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Human gut microbiota produce a variety of molecules, some of which enter the bloodstream and impact health. Conversely, dietary or pharmacological compounds may affect the microbiota before entering the circulation. Characterization of these interactions is an important step towards understanding the effects of the gut microbiota on health. In this cross-sectional study, we used deep metagenomic sequencing and ultra-high-performance liquid chromatography linked to mass spectrometry for a detailed characterization of the gut microbiota and plasma metabolome, respectively, of 8583 participants invited at age 50 to 64 from the population-based Swedish CArdioPulmonary bioImage Study. Here, we find that the gut microbiota explain up to 46% of the variance of individual plasma metabolites and we present 997 associations between alpha diversity and plasma metabolites and 546,819 associations between specific gut metagenomic species and plasma metabolites in an online atlas ( https://gutsyatlas.serve.scilifelab.se/ ). We exemplify the potential of this resource by presenting novel associations between dietary factors and oral medication with the gut microbiome, and microbial species strongly associated with the uremic toxin p -cresol sulfate. This resource can be used as the basis for targeted studies of perturbation of specific metabolites and for identification of candidate plasma biomarkers of gut microbiota composition. Here, Dekkers et al. characterize associations of 1528 gut metagenomic species with the plasma metabolome in 8583 participants of the SCAPIS Study, and find that gut microbiota explain up to 58% of the variance of individual plasma metabolites.

Previous spatio-temporal COVID-19 prediction models have focused on the prediction of subsequent number of cases, and have shown varying accuracy and lack of high geographical resolution. We aimed to predict trends in COVID-19 test positivity, an important marker for planning local testing capacity and accessibility. We included a full year of information (June 29, 2020–July 4, 2021) with both direct and indirect indicators of transmission, e.g. mobility data, number of calls to the national healthcare advice line and vaccination coverage from Uppsala County, Sweden, as potential predictors. We developed four models for a 1-week-window, based on gradient boosting (GB), random forest (RF), autoregressive integrated moving average (ARIMA) and integrated nested laplace approximations (INLA). Three of the models (GB, RF and INLA) outperformed the naïve baseline model after data from a full pandemic wave became available and demonstrated moderate accuracy. An ensemble model of these three models slightly improved the average root mean square error to 0.039 compared to 0.040 for GB, RF and INLA, 0.055 for ARIMA and 0.046 for the naïve model. Our findings indicate that the collection of a wide variety of data can contribute to spatio-temporal predictions of COVID-19 test positivity.

Background There is mounting evidence supporting the role of the microbiota in hypertension from experimental studies and population-based studies. We aimed to investigate the relationship between specific characteristics of the gut microbiome and 24-h ambulatory blood pressure measurements. Methods The association of gut microbial species and microbial functions, determined by shotgun metagenomic sequencing of fecal samples, with 24-h ambulatory blood pressure measurements in 3695 participants and office blood pressure was assessed in multivariable-adjusted models in 2770 participants without antihypertensive medication from the Swedish CArdioPulmonary bioImage Study. Results Gut microbiome alpha diversity was negatively associated with diastolic blood pressure variability. Additionally, four microbial species were associated with at least one of the 24-h blood pressure traits. Streptococcus sp001556435 was associated with higher systolic blood pressure, Intestinimonas massiliensis and Dysosmobacter sp001916835 with lower systolic blood pressure, Dysosmobacter sp001916835 with lower diastolic blood pressure, and ER4 sp900317525 with lower systolic blood pressure variability. Moreover, office blood pressure data from a subsample without ambulatory blood pressure measurements replicated the association of Intestinimonas massiliensis with systolic blood pressure and Dysosmobacter sp001916835 with diastolic blood pressure. Species associated with 24-h blood pressure were linked to a similar pattern of metabolites. Conclusions In this large cross-sectional analysis, gut microbiome alpha diversity negatively associates with diastolic blood pressure variability, and four gut microbial species associate with 24-h blood pressure traits. Plain language summary High blood pressure is a major risk factor for heart disease and stroke. Recent research suggests that bacteria in the gut may influence blood pressure, but more studies are needed. In this study, we analyzed data from 3695 people in Sweden who wore a 24-h blood pressure monitor and provided stool samples for gut microbiome analysis—a method that identifies the types and abundance of microorganisms in the sample. We found that people with greater gut bacteria diversity had more stable blood pressure. Additionally, four specific bacterial species were linked to blood pressure levels; three were associated with lower blood pressure, while one was linked to higher levels. These findings suggest that gut bacteria may play a role in regulating blood pressure. Future research could explore whether changing the gut microbiome might help prevent or treat high blood pressure. Lin et al. investigate the relationship between specific characteristics of the gut microbiome and 24-h ambulatory blood pressure measurements. Four gut microbial species and microbial diversity associate with 24-h blood pressure traits, supporting a potential role for the gut microbiome in blood pressure regulation and variability.

The app-based COVID Symptom Study was launched in Sweden in April 2020 to contribute to real-time COVID-19 surveillance. We enrolled 143,531 study participants (≥18 years) who contributed 10.6 million daily symptom reports between April 29, 2020 and February 10, 2021. Here, we include data from 19,161 self-reported PCR tests to create a symptom-based model to estimate the individual probability of symptomatic COVID-19, with an AUC of 0.78 (95% CI 0.74–0.83) in an external dataset. These individual probabilities are employed to estimate daily regional COVID-19 prevalence, which are in turn used together with current hospital data to predict next week COVID-19 hospital admissions. We show that this hospital prediction model demonstrates a lower median absolute percentage error (MdAPE: 25.9%) across the five most populated regions in Sweden during the first pandemic wave than a model based on case notifications (MdAPE: 30.3%). During the second wave, the error rates are similar. When we apply the same model to an English dataset, not including local COVID-19 test data, we observe MdAPEs of 22.3% and 19.0% during the first and second pandemic waves, respectively, highlighting the transferability of the prediction model. The app-based COVID Symptom Study was launched in Sweden in April 2020 to contribute to real-time COVID-19 surveillance using daily symptom reports from study participants. Here, the authors show how syndromic surveillance can be used to estimate regional COVID-19 prevalence and to predict later COVID-19 hospital admissions.

Abstract Ensuring high vaccination coverage is vital, particularly during a pandemic. While pre-booked appointment letters have shown promise in vaccination campaigns, their effectiveness in specific sociodemographic groups remains to be explored. Our study evaluated the effect of pre-booked appointment letters on COVID-19 vaccine uptake within different sociodemographic groups using a quasi-experimental methodology. In Uppsala County, Sweden, residents born between 1962 and 1971 received pre-booked COVID-19 vaccination letters starting 24 May 2021, while younger residents received SMS prompts for self-booking starting 7 June 2021. Through a regression discontinuity design, we used the intervention cut-off at birth year 1971 to assess the effectiveness of the letters to increase vaccine uptake compared to the SMS campaign. Our analysis included 96 194 individuals born between 1962 and 1981, examining vaccination within 90 days post-eligibility as primary outcome. We investigated effects within sociodemographic groups, assessed household spillover effects, and performed negative control analyses using neighbouring counties. Adults just above the cut-off had an odds ratio of 1.3 (95% CI 1.10–1.53) of being vaccinated than those just below, with a 1.97 percentage point increase (95% CI: 0.45–3.50) from a baseline of 91.95%. The intervention showed effectiveness within most sociodemographic strata. No effects were found in negative control counties, nor were there household spillover effects. Pre-booked appointment letters are effective at boosting vaccination uptake, even in diverse sociodemographic groups. While our findings come from COVID-19 vaccination, they align with evidence from various immunization programs, suggesting that personalized communications can achieve equitable vaccine coverage across different healthcare settings.

Background Diagnostic testing is essential for disease surveillance and test–trace–isolate efforts. We aimed to investigate if residential area sociodemographic characteristics and test accessibility were associated with Coronavirus Disease 2019 (COVID-19) testing rates. Methods We included 426 224 patient-initiated COVID-19 polymerase chain reaction tests from Uppsala County in Sweden from 24 June 2020 to 9 February 2022. Using Poisson regression analyses, we investigated if postal code area Care Need Index (CNI; median 1.0, IQR 0.8–1.4), a composite measure of sociodemographic factors used in Sweden to allocate primary healthcare resources, was associated with COVID-19 daily testing rates after adjustments for community transmission. We assessed if the distance to testing station influenced testing, and performed a difference-in-difference-analysis of a new testing station targeting a disadvantaged neighbourhood. Results We observed that CNI, i.e. primary healthcare need, was negatively associated with COVID-19 testing rates in inhabitants 5–69 years. More pronounced differences were noted across younger age groups and in Uppsala City, with test rate ratios in children (5–14 years) ranging from 0.56 (95% CI 0.47–0.67) to 0.87 (95% CI 0.80–0.93) across three pandemic waves. Longer distance to the nearest testing station was linked to lower testing rates, e.g. every additional 10 km was associated with a 10–18% decrease in inhabitants 15–29 years in Uppsala County. The opening of the targeted testing station was associated with increased testing, including twice as high testing rates in individuals aged 70–105, supporting an intervention effect. Conclusions Ensuring accessible testing across all residential areas constitutes a promising tool to decrease inequalities in testing.

Abstract Background This article investigates the impact of a non-mandatory and age-specific social distancing recommendation on isolation behaviours and disease outcomes in Sweden during the first wave of the coronavirus disease 2019 (COVID-19) pandemic (March to July 2020). The policy stated that people aged 70 years or older should avoid crowded places and contact with people outside the household. Methods We used a regression discontinuity design—in combination with self-reported isolation data from COVID Symptom Study Sweden (n = 96 053; age range: 39–79 years) and national register data (age range: 39–100+ years) on severe COVID-19 disease (hospitalization or death, n = 21 804) and confirmed cases (n = 48 984)—to estimate the effects of the policy. Results Our primary analyses showed a sharp drop in the weekly number of visits to crowded places (−13%) and severe COVID-19 cases (−16%) at the 70-year threshold. These results imply that the age-specific recommendations prevented approximately 1800–2700 severe COVID-19 cases, depending on model specification. Conclusions It seems that the non-mandatory, age-specific recommendations helped control COVID-19 disease during the first wave of the pandemic in Sweden, as opposed to not implementing a social distancing policy aimed at older adults. Our study provides empirical data on how populations may react to non-mandatory, age-specific social distancing policies in the face of a novel virus.

This study aimed to develop hydrogenated amorphous carbon thin films with embedded metallic nanoparticles (a–C:H:Me) of controlled size and concentration. Towards this end, a novel hybrid deposition system is presented that uses a combination of Plasma Enhanced Chemical Vapor Deposition (PECVD) and Physical Vapor Deposition (PVD) technologies. The a–C:H matrix was deposited through the acceleration of carbon ions generated through a radio-frequency (RF) plasma source by cracking methane, whereas metallic nanoparticles were generated and deposited using terminated gas condensation (TGC) technology. The resulting material was a hydrogenated amorphous carbon film with controlled physical properties and evenly dispersed metallic nanoparticles (here Ag or Ti). The physical, chemical, morphological and mechanical characteristics of the films were investigated through X-ray reflectivity (XRR), Raman spectroscopy, Scanning Electron Microscopy (SEM), Atomic Force Microscopy (AFM), Transmission Electron Microscopy (TEM) and nanoscratch testing. The resulting amorphous carbon metal nanocomposite films (a–C:H:Ag and a–C:H:Ti) exhibited enhanced nanoscratch resistance (up to +50%) and low values of friction coefficient (<0.05), properties desirable for protective coatings and/or solid lubricant applications. The ability to form nanocomposite structures with tunable coating performance by potentially controlling the carbon bonding, hydrogen content, and the type/size/percent of metallic nanoparticles opens new avenues for a broad range of applications in which mechanical, physical, biological and/or combinatorial properties are required.

The tourism model of 4s prevails as the dominant development model for tourist island destinations. Corfu following the 4s model of tourism development records negative effects which combined with increased environmental sensitivity result in the search for alternative forms of tourism. Cultural tourism based can emerge as an alternative tourism carrying capacity model. The development of the conditions of cultural tourism has not been sufficiently studied for its island destinations. The development of cultural tourism can have the effect of increasing tourism revenues and improving the standard of living in mature tourist destinations such as Corfu. Tourism policy and destination marketing should be devoted into an alternative model of cultural tourism. This article examines a possible correlation between cultural tourism and accessibility, the sun - sea, attractions and sights. Key findings of the present study are that cultural tourism is strongly related with attractions and sights. In addition, there is a relatively small correlation between cultural tourism and accessibility. These research findings can help decision makers, the regional authority, the municipal authority, entrepreneurs involved, and any interested party related to tourism policies and destination marketing understand some of the conditions required for the development of cultural tourism.