How oxygen deficiency in the Baltic Sea proper has spread and worsened: The role of ammonium and hydrogen sulphide.

Even large inflows of oxygen-rich seawater to the Baltic Proper have in recent decades given only short-lived relief from oxygen deficiency below the halocline. We analyse long-term changes in oxygen deficiency, and calculate the "total oxygen debt" [Formula: see text]OD, the oxygen required to oxidize the hydrogen sulphide (H2S) and ammonium (NH4) that builds up during stagnation periods. Since the early 1990s, oxygen below 65m has gradually decreased during successive stagnation periods, and the [Formula: see text]OD has increased, with NH4 more important than previously recognised. After the major inflow in 2014, the Baltic Proper [Formula: see text]OD has reached its highest level so far. The gradual shift of the [Formula: see text]OD to shallower sub-halocline waters in the western and northern basins has increased the risk of periodic coastal hypoxia and export of hypoxic water to the Bothnian Sea. The potential for inflows large enough to more than eliminate the [Formula: see text]OD seems limited in the near term.

Healthcare professionals' perceptions about interprofessional teamwork: a national survey within Swedish child healthcare services.

BACKGROUND: Globally, interprofessional teamwork is described as a key method to promote health and prevent illness in children, namely, to achieve the goals of Child Healthcare Services (CHS). However, how teamwork should be designed within CHS to achieve the goals is unclear. This study aimed to investigate healthcare professionals' perceptions about 1) taking part in interprofessional teamwork, 2) team characteristics, and 3) whether the perceptions were related to professional affiliation or workplace. METHODS: A national cross-sectional survey was conducted using a web-based study-specific questionnaire sent to all accessible nurses, physicians, and psychologists in Swedish CHS (n = 3552). The response rate was 31.5%. To identify possible associations, logistic regressions were conducted. RESULTS: Almost all respondents, 1096/1119 (97.9%), reported taking part in some type of interprofessional teamwork within the Swedish CHS. Among those, the most common was team-based visits (82.2%). It was perceived that performing team-based visits resulted in fulfilled goals, expertise exceeding individual team members' competences, provision of high-quality care, and meeting children's and families' needs, to a greater extent, than if not performing team-based visits. Correspondingly, working as a team in parental groups was perceived as resulting in fulfilled goals, meeting the needs of children and their families, and continuity within the team to a greater extent than if not working together in a team. Professional affiliation was associated with different perceptions and types of teamwork. Family Centers were positively associated with all types of teamwork as well as continuity within the team. CONCLUSIONS: Healthcare professionals' perceptions about team characteristics were associated with professional affiliation, workplace, and type of teamwork (defined as team activities) within the CHS. Professionals within Swedish CHS, taking part in team-based visits and in interprofessional teamwork in parental groups, perceived that the team fulfilled its goals and met the needs of children and families to a greater extent than professionals not taking part in these types of teamwork. Professionals at Family Centers were more likely to work in teams in different ways. Knowledge about interprofessional teamwork for individuals and groups in Swedish CHS might also be valuable in other healthcare settings, dealing with complex needs.

Radical cystectomy compared to intravesical BCG immunotherapy for high-risk non-muscle invasive bladder cancer - is there a long-term survival difference? A Swedish nationwide analysis.

OBJECTIVES: High-risk non-muscle invasive urinary bladder cancer (NMIBC) presents an increased risk of progression and cancer death. To reduce these risks, two different treatments are recommended - BCG or radical cystectomy (RC). The purpose of this study is to analyze cancer-specific survival of these two initial treatments. MATERIALS AND METHODS: BladderBaSe links information from the SNRUBC from 1997 to 2014, with a number of national healthcare and demographic registers. BCG was used for 3,862 patients (399 had delayed RC), while 687 had initial RC. Propensity scores were used to match the patients treated with RC and with relevant variables such as age, gender, and tumor stage with the same number treated with BCG (673 each arm). In a further comparison, an instrumental variable analysis using hospital strategy as the instrument was used. RESULTS: The 5-year cancer-specific survival chance was higher for the BCG group than it was for the initial RC group, 87 vs 71%, respectively. In the population with propensity score matching, 78 died from cancer in the BCG group during follow-up and 162 in the RC group. In the instrumental variable analysis, the multivariate adjusted risk difference of cancer-specific death 2 years after diagnosis was 32 per 100 treated patients, in favor of the BCG group. CONCLUSIONS: BCG therapy had better cancer-specific survival than RC also when two different statistic methods were used to try to control for confounding. A prospective randomized trial will be necessary to rule out that selection is a major factor for the outcome.

Fall Prevention Exercises With or Without Behavior Change Support for Community-Dwelling Older Adults: A Two-Year Follow-Up of a Randomized Controlled Trial.

This study investigates the effectiveness of two fall prevention exercise interventions targeting physical performance, activity level, fall-related self-efficacy, health-related quality of life, and falls: the Otago Exercise Programme (OEP) with and the OEP without behavior change support. In this randomized controlled trial (RCT), 175 participants were randomised into two intervention groups and one control group. A total of 124 community-dwelling older adults over the age of 75 who needed walking aids or home support participated in the two-year follow-up. The OEP with and the OEP without support for behavior change displayed no long-term benefits on physical performance, fall-related self-efficacy, health-related quality of life, and falls compared to a control group. Although no significant differences were detected between the groups, the results implied the control group's physical activity level decreased compared to the intervention groups at two-year follow up.

Nitrogen fixation by cyanobacteria stimulates production in Baltic food webs.

Filamentous, nitrogen-fixing cyanobacteria form extensive summer blooms in the Baltic Sea. Their ability to fix dissolved N2 allows cyanobacteria to circumvent the general summer nitrogen limitation, while also generating a supply of novel bioavailable nitrogen for the food web. However, the fate of the nitrogen fixed by cyanobacteria remains unresolved, as does its importance for secondary production in the Baltic Sea. Here, we synthesize recent experimental and field studies providing strong empirical evidence that cyanobacterial nitrogen is efficiently assimilated and transferred in Baltic food webs via two major pathways: directly by grazing on fresh or decaying cyanobacteria and indirectly through the uptake by other phytoplankton and microbes of bioavailable nitrogen exuded from cyanobacterial cells. This information is an essential step toward guiding nutrient management to minimize noxious blooms without overly reducing secondary production, and ultimately most probably fish production in the Baltic Sea.

Responses of phyto- and zooplankton communities to Prymnesium polylepis (Prymnesiales) bloom in the Baltic Sea.

A large bloom of Prymnesium polylepis occurred in the Baltic Sea during the winter 2007-spring 2008. Based on numerous reports of strong allelopathic effects on phytoplankton exerted by P. polylepis and its toxicity to grazers, we hypothesized that during this period negative correlations will be observed between P. polylepis and (1) main phytoplankton groups contributing to the spring bloom (i.e., diatoms and dinoflagellates), and (2) zooplankton growth and abundance. To test these hypotheses, we analyzed inter-annual variability in phytoplankton and zooplankton dynamics as well as growth indices (RNA:DNA ratio) in dominant zooplankton in relation to the Prymnesium abundance and biomass. Contrary to the hypothesized relationships, no measurable negative responses to P. polylepis were observed for either the total phytoplankton stocks or the zooplankton community. The only negative response, possibly associated with P. polylepis occurrence, was significantly lower abundance of dinoflagellates both during and after the bloom in 2008. Moreover, contrary to the expected negative effects, there were significantly higher total phytoplankton abundance as well as significantly higher winter abundance and winter-spring RNA:DNA ratio in dominant zooplankton species in 2008, indicating that P. polylepis bloom coincided with favourable feeding conditions for zooplankton. Thus, primary consumers, and consequently also zooplanktivores (e.g., larval fish and mysids), may benefit from haptophyte blooms, particularly in winter, when phytoplankton is scarce.

Hypoxia is increasing in the coastal zone of the Baltic Sea.

Hypoxia is a well-described phenomenon in the offshore waters of the Baltic Sea with both the spatial extent and intensity of hypoxia known to have increased due to anthropogenic eutrophication, however, an unknown amount of hypoxia is present in the coastal zone. Here we report on the widespread unprecedented occurrence of hypoxia across the coastal zone of the Baltic Sea. We have identified 115 sites that have experienced hypoxia during the period 1955-2009 increasing the global total to ca. 500 sites, with the Baltic Sea coastal zone containing over 20% of all known sites worldwide. Most sites experienced episodic hypoxia, which is a precursor to development of seasonal hypoxia. The Baltic Sea coastal zone displays an alarming trend with hypoxia steadily increasing with time since the 1950s effecting nutrient biogeochemical processes, ecosystem services, and coastal habitat.

Gender and age differences in the relative burden of rhinitis and asthma on health-related quality of life--a Swedish population study.

The aim of this study was to investigate the relative burden of rhinitis and asthma on health-related quality of life (HRQL) as a function of gender and age in the general population. A cross-sectional, general population survey was conducted, comprising 5918 men and women aged 16-64 years. The SF-36 Health Survey was administered by mail, along with questions regarding nasal complaints after 15 years of age and physician-diagnosed asthma. Overall, rhinitis and asthma were each associated with impaired HRQL compared with non-cases and the burden of these illnesses in combination was incremental. In the age group 16-49 years, men and women with rhinitis alone had significantly worse health profiles on most scales than non-cases, while asthmatics, with or without rhinitis, showed further decrements on only a few scales. In the age group 50-64 years, men with rhinitis did not differ from non-cases and no differences were found between asthmatics and rhinitis victims on any scale. In contrast, women aged 50-64 years with rhinitis had significantly worse scores than non-cases on bodily pain and general well-being scales (GH, VT), and asthmatics scored much lower on all scales than those with rhinitis alone. The negative association of rhinitis and asthma with HRQL differs by age and sex in the general population. Women aged 50-64 years with one or both ailments are particularly affected. Such gender and age differences should be taken into consideration in the care and treatment of patients with rhinitis and asthma.

Particle-water partitioning of PCBs in the photic zone: a 25-month study in the open Baltic Sea.

From previous laboratory and field studies, it remains unclear whether partitioning of hydrophobic organic contaminants (HOCs) to phytoplankton from water is kinetically limited or may be treated as an equilibrium process. Here, we report on the partitioning of polychlorinated biphenyls (PCBs) to particulate organic carbon (POC), dominated by planktonic primary production, in the open Baltic Sea during a 25-month period. The organic carbon-normalized partition coefficient (Koc) was corrected for temperature, salinity, and sorption to filter-passing organic carbon. At all 21 sampling occasions, the log Koc-log Kow regression was significantly linear, despite a large variation in biogeochemical parameters such as POC concentration and composition, primary production, and phytoplankton species composition. These data strongly suggest that partitioning of PCBs to POC in temperate surface waters is equilibrated and therefore not kinetically limited by factors such as rapid phytoplankton growth rate or large cell size. The partitioning of PCBs to the POC was described throughout seasonal cycles by log Koc = 0.88 +/- 0.07 log Kow + 0.90 +/- 0.47 (95% confidence interval). The slope of the log Koc-log Kow regression for the single sampling occasions varied between 0.56 and 1.25, and there was a seasonal variation in the POC sorbent quality (e.g., log Koc for PCB 28 varied between 5.5 and 6.9; median 5.9). These variations reflect the variability in structural composition of the POC pool in such pelagic waters. Being able to predict particle-water partitioning of HOCs significantly reduces the required complexity of both food web uptake models and predictions of POC-mediated export of HOCs to the deep ocean.