Swedish Program Research Articles

Higher carbon sequestration on Swedish dairy farms compared with other farm types as revealed by national soil inventories

Small changes in the large stock of soil organic carbon (SOC) can have a substantial influence on the climate impact of agriculture. We used information from a Swedish soil monitoring program, in combination with farm census data, to analyze decadal SOC concentrations and SOC stock changes on dairy farms compared with other farm types, and to quantify the climate impact of these changes on dairy farms. Soil monitoring data included topsoil samples from two inventories on 159 dairy farms, 86 beef farms, 318 arable farms, and 13 pig farms, taken at the same locations in 2001–2007 and 2011–2017. Concentrations of SOC on dairy farms (3.0%) were significantly higher than on arable farms (2.3%) and pig farms (2.4%), but not significantly different from beef farms (3.1%). SOC concentration was correlated with proportion of ley at farm scale. SOC stocks in the upper 20 cm increased significantly on dairy, beef, and arable farms, by 0.38, 0.14, and 0.21 Mg C ha−1 year−1, respectively, between 2001–2007 and 2011–2017. For dairy farms, this corresponded to −1.4 Mg CO2 ha−1 and approximately −0.22 kg CO2 kg−1 energy-corrected milk, demonstrating that SOC changes could have a substantial influence on the climate footprint of milk.

Patients' Perspectives on Coming Off Opioid Agonist Treatment: A Qualitative Study.

Aims:Opioid agonist treatment (OAT) programs are life-saving, as they reduce opioid use, overdoses, and criminal activities. Disadvantages reported with long-term OAT include side effects of the medication, especially on cognitive ability and sexual function, which may discourage potential participants. Many of those who participate in OAT have a desire to come off treatment. The aims of this study were to explore patients’ thoughts about coming off OAT and to investigate their perceptions of what support they would need in order to realize a planned withdrawal from OAT.Methods:A qualitative interview study with semi-structured interviews, using applied thematic analysis. Persons with experiences of participating in OAT were invited from Swedish programs and a private Facebook community.Results:Fifteen persons, with a mean of 9.6 (±6.4) years of treatment experience, were included. The participants underlined the need for a patient-centered focus within the treatment. They wanted to be regarded as capable of deciding if, when, and how a planned ending was to take place. They also called for staff to be supportive in making such decisions. Participants recommended staff to be sensitive to the needs of the specific patient and to have strategies for coming off OAT that could be adjusted for the single person.Conclusions:OAT programs need to be continually updated and adapted to the persons who can benefit from them. Applying a person-centered, holistic perspective would enhance the quality of the treatment by emanating from individual goals. Regulatory guidelines need to take into account research on patient experiences and perspectives on coming off.

Health-related quality of life in adults treated for paediatric acute lymphoblastic leukaemia: a cross-sectional and longitudinal cohort study

IntroductionAcute lymphoblastic leukaemia (ALL) is the most common form of cancer in children. Although treatment methods have improved and resulted in significant improvement of survival and reduction in late effects...

Colposcopic assessment by Swedescore, evaluation of effectiveness in the Swedish screening programme: a cross-sectional study.

To evaluate the effectiveness and performance of Swedescore in the Swedish screening programme. Cross-sectional register study. All Swedish women aged over 18years with a colposcopic assessment linked to a biopsy in the Swedish National Cervical Screening Registry, 2015-20. Colposcopies with Swedescore were compared with the histopathological diagnosis of cervical intraepithelial neoplasia grade 2 or higher (CIN2+). The respective influence of cytology and human papillomavirus (HPV) testing, at referral for colposcopy and concurrently with colposcopy, were investigated in regression models. CIN2+. A total of 11317 colposcopic assessments with Swedescore were included. Odds ratios for CIN2+ increased for every step in the Swedescore scale. At Swedescore ≥0-1, the proportion of CIN2+ was 9.8%. At Swedescore ≥8, the specificity was 93.3% and the positive predictive value was 60.1%, Area under the receiver operating characteristics curve (AUC) was 0.71. If the smear had been abnormal at referral, a normal colposcopy (Swedescore 0-1) was still associated with a CIN2+ risk of more than 5%. In the regression model, cytology and HPV had higher odds ratio for CIN2+ than colposcopy; the combination resulted in an AUC of 0.88. Swedescore works well in a routine clinical setting but colposcopy assessed with Swedescore was inferior to that reported in previous clinical studies. No safe cutoff level was identified for refraining from biopsy. See-and-treat at Swedescore 8-10 is feasible only if referral cytology showed high-grade squamous intraepithelial lesion. No safe cutoff level for refraining from biopsy nor for see-and-treat with Swedescore.

The Principal as the Instructional Leader in School-Age Educare

ABSTRACT With the inclusion of school-age educare (SAEC) in the Swedish National curriculum in 2016, the principal’s role now includes pedagogical leadership in SAEC. This study consists of reflection responses provided by twenty principals in the project The Pedagogical task of School Age educare. Findings indicate that a minority of the participants have a good grasp of the instructional aspect of the SAEC program. As them Swedish national principal training program currently does not specifically address the SAEC program, principals are at a disadvantage when it comes to their ability to lead and develop this part of the Swedish school system.

Evaluation of the Swedish school-based program “tobacco-free DUO” in a cluster randomized controlled trial (TOPAS study). Results at 2-year follow-up

Friends' and parents' tobacco use are strong predictors of tobacco uptake among adolescents, however the effectiveness of interventions based on public commitments and agreements to remain tobacco-free are not established.Here, we evaluated the effectiveness of the school-based Swedish program Tobacco-Free Duo (T-Duo) in preventing adolescents from initiating tobacco use (TOPAS study).T-Duo is a multi-component intervention witha formal agreement between a student and an adult partner to remain tobacco-free during the entire 3-year study period as core component. The standardized educational component of the same program was used as comparator (control).Primary outcome was the probability to “remain a non-user” of i) cigarettes and secondary outcomes ii) other types of tobacco at second (21-month) follow-up. Analysis was conducted according to Intention To Treat. In total 1776 adolescents (51% female) aged 12–13 in grade 7 from 34 participating high schools in Sweden were included at baseline in 2018, of which 1489 were retained after 21 months. The Risk Ratio (RR) of not having tried cigarettes 21-months after initiation of the intervention was 1.03(CI 0.98–1.08), Bayes Factor(BF) = 0.93, Absolute Risk Difference(ARD) = 3.1%. Similar associations were found for never smoked a whole cigarette and never use of other tobacco/nicotine products.There was a minimal reduction of tobacco use initiation among Swedish adolescents assigned to a multi-component intervention (T-Duo) compared to those assigned to standardized classroom education after 2 schoolyears. However, for most outcomes' findings were inconclusive and not reliably different from zero.Trial registration: ISRCTN5285808 (doi:https://doi.org/10.1186/ISRCTN52858080); Study protocol: DERR1-https://doi.org/10.2196/21100.Registration: Current Controlled Trials ISRCTN52858080 Date: January 4, 2019, retrospectively registered.Protocol: Galanti, M.R., Pulkki-Brännström, A.-M., Nilsson, M., 2020. Tobacco-free duo adult-child contract for prevention of tobacco use among adolescents and parents: protocol for a mixed-design evaluation. JMIR Res. Protoc. 9, e21100. doi:10.2196/21100.

Efficacy of topical lidocaine-prilocaine (EMLA®) for management of infant pain during pneumococcal vaccination: A randomized controlled trial.

Few studies have evaluated whether topical anesthetic cream reduces pain during pneumococcal vaccination. This is crucial, since effective pain management should be evidence‐based. Previous studies have shown that topical lidocaine‐prilocaine (EMLA®) reduces vaccination‐related pain, measured using pain‐rating instruments and observation of crying time. This intervention study aimed to compare the efficacy of topical lidocaine‐prilocaine cream with that of the standard of care on the expression of pain during the first pneumococcal vaccination administered at age 3 months under the Swedish national vaccination program. A randomized controlled trial included 72 infants receiving their first pneumococcal vaccination (Prevenar 13®). The study showed that topical lidocaine‐prilocaine before pneumococcal vaccination significantly reduced infants’ expression of pain according to the Face, Legs, Activity, Cry, Consolability (FLACC) score (P = .006) and increased latency to cry (P = .001). There were no statistically significant differences in the total crying time (P = .146) between the groups. Topical lidocaine‐prilocaine cream reduced pain expression and increased latency to cry in infants receiving their first pneumococcal vaccine. Systematic efforts are needed to successfully implement the use of topical anesthetic cream and other effective non‐pharmacological pain‐relieving strategies during infant vaccination procedures.

A Pilot Study of the Swedish Sexual Offender Treatment Program

Purpose: The aim was to test whether dynamic criminogenic risk factors change after participation in a new cognitive-behavioral treatment program adhering to the Risk-Need-Responsivity (RNR) model, within a group of adult men convicted of a sexual offense in Sweden. Methods: Three psychometric tests from approximately 26 participants were completed. Therapists rated 46 participants using the Therapist Rating Scale-2 (TRS-2). Results: Participants reported a significant decrease in hypersexuality, small to medium effect size, a non-significant, increased, internal locus of control, but no change regarding attachment styles, posttreatment. Therapists rated significant decrease in all treatment needs posttreatment, medium to large effect size. Conclusions: The significant reduction of several criminogenic risk factors posttreatment indicates the treatment program may reduce problems related to increased risk of recidivism, especially hypersexuality. Moreover, treatment did not appear to have negative effects, motivating further implementation. However, to evaluate the effectiveness, more research is necessary.

Gendered Vocational Identities – Female Students' Strategies for Identity Formation During Workplace-Based Learning in Male-Dominated Work

Purpose: This article investigates female vocational students' strategies for becoming part of a workplace community, what these strategies are and how they are tied to the formation of vocational identities within male-dominated industrial work. Of particular interest is how female students enrolled on Swedish upper secondary industrial programmes experience workplace-based learning at industrial workplaces as part of their vocational education. The theoretical framework derives from Wenger's concept of community of practice, but his theoretical concept does not explicitly include gender dimensions. Therefore, the concept of community of practice is also combined with Paechter's assumption of gender, whereby femininity and masculinity can be considered as different communities of practice. Methods: The article draws on evidence from a Swedish study based on interviews with 20 female students enrolled on the industrial programme at six upper secondary schools. In this vocational programme, there is a distinct gender distribution and only a small minority of the students on the programme are girls. In the analysis, the focus is on the female students' strategies used during workplace-based learning to become part of the work community which consists almost exclusively of male workers.Findings: The female students deliberately negotiated vocational identities as female industrial workers to become accepted in the male-dominated work community. The findings highlight three specific strategies that the female students used: Acting like gender does not matter, acting like boys (not like drama queens), and acting tough and joking around. The female students' strategies were part of – and tied to – a complex vocational identity formation process that featured contradictory requirements. By taking individual responsibility, they identified relevant information for becoming industrial workers and chose to act like boys. The female students saw no problem with being a girl, yet they struggled with implicit, diffuse and hidden gender structures and prejudices in the male-dominated industrial companies. Nevertheless, they strived for what they perceived to be an attractive vocational identity as industrial workers; it was an alternative, atypically feminine way of being that attracted the female students. Conclusions: The study concludes that female students mostly rely on their individual agency when interacting with others in the male-dominated workplace community. A "gendered vocational identity" is formed which shows that the identity formation of female students is a complex double process, in which vocational and gender identities are formed simultaneously and in parallel within the male-dominated workplace.

Salix spp. Bark Hot Water Extracts Show Antiviral, Antibacterial, and Antioxidant Activities-The Bioactive Properties of 16 Clones.

Earlier studies have shown that the bark of Salix L. species (Salicaceae family) is rich in extractives, such as diverse bioactive phenolic compounds. However, we lack knowledge on the bioactive properties of the bark of willow species and clones adapted to the harsh climate conditions of the cool temperate zone. Therefore, the present study aimed to obtain information on the functional profiles of northern willow clones for the use of value-added bioactive solutions. Of the 16 willow clones studied here, 12 were examples of widely distributed native Finnish willow species, including dark-leaved willow (S. myrsinifolia Salisb.) and tea-leaved willow (S. phylicifolia L.) (3 + 4 clones, respectively) and their natural and artificial hybrids (3 + 2 clones, respectively). The four remaining clones were commercial willow varieties from the Swedish willow breeding program. Hot water extraction of bark under mild conditions was carried out. Bioactivity assays were used to screen antiviral, antibacterial, antifungal, yeasticidal, and antioxidant activities, as well as the total phenolic content of the extracts. Additionally, we introduce a fast and less labor-intensive steam-debarking method for Salix spp. feedstocks. Clonal variation was observed in the antioxidant properties of the bark extracts of the 16 Salix spp. clones. High antiviral activity against a non-enveloped enterovirus, coxsackievirus A9, was found, with no marked differences in efficacy between the native clones. All the clones also showed antibacterial activity against Staphylococcus aureus and Escherichia coli, whereas no antifungal (Aspergillus brasiliensis) or yeasticidal (Candida albicans) efficacy was detected. When grouping the clone extract results into Salix myrsinifolia, Salix phylicifolia, native hybrid, artificial hybrid, and commercial clones, there was a significant difference in the activities between S. phylicifolia clone extracts and commercial clone extracts in the favor of S. phylicifolia in the antibacterial and antioxidant tests. In some antioxidant tests, S. phylicifolia clone extracts were also significantly more active than artificial clone extracts. Additionally, S. myrsinifolia clone extracts showed significantly higher activities in some antioxidant tests than commercial clone extracts and artificial clone extracts. Nevertheless, the bark extracts of native Finnish willow clones showed high bioactivity. The obtained knowledge paves the way towards developing high value-added biochemicals and other functional solutions based on willow biorefinery approaches.

Greenhouse production contributes to pesticide occurrences in Swedish streams

Greenhouse and other covered cultivation systems have increased globally over the past several decades, leading to considerably improved product quality and productivity per land area unit. However, there is a paucity in information regarding the environmental impacts of covered production systems, especially regarding pesticides entering the surrounding environment. Aiming to address this knowledge gap, we collected grab samples downstream of greenhouses from seven Swedish streams every 14 days during a 12 month period. In three of the streams, samples were also taken upstream of the greenhouses and in four of the streams time-integrated samples were collected by TIMFIE samplers in the period between grab sampling occasions. The samples were analyzed for 28 substances (27 that were permitted for use in greenhouse production systems in Sweden and one degradation product to a permitted substance). Pesticide use journals were collected from the greenhouse producers for the 12 month period. The results were examined for indications of greenhouse contributions to detection frequencies, maximum and average concentrations, and potential ecotoxicicity in several ways: (1) comparing locations downstream of greenhouses with registered use of a substance with those without registered use, (2) comparing results from this study with those from the Swedish environmental monitoring program of pesticides in surface water from catchments with no greenhouses from the same period and region, (3) comparing concentration trends with registered pesticide application times in the greenhouses, and (4) comparing up- and downstream concentrations. The results strongly suggest that greenhouse applications do contribute to pesticide occurrences, maximum and median concentrations for most of the pesticides included in this study, and to potential toxicity to aquatic organisms for several of them, most notably imidacloprid, acetamiprid, carbendazim, and pirimicarb.

Postural Asymmetries and Assistive Devices Used by Adults With Cerebral Palsy in Lying, Sitting, and Standing.

Purpose: To describe the use of assistive devices and postural asymmetries in lying, sitting and standing positions in adults with cerebral palsy, and to analyze postural asymmetries and any associations with their ability to maintain or change position and time in these positions.Methods: A cross-sectional study based on data from the Swedish Cerebral Palsy follow-up program of 1,547 adults aged 16–76 years, at Gross Motor Function Classification System (GMFCS) levels I (n = 330), II (n = 323), III (n = 235), IV (n = 298), and V (n = 361). Assistive devices such as wheelchairs, seating systems, adjustable beds, standing equipment and time in each position were reported. The Posture and Postural Ability Scale was used to identify asymmetries and rate the ability to maintain or change position. Binary logistic regression models were used to estimate odds ratios (OR) for postural asymmetries in supine, sitting and standing.Results: Assistive devices were used by 63% in sitting (range 5–100% GMFCS levels I–V), 42% in lying (4–92% levels I-V), and 32% in standing (2–70% levels II–V). Wheelchairs were used as seating systems by 57%. Most adults had postural asymmetries in supine (75%; range 35–100% levels I–V), sitting (81%; 50–99% levels I–V) and standing (88%; 65–100% levels I–V). Men were more likely than women to have postural asymmetries, and the likelihood of postural asymmetries increased with age, GMFCS levels and inability to change position. Inability to maintain position increased the probability of postural asymmetries in all positions from OR 2.6 in standing to OR 8.2 in lying and OR 13.1 in sitting.Conclusions: Almost twice as many adults used assistive devices in sitting than in lying or standing. Two thirds of the adults who used standing devices used it for <1 h per day, indicating that they might spend the remaining 23 out of 24 h per day either sitting or lying. Asymmetric postures were frequent across all ages and were highly associated with inability to change or maintain position.

Lung Function and Health Status in Individuals with Severe Alpha-1-Antitrypsin Deficiency at the Age of 42.

BackgroundSevere hereditary alpha-1-antitrypsin deficiency (AATD) is a known risk factor for the early development of pulmonary emphysema and COPD, especially in smokers. By the Swedish national screening programme carried out from 1972 to 1974, a cohort of individuals with severe (PiZZ) AATD was identified and has been followed up regularly. The aim of this study was to investigate health status, quality of life and lung function in this cohort at the age of 42 years compared with an age-matched control group randomly selected from the population registry.MethodsAll study participants answered a questionnaire on smoking habits, symptoms, occupation, exposure to airway irritants and quality of life using Saint George’s Respiratory Questionnaire (SGRQ). They underwent complete pulmonary function tests (PFT) and forced oscillation technique (FOT) for the measurement of airway resistance and reactance. Blood samples were taken for allergies and IgG-subclasses as an indicator of increased risk of airway infections.ResultsThe residual volume (RV), total lung capacity (TLC) and RV/TLC ratio were significantly higher in the PiZZ ever-smokers compared to the PiMM ever-smokers and PiZZ never-smokers (p < 0.05). The resistance in the upper, small and total airways was significantly lower in PiZZ subjects compared to PiMM subjects (p < 0.05). A greater proportion of PiZZ never-smokers had an FEV1/VC ratio <0.7 than PiMM never-smokers (p = 0.043). PiZZ subjects with occupational exposure to airway irritants showed a significantly lower FEV1, VC and higher RV/TLC ratio than PiMM individuals with exposure (p < 0.05).ConclusionAt the age of 42, ever-smoking PiZZ individuals have signs of COPD, and also PiZZ never-smokers have early, physiological signs of emphysema.

Selected 15-year-old boy and girl football players’ continuation with football and competitive level in young adulthood: the impact of individual and contextual factors

This study investigates players who have been selected to a district team in the Swedish Football Association U15 talent programme. Using register data on all selected 15-year-old boy and girl district team players (3943 boys and 4056 girls born between 1986 and 1996) from Sweden’s 24 football districts, we analysed the relationships between club affiliation at age 15, the player population of the district, date of birth, and continuation with football and competitive level as young adults. The results show that a higher percentage of boys than girls continued playing football into young adulthood and that continuation is related to district size. Belonging to an elite club at age 15 reduces the likelihood of girls playing football at age 21, but it has no effect on the likelihood of boys playing football at age 21. In addition, 15-year-old boys and girls from larger districts who played on an elite club at age 15 were more likely to play elite football at age 21. In sum, the study shows that football district size and club affiliation at age 15 affect whether boys and girls continue to play football and whether they play at an elite level as young adults.

A systematic approach for surface exploration of sites – analysis of international exploration programs

Abstract. The site selection procedure for a high-level radioactive waste repository in Germany is based on the Repository Site Selection Act (StandAG, 2017), which comprises three phases. In phase 2 the Federal Company for Radioactive Waste Disposal (BGE) will conduct surface exploration. Based on the exploratory findings, the further developed preliminary safety analyses, the common requirements and criteria, and potential socioeconomic analyses will be applied feeding into proposed sites for underground exploration. Commissioned by the BGE, the Federal Institute for Geosciences and Natural Resources (BGR) contributes to this procedure with the projects GeoMePS and ZuBeMErk, which collate and assess geoscientific and geophysical methods and programs for surface exploration. Their common goal is to develop recommendations for surface exploration of siting regions. For this purpose, the BGR has developed a systematic approach that includes (1) deducing exploration targets, (2) compilation of geoscientific and geophysical exploration methods in a database structure, and (3) analysis of case studies of national and international exploration programs for high-level radioactive waste disposal. Exploration targets are based on the common criteria and requirements as defined by the StandAG. The identified exploration targets (Kneuker et al., 2020) together with a large number of geoscientific and geophysical exploration methods were integrated and linked within the BGR database “GeM-DB”. All methods were evaluated according to their suitability and applicability for (a) the three defined host rocks (crystalline rock, claystone, rock salt) and (b) the previously defined exploration targets. In step (3) the BGR reviews national and international waste disposal programs exploring for crystalline rock, claystone, and rock salt. Here, the focus is on nondestructive and minimally invasive surface exploration techniques, such as geophysical airborne and ground-based methods or investigations in drill holes and on drill cores. The aims are to identify gaps in the method catalogue of the GeM-DB and to infer exploration directives for surface exploration during phase 2. An example is the analysis of the Swedish site selection process, especially the site investigation program. There, the site investigations are, e.g. the basis for the discipline-specific site descriptive models, which were applied for design and safety assessments (SKB, 2001). The Swedish site investigation program along with programs of other countries considering crystalline host rocks, such as Finland and Canada, show a common ground, which could be adapted for surface exploration of crystalline host rock regions in Germany. The assessment and evaluation of selected programs exploring for rock salt and claystone is currently in progress. The entire systematic approach of the projects GeoMePS and ZuBeMErk aims to develop recommendations for a nondestructive and minimally invasive surface exploration program of siting regions in Germany, regarding the lithological, structural, mechanical, and hydrogeological characterization of the different host rock formations.

The wait time to primary surgery in endometrial cancer – impact on survival and predictive factors: a population-based SweGCG study

Background Poor survival rates in different cancer types are sometimes blamed on diagnostic and treatment delays, and it has been suggested that such delays might be related to sociodemographic factors such as education and ethnicity. We examined associations of the wait time from diagnosis to surgery and survival in endometrial cancer (EC) and explored patient and tumour factors influencing the wait time. Material and methods In this historical population-based cohort study, The Swedish Quality Registry for Gynaecologic Cancer (SQRGC) was used to identify EC patients who underwent primary surgery between 2010 and 2018. Factors associated with a wait time > 32 d were analysed with logistic regression. The 32-d time point was defined in accordance with the Swedish Standardisation Cancer Care programme. Adjusted Poisson regression analyses were used to analyse excess mortality rate ratio (EMRR). Results Out of 7366 women, 5535 waited > 32 d for surgery and 1098 > 70 d. The overall median wait time was 44 d. The factors most strongly associated with a wait time > 32 d were surgery at a university hospital (adjusted odds ratio [OR] 1.34, 95% confidence interval [CI] 1.08–1.66) followed by country of birth (OR 1.31, 95% CI 1.10–1.55) and year of diagnosis. There were no associations between wait time and histology or age. A wait time < 15 d was associated with higher mortality (adjusted EMRR 2.29,95% CI 1.36–3.84) whereas no negative survival impact was seen with a wait time of 70 d. Age, tumour stage, histology and risk group were highly associated with survival, whereas education, country of origin and hospital level did not have any impact on survival. Conclusions Surgery within the first two weeks after EC diagnosis was associated with worsened survival. A prolonged wait time did not seem to have any significant adverse effect on prognosis. Highlights Surgery within the first two weeks after diagnosis of endometrial cancer (EC) was associated with poorer survival. A prolonged wait time to surgery did not worsen prognosis. Delay in time to surgery was associated with sociodemographic factors.

ANALYSIS OF DOMESTIC AND FOREIGN EXPERIENCE OF THE ORGANIZATION OF ROAD SAFETY

The experience of traffic safety in the USA and European countries is studied, as well as a comparative analysis of road accidents in Ukraine, taking into account building codes in this area, analyzed foreign experience and prerequisites for the formation and implementation of road safety.&#x0D; Vision Zero (Zero Mortality) is a Swedish program to increase road safety and reduce road deaths. The basic principle of the program is the inadmissibility of fatal traffic accidents. The main tools of the program:&#x0D; Crossroads with circular traffic. Despite the fact that traffic light regulation reduces the number of accidents and increases the capacity of the intersection; roads with a dividing barrier. The solution effectively prevents accidents related to collisions of oncoming vehicles. Construction of dividing barriers has been active in Sweden since 1998; speed limit in settlements up to 30 km / h. Cleaning of areas adjacent to roads. To minimize the consequences of the congress of transport from the road from the surrounding areas were removed dangerous objects: stones and trees, fences. Detailed investigation of fatal accidents. All fatal road accidents are investigated by a special commission. Seat belt reminder. Alcolocks. The technology is designed to reduce the number of cases of drunk driving. Photo radars. Means of control over the established speed limits on roads. Bicycle helmets. All children under the age of 15 are required to wear a helmet when cycling.

Adapting the preschool environment to the needs of children on the autism spectrum in Sweden: A quasi-experimental study

Background Children on the autism spectrum may receive Early Intensive Behavioural Intervention (EIBI) in Sweden to support development by providing learning opportunities. However, research suggests a need to improve the quality of their learning environment. Aim This pre-registered study (#NCT03634761) aimed to evaluate the Swedish Autism Program Environment Rating Scale (APERS-P-SE) as a means to promote the quality of the pre-school learning environment for children on the autism spectrum, along with outcomes for these children, and their pre-school staff. Material and methods In a quasi-experimental study, pre-school staff (n = 35) conducted either EIBI supported by in-service training and on-site coaching based on APERS-P-SE assessment (at k = 9 preschools) or EIBI only (k = 8), during an 8-months period. Results The quality of the immediate learning environment (primary outcome) increased significantly in the EIBI/APERS-P-SE preschools. However, changes in child and pre-school staff measures were not significant. Conclusions and significance In-service training and on-site coaching based on APERS-P-SE assessments can increase the quality of the learning environment in Swedish pre-school. Studies of longer duration and larger sample size are required to determine if using the APERS-P-SE can also achieve desired behavioural change for children-, and impact pre-school staff applying EIBI.

Government lending in a crisis

The economic disruption from the COVID-19 pandemic prompted governments around the world to initiate an unprecedented number of temporary lending and tax deferment programs. Which firms will benefit from these programs? What are the implications for firm balance sheets and post-crisis survival? We provide some novel insights on these questions by studying one of the first government programs of this type, which Sweden launched at the height of the 2008–2009 financial crisis. The Swedish program allowed firms to temporarily suspend payment of all labor-related taxes and fees, treating these deferred amounts as a short-term loan from the government. Firms participating in the program are younger, less profitable, hold fewer cash reserves, are more leveraged, and have less unused slack in their credit lines when the crisis hits. Given the structure of the Swedish program, it provided more liquidity to firms with relatively larger ex ante wage bills. Exploiting this feature of the policy, we find that firms use the program to increase overall debt levels rather than to substitute for other borrowing. The leverage increase is due entirely to higher levels of non-bank debt. Firms use the funds to avoid making even deeper cuts to current assets. Despite the increase in leverage, access to the lending program is unrelated to the likelihood a firm files for bankruptcy and is negatively related to the likelihood a firm encounters severe financial distress in the years immediately following the crisis.

Range of hip abduction after preventive and reconstructive surgery in cerebral palsy: a longitudinal registry study of 307 children

Background and purpose — Hip dislocation in cerebral palsy (CP) is caused by altered muscle forces on the joint during typical hip positioning in adduction–flexion–inward rotation. Preventive surgery includes adductor–psoas lengthening (APL) or varus derotation osteotomy (VDRO) of the proximal femur. We assessed the changes in the hip abduction range after these operations. Patients and methods — Data were obtained from the Swedish Surveillance Programme for CP. The range of hip abduction before and up to 18–36 months after surgery was assessed for all children who underwent APL or VDRO. Data for 1 hip per child was assessed. Ordinary linear regression was used. Results — In the 150 children who underwent APL, the mean range of abduction increased from 29° (95% confidence interval [CI] 28–32) preoperatively to 37° (CI 35–39) at 18–36 months. In the 157 children who underwent VDRO, the respective mean values were 30° (CI 29–32) and 29° (CI 28–31). The mean difference in preoperative abduction between sides was greater in children who underwent unilateral (9.4°, CI 7.8–11) than bilateral (5.5°, CI 3.4–7.6) VDRO. At 18–36 months postoperatively, the differences between sides were almost unchanged. Interpretation — The range of hip abduction increased after APL but remained unchanged after VDRO. This may explain the normal development of hip displacement after these operations. Differences in abduction between sides were not substantially affected by whether VDRO was performed uni- or bilaterally.