Sweden has a long tradition of recording cause of death data. The Swedish cause of death register is a high quality virtually complete register of all deaths in Sweden since 1952. Although originally created for official statistics, it is a highly important data source for medical research since it can be linked to many other national registers, which contain data on social and health factors in the Swedish population. For the appropriate use of this register, it is fundamental to understand its origins and composition. In this paper we describe the origins and composition of the Swedish cause of death register, set out the key strengths and weaknesses of the register, and present the main causes of death across age groups and over time in Sweden. This paper provides a guide and reference to individuals and organisations interested in data from the Swedish cause of death register.Electronic supplementary materialThe online version of this article (doi:10.1007/s10654-017-0316-1) contains supplementary material, which is available to authorized users.

BackgroundTargeting specific time periods of the day or week may enhance physical activity (PA) interventions in youth. The most prudent time segments to target are currently unclear.ObjectivesTo systematically review the literature describing differences in young people’s objectively measured PA on weekdays vs. weekends, in school vs. out of school, weekends vs. out of school and lesson time vs. break time.MethodsElectronic databases were searched for English-language, cross-sectional studies of school-aged children (4–18 years) reporting time-segment-specific accelerometer-measured PA from 01/1990 to 01/2013. We meta-analysed standardised mean differences (SMD) between time segments for mean accelerometer counts per minute (TPA) and minutes in moderate-to-vigorous PA (MVPA). SMD is reported in units of standard deviation; 0.2, 0.5 and 0.8 represent small, moderate and large effects. Heterogeneity was explored using meta-regression (potential effect modifiers: age, sex and study setting).ResultsOf the 54 included studies, 37 were eligible for meta-analyses. Children were more active on weekdays than weekends [pooled SMD (95 % CI) TPA 0.14 (0.08; 0.20), MVPA 0.42 (0.35; 0.49)]. On school days, TPA was lower in school than out of school; however, marginally more MVPA was accumulated in school [TPA −0.24 (−0.40; −0.08), MVPA 0.17 (−0.03; 0.38)]. TPA was slightly lower on weekends than out of school on school days, but a greater absolute volume of MVPA was performed on weekends [TPA −0.10 (−0.19; −0.01), MVPA 1.02 (0.82; 1.23)]. Heterogeneity between studies was high (I2 73.3–96.3 %), with 20.3–53.1 % of variance between studies attributable to potential moderating factors.ConclusionsSchool-aged children are more active on weekdays than weekend days. The outcome measure influences the conclusions for other comparisons. Findings support the tailoring of intervention strategies to specific time periods.Electronic supplementary materialThe online version of this article (doi:10.1007/s40279-014-0215-5) contains supplementary material, which is available to authorized users.

CRD42015026850.

ObjectivesDescribe (1) time-segment specific changes in physical activity (PA) into adolescence, (2) differences in change in PA between specific time-segments (weekdays–weekends, in-school–out-of-school, out-of-school–weekends, lesson-time–lunch-time), and (3) associations of change in time-segment specific with overall PA.DesignLongitudinal observational study (4-year follow-up).MethodsChildren from the SPEEDY study (n = 769, 42% boys) had PA measured by accelerometer for at least three days at ages 10.2 ± 0.3, 11.2 ± 0.3 and 14.3 ± 0.3 years. Changes in moderate-to-vigorous PA (ΔMVPA, minutes ≥2000 counts/minute [cpm]) and total PA (ΔTPA, average cpm) during weekdays, weekends, in-school, out-of-school, lesson-times and lunch-times, were tested using three level (age, individual, school) mixed-effects linear regression. Differences in ΔMVPA/ΔTPA between time-segments were tested using time-segment × age interaction terms. Associations of four-year time-segment specific ΔMVPA/ΔTPA with four-year overall ΔMVPA/ΔTPA were tested using two level (time-segment specific ΔMVPA/ΔTPA, school) mixed-effects linear regression.ResultsMVPA and TPA declined in all time-segments, except lesson-time MVPA. Annual ΔMVPA and, for boys only, ΔTPA was greater on weekends than weekdays (beta ± SE for interaction term: boys, −3.53 ± 0.83 min, −29.64 ± 7.64 cpm; girls, −2.20 ± 0.64 min) and out-of-school (boys, −4.36 ± 0.79 min, −19.36 ± 8.46 cpm; girls, −2.44 ± 0.63 min). ΔMVPA and ΔTPA during lunch-time was greater than during lesson-time (boys, −0.96 ± 0.20 min, −36.43 ± 6.55 cpm; girls, −0.90 ± 0.13 min, −38.72 ± 4.40 cpm). ΔTPA was greater out-of-school than in-school (boys, −19.89 ± 6.71 cpm; girls, −18.46 ± 6.51 cpm). For all time-segments, four-year ΔMVPA/ΔTPA was positively associated with four-year overall ΔMVPA/ΔTPA (all p < 0.042), except for girl's in-school and lunch-time TPA.ConclusionsInterventions focused on PA maintenance could target all time-segments, but weekends and out-of-school may be particularly advantageous due to the relatively large declines observed.

BackgroundThe increasing rates of obesity among children and adolescents, especially in those from lower socio-economic backgrounds, emphasise the need for interventions promoting a healthy diet and physical activity. The present study aimed to examine the effectiveness of the ‘Health Scores!’ program, which combined professional football player role models with a school-based program to promote a healthy diet and physical activity to socially vulnerable children and adolescents.MethodsThe intervention was implemented in two settings: professional football clubs and schools. Socially vulnerable children and adolescents (n = 165 intervention group, n = 440 control group, aged 10-14 year) provided self-reported data on dietary habits and physical activity before and after the four-month intervention. Intervention effects were evaluated using repeated measures analysis of variance. In addition, a process evaluation was conducted.ResultsNo intervention effects were found for several dietary behaviours, including consumption of breakfast, fruit, soft drinks or sweet and savoury snacks. Positive intervention effects were found for self-efficacy for having a daily breakfast (p < 0.01), positive attitude towards vegetables consumption (p < 0.01) and towards lower soft drink consumption (p < 0.001). A trend towards significance (p < 0.10) was found for self-efficacy for reaching the physical activity guidelines. For sports participation no significant intervention effect was found. In total, 92 pupils completed the process evaluation, the feedback was largely positive.ConclusionsThe ‘Health Scores!’ intervention was successful in increasing psychosocial correlates of a healthy diet and PA. The use of professional football players as a credible source for health promotion was appealing to socially vulnerable children and adolescents.

Exercise during cancer treatment improves cancer‐related fatigue (CRF), but the importance of exercise intensity for CRF is unclear. We compared the effects of high‐ vs low‐to‐moderate‐intensity exercise with or without additional behavior change support (BCS) on CRF in patients undergoing (neo‐)adjuvant cancer treatment. This was a multicenter, 2x2 factorial design randomized controlled trial (Clinical Trials NCT02473003) in Sweden. Participants recently diagnosed with breast (n = 457), prostate (n = 97) or colorectal (n = 23) cancer undergoing (neo‐)adjuvant treatment were randomized to high intensity (n = 144), low‐to‐moderate intensity (n = 144), high intensity with BCS (n = 144) or low‐to‐moderate intensity with BCS (n = 145). The 6‐month exercise intervention included supervised resistance training and home‐based endurance training. CRF was assessed by Multidimensional Fatigue Inventory (MFI, five subscales score range 4‐20), and Functional Assessment of Chronic Illness Therapy‐Fatigue scale (FACIT‐F, score range 0‐52). Multiple linear regression for main factorial effects was performed according to intention‐to‐treat, with post‐intervention CRF as primary endpoint. Overall, 577 participants (mean age 58.7 years) were randomized. Participants randomized to high‐ vs low‐to‐moderate‐intensity exercise had lower physical fatigue (MFI Physical Fatigue subscale; mean difference −1.05 [95% CI: −1.85, −0.25]), but the difference was not clinically important (ie <2). We found no differences in other CRF dimensions and no effect of additional BCS. There were few minor adverse events. For CRF, patients undergoing (neo‐)adjuvant treatment for breast, prostate or colorectal cancer can safely exercise at high‐ or low‐to‐moderate intensity, according to their own preferences. Additional BCS does not provide extra benefit for CRF in supervised, well‐controlled exercise interventions.

In contrast to previous cross-sectional studies, neither individual movement behaviours nor combinations of behaviours at age 4 years was associated with overweight or obesity, BMI or BMI z-score at age 4 or 5 years. More prospective data are needed before effects on weight status from meeting the 24-h movement guidelines are elucidated.

BackgroundPromoting physical activity in youth is important for health, but existing physical activity interventions have had limited success. We aimed to inform intervention design by i) describing drop-out, continuation and uptake of specific activities over the transition to adolescence; and ii) examining Variety (number of different activities/week) and Frequency (number of activity session/week) of activity participation and their associations with changes in objectively measured physical activity from childhood to adolescence.MethodsAt age 10.2±0.3 and 14.2±0.3 years, 319 children in the SPEEDY study (46% boys) wore GT1M Actigraph accelerometers for 7 days and provided self-reported participation (never, once, 2 to 3 times or four or more times, over the last 7 days) in 23 leisure-time activities. Associations of change in moderate-to-vigorous intensity PA (MVPA) (≥2000 counts/minute) and change in total physical activity (TPA) (average accelerometer counts/minute) with exposure variables Z-score transformed (change in) Variety and Frequency were examined using multilevel linear regression, clustered by school, in simple and adjusted models.ResultsThe number of children ever reporting a specific activity ranged from 30 (‘Hockey’) to 279 (‘Running or jogging’). Some activities were susceptible to drop-out (e.g. ‘Skipping’) but others were commonly continued or taken up (e.g. ‘Household chores’). Overall, Variety and Frequency declined (mean±SD ΔVariety −3.1±4.4 activities/week; ΔFrequency −7.2±12.0 session/week). ΔMVPA and ΔTPA were not associated with Variety or Frequency at baseline, nor with ΔVariety or ΔFrequency (p>0.29 in all models).ConclusionsPopularity of specific activities as well as drop-out, continuation and uptake should be considered in future intervention development. Activities that are commonly continued or taken up may be more valuable to encourage in interventions than those with low participation or high drop-out. We did not find evidence to support the idea that Variety and Frequency may be key elements to include in future interventions.