Individual and neighborhood risk factors of hospital admission and death during the COVID-19 pandemic: a population-based cohort study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) disproportionately affects minority populations in the USA. Sweden - like other Nordic countries - have less income and wealth inequality but lacks data on the socioeconomic impact on the risk of adverse outcomes due to COVID-19. METHODS: This population-wide study from March 2020 to March 2022 included all adults in Stockholm, except those in nursing homes or receiving in-home care. Data sources include hospitals, primary care (individual diagnoses), the Swedish National Tax Agency (death dates), the Total Population Register "RTB" (sex, age, birth country), the Household Register (size of household), the Integrated Database For Labor Market Research "LISA" (educational level, income, and occupation), and SmiNet (COVID data). Individual exposures include education, income, type of work and ability to work from home, living area and living conditions as well as the individual country of origin and co-morbidities. Additionally, we have data on the risks associated with living areas. We used a Cox proportional hazards model and logistic regression to estimate associations. Area-level covariates were used in a principal component analysis to generate a measurement of neighborhood deprivation. As outcomes, we used hospitalization and death due to COVID-19. RESULTS: Among the 1,782,125 persons, male sex, comorbidities, higher age, and not being born in Sweden increase the risk of hospitalization and death. So does lower education and lower income, the lowest incomes doubled the risk of death from COVID-19. Area estimates, where the model includes individual risks, show that high population density and a high percentage of foreign-born inhabitants increased the risk of hospitalization. CONCLUSIONS: Segregation and deprivation are public health issues elucidated by COVID-19. Neighborhood deprivation, prevalent in Stockholm, adds to individual risks and is associated with hospitalization and death. This finding is paramount for governments, agencies, and healthcare institutions interested in targeted interventions.

Spatial and Temporal Trends of Persistent Organic Pollutants across Europe after 15 Years of MONET Passive Air Sampling.

The Global Monitoring Plan of the Stockholm Convention on Persistent Organic Pollutants (POPs) was established to generate long-term data necessary for evaluating the effectiveness of regulatory measures at a global scale. After 15 years of passive air monitoring (2003-2019), MONET is the first network to produce sufficient data for the analysis of continuous long-term temporal trends of POPs in air across the entire European continent. This study reports long-term concentrations of 20 POPs monitored at 32 sites in 27 European countries. As of January 1, 2019, the concentration ranges (pg/m3) were 1.1-52.8 (∑6PCB), 0.3-8.5 (∑12dl-PCB), 0.007-0.175 (∑17PCDD/F), 0.02-2.2 (∑9PBDE), 0.4-24.7 (BDE 209), 0.5-247 (∑6DDT), 1.7-818 (∑4HCH), 15.8-74.7 (HCB), and 5.9-21.5 (PeCB). Temporal trends indicate that concentrations of most POPs have declined significantly over the past 15 years, with median annual decreases ranging from -8.0 to -11.5% (halving times of 6-8 years) for ∑6PCB, ∑17PCDD/F, HCB, PeCB, and ∑9PBDE. Furthermore, no statistically significant differences were observed in either the trends or the concentrations of specific POPs at sites in Western Europe (WEOG) compared to sites in Central and Eastern Europe (CEE), which suggests relatively uniform compound-specific distribution and removal at the continental scale.

"Drugs Can Be a Great Coercion": Service Providers' Perspectives on the Relationship between Substance Use and Trauma Bonding among Survivors of Sex Trafficking.

While research has demonstrated a complex relationship between sex trafficking and substance use, the relationship between substance use and trauma bonding is not well understood. A trauma bond refers to an emotional attachment that can develop between victims and their abusers. This study aims to explore the relationship between substance use and trauma bonding among survivors of sex trafficking from the perspective of service providers working directly with survivors of sex trafficking. This qualitative study involved in-depth interviews with 10 participants. Purposeful sampling was employed among licensed social workers or counselors working directly with survivors of sex trafficking. Audio recordings of interviews were transcribed and coded using aspects of a grounded theory approach. Three themes emerged from the data regarding the relationship between substance use and trauma bonding among survivors of sex trafficking: substance use as a tactic, substance use as a risk factor, and substance use as a potential trauma bond. These findings support the need to treat substance use and mental health concerns concurrently among sex trafficking survivors. Additionally, these findings can inform legislators and policymakers as they consider the needs of survivors.

Comparison of the predictive value of the Helsinki, Rotterdam, and Stockholm CT scores in predicting 6-month outcomes in patients with blunt traumatic brain injuries.

PURPOSE: Despite advances in modern medicine, traumatic brain injuries (TBIs) are still a major medical problem. Early diagnosis of TBI is crucial for clinical decision-making and prognosis. This study aims to compare the predictive value of Helsinki, Rotterdam, and Stockholm CT scores in predicting the 6-month outcomes in blunt TBI patients. METHODS: This cohort study was conducted on blunt TBI patients of 15 years or older. All of them were admitted to the surgical emergency department of Shahid Beheshti Hospital in Kashan, Iran from 2020 to 2021 and had abnormal trauma-related findings on brain CT images. The patients' demographic data such as age, gender, history of comorbid conditions, mechanism of trauma, Glasgow coma scale, CT images, length of hospital stay, and surgical procedures were recorded. The Helsinki, Rotterdam, and Stockholm CT scores were simultaneously determined according to the existing guidelines. The included patients' 6-month outcome was determined using the Glasgow outcome scale extended. M Data were analyzed by SPSS software version 16.0. Sensitivity, specificity, negative/positive predictive value and the area under the receiver operating characteristic curve were calculated for each test. The Kappa agreement coefficient and Kuder Richardson-20 were used to compare the scoring systems. RESULTS: Altogether 171 TBI patients met the inclusion and exclusion criteria, with the mean age of (44.9 ± 20.2) years. Most patients were male (80.7%), had traffic related injuries (83.1%) and mild TBIs (64.3%). Patients with lower Glasgow coma scale had higher Helsinki, Rotterdam, and Stockholm CT scores and lower Glasgow outcome scale extended scores. Among all the scoring systems, the Helsinki and Stockholm scores showed the highest agreement in predicting patients' outcomes (kappa = 0.657, p < 0.001). The Rotterdam scoring system had the highest sensitivity (90.1%) in predicting death of TBI patients, whereas the Helsinki scoring system had the highest sensitivity (89.8%) in predicting the 6-month outcome in TBI patients. CONCLUSION: The Rotterdam scoring system was superior in predicting death in TBI patients, whereas the Helsinki scoring system was more sensitive in predicting the 6-month outcome.

A data-driven analysis of global research trends on dirty-dozen persistent organic pollutants.

The occurrence, distribution, and fate of persistent organic pollutants (POPs) have been extensively studied worldwide; however, the patterns and dynamics of scientific publications on POPs are still unclear. In this study, the research trends on dirty dozen POPs, which are identified under the Stockholm Convention (SC) for immediate action were investigated and evaluated in a broad context to obtain up-to-date information. For this purpose, bibliometric analysis was carried out between 1945 and 2021 using the Web of Science (WoS) database. A total of 197,029 publications were analyzed. "Environmental Sciences" was the most popular research category and the USA was the leading country in dirty dozen POPs studies. The research hotspots are related to the most used keywords such as "Polychlorinated Biphenyls", "Dioxin" and "Persistent Organic Pollutants". In the evaluation of keyword clusters with highlighted research points, 7 clusters were obtained from the publications, which are related to the chemical properties, synthesis, structures, health effects, and analysis methods of dirty dozen POPs. The number of publications and, accordingly, the scientific interest in dirty dozen POPs listed under the SC has not reached equilibrium and continues regardless of the level of development of countries in the world.

The Emissions Fractions Approach to Assessing the Long-Range Transport Potential of Organic Chemicals.

The assessment of long-range transport potential (LRTP) is enshrined in several frameworks for chemical regulation such as the Stockholm Convention. Screening for LRTP is commonly done with the OECD Pov and LRTP Screening Tool employing two metrics, characteristic travel distance (CTD) and transfer efficiency (TE). Here we introduce a set of three alternative metrics and implement them in the Tool's model. Each metric is expressed as a fraction of the emissions in a source region. The three metrics quantify the extent to which the chemical (i) reaches a remote region (dispersion, ϕ1), (ii) is transferred to surface media in the remote region (transfer, ϕ2), and (iii) accumulates in these surface media (accumulation, ϕ3). In contrast to CTD and TE, the emissions fractions metrics can integrate transport via water and air, enabling comprehensive LRTP assessment. Furthermore, since there is a coherent relationship between the three metrics, the new approach provides quantitative mechanistic insight into different phenomena determining LRTP. Finally, the accumulation metric, ϕ3, allows assessment of LRTP in the context of the Stockholm Convention, where the ability of a chemical to elicit adverse effects in surface media is decisive. We conclude that the emission fractions approach has the potential to reduce the risk of false positives/negatives in LRTP assessments.

Persistent Problem: Global Challenges to Managing PCBs.

Polychlorinated biphenyls (PCBs), "famous" as persistent organic pollutants (POPs), have been managed nationally since the 1970s and globally under the Stockholm Convention on POPs since 2004, requiring environmentally sound management (ESM) of PCBs by 2028. At most, 30% of countries are on track to achieve ESM by 2028. Globally over 10 million tonnes of PCB-containing materials remain, mostly in countries lacking the ability to manage PCB waste. Canada (Ontario) and Czechia, both parties to the Stockholm Convention, are close to achieving the 2028 goal, having reduced their stocks of pure PCBs by 99% in the past 10 years. In contrast, the USA, not a party to the Stockholm Convention, continues to have a substantial but poorly inventoried stock of PCBs and only ∼3% decrease in mass of PCBs since 2006. PCB management, which depends on Stockholm Convention support and national compliance, portends major challenges for POP management. The failure to manage global PCB stocks >30 years after the end of production highlights the urgent need to prioritize reducing production and use of newer, more widely distributed POPs such as chlorinated paraffins and per- and polyfluorinated alkyl substances, as these management challenges are unlikely to be resolved in the coming decades.

Very high radiofrequency radiation at Skeppsbron in Stockholm, Sweden from mobile phone base station antennas positioned close to pedestrians' heads.

In urban environment there is a constant increase of public exposure to radiofrequency electromagnetic fields from mobile phone base stations. With the placement of mobile phone base station antennas radiofrequency hotspots emerge. This study investigates an area at Skeppsbron street in Stockholm, Sweden with an aggregation of base station antennas placed at low level close to pedestrians' heads. Detailed spatial distribution measurements were performed with 1) a radiofrequency broadband analyzer and 2) a portable exposimeter. The results display a greatly uneven distribution of the radiofrequency field with hotspots. The highest spatial average across all quadrat cells was 12.1 V m⁻1 (388 mW m⁻2), whereas the maximum recorded reading from the entire area was 31.6 V m⁻1 (2648 mW m⁻2). Exposimeter measurements show that the majority of exposure is due to mobile phone downlink bands. Most dominant are 2600 and 2100 MHz bands used by 4G and 3G mobile phone services, respectively. The average radiofrequency radiation values from the earlier studies show that the level of ambient RF radiation exposure in Stockholm is increasing. This study concluded that mobile phone base station antennas at Skeppsbron, Stockholm are examples of poor radiofrequency infrastructure design which brings upon highly elevated exposure levels to popular seaside promenade and a busy traffic street.

Body image perception, smoking, alcohol use, indoor tanning, and disordered eating in young and middle-aged adults: findings from a large population-based Swedish study.

BACKGROUND: Body image concerns may give rise to a multitude of risk behaviors, such as unhealthy weight control practices, disordered eating behaviors (e.g., compensatory purging or preoccupation with food), smoking, excessive alcohol intake, or sunbed use. However, the distribution of these risk behaviors across adulthood has rarely been studied. METHODS: The aim of this study was to explore health risk behaviors as correlates of body image perception in a randomly selected study population of 30,245 individuals aged 30-66 in Stockholm, Sweden, utilizing data from the Stockholm Public Health Cohort. Bivariate correlations were explored and a hierarchic binary logistic regression analysis was performed. RESULTS: The prevalence of body image discrepancy was higher among smokers and respondents displaying disordered eating behaviors. In contrast, alcohol and sunbed use were inversely correlated to body image discrepancy. Body mass index was the substantially strongest explanatory factor behind the observed variance in body image discrepancy, followed by loss-of-control eating. Notably, no major gender differences in body image perception were detected. Some unexpected patterns of association between variables other than body image perception, such as those between smoking, alcohol use, and sunbed use, were seen. CONCLUSIONS: Overall, the patterns differ substantially from what has previously been found in adolescent and young adult samples, indicating that the synergy and aggregation of risk behaviors observed among younger individuals may not apply to adults aged 30-66.

Global intercomparison of polyurethane foam passive air samplers evaluating sources of variability in SVOC measurements.

Polyurethane foam passive air samplers (PUF-PAS) are the most common type of passive air sampler used for a range of semi-volatile organic compounds (SVOCs), including regulated persistent organic pollutants (POPs) and polycyclic aromatic hydrocarbons (PAHs), and emerging contaminants (e.g., novel flame retardants, phthalates, current-use pesticides). Data from PUF-PAS are key indicators of effectiveness of global regulatory actions on SVOCs, such as the Global Monitoring Plan of the Stockholm Convention on Persistent Organic Pollutants. While most PUF-PAS use similar double-dome metal shielding, there is no standardized dome size, shape, or deployment configuration, with many different PUF-PAS designs used in regional and global monitoring. Yet, no information is available on the comparability of data from studies using different PUF-PAS designs. We brought together 12 types of PUF-PAS used by different research groups around the world and deployed them in a multi-part intercomparison to evaluate the variability in reported concentrations introduced by different elements of PAS monitoring. PUF-PAS were deployed for 3 months in outdoor air in Kjeller, Norway in 2015-2016 in three phases to capture (1) the influence of sampler design on data comparability, (2) the influence of analytical variability when samplers are analyzed at different laboratories, and (3) the overall variability in global monitoring data introduced by differences in sampler configurations and analytical methods. Results indicate that while differences in sampler design (in particular, the spacing between the upper and lower sampler bowls) account for up to 50 % differences in masses collected by samplers, the variability introduced by analysis in different laboratories far exceeds this amount, resulting in differences spanning orders of magnitude for POPs and PAHs. The high level of variability due to analysis in different laboratories indicates that current SVOC air sampling data (i.e., not just for PUF-PAS but likely also for active air sampling) are not directly comparable between laboratories/monitoring programs. To support on-going efforts to mobilize more SVOC data to contribute to effectiveness evaluation, intercalibration exercises to account for uncertainties in air sampling, repeated at regular intervals, must be established to ensure analytical comparability and avoid biases in global-scale assessments of SVOCs in air caused by differences in laboratory performance.

Effects of replacing PSA with Stockholm3 for diagnosis of clinically significant prostate cancer in a healthcare system - the Stavanger experience.

OBJECTIVE: To describe early experience of replacing PSA with Stockholm3 for detection of prostate cancer in primary care. DESIGN AND METHODS: Longitudinal observations, comparing outcome measures before and after the implementation of Stockholm3. SETTING: Stavanger region in Norway with about 370,000 inhabitants, 304 general practitioners (GPs) in 97 primary care clinics, and one hospital. INTERVENTION: GPs were instructed to use Stockholm3 instead of PSA as standard procedure for diagnosis of prostate cancer. MAIN OUTCOME MEASURES: Proportion of GP clinics that had ordered a Stockholm3 test. Number of men referred to needle biopsy. Distribution of clinically significant prostate cancer (csPC) (Gleason Score ≥7) and clinically non-significant prostate cancer (cnsPC) (Gleason Score 6), in needle biopsies. Estimation of direct healthcare costs. RESULTS: Stockholm3 was rapidly implemented as 91% (88/97) of the clinics started to use the test within 14 weeks. After including 4784 tested men, the percentage who would have been referred for prostate needle biopsy was 29.0% (1387/4784) if based on PSA level ≥3ng/ml, and 20.8% (995/4784) if based on Stockholm3 Risk Score (p < 0.000001). The proportion of positive biopsies with csPC increased from 42% (98/233) before to 65% (185/285) after the implementation. Correspondingly, the proportion of cnsPC decreased from 58% (135/233) before to 35% (100/285) after the implementation (p < 0.0017). Direct healthcare costs were estimated to be reduced by 23-28% per tested man. CONCLUSION: Replacing PSA with Stockholm3 for early detection of prostate cancer in primary care is feasible. Implementation of Stockholm3 resulted in reduced number of referrals for needle-biopsy and a higher proportion of clinically significant prostate cancer findings in performed biopsies. Direct healthcare costs decreased. KEY POINTS A change from PSA to Stockholm3 for the diagnosis of prostate cancer in primary care in the Stavanger region in Norway is described and assessed. •Implementation of a new blood-based test for prostate cancer detection in primary care was feasible. A majority of GP clinics started to use the test within three months. •Implementation of the Stockholm3 test was followed by: -a 28% reduction in number of men referred for urological prostate cancer work-up -an increase in the proportion of clinically significant cancer in performed prostate biopsies from 42 to 65% -an estimated reduction in direct health care costs between 23 and 28%.

Stockholm City's Elderly Care and Covid19: Interview with Barbro Karlsson.

Upwards of 70% of the Covid19 death toll in Sweden has been people in elderly care services (as of mid-May 2020). We summarize the Covid19 tragedy in elderly care in Sweden, particularly in the City of Stockholm. We explain the institutional structure of elderly care administration and service provision. Those who died of Covid19 in Stockholm's nursing homes had a life-remaining median somewhere in the range of 5 to 9 months. Having contextualized the Covid19 problem in City of Stockholm, we present an interview of Barbro Karlsson, who works at the administrative heart of the Stockholm elderly care system. Her institutional knowledge and sentiment offer great insight into the concrete problems and challenges. There are really two sides to the elderly care Covid19 challenge: The vulnerability and frailty of those in nursing homes and the problem of nosocomial infection-that is, infection caused by contact with others involved in the elderly care experience. The problem calls for targeted solutions by those close to the vulnerable individuals.

International consensus criteria for diagnosing and staging hand-arm vibration syndrome.

PURPOSE: In the 30 years since the Stockholm Workshop Scale (SWS) was published, the scientific literature on hand-arm vibration syndrome (HAVS) has grown and experience has been gained in its practical application. This research was undertaken to develop an up-to-date evidence-based classification for HAVS by seeking consensus between experts in the field. METHODS: Seven occupational physicians who are clinically active and have had work published on HAVS in the last 10 years were asked to independently take part in a three-round iterative Delphi process. Consensus was taken when 5/7 (72%) agreed with a particular statement. Experts were asked to provide evidence from the literature or data from their own research to support their views. RESULTS: Consensus was achieved for most of the questions that were used to develop an updated staging system for HAVS. The vascular and neurological components from the SWS are retained, but ambiguous descriptors and tests without adequately developed methodology such as tactile discrimination, or discriminating power such as grip strength, are not included in the new staging system. A blanching score taken from photographs of the hands during vasospastic episodes is recommended in place of self-recall and frequency of attacks to stage vascular HAVS. Methods with the best evidence base are described for assessing sensory perception and dexterity. CONCLUSIONS: A new classification has been developed with three stages for the clinical classification of vascular and neurological HAVS based on international consensus. We recommend it replaces the SWS for clinical and research purposes.

DNA damage in different wildlife species exposed to persistent organic pollutants (POPs) from the delta of the Coatzacoalcos river, Mexico.

The delta of the Coatzacoalcos river is a priority region for the biological conservation in the Gulf of Mexico. Environmental studies in the area have detected a complex mixture of contaminants where the presence of Persistent organic compounds (POPs) is highlighted. Deoxyribonucleic acid (DNA) integrity of biological populations are global concerns due to their ecological implications. The purpose of this study was to measure the exposure to POPs and DNA damage in nine species residing in the Coatzacoalcos river classified by taxonomic group, type of habitat and feeding habits. Total POPs concentrations (minimum and maximum) detected for all species were from 22.7 to 24,662.1 ng/g l.w; and the values of DNA damage (minimum and maximum) varied from 0.7 to 20.5 and from 6.5 to 56.8 µm (Olive tail moment and tail length respectively). Broadly speaking, reptiles, species residing in the wetland and the ones with a carnivorous diet showed higher levels of POPs and DNA damage. This study provides us with a baseline of the state of POPs contamination and shows the degree of environmental stress to which the different components of the ecosystem of the Coatzacoalcos river delta are subject to.

Neurosensory component of hand-arm vibration syndrome: a 22-year follow-up study.

BACKGROUND: Knowledge about the long-term course of the neurologic component of hand-arm vibration syndrome (HAVS) is scarce. AIMS: To study the course and prognostic factors of the neurosensory component of HAVS over a period of 22 years. METHODS: Forty male sheet metal workers, with a mean age of 60 (range 45-78) years at follow-up, were examined with a test battery in 1994 and 2017. At baseline, the sample comprised 27 workers with HAVS symptoms and 13 workers without HAVS symptoms. Among the 27 workers, 25 workers reported work-related hand-arm vibration during follow-up (mean 3639 h). In 2017, the mean time since vibration stopped was 8.4 years. RESULTS: Among the 27 workers with HAVS in 1994, no overall statistically significant change was observed in hand numbness (Stockholm Workshop Scale), shoulder/arm pain (pain scale) or finger pain from 1994 to 2017. However, vibration exposure during follow-up was associated with increased finger pain. Cotinine, carbohydrate-deficient transferrin, glycosylated haemoglobin and folate were not associated with changes in neurosensory symptoms or manual dexterity (Grooved Pegboard) from 1994 to 2017. A diagnosis of HAVS in 1994 did not predict poor hand strength 22 years later. Isolated hand numbness (without white finger attacks) was more common at baseline than at follow-up. CONCLUSIONS: This 22-year follow-up study indicates a tendency towards irreversibility of hand numbness and finger pain in workers with HAVS. Continued vibration exposure seems to predict increased finger pain. Our findings highlight the importance of HAVS prevention.

Polyunsaturated fatty acids in plasma at 8 years and subsequent allergic disease.

BACKGROUND: Polyunsaturated fatty acids (PUFAs) are hypothesized to modulate the risk of allergic disease. However, evidence from previous studies is inconclusive, and limited longitudinal data exist using circulating biomarkers of PUFA intake and metabolism. OBJECTIVE: We aimed to investigate associations between n-3 and n-6 PUFAs at age 8 years and asthma, rhinitis, and aeroallergen sensitization at age 16 years. METHODS: Proportions of n-3 PUFAs (very long-chain n-3 [VLC n-3; sum of eicosapentaenoic acid, docosapentaenoic acid, and docosahexaenoic acid] and α-linolenic acid) and n-6 PUFAs (linoleic acid and arachidonic acid [AA]) in blood samples at age 8 years were measured for 940 children from the prospective Swedish birth cohort BAMSE (Children, Allergy, Milieu, Stockholm, Epidemiology). Allergic disease phenotypes were defined by using questionnaires and IgE measures at the ages of 8 and 16 years. Logistic regression was used to examine potential associations. RESULTS: A higher proportion of total VLC n-3 PUFAs in plasma at age 8 years was associated with a reduced risk of prevalent asthma, rhinitis, and aeroallergen sensitization at age 16 years and with incidence of asthma between 8 and 16 years (adjusted odds ratio, 0.67; 95% CI, 0.47-0.94). AA was associated with a reduced risk of asthma, aeroallergen sensitization, and allergic rhinitis. The findings were most evident for allergic phenotypes of asthma and rhinitis. Additionally, AA was associated with an increased probability of asthma and rhinitis remission between 8 and 16 years of age. CONCLUSION: Higher proportions of certain VLC n-3 and very long-chain n-6 PUFAs in plasma phospholipids at age 8 years were associated with a reduced risk of allergic disease at age 16 years.

A Concept Analysis of Trauma Coercive Bonding in the Commercial Sexual Exploitation of Children.

BACKGROUND: The sex trafficking of adolescents is known as commercial sexual exploitation of children (CSEC). CSEC is a complex phenomenon where identification requires understanding of developmental disruptions from toxic bonding experiences that increase in complexity over time. These toxic bonding experiences forced through coercive methods disrupt the holistic development of a self in the CSEC victim that interferes with daily functions, decision-making and social and emotional development. Lacking in the literature is a conceptual foundation for trauma coerced bonding. PURPOSE: The purpose of the analysis is to define and clarify the future concept of trauma coerced bonding from trauma bonding as it relates to CSEC victimization. METHODS: The concept analysis used Rodgers' evolutionary method to search four databases (PubMed, CINHAL, Scopus, and Google Scholar [for grey literature]), using terms associated with various descriptions of trauma bonding (for instance, Stockholm syndrome), resulting in twenty papers for review. RESULTS: Attributes, antecedents, and consequences of trauma bonding were delineated and explained. It became apparent through this analysis that the concept of trauma bonding of adolescents exposed to CSEC is very different from other forms of trauma bonding, leading this author to a more precise term, trauma-coercive bonding. Trauma coercive bonding is a long process that is a developmentally disruptive form of bonding that has ramifications throughout the life span. DISCUSSION: Trauma coercive bonding is influenced by more than just an emotional bond. The proposed definition of trauma coercive bonding brings an in-depth description of vulnerabilities and disruptions to childhood when CSEC, which persists long into adulthood. CONCLUSION: Future qualitative research should pursue a grounded theory of trauma coercive bonding to further explain and study this phenomenon.

Meeting sustainable development challenges in growing cities: Coupled social-ecological systems modeling of land use and water changes.

Ongoing urban expansion may degrade natural resources, ecosystems, and the services they provide to human societies, e.g., through land use and water changes and feedbacks. In order to control and minimize such negative impacts of urbanization, best practices for sustainable urban development must be identified, supported, and reinforced. To accomplish this, assessment methods and tools need to consider the couplings and feedbacks between social and ecological systems, as the basis for improving the planning and management of urban development. Collaborative efforts by academics, urban planners, and other relevant actors are also essential in this context. This will require relevant methods and tools for testing and projecting scenarios of coupled social-ecological system (CSES) behavior, changes, and feedbacks, in support of sustainable development of growing cities. This paper presents a CSES modeling approach that can provide such support, by coupling socio-economically driven land use changes and associated hydrological changes. The paper exemplifies and tests the applicability of this approach for a concrete case study with relevant data availability, the Tyresån catchment in Stockholm County, Sweden. Results show that model integration in the approach can reveal impacts of urbanization on hydrological and water resource, and the implications and feedbacks for urban societies and ecosystems. The CSES approach introduces new model challenges, but holds promise for improved model support towards sustainable urban development.