Swedish Authorities Research Articles

Increased endothelial cell uptake of erythrocyte-derived extracellular vesicles carrying arginase-1 induces endothelial dysfunction in type 2 diabetes

Abstract Background Recently, we have demonstrated that red blood cells (RBCs) from individuals with type 2 diabetes (T2D-RBCs) induce endothelial dysfunction. However, the mechanism by which RBCs communicate with the vessel is unknown. Extracellular vesicles (EVs) are actively secreted by practically all cell types, including RBCs, and represent a novel mechanism of intercellular communication. However, the involvement of EVs from RBC in the development of endothelial dysfunction remains to be elucidated. Purpose This study was designed to test the hypothesis that EVs are key players in the communication and the transfer of signalling between RBCs and the vascular endothelium to induce endothelial dysfunction in T2D. Methods RBCs from T2D patients and age-matched healthy controls (H-RBCs) were incubated for 18h with Krebs-Henseleit buffer (20% haematocrit) for EV release. RBC-derived EVs in the conditioned medium were isolated using a membrane affinity column. The EVs were co-incubated with mouse aortae to evaluate endothelium-dependent relaxation and with endothelial cells for expression analysis. The uptake of the EVs by endothelial cells and their content of arginase-1 were determined. The functional involvement of arginase was investigated using pharmacological interventions and expression analyses. All animal experiments were performed according to the principles of laboratory animal care (NIH Publication no. 85-23 revised 1985) and human procedures according to the declaration of Helsinki with approval by the Swedish Ethical Review Authority. Results The uptake of EVs derived from T2D-RBCs by endothelial cells was 2-fold greater than that of EVs from H-RBCs (Fig. 1A-B). Inhibiting the uptake of EVs derived from T2D-RBCs by the addition of heparin during the co-incubation rescued the endothelial function (Fig. 1C). Arginase-1 was detected in RBC-derived EVs (Fig. 2A). Arginase-1 mRNA and protein levels were increased in endothelial cells following co-incubation with EVs derived from T2D-RBCs (Fig. 2B-D). Additionally, the increase in arginase-1 protein induced by EVs derived from T2D-RBCs in endothelial cells was observed also following mRNA silencing for arginase-1 (Fig. 2E-F). Finally, mouse aortae co-incubated with EVs derived from T2D-RBCs in the presence or absence of the arginase inhibitor 2(S)-amino-6-boronohexanoic acid significantly attenuated the impairment in endothelial function induced by EVs derived from T2D-RBCs (Fig. 2G). Conclusion Increased uptake of RBC-derived EVs by the endothelial cells is an important feature of the endothelial dysfunction induced by these EVs in T2D. In addition, these EVs carry arginase-1 protein to induce endothelial dysfunction. The mechanism underlying the increased uptake of EVs in target cells is of importance to identify in future studies, as it could lead to new treatment strategies.

Breast and endometrial safety of micronised progesterone versus norethisterone acetate in menopausal hormone therapy (PROBES): study protocol of a double-blind randomised controlled trial

IntroductionData suggest that micronised progesterone (mP) in menopausal hormone therapy is safer for the breast than synthetic progestins, while protection of the endometrium appears to be less effective. However, comparative...

Inside de- and re-centralisation: the formation of governance in Swedish local education authorities during education reform

ABSTRACT This article concerns the professional work of Swedish heads of local educational authority [LEA] school administrations) with a particular focus on their relationships with local politicians since the 1990s. In recent decades, Sweden has undergone foundational educational reforms, radically de-centralising - and then re-centralising - the school system. Thus, Sweden represents an interesting case for understanding both de-centralisation and re-centralisation processes. We cover seven empirical studies of superintendents to understand how municipal governance and the role of superintendents have changed over time in response to these large-scale reforms. We show that the de-centralisation reforms of the 1990s destabilised municipal administrative structures and superintendents' roles and duties with regard to politicians. However, during the 2000s, the municipal administrative structures and the role and duties of superintendents stabilised significantly. In the mid-2010s, reforms institutionalised superintendents' roles and bound them more closely to the state administration.

Paradoxical intention as a treatment for insomnia disorder: study protocol for a mixed-methods pilot trial

IntroductionParadoxical intention (PI) is an insomnia treatment developed in the 1970s, which instructs patients to gently attempt to remain awake while in bed at night with the lights off. Previous...

Single-blinded, randomised, parallel-group, controlled trial comparing the efficacy and cost-effectiveness of therapist- and self-guided internet-delivered behavioural activation versus treatment as usual for adolescents with mild to moderate depression: study protocol

IntroductionThe number of adolescents seeking professional help for depression is increasing and, despite advances in treatment, large unmet treatment needs remain. In the current protocol, we describe the design and...

Cybersecurity work at Swedish administrative authorities: taking action or waiting for approval

Cybersecurity work at Swedish administrative authorities: taking action or waiting for approval

Responsibilization as a return to collectivity? Legitimating the responsibilization of preparedness: the case of the Swedish Civil Contingencies Agency (MSB)

PurposeThis study investigates how communication is used by a Swedish public authority to legitimate the responsibilization of preparedness, i.e. how the state encourages individual citizens to take more responsibility for their security.Design/methodology/approachA multimodal discursive approach drawing on multimodal narrative analysis of video clips and multimodal critical discourse analysis (MCDA) is used to examine how the responsibilization of preparedness is legitimated in video material published on Swedish Civil Contingencies Agency's (MSB’s) YouTube channel.FindingsThe study finds that the responsibilization of preparedness is legitimated through an ongoing but evolving normalization of threat. The findings also show how responsibilization is legitimated in moralizing terms of individual contribution to society, which may indicate a return from neo-liberal values to more traditional Swedish collectivist values.Originality/valueThe study shows how communication around preparedness and responsibilization is discursively constructed and legitimated through multimodal features, while previous research has mainly focused on verbal or written communication.

Effects of yoga compared with health promotion on health-related quality of life in adults with post-COVID-19 condition: protocol for a randomised controlled trial

IntroductionPost-COVID-19 condition (post COVID, also known as long COVID) is a global public health issue estimated to affect over 100 million people. Common symptoms include fatigue, dyspnoea and cognitive dysfunction...

Baseline measurements in the assessment of ESS-specific radionuclide uptake by crops cultivated in Southern Sweden

The European Spallation Source, ESS, is a neutron research facility under construction in Lund, Southern Sweden. The Facility will produce neutrons by spallation, using a powerful linear accelerator to deliver protons to a tungsten target. In addition to the desired neutron production, a long list of radionuclides will be created as by-products of the nuclear reaction inside the target. The Swedish Radiation Safety Authority has established a list of the most relevant radionuclides, in terms of contribution to the effective dose to ESS workers and the general public, should an accidental release of irradiated target material occur. This list includes radionuclides that are not produced by the nuclear energy industry, in particular 178mHf, 182Ta, 187W, 148Gd and 173Lu. Ongoing research efforts aim to determine the best analytical methods to assess these exotic and often difficult-to-measure radionuclides in environmental samples. This work investigates the potential of X-ray fluorescence and time-of-flight elastic Recoil detection analysis for the assessment of soil samples, and the potential of particle induced X-ray emission for the assessment of crop samples. These techniques require only simple sample preparation steps and no chemical extraction, unlike the conventional environmental monitoring methods such as inductively-coupled plasma mass spectrometry, and show promise as complimentary methods enabling fast sample throughput. This study focuses on the analysis of uncontaminated soil and crops, to provide baseline data, whilst simultaneously assessing the available measurement capabilities. For the X-ray fluorescence system used in this study, the method detection limit for W in soil was determined to be 0.147ppth, and Zr which can be correlated with the migration of Hf was clearly measurable.

Study protocol: diagnostic accuracy study comparing Cy-Tb and STANDARD F TB-Feron FIA tests for tuberculosis infection diagnosis in Vietnam

IntroductionThe large reservoir of tuberculosis (TB) infections is one of the main reasons for the persistent incidence of TB. Accurate diagnostic tests are crucial to correctly identify and treat people...

Using a participatory action research approach to explore, understand and evaluate well-being among children living in socially deprived areas in Southern Sweden: a study protocol

IntroductionResearch suggests that participating in after-school leisure activities has been related to promoting health, well-being and safety among children living in disadvantaged neighbourhoods. The United Nations Child Rights Convention emphasises...

Cardiovascular risk factor assessment in late-onset seizures: A study protocol to assess the value of structured intervention.

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

Traffic safety implementation at local level in line with 2030 Agenda for Sustainable Development: synergies, challenges and enablers

This study explores how traffic safety implementation at local level in line with the 2030 Agenda for Sustainable Development is characterised. By investigating interactions between traffic safety and other sustainability goals (synergies), as well as identifying contradictions between goals and conflicting interests (challenges), the study aims to pinpoint the main enablers for implementing traffic safety as part of sustainability. The emphasis lies on local authorities in Sweden representing a mature traffic safety context when viewed globally. To delve into this issue, interviews were conducted with 37 municipal employees from the city of Gothenburg, encompassing diverse roles that exemplify the significant influence Swedish local authorities wield in shaping traffic safety: as road manager and planner, in maintenance and construction phases, as employer and purchaser, and as influencer of behaviour. The study reveals several synergies between traffic safety and other sustainability goals, as well as contradictions between goals and conflicting interests posing challenges to traffic safety implementation. Main enablers for implementation of traffic safety as part of sustainability at the local level concern, for example, an integrated approach on strategic level where traffic safety could be handled as either a prerequisite (e.g. for active mobility) or a framework condition (e.g. for green cars). The necessity to bridge gaps between strategic and operational levels is also emphasised. Contradicting goals and interests are inevitable and must be managed. The study identifies the traffic strategy and strategic analyses, in the European context referred to as Sustainable Urban Mobility Planning, as a platform for traffic safety implementation as part of sustainability. Such platform highlights implementation areas in common for different target areas. The significance of integrating traffic safety in relevant activities and processes, alongside fostering horizontal collaborations across target areas, becomes apparent when striving to embed traffic safety in a wider sustainability context. While Swedish municipalities may not always recognize traffic safety as part of the sustainability agenda, existing platforms within municipalities serve as a foundation for adopting an integrated approach to traffic safety implementation. However, there is a need for a central coordinating function to ensure robust leadership in integrating traffic safety as a vital component of sustainability.

PARENTAL OVER-INDEBTEDNESS AND YOUTH CRIME IN SWEDEN: A NATIONWIDE REGISTER-BASED STUDY

Very little is known about whether a child’s delinquency can be related to a parent’s economic problems in terms of financial indebtedness. This would seem to be an important research gap, not least at a time when the repercussions of the 2008 global financial crisis are still being felt by many people. This study concerned boys and girls born in 2002 who had a parent with a registration date for a debt in the Swedish Enforcement Authority register between 2016 and 2017 (n = 3,284). We determined whether the adolescents had been convicted of a crime during the 3-year period when they were 15 to 17 years old, and compared their records with a sample from the general Swedish population (n = 16,435). Results from logistic regressions show that children who, at age 15 to 17, had a parent with debt problems were approximately one and a half times more likely to be convicted of a crime than children who were unexposed to registered debts of parents (OR = 1.55), irrespective of other well-established criminogenic risk factors observed prior to the parent’s date of registration at the Enforcement Authority. The results provide support for the notion that financial challenges and problems with creditors may be an important proximate risk factor of delinquency.

Transparency of the Swedish Competition Authority

The constitutional principle of access to public records and the administrative principle of parties’ right to access their files create transparency in the Swedish Competition Authority. In many ways Swedish law is built on the same ideas as EU law. However, the Swedish constitution requires more specific provisions on confidentiality in statutes decided by the Parliament. As regards the Swedish Competition Authority, five different sections of the law protect confidentiality, depending on who is to be protected, what activities are concerned, what kind of information is involved and how likely it is that someone will be harmed. These detailed provisions can in principle contribute to predictability, limiting the authorities’ discretional power, but they also constitute a complex patchwork that can be difficult to comprehend. A problematic legal conflict would arise if a document were confidential according to EU law, for example to protect trade secrets, but not confidential according to Swedish law. However, so far, EU law has only been invoked to expand the right to access to documents, especially regarding companies that intend to bring action for competition law damages.

VAT/GST harmonisation challenges for digital assets such as bitcoin and NFTs in the EU following Case C-264/14 (Skatteverket v David Hedqist)

The verdict in the case of Skatteverket v. David Hedqvist (Kokott, Advocate General (2015) Opinion delivered on 16 July 2015, Case C-264/14. ECLI:EU:C:2015:498. Available via TandF Online. https://doi.org/10.1080/20488432.2015.1096631.) is crucial for understanding how the EU treats virtual currencies, such as Bitcoin, in terms of Value-added Tax (VAT). This case involved the Swedish citizen David Hedqist who was seeking clarity from the Swedish Tax Authority Skatteverket on exchanging money for Bitcoins. The case set a precedent exempting such services from VAT under the EU’s VAT Directive (Council Directive 2006/112/EC (2006) On the common system of value added tax. OJ L347. Available via EUR-Lex. https://eur-lex.europa.eu/legal-content/EN/ALL/?uri=CELEX:32006L0112. Accessed 3 January 2024.). Specifically, Article 135(1)(e) of the EU’s VAT Directive excludes those transactions from VAT that include money-related transactions, that include deals or negotiations about different kinds of money, including cash and coins that are officially legal tender, i.e., used for buying things, except for collectable items like special coins or notes that people collect but do not use as a means of payment. Skatteverket (Kokott, Advocate General (2015) Opinion delivered on 16 July 2015, Case C-264/14. ECLI:EU:C:2015:498. Available via TandF Online. https://doi.org/10.1080/20488432.2015.1096631.) clarified that cash transactions are not subject to VAT, even though they are considered services for VAT purposes.Despite this clarity, the evolving landscape of digital assets’ uniqueness, including Non-Fungible Tokens (Alawadhi KM, Alshamali N (2022) NFTs Emergence in Financial Markets and their Correlation with DeFis and Cryptocurrencies. Applied Economics and Finance 9:108. https://doi.org/10.11114/aef.v9i1.5444. Available at CORE. https://core.ac.uk/download/pdf/524752899.pdf. Accessed 3 January 2024.), continues to challenge VAT frameworks across member states.Using insights from the European Commission’s Working Paper 1060, this article advocates for a unified approach tailored to digital and crypto services, addressing complexities in NFT taxation to reduce uncertainty and foster market cohesion. The findings highlight the importance of legislative changes and increased cross-border collaboration, as well as provide recommendations for policymakers and stakeholders in the digital finance and platform sector (European Commission (2024) Working Paper 1060. Available at: https://ec.europa.eu/info/publications/working-paper-1060_en. Accessed 3 March 2024.). By proposing strategic harmonisation of VAT enforcement, the research helps to improve tax compliance and support long-term growth in the EU’s digital market (Cappai M (2023) The role of private and public regulation in the case study of crypto-assets: The Italian move towards participatory regulation. Computer Law & Security Review 49:105831. Available at: https://www.sciencedirect.com/journal/computer-law-and-security-review/vol/49/suppl/C.; Hasa J (2021) Digitaalisten palvelujen rajat ylittävä kuluttajakauppa ja laajeneva arvonlisäveron erityisjärjestelmä. Licentiate thesis. University of Lapland, Faculty of Law. Available at: https://lauda.ulapland.fi/bitstream/handle/10024/64771/Hasa_Juho.pdf?sequence=1. Accessed 1 March 2024.).

Gothenburg Breast reconstruction (GoBreast) II protocol: a Swedish partially randomised patient preference, superiority trial comparing autologous and implant-based breast reconstruction

IntroductionAlthough breast reconstruction is an integral part of breast cancer treatment, there is little high-quality evidence to indicate which method is the most effective. Randomised controlled trials (RCTs) are generally...

Implementing injury prevention training in youth handball (I-PROTECT) in Sweden: study protocol for a cluster randomised trial

IntroductionEfficacy trials show that evidence-based injury prevention training reduces injuries in youth athletes but effectiveness, that is, outside the controlled setting, is lower and, consequently this training has had limited...

Children’s voices on their values and moral dilemmas when being cared and treated for cancer– a qualitative interview study

BackgroundChildhood cancers affect about 350 children every year in Sweden and are life-threatening diseases. During the treatment period, situations arise that can become morally challenging for the child. When knowing children’s values and morally challenging situations in childhood cancer care, targeted ethics support could be developed and used in care.AimTo explore children’s values and moral dilemmas ​​when undergoing cancer treatment.MethodsThis is a qualitative study based on empirical data. The data collection was conducted through three focus group interviews and six individual interviews with children between 10 and 18 years (n = 16). A content analysis methodology was used to generate themes. Children who were/have been treated for cancer at three childhood cancer centres in Sweden were invited to participate. The study was approved by the Swedish Ethical Review Authority. The children’s participation was based on voluntariness and consent/assent.FindingsDuring the analysis, five themes of values emerged: Personal relationships, Bodily ease and identity, Feeling in control and being involved, Positive distractions and Right care that is needed. Their moral dilemmas were thematized into: Should I consider others or not? Should I rest or not? and Should I refuse treatment or not?ConclusionChildren undergoing cancer treatment want to have personal relationships with healthcare professionals. Their moral dilemmas were about questioning their own physical and psychological well-being against their expectations, the values of others and the treatment required. Further research is needed to understand how to deal with moral dilemmas in children undergoing cancer treatment.

Exploring the impact of pharmacist-supported medication reviews in dementia care: experiences of general practitioners and nurses

BackgroundDementia is a major global public health challenge, and with the growing elderly population, its prevalence is expected to increase in the coming years. In Sweden, municipalities are responsible for providing special housing for the elderly (SÄBO), which offers services and care for older individuals needing specific support. SÄBO is both the person´s home and a care environment and workplace. Polypharmacy in patients with dementia is common and increases the risk of medication interactions. Involving clinical pharmacists in medication reviews has been shown to enhance medication safety and improve prescribing practices. However, the views of the standard care team involved in medication prescribing, administration, monitoring and documentation on integrating pharmacist services have received less attention. Thus, this study aims to explore how pharmacists’ contributions can enhance medication safety, improve patient care efficiency, and potentially alleviate the workload of general practitioners for people with dementia living in special housing.MethodsThis study has a descriptive qualitative study design using semi-structured interviews and qualitative content analysis. The study was conducted in a southern Swedish special housing and included nurses, assistant nurses, general practitioners (GPs), and a pharmacist. Due to the COVID-19 pandemic, interviews were conducted over the phone. The Swedish Ethical Review Authority approved the study.ResultsThe analysis revealed three main categories, and eleven subcategories.: (1) Integrating multidisciplinary approaches for holistic dementia care, (2) Strengthening dementia care through effective medication management and (3) Advancing dementia care through pharmacist integration and role expansion. Nurses focused on non-pharmacological treatments, while GPs emphasized the importance of medication reviews in assessing the benefits and side-effects of prescribed medication. Pharmacists were valued for their reliable medication expertise, appreciated by GPs for saving time and providing recommendations prior to consultations with individuals with dementia and their next-of-kin. Although medication reviews were considered beneficial, there was skepticism about their ability to solve all medication-related problems associated with dementia care.ConclusionsThis study highlights the critical role pharmacists play in enhancing medication safety and patient care efficiency in special housing for individuals with dementia. Despite the value of their contributions, communication barriers within healthcare teams pose significant challenges. Recognising potential pharmacist role expansion is essential to alleviate the workload of GPs and ensure effective collaborative practices for better patient outcomes.