Adolescent alcohol use: Implications for prevention

Background Alcohol use, especially heavy episodic drinking, at an early age has been associated with various problems (e.g. risky sexual behaviours, health problems, depression, and heavy alcohol consumption at a later age). Thus, a better understanding of the risk and protective factors that influence adolescent alcohol use is crucial to developing effective prevention strategies. The aim of this thesis is to examine the importance of risk and protective factors in the development of heavy episodic drinking and subsequent problems for adolescent boys and girls. In addition, the prevention paradox (most alcohol-related problems occur in the 90 % of the population with lowest alcohol consumption) was examined among adolescents in Sweden and Europe. Methods Data from three different questionnaire studies were analysed: (1) a longitudinal cohort study with 1222 adolescents from Stockholm, aged 13 to 19 years, (2) a cross-sectional study with 3000 adolescents aged 15 years and 17 years from random samples of school classes throughout the whole of Sweden, and (3) a cross-sectional study (the European School Survey Project on Alcohol and Other Drugs, ESPAD) performed in 35 countries among students who turned 16 during the year of the data collection. Twenty-three countries with 38 370 alcohol-consuming adolescents were included. Results Smoking and peer alcohol use were strongly associated with heavy drinking among both boys and girls, both cross-sectionally and longitudinally. Some gender differences were found; parental provision of alcohol in the 7th grade increased the odds for heavy alcohol use in girls two years later, and truancy was associated with later heavy alcohol use in boys. For boys, heavy episodic drinking at age 13 was one of the most distinct predictors of later heavy episodic drinking. For girls, secure bonds to parents lowered the risk for heavy episodic drinking, even if the girls had friends who drank alcohol, money to spend, or parents who offered them alcohol. For boys whose parents offered them alcohol, parental monitoring had a protective effect. Also, we found that adolescents on a consistent high alcohol use trajectory during early adolescence had higher levels of heavy episodic drinking and alcohol-related problems at age 19. Furthermore, the prevention paradox was valid for adolescent boys and girls in Sweden and in most European countries; despite differences in annual alcohol consumption, levels of heavy episodic drinking, and reported problems, the heavy episodic drinkers in the bottom 90% consumer group accounted for a majority of all reported problems. Conclusions Effective population strategies may have large potential to reduce risk drinking and the overall problem level. A comprehensive prevention strategy should nevertheless also include efforts to reach adolescent high consumers. Furthermore, our results lend support to prevention initiatives to strengthen the parent–child relationship, to focus on adolescents‟ ability to resist peer pressure, and to limit parental provision of alcohol

Chemical and transcriptional responses of Norway spruce genotypes with different susceptibility to Heterobasidion spp. infection

Background: Norway spruce [Picea abies (L.) Karst.] is one of the most important conifer species in Europe. The wood is economically important and infections by wood-rotting fungi cause substantial losses to the industry. The first line of defence in a Norway spruce tree is the bark. It is a very efficient barrier against infection based on its mechanical and chemical properties. Once an injury or an infection is recognized by the tree, induced defences are activated. In this study we examined transcriptional response, using 454-sequencing, and chemical profiles in bark of Norway spruce trees with different susceptibility to Heterobasidion annosum s.l. infection. The aim was to find associations between the transcriptome and chemical profiles to the level of susceptibility to Heterobasidion spp. in Norway spruce genotypes. Results: Both terpene and phenol compositions were analysed and at 28 days post inoculation (dpi) high levels of 3-carene was produced in response to H. annosum. However, significant patterns relating to inoculation or to genotypes with higher or lower susceptibility could only be found in the phenol fraction. The levels of the flavonoid catechin, which is polymerized into proanthocyanidins (PA), showed a temporal variation; it accumulated between 5 and 15 dpi in response to H. annosum infection in the less susceptible genotypes. The transcriptome data suggested that the accumulation of free catechin was preceded by an induction of genes in the flavonoid and PA biosynthesis pathway such as leucoanthocyanidin reductase. Quantitative PCR analyses verified the induction of genes in the phenylpropanoid and flavonoid pathway. The qPCR data also highlighted genotype-dependent differences in the transcriptional regulation of these pathways. Conclusions: The varying dynamics in transcriptional and chemical patterns displayed by the less susceptible genotypes suggest that there is a genotypic variation in successful spruce defence strategies against Heterobasidion. However, both high levels of piceasides and flavonoids in the less susceptible genotypes suggested the importance of the phenolic compounds in the defence. Clearly an extended comparison of the transcriptional responses in the interaction with Heterobasidion between several independent genotypes exhibiting reduced susceptibility is needed to catalogue mechanisms of successful host defence strategies

Genetic- and Lifestyle-dependent Dental Caries Defined by the Acidic Proline-rich Protein Genes PRH1 and PRH2.

Dental caries is a chronic infectious disease that affects billions of people with large individual differences in activity. We investigated whether PRH1 and PRH2 polymorphisms in saliva acidic proline-rich protein (PRP) receptors for indigenous bacteria match and predict individual differences in the development of caries. PRH1 and PRH2 variation and adhesion of indigenous and cariogenic (Streptococcus mutans) model bacteria were measured in 452 12-year-old Swedish children along with traditional risk factors and related to caries at baseline and after 5-years. The children grouped into low-to-moderate and high susceptibility phenotypes for caries based on allelic PRH1, PRH2 variation. The low-to-moderate susceptibility children (P1 and P4a-) experienced caries from eating sugar or bad oral hygiene or infection by S. mutans. The high susceptibility P4a (Db, PIF, PRP12) children had more caries despite receiving extra prevention and irrespective of eating sugar or bad oral hygiene or S. mutans-infection. They instead developed 3.9-fold more caries than P1 children from plaque accumulation in general when treated with orthodontic multibrackets; and had basic PRP polymorphisms and low DMBT1-mediated S. mutans adhesion as additional susceptibility traits. The present findings thus suggest genetic autoimmune-like (P4a) and traditional life style (P1) caries, providing a rationale for individualized oral care

Digital teknik och socialt arbete : Att motivera socialt utsatta ungdomar med stöd av motivationsappar och hälsoarmband

Digital teknik och socialt arbete är en pilotstudie som syftat till att undersöka effekter av att använda aktivitetsarmband med tillhörande motivationsapp för att stärka ungdomars motivation till fysisk aktivitet och goda sömnvanor. Projektet har präglats av ett explorativt angreppsätt i det att vi undersökt hur introduktion av ny digital teknik mottas av olika målgrupper inom socialtjänsten. Forskning har visat sig att det finns en tydlig koppling mellan ökad fysisk aktivitet och minskad psykisk ohälsa. Sömnen är ytterligare faktor som spelar en betydande roll för barn och ungas hälsa. Vi har denna kunskap om fysiska aktivitet och sömn i samhället idag samtidigt som barn och ungas psykiska och fysiska hälsosituation utgör ett uppmärksammat folkhälsoproblem. Att barn rör på sig för lite syns hos alla grupper av barn och unga oavhängigt faktorer som familjeförhållanden, arbetsmarknadsstatus och föräldrars samhällsekonomiska status. Enligt Socialstyrelsen (2013) är det av extra vikt att barn och unga uppnår bästa möjliga hälsa eftersom det visat sig att nedsatt hälsotillstånd i unga år kan få betydelse för resten av individens liv. Insatser för att preventivt främja våra barns och ungas hälsa är därför en önskvärd och god samhällsinvestering både för den enskilda individen och för allas vår gemensamma hållbara framtid. Denna rapport beskriver resultatet av ett forsknings-och utvecklingsprojekt där vi undersökt hur appar och aktivitetsarmband skulle kunna användas för att motivera barn och unga till ökad fysisk aktivitet samt bättre sömnvanor.  Våra undersökningar av tidigare forskning inom problemområdet har visat på att det finns en tydlig koppling mellan ökad fysisk aktivitet och minskad psykisk ohälsa, såsom t.ex. att fysisk aktivitet kan minska depression och ångest. Fysisk aktivitet har samma effekt som psykologisk behandling och medicinering, men ger betydligt färre biverkningar än medicinering. Det finns också framgångsrika försök med viktminskningsgrupper som arbetat med stöd av digitala lösningar. Tekniken i sig kan bidra med att sätta mål, motivera, och följa upp resultat. Sociala funktioner för att kunna följa andras framsteg har visat sig öka motivation gällande att vara mer fysiskt aktiv. Angreppsätt där man låter användare mäta och följa sitt eget beteende ger den största positiva effekten för att åstadkomma hälsofrämjande beteendeförändringar.  Om fysisk aktivitet är bra för hälsa är sömn om möjligt ännu viktigare. Forskning inom sömn visar att det en tydlig koppling mellan sömn och vardagligt välbefinnande. Det har konstaterats att olika typer av sömn har olika funktioner. REM-sömnen har t.ex. påvisat koppling till bättre mönsterigenkänning medan djupsömnen har en påverkan på minnet. Forskning visar också att sömnlöshet påverkar immunförsvaret negativt vilket i sin tur kan bidra till sömnstörningar och övervikt hos ungdomar. Vad gäller teknik så visar forskning att professionell kompetens inom hälsa och medicin inte alltid används vid framtagning av teknik, vilket utgör ett återkommande problem. Det är inte enbart är tekniken som måste fungera för att insatsen ska kunna lyckas, attityden till e-hälsa bland befolkningen generellt sett kan också ha en avgörande betydelse. Om den generella bilden av tekniken bland befolkningen är negativ så är det svårt att införa och lyckas med teknikstöd. Teknikutvecklingen är snabb, och vi står inför en dramatisk ökning av olika informations- och telekommunikationsteknologier vars syfte är att förbättra och utveckla egenvård och omsorg. Frågor om integritet hamnar ofta i skymundan. Flertalet av de identifierade relevanta publikationerna fokuserade mer på tekniken än det hälsobefrämjande stödet. Vår bibliografiska undersökning visar att det finns förhållandevis lite av samband mellan begrepp som är relaterade till hälsoappar och egenvård kontra motivationsarbete och socialt arbete. De starkaste sambanden av intresse för oss hittade vi i ett gränsland mellan medicin och datavetenskap. Sammanfattningsvis kan vi säga att flertalet av de här identifierade akademiska publikationerna diskuterar de tekniska lösningarna i sig, eller presenterar användarvalidering av olika lösningar; snarare än socialt arbete, eget motivations- och förändringsarbete av dåliga vanor och livsmönster - som är vårt intresseområde i denna studie. För att bättre förstå och bidra till utmaningarna så har ett samarbete initierats mellan Helsingborgs stads Forsknings- och utvecklingsenhet för social hållbarhet (FoU Helsingborg), Preventivt arbete tillsammans (PART) från Helsingborgs stad och forskare från både Lunds Internet institut (LUii), Lunds Universitet samt Digital design, Sektionen för hälsa och samhälle på Kristianstad Högskola (HKR). Ett internt utvecklingsprojekt har genomförts av PART med stöd av FoU i Helsingborgs stad. I samband med utvecklingsprojektet har ett gränsöverskridande samarbete initierats där aktionsforskning ramat in utvecklingsprojektets empiriska studie och möjliggjort en gemensam yta för ett bredare kunskapsskapande. Vårt fokus har varit ett kunskapsbildande vad gäller aktivitetsarmband och motivationsappar för barn och unga som löper risk för ohälsa. Denna rapport presenterar en akademisk kunskapsöversikt, samt resultatet från ett utvecklingsprojekt där vi tillsammans undersökt effekterna av att använda aktivitetsarmband och tillhörande social app. Vi har beforskat vilken påverkan dessa kan ha på ungdomars egen motivation till fysisk aktivitet och goda sömnvanor. Syftet med pilotprojektet har varit att kartlägga forskningen på området, undersöka de upplevda effekter av att använda aktivitetsarmband med tillhörande motivationsapp för att stärka deltagares motivation till fysisk aktivitet och förbättrade sömnvanor, samt undersöka hur vi kan förstå de faktorer som verkar vara mest betydande för att uppnå effekter. Det senare har vi gjort genom att fokusera på fyra övergripande områden: Användandet av motivationsapp - Hur länge och med vilken frekvens använder deltagarna armband och motivationsapp? Värdeskapande för ungdomar - Till vilka positiva resultat bidrar armband och motivationsapp? Negativa bieffekter - Kan armband och motivationsapp orsaka negativa bieffekter hos deltagarna? Om så, till vilka områden hänför sig dessa bieffekter? Värdeskapande för personal – Vilken nytta ser personalen av armband och motivationsapp i sitt arbete? Ur ett forskningsperspektiv så är studien att betrakta som mindre, varvid dess värde skall beaktas utifrån detta. Mer forskning behövs i området motivationsappar och socialt arbete. Studieresultatet visar på faktorer som har betydelse för frågeställningarna, som också kan identifieras i tidigare forskning. Positiva upplevelser har varit att ungdomarna fått en märkbart ökad medvetenhet om sina egna levnadsmönster vad gäller motion och sömn. Tydligast märktes den nya medvetenhet som växte fram runt egna sömnvanor, även att dessa inte alltid gick att åtgärda på egen hand. Det var också uppenbart att den nya medvetenheten ledde ökad motivation och fysisk aktivitet. Identifierade negativa bieffekter var att stress kunde uppstå när ungdomarna var förhindrade att själva öka sitt stegantal samtidigt som de såg andra ungdomars resultat öka. Det rapporterades problem med att sköta den dagliga laddningen av aktivitetsarmbandet, samt att aktivera sömnmätningen när de skulle lägga sig. Ett stort värde för personalen var att de fick ett instrument som berikade kommunikationen utifrån “objektiv” data genererad av ungdomarnas egna mätningar av motion och sömn. Ett verktyg som utgjorde god hjälp för samtal, som i sig kunde bidra till bättre struktur i ungdomars liv

Disease Burden Attributed to Drug use in the Nordic Countries: a Systematic Analysis for the Global Burden of Diseases, Injuries, and Risk Factors Study 2019

The Nordic countries share similarities in many social and welfare domains, but drug policies have varied over time and between countries. We wanted to compare differences in mortality and disease burden attributed to drug use over time. Using results from the Global Burden of Disease (GBD) study, we extracted age-standardized estimates of deaths, DALYs, YLLs and YLDs per 100 000 population for Denmark, Finland, Iceland, Norway, and Sweden during the years 1990 to 2019. Among males, DALY rates in 2019 were highest in Finland and lowest in Iceland. Among females, DALY rates in 2019 were highest in Iceland and lowest in Sweden. Sweden have had the highest increase in burden since 1990, from 252 DALYs to 694 among males, and from 111 to 193 among females. Norway had a peak with highest level of all countries in 2001–2004 and thereafter a strong decline. Denmark have had the most constant burden over time, 566–600 DALYs among males from 1990 to 2010 and 210–240 DALYs among females. Strict drug policies in Nordic countries have not prevented an increase in some countries, so policies need to be reviewed.publishedVersio

Up-regulation of cell cycle arrest protein BTG2 correlates with increased overall survival in breast cancer, as detected by immunohistochemistry using tissue microarray

<p>Abstract</p> <p>Background</p> <p>Previous studies have shown that the <it>ADIPOR1</it>, <it>ADORA1</it>, <it>BTG2 </it>and <it>CD46 </it>genes differ significantly between long-term survivors of breast cancer and deceased patients, both in levels of gene expression and DNA copy numbers. The aim of this study was to characterize the expression of the corresponding proteins in breast carcinoma and to determine their correlation with clinical outcome.</p> <p>Methods</p> <p>Protein expression was evaluated using immunohistochemistry in an independent breast cancer cohort of 144 samples represented on tissue microarrays. Fisher's exact test was used to analyze the differences in protein expression between dead and alive patients. We used Cox-regression multivariate analysis to assess whether the new markers predict the survival status of the patients better than the currently used markers.</p> <p>Results</p> <p>BTG2 expression was demonstrated in a significantly lower proportion of samples from dead patients compared to alive patients, both in overall expression (<it>P </it>= 0.026) and cell membrane specific expression (<it>P </it>= 0.013), whereas neither ADIPOR1, ADORA1 nor CD46 showed differential expression in the two survival groups. Furthermore, a multivariate analysis showed that a model containing BTG2 expression in combination with HER2 and Ki67 expression along with patient age performed better than a model containing the currently used prognostic markers (tumour size, nodal status, HER2 expression, hormone receptor status, histological grade, and patient age). Interestingly, BTG2 has previously been described as a tumour suppressor gene involved in cell cycle arrest and p53 signalling.</p> <p>Conclusions</p> <p>We conclude that high-level BTG2 protein expression correlates with prolonged survival in patients with breast carcinoma.</p

Global age-sex-specific fertility, mortality, healthy life expectancy (HALE), and population estimates in 204 countries and territories, 1950-2019 : a comprehensive demographic analysis for the Global Burden of Disease Study 2019

Background: Accurate and up-to-date assessment of demographic metrics is crucial for understanding a wide range of social, economic, and public health issues that affect populations worldwide. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 produced updated and comprehensive demographic assessments of the key indicators of fertility, mortality, migration, and population for 204 countries and territories and selected subnational locations from 1950 to 2019. Methods: 8078 country-years of vital registration and sample registration data, 938 surveys, 349 censuses, and 238 other sources were identified and used to estimate age-specific fertility. Spatiotemporal Gaussian process regression (ST-GPR) was used to generate age-specific fertility rates for 5-year age groups between ages 15 and 49 years. With extensions to age groups 10–14 and 50–54 years, the total fertility rate (TFR) was then aggregated using the estimated age-specific fertility between ages 10 and 54 years. 7417 sources were used for under-5 mortality estimation and 7355 for adult mortality. ST-GPR was used to synthesise data sources after correction for known biases. Adult mortality was measured as the probability of death between ages 15 and 60 years based on vital registration, sample registration, and sibling histories, and was also estimated using ST-GPR. HIV-free life tables were then estimated using estimates of under-5 and adult mortality rates using a relational model life table system created for GBD, which closely tracks observed age-specific mortality rates from complete vital registration when available. Independent estimates of HIV-specific mortality generated by an epidemiological analysis of HIV prevalence surveys and antenatal clinic serosurveillance and other sources were incorporated into the estimates in countries with large epidemics. Annual and single-year age estimates of net migration and population for each country and territory were generated using a Bayesian hierarchical cohort component model that analysed estimated age-specific fertility and mortality rates along with 1250 censuses and 747 population registry years. We classified location-years into seven categories on the basis of the natural rate of increase in population (calculated by subtracting the crude death rate from the crude birth rate) and the net migration rate. We computed healthy life expectancy (HALE) using years lived with disability (YLDs) per capita, life tables, and standard demographic methods. Uncertainty was propagated throughout the demographic estimation process, including fertility, mortality, and population, with 1000 draw-level estimates produced for each metric. Findings: The global TFR decreased from 2·72 (95% uncertainty interval [UI] 2·66–2·79) in 2000 to 2·31 (2·17–2·46) in 2019. Global annual livebirths increased from 134·5 million (131·5–137·8) in 2000 to a peak of 139·6 million (133·0–146·9) in 2016. Global livebirths then declined to 135·3 million (127·2–144·1) in 2019. Of the 204 countries and territories included in this study, in 2019, 102 had a TFR lower than 2·1, which is considered a good approximation of replacement-level fertility. All countries in sub-Saharan Africa had TFRs above replacement level in 2019 and accounted for 27·1% (95% UI 26·4–27·8) of global livebirths. Global life expectancy at birth increased from 67·2 years (95% UI 66·8–67·6) in 2000 to 73·5 years (72·8–74·3) in 2019. The total number of deaths increased from 50·7 million (49·5–51·9) in 2000 to 56·5 million (53·7–59·2) in 2019. Under-5 deaths declined from 9·6 million (9·1–10·3) in 2000 to 5·0 million (4·3–6·0) in 2019. Global population increased by 25·7%, from 6·2 billion (6·0–6·3) in 2000 to 7·7 billion (7·5–8·0) in 2019. In 2019, 34 countries had negative natural rates of increase; in 17 of these, the population declined because immigration was not sufficient to counteract the negative rate of decline. Globally, HALE increased from 58·6 years (56·1–60·8) in 2000 to 63·5 years (60·8–66·1) in 2019. HALE increased in 202 of 204 countries and territories between 2000 and 2019

Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Background: In an era of shifting global agendas and expanded emphasis on non-communicable diseases and injuries along with communicable diseases, sound evidence on trends by cause at the national level is essential. The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) provides a systematic scientific assessment of published, publicly available, and contributed data on incidence, prevalence, and mortality for a mutually exclusive and collectively exhaustive list of diseases and injuries. Methods: GBD estimates incidence, prevalence, mortality, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life-years (DALYs) due to 369 diseases and injuries, for two sexes, and for 204 countries and territories. Input data were extracted from censuses, household surveys, civil registration and vital statistics, disease registries, health service use, air pollution monitors, satellite imaging, disease notifications, and other sources. Cause-specific death rates and cause fractions were calculated using the Cause of Death Ensemble model and spatiotemporal Gaussian process regression. Cause-specific deaths were adjusted to match the total all-cause deaths calculated as part of the GBD population, fertility, and mortality estimates. Deaths were multiplied by standard life expectancy at each age to calculate YLLs. A Bayesian meta-regression modelling tool, DisMod-MR 2.1, was used to ensure consistency between incidence, prevalence, remission, excess mortality, and cause-specific mortality for most causes. Prevalence estimates were multiplied by disability weights for mutually exclusive sequelae of diseases and injuries to calculate YLDs. We considered results in the context of the Socio-demographic Index (SDI), a composite indicator of income per capita, years of schooling, and fertility rate in females younger than 25 years. Uncertainty intervals (UIs) were generated for every metric using the 25th and 975th ordered 1000 draw values of the posterior distribution. Findings: Global health has steadily improved over the past 30 years as measured by age-standardised DALY rates. After taking into account population growth and ageing, the absolute number of DALYs has remained stable. Since 2010, the pace of decline in global age-standardised DALY rates has accelerated in age groups younger than 50 years compared with the 1990–2010 time period, with the greatest annualised rate of decline occurring in the 0–9-year age group. Six infectious diseases were among the top ten causes of DALYs in children younger than 10 years in 2019: lower respiratory infections (ranked second), diarrhoeal diseases (third), malaria (fifth), meningitis (sixth), whooping cough (ninth), and sexually transmitted infections (which, in this age group, is fully accounted for by congenital syphilis; ranked tenth). In adolescents aged 10–24 years, three injury causes were among the top causes of DALYs: road injuries (ranked first), self-harm (third), and interpersonal violence (fifth). Five of the causes that were in the top ten for ages 10–24 years were also in the top ten in the 25–49-year age group: road injuries (ranked first), HIV/AIDS (second), low back pain (fourth), headache disorders (fifth), and depressive disorders (sixth). In 2019, ischaemic heart disease and stroke were the top-ranked causes of DALYs in both the 50–74-year and 75-years-and-older age groups. Since 1990, there has been a marked shift towards a greater proportion of burden due to YLDs from non-communicable diseases and injuries. In 2019, there were 11 countries where non-communicable disease and injury YLDs constituted more than half of all disease burden. Decreases in age-standardised DALY rates have accelerated over the past decade in countries at the lower end of the SDI range, while improvements have started to stagnate or even reverse in countries with higher SDI. Interpretation: As disability becomes an increasingly large component of disease burden and a larger component of health expenditure, greater research and developm nt investment is needed to identify new, more effective intervention strategies. With a rapidly ageing global population, the demands on health services to deal with disabling outcomes, which increase with age, will require policy makers to anticipate these changes. The mix of universal and more geographically specific influences on health reinforces the need for regular reporting on population health in detail and by underlying cause to help decision makers to identify success stories of disease control to emulate, as well as opportunities to improve. Funding: Bill & Melinda Gates Foundation. © 2020 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licens

Revised structures of municipality block

This paper is about a new organization how to get smaller communities to join together and become much larger. The purpose is to find out why Norra Sandsjö community and Bringetofta and Norra Sandsjö parishes were separated when Sävsjö municipality block was formed. The purpose is further to find out what the councils of Norra Sandsjö, Nässjö and Sävsjö, the church council and the people who lived in the area thought about the decision that was made by the executive organization in this matter (länsstyrelsen in Jönköping). Voting was arranged amongst the people, who lived in the specific area that in the first inquiry was suggested to be connected with Nässjö municipality block. The source material gives the result of this voting and the opinions of Norra Sandsjö, Nässjö and Sävsjö communities in this question. The source material includes inquires made by the executive organization (länsstyrelsen) and records from the meetings of Nässjö, Sävsjö and Norra Sandsjö councils. The theory is based on the case to have enough proximity to a chief town within the municipality block. The question if the south part of Norra Sandsjö commune and parts of Bringetofta and Norra Sandsjö parishes was going to be connected with Sävsjö municipality block instead of Nässjö municipality block is about the question of proximity to a chief town