Linköping University Hospital

This repeated cross-sectional study examined trends and behavioral correlates of excessive screen time among Swedish adolescents across 2017, 2020 and 2023. Specifically, this study examined 1) temporal trends of variables used, 2) correlates of pooled screen time, and 3) correlates of specific screen modalities (gaming, social media, and film/TV viewing). Data were collected from n=8,300 upper secondary school students in Jönköping County (n=2,319 in 2017; n=3,056 in 2020; n=2,925 in 2023). Measures used included risk behaviors (e.g., alcohol, smoking), physical activity, psychosocial trust, exposure to violence and victimization, sleep duration, psychosomatic symptoms, absenteeism and living arrangement. General linear models (GLM; UNIANOVA) were conducted, adjusting for relevant covariates. Alcohol use, smoking, shorter sleep duration, higher psychosomatic symptoms, and school absenteeism were associated with higher pooled screen time, whereas physical activity, female gender, and living with both parents were associated with lower pooled screen time. Across modality-specific analyses, shorter sleep duration, lower physical activity, living without both parents, and school absenteeism were consistently associated with higher screen use across gaming, social media, and film/TV viewing, while substance-use and gender associations varied by modality. Sleep, physical activity, family structure, and school absenteeism appear to be robust correlates across screen modalities, supporting the importance of targeting these factors in adolescent health promotion and digital media guidance. These findings highlight the need for parents, researchers, and health professionals to pay closer attention to adolescents' digital media use.

Artificial intelligence (AI) is increasingly integrated into radiology workflows, supporting tasks such as image reconstruction, patient positioning, and administrative processes. While these developments promise efficiency and improved diagnostic quality, their impact on radiographers' professional roles remains unclear, particularly in Sweden, where formal AI training is absent, and staffing shortages persist. Understanding radiographers' perspectives is essential for safe implementation and workforce sustainability. This study aims to explore how the professional role of radiographers is influenced by the current and future implementation of AI in radiology. A qualitative multi-case study was conducted across three Swedish university hospitals. Semi-structured interviews were carried out with 18 strategically selected participants, including section leaders, researchers, and department managers. Data were analysed using thematic analysis, focusing on perceptions of AI, its impact on professional identity, and anticipated future tasks. Five themes emerged in each of the 18 cases and were compared across hospitals. Participants reported a lack of training and uncertainty about the future, as radiographers' roles are rarely considered in technology implementation. Maintaining competence and professional development was highlighted as critical when introducing AI. AI is present in workflows such as image reconstruction, protocol optimisation and patient positioning, but formal training remains limited. Participants viewed AI as both a facilitator of daily work and a potential threat to core tasks, raising concerns about deskilling and loss of identity. Maintaining responsibility for patient safety was emphasised. Thoughtful implementation, structured training, and inclusive planning could enable radiographers to assume advanced roles, including oversight of AI outputs. Including radiographers in the implementation of AI models and formalising AI education, both in undergraduate education and postgraduate courses, are essential for strengthening the profession.

The connection between childhood trauma and irritable bowel syndrome (IBS) is well documented. However, knowledge regarding distinct associations between different subtypes of childhood trauma and both intestinal and extraintestinal symptoms is widely lacking. The current cross-sectional study aimed to elucidate the impact of different types of childhood trauma on IBS symptomatology. In 169 women with moderate to severe IBS and 39 healthy women (HCs), childhood trauma was assessed using the Childhood Trauma Questionnaire. Gastrointestinal, extraintestinal, and psychological symptoms were evaluated via symptom diaries and questionnaires. The overall prevalence of childhood trauma was significantly higher in women with IBS compared to HCs, with odds ratio (OR) 3.41 (95% CI, 1.35-8.60, p = 0.009) and with the highest rates observed for emotional and sexual abuse. Overall childhood trauma was positively associated with symptom severity (r = 0.305, p = 0.016). Among trauma types, emotional abuse was the strongest predictor of IBS, with a 6-fold increased odds of disorder, OR 6.69 (95% CI, 1.97-22.68, p = 0.002). Women with IBS and a history of emotional abuse reported longer episodes of abdominal pain, more defecation urgency, and higher levels of anxiety and depression. Our findings support the significant role of childhood trauma in IBS pathology and increased symptom burden. They further indicate the specific relevance of emotional abuse influencing not only gastrointestinal symptoms but also extraintestinal and psychological complaints. These findings may help contribute to the identification of a distinct phenotype of IBS patients with a history of traumatic emotional abuse during childhood.

The turnover of type I collagen plays an important role in atherogenesis and atherothrombosis. The pro-α1(I) chain of type I collagen (COL1α1) has emerged as a novel circulating biomarker associated with coronary artery disease (CAD) events. This study aimed to investigate the association between circulating COL1α1 and coronary atherosclerosis in a middle-aged general population. Participants (n = 1 078) were randomly recruited from the Linköping branch of the Swedish Cardiopulmonary Bioimage Study (SCAPIS) comprising an equal number of men and women 50–64 years old. Coronary artery calcium scores were calculated from non-contrast computed tomography (CT) while coronary stenosis, presence of plaques and segmental involvement scores were derived from coronary CT angiography. COL1α1, interleukin-6 and matrix metalloproteinase-9 were quantified in plasma. Binary logistic regression models were used. Participants with low COL1α1 levels exhibited a more unfavorable cardiovascular risk profile. There was an inverse association between COL1α1 and all measures of coronary atherosclerosis before adjustment (ORrange=0.50–0.73, p < 0.05 for all). In two multivariable models adjusting for potential confounders and CAD risk factors, an association with coronary stenosis ≥ 50% (OR = 0.61 and 0.59, respectively) and non-calcified atherosclerotic plaques (OR = 0.62 for both) remained (p < 0.05 for all). The findings shed further light on COL1α1 as a potential CAD biomarker.

Abstract Acute myeloid leukemia (AML) is an aggressive hematologic cancer characterized by proliferation of immature myeloblasts 1 . It shows profound molecular heterogeneity, which has been primarily studied through genetic abnormalities, providing the basis for disease classification, prognostication, and therapeutic choice 2–8 . However, genetic factors alone may not fully explain AML pathogenesis and diversity, while leaving the role of abnormal epigenome, particularly chromatin state, largely unexplored in a large cohort of patients. Here we show that AML is classified into 16 subgroups with distinct chromatin accessibility profiles based on ATAC-seq in 1,563 AML cases, derived from the encyclopedia of chromatin in AML (eCHROMA AML) dataset, including novel AML subgroups not previously recognized in conventional genomic classifications. By integrating multi-omics analyses of genome, transcriptome, and major histone marks, we show that these epigenetic subgroups exhibit unique features in clinical presentation, gene mutations, differentiation states, gene expression, and super-enhancer profiles, which are validated across independent cohorts. Single-cell sequencing demonstrates the presence of subgroup-specific ATAC signatures that are shared by all leukemic cells, confirming the key role of the epigenome in the ATAC-based classification. Mechanistically, each subgroup is associated with a distinct gene regulatory network centered on key transcription factors, where subgroup-specific super-enhancers play a pivotal role. These ATAC subgroups also have prognostic significance independent of genomic classification, and help reveal unexpected drug sensitivities. In summary, ATAC-based chromatin profiling in this large sample set, combined with multi-omics data, provides new insights into AML pathogenesis beyond genomic profiling and also serves as an invaluable resource for AML research.

Prolonged emergency department waiting times are associated with increased mortality among older patients. In January 2025, the ED of Linkoping University Hospital, Sweden, implemented a low-resource routine to expedite the workup of older patients living with frailty by prioritized physician assessment and subsequent workup. To investigate if a frailty alert using the Clinical Frailty Scale followed by prioritized clinical assessment influences ED operating metrics. This was an observational before and after study of a pre-implementation group (control) and a post-implementation group (intervention) between October 2024 and February 2025. Consecutive patients aged > 64 years, with a documented CFS assessment during the ED visit at the Linkoping University Hospital, Sweden, who consented to participation, were included. Standard ED operating metrics, Time to physician, ED length of stay (LOS), and admission rates were compared between a pre-implementation group and a post-implementation group. A total of 542 ED visits were analyzed (248 pre-implementation, 294 post-implementation). Time to physician was shorter in the post-implementation group at 31 min (IQR 15, 65) versus 44 min (IQR 20, 94) (p < 0.001). ED LOS was reduced from 352 (IQR 266, 515) to 319 (IQR 240, 458) minutes (p = 0.014). The admission rate was unchanged at 59% and 60% (p = 0.4). Frailty alerts based on the CFS with prioritized workup reduced ED LOS and time to physician in older patients living with frailty in this single center study and may be a low-resource intervention to reduce the risks of adverse events in the ED. ClinicalTrials.gov identifier: NCT06869148.

Heart failure (HF) and arterial hypertension (AH) are strongly associated with obesity, with a linear relationship to increasing body mass index (BMI). However, some individuals with obesity do not exhibit signs of HF or AH. This study aimed to compare, for the first time in a large population-based cohort, individuals with obesity who have normal left ventricular function and remodeling (LVFR) and no AH (ObNI) with those who have impaired LVFR or AH (ObI), and corresponding individuals without obesity (NObNI and NObI). A cross-sectional analysis was performed on 4 435 participants from the Swedish CArdioPulmonary bioImage Study (SCAPIS). Participants were grouped into four categories: (1) ObNI (n = 586), (2) ObI (n = 224), (3) NObNI (n = 3 041), and (4) NObI (n = 584). Descriptive analyses compared individuals with obesity with normal LVFR and no AH (ObNI) to the other three groups. Although no significant differences between the two subgroups with obesity could be seen regarding BMI (33.1 vs. 33.5 kg/m2, p = 0.095), there was significant differences in coronary artery calcification score (CACS) levels, where ObNI participants were more prone to show no or very low CACS in comparison with ObI participants (p < 0.001). Also compared to ObI participants, ObNI individuals had lower levels of HbA1c, fasting plasma glucose, triglycerides, and troponin I (all p < 0.001). Furthermore, significant differences were observed between the two groups regarding sedentary behavior (p = 0.041), where ObNI subjects showed a more active lifestyle. Compared with ObNI, individuals with ObI exhibited a higher left ventricular mass index (LVMI; p < 0.001) and lower diastolic function parameters (p < 0.001), while left ventricular ejection fraction (EF) did not differ significantly (p = 0.27). Relative to NObNI, ObNI participants demonstrated increased LVMI (p = 0.007), lower EF (p < 0.001), and impaired diastolic function (p < 0.001). Coronary artery calcification scores (CACS) were higher in ObI than in ObNI (p < 0.001), and ObNI also showed higher CACS than NObNI (p = 0.008). ObNI participants had lower CACS levels, more favorable metabolic profiles, better cardiac function, and greater physical activity than ObI individuals. However, compared to NObNI, they showed higher CACS, increased left ventricular mass, and reduced cardiac function, highlighting distinct cardiovascular risks across obesity phenotypes.