Remote neuropsychological assessment of patients with neurological disorders and injuries-a study protocol for a cross-sectional case-control validation study.

INTRODUCTION: There are great potential benefits of being able to conduct neuropsychological assessments remotely, especially for hard-to-reach or less mobile patient groups. Such tools need to be equivalent to standard tests done in the clinic and also easy to use in a variety of clinical populations. METHODS AND ANALYSIS: This study protocol describes a cross-sectional study aimed at validating the newly developed digitalized neuropsychological test battery Mindmore Remote in patients with neurological disorders and injuries. Diagnoses comprise traumatic brain injury, stroke, Parkinson's disease, multiple sclerosis, brain tumour and epilepsy. 50 patients in each patient group will be included. In addition, 50 healthy controls will be recruited. All participants will undergo both testing with Mindmore Remote at home and traditional neuropsychological assessment face-to-face in a randomised order. The primary outcome is the association between tests from the Mindmore Remote battery and their equivalent traditional neuropsychological tests. Further, bias between methods and differences between groups will also be investigated. ETHICS AND DISSEMINATION: The study protocol has been approved by the Swedish Ethical Review Authority (2022-06230-01) and adheres to the declaration of Helsinki. All participants will be given oral and written information about the study and sign informed consent forms before entering the study. All participants are informed that they can terminate their participation in the study at any given time, without giving any explanation, and participating in the study or not will not affect their care at the clinic. Neither authors nor personnel involved in the research project are affiliated with Mindmore AB. The results from the study will be published in peer-reviewed scientific journals and presented at national and international conferences on the topic. TRIAL REGISTRATION NUMBER: NCT05819008.

Kinship and socio-economic status: Social gradients in frequencies of kin across the life course in Sweden.

The influence of kin on various outcomes is heavily debated. However, kinship size itself conditions the probability of potential effects. Socio-economic gradients in the prevalence, variance, and types of kin are, therefore, a vital aspect of the functions of kin. Unfortunately, these parameters are largely unknown. We used Swedish register data to enumerate consanguine and in-law kin across the life course of the 1975 birth cohort. We calculated differences in kinship size between this cohort's income quartiles and educational groups. We decomposed how specific kin relations, generations, and demographic behaviours contributed to these differences. Among low socio-economic status (SES) groups, higher fertility in earlier generations resulted in more kin compared with high-SES groups. Low-SES groups had more horizontal consanguine kin, while high-SES groups had more in-laws. Lower fertility and higher union instability among low-SES men substantially narrowed SES differences in kinship size. Kinship size varied substantially within SES groups.

The Swedish Kinship Universe: A Demographic Account of the Number of Children, Parents, Siblings, Grandchildren, Grandparents, Aunts/Uncles, Nieces/Nephews, and Cousins Using National Population Registers.

Given that surprisingly little is known about the demography of human kinship, we provide a demographic account of the kinship networks of individuals in Sweden in 2017 across sex and cohort between ages 0 and 102. We used administrative register data of the full population of Sweden to provide the first kinship enumeration for a complete population based on empirical data. We created ego-focused kinship networks of children, parents, siblings, grandchildren, grandparents, aunts and uncles, nieces and nephews, and cousins. We show the average number of kin of different types, the distribution of the number of kin, and changes in dispersion over time. A large share of all kin of an individual are horizontal kin, such as cousins. We observe the highest number of kin-on average, roughly 20-around age 35. We show differences between matrilineal and patrilineal kin and differences in the kinship structure arising from fertility with more than one childbearing partner, such as half-siblings. The results demonstrate substantial variability in kinship within a population. We discuss our findings in the context of other methods to estimate kinship.

Mental fatigue, cognitive performance and autonomic response following sustained mental activity in clinical burnout.

OBJECTIVE: To investigate the effects of sustained mental activity on perceptions of mental fatigue, cognitive performance, and autonomic response in patients with clinical burnout as compared to a healthy control group. METHODS: Patients with clinical burnout (n = 30) and healthy control participants (n = 30) completed a 3-hour test session, in which they were administered a set of cognitive tests before and after an effortful cognitive task with concurrent sound exposure. Perceptions of mental fatigue and task demands (mental effort and concentration difficulties) were assessed repeatedly over the course of the test session. Heart rate variability was recorded to index autonomic response. RESULTS: In comparison with controls, perceived mental fatigue increased earlier in the session for the clinical burnout group and did not recover following a short rest period. Throughout the session, patients rated the tasks as more demanding and showed less improvement on measures of attention and processing speed, inhibition and working memory. While autonomic responses were initially comparable, there was a unique decrease in high-frequency heart rate variability in the clinical burnout group after extended testing and exposure. CONCLUSION: Patients with clinical burnout are affected differently than healthy controls by sustained mental activity, as reflected by ratings of perceived mental fatigue, aspects of cognitive performance and autonomic response. Further investigation into the role of autonomic regulation in relation to cognitive symptoms in clinical burnout is warranted.

A matter of time: Bateman's principles and mating success as count and duration across social strata in contemporary Finland.

Bateman's principles heavily influence the understanding of human reproductive behaviour. Yet, few rigorous studies on Bateman's principles in contemporary industrialized populations exist. Most studies use small samples, exclude non-marital unions, and disregard recent insights on within-population heterogeneity in mating strategies. We assess mating success and reproductive success using population-wide Finnish register data on marital and non-marital cohabitations and fertility. We examine variability across social strata in the Bateman principles and analyse the mate count, the cumulated duration with a mate, and the association with reproductive success. Results support Bateman's first and second principles. Regarding Bateman's third principle, the number of mates is more positively associated with reproductive success for men than women, but this association is driven by ever having a mate. Having more than one mate is on average associated with lower reproductive success. However, for men in the lowest income quartile, having more than one mate positively predicts reproductive success. Longer union duration is associated with higher reproductive success, and more so for men. We note that sex differences in the relationship between mating success and reproductive success differ by social strata, and argue that mate duration may be an important component of mating success alongside mate count.

Comparable responses to a wide range of olfactory stimulation in women and men.

The evidence for differences between women and men in terms of olfactory abilities is contradictory. We analyzed women and men's performance and reactions to a wider range of odour exposure outcomes than usually studied, to assess possible differences and similarities between sexes. Measures of sensitivity and sensory decision rule were established in 37 women and 39 men. Perceptual, cognitive, symptom-related and autonomic nervous system (skin conductance level and heart-rate variability) reactions were also assessed during extended ambient odour exposure, as well as participants' self-rated chemical intolerance. Bayesian analyses consistently revealed greater support for sex-related similarities than differences, suggesting that women and men perform and react comparably not only in terms of basic olfactory measures, but also to environmental odour exposure mimicking everyday situations.

Less Is More? Repartnering and Completed Cohort Fertility in Finland.

An extensive literature theorizes the role of repartnering for cohort fertility and whether union dissolution can be an engine for fertility. A large share of higher order unions are nonmarital cohabitations, but most previous studies on completed cohort fertility have analyzed only marital unions, and none have incorporated nonmarital cohabitations using population-level data. To analyze the relationship between the number of unions and cohort fertility for men and women, we use Poisson regression with Finnish register data to enumerate every birth, marriage, and cohabitation among the 1969-1972 birth cohorts at ages 18-46. We show that dissolutions of first cohabitations are the main pathway to repartnering and that most higher order unions are cohabitations. Nonmarital repartnering is a strong predictor of low fertility. In contrast, remarriage is positively associated with cohort fertility. Because the bulk of first-union dissolutions and higher order unions are nonmarital, repartnering is not an efficient engine for fertility at the aggregate level. Marriage and cohabitation are far from indistinguishable in a country often described as a second demographic transition forerunner.

Parity disparity: Educational differences in Nordic fertility across parities and number of reproductive partners.

Most research on trends in socio-economic fertility differences has focused on cohort total fertility and on women. This study aimed to analyse how cohort trends in parity-specific fertility differ across educational segments for men and women and what role multi-partner fertility plays in these trends. We used Finnish and Swedish register data on cohorts born in 1940-73/78. The main analyses used parity progression ratios, comparing ordinary ratios with similar ratios using births to first reproductive partners only. Among the low and medium educated, we observe strengthening parity polarization across cohorts, with increases in both childlessness and births of order three or higher, the latter largely reflecting increases in multi-partner fertility. Highly educated men and women more often have exactly two children. We demonstrate that cohort total fertility can mask significant parity-specific trends across educational groups and that changes in multi-partner fertility can play a part in cohort trends in socio-economic fertility differentials.

Multiple chemical sensitivity described in the Danish general population: Cohort characteristics and the importance of screening for functional somatic syndrome comorbidity-The DanFunD study.

BACKGROUND: Multiple chemical sensitivity (MCS) is characterized by widespread symptoms attributed to exposure to airborne chemicals. MCS is categorized as a functional somatic syndrome (FSS), and MCS cases often meet the criteria for other types of FSS, e.g. fibromyalgia. The primary aim was to characterize MCS regarding symptom triggers, symptoms, lifestyle and describe demographics, socioeconomics and lifestyle factors associated with MCS. A secondary aim was to examine the implication of FSS comorbidity. METHODS: Data were derived from a random sample of the Danish adult population enrolled in the Danish Study of Functional Disorders (DanFunD; n = 9,656). Questionnaire data comprised information used to delimit MCS and four additional types of FSS, as well as data on demographics, socioeconomics and lifestyle. MCS cases (n = 188) was stratified into subgroups; MCS only (n = 109) and MCS with comorbid FSS (n = 73). Information regarding FSS comorbidities were missing for six MCS cases. MCS subgroups and controls without FSS comorbidities (n = 7,791) were compared by means of logistic regression analyses, adjusted for age and sex. RESULTS: MCS was associated with female sex, not being in occupation and low social status, but not with age or education. MCS cases reported normal dietary intake and smoking habits and lower alcohol consumption. Additional associations were found between MCS and low rate of cohabitation, sedentarism, daily physically limitations, and poor quality of sleep. However, subgroup analysis revealed that these findings were primarily associated with MCS with comorbid FSS. CONCLUSIONS: MCS was associated with lower socioeconomic status, physically inactivity and poor quality of sleep. Subgroup analysis revealed that several associations was explained by FSS comorbidity, i.e. MCS cases with no comorbid FSS showed normal rate of cohabitation and did not report physical limitations or difficulties sleeping. Overall, our findings emphasise the importance of screening MCS cases for FSS comorbidity both in epidemiological and clinical settings.

Lifetime parenthood in the context of single- and multiple-partner fertility.

The proportion of life spent caring for dependent children is a defining feature of life courses. This study uses Swedish register data to analyze the period of life spent as parents to children no older than 18 as a salient difference between single- and multiple-partner fertility trajectories. Individuals who have children with more than one partner spend a much longer time as parents to dependent children than those who have children with one partner, on average 8.2 more years among men and 6.2 more years among women. Cross-partner birth spacing is a more powerful proximate cause of this gap than completed fertility. We argue that an extended time parenthood is part and parcel to multi-partner fertility and discuss implications of this.

Chemical Intolerance Is Associated With Altered Response Bias, not Greater Sensory Sensitivity.

Chemical intolerance is a surprisingly prevalent condition or affliction characterized by adverse reactions to low levels of chemical, often odorous stimulation. Sufferers often assume that their plight is due to an uncommon sensory acuteness, yet studies repeatedly fail to reveal altered detection thresholds. Here, we investigated whether self-reported chemical intolerance is associated with altered sensory sensitivity or response bias. The sensory acuity (sensitivity; A) and sensory decision rule (criterion; B) to n-butanol was assessed using the method of constant stimuli in 82 participants with different degrees of chemical intolerance (low to high). Higher self-reported chemical intolerance was associated with a lower criterion, but not with sensitivity.

Neurocognitive processes underlying heuristic and normative probability judgments.

Judging two events in combination (A&B) as more probable than one of the events (A) is known as a conjunction fallacy. According to dual-process explanations of human judgment and decision making, the fallacy is due to the application of a heuristic, associative cognitive process. Avoiding the fallacy has been suggested to require the recruitment of a separate process that can apply normative rules. We investigated these assumptions using functional magnetic resonance imaging (fMRI) during conjunction tasks. Judgments, whether correct or not, engaged a network of brain regions identical to that engaged during similarity judgments. Avoidance of the conjunction fallacy additionally, and uniquely, involved a fronto-parietal network previously linked to supervisory, analytic control processes. The results lend credibility to the idea that incorrect probability judgments are the result of a representativeness heuristic that requires additional neurocognitive resources to avoid.

Online Distance Education and Transition to Parenthood Among Female University Students in Sweden.

The expansion of tertiary education is key to understanding postponement of first births. Currently, online distance education is changing the nature of university enrolment. In this study, I suggest that online distance education impacts on fertility by facilitating the transition to parenthood among students. I examine the relationship between online distance education and first births during university enrolment. Using survival analysis of register data for the 1968-1991 female cohorts, I examine the impact of distance and campus education on first-parity transitions during university enrolment between 2004 and 2012 (N = 938,768). Results indicate that the negative association between enrolment and first parity conception differs substantially between campus and distance enrolment. Compared to non-enrolment, the hazard of first parity conception is 70% lower during campus enrolment but 43% lower during distance enrolment. These findings are discussed in relation to educational heterogeneity and fertility postponement and the impact of technological innovation on family dynamics.

Insights from the third international conference on hyperacusis: causes, evaluation, diagnosis, and treatment.

BACKGROUND: Hyperacusis is intolerance of certain everyday sounds that causes significant distress and impairment in social, occupational, recreational, and other day-to-day activities. OBJECTIVE: The aim of this report is to summarize the key findings and conclusions from the Third International Conference on Hyperacusis. TOPICS COVERED: The main topics discussed comprise (1) diagnosis of hyperacusis and audiological evaluations, (2) neurobiological aspect of hyperacusis, (3) misophonia, (4) hyperacusis in autism spectrum disorder, (5) noise sensitivity, (6) hyperacusis-related distress and comorbid psychiatric illness, and (7) audiologist-delivered cognitive behavioral therapy for hyperacusis. CONCLUSIONS: Implications for research and clinical practice are summarised.

Effects of Task Demands on Olfactory, Auditory, and Visual Event-Related Potentials Suggest Similar Top-Down Modulation Across Senses.

A widely held view is that top-down modulation of sensory information relies on an amodal control network that acts through the thalamus to regulate incoming signals. Olfaction lacks a direct thalamic projection, which suggests that it may differ from other modalities in this regard. We investigated the late positive complex (LPC) amplitudes of event-related potentials (ERP) from 28 participants, elicited by intensity-matched olfactory, auditory and visual stimuli, during a condition of focused attention, a neutral condition, and a condition in which stimuli were to be actively ignored. Amplitudes were largest during the attend condition, lowest during the ignore condition, with the neutral condition in between. A Bayesian analysis resulted in strong evidence for similar effects of task across sensory modalities. We conclude that olfaction, despite its unique neural projections, does not differ from audition and vision in terms of task-dependent neural modulation of the LPC.

Symptoms from masked acrolein exposure suggest altered trigeminal reactivity in chemical intolerance.

BACKGROUND: Chemical intolerance (CI) is a widespread occupational and public health problem characterized by symptoms that reportedly result from low-levels of chemical exposure. The mechanisms behind CI are unknown, however modifications of the chemical senses (rather than toxic processes) have been suggested as key components. The aim of this study was to investigate whether individuals with self-reported CI report more sensory irritation during masked acrolein exposure compared to controls without CI. METHODS: Individuals with CI (n=18) and controls without CI (n=19) were exposed in an exposure chamber. Each participant took part in two exposure conditions - one with heptane (the masking compound), and one with heptane and acrolein at a dose below previously reported sensory irritation thresholds. The exposures lasted for 60min. Symptoms and confidence ratings were measured continuously throughout the exposure as were measurements of electrodermal activity and self-reported tear-film break-up time. Participants were blind to exposure condition. RESULTS: Individuals with CI, compared with controls reported greater sensory irritation in the eyes, nose and throat when exposed to acrolein masked with heptane. There was no difference during exposure to heptane. CONCLUSIONS: Masked exposure to acrolein at a concentration below the previously reported detection threshold is perceived as more irritating by individuals with CI compared with controls. The results indicate that there is altered trigeminal reactivity in those with CI compared to controls.

Short-term olfactory sensitization involves brain networks relevant for pain, and indicates chemical intolerance.

Chemical intolerance is a medically unexplained affliction that implies deleterious reactions to non-toxic everyday chemical exposure. Sensitization (i.e. increased reactivity to repeated, invariant stimulation) to odorous stimulation is an important component in theoretical explanations of chemical intolerance, but empirical evidence is scarce. We hypothesized that (1) individuals who sensitize to repeated olfactory stimulation, compared with those who habituate, would express a lower blood oxygenated level dependent (BOLD) response in key inhibitory areas such as the rACC, and higher signal in pain/saliency detection regions, as well as primary and/or secondary olfactory projection areas; and (2) olfactory sensitization, compared with habituation, would be associated with greater self-reported chemical intolerance. Moreover, we assessed whether olfactory sensitization was paralleled by comparable trigeminal processing - in terms of perceptual ratings and BOLD responses. We grouped women from a previous functional magnetic imaging study based on intensity ratings of repeated amyl acetate exposure over time. Fourteen women sensitized to the exposure, 15 habituated, and 20 were considered "intermediate" (i.e. neither sensitizers nor habituaters). Olfactory sensitizers, compared with habituaters, displayed a BOLD-pattern in line with the hypothesis, and reported greater problems with odours in everyday life. They also expressed greater reactions to CO2 in terms of both perceived intensity and BOLD signal. The similarities with pain are discussed.

Gene expression profiling in persons with multiple chemical sensitivity before and after a controlled n-butanol exposure session.

OBJECTIVES: To investigate the pathophysiological pathways leading to symptoms elicitation in multiple chemical sensitivity (MCS) by comparing gene expression in MCS participants and healthy controls before and after a chemical exposure optimised to cause symptoms among MCS participants.The first hypothesis was that unexposed and symptom-free MCS participants have similar gene expression patterns to controls and a second hypothesis that MCS participants can be separated from controls based on differential gene expression upon a controlled n-butanol exposure. DESIGN: Participants were exposed to 3.7 ppm n-butanol while seated in a windowed exposure chamber for 60 min. A total of 26 genes involved in biochemical pathways found in the literature have been proposed to play a role in the pathogenesis of MCS and other functional somatic syndromes were selected. Expression levels were compared between MCS and controls before, within 15 min after being exposed to and 4 hours after the exposure. SETTINGS: Participants suffering from MCS and healthy controls were recruited through advertisement at public places and in a local newspaper. PARTICIPANTS: 36 participants who considered themselves sensitive were prescreened for eligibility. 18 sensitive persons fulfilling the criteria for MCS were enrolled together with 18 healthy controls. OUTCOME MEASURES: 17 genes showed sufficient transcriptional level for analysis. Group comparisons were conducted for each gene at the 3 times points and for the computed area under the curve (AUC) expression levels. RESULTS: MCS participants and controls displayed similar gene expression levels both at baseline and after the exposure and the computed AUC values were likewise comparable between the 2 groups. The intragroup variation in expression levels among MCS participants was noticeably greater than the controls. CONCLUSIONS: MCS participants and controls have similar gene expression levels at baseline and it was not possible to separate MCS participants from controls based on gene expression measured after the exposure.

Effects of Negative Affectivity and Odor Valence on Chemosensory and Symptom Perception and Perceived Ability to Focus on a Cognitive Task.

The aim was to gain understanding for the impact of negative affectivity (NA) and odor valance on perceptual aspects during low-level odorous exposure. Fifty-five young adults who were either relatively low or high in NA (anxiety, depression, and somatization) were randomized for exposure to either limonene (pleasant odor) or pyridine (unpleasant odor). In an exposure chamber, they took part in baseline, blank and stable exposure sessions, during which they rated odor intensity, impact on ability to focus on an imagined cognitive task, and intensity of symptoms. The results showed higher ratings of negative impact on ability to focus during exposure to the unpleasant odor compared with the pleasant odor, and an association between NA and symptom intensity, with 18% of the variance in symptom intensity explained by somatization. The association between NA and symptom intensity was found to be driven by the factor sex. These results imply (a) that prior findings of odorous exposure that interfere negatively with work performance may be due to impact of an unpleasant odor on ability to focus on cognitive tasks and (b) that there are associations between NA, sex, and symptoms that may partly be referred to attentiveness to and interpretation of bodily sensations.