To Örebro University

We hypothesize that auditory and motor entrainment evolved in early hominin fetuses in direct response to their mothers' bipedal footsteps and, later, contributed to the evolution of music and language via two related processes. First, selection for bipedalism transformed feet from grasping into weight-bearing organs, which negatively affected infants' ability to cling to their mothers, provoking the emergence of novel affective vocal exchanges between mothers and infants that became building blocks for the emergence of motherese. Second, the derived ability to entrain movements to sound was incorporated during the prehistoric emergence of wide-ranging rhythmic behaviors such as synchronized chanting of nonlexical vocables and coordinated rhythmic clapping and stomping, which became instrumental during the more recent evolution of music. Like the derived ability to keep beat with rhythmic sounds, nascent motherese entailed entrainment of motor behavior (the physical production of pitch, timing, and vocalization rate) with external sources of sound (conversational utterances). If motherese was a precursor for language evolution, as many believe, music and language share phylogenetically derived substrates for auditory and motor entrainment that stemmed directly from bipedalism. If so, bipedalism was more important for serendipitously sculpting advanced cognition in our prehistoric ancestors than previously believed.

Simple Summary: How can fish manage to swim together in such amazing formations? (This behavior is called schooling in scientific terms.) Many have suggested a primary role of vision, but I explore this dazzling phenomenon from a new perspective: fish mainly use acoustic signals (sound/water-movements) produced by their own movements to achieve synchronization and for keeping appropriate distance from their neighbors. I also propose that schooling prey fish confuse predators' hearing and lateral line as well as their electrosensory system. Swimming together causes overlapping and complex acoustic signals and blurred electric images, which give the school significant survival advantages. We are descendants of fish, and schooling fish behavior might give clues about human rhythmic behavior (such as music). When human pairs are walking at the same pace, they manage to by listening to footsteps. Walking at the same pace provides acoustical advantages, e.g., short noise-free intervals between steps, which improves hearing. In dangerous times, it could allow for detection of predators and stalkers! The regular and predictable sound of human bipedal walking may have stimulated the evolution of rhythm and music, but could schooling fish "dancing around" in the ocean have started the process?

Abstract: The acoustic hypothesis suggests that schooling can result in several benefits. (1) The acoustic pattern (AP) (pressure waves and other water movements) produced by swimming are likely to serve as signals within fish shoals, communicating useful spatial and temporal information between school members, enabling synchronized locomotion and influencing join, stay or leave decisions and shoal assortment. (2) Schooling is likely to reduce the masking of environmental signals, e.g., by auditory grouping, and fish may achieve windows of silence by simultaneously stopping their movements. (3) A solitary swimming fish produces an uncomplicated AP that will give a nearby predator's lateral line organ (LLO) excellent information, but, if extra fish join, they will produce increasingly complex and indecipherable APs. (4) Fishes swimming close to one another will also blur the electrosensory system (ESS) of predators. Since predators use multimodal information, and since information from the LLO and the ESS is more important than vision in many situations, schooling fish may acquire increased survival by confusing these sensory systems. The combined effects of such predator confusion and other acoustical benefits may contribute to why schooling became an adaptive success. A model encompassing the complex effects of synchronized group locomotion on LLO and ESS perception might increase the understanding of schooling behavior.

Humans show a population-level preference for using the right hand. The fighting hypothesis is an influential theory that suggests that left-handedness persists because its rarity provides a surprise advantage in fighting interactions, and that left-handedness is less frequent because it has a health cost. However, evidence for the health cost of left-handedness is unsubstantiated, leaving the greater frequency of right-handers unexplained. Research indicates that homicide may have been common in early hominins. We propose that the hand used to hold a weapon by early hominins could have influenced the outcome of a fight, due to the location of the heart and aorta. A left-handed unilateral grip exposes the more vulnerable left hemithorax towards an opponent, whereas a right-hand unilateral grip exposes the less vulnerable right hemithorax. Consequently, right-handed early ancestors, with a preference for using the right forelimb in combat, may have had a lower risk of a mortal wound, and a fighting advantage. This would explain their greater frequency. In accordance with the original fighting hypothesis, we also suggest that left-handed fighters have a surprise advantage when they are rare, explaining their persistence. We discuss evidence for the modified fighting hypothesis, its predictions, and ways to test the theory.

Introduction: Tobacco is still one of the single most important risk factors among the lifestyle habits that cause morbidity and mortality in humans. Furthermore, tobacco has a heavy social gradient, as the consequences are even worse among disadvantaged and vulnerable groups. To reduce tobacco-related inequity in health, those most in need should be offered the most effective tobacco cessation intervention. The aim of this study is to facilitate and improve the evaluation of already implemented national tobacco cessation efforts, focusing on 10 disadvantaged and vulnerable groups of tobacco users.

Methods and analysis: This is a prospective cohort study. Data will be collected by established tobacco cessation counsellors in Sweden. The study includes adult tobacco or e-cigarette users, including disadvantaged and vulnerable patients, receiving in-person interventions for tobacco or e-cigarette cessation (smoking, snus and/or e-cigarettes). Patient inclusion was initiated in April 2020. For data analyses patients will be sorted into vulnerable groups based on risk factors and compared with tobacco users without the risk factor in question.

The primary outcome is continuous successful quitting after 6 months, measured by self-reporting. Secondary outcomes include abstinence at the end of the treatment programme, which could be from minutes over days to weeks, 14-day point prevalence after 6 months, and patient satisfaction with the intervention. Effectiveness of successful quitting will be examined by comparing vulnerable with non-vulnerable patients using a mixed-effect logistic regression model adjusting for potential prognostic factors and known confounders.

Ethics and dissemination: The project will follow the guidelines from the Swedish Data Protection Authority and have been approved by the Swedish Ethical Review Authority before patient inclusion (Dnr: 2019-02221). Only patients providing written informed consent will be included. Both positive and negative results will be published in scientific peer-reviewed journals and presented at national and international conferences. Information will be provided through media available to the public, politicians, healthcare providers and planners as these are all important stakeholders.

We compared the odds of smoking cessation at 2-months post-myocardial infarction (MI), before and after implementing routines optimizing use of evidence-based smoking cessation methods, with start during admission. The following routines were implemented at six Swedish hospitals: cardiac rehabilitation nurses offering smokers consultation during admission, optimizing nicotine replacement therapy and varenicline prescription, and contacting patients by telephone during the 1st week post-discharge. Using logistic regression, odds for smoking cessation at 2-months before (n smokers/n admitted = 188/601) and after (n = 195/632) routine implementation were compared. Secondary outcomes included adherence to implemented routines and assessing the prognostic value of each routine on smoking cessation. After implementation, a larger proportion of smokers (65% vs. 54%) were abstinent at 2-months (OR 1.60 [1.04-2.48]). Including only those counselled during admission (n = 98), 74% were abstinent (2.50 [1.42-4.41]). After implementation, patients were more often counselled during admission (50% vs. 6%, p < 0.001), prescribed varenicline (23% vs. 7%, p < 0.001), and contacted by telephone post-discharge (18% vs. 2%, p < 0.001). Being contacted by telephone post-discharge (adjusted OR 2.74 [1.02-7.35]) and prescribed varenicline (adjusted OR 0.39 [0.19-0.83]) predicted smoking cessation at 2-months. In conclusion, readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with beneficial effects for post-MI patients.

Nicotine users are at greater risk of developing alcohol dependence. Conversely, alcohol is often consumed when young people test tobacco. The prevalence of smokers is high among alcohol dependent individuals and people who overconsume alcohol get more nicotine withdrawal symptoms when trying to quit tobacco and are less likely to succeed. Alcohol as well as smoking provides a high burden of disease, and combined use often causes multiplier damage effects. Alcohol dependent persons die more often from smoking-related illness than from alcohol. Nicotine cessation is more successful if alcohol advice is included. Cross-tolerance and other interactions between nicotine and opioids increase the likelihood of dependence. Tobacco smokers need higher opioid doses against pain. Despite evidence of association between smoking and chronic pain, understanding of causality is limited. Smoking is associated with an increased risk of opioid dependence. Nicotine is recognized as an important underlying factor. Further research in humans concerning the interactions between nicotine and opioids is urgent. Treatment of nicotine dependence in the medical management of opioid dependence seems promising, but at what point in the course - simultaneously, shortly after, or far behind - has yet to be determined.

Objective: To study occupational groups and occupational exposure in association with chronic obstructive respiratory diseases.

Methods: In early 2000s, structured interviews on chronic respiratory diseases and measurements of lung function as well as fractional expiratory nitric oxide (F-ENO) were performed in adult random population samples of Finland, Sweden and Estonia. Occupations were categorized according to three classification systems. Occupational exposure to vapours, gases, dusts and fumes (VGDF) was assessed by a Job-Exposure Matrix (JEM). The data from the countries were combined.

Results: COPD, smoking and occupational exposure were most common in Estonia, while asthma and occupations requiring higher educational levels in Sweden and Finland. In an adjusted regression model, non-manual workers had a three-fold risk for physician-diagnosed asthma (OR 3.18, 95%CI 1.07-9.47) compared to professionals and executives, and the risk was two-fold for healthcare & social workers (OR 2.28, 95%CI 1.14-4.59) compared to administration and sales. An increased risk for physician-diagnosed COPD was seen in manual workers, regardless of classification system, but in contrast to asthma, the risk was mostly explained by smoking and less by occupational exposure to VGDF. For F-ENO, no associations with occupation were observed.

Conclusions: In this multicenter study from Finland, Sweden and Estonia, COPD was consistently associated with manual occupations with high smoking prevalence, highlighting the need to control for tobacco smoking in studies on occupational associations. In contrast, asthma tended to associate with non-manual occupations requiring higher educational levels. The occupational associations with asthma were not driven by eosinophilic inflammation presented by increased F-ENO.

Background: For smokers who suffer a myocardial infarction (MI), smoking cessation is the most effective measure to reduce recurrent event risk. Still, evidence-based treatment methods for aiding smoking cessation post-MI are underused.

Purpose: To compare the odds of smoking cessation at two-months post-MI before and after implementing a set of pre-specified routines for optimization of evidence-based treatment methods for smoking cessation, with start during admission.

Methods: Structured routines for early smoking cessation counselling and treatment optimization were implemented at six cardiac rehabilitation (CR) centres in Sweden. The routines included CR nurses providing current smokers hospitalized for acute MI with short consultation, written material, and optimal dosage of nicotine replacement therapy during admission, increasing early prescription of varenicline for eligible patients, and contacting the patients by telephone 3–5 days after discharge, after which usual care CR follow-up commenced. Centres were also encouraged to strive for continuity in nurse-patient care. Patient data was retrieved from the SWEDEHEART registry and medical records. Using logistic regression, we compared the odds for smoking cessation at two-months post-MI for currently smoking patients admitted with MI (a) before (n=188, median age 60 years, 23% females) and (b) after (n=195, median age 60 years, 29% females) routine implementation. Secondary outcomes included adherence to implemented routines and the association of each routine with smoking cessation odds at two-months.

Results: In total, 159 (85%) and 179 (92%) of enrolled patients attended the two-month CR follow-up, before and after implementation of the new routines. After implementation, a significantly larger proportion of patients (65% vs 54%) were abstinent from smoking at two-months (crude OR 1.60 [1.04–2.48], p=0.034) (Figure 1). Including only those counselled during admission (n=89), 74% (vs 54%) were abstinent at two-months (crude OR 2.50 [1.42–4.41], p=0.002). After the new routine implementation patients were counselled more frequently during admission (50% vs 6%, p<0.001), prescribed varenicline at discharge or during follow-up (23% vs 7%, p<0.001), and contacted by telephone during the first week post-discharge (18% vs 2%, p<0.001), compared to before implementation. Crude and adjusted associations between each routine and smoking cessation at two-months are shown in Table 1. Entering all routines into the regression model simultaneously, being prescribed varenicline before discharge or during follow-up had the strongest independent association with smoking abstinence at two-months (adjusted OR 4.09 [1.68–10.00], p=0.002).

Conclusion: Our results support that readily available methods for aiding smoking cessation can be implemented effectively in routine practice, with possible beneficial effects on smoking cessation for the high-risk group of smoking MI patients.

Objective: A school tobacco policy (STP) commonly is used to reduce smoking among adoles-cents, but the effectiveness of such programs is unclear. We evaluated the impact of an STP on tobacco use in 4 schools.

Methods: The study included 4 intervention and 4 control schools, located in the inner city of Stockholm, Sweden. Schools self-selected for assignment to either an intervention program or a comparison group. In total, the study was comprised of 2671 students in grades 9 and 11, ages 15 to 18, and 1998 students (75%) responded to the questionnaire. We used a repeated cross-sectional design with assessment of tobacco use prevalence before im-plementation of the STP in 2016 and after 2 years under the program, in 2018.

Results: Two years after the STP, the intervention school in grade 9 showed a lower prevalence (13.5% vs 1.6%) in the proportion of students who reported smoking (χ2 = 4.54; p &lt; .05) whereas the proportion reporting snus use was practically unchanged. We found no statistically significant impact of the STP for grade 11. Conclusions: The results are promising with regard to smoking, when the STP is implemented in early adolescence.

The prevalence of asthma is higher in Sweden and Finland than in neighbouring eastern countries including Estonia. Corresponding difference in bronchial eosinophilic inflammation could be studied by FENO measurements. We aimed to compare FENO in adult general populations of Sweden, Finland, and Estonia, to test the plausibility of the west-east disparity hypothesis of allergic diseases.

We conducted clinical interviews (N = 2658) with participants randomly selected from the general populations in Sweden (Stockholm and dOrebro), Finland (Helsinki), and Estonia (Narva and Saaremaa), and performed FENO (n = 1498) and skin prick tests (SPT) in 1997-2003.

The median (interquartile range) of FENO (ppb) was 15.5 (9.3) in Sweden, 15.4 (13.6) in Finland and 12.5 (9.6) in Estonia. We found the lowest median FENO values in the Estonian centres Saaremaa 13.1 (9.5) and Narva 11.8 (8.6). In the pooled population, asthma was associated with FENO >= 25 ppb, odds ratio (OR) 3.91 (95% confidence intervals: 2.29-6.32) after adjusting for SPT result, smoking, gender and study centre. A positive SPT test increased the likelihood of asthma OR 3.19 (2.02-5.11). Compared to Saaremaa, the likelihood of having asthma was higher in Helsinki OR 2.40 (1.04-6.02), Narva OR 2.45 (1.05-6.19), dOrebro OR 3.38 (1.59-8.09), and Stockholm OR 5.54 (2.18-14.79).

There was a higher prevalence of asthma and allergic airway inflammation in adult general populations of Sweden and Finland compared to those of Estonia. Atopy and elevated FEND level were independently associated with an increased risk of asthma. In conclusion, the findings support the earlier west-east disparity hypothesis of allergic diseases.