Swedish State Research Articles

52-OR: Risk Factors and Incidence over Time for Lower Extremity Amputations in Persons with Type 1 Diabetes: An Observational Cohort Study of 46,008 Patients from the Swedish National Diabetes Registry

Background: Lower extremity amputations in people with diabetes is a major source of disability and distress and it constitutes a significant financial burden for the healthcare system. Risk factors and current risks for amputation in persons with type 1 diabetes have not been extensively studied. Methods: Persons with type 1 diabetes registered in the Swedish National Diabetes Registry with no previous amputation from 1998 and followed until 2019 were included. Time-updated Cox regression and gradient of risk per SD were used to evaluate the impact of risk factors on the incidence of amputation. Age and sex adjusted incidences were estimated over time. Findings: Of 46,008 persons with type 1 diabetes with no previous amputation and a mean age of 32.5 years (SD 14.5) and 25 354 (55%) male, 1,519 (3.3%) underwent amputation. Median follow-up was 12.4 years. The age and sex adjusted incidence for any amputation decreased over time. The standardized incidence was 1998-2001 2.84 (95% CI 2.32-3.36) per 1000 patient years and decreased to 1.64 (95% CI 1.38-1.90) in 2017-2019 along with improved glycaemic control (0.02% [95% CI 0.02-0.02] per year) and renal function (0.23 ml/min/1.73m² [95% CI 0.21-0.24] per year). Risk factors for amputations were hyperglycemia, renal dysfunction, older age, male gender, cardiovascular comorbidities, smoking and hypertension. Interpretation: Prognosis has improved considerably regarding the risk of amputations in persons with type 1 diabetes while glycaemic control and renal function improved which were the most prominent risk factors. Disclosure S. Hallström: None. A. Svensson: None. A. Pivodic: None. A. F. Olafsdottir: None. M. Londahl: Advisory Panel; Self; Abbott, Speaker’s Bureau; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Lilly Diabetes, Novo Nordisk, Sanofi. H. Wedel: None. M. Lind: Consultant; Self; AstraZeneca, Eli Lilly and Company, Other Relationship; Self; Novo Nordisk, Research Support; Self; Dexcom, Inc. Funding Novo Nordisk Foundation; Swedish State

Digitization Without Digital Evidence: Technology and Sweden’s Asylum System

Abstract States and asylum seekers are at the centre of rapid digital innovation in surveillance, mobility, welfare and identity. Why do some states rush to digitalize asylum systems, while others do not? Why is the pace and form of digitalization within countries uneven within asylum agencies? In this article, we examine drivers of the digitalization of the Swedish state, in particular uneven digitalization within the Swedish Migration Agency (Migrationsverket). While many processes were swiftly digitalized, we found that Swedish bureaucrats, rather than politicians or activist lawyers, resisted the adoption of digital evidence within the refugee status determination process, despite enthusiastically digitizing elsewhere. We explore these differences by looking at the historical, institutional and cultural bases of Swedish refugee policy. We present evidence from fieldwork in Sweden and find an unequal pace of digitalization that was largely dependent on the bureaucratic risk-aversion, extant legal norms, and perceived vulnerability to fraud.

Potential risk factors for caesarean scar pregnancy: a retrospective case-control study.

STUDY QUESTIONWhat are the important risk factors for having a caesarean scar pregnancy (CSP)?SUMMARY ANSWERIndependent risk factors were smoking in the first trimester, higher parity, and previous caesarean section (CS) before the index caesarean delivery.WHAT IS KNOWN ALREADYA spectrum of risk factors for CSP has been suggested but not proven: parity, number of previous caesarean section, elective as opposed to emergency CS, IVF-pregnancy, breech presentation, previous gynaecological surgery as well as suture technique.STUDY DESIGN, SIZE, DURATIONThis retrospective case-control study included 31 women with a CSP during the period 2003–2018 treated at a tertiary care centre for gynaecology and reproduction. A control cohort of 8300 women with a history of a CS and a subsequent delivery during the same time period was formed.PARTICIPANTS/MATERIALS, SETTING, METHODSVariables describing demography, lifestyle factors, and reproductive and obstetric history were retrieved from medical records and the obstetric hospital database. Logistic regression analyses were applied to identify potential risk factors.MAIN RESULTS AND THE ROLE OF CHANCEIn a multivariable analysis, smoking in first trimester (adjusted odds ratio (OR) 3.03, 95% CI 1.01–9.07), higher parity (adjusted OR 1.30, 95% CI 1.03–1.64) and previous CS in addition to the preceding CS (adjusted OR 3.43, 95% CI 1.35–8.66) were independently predictive of a CSP. An elective CS at the index pregnancy was associated with an increased risk of CSP but did not remain significant in the multivariable analysis.LIMITATIONS, REASONS FOR CAUTIONCSP is a very rare phenomenon and several of the risk factor estimates are imprecise. Nevertheless, significant risk factors could be identified. Another limitation is the lack of electronically recorded details on suture techniques.WIDER IMPLICATIONS OF THE FINDINGSThe identified factors, namely higher parity and previous CS before the index caesarean section, are in accordance with previously suggested risk factors. Whether there is a true risk association between elective CS and future CSP needs to be investigated further. Smoking in the first trimester is a new finding, which has a plausible rationale. These factors should be recognised when counselling women after a caesarean delivery, particularly in a subsequent pregnancy with early complications.STUDY FUNDING/COMPETING INTEREST(S)This work was supported by a grant from the Swedish state under the agreement between the Swedish government and the county councils the ALF-agreement (ALFGBG-720291). None of the authors has any conflict of interest to declare.

Finland: Identities on the periphery

The troubled histories of nations are built from the bones of a million damaged children. But what about the nations and children who are stuck in the periphery between troubled and happy, between damaged and healthy? These are the settings that anthropology can thrive in: nations that have both suffered and benefited from colonialism, oppressed groups discriminating against others, and other ambiguous cultural dynamics. In this paper, I want to focus on Finland as a specific nation that serves as a good example of how collective trauma and ambiguous histories can be contested. These contestations are most commonly expressed through minute inequalities between the two main cultural groups in Finland: Finnish and Swedish-speaking Finns. Modern inequalities between different cultural and linguistic groups in and around Finland are expressed through stereotypes and expressions of identity. These stereotypes and identities are often mixed with ambivalent feelings, especially in regard to Finns' relationship with Sweden: the state and people, both historically and in the present. These relationships are based on the hegemonic and non-hegemonic views that Finnish speakers, Fennoswedes, and Swedes hold of each other. Hegemonically, quiet admiration and casual disapproval are common, hence the ambiguity. Non-hegemonically, extreme emotions and fixations are commonly perceived as strange and distasteful; everything must be just right, or lagom in Swedish. In this paper, I focus the discussion on Finnish issues of cultural and linguistic identity while keeping their relationship with the Swedish state and people in mind. Hence, my goal is to answer these questions: How has discrimination shaped Finnish identities? Has it shaped Finnish-speaking versus Swedish-speaking Finnish identities differently? How does a collective memory of oppression affect Finnish peoples' perceptions of others? However, what I ultimately want to answer is what is the source of Finland’s ambiguous historical identity: were Finns victims of ethnic discrimination or is this a narrative produced by historical revisionism?

Severe COVID-19 in People with Type 1 and Type 2 Diabetes in Sweden: A Nationwide Retrospective Case-Control Study

Introduction: Whether infection with SARS-CoV-2 leads to excess risk of requiring hospitalization or intensive care in persons with diabetes has not been reported, nor have risk factors in diabetes associated with increased risk for these outcomes.Methods: We included 44,639 and 411,976 adult patients with type 1 and type 2 diabetes alive on Jan 1, 2020, and compared them to controls matched for age, sex, and county of residence (n=204,919 and 1,948,900). Standardized rates of hospitalizations, admissions to intensive care and death were estimated and hazard ratios were calculated using Cox regression analyses.Findings: There were 10,486 hospitalizations and 1,416 admissions into intensive care. A total of 1,175 patients with diabetes and 1,820 matched controls died from COVID-19, of these 53·2% had been hospitalized and 10·7% had been in intensive care. Patients with type 2 diabetes, compared to controls, displayed a hazard ratio (HR) of 2·22, 95%CI 2·13-2·32) of being hospitalized, which decreased to HR 1·40, 95%CI 1·34-1·47) after adjustment for sociodemographic factors, pharmacological treatment and comorbidities, had higher risk for admission to intensive care (HR 2·49, 95%CI 2·22-2·79, decreasing to 1·42, 95%CI 1·25-1·62 after adjustment, and increased risk for death (HR 2·19, 95%CI 2·03-2·36, adjusted 1·50, 95%CI 1·39-1·63). HR for hospitalization for type 1 diabetes was 2·10, 95%CI 1·72-2·57), decreasing to 1·25, 95%CI 0·3097-1·62) after adjustment· Patients with diabetes type 1 were twice as likely to require intensive care for COVID-19, however, not after adjustment (HR 1·49, 95%CI 0·75-2·92), and more likely to die (HR 2·90, 95% CI 1·6554-5·47), but not independently of other factors (HR 1·38, 95% CI 0·64-2·99). Among people with diabetes, elevated glycated hemoglobin levels were associated with higher risk for most outcomes.Interpretation: In this nationwide study, type 2 diabetes was independently associated with increased risk of hospitalization, admission to intensive care and death for COVID-19, whereas type 1 diabetes was not independently associated with excess risk for any outcome.Funding Statement: This work was supported by grants from: the Swedish state under an agreement concerning research and education of doctors [ALFGBG-717211]; the Swedish Heart and Lung Foundation [2018- 0366]; the Swedish Research Council [2013-05187, VRREG 2019-00193, 2020-05792]Declaration of Interests: Professor Eliasson reports personal fees (expert panels, lectures) from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Merck Sharp & Dohme, Mundipharma, Navamedic, NovoNordisk, RLS Global, grants and personal fees from Sanofi, all outside the submitted work. NN declare that they have no conflict of interest. MG reports personal fees (scientific advisory boards, lectures) from Gilead Sciences, GSK/ViiV, MSD, Biogen, Amgen, Novocure, Novo Nordic and research grants from Gilead Sciences, all outside the submitted work. All other authors have nothing to disclose. Ethics Approval Statement: The Swedish Ethical Review Authority approved the study.

The patchwork planning of a welfare landscape: reappraising the role of leisure planning in the Swedish welfare state

ABSTRACT The public memory of the social democratic welfare state in Sweden often emphasizes housing, but in fact post-war planning was far more diverse. One asset which postwar planning developed over time was a landscape that materialized a range of different concerns over welfare. Even today, the impressive investments in recreational facilities and green spaces made during the high point of welfarist planning in Sweden still provides the backbone of Sweden’s recreational infrastructure and areas for outdoor leisure and play. This paper highlights ‘leisure planning’ as a forgotten aspect of the postwar decades, and argues that the relationship between urban planning and leisure planning speaks to the patchwork character of the welfare landscape and explains why it remains elusive or even invisible in the current debate. We illustrate the making of welfare landscapes by analyzing developments in Upplands Väsby municipality, focusing on the complex interplay between leisure planning and urban planning from the 1950s to the 1980s.

Improvement of Public Governance by Olof Palme and his Historical Ideological Heritage (30 years after the assassination of Palme in Stockholm)

The essence of the “Swedish socialism” created in the 20th century lies in “democratic functional socialism”. During the last 30 years, even after having refused part of its elements, it remains the foundation of the Swedish welfare state, and historically the name of the “Swedish socialism” is mostly related to the famous Swedish and global figure of the smart political powers, social democrat Olof Palme. The article reviews the features of the biography of Olof Palme and his both theoretical and practical activity opting for social justice and by creating a welfare state in Sweden by the means of “democratic functional socialism”. Olof Palme was also an advocate of human rights and freedoms, neutrality of small countries, an international mediator, an advocate of nuclear disarmament policy and a severe critic of neo-liberal ideas. KEY WORDS: Olof Palme, Sweden, social democracy, democratic socialism, functional socialism, welfare state, public governance, peace. JEL CLASSIFICATION: B 14, L 30. DOI: http://dx.doi.org/10.15181/rfds.v19i2.1281

Lost and lonely: a qualitative study of women's experiences of no embryo transfer owing to non-fertilization or poor embryo quality.

STUDY QUESTIONWhat are the experiences of women undergoing IVF who could not receive an embryo transfer because of failed fertilization or poor embryo development?SUMMARY ANSWERNo embryo transfer because of failed embryo development is associated with considerable emotional suffering and the need for an early appointment with a physician to obtain information on what went wrong and new alternatives.WHAT IS KNOWN ALREADYThe psychological and emotional impact of IVF treatments as experienced by IVF patients is well known, particularly following the failure to achieve pregnancy.STUDY DESIGN, SIZE, DURATIONA qualitative study running from January 2018 to April 2019 was carried out at one public and one private IVF clinic. The invitation to participate was sent to women within 1 month after the cycle failed.PARTICIPANTS/MATERIALS, SETTING, METHODSThe women undergoing IVF were diverse in terms of cause of infertility, age, number of previous cycles, country of birth and educational level. Nineteen of the 41 invited women who had experienced no embryo transfer because of non-fertilization or poor embryo development took part in a semi-structured interview. Data were analysed by thematic content analysis.MAIN RESULTS AND THE ROLE OF CHANCEThe master theme was identified as: ‘Lost and lonely’ organized in two main themes ‘Experience of the event’ and ‘Perception of needs from healthcare providers’. Considerable emotional suffering was recognized after no embryo transfer. The need for support was expressed as to be offered an early appointment with a physician for information about what went wrong, looking at new alternatives and, for many women, providing information about counselling.LIMITATIONS, REASONS FOR CAUTIONOnly women participated, not partners. Of the women invited, 46% participated. Several declined to participate because of high levels of emotional stress.WIDER IMPLICATIONS OF THE FINDINGSPatients undergoing IVF and not achieving embryo transfer due to poor embryo development are a vulnerable group. They need early feedback concerning reasons for failure and future alternatives. They also require psychological support. This ought to be offered by IVF clinics.STUDY FUNDING/COMPETING INTEREST(S)The study was financed by grants from the Swedish state under the agreement between the Swedish government and the county councils, the ALF-agreement (ALFGBG-70940). It was also financed by the Local Research and Development Board for Gothenburg and Södra Bohuslän (VGFOUGSB-866771) and by Hjalmar Svensson’s research foundation (HJSV-2017012). None of the authors declares any conflicts of interest.LARGE SCALE DATAN/A.

Gonadotrophin stimulation and risk of relapse in breast cancer.

STUDY QUESTIONIs gonadotrophin stimulation as part of IVF associated with an increased risk of relapse in breast cancer?SUMMARY ANSWERControlled ovarian stimulation (COS) in connection with IVF in women with previous breast cancer was not associated with an increased risk of breast cancer relapse.WHAT IS KNOWN ALREADYBreast cancer is the most common malignancy among women worldwide and the leading cause of cancer death among females. The use of COS with gonadotrophins with subsequent cryopreservation of oocytes or embryos in order to enhance the chances of pregnancy after cancer treatment is the current most established fertility preservation method for women with breast cancer. To date, there are only a few small retrospective hospital-based controlled studies evaluating the risk of breast cancer relapse in patients undergoing fertility preservation with or without COS, showing no evident risk of relapse in breast cancer after the use of gonadotoxic agents.STUDY DESIGN, SIZE, DURATIONThis was a retrospective, population-based cohort study comprising 5857 women with previous breast cancer of whom 337 were exposed to COS. Exposure (COS) and outcomes (relapse and death) were identified for all patients from 2005 to 2014 by assessing the National Quality Register for Assisted Reproduction, the Swedish Medical Birth Register, the National Patient Register, the Swedish Prescribed Drug Register, the Swedish Cause of Death Register, the National Breast Cancer Register and the Swedish Cancer Register. Matching according to set criteria was possible for 334 women, who constituted the control group. A total of 274 women had undergone IVF after completing breast cancer treatment and 63 women had undergone COS for fertility preservation at the time of breast cancer diagnosis.PARTICIPANTS/MATERIALS, SETTING, METHODSWomen aged 20–44 years previously diagnosed with breast cancer and exposed to COS were matched for age at breast cancer diagnosis ±5 years, tumour size and lymph node involvement with a non-exposed control group, including women with known T- and N-stages. In a subsequent analysis, the matched cohort was assessed by also including women with unknown T- and N-stages. A secondary analysis comprised the entire non-matched cohort, including all women with known T- and N-stages. Also here, a subsequent analysis included women with missing data for T- and N-stages. The risk of relapse in breast cancer was estimated as crude hazard ratios (HRs) and 95% CI using Cox proportional hazards models in the primary and secondary analyses where T- and N-stages were known: otherwise the risks of relapse were only given descriptively.MAIN RESULTS AND THE ROLE OF CHANCEIn the primary matched analysis, relapse occurred in 20 of 126 women exposed to COS (15.9%) compared with 39 of 126 (31.0%) in the control cohort (HR = 0.70; 95% CI 0.39–1.45; P = 0.22). In the subsequent analysis, also including women with unknown T- and N-stages, relapse occurred in 27 of 337 (8.0%) women having undergone COS compared with 71/334 (21.3%) among the non-exposed. In the secondary adjusted analysis, relapse occurred in 20 of 126 (15.9%) exposed women and in 918 of 3729 (24.6%) non-exposed women (HR = 0.81; 95% CI 0.49–1.33; P = 0.70). In the subsequent analysis, including unknown T- and N-stages, relapse occurred in 27 of 337 (8.0%) women in the exposed group and 1176 of 5520 (21.3%) in the non-exposed cohort.LIMITATIONS, REASONS FOR CAUTIONA substantial degree of missing data on important prognostic variables was a limitation, particularly when analysing the total cohort. Furthermore, data on confounding factors, such as BMI, were not completely covered. Another limitation was that a pre-specified variable for relapse was not in use for the majority of the National Breast Cancer Register. Furthermore, the follow-up time from available register data (2005–2014) is rather short. Finally, we cannot be sure whether the prognostic information from receptor status, showing a lower incidence in the exposed group, is representative. Information on T- and N-stages was missing in more than half of the patients.WIDER IMPLICATIONS OF THE FINDINGSIn this large, retrospective, matched cohort study, we found no increased risk of relapse in breast cancer among women who had been exposed to gonadotrophins as part of IVF. This is reassuring but might be confounded by the selection of a group of women with a more favourable prognosis than those not undergoing IVF. The present study strengthens previous findings by being large, national and register based. Its results are applicable to women undergoing fertility preservation as well as to those undergoing regular IVF treatment.STUDY FUNDING/COMPETING INTEREST(S)Supported in part by grants from the Swedish state under the agreement between the Swedish government and the county councils the ALF-agreement (ALFGBG-720291), The Assar Gabrielsson Fund (FB 15-20), The Breast Cancer Fund and the Swedish Association of Local authorities and Regions, SKR. There are no conflicts of interest to declare.TRIAL REGISTRATIONN/A

Academized or deprofessionalized?– policy discourses of teacher professionalism in relation to research-based education

ABSTRACT A key concern in international educational policy during the 21st century has been the impact of teacher professionalism on outcomes of schooling. Sweden makes for an interesting case because of the country’s initiatives to improve the quality of education through an academization of the teachers. The aim of this study is to analyse how Swedish state policy of ‘education on a scientific foundation’ is constructed in a selection of texts and videos presented by the Swedish National Agency of Education, and how these policy texts construct discourses of teacher professionalism. The result shows how the formulation in the Education Act, prescribing that the education shall rest on a scientific foundation, is interpreted into ‘policy-as-text’ and a policy apparatus consisting of four central concepts. Here, the terms ‘research-based way of working’ and ‘evidence’ are added to the terms ‘scientific foundation’ and ‘proven experience’ from the Education Act. Furthermore, the result shows three policy discourses of teacher professionalism that are constructed in the analysed texts: the selectively critical and accountable teacher; the positive, flexible, responsible and effective teacher; and the semi-autonomous teacher.

Quantification of the Trans-Synaptic Partners Neuroligin-Neurexin in CSF of Neurodegenerative Diseases by Parallel Reaction Monitoring Mass Spectrometry

Background: Synaptic proteins are increasingly studied as biomarkers for synaptic dysfunction and loss, which are early and central events in Alzheimer’s disease (AD) and strongly correlate with the degree of cognitive decline. In this study, we specifically investigated the synaptic binding partners neurexins (NRXN) and neuroligins (Nlgn), to assess their biomarker’s potential. Methods: We developed a parallel reaction monitoring mass spectrometric method for the simultaneous quantification of NRXNs and Nlgns in cerebrospinal fluid (CSF) of neurodegenerative diseases, focusing on AD. Specifically, NRXN-1α, NRXN-1β, NRXN-2α, NRXN-3α and Nlgn1, Nlgn2, Nlgn3 and Nlgn4 proteins were targeted. Findings: The proteins were investigated in a clinical cohort including CSF from controls (n=22), mild cognitive impairment (MCI) due to AD (n=44), MCI due to other conditions (n=46), AD (n=77) and a group of non-AD dementia (n=28). No difference in levels of NRXNs and Nlgns was found between AD (both at dementia and MCI stages) or controls or the non-AD dementia group for any of the targeted proteins. NRXN and Nlgn proteins correlated strongly with each other, but only a weak correlation with the AD core biomarkers and the synaptic biomarkers neurogranin and growth-associated protein 43, was found, possibly reflecting different pathogenic processing at the synapse. Interpretation: We conclude that NRXN and Nlgn proteins do not represent suitable biomarkers for synaptic pathology in AD. The panel developed here could aid in future investigations of the potential involvement of Nlgns and NRXNs in synaptic dysfunction in other disorders of the central nervous system. Funding: HZ is a Wallenberg Scholar supported by grants from the Swedish Research Council (#2018-02532), the European Research Council (#681712), Swedish State Support for Clinical Research (#ALFGBG- 720931), the Alzheimer Drug Discovery Foundation (ADDF), USA (#201809-2016862), the AD Strategic Fund and the Alzheimer's Association (#ADSF-21-831376-C, #ADSF-21-831381-C and #ADSF-21-831377-C), the Olav Thon Foundation, the Erling-Persson Family Foundation, Stiftelsen for Gamla Tjanarinnor, Hjarnfonden, Sweden (#FO2019-0228), the European Union’s Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie grant agreement No 860197 (MIRIADE), and the UK Dementia Research Institute at UCL. KB is supported by the Swedish Research Council (#2017-00915), the Alzheimer Drug Discovery Foundation (ADDF), USA (#RDAPB- 201809- 2016615), the Swedish Alzheimer Foundation (#AF-742881), Hjarnfonden, Sweden (#FO2017-0243), the Swedish state under the agreement between the Swedish government and the County Councils, the ALF-agreement (#ALFGBG-715986), and European Union Joint Program for Neurodegenerative Disorders (JPND2019-466-236). The funders had no role in data collection, analysis, or decision to publish. EC received support from Gamla tjanarinnor, Stohnes stiftelse, Demensfonden and Emil och Maria Palms stiftelse. AV is supported by Fondation Ophtalmologique Adolphe de Rothschild, Fondation Chatrier and AAIHP association. Declaration of Interest: HZ has served at scientific advisory boards for Eisai, Denali, Roche Diagnostics, Wave, Samumed, Siemens Healthineers, Pinteon Therapeutics, Nervgen, AZTherapies and CogRx, has given lectures in symposia sponsored by Cellectricon, Fujirebio, Alzecure and Biogen, and is a co-founder of Brain Biomarker Solutions in Gothenburg AB (BBS), which is a part of the GU Ventures Incubator Program. KB has served as a consultant or at advisory board for Axon, Biogen, CogRx, Lilly, MegQu, Novartis and Roche Diagnostics. OH has acquired research support (for the institution) from Roche, Pfizer, GE Healthcare, Biogen, Eli Lilly and AVID Radiopharmaceuticals. In the past 2 years, he has received consultancy/speaker fees (paid to the institution) from Biogen and Roche. All other authors have nothing to declare. Ethical Approval: The use of these patient samples was approved by the Ethics Committee at the University of Gothenburg (EPN 140811).

Somalis in Sweden: Regional Dimension

The article discusses the process of formation and development of parallel societies in Sweden in the case of the Somali community. The transformation of Sweden into a country of mass immigration, which began in the second half of the 20th century, and its positioning as a “humanitarian superpower” significantly changes the country’s socio-cultural space. The authors conclude that the narrow spatial localization of the extraneous cultural and confessional population, with a specific imperative of behavior, results inthe formation of parallel communities, and in the case of the Somali community, to its marginalization. Within these segregated areas on the territory of Sweden, a fragmented social space is formed, the interaction between the subjects of which is similar to that in Somalia. At the same time the Swedish state organizations lose their monopoly on the implementation of the legislatively fixed rights and freedoms of citizens across these territories. It negatively affects Sweden’s internal security aspects, leading to an increase in the radicalization of Swedish society and in the threat of terrorism. The current situation undermines the security not only of Sweden itself, but also of its EU neighbors – primarily the Nordic countries. Therefore, nowadays, the integration of immigrants from the Muslim countries of Asia and Africa is one of the most important problems facing the Swedish government and the entire Swedish society.

From Socialist Hero to Capitalist Icon: The Cultural Transfer of the East German Children’S Television Programme Unser Sandmännchen to Sweden in the Early 1970S

Based on a case study of the import of the German Democratic Republic (GDR) children’s programme Unser Sandmännchen to Sweden in the early 1970s, this article explores the cultural recoding at work in the processes of transnational media exchange. Using archival source material from both Germany and Sweden as well as Swedish press debate, the article argues for an entangled media perspective on Cold War East-West cultural exchanges. In the process of transfer, Unser Sandmännchen, called John Blund in Sweden, was transformed from a calm, socialist hero to an outspoken and sometimes rude capitalist. This was the result of the active agency of individual entrepreneurs as well as the turnout of the political ambitions of Swedish and East German state television institutions. In Sweden, although stripped from its possible ideological content, the cultural transfer of Unser Sandmännchen contributed to strengthening the relations between the two countries and to opening up Swedish relations to the GDR in areas well beyond the media sector.

Revanchism via Pedestrianism: Street‐level Bureaucracy in the Production of Uneven Policing Landscapes

AbstractThe emergence over the last decade of large numbers of vulnerable EU citizens begging on Swedish streets has led to ambivalent responses from the Swedish state, including from local police forces charged with policing public order. Based on research including interviews with vulnerable EU citizens and with police officials in two socio‐economically divergent areas of Stockholm, this paper seeks to understand how policing practices are motivated and enacted towards this group and how these practices are experienced by those targeted. The results reveal a set of policing practices which, whilst framed within a depoliticised logic of what Nicholas Blomley calls “pedestrianism”, work to produce spatially uneven punitive landscapes for those begging. The paper argues that understanding the role of police as “street‐level bureaucrats” (following Michael Lipsky), with the agency to escalate or soften revanchist landscapes, is fundamental to understanding the contingencies at the heart of punitive urbanisms.

Longitudinal plasma protein profiling of newly diagnosed type 2 diabetes.

BackgroundComprehensive proteomics profiling may offer new insights into the dysregulated metabolic milieu of type 2 diabetes, and in the future, serve as a useful tool for personalized medicine. This calls for a better understanding of circulating protein patterns at the early stage of type 2 diabetes as well as the dynamics of protein patterns during changes in metabolic status.MethodsTo elucidate the systemic alterations in early-stage diabetes and to investigate the effects on the proteome during metabolic improvement, we measured 974 circulating proteins in 52 newly diagnosed, treatment-naïve type 2 diabetes subjects at baseline and after 1 and 3 months of guideline-based diabetes treatment, while comparing their protein profiles to that of 94 subjects without diabetes.FindingsEarly stage type 2 diabetes was associated with distinct protein patterns, reflecting key metabolic syndrome features including insulin resistance, adiposity, hyperglycemia and liver steatosis. The protein profiles at baseline were attenuated during guideline-based diabetes treatment and several plasma proteins associated with metformin medication independently of metabolic variables, such as circulating EPCAM.InterpretationThe results advance our knowledge about the biochemical manifestations of type 2 diabetes and suggest that comprehensive protein profiling may serve as a useful tool for metabolic phenotyping and for elucidating the biological effects of diabetes treatments.FundingThis work was supported by the Swedish Heart and Lung Foundation, the Swedish Research Council, the Erling Persson Foundation, the Knut and Alice Wallenberg Foundation, and the Swedish state under the agreement between the Swedish government and the county councils (ALF-agreement).

Gender Knowledge and Gender Expertise: The Implementation of Gender Mainstreaming in Swedish State Agencies

Abstract Through an analysis of the Swedish government development program for gender mainstreaming in state agencies—the JIM (Jämställdhet i myndigheter)program—this article analyzes how gender equality is constructed (gender knowledge) and what role specialized knowledge (gender expertise) has in policy implementation. The article claims that even in best-case scenarios, such as Sweden, where intensive efforts to integrate a gender perspective have been undertaken, gender knowledge is based on visions and strategies that do not question prevailing policy paradigms. However, cross-cutting and intersectional conceptualizations of gender equality have created epistemic space for transformative interventions on the part of gender experts.

Osobennosti politiki shvedizacii v otnoshenii sa­amov v konce XIX — nachale XX v.

The article analyzes the features of the Swedish state policy transformation towards the Sami in the second half of the 19th - early 20th centuries. The author identifies the main stages of the swedishization policy and characterizes the activities of the first Sami public organizations and their role in the political development of the Sami people. The research is based on the various sources - legislative acts, statistical and publicist materials of the period mentioned above. The policy of norwegianization is compared with swedishization policy. The author concludes that there were differences in the approaches to the Sami population by the Swedish and Norwegian governments.

The costs of human uterus transplantation: a study based on the nine cases of the initial Swedish live donor trial.

What are the costs of live donor uterus transplantation in a European setting? The total costs for preoperative investigations, including IVF, and live donor uterus transplantation including postoperative costs for 2 months, were calculated to be €74564 (mean), with the costs of recipient being somewhat higher than for donor and the cost components of total costs distributed between sick leave (25.7%), postoperative hospitalization (17.8%), surgery (17.1%), preoperative investigations (15.7%), anaesthesia (9.7%), drugs (7.8%), tests after surgery (4.0%) and for re-hospitalization (2.2%). Uterus transplantation has proved to be successful by demonstrations of live births, both after live donor and deceased donor procedures. The transplantation is considered as a complex and expensive infertility treatment. There exist no analyses of costs involved in uterus transplantation. This prospective cohort study included nine uterus transplantations procedures, performed in Sweden in 2013. Study duration of this health economic study included 6-12 months of pre-transplantation investigations and the time interval from transplantation to 2 months after. Nine triads of uterus recipient, partner of recipient and uterus donor participated. All prospective recipients were in stable relationships and performed IVF with their partners before transplantation. The nine donors were relatives or family friends. The recipients and donors underwent pre-transplantation investigations with imaging, laboratory tests and psychological/medical screening prior to transplantation. Transplantation was by laparotomy in both donor and recipient. Standard immunosuppression and postoperative medication were used. After discharge from the hospital, the recipients were followed frequently with laboratory tests and examinations. The mean costs for preoperative investigations, including IVF, and live donor uterus transplantation with postoperative costs for 2 months, were calculated to be €74564 (range €50960-€99658), from a societal perspective. The four largest components were cost of sick leave (€19164), cost of postoperative hospitalization (€13246), surgery cost (€12779) and costs for preoperative investigations, including IVF (€11739). Smaller components were costs for anaesthesia (€7207), costs for drugs (€5821), costs for post-surgical tests (€2985) and costs for re-hospitalization (€1623). The costs of the recipient (€42984) were somewhat higher than the costs of the donor (€31580), but in terms of costs, they should be viewed as one entity. By using a health care perspective, excluding cost for productivity loss, the total costs would be reduced by 26%. A limitation is the restricted sample size and that this is in the experimental, clinical stage of development. The results provide the first information concerning the costs for pre-transplantation investigations and uterus transplantation procedures with postoperative follow-up. We consider the total estimate to be in the higher interval, because of the extensive research protocol. It is likely that the cost of live donor uterus transplantation will vary between countries and that the costs will be lower in a future clinical setting. Funding was received from the Jane and Dan Olsson Foundation for Science; the Knut and Alice Wallenberg Foundation; an ALF grant from the Swedish state under an agreement between the government and the county councils; and the Swedish Research Council. None of the authors have a conflict of interest with regard to the study. NCT01844362.

Risk of ischemic stroke in adult patients with congenital heart disease

Abstract Introduction With an increasing proportion of adults with congenital heart disease (CHD) surviving into middle age and beyond, CHD patients will be at increased risk of acquired cardiovascular conditions, such as ischemic stroke. Compared to controls, patients with CHD have a higher prevalence of arrhythmias, persistent shunts enabling paradoxical embolization, heart failure, mechanical valves as well as potentially hypercoagulable states, all of which can further increase the risk of stroke. Purpose The aim of our study was to investigate the risk of developing ischemic stroke in adults with CHD in Sweden compared to controls from the general population. Methods We used data from the Swedish National Patient and Cause of Death registries to identify all CHD patients ≥18 years of age, born during the period 1930–1998, with a first time diagnosis of ischemic stroke. Follow-up started in January 1970 and went on until December 2017. Approximately ten controls matched for age and sex were randomly selected from the general population for each patient with CHD. CHD diagnoses were classified into six lesion groups according to a previously published hierarchical classification system. Results In total, 43,110 patients with CHD and 474,267 controls were included in the study (51.4% men) and mean follow up time was 25.4±18.4 years. Patients with CHD had a 6 times higher risk of developing an ischemic stroke compared with controls (hazard ratio 6.0, 95% confidence interval 5.8–6.2, p≤0.001), with altogether 8.8% (n=3785) of CHD patients developing ischemic stroke compared with 1.6% (n=7516) of controls. Ischemic stroke was more common in all CHD lesion groups; however, patients with atrial septal defects/patent foramen ovale had the highest incidence rate of ischemic stroke with an incidence rate of 76.1 events/10,000 patient years compared with 8.7 in controls. Patients with CHD and ischemic stroke had markedly less hypertension, diabetes mellitus and hypercholesterolemia, compared with controls (7.1%, 2.0%, 2.9% respectively in CHD patients, compared with 19.6%, 6.6%, 5.3%, in controls, p≤0.001 for all). In addition, atrial fibrillation and heart failure were only slightly more common in CHD patients with ischemic stroke compared to controls (atrial fibrillation: 12.0% in CHD vs 10.4% in controls, p=0.01; heart failure: 8.7% in CHD vs 7.3% in controls, p=0.009). Conclusion In this large nationwide study, we found that the risk of ischemic stroke in adult patients with CHD was six times higher than in controls, despite a lower prevalence of common risk factors for stroke such as hypertension, diabetes mellitus and hypercholesterolemia. In addition, atrial fibrillation and heart failure were only slightly more common in CHD patients compared with controls. This implies that the etiology of ischemic stroke might be different in CHD patients compared with controls. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was funded by the Swedish state under an agreement between the Swedish government and county councils, the ALF agreement (Grant number: 236611) and the Swedish Heart-Lung Foundation (Grant Number: 20090724).

High prevalence of alcohol- and substance abuse among young heart failure patients in Sweden

Abstract Background Heart failure in the young is increasing. Increasing prevalence of overweight and obesity may be of importance. While alcohol and drugs are known to have cardiotoxic effects, few studies have investigated the prevalence of alcohol- or substance abuse among young patients with HF. Aim To investigate the prevalence of alcohol- and substance abuse in a cohort of young patients with heart failure. Methods All patients that received a diagnosis of heart failure at Sahlgrenska University Hosital (Sweden) between 1997 and 2016, ages 18–54, with a previously documented transthoracic echocardiogram were included. A systematic evaluation of participants electronic health records was performed, where predefined details about the use of alcohol, narcotic drugs and anabolic steroids, as well as echocardiographic findings were recorded. Result A total of 1363 patients were included (1001 men and 366 women, mean age 45 years), 190 (14%) of which were <34 years, 304 (22%) 35–44, and 869 (64%) 45–54 years. In total, a record of either alcohol- or substance abuse was found in 28% of men and 9% of women, respectively. The prevalence of Anabolic steroids was found to be 2% among men. For substance abuse, the prevalence was found to be 12% in men and 5% in women. Alcohol abuse was found in 24% of men and 5% of women. Both alcohol- and drug abuse was most common in the highest age group. Conclusion There was a high prevalence of alcohol- and/or drug-abuse among young adults with heart failure, especially in male patients. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Swedish state under the agreement concerning research and education of doctors [grant number ALFGBG-427301]; The Swedish Society for Physicians, the Health & Medical Care Committee of the Regional Executive Board, Region Västra Götaland, Sweden, and the Swedish Heart and Lung Foundation [grant number 2015-0438]