Using Scandinavian literature reporting patient experiences of intensive care as a case, the aim of this qualitative systematic review was to explore if humanising was addressed in the descriptions of patient experiences and, if so, what words and theoretical perspectives were used to underpin the results. A comprehensive search of qualitative studies published between 1 January 2016 and 12 December 2024 was conducted in Embase, CINAHL, MEDLINE, Scopus, and Web of Science. Twenty-nine studies reporting patient ICU experiences were included and analysed using thematic synthesis following Thomas and Harden. The review adhered to the Enhancing Transparency in Reporting the Synthesis of Qualitative Research checklist. The terms humanisation and de-humanisation were not explicitly used, but the studies engaged with these concepts by corroborating the three themes that defined humanising ICU in this study: (1) feeling recognised as a human being when experiencing connectedness with healthcare professionals, (2) feeling connected with themselves and the situation when experiencing safety and well-being, and (3) feeling connected with significant persons and life outside the ICU. In addition, our analysis identified a further theme: (4) experiencing capacity to influence the situation when able to express themselves. Humanising intensive care involves ethical and caring engagement with the patient, helping them feel connected, experience well-being, and influence their situation. Although Scandinavian literature has not directly studied humanisation, it has focused on understanding patients' experiences and addressing the ontology of critical illness. As such, humanising ICU aligns well with Scandinavian nursing traditions.Implications for clinical practiceICU staff should actively listen to patients and encourage them to express needs and preferences, create a safe and calm environment that supports well-being, and maintain communication with patients and families to promote a humanising approach to intensive care.
Survivors of critical illness commonly experience physical, cognitive, and psychological impairments. Early rehabilitation may mitigate these impairments; however, how rehabilitation practices are perceived and implemented by healthcare professionals in intensive care unit (ICU) remains insufficiently described. This study aimed to describe healthcare professionals' perceptions of rehabilitation activities in the ICU and to explore their self-reported estimates of the time devoted to these activities in Scandinavian ICUs. A cross-sectional survey was conducted among healthcare professionals working in ICUs in Denmark, Norway, and Sweden. Using convenience sampling, data were collected on rehabilitation activities, time allocation, timing of initiation, and availability of post-ICU rehabilitative services. In total, 518 healthcare professionals participated. Rehabilitation was described as a multidimensional practice encompassing cognitive, sensory stimulation, physical, and social rehabilitation activities, as well as patient participation in personal care. Activities were typically performed daily throughout the ICU stay. Respondents reported spending a median of 40% of their working time on rehabilitation, and most patients were considered eligible. Commonly reported activities included verbal interaction, sitting on the edge of the bed, family visits, and participation in personal care. Rehabilitation is an established component of ICU care in Scandinavia and is integrated into routine clinical practice. Activities span multiple domains, with physical and social rehabilitation activities being most prominent. Further research is needed to clarify optimal timing and prioritisation of rehabilitation activities. This survey study presents perceptions from ICU personnel of how rehabilitation activities tend to be implemented in their workplace. Through different means, rehabilitation efforts are described as established in ICU practice in the three Scandinavian countries which were sampled.
Recent decades have seen pronounced changes in European hydroclimate, including widespread summer drying, yet its spatiotemporal variability and underlying drivers remain uncertain. Here we present the European Last Millennial Data Assimilation (EULMDA), a new reconstruction of European hydroclimate and its main drivers covering the past millennium. EULMDA integrates five Earth System Model simulations with over one hundred moisture and temperature sensitive tree-ring records. It demonstrates high skill in reproducing instrumental variability across climate variables, including large-scale atmospheric circulation changes. We show that European warm-season drought variability is primarily governed by circulation changes associated with the Scandinavian pattern (SCAND) and long-term summer temperature changes, together explaining over half of the spatiotemporal drought variance. SCAND drives a pronounced north-south dipole in summer hydroclimate, explaining a larger fraction of Mediterranean drought variability than other major circulation modes, contributing to recent multidecadal drying in the Mediterranean alongside wetting in northern Europe. Meanwhile, summer warming intensifies drying across much of Europe. These results provide critical context for interpreting recent drought trends and insight into mechanisms shaping future hydroclimate risks.
The use of antipsychotic drugs has increased in recent years, extending beyond traditional indications like schizophrenia and bipolar disorder while the use of lithium has remained stable or declined. However, current data on prescribing trends and dosages in Scandinavian countries are limited. This study aims to analyze trends in the prevalence and dosing of antipsychotics and lithium in Scandinavia from 2010 to 2023. Data were obtained from national prescription registers in Norway, Sweden, and Denmark, covering 2010–2023. For each antipsychotic class, we calculated: one-year prevalence (users per 1,000 inhabitants), therapeutic intensity (Defined Daily Doses [DDD] per 1,000 inhabitants per day), and mean dose (DDD per user per day). These metrics were analyzed overall, by sex, and by age groups. In 2010–2023, overall antipsychotic use increased across all countries, with Sweden (+ 24.4%) and Norway (+ 23.7%) experiencing the largest rises, and Denmark (+ 8.1%) the smallest. Lithium use was stable in Denmark, decreased in Norway, and increased in Sweden. Use was most prevalent among women and adults aged 25–44, primarily driven by a rise in second-generation antipsychotics (SGAs), especially quetiapine. Over the period, quetiapine’s therapeutic intensity increased (e.g., Norway from 1.29 to 2.96 DDD/1,000 inhabitants/day; Sweden from 0.91 to 1.58; Denmark from 2.32 to 3.07), while its mean dose decreased (e.g., Norway from 0.63 to 0.18 DDD/user/day; Sweden from 0.35 to 0.22; Denmark from 0.34 to 0.20), indicating a trend toward low dose prescribing. From 2010 to 2023, prescribing patterns of antipsychotics in Scandinavia shifted toward increased use of SGAs, higher therapeutic intensity, and lower mean doses for most drugs within this class. These trends were especially notable for quetiapine and could be influenced by off-label use. These findings highlight the importance of ongoing monitoring and research that integrates prescription data with clinical information to enhance safety and promote evidence-based prescribing. The online version contains supplementary material available at 10.1186/s12888-026-08006-z.
To investigate the association between use of GLP-1 receptor agonists and incident Parkinson's disease. Cohort study using data from nationwide registers in Denmark, Norway and Sweden and an active-comparator, new-user design. We included 158 961 new users of GLP-1 receptor agonists and 188 065 new users of sulfonylureas, aged 45 years or older. Liraglutide accounted for 72.9% of GLP-1 receptor agonist follow-up time, followed by semaglutide (13.4%), exenatide (7.3%), dulaglutide (5.1%) and lixisenatide (1.3%). The primary outcome was incident Parkinson's disease, defined as a first-ever diagnosis of Parkinson's disease (ICD-10 G20) or Parkinson's disease dementia (ICD-10 F02.3) in national patient registers. Cox regression with propensity score weighting was used to estimate hazard ratios (HRs) and control for confounding. Mean age was 65 years and 43% were female. Incidence rates for Parkinson's disease were 5.2 and 8.0 per 10 000 person-years among GLP-1 receptor agonist and sulfonylurea users, respectively (adjusted HR 0.81 [95% CI 0.68-0.96]). Results were consistent in a 2-year lag-time analysis (HR 0.84 [95% CI 0.70-1.02]) after excluding or censoring users of DPP-4 inhibitors at cohort entry or during follow-up (HR 0.74 [95% CI 0.60-0.93]) and in subgroup analyses by sex and age. In this large observational cohort study, use of GLP-1 receptor agonists compared with sulfonylureas was associated with a lower risk of incident Parkinson's disease. These findings support a potential neuroprotective role of GLP-1 receptor agonists, though replication in additional studies is needed.
Skin wounds remain a clinical challenge, especially for burns and chronic wounds, and existing therapies seldom re-engage the rapid, scar-sparing repair programs observed in nature. Planarians are super-regenerators capable of rebuilding the entire organism from small fragments, and their extracellular vesicles might encode potent prorepair cues. But whether planarian-derived extracellular vesicles (EVs) can enhance mammalian skin healing is unknown. Therefore, we isolated EVs from a wild-type planarian flatworm collected in Sweden and evaluated their therapeutic activity in complementary wound models: a chicken chorioallantoic membrane assay and a human 3D skin model. In our models, planarian EVs significantly accelerated tissue regeneration and wound closure, and improved re-epithelialization and barrier integrity compared to controls. These data indicate that cross-species (xenogeneic) EVs from planarians carry bioactive factors capable of expediting cutaneous repair. Together, the results position planarian-derived EVs as a potential cell-free therapeutic strategy for burns and chronic wounds, motivating additional mechanistic and translational studies for clinical use.
It remains a challenge to obtain well-preserved tissue samples from deceased patients as access to regular autopsy is limited. Minimally invasive autopsy (MIA) is a potential alternative to the complete diagnostic autopsy because of its efficacy in providing non-autolyzed tissue samples and its increased acceptability amongst the bereaved. The study follows an exploratory, prospective design without any kind of intervention. Inclusion criteria are deceased adults (≥ 18 years), confirmed signs of death, uncertain or multifactorial cause of death, present or previous infection, and permission from next of kin to perform MIA, defined by ultrasound (US)-guided samples from the heart, lungs, liver, spleen, and kidneys using a TruCut semi-automatic coaxial needle (14G; 16 cm length). Tissue samples, fixed in BiopSafe 20 mL formalin test tubes, are sent for pathological evaluation. The primary outcome is the achievement of well-preserved tissue samples, representative of the target organ and suitable for histopathological evaluation and diagnosis. An exploratory outcome is to establish the degree of clinico-pathological discrepancies between pre-mortem clinical status and post-mortem pathological descriptions. This investigator-initiated study is designed to validate the feasibility of MIA to enable fast-track post-mortem evaluation in an ICU environment.
Bereavement support for families experiencing the loss of a child is a crucial aspect of Specialized Paediatric Palliative Care (SPPC). As an offering of SPPC, bereavement groups have the potential to provide meaningful support. Limited research, however, exists considering parents' direct experiences of these groups and considerations for how to approach them in a Scandinavian context. To explore parents' experiences of bereavement support groups to explicate thematic priorities that speak to the design, facilitation, and other practical considerations for delivering these groups in a Scandinavian context. A qualitative study, inspired by a phenomenological approach, was conducted in a regional Danish hospital-based bereavement program. Parents who had lost a child and participated in a bereavement group were invited to share their experiences in a focus group and/or individual interview. Thematic analysis methods were utilized to explicate thematic priorities. Three thematic priorities were articulated for delivering bereavement support groups: (1) to cultivate a sense of belonging; (2) To share and bear memories that sustain presence; and, (3) to support parents make sense of past experiences in the present. Additional specific practical considerations were elucidated. In a Scandinavian context, hospital-initiated bereavement groups may aspire to provide a shared space for parents to engage with existential aspects of loss. This study contributes to evolving understandings of best practices for bereavement support in regional paediatric palliative care programs.
Primary sclerosing cholangitis (PSC) has a variable disease course, complicating patient counseling and timing of liver transplantation. Vitamin B6 deficiency predicts reduced liver transplantation-free survival in Scandinavian PSC cohorts. Here, we aimed to validate this observation in U.S. and German PSC cohorts and expanded our analyses to include hepatic decompensation as a clinical outcome. Serum active vitamin B6 (pyridoxal 5'-phosphate, PLP) was analyzed using LC-MS/MS in retrospective cohorts of people with PSC from Norway (NOR, N=315), the U.S. (USA, N=756), and Germany (GER, N=149). Cox proportional hazards and Fine and Gray competing risk models were fitted to estimate the ability of PLP to predict liver transplantation-free survival and the cumulative incidence of hepatic decompensation, respectively. The prevalences of vitamin B6 deficiency (PLP<20 nmol/L) in pre-transplant PSC from the NOR and USA cohorts were 50% and 25%. The prevalence was higher among those with previous hepatic decompensation. The cumulative incidence of hepatic decompensation was higher in the USA cohort, while individuals in the NOR cohort were more commonly transplanted for indications other than hepatic decompensation. Despite differences in clinical practice, low PLP consistently associated with shorter liver transplant-free survival, and PLP added value to predict liver transplantation or death from PSC over and above contemporary prediction models. Low PLP also associated with higher incidence of hepatic decompensation, which was mainly evident in the USA cohort, where decompensation was more common. The risk of both outcomes rose sharply in the definitive and marginal deficiency ranges and plateaued beyond sufficiency levels. Vitamin B6 deficiency was common in PSC also outside Scandinavia and consistently associated with poor outcomes in geographically distinct PSC populations. We previously showed that vitamin B6 deficiency was prevalent and associated with reduced liver transplantation-free survival in Scandinavian PSC cohorts. The current work shows that these observations are translatable to a U.S population and that low vitamin B6 also associates with development of hepatic decompensation. Our findings show that vitamin B6 adds value to predict outcomes in PSC across geographically distinct PSC populations and that efforts to restore B6 sufficiency should be focused on the many individuals who present with vitamin B6 levels within the marginal-to-definitive deficiency range.
The ICD-11 classification of Personality Disorder (PD) relies on global severity of personality dysfunction, while up to five trait domains can be specified as individual expressions (i.e. Negative affectivity, Detachment, Dissociality, Disinhibition, and Anankastia). The 60-item Personality inventory for ICD-11 (PiCD) was developed to measure these domains but has not yet been evaluated in Scandinavian context. Using a representative and socio-demographically stratified sample of the Danish adult population (N = 714), this study aimed to investigate the psychometric properties of the PiCD and to provide normative data for clinical cutoffs and interpretation of scores. Results support a four-factor model, including a bipolar dimension of Disinhibition versus Anankastia, which is consistent with previous studies. The hierarchical structure from one global factor to the four specific factors also revealed a conceptually coherent pattern across all four levels. The PiCD domain scores show acceptable internal consistency and significant associations with psychosocial functioning (particularly for Negative affectivity and Detachment scores). The findings overall support the PiCD's utility in assessing ICD-11 trait domains and highlight the importance of representative normative data for clinical application in Scandinavian contexts. Normative data, tentative-cutoffs, and a scoring-key for a clinical interpretive report are provided to guide clinical interpretation and decision-making.
The European green toad (Bufotes viridis) is Sweden's most threatened amphibian. Its range has contracted over the past century, with many local extinctions; remaining populations are fragmented and often isolated. Since the 1990s, conservation has focused on translocations to existing breeding sites and new localities, but many efforts have had limited success. We detected lower genetic diversity in Scandinavian populations (southern Sweden and nearby Denmark) than in Poland, plus strong structure and differentiation among Scandinavian subpopulations, implying unexpectedly low gene flow despite translocations. Small, isolated populations are strongly affected by drift, and whole-genome analyses reveal inbreeding and high genetic load in some subpopulations. We recommend reassessing source populations for translocations: the stock used in captive breeding and most past releases shows intermediate diversity but also signs of divergent selection and putative local adaptation. Management should balance minimizing inbreeding depression against risks of outbreeding depression and erosion of local adaptation risks.
Digestive neuroendocrine carcinomas (NEC) are rare, aggressive, and treatment-resistant malignancies. Platinum and etoposide are recommended as first line treatment; however, with limited benefit in colorectal NEC and in NEC with low Ki67 of 20%-55%. There is no firm evidence for second-line treatment. Being efficient in digestive adenocarcinomas, FOLFIRINOX is sometimes used also in patients with NEC. In this retrospective cohort study, patients with digestive NEC who received FOLFIRINOX and were diagnosed 2014-2021 were retrospectively identified at three Scandinavian centers. Histology was re-evaluated according to the 2019 WHO classification to exclude NET G3 tumors. Patient characteristics, treatment response, and survival outcomes were assessed. Fifty cases were identified; four of these were classified as mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN). The most common primary sites were colon (n = 17) and pancreas (n = 13). FOLFIRINOX was administrated predominantly in later lines (82%). Overall response rate (RR) was 44% (95% confidence interval (CI): 29%-58%) and disease control rate 72% (CI: 57%-83%), while median progression free survival was 5.6 months (CI: 4.3-6.9 months). Twenty-three patients with colorectal primary, 12 patients with Ki67 < 55%, and 33 patients previously exposed to platinum and etoposide as first line; the RR was 52%, 50%, and 39%, respectively. This study suggests a role for FOLFIRINOX in digestive NEC. High efficacy was observed, even in patients with hard-to-treat colorectal primaries, in those with Ki67 < 55%, and in patients previously exposed to platinum and etoposide.
AimTo uncover the substance of how suffering is associated with human beings with thoughts or plans about ending their lives by suicide and to bring out more diversity, complexity, and contextuality of this phenomenon. Understanding as an important virtue underscores the safeguarding of the patient's dignity as a holy element.BackgroundThe study is grounded in a caring science perspective where suffering is seen as embodied in the human being. Methodology and design: This integrative literature review presents a combination of data from both theoretical and empirical literature with a reading of selected articles. Ethical ontological questions are prerequisites for highlighting caring understanding. Through the reading of a truthful written text of experienced suffering with love and compassion, it is possible to confirm and serve life and health.Data sourcesEmbase, CINAHL, PsycINFO, Scandinavian Journal of Caring Sciences, and Nursing Ethics. Ethical consideration: The study was conducted in accordance with the guidelines of the Finnish National Board on Research Integration.ResultsThree distinct themes were identified as a basis for considerations related to suffering: (a) Suffering in time and space, (b) Bearable and unbearable suffering, and (c) Language as essential for being.ConclusionThe language of suffering in caring science is made visible. Caring understanding has an inherent ought to, embraced by ethos towards alleviation. Life-threatening suffering is revealed. Thinking of suicide as a way out can make it possible to endure the suffering. Lack of caring understanding was a threat to some of the patients' dignity. Lack of evidence exists as to whether telling the suffering story is a movement in the direction of alleviation and this calls for further research to examine if caring and caring science can embrace this suffering.
Disordered eating behaviors are prevalent among children and adolescents with overweight and obesity but are frequently overlooked or underrecognized. We performed a scoping review to identify and map which self- and proxy-report instruments which have been utilized to identify disordered eating in children and adolescents with overweight or obesity. A literature search was conducted by searching five databases (OVID Medicine, Embase, PsycInfo, PubMed, Cochrane Systematic Reviews/Cochrane Central Register of Controlled Trials) from 1994 to 2025. We included studies that administered a self-report or proxy-report questionnaire to dimensionally assess disordered eating behavior in samples aged 8 to 19 years in which a majority (≥ 50%) of participants had overweight or obesity. Published articles in English or a Scandinavian language were included. In total, there were 2086 hits and 1416 studies were screened after the removal of duplicates using the Covidence review management tool. Of these, 1198 were deemed irrelevant based on titles/abstracts and 218 studies were assessed for eligibility. After full-text review, 75 studies from 22 countries were included. A total of 25 instruments had been administered, ranging in length from 5 items to 91 items. The different versions (e.g., adult/child, abbreviated) of the Eating Disorder Examination-Questionnaire and the Dutch Eating Behavior Questionnaire were the most frequently administered tools, followed by the Three-Factor Eating Questionnaire and the Eating Attitudes Test. The Binge Eating Scale was the most frequently administered tool that specifically assessed binge eating. This scoping review highlights several challenges and limitations facing the assessment of disordered eating among children and adolescents with higher weight. The most frequently used instruments were originally designed for adults, women, and individuals classified with underweight or normal weight. Several tools had been modified for younger age or reading level, but none were reportedly modified with respect to higher BMI or weight status of the children. Moving forward, there is a need to develop instruments which are suitably and sensitively designed or adapted for youth with overweight and obesity. Disordered eating behaviors are common among young persons with higher weight yet often go unrecognized. This study looked at how disordered eating is being measured in children and teens with overweight and obesity in research and clinical settings. We reviewed prior research to see which self- and proxy-report questionnaires have been used to assess disordered eating behaviors in this population, focusing on studies of kids aged 8 to 19 years in which the majority of participants had a higher-than-average body weight. Out of over 2000 studies identified, 75 studies and 25 questionnaires met criteria and were included in the final review. The studies came from 22 different countries, but the vast majority had been conducted in the United States and Europe. The most commonly used tools were the Eating Disorder Examination-Questionnaire and the Dutch Eating Behavior Questionnaire. Some tools were adjusted for younger age or lower reading levels, but none reported modifications specifically for youth with higher BMI or weight. The most frequently used instruments had items originally developed for adults, females, and individuals with normal or underweight. The review underscores a critical gap in current assessment tools, which may fail to sensitively and accurately reflect disordered eating behaviors in children and adolescents with overweight or obesity, thereby limiting opportunities for detection and early intervention.
Social disparities in healthcare access and utilisation are well-documented. However, the underlying mechanisms driving these disparities are not fully uncovered. This study presents a systematic review of qualitative research exploring organisational and relational factors that contribute to social disparities in healthcare encounters. The review was conducted in three scientific databases (PubMed, Embase and PsycInfo). Studies were independently screened by two researchers, and the quality was assessed using the Critical Appraisal Skills Programme assessment tool. A thematic analysis was used to identify patterns across included studies. In total, 15 qualitative studies were included, from which 10 themes were identified, including: (1) complexity of the healthcare system, (2) resource constraints in the healthcare system, (3) deficiencies in healthcare professionals' education, (4) patients' perceptions of health and illness, (5) roles and expectations in patient decision-making and communication, (6) prejudices and labelling of patients with lower socioeconomic status, (7) equality and power balance in healthcare interactions, (8) patients' financial and social living circumstances, (9) patients' understanding of health information, and (10) trust and respect in healthcare interactionsConclusions:The study identified key mechanisms that contribute to social disparities in healthcare encounters between patients and the healthcare system. These findings may inform future health interventions and policy actions aimed at reducing social disparities in patient-healthcare interactions. However, further research within the Scandinavian context is warranted to validate and expand upon these results.
The cold-water siliceous sponge Geodia barretti, largely present in the North Atlantic Ocean, notably around Scandinavian costs, plays important roles in carbon and silicon cycling in the deep-sea. The demosponge provides a reservoir for numerous microorganisms. Bioactive natural products have been isolated from this sponge, in particular the indole alkaloid barettin discovered forty years ago. Barettin and analogues, notably 8,9-dihydrobarettin, 8,9-dihydro-8-hydroxybarrettin, bromobenzisoxalone barettin, and geobarrettins A-B, contribute to the maintenance of the sponge stability and security (anti-fouling) and the regulation of its microbial environment. The four indole alkaloids 6-bromo-8-hydroxyconicamin, 6-bromoconicamin, and geobarrettin C-D are also implicated in the defense of the sponge against physical and biochemical aggressions. Altogether, these ten natural products are essential to the sponge life. The present review presents a survey of the chemistry and biology associated with Geodia barretti. The pharmacological properties of (dihydro)barettin, notably their antioxidant and anti-inflammatory properties, are discussed, as well as the synthetic processes set up to produce these diketopiperazine derivatives. Their molecular targets and mechanism of action are also discussed. The review takes the sponge G. barretti from the depths of knowledge and brings barettin and analogues to the surface, with the hope of guiding future research in this field.
Variants in the KCNQ1 underlie type 1 long QT syndrome. The clinical manifestations are influenced by the specific KCNQ1 pathogenic variant. We aimed to describe the phenotype in patients found to possess the p.Gln530Ter-KCNQ1 pathogenic variant common in Scandinavian patients with long QT syndrome. Clinical characteristics of p.Gln530Ter-KCNQ1 variant-positive patients from 6 university hospital registries in Sweden, Denmark, Norway, and the United States were compared with carriers of other KCNQ1 pathogenic variants (non-p.Gln530Ter-KCNQ1) and gene-negative controls. Cardiac events (CEs) encompassed syncope of unknown origin and ventricular arrhythmias (VAs) (episodes of torsades de pointes, appropriate implantable cardioverter-defibrillator shocks, aborted cardiac arrest, or sudden cardiac death). The p.Gln530Ter-KCNQ1, non-p.Gln530Ter-KCNQ1, and control groups included 139 (65% female; 24% probands; mean age at end of follow-up 51 ± 20 years), 194 (65% female; mean age 44 ± 19), and 717 individuals (55% female; mean age 39 ± 24), respectively. CEs by 60 years of age were reported in 30 of the p.Gln530Ter-KCNQ1 group (22%; of those 5 VA, all nonfatal), 46 of the non-p.Gln530Ter-KCNQ1 group (24%; 4 VA, all nonfatal), and 81 of controls (11%; no VA). In the p.Gln530Ter-KCNQ1 group, CE occurred at a significantly older age than in the non-p.Gln530Ter-KCNQ1 group (44 ± 22 vs 31 ± 22; P = .02). Before 30 years of age, CE risk in the p.Gln530Ter-KCNQ1 group did not differ from that in controls (adjusted hazard ratio 1.11 [95% confidence interval 0.65-1.89]; P = .707) and was significantly lower than in the non-p.Gln530Ter-KCNQ1 group. After 30 years of age, CE risk in the p.Gln530Ter-KCNQ1 group increased significantly (adjusted hazard ratio 3.21 [95% confidence interval 1.49-6.92]; P = .003, compared with controls) and did not differ from the non-p.Gln530Ter-KCNQ1 group. The p.Gln530Ter-KCNQ1 variant is associated with a later onset of CE than other KCNQ1 pathogenic variants.
Low vitamin D levels in individuals with idiopathic scoliosis (IS) have been reported and suggested as a potential contributor to IS. Bone density has also been shown to be lower in individuals with IS. To investigate serum levels of vitamin D, parathyroid hormone (PTH), markers of bone metabolism, and the genetic variation associated with vitamin D levels and bone density in individuals with IS and healthy controls. Case-control study combining Scandinavian serum cohorts and genetic cohorts. Serum analyses: 174 individuals with IS and 153 non-scoliotic controls. 1,394 individuals with IS and 11,108 controls. Serum 25-hydroxyvitamin D [25(OH)D)], PTH, C-terminal telopeptide (CTX), osteocalcin, calcium, phosphate, creatinine, albumin, ALP and leptin. Polygenic risk scores (PRS) for 25(OH)D and bone mineral density (BMD). Serum samples were analyzed using validated clinical laboratory methods. PRS for 25(OH)D and bone mineral density (BMD) were calculated based on previous literature. Statistical analyses were performed using Mann-Whitney U-tests, logistic and linear regression. Mendelian randomization was analyzed using logistic regression and the inverse-variance weighted method. In the serum cohort, median 25(OH)D levels were 54.4 nmol/L in individuals with IS and 67.0 nmol/L in controls. Corresponding PTH levels were 4.0 pmol/L and 3.2 pmol/L. No statistically significant differences were found in CTX, osteocalcin, ALP, or leptin. PRS for 25(OH)D was associated with serum 25(OH)D levels. PRS in individuals with IS and controls were non-significant for 25(OH)D, BMD femoral neck, and BMD lumbar spine. A tendency for lower values for estimated BMD heel was seen in individuals with scoliosis compared to controls. Our findings indicate altered regulation of the vitamin D-PTH axis in idiopathic scoliosis, likely driven by environmental rather than genetic factors. Bone turnover markers were comparable between groups, no clear genetically mediated BMD differences could be observed.
M. Quintana-Cepedal, O. de la Calle, P. Diez-Solorzano, B. Sanchez-Martinez, I. Crespo, and H. Olmedillas, "The Copenhagen Adduction Exercise Effect on Sport Performance and Injury Prevention: A Systematic Review With Meta-Analysis," Scandinavian Journal of Medicine & Science in Sports 35, no. 8 (2025): e70119, https://doi.org/10.1111/sms.70119. The above article, published online on 19 August 2025 in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the authors; the journal Editor-in-Chief, José A. Calbet; and John Wiley & Sons Ltd. Following publication, the journal received concerns from a third party that the article contains an erroneous analysis, which was not detected during peer review. The journal editors investigated and determined that the meta-analysis misrepresents the reported outcomes of two out of the three cited studies, and contains fundamental methodological flaws that invalidate the article's conclusions. The authors resubmitted a revised version of their manuscript, which after peer review and careful evaluation was deemed unsuitable for publication in the journal. The article must therefore be retracted, without the possibility of publishing a correction.
University tertiary hospitals in Croatia carry a disproportionate share of complex care, teaching, and research responsibilities, yet they are reimbursed under the same Diagnosis-Related Group framework as smaller secondary hospitals. This structural misalignment contributes to workforce strain, physician migration, and inefficiencies in patient flow, while challenging long-term system sustainability. This narrative review and policy analysis synthesizes biomedical literature, international policy reports, and national documents published between 2000 and 2024 to examine workforce shortages, burnout, migration patterns, financing models, and the Croatian context. Croatia reports 3.4 physicians per 1000 inhabitants compared with the European Union average of 4.1, while maintaining a highly centralized referral structure. Burnout prevalence among physicians is estimated at 30-50%, and in 2021 approximately 7% of Croatian physicians applied for certificates enabling employment abroad. Germany, France, the United Kingdom, Scandinavian countries, and Canada have introduced differentiated financing mechanisms that compensate tertiary hospitals for case complexity, referral flows, and academic responsibilities. A pilot Workload Index model is proposed to align reimbursement with case mix, teaching load, referral inflow, and occupational risk exposure. Linking financing to measurable workload indicators may support fairer resource allocation, workforce protection, and improved access to complex care within Croatia's tertiary health services.