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Background

The objective of this study was to explore the potential of Airspace Dimension Assessment (AiDA) to rapidly determine the type and severity of airway obstruction, detect emphysema in individuals with chronic airflow limitation (CAL), and distinguish it from non-emphysematous obstruction, asthma, and absence of respiratory disease with normal spirometry.

Methods

Among the 744 participants measured with AiDA within the Swedish CArdioPulmonary bioImage Study (SCAPIS) cohort, 40 had asthma, and 34 had a CAL (defined by a post-bronchodilator FEV₁/FVC < 0.7), whereof 12 had CT-detected emphysema. AiDA measurements were compared across these groups and to 111 healthy controls (never-smokers with normal spirometry and no history of respiratory disease).

Results

Subjects with CAL had significantly larger distal airspaces radii (median r_AiDA=298 μm) than controls (r_AiDA=278 μm, p < 0.001), but no significant difference was observed in asthmatics (r_AiDA=273 μm, p = 0.79). Subjects with CT-detected emphysema in the CAL group displayed further differentiation from the control (r_AiDA=349 μm, p < 0.001), while those without emphysema displayed no significant increase. Unlike r_AiDA, neither low attenuation volume nor 15th percentile density could clearly distinguish between obstruction and radiologist-assessed emphysema. In addition, the zero-second particle recovery (R₀), which is theorized to reflect conducting airway dysfunction, was decreased in both asthmatics (R₀ = 0.41, p = 0.011), and in the CAL group (R₀ = 0.45, p = 0.020) when compared to controls (R₀ = 0.56).

Conclusions

These findings display AiDA’s potential in identifying emphysema as well as obstructive airway disease. The absence of an increased distal airspace radius in asthmatics confirm that r_AiDA is a measure of the distal airspaces, unaffected by abnormalities in the conducting airways. However, the decreased R₀ in both asthma and CAL suggests that R₀ does reflect conducting airway abnormality.

Objective: To investigate associations between short-term fluctuations in urban background air pollution and the incidence of COVID-19 across three Swedish cities using detailed individual-level data.

Methods: A case-crossover analysis was conducted using individual-level data from a prospective cohort of adults across three Swedish cities (Stockholm, Gothenburg and Uppsala), including 3999 confirmed COVID-19 cases. Subjects were classified as cases on the date of their first positive PCR test, which occurred between 7 March 2020 and 26 January 2022. Exposure data for daily levels of PM2.5, PM10 and NO₂ were obtained from urban background monitoring stations. Lag-specific and cumulative associations were examined using distributed lag models and distributed lag non-linear models, adjusting for meteorological variables.

Results: A significant association was observed between elevated PM2.5 levels and testing positive for COVID-19 on the same day (lag 0), with an OR of 1.084 (95% CI 1.011 to 1.162) per IQR (3.3 μg/m³) increase. Similar lag 0 effects were found across the three cities. For PM10, the most consistent associations were observed at lag 3. For NO₂, significant effects at lag 0 emerged only after excluding the final COVID-19 wave. Subgroup analyses showed similar effects among individuals with pre-existing respiratory conditions, though results were less consistent.

Conclusions: Our findings suggest that short-term fluctuations in air pollution, particularly for PM2.5, are associated with the timing of confirmed COVID-19 cases. A possible explanation for the short lag association is that air pollution exacerbates symptoms, prompting individuals to seek testing, rather than directly facilitating new infections.

Background

Occupational exposures are contributors to chronic respiratory diseases, particularly in low- and middle-income countries (LMICs), where regulatory policies are limited. We investigated associations between occupational exposures and respiratory outcomes using longitudinal data from the Burden of Obstructive Lung Disease study.

Methods

We analysed data from 4237 participants across 17 sites, mostly in LMICs. Occupational exposures were assessed by self-report (never vs ever) and the ALOHA+Job Exposure Matrix for vapours, gases, dusts, fumes (VGDF), pesticides, solvents and metals (cumulative exposure). Respiratory outcomes included: forced expiratory volume in 1 s (FEV₁), forced vital capacity (FVC), the FEV₁/FVC and respiratory symptoms. Associations were examined using multilevel linear and logistic regression models adjusted for age, sex, smoking, pack-years, education, body mass index and baseline FVC. We further explored sex differences and non-linear relationships for symptoms.

Results

Over a median 10 years of follow-up, FEV₁/FVC decline was associated with moderate (β=–1.34; 95% CI –2.32 to –0.35) and high (β=–1.79; 95% CI –3.33 to –0.20) exposure to VGDF and low (β=–1.11; 95% CI –2.11 to –0.08) and high (β=–2.16; 95% CI –4.08 to –0.24) exposure to pesticides. Increased risk of wheeze was associated with moderate (Relative Risk (RR) =1.45; 95% CI 1.05 to 2.15) and high (RR=1.89; 95% CI 1.100 to 3.26) exposure to pesticides. Associations did not differ by sex. There was weak evidence of non-linear exposure–response relationships and no associations with solvents or metals.

Conclusions

A significant decline in FEV1/FVC was associated with exposure to VGDF and pesticides. Increased risk of wheeze was also associated with exposure to pesticides. These findings underscore the need for continued monitoring in high-exposure settings, particularly in LMICs.

Background The relationship between sedentary behavior and cognitive health remains insufficiently understood. The aim of this study was to examine associations between occupational and leisure-time sitting and self-reported cognitive dysfunction.

Methods Data from men and women, aged 50-64 years old, participating in the Ume & aring; site of the cross-sectional Swedish CArdioPulmonary bioImage Study (SCAPIS) was used. Occupational and leisure-time sitting were measured using a thigh-worn accelerometer over seven days. Work hours were reported in a diary. Cognitive dysfunction was measured using the Cognitive Dysfunction Questionnaire. A Hurdle model was used to firstly assess the association of domain-specific sitting time with any cognitive dysfunction (logistic regression) and secondly with the severity of cognitive dysfunction (beta-binomial regression). Analyses were adjusted for sex, age, educational level, moderate- to vigorous physical activity, sleep duration, risky alcohol intake and emotional health limitations.

Results A total of 1559 participants were included. In the fully adjusted model, each additional hour of occupational sitting was associated with 8% lower odds of reporting cognitive dysfunction (odds ratio (OR) 0.92, 95% confidence interval (CI) 0.87-0.98), while each additional hour of leisure-time sitting was associated with 12% higher odds (OR 1.12, 95% CI 1.03-1.21). Neither occupational nor leisure-time sitting was significantly associated with the severity of cognitive dysfunction among individuals reporting any dysfunction.

Conclusions Domain-specific sitting time was associated with the occurrence, but not the severity, of self-reported cognitive dysfunction in middle-aged adults. The contrasting associations observed for occupational and leisure-time sitting suggest that the context of sedentary behavior may be relevant for cognitive health. Future longitudinal studies using device-based measurements are needed to clarify causality and to explore the potential role of cognitively active and passive sedentary behaviors.

Background

Retirement is a major life transition that can alter patterns of movement behaviors (physical activity, sedentary behavior and sleep). While some studies indicate an increase in physical activity post-retirement, others report a rise in sedentary behavior. However, evidence is lacking on how individuals re-allocate time among movement behaviors, particularly using analytical approaches that account for the co-dependence of 24-hour time-use data. Furthermore, little is known about how pre-retirement occupational physical activity (OPA) levels influence physical activity after retirement. This study examined changes in the relative time spent in sleep, sedentary behavior (SB), light physical activity (LPA), and moderate-vigorous physical activity (MVPA) over retirement, and how these changes vary by pre-retirement OPA levels.

Methods

Data were drawn from the Swedish Retirement Study, which followed 112 participants (47 men, 65 women; age: 60–72) at three timepoints during the retirement transition. Movement behavior and sleep data were collected over a week-long period using thigh-worn accelerometers and wrist-worn actigraphs. Compositional data analysis (CoDA) was employed to account for the co-dependent nature of 24-hour time-use data. Multivariable linear mixed models, adjusted for sociodemographic and health covariates, were used to evaluate the associations between retirement, OPA tertiles, and movement behaviors.

Results

In the overall sample, changes in movement behaviors mainly involved sleep. However, substantial variation was observed across OPA tertile groups. The sleep-to-wake time ratio increased in the high OPA group and, to a lesser extent, in the medium OPA group. Regarding physically active and sedentary time, a convergence between the high and low OPA groups was observed, as pre-retirement differences diminished. Specifically, the ratio of physically active time to SB decreased in the high OPA group and increased in the low OPA group.

Conclusions

The findings indicate that pre-retirement OPA is a significant factor in understanding changes in movement behaviors during the retirement transition. The reduction in post-retirement physical activity among high-OPA workers may represent a healthier rebalancing rather than a decline, which aligns with the “physical activity paradox” and the “Sweet-Spot Hypothesis”. This evidence highlights the need for tailored interventions for retirees, particularly those from physically demanding occupations.

Background: Wearable accelerometers are widely used in health research, but differing placements (e.g. wrist vs. thigh) hinder harmonising activity classification across studies. Prior studies report 1.5- to 2.0-fold differences in physical activity level by wear location, hampering data comparability, and compromising the potential for pooling data to develop consortia and carrying out Meta- and Individual Participant Data analysis. Although supervised machine learning is increasingly used in wearables research, its reliance on extensive labelled data limits its use in free-living datasets. Semi-supervised learning offers an efficient alternative by using laboratory collected labelled data to iteratively self-train models on unlabelled free-living data. Using a self-training approach, the aim of this study was to train and evaluate algorithms for wrist- and thigh-worn devices to facilitate harmonisation of posture and activity type classification between placements.

Methods: A total of 146 participants aged 30-75 years completed either structured laboratory-based activity trials or one of two independent free-living assessments while wearing Axivity AX3 accelerometers on the wrist and thigh. For each placement, a supervised Random Forest classifier was initially trained using a labelled laboratory dataset (n = 40) to classify sitting, standing, walking, running, stair climbing, and cycling - and then re-trained using self-training on free-living data (n = 53, independent to the laboratory study sample). The final models were validated using another hold-out free-living independent dataset (n = 53) with ground-truth activity labels obtained via direct video observation. Overall model comparison and performance was assessed using accuracy, kappa statistic, and F1 scores. Individual activity class comparison and performance was evaluated using equivalence testing, confusion matrices, and coefficient of variation between the wrist and thigh estimates.

Results: During a total of 43,800 min, of which 19,080 min were in the hold-out dataset, both self-trained models achieved high overall classification accuracy: 91.8% (SD = 6.8%) for the wrist and 95.1% (SD = 5.4%) for the thigh. The overall F1 score was 88.2 (SD = 9.6%) for the wrist classifier and 90.1 (SD = 9.3%) for the thigh classifier. Equivalence testing demonstrated that both classifiers produced activity duration estimates statistically equivalent to ground-truth for all activity types except stair climbing. Confusion matrices for the wrist demonstrated very good to excellent (88% - 97%) classification accuracy for sitting, walking, running, and cycling, and good accuracy for standing and stair climbing (71%-78%). For the thigh, classification performance was very good to excellent (83% - 98%) across sitting, standing, walking, running, and cycling, with good accuracy for stair climbing (75%). The coefficient of variation values ranged from 0.022 for running to 0.140 for standing.

Conclusion: These findings highlight the potential of self-training models to support harmonisation of wearable accelerometer data collected using different wear placements. Self-training models reduce reliance on extensive labelled data and demonstrated high activity type classification accuracy for both wrist- and thigh-worn accelerometers, with a high degree of agreement and equivalence with ground-truth data across almost all activity types.

Purpose

To explore how educators in postgraduate nursing programs in anesthesia care, operating room care, and intensive care nursing—both in academic and clinical settings—experience teaching digital documentation in theory and practice.

Design

Qualitative descriptive study using thematic analysis by Braun and Clarke.

Methods

Individual interviews were conducted between April and August 2023 with 12 participants, including faculty members at the universities and clinical supervisors (10 women, 2 men). The participants were between 37 and 72 years of age (mean, 52 years) and had between 1 and 15 years (mean, 6 years) of work experience.

Findings

Two themes were identified: (1) “Faculty members’ contradictory attitudes and opinions regarding the content, importance, and need for documentation in patients’ electronic medical records in perioperative care” and (2) “The relationship between universities, healthcare providers, and individuals.” Subthemes included the lack of consensus on teaching digital documentation, factors influencing successful teaching, prioritizing patient-oriented competencies and tasks, and viewing documentation as a potential obstacle to care.

Conclusions

The topic of documentation is often a low priority. Higher education and clinical practice lack a consensus on the purpose, content, and methods for teaching documentation. Thus, greater attention is needed to clarify the purpose of documentation, particularly digital documentation, and to define relevant teaching content. Digital competence can better prepare students for future work and reduce technostress. The goal should be to narrow the gap between “work as imagined” and “work as done.”

Childhood allergic rhinitis (AR) is associated with ozone (O3) exposure, yet the sensitive exposure window (SEW) remains unclear. This multicenter survey of 38,176 children aged 3–6 years across 7 Chinese cities (2019–2020) estimated satellite-based individual maximum daily 8 h average O3 exposure. The SEW and its exposure–response (E–R) relationship were assessed. Doctor-diagnosed AR prevalence was 11.9%. Average O3 exposure from prenatal to AR onset ranged from 67.5 to 76.7 μg/m3. The critical SEW was identified as infancy, specifically 30–38 weeks postnatal (7.5–9.5 months). Per interquartile range (IQR) (10.1 μg/m3) increase in O3, the adjusted odds ratio was 1.29 (95% CI: 1.22–1.36), independent of PM2.5. The E–R relationship was nonlinear, J-shaped, and threshold-free. The SEW effect was stronger in southern cities and mitigated by ≥6 months of exclusive breastfeeding. In conclusion, O3 significantly increases AR risk, with 7.5–9.5 months postnatal being a critical SEW, especially in exclusive breastfeeding <6 months and southern regions

PURPOSE: A trusting relationship between employee and manager is crucial for constructive dialogue regarding work ability. However, employees may sometimes experience collaboration as unpleasant if the dialogue with their manager is not constructive. The aim of the study was to explore how employees on sick leave experience manager involvement in the RTW through a three-party meeting using the Demand and Ability Protocol (DAP) in primary healthcare.

MATERIALS AND METHODS: Data included 20 semi-structured individual interviews with employees diagnosed with common mental disorders or musculoskeletal disorders who had participated in a DAP dialogue. Thematic analysis was used to analyse the data.

RESULTS: Employees wanted to reach out to their manager but had challenges getting the message through about their reduced work ability. During sick leave, the structured DAP held within primary healthcare was experienced as a helpful measure to foster collaboration with the manager. The dialogue helped explore the balance between workplace demands and the employee's capabilities. This enabled both parties to share their view and the rehabilitation coordinator could guide towards potential adaptations. Employees found that the increased mutual understanding fostered by the DAP helped pave the way for ongoing collaboration in the RTW process.

CONCLUSIONS: The results underscore the importance of facilitating collaboration between employees and managers before, during, and after sick leave. The DAP can support the development of a trust-based relationship that enables all involved stakeholders to articulate needs, propose measures, and make informed decisions that enhance efforts throughout the RTW process.

With activation driving labour market policy, job-seekers are often offered subsidised employment on the condition that they fulfill certain obligations, such as job searching and participating in training. Nevertheless, such initiatives often receive criticism for their ineffectiveness, and little is known about how these policies can achieve their desired results in practice. This study explores how active labour market programme participants, caseworkers and workplace supervisors perceive the feasibility, acceptability, and value of a structured development plan within an active labour market programme (ALMP). The development plan was piloted for one month in a Swedish municipality and was followed by focus group or individual interviews. The findings indicate that the development plan was perceived as strengthening structured communication among the actors, increasing awareness and reflection on development progress through the use of concrete goals; enabling the combination of long- and short-term goals, and finally, clarifying the responsibilities of various actors involved in the ALMP process. In conclusion, this study contributes to knowledge on how individualised support can be provided in a feasible and structured way, and identifies mechanisms that may support future implementation and evaluation of individualised support within ALMPs.