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Background: There is a need for the development of accurate, accessible and efficient screening instruments, focused on early-stage detection of neurocognitive disorders. The Geras Solutions cognitive test (GSCT) has showed potential as a digital screening tool for cognitive impairment but normative data are needed.

Objective: The aim of this study was to obtain normative data for the GSCT in cognitively healthy patients, investigate the effects of gender and education on test scores as well as examine test-retest reliability.

Methods: The population in this study consisted of 144 cognitively healthy subjects (MMSE>26) all at the age of 70 who were earlier included in the Healthy Aging Initiative Study conducted in Umeå, Sweden. All patients conducted the GSCT and a subset of patients (n=32) completed the test twice in order to establish test-retest reliability.

Results: The mean GSCT score was 46.0 (±4.5) points. High level of education (>12 years) was associated with a high GSCT score (p = 0.02) while gender was not associated with GSCT outcomes (p = 0.5). GSCT displayed a high correlation between test and retest (r(30) = 0.8, p <0.01).

Conclusion: This study provides valuable information regarding normative test-scores on the GSCT for cognitively healthy individuals and indicates education level as the most important predictor of test outcome. Additionally, the GSCT appears to display a good test-retest reliability further strengthening the validity of the test.

Summary: We describe the collection of cohorts together with the analysis plan for an update of the fracture risk prediction tool FRAX with respect to current and novel risk factors. The resource comprises 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures.

Introduction: The availability of the fracture risk assessment tool FRAX® has substantially enhanced the targeting of treatment to those at high risk of fracture with FRAX now incorporated into more than 100 clinical osteoporosis guidelines worldwide. The aim of this study is to determine whether the current algorithms can be further optimised with respect to current and novel risk factors.

Methods: A computerised literature search was performed in PubMed from inception until May 17, 2019, to identify eligible cohorts for updating the FRAX coefficients. Additionally, we searched the abstracts of conference proceedings of the American Society for Bone and Mineral Research, European Calcified Tissue Society and World Congress of Osteoporosis. Prospective cohort studies with data on baseline clinical risk factors and incident fractures were eligible.

Results: Of the 836 records retrieved, 53 were selected for full-text assessment after screening on title and abstract. Twelve cohorts were deemed eligible and of these, 4 novel cohorts were identified. These cohorts, together with 60 previously identified cohorts, will provide the resource for constructing an updated version of FRAX comprising 2,138,428 participants with a follow-up of approximately 20 million person-years and 116,117 documented incident major osteoporotic fractures. For each known and candidate risk factor, multivariate hazard functions for hip fracture, major osteoporotic fracture and death will be tested using extended Poisson regression. Sex- and/or ethnicity-specific differences in the weights of the risk factors will be investigated. After meta-analyses of the cohort-specific beta coefficients for each risk factor, models comprising 10-year probability of hip and major osteoporotic fracture, with or without femoral neck bone mineral density, will be computed.

Conclusions: These assembled cohorts and described models will provide the framework for an updated FRAX tool enabling enhanced assessment of fracture risk (PROSPERO (CRD42021227266)).

Background: Individuals with intellectual disability (ID) are less physically active, have a higher body mass index (BMI) and are at greater risk for cardiovascular diseases (CVDs) than people without ID. The purpose of the study was to explore the effectiveness of a web-based training programme, consisting of 150 min of activity per week, on the health of people with ID.

Method: Participants with ID living in supported accommodation (n = 28, 48% female, age = 36.4 ± 9.56 years) participated in a web-based training programme, consisting of a combination of exercises (endurance, strength balance and flexibility) of moderate intensity, 50 min, three times per week for 12 weeks. The body composition and waist circumference (WC) were measured, and questionnaires were used to assess enjoyment, quality of life (QoL) and physical activity (PA) level. Descriptive statistics and pairwise comparison pre and post intervention were carried out.

Results: A total of 22 out of 28 participants completed the 12-week training intervention with 83% mean attendance of training sessions. The intensity of the PA level increased and a decrease in fat mass of 1.9 ± 2.4 kg, P < 0.001 and WC of 3 ± 5 cm, P = 0.009 were observed. Enjoyment of training sessions was 3.9 out of 5, and no differences in QoL were found.

Conclusion: A web-based training programme is an effective tool for improving health parameters of people with ID and offers a new way for caregivers to enhance the PA for the target group.

Objective: The primary goals of this study were to (a) provide the first estimate of prevalence of self-reported history of having been emotionally, physically, and/or sexually abused for men with a substance use disorder in Sweden and (b) identify, for men with a substance use disorder, mental health, substance use, and criminal justice characteristics associated with having a history of abuse. Methods: Assessment interviews for a substance use disorder were conducted in 50 out of 300 Swedish counties for the time period 2003 to 2008. Participants were a nationally representative sample of 9,571 Swedish men interviewed in county welfare offices. The Addiction Severity Index (ASI) was used as an assessment tool in these counties. From the ASI, answers to questions asking about lifetime history of emotional, physical, and sexual abuse were analyzed to provide this initial measure on history of abuse. Bivariate statistical analysis and multivariate logistic regression methods were used to explore the relationships between substance use severity, level of mental health problems reported, criminal justice history, and history of being abused. Results: Overall, 47.9% of the men in this sample reported having experienced abuse; specifically, 26.9% of clients reported a history of physical abuse, 4.5% reported a history of sexual abuse, and 40.7% reported a history of emotional abuse. Results from logistic regression modeling identified that higher ASI mental health symptomology scores were associated with 13times higher likelihood of having experienced any abuse. Further, results from logistic regression models identified that scoring higher on the ASI mental health symptoms core was associated with an 8times higher likelihood of having experienced physical abuse,14times higher likelihood of having experienced sexual abuse, and 13times higher likelihood of having experienced emotional abuse. Conclusions: Both the high prevalence of reporting a history of abuse among men with substance use disorders and the strong association between reporting more mental health symptoms and history of abuse indicate a need for Swedish substance use disorder treatment programs to start using more comprehensive and clinically appropriate trauma assessment tools and to provide empirically supported trauma treatments.

The objective of this study was to investigate hazardous drinking among reindeer-herding Sami in Sweden. A cross-sectional questionnaire study was conducted in 2007, which included the Alcohol Use Disorder Identification Test. A total of 319 reindeer-herding Sami were compared with urban and rural reference populations of 1,393 persons. Data were analyzed with regard to population, gender, age group, education, anxiety, depression, and work-related stress. The Sami population did not report a higher prevalence of hazardous drinking compared with the reference groups; however, subgroups of Sami men with symptoms of depression were revealed as at risk, in contrast to Sami women who were not found to be at risk at all. Limitations of the study are discussed.

BACKGROUND: More than half of patients with depression go undetected. Self-rating scales can be useful in screening for depression, and measuring severity and treatment outcome. AIM: This study compares the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ-9) with regard to their psychometric properties, and investigates their agreement at different cut-off scores. METHOD: Swedish primary care patients and psychiatric outpatients (n = 737) who reported symptoms of depression completed the self-rating scales. Data were collected from 2006 to 2007. Analyses with respect to internal consistency, factor analysis, and agreement (Cohen's kappa) at recommended cut-offs were performed. RESULTS: Both scales had high internal consistency (alpha = 0.9) and stable factor structures. Using severity cut-offs, the PHQ-9 (> or =5) diagnosed about 30% more patients than the HADS depression subscale (HADS-D; > or =8). They recognised the same prevalence of mild and moderate depression, but differed in relation to severe depression. When comparing recommended screening cut-offs, HADS-D > or =11 (33.5% of participants) and PHQ-9 > or =10 (65.9%) agreement was low (kappa = 0.35). Using the lower recommended cut-off in the HADS-D (> or =8), agreement with PHQ-9 > or =10 was moderate (kappa = 0.52). The highest agreement (kappa = 0.56) was found comparing HADS-D > or =8 with PHQ-9 > or =12. This also equalised the prevalence of depression found by the scales. CONCLUSION: The HADS and PHQ-9 are both quick and reliable. The HADS has the advantage of evaluating both depression and anxiety, and the PHQ-9 of being strictly based upon the Diagnostic and Statistical Manual of Mental Disorders. The agreement between the scales at the best suitable cut-off is moderate, although the identified prevalence was similar. This indicates that the scales do not fully identify the same cases. This difference needs to be further explored.

The aims of the study were to explore the prevalence of patients with depression and anxiety in primary care, its co-occurrence with hazardous/harmful alcohol use, and its relation to gender, age and reason for visit. A questionnaire, including the self-rating Hospital Anxiety and Depression scale and the Alcohol Use Disorder Identification Test, was consecutively distributed to 1800 patients at 11 primary healthcare centres in the county of Västerbotten, Sweden. The response rate was 77.3% (1392 patients), 38% men and 62% women. A total of 31.9% showed symptoms of depression and/or anxiety, with no gender differences. Harmful/hazardous alcohol use was found in 11.9% of the patients, 17.3% in men and 8.8% in women, although the region in Sweden has relatively low alcohol consumption among the population. Age was an important factor. Incidences of the conditions often occurred simultaneously. About half (51%) of those with harmful/hazardous alcohol use also showed symptoms of depression and/or anxiety. The most common causes for patients with symptoms of depression, anxiety or risk consumption of alcohol to seek care were the same as for the general population, namely complaints of pain or infection. Only 7.8% visited the primary care for psychiatric reasons, according to their own given reasons. In all, 38% of the patients showed signs of psychiatric symptoms and/or alcohol problems or a combination of these. The fact that every third patient showed symptoms of depression, anxiety and/or alcohol problems underlines the strategic position for early identification, intervention and treatment within primary healthcare.

Individuals with schizophrenia have an increased risk of committing a violent crime, although their contribution to the overall criminality in society is small. In this qualitative study we have interviewed parents of adult sons, diagnosed with schizophrenia and who recently had been referred to forensic psychiatric treatment due to a violent crime, with an aim to explore the parents' experiences and emotional reactions. Four events, or status passages, emerged as crucial and common for all parents. These were the onset of the mental disorder, the diagnosis of schizophrenia, the violent behaviour/criminality and the recent referral to forensic psychiatric treatment. Every passage evoked strong emotional reactions such as guilt, fear, disappointment, anger and relief, which in return led to different actions taken. Unawareness of the character and severity of their sons' mental illness and the type of violent criminality they had committed were common and complicated contacts both between the parents and their sons, and also between family members and official authorities. The findings emphasize that psychiatric healthcare professionals must take the initiative and responsibility for information, education and support of family members.