Background: This study investigates how Faroese deep-sea fishers’ exposure to work-related stressors affects their sleep, sleepiness, and levels of fatigue. Being constantly exposed to the unpredictable and harsh North Atlantic Ocean, having long work hours and split sleep for up to 40 days consecutively, they will arguably suffer from fatigue.

Materials and methods: One hundred and fifty seven fishers participated in this study, and data was gathered throughout 202 days at sea. Subjective data was collected at the start and end of trips via questionnaires, sleep and sleepiness diaries and supplemented by objective sleep data through actigraphs. Ship movements were logged with a gyroscope connected to a laptop. A noise metre measured each work station and resting area, and noise exposure profiles were calculated based on each participant’s activity and location. Linear mixed-effect models investigated the effects of work exposure variables on sleep efficiency, and cumulative link mixed models measured effects on the Karolinska Sleepiness Scale and physical fatigue scale.

Results: Time of day followed by ship movement were the exposure variables with the highest impact on the outcome variables of sleep efficiency, sleepiness and physical fatigue. The number of days at sea revealed correlations to outcome variables either by itself or interacting with the sleep periods per day. Crew size, shift system or noise did not impact outcome variables when in the model with other variables. Larger catches improved sleep efficiency but did not affect sleepiness and physical fatigue ratings.

Conclusions: The findings indicate a chronically fatigued fisher population, and recommends urgent attention being paid to improving the structure of vessels and installing stabilators for greater stability at sea; work schedules being evaluated for protection of health; and work environments being designed that fulfill human physiological requirements in order to ensure the wellbeing and safety of those at sea.

Aims: Employee-based flexible working hours are increasing, particularly among knowledge workers. Research indicates that women and men use work–time control (WTC; control over time off and daily hours) differently: while men work longer paid hours, women use WTC to counteract work–life interference. In a knowledge-worker sample, we examined associations between WTC and overtime, work–life interference and exhaustion and tested whether gender moderates the mediating role of overtime. Methods: The sample contained 2248 Swedish knowledge workers. Employing hierarchical regression modelling, we examined effects of control over time off/daily hours on subsequent overtime hours, work–life interference and exhaustion in general and in gender-stratified samples. Using conditional process analysis, we tested moderated mediation models. Results: Control over time off was related to less work–life interference (β_men= −0.117; 95% confidence interval (CI): −0.237 to 0.003; β_women= −0.253; 95% CI: −0.386 to −0.120) and lower exhaustion (β_men= −0.199; 95% CI: −0.347 to −0.051; β_women= −0.271; 95% CI: −0.443 to −0.100). For control over daily hours, estimates were close to zero. While men worked more overtime (42 min/week), we could not confirm gender moderating the indirect effect of control over time off/daily hours on work–life interference/exhaustion via overtime. Independent of gender, effects of control over time off on work–life interference were partly explained by working fewer overtime hours. Conclusions: Control over time off was related to lower exhaustion and better work–life balance (in particular for women). We found no evidence for men’s work–life interference increasing with higher WTC owing to working more overtime. Knowledge workers’ control over time off may help prevent work–life interference and burnout.

Background and Aims

Inflammatory bowel disease may cause long-standing inflammation and fibrosis and may increase the risk of adverse events in colonoscopy. We evaluated whether inflammatory bowel disease and other potential risk factors are associated with bleeding or perforation in a nationwide, population-based, Swedish study.

Methods

Data from 969 532 colonoscopies, including 164 012 [17%] on inflammatory bowel disease patients, between 2003 and 2019, were retrieved from the National Patient Registers. ICD-10 codes for bleeding [T810] and perforation [T812] within 30 days of the colonoscopy were recorded. Multivariable logistic regression was used to test if inflammatory bowel disease status, inpatient setting, time period, general anaesthesia, age, sex, endoscopic procedures, and antithrombotic treatment were associated with higher odds for bleeding and perforation.

Results

Bleeding and perforation were reported in 0.19% and 0.11% of all colonoscopies, respectively. Bleeding [odds ratio 0.66, p <0.001] and perforation [odds ratio 0.79, p <0.033] were less likely in colonoscopies in individuals with inflammatory bowel disease status. Bleeding and perforation were more common in inpatient than in outpatient inflammatory bowel disease colonoscopies. The odds for bleeding but not perforation increased between 2003 to 2019. General anaesthesia was associated with double the odds for perforation.

Conclusions

Individuals with inflammatory bowel disease did not have more adverse events compared with individuals without inflammatory bowel disease status. However, the inpatient setting was associated with more adverse events, particularly in inflammatory bowel disease status. General anaesthesia was associated with a greater risk of perforation.

Background: The etiopathogenesis of diverticular disease is unknown.

Objective: To compare the fecal and mucosa-associated microbiota between participants with and without diverticulosis and participants who later developed diverticulitis versus those that did not from a population-based study.

Methods: The PopCol study, conducted in Stockholm, Sweden, invited a random sample of 3556 adults to participate, of which 745 underwent colonoscopy. Overall, 130 participants (17.5%) had diverticulosis. 16S rRNA gene sequencing was conducted on available sigmoid biopsy samples from 529 and fecal samples from 251 individuals. We identified individuals who subsequently developed acute diverticulitis up to 13 years after sample collection. In a case-control design matching for gender, age (+/−5 years), smoking and antibiotic exposure, we compared taxonomic composition, richness and diversity of the microbiota between participants with or without diverticulosis, and between participants who later developed acute diverticulitis versus those who did not.

Results: No differences in microbiota richness or diversity were observed between participants with or without diverticulosis, nor for those who developed diverticulitis compared with those who did not. No bacterial taxa were significantly different between participants with diverticulosis compared with those without diverticulosis. Individuals who later developed acute diverticulitis (2.8%) had a higher abundance of genus Comamonas than those who did not (p = .027).

Conclusions: In a population-based cohort study the only significant difference was that those who later develop diverticulitis had more abundance of genus Comamonas. The significance of Comamonas is unclear, suggesting a limited role for the gut microbiota in the etiopathogenesis of diverticular disease.

BackgroundIt is possible to calculate the number of years to the expected clinical onset (YECO) of autosomal-dominant Alzheimer's disease (adAD). A similar time scale is lacking for sporadic Alzheimer's disease (sAD). The purpose was to design and validate a time scale in YECO for patients with sAD in relation to CSF and PET biomarkers.MethodsPatients diagnosed with Alzheimer's disease (AD, n = 48) or mild cognitive impairment (MCI, n = 46) participated in the study. They underwent a standardized clinical examination at the Memory clinic, Karolinska University Hospital, Stockholm, Sweden, which included present and previous medical history, laboratory screening, cognitive assessment, CSF biomarkers (A beta(42), total-tau, and p-tau), and an MRI of the brain. They were also assessed with two PET tracers, C-11-Pittsburgh compound B and F-18-fluorodeoxyglucose. Assuming concordance of cognitive decline in sAD and adAD, YECO for these patients was calculated using equations for the relationship between cognitive performance, YECO, and years of education in adAD (Almkvist et al. J Int Neuropsychol Soc 23:195-203, 2017).ResultsThe mean current point of disease progression was 3.2 years after the estimated clinical onset in patients with sAD and 3.4 years prior to the estimated clinical onset in patients with MCI, as indicated by the median YECO from five cognitive tests. The associations between YECO and biomarkers were significant, while those between chronological age and biomarkers were nonsignificant. The estimated disease onset (chronological age minus YECO) followed a bimodal distribution with frequency maxima before (early-onset) and after (late-onset) 65 years of age. The early- and late-onset subgroups differed significantly in biomarkers and cognition, but after control for YECO, this difference disappeared for all except the APOE e4 gene (more frequent in early- than in late-onset).ConclusionsA novel time scale in years of disease progression based on cognition was designed and validated in patients with AD using CSF and PET biomarkers. Two early- and late-disease onset subgroups were identified differing with respect to APOE e4.

Background: Several studies and meta-analysis suggest that ICBT works for patients with mild to moderate depression/depressive symptoms. Given the quality of the data is is now possible to conduct IPMAs. Several IPMAs have been published with data from different countries. A problem with that approach is the some studies may be left out as data are not provided. The aim of this IPMA was to study the effects focusing on Swedish data only with less loss of data/studies.

Methods: We were able to include data from 16 studies with a total of 2952 participants. Missing data were imputed. The overall effect-size for nine studies compared to wait-list was d = 0.63 95 % CI [0.48, 0.78] and within-group effect-size for 15 studies d = 1.17 95 % CI [1.11, 1.22]. The results were surprisingly similar across different subgroups. Women had on average more symptoms before treatment and also reported a larger symptom decrease after treatment.

Conclusions: Results show a large effect of ICBT on depressive symptoms in a Swedish setting, including in routine care. This meta-analysis supports treatment of depressive symptoms with ICBT in Sweden.

The COVID-19 pandemic precipitated numerous changes in daily life, including the cancellation and restriction of sports globally. Because sports participation contributes positively to the development of student-athletes, restricting these activities may have led to long-term mental health changes in this population. Using a repeated cross-sectional study design, we measured rates of depression using the Patient Health Questionnaire-2 and anxiety using the Generalized Anxiety Disorder-2 scale in student-athletes attending elite sport high schools in Sweden during the second wave of the pandemic (February 2021; n = 7021) and after all restrictions were lifted (February 2022; n = 6228). Depression among student-athletes decreased from 19.8% in 2021 to 17.8% in 2022 (p = .008, V = .026), while anxiety screening did not change significantly (17.4% to 18.4%, p > .05). Comparisons between classes across years revealed older students exhibited decreases in depressive symptoms, while younger cohorts experienced increases in symptoms of anxiety from 2021 to 2022. Logistic regressions revealed that being female, reporting poorer mental health due to COVID-19, and excessive worry over one’s career in sports were significant predictors of both depression and anxiety screenings in 2022. Compared to times when sports participation was limited, the lifting of restrictions was associated with overall reduced levels of depression, but not anxiety. 

Deliberate fire-setting, such as the crime of arson, can have devastating, even lethal, consequences. This study compared factors at the time of arson by female and male offenders in Sweden between 2000–2010. The women (n = 100), and men (n = 100) included in this study were randomly chosen from among all individuals who had been convicted for arson during this period and who underwent forensic psychiatric investigations. Information regarding psychiatric and somatic characteristics, their psychosocial situation, and whether they were in contact with health or social services before the arsons were examined. The results showed that both women and men have complex psychiatric and somatic characteristics, as well as psychosocial situations. Women showed more self-destructive behaviour, lower Global Assessment of Functioning scores, and had been in contact with psychiatric health services to a greater extent than men. More women than men had children. These findings suggest that specific actions may be needed for preventing and treating women compared with men at risk for committing arson.

Interest is surging around the ”next-word-predictability” task that allowed large language models to reach their current capacity. It is sometimes claimed that prediction is enough to model language production. We set out to study predictability in an interactive setting. The current fMRI study used the information-theoretic measure of surprisal – the negative log-probability of a word occurring given the preceding linguistic context, estimated by a pre-trained language model (GPT-2). Surprisal has been shown to correlate with bottom-up processing located in the bilateral middle and superior temporal gyri (MTG/STG) during narrative comprehension (Willems et al., 2016). Still, surprisal has never been used to investigate conversational comprehension or any kind of language production. We hypothesized that previous results on surprisal in narrative comprehension would be replicated with conversational comprehension and that next-word- predictability would not encompass language production processes. We utilized a publicly available fMRI dataset in which participants (N=24) engaged in unscripted conversations (12 min/participant) via an audio- video link with a confederate outside the scanner. The conversational events Production, Comprehension, and Silence were modeled in a whole-brain analysis. Two parametric modulations of production and comprehension were added: (1) log-transformed context-independent word frequency (control regressor) and (2) surprisal. Production-surprisal and Comprehension-surprisal were respectively contrasted against the implicit baseline. These contrasts were compared with the contrasts Production and Comprehension vs implicit baseline. If surprisal merely indexed part of the activity in the latter, broader contrasts, this provides a handle on production and comprehension processes beyond next-word-predictability. For surprisal in conversational production, we observed statistically signi�cant clusters in the left inferior frontal gyrus (LIFG), the medial frontal gyrus, and the motor cortex. Importantly, Production vs implicit baseline showed bilateral STG activation while STG was not parametrically modulated by surprisal. Moreover, the bilateral MTG/STG were the only clusters active for Comprehension vs implicit baseline and they were also modulated by surprisal. For comprehension, we thus replicated the previous narrative comprehension study (Willems et al.,2016), showing that unpredictable words activate the bilateral MTG/STG also in conversational settings. Next- word-predictability is thus so far a good model for conversational comprehension. For production, however, the next-word-predictability task helped to hone in on what is sometimes considered core production machinery in LIFG. Several functional interpretations of the STG recruitment during production are possible (such as monitoring for speech errors), but the current results point in the direction of two important conclusions: (1) a functional division of the frontal and temporal cortices during production, where the frontal component is prediction-related, and (2) that language processing during production is more than prediction, at least at the word-level. We provide a functional handle on such extra-predictive processes.

Introduction: This randomized, controlled pilot trial evaluated the efficacy of a brief internet-based recovery training intervention targeting a clinical sample of distressed employees.

Method: A sample of 69 employees with elevated symptoms of stress were assigned randomly to a five-week guided recovery training intervention (iRTP, n = 35) or a wait-list control (WLC, n = 34). The study was conducted in Sweden and participants enrolled via an open recruitment strategy. Self-report data were collected pre- and post-intervention, then six and 12 months after the intervention. The primary outcome measure was the Recovery Experience Questionnaire (REQ. The secondary outcome measures gauged other relevant mental and work-related health outcomes. Participants in the wait-list control group received access to iRTP after the six-month follow-up.

Results: Compared with the controls, participants in the intervention group showed a significant and large overall improvement on the primary outcome REQ (d = 0.93), and small to moderate effects on the secondary outcomes including, perceived stress (d = 0.48), anxiety (d = 0.49), quality of life (d = 0.47), and work ability (d = 0.47) during post-assessment. No significant differences were found at any time point regarding burnout, exhaustion, depression, physical exercise, work experience, or sickness absences.

Conclusion: This pilot trial is one of the first to examine a brief recovery training program's efficacy, suggesting that employees across a wide range of professions could learn how to recover from elevated stress symptoms. This type of accessible and brief recovery intervention could potentially prevent and reduce the negative effects of stress, as well as improve recovery and quality of life. However, more research is needed with larger samples before further conclusions can be drawn.

Trial Registration: The study was registered at Clinical Trials (clinicaltrials.gov) number NCT05220592.

Turner syndrome is a genetic condition caused by a complete or partial loss of one of the X chromosomes. Previous studies indicate that Turner syndrome is associated with challenges in social skills, but the underlying mechanisms remain largely unexplored. A possible mechanism is a reduced social influence on learning. The current study examined the impact of social and non-social feedback on learning in women with Turner syndrome (n=35) and a sex- and age-matched control group (n=37). Participants were instructed to earn points by repeatedly choosing between two stimuli with unequal probabilities of resulting in a reward. Mastering the task therefore required participants to learn through feedback which of the two stimuli was more likely to be rewarded. Data were analyzed using computational modeling and analyses of choice behavior. Social feedback led to a more explorative choice behavior in the control group, resulting in reduced learning compared to non-social feedback. No effects of social feedback on learning were found in Turner syndrome. The current study thus indicates that women with Turner syndrome may be less sensitive to social influences on reinforcement learning, than the general population.

A wide range of psychological treatments have been found to reduce the symptoms of irritable bowel syndrome (IBS) but their relative effects are unclear. In this systematic review and meta-analysis, we determined the effects of psychological treatments for IBS, including subtypes of cognitive behavior therapy, versus attention controls. We searched 11 databases (March 2022) for studies of psychological treatments for IBS, reported in journal articles, books, dissertations, and conference abstracts. The resulting database comprised 9 outcome domains from 118 studies published in 1983–2022. Using data from 62 studies and 6496 participants, we estimated the effect of treatment type on improvement in composite IBS severity using random-effects meta-regression. In comparison with the attention controls, there was a significant added effect of exposure therapy (g = 0.52, 95% CI = 0.17–0.88) and hypnotherapy (g = 0.36, 95% CI = 0.06–0.67) when controlling for the pre- to post-assessment duration. When additional potential confounders were included, exposure therapy but not hypnotherapy retained a significant added effect. Effects were also larger with a longer duration, individual treatment, questionnaire (non-diary) outcomes, and recruitment outside of routine care. Heterogeneity was substantial. Tentatively, exposure therapy appears to be a particularly promising treatment for IBS. More direct comparisons in randomized controlled trials are needed. OSF.io identifier: 5yh9a.

IntroductionAdolescent delinquency has been suggested to evolve from a normative motivation to establish independence and identity. However, few studies have examined this in detail, especially in young women. The aim was, therefore, to investigate identity formation in adolescent females with limited delinquency by focusing on identity status and identity processes in narratives about committing crimes and being convicted.MethodsInterviews with 10 females, 15-18 years old, sentenced to youth service in three Swedish cities were conducted on Zoom.ResultsThe results showed an equal distribution of all identity statuses within the group. Thematic analysis of their stories about crime and conviction showed that delinquency was described in terms of exploration and commitment, although commitment appeared more clearly. Social relations, in particular peers, played an important role in both committing as well as desisting from delinquency. In terms of narrative processes, the stories contained elements of agency, although diminishing of one's own capability and/or responsibility was common, and meaning making, mostly lesson learning, usually pertained to behaviors, interactional rules, or norms.ConclusionThese findings point to the importance of viewing delinquency among young women in a social and developmental context, where delinquency may be a part of the process of identity formation. Interventions focusing on expressing needs of belonging as well as finding oneself in more adaptive ways are warranted, where supporting pro-social relations and contexts is a suggested focus.

Rehabiliteringskoordinatorer är en ny yrkesroll inom hälso – och sjukvården som stödjer sjukskrivna patienter i rehabiliteringsprocessen. Koordinatorerna saknar dock en tydlig roll – och kompetensbeskrivning, och det faktum att yrkesrollen saknar en gemensam yrkesutbildning och innehas och utvecklas av olika professioner gör den unik. Syftet med studien var att undersöka skillnader i kompetens baserat på rehabiliteringskoordinatorers olika grundprofessioner, samt vilka professioner de menade hade bäst kompetens för att arbeta som rehabiliteringskoordinator. Alla rehabiliteringskoordinatorer i en region bjöds in att svara på en enkät (89% svarsfrekvens). Både kvantitativa och kvalitativa analysmetoder användes. Resultaten visade att kuratorer hade mer vidareutbildning än övriga professioner, särskilt inom samtalsmetoder, och kuratorerna uppgav mindre behov av ytterligare kompetens inom områdena jämställdhet, sociala problem, försäkringar/bidrag och samtalsmetoder. Analysen av fritextsvaren visade att holistisk syn, personlighet framför profession samt rådgivning och vägledning ansågs vara tre viktiga kompetensområden för rehabiliteringskoordinatorer. Arbetsterapeuter och socionomer ansågs ha mest passande kompetens för att arbeta som rehabiliteringskoordinator. Resultaten adresserar några gemensamma grundvärden, normer och viktiga kompetensområden för rehabiliteringskoordinatorer som kan bidra i utvecklingen av utbildning för rehabiliteringskoordinatorer och bana väg för deras professionaliseringsprocess.

Objectives: Compare mental health, stress, and well-being in the Swedish population as measured before and during the COVID-19 pandemic. Methods: Repeated cross-sectional design using data measured before (Jan-2019; n = 2791) and during (Oct/Nov-2020; n = 2926) COVID-19 pandemic in Swedish population-representative cohorts. Following constructs were measured: anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory-II), stress (Perceived Stress Scale-10 items), health-related quality of life (HRQOL[Functional Assessment of Cancer Therapy-General Population]) and self-rated health (SRH) was assessed with a single-item question. Results: When adjusting for age, sex, education, and income there were significantly higher levels of anxiety (M = 9.15 vs. 8.48, p < 0.01) and depression (M = 3.64 vs. 3.30, p = 0.03), lower levels of stress (M = 14.06 vs. 14.91, p < 0.001), but worsened HRQOL (M = 76.40 vs. 77.92, p < 0.01) and SRH (M = 6.91 vs. 7.20, p < 0.001), observed in 2020 compared to 2019. For the negative effects seen in anxiety, depression, HRQOL, and SRH, higher income and education had a protective effect. The decrease in stress was also correlated with higher income. Conclusions: The COVID-19 pandemic led to a small but significant worsening in mental health and well-being in the general Swedish population, where higher socioeconomic status seemed to have a protective effect.

Metabolites of the kynurenine pathway are hypothesized to be implicated in inflammation-associated depression, but there is a lack of experimental studies in humans assessing the kinetics of kynurenine metabolites in relation to experimentally-induced sickness. The aim of the present study was to assess changes in the kynurenine pathway and to explore its relation to symptoms of sickness behavior during an acute experimental immune challenge.

This double-blind placebo-controlled randomized cross-over study included 22 healthy human participants (n = 21 both sessions, M_age = 23.4, SD = 3.6, nine women) who received an intravenous injection of 2.0 ng/kg lipopolysaccharide (LPS) and saline (placebo) on two different occasions in a randomized order. Blood samples (0 h, 1 h, 1.5 h, 2 h, 3 h, 4 h, 5 h, 7 h post-injection) were analyzed for kynurenine metabolites and inflammatory cytokines. The intensity of symptoms of sickness behavior was assessed using the 10-item Sickness Questionnaire at 0 h, 1.5 h, 3 h, 5 h, and 7 h post-injection.

LPS induced significantly lower concentrations of plasma tryptophan (at 2 h, 4 h, 5 h, and 7 h post-injection), kynurenine (at 2 h, 3 h, 4 h, and 5 h post-injection), nicotinamide (at 4 h, 5 h, and 7 h post-injection), and higher levels for quinolinic acid at 5 h post-injection as compared to placebo. LPS did not affect kynurenic acid, 3-hydroxykynurenine, and picolinic acid. The development of the sickness symptoms was largely similar across items, with the highest levels around 1.5–3 h post-injection. Changes in plasma levels of kynurenine metabolites seem to coincide rather than precede or follow changes in subjective sickness. Exploratory analyses indicate that higher Sickness Questionnaire total scores at 1.5–5 h post-injection were correlated with lower kynurenic acid and nicotinamide levels.

These results lend further support for LPS-induced changes in the kynurenine pathway, but may not, as interpreted from blood levels, causally link to LPS-induced acute symptoms of sickness behavior. Future research may consider a larger sample to further scrutinize the role of the kynurenine pathway in the sickness response.

Transfer of learning refers to successful application of previously acquired knowledge or skills to novel settings. Although working memory (WM) is thought to play a role in transfer learning, direct evidence of the effect of limitations in WM on transfer learning is lacking. To investigate, we used an acquired equivalence paradigm that included tests of association and transfer learning. The effects of imposing an acute WM limitation on young adults was tested (within-subjects design: N = 27 adults; M_age = 24 years) by conducting learning transfer tests concurrent with a secondary task that required carrying a spatial WM load when performing the learned/transfer trial (Load condition) to acutely limit WM resources or no WM load (No-Load condition; WM was unloaded prior to performing the learned/transfer trial). Analyses showed that although success on the transfer trials was high in the No-Load condition, performance dropped to chance in the Load condition. Performance on tests of learned associations remained high in both conditions. These results indicate that transfer of learning depends on access to WM resources and suggest that even healthy young individuals may be affected in their ability to cross-utilize knowledge when cognitive resources become scarce, such as when engaging in two tasks simultaneously (e.g., using satellite navigation while driving).