The circular economy advocates for a fundamental shift, focusing on the reuse, recycling, and valorization of waste to keep materials in use for as long as possible, thereby reducing the need for new resources and minimizing waste. In this context, the concept of the Blue Circular Economy emerges, emphasizing the preservation and sustainable use of marine and coastal resources. This paper presents and explains a dataset collected through a survey administered in two regions: Algarve-Portugal, and Oslo-Norway. The aim was to address the existing data gap on the production, consumption, and disposal of bivalve shells from aquaculture, as well as to assess stakeholders' perceptions of the reuse and circularity of products. In Portugal, data collection focused on analyzing the mollusk supply chain in the Algarve region and assessing the potential for oyster shell reuse within the country. In Norway, data collection targeted the construction industry and academia to understand their perspectives on the reuse of shells in building applications. The dataset comprises responses from 112 voluntary participants from different countries, categorized into three main groups. The questions addressed the quantity of bivalves produced and consumed, shell disposal practices, perceptions regarding the potential reuse of this waste, and the level of awareness of public policies promoting circular economy strategies. Upon completion of the survey, respondents were given the opportunity to receive a summary of the study findings by voluntarily providing their e-mail address in a designated field of the survey. The dataset integrates quantitative data from online and local face-to-face surveys across different groups. This dataset provides a valuable resource for stakeholders in the aquaculture and construction sectors seeking to explore the potential of this biomaterial to valorise waste into innovative products, as well as for public authorities aiming to support the transition towards a circular economy.
Both passion and disordered eating attitudes (DEA) have been associated with increased injury risk among dancers, yet their interplay remains unclear. Pre-professional ballet and contemporary dancers appear particularly vulnerable. This study examined how harmonious and obsessive passion, together with DEA, relate to injury risk in contemporary and ballet pre-professional dancers aged 15+. In September 2023, participants from a French dance school completed baseline questionnaires assessing demographics (age, sex, injury history), passion (Passion Scale), and DEA (EAT-26). From October 2023 to May 2024, participants completed monthly follow-up questionnaires on injuries, using the Oslo Sports Trauma Research Center questionnaire on Health Problems (OSTRC-H). Injuries were defined as all-complaints (any physical complaint irrespective of the need for medical attention and/or time loss) and/or substantial (leading to moderate/severe/complete reduction in training volume or performance). Of 75 dancers enrolled, 62 (M = 17.2 years, SD = 2; 23 males) were included in the analyses. During follow-up, 48 dancers (77.4%) reported at least one injury, and 26 (41.9%) a substantial injury. Injury incidence rates were 2.27 per 1000 h of dance exposure for all-complaints injuries, and 0.76 for substantial injuries. Higher EAT-26 scores were associated with more all-complaints injuries (b = 0.02, p = .001), whereas harmonious passion was negatively associated with injury occurrence (b = -0.05, p = .005). Mediation analysis indicated an indirect association between obsessive passion and all-complaints injuries through DEA (indirect effect: b = 0.045, p = .031). These findings highlight the need to address obsessive passion, DEA, and to promote more autonomous, balanced engagement in dance to potentially reduce injury risk in pre-professional dancers.
Digital Patient Reported Outcome Measures (PROMs) can help to promote patient-centred care (PCC). However, they are currently not routinely used, potentially compromising patient outcomes. In this work we sought to (i) explore existing processes, patient and healthcare professionals' (HCP) perceptions of current gaps in PCC and (ii) their views on how a PROMs-based digital system could help to address these gaps in four European oncology outpatient clinics. We conducted a qualitative multi-site case study including healthcare staff (organisational leaders, managers and HCPs), patients being treated for cancer and caregivers in four outpatient clinics in Brussels (Belgium), Edinburgh (United Kingdom), Oslo (Norway), and Valencia (Spain). Data were collected through a series of semi-structured interviews to explore existing work practices, needs and attitudes. We also conducted non-participant observations of staff meetings and clinic activities to explore existing processes. Data were analysed through a mixture of inductive and deductive approaches drawing on the Technology, People, Organizations, and Macroenvironmental (TPOM) factors framework. We conducted 99 interviews with HCPs, patients and caregivers and 30 observations across the four sites. PCC was regarded as important across all sites. We observed limited existing efforts on systematically recording psychosocial needs of patients. Participants reported concerns that a new digital system to record PROMs may result in increased workloads for clinical staff and adversely impact patient-clinician relationships. Attitudes were influenced by previous experience with digital systems. Organisational leadership and support were viewed as crucial in facilitating adoption, including efforts to train and engage clinical and patient users, making available sufficient resources, and including end-users in system design. While digital PROMs have the potential to enhance PCC in cancer, their routine use is often hindered by sociotechnical challenges. This issue persists across different countries. Success in developing and implementing digital PROMs will require tailored system design and implementation strategies being cognisant of various stakeholder needs. This may include supplementing technological aspects of interventions with educational strategies, supporting local adaptations of designs, and aligning with clinician and organisational drivers for implementation.
Repetitive head impacts (RHIs) are associated with later-life neurodegeneration. Because soccer is the most widely played sport among youth worldwide, identifying early changes associated with RHI is important. To determine whether participation in 1 season of youth soccer is associated with changes in cognition, behavior, balance, brain structure or function, or blood biomarkers compared with noncontact sports. Prospective longitudinal cohort study at European centers (Munich, Germany; Leuven, Belgium; and Oslo, Norway). Male adolescent soccer players and noncontact athletes were each studied across a single competitive season with assessments at preseason, postseason, and 2 months later. Data were analyzed from January 2023 to March 2025. Soccer players were compared with noncontact athletes. In addition, self-reported heading of a soccer ball was assessed among soccer players as a measure of RHI. Cognition, behavior, balance, magnetic resonance imaging (brain structure, function, and biochemistry), and plasma biomarkers. Male adolescent soccer players (n = 82; mean [SD] age, 14.8 [0.6] years) did not differ from noncontact sport athletes (n = 47; mean [SD] age, 14.7 [0.7] years) in cognition, behavior, balance, cortical thickness, brain volumes, white-matter microstructure, or functional connectivity. At preseason, soccer players had higher total N-acetylaspartate (tNAA; β, -0.379 [95% CI, -0.627 to -0.131]; P = .003), glial fibrillary acidic protein (GFAP; β, -0.055 [95% CI, -0.103 to -0.006]; P = .03), and neurofilament light chain (NfL; β, -0.071 [95% CI, -0.122 to -0.020]; P = .01) than noncontact sport controls. Across the season, tNAA (β, 0.047 [95% CI, 0.020-0.074]; P = .001) declined in soccer players and increased in controls, converging by postseason. Group trajectories of GFAP and NfL did not differ between groups. Within soccer players, heading exposure was not significantly associated with changes in any outcome. In this cohort study of adolescent males, no statistically significant differences were detected over 1 season between soccer players and noncontact sport athletes in cognition, behavior, or brain structure and function. Group differences in GFAP and NfL may represent early signs of exposure, but lack of association with heading exposure warrants further investigation. These results highlight the need for large, multiyear studies to inform health policy.
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Sophisticated hand movements are essential for daily activities, but central neurological impairments often compromise them. Since full recovery through conventional physiotherapy is rare, assistance is crucial. While neural implants show promise, clinical use remains distant, urging immediate assistive alternatives. Current exoskeletons and neurostimulation garments lack sufficient motor support and sensory feedback, limiting dexterity. We developed a neurorobotic system combining portable exoskeletons with targeted neurostimulation via custom-made e-sleeve and tested it in 14 individuals with central neural injuries. We provide evidence of restored finger mobility and tactile perception, even in patients with clinically complete sensory loss, by recruiting residual peripheral pathways. Eight participants completed functional assessments, in which they exploited neurostimulation to improve grasp precision and enhance strength. This enabled manipulation of fragile and cumbersome objects, essential for everyday activities. Personalized assistive technologies have clinical potential to promote independence and support the reintegration of people with neurological impairments into society.
Progressive diamond bur degradation during the subtractive manufacturing (SM) of polymer-infiltrated ceramic networks (PICNs) compromises restorative clinical quality. To evaluate the degradation extent across two SM systems and investigate its effects on the trueness and surface roughness of PICN crowns. A total of 121 premolar crowns were fabricated from PICN blocks (Vita Enamic) using two SM machines (PrograMill PM7 and inLab MC X5). Crown trueness was quantified by superimposing crown scans onto the original digital design using three-dimensional inspection software (Geomagic Control X) and reported as the root-mean-square (RMS) ± standard deviation (µm). Surface roughness (Ra, Sa, Sq) was measured using confocal microscopy. Bur degradation was assessed after every five crown fabrications using machine-reported lifespan, surface roughness, and color deviation maps. Diamond bur tips, before and after use, were examined using scanning electron microscopy to characterize wear patterns. Statistical comparisons were performed both between and within machines using Welch's Analysis of Variance (ANOVA) (p < 0.05). Significant differences were observed in regional trueness (p < 0.0001): the PM7 yielded more accurate intaglio (inner) surfaces (22.21 ± 4.31 µm), while the MC X5 achieved higher external surface trueness (17.89 ± 2.76 µm). Bur degradation led to distinct error modes - whereas the PM7 exhibited a significant increase in negative deviations (overmilling), the MC X5 predominantly resulted in under-milled surfaces but with less impact from bur degradation. Crown surface roughness also differed between the two SM systems. While a consistent decreasing trend in surface roughness was observed in the MC X5 with repetitive milling cycles, the PM7 showed an initial decline followed by an accelerated increase after the 55th crown. The rate and extent of bur degradation varied by systems, causing distinct impacts on crown quality. Degradation in the PM7 predominantly resulted in adverse over-milling errors, whereas the MC X5 was more likely to cause inadequate material removal. System-specific degradation mechanisms substantially affect the ultimate quality of restorations. Surface roughness initially decreased in both SM systems; however, the systems followed divergent late-stage trajectories - one maintained a downward trend while the other exhibited a U-shaped recovery.
Over the past decade, the digitalization of health and telemedicine solutions has accelerated. Optimized digital infrastructure enables telemedicine as a complementary health care service, reducing organizational pressures and increasing accessibility. Tele medicine (TM) is well suited for chronic wound care, particularly diabetes-related foot ulcers, owing to its photo documentation and data exchange capabilities. This study aimed to explore health care professionals' (HCPs') cross-sectoral use of TM technology for the treatment and care of patients with diabetic foot ulcers (DFUs). The study used a realistic evaluation design. From 2023 to 2024, we conducted 68 h of participant observation of healthcare professionals in hospital and primary care during DFU treatment within a Danish cross-sectoral setting. The Standards for Reporting Qualitative Research (SRQR) were applied. We generated three key themes: (1) Time matters: navigating allocated and limited time in person-centred care and treatment. (2) Tech hurdles: adapting/aligning perceptions and mastering digital tools. (3) Building bridges: the power of relationships in sustaining telemedicine use. Our study led to a refined program theory allowing us to propose an answer to the problem of "what works, for whom, and under what circumstances": HCPs' cross-sectoral collaboration using the TM communication solution Pleje.net© enhances the treatment and care of patients with DFUs. This improvement is achieved in a cross-sectoral setting when care management addresses organizational challenges, such as managing time constraints, overcoming technological hurdles, and fostering strong relationships among HCPs. When robust relationships are present, the TM solution facilitates timely and coordinated care across different sectors, ultimately improving patient outcomes in a multidisciplinary setting. Findings are limited to a Danish cross-sectoral healthcare context and may not be directly transferable to other health systems.
Plasma 4β-hydroxycholesterol (4β-OHC) normalized for the levels of its parent cholesterol (4β-OHC/C) is an endogenous biomarker for hepatic CYP3A4. This study evaluated CYP3A4 activity longitudinally in individuals while their obesity status was changing. 4β-OHC/C was measured pre-surgery (n = 54) and 2 years after Roux-en-Y gastric bypass (n = 30) and used as an input for creating virtual twins of each patient within physiologically-based pharmacokinetic (VT-PBPK) models, alongside other available data (e.g., demographics). Additionally, individual CYP3A4 abundance quantified from liver biopsies during surgery was available. Predicted CYP3A4 abundance using 4β-OHC/C was within twofold of the measured abundance in 85% of the individuals (n = 54). Pre-surgery VT-PBPK models informed by biomarker data predicted area under curve after intravenous midazolam (AUCinf,iv) within twofold of observed values in 85% of individuals (geometric mean fold error (GMFE) = 1.58). VT-PBPK models using CYP3A4 protein measurements showed similar performance (83% within twofold, GMFE = 1.66), verifying the biomarker approach. The post-surgery VT-PBPK models were revised to reflect surgery-related alterations and changes in obesity status. Hepatic CYP3A4 activity at 2 years was predicted from 4β-OHC/C measured in the same individuals. Biomarker-informed models predicted midazolam AUCinf,iv within twofold for 87% of individuals (GMFE = 1.48; n = 30). ~60% of observed oral midazolam PK parameters were predicted within twofold, improving to 70% when the surgery model assumed full intestinal CYP3A4/5 recovery. This study highlights the utility of 4β-OHC/C for continuous monitoring of CYP3A4 activity and possibility to use biomarker-informed VT-PBPK models for individual dose requirements of intravenously administered CYP3A substrates in individuals with obesity over the course of weight loss treatment.
To describe and explore factors related to unmet needs and differences in urban vs rural centrality of community-based rehabilitation in patients with moderate-to-severe traumatic injuries with TBI at 12 months postinjury. A 12-month follow-up study of rehabilitation needs in a longitudinal multicenter cohort study Rehabilitation Needs, Service Provision, and Costs in the First Year after Traumatic Injuries. Two reginal trauma centers and the patients' municipality of residence. Patients with moderate-to-severe trauma with a traumatic brain injury with age≥18 years, a New Injury Severity Score>9, an Abbreviated Injury - Head score≥2, admission to the trauma centers within 72 hours, and a hospital stay of at least 2 days. N=235 community dwelling patients (mean age 51.9y; 77.4% men) were included. Not applicable. Unmet rehabilitation needs at 12 months on the Needs and Provision Complexity Scale. We hypothesized that injury severity and urban vs rural centrality of residence would predict unmet rehabilitation needs at 12 months postinjury. 42.1% reported unmet rehabilitation needs on the Needs and Provision Complexity Scale Rehabilitation subscale at 12 months postinjury. Median unmet rehabilitation needs was 2.0 (interquartile range 1-3). Mean Glasgow Outcome Scale Extended (GOSE) was 6.2 (SD, 1.5).A logistic regression model that included demographic and injury-related variables, urban vs rural centrality of residence and global functioning on the GOSE found that significant predictors of unmet rehabilitation needs were living in less central municipalities (odds ratio [OR], 2.18), AIS-Head≥3 (OR, 3.35), and lower GOSE scores at 6 months (OR, 1.60). Unmet rehabilitation needs are common after moderate-to-severe trauma with TBI at 12 months postinjury. Particular attention is required for individuals with more severe TBI and those in less central municipalities, because they face higher risk of unmet rehabilitation needs.
Listeriosis remains one of the most severe foodborne diseases in terms of fatality rate. Listeria monocytogenes can grow under stressful conditions and contaminate various food categories. Regulation (EC) No 2073/2005 modified on microbiological criteria for foodstuffs includes both qualitative and quantitative food safety criteria on L. monocytogenes and mentions EN ISO 11290-2 Standard as the reference enumeration method for the quantitative criteria. As food products are usually contaminated at very low levels, more sensitive enumeration methods are necessary to provide reliable data for research studies or routine analysis. This study, conducted by the EURL Lm, in collaboration with a group of NRLs, allowed to evaluate 2 more sensitive alternative methods derived from ISO 11290-2 Standard. In particular, the practicability, relative trueness, repeatability and accuracy profile were examined.
Liver diseases are a major global health concern, affecting over 1.5 billion people and ranking among the leading causes of death. Sub-Saharan Africa carries a high burden, yet the underlying etiology of chronic liver disease is poorly described. The aim of this study was to assess biomarkers of chronic liver disease and their determinants in Northern Ethiopia. A community-based cross-sectional study was conducted between December 2019 and June 2020 among randomly selected participants aged 5 years or older in Alamata district of Tigray region. Socio-demographic, behavioral, and clinical factors were collected via structured questionnaires; blood was tested for liver function biomarkers and Hepatitis B Virus (HBV) and stool samples for S.mansoni infection. Liver function biomarkers' abnormalities were defined based on age and sex-specific thresholds. Multivariable hierarchical logistic regression analysis was performed to identify predictors of abnormal alanine aminotransferase (ALT) and adjusted odds ratios (AOR) with 95% confidence intervals (CI) were reported. A total of 767 participants were included, with a median age of 27 years (5-80 years); 53.1% were female and 67.5% resided in rural areas. The prevalence of HBV and S.mansoni infection was 5.9%, and 26.6%, respectively. Overall, 23.5% of participants had abnormal liver function biomarker with 7.3%, 14.2%, 9,4%, and 8.0% had elevated aspartate aminotransferase(AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin levels, respectively. Besides, the De Ritis, aspartate to alanine (AAR) ratio revealed a median of 0.96(IQR:0.62-1.74), with 51% (79/155) of the participants presented with an AAR < 1.0, and 21.3% of participants exhibited an AAR > 2.0. Moreover, the R value depicted the patterns of liver injury with 90(52.0%) participants exhibited R-value below 2(cholestatic injury), whereas 44(22.43%), and 39(22.54%) of the participants were found to have R-values between 2 and 5(mixed injury), and R > 5(hepatocellular injury), respectively. The hierarchical modeling depicted that the infectious domain accounted for the largest portion of model variance (change in Nagelkerke R-squared (ΔR2) =0.157, p < .001). Accordingly, the model demonstrated that several determinants of hepatocellular injury led by significant synergistic interaction between HBV and S. mansoni co-infection conferred a 19.7-fold increase in the odds of elevated ALT (aOR:19.7; 95%CI:5.50, 70.6; p < .001), significantly higher than mono-infections of HBV (aOR:13.7; 95%CI: 5.82, 32.04; p < .001) or S. mansoni (aOR:3.4;95% CI:2.5; 5.51, p < .001). Beyond the infectious synergy, khat chewing (aOR:4.1, 95%CI:2.21, 7.58), and diabetes mellitus (aOR:4.01, 95%CI:1.55-10.36); p = .004) were confirmed as significant independent predictors, each associated with a four-fold increase in likelihood of having elevated ALT. Liver function biomarkers' abnormalities were common in northern Ethiopia driven by infectious, metabolic and lifestyle factors. The significant synergy between HBV and S.mansoni creates a compounded risk that far exceeds the impact of mono-infections, diabetes, or khat chewing. The findings emphasize the need for integrated public health strategies that address both infectious and non-infectious determinants simultaneously to effectively reduce the burden of chronic liver disease in the region.
Catheter ablation from the epicardial space is increasingly utilized to treat ventricular tachycardias (VTs). We report a rare complication. A 67-year-old male with dilated cardiomyopathy and frequent, exercise-induced VTs had been ablated once with endocardial and twice with epicardial access. Six weeks after the last procedure, he was hospitalized with abdominal and back pain due to an iatrogenic diaphragmatic hernia with displacement of the stomach and spleen into the left thoracic cavity. Following an acute exacerbation with cardiac arrest and splenic bleeding, he underwent successful surgery with splenectomy, reposition of the stomach, and direct suture of the diaphragmatic hernia. This is a rare complication, but notable for its delayed clinical manifestation several weeks after the procedure and necessitates urgent surgical treatment.
Painlessly obtained samples can improve diagnostics and care in paediatric conditions with affected steroidogenesis. To establish neonatal reference intervals (RIs) and identify sources of biological variation for steroid hormones in saliva. Steroid concentrations were determined using LC-MS/MS in 412 saliva samples from 174 infants aged 0-4 weeks, born at gestational age 26-42 weeks, recruited from three neonatal intensive care units and one maternity ward. We used six approaches to construct RIs with partitioning based on results from linear mixed models. RIs in nmol/L calculated with robust method using median of up to six samples with sufficient volume from each infant were for salivary 17OH-pregnenolone: <4.0; 17OH-progesterone: <2.5; 11-deoxycortisol: 0.02-0.99; 21-deoxycortisol: <0.2; cortisol: 0.65-39; cortisone: 18-154; deoxycorticosterone: <0.04; corticosterone: <0.76; aldosterone: 0.21-4.2; dehydroepiandrosterone: <2.4; dehydroepiandrosterone sulphate: <100; androstenedione: <1.5; testosterone girls: <0.10; testosterone boys: <0.32. Following multivariable adjustment, prematurity was associated with elevated concentrations of mineralocorticoids, androgens and glucocorticoid-precursors (up to 240%, 500% and 1060% respectively), but not cortisol or cortisone. Being on respiratory support was linked with qualitative and quantitative changes in all corticosteroid pathways, while sampling during the first 48 h of life was associated with an increase in adrenocorticotropin-regulated glucocorticoids and androgens (except dehydroepiandrosterone) but not mineralocorticoids. Perinatal exposure to synthetic glucocorticoids led to 33% reduction in salivary cortisol, but not other hormones. Betamethasone was detectable in infants' saliva up to 12 days following maternal administration. We present neonatal reference intervals for steroid hormones in saliva thereby supporting a non-invasive and painless option for obtaining a steroid hormone profile in this fragile population.
Nitroimidazole-refractory giardiasis is an increasing problem. We present data on efficacy of a treatment ladder and on clinical characteristics and assemblage types in nitroimidazole-refractory giardiasis. We conducted a prospective clinical observational study of adult patients with giardiasis at four centres in Norway and England during 2009 - 2024. Patients with nitroimidazole-refractory giardiasis were treated with albendazole plus a 5-nitroimidazole followed by quinacrine (mepacrine) if failure. Treatment efficacy was defined as negative stool microscopy and/or PCR four to six weeks after treatment. For analyses of assemblage types and risk factors for treatment failure, patients from a previously published Swiss treatment study were additionally included. Assemblage typing of Giardia isolates was performed collectively in the same laboratory by real-time PCR targeting the glutamate dehydrogenase gene (gdh). Predictors identified by univariate analyses were analysed by multivariate logistic regression for association with nitroimidazole failure. A total of 120 patients were prospectively included; 59 of these had nitroimidazole refractory giardiasis and were treated according to the treatment ladder. In addition, 20 patients from the Swiss cohort were included for assemblage and risk factor analyses. A repeated course of nitroimidazole cured only 24% (5/21). Metronidazole or tinidazole in combination with albendazole cured 76% (35/46). Quinacrine was effective in 100% (15/15). Assemblage B was more common in travellers from India and Africa, but only acquisition of infection in India (aOR 11.9; 95%CI 2.94, 47.6) and more recent year of diagnosis (aOR 1.18, 95% CI 1.03, 1.35) were associated with nitroimidazole failure in multivariate analysis. Second line treatment with nitroimidazole in combination with albendazole, and third line treatment with quinacrine, are effective options in nitroimidazole-refractory giardiasis. Nitroimidazole failure seems to be highly associated with infection acquired in India, but not with assemblage A or B. Further studies of resistance mechanisms are needed.
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Patients with familial hypercholesterolemia (FH) have elevated LDL-C levels from birth and increased risk of cardiovascular disease due to atherosclerosis, mostly affecting larger arteries. Less is known about effects of elevated LDL-cholesterol on smaller arteries. Retinal arterioles are prone to damage in the form of stiffening and thickening. We therefore explored the occurrence of retinal arteriolosclerosis in patients with genetically verified FH, and in a control group. Associations between retinal arteriolosclerosis and current serum lipid values, sex, age, statin treatment, and years on lipid-lowering treatment were also investigated. Eligible patients were 40 to 70 years of age, normotensive, and non-smokers. Exclusion criteria were diabetes and vascular retinal disease. Control subjects had to have normal lipid levels and no history of cardiovascular disease. Lipid measurements were collected prior to the visit, and at the visit retinal fundus photographs of both eyes were taken. The fundus photographs were graded by two ophthalmologists according to the Scheie classification for retinal arteriolosclerosis. Fifty patients with FH and 30 control subjects participated. Mean duration of lipid-lowering medication for the patient group was 17.0 years. The control group had higher total cholesterol, LDL-C and HDL-C, ApoB and ApoA1 levels than the patient group. There were no differences in the occurrence of retinal arteriolosclerosis between the two groups, and no associations were found between current lipid levels, age, sex, statin treatment, years on LLT and retinal arteriolosclerosis. Patients with FH did not have increased prevalence of retinal arteriolosclerosis compared to controls.
Studies suggest that breastfeeding may be associated with a reduced risk of childhood ADHD. However, determining causality is challenging because potential confounders, including genetic predisposition, may influence this relationship. We prospectively examined the relationship between full (exclusive or predominant) breastfeeding duration and ADHD symptoms in children, accounting for sociodemographic and perinatal factors and polygenic risk of ADHD. We obtained data from 37,643 children (49.1% girls) born 1999-2009, and 18,349 mother-father-child units from the Norwegian Mother, Father and Child Cohort Study. We examined the effect of full breastfeeding per month (self-reported when the child was 6 months old) on parent-rated ADHD symptoms in offspring at 3, 5 and 8 years (multivariate regression models). Measures are expressed as unstandardized regression coefficients (B) with 95% confidence intervals, adjusting for socioeconomic and perinatal factors, and ADHD polygenic scores in child, mother, and father. Full breastfeeding per month was significantly associated with lower ADHD symptoms at all ages (adjusted Bage3= -0.08(-0.09, -0.07); Bage5= -0.07(-0.08, -0.06); Bage8= -0.06(-0.07, -0.05)), indicating that each month of full breastfeeding associated with lower ADHD symptoms. Similar results were observed when modelling breastfeeding as a categorical variable including both full and partial breastfeeding. Inverse probability weighting, accounting for loss to follow-up, and sibling analyses with discordant breastfeeding exposures, accounting for unmeasured confounding, supported the main results. Our findings suggest that full breastfeeding could partially protect against childhood ADHD symptoms. Further studies are needed to understand the potential mechanisms of the association between breastfeeding and lower ADHD symptoms.
Long-term sickness absence (LTSA) in young adults has important consequences for labour market participation and future work disability. Chronic pain and psychological distress are key risk factors and frequently co-occur, yet their combined impact during adolescence on later LTSA remains insufficiently understood. This study aims to explore factors that influence adolescents' and young people's risk of receiving LTSA benefits during emerging adulthood. This longitudinal study used data from the Young-HUNT1 (1995-1997; n = 8736) and Young-HUNT3 (2006-2008; n = 7935) cohorts linked to Norwegian registry data and followed into early adulthood. The outcome was time to LTSA (≥90 or ≥180 days). Associations were examined using Cox proportional hazards models and Kaplan-Meier analyses. Continuous- and discrete-time models were developed and evaluated using the concordance index, time-dependent AUC, and integrated Brier score. Risk factors were analysed using SurvSHAP, SHAP, and regression-based methods. Chronic pain and co-occurring pain and psychological distress were consistently associated with increased LTSA risk (adjusted HRs between 1.3 and 1.5 for pain and between 1.6 and 1.7 for co-occurrence). In contrast, psychological distress alone showed no consistent association. Model performance was moderate and similar across approaches (C-index between 0.63 and 0.67). Key predictors included female sex, low parental education, chronic pain, poor perceived health, and indicators of early health problems. Adolescent chronic pain, particularly when co-occurring with psychological distress, is an important predictor of LTSA in early adulthood. While absolute LTSA levels may vary across cohorts, underlying risk patterns remain stable. More complex models did not outperform traditional approaches. These findings highlight the importance of early-life conditions and support early identification and intervention to reduce later work absence.