Objectives: To study differences regarding pain and activity limitations during the 3 years following diagnosis in women and men with contemporary treated early RA compared with their counterparts who were diagnosed 10 years earlier. Method: This study was based on patients recruited to the Early Intervention in RA (TIRA) project. In the first cohort (TIRA-1) 320 patients were included in time for diagnosis during 1996-1998 and 463 patients were included in the second cohort (TIRA-2) during 2006-2009. Disease activity, pain intensity (Visual Analogue Scale, VAS), bodily pain (BP) in the 36-item Short Form Health Survey (SF-36), activity limitations (Health Assessment Questionnaire, HAQ), and medication were reported at inclusion and at follow-up after 1, 2, and 3 years. Results: Disease activity, pain, and activity limitations were pronounced at inclusion across both genders and in both cohorts, with some improvement observed during the first year after diagnosis. Disease activity did not differ between cohorts at inclusion but was significantly lower at the follow-ups in the TIRA-2 cohort, in which the patients were prescribed traditional disease-modifying anti-rheumatic drugs (DMARDs) and biological agents more frequently. In TIRA-2, patients reported significantly lower pain and activity limitations at all follow-ups, with men reporting lower pain than women. Women reported significantly higher activity limitations at all time points in TIRA-2. Conclusions: Pain and activity limitations were still pronounced in the contemporary treated early RA cohort compared with their counterparts diagnosed 10 years earlier and both of these factors need to be addressed in clinical settings.

The detection of antinuclear antibodies is central to the diagnosis and prognosis of systemic lupus erythematosus (SLE), primary Sjogrens syndrome (pSS) and mixed connective tissue disease (MCTD). Anti-U1-RNP and anti-RNP70 antibodies were assayed in the sera of patients with SLE (n = 114), pSS (n = 54) and MCTD (n = 12). In the SLE group, 34/114 (30%) were anti-U1-RNP positive, and 21/114 (18%) were both anti-RNP70 positive and anti-U1-RNP positive. In the MCTD group, 10/12 (83%) were anti-U1-RNP positive, and 9/12 (75%) were anti-RNP70 positive. Only one individual with pSS was antibody positive (for both anti-U1-RNP and anti-RNP70). All anti-RNP70-positive samples were also anti-U1-RNP positive. Anti-U1-RNP-positive subjects with SLE were younger (p < 0.0001); showed lower concentrations of complement protein 3 (p = 0.03); had lower eosinophil (p = 0.0005), lymphocyte (p = 0.006) and monocyte (p = 0.03) counts; and had accrued less organ damage (p = 0.006) than the anti-U1-RNP-negative SLE patients. However, we observed no significant clinical or laboratory parameter differences between the anti-U1-RNP-positive individuals with/without anti-RNP70 in the SLE group. In conclusion, anti-RNP70 antibodies are not exclusive to MCTD but are rarely detected in pSS and healthy individuals. In SLE, anti-U1-RNP antibodies are associated with a clinical phenotype that resembles MCTD, with hematologic involvement and less damage accrual. Based on our results, the clinical value of subtyping anti-RNP70 in anti-U1-RNP-positive sera appears to be of limited value.

OBJECTIVES: To determine the health status of athletes before the start of an international athletics championship and to determine whether preparticipation risk factors predicted in-championship injuries.

METHODS: At the beginning of the 2013 International Association of Athletics Federations (IAAF) World Championships, all registered athletes (n=1784) were invited to complete a preparticipation health questionnaire (PHQ) on health status during the month preceding the championships. New injuries that occurred at the championships were prospectively recorded.

RESULTS: The PHQ was completed by 698 (39%) athletes; 204 (29.2%) reported an injury complaint during the month before the championships. The most common mode of onset of preparticipation injury complaints was gradual (43.6%). Forty-nine athletes in the study reported at least one injury during the championships. Athletes who reported a preparticipation injury complaint were at twofold increased risk for an in-championship injury (OR=2.09; 95% CI 1.16 to 3.77); p=0.014). Those who reported a preparticipation gradual-onset injury complaint were at an almost fourfold increased risk for an in-championship time-loss injury (OR=3.92; 95% CI 1.69 to 9.08); p=0.001). Importantly, the preparticipation injury complaint severity score was associated with the risk of sustaining an in-championship injury (OR=1.14; 95% CI 1.06 to 1.22); p=0.001).

SUMMARY AND CONCLUSIONS: About one-third of the athletes participating in the study reported an injury complaint during the month before the championships, which represented a risk factor for sustaining an injury during the championship. This study emphasises the importance of the PHQ as a screening tool to identify athletes at risk of injuries before international championships.

BackgroundNonsuicidal self-injury (NSSI) is common in adolescents. Emotion dysregulation has been identified as a core mechanism in the development and maintenance of NSSI and it is therefore an important target when addressing NSSI. The pathogenic connection between different kinds of childhood abuse, difficulties in emotion regulation and NSSI needs further investigation. The objective of this study was to examine whether difficulties with emotion regulation and trauma symptoms, separately and together, mediate the relationships between sexual, physical and emotional abuse and NSSI. MethodCross-sectional data was collected from 3,169 adolescent high-school students aged 16-19 years (M = 18.12, SD = 0.45). Data from self-reported experiences of childhood abuse, current difficulties with emotion regulation (measured with the Difficulties with Emotion Regulation Scale, DERS-16) and trauma symptoms (measured with the Trauma Symptom Checklist for Children, TSCC), and NSSI were collected. Structural Equation Modeling (SEM) was used to test the proposed relationships between variables. ResultsThe prevalence of life-time NSSI was 27.4%. Prevalence of reported childhood abuse was 9.2, 17.5, and 18.0% for sexual, physical, and emotional abuse, respectively. Childhood abuse, difficulties with emotion regulation and trauma symptoms exhibited significant positive associations with NSSI in adolescents. Emotional dysregulation and trauma symptoms were both found to mediate the relationship between childhood abuse and NSSI. Latent variable models were found to fit data well. ConclusionResults indicate that increased levels of emotional dysregulation and trauma symptoms in relation to childhood abuse contribute to the increased risk of NSSI. Further, results point to some aspects of emotional dysregulation and trauma symptoms being more important in this regard. Clinical implications are discussed.

Evidence suggests that the lag reported in mathematics for deaf signers derives from difficulties related to verbal processing of numbers, whereas magnitude processing seems unaffected by deafness. Neuroimaging evidence from hearing individuals suggests that verbal processing of numbers engages primarily left angular gyrus (lAG), whereas magnitude processing engages primarily the horizontal portion of the right intraparietal sulcus (rHIP). In a ROI analysis of brain imaging data from 16 adult deaf signers and 16 adult hearing non-signers, who did not differ on sex, age or education, we examined if activity in lAG and rHIP changed as a result of task (multiplication vs subtraction) and group (deaf signers and hearing non-signers). We found a significant main effect of brain region (F(1,30) = 117.00, p < .001, η_p^2 = .80) and an interaction effect between region and group (F(1,30) = 20.70, p < .001, η_p^2 = .41). Further analyses showed that there were no significant differences in average activation between groups in lAG (F(1,30) = 0.16, p = .70). However, in rHIP deaf signers showed significantly greater average activation compared to non-signers (F(1,30) = 15.20, p < .001, η_p^2 = .34). There were no significant differences in activation between subtraction and multiplication (F(1,30) = 0.66, p = .42) and no behavioural differences between groups (F(1,30) = 1.70, p = .20). These results suggest that when engaging in arithmetic tasks deaf signers successfully make use of qualitatively difference processes, compared to hearing non-signers, with stronger emphasis on brain regions relating to magnitude manipulation.

Profoundly deaf individuals sometimes have difficulty with arithmetic and phonological tasks. In the present study we investigate if these differences can be attributed to differences in recruitment of neurobiological networks. Seventeen hearing non-signers (HN) and sixteen deaf signers (DS) matched on age, gender and non-verbal intelligence took part in an fMRI study. In the scanner three digit/letter pairs were visually presented and the participants performed six different blocked tasks tapping processing of digit and letter order, multiplication, subtraction and phonological ability. Data were analysed using two 2x2x2 ANOVAs; process (arithmetic, language) x level (high, low) x group (DS, HN). A main effect of process revealed language networks in the left inferior frontal gryus, supramarginal gyrus, fusiform gyrus and insula. Arithmetic networks included left middle orbital gyrus and superior medial gyrus. A main effect of level revealed low level processing (digit/letter order) in the right middle occipital gyrus and the right precuneus and high level processing (subtraction/multiplication/phonological ability) in left inferior frontal gyrus. There was no main effect of group but a significant task x group interaction in the right temporal pole which in DS (but not HN) was activated more for arithmetic than language processing (p_fwe = .022) when multiplication was included in the analysis. This region is implicated in conceptual representation. These results suggest that both arithmetic and language are processed similarly by DS and HN with possible between-group differences in the use of conceptual representation in arithmetic and language tasks.

Evidence suggests that the lag reported in mathematics for deaf signers derives from difficulties related to the verbal system of number processing as described in the triple code model. For hearing individuals the verbal system has been shown to be recruited for both arithmetic and language tasks. In the present study we investigate for the first time neuronal representations of arithmetic in deaf signers. We examine if the neural network supporting arithmetic and language, including the horizontal portion of the intraparietal sulcus (HIPS), the superior parietal lobule (SPL) bilaterally, the left angular gyrus (AG), pars opercularis (POPE) and pars triangularis (PTRI) of the left inferior frontal gyrus (IFG), is differently recruited for deaf and hearing individuals. Imaging data were collected from 16 deaf signers and 16 well-matched hearing nonsigners, using the same stimulus material for all tasks, but with different cues. During multiplication, deaf signers recruited rHIPS more than hearing non-signers, suggesting greater involvement of magnitude manipulation processes related to the quantity system, whereas there was no evidence that the verbal system was recruited. Further, there was no support for the notion of a common representation of phonology for sign and speech as previously suggested.

In hearing individuals, multiplication relies mainly on the phonological loop while subtraction relies on the visuo-spatial sketchpad (VSSP; Lee & Kang, 2002). Little is known about arithmetic neural networks in deaf signers (DS). Since DS often perform worse than hearing non-signers (NH) on arithmetic in general and multiplication in particular (Traxler, 2000), we hypothesized that there are strategic differences between how groups recruit the phonological loop in multiplication, but not in subtraction, leading to differential activation of phonological processing areas in left inferior frontal gyrus (Broca’s area). We investigated this using a blocked fMRI-design in which nine DS and 17 HN matched on age, gender, education and non-verbal intelligence (Raven & Raven, 1998) were tested on tasks of multiplication, subtraction and phonology (rhyme). The contrasts rhyme versus multiplication and rhyme versus subtraction were examined across groups within the region of interest defined by a probability map of Broca’s area (Amunts, 1999). We observed a significant interaction between task (multiplication and rhyme) and group (F = 12.64, p = .034, FWE-corrected), where the HN showed higher activation for rhyme than for multiplication (T = 4.55, p = .001, FWE-corrected) whereas there were no differences in activations between tasks for DS. For subtraction versus rhyme no interaction with group was found. These results suggest that there are differences between DS and HN in the phonology dependent neural networks in Broca’s area used during multiplication, which may be part of the explanation for poorer performance in DS.

Deafness is generally associated with poor mental arithmetic, possibly due to neuronal differences in arithmetic processing across language modalities. Here, we investigated for the first time the neuronal networks supporting arithmetic processing in adult deaf signers. Deaf signing adults and hearing non-signing peers performed arithmetic and phonological tasks during fMRI scanning. At whole brain level, activation patterns were similar across groups. Region of interest analyses showed that although both groups activated phonological processing regions in the left inferior frontal gyrus to a similar extent during both phonological and multiplication tasks, deaf signers showed significantly more activation in the right horizontal portion of the inferior parietal sulcus. This region is associated with magnitude manipulation along the mental number line. This pattern of results suggests that deaf signers rely more on magnitude manipulation than hearing non-signers during multiplication, but that phonological involvement does not differ significantly between groups.Abbreviations: AAL: Automated Anatomy Labelling; fMRI: functional magnetic resonance imaging; HIPS: horizontal portion of the intraparietal sulcus; lAG: left angular gyrus; lIFG: left inferior frontal gyrus; rHIPS: right horizontal portion of the intraparietal sulcus

ObjectiveSLE, primary Sjogrens syndrome (pSS) and systemic sclerosis (SSc) are heterogeneous autoimmune diseases with a dysregulated type I interferon (IFN) system. The diseases often show overlapping clinical manifestations, which may result in diagnostic challenges. We asked to which extent SSc-associated autoantibodies are present in SLE and pSS, and whether these link to serum IFN-alpha, clinical phenotypes and sex. Samples with clinical data from patients with SSc and healthy blood donors (HBDs) served as controls. Finally, the diagnostic performance of SSc-associated autoantibodies was evaluated.MethodsSamples from well-characterised subjects with SLE (n=510), pSS (n=116), SSc (n=57) and HBDs (n=236) were analysed using a commercially available immunoassay (EuroLine Systemic Sclerosis Profile (IgG)). IFN-alpha was quantified by ELISA. Self-reported data on Raynauds phenomenon (RP) were available.ResultsWith exceptions for anti-Ro52/SSA and anti-Th/To, SSc-associated autoantibodies were more frequent in SSc than in SLE, pSS and HBDs regardless of sex. IFN-alpha levels correlated with the number of positive SSc-associated autoantibodies (r=0.29, p&lt;0.0001) and associated with Ro52/SSA positivity (p&lt;0.0001). By using data from SLE, SSc and HBDs, RP was significantly associated with topoisomerase I, centromere protein (CENP)-B, RNA polymerase III 11 kDa, RNA polymerase III 155 kDa and PM-Scl100 whereas Ro52/SSA associated inversely with RP. In SLE, CENP-A was associated with immunological disorder, CENP-B with serositis and Ku with lupus nephritis. By combining analysis of ANA (immunofluorescence) with SSc-associated autoantibodies, the diagnostic sensitivity reached 98% and the specificity 33%.ConclusionsThe 13 specificities included in the EuroLine immunoassay are commonly detected in SSc, but they are also frequent among individuals with other diseases imprinted by type I IFNs. These findings are valuable when interpreting serological data on patients with suspected SSc, especially as patients may present with disease manifestations overlapping different rheumatological diseases. In SLE, we observed associations between manifestations and SSc-associated autoantibodies which have not previously been reported.

Background

Child physical abuse (CPA) is an extensive public health problem because of its associations with poor health outcomes. The aim of this study was to examine which of the background factors of CPA committed by a parent or other caregiver relates to self-reported poor health among girls and boys (13; 15 and 17 years old): perpetrator, last year exposure; severity and frequency; socioeconomic load and foreign background.

Methods

In a cross-sectional study in a Swedish county (n = 8024) a path analysis was performed to evaluate a model where all background variables were put as predictors of three health-status variables: mental; physical and general health problems. In a second step a log linear analysis was performed to examine how the distribution over the health-status categories was different for different combinations of background factors.

Results

Children exposed to CPA reported poor health to a much higher extent than those who were not exposed. In the path analysis it was found that frequency and severity of abuse (boys only) and having experienced CPA during the last year, was significantly associated with poor health as well as socioeconomic load in the families. Foreign background was significantly negatively associated with all three health indicators especially for girls. Neither mother nor father as perpetrator remained significant in the path analysis, while the results from the log linear analyses showed that mother-abuse did in fact relate to poor general health and mental as well as physical health problems among boys and girls. Father-abuse was associated with poor mental health if severe abuse was reported. Poor mental health was also associated with mild father-abuse if exposure during the last year was reported.

Conclusion

Despite the limitations that cross-sectional studies imply, this study provides new knowledge about factors associated with poor health among physically abused children. It describes details of CPA that have significant associations to different aspects of poor health and thus what needs to be addressed by professionals within mental health providers and social services. Understanding how different factors may contribute to different health outcomes for exposed children is important in future research and needs further studies.

BackgroundNonsuicidal self-injury (NSSI) is highly prevalent in adolescents. In survey and interview studies assessing NSSI, methods of assessment have been shown to influence prevalence estimates. However, knowledge of which groups of adolescents that are identified with different measurement methods is lacking, and the characteristics of identified groups are yet to be investigated. Further, only a handful of studies have been carried out using exploratory methods to identify subgroups among adolescents with NSSI.MethodsThe performance of two prevalence measures (single-item vs. behavioral checklist) in the same cross-sectional community sample (n = 266, age M = 14.21, 58.3% female) of adolescents was compared regarding prevalence estimates and also characterization of the identified groups with lifetime NSSI prevalence. A cluster analysis was carried out in the same sample. Identified clusters were compared to the two groups defined using the prevalence measures.ResultsA total of 118 (44.4%) participants acknowledged having engaged in NSSI at least once. Of these, a group of 55 (20.7%) adolescents confirmed NSSI on a single item and 63 (23.7%) adolescents confirmed NSSI only on a behavioral checklist, while denying NSSI on the single item. Groups differed significantly, with the single-item group being more severely affected and having higher mean scores on difficulties in emotion regulation, self-criticism, number of methods, higher frequency of NSSI, higher rates of suicidal ideation and suicidal behavior and lower mean score on health-related quality of life. All cases with higher severity were not identified by the single-item question. Cluster analysis identified three clusters, two of which fit well with the groups identified by single-item and behavioral checklist measures.ConclusionsWhen investigating NSSI prevalence in adolescents, findings are influenced by the researchers' choice of measures. The present study provides some directions toward what kind of influence to expect given the type of measure used, both with regards to the size of the identified group and its composition. Implications for future research as well as clinical and preventive work are discussed.

Background Programs for mental health promotion and prevention of nonsuicidal self-injury (NSSI) in schools have gained increased focus during the last decades, but less is known about adolescents’ experiences of such interventions.

Methods A whole-school preventive intervention targeting mental health and NSSI was delivered to six secondary schools. Adolescents participated in the Youth Aware of Mental Health program combined with an NSSI-focused psychoeducation module. Caregivers and teachers were given online psychoeducation on NSSI, and school health care staff were given a workshop on self-injury. Eleven group interviews (n = 65 participants) were conducted with adolescents (ages 13–15 years, 65% females) exploring participant experiences. Interviews were analyzed using thematic analysis and interpreted in light of a biopsychosocial understanding of adolescence.

Results The analysis generated two main themes. The first theme, Mental health in the context of adolescence, centered around adolescents’ conception of mental health, after having taken part in the intervention, framed in a context of coping with external stressors. The dilemma of autonomy versus help-seeking was also identified as part of the first main theme. The second theme, The who, when, what, and how of the intervention, described adolescents’ experiences of the intervention. This theme included increased awareness and knowledge of mental ill-health. The participants generally agreed that the topics included are important to adolescents and emphasized that the content needs to be relatable. Several factors that influence how a school-based program is received by adolescents were identified, such as who should be targeted and when. Adolescents also identified challenges and gave recommendations for future similar projects.

Conclusions Adolescents generally perceived addressing mental health and NSSI in schools as important. Help-seeking initiatives need to be balanced against adolescents’ need for autonomy when planning mental health prevention and intervention.

Objective: The aim of this study was to analyse how support from significant others affects the associations between disease-related variables and sickness absence during the first 2 years after rheumatoid arthritis (RA) diagnosis. Method: Data from 274 people with RA (73% women) of working age (18-63 years) were retrieved from the Swedish early RA cohort TIRA-2. These data concerned disease-related variables (disease activity, activity limitations, pain intensity, and grip force), sickness absence, and perceived support from significant others. Associations of disease-related variables with sickness absence and how these associations were moderated by support from significant others were analysed using zero-inflated negative binomial regression. Results: During the 2 years after diagnosis, higher disease activity was significantly associated with increased odds of sickness absence, a connection strengthened by perceived support from family during the first year. More perceived support was also directly and significantly associated with increased odds of sickness absence during the first year. Conclusions: Support from significant others is related to sickness absence in RA, specifically during the first year after diagnosis. Although patients report high levels of support from significant others, this does not necessarily lead to more positive work outcomes. Therefore, it is important to consider other aspects of support that might influence work outcomes, e.g. type and quality of support. Future research should investigate these forms of support, and when significant others should be encouraged to support in the rehabilitation process to increase the chances of people with RA having a well-functioning and sustainable work life.

To examine prevalence of verbal, physical, and sexual abuses in young elite athletes, a cross sectional questionnaire-based survey was conducted during the World Athletics under 20 World Championships. This questionnaire aimed at distinguishing between abuses perpetrated in the context of Athletics from those which were unrelated to Athletics. Four hundred and eighty athletes (52.3%, male) from North America, South America, Europe, Africa, Asia, and Oceania took part in the electronic anonymous survey. Outside Athletics setting, no gender difference was found for the prevalence of verbal, physical, and sexual abuses. However, 45 males (18% of the male population) and 34 females (15% of the female population) athletes reported sexual abuse. Asian athletes reported a slightly higher rate of sexual abuse; three quarters of them being non-touching abuses. Inside Athletics setting, no gender difference was found for the prevalence of verbal, physical, and non-touching sexual abuses. However, 58 males (23%) and 47 females (21%) reported verbal abuses. Thirty-one males (12%) and 20 females (9%) reported physical abuses, whereas 30 males (12%) and 17 females (7%) reported sexual abuses. Physical abuses were slightly more frequent in Asia and in Africa and less frequent in South America. Sexual abuses inside Athletics also differed over regions, and were unexpectedly twice more frequent than expected in Asia and slightly less frequent than expected in Europe. Friends and partners were identified as the more frequent (&gt; 50%) abusers outside or inside the Athletics settings, whereas outside Athletics and inside Athletics, coaches were identified as sexual abuse perpetrators in 8 and 25% of cases, respectively. The prevalence of verbal, physical, or sexual abuses is high but consistent with what has been reported in United Kingdom, Norway, Canada, and Sweden at national level in recreational or elite athletes. Sexual abuse, including touching or penetrative abuses, occurred significantly more often in male athletes when compared to female athletes. This finding invites healthcare and social workers, and policymakers to also consider the risk of sexual abuse of young male athletes in Athletics. These results also call for longitudinal studies on young elite athletes.

Background: Students with disability show an increasing incidence of school failure. Quality teaching and appropriate support may foster high self-efficacy, a predictive factor for successful school outcomes. Physical Education (PE) can provide students with a context in which self-efficacy and participation are promoted leading to improved academic achievement. The transition into secondary school can be challenging for many students with increased educational demands, developmental changes and individual social identification coinciding. A disability may add to the challenge of success.Methods: Three groups of students, aged 13 years and enrolled in Swedish mainstream schools were targeted (n=439). Groups included students with 1.A diagnosed disability, 2.Low grades in PE (D-F) and 3.High grades (A-C) in PE. Questionnaires were collected and analyzed from 30/439 students with a diagnosed disability (physical, neuro-developmental and intellectual) from 26 classes, their classmates and their PE-teachers (n=25). Relationships between student self-reports and PE-teachers self-ratings were investigated. Also examined was the potential to which students functional skills could predict elevated general school self-efficacy, PE specific self-efficacy and aptitude to participate in PE. Results were compared with the total sample and between the three target groups (n=121).Results: For students with disabilities, better self-rated teaching skills were related to lower student perceived general school self-efficacy, PE specific self-efficacy and aptitude to participate in PE. The impact of classroom climate in PE was more obvious among students with disabilities. Perceived functional skills were associated with elevated general school self-efficacy, PE specific self-efficacy and aptitude to participate in PE. Better socio-cognitive functional skills had an overall positive effect on all outcomes. Students with disabilities reported results similar to the total sample, the D-F group scored lower and the A-C group higher than the total sample and the disability group. Elevated self-efficacy in PE is six times less probable in students with disabilities, compared to the A-C group.Conclusions: Our findings that better teacher planning and grading skills, are detrimental to students disadvantaged by disability is contradictive. Improving the establishment and communication of adapted learning standards at the transition to secondary school is a crucial and a predictive factor for promoting positive school experiences for students with disability. Students with disabilities need to be assured that the intended learning outcomes can be reached by doing activities differently than their typically functioning peers. Consideration of class composition is suggested as a means of promoting a positive learning climate, which would particularly benefit students with disabilities. Allocation of resources to support student socio-cognitive skills would improve experiences for the D-F group and likely promote a positive learning environment.

Background: Systemic lupus erythematosus (SLE) is an autoimmune multi-organ disease, characterized by episodes of disease flares and remissions over time, which may restrain affected patients ability to perform daily activities. The purpose of the present study was to characterize variation in activity limitations among well-defined SLE patients, and to describe disease phenotypes, acquired organ damage and their relations to activity limitation and self-reported health, respectively. Methods: The disease phenotypes were organized into 4 different clinical groups and logistic regression analyses were used to identify how an elevated health assessment questionnaire (HAQ) score was related to disease variables such as phenotypes, disease activity and damage accrual. Correlation and multiple linear regression analyses were used to examine the association between each group of variables - background variables, disease variables and self-reported measurements - and the degree of elevated HAQ. Results: We found a higher proportion of activity limitation in patients with skin and joint involvement compared to others. The presence of activity limitation, as detected by the HAQ instrument, was significantly associated with quality of life (EuroQol-5D) and accrual of organ damage using the Systemic Lupus International Collaborative Clinics/ACR damage index. Conclusions: The findings highlight the differing requirements of the multi-professional rehabilitation interventions for the various SLE phenotypes in order to optimize the clinical care of the patients.

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease. Treatment strategies emphasize early multi-professional interventions to reduce disease activity and to prevent disability, but there is a lack of knowledge on how optimal treatment can be provided to each individual patient.

Aim: To elucidate how clinical manifestations of early RA are associated to disease and disability outcomes, to strive for greater potential to establish prognosis in early RA, and to facilitate implementation of decision support through analyses of the decision-making environment in chronic care.

Methods: Multivariate statistics and mathematical modelling, as well as field observations and focus group interviews.

Results: Decision support: A prognostic tree that predicted patients with a poor prognosis (moderate or high levels of DAS-28) at one year after diagnosis had a performance of 25% sensitivity, 90% specificity and a positive predictive value of 76%. Implementation of a decision support application at a rheumatology unit should include taking into account incentive structures, workflow and awareness, as well as informal communication structures. Prognosis: A considerable part of the variance in disease activity at one year after diagnosis could be explained by disease progression during the first three months after diagnosis. Using different types of knowledge – different expertise – prior to standardized data mining methods was found to be a promising when mining (clinical) data for new patterns that elicit new knowledge. Disease and disability: Women report more fatigue than men in early RA, although the difference is not consistently significant. Fatigue in early RA is closely and rather consistently related to disease activity, pain and activity limitation, as well as to mental health and sleep disturbance.

Conclusion: A decision tree was designed to identify patients at risk of poor prognosis at one year after the diagnosis of RA. When constructing prediction rules for good or poor prognosis, including more measures of disease and disability progressions showed promise. Using different types of knowledge – different lenses of expertise – prior to standardized data mining methods was also a promising method when mining (clinical) data for new patterns that elicit new knowledge.

Collaborative testing has been suggested to serve as a good learning activity, for example, compared to individual testing. The aim of the present study was to measure learning at different levels of knowledge during a collaborative final exam in a course in basic methods and statistical procedures. Results on pre- and post-tests taken individually (N = 30) before and after the collaborative part of the final exam confirmed learning effects at the uni- and multi-structural levels, as well as on the relational level of Biggs’ structure of the observed learning outcome (SOLO) taxonomy (Biggs & Collins, 1982). Low performers at pre-test raised their test scores more than high performers. No differences could be generalized at the extended level of knowledge. Results also suggest that it might be preferable to collaborate without first deciding on questions individually. The experimental design can be applied when evaluating learning, at different levels of knowledge, during a variety of learning activities.

Background Athletes competing in athletics (track and field) at international level may be participating with underlying undiagnosed life-threatening cardiovascular conditions. Our objective was to analyse variations in pre-participation cardiac evaluation prevalence among athletes participating in two International Association of Athletics Federations (IAAF) World Athletics Championships, with regard to the human developmental level and global region of their home countries, as well as athletes’ age category, gender, event group and medical insurance type.

Design Cross-sectional web-based survey.MethodsA total of 1785 athletes competing in the IAAF World Under 18 Championships Nairobi 2017 and World Championships London 2017 were invited to complete a pre-participation health questionnaire investigating the experience of a pre-participation cardiac examination.

Results A total of 704 (39%) of the athletes participated. Among these, 59% (60% of women; 58% of men) reported that they had been provided at least one type of pre-participation cardiac evaluation. Athletes from very high income countries, Europe and Asia, showed a higher prevalence of at least one pre-participation cardiac evaluation.

Conclusions The prevalence of pre-participation cardiac evaluation in low to middle income countries, and the African continent in particular, needs urgent attention. Furthermore, increases in evaluation prevalence should be accompanied by the development of cost-effective methods that can be adopted in all global regions.

Cluster analysis is one way of data mining from large amounts of information. Being able to perform series of analyses, varying clinical criteria and requests, expected results of the clustering might be truly rewarding. Instead of having a few hypotheses prepared and tested, medical experts can be surprised by obtaining a set of hypotheses to further validate and work on.

Internet technologies enable a substantial flexibility that can be taken advantage of when implementing a Web-based tool. Division of Medical Informatics together with Linkoping Heart Center of the Linkoping University is developing procedures for multivariate clustering within the Web-based AssistMe1 system.

Background: Football (soccer) is endorsed as a health-promoting physical activity worldwide. When football programs are introduced as part of general health promotion programs, equal access and limitation of pre-participation disparities with regard to injury risk are important. The aim of this study was to explore if disparity with regard to parents educational level, player body mass index (BMI), and self-reported health are determinants of football injury in community-based football programs, separately or in interaction with age or gender. less thanbrgreater than less thanbrgreater thanMethodology/Principal Findings: Four community football clubs with 1230 youth players agreed to participate in the cross-sectional study during the 2006 season. The study constructs (parents educational level, player BMI, and self-reported health) were operationalized into questionnaire items. The 1-year prevalence of football injury was defined as the primary outcome measure. Data were collected via a postal survey and analyzed using a series of hierarchical statistical computations investigating associations with the primary outcome measure and interactions between the study variables. The survey was returned by 827 (67.2%) youth players. The 1-year injury prevalence increased with age. For youths with parents with higher formal education, boys reported more injuries and girls reported fewer injuries than expected; for youths with lower educated parents there was a tendency towards the opposite pattern. Youths reporting injuries had higher standardized BMI compared with youths not reporting injuries. Children not reporting full health were slightly overrepresented among those reporting injuries and underrepresented for those reporting no injury. less thanbrgreater than less thanbrgreater thanConclusion: Pre-participation disparities in terms of parents educational level, through interaction with gender, BMI, and self-reported general health are associated with increased injury risk in community-based youth football. When introduced as a general health promotion, football associations should adjust community-based youth programs to accommodate children and adolescents with increased pre-participation injury risk.

The article by Blumen, Rajaram, and Henkel (2013) raises some very interesting research topics. Using the aging population as the prime example, they also provide general recommendations for future research in the area of collaborative memory; ‘it's time to become more applied’, and we appreciate such a suggestion.

The article spans many subfields and for obvious reasons, it is not possible to consider every potential issue in this field in one single article. In addition, there are several issues that could be either extended or added. We will in this commentary focus on issues we consider important for the understanding of the current literature, and we will add some from our own research.

The purpose of the experiment on collaborative memory was to investigate if the collaborative inhibition is due to collaborating pair's disruption of each others' retrieval strategies (the retrieval strategy disruption hypothesis, RSD). The participants' (N=36) task was to recall a list of 60 words individually and collaboratively. Retrieval strategies were manipulated by presenting word lists organised either by categories or by country of origin and adoption of retrieval strategies were examined by the adjusted ratio of clustering score. Half of the dyads received word lists organised by the same strategy and half of the dyads received word lists organised by different strategies. The results revealed a main effect of collaboration, i.e., collaborative recalled items were significantly fewer than the sum of the non-redundant individually recalled items. Both conditions (same strategies vs different strategies) suffered to the same extent from collaboration, which did not support the RSD hypothesis. However, focusing on words recalled individually but not collaboratively, dyads with different strategies, as predicted by the RSD, forgot more items during collaboration than did dyads with the same strategy. Additional results suggest that collaborative forgetting is mainly manifested by forgetting of non-overlapping items (as measured by individual recalls).

The organization of sports at the national level has seldom been included in scientific discussions of sports injury prevention. The aim of this study was to develop a model for organization of sports that supports prevention of overuse injuries. The quality function deployment technique was applied in seminars over a two-season period to develop a national organizational structure for athletics in Sweden that facilitates prevention of overuse injuries. Three central features of the resulting model for organization of sports at the national level are (a) diminishment of the organizational hierarchy: participatory safety policy design is introduced through annual meetings where actors from different sectors of the sporting community discuss training, injury prevention, and sports safety policy; (b) introduction of a safety surveillance system: a ubiquitous system for routine collection of injury and illness data; and (c) an open forum for discussion of safety issues: maintenance of a safety forum for participants from different sectors of the sport. A nonhierarchical model for organization of sports at the national level - facilitated by modern information technology - adapted for the prevention of overuse injuries has been developed. Further research is warranted to evaluate the new organizational model in prospective effectiveness studies.

In a joint effort, the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR) recently proposed new criteria for the classification of systemic lupus erythematosus (SLE) with the overarching goal to identify potential participants for clinical studies. Herein, we present the first independent evaluation of these criteria in comparison with older classification grounds using an adult Scandinavian study population of confirmed SLE cases and individuals with SLE-mimicking conditions. We included 56 confirmed SLE cases meeting the 1982 ACR criteria (ACR-82) and/or the Fries diagnostic principle (antinuclear antibodies on at least one occasion plus involvement of at least two defined organ systems) and 55 controls with possible systemic autoimmune disease, including the presence of any SLE-related autoantibody. The proposed EULAR/ACR criteria showed a diagnostic sensitivity of 93% (95% confidence interval (CI), 0.83-0.98) compared with 83% (95% CI, 0.72-0.91) for the updated ACR criteria from 1997. The diagnostic accuracy of all tested classification grounds was fairly similar, achieving approximately 85%. However, the disease specificity of the EULAR/ACR criteria reached only 73% (95% CI, 0.59-0.83), which was comparable with the 2012 Systemic Lupus International Collaborating Clinics (SLICC) criteria, 75% (95% CI, 0.61-0.85), but clearly lower than for ACR-82, 94% (95% CI, 0.83-0.99). In this first independent evaluation of a limited number of cases, we found comparable results with respect to diagnostic sensitivity, specificity and accuracy regarding the SLICC-12 and the proposed EULAR/ACR classification criteria. However, their specificity for SLE appeared to be lower compared with ACR-82.

Cognitive training might have potential to improve speech understanding under adverse listening conditions. Here, we have examined the effects of a 5-week computer-based cognitive training program on speech-in-noise-performance, in normal hearing (NH) participants and in participants with mild-to-moderate sensorineural hearing loss (HI).

Two groups, matched on gender and age (45-65 years), of 20 participants each (HI and NH respectively) are recruited. Participants perform four test-sessions; inclusion (t0), five weeks (t1), ten weeks (t2) and six months (t3). Training is performed either between t0 and t1, or between t1 and t2 (using a cross-over design), using the computer-based Cogmed training program, approximately 30-40 minutes per day, five days per week, during five weeks. At each session participants are tested in three different ways: (a) cognitive testing (KIPS, SICSPAN, TRT); (b) auditory performance (pure tone-audiometry (air- and bone-conduction) and speech audiometry (HINT, Swedish SPIN-test (SNR +4dB))); (c) cortical activation (MR sessions where participants performed a speech-in-noise task using Hagerman-sentences with steady-state speech-spectrum noise (SSN) and with two competing talkers). MR imaging is performed on a Philips Achieva 1.5 Tesla scanner using a sparse imaging technique in which stimuli are presented during the silent period between successive scans. Participants listen to auditory stimuli under eight different conditions: clear speech, SSN or two competing talkers (each at 90%, 50% and 0% intelligibility), and silent rest. Pre- and post-training, hearing disability is assessed by the Speech-Spatial-Qualities-Questionnaire.

The study is on-going and behavioral results as well as results from fMRI will be presented.

The aim of this study was to identify the social and organizational requirements for a decision support system (DSS) to be implemented in a clinical rheumatology setting, utilizing data-mining techniques. Field observations and focus group interviews were used for data collection. The decision-making was found to be situated, patient-focused, and long-term in nature. At the same time, the main part of peer-to-peer communication was informal. Patient records were involved in almost every decision. The conclusion is that the main challenges, when introducing a DSS at a rheumatology unit, are adapting the system to informal communication structures and integrating it with patient records. Considering incentive structures, understanding workflow and incorporating awareness are relevant issues when addressing these issues in future studies.

Identification of prognostic subgroups is of key clinical interest at the early stages of chronic disease. The aim of this study is to examine whether representation of physicians' expert knowledge in a simple heuristic model can improve data mining methods in prognostic assessments of patients with rheumatoid arthritis (RA). Five rheumatology consultants' experiences of clinical data patterns among RA patients, as distinguished from healthy reference populations, were formally represented in a simple heuristic model. The model was used in K-mean-clustering to determine prognostic subgroups. Cross-sectional validation using physician's global assessment scores indicated that the simple heuristic model performed better than crude data made in identification of prognostic subgroups of RA patients. A simple heuristic model of experts' knowledge was found useful for semi-automatic data mining in the chronic disease setting. Further studies using categorical baseline data and prospective outcome variables are warranted and will be examined in the Swedish TIRA-program.

Introduction: There is a need for tools that are easy to use in clinical practice supporting decision making upon treatment in early rheumatoid arthritis (RA). Aim: The aim was to identify components of prognosticators in early RA and to identify individual patients with a poor prognosis as early as possible.

Methods: Two cohorts from the Swedish TIRA project including 320+408 patients with recent onset RA were included in the study. Disease activity was measured by C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and the 28-joint count disease activity score (DAS-28), and by the physicians’ global assessment of disease activity (PGA). Disability was assessed as activity limitation by the Swedish version of the Health Assessment Questionnaire (HAQ) and impairment was reported by pain on a visual analogue scale of 0–100 mm. Serological markers were rheumatoid factor (RF) and anti-CCP. RF was measured at the time for diagnosis, and anti-CCP at the time of diagnosis or at one or some of the follow-ups. If at least one anti-CCP test was positive, the patient was judged to be anti-CCP-positive. Assuming different clinical practice in the different cohorts, two different treatment strategies were assumed based on clinical practice in real-world settings. Principal Component Analysis and Multiple Linear Regression Analysis were used to identify prognosticators. Prediction rules were identified by data-driven approach, controlling for different treatment strategies.

Results: Progression of disease and disability measures and inflammation measures the first three months after inclusion predicted a considerable part of DAS-28 at the 1-year follow-up. Serological markers had a larger explanatory power for men than for women. Anti-CCP was a significant predictor for men, but not for women. Two versions of rules, one for women and one for men, predicting good or poor prognosis at one year after inclusion were produced by using measures of disability (Health Assessment Questionnaire), DAS-28, relative change in DAS-28 during first three months, sex, and test of anti-CCP. The rules demanded high prognostic specificity but the prognostic sensitivity was moderate.

Conclusion: A considerable part of DAS-28 at one year after inclusion could be explained by the first 3 months’ progression of disease, disability and inflammation. Anti-CCP was predictive for men but not for women, and needs further investigation. A decision tree predicting poor prognosis among individual early RA-patients showed high specificity and moderate sensitivity on a validationcohort. The medical informatics approach used, controlling for different treatment strategies, yields promising results and further studies will control for more specific differences in treatment strategies, e.g. different DMARDs initiated.

Given that nonsuicidal self-injury (NSSI) is prevalent in adolescents, structured assessment is an essential tool to guide treatment interventions. The Functional Assessment of Self-Mutilation (FASM) is a self-report scale that assesses frequency, methods, and functions of NSSI. FASM was administered to 3,097 Swedish adolescents in a community sample. With the aim of examining the underlying factor structure of the functions of FASM in this sample, the adolescents with NSSI who completed all function items (n = 836) were randomly divided into 2 subsamples for cross-validation purposes. An exploratory factor analysis (EFA) was followed by a confirmatory factor analysis (CFA) using the mean and variance adjusted weighted least squares (WLSMV) estimator in the Mplus statistical modeling program. The results of the EFA suggested a 3-factor model (social influence, automatic functions, and nonconformist peer identification), which was supported by a good fit in the CFA. Factors differentiated between social/interpersonal and automatic/intrapersonal functions. Based on learning theory and the specific concepts of negative and positive reinforcement, the nonconformist peer identification factor was then split into 2 factors (peer identification and avoiding demands). The resulting 4-factor model showed an excellent fit. Dividing social functions into separate factors (social influence, peer identification, and avoiding demands) can be helpful in clinical practice, where the assessment of NSSI functions is an important tool with direct implications for treatment.

Objective: This study aims to examine the associations between microfinance programme membership and intimate partner violence (IPV) in different socioeconomic strata of a nationally representative sample of women in Bangladesh. Methods: The cross-sectional study was based on a nationally representative interview survey of 11 178 ever-married women of reproductive age (15-49 years). A total of 4465 women who answered the IPV-related questions were analysed separately using chi(2) tests and Cramers V as a measure of effect size to identify the differences in proportions of exposure to IPV with regard to microfinance programme membership, and demographic variables and interactions between microfinance programme membership and factors related to non-economic empowerment were considered. Results: Only 39% of women were members of microfinance programmes. The prevalence of a history of IPV was 48% for moderate physical violence, 16% for severe physical violence and 16% for sexual violence. For women with secondary or higher education, and women at the two wealthiest levels of the wealth index, microfinance programme membership increased the exposure to IPV two and three times, respectively. The least educated and poorest groups showed no change in exposure to IPV associated with microfinance programmes. The educated women who were more equal with their spouses in their family relationships by participating in decision-making increased their exposure to IPV by membership in microfinance programmes. Conclusions: Microfinance plans are associated with an increased exposure to IPV among educated and empowered women in Bangladesh. Microfinance firms should consider providing information about the associations between microfinance and IPV to the women belonging to the risk groups.

The aim of the present study was to investigate collaborative memory in adolescents withintellectual disabilities when collaborating with an assistant, and also the extent to whichdecisiveness is related to individual memory performance.Nineteen students with intellectual disabilities (mean age = 18.5, SD = 0.9) eachcollaborated with a teaching assistant (mean age 40.3, SD = 12.1) familiar from everydaywork in school. Pictures were presented individually. Recognition was performed in twoparts, first individually and thereafter collaboratively. The design involved 2 settings, onenatural (with equal encoding time) and another with equal individual memoryperformance (assistants had shorter encoding time than the students). Results showedcollaborative inhibition in this previously uninvestigated collaboration setting withadolescents with intellectual disabilities and their assistants. The assistants bothperformed higher and decided more than the students with intellectual disabilities inthe natural setting, but not in the equated performance setting. Inhibition was larger in theequated setting. The assistants’ decisiveness was moderately correlated with individualmemory performance. Implications for everyday life are discussed.

Collaborative memory is traditionally assessed among persons with presumed equal memory capability, which is not always true in ecological settings. We have investigated collaborative memory performances both when a difference in memory performance within the pair is provoked and when it is not. This was manipulated by different encoding times in a within participant design. 20 pairs were presented with a word list for later recall. The word list was firstly recalled individually and afterwards collaboratively for both memory difference conditions. Nominal recall (the sum of the individual nonredundant performances) and collaborative recall was calculated. An interaction between type of recall and difference in memory performance was found, where collaborative recall at same memory performance was especially impaired by net negative effects of collaboration. These results are discussed in relation to item analysis of which words were recalled.

Objective

During international athletics championships, the incidence and characteristics of new injuries have been well described: about 10% of registered athletes have a new injury. It seemed also important to understand the complaints of athletes in terms of injuries in the period before and at the start of the championships and potential association with potential new injuries for identification of possible risk factors.

The objective of this study was to determine the health of athletes before the start of an international athletics championship and to identify risk factors for new injuries.

Patients and methods

In the 2013 World Athletics Championships in Moscow, all athletes enrolled (n = 1784) were asked to complete a pre-participation health questionnaire (PHQ) collecting data on the health status during the months preceding the championships. During the period of the Championships, all new injuries were prospectively recorded.

Results

The PHQ was completed by 698 (39%) of the athletes; 204 (29.2%) reported suffering such injury complaint during the month before the championships. The most common mode of onset of pain before championships was gradual (43.6%). Forty-nine athletes reported at least one new injury during the championships. Athletes who reported suffering injuries before championships had an increased risk of having a new injury during the championship [odds ratio (OR) = 2.09; 95% confidence interval (95% CI): 1.16–3.77; P = 0.014] and those who reported suffering injuries championships before a gradual fashion appearance were at increased risk of almost four times to re-injury with sport stop in the championship (OR = 3.92; 95% CI: 1.69–9.08; P = 0.001).

Discussion/Conclusion

Approximately one third of athletes participating in an international athletics championship and involved in this study reported an injury complaint during the month before the championships. This represented a risk factor to suffer a new injury during the championship.

This study highlights the potential importance of a pre-participation health questionnaire as a screening tool to identify athletes at risk of injury before international athletics championships.

BACKGROUND: Research has demonstrated that persons with Usher syndrome type 1 (USH1) have significantly poorer physical and psychological health compared to a reference group. PURPOSE: To explore the relation between work, health, social trust, and financial situation in USH1 compared to a reference group. MATERIAL: Sixty-six persons (18-65 y) from the Swedish Usher database received a questionnaire and 47 were included, 23 working and 24 non-working. The reference group comprised 3,049 working and 198 non-working persons. METHODS: The Swedish Health on Equal Terms questionnaire was used and statistical analysis with multiple logistic regression was conducted. RESULTS: The USH1 non-work group had a higher Odds ratio (95% CI) in poor psychological and physical health, social trust, and financial situation compared to the USH1 work group and reference groups. Age, gender, hearing, and vision impairment did not explain the differences. The relation between the USH1 work and non-work groups showed the same pattern as the reference groups, but the magnitude of problems was significantly higher. CONCLUSIONS: Both disability and unemployment increased the risk of poor health, social trust and financial situation in persons with USH1, but having an employment seemed to counteract the risks related to disability.

Previous research has shown deficits in vocal emotion recognition in sub-populations of individuals with hearing loss, making this a high priority research topic. However, previousresearch has only examined vocal emotion recognition using verbal material, in which emotions are expressed through emotional prosody. There is evidence that older individualswith hearing loss suffer from deficits in general prosody recognition, not specific to emotionalprosody. No study has examined the recognition of non-verbal vocalization, which constitutes another important source for the vocal communication of emotions. It might be thecase that individuals with hearing loss have specific difficulties in recognizing emotionsexpressed through prosody in speech, but not non-verbal vocalizations. We aim to examinewhether vocal emotion recognition difficulties in middle- aged-to older individuals with sensorineural mild-moderate hearing loss are better explained by deficits in vocal emotion recognition specifically, or deficits in prosody recognition generally by including both sentencesand non-verbal expressions. Furthermore a, some of the studies which have concluded thatindividuals with mild-moderate hearing loss have deficits in vocal emotion recognition abilityhave also found that the use of hearing aids does not improve recognition accuracy in thisgroup. We aim to examine the effects of linear amplification and audibility on the recognitionof different emotions expressed both verbally and non-verbally. Besides examining accuracy for different emotions we will also look at patterns of confusion (which specific emotionsare mistaken for other specific emotion and at which rates) during both amplified and nonamplified listening, and we will analyze all material acoustically and relate the acoustic content to performance. Together these analyses will provide clues to effects of amplification onthe perception of different emotions. For these purposes, a total of 70 middle-aged-olderindividuals, half with mild-moderate hearing loss and half with normal hearing will perform acomputerized forced-choice vocal emotion recognition task with and without amplification

Few studies have examined which acoustic features of speech can be used to distinguish between different emotions, and how combinations of acoustic parameters contribute to identification of emotions. The aim of the present study was to investigate which acoustic parameters in Swedish speech are most important for differentiation between, and identification of, the emotions anger, fear, happiness, sadness, and surprise in Swedish sentences. One-way ANOVAs were used to compare acoustic parameters between the emotions and both simple and multiple logistic regression models were used to examine the contribution of different acoustic parameters to differentiation between emotions. Results showed differences between emotions for several acoustic parameters in Swedish speech: surprise was the most distinct emotion, with significant differences compared to the other emotions across a range of acoustic parameters, while anger and happiness did not differ from each other on any parameter. The logistic regression models showed that fear was the best-predicted emotion while happiness was most difficult to predict. Frequency- and spectral-balance-related parameters were best at predicting fear. Amplitude- and temporal-related parameters were most important for surprise, while a combination of frequency-, amplitude- and spectral balance-related parameters are important for sadness. Assuming that there are similarities between acoustic models and how listeners infer emotions in speech, results suggest that individuals with hearing loss, who lack abilities of frequency detection, may compared to normal hearing individuals have difficulties in identifying fear in Swedish speech. Since happiness and fear relied primarily on amplitude- and spectral-balance-related parameters, detection of them are probably facilitated more by hearing aid use.

Pandemic simulation is a useful tool for analyzing outbreaks and exploring the impact of variations in disease, population, and intervention models. Unfortunately, this type of simulation can be quite time-consuming especially for large models and significant outbreaks, which makes it difficult to run the simulations interactively and to use simulation for decision support during ongoing outbreaks. Improved run-time performance enables new applications of pandemic simulations, and can potentially allow decision makers to explore different scenarios and intervention effects. Parallelization of infection-probability calculations and multicore architectures can take advantage of modern processors to achieve significant run-time performance improvements. However, because of the varying computational load during each simulation run, which originates from the changing number of infectious persons during the outbreak, it is not useful to us the same multicore setup during the simulation run. The best performance can be achieved by dynamically changing the use of the available processor cores to balance the overhead of multithreading with the performance gains of parallelization.

Introduction Sports-related injuries and illnesses in Paralympic sport (SRIIPS) are a concern, but knowledge about the etiology and risk factors is limited. The aim of this study was to describe the annual incidence, type, and severity of injuries and illnesses among Swedish Paralympic athletes and to assess risk factors. Methods Swedish Paralympic athletes (n = 107) self-reported SRIIPS every week during 52 weeks using an eHealth application. Incidence proportions (IP) and incidence rates (IR) were used as measures of disease burden. Time-to-event methods (Kaplan-Meier and Cox regression) were used to identify risk factors. Results The annual IP for injury was 68% and for illness 77%. The injury IR was 6.9/1000 hours and the illness IR 9.3/1000 hours. The median time to injury was 19 weeks (95% CI: 10.5-27.4) and to illness 9 weeks (95% CI: 1.4-16.6). Most injuries occurred during training, and 34% were classified as severe (&gt;= 21 days of time loss). An increased injury risk was observed among athletes in team sports (HR 1.88; 95% CI: 1.19-2.99), athletes with a previous severe injury (HR 2.37; 95% CI: 1.47-3.83), and male athletes (HR 1.76; 95% CI: 1.06-2.93). The most common illness type was infection (84%). Athletes in team sports (HR 1.64; 95% CI: 1.05-2.54) and males with a previous illness (HR = 2.13; 95% CI: 1.04-4.36) had a higher illness risk. Conclusion Paralympic athletes report a high incidence of injuries and illnesses over time. This emphasizes the need to develop preventive strategies of SRIIPS and optimize medical services for this heterogeneous athlete population.