The Neolithic Pitted Ware culture foragers were culturally but not genetically influenced by the Battle Axe culture herders.

OBJECTIVES: In order to understand contacts between cultural spheres in the third millennium BC, we investigated the impact of a new herder culture, the Battle Axe culture, arriving to Scandinavia on the people of the sub-Neolithic hunter-gatherer Pitted Ware culture. By investigating the genetic make-up of Pitted Ware culture people from two types of burials (typical Pitted Ware culture burials and Battle Axe culture-influenced burials), we could determine the impact of migration and the impact of cultural influences. METHODS: We sequenced and analyzed the genomes of 25 individuals from typical Pitted Ware culture burials and from Pitted Ware culture burials with Battle Axe culture influences in order to determine if the different burial types were associated with different gene-pools. RESULTS: The genomic data show that all individuals belonged to one genetic population-a population associated with the Pitted Ware culture-irrespective of the burial style. CONCLUSION: We conclude that the Pitted Ware culture communities were not impacted by gene-flow, that is, via migration or exchange of mates. These different cultural expressions in the Pitted Ware culture burials are instead a consequence of cultural exchange.

The impact of increased immigration to Sweden on the incidence and treatment of patients with HCC and underlying liver disease.

Background: Sweden has traditionally been considered a country with a low incidence of hepatocellular carcinoma (HCC). However, the increasing number of immigrants from areas with a high incidence of HCC might affect the number of HCC patients in Sweden. Aim: To examine trends in the incidence, treatment and overall survival of patients with HCC and an underlying liver disease (ULD) from a restricted, well-defined region of Sweden, between 2000 and 2014. Patients and methods: Nine hundred and eight patients with HCC were identified. Subjects were grouped into 5-year periods, and analysed for HCC diagnosis, ULD, staging and treatment selection in populations born outside Sweden versus non-immigrants and patient survival. The regions were Africa, Asia, EU-28 together with America and the Nordic countries, eastern Europe and Sweden. Results: Over the time periods, the patients with HCC and ULD increased. More patients from Africa had HCC and ULD than what would have been expected based on the number of immigrants from this region and they were also significantly younger than Sweden-born patients. For patients from Africa, Asia and eastern Europe; viral hepatitis was dominating ULDs. Patients from Africa, Asia and eastern Europe were subjected to liver transplantation (LT) in higher proportions than patients from Sweden. The survival rate for patients from eastern Europe was significantly better. Conclusions: Immigration increased the incidence of HCC and the need for active treatment such as LT. This fact raises the question of whether immigrants from regions with a high incidence of HCC ought to be subjected to mandatory hepatitis B and C virus (HBV and HCV) diagnosis and consequent liver ultrasounds for diagnosis of occult HCC. With such strategies, the morbidity and mortality of HCC could be reduced.

Nordic homecare nursing from the perspective of homecare nurses-a meta-ethnography.

The pressure on homecare nursing in the Nordic countries has increased in recent years because of a reorganisation of healthcare systems that has put a focus on very early discharge from hospital as well as demographic changes. This article details an analysis of the findings of 13 published qualitative research reports about Nordic homecare nurses' experiences of their work. Using a process of meta-ethnography, the authors identify five themes within the primary research: home care as a professional practice on foreign ground; home care as a massive time constraint; home care as fair rationing; home care as relationships with relatives as fellow players or opponents; and home care as latent paternalism. These have two main implications for practice: homecare nurses should continuously be taught how to cooperate with partners who are emotionally involved; and also homecare nurses may benefit from training that focuses on the challenges of carrying out professional work in private settings.

Do Sociocultural Factors Influence Periviability Counseling and Treatment More Than Science? Lessons From Scandinavia.

All of us (doctors, parents, bioethicists, and health policy makers) think differently about premature infants who require neonatal intensive care than we do about other patients who are critically ill. In most other clinical circumstances, those that involve patients other than premature infants, our first impulse when confronted with a patient in an emergency is to do whatever we can to rescue the patient. We offer life-sustaining treatments first and ask questions later. With extremely premature infants, by contrast, we first ask questions, ponder our options, and try to develop policies about whether it is appropriate to try to save these infants. We wonder aloud whether these tiny patients are even worth saving. In most countries that have NICUs, and in many hospitals, doctors and policy makers have explicitly specified which infants ought to be offered life-sustaining treatment and which should be allowed to die. Regarding the treatment of infants who are born at the borderline of viability, there are markedly distinct approaches in Sweden, Norway, and Denmark. In each country, the prevailing approaches were developed after careful consideration of many factors, including public sentiment, professional preferences, reported outcomes, philosophical factors, and considerations of cost and cost-effectiveness. In this article, we comment on some of these considerations and the soundness of the resulting practice variations.

Population genomics of Mesolithic Scandinavia: Investigating early postglacial migration routes and high-latitude adaptation.

Scandinavia was one of the last geographic areas in Europe to become habitable for humans after the Last Glacial Maximum (LGM). However, the routes and genetic composition of these postglacial migrants remain unclear. We sequenced the genomes, up to 57× coverage, of seven hunter-gatherers excavated across Scandinavia and dated from 9,500-6,000 years before present (BP). Surprisingly, among the Scandinavian Mesolithic individuals, the genetic data display an east-west genetic gradient that opposes the pattern seen in other parts of Mesolithic Europe. Our results suggest two different early postglacial migrations into Scandinavia: initially from the south, and later, from the northeast. The latter followed the ice-free Norwegian north Atlantic coast, along which novel and advanced pressure-blade stone-tool techniques may have spread. These two groups met and mixed in Scandinavia, creating a genetically diverse population, which shows patterns of genetic adaptation to high latitude environments. These potential adaptations include high frequencies of low pigmentation variants and a gene region associated with physical performance, which shows strong continuity into modern-day northern Europeans.

Mortality and causes of death among the migrant population of Finland in 2011-13.

Background: Lower mortality among migrants than in the general population has been found in many, but not in all, previous studies. The mortality of migrants has not been studied in Finland, which has a relatively small and recent migrant population. Methods: People who were born abroad and whose mother tongue is not Finnish were identified from the Finnish Central Population Register (n = 185 605). A Finnish-born control matched by age, sex and place of residence was identified for each case (n = 185 605). Information about deaths was collected from the Finnish Causes of Death Register. Cox proportional hazards model was used for assessing the association between migrant status and death in 2011­13. Results: The mortality risk was found to be significantly lower for migrants than for Finnish controls (adjusted hazard ratio 0.77, 95% CI 0.72­0.84), both for migrant men (aHR 0.80, 95% CI 0.73­0.89) and women (aHR 0.78, 95% CI 0.70­0.88). The difference was statistically significant only among people who were not married and among people who were not in employment. There was variation by country of birth, but no migrant group had higher mortality than Finnish controls. No differences in mortality were found by duration of residence in Finland. The higher mortality of Finnish controls was largely explained by alcohol-related conditions and external causes of death. Conclusions: The mortality risk of migrants is lower than of people who were born in Finland. Possible explanations include selection and differences in substance use and other health behaviour.

Self-reported Oral Health Behaviour among Scandinavian and Polish Medical Students Studying in Poland.

AIM: The aim of the study was to assess the self-reported oral health behaviour of Scandinavian and Polish medical students studying in Poland. METHODS: Three hundred and fifty subjects took part in the questionnaire survey. They were the 4th to 6th year Scandinavian and Polish medical students attending the same medical school. Test-retest reliability demonstrated an accepted level of kappa > 0.50. The questionnaire comprised issues dealing with demographics, dental health behaviour, fluoride tablet recommendation, self-rated oral health, and smoking habit. Statistical analyses were performed using the Fisher-Freeman-Halton test, Fisher's exact test and the multiple logistic regression. A p value<0.05 was considered significant. RESULTS: Gender and nationality statistical differences were observed regarding the frequency of visiting a dentist: more Polish females visited a dentist less than a year ago (p=0.011), the reasons for visiting a dentist - check up, filling (p=0.002; p=0.040); the frequency of tooth brushing was higher among Polish females compared to Polish males and Scandinavian females (p<0.001; p<0.001). Polish males ate sweet snacks significantly more often than Polish females and Scandinavian males (p=0.018; p=0.004). In the logistic regression analysis factors were independently associated with visiting a dentist at least once a year: female gender (OR=2.310; 95% CI 1.381-3.865), Polish nationality (OR=3.833; 95% CI 2.293-6.408). Associations with the female gender were significant for the following dependent variables: visiting a dentist more than a year ago (OR=1.913; 95% CI 1.192-3.070), brushing teeth at least once a day (OR=3.759; 95% CI 1.567-9.017), and use of dental floss (OR=2.249; 95% CI 1.445-3.503). Polish nationality was associated with an increasing rate of brushing teeth for at least 3 minutes (OR=2.435; 95% CI 1.526-3.885), and smoking cigarettes (OR=2.340; 95% CI 1.336-4.098). CONCLUSIONS: Better prognosis for maintaining good oral health was established in the Scandinavian group of students. Polish females took greater care of their teeth than Polish males and the majority of their Scandinavian counterparts.

Prescribed journeys through life: Cultural differences in mental time travel between Middle Easterners and Scandinavians.

Mental time travel is the ability to remember past events and imagine future events. Here, 124 Middle Easterners and 128 Scandinavians generated important past and future events. These different societies present a unique opportunity to examine effects of culture. Findings indicate stronger influence of normative schemas and greater use of mental time travel to teach, inform and direct behaviour in the Middle East compared with Scandinavia. The Middle Easterners generated more events that corresponded to their cultural life script and that contained religious words, whereas the Scandinavians reported events with a more positive mood impact. Effects of gender were mainly found in the Middle East. Main effects of time orientation largely replicated recent findings showing that simulation of future and past events are not necessarily parallel processes. In accordance with the notion that future simulations rely on schema-based construction, important future events showed a higher overlap with life script events than past events in both cultures. In general, cross-cultural discrepancies were larger in future compared with past events. Notably, the high focus in the Middle East on sharing future events to give cultural guidance is consistent with the increased adherence to normative scripts found in this culture.

Cattle Management for Dairying in Scandinavia's Earliest Neolithic.

New evidence for cattle husbandry practices during the earliest period of the southern Scandinavian Neolithic indicates multiple birth seasons and dairying from its start. Sequential sampling of tooth enamel carbonate carbon and oxygen isotope ratio analyses and strontium isotopic provenancing indicate more than one season of birth in locally reared cattle at the earliest Neolithic Funnel Beaker (EN I TRB, 3950-3500 cal. B.C.) site of Almhov in Scania, Sweden. The main purpose for which cattle are manipulated to give birth in more than one season is to prolong lactation for the production of milk and dairy-based products. As this is a difficult, intensive, and time-consuming strategy, these data demonstrate complex farming practices by early Neolithic farmers. This result offers strong support for immigration-based explanations of agricultural origins in southern Scandinavia on the grounds that such a specialised skill set cannot represent the piecemeal incorporation of agricultural techniques into an existing hunter-gatherer-fisher economy.

Cancer in immigrants as a pointer to the causes of cancer.

The early cancer studies on immigrants, which started to appear some 50 years ago, showed that the incidence in cancers changes to the level of the new host country in one or two generations. These findings were fundamental to the understanding of the environmental etiology of human cancer. Many immigrant groups originate from countries with no cancer registration, and, hence, the immigrant studies may provide estimates on the indigenous cancer rates. The Swedish Family-Cancer Database has been an important source of data for immigrant studies on various diseases. The Database covers the Swedish population of the past 100 years, and it records the country of birth for each subject. A total of 1.79 million individuals were foreign born, Finns and other Scandinavians being the largest immigrant groups. Over the course of years, some 30 publications have appeared relating to cancer in immigrants. In the present article, we will review more recent immigrant studies, mainly among Swedish immigrants, on all cancers and emphasize the differences between ethnic groups. In the second part, we discuss the problem of reliable registration of cancer and compare cancer incidence among non-European immigrants with cancer incidence in countries of origin, as these have now active cancer registries. We discuss the experiences in cancer registration in Morocco and Egypt. We show the usefulness and limitations in predicting cancer incidence in the countries of origin.

Use of hormonal contraceptives among immigrant and native women in Norway: data from the Norwegian Prescription Database.

OBJECTIVE: To examine the use of hormonal contraceptives among immigrant and native women in Norway. DESIGN: Nationwide registry-based study based on merged data from the Norwegian Prescription Database, the Norwegian Population Registry, the Regular General Practitioner Database and the Medical Birth Registry. SETTING: Norway. SAMPLE: All women born abroad to two foreign-born parents (immigrants), or born in Norway to two Norwegian-born parents (natives) aged 16-45 years, who lived in Norway in 2008. METHODS: Data on all collected supplies of hormonal contraceptives in 2008 were merged with demographic, socio-economic and immigration data, information on any delivery and women's general practitioners. MAIN OUTCOME MEASURES: User rates of hormonal contraception and predictors of contraceptive use. RESULTS: A total of 893,073 women were included, of whom 130,080 were immigrants. More native women (38%) used hormonal contraceptives compared with all immigrant groups (15-24%). The odds ratios for any use of hormonal contraceptives for immigrants compared with Norwegian-born women were; Nordic countries 0.53, South and Central America 0.53, Western countries 0.39, Asia 0.30, Eastern Europe 0.29, Africa 0.29. Work, education, long stay in Norway and young age of immigration predicted the use of hormonal contraceptives among immigrants. CONCLUSIONS: The use of hormonal contraceptives varies between natives and immigrant groups. Further work is needed to ascertain whether these differences can be explained by higher desires for fertility, preferential use of non-hormonal contraceptives or other reasons identified through qualitative research.

No consensus on gestational diabetes mellitus screening regimes in Sweden: pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study.

BACKGROUND: Although associated adverse pregnancy outcomes, no international or Swedish consensus exists that identifies a cut-off value or what screening method to use for definition of gestational diabetes mellitus. This study investigates the following: i) guidelines for screening of GDM; ii) background and risk factors for GDM and selection to OGTT; and iii) pregnancy outcomes in relation to GDM, screening regimes and levels of OGTT 2 hour glucose values. METHODS: This cross-sectional and population-based study uses data from the Swedish Maternal Health Care Register (MHCR) (2011 and 2012) combined with guidelines for GDM screening (2011-2012) from each Maternal Health Care Area (MHCA) in Sweden. The sample consisted of 184,183 women: 88,140 in 2011 and 96,043 in 2012. Chi-square and two independent samples t-tests were used. Univariate and multivariate logistic regression analyses were performed. RESULTS: Four screening regimes of oral glucose tolerance test (OGTT) (75 g of glucose) were used: A) universal screening with a 2-hour cut-off value of 10.0 mmol/L; B) selective screening with a 2-hour cut-off value of 8.9 mmol/L; C) selective screening with a 2-hour cut-off value of 10.0 mmol/L; and D) selective screening with a 2-hour cut-off value of 12.2 mmol/L. The highest prevalence of GDM (2.9%) was found with a 2-hour cut-off value of 8.9 mmol/L when selective screening was applied. Unemployment and low educational level were associated with an increased risk of GDM. The OR was 4.14 (CI 95%: 3.81-4.50) for GDM in obese women compared to women with BMI <30 kg/m2. Women with non-Nordic origin presented a more than doubled risk for GDM compared to women with Nordic origin (OR = 2.24; CI 95%: 2.06-2.43). Increasing OGTT values were associated with increasing risks of adverse pregnancy outcomes. CONCLUSIONS: There was no consensus regarding screening regimes for GDM from 2011 through 2012 when four different regimes were applied in Sweden. Increasing levels of OGTT 2-hour glucose values were strongly associated with adverse pregnancy outcomes. Based on these findings, we suggest that Sweden adopts the recent recommendations of the International Association of Diabetes and Pregnancy Study Group (IADPSG) concerning the performance of OGTT and the diagnostic criteria for GDM.

Objectively recorded physical activity in early pregnancy: a multiethnic population-based study.

This study aimed to compare objectively recorded physical activity (PA) levels and walking steps among pregnant women. Cross-sectional data from a multiethnic cohort (n = 823) of pregnant women consisting of 44% from Western countries, 24% from South Asia, 14% from Middle East, and 18% from other countries. PA and steps were recorded by the activity monitor SenseWear™ Pro3 Armband. A total of 678 women were included in the analysis. Western women walked significantly more steps and had higher moderate-to-vigorous-intensity physical activity (MVPA) levels compared with South Asian women per weekday and weekend day. Interaction terms (P = 0.008) between ethnicity (Western vs South Asian) and parity, and education, respectively, were identified: having ≥ 1 children was positively associated with steps during weekends in South Asians in contrast to Western women. Having <12 years education was associated with more MVPA time among South Asians in contrast to Western women. South Asian women are prone to low levels of PA during pregnancy and South Asian women without children and with higher education may have an elevated risk for an inactive lifestyle during pregnancy.

Variations in the length of stay of intensive care unit nonsurvivors in three Scandinavian countries.

INTRODUCTION: The length of stay (LOS) in intensive care unit (ICU) nonsurvivors is not often reported, but represents an important indicator of the use of resources. LOS in ICU nonsurvivors may also be a marker of cultural and organizational differences between units. In this study based on the national intensive care registries in Finland, Sweden, and Norway, we aimed to report intensive care mortality and to document resource use as measured by LOS in ICU nonsurvivors. METHODS: Registry data from 53,305 ICU patients in 2006 were merged into a single database. ICU nonsurvivors were analyzed with regard to LOS within subgroups by univariate and multivariate analysis (Cox proportional hazards regression). RESULTS: Vital status at ICU discharge was available for 52,255 patients. Overall ICU mortality was 9.1%. Median LOS of the nonsurvivors was 1.3 days in Finland and Sweden, and 1.9 days in Norway. The shortest LOS of the nonsurvivors was found in patients older than 80 years, emergency medical admissions, and the patients with the highest severity of illness. Multivariate analysis confirmed the longer LOS in Norway when corrected for age group, admission category, sex, and type of hospital. LOS in nonsurvivors was found to be inversely related to the severity of illness, as measured by APACHE II and SAPS II. CONCLUSIONS: Despite cultural, religious, and educational similarities, significant variations occur in the LOS of ICU nonsurvivors among Finland, Norway, and Sweden. Overall, ICU mortality is low in the Scandinavian countries.

A genome-wide association study for age-related hearing impairment in the Saami.

This study aimed at contributing to the elucidation of the genetic basis of age-related hearing impairment (ARHI), a common multifactorial disease with an important genetic contribution as demonstrated by heritability studies. We conducted a genome-wide association study (GWAS) in the Finnish Saami, a small, ancient, genetically isolated population without evidence of demographic expansion. The choice of this study population was motivated by its anticipated higher extent of LD, potentially offering a substantial power advantage for association mapping. DNA samples and audiometric measurements were collected from 352 Finnish Saami individuals, aged between 50 and 75 years. To reduce the burden of multiple testing, we applied principal component (PC) analysis to the multivariate audiometric phenotype. The first three PCs captured 80% of the variation in hearing thresholds, while maintaining biologically important audiometric features. All subjects were genotyped with the Affymetrix 100 K chip. To account for multiple levels of relatedness among subjects, as well as for population stratification, association testing was performed using a mixed model. We summarised the top-ranking association signals for the three traits under study. The top-ranked SNP, rs457717 (P-value 3.55 x 10(-7)), was associated with PC3 and was localised in an intron of the IQ motif-containing GTPase-activating-like protein (IQGAP2). Intriguingly, the SNP rs161927 (P-value 0.000149), seventh-ranked for PC1, was positioned immediately downstream from the metabotropic glutamate receptor-7 gene (GRM7). As a previous GWAS of a European and Finnish sample set already suggested a role for GRM7 in ARHI, this study provides further evidence for the involvement of this gene.

Adolescent alcohol and illicit drug use among first- and second-generation immigrants in Sweden.

AIM: This article compares adolescent alcohol and illicit drug use among first- and second-generation immigrants from Nordic, non-Nordic European and non-European countries with that of the native Swedish majority population. METHODS: Using data from a 2005 survey, multilevel logistic regression analysis was performed on a sample of 13,070 adolescents. The survey was conducted in three Swedish regions containing 24 municipalities. RESULTS: Second-generation immigrants from Nordic countries were more likely to use alcohol and to binge drink, while first generation immigrants from non-European countries were less likely to; this difference is mainly explained by the relatively low use by girls from non-European countries. All immigrant groups were more likely to use illicit drugs than were the majority population. The highest drug use was found among first-generation Nordic immigrants and non-European immigrants. Consumption patterns among second-generation immigrants were more similar to those of the Swedish majority population, implying more alcohol use and less illicit drug use. CONCLUSIONS: Preventive policy for alcohol use should target Nordic immigrants in Sweden (second generation), while preventive policy for drug use, which is a more general immigrant phenomena, should mostly target both Nordic and non-European immigrants.