Preventing retraumatisation in torture survivors during surgical care: results of a guideline-development project and qualitative study exploring healthcare providers' experiences.

OBJECTIVES: Insufficient training and the absence of guidelines increase the risk of retraumatisation in torture survivors during surgical procedures. This study aims to develop guidelines to mitigate this risk and gather healthcare professionals' experiences treating torture survivors and insights on the guideline's feasibility and acceptability. DESIGN: The study was conducted in two phases. Phase 'a' involved developing guidelines based on reviews of torture survivors' encounters in somatic care and potential retraumatisation triggers, as well as a qualitative study on survivors' experiences during surgical interventions. The development process adhered to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) principles and the Appraisal of Guidelines for Research and Evaluation (AGREE II) instrument for methodological rigour. Phase 'b' involved focus groups and individual interviews with healthcare professionals to explore challenges in caring for torture survivors and to evaluate the guidelines. SETTING: The study, conducted from May to August 2023, involved participants from surgical departments in three hospitals in southern and southeastern Norway. PARTICIPANTS: Twenty-one healthcare professionals, including surgeons, anaesthesiologists, nurses and a dentist, participated in the study. Both focus group interviews and individual interviews were conducted. RESULTS: Phase 'a': guidelines comprising six sections were developed: an introduction, general guidelines and four sections covering the preoperative, perioperative and postoperative surgical stages. Phase 'b': healthcare professionals struggled to understand torture's complexities and identify survivors' unique needs. They faced challenges using interpreters and assisting patients with strong reactions. While the guidelines were viewed as practical and useful for raising awareness, their length was questioned. CONCLUSIONS: We provide recommendations for preventing retraumatisation in torture survivors undergoing surgical treatment. The guidelines may serve as a starting point for offering safe and individualised care to torture survivors. Teaching institutions and hospitals may incorporate the guidelines into healthcare professionals' education.

Norwegian pre-service teacher students' and public health nursing students' views on health - a qualitative study of students' perceptions.

PURPOSE: In 2020, the Norwegian school curriculum was revised, introducing a new cross-curricular subject, Public Health, and Life Skills. The curriculum emphasizes collaboration between teachers and the school health service. Subsequently, a research project, Literacies for Health and Life Skills, was initiated at Oslo Metropolitan University. The aim was to develop a new approach to the subject. A part of the research was to explore perceptions about good and poor health among teacher students and public health nursing students. METHODS: This study has a qualitative design using auto-photography, group discussions and photo-elicitation interviews as methods to explore the students' views on health. RESULTS: A analysis revealed three themes about good health in both student groups: Relaxation and tranquillity, belonging and relations, and enjoyment as important to health. Three themes about poor health emerged in both student groups: The ideal body and self-perception, you are as healthy as you feel, and the best in life is also the worst. The students' statements were characterized by underlying assumptions about health in society, with a focus on "healthism". No major differences between the student groups were found. CONCLUSION: This study serves as a step towards increased understanding of health perceptions among future professionals working with children and adolescents.

Torture survivors' experiences of receiving surgical treatment indicating re- traumatization.

Due to the invasive nature of surgical procedures and the involvement of medical personnel, torture survivors may experience re-traumatization during surgical treatment. This study aimed to explore torture survivors' experiences of re-traumatization during surgical treatment as well as the process by which trauma-related emotions and responses are evoked during surgical treatment for torture survivors. Eight men, aged 45 to 72, from four different countries, who have lived in Norway for 6-40 years, were recruited. We assessed torture and surgical care experiences through in-depth interviews, and the data were analyzed using thematic analysis, resulting in five themes: (1) Interactions with healthcare providers, (2) Reactions during treatment, (3) Triggers causing re-experiences, (4) Avoidance, and (5) Suggestions to healthcare providers. In this study, survivors reported challenges receiving surgical treatment, indicating re-traumatization and difficulty returning to daily life following treatment. Participants reported little collaboration in care-related decision-making processes, lack of recognition of torture by healthcare providers involved in surgical care and experiencing healthcare professionals' attitudes as a source of perplexity, frustration, and despair. Exacerbation of torture memories throughout treatment and re-experiencing of trauma symptoms aggravated these difficulties. Our findings suggest that surgical treatment can remind torture survivors of the traumatic aspects of torture, eliciting strong reactions and feelings like those experienced during torture.

Modelling PCB-153 in northern ecosystems across time, space, and species using the nested exposure model.

There is concern over possible effects on ecosystems and humans from exposure to persistent organic pollutants (POPs) and chemicals with similar properties. The main objective of this study was to develop, evaluate, and apply the Nested Exposure Model (NEM) designed to simulate the link between global emissions and resulting ecosystem exposure while accounting for variation in time and space. NEM, using environmental and biological data, global emissions, and physicochemical properties as input, was used to estimate PCB-153 concentrations in seawater and biota of the Norwegian marine environment from 1930 to 2020. These concentrations were compared to measured concentrations in (i) seawater, (ii) an Arctic marine food web comprising zooplankton, fish and marine mammals, and (iii) Atlantic herring (Clupea harengus) and Atlantic cod (Gadus morhua) from large baseline studies and monitoring programs. NEM reproduced PCB-153 concentrations in seawater, the Arctic food web, and Norwegian fish within a factor of 0.1-31, 0.14-3.1, and 0.09-21, respectively. The model also successfully reproduced measured trophic magnification factors for PCB-153 at Svalbard as well as geographical variations in PCB-153 burden in Atlantic cod between the Skagerrak, North Sea, Norwegian Sea, and Barents Sea, but estimated a steeper decline in PCB-153 concentration in herring and cod during the last decades than observed. Using the evaluated model with various emission scenarios showed the important contribution of European and global primary emissions for the PCB-153 load in fish from Norwegian marine offshore areas.

Climate change dynamics and mercury temporal trends in Northeast Arctic cod (Gadus morhua) from the Barents Sea ecosystem.

The Northeast Arctic cod (Gadus morhua) is the world's northernmost stock of Atlantic cod and is of considerable ecological and economic importance. Northeast Arctic cod are widely distributed in the Barents Sea, an environment that supports a high degree of ecosystem resiliency and food web complexity. Here using 121 years of ocean temperature data (1900-2020), 41 years of sea ice extent information (1979-2020) and 27 years of total mercury (Hg) fillet concentration data (1994-2021, n = 1999, ≥71% Methyl Hg, n = 20) from the Barents Sea ecosystem, we evaluate the effects of climate change dynamics on Hg temporal trends in Northeast Arctic cod. We observed low and consistently stable, Hg concentrations (yearly, least-square means range = 0.022-0.037 mg/kg wet wt.) in length-normalized fish, with a slight decline in the most recent sampling periods despite a significant increase in Barents Sea temperature, and a sharp decline in regional sea ice extent. Overall, our data suggest that recent Arctic amplification of ocean temperature, "Atlantification," and other perturbations of the Barents Sea ecosystem, along with rapidly declining sea ice extent over the last ∼30 years did not translate into major increases or decreases in Hg bioaccumulation in Northeast Arctic cod. Our findings are consistent with similar long-term, temporal assessments of Atlantic cod inhabiting Oslofjord, Norway, and with recent investigations and empirical data for other marine apex predators. This demonstrates that Hg bioaccumulation is highly context specific, and some species may not be as sensitive to current climate change-contaminant interactions as currently thought. Fish Hg bioaccumulation-climate change relationships are highly complex and not uniform, and our data suggest that Hg temporal trends in marine apex predators can vary considerably within and among species, and geographically. Hg bioaccumulation regimes in biota are highly nuanced and likely driven by a suite of other factors such as local diets, sources of Hg, bioenergetics, toxicokinetic processing, and growth and metabolic rates of individuals and taxa, and inputs from anthropogenic activities at varying spatiotemporal scales. Collectively, these findings have important policy implications for global food security, the Minamata Convention on Mercury, and several relevant UN Sustainable Development Goals.

Congener-specific accumulation of persistent organic pollutants in marine fish from the Northeast Atlantic Ocean.

Bioaccumulation of persistent organic pollutants (POPs) in marine fish may pose a health risk to human consumers. Using data from ∼8400 individuals of 15 fish species collected in the North-East Atlantic Ocean (NEAO), we assessed concentrations of individual POP congeners, including dioxins, polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs). POPs analyses were performed with accredited methods using high-resolution gas chromatography/high-resolution mass spectrometry, gas chromatography/tandem mass spectrometry (GC-MS/MS) and GC/MS. The results showed that POPs congener composition profiles were more influenced by fish species than by geography. However, due to long range transport from emissions at lower latitudes, lighter congeners made a larger contribution to the total POPs concentrations in the northernmost areas compared to southern regions. A model was developed to elucidate the relative effects of several factors on POPs concentrations and showed that variation among and within fish species was associated with fat content, fish size, trophic position, and latitude. For the first time, POPs concentrations were shown to increase nonlinearly with fat content, reaching an asymptotic plateau when fat content was > 10%. This study explored detailed POP congener profiles and the factors associated with POPs accumulation in commercially relevant fish harvested from the NEAO.

Re-traumatization of torture survivors during treatment in somatic healthcare services: A mapping review and appraisal of literature presenting clinical guidelines and recommendations to prevent re-traumatization.

RATIONALE: The number of torture survivors is on the rise, posing issues for their care in healthcare settings. Even healthcare experts with training in refugee care are unaware of the health difficulties faced by torture survivors. Any medical evaluation or treatment has the potential to re-traumatize torture survivors, thereby reactivating trauma symptoms without applicable guidelines to prevent re-traumatization. OBJECTIVE: Our objective was to identify, characterize, evaluate, and organize current, available evidence presenting existing recommendations and suggestions to prevent re-traumatization during the treatment of torture survivors' physical diseases in healthcare services. METHODS: A comprehensive search of electronic databases was conducted. Gray literature coverage was obtained by searching for publications from relevant associations and healthcare organizations focusing on torture survivors. Clinical practice guidelines (CPGs) and research focusing on somatic healthcare services for adult torture survivors, regardless of study design, were eligible for review. Studies that concentrated on psychiatric departments were excluded. To conduct an overview of the available research and describe the scope and distribution of evidence, a mapping review methodology was used. RESULTS: Forty out of 13,111 initial citations met our criteria. There were two guidelines, and text and opinion statements predominated. Two authors independently assessed the risk of bias in each primary research study using the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for the research design. CONCLUSIONS: This mapping review identifies triggers that may re-traumatize torture survivors during treatment and makes recommendations for prevention. Only a few studies have considered torture survivors' perspectives on treatment and re-traumatization. According to the findings of the mapping review, healthcare providers should consider survivors' biopsychosocial situations, demonstrate cultural sensitivity, and change theirpersonal attitudes . They must also identify tortured patients and determine when professional interpreters should be used.

Quality of life and associated factors among Norwegian public health nurse students during the first months of the COVID-19 pandemic: A cross-sectional study.

The main objective of this study was to investigate the association between quality of life (QOL) and civil status, self-efficacy, loneliness, and physical and mental health among public health nurse (PHN) students during the COVID-19 pandemic in April 2020. PHN students were recruited from eight universities and university colleges in Norway. A range of potential predictive factors were entered into a model using a stepwise linear regression approach. In general, the PHN students reported a high level of QOL during the first month of the pandemic. The students' civil status, perceived physical health, self-efficacy and loneliness were all significantly correlated with QOL. Among these, the strongest predictive factors for QOL were found to be perceived loneliness and self-efficacy. Our results provide insight into the QOL of PHN students, which managers in the higher education sector can use to outline specific coping strategies that can help students during a pandemic.

Unpacking the Public Health Triad of Social Inequality in Health, Health Literacy, and Quality of Life-A Scoping Review of Research Characteristics.

Social inequalities in health, health literacy, and quality of life serve as distinct public health indicators, but it remains unclear how and to what extent they are applied and combined in the literature. Thus, the characteristics of the research have yet to be established, and we aim to identify and describe the characteristics of research that intersects social inequality in health, health literacy, and quality of life. We conducted a scoping review with systematic searches in ten databases. Studies applying any design in any population were eligible if social inequality in health, health literacy, and quality of life were combined. Citations were independently screened using Covidence. The search yielded 4111 citations, with 73 eligible reports. The reviewed research was mostly quantitative and aimed at patient populations in a community setting, with a scarcity of reports specifically defining and assessing social inequality in health, health literacy, and quality of life, and with only 2/73 citations providing a definition for all three. The published research combining social inequality in health, health literacy, and quality of life is heterogeneous regarding research designs, populations, contexts, and geography, where social inequality appears as a contextualizing variable.

Children as Next of Kin in Higher Education: An Exploratory Cross-Sectional Study Among Health, Social Care, and Teacher Education Programs.

INTRODUCTION: Children who are "next of kin" (ie, sick/dying/addicted/imprisoned close relatives) are at increased risk for health consequences. Health professionals in Norway are required by law to help such children, and professional educations should focus on this issue. AIM: To assess the extent to which students attending health, social care, and teacher education felt their uni-professional education and a mandatory interprofessional learning (IPL) course had taught them about children as next of kin. To explore variations in student responses according to age and educational background. METHODS: This was a cross-sectional study. Students (n = 2811) completed questionnaires relating to IPL courses delivered in 2019 and 2020 (hybrid case-based learning). Students discussed issues relating to interprofessional collaboration targeting children, young people and their families in small IPL groups. FINDINGS: The response rates ranged from 25.8% to 36.0%. All but 5.2% of the students agreed that it was important to learn about children as next of kin. Although 61.9% reported that their education had not taught about such children, 73.8% had gained increased insight from the IPL course (difference 35.7% 95% CI (29.0; 42.0), p < 0.001). The teacher and child welfare students had gained greater insight than the health and social care students. Significant pre- to post-course increases were found among the physiotherapy (p < 0.001), Mensendieck physiotherapy (p < 0.001), teacher education (p < 0.001), early childhood education (p < 0.001), and teacher education in art and design (p = 0.042) students. CONCLUSION: Nearly 2/3 reported that they had not been taught about children as next of kin at their own educations, but more than 2/3 had gained greater insight from the IPL course. The health and social care students reported the least gain. Although the law has existed for a decade, the topic of children as next of kin is still omitted from most educational programs.

Development and evaluation of guidelines for prevention of retraumatisation in torture survivors during surgical care: protocol for a multistage qualitative study.

INTRODUCTION: Healthcare professionals working in somatic departments are not trained to recognise signs of torture or provide appropriate healthcare to torture survivors, which may result in retraumatisation during surgical treatment. METHODS AND ANALYSIS: This protocol outlines a four-stage qualitative-method strategy for the development and evaluation of guidelines for prevention of retraumatisation of torture survivors during surgical care. The systematic search for literature review in stages 1 and 2 was conducted in August 2019 and March 2021, respectively, using nine databases. The search strategies employed in stage 1, without imposing any date limits, resulted in the inclusion of eight studies that addressed inadequate healthcare strategies associated with retraumatisation. The clinical guidelines review in stage 2 will include publications from 2000 onwards, which will be appraised using the Appraisal of Guidelines Research and Evaluation Version II instrument. Following multi-institutional recruitment in Norway, stage 3 will explore survivors' experiences of receiving surgical treatment using indepth interviews (n=8-12), which will be audio-recorded, transcribed verbatim and analysed using the interpretative phenomenological analysis approach. In stage 4a, based on the findings from stages 1, 2 and 3, a set of clinical guidelines for preventing retraumatisation during surgical treatment will be developed. Next, the feasibility and acceptability of the guidelines will be assessed in stage 4b in three interdisciplinary focus group interviews (n=5 per group) and text condensation analyses. ETHICS AND DISSEMINATION: The Regional (South-East C) Committee for Medical and Health Research Ethics approved the study in May 2021 (#227624). In stages 3 and 4, an informational letter and an informed consent form will be distributed to the participants to sign before the interview. The study results will be disseminated through publications, conference presentations, and national and local public forums to healthcare professionals, service managers, policymakers and refugee-supporting agencies.

Co-occurrence of contaminants in marine fish from the North East Atlantic Ocean: Implications for human risk assessment.

Marine fish from the North East Atlantic Ocean (NEAO) are nutrient rich and considered a valuable economic resource. However, marine fish are also a major dietary source of several contaminants, including persistent organic pollutants (POPs) and heavy metals. Using one of the world's largest seafood datasets (n > 25,000 individuals), comprising 12 commercially important fish species collected during 2006-2019 in the NEAO, we assessed the co-occurrence of elements and POPs, and evaluated potential risks to human consumers. Several positive correlations between concentrations of mercury (Hg), dioxins, polychlorinated biphenyls (PCBs) and polybrominated diphenyl ethers (PBDEs) were observed. Concentrations of Hg, dioxins, PCBs and PBDEs increased from North to South and associations between marine sediment contamination, sea temperature, and fish Hg and POPs concentrations were identified using multi-linear regression (MLR) models. In general, Hg concentrations in fillet and liver of fish were positively associated with increases in both sediment contamination and sea temperature. POPs concentrations in both fillet and liver were positively associated with increases in sediment contamination, and only POPs concentrations in the liver of benthopelagic and demersal species were found to be positively correlated with sea temperature. Using a probabilistic approach to estimate human contaminant exposure from seafood, we showed that intake of pelagic species posed the highest risk of dioxins and dioxin-like PCBs (DL-PCBs) exposure, while intake of benthopelagic and demersal species posed the highest risk of Hg exposure. This study can serve as a model to further understand the distribution, co-occurrence, and trends of contaminants in seafood harvested from the NEAO and their potential risks to human consumers.

Core Competencies for Interprofessional Collaborative Practice Among Teacher Education, Health and Social Care Students in a Large Scaled Blended Learning Course.

INTRODUCTION: Society's demands for better coordination of services for children are increasing. Interprofessional learning (IPL) has been suggested to achieve the triple aim of better services, better outcomes and reduced costs. The aims were to assess 1) to what extent students taking teacher education, health and social care programmes agreed that blended learning was a suitable approach in a mandatory IPL course, 2) to what extent they had learnt about the WHO's core IPL competencies (roles and responsibilities, values and ethics, interprofessional communication, and teams and teamwork), and 3) the students' ranking of the learning outcomes from different components of the IPL course. METHODS: This was a quantitative cross-sectional study. Students completed an online course evaluation after a two-day combination of online and face-to-face IPL small-group training. FINDINGS: The response rate was 25.8% (n=363). Among the students, 60.6% strongly agreed that blended learning was suitable, while 8.9% strongly disagreed. Among the respondents, 46.8%, 50.2%, 56.8% and 62.3% gained increased insight into roles and responsibilities, values and ethics, interprofessional communication, and teams and teamwork, respectively. In ascending order, students were most satisfied with the learning outcomes from the supervision (16.0%), the syllabus (28.6%), the submission assignment (42.4%), the digital learning content of Canvas (43.8%), the combination of everything (43.8%), and the IPL group discussions (78.6%). In stratified analyses, 'teacher education and child welfare students' were significantly more likely to gain better insight into the WHO competencies than "health and social care students", and they were also more overall satisfied. CONCLUSION: Students agreed that blended learning was a suitable approach, although the learning outcomes from the face-to-face discussions were markedly higher than from other course components. While the majority had learnt something about the WHO competencies, the teacher and child welfare students achieved the best learning outcomes, including new knowledge about the WHO competencies.

Rapid temporal decline of mercury in Greenland halibut (Reinhardtius hippoglossoides).

Mercury (Hg) pollution in the ocean is an issue of global concern, however bioaccumulation regimes of this ubiquitous pollutant in marine apex predators have important knowledge gaps. Our fish length and stable isotope (δ15N and δ13C) normalized data of Greenland halibut (GH) (Reinhardtius hippoglossoides) showed that Hg bioaccumulation in fillet tissue decreased by ~35-50 %, over a ten-year period from 2006 to 2015 (n = 7 individual sampling years). Hg was predominantly in the methylmercury form (>77 %). Results from a Bayesian information theoretic model showed that GH Hg concentrations decreased with time and its associated declines in Hg air emissions, estimated trophic position, and a potentially lower degree of demersal prey use as indicated by temporal trend shifts in nitrogen (δ15N) and carbon (δ13C) stable isotope values. GH trophic shifts accounted for about one third of the observed temporal reduction in Hg. Our study demonstrates the importance of simultaneously considering Hg emissions, food web dynamics and trophic shifts as important drivers of Hg bioaccumulation in a marine, deep water fish species and highlights the effectiveness of Hg regulations on ocean apex predator Hg concentrations and overall seafood safety.

Students' top 10 priorities of research uncertainties on students' sleep: a pragmatic James Lind Alliance approach.

OBJECTIVES: Inspired by the James Lind Alliance (JLA) user involvement approach, the aim of the present study was to identify the top 10 uncertainties for sleep research raised by students in higher education, and to discuss our experiences with adapting the JLA method to a student population. DESIGN: The study design is a pragmatic JLA approach, including a priority setting partnership within the field of sleep, collection of sleep-related research uncertainties as reported by students in higher education, sorting of the uncertainties and a final identification of the top 10 uncertainties through collaborative work between researchers, students, stakeholders and experts in the field. Uncertainties were collected using a one-question online survey: 'as a student, which question(s) do you consider to be important with regards to sleep?'. A variety of approaches were applied to promote the survey to the students, including social media, radio, the university website, stands in university cafeterias and a sleep stunt. NVivo V.12 was used to code and sort the questions. SETTING: A higher education institution in Norway. PARTICIPANTS: 555 students. RESULTS: The data collection provided 608 uncertainties, and the following prioritised top 10: (1) screen time, (2) stress, (3) educational achievements, (4) social relations, (5) mental health, (6) physical activity, (7) indoor environment, (8) substance abuse, (9) shift work and (10) sleep quality. Despite successful data collection, we found sleep to be a broad topic, and defining specific questions throughout the sorting and verification process proved difficult. CONCLUSIONS: We identified the prioritised top 10 research uncertainties as reported by students in higher education, ranking screen time first. However, the process was time and resource consuming. The research uncertainties addressed by the students showed great diversity, characterised by heterogeneity and a lack of specificity, making verification of the uncertainties challenging.

A Gap Between Children's Rights and Curricular Content in Health, Social Care, and Teacher Education Programs: An Exploratory Cross-Sectional Study.

INTRODUCTION: Exposure to child maltreatment is a social and public health challenge that will require interprofessional collaboration to overcome. Evidence indicates that professional students in health, social care, and teacher education programs receive inadequate training in recognizing and responding to child maltreatment. The aims are to 1) assess the extent to which these students found that their uniprofessional education and a large-scale interprofessional learning (IPL) course had taught them about children in general, children's rights, and vulnerable/at-risk children; and 2) explore differences in student responses according to age and educational background. METHODS: A cross-sectional study. Students (n=2811) completed questionnaires prior to or after IPL courses held in 2019 and 2020 (hybrid case-based, small-group, on-campus courses targeting children, young people, and their families as end users). FINDINGS: The majority (>90%) agreed that it was important to learn about child-related topics. Only 4.3% disagreed that it was important to learn about vulnerable/at-risk children. Health and social care students enhanced their insight into all the child-related topics (p<0.001) after the IPL course. Teacher education and child welfare students reported decreased insight into children in general (p<0.001 in 2019 and p=0.008 in 2020) but increased insight into vulnerable/at-risk children in 2020 (p=0.001). According to stratified analyses, there was a significantly increased insight into all child-related topics among physiotherapy and Mensendieck physiotherapy students (p<0.001), decreased insight into children in general among teacher education students (p<0.02), and increased insight into vulnerable/at-risk children among teacher education students (p ≤ 0.001) in both 2019 and 2020. Age was of minor importance. The response rates ranged from 16.0% to 36.0%. CONCLUSION: After the IPL course, the health and social care students significantly enhanced their insight into child-related topics, whereas the students in teacher education and child welfare gained increased insight into vulnerable/at-risk children.

Effects of geography and species variation on selenium and mercury molar ratios in Northeast Atlantic marine fish communities.

Methylmercury (MeHg) is a potent neurotoxin that bioaccumulates in seafood. Co-occurrence of selenium (Se) may affect the bioavailability and toxicity of MeHg in organisms. Here we report the concentrations of total mercury (Hg) and Se in 17 teleost fish species (n = 8459) sampled during 2006-2015 from the North East Atlantic Ocean (NEAO) and evaluate species variation and effects of geography. Mean Hg concentration ranged from 0.04 mg kg-1 ww in Atlantic mackerel (Scomber scombrus) and blue whiting (Micromesistius poutassou) to 0.72 mg kg-1 ww in blue ling (Molva dypterygia). Se concentrations were less variable and ranged from 0.27 mg kg-1 ww in Atlantic cod (Gadus morhua) to 0.56 mg kg-1 ww in redfish (Sebastes spp.). The mean Se:Hg molar ratio ranged from 1.9 in blue ling to 43.3 in mackerel. Pelagic species had the lowest Hg concentrations and the highest Se:Hg ratios, whereas demersal species had the highest Hg concentrations and the lowest Se:Hg ratios. Se and Hg concentrations were positively correlated in 13 of the 17 species. Hg concentrations increased from the North to South in contrast to the Se:Hg molar ratio which exhibited the opposite trend. Fish from fjord and coastal areas had higher concentrations of Hg and lower Se:Hg molar ratios compared to fish sampled offshore. All species had average Se:Hg molar ratios >1 and Hg concentrations were largely below the EU maximum level of 0.5 mg kg-1 ww with few exceptions including the deep water species tusk (Brosme brosme) and blue ling sampled from fjord and coastal habitats. Our results show that two fillet servings of tusk, blue ling or Atlantic halibut (Hippoglossus hippoglossus) exceeded the tolerable weekly intake of MeHg although the surplus Se may possibly ameliorate the toxic effects of MeHg. However, some individuals with selenium deficiencies may exhibit greater sensitivity to MeHg.

Beverage consumption patterns and energy contribution from beverages per meal type: results from a national dietary survey in Sweden.

OBJECTIVE: Many studies of food intake have been performed and published in Sweden, but to our knowledge no studies have extensively explored the beverage consumption of the Swedish adult population. The present study aimed to describe the beverage consumption and the contribution of beverage energy (including alcohol energy) to total energy intake according to gender, region of living, meal type and day for a Swedish adult population. DESIGN: National dietary survey Riksmaten (2010-2011), collected by the Swedish National Food Agency. SETTING: Sweden. SUBJECTS: A total of 1682 participants (57 % women) reported dietary intake data during four consecutive days, specified by portion size, meal, time point, day of the week and venue. Meals were categorized as breakfast, lunch, dinner and 'other'.ResultThe beverage reported to be consumed the most was water (ml/d), followed by coffee. Men had a higher consumption of juice, soft drinks, beer, spirits and low-alcohol beer, while the consumption of tea and water was higher for women. For both genders, milk contributed the most to beverage energy intake. Energy percentage from beverages was higher at lunch and dinner during weekends for both genders. Participants from the biggest cities in Sweden had a higher consumption of wine for both genders and tea for men than participants from other regions. CONCLUSIONS: A considerable part of total energy intake was contributed by beverages, especially for men. Beverages can contribute to a more enjoyable diet, but at the same time provide energy, sugar and alcohol in amounts that do not promote optimal health.

Factors influencing risk assessments of brominated flame-retardants; evidence based on seafood from the North East Atlantic Ocean.

Brominated flame-retardants (BFRs) such as polybrominated diphenyl ethers (PBDE) and hexabromocyclododecane (HBCD) are considered hazardous to human health. Due to their persistence, they are still present in the environment and in biota and seafood is major contributor of BFRs to human exposure. Here, we used data from >9700 samples of wild and farmed fish, fish feed and fish feed ingredients collected from the North Atlantic between 2006 and 2016 aiming to investigate factors influencing the risk assessments of BFRs. Due to most representative number of analyses, PBDEs were the main focus of investigation. Mean ∑PBDE in fillet samples ranged from below quantification in Atlantic cod fillet to 2.0 µg kg-1 in Atlantic halibut. The main congener contributing to the ∑PBDE in all species was BDE 47. Factors affecting the level of BFR in seafood were multifaceted, and the levels were within species mainly determined by fish age, geographical origin and time of sampling. BDE 47, 99, 153 and HBCD were selected for margin of exposure (MOE) evaluation. When other sources of BFR than seafood were excluded, our risk assessment showed low risk at the current dietary intake of seafood. However, the dietary intake of BDE 99 may be of concern for toddlers when all sources are considered. The choice of fish species, dietary studies, choice of statistics, as well as exposure from other sources than seafood, were all factors that influenced the final MOE of BFRs. We propose the use of regression on order statistics as a tool for risk assessment, to illustrate means and spreads in large surveillance datasets to avoid the issue of measurements below the limit of quantification. A harmonized, updated evaluation of the risk associated with exposure to BFRs from diet, air and dust is warranted, where the fish species most commonly consumed also is taken into consideration.