LVU och påtaglig risk - en studie av riskrekvisitets tillämpning

In order to take a child into custody without the consent of the child or its parents it is necessary that there are deficiencies in the child’s home environment or in his or her behaviour. In addition, there also has to be a significant risk that the child’s health and development will be harmed. The term significant risk has been in use since the law was renewed in 1990 when it replaced the old terms “danger” and “severe danger”. Those terms had been criticized for being obscure, leading to an uncertainty regarding when the law was applicable. However, the term significant risk is not as clear as would be desired leading to a risk that the courts might still be uncertain about how the term is supposed to be used. An empirical investigation shows that the administrative courts sometimes apply the term poorly, for instance the word “significant” is not always even mentioned and the reasons behind the courts’ usage of the term are not always well explained. The investigation includes eighty judgments from four administrative courts and the poor explanations can be found in judgments from all of the courts. This causes a risk for arbitrariness and a lack of legal security in the courts’ judgments.För att ett barn ska kunna omhändertas utan dennes eller föräldrarnas samtycke krävs antingen att det föreligger brister i den unges hemmiljö eller i dennes beteende. Dessutom krävs att en prognos görs från förvaltningsrättens sida huruvida dessa brister utgör en påtaglig risk för att den unges hälsa och utveckling skadas. Rekvisitet påtaglig risk ersatte 1990 de tidigare rekvisiten fara respektive allvarlig fara i syfte att underlätta för domstolarna när de skulle avgöra huruvida vård skulle beredas den unge eller ej. Uttrycket påtaglig risk är dock ett svårdefinierat begrepp och med hjälp av en empirisk undersökning av åttio mål från fyra förvaltningsrätter kan konstateras att begreppet är svårdefinierat även för dem. Rekvisitet tillämpas inte alltid korrekt, bland annat bortser domstolen emellanåt från att bedöma huruvida risken är påtaglig eller ej. Dessutom är motiveringarna av den påtagliga risken i flera fall tämligen tunna och det är ibland svårt att avgöra hur förvaltningsrätten kommit fram till att en påtaglig risk faktiskt föreligger. De brister som finns i de undersökta målen visar att det finns en risk för att rekvisitet inte är tillräckligt tydligt för att man ska kunna tala om att det föreligger rättssäkerhet i önskvärd utsträckning, exempelvis visar undersökningen att risken för godtycklighet finns samt att förutsebarheten riskerar att bli låg. Brister går att finna i domar från samtliga förvaltningsrätter

The effectiveness of virtual reality training on knowledge, skills and attitudes of health care professionals and students in assessing and treating mental health disorders: a systematic review

Background: Virtual reality (VR) training can enhance health professionals' learning. However, there are ambiguous findings on the effectiveness of VR as an educational tool in mental health. We therefore reviewed the existing literature on the effectiveness of VR training on health professionals' knowledge, skills, and attitudes in assessing and treating patients with mental health disorders. Methods: We searched MEDLINE, PsycINFO (via Ovid), the Cochrane Library, ERIC, CINAHL (on EBSCOhost), Web of Science Core Collection, and the Scopus database for studies published from January 1985 to July 2023. We included all studies evaluating the effect of VR training interventions on attitudes, knowledge, and skills pertinent to the assessment and treatment of mental health disorders and published in English or Scandinavian languages. The quality of the evidence in randomized controlled trials was assessed with the Cochrane Risk of Bias Tool 2.0. For non-randomized studies, we assessed the quality of the studies with the ROBINS-I tool. Results: Of 4170 unique records identified, eight studies were eligible. The four randomized controlled trials were assessed as having some concern or a high risk of overall bias. The four non-randomized studies were assessed as having a moderate to serious overall risk of bias. Of the eight included studies, four used a virtual standardized patient design to simulate training situations, two studies used interactive patient scenario training designs, while two studies used a virtual patient game design. The results suggest that VR training interventions can promote knowledge and skills acquisition. Conclusions: The findings indicate that VR interventions can effectively train health care personnel to acquire knowledge and skills in the assessment and treatment of mental health disorders. However, study heterogeneity, prevalence of small sample sizes, and many studies with a high or serious risk of bias suggest an uncertain evidence base. Future research on the effectiveness of VR training should include assessment of immersive VR training designs and a focus on more robust studies with larger sample sizes. Trial registration: This review was pre-registered in the Open Science Framework register with the ID-number Z8EDK. Keywords: Clinical skills; Health care professionals; Health care students; Mental health; Systematic review; Training; Virtual reality.Open access funding provided by Inland Norway University Of Applied Sciences The study forms a part of a collaborative PhD project funded by South-Eastern Norway Regional Health Authority through Innlandet Hospital Trust and the Inland University of Applied Sciences.publishedVersio

Urbanization causes biotic homogenization of woodland bird communities at multiple spatial scales

Abstract Urbanization is a major contributor to biodiversity declines. However, studies assessing effects of urban landscapes per se (i.e., disentangled from focal habitat effects) on biodiversity across spatial scales are lacking. Understanding such scale-dependent effects is fundamental to preserve habitats along an urbanization gradient in a way that maximizes overall biodiversity. We investigated the impact of landscape urbanization on communities of woodland-breeding bird species in individual (local scale) and across multiple (regional scale) cities, while controlling for the quality of sampled habitats (woodlands). We conducted bird point counts and habitat quality mapping of trees, dead wood and shrubs in 459 woodlands along an urban to rural urbanization gradient in 32 cities in Sweden. Responses to urbanization were measured as local and regional total diversity (?), average site diversity (α) and diversity between sites (?). We also assessed effects on individual species and to what extent dissimilarities in species composition along the urbanization gradient were driven by species nestedness or turnover. We found that landscape urbanization had a negative impact on ?-, α- and ?-diversity irrespective of spatial scale, both regarding all woodland-breeding species and red-listed species. At the regional scale, dissimilarities in species composition between urbanization levels were due to nestedness, i.e., species were lost with increased landscape urbanization without being replaced. In contrast, dissimilarities at the local scale were mostly due to species turnover. Because there was no difference in habitat quality among woodlands across the urbanization gradient, we conclude that landscape urbanization as such systematically causes poorer and more homogeneous bird communities in adjacent natural habitats. However, the high local turnover and the fact that several species benefited from urbanization demonstrates that natural habitats along the entire urbanization gradient are needed to maintain maximally diverse local bird communities.Urbanization is a major contributor to biodiversity declines. However, studies assessing effects of urban landscapes per se (i.e., disentangled from focal habitat effects) on biodiversity across spatial scales are lacking. Understanding such scale-dependent effects is fundamental to preserve habitats along an urbanization gradient in a way that maximizes overall biodiversity. We investigated the impact of landscape urbanization on communities of woodland-breeding bird species in individual (local scale) and across multiple (regional scale) cities, while controlling for the quality of sampled habitats (woodlands). We conducted bird point counts and habitat quality mapping of trees, dead wood, and shrubs in 459 woodlands along an urban to rural urbanization gradient in 32 cities in Sweden. Responses to urbanization were measured as local and regional total diversity (gamma), average site diversity (alpha), and diversity between sites (beta). We also assessed effects on individual species and to what extent dissimilarities in species composition along the urbanization gradient were driven by species nestedness or turnover. We found that landscape urbanization had a negative impact on gamma-, alpha-, and beta-diversity irrespective of spatial scale, both regarding all woodland-breeding species and red-listed species. At the regional scale, dissimilarities in species composition between urbanization levels were due to nestedness, that is, species were lost with increased landscape urbanization without being replaced. In contrast, dissimilarities at the local scale were mostly due to species turnover. Because there was no difference in habitat quality among woodlands across the urbanization gradient, we conclude that landscape urbanization as such systematically causes poorer and more homogeneous bird communities in adjacent natural habitats. However, the high local turnover and the fact that several species benefited from urbanization demonstrates that natural habitats along the entire urbanization gradient are needed to maintain maximally diverse local bird communities.Peer reviewe

Urbanization causes biotic homogenization of woodland bird communities at multiple spatial scales

Urbanization is a major contributor to biodiversity declines. However, studies assessing effects of urban landscapes per se (i.e., disentangled from focal habitat effects) on biodiversity across spatial scales are lacking. Understanding such scale-dependent effects is fundamental to preserve habitats along an urbanization gradient in a way that maximizes overall biodiversity. We investigated the impact of landscape urbanization on communities of woodland-breeding bird species in individual (local scale) and across multiple (regional scale) cities, while controlling for the quality of sampled habitats (woodlands). We conducted bird point counts and habitat quality mapping of trees, dead wood, and shrubs in 459 woodlands along an urban to rural urbanization gradient in 32 cities in Sweden. Responses to urbanization were measured as local and regional total diversity (gamma), average site diversity (alpha), and diversity between sites (beta). We also assessed effects on individual species and to what extent dissimilarities in species composition along the urbanization gradient were driven by species nestedness or turnover. We found that landscape urbanization had a negative impact on gamma-, alpha-, and beta-diversity irrespective of spatial scale, both regarding all woodland-breeding species and red-listed species. At the regional scale, dissimilarities in species composition between urbanization levels were due to nestedness, that is, species were lost with increased landscape urbanization without being replaced. In contrast, dissimilarities at the local scale were mostly due to species turnover. Because there was no difference in habitat quality among woodlands across the urbanization gradient, we conclude that landscape urbanization as such systematically causes poorer and more homogeneous bird communities in adjacent natural habitats. However, the high local turnover and the fact that several species benefited from urbanization demonstrates that natural habitats along the entire urbanization gradient are needed to maintain maximally diverse local bird communities

Plasma cotinine is positively associated with homocysteine in smokers but not in users of smokeless tobacco

Plasma total homocysteine (tHcy) is a risk marker, and smoking is an established risk factor for cardiovascular disease. It is unclear if the effect of smoked tobacco on homocysteine is mediated by nicotine or other combustion products in smoked tobacco. Snus (moist smokeless tobacco) is high nicotine-containing tobacco, and little is known about the effect of snus on plasma homocysteine. Therefore, we studied, in a cross-section of subjects (n = 1375) from the Northern Sweden Health and Disease Study, with strictly defined current smokers (n = 194) and snus users (n = 47), the impact of tobacco exposure on tHcy, assessed by self-reported tobacco habits and plasma cotinine concentrations. The snus users had higher cotinine concentrations than the smokers. Cotinine, creatinine, methylmalonic acid, and the methylenetetrahydrofolate reductase genotype (MTHFR) T allele were positively associated with tHcy among the smokers, but not among the snus users. No association was observed between tHcy and the number of cigarettes/day. There was a positive association between cotinine and tHcy in the smokers, but not among the snus users. This indicates that substances other than nicotine in tobacco smoke could be responsible for the differential effects on homocysteine status. Self-reported smoking should be complemented by a cotinine assay whenever possible.publishedVersio

Low-cost exercise interventions improve long-term cardiometabolic health independently of a family history of type 2 diabetes : a randomized parallel group trial

Introduction To investigate the effect of an exercise prescription and a 1-year supervised exercise intervention, and the modifying effect of the family history of type 2 diabetes (FH), on long-term cardiometabolic health. Research design and methods For this prospective randomized trial, we recruited non-diabetic participants with poor fitness (n=1072, 30-70 years). Participants were randomly assigned with stratification for FH either in the exercise prescription group (PG, n=144) or the supervised exercise group (EG, n=146) group and compared with a matched control group from the same population study (CON, n=782). The PG and EG received exercise prescriptions. In addition, the EG attended supervised exercise sessions two times a week for 60 min for 12 months. Cardiometabolic risk factors were measured at baseline, 1 year, 5 years, and 6 years. The CON group received no intervention and was measured at baseline and 6 years. Results The EG reduced their body weight, waist circumference, diastolic blood pressure, and low-density lipoprotein-cholesterol (LDL-C) but not physical fitness (p=0.074) or insulin or glucose regulation (p>0.1) compared with the PG at 1 year and 5 years (p Conclusions Low-cost physical activity programs have long-term beneficial effects on cardiometabolic health regardless of the FH of diabetes. Given the feasibility and low cost of these programs, they should be advocated to promote cardiometabolic health.Peer reviewe

Pulmonary manifestations and the effectiveness of enzyme replacement therapy in Fabry Disease with the p. Arg227Ter (p.R227*) mutation

Background: Fabry disease (FD) is caused by a defect in α-galactosidase A gene (GLA) which leads to a progressive accumulation of neutral shingolipids, mainly globotriaosylceramide and its metabolites in several organs. Pulmonary manifestations of FD mimic chronic obstructive pulmonary disease and are disproportionate to smoking status. The effect of enzyme replacement therapy (ERT) on pulmonary function is inconclusive. We studied the effect of ERT on pulmonary function in FD with a mutation p. Arg227Ter (p.R227*) which is one of the most common mutations causing classical FD in Finland and worldwide.Methods: Patients were annually examined by multidisciplinary team. Based on the maximal pulmonary oxygen consumption at the baseline, either cardiopulmonary exercise test or combination of spirometry and 6-minute walking test were performed annually during 5-year follow-up.Results: Four males and eight females met the criteria for ERT and were included in this study. Three of 12 patients had obstruction by GOLD criterion before ERT, and one had a borderline obstruction. In 5 years, five patients were classified as obstructive, although the real change in FEV1/FVC was unchanged in the whole cohort. Only one patient was an active smoker.Conclusion: In nonsmokers, pulmonary manifestations in classical FD are mild and might be stabilized by ERT.</p