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1.	Moberg, Christina, et al. (author) De unga gör helt rätt när de stämmer staten 2022 In: Aftonbladet. - 1103-9000. Journal article (pop. science, debate, etc.)abstract 1 620 forskare och lärare i forskarvärlden: Vi ställer oss bakom Auroras klimatkrav
2.	Ahlberg, Mats Steinholtz, 1979- (author) Surveillance and follow-up of early prostate cancer 2024 Doctoral thesis (other academic/artistic)abstract Active surveillance (AS) for prostate cancer was introduced to address overtreatment resulting from prostate-specific antigen (PSA) testing. Despite advancements such as Magnetic Resonance Imaging (MRI) and targeted biopsies, PSA remains crucial in prostate cancer diagnostics, leading to ongoing challenges of overdiagnosis and overtreatment. This thesis aimed to investigate different aspects of AS and follow-up of early prostate cancer and provide new insights to reduce overtreatment and enhance surveillance and follow-up. In Paper I, the rationale and methodology of a randomized controlled trial, the Prostate Cancer Active Surveillance Trigger trial/Scandinavian Prostate Cancer Group study no. 17 (PCASTt/SPCG17), were outlined. This trial's objective is to evaluate the safety of an AS protocol based on MRI and standardized triggers for repeat biopsies and transition to radical treatment. Patient recruitment is anticipated to conclude in 2024. Paper II investigated the risks of biochemical recurrence, metastatic disease, and prostate cancer-related death in patients following radical prostatectomy. The analysis was conditioned on time after radical prostatectomy without biochemical recurrence. For patients with favourable histopathology in prostatectomy specimens and no biochemical recurrence five years post-prostatectomy, the probability of developing metastatic disease or dying from prostate cancer within 20 years after surgery was very low. This suggests shorter follow-up for selected patients. Paper III compared outcomes of AS for men from different healthcare regions in Sweden with varying traditions of AS. Regions with lower uptake in AS demonstrated a higher probability of transitioning from AS to radical treatment, but no difference in AS failure. The results suggest overtreatment in regions with low uptake in AS. Paper IV explored the associations between potential triggers for transitioning from AS to radical treatment and the transition to treatment. We analysed how this association changed with the introduction of prostate MRI. We found an increasingly strong association between triggers, particularly histopathological progression, and transition. However, most treated men had not experienced histopathological progression. The introduction of MRI did not contribute much to the change. In conclusion, this thesis outlines an ongoing study on defined triggers for transitioning from AS to radical treatment, suggests shorter follow-up after radical prostatectomy for selected patients, reveals overtreatment in regions with low uptake in AS, and shows an increasing use of histopathological progression as a trigger for transition to radical treatment.
3.	Bergengren, Oskar, et al. (author) Changes in lifestyle among prostate cancer survivors: A nationwide population-based study 2020 In: Psycho-Oncology. - : Wiley. - 1057-9249 .- 1099-1611. ; 29:10 Journal article (peer-reviewed)abstract Objective Long-term information on lifestyle changes among prostate survivors is lacking. In this nationwide, population-based study we investigated the prevalence of lifestyle changes, factors associated with lifestyle changes and associations between lifestyle changes and general quality of life. Methods All men registered in the National Prostate Cancer Register of Sweden diagnosed in 2008 with low-risk prostate cancer at age 70 years or younger were sent a questionnaire. Logistic regression was used to calculate odds ratios (ORs) with 95% confidence intervals for factors potentially associated with lifestyle change. Results Out of 1288, 1720 men (75%) were responded. A total of 279 (22%) reported a positive lifestyle change regarding diet or exercise. Poor functional outcomes after treatment was associated with exercising less (OR 1.6, 95% CI 1.2-2.1) and less interest in social activities and relationships (OR 1.8, 95% CI 1.5-2.1). Men who exercised more (OR 7.9, 95% CI 4.4-14) and men who had an increased interest in relationships and social activities (OR 5.2, 95% CI 2.1-13) reported higher general quality of life. Conclusions A considerable proportion of men reported making positive lifestyle changes after the prostate cancer diagnosis. The time after diagnosis may be a teachable moment that facilitates lifestyle interventions. Poor functional outcomes after treatment may reduce the willingness to engage in positive lifestyle change, which need be considered when supporting men after treatment. Men who made a positive lifestyle change, regardless of whether it was exercise or regarding relationships and social activities more often reported a high level of general quality of life.
4.	Gerdtsson, Axel, et al. (author) Initial surveillance in men with marker negative clinical stage IIA non-seminomatous germ cell tumours 2024 In: BJU INTERNATIONAL. - : John Wiley & Sons. - 1464-4096 .- 1464-410X. Journal article (peer-reviewed)abstract Objectives To assess whether extended surveillance with repeated computed tomography (CT) scans for patients with clinical stage IIA (CS IIA; <2 cm abdominal node involvement) and negative markers (Mk-) non-seminomatous germ cell tumours (NSGCTs) can identify those with true CS I. To assess the rate of benign lymph nodes, teratoma, and viable cancer in retroperitoneal lymph node dissection (RPLND) histopathology for patients with CS IIA Mk- NSGCT. Patients and methods Observational prospective population-based study of patients diagnosed 2008-2019 with CS IIA Mk- NSGCT in the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) registry. Patients were managed with surveillance, with CT scans, and tumour markers every sixth week for a maximum of 18 weeks. Patients with radiological regression were treated as CS I, if progression with chemotherapy, and remaining CS IIA Mk- disease with RPLND. The end-point was the number and percentage of patients down-staged to CS I on surveillance and rate of RPLND histopathology presented as benign, teratoma, or viable cancer. Results Overall, 126 patients with CS IIA Mk- NSGCT were included but 41 received therapy upfront. After surveillance for a median (range) of 6 (6-18) weeks, 23/85 (27%) patients were in true CS I and four (5%) progressed. Of the remaining 58 patients with lasting CS IIA Mk- NSGCT, 16 received chemotherapy and 42 underwent RPLND. The RPLND histopathology revealed benign lymph nodes in 11 (26%), teratoma in two (6%), and viable cancer in 29 (70%) patients. Conclusions Surveillance with repeated CT scans can identify patients in true CS I, thus avoiding overtreatment. The RPLND histopathology in patients with CS IIA Mk- NSGCT had a high rate of cancer and a low rate of teratoma.
5.	Gerdtsson, Axel, et al. (author) Unilateral or Bilateral Retroperitoneal Lymph Node Dissection in Nonseminoma Patients with Postchemotherapy Residual Tumour? Results from RETROP, a Population-based Mapping Study by the Swedish Norwegian Testicular Cancer Group 2022 In: European Urology Oncology. - : Elsevier BV. - 2588-9311. ; 5:2, s. 235-243 Journal article (peer-reviewed)abstract BACKGROUND: The distribution of retroperitoneal lymph node metastases for patients with nonseminoma and a residual tumour of 10-49 mm in a population-based setting is unknown. This information is needed to justify selection of patients for a unilateral template resection. OBJECTIVE: To describe the location of retroperitoneal metastases and recurrences in patients with nonseminoma germ cell tumour (NSGCT) with a residual tumour of 10-49 mm. DESIGN, SETTING, AND PARTICIPANTS: RETROP is a population-based prospective observational mapping study of 213 patients in Sweden and Norway with a retroperitoneal residual tumour of 10-49 mm who underwent postchemotherapy retroperitoneal lymph node dissection for metastatic NSGCT during 2007-2014 with median follow-up of 100 mo. Patients were classified according to the testis primary tumour and the distribution of unilateral or bilateral lymph node metastases (with reference to the aorta) present on pre- and/or postchemotherapy computed tomography (CT) scans. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The distribution and rate of teratoma or cancer in unilateral or bilateral retroperitoneal fields and the location and rate of retroperitoneal recurrence were measured. RESULTS AND LIMITATIONS: In total, 65% of the patients had unilateral retroperitoneal lymph node metastases (RLNMs) on CT scans. Patients with unilateral RLNMs had a low risk of contralateral teratoma or cancer (1.6% for right- and 2.6% for left-sided NSGCT) or retroperitoneal recurrence (0% for right- and 4% for left-sided NSGCT). A weakness of the study is that the pathology specimen could not be fully designated to one specific area for some of the patients. CONCLUSIONS: Men with postchemotherapy residual disease of 10-49 mm and unilateral metastases on pre- and postchemotherapy CT scans have a low risk of contralateral disease and should be considered for a unilateral template resection. PATIENT SUMMARY: The surgeon can use computed tomography (CT) scans in deciding on the extent of lymph node dissection in patients with testicular cancer.
6.	Kjällander, Susanne, et al. (author) Förskolan behöver en digitaliseringsstrategi 2023 In: Svenska Dagbladet. - Stockholm. - 2001-3868. ; :18-jun Journal article (pop. science, debate, etc.)
7.	Leiler, Anna, et al. (author) A Pilot Study of a Psychoeducational Group Intervention Delivered at Asylum Accommodation Centers-A Mixed Methods Approach 2020 In: International Journal of Environmental Research and Public Health. - : MDPI AG. - 1661-7827 .- 1660-4601. ; 17:23 Journal article (peer-reviewed)abstract Asylum seekers suffer high levels of distress but have restricted access to mental health care. This paper constitutes an evaluation of a psycho-educational group intervention, called AMIN, which was provided at two asylum accommodation centers in Sweden. A mixed-methods approach was used. To assess potential effectiveness, acceptability, and feasibility, quantitative outcome measures were combined with qualitative information from interviews with both intervention participants and staff providing the intervention. Potential effectiveness in reducing symptoms of distress and insomnia and in increasing physical quality of life was found, even though the intervention participants suffered from more severe distress than expected. In general, the intervention seemed to be acceptable to both participants and staff, with concrete strategies seeming more meaningful than abstract psychological techniques. Finally, regardless of the asylum process itself being a complicating factor, the intervention seemed feasible to deliver to individuals with different backgrounds and conditions. Taken together, these results indicate that some sessions may need further elaboration, but also that the transition to a randomized control trial is reasonable.
8.	Pramling, Ingrid, et al. (author) 27 forskare i upprop mot skärmfri förskola 2024 In: Förskolan. - Stockholm : Sveriges Lärare. Journal article (pop. science, debate, etc.)abstract VI LÄRARE DEBATT: Regeringens uppdrag till Skolverket – att göra utbildningen i förskolan skärmfri – riskerar att ge negativa och allvarliga konsekvenser, särskilt för barn som är i störst behov av att möta en digitaliserad värld med stöd av utbildade förskollärare och barnskötare. Det skriver 27 barn- och förskoleforskare i ett gemensamt upprop.
9.	Pramling Samuelsson, Ingrid, et al. (author) 27 forskare i upprop mot skärmfri förskola 2024 In: Förskolan. - Stockholm : Sveriges Lärare. Journal article (pop. science, debate, etc.)abstract VI LÄRARE DEBATT: Regeringens uppdrag till Skolverket – att göra utbildningen i förskolan skärmfri – riskerar att ge negativa och allvarliga konsekvenser, särskilt för barn som är i störst behov av att möta en digitaliserad värld med stöd av utbildade förskollärare och barnskötare. Det skriver 27 barn- och förskoleforskare i ett gemensamt upprop.
10.	Tegel, Hanna, et al. (author) High throughput generation of a resource of the human secretome in mammalian cells 2020 In: New Biotechnology. - : Elsevier BV. - 1871-6784 .- 1876-4347. ; 58, s. 45-54 Journal article (peer-reviewed)abstract The proteins secreted by human tissues and blood cells, the secretome, are important both for the basic understanding of human biology and for identification of potential targets for future diagnosis and therapy. Here, a high-throughput mammalian cell factory is presented that was established to create a resource of recombinant full-length proteins covering the majority of those annotated as 'secreted' in humans. The full-length DNA sequences of each of the predicted secreted proteins were generated by gene synthesis, the constructs were transfected into Chinese hamster ovary (CHO) cells and the recombinant proteins were produced, purified and analyzed. Almost 1,300 proteins were successfully generated and proteins predicted to be secreted into the blood were produced with a success rate of 65%, while the success rates for the other categories of secreted proteins were somewhat lower giving an overall one-pass success rate of ca. 58%. The proteins were used to generate targeted proteomics assays and several of the proteins were shown to be active in a phenotypic assay involving pancreatic beta-cell dedifferentiation. Many of the proteins that failed during production in CHO cells could be rescued in human embryonic kidney (HEK 293) cells suggesting that a cell factory of human origin can be an attractive alternative for production in mammalian cells. In conclusion, a high-throughput protein production and purification system has been successfully established to create a unique resource of the human secretome.
11.	Zaigham, Mehreen, et al. (author) Intrauterine vertical SARS-CoV-2 infection : a case confirming transplacental transmission followed by divergence of the viral genome 2021 In: BJOG: An International Journal of Obstetrics & Gynaecology. - : Wiley. - 1471-0528 .- 1470-0328. ; 128:8, s. 1388-1394 Journal article (peer-reviewed)abstract A 27-year-old woman (gravida 2, para 1) was transported to the regional university hospital in gestational week (GW) 34 + 4 due to a three-day history of fever, abdominal pain and reduced foetal movements. She had developed a dry cough one day prior to the admission (Figure S1). The woman, was slightly overweight (BMI 27 kg/m2 ) but otherwise healthy. She had normal antenatal check-ups and an obstetric ultrasound at GW 32 + 2 showed a normal foetal weight deviation of +8%1 .
12.	Ahlberg, Mats Steinholtz, et al. (author) Time without PSA recurrence after radical prostatectomy as a predictor of future biochemical recurrence, metastatic disease and prostate cancer death : a prospective Scandinavian cohort study 2022 In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:12 Journal article (peer-reviewed)abstract Objective: Although surveillance after radical prostatectomy routinely includes repeated prostate specific antigen (PSA)-testing for many years, biochemical recurrence often occurs without further clinical progression. We therefore hypothesised that follow-up can be shortened for many patients without increasing the risk of prostate cancer death. We investigated the long-term probabilities of PSA recurrence, metastases and prostate cancer death in patients without biochemical recurrence five and 10 years after radical prostatectomy.Design: Prospective cohort study. Stratification by Gleason score (<= 3+4=7or >= 4+3=7), pathological tumour stage (pT2 or >= pT3) and negative or positive surgical margins.Setting: Between 1989 and 1998, 14 urological centres in Scandinavia randomised patients to the Scandinavian Prostate Cancer Group study number 4 (SPCG-4) trial.ParticipationAll 306 patients from the SPCG-4 trial who underwent radical prostatectomy within 1year from inclusion were eligible. Four patients were excluded due to surgery-related death (n=1) or salvage radiotherapy or hormonal treatment within 6weeks from surgery (n=3).Primary outcome measures: Cumulative incidences and absolute differences in metastatic disease and prostate cancer death.Results: We analysed 302 patients with complete follow-up during a median of 24 years. Median preoperative PSA was 9.8ng/mL and median age was 65 years. For patients without biochemical recurrence 5 years after radical prostatectomy the 20-year probability of biochemical recurrence was 25% among men with Gleason score <= 3+4=7and 57% among men with Gleason score >= 4+3=7; the probabilities for metastases were 0.8% and 17%; and for prostate cancer death 0.8% and 12%, respectively. The long-term probabilities were higher for pT >= 3versus pT2 and for positive versus negative surgical margins. Limitations include small size of the cohort.Conclusion: Many patients with favourable histopathology without biochemical recurrence 5years after radical prostatectomy could stop follow-up earlier than 10 years after radical prostatectomy.
13.	Ahlberg, Mats Steinholtz, et al. (author) Variations in the Uptake of Active Surveillance for Prostate Cancer and Its Impact on Outcomes 2023 In: European Urology Open Science. - : Elsevier BV. - 2666-1691 .- 2666-1683. ; 52, s. 166-173 Journal article (peer-reviewed)abstract Background: Regional differences in active surveillance (AS) uptake for prostate cancer (PC) illustrate an inequality in treatment strategies.Objective: To examine the association between regional differences in AS uptake and transition to radical treatment, start of androgen deprivation therapy (ADT), watchful waiting, or death.Design, setting, and participants: A Swedish population-based cohort study was con-ducted including men in the National Prostate Cancer Register in Sweden with low -risk or favorable intermediate-risk PC, starting AS from January 1, 2007 and continuing till December 31, 2019.Intervention: Regional tradition of low, intermediate, or high proportions of immediate radical treatment. Outcomes measurements and statistical analysis:Probabilities of transition from AS to radical treatment, start of ADT, watchful waiting, or death from other causes were assessed.Results and limitations: We included 13 679 men. The median age was 66 yr, median PSA 5.1 ng/ml, and median follow-up 5.7 yr. Men from regions with a high AS uptake had a lower probability of transition to radical treatment (36%) than men from regions with a low AS uptake (40%; absolute difference 4.1%; 95% confidence interval [CI] 1.0-7.2), but not a higher probability of AS failure defined as the start of ADT (absolute difference 0.4%; 95% CI -0.7 to 1.4). There were no statistically significant differences in the probability of transition to watchful waiting or death from other causes. Limitations include uncertainty in the estimation of remaining lifetime and transition to watchful waiting.Conclusions:A regional tradition of a high AS uptake is associated with a lower probability of transition to radical treatment, but not with AS failure. A low AS uptake suggests overtreatment.
14.	Bennesved, Anna, et al. (author) Ambulance clinicians’ understanding of older patients’ self-determination : A vignette study 2024 In: Nursing Ethics. - : Sage Publications. - 0969-7330 .- 1477-0989. ; 31:2-3, s. 342-354 Journal article (peer-reviewed)abstract Background: Older patients are often vulnerable and highly dependent on healthcare professionals’ assessment in the event of acute illness. In the context of ambulance services, this poses challenges as the assessment is normally conducted with a focus on identifying life-threatening conditions. Such assessment is not fully satisfactory in a patient relationship that also aims to promote and protect patient autonomy.Aim: To describe ambulance clinicians’ understanding of older patients’ self-determination when the pa- tient’s decision-making ability is impaired.Research design: A qualitative design with an inductive approach, guided by descriptive phenomenology.Participants: In total, 30 ambulance clinicians, comprised of 25 prehospital emergency nurses, 1 nurse and 4 emergency medical technicians participated in 15 dyadic interviews.Ethical considerations: The research was conducted in accordance with the Declaration of Helsinki, and permission was granted by the Swedish Ethical Review Authority.Findings: The findings are presented in two themes: (1) Movement between explicit and implicit will; and (2) Contradictions about the patient’s best interests. The clinicians’ interpretations are based on an understanding of the patient’s situation using substitute decision-making in emergency situations and conversations that reveal the patient’s explicit wishes. Sometimes the clinicians collaborate to validate the patient’s implicit will, while they at other times subordinate themselves to others’ opinions. The clinicians find themselves in conflict between personal values and organisational values as they try to protect the patient’s self-determination.Conclusion: The results indicate that older patients with an impaired decision-making ability risk losing the right to self-determination in the context of ambulance services. The clinicians face challenges that significantly affect their ability to handle the older patient’s unique needs based on a holistic perspective and their ability to be autonomous.
15.	Bergengren, Oskar, et al. (author) Short term outcomes after robot assisted and open cystectomy- A nation-wide population-based study 2023 In: Ejso. - : Elsevier BV. - 0748-7983 .- 1532-2157. ; 49:4, s. 868-874 Journal article (peer-reviewed)abstract Introduction: We aimed to compare short term outcomes after robot assisted radical cystectomy (RARC) and open radical cystectomy (ORC) for urinary bladder cancer in a large population.Materials and methods: We included all patients without distant metastases who underwent either RARC or ORC with ileal conduit between 2011 and 2019 registered in the Bladder cancer data Base Sweden (BladderBaSe) 2.0. Primary outcome was unplanned readmissions within 90 days, and secondary out-comes within 90 days of surgery were reoperations, Clavien 3-5 complications, total days alive and out of hospital, and mortality. The analysis was carried out using multivariate regression models.Results: Out of 2905 patients, 832 were operated with RARC and 2073 with ORC. Robotic procedures were to a larger extent performed during later years, at high volume centers (47% vs 17%), more often for organ-confined disease (82% vs. 72%) and more frequently in patients with high socioeconomic status (26% vs. 21%). Patients operated with RARC were more commonly readmitted (29% vs. 25%). In multi -variable analysis RARC was associated with decreased risk of Clavien 3-5 complications (OR 0.58, 95% CI 0.47-0.72), reoperations (OR 0.53, 95% CI 0.39-0.71) and had more days alive and out of hospital (mean difference 3.7 days, 95% CI 2.4-5.0).Conclusion: This study illustrates the "real-world" effects of a gradual and nation-wide introduction of RARC. Patients operated with RARC had fewer major complications and reoperations but were more frequently readmitted compared to ORC. The observed differences were largely due to more wound related complications among patients treated with ORC.(c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
16.	Bergengren, Oskar, et al. (author) Variation in Prostate-Specific Antigen Testing Rates and Prostate Cancer Treatments and Outcomes in a National 20-Year Cohort 2021 In: JAMA Network Open. - : American Medical Association (AMA). - 2574-3805. ; 4:5 Journal article (peer-reviewed)abstract IMPORTANCE: The diagnostic activity for prostate cancer has increased during the past decades. However, the benefit and harm of the increased diagnostic activity have not been quantified in detail for a country or a large region.OBJECTIVE: The aim of this study was to evaluate and quantify the association between increases in diagnostic activity driven by prostate-specific antigen testing and incidence of prostate cancer diagnosis, treatment, and mortality.DESIGN, SETTING, AND PARTICIPANTS: This cohort study used the Proxy-Based Risk-Stratified Incidence Simulation Model-Prostate Cancer to examine observed data on all Swedish men with prevalent prostate cancer and compare them with a corresponding, hypothetical, simulated scenario with more restrictive diagnostic activity. All men aged 40 to 100 years living in Sweden during the time period 1996 to 2016 with incident and prevalent prostate cancer were included. The second scenario is the corresponding, hypothetical, simulated scenario where diagnostic activity remained constant as of 1996 (the beginning of the prostate-specific antigen testing era) throughout the study period.EXPOSURES: High or low diagnostic activity for prostate cancer.MAIN OUTCOMES AND MEASURES: Incidence of prostate cancer diagnosis, treatment (deferred treatment, curative treatment, and hormonal treatment), and prostate cancer mortality.RESULTS: During the study period from 1996 to 2016, 188 884 men were diagnosed with prostate cancer at a median (interquartile range) age of 71 (64-77) years. Compared with the low-diagnostic activity scenario, in the high-diagnostic activity scenario, the number of men diagnosed with prostate cancer was 48% higher (423 vs 286 [95% CI, 271-302] per 100 000 men per year), 148% more men were diagnosed with low- or intermediate-risk cancer (221 vs 89 [95% CI, 73-105] per 100 000 men per year), and 108% more men received curative treatment (152 vs 73 [95% CI: 66-85] per 100 000 men per year). There were up to 15% fewer prostate cancer deaths in the scenario with high-diagnostic activity (incidence rate ratio, 0.85; 95% CI, 0.82-0.88).CONCLUSIONS AND RELEVANCE: This studys results suggest that increased prostate-specific antigen testing and diagnostic activity are associated with a larger number of men being diagnosed with prostate cancer, predominately with low- and intermediate-risk disease. The increased diagnostic activity was associated with a 2-fold increase in curative treatment and a modest decrease in mortality.
17.	Borgenvik, Anna, 1987-, et al. (author) Dormant SOX9-Positive Cells Facilitate MYC-Driven Recurrence of Medulloblastoma 2022 In: Cancer Research. - : AMER ASSOC CANCER RESEARCH. - 0008-5472 .- 1538-7445. ; 82:24, s. 4586-4603 Journal article (peer-reviewed)abstract Relapse is the leading cause of death in patients with medulloblas-toma, the most common malignant pediatric brain tumor. A better understanding of the mechanisms underlying recurrence could lead to more effective therapies for targeting tumor relapses. Here, we observed that SOX9, a transcription factor and stem cell/glial fate marker, is limited to rare, quiescent cells in high-risk medulloblastoma with MYC amplification. In paired primary-recurrent patient samples, SOX9-positive cells accumulated in medulloblastoma relapses. SOX9 expression anti-correlated with MYC expression in murine and human medulloblastoma cells. However, SOX9-positive cells were plastic and could give rise to a MYC high state. To follow relapse at the single-cell level, an inducible dual Tet model of medulloblastoma was developed, in which MYC expression was redirected in vivo from treatment-sensitive bulk cells to dormant SOX9-positive cells using doxycycline treatment. SOX9 was essential for relapse initiation and depended on suppression of MYC activity to promote therapy resistance, epithelial-mesenchymal transition, and immune escape. p53 and DNA repair pathways were downregulated in recurrent tumors, whereas MGMT was upregulated. Recurrent tumor cells were found to be sensitive to treatment with an MGMT inhibitor and doxorubicin. These findings suggest that recurrence-specific targeting coupled with DNA repair inhibition comprises a potential therapeutic strategy in patients affected by medulloblastoma relapse.Significance: SOX9 facilitates therapy escape and recurrence in medulloblastoma via temporal inhibition of MYC/MYCN genes, revealing a strategy to specifically target SOX9-positive cells to prevent tumor relapse.
18.	Bratt, Anna S., 1969-, et al. (author) An internet-based compassion course for healthcare professionals : Rationale and protocol for a randomised controlled trial 2022 In: Internet Interventions. - : Elsevier BV. - 2214-7829. ; 28 Journal article (peer-reviewed)abstract Background: Severe stress is one of the most common causes of sick leave in Sweden. Previous research has shown that compassion interventions for healthcare professionals can decrease work-related stress through the introduction of self-care, self-awareness, and emotion regulation abilities when experiencing difficult situations. Internet-based stress management interventions have hitherto shown promising results in reducing stress. However, further research is needed to examine the effectiveness of internet-based compassion interventions for healthcare professionals. Objective: In the present study protocol, a randomised controlled trial is described, aiming to examine the effects of an internet-based compassion course for healthcare professionals on work-related stress and stress of conscience. Method: Healthcare professionals will be offered an internet-based stress management course of five modules across a period of five weeks. The design is a randomised controlled study consisting of three groups enrolled in one of the following: a compassion course (n = 120), a cognitive behavioural stress management course (n = 120), or placed on a waitlist followed by either the compassion course or the cognitive behavioural stress management course (n = 36). We hypothesise that the internet-based compassion course would reduce the participants' stress of conscience to a greater degree compared to the other two groups. The secondary hypothesis is that the compassion course would increase the participants' professional quality of life (i.e., higher job satisfaction and lower empathy fatigue) and self-compassion. In addition, the internet-based compassion course is expected to reduce the participants' work-related stress and sick leave rates to the same degree (non-inferiority) as the cognitive behavioural stress management course and to a higher degree when compared to the waitlist condition. The primary outcome measure is the Stress of Conscience Questionnaire (SCQ) and the secondary outcome measures are the Professional Quality of Life Scale (PROQOL), the Work-related Stress Copenhagen Psychosocial Questionnaire (COPSOQ), and the Self-compassion Scale (SCS). Assessments will be performed at baseline, four weekly assessments during treatment, post-treatment (5 weeks), and follow-ups at 10 weeks, 15 weeks, and 6 months. The repeated measures data will be analysed using a generalised estimating equation for repeated measurements to examine whether changes over time differ between the groups and whether the improvements persist over time. Discussion: The clinical trial is expected to provide novel data on the effects of compassion interventions and add to the existing knowledge of internet-based interventions for stress management in healthcare professionals.
19.	Brew, Bronwyn K., et al. (author) Paediatric asthma and non-allergic comorbidities : A review of current risk and proposed mechanisms 2022 In: Clinical and Experimental Allergy. - Stockholm : Wiley-Blackwell Publishing Inc.. - 0954-7894 .- 1365-2222. ; 15:9, s. 1035-1047 Research review (peer-reviewed)abstract It is increasingly recognized that children with asthma are at a higher risk of other non-allergic concurrent diseases than the non-asthma population. A plethora of recent research has reported on these comorbidities and progress has been made in understanding the mechanisms for comorbidity. The goal of this review was to assess the most recent evidence (2016-2021) on the extent of common comorbidities (obesity, depression and anxiety, neurodevelopmental disorders, sleep disorders and autoimmune diseases) and the latest mechanistic research, highlighting knowledge gaps requiring further investigation. We found that the majority of recent studies from around the world demonstrate that children with asthma are at an increased risk of having at least one of the studied comorbidities. A range of potential mechanisms were identified including common early life risk factors, common genetic factors, causal relationships, asthma medication and embryologic origins. Studies varied in their selection of population, asthma definition and outcome definitions. Next, steps in future studies should include using objective measures of asthma, such as lung function and immunological data, as well as investigating asthma phenotypes and endotypes. Larger complex genetic analyses are needed, including genome-wide association studies, gene expression-functional as well as pathway analyses or Mendelian randomization techniques; and identification of gene-environment interactions, such as epi-genetic studies or twin analyses, including omics and early life exposure data. Importantly, research should have relevance to clinical and public health translation including clinical practice, asthma management guidelines and intervention studies aimed at reducing comorbidities.
20.	Consiglio, Camila, et al. (author) Immune system adaptation during gender-affirming testosterone treatment 2023 In: Journal of Reproductive Immunology. - : Elsevier. - 0165-0378 .- 1872-7603. ; 159, s. 29-30 Journal article (other academic/artistic)abstract Biological sex impacts human immune responses, modulating susceptibility and severity to immune-related diseases. Female generally mount more robust immune responses than males, resulting in lower infection severity and greater autoimmunity incidence. Here, we addressed the contribution of testosterone to human immune function by analyzing a cohort of subjects undergoing gender-affirming testosterone treatment. We performed systems-level immunomonitoring through mass cytometry, scRNA and scA-TAC-Sequencing, and proteome profiling of blood samples at baseline and following 3 and 12 months of treatment. Testosterone treatment was associated with a low-grade inflammatory profile, evidenced by upregulation of proinflammatory plasma proteome (e.g., EN-RAGE, OSM, TNF), and induction of an inflammatory transcriptional program associated with NFkB signaling, and TNF signaling. Following testosterone treatment, higher NFkB activity was revealed in CD4 T, CD8 T, and NK cells in scATACseq analyses. Further, testosterone increased monocytic inflammatory responses upon bacterial stimulation in vitro. Although testosterone was associated with this inflammatory profile, it also exerted negative effects on antiviral immunity. Firstly, the percentage of plasmacytoid dendritic cells (pDC) decreased over transition, with pDC also displaying phenotypic changes associated with lower IFN responses. Secondly, bulk transcriptomics analyses show an overall reduction of IFNa responses. Thirdly, testosterone treatment led to reduced IFNa production upon PBMCs stimulation with a viral agonist. Our results show that testosterone has broad effects on the human immune system, and significantly modulates important players in antiviral immunity and inflammatory response. Identifying pathways involved in immune sexual dimorphism will help define novel targets for effective prevention and treatment of immune-mediated diseases.
21.	Douglas, Anna, et al. (author) Challenge Lab NMS log book : exploring the role of hydrogen in realizing a good life in North Middle Sweden through circular and low carbon industrial transformation: technical report for DG REGIO pilot for regions in industrial transition 2021 Reports (pop. science, debate, etc.)abstract North Middle Sweden took part in a pilot “Regions in Industrial Transition”, launched by the European Commission to test new approaches to dealing with industrial transition. By focusing on specific challenges related to industrial transition, the pilot sought to develop new tools for regions and cities.
22.	Dunst, Anna Katharina, et al. (author) A Novel Approach to Determining the Alactic Time Span in Connection with Assessment of the Maximal Rate of Lactate Accumulation in Elite Track Cyclists 2023 In: International Journal of Sports Physiology and Performance. - : Human Kinetics. - 1555-0265 .- 1555-0273. ; 18:2, s. 157-163 Journal article (peer-reviewed)abstract Purpose: Following short-term all-out exercise, the maximal rate of glycolysis is frequently assessed on the basis of the maximal rate of lactate accumulation in the blood. Since the end of the interval without significant accumulation (talac) is 1 of 2 denominators in the calculation employed, accurate determination of this parameter is crucial. Although the very existence and definition of talac, as well as the validity of its determination as time-to-peak power (tPpeak), remain controversial, this parameter plays a key role in anaerobic diagnostics. Here, we describe a novel approach to determination of talac and compare it to the current standard. Methods: Twelve elite track cyclists performed 3 maximal sprints (3, 8, and 12 s) and a high-rate, low-resistance pedaling test on an ergometer with monitoring of crank force and pedaling rate. Before and after each sprint, capillary blood samples were taken for determination of lactate accumulation. Fatigue-free force–velocity and power–velocity profiles were generated. talac was determined as tPpeak and as the time point of the first systematic deviation from the force–velocity profile (tFf). Results: Accumulation of lactate after the 3-second sprint was significant (0.58 [0.19] mmol L−1; P < .001, d = 1.982). tFf was <3 seconds and tPpeak was ≥3 seconds during all sprints (P < .001, d = − 2.111). Peak power output was lower than maximal power output (P < .001, d = −0.937). Blood lactate accumulation increased linearly with increasing duration of exercise (R2 ≥ .99) and intercepted the x-axis at ∼tFf. Conclusion: Definition of talac as tPpeak can lead to incorrect conclusions. We propose determination of talac based on tFf, the end of the fatigue-free state that may reflect the beginning of blood lactate accumulation.
23.	Dunst, Anna Katharina, et al. (author) A Novel Approach to the Determination of Time- and Fatigue-Dependent Efficiency during Maximal Cycling Sprints 2023 In: Sports. - : MDPI. - 2075-4663. ; 11:2 Journal article (peer-reviewed)abstract Background: During maximal cycling sprints, efficiency (η) is determined by the fiber composition of the muscles activated and cadence-dependent power output. To date, due to methodological limitations, it has only been possible to calculate gross efficiency (i.e., the ratio of total mechanical to total metabolic work) in vivo without assessing the impact of cadence and changes during exercise. Eliminating the impact of cadence provides optimal efficiency (ηopt), which can be modeled as a function of time. Here, we explain this concept, demonstrate its calculation, and compare the values obtained to actual data. Furthermore, we hypothesize that the time course of maximal power output (Pmax) reflects time-dependent changes in ηopt. Methods: Twelve elite track cyclists performed four maximal sprints (3, 8, 12, 60 s) and a maximal-pedaling test on a cycle ergometer. Crank force and cadence were monitored continuously to determine fatigue-free force-velocity profiles (F/v) and fatigue-induced changes in Pmax. Respiratory gases were measured during and for 30 min post-exercise. Prior to and following each sprint, lactate in capillary blood was determined to calculate net blood lactate accumulation (ΔBLC). Lactic and alactic energy production were estimated from ΔBLC and the fast component of excess post-exercise oxygen consumption. Aerobic energy production was determined from oxygen uptake during exercise. Metabolic power (MP) was derived from total metabolic energy (WTOT). ηopt was calculated as Pmax divided by MP. Temporal changes in Pmax, WTOT, and ηopt were analyzed by non-linear regression. Results: All models showed excellent quality (R2 > 0.982) and allowed accurate recalculation of time-specific power output and gross efficiency (R2 > 0.986). The time-constant for Pmax(t) (τP) was closely correlated with that of ηopt (τη; r = 0.998, p < 0.001). Estimating efficiency using τP for τη led to a 0.88 ± 0.35% error. Conclusions: Although efficiency depends on pedal force and cadence, the latter influence can be eliminated by ηopt(t) using a mono-exponential equation whose time constant can be estimated from Pmax(t).
24.	Dunst, Anna Katharina, et al. (author) Fatigue-Free Force-Velocity and Power-Velocity Profiles for Elite Track Sprint Cyclists: The Influence of Duration, Gear Ratio and Pedalling Rates 2022 In: Sports. - : MDPI. - 2075-4663. ; 10:9 Journal article (peer-reviewed)abstract Background: Maximal force-velocity (F/v) profiles for track cyclists are commonly derived from ergometer sprints using an isovelocity or isoinertial approach. Previously, an attempt was made to derive maximal F/v profiles from a single maximal 65-m sprint on the cycling track. Hypothesising that this approach may not accurately reflect the fatigue-free F/v profile, we propose an alternative procedure and compare it to the previous method. Moreover, we test for the impact of gear ratio on diagnostic results.Methods: Twelve elite track cyclists completed a high-cadence low-resistance pedalling test on a freestanding roller (motoric test) and two series of three maximal 65-m sprints on a cycling track with different gear ratios. F/v profiles were calculated based on the measured crank force and cadence either during the first 6–7 revolutions (≤6 s) on the track (model I) or were derived from the first 3–4 revolutions (≤3 s) on the track combined with 1 or 2 fatigue-free cycles at cadences above 160 rpm from the motoric test (model II).Results: Although both models exhibit high-to-excellent linearity between force and velocity, the extrapolated isometric force was higher (1507.51 ± 257.60 N and 1384.35 ± 276.84 N; p < 0.002; d = 2.555) and the slope steeper (−6.78 ± 1.17 and −5.24 ± 1.11; p < 0.003, d = −2.401) with model I. An ICC of 1.00 indicates excellent model consistency when comparing the F/v profiles (model II) derived from the different geared sprints.Conclusions: Assuring fatigue-free measurements and including high-cadence data points in the calculations provide valid maximal F/v and P/v profiles from a single acceleration-sprint independent of gear ratio.
25.	Dunst, Anna Katharina, et al. (author) Modeling optimal cadence as a function of time during maximal sprint exercises can improve performance by elite track cyclists 2021 In: Applied Sciences. - : MDPI. - 2076-3417. ; 11:24 Journal article (peer-reviewed)abstract In track cycling sprint events, optimal cadence PRopt is a dynamic aspect of fatigue. It is currently unclear what cadence is optimal for an athlete’s performance in sprint races and how it can be calculated. We examined fatigue-induced changes in optimal cadence during a maximal sprint using a mathematical approach. Nine elite track cyclists completed a 6-s high-frequency pedaling test and a 60-s isokinetic all-out sprint on a bicycle ergometer with continuous monitoring of crank force and cadence. Fatigue-free force-velocity (F/v) and power-velocity (P/v) profiles were derived from both tests. The development of fatigue during the 60-s sprint was assessed by fixing the slope of the fatigue-free F/v profile. Fatigue-induced alterations in PRopt were determined by non-linear regression analysis using a mono-exponential equation at constant slope. The study revealed that PRopt at any instant during a 60-s maximal sprint can be estimated accurately using a mono-exponential equation. In an isokinetic mode, a mean PRopt can be identified that enables the athlete to generate the highest mean power output over the course of the effort. Adding the time domain to the fatigue-free F/v and P/v profiles allows time-dependent cycling power to be modelled independent of cadence.
26.	Dutceac Segesten, Anamaria, et al. (author) Risken för ökad polarisering måste tas på allvar 2021 In: Göteborgs-Posten. - 1103-9345. Journal article (pop. science, debate, etc.)
27.	Ferrari, Desiree, et al. (author) Concentration of carprofen in the milk of lactating bitches after cesarean section and during inflammatory conditions 2022 In: Theriogenology. - : Elsevier. - 0093-691X .- 1879-3231. ; 181, s. 59-68 Journal article (peer-reviewed)abstract Pain treatment of lactating bitches is a clinically relevant, but complicated issue. Published scientific studies regarding the excretion of drugs in canine milk are scarce. When considering the risk of side effects in their offspring, lactating bitches have traditionally received very restricted analgesic and anti-inflammatory therapy. Our aim was to quantify the concentrations of carprofen in milk from lactating bitches and relate those to potential risks for the puppies. A second aim was to evaluate the impact mastitis may have on the concentration of carprofen in milk. A population of 100 bitches was enrolled in the study, among which 88 were bitches treated with carprofen after cesarean section (Group CS), eight were bitches with painful inflammatory conditions (Group I) and four were bitches with mastitis (Group M). The patients enrolled in the study received carprofen 4 mg/kg sc at day 1 followed by 2 mg/kg po every 12 h for the following 2-5 days. Owners were instructed to collect milk once a day for five days. The concentration of carprofen in the milk was quantified with ultra-performance liquid chromatography-tandem mass spectrometry. The data obtained were statistically analyzed as repeated-measures data with a mixed-model approach. Data were used to calculate the theoretical maximum total daily intake of carprofen by the puppies in order to perform a computerized simulation of the plasma concentration of carprofen in the puppies. Follow-up telephone interviews to check the status of the enrolled bitches and their litters occurred at one week and three-six months after treatment with car-profen. The major finding of the study was that the concentration of carprofen in the milk was <700 ng/ mL from bitches undergoing CS or suffering painful conditions other than mastitis. In comparison, administration of 2 mg/kg of carprofen sc or po to adult dogs, results in mean maximal plasma con-centrations of 19480 +/- 5420 ng/mL (mean +/- SD). Moreover, data suggests that inflammation of the mammary gland results in a higher concentration of carprofen in milk (up to 1300 ng/mL). In the computerized simulation, the plasma concentrations of carprofen in puppies in group CS and in group I are one tenth of the concentration in adult dogs receiving carprofen at standard doses. Considering the low excretion into milk, carprofen provides an analgesic alternative to lactating bitches without mastitis.(c) 2022 Published by Elsevier Inc.
28.	Forsberg, Anna, et al. (author) Once-only colonoscopy or two rounds of faecal immunochemical testing 2 years apart for colorectal cancer screening (SCREESCO): preliminary report of a randomised controlled trial 2022 In: The Lancet Gastroenterology & Hepatology. - : ELSEVIER INC. - 2468-1253. ; 7:6, s. 513-521 Journal article (peer-reviewed)abstract Background Screening for colorectal cancer is done with lower gastrointestinal endoscopy or stool-based tests. There is little evidence from randomised trials to show primary colonoscopy reduces mortality in colorectal cancer We aimed to investigate the effect of screening with once-only colonoscopy or two rounds of faecal immunochemical test screening on colorectal cancer mortality and incidence. Methods We did a randomised controlled trial in Sweden (SCREESCO). Residents in 18 of 21 regions who were age 60 years in the year of randomisation were identified from a population register maintained by the Swedish Tax Agency. A statistician with no further involvement in the trial used a randomised block method to assign individuals to once-only colonoscopy, two rounds of faecal immunochemical testing (OC-Sensor; 2 years apart), or a control group (no intervention; standard diagnostic pathways), in a ratio of 1:6 for colonoscopy versus control and 1:2 for faecal immunochemical testing versus control. Masking was not possible due to the nature of the trial. The primary endpoints of the trial are colorectal cancer mortality and colorectal cancer incidence. Here, we report preliminary participation rates, baseline findings, and adverse events from March, 2014, to December, 2020, in the two intervention groups after completion of recruitment and screening, up to the completion of the second faecal immunochemical testing round. Analyses were done in the intention-to-screen population, defined as all individuals who were randomly assigned to the respective study group. This study is registered with Clinical Trials.gov, NCT02078804. Findings Between March 1, 2014, and Dec 31, 2020, 278 280 people were induded in the study; 31 140 were assigned to the colonoscopy group, 60 300 to the faecal immunochemical test group, and 186 840 to the control group. 10 679 (35.1%) of 30 400 people who received an invitation for colonoscopy participated. 33 383 (55.5%) of 60 137 people who received a postal faecal immunochemical test participated. In the intention-to-screen analysis, colorectal cancer was detected in 49 (0.16%) of 31140 people in the colonoscopy group versus 121 (0. 20%) of 60 300 in the faecal immunochemical test group (relative risk [RR] 0.78, 95% CI 0.56-1.09). Advanced adenomas were detected in 637 (2.05%) people in the colonoscopy group and 968 (1.61%) in the faecal immunochemical test group (RR 1.27, 95% CI 1.15-1.41). Colonoscopy detected more right-sided advanced adenomas than faecal immunochemical testing. There were two perforations and 15 major bleeds in 16 555 colonoscopies. No intervention-related deaths occurred. Interpretation The diagnostic yield and the low number of adverse events indicate that the design from this trial, both for once-only colonoscopy and faecal immunochemical test screening, could be transferred to a population-based screening service if a benefit in disease-specific mortality is subsequently shown. Copyright (C) 2022 Elsevier Ltd. All rights reserved.
29.	Gedeborg, Rolf, et al. (author) An Aggregated Comorbidity Measure Based on History of Filled Drug Prescriptions : Development and Evaluation in Two Separate Cohorts 2021 In: Epidemiology. - : Lippincott Williams & Wilkins. - 1044-3983 .- 1531-5487. ; 32:4, s. 607-615 Journal article (peer-reviewed)abstract Background: The ability to account for comorbidity when estimating survival in a population diagnosed with cancer could be improved by using a drug comorbidity index based on filled drug prescriptions.Methods: We created a drug comorbidity index from age-stratified univariable associations between filled drug prescriptions and time to death in 326,450 control males randomly selected from the general population to men with prostate cancer. We also evaluated the index in 272,214 control females randomly selected from the general population to women with breast cancer.Results: The new drug comorbidity index predicted survival better than the Charlson Comorbidity Index (CCI) and a previously published prescription index during 11 years of follow-up. The concordance (C)-index for the new index was 0.73 in male and 0.76 in the female population, as compared with a C-index of 0.67 in men and 0.69 in women for the CCI. In men of age 75-84 years with CCI = 0, the median survival time was 7.1 years (95% confidence interval [CI] = 7.0, 7.3) in the highest index quartile. Comparing the highest to the lowest drug comorbidity index quartile resulted in a hazard ratio (HR) of 2.2 among men (95% CI = 2.1, 2.3) and 2.4 among women (95% CI = 2.3, 2.6).Conclusions: A new drug comorbidity index based on filled drug prescriptions improved prediction of survival beyond age and the CCI alone. The index will allow a more accurate baseline estimation of expected survival for comparing treatment outcomes and evaluating treatment guidelines in populations of people with cancer.
30.	Genell, Anders, 1974-, et al. (author) A synthesized road traffic noise scenario for health impact assessment 2023 In: Proceedings of the 10<sup>th </sup>Convention of the European Acoustics Association Forum Acusticum 2023. - : European Acoustics Association (EAA). - 9788888942674 ; , s. 2077-2081 Conference paper (other academic/artistic)abstract Within the Horizon 2020 project LEON-T (Low particle Emissions and lOw Noise Tyres), one of the aims is to investigate the effect on cardiovascular health from the effect on sleep of noise from heavy vehicle (EU class N2 and N3) tyres. Effects of noise on sleep are investigated by performing sleep experiments in a controlled lab environment where participants sleep several nights subjected to different traffic noise scenarios. The traffic noise scenarios have been constructed using synthesized tyre noise allowing for variation in parameters such as tyre tread pattern design, tyre air cavity resonance, traffic flow properties and distance between traffic noise source and receiver. The synthesized scenarios have been designed in close cooperation with experts on health effects from noise in order to expose the participants to such stimuli that provide relevant and valid responses. For the initial sleep experiment properties such as high or low traffc flow, individual vehicle noise level and level of perceptually salient tonal components in the synthesized tyre sound are investigated. This paper describes the synthesized vehicle sounds and the traffic noise scenario design process for the scenario used in the first sleep experiment.
31.	Gerdtsson, Axel, et al. (author) Validation of a prediction model for post-chemotherapy fibrosis in nonseminoma patients 2023 In: Bju International. - 1464-4096 .- 1464-410X. ; 132:3, s. 329-336 Journal article (peer-reviewed)abstract Objective To validate Vergouwe's prediction model using the Swedish and Norwegian Testicular Cancer Group (SWENOTECA) RETROP database and to define its clinical utility. Materials and methods Vergouwe's prediction model for benign histopathology in post-chemotherapy retroperitoneal lymph node dissection (PCRPLND) uses the following variables: presence of teratoma in orchiectomy specimen; pre-chemotherapy level of alphafetoprotein; b-Human chorionic gonadotropin and lactate dehydrogenase; and lymph node size pre- and postchemotherapy. Our validation cohort consisted of patients included in RETROP, a prospective population-based database of patients in Sweden and Norway with metastatic nonseminoma, who underwent PC-RPLND in the period 2007-2014. Discrimination and calibration analyses were used to validate Vergouwe's prediction model results. Calibration plots were created and a Hosmer-Lemeshow test was calculated. Clinical utility, expressed as opt-out net benefit (NBopt-out), was analysed using decision curve analysis. Results Overall, 284 patients were included in the analysis, of whom 130 (46%) had benign histology after PC-RPLND. Discrimination analysis showed good reproducibility, with an area under the receiver-operating characteristic curve (AUC) of 0.82 (95% confidence interval 0.77-0.87) compared to Vergouwe's prediction model (AUC between 0.77 and 0.84). Calibration was acceptable with no recalibration. Using a prediction threshold of 70% for benign histopathology, NBopt-out was 0.098. Using the model and this threshold, 61 patients would have been spared surgery. However, only 51 of 61 were correctly classified as benign. Conclusions The model was externally validated with good reproducibility. In a clinical setting, the model may identify patients with a high chance of benign histopathology, thereby sparing patients of surgery. However, meticulous follow-up is required.
32.	Hansson, Lena, 1968, et al. (author) Grocery shopping among elderly during Corona 2021 In: ESA 2021 - 15th Conference of the European Sociological Association. Conference paper (other academic/artistic)abstract During the Corona-pandemic, elderly people have had to limit their physical and social contacts, and consequently adjust several of their mundane routines. In this paper, we will discuss how routines and habits connected to food purchases have changed for elderly consumers (70+) during 2020. We specifically focus on the role of digital technology in the (new) shopping practices. Previous findings regarding importance of age versus experience of online shopping and mobile shopping are contradictory. Theoretically, we draw on the concept of ‘Shopping as practice’ (Elms et al., 2016; Fuentes & Svingstedt, 2017) and the theory of social practice by Shove et al. (2012) for understanding the mundane habits and routines involved in practice of grocery shopping and how they can change. The findings are based on 35 interviews with elderly consumers in Sweden, 70 years or older. The grocery shopping practices described fall into 3 main subcategories: switching to online shopping, continuing to shop in a physical store, and acquiring help from friends and relatives. The practices have been reshaped, e.g., in terms of purchasing frequency, food range, offers, payments, ordering, and delivery options. Digital technology and digital competence are essential parts in all three, as is the meaning of independence, but how these elements interact and the type of opportunities and limitations produced vary greatly. We discuss if and how (some) reshaped and new practices become stabilized.
33.	Hansson, Lena, 1968, et al. (author) Grocery shopping among elderly during Corona - Changing practices or temporary disruption? 2021 In: NRWC2021 - The 7th Nordic Retail and Wholesale Conference. Conference paper (other academic/artistic)abstract Elderly people (70+) have been significantly affected by the special recommendations for the age-group during March and October 2020. Under this period, many elderly had limited opportunities to visit groceries stores and 23 percent of them (65-79) started to purchase food online (e-barometern, 2020). While this indicates that some elderly consumers have changed their routines when purchasing food, no insights is given into how these changes are carried out and experienced in practice. Thus, this paper aims to deepen the understanding of elderly consumers’ grocery shopping practices during Covid-19 and the role digitalization of the food market plays for them during. Theoretically we draw on the concept of ‘Shopping as practice’ (Elms et al., 2016; Fuentes & Svingstedt, 2017) and the theory of social practice by Shove et al. (2012) for understanding mundane habits and routines. The paper analyses how the practice of grocery shopping has changed in the group of elderly consumers during the Corona pandemic.
34.	Hansson, Lena, 1968, et al. (author) Reorganising grocery shopping practices - the case of elderly consumers 2022 In: International Review of Retail Distribution and Consumer Research. - : Informa UK Limited. - 0959-3969 .- 1466-4402. ; 32:4, s. 351-369 Journal article (peer-reviewed)abstract This paper aims to deepen the understanding of elderly consumers' grocery shopping practices during Covid-19. Drawing on the shopping-as-practice approach within social practice theory, we show how the practices unfold as the pandemic evolves and the situation of the elderly change, which implies new possibilities and limitations in grocery shopping. Qualitative telephone interviews with elderly consumers were conducted in 2020 and followed up during 2021. By analysing the elderly's grocery shopping as a social practice, we show how different modes of shopping practices (in-store, online and assisted shopping), came about, how they were reconfigured, and what made them work smoothly or not during the corona pandemic. We also show how the grocery shopping practices, and the modes involved were situated and synchronised in everyday life. The paper also discusses the implication for retailers.
35.	Hansson, Lena, 1968, et al. (author) Scripting accessibility in online grocery shopping - the case of elderly consumers 2022 In: NRWC2022. Conference paper (other academic/artistic)abstract This paper analyses accessibility in online grocery shopping practices by looking into the retailer-consumer interactions. How does accessibility in online grocery shopping come about? More specifically we focus on the reconfiguration(s) of grocery shopping from offline to online from the perspective of elderly consumers.
36.	Hansson, Lena, 1968, et al. (author) Who's purchasing the food? Elderly, stores, home service and digital technology in interaction 2020 In: ESA RN5 – Midterm Meeting of the Research Network of Sociology of Consumption. Conference paper (other academic/artistic)abstract This paper aims to deepen the understanding of older consumers' food purchases and the role digitalisation of the food market plays for them. The paper analyses the temporary acting assemblages of heterogenous entities – humans, objects, tools, infrastructures etc. – involved in elderly consumers’ food purchases. We are interested in their capability to act, what actions become possible or restricted and how they can be changed. Theoretically we draw on ANT and the concept of ‘agencements’ (Callon 2008 and Latour 2005). We account for the varying life situations among elderly, regarding i.e. mobility, assistance, interest in and knowledge of digital technology, and highlights how actors, such as family and home service, as well as the accessibility of stores and digital platforms, create opportunities and limitations. The paper discusses strategies used in society to increase accessibility. Elderly consumers’ opportunities to shop for food are analyzed on the basis of so-called prosthetic and habilitation strategies (Callon 2008). Many times, it is the elderly who needs to adapt to the environment and its limitations, with or without prostheses, rather than adapting the environment to the individual (habilitation). The discussion shows the complexity of elderly’s grocery shopping. It highlights the challenges of increasing accessibility, despite inclusive ambitions among both public and commercial actors in society. The analysis is based on a literature review and a survey of initiatives and services offered to elderly consumers. This includes previous research on aging, eating habits, purchasing routines, grocery stores, accessibility and digital technology from an elderly perspective. The survey focuses on home services for the elderly, various commercial initiatives and adaptations, such as accessibility in stores and various digital solutions. The research is work in progress, interviews with seniors are planned for the spring 2020.
37.	Hellsten, Caroline, et al. (author) Cervical cancer in Region Skåne, Sweden 2017–2020 after the implementation of primary HPV screening : A quality assurance audit 2024 In: Acta Obstetricia et Gynecologica Scandinavica. - 0001-6349. ; 103:1, s. 129-137 Journal article (peer-reviewed)abstract Introduction: Primary human papilloma virus (HPV) screening to detect cervical cancer and dysplastic lesions was implemented in Region Skåne 2017 for women aged 30–70. The aim of this study was to characterize the screening history of women diagnosed with cervical cancer to evaluate the performance of the screening program, as well as to assess the cancer treatments given and shortcomings in the follow-up of women with cervical dysplasia. Material and methods: We performed a quality assurance audit. The data was collected from the National Cervical Cancer Prevention Registry, Region Skåne Labmedicin database and the Melior Journal system in 2017–2020. Results: We identified 247 women diagnosed with invasive cervical cancer in Region Skåne in 2017–2020. Of these, 35 (14.2%) had a screening history over at least two screening rounds before diagnosis. There were 25 (10.1%) women diagnosed with cervical cancer in between screening intervals, i.e., interval cancer. The most common screening history in women with cervical cancer was irregular screening (143, 57.9%), followed by women being above screening age (44, 17.8%). HPV was detected in 96% of the cases, either in cervical cytology or in the tumor tissue. The screening program detected the disease in 96 (38.9%) of the patients, 149 (60.3%) were diagnosed through symptoms and two (0.80%) as a result of incidental findings. Conclusions: The most powerful tool in the prevention of cervical cancer is screening program attendance. Prolongation with HPV screening among elderly women will also reduce the incidence of cervical cancer. Today, such cancers are usually discovered when symptoms appear.
38.	Henning, Petra, 1974, et al. (author) The novel cytotoxic polybisphosphonate osteodex decreases bone resorption by enhancing cell death of mature osteoclasts without affecting osteoclastogenesis of RANKL-stimulated mouse bone marrow macrophages 2024 In: INVESTIGATIONAL NEW DRUGS. - : Springer. - 0167-6997 .- 1573-0646. Journal article (peer-reviewed)abstract It has previously been demonstrated that the polybisphosphonate osteodex (ODX) inhibits bone resorption in organ-cultured mouse calvarial bone. In this study, we further investigate the effects by ODX on osteoclast differentiation, formation, and function in several different bone organ and cell cultures. Zoledronic acid (ZOL) was used for comparison. In retinoid-stimulated mouse calvarial organ cultures, ODX and ZOL significantly reduced the numbers of periosteal osteoclasts without affecting Tnfsf11 or Tnfrsf11b mRNA expression. ODX and ZOL also drastically reduced the numbers of osteoclasts in cell cultures isolated from the calvarial bone and in vitamin D3-stimulated mouse crude bone marrow cell cultures. These data suggest that ODX can inhibit osteoclast formation by inhibiting the differentiation of osteoclast progenitor cells or by directly targeting mature osteoclasts. We therefore assessed if osteoclast formation in purified bone marrow macrophage cultures stimulated by RANKL was inhibited by ODX and ZOL and found that the initial formation of mature osteoclasts was not affected, but that the bisphosphonates enhanced cell death of mature osteoclasts. In agreement with these findings, ODX and ZOL did not affect the mRNA expression of the osteoclastic genes Acp5 and Ctsk and the osteoclastogenic transcription factor Nfatc1. When bone marrow macrophages were incubated on bone slices, ODX and ZOL inhibited RANKL-stimulated bone resorption. In conclusion, ODX does not inhibit osteoclast formation but inhibits osteoclastic bone resorption by decreasing osteoclast numbers through enhanced cell death of mature osteoclasts.
39.	Hjalmarsson, Anna, 1976-, et al. (author) A matter of participation? : A critical incident study of municipal care personnel in situations involving care-dependent older persons and emergency medical services 2022 In: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis Group. - 1748-2623 .- 1748-2631. ; 17:1 Journal article (peer-reviewed)abstract PURPOSE: This study aimed at describing municipal care personnel’s experiences of and actions in situations when older persons need emergency medical services (EMS) at home. METHODS: An inductive descriptive design adhering to critical incident technique (CIT) was used. Data were collected through interviews and free text written questionnaires, analysed in accordance with CIT procedure. RESULTS: Experiences related to the main areas of Lifesaving competence and Collaborative care. Lifesaving competence involved having sufficient knowledge to guide older persons in emergencies without organizational support. The lack of care alternatives carries dependence on inter-organizational collaboration, as well as having to accept the collaborative conditions provided by the EMS. Actions meant Adjusting to situational needs and EMS authority, which involved safeguarding the person while being directed by the EMS. CONCLUSIONS: Lack of organizational support, care alternatives, and structured collaboration jeopardize care-dependent older persons’ health, and ability to influence care when emergency situations occur at home. Municipal care personnel’s actions as the older person’s representative support human agency, allowing older persons to become active participants in care despite acute suffering. This study underlines the importance of further developing welfare policies that facilitate and regulate inter-organizational responsibilities of health and social care to favour older people.
40.	Hjalmarsson, Anna, 1976-, et al. (author) Balancing power : Ambulance personnel's lived experience of older persons' participation in care in the presence of municipal care personnel 2023 In: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 37:3, s. 766-776 Journal article (peer-reviewed)abstract Background: Patient participation is considered to promote well- being and is, there-fore, central in care contexts. Care- dependent older persons living at home constitute a vulnerable population with increased ambulance care needs. Care transfers risk challenging participation in care, a challenge that can be accentuated in situations involving acute illness.Aim: To illuminate meanings of older persons' participation in ambulance care in the presence of municipal care personnel from the perspective of ambulance personnel.Method: A phenomenological hermeneutical method was used to analyse tran-scripts of narrative interviews with 11 ambulance personnel.Results: The ambulance personnel's lived experience of older persons' participa-tion includes passive and active dimensions and involves a balancing act between an exercise of power that impedes participation and equalisation of power that em-powers participation. The main theme ‘Balancing dignity in relation to manipulat-ing the body’ included the themes Providing a safe haven and Complying with bodily expressions, which means shouldering responsibility for existential well- being and being guided by reactions. The main theme ‘Balancing influence in relation to per-ceived health risks’ included the themes Agreeing on a common perspective, Directing decision- making mandate, and Sharing responsibility for well- being, which means shouldering responsibility for health focusing on risks. Influence is conditional and includes performance requirements for both the older person and municipal care personnel.Conclusion: Care- dependent older persons' participation in care from the per-spective of ambulance personnel means recognising passive and active dimensions involving human dignity, the ability to influence care, and optimising care efforts through collaboration. This study provides a deepened understanding of the balanc-ing of power involved in ambulance care determining participation, where power is equalised or exercised depending on personal engagement, health risks, and available care options. The knowledge provided holds the potential to improve am-bulance care to benefit older persons in critical life situations.
41.	Hjalmarsson, Anna, 1976- (author) Being provided with a safe haven : Care-dependent older persons' participation in prehospital emergency care 2023 Doctoral thesis (other academic/artistic)abstract Participation in care is a key concept in many welfare societies and serves to guide clinical practice and adapt care to personal preferences and needs in order to promote well-being and quality of life. Previous research has shown that practicing participation in care is complex due to the concept not being clearly defined. A significant risk is, therefore, that participation in care is practiced based on the professional caregivers' own definitions, which might be inconsistent with the cared-for persons' perceptions of what participation is.Older persons can continue to live in their own homes with the support of municipal home care services that meet everyday care needs. Care-dependent older persons are known to have increased emergency care needs, which in Sweden require inter-organizational and inter-professional collaboration involving a care transfer between welfare levels. This thesis aimed to deepen the understanding of care-dependent older persons' participation in prehospital emergency care from lifeworld and welfare perspectives. The inductive design was based on a lifeworld approach and included triangulation of the phenomenon of participation in care using descriptive, interpretative, and comparative methods.From the perspective of care-dependent older persons, participation in prehospital emergency care means a forced transfer of life responsibility to professional caregivers when being existentially unsafe and incapacitated due to acute illness. Through authorized representation, the professional caregivers act for the older person, with the power to bring about change and create opportunities for existence. Care-dependent older persons' participation in prehospital emergency care involves a deepened dependence that necessitates coexistence and being provided with a 'safe haven' through the entire emergency care chain. A 'safe haven' can be understood as an unconditional, calm, and sheltered interpersonal space for emotional rest that is provided to the older person during an existentially challenging situation. From the perspective of care-dependent older persons, the emergency care chain transcends organizational boundaries and includes mobile safety alarm services and emergency department attendance.The involved professionals must be supported in practicing participation in care based on a comprehensive understanding of the concept, and emergency care options must be aligned with the care-dependent older persons' need for coordinated and continuous care. Collaborative challenges related to unstructured collaboration and professional hierarchy need to be addressed to support well-functioning collaboration in situations involving acutely ill older persons. The involved organizations need to recognize care-dependent older persons' deepened dependence when acutely ill, as well as their extended view of the prehospital emergency care chain.
42.	Hjalmarsson, Anna, 1976-, et al. (author) Characteristic patterns of emergency ambulance assignments for older adults compared with adults requiring emergency care at home in Sweden : a total population study 2020 In: BMC Emergency Medicine. - : BioMed Central. - 1471-227X. ; 20, s. 1-12 Journal article (peer-reviewed)abstract Background: Since the vast majority of older adults in Sweden live in their private homes throughout life, the emergency medical services need to adapt accordingly. Hence, we aimed to describe characteristic patterns of dyadic staffed emergency ambulance assignments for older adults aged > 70 years compared with adults aged 18– 69 years requiring emergency care at home in Sweden.Methods: A descriptive retrospective study was performed using anonymized registry data from the emergency medical services in a region of Sweden during 2017–2018. One-sample χ2 test, one-way analysis of variance, and binary logistic regression models were used for investigating group differences. Variables for analysis were age, gender, clinical assessments, on-scene time, priority levels, result of response, and temporal patterns.Results: Of all included emergency ambulance assignments (n = 28,533), 59.9% involved older adults, of which 53.8% were women. The probability for older adults to receive the highest priority was decreased for both dispatch (p < 0.001, odds ratio [OR] 0.63, 95% confidence interval [CI] 0.59–0.66), and transport priorities (p < 0.001, OR 0.74, 95% CI 0.68–0.80). Older adults were more likely to receive dispatch priority levels 2 (p < 0.001, OR 1.48, 95% CI 1.40–1.56), and 3 (p < 0.001, OR 1.73, 95% CI 1.46–2.06). The older adults were similarly more likely to receive transport priority level 3 (p < 0.001, OR 1.40, 95% CI 1.28–1.52) compared with adults. Age had a small but additive effect in relation to on-scene time (p < 0.001, R2 = 0.01, F = 53.82). Distinguishing initial clinical assessments for older adults were circulatory, respiratory, trauma, infection, and nonspecific assessments. Emergency ambulance assignments for older adults were more frequently occurring on Mondays (p < 0.001, χ2 = 232.56), and in the 08:00– 11:59 interval (p < 0.001, χ2 = 1224.08).Conclusion: The issues of the lower priority level preponderance, and the decreased probability for receiving the highest priority warrant further attention in future research and clinical practice.
43.	Hjalmarsson, Anna, 1976-, et al. (author) Entrusting life to professionals : A phenomenological hermeneutical study of older persons' participation in prehospital emergency care involving municipal home care and ambulance services. 2023 In: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. Journal article (peer-reviewed)abstract Background: Participation in care is considered to promote safe and qualitative care. Care-dependent older persons ageing in place have increased emergency care needs, which initiate inter-organisational collaboration involving municipal home care and ambulance services. Previous research concludes that uncertainties exist regarding what participation in care means in clinical practice, which necessitates the need to illuminate the phenomenon for older persons in critical life situations.Aim: This study aimed to illuminate meanings of participation in prehospital emergency care from the perspective of care-dependent older persons experiencing acute illness at home.Design: This study has a qualitative design with a lifeworld approach.Method: A phenomenological hermeneutical method was used to analyse transcribed telephone interviews with eleven care-dependent persons aged 70–93 years.Results: Care-dependent older persons' participation in prehospital emergency care means ‘Entrusting life to professional caregivers’ when being in helpless solitude and existentially unsafe, which emphasises a deepened interpersonal dependence. Meanings of participation in care from the perspective of older persons involve Being reassured in togetherness, Being pliant in trust of emergency expertise, Being enabled through the agency of professional caregivers, and Encountering readiness in the emergency care chain.Conclusion: Care-dependent older persons' participation in prehospital emergency care is existential and involves interpersonal dependence. Togetherness brings reassurance, safety and opportunity for emotional rest while accessing the professional caregivers' power, competence and abilities which provide opportunities for existence and movement towards well-being and continued living.Implications for practice: Prehospital emergency care from the perspective of care-dependent older persons transcends organisational boundaries and includes the municipal mobile safety alarm service. The involved municipal and regional organisations need to provide support by implementing lifeworld-led care models and care alternatives that enable professionals to recognise the existential dimension of participation in care.
44.	Hjalmarsson, Anna, 1976-, et al. (author) When older persons need Emergency Medical Services at home : a critical incident study on Swedish municipal care personnel 2021 Conference paper (other academic/artistic)abstract Older persons in Sweden can continue to live at home, assisted by the municipal home care services. Older age raises the risk of emergency situations that require involvement of the emergency medical services (EMS). Such situations intersect two different organizations, the municipal social care services and the regional EMS. The transfer of care between the organizations might impact the older persons´ health, and quality of life or death. Research question: How do municipal care personnel describe their experiences of and actions in situations when older persons are in need of EMS? Design: The study has a qualitative inductive design. Sample: Municipal care personnel (n=19) consisting of home care personnel and security alarm responders. Data collection and analysis: Data was collected through group interviews and free text written critical incidents analyzed according to critical incident technique. Results: Experiences related to the two main areas Lifesaving competence, and Collaborative care, which encompass the four categories Emergency knowledge, Companionship in a vulnerability, Limited caring options and Conditions for EMS collaboration. Actions related to the one main area Adjusting actions to actual conditions, which encompasses the three categories Adapting care to emergency needs, Safeguarding the person, and Adapting actions to EMS leadership.
45.	Holmberg, Anna, et al. (author) General somatic health and lifestyle habits in individuals with obsessive- compulsive disorder : an international survey 2024 In: BMC Psychiatry. - 1471-244X. ; 24:1 Journal article (peer-reviewed)abstract Background: Obsessive-compulsive disorder (OCD) has been associated with a broad range of health-related issues. Unhealthy lifestyle habits such as physical inactivity, an unhealthy diet, smoking, and alcohol consumption are hypothesized to contribute to this association. However, the lifestyle habits of individuals with OCD have been scarcely investigated. In this international survey, we explored the physical health and lifestyle habits of adults with a self-reported diagnosis of OCD. Methods: An online global survey available in seven languages was disseminated through interest organizations and social media between July 2021 and March 2022. The survey included questions relating to socio-demographic variables and clinical characteristics (including OCD symptom severity – as measured with the 12-item self-report scale Obsessive-Compulsive Inventory [OCI-12] – and psychotropic medication), physical health, and lifestyle habits. Frequencies and percentages, or means and standard deviations, as appropriate, were calculated. Subgroup analyses by OCD symptom severity, gender, and age group were performed. Results: A total of 496 individuals with OCD completed the survey and were included in the analyses (mean age = 36.0 years, SD = 12.5, range 18–79; 78.8% women). Most participants were from Europe (n = 245, 49.4%) and North America (n = 187, 37.7%). OCD symptom severity scores were on the moderate range (OCI-12 mean score = 21.2, SD = 9.1). A majority (n = 354, 71.4%) reported having comorbid somatic health issues, mainly allergies, gastrointestinal conditions, and cardiometabolic conditions. Nearly half of the sample (n = 236, 47.6%) reported a body mass index ≥ 25, corresponding to at least overweight. A significant proportion of the participants reported low physical activity (n = 271, 55.0%), unhealthy dietary habits (n = 182, 36.7%), risk consumption of alcohol (n = 111, 22.3%), and non-restorative sleep (n = 268, 54.0%). Subgroup analyses showed overall similar results across groups, with some exceptions. Conclusions: In this sample, individuals with OCD self-reported a range of health-related issues and a number of unhealthy lifestyle behaviors, most prominently a lack of physical activity. Interventions aimed at modifying unhealthy lifestyles to prevent or improve health conditions beyond the psychiatric symptoms should be considered.
46.	Holmberg, Bodil, 1970-, et al. (author) Caring for older patients with reduced decision-making capacity : a deductive exploratory study of ambulance clinicians’ ethical competence 2023 In: BMC Medical Ethics. - : BioMed Central (BMC). - 1472-6939. ; 24 Journal article (peer-reviewed)abstract Background: As more people are living longer, they become frail and are affected by multi-morbidity, resulting in increased demands from the ambulance service. Being vulnerable, older patients may have reduced decision-making capacity, despite still wanting to be involved in decision-making about their care. Their needs may be complexand difficult to assess, and do not always correspond with ambulance assessment protocols. When needing an ambulance, older patients encounter ambulance clinicians who are under high workloads and primarily consider themselves as emergency medical care providers. This situates them in the struggle between differing expectations, and ethical conflicts may arise. To resolve these, providing ethical care, focussing on interpersonal relationships and using ethical competence is needed. However, it is not known whether ambulance clinicians possess the ethical competence required to provide ethical care. Thus, the aim of this study was to deductively explore their ethical competence when caring for older patients with reduced decision-making ability.Methods: A qualitative deductive and exploratory design was used to analyse dyadic interviews with ambulance clinicians. A literature review, defining ethical competence as comprising ethical sensitivity, ethical knowledge, ethical reflection, ethical decision-making, ethical action and ethical behaviour, was used as a structured categorization matrix for the analysis.Results: Ambulance clinicians possess ethical competence in terms of their ethical knowledge, highlighting the need for establishing an interpersonal relationship with the older patients. To establish this, they use ethical sensitivity to interpret the patients’ needs. Doing this, they are aware of their ethical behaviour, signifying how they must act respectfully and provide the necessary time for listening and interacting.Conclusions: Ambulance clinicians fail to see their gut feeling as a professional ethical competence, which might hinder them from reacting to unethical ways of working. Further, they lack ethical reflection regarding the benefits and disadvantages of paternalism, which reduces their ability to perform ethical decision-making. Moreover, their ethical knowledge is hampered by an ageist approach to older patients, which also has consequences for their ethical action. Finally, ambulance clinicians show deficiencies regarding their ethical reflections, as they reflect merely on their own actions, rather than on their values
47.	Holmberg, Bodil, 1970-, et al. (author) Caring for older patients with reduced decision-making capacity : A deductive study of ambulance clinicians' ethical competence 2023 In: Presented at the 4th Global Conference on Emergency Nursing & Trauma Care, Gothenburg, Sweden, November 9-11, 2023, 2023. Conference paper (peer-reviewed)
48.	Holmberg, Mats, Med.Dr. 1976-, et al. (author) Det prehospitala patientmötet från ett vårdvetenskapligt perspektiv 2022. - 3 In: Prehospital akutsjukvård. - Stockholm : Liber. - 9789147142071 ; , s. 44-53 Book chapter (other academic/artistic)
49.	Holmberg Olausson, Karl O., et al. (author) Drivers Underlying Metastasis and Relapse in Medulloblastoma and Targeting Strategies 2024 In: Cancers. - : MDPI. - 2072-6694. ; 16:9 Research review (peer-reviewed)abstract Simple Summary In this review, we summarize reported molecular mechanisms underlying tumor progression and relapse of medulloblastoma, one of the most frequent malignant pediatric brain tumor entities. Medulloblastoma relapses are difficult to treat, and patients have, overall, a poor prognosis. Apart from describing the biology promoting brain tumor spread, the review will also highlight important preclinical models used to study leptomeningeal disease and recurrence. Finally, we identified clinical trials for medulloblastoma relapse and will discuss novel attempts to target therapy-escaping cancer cells responsible for recurrence.Abstract Medulloblastomas comprise a molecularly diverse set of malignant pediatric brain tumors in which patients are stratified according to different prognostic risk groups that span from very good to very poor. Metastasis at diagnosis is most often a marker of poor prognosis and the relapse incidence is higher in these children. Medulloblastoma relapse is almost always fatal and recurring cells have, apart from resistance to standard of care, acquired genetic and epigenetic changes that correlate with an increased dormancy state, cell state reprogramming and immune escape. Here, we review means to carefully study metastasis and relapse in preclinical models, in light of recently described molecular subgroups. We will exemplify how therapy resistance develops at the cellular level, in a specific niche or from therapy-induced secondary mutations. We further describe underlying molecular mechanisms on how tumors acquire the ability to promote leptomeningeal dissemination and discuss how they can establish therapy-resistant cell clones. Finally, we describe some of the ongoing clinical trials of high-risk medulloblastoma and suggest or discuss more individualized treatments that could be of benefit to specific subgroups.
50.	Holmberg, Per-Erik, et al. (author) Kombinerad mobilitet uppskalning i Sverige (KOMPIS) : Projektrapport 2021 Reports (other academic/artistic)abstract Kombinerad mobilitet, Mobilitet som tjänst, Mobility as a Service (MaaS), integrerade mobilitetstjänster. Företeelsen har många namn, och många forskare, entreprenörer, innovatörer och konsulter som ägnat mycket tid åt den utifrån olika perspektiv. En del hävdar att det finns fler som studerar kombinerad mobilitet än faktiska användare. Det är dock en av de frågor vi inte adresserat i KOMPIS – alltså hur många som studerar kombinerad mobilitet. Flera av oss som varit delaktiga i projektet KOMPIS, allt från forskare, finansiärer och entreprenörer – har varit med på denna resa sedan långt före begreppet MaaS stadfästes i Finland . I Sverige startade den resan egentligen med ett förstudieprojekt 2011 som finansierades av Västra Götalandsregionen och leddes av Hans Arby och Olle Boethius - Den flexible trafikanten. En idé om en affärsmodell där det skulle gå att erbjuda mobilitet i delar, fast i ett paket; att det kanske skulle kunna finnas en tredje part vars affärsidé var att kombinera alla dessa delar till något bättre, och mer anpassat till resenärers verkliga behov.I förstudien deltog förutom forskare och entreprenörer även kollektivtrafiken, hyrbils- och bilpoolsföretagen taxi och många fler. Slutsatsen var ganska enhällig: “Ja det skulle nog behövas en sådan konsoliderande tjänst, men det är inte vi som ska ta den rollen”.Under förstudieprojektet till GoSmart som drevs av Lindholmen Science Park fick jag möjlighet att tillsammans med MariAnne Karlsson på Chalmers att utarbeta ett förslag till hur man faktiskt tillsammans med Hans och Olle skulle kunna pröva idén som de hade mejslat fram i förstudien. Det ledde till, påstår vi, det först riktiga försöket i världen att bygga och testa en KM-tjänst. Jo, jag vet – många kommer vända sig mot det påståendet och visa att det visst testats kombinerade mobilitetstjänster innan – men ingen hade på riktigt prövat affärsmodellen för kombinerad mobilitet före GoSmart – men det är mindre viktigt. Projektet, som måste sägas var lyckat, visade ändå att denna typ av tjänst var uppskattad av de som testade – och förmodligen behövde en sådan tjänst. Men hur många är de egentligen? Hur stor är potentialen?Samtidigt, i en annan ände av innovationssystemet, hade Viktoriainstitutet (numera en del av RISE) tillsammans med Samtrafiken och Chalmers precis genomfört innovationstävlingen Travelhack inom projektet Innovation för Hållbart Vardagsresande. Förutom tanken att få hela kollektivtrafiken att öppna upp sin data också erbjuda den på något man kallade Trafiklab, till tredjepartsutvecklare. En del i denna plan var också att stimulera tredjepartsutveckling med innovationstävlingar baserat på kollektivtrafikdata – Travelhack. En av pristagarna hade tagit fram en app där man kunde söka efter och beställa biljetter för olika kollektivtrafikaktörer i en och samma app. De hade under prisutdelningskvällen en lång diskussion, som jag fick lyssna på, med Samtrafikens VD och en av SL’s representanter, om varför man inte kunde få tillgång till kollektivtrafikens biljetter som API – detta var 2013.Västtrafik, som var en av parterna i GOSMART började i detta projekt sin resa kring kombinerad mobilitet; att utforska behovet och på vilket sätt de bör och kan engagera sig. Denna resa är väl beskriven i flera forskningsartiklar av KOMPIS egen bibliotekarie, Göran Smith, vilka tillsammans illustrerar hur komplicerad frågan faktiskt är .2015, på ITS World Congress i Bordeaux fullkomligt exploderade begreppet Mobility as a Service. Vi som arbetat med forskningsfrågan, och knappt hade hunnit sätta ett namn på det, blev tagna på sängen. Från att behöva lägga mycket tid på att beskriva fenomenet, roller och hitta intressenter, var kombinerad mobilitet plötsligt på allas läppar – mycket beroende på att Finland under sin ordförandeperiod valde att lyfta fram kombinerad mobilitet som en av landets stora, framtida exporttjänster. Finlands jättemonter i Bordeaux var målad med just den affärsmodell som föreslagits av Hans och Olle i förstudien 2011. ERTICO bildade MaaS Alliance och fordonsindustrin började på allvar prata om mobilitetstjänster som något även de skulle erbjuda i framtiden.Finlands roll i att lyfta fram kombinerad mobilitet skall inte underskattas. Sverige och Finland hade samarbetat kring frågan under flera år. När drivkraften för oss i Sverige var ett hållbart transportsystem, så var det i vårt grannland i öster snarare en vision av att hitta ett nytt NOKIA och ett nytt GSM som var drivkraften. Målsättning med företag, export och arbetstillfällen var tydligare där än i Sverige och förmodligen ett av skälen till att Finland, ända upp på ministernivå, drev frågan så hårt.Vi i Sverige fick också en insikt i hur Finland hade nått så långt på så kort tid. ITS Finland samlade tidigt intressenter från näringsliv och offentlig sektor i en informell sammanslutning av aktörer som ’ville kombinerad mobilitet’. Deras så kallade ’MaaS-öl’ på en särskild restaurang i Helsingfors har beskrivits för mig av många som en av de viktigare anledningarna till att kombinerad mobilitet tog fart i Finland. En möjlighet att träffas över organisationsgränser och skapa nya idéer under otvungna förhållanden. En idé som vi tog med oss in i KOMPIS och blev grunden till Kompis MeetUps.Flertalet förstudier, konsultrapporter och konferenser senare – 2016, tog regeringens samverkansgrupp för Nästa Generations Resor och Transporter, på initiativ av Ulrika Bokeberg på Västra Götalandsregionen, beslut om att en färdplan för kombinerad mobilitet skulle tas fram för Sverige. Uppdraget gick till Drive Sweden och Anna Pernestål. Anna samlade en kärngrupp med representanter från Kungliga tekniska högskolan, KTH (Anna Kramers), Västra Götalandsregionen (Göran Smith), Samtrafiken (Adam Laurell) och RISE (som jag fick äran att representera) vilken utvecklade och förankrade den första versionen av Färdplanen för Kombinerad mobilitet i Sverige. 2017 fick vi av samma grupp en förfrågan att starta ett samverkansprojekt för att stötta realiserandet av färdplanen. Ett uppdrag som jag, tillsammans med Anna och på senare tid, Steven Sarasini, med stor respekt och entusiasm tog på oss att leda. Detta projekt blev Kombinerad Mobilitet - imPlementering I Sverige (KOMPIS).

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