Western Sweden Research Articles

To deviate from the expected: a collective story of physical activity among inactive rural children

ABSTRACT Physically inactive children in rural areas are overlooked in research because of the dominance of urban perspectives focusing on physical activity rather than inactivity. The aim of this article is to examine an emerging collective story of how physically inactive children (aged 9–11 years) in two rural areas experience their relationships with physical activity. Based on praxis-oriented sociocultural theorising, this study focuses on how practical physical activity is understood by rural children as part of their sociocultural environment. Five focus group interviews with 21 physically inactive rural children in western Sweden were conducted. Experiences and behaviours that the children emphasised as central to their inactivity were analysed as sociocultural expressions in a collective story about physical activity. To underline the importance of narratives for behaviour in the sociocultural environment, the collective story is presented through three composite narratives told by three fictional characters: ‘Robin, the shy one’, ‘Kim, the farm kid’, and ‘Angry Alex’. Characteristic of these inactive rural children is a lack of self-confidence, a lack of meaning, and difficulties in managing social physical activities. Common to the behaviours that follow from the children’s experiences is that they are perceived as deviating from what is expected of them in accordance with the cultural story about a physically active child. The analysis shows that the underlying cause is the discrepancy between the children’s understanding of physical activity and the understanding conveyed via institutions informed by urban perspectives such as, for example, school. For instance, children view physical activity as part of daily labour at the same time that the school teaches physical activities intended for recreational purposes in spare time. Institutions should make room for more interpretations, including rural ones, of the meaning of physical activity and, thus, contribute to reconstructing the cultural narrative about physical activity.

Documentation of pressure ulcers in medical records at an internal medicine ward in university hospital in western Sweden.

Pressure ulcers cause suffering, prolong care periods, and increase mortality. The aim was to describe and analyze the documentation of pressure ulcers and focused on the medical records from an internal medicine ward in a university hospital in western Sweden. A quantitative, retrospective review of medical records was conducted for all care events (n=1,458) with descriptive statistics. Documentation of the pressure ulcers in care plans was 2.1% (n=31) compared to 6.7 % (n= 46) within final notes written by registered nurses (RN), a lower result compared to PPM (n=3/14, 21.4%). Risk assessments were carried out in 68 (4.7%) care events, and 31 care plans included pressure ulcers. Moreover, 198 cases of tissue damage were documented, 43 (21.7%) defined as pressure ulcers, the other 147 (74.2%) lacked definition. Differences (2.1%-21.4%) highlight improvements; knowledge and communication of pressure ulcers ensure reliable documentation in medical records.

Temporal and spatial dynamics of Fusarium spp. and mycotoxins in Swedish cereals during 16 years

We analysed the dynamics of Fusarium spp. and mycotoxin contamination in Swedish cereals during 2004–2018. More than 1400 cereal samples from field trials were included, collected in a monitoring programme run by the Swedish Board of Agriculture. Five Fusarium mycotoxins were quantified with LC-MS/MS and fungal DNA from four species was quantified using quantitative real-time PCR. Correlation analyses revealed that deoxynivalenol (DON) and zearalenone (ZEN) were mainly associated with Fusarium graminearum, but stronger correlations with F. culmorum was seen some years. Nivalenol (NIV) was associated with F. poae and the HT-2 and T-2 toxins with F. langsethiae. Clear differences in mycotoxin contamination between different cereal crops and geographical regions were identified. The highest levels of DON and ZEN were found in spring wheat in Western Sweden. For NIV, HT-2 and T-2 toxins, the levels were highest in spring oats and spring barley. Regional differences were not detected for NIV, while HT-2 and T-2 toxins were associated with the northernmost region. We found that delayed harvest was strongly associated with increased levels of DON and ZEN in several crops. However, harvest date did not influence the levels of NIV or HT-2 and T-2 toxins. Our results suggest similar distribution patterns of DON and ZEN, in contrast to NIV and HT-2 and T-2 toxins, probably mirroring the differences in the ecology of the toxin-producing Fusarium species. Timely harvest is important to reduce the risk of DON and ZEN contamination, especially for fields with other risk factors.

Incidence and mortality of women diagnosed with peripartum cardiomyopathy from 1997 to 2019 in Sweden, national registry-based study

Abstract Background Data from previous studies indicate on increase in incidence of cardiomyopathies in Sweden. Another study confirmed high validity of diagnosis cardiomyopathy in western Sweden suggesting that a real increase in cardiomyopathy diagnosis might have occurred. Peripartum cardiomyopathy is a potentially dangerous condition that occurs few months before or up to five months after delivery. Purpose To assess incidence and mortality rates of women diagnosed with PPCM over last two decades in Sweden. Methods All women 18 to 50 years of age registered in the National Patient Register (NPR) in the period 1st January 1997 to 31st December 2019 were included. With the use of personal identification number (PIN), the data was than linked to other registers. Data on pregnancies were obtained from the Swedish Medical Birth Register (MBR) and data on the time of death and causes of death were gained from the Cause of Death Register. Women with PPCM were identified in the NPR using the international classification code for disease ICD-10 codes 090.3 as well as other coexisting conditions. The observation time was divided into fallowing periods: 1997–2001, 2002–2004, 2005–2007, 2008–2010, 2011–2013, 2014–2016 and 2017–2019. Results In total, over the period of 23 years we identified 2376988 deliveries. There were 23 women diagnosed with PPCM. The prevalence of women who received the diagnostic code for PPCM increased over time from 0.003% in the first time period to 0.012% in the last time period (Figure 1). In total 4.5% of women diagnosed with PPCM died during the observation time. Conclusion In this national, register-based study 187 women had diagnose PPCM. Total mortality over twenty years of time was low. Worryingly, we observed a four-fold increase in the use of diagnostic code for PPCM, suggesting an increse in incidence of PPCM over the last twenty-three years. More research is needed to investigate reasons for that. Funding Acknowledgement Type of funding sources: None.

The panorama of cerebral palsy in Sweden part XIII shows declining prevalence in birth-years 2011-2014.

To describe epidemiology and characteristics of cerebral palsy (CP) in western Sweden 1954-2014. Population-based study covering 105 935 live births in the area in 2011-2014. Birth characteristics, neuroimaging findings and outcome were analysed and prevalence calculated. Non-parametric methods were used for group comparisons. CP was diagnosed in 192 children. Crude prevalence had decreased to 1.81 per 1000 live births (p=0.0067). Gestational age-specific prevalence for <28 gestational weeks was 74.8 per 1000 live births, 46.6 for 28-31 weeks, 5.8 for 32-36 weeks and 1.1 per 1000 for >36 weeks of gestation. Hemiplegia, found in 36.2%, had declined (p=0.03). Diplegia was found in 36.2% and tetraplegia 5.3%. Dyskinetic CP accounted for 18.6% and ataxia for 3.7%. Neuroimaging revealed maldevelopments in 14%, white matter lesions in 44%, cortical/subcortical lesions in 13% and basal ganglia lesions in 17%. Prenatal aetiology was considered in 34%, peri- or neonatal in 48%, while in 18% aetiological period remained unclassified. Motor outcome in children who needed neonatal care had improved (p=0.04). Motor function in dyskinetic CP had improved compared to previous cohorts (p=0.008). The prevalence of CP has declined, mainly in term-born and in hemiplegia, and motor severity has changed compared to previous cohorts.

Epidemiology and clinical features of PFAPA: a retrospective cohort study of 336 patients in western Sweden

BackgroundPeriodic fever, aphthous stomatitis, pharyngitis and cervical adenitis (PFAPA) syndrome is generally regarded as the most common autoinflammatory disease, but the epidemiology of the disease is largely unknown. The objectives of this study were to estimate the annual incidence and describe the clinical features of PFAPA in a large cohort from western Sweden.MethodsThe study retrospectively included children < 18 years of age diagnosed with PFAPA between 2006 and 2017 at three hospitals: NU Hospital Group, Skaraborg Hospital and Queen Silvia Children’s Hospital. Patients were identified by searching for relevant diagnostic ICD-10 codes in the comprehensive electronic medical records and data were retrieved by reviewing case records. To estimate incidence, patients with symptom onset from January 1, 2006, to December 31, 2016, were included. Population data for the study area during this period were retrieved from Statistics Sweden.ResultsIn this study, 336 patients with PFAPA were identified. Of these, 156 (46%) were girls and 180 (54%) were boys. Almost 90% of the children with PFAPA (291 patients) experienced their first symptoms before the age of 5 years and fewer than 3% presented at ages above 10 years. Pharyngitis was the most common symptom during febrile episodes, followed by cervical adenitis and aphthous stomatitis. Fourteen percent of the patients displayed atypical features, of which skin rash was the most common.To calculate incidence, 251 patients with symptom onset during the study period were identified. The mean annual incidence was estimated at 0.86/10,000 for children < 18 years of age and 2.6/10,000 for children < 5 years of age.ConclusionsThis study adds to the understanding of the epidemiology of PFAPA syndrome by presenting incidence rates based on a large cohort and in different age groups in a population-based setting. It also shows the distribution of age of onset of PFAPA, with a peak in 1-year-olds and waning at older ages. Signs and symptoms of PFAPA syndrome were similar in children with symptom onset before vs. after 5 years of age.

Sensitization to molecular dog allergens in an adult population: Results from the West Sweden Asthma Study.

As the prevalence of dog allergy rises, component resolved diagnosis might improve the diagnosis, understanding of the clinical outcomes and the effectiveness of immunotherapy. Considering the paucity of data in adults, the current study characterized the patterns of sensitization to dog molecular allergens in an adult population. Data were derived from the West Sweden Asthma Study, a population-based and representative sample of adults from western Sweden. Of the 2006 subjects clinically examined, 313 participants sensitized to whole dog allergen extract were measured for specific immunoglobulin E (sIgE) levels to Can f 1, Can f 2, Can f 3, Can f 4, Can f 5 and Can f 6 using ImmunoCAP™. Polysensitization was defined as sensitization to ≥3 components. Overlapping sensitization was defined as having concomitant sensitization to at least two dog molecular allergen families (lipocalin, albumin or prostatic kallikrein). Of 313, 218 (70%) subjects tested positive to at least one dog allergen component. Sensitization to Can f 1 (43%) was the most common, followed by Can f 5 (33%) among molecular allergens, while sensitization to lipocalins (56%) was the most common among component families. Polysensitization was found in 22% of all participants and was more common in participants with than in those without asthma. Subjects with asthma were less likely to be monosensitized to Can f 5 than those without asthma. Subjects with asthma had higher IgE levels of Can f 3, Can f 4 and Can f 6 than those without asthma. Overlapping sensitizations also differed between those with asthma and allergic rhinitis and those without. Increased knowledge about the sensitization patterns of dog allergen components can aid in defining their role in asthma and rhinitis. In complex clinical cases of dog allergy, a detailed analysis of dog allergen components can provide additional information on the nature of sensitization.

Transit-oriented development and sparse settlement structures. The case of western Sweden

ABSTRACT This paper reports on a study of how TOD can contribute to sustainable development locally and regionally in sparse settlement structures. While TOD theory focuses on large cities and densely populated areas, it also tends to be applied in less populated areas. ‘Station communities’ are of great interest in Sweden, given the opportunities they apparently offer to combine economic growth through regional enlargement with decreased climate impact. This idea is, in many ways, inspired by the transit-oriented development (TOD) theory, and applied in the Västra Götaland region, aiming for regional development and increased public transportation use. The study has examined how the conditions for TOD are met in small towns with train stations located in sparse settlement structures through a case study and semi-structured interviews. The results indicate that train stations, together with planning approaches inspired by TOD theory, are regarded as important in municipal planning when identifying future developments, although the prerequisites for TOD are absent and the demand for new housing and businesses is weak. One conclusion is that a new concept is needed that does not focus on densification and urban qualities, but draws on the place qualities, where the connections to the train stations are enforced.

Treatment for hyperuricemia and gout in Japan: Aspect of prescription and duration.

Treatment for hyperuricemia and gout in Japan: Aspect of prescription and duration.

The association between self-efficacy and sick-leave among men and women: a cross-sectional study of the general working population in Sweden

&#x0D; Background: The aim of this study was to investigate if low self-efficacy was associated with increased risk for sickness absence, in a general population of employed women and men. The aim was also to analyse differences in self-efficacy concerning age, education, income, and socio-economic position.&#x0D; Methods: This cross-sectional study was based on data collected in western Sweden, 2008. The study population consisted of 2,900 employed sick-listed individuals (E-SL) and 2,649 random working population individuals (R-WP). Both mailed questionnaire, including the General Self-Efficacy Scale (GSE) and register data on age, education, income and socio-economic position were used. A continuous mean score of the total GSE was calculated for each individual. A low GSE-score indicated low general self-efficacy.&#x0D; Results: Lower general self-efficacy had an increased odds ratio (OR) of belonging to a sick-listed general working population among both men (OR=1.60; 95% CI 1.32–1.94) and women (OR=1.26; 95% CI 1.08–1.47). The OR remained significant after adjustments for socio-demographic variables. Yet, men in the R-WP and women in both the R-WP and E-SL with lower education, income or socio-economic position had lower general self-efficacy compared with those in each cohort with higher education, income or socio-economic position.&#x0D; Conclusions: Low self-efficacy was associated with increased probability to belong to a sick-listed general working population. Although more research is needed, it seems highly relevant to take both self-efficacy and socio-economic factors into account, in preventive and rehabilitation work targeting persons on sickness absence.&#x0D;

Prehospital assessment of patients with abdominal pain triaged to self-care at home: an observation study

BackgroundPatients who call for emergency medical services (EMS) due to abdominal pain suffer from a broad spectrum of diseases, some of which are time sensitive. As a result of the introduction of the concept of ‘optimal level of care‘, some patients with abdominal pain are triaged to other levels of care than in an emergency department (ED). We hypothesised that it could be challenging in a patient safety perspective.AimThis study aims to describe consecutive patients who call for EMS due to abdominal pain and are triaged to self-care by EMS clinicians.MethodsThis was an observational study performed in an EMS organisation in Western Sweden during 2020. The triage tool Rapid Emergency Triage and Treatment System (RETTS), which included Emergency Signs and Symptom (ESS) codes, was used to find medical records where patients with abdominal pain have been triaged to self-care and 194 patients was included in the study.ResultsOf total 48,311 ambulance missions, A total of 1747 patients were labelled with ESS code six (abdominal pain), including 223 (12.8%) who were given the code for self-care and 194 who were further assessed by the research group. Of these patients, 32 (16.3%) had a return visit within 96 hours due to the same symptoms and 11 (5.6%) were hospitalised. In six of these patients, the EMS triage was evaluated retrospectively and assessed as inappropriate. These patients had a final diagnosis of ruptured abdominal aneurysm (n = 1), acute appendicitis with peritonitis (n = 2) and acute pancreatitis (n = 3). All these patients required extensive evaluation and different treatments, including acute surgery, antibiotics and fluid therapy.ConclusionAmongst the 1747 patients assessed by EMS due to abdominal pain, 223 (12.8%) were triaged to self-care. Of the 194 patients who were further assessed, 16.3% required a return visit to the ED within 96 hours and 5.6% were hospitalised. Six patients had obvious time-sensitive conditions. Our study highlights the difficulties in the early assessment of abdominal pain and the requirement for an accurate decision support tool.

Relationship between serum insulin-like growth factor 1 levels and ischaemic stroke: a systematic review and meta-analysis

ObjectiveTo assess the association of insulin-like growth factor 1 (IGF-1) with the risk of incident ischaemic stroke and outcome after ischaemic stroke.DesignA systematic review of primary studies.SettingHospitals in Western Sweden,...

The Influence of Surgeon Sex on Adverse Events Following Primary Total Hip Arthroplasty: A Register-Based Study of 11,993 Procedures and 200 Surgeons in Swedish Public Hospitals.

Stereotypes may prevail, but little is known about the influence that the sex of an orthopaedic surgeon may have on outcomes. In a recently published study, there were no differences in the rate of adverse events following total hip arthroplasties (THAs) performed by female or male orthopaedic surgeons. The objective of the present study was to investigate whether there was any difference in adverse events within 90 days following a primary THA performed by either a male or female surgeon in Sweden. A retrospective study was performed to evaluate primary THAs performed for osteoarthritis between 2008 and 2016 at 10 hospitals in western Sweden. Local hospital data were linked with the Swedish Hip Arthroplasty Register (SHAR) and with a regional patient register. Data collected from local hospitals and the SHAR included surgeon-related information (e.g., sex, annual volume, and level of training) and patient-related information (e.g., age, sex, and Elixhauser comorbidity index). Adverse events were retrieved from the regional patient register. The definition of adverse events followed the SHAR definition of adverse events. Mixed models were used to investigate the impact of surgeon sex on adverse events. A total of 11,993 primary THAs were performed by 200 surgeons, of whom 17.5% were women. The proportions of adverse events within 90 days were similar for female (6%) and male (7%) surgeons. No association was found between surgeon sex and adverse events (adjusted odds ratio, 0.72; 95% confidence interval, 0.52 to 1.00) when all surgeons (both attendings and residents) were included in the analysis. A sensitivity analysis that included attendings only yielded similar results (adjusted odds ratio, 0.88; 95% confidence interval, 0.60 to 1.29). Despite a small tendency toward lower rates of adverse events at 90 days after THAs performed by female surgeons, there was no significant association between surgeon sex and the risk of adverse events following THA. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.

Stereotactic radiotherapy for brain metastases in patients with lung cancer; outcome and toxicity in clinical practice.

BackgroundStereotactic radiotherapy (SRT) is an established modality for treating limited brain metastases (BMs). This study aimed to assess the real-life treatment outcome and associated prognostic factors for survival in a consecutive lung cancer cohort receiving SRT for BMs.Materials and methodsA retrospective review and analysis of patients with lung cancer with BMs treated with SRT in western Sweden between 2002 and 2017 were performed. Data were collected from patient charts and the radiotherapy dose planning system.ResultsOne hundred nine patients corresponding to 139 lesions were assessed; the majority were treated with single-fractionated SRT with 20 Gy. The median overall survival (OS) was 6.1 months, with a 12-month survival rate of 24%. The estimated overall disease control rate (DCR) was 84% at a median time of three months. On multivariate analysis, WHO performance status (PS) (p = 0.002) and smoking status (p = 0.005) were significant predictive factors for survival. Four percent of the patients experienced possible grade III–IV toxicity, and previously administered cranial radiation therapy was a significant independent factor (p = 0.03) associated with the risk of developing acute toxicity.ConclusionsSRT due to brain metastases from lung cancer is a well-tolerated treatment. When selecting patients suitable for treatment, PS and extracranial disease progression should be considered. Smoking cessation is probably of value even in this palliative setting. The goal of SRT for BMs is not only to improve survival but also to provide symptom relief, and future studies on SRT should assess patient-reported outcomes in addition to survival.

Pain and pain management in children and adolescents receiving hospital care: a cross-sectional study from Sweden.

BackgroundPain is a common symptom in children receiving hospital care. Adequate pain management in paediatric patients is of the utmost importance. Few studies have investigated children’s own experiences of pain during hospitalization.AimTo describe the prevalence of pain, self-reported pain intensity at rest and during movement, pain management and compliance with pain treatment guidelines in children and adolescents receiving hospital care. Furthermore, to examine self-reported statements about pain relief and how often staff asked about pain.MethodsA quantitative, cross-sectional study with descriptive statistics as the data analysis method was conducted at a county hospital in western Sweden. Sixty-nine children/adolescents aged 6–18 years who had experienced pain during their hospital stay were included. A structured, verbally administered questionnaire was used to obtain pain reports. The participants were also asked what they considered alleviated pain and how often they told staff about pain. Patient demographics, prescribed analgesics and documentation of pain rating were obtained from medical records.ResultsFifty children/adolescents (72%) experienced moderate to severe pain in the previous 24 hours. At the time of the interview 36% reported moderate to severe pain at rest and 58% during movement. Seven participants (10%) reported severe pain both at rest and during movement. About one-third were on a regular multimodal analgesic regimen and 28% had used a validated pain rating scale. Thirty children/adolescents (43%) reported that they had experienced procedural pain in addition to their underlying pain condition. Most of the children/adolescents (74%) reported that analgesics provided pain relief. Forty (58%) stated that various non-pharmacological methods were helpful.ConclusionsDespite evidence-based guidelines, half of the children/adolescents experienced moderate to severe pain, highlighting the need for improvement. Pain levels should be assessed both at rest and during movement. Response to treatment should be evaluated to prevent undertreatment of pain. Compliance with guidelines and professional communication are of the utmost importance for pain management in children/adolescents. Non-pharmacological methods are a valuable part of a pain management strategy. This study shows that it is important to evaluate and improve pain care also outside specialised tertiary clinics.

Real-world Follow-up Practice of Children With Coeliac Disease: A Cross-sectional Study From Western Sweden.

Coeliac disease (CD) is one of the most common chronic diseases of childhood. Follow-up of CD aims to ensure dietary adherence and prevent disease complications, but there are few real-world data on how its management in children is conducted. This study aimed to survey the follow-up practice of pediatric CD in Western Sweden. Two web-based surveys were distributed to all 22 pediatric outpatient clinics rendering answers from 48 physicians and 12 dietitians. Overall, clinical practice was similar throughout the region and in line with national and international CD guidelines, including an annual to biannually follow-up frequency and dietary adherence assessment through unstructured interviewing and serology measurements. The study identified possible areas of improvement, such as implementing a formal transition process to adult care and the use of validated questionaries to assess dietary adherence. Additionally, a positive attitude towards electronic-health technologies (eHealth) as part of CD follow-up was identified.

Weighted blankets for sleep problems – prescription, use and cost analysis

Background Weighted blankets (WBs) have been suggested as a treatment option for insomnia and are commonly prescribed despite lack of evidence of efficacy. Aim To investigate prescription pattern, return rate and cost of WBs. Material and methods This observational cohort register-based study in western Sweden included every individual who, in a 2.5-year period, was prescribed and received at least one WB (n = 4092). A cost evaluation was made by mapping prescription processes for WBs and sleep medication. Results Individuals diagnosed with dementia, anxiety, autism or intellectual disability (ID) retained the WB longer than others. Individuals younger than six and older than 65 years had shorter use time. The cost evaluation showed that the prescription process for WBs was longer and resulted in a higher cost than for sleep medication. Conclusions Some individuals had longer use time, indicating a possible benefit from using a WB. Due to low risk of harm but high economic cost, a revision of the WBs prescription process could be recommended to identify those who might benefit from WB. Significance Our result points towards a need for revision of the prescription process, to implement standardized sleep assessments, and create a more efficient prescription process to lower the cost.

Decision Making in City Planning: Processes of Visioning and Stakeholders Engagement and their Relation to Sustainable Land-Use in the SATURN Project

The EIT Climate-KIC SATURN project deals with rural-urban territories, their landscapes and environmental challenges. The land of our cities and regions is fragmented and prone to several challenges in terms of ecology, governance and social coherence. As a result of unregulated overlapping of different land uses and complex governance patterns, landscape fragmentation creates severe challenges in the ways the land is perceived, identified and therefore managed. The SATURN consortium is working on different models to help address the governance and decision-making process and support on a policy level by applying holistic ideas of visioning and stakeholder engagement at a city scale. The diversity of the three hubs (Birmingham in central England, Gothenburg in western Sweden, and Trentino in northern Italy) is reflected by their approaches to stakeholders’ engagement and visioning processes as well as especially adopted activities in each location. Within the SATURN project, we are investigating how these approaches could change perceptions and impact on landscape strategic actions. Through a series of especially designed workshops on landscape visioning and stakeholder engagement, the project aims to create a toolbox supporting urban, peri-urban and regional planning. This paper reports on the visioning and stakeholder mapping and analysis tools, and shares examples where these processes were tested during the broader SATURN scheme. Results demonstrate how the visioning exercise has changed public perceptions about an area and how this has affected the decision-making process of each city towards a more effective planning of sustainable landscapes. The stakeholder engagement activity demonstrates the importance of “mapping and analysis” of the various actors involved in a city and the ways a landscape project can effectively engage with them and seek further collaboration. Questions on how the results differ in cases where the stakeholder engagement process focused on a broad policy level or targeted specific actions for a certain region are being explored. Both the visioning and stakeholder engagement tools are subject to a holistic approach and a collaborative and open process between the stakeholders and the trainers, allowing the participants to build a vision for their regions and be one-step closer to systemic change.

Assessment of the ability of game-based science learning to enhance genetic understanding

ABSTRACT Background Game-based science learning (GBSL) provide an alternative route for learning genetics, but its effects on students’ conceptual learning is contested. In this paper we assess the utility, in primary teacher education, of Recal: a game designed to promote participants’ learning of key genetic concepts through acting as detectives investigating a case. Purpose The purpose of the study was to analyse and compare teacher students’ learning of genetics through the game, and both their attitudes towards and experiences of it. Tests were conducted in Spanish and Swedish contexts to assess its potential utility in contrasting cultural and educational contexts to obtain indications of the potential breadth of its application. Samples Participants included 120 pre-service teacher students from a university in north-eastern Spain and 51 from a university in western Sweden. Design and methods The research involved an intervention, in which students played the game, and assessment of its efficacy by questionnaires designed to investigate students’ knowledge of genetics before and after the game, their expectations and experience of it, and their satisfaction with it. The results were analysed statistically. Results The game appeared to enhance both Spanish and Swedish participants’ knowledge of genetics, and they reportedly found it both educationally beneficial and engaging. It was also assessed in terms of the following characteristics of GBSL, based on experiential data: contextualisation, authenticity, collaboration, problem-solving, guided paths and competition. Conclusion The results clearly indicate that the game has utility in different countries and educational contexts. The article discusses how the six characteristics of GBSL facilitate or hinder learning, and implications (for educational professionals and researchers) of the findings.

BMI, sex and outcomes in hospitalised patients in western Sweden during the COVID-19 pandemic

High body mass index (BMI) is associated with severe COVID-19 but findings regarding the need of intensive care (IC) and mortality are mixed. Using electronic health records, we identified all patients in western Sweden hospitalised with COVID-19 to evaluate 30-day mortality or assignment to IC. Adjusted logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI) for outcomes. Of totally 9761 patients, BMI was available in 7325 (75%), included in the study. There was a marked inverse association between BMI and age (underweight and normal weight patients were on average 78 and 75 years, whereas overweight and obese were 68 and 62 years). While older age, male sex and several comorbidities associated with higher mortality after multivariable adjustment, BMI did not. However, BMI ≥ 30 kg/m2 (OR 1.46, 95% CI 1.21–1.75) was associated with need of IC; this association was restricted to women (BMI ≥ 30; OR 1.96 (95% CI 1.41–2.73), and not significant in men; OR 1.22 (95% CI 0.97–1.54). In this comprehensive hospital population with COVID-19, BMI was not associated with 30-day mortality risk. Among the obese, women, but not men, had a higher risk of assignment to IC.