Risk of recurrent stroke and death after first stroke in long-distance ski race participants

Background: Physical activity is of benefit for primary prevention of cardiovascular diseases, but it appears to increase the risk for atrial fibrillation. We aimed to study a cohort of patients following a first stroke in individuals with previous high physical activity, compare them to the general population with respect to recurrent stroke and death, and relate these to atrial fibrillation. Methods and results: From the participants of the Vasaloppet, the world's largest ski-race, and matched individuals from the general population (n=708 604), we identified 5964 patients hospitalized with a first-time stroke between 1994 and 2010. Individuals with severe diseases were excluded. One half percent of skiers and 1% of nonskiers were hospitalized due to stroke. The incidence rate was 8.3 per 100 person-years among skiers and 11.1 among nonskiers. The hazard ratio (HR) for recurrent stroke or death between the 2 groups was 0.76 (95% CI 0.67 to 0.86). The result was consistent in subgroups. The HR for death was 0.66 (95% CI 0.56 to 0.78) and for recurrent stroke 0.82 (95% CI 0.70 to 0.96). After adjustment for smoking and socioeconomic factors, the HR for death was consistent at 0.70 (95% CI 0.56 to 0.87) while the HR for recurrent stroke was not statistically significant. Outcomes for skiers with atrial fibrillation tended to show a lower risk than for nonskiers. Conclusions: This large cohort study supports the hypothesis that patients with a stroke and with prior regular physical activity have a lower risk of death, while their risk for recurrent stroke is similar to that of nonskiers. The skiers had a higher incidence of atrial fibrillation, but still no increased risk of recurring stroke.

Self-assessment of the outcome of early medical abortion versus clinic follow-up in India : a randomised, controlled, non-inferiority trial

Background: The need for multiple clinical visits remains a barrier to women accessing safe legal medical abortion services. Alternatives to routine clinic follow-up visits have not been assessed in rural low-resource settings. We compared the effectiveness of standard clinic follow-up versus home assessment of outcome of medical abortion in a low-resource setting. Methods: This randomised, controlled, non-inferiority trial was done in six health centres (three rural, three urban) in Rajasthan, India. Women seeking early medical abortion up to 9 weeks of gestation were randomly assigned (1:1) to either routine clinic follow-up or self-assessment at home. Randomisation was done with a computer-generated randomisation sequence, with a block size of six. The study was not blinded. Women in the home-assessment group were advised to use a pictorial instruction sheet and take a low-sensitivity urine pregnancy test at home, 10-14 days after intake of mifepristone, and were contacted by a home visit or telephone call to record the outcome of the abortion. The primary (non-inferiority) outcome was complete abortion without continuing pregnancy or need for surgical evacuation or additional mifepristone and misoprostol. The non-inferiority margin for the risk difference was 5%. All participants with a reported primary outcome and who followed the clinical protocol were included in the analysis. This study is registered with ClinicalTrials.gov, number NCT01827995. Findings: Between April 23, 2013, and May 15, 2014, 731 women were recruited and assigned to clinic follow-up (n=366) or home assessment (n=365), of whom 700 were analysed for the main outcomes (n=336 and n=364, respectively). Complete abortion without continuing pregnancy, surgical intervention, or additional mifepristone and misoprostol was reported in 313 (93%) of 336 women in the clinic follow-up group and 347 (95%) of 364 women in the home-assessment group (difference -2.2%, 95% CI -5.9 to 1.6). One case of haemorrhage occurred in each group (rate of adverse events 0.3% in each group); no other adverse events were noted. Interpretation Home assessment of medical abortion outcome with a low-sensitivity urine pregnancy test is non-inferior to clinic follow-up, and could be introduced instead of a clinic follow-up visit in a low-resource setting.

What is important for you? A qualitative interview study of living with diabetes and experiences of diabetes care to establish a basis for a tailored Patient-Reported Outcome Measure for the Swedish National Diabetes Register

OBJECTIVES: There is a growing emphasis on the perspective of individuals living with diabetes and the need for a more person-centred diabetes care. At present, the Swedish National Diabetes Register (NDR) lacks patient-reported outcome measures (PROMs) based on the perspective of the patient. As a basis for a new PROM, the aim of this study was to describe important aspects in life for adult individuals with diabetes. DESIGN: Semistructured qualitative interviews analysed using content analysis. SETTING: Hospital-based outpatient clinics and primary healthcare clinics in Sweden. PARTICIPANTS: 29 adults with type 1 diabetes mellitus (DM) (n=15) and type 2 DM (n=14). INCLUSION CRITERIA: Swedish adults (≥18 years) living with type 1 DM or type 2 DM (duration ≥5 years) able to describe their situation in Swedish. Purposive sampling generated heterogeneous characteristics. RESULTS: To live a good life with diabetes is demanding for the individual, but experienced barriers can be eased by support from others in the personal sphere, and by professional support from diabetes care. Diabetes care was a crucial resource to nurture the individual's ability and knowledge to manage diabetes, and to facilitate life with diabetes by supplying support, guidance, medical treatment and technical devices tailored to individual needs. The analysis resulted in the overarching theme 'To live a good life with diabetes' constituting the two main categories 'How I feel and how things are going with my diabetes' and 'Support from diabetes care in managing diabetes' including five different categories. CONCLUSIONS: Common aspects were identified including the experience of living with diabetes and support from diabetes care. These will be used to establish a basis for a tailored PROM for the NDR.

High female mortality resulting in herd collapse in free-ranging domesticated reindeer (Rangifer tarandus tarandus) in Sweden

Reindeer herding in Sweden is a form of pastoralism practised by the indigenous Sami population. The economy is mainly based on meat production. Herd size is generally regulated by harvest in order not to overuse grazing ranges and keep a productive herd. Nonetheless, herd growth and room for harvest is currently small in many areas. Negative herd growth and low harvest rate were observed in one of two herds in a reindeer herding community in Central Sweden. The herds (A and B) used the same ranges from April until the autumn gathering in October-December, but were separated on different ranges over winter. Analyses of capture-recapture for 723 adult female reindeer over five years (2007-2012) revealed high annual losses (7.1% and 18.4%, for herd A and B respectively). A continuing decline in the total reindeer number in herd B demonstrated an inability to maintain the herd size in spite of a very small harvest. An estimated breakpoint for when herd size cannot be kept stable confirmed that the observed female mortality rate in herd B represented a state of herd collapse. Lower calving success in herd B compared to A indicated differences in winter foraging conditions. However, we found only minor differences in animal body condition between the herds in autumn. We found no evidence that a lower autumn body mass generally increased the risk for a female of dying from one autumn to the next. We conclude that the prime driver of the on-going collapse of herd B is not high animal density or poor body condition. Accidents or disease seem unlikely as major causes of mortality. Predation, primarily by lynx and wolverine, appears to be the most plausible reason for the high female mortality and state of collapse in the studied reindeer herding community.

Perceptions of Sustainability and Functional Aspects on Liquid Carton Board Packaging Materials versus Competing Materials for Juice Applications in Sweden

This research explores the downstream perceptions of liquid carton board versus competing materials in packaging applications for juice. The methodology used is focus groups. The context is sustainability and functional performance, and related potential implications for the beverage industry value chain. The purpose is to get a deeper insight and understanding of functionality in relation to juice beverage packaging. The results confirm that there is no optimal packaging for every juice product, but a multitude, depending on the distribution channel, retail outlet, customer preferences, and context of consumption. There are some general packaging preferences, but the main deciding criteria for purchase seem to be the product characteristics in terms of quality, taste, brand, price and shelf life. For marketing reasons, packaging has to be adopted to the product and its positioning, liquid carton board packaging seem to have some functional advantages in distribution and is considered as sustainable and functional among many consumers. Major drawbacks seem to be shape limitations, lack of transparency, and lack of a “premium look”. To improve packaging performance and avoid sub-optimization, actors in the beverage industry value chain need to be integrated in development processes.

Geoprocessing journey-to-work data : delineating commuting regions in Dalarna, Sweden

Delineation of commuting regions has always been based on statistical units, often municipalities or wards. However, using these units has certain disadvantages as their land areas differ considerably. Much information is lost in the larger spatial base units and distortions in self-containment values, the main criterion in rule-based delineation procedures, occur. Alternatively, one can start from relatively small standard size units such as hexagons. In this way, much greater detail in spatial patterns is obtained. In this paper, regions are built by means of intrazonal maximization (Intramax) on the basis of hexagons. The use of geoprocessing tools, specifically developed for the processing ofcommuting data, speeds up processing time considerably. The results of the Intramax analysis are evaluated with travel-to-work area constraints, and comparisons are made with commuting fields, accessibility to employment, commuting flow density and network commuting flow size. From selected steps in the regionalization process, a hierarchy of nested commuting regions emerges, revealing the complexity of commuting patterns.

När kallet ställs på sin spets : Pensionering ur ett existenssociologiskt perspektiv

When the calling is brought to a head: Retirement from an existential sociology perspective In this article we analyze how the meaning and value of work can emerge, be defined and redefined in relation to the coming of retirement, by focusing individuals with dedicated work approaches interpreted as a calling. By relying on an existential sociology framework we analyze the retirement process as an existential imperative, e.g. life phases or processes where questions on meaning and life quality become prominent. For the interviewees, the day of retirement becomes a sort of a road sign that – depending on the distance of time to the point of retirement – has intensified existential questions and the meaning of work. The article explores the defining dimensions of a calling as found in the interviewees dedicated work approaches. We address the types of problems and opportunities that arise when the interviewees are soon to retire and their associated strategies: listening to a calling on ”standby”; learning not to listen to one’s calling, listening to a calling from a private sphere and project the calling’s commitment to other activities.

Democracy lessons in market-oriented schools : The case of Swedish upper secondary education

Based on recent ethnographic research, this article explores young people’s opportunities of formal and informal democracy learning and expressions of such learning in the highly market-influenced Swedish upper secondary education. With its ambitious democracy-fostering goals and far-reaching marketisation, Swedish education constitutes an interesting case in this respect. The analysis indicates that ‘voting with the feet’ emerges as an important way of exerting student influence. At the same time, young people’s voice is surprisingly neglected in classroom practice. Increased focus on performance and goal attainment tends to overshadow less ‘rewarding’ aspects of the curriculum, such as democracy teaching and learning, both from the side of teachers and students. Students are also increasingly expected to act as school representatives and to avoid giving negative impressions of their school.

Medborgarskapande för ett nytt millennium : utbildning och medborgarfostran i 2000-talets Sverige.

Citizenship in the making for a new millenium – education and citizen formation in 21st century Sweden. The aim of this article is to analyse citizenship formation in Swedish education. In highlighting trends regarding the assignment of the educational system to provide for democratic citizenship there are certain depictions of citizenship prevail- ing. The first stresses an inward-looking and inward-feeling citizenship, characterizing the citizen as deliberative and emotional. The second stresses an inward-looking and outward-making citizenship, characterizing the citizen as entrepreneurial and willing. Here, democracy is portrayed as already achieved. This, we argue, is hazardous as society risk being pictured as apolitical and democratically ‘saturated’. This situation does not open up for democratic change to come into question as desirable or even possible. Put differently, it leaves us with the notion that things have to be as they are, as we are living in the best of worlds.

Från nationsbyggare till global marknadsnomad : Om medborgarskap i svensk utbildningspolitik under 1990-talet

I den här avhandlingen är intresset riktat mot svensk utbildningspolitik och medborgarskap. I tider av globalisering, och med ett etablerat svenskt medlemskap i Europeiska unionen, har det nationella policyskapandet kring utbildningens medborgardanande funktion hamnat under ökat tryck. I studien undersöks hur detta hanteras i svensk utbildningspolitik under 1990-talet, en tid som utmärker sig genom betydande förändringar på utbildningsområdet i Sverige. Frågan är, mera precist, vilken riktning för skolans, enligt lag befästa, uppdrag att fostra demokratiska medborgare som utstakas i svensk utbildningspolitik vid denna tid. Genom att fästa vikt vid mål, visioner och motiv som formuleras i utbildningspolitiska 1990-talstexter klarläggs förståelser av medborgarskap som karaktäriserar svensk utbildningspolitik under denna tid. Även en bredare historisk analys görs, ur vilken historiska målsättningar med skolans medborgarfostran som föregår 1990-talets framträder. Studiens syfte är kritiskt. Förståelserna granskas utifrån vad de innesluter och vad de utesluter, vilka möjliga konsekvenser de kan tänkas få för olika individer och grupper i samhället, och om det finns öppningar för tänkbara alternativ. Studien visar på två historiska skiften vad gäller medborgarskapets innehåll och mening i det inhemska policyskapandet. Det första skiftet äger rum under 1990-talets tidiga del. Då bryts en etablerad samhällsbyggande medborgarroll upp, till förmån för andra mera marknadsorienterade medborgarroller. Under 1990-talets senare del, då marknadsorienteringen förstärks i neoliberal riktning, sker ett andra skifte; en historiskt vedertagen gemenskapstanke – nationen – bryts upp som grund för medborgerlig gemenskap. Denna tanke ersätts av en annan som är globaliseringsinriktad, vilken visar sig ha andra inne- och uteslutande mekanismer för olika individer och samhällsgrupper. Utifrån dessa forskningsrön tecknas avslutningsvis några konturer till ett alternativt sätt att tänka kring medborgarskap och gemenskap. Detta alternativ tar form i ambitionen att, i högre grad än vad som blir synligt i svensk utbildningspolitik, resonera kring möjligheter för ett medborgarskap bortom förhandstecknade indelningsgrunder för ett “vi”. Språk som politisk och samhällelig förändringskraft ges en central betydelse i avhandlingen. I analysen av texternas tal om skolans medborgarfostrande roll undersöks pågående politiska motsättningar när det gäller att vinna tal- och tolkningsföreträde till skolans fostransmål. Utgångarna av dessa motsättningar belyses genom tre områden för medborgarfostran som urskilts som centrala; ett politiskt, ett kulturellt samt ett ekonomi- och arbetslivsriktat. Genom dessa har rådande medborgarskapsdiskurser tagit form, ur vilka de utbildningspolitiska förståelserna av medborgarskap gestaltas och diskuteras.

Revisiting a destination: A tourist’s choice model : A case study of Sweden

This paper documents the design and results of a study on tourists’ decision-making about destinations in Sweden. For this purpose, secondary data, available from surveys were used to identify which type of individual has the highest probability to revisit a destination and what are influencing factors to do so. A binary logit model is applied. The results show that very important influencing factors are the length of stay as well as the origin of the individual. These results could be useful for a marketing organization as well as for policy, to develop strategies to attract the most profitable tourism segment. Therefore, it can also be a great support for sustainable tourism development, where the main focus does not has priority on increasing number of tourists.

Modeling Hospital Readmissions in Dalarna County, Sweden

Unplanned hospital readmissions increase health and medical care costs and indicate lower the lower quality of the healthcare services. Hence, predicting patients at risk to be readmitted is of interest. Using administrative data of patients being treated in the medical centers and hospitals in the Dalarna County, Sweden, during 2008 – 2016 two risk prediction models of hospital readmission are built. The first model relies on the logistic regression (LR) approach, predicts correctly 2,648 out of 3,392 observed readmission in the test dataset, reaching a c-statistics of 0.69. The second model is built using random forests (RF) algorithm; correctly predicts 2,183 readmission (out of 3,366) and 13,198 non-readmission events (out of 18,982). The discriminating ability of the best performing RF model (c-statistic 0.60) is comparable to that of the logistic model. Although the discriminating ability of both LR and RF risk prediction models is relatively modest, still these models are capable to identify patients running high risk of hospital readmission. These patients can then be targeted with specific interventions, in order to prevent the readmission, improve patients’ quality of life and reduce health and medical care costs.

Internal Control application : Empirical evidence from Sweden

Aim The aim of this study is to explore based on internationally recognised frameworks: 1. how internal control structures are applied in Sweden among different sectors; 2. how organizational size and environment affect internal control structures; and 3. the impact of internal control structures on organizational performance. Methods A quantitative method was used in the data collection and analysis. The sample consisted of 1117 organizations operating in Sweden. A mean analysis was conducted to measure the level of internal control structures among different industries, organizational sizes, and different choices of listing in the stock exchange market. Person’s correlation analysis was then used to explore possible correlations between external environmental factors and internal control structures, and internal control structures and organizational performance. Lastly, a structural model was built to measure the impact of internal control structures on organizational performance. The measurements of internal control structures and organizational performance are based on COSO framework’s principles and objectives. Results This study gives an insight on how internal control structures are applied across industrial sectors in Sweden, with financial institutions and manufacturing organizations having notably higher levels of internal control structures. Additionally, it provides evidence of the impact external environmental factors have on internal control structures. Furthermore, it shows that organizations that are listed in the Swedish stock exchange market have an equivalent level of internal control structures to those registered in the American stock exchange market. In contrast, organisations that are not listed in the stock exchange market have a notably lower level of internal control structures. Lastly, it illustrates the positive impact the presence of internal control structures has on organizational performance. 3 | P a g e Conclusion The results highlight a crucial role the supervisory authority Finansinspektionen (FI) has in regulating the Swedish financial market. They also show that the stability of the Swedish business environment has had a positive impact on the level of internal control structures.