacy of collaborative processes, discrediting the very concept of GI in Sweden. Our analysis indicates that a genuine collaborative process and a long-term commitment to implementing GI is unachievable without sustained and substantial governmental funding, capacity development at the lead agency, thorough consideration of prehistory, and targeted measures to increase trust among stakeholders.

Preliminary strontium isotope (87Sr/86Sr) baselines for the Bjäre Peninsula and Halland in southern Sweden

During the last decade, the application of strontium isotope analysis (87Sr/86Sr) has increased rapidly. The understanding of the strontium isoscape and the construction of a strontium isotope baseline in southern Scandinavia are biased toward Denmark and southwestern to eastern Scania. We report the results of new baseline samples in Halland and the Bjäre Peninsula, adding to the rich strontium isotope library that exists for southern Scandinavia. We add nuance to the previous divisions of Scania, in which the Bjäre Peninsula is not well represented. The results show that the Bjäre Peninsula is characterized by relatively low 87Sr/86Sr values gathered in the preliminary baseline 0.7100 ± 0.0024 (2σ, n = 8), similar to that of southwest Scania and Zealand in Denmark. There is a greater variation and higher values among the Halland samples. Together with previously published faunal samples, a preliminary 87Sr/86Sr baseline for Halland is 0.7122 ± 0.0055 (2σ, n = 24). We apply these baseline results to archaeological cases, both human and animal, from recent excavations in the Bjäre Peninsula. The results imply that there was a certain degree of mobility and interaction across the landscape in this region of southern Scandinavia in prehistory.

The importance of recurring public transport delays for accessibility and mode choice

This paper looks at the relationship between recurring public transport delays, accessibility to jobs, and travel behaviour in the region of Scania, Sweden. The difference between potential (scheduled) accessibility, observed (actual) accessibility, and behaviour is an important part of this research. This paper contributes to the growing body of literature that uses GTFS data (for both scheduled and actual services) to provide a deeper understanding of temporal variations in accessibility with public transport. Historic public transport data were used to develop a measure for typical delays in the region. The accessibility analysis shows that, on average, recurring public transport delays result in a 4–9% reduction in accessibility to jobs in the region. The loss in accessibility varied depending on the travel time budget that was considered and the location within the region. The accessibility analysis also shows that areas with higher concentrations of households with a lower economic standard experience a smaller loss in job accessibility caused by public transport delays. However, the concentration of these effects depends on the measure that is used. The measurement of typical delays was also analysed in relation to actual trips from the regional travel survey. The statistical analysis found that recurring public transport delays were associated with a lower likelihood of using public transport compared to other motorised modes.

Ambulance Travel Time Estimation using Spatiotemporal Data

Ambulance travel time estimations play a pivotal role in ensuring timely and efficient emergency medical care by predicting the duration for an ambulance to reach a specific location. Overlooking factors such as local traffic situations, day of the week, hour of the day, or the weather may create a risk of inaccurately estimating the ambulance travel times, which might lead to delayed emergency response times, potentially impacting patient outcomes. In the current paper, we propose a novel framework for accurately estimating ambulance travel times using machine learning paradigms, employing real-world spatiotemporal ambulance data from the Skane region, Sweden. Our framework includes data preprocessing and feature engineering, with a focus on variables significantly correlated with travel time. First, through a comprehensive exploratory data analysis, we highlight the main characteristics, patterns, and underlying trends of the considered ambulance data set. Then, we present an extensive empirical analysis comparing the performance of different machine learning models across different ambulance travel trip scenarios and feature sets, revealing insights into the importance of each feature in improving the estimation accuracy. Our experiments indicate that the aforementioned factors play a significant role when estimating the travel time.

Harm reduction social work with people who use drugs: a qualitative interview study with social workers in harm reduction services in Sweden

BackgroundSocial work with people who use drugs (PWUD) has traditionally focused on abstinence and rehabilitation. In recent years, harm reduction has gained an increasingly more important role in social work with PWUD, and social workers are key professionals in many harm reduction services. This study investigates how social workers in harm reduction services for PWUD in Sweden understand the concept of harm reduction and how it relates to goals of rehabilitation, and how they assess and deal with dilemmas and challenges in everyday work.MethodsThe study is based on interviews with 22 social workers in harm reduction services for PWUD in the Scania region of Sweden. A thematic analysis in three steps was used in coding and processing the data.ResultsThe social workers pointed to similar values between social work and harm reduction and argued for combining the two fields to improve services for PWUD. Three overarching principles for Harm Reduction Social Work (HRSW) were developed based on the social workers accounts: (1) Harm reduction is a prerequisite for rather than a counterpoint to rehabilitation and recovery, (2) motivational work must be non-mandatory and based on the client’s goals, (3) a holistic perspective is crucial for Harm Reduction Social Work. Challenges in doing HRSW concerned restrictive laws, policies, and guidelines, resistance from managers, difficulties in setting boundaries between client autonomy and life-saving interventions, and the risk of normalizing high-risk behaviors.ConclusionsWe use the concept of Harm Reduction Social Work to show how social work with PWUD can have a primary focus on reducing harm and risks, while at the same time it involves a holistic perspective that facilitates motivation and change. The suggested principles of HRSW can provide guidance in practical social work with vulnerable PWUD. Social workers can have important roles in most harm reduction settings and may act to enable recovery.

Health care professionals’ experiences and perceptions of health promotion through the health dialogue intervention in the scania region, Sweden: a qualitative interview study

BackgroundCardiovascular disease and type 2 diabetes are among the largest public health challenges in Sweden. Research indicates that a healthy lifestyle can prevent most cases. The health dialogue is an evidence-based public health programme for primary care with positive results in several regions of Sweden. This study aimed to describe health care professionals’ experiences and perceptions of health promotion through the health dialogue intervention during the pilot phase in the Scania region of Sweden.MethodsThe study consists of 12 individual interviews with health care professionals educated in the health dialogue method, implementing the intervention in Scania. Qualitative content analysis with an inductive approach was used.ResultsThe analysis resulted in 10 sub-categories and the four main categories: A more health-promoting mindset would benefit primary care; Empower individuals; Facilitate sustainable lifestyle changes; Challenges, tools and support for the implementation of the health dialogue. One overarching theme emerged: “Health dialogue, a potential start of a paradigm shift in Swedish primary care”.ConclusionsConclusions imply that the health dialogue is a well-structured method with tools to make health promotion and primary prevention an integrated part of primary care. A respectful and motivating approach during the health dialogue is recommended. It is important to have an ongoing discussion about the approach among the health care professionals. Incorporating the Health Belief Model in the health care professionals’ education in the method could increase the focus on self-efficacy during counselling, which could favour the participants’ change process.

Estimating Sepsis Incidence Using Administrative Data and Clinical Medical Record Review

Despite the large health burden, reliable data on sepsis epidemiology are lacking; studies using International Statistical Classification of Diseases and Related Health Problems (ICD)-coded hospital discharge diagnosis for sepsis identification suffer from limited sensitivity. Also, ICD data do not allow investigation of underlying pathogens and antimicrobial resistance. To generate reliable epidemiological estimates by linking data from a population-based database to a reference standard of clinical medical record review. This was a retrospective, observational cohort study using a population-based administrative database including all acute care hospitals of the Scania region in Sweden in 2019 and 2020 to identify hospital-treated sepsis cases by ICD codes. From this database, clinical medical records were also selected for review within 6 strata defined by ICD discharge diagnosis (both with and without sepsis diagnosis). Data were analyzed from April to October 2022. Hospital and population incidences of sepsis, case fatality, antimicrobial resistance, and temporal dynamics due to COVID-19 were assessed, as well as validity of ICD-10 case identification methods compared with the reference standard of clinical medical record review. Out of 295 531 hospitalizations in 2019 in the Scania region of Sweden, 997 patient medical records were reviewed, among which 457 had sepsis according to clinical criteria. Of the patients with clinical sepsis, 232 (51%) were female, and 357 (78%) had at least 1 comorbidity. The median (IQR) age of the cohort was 76 (67-85) years. The incidence of sepsis in hospitalized patients according to the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) criteria in 2019 was 4.1% (95% CI, 3.6-4.5) by medical record review. This corresponds to an annual incidence rate of 747 (95% CI, 663-832) patients with sepsis per 100 000 population. No significant increase in sepsis during the COVID-19 pandemic nor a decrease in sepsis incidence when excluding COVID-19 sepsis was observed. Few sepsis cases caused by pathogens with antimicrobial resistance were found. The validity of ICD-10-based case identification in administrative data was low. In this cohort study of sepsis epidemiology, sepsis was a considerable burden to public health in Sweden. Supplying administrative data with information from clinical medical records can help to generate reliable data on sepsis epidemiology.

Waning protection after vaccination and prior infection against COVID-19-related mortality over 18 months

ObjectivesEvidence on waning patterns in protection from vaccine-induced, infection-induced, and hybrid immunity against death is scarce. The aim of this study is to assess the temporal trends in protection against mortality. MethodsPopulation-based case-control study nested in the total population of Scania Region, Sweden using individual-level registry data of COVID-19-related deaths (<30 days after positive SARS-CoV-2 test) between 27 December 2020 and 3 June 2022. Controls were matched for age, sex, and index date. Conditional logistic regression was used to estimate the preventable fraction (PF) from vaccination (PFvac corresponding to vaccine effectiveness; ≥2 vaccine doses vs. 0 doses), prior infection (PFinf), and hybrid immunity (PFhybrid). PF was calculated as one minus odds ratio. Models were adjusted for comorbidities, long-term care facility residence, prior infection (for PFvac), country of birth, socio-economic conditions, and time since last vaccination (for PFinf). ResultsIn total, 14 936 individuals (1440 COVID-19-related deaths and 13 496 controls) were included in the case-control analyses (45% females, median age: 84 years). PFvac was above 90% during the first month after vaccination, regardless of the number of vaccine doses. After 6 months, PFvac of two doses waned to 34% (95% CI: −30% to 66%). PFinf for people surviving a SARS-CoV-2 infection waned from 88% (−16% to 99%) 3 months after infection to 62% (34–79%) after 9 months. No differences in waning patterns in PFvac were seen between virus variants, gender, and age. DiscussionGiven the waning of protection against death, continuous surveillance of population immunity status, particularly among the most vulnerable population groups, could help to further fine-tune vaccination recommendations.

Risk-adjusted benchmarking of long-term overall survival in patients with HER2-positive early-stage Breast cancer: A Swedish retrospective cohort study.

The main objective of the current study was to explore the value of risk-adjustment when comparing (i.e. benchmarking) long-term overall survival (OS) in breast cancer (BC) between Swedish regions. We performed risk-adjusted benchmarking of 5- and 10-year OS after HER2-positive early BC diagnosis between Sweden's two largest healthcare regions, constituting approximately a third of the total population in Sweden. All patients diagnosed with HER2-positive early-stage BC between 01-01-2009 and 31-12-2016 in healthcare regions Stockholm-Gotland and Skane were included in the study. Cox proportional hazards model was used for risk-adjustment. Unadjusted (i.e. crude) and adjusted 5- and 10-year OS was benchmarked between the two regions. The crude 5-year OS was 90.3% in the Stockholm-Gotland region and 87.8% in the Skane region. The crude 10-year OS was 81.7% in the Stockholm-Gotland region and 77.3% in the Skane region. However, when adjusted for age, menopausal status and tumour biology, there was no significant OS disparity between the regions, neither at the 5-year nor 10-year follow-up. This study showed that risk-adjustment is relevant when benchmarking OS in BC, even when comparing regions from the same country that share the same national treatment guidelines. This is, to our knowledge, the first published risk-adjusted benchmarking of OS in HER2-positive BC.

Historical and citizen-reported data show shifts in bumblebee phenology over the last century in Sweden

Bumblebees are a key taxon contributing to the provision of crop pollination and ecosystem functioning. However, land use and climate change are two of the main factors causing bee decline across the world. In this study, we investigated how the flight period of bumblebee spring queens has shifted over the last century in Sweden, and to what extent such shifts depended on climate change, landscape context, latitude, and the phenology of bumblebee species. We studied ten species of bumblebees and used observations from museum specimens covering 117 years from the southernmost region in Sweden (Scania), combined with citizen-reported observations during the past 20 years across Sweden. We found that the flight period of bumblebees has advanced by 5 days on average during the last 20 years across Sweden. In the agriculture-dominated region of Scania, we found that in the late 2010s bumblebee spring queen activity in simplified landscapes had advanced by on average 14 days, compared to 100 years ago. In addition, in simplified landscapes the flight period of early species was significantly earlier compared to in complex landscapes. Our results provide knowledge on the intraspecific variation of phenological traits, indicating that early species (often common species) exhibit a higher plastic response to the environment, which may facilitate adaptation to both climate and landscape changes, compared to the late species of which many are declining.

The incremental value of exercise ECG to myocardial perfusion SPECT for prediction of cardiac events

Abstract Background Both myocardial perfusion SPECT (MPS) and exercise ECG (Ex-ECG) are known to carry prognostic information in patients with chronic coronary syndrome (CCS). However, it is not fully understood if combining MPS and Ex-ECG results improves risk prediction. Current guidelines no longer recommend Ex-ECG for diagnostic evaluation of CCS, but adding Ex-ECG results to MPS could be of incremental prognostic importance. Purpose The study aimed to assess the incremental prognostic value of Ex-ECG to MPS results in patients with CCS. Methods A single-center study of 908 consecutive patients with CCS (age 63±9 years, 49% male) who underwent a MPS with Ex-ECG. Subjects were followed for five years. The clinical endpoint was a composite of cardiovascular death (CV), acute myocardial infarction (AMI), unstable angina and unplanned PCI. National registry data and electronic medical charts were used for end point allocation. Results Combining the findings of MPS and Ex-ECG resulted in concordant evidence of ischemia in 72 patients (8%) or absence of ischemia in 634 patients (70%). Dis-concordant results were found in 202 patients (22%; MPS−/Ex-ECG+, n=126 and MPS+/Ex-ECG−, n=76). During follow-up 95 composite cardiac events occurred (CV deaths n=6, AMI n=27, unstable angina n=34 and unplanned PCI n=28). Kaplan-Meier curves display an increased risk of cardiac events in patients with any combination of abnormal stress test results (Figure 1). In a multivariable regression model (adjusting for age, sex, smoking, known IHD, diabetes, dyslipidaemia and exercise capacity) MPS was the strongest predictor of cardiac events regardless of Ex-ECG results (MPS+/Ex-ECG−, Hazard ratio (HR) = 3.0, p=0.001 or MPS+/Ex-ECG+, HR=4.0, p&amp;lt;0.001). However, an abnormal Ex-ECG almost doubled the risk of event in subjects with a normal MPS (MPS−/Ex-ECG+, HR=1.9, p=0.04). Conclusions Combining the results from MPS and Ex-ECG in patients with chronic coronary syndrome lead to an improved prediction of future cardiac events. Even though MPS is the stronger predictor, there is an incremental prognostic value of adding data from Ex-ECG to MPS, especially in patients with normal MPS findings. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Swedish Heart and Lung Foundation, Region of Scania

Patronage effects of off-peak service improvements in regional public transport

The purpose of this study is to look into patronage effects of extended supply outside peak hours on regional public transport services. Previous studies have shown that the service frequency is an attribute of great importance for regional passengers, but little is known about the details regarding peak and off-peak frequencies or service hours. The present study addresses this knowledge gap, departing from the hypothesis that additional off-peak supply means more flexibility for the passengers in terms of departure time options, and possibly also a sense of security for passengers who are uncertain about the time of their (return) trips. Essentially, the added off-peak departures may attract more passengers even if they normally do not or only occasionally use the off-peak services. The patronage effects are explored through four case studies from the region of Scania in southern Sweden. The cases include regional rail and bus services where substantial improvements have been made outside peak hours, resulting in at least hourly all-day services. The results of the study provide new insights into the fundamental planning policy trade-off between maximum frequency and span of public transport services in urban peripheries and rural areas. Importantly, the results suggest that improved time coverage may lead to substantial patronage growth, and this growth is evident also during peak hours, despite unaltered peak hour frequencies. Hence, off-peak departures cannot be assessed only through patronage levels in isolated time periods, let alone on the individual departures.

ABO and RhD blood group are not associated with mortality and morbidity in critically ill patients; a multicentre observational study of 29 512 patients

BackgroundThe ABO and RhD blood group represent antigens on the surface of erythrocytes. The ABO blood group antigens are also present on multiple other cells. Interestingly, previous studies have demonstrated associations between the blood group and many types of disease. The present study aimed to identifying associations between the ABO blood group, the RhD blood group, and morbidity and mortality in a mixed cohort and in six pre-defined subgroups of critically ill patients.MethodsAdult patients admitted to any of the five intensive care units (ICUs) in the Scania Region, Sweden, between February 2007 and April 2021 were eligible for inclusion. The outcomes were mortality analysed at 28– and 90–days as well as at the end of observation and morbidity measured using days alive and free of (DAF) invasive ventilation (DAF ventilation) and DAF circulatory support, including vasopressors or inotropes (DAF circulation), maximum Sequential Organ Failure Assessment score (SOFAmax) the first 28 days after admission and length of stay. All outcomes were analysed in separate multivariable regression models adjusted for age and sex. In addition, in a sensitivity analysis, five subgroups of patients with the main diagnoses sepsis, septic shock, acute respiratory distress syndrome, cardiac arrest and trauma were analysed using the same separate multivariable regression models.ResultsIn total, 29,512 unique patients were included in the analyses. There were no significant differences for any of the outcomes between non-O blood groups and blood group O, or between RhD blood groups. In the sensitivity analysis of subgroups, there were no differences in mortality between non-O blood groups and blood group O or between the RhD blood groups. AB was the most common blood group in the COVID-19 cohort.ConclusionsThe ABO and RhD blood group do not influence mortality or morbidity in a general critically ill patient population.

Impact of the COVID-19 Pandemic on the General Mental Health in Sweden: No Observed Changes in the Dispensed Amount of Common Psychotropic Medications in the Region of Scania.

Some first investigations have focused on the consequences of the COVID-19 pandemic for the general mental health after its outbreak in 2020. According to multiple self-reporting surveys, symptoms of stress, anxiety, and depression have risen worldwide. Even some studies based on health care records start to be published, providing more objective and statistically reliable results. Additionally, concerns have been raised, to what extend the access to mental health care has been compromised by the COVID-19 outbreak. The aim of this study was to detect changes in prescription trends of common psychotropic medications in the Swedish region of Scania. The monthly dispensed amounts of selected pharmaceuticals were compared from January 2018 until January 2021, regarding the prescription trends before and after the outbreak of COVID-19. Using an interrupted time series analysis for each medication, no general trend changes were observed. On the one hand, a possible deterioration of the general mental health could not be confirmed by these results. On the other hand, the access to mental health care did not seem to be impaired by the pandemic. When interpreting findings related to the COVID-19 pandemic, regional differences and country-specific approaches for coping with the pandemic should be considered. The Swedish population, for instance, never experienced a full “lock-down” and within Sweden the time point of the outbreak waves differed regionally. In general, the effects of the COVID-19 outbreak on mental health are still unclear and need to be investigated further in an international comparison.

Obstetric violence a qualitative interview study

ObjectiveTo investigate the meaning of the concept of ‘obstetric violence’ to women in Sweden, who reported a negative birth experience. DesignAn inductive qualitative approach with individual narratives. A thematic qualitative content analysis was used. SettingThree midwifery clinics in southwest Scania. ParticipantsTwelve women who had given birth less than three years previously and reported a negative/traumatic birth experience. FindingsThe key findings showed that the women had experienced psychological and physical abuse during childbirth which may be interpreted as ‘obstetric violence’. Four categories emerged from the analyses describing the women's experiences: Lack of information and consent including poor information and no right to participate in decisions concerning the process of labour, Insufficient pain relief, which encompassed unbearable pain without pain relief, Lack of trust and security where the women experienced staff with bad attitudes and jargon, and The experience of abuse including threats of violence from midwives and where the birth experience was compared to rape. Key conclusionsThe study shows that physical and psychological abuse during childbirth exists in Sweden and that women experience this as being subjected to ‘obstetric violence’ during childbirth. The phenomenon of obstetric violence is very complex. The abuse of women during childbirth might be a significant problem and quality assurance is required to secure the rights of women giving birth. Implications for practiceIn order to secure the rights of birthing women and to promote respectful and supportive care for new mothers, quality development programs are required.

Association of clinically relevant carpal tunnel syndrome with type of work and level of education: a general-population study

Carpal tunnel syndrome (CTS) is a common cause of work disability. The association with occupational load and education level has not been established in general-population studies. The purpose of this study was to investigate the association of clinically relevant CTS with work and education. From the Healthcare Register of Skane region (population 1.2 million) in southern Sweden we identified all individuals, aged 17–57 years, with first-time physician-made CTS diagnosis during 2004–2008. For each case we randomly sampled 4 referents, without a CTS diagnosis, from the general population matched by sex, age, and residence. We retrieved data about work and education from the national database. The study comprised 5456 individuals (73% women) with CTS and 21,667 referents. We found a significant association between physician-diagnosed CTS and type of work and level of education in both women and men. Compared with white-collar workers, the odds ratio (OR) for CTS among blue-collar workers was 1.67 (95% CI 1.54–1.81) and compared with light work, OR in light-moderate work was 1.37 (1.26–1.50), moderate work 1.70 (1.51–1.91), and heavy manual labor 1.96 (1.75–2.20). Compared with low-level education, OR for CTS in intermediate level was 0.82 (0.76–0.89) and high-level 0.48 (0.44–0.53). In women and men there is significant association with a dose–response pattern between clinically relevant CTS and increasing manual work load and lower education level. These findings could be important in design and implementation of preventive measures.

An Extended Home Visit Programme Within the Swedish Child Healthcare System for First-Time Parents in Scania, Sweden: A Study Protocol.

Background: The Swedish Child Healthcare (CHC) system aims to provide equal and fair health care for all children and families in Sweden. Currently in Sweden, the CHC offers every family two home visits during the child's 1st year of life. During 2019, an extended home visit programme, called Grow Safely, was started in the region of Scania for first-time parents. The aim of the extended home visit programme was to provide support for first-time parents in order to improve the overall health of the child and family and contribute to better conditions for equal health. Instead of two home visits during the 1st year, a subsample of first-time parents would receive six visits during the child's first 15 months. These six visits would be conducted by CHC nurses and social workers, midwives, and dental assistants. In the present paper, we describe a research project related to the regional extended home visit programme; the project aims to illuminate the experiences of the participants and to investigate the perceived benefits of the programme in relation to improved health, social and emotional interaction between parent and child, and attitudes toward authorities and surrounding society.Method/Analysis: In order to evaluate the introduction of the intervention, three qualitative interview studies and one quantitative study with follow-up questionnaires will be conducted. Since the research project also comprises studies focusing on the implementation and expectations of politicians, civil servants, organizational managers, and professionals working within the programme, interviews within these fields will be conducted.Discussion: Sweden has a well-established CHC programme, but improvements are always possible. Previous research has shown that home visits are an effective tool to improve both the child's physical and mental health as well as the parents' well-being. However, this kind of intervention involves a significant investment from all organizations involved in the home visits; hence, it is important that the intervention is evaluated. The research project described in the present paper intends to examine the impact of the intervention, and its findings will aid decisionmakers in determining the future of the home visit programme.

Physical Activity in Relation to Wellbeing Among Newly Arrived Refugees in Sweden: A Quantitative Study.

Background: Little is known about physical activity among newly arrived refugees and what impact physical activity might have on their health, as measured by mental wellbeing, vitality, stress and sleep quality. Thus, this study sought to investigate the relationship between physical activity and wellbeing among refugees who were newly arrived in Sweden.Methods: The present study was based on the results from a survey, conducted in 2015–2016 among newly arrived adult refugees who spoke Arabic, Pashto, Somali or Dari, participated in a mandatory public integration support programme in the Scania region of Sweden and agreed to participate in the survey. Ultimately 681 participants completed the survey (a response rate of 39.5%).Results: We found a significant association between physical activity and mental wellbeing, vitality, stress and sleep quality among newly arrived refugees.Conclusions: Newly arrived refugees need to be informed about the importance of prioritizing physical activity for their health and wellbeing, regardless of their external circumstances, and supported in their attempts to do so.

Intraventricular hemodynamic forces do not differentiate between healthy controls and heart failure patients with preserved ejection fraction

Abstract Background Hemodynamic force analysis has been proposed as a noninvasive marker of cardiac function. In a recent study, longitudinal (apical-to-basal) hemodynamic forces were derived from anatomical MRI images and found decreased in heart failure with preserved ejection fraction (HFpEF) patients compared to controls, indicating a potential use for prognostication and testing of therapeutic response. This issue has not been investigated using the reference method of measurement. Purpose To investigate whether intraventricular hemodynamic forces computed using gold-standard cardiac magnetic resonance flow maps can reproducibly differentiate between healthy controls and HFpEF patients. Methods 4D flow data were acquired in 59 subjects through cardiac magnetic resonance imaging using a 1.5T scanner (Siemens Healthcare, Erlangen, Germany). Hemodynamic forces within the LV were computed across the cardiac cycle using the Navier-Stokes equation to find the global pressure gradient, which was then integrated over the LV volume to produce the instantaneous hemodynamic force (unit: Newton) and subsequently normalized to ventricular volume, resulting in a force-volume index (N/l). Average longitudinal forces (root mean square, FRMS) were quantified over the entire cardiac cycle, with and without volume normalization. Results We studied 33 healthy subjects, 14 patients with HFpEF, 6 patients with HFmEF and 6 patients with HFrEF. Groups were similar with regards to sex, cardiac output, heart rate, systolic and diastolic blood pressure, and body surface area. Volume-normalized FRMS did not differ between controls and HFpEF (0.86±0.19 vs. 0.75±0.19 N/l, p=0.08) while lower values were found in HFmEF (0.60±0.19 N/l, p=0.004) and HFrEF (0.38±0.15 N/l, p&amp;lt;0.0001) compared to controls (Figure 1A). There was a significant positive correlation between EF and FRMS, both for the entire population (R2 = 0.54, Figure 1B) and for patients (R2 = 0.67, p&amp;lt;0.0001 for both). Importantly, non-normalized FRMS did not differ between controls (Figure 1C, 0.10±0.03 N) and HFpEF (0.09±0.03 N, p=0.25), HFmEF (0.11±0.02 N, p=0.18) or HFrEF (0.09±0.02 N, p=0.67). Moreover, no correlation was seen between non-normalized FRMS and EF (Figure 1D). Conclusions Hemodynamic forces computed from reference standard 4D flow CMR data do not differentiate between healthy controls and HFpEF patients regardless of whether volume normalization is used or not. Our findings do not support a role for hemodynamic forces in HFpEF assessment. Figure 1. (A) Volume-normalized hemodynamic forces over the entire cardiac cycle (lines: average values, shaded area: ±1SD for HFpEF), and (B) variation of volume-normalized average force, FRMS, with left ventricular ejection fraction (LVEF). (C), (D): When indexing to LV volume was not performed, the differences between groups was attenuated, and no correlation was seen between EF and FRMS. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Swedish Heart and Lung Foundation, Region of Scania

Physical activity in relation to wellbeing among newly arrived refugees in Sweden

Abstract Background In the light of the growing number of refugees that the world has faced during the last years it is reasonable to suggest that the number with both physiological and mental health needs will raise and result in increased public health challenges. Physical activity with its well documented positive impact on both mental and physical health might be one way for refugees to promote health. The importance of investigating participation in physical activity in this group and the impact it might have on their health and wellbeing cannot be underestimated. Few studies exists in the field and therefore, this study aimed to investigate physical activity in relation to mental well-being, vitality, stress and sleep quality among newly arrived refugees in Sweden. Methods The study was based on the results from a survey, conducted in 2015 - 2016 among newly arrived adult refugees who spoke Arabic, Pashto, Somali or Dari, participated in a mandatory public integration support programme in the Scania region of Sweden and agreed to participate in the survey. Ultimately 681 participants completed the survey (a response rate of 39,5%). Results We found a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees. Conclusions Newly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, regardless of their external circumstances, and supported in their attempts to do so. Key messages There is a significant association between physical activity and mental well-being, vitality, stress and sleep quality among newly arrived refugees. Newly arrived refugees need to be informed about the importance of prioritising physical activity for their health and wellbeing, and supported in their attempts to do so.