Food waste in Beijing - life cycle assessment approach to estimating the environmental impact and resource utilization of various alternatives for food waste treatment in Beijing

Around the world, the treatment of food waste is a major administrative and environmental problem throughout the food supply chain. Beijing, as any other mega city, is facing vast issues of sustainable food waste treatment in addition to efforts for food waste reduction. Presently the majority of Beijing's food waste is treated together with the mixed residual waste in landfills (53%) and incinerators (43%) with only 4.3 % of the food waste being organically recycled. This despite the majority of Beijing's municipal solid waste being food waste. Beijing is quickly developing its incineration capacity due to the volume reduction and energy recovery potential. Treating the food waste with anaerobic digestion could provide an alternative waste-to-energy method which includes resource recycling. Demands for the by-products of anaerobic digestion appear to increase as demand for natural gas and demand for organic produce is predicted to increase in China. The software WAMPS (Waste Management Planning System) is used to investigate six scenarios for the various possibilities of future food waste treatment in Beijing using a life cycle perspective. The scenarios are modelled after a goal scenario where 50% of the food waste is recycled and a half way scenarios between present situation and the goal. The study concludes that incineration is the most environmentally friendly alternative but foremost shows a lot of room for improvement for the present management system. The results are largely influenced by the coal based electricity production in China which causes severe environmental problems and offers great environmental advantages when reduced and replaced with cleaner electricity. The case study does not consider the sustainable use of resources, only eutrophication, acidification, greenhouse gas emissions, and photo oxidant formation

Insulin resistance in children and adolescents : mechanisms and clinical effects

Background: Insulin resistance is a condition in which insulin does not achieve appropriate response in different target tissues, it is associated with obesity and one of the main culprits in the development of type 2 diabetes. An early sign of disturbed glucose-insulin homeostasis is impaired fasting glucose (IFG) where glucose is elevated in the fasting state. The American Diabetes Association (ADA) and the International Society for Pediatric Diabetes (ISPAD) suggest 5.6 mmol/L as a cut-off level for IFG, the World Health Organization supports 6.1 mmol/L. Impaired glucose tolerance (IGT) is defined as elevated glucose after a 2-hour glucose tolerance test, which also is a sign of disturbed glucose-insulin homeostasis. IFG and/or IGT, collectively prediabetes, is associated with a significantly elevated risk of type 2 diabetes development in adults, but the consequences of the prediabetic condition in children is not as evident. In Sweden the prevalence of type 2 diabetes in youth has been low, in spite of an increasing overweight and obesity, which are major risk factors for type 2 diabetes. However, the exact present prevalence of type 2 diabetes in youth is currently not known. Early-onset of type 2 diabetes is associated with a high morbidity already at young age and seems to be more aggressive compared with early-onset type 1 diabetes. Aim: The aims of this thesis were to investigate the pathogenesis of prediabetes in obese children, to examine the prevalence of prediabetes and type 2 diabetes among severely obese adolescents and to estimate the occurrence of complications related to early-onset type 2 diabetes compared to type 1 diabetes of same duration. Method: Study I and II in this thesis contain data from the Swedish Childhood Obesity Register (BORIS), which is a national quality registry for obesity treatment in childhood and adolescence. Fasting glucose and glucose levels after an oral glucose tolerance test (OGTT) was made to define normal glucose tolerance or prediabetic stage. A frequently sampled intravenous glucose tolerance test was used to study acute insulin response (AIR), insulin sensitivity (Si), and disposition index (DI) in children with obesity. Study III contains data from the National Diabetes Register (NDR); both from the pediatric register (SWEDIABKIDS) and the adult register (NDR) regarding adolescents and young adults with type 1 and 2 diabetes. Study I and II are cross-sectional observational studies and Study III is a longitudinal, retrospective cohort study. Results: Among severely obese children the prevalence of isolated IFGADA was 35.8 %, isolated IGT 6% and a combined IFG and IGT in 14.2 %. Combined IFG/IGT was associated with significantly lower AIR compared with subjects who had normal glucose metabolism (p<0.05) and DI was the major determinant of 2-h OGTT glucose levels (β=−0.49, p=0.0126). Comparing IFGADA and IFGWHO in obese children, only IFGWHO was associated with a lower AIR and DI (p<0.001). In total 1413 adolescents and young adults were diagnosed and registered in NDR with type 2 diabetes between 1994-2014. Early-onset type 2 diabetes had, compared with individuals with type 1 diabetes with equivalent diabetes duration, significantly higher risk of developing microalbuminuria with a hazard ratio (HR) of 3.32 (95% CI 2.86-3.85, P < .001), and also retinopathy with a HR of 1.17 (95% CI 1.06-1.30, P 0.04). These differences occurred despite lower HbA1c levels among individuals with type 2 diabetes in comparison with type 1 diabetes. Conclusion: The prevalence of prediabetes was very high among adolescents with severe obesity. IFGWHO is significantly associated to disturbed glucose metabolism, and IFGADA could be associated with IGT. A combination of IFGADA/ IGT was significantly associated with impaired -cell function. Although both type 1 and 2 diabetes were associated with complications, the prevalence of complications and comorbidities is significantly higher among those with early-onset type 2 diabetes compared with type 1 diabetes. Our results confirm previous studies that type 2 diabetes is a severe disease when young individuals are affected, and an active treatment with a widened focus on cardiometabolic risk factors is required to reduce the risk

O modelo sueco de home care avançado: organização e implicações da adoção desta modalidade de cuidado pelo serviço de saúde brasileiro

Este artículo tiene como objetivo describir la organización del programa de atención médica domiciliar avanzada en una región de Suecia y discutir los beneficios e implicaciones que pueden resultar de adoptar este modelo en Brasil. Como enfoque metodológico se utilizó la triangulación de datos combinando entrevista, observación y encuesta. Integraron el estudio 32 miembros del equipo profesional. Se describieron la estructura organizacional, el método de trabajo, las visitas domiciliares y los recursos de salud implicados en la atención. El modelo investigado presenta evidencias de eficiencia y efectividad y se muestra versátil para ser adaptado a Brasil para atender a las necesidades de la salud de la población. Sin duda, la mejora de la calidad de vida y de la seguridad son beneficios sociales de grande relevancia que emergen de este tipo de atención.Este artigo descreve a organização do programa de "home care" avançado em uma região da Suécia e discute os benefícios e implicações que podem resultar da adoção deste modelo pelo Brasil. Como enfoque metodológico foi utilizada a triangulação de dados combinando entrevista, observação e questionário. Integraram o estudo 32 membros da equipe profissional. A estrutura organizacional, o método de trabalho, as visitas domiciliares e os recursos de saúde envolvidos na assistência foram descritos. O modelo investigado apresenta evidências de eficiência e efetividade e mostra-se versátil para ser adaptado ao Brasil para atender as necessidades de saúde da população. Sem dúvida, a melhoria da qualidade de vida e segurança são benefícios sociais de grande relevância que emergem desta modalidade de cuidado.The purpose of this paper was to describe the organization of the Advanced Home Care Program provided in a region of Sweden and to discuss some benefits and implications of this model adoption in Brazilian settings. Data triangulation as interview, observation and questionnaire was used. Thirty two professionals participated in this study. The organizational structure, working method, home visits, and related health resources were described. The investigated model presented both clear effectiveness and versatility; therefore feasible to be adopted in Brazilian settings improving their population health care. Doubtless, the improvement of life quality and security are the best benefits this model of care can provide

What stains a process of water protection? : a study of the assumptions that underline agricultural and management actors’ views of water protection

Denna studies syfte är att identifiera och undersöka de underliggande antaganden som färgar problemrepresentationer i vattenskyddsprocesser. Målet är att tolka antaganden om de agrara och förvaltande parternas syn på naturresurserna, deras ansvars- samt rollfördelning inom ramarna för vattenskydd. Frågeställningarna som används har varit; vad identifierar parterna som ”problem”; vilka antaganden utgör grunden för dessa representationer av problem? Den diskursanalytiska metod som används under studien utgår från Carol Bacchis (2009) ramverk ”What’s the problem representet to be?”. Uppsatsen utgår från empiriskt material från vattenskyddsprocessen vid Svartån i Örebro, med kompletterande analyser av nationella styrdokument. Under arbetet har sam-spelet mellan agrara och förvaltande aktörer legat i fokus. Studien har visat att aktörernas samspel färgas av deras respektive natursyner, vilka ligger till grund för de skillnader som går att identifiera inom aktörernas diskurser. Den slutsats som dras till följd av analysen är att aktörerna skulle kunna dra fördel av att se sin bild av vattenskyddsprocesser som en del av en diskurs. Att göra detta hade kunnat ge aktörerna en djupare förståelse för varandra, och på vad det är som influerar synen på förvaltning och brukande av naturresursen så som vatten.The purpose of this study is to identify and investigate how underlining as-sumptions stains problem representations within the processes of water pro-tection. The goal is to interpret the assumptions of agricultural and manage-ment actors’ views within the frames of water protection. The questions of the study have been; what do the actors identify as “problems”; what assumptions underlines these representations of problems? The method of discourse anal-ysis that is applied within the study is Carol Bacchis (2009) “What’s the prob-lem represented to be?”. The thesis is based on empirical material from the process of adopting a water protection area around Svartån in Örebro, with supplementary analyzes of national governance documents. While analyzing, the interaction between agricultural and managing actors’ have been within focus. The study has found that the actors’ interaction is stained by their sep-arate view on conception of nature, which underline the differences that can be identified within the actor’s discourses. The conclusion drawn from the analysis is that the actors could benefit from viewing their interpretation of water protection processes as parts of dis-courses. By doing this the actors could gain a deeper understanding of each other, and of what influences the view of governing and use of resources like water

Early obesity : family-based risk factors and treatment interventions

Background The high prevalence of preschool obesity is a global concern. In order to support families through obesity interventions, we need a better understanding of underlying family-based risk factors. Specifically, there is a gap in the knowledge related to challenges that families face in everyday life. Thus, valid and reliable instruments to assess child and parental behaviors are required. Further, obesity treatment in early childhood seems to be more effective than treatment of adolescents but the support offered to parents needs to be optimized. Aims The overall aim of this thesis was to examine the family’s role in early childhood obesity. Study I: To examine associations between infant growth and known early risk factors. Study II and III: To validate two questionnaires on child and parental behaviors related to obesity and to examine associations between potential confounders. Study IV: To describe the conceptual frame and design of a novel parent-only treatment program for early childhood obesity, the More and Less (ML) study. Study V: To examine the effects of a parent-only program as compared to standard care as a treatment for preschool obesity (primary outcome body mass index standard deviation score; BMI SDS). To assess the acceptance and feasibility of the parent-only program. Materials Three samples of parents and preschoolers from Stockholm County were examined: Study I: 197 one-year-old children (52% girls, mean BMI SDS -0.4) and their parents (mean age 35 years, mean body mass index (BMI) 29, 54% had a university degree and 13% born in a non-Nordic country) participating in the Early Stockholm Obesity Prevention Project (Early STOPP) recruited from child health care centers in Stockholm County. Study II and III: A school sample of 431 parents of preschoolers recruited via 25 preschools/schools and a clinical sample of 47 parents from the ML study recruited through child health care centers. In this sample, 80% of the children were of normal weight and 20% had overweight or obesity (mean age 5.5 years, mean BMI SDS 0.2). The parents were 39 years old on average with mean BMI of 24; 70% had a university degree and 13% were born in a non-Nordic country. Study IV-V: 177 children aged 4-6 years with obesity (56% girls, mean age 5.2 years, mean BMI SDS 3.2) and their parents (mean age 38 years, mean BMI 29, 57% of foreign background, 40% had a university degree) were randomized to either parent-group treatment (n=89) or to standard treatment (n=88). Methods Study I: Infant BMI SDS at 3, 6 and 12 months and rapid weight gain during the first year of life was compared between children at high and low risk of developing obesity based on parental BMI (n=144 high risk and n=53 low risk) and education level (n=57 high risk and n=139 low risk), adjusting for early life risk factors. Study II: We translated and validated the Lifestyle Behavior Checklist (LBC), a questionnaire measuring obesity-related child behaviors (Problem scale) and parents’ confidence (Confidence scale) in handling these behaviors. Parents’ understanding of the translated questions was assessed with cognitive interviews. Confirmatory factor analysis (CFA) was used to assess psychometric properties. We also examined associations between the LBC and the Child Feeding Questionnaire (CFQ), which measures parental feeding practices , and sociodemographic factors. Study III: We validated the Child Eating Behavior Questionnaire (CEBQ) with CFA. We also examined associations between child eating behaviors and CFQ parental feeding practices with structural equation modelling (SEM), adjusting for sociodemographic factors. Parents’ concern for their child being overweight was used as a mediator in the model. Study IV-V: We compared a parent-only program (10 sessions at 1.5 h/week) based on skills training in evidence-based positive parenting practices to standard treatment focused on lifestyle changes. BMI SDS (primary outcome) was measured at 3 and 6 months follow-up, adjusting for sociodemographic factors. Acceptance of the parent-only program by parents was assessed by mean scores on evaluation forms and by reviewing interviews with participants. The interviews were evaluated with thematic analysis. Results Study I: Child BMI SDS during the first year of life was associated to parental education level but not to parental BMI. The associations could not be explained by previously known risk factors. No associations were found for rapid weight gain. Study II: A five factor structure of the LBC proved best fit to the data, introducing a new factor, Screen time. The validity of the LBC was proven by: correlations to the CFQ, associations to child BMI SDS and different scorings of parents of normal weight and overweight/obese children. The LBC Confidence scale proved to be unidimensional and was not associated to any child or parental characteristics. Study III: An eight factor structure of the CEBQ proved best fit to the data. Child’s small appetite was associated to higher levels of parental pressuring feeding practices. A large appetite in the child was not directly associated to restrictive feeding practices but indirectly via parental concern for the child being overweight. Study IV-V: Children in the parent-only group reduced their BMI SDS after 3 (0.21) and 6 months (0.42) compared to an increase of 0.01 at 3 months and 0.02 at 6 months in the standard treatment group (p < 0.001). The parent-only group children were four times more likely to reach a clinically significant reduction of 0.5 in BMI SDS. Children of Swedish parents with a university degree succeeded better in treatment. The program was highly accepted by parents. Conclusions Parental education level is important for infant weight development as early as the first year of life, independent of parental BMI and other known early risk factors for childhood obesity. To be able to help families in treatment, we need to know what challenges the family faces in everyday life. Thus, valid and reliable instruments to assess child and parental behaviors are required. The LBC and the CEBQ are two such instruments. The associations found between child eating behavior and parental feeding practices suggest an important role for child health care practitioners to support appropriate feeding practices. Further, a parent -only program including skills training in positive parenting practices outperformed standard treatment of preschool obesity regarding child weight status. The program was well accepted by parents. This thesis strengthens the evidence for early initiated obesity interventions and elucidates considerations for reaching families of different socioeconomic backgrounds

Planting a seed - child health care nurses’ perceptions of speaking to parents about overweight and obesity : a qualitative study within the STOP project

Background Nurses in child health care (CHC) centers in Sweden play a key role in the early detection and management of childhood overweight/obesity, through meeting families early, regularly and over many years. However, research focusing on CHC nurses’ perceptions of their role in childhood overweight/obesity management is scarce. As part of the EU-funded project “Science and Technology in childhood Obesity Policy” (STOP), this study examines CHC nurses’ perceptions of speaking to parents about children’s overweight/obesity and of their role in referring children to treatment for overweight/obesity. Methods All registered CHC nurses in Stockholm County (n = 442) received an email invitation letter explaining the study. Individual face-to-face visits (n = 15) in selected centers, and phone calls (n = 24) to nurses working in these centres were also conducted. In total, 17 CHC nurses (all female, average work experience 6.7 years (SD ± 4.9 years)) from 10 municipalities (including four of the top five municipalities with the highest prevalence of overweight and obesity) in Stockholm County were interviewed. The interviews were conducted by phone, transcribed and analyzed using thematic analysis. Results Two main themes were developed through the analysis: 1) The relationship between the nurse and the parent and 2) Glitch in the system. Under the first theme, nurses reported that weight-related discussions were facilitated by building and maintaining trust with parents. However, nurses also said they were reluctant to address children’s weights if this could compromise parents’ trust. Under the second theme, nurses highlighted several organizational barriers to addressing a child’s weight with parents, including insufficient cooperation with other healthcare providers and limited time for visits. Nurses also identified lack of sufficient knowledge about what to offer the family and lack of confidence in their communication skills as additional barriers. Conclusions We found that pediatric nurses perceive relational and organizational factors as barriers to address childhood obesity with parents. To improve care, it is necessary to provide nurses with continuing education about obesity and communication skills and organizational support to improve communication within the healthcare system

A striving for independence: a qualitative study of women living with vertebral fracture

<p>Abstract</p> <p>Background</p> <p>Quantitative studies using generic and disease-specific health-related quality of life (HRQOL) questionnaires have shown that osteoporosis-related vertebral fractures have a significant negative effect on HRQOL, but there are only few studies that address what it means to live with vertebral fracture from a deeper experiential perspective. How HRQOL and daily life are affected several years after vertebral fracture and how women cope with this are more unclear. This study aimed to describe how HRQOL and daily life had been affected in women with vertebral fracture several years after diagnosis.</p> <p>Methods</p> <p>The study design was qualitative. Semi-structured interviews were conducted with ten Swedish women during 2008. Data were analysed using qualitative inductive content analysis.</p> <p>Results</p> <p>The findings of this study revealed three themes related to the influence on HRQOL and daily life: <it>A threatened independence</it>, i.e. back pain, anxiety, negative impact on self-image and consequences in daily life; <it>Strategies for maintaining independence</it>, i.e. coping, self-care and support; and <it>The importance of maintaining independence</it>, i.e. the ability to perform everyday activities, social interaction and having something meaningful to do. The women were striving for independence or maintaining their independence by trying to manage different types of symptoms and consequences in different ways.</p> <p>Conclusion</p> <p>HRQOL and daily life were strongly affected in a negative way by the impact of the vertebral fracture. Information from this study may provide new knowledge and understanding of the women's experiences of living with vertebral fracture from an insider's point of view in order to obtain a deeper understanding of the women's everyday life. However, further evaluation is still needed in larger study groups.</p

Syns vi - finns vi !?

A couple of hundred years ago half of the earth's surface was covered by forest. Today, only half remains and every year an area the size of Nepal is disappearing. Deforestation, together with the burning of fossil fuels, is also one of the reasons for the increasing greenhouse effect. Another relatively unknown problem for the world's forests is the trade with illegally harvested timber. From an increasing awareness regarding problems with the forests of the world, the Forest Stewardship Council, FSC, was established. FSC is an international non-profit certification organization working for a sustainable management of the world's forests. In order for FSC to survive, the organisation has to consist of an equally large part standard setting, control systems and marketing. The Swedish FSC initiative has so far only been working with certification and organizational issues. None or very little attention has been given to marketing efforts in order to increase the consumer knowledge of FSC. By conducting a survey of the Swedish consumer's knowledge of FSC and preferences towards other value-added labels and by interviews with the FSC initiative in the Netherlands and KRAV, the thesis aims to answer the question of how FSC can survive on the Swedish market. The thesis focuses on how FSC should be communicated most effectively towards the Swedish end consumer. The estimated recognition, with no statistical certainty, of FSC in Sweden is about 5 %. The survey shows that TV is the most important forum for communicating environmental issues, followed by newspapers, the common societal values and in-store information. Of the interviewed, 90 % would like to see a labelling scheme that ensures that the product they buy guarantees sustainable managed forests. The criteria for buying an FSC-product were primarily information about the label, followed by a fair price and reliability for the label. The survey also shows that price difference relative other non-labelled products can not be too big. A couple of percent is enough for the consumer not to buy the labelled product. General care for the environment, no clear cutting, replanting and responsibility for the animals and plants are the most important factors that the FSC-brand should guarantee the consumer. The interviews show two different strategies for organizations with limited resources to conduct marketing efforts. FSC Netherlands have been working with undifferentiated marketing, concentrating on finding cheap but effective alternatives to reach all the consumers with their message. These efforts have generated recognition of FSC of 63 %. KRAV, on the other hand, have worked to create preference for KRAV-products and have carefully selected forums and target markets for their marketing efforts. This way, KRAV have with relatively limited resources become a well known and demanded product for the Swedish consumer. Both organisations have been working with non-government organizations to help create credibility; FSC Netherlands have been working closely with WWF, and KRAV have had collaboration with SSNC, the Swedish Society for Nature Conservation. The message that FSC communicates must create awareness, be persuasive and in the post-purchase process, help the consumer to verify a good choice. To create awareness, the message must be simplified so that the consumer understands it. By communicating credibility, the organization might persuade the consumer to choose FSC-labelled products. In the post-purchase process the consumer has to be helped to verify that the purchase decision actually does contribute to sustainable management of the forests of the world.För ett par hundra år sedan täcktes halva jordens landyta av skog. Idag är hälften borta och varje år avskogas en yta lika stor som Nepal. Avskogningen, tillsammans med förbränning av fossila bränslen, är också en av orsakerna till den ökande växthuseffekten. Ett mycket stort och relativt okänt problem för världens skogar är en omfattande handel med illegalt avverkad skogsråvara. Ur ett ökat medvetande om problemen med världens skogar växte Forest Stewardship Council, FSC, fram. FSC är en ideell, politisk oberoende, internationell certifieringsorganisation som arbetar för ett uthålligt bruk av världens skogar. För att en organisation som FSC ska överleva krävs lika stor del av standardsättning, kontrollsystem och marknadsföring. Svenska FSCs arbete har hittills huvudsakligen fokuserats på certifierings- och organisationsfrågor. Inget fokus har lagts på marknadsföring eller ökad kännedom om FSC i konsumentled. Examensarbetet syftar till att kartlägga hur FSC idag, och i en framtid, mest effektivt kommuniceras som en trovärdig och fungerande mervärdessymbol gentemot den enskilda, svenska slutkonsumenten. Studien söker svara på frågorna om huruvida en marknad för FSC existerar i Sverige, hur FSC i så fall ska överleva på denna marknad och till sist hur FSC-märkningen ska kommuniceras mest effektivt. Studiens empiriska arbete utgörs av en enkätundersökning om svenska konsumenters igenkänning av FSC och preferenser till andra mervärdesmärkningar, samt djupintervjuer med representanter från KRAV och FSCs nationella initiativ i Holland. Uppskattad igenkänning bland konsumenter, dock utan statistisk säkerhet, av FSC i Sverige är ca 5 %. Studien visar också att TV är det forum som konsumenten blir mest påverkad till miljömässiga val av, följt av dagspress, den allmänna samhällsvärderingen samt information i butik. Hela 90 % av de tillfrågade anser att det finns ett behov av en märkning som talar om att produkten de köper kommer från ett ansvarsfullt skogsbruk. Kriterier för att börja köpa FSC-märkta produkter är framför allt mer information, följt av rimligt pris och trovärdighet för märkningen. Undersökningen visar dessutom att prisskillnaden inte får vara för stor, några få procents påslag räcker för att konsumenten ska välja att inte köpa produkten. Allmän naturhänsyn, ingen skövling, återplantering och ansvar för djur och växter är de viktigaste egenskaperna som FSC-märkningen måste garantera konsumenten. Djupintervjuer med representanter från KRAV och FSC Holland ger erfarenheter från två skilda marknadsföringsstrategier som organisationer med begränsade resurser kan använda sig av. FSC Holland har arbetat med odifferentierad marknadsföring och letat efter billiga alternativ för att nå ut till så många konsumenter som möjligt. Detta har resulterat i en igenkänning av FSC hos 63 % av konsumenterna. KRAV har arbetat med att skapa preferens för KRAV-märkta produkter och omsorgsfullt valt forum och målmarknader för sina marknadsföringsinsatser. På så sätt har KRAV med relativt små medel blivit ett efterfrågat och välkänt varumärke för den svenska konsumenten. Gemensamt för de båda organisationerna är att de arbetat med enskilda organisationer för att skapa trovärdighet; FSC Holland med framför allt WWF, och KRAV med framförallt Svenska Naturskyddsföreningen. Budskapen som FSC kommunicerar måste skapa ett medvetande, verka övertygande, samt i efterköpsprocessen, kunna verifiera ett bra val. För att skapa ett medvetande måste informationen förenklas så att konsumenten har möjlighet att ta åt sig budskapet. Genom att kommunicera trovärdighet kan FSC övertyga konsumenten att välja FSC-märkta produkter. I efterköpsprocessen måste konsumenten ges möjlighet till verifiering, att det val som gjorts är ”rätt” och verkligen bidrar till ett uthålligt bruk av världens skogar

Infiltration of CD163-, PD-L1-and FoxP3-positive cells adversely affects outcome in patients with mantle cell lymphoma independent of established risk factors

We characterised patients with mantle cell lymphoma (MCL) with poor prognosis based on differences in immune infiltration. Different expressions of the tumour cell markers Cyclin D1 and sex-determining region Y-box transcription factor 11 (SOX11), and the immune markers cluster of differentiation 3 (CD3), CD4, CD8, CD25, forkhead box protein P3 (FoxP3), T-box transcription factor TBX21 (T-bet), programmed cell death protein 1 (PD-1), programmed-death ligand 1 (PD-L1) and CD163 were investigated for all-cause mortality in 282 patients with MCL and time-to-progression (TTP) in 106 clinical trial patients. With increasing age, a significantly lower infiltration of CD3(+) T lymphocytes was seen. T-cell infiltration was independent of cellular tumour antigen p53 (p53) expression, Ki-67, morphology and frequency of tumour cells. The all-cause mortality was higher in patients with PD-L1-expression above cut-off [hazard ratio (HR) 1 center dot 97, 95% confidence interval (CI) 1 center dot 18-3 center dot 25, adjusted for sex and MCL International Prognostic Index (MIPI)] and a higher frequency of CD163(+) cells (continuously, HR 1 center dot 51, 95% CI 1 center dot 03-2 center dot 23, adjusting for age, sex, morphology, Ki-67 and p53). In patients treated within the Nordic Lymphoma Group MCL2/3 trials, TTP was shorter in patients with a higher frequency of FoxP3(+) cells (HR 3 center dot 22, 95% CI 1 center dot 40-7 center dot 43) and CD163(+) cells (HR 6 center dot 09, 95% CI 1 center dot 84-20 center dot 21), independent of sex and MIPI. When combined a higher frequency of CD163(+) macrophages and PD-L1(+) cells or high CD163(+) macrophages and FoxP3(+) regulatory T cells indicated worse outcome independent of established risk factors. The T-cell infiltrate was in turn independent of molecular characteristics of the malignant cells and decreased with age.Peer reviewe