Associating Land Cover Changes with Patterns of Incidences of Climate-Sensitive Infections: An Example on Tick-Borne Diseases in the Nordic Area.

Some of the climate-sensitive infections (CSIs) affecting humans are zoonotic vector-borne diseases, such as Lyme borreliosis (BOR) and tick-borne encephalitis (TBE), mostly linked to various species of ticks as vectors. Due to climate change, the geographical distribution of tick species, their hosts, and the prevalence of pathogens are likely to change. A recent increase in human incidences of these CSIs in the Nordic regions might indicate an expansion of the range of ticks and hosts, with vegetation changes acting as potential predictors linked to habitat suitability. In this paper, we study districts in Fennoscandia and Russia where incidences of BOR and TBE have steadily increased over the 1995-2015 period (defined as 'Well Increasing districts'). This selection is taken as a proxy for increasing the prevalence of tick-borne pathogens due to increased habitat suitability for ticks and hosts, thus simplifying the multiple factors that explain incidence variations. This approach allows vegetation types and strengths of correlation specific to the WI districts to be differentiated and compared with associations found over all districts. Land cover types and their changes found to be associated with increasing human disease incidence are described, indicating zones with potential future higher risk of these diseases. Combining vegetation cover and climate variables in regression models shows the interplay of biotic and abiotic factors linked to CSI incidences and identifies some differences between BOR and TBE. Regression model projections up until 2070 under different climate scenarios depict possible CSI progressions within the studied area and are consistent with the observed changes over the past 20 years.

Linking climate and infectious disease trends in the Northern/Arctic Region.

Recognition of climate-sensitive infectious diseases is crucial for mitigating health threats from climate change. Recent studies have reasoned about potential climate sensitivity of diseases in the Northern/Arctic Region, where climate change is particularly pronounced. By linking disease and climate data for this region, we here comprehensively quantify empirical climate-disease relationships. Results show significant relationships of borreliosis, leptospirosis, tick-borne encephalitis (TBE), Puumala virus infection, cryptosporidiosis, and Q fever with climate variables related to temperature and freshwater conditions. These data-driven results are consistent with previous reasoning-based propositions of climate-sensitive infections as increasing threats for humans, with notable exceptions for TBE and leptospirosis. For the latter, the data imply decrease with increasing temperature and precipitation experienced in, and projected for, the Northern/Arctic Region. This study provides significant data-based underpinning for simplified empirical assessments of the risks of several infectious diseases under future climate change.

Healthy Ecosystems Are a Prerequisite for Human Health-A Call for Action in the Era of Climate Change with a Focus on Russia.

Throughout history, humans have experienced epidemics. The balance of living in nature encircled by microorganisms is delicate. More than 70% of today's emerging infections are zoonotic, i.e., those in which microorganisms transmitted from animals infect humans. Species are on the move at speeds never previously recorded, among ongoing climate change which is especially rapid at high latitudes. This calls for intensified international surveillance of Northern infectious diseases. Russia holds the largest area of thawing permafrost among Northern nations, a process which threatens to rapidly disrupt the balance of nature. In this paper, we provide details regarding Russian health infrastructure in order to take the first steps toward a collaborative international survey of Northern infections and international harmonization of the procured data.

Physiotherapy treatment of the diabetic shoulder: health-related quality of life and measures of shoulder function regarding patients with type 1 diabetes.

PURPOSE: The aim of this study was to investigate how health-related quality of life (HRQoL) and functional shoulder range of motion are affected among patients with diabetes with shoulder problems, treated with a specific physiotherapy programme. A further aim was to investigate how health-related quality of life, functional shoulder range of motion, pain intensity, and shoulder function correlate within the group of patients after the treatment period. METHOD: A pre-post treatment design was applied for a study group of ten patients with type 1 diabetes and shoulder problems. The physiotherapy treatment consisted of exercises promoting enhanced micro-circulation in the shoulder tissues, optimal shoulder co-ordination, and muscle relaxation. The Short Form-36 (SF-36), shoulder range of motion measures, the Shoulder Rating Scale - Swedish version, and pain intensity measures were used. The results regarding SF-36 were compared with the results of a control group of patients having either type 1 or type 2 diabetes and shoulder problems that did not receive any specific physiotherapy treatment. RESULTS: As a potential result of physiotherapy training, a significant change towards higher scores was observed in the physical component summary (PCS) measure of SF-36. There was a significant improvement regarding PCS in the study group as compared with the control group. There were negative correlations between the four aspects of pain intensity and PCS and Shoulder Rating Scale - Swedish version, respectively, but a positive correlation between PCS and Shoulder Rating Scale - Swedish version. "Hand-raising" and "hand-behind-back" were significantly improved, and proved to be positively correlated with Shoulder Rating Scale - Swedish version. CONCLUSIONS: The results of this study indicate that patients with type 1 diabetes and shoulder problems, treated with a specific physiotherapy programme, may improve with respect to physical aspects of health-related quality of life, and partially regain their range of motion in the shoulder joint. Based on these results, the associated treatment protocol may be recommended for physiotherapy treatment in such patients. Implications for Rehabilitation Diabetes is a significant risk factor in the development of shoulder pain and disability. Health-related quality of life (HRQoL) is affected in patients with diabetes and shoulder problems. A specific physiotherapy programme may improve physical aspects of HRQoL in patients with diabetes and shoulder problems. Specific physiotherapy intervention may also improve range of motion in the shoulder joint in patients with diabetes and shoulder problems.

Discrepancies in data reporting of zoonotic infectious diseases across the Nordic countries - a call for action in the era of climate change.

Emerging infections have in recent years caused enormous health problems. About 70% of these infections are zoonotic e.g. arise from natural foci in the environment. As climate change impacts ecosystems there is an ongoing transition of infectious diseases in humans. With the fastest changes of the climate occurring in the Arctic, this area is important to monitor for infections with potentials to be climate sensitive. To meet the increasing demand for evidence-based policies regarding climate-sensitive infectious diseases, epidemiological studies are vital. A review of registered data for nine potentially climate-sensitive infections, collected from health authorities in Denmark/Greenland, Finland, Iceland, Norway and Sweden, found that performing such studies across countries is constrained by incompatible reporting systems and differences in regulations. To address this, international standardisation is recommended.

Identifying climate-sensitive infectious diseases in animals and humans in Northern regions.

BACKGROUND: General knowledge on climate change effects and adaptation strategies has increased significantly in recent years. However, there is still a substantial information gap regarding the influence of climate change on infectious diseases and how these diseases should be identified. From a One Health perspective, zoonotic infections are of particular concern. The climate in Northern regions is changing faster than the global average. This study sought to identify climate-sensitive infectious diseases (CSIs) of relevance for humans and/or animals living in Northern regions. Inclusion criteria for CSIs were constructed using expert assessments. Based on these principles, 37 potential CSIs relevant for Northern regions were identified. A systematic literature search was performed in three databases using an explicit stepwise approach to determine whether the literature supports selection of these 37 potential CSIs. RESULTS: In total, 1275 nominated abstracts were read and categorised using predefined criteria. Results showed that arthropod vector-borne diseases in particular are recognised as having potential to expand their distribution towards Northern latitudes and that tick-borne encephalitis and borreliosis, midge-borne bluetongue and the parasitic infection fasciolosis can be classified as climate-sensitive. Many of the other potential CSIs considered are affected by extreme weather events, but could not be clearly classified as climate-sensitive. An additional literature search comparing awareness of climate influences on potential CSIs between 1997-2006 and 2007-2016 showed an increase in the number of papers mentioning effects of climate change. CONCLUSIONS: The four CSIs identified in this study could be targeted in a systematic surveillance programme in Northern regions. It is evident that climate change can affect the epidemiology and geographical range of many infectious diseases, but there were difficulties in identifying additional CSIs, most likely because other factors may be of equal or greater importance. However, climate-ecological dynamics are constantly under change, and therefore diseases may fall in or out of the climate-sensitive definition over time. There is increasing awareness in the literature of the effects of climate change on infectious diseases over time.

The creosote content of used railway crossties as compared with European stipulations for hazardous waste.

Through the history of railways, wooden crossties impregnated with potentially hazardous creosote tar have supported the rails. With impregnated crossties having a lifespan of approximately 50 years, their creosote content is considered as quite safely stored while in dug-down usage. This situation of relative safety does, however, change into acute risk upon replacement and destruction. Carrying a highly flammable content, creosote crossties discharge a pulse of carcinogenic PAH compounds if burnt as ordinary waste. Safe destruction is therefore required if concentrations exceed a critical limit stipulated by the European Union. Since safe destruction is a process of considerable expense, there is a tendency among financial stakeholders to underestimate the creosote content of used railway crossties. In order to actually test whether concentrations generally exceed the critical limit, a set of used creosote ties was therefore sampled while still situated in the railway embankment. With a standard sum of sixteen PAH compounds used as an expression of their total creosote content, the generic concentration was formally inferred and found to significantly exceed the critical limit. The same applies to the fraction of seven carcinogenic PAH compounds, that alone exceed the stipulated limit for hazardous waste. It was also found that the material of railway embankments, whether or not the crossties were used in switches and/or railway yards, and sample depth within the crossties, has a significant effect on creosote concentrations. Regardless of the status of these factors, the concentrations significantly exceed the critical limit that defines hazardous waste within the European Union.

Functional microbial diversity of the railway track bed.

Railways constitute relatively unexplored microbial habitats. Little is known about the amounts, activities or distributions of microorganisms and their associated heterotrophic capabilities on railway embankments. The aim of this study was to investigate the microbiology of two Swedish railway tracks in order to fill some of the gaps in the available information. We estimated microbial biomass by means of substrate-induced respiration, microbial activity as basal respiration (BR) and as a kinetically derived parameter (r) hypothesised to correspond to the active fraction of the microbial biomass. It was confirmed that the microbial biomass and activity were low as compared with agricultural soils and that their distributions were distinctly positively skewed. Spatial Kriging revealed that covariance structures were sustained on a scale smaller than the employed sampling grid (<1 m). Substrate richness (SR), as measured with Biolog ECO plates, was used as a quantitative measure of functional diversity. SR correlated to microbial activity and SIR, indicating that functional traits were lacking where the microbial biomass was low or less active. The dependence of microbial activities on basic soil characteristics were inferred by separately designed general linear models. Water content was found to be the most important factor moderating basal respiration and functional diversity, whereas the organic matter content was identified as the most important covariate for SIR. Multivariate analysis of the carbon source utilisation patterns of the Biolog plates with equivalent average well-colour development revealed homogenous substrate utilisation among samples. This indicates that the microbial functional potential is randomly distributed in the railway track bed. In combination, our findings imply that the ecosystem functionality of railway embankments may be seriously hampered as compared with agricultural soils. This has consequences for the risk assessment of herbicides applied to railways.

Prognostic factors in whiplash-associated disorders.

Whiplash-associated disorders (WADs) have become an increasing problem over the years and many authors have addressed the issue. The aim of the present study is to identify predictors for perceived disability and self-registered pain from a functional perspective, as well as to study the temporal evolution of patients' complaints. Eighty-three patients suffering from pain in the neck following acute whiplash injury were included in the study and they were consecutively monitored at three weeks, three months and one year after injury. The results suggest that a linear combination of sex, self-efficacy and WAD grade significantly explains 24% of the variation observed in pain intensity at the one-year follow-up, whereas a linear combination of self-efficacy, sex and age significantly explains 36% of the variation observed in disability at the one-year follow-up. Five per cent of the patients were non-symptomatic at the first monitoring occasion and 16% at the one-year follow-up. It is concluded that WAD patients' self-efficacy at an early stage after whiplash injury significantly predicts the temporal development of pain intensity and disability. It may therefore be suggested that patients' confidence in performing daily activities should be reinforced in order to optimize treatment after whiplash injury.

Physiotherapy treatment of the diabetic shoulder: a longitudinal study following patients with diabetes and shoulder pain using a pre-post treatment design.

PURPOSE: The aim of this study was to describe and evaluate a physiotherapy program targeted to reduce pain intensity and improve the daily functioning of diabetics with shoulder problems. It was hypothesized that patients receiving specific physiotherapy treatment improved more frequently and rapidly than diabetic patients followed up without specific physiotherapeutic intervention. METHOD: A pre-post treatment design was completed for a group of 10 subjects. The treatment protocol, also applied during the daily activities of the subjects, was aiming at reducing pain intensity and shoulder stiffness and improving impaired functioning in daily activities by muscle relaxation, light-load exercise and enhancing proper shoulder co-ordination. RESULTS: The group analysis showed significant decrease of pain intensity level as well as improved shoulder functioning and sustained level of subject self-efficacy beliefs throughout the study period. CONCLUSIONS: The results suggest that it is possible to relieve shoulder pain intensity and improve daily activities of patients with diabetes-related shoulder problems by employing a physiotherapy program focusing on muscle relaxation, light-load exercise and on the enhancement of proper shoulder co-ordination in daily activities. IMPLICATIONS FOR REHABILITATION: A physiotherapy program can be effective in reducing pain and improving shoulder function in diabetics with shoulder problems. The treatment should focus on muscle relaxation, light-load exercise and on the enhancement of proper shoulder co-ordination in daily activities.

Time lag between peak concentrations of plasma and salivary cortisol following a stressful procedure in dairy cattle.

BACKGROUND: Measurement of salivary cortisol has been used extensively as a non-invasive alternative to blood sampling to assess adrenal activity in ruminants. However, there is evidence suggesting a considerable delay in the transfer of cortisol from plasma into saliva. Previous studies in cattle have used long sampling intervals making it difficult to characterise the relationship between plasma and salivary cortisol (PLCort and SACort, respectively) concentrations at different time points and determine whether or not such a time lag exist in large ruminants. Therefore, the objective of this study was to characterise the relationship between plasma and salivary cortisol and determine if there is a significant time lag between reaching peak cortisol concentrations in plasma and saliva across a 4.25 h time-period, using short sampling intervals of 10-15 min, following social separation in dairy cattle.Five cows were separated from their calves at 4 days after calving, and six calves were separated from a group of four peers at 8 weeks of age. Following separation, the animals were moved to an unfamiliar surrounding where they could not see their calves or pen mates. The animals were catheterised with indwelling jugular catheters 1 day before sampling. Blood and saliva samples were obtained simultaneously before and after separation. RESULTS: In response to the stressors, PLCort and SACort increased reaching peak concentrations 10 and 20 min after separation, respectively. This suggested a 10 min time lag between peak cortisol concentrations in plasma and saliva, which was further confirmed with a time-series analysis. Considering the 10 min time lag, SACort was strongly correlated with PLCort (P < 0.0001). CONCLUSIONS: Salivary cortisol correlates well with plasma cortisol and is a good indicator of the time-dependent variations in cortisol concentrations in plasma following acute stress. However, there is a time lag to reach peak cortisol concentrations in saliva compared to those in plasma, which should be considered when saliva samples are used as the only measure of hypothalamic-pituitary-adrenal axis response to stress in cattle.

Ecosystem change and stability over multiple decades in the Swedish subarctic: complex processes and multiple drivers.

The subarctic environment of northernmost Sweden has changed over the past century, particularly elements of climate and cryosphere. This paper presents a unique geo-referenced record of environmental and ecosystem observations from the area since 1913. Abiotic changes have been substantial. Vegetation changes include not only increases in growth and range extension but also counterintuitive decreases, and stability: all three possible responses. Changes in species composition within the major plant communities have ranged between almost no changes to almost a 50 per cent increase in the number of species. Changes in plant species abundance also vary with particularly large increases in trees and shrubs (up to 600%). There has been an increase in abundance of aspen and large changes in other plant communities responding to wetland area increases resulting from permafrost thaw. Populations of herbivores have responded to varying management practices and climate regimes, particularly changing snow conditions. While it is difficult to generalize and scale-up the site-specific changes in ecosystems, this very site-specificity, combined with projections of change, is of immediate relevance to local stakeholders who need to adapt to new opportunities and to respond to challenges. Furthermore, the relatively small area and its unique datasets are a microcosm of the complexity of Arctic landscapes in transition that remains to be documented.

Impact of stroke on anterior-posterior force generation prior to seat-off during sit-to-walk.

Force generation during sit-to-walk (STW) post-stroke is a poorly studied area, although STW is a common daily transfer giving rise to a risk of falling in persons with disability. The purpose of this study was to describe and compare strategies for anterior-posterior (AP) force generation prior to seat-off during the STW transfer in both subjects with stroke and in matched controls. During STW at self-selected speed, AP force data were collected by 4 force plates, beneath the buttocks and feet from eight subjects with stroke (>6 months after onset) and 8 matched controls. Subjects with post-stroke hemiparesis and matched controls generated a similar magnitude of total AP force impulses (F(1,71)=0.67; p=0.42) beneath buttocks and feet prior to seat-off during STW. However, there were significant group differences in AP force impulse generation beneath the stance buttock (i.e. the non-paretic buttock in the stroke group), with longer duration (F(1,71)=8.78; p<0.005), larger net AP impulse (F(1,71)=6.76; p<0.05) and larger braking impulse (F(1,71)=7.24; p<0.05) in the stroke group. The total braking impulse beneath buttocks and feet was about 4.5 times larger in the stroke group than in the control group (F(1,71)=8.84; p<0.005). An intra- and inter-limb dys-coordination with substantial use of braking impulses was demonstrated in the stroke group. This motor strategy differed markedly from the smooth force interaction in the control group. These results might be important in the development of treatment models related to locomotion post-stroke.