KI News

Hello there, Alicja Wolk, Professor of Nutritional Epidemiology at the Institute of Environmental Medicine and responsible for the Swedish Mammography Cohort. Facts: What is a cohort? Researchers call a group of individuals with certain shared characteristics who take part in a major study a cohort. By following a cohort over a long period of time or comparing different cohorts, researchers can draw conclusions about, for example, how and why diseases develop in different groups. A group of women in Västmanland and Uppsala Counties have made possible much of the Swedish research on lifestyle, diet and diseases. The Swedish Mammography Cohort turns 30 today. How did the Swedish Mammography Cohort start? “On 1 March 1987 all women between the ages of 40 and 74 in Västmanland and Uppsala Counties began to be invited to undergo a mammography and to answer a questionnaire about their diet, weight, height, education level and family history of breast cancer. Approximately 66,000 women chose to take part. Since then, the women have been followed up with new questionnaires every ten years. A sub-group of approximately 7,000 women have also taken part in clinical investigations, including bone density measurements and giving samples of fatty tissue, blood, urine and faeces.”  How important have these women been for the research? “It is unusual to be able to follow this many individuals for such a long time so it’s a real goldmine for the research. By comparing the questionnaire responses and test results with information about the women’s illnesses in national health registers we’ve learned a great deal about how diet, lifestyle and genes affect diseases like different forms of cancer, cardiac infarction, stroke, osteoporosis and diabetes. We at Karolinska Institutet currently have responsibility for the register but it is available to all researchers and is the basis for many research collaborations. What research findings have been the most significant? About 500 studies have been published on these women so there is a lot to choose between. Personally I think it was interesting to be able to show that too much vitamin A is harmful to bone health. Many researchers doubted it at first but it has later been confirmed in other studies. Was it difficult to get the women to participate? “No, we’ve always had very high participation. When the women were first invited to mammography scans, 94 per cent chose to take part and between 70 and 80 per cent of those women have then answered the questionnaires we’ve sent out over the years. When similar studies begin nowadays participation unfortunately tends to be low, not seldom around 10-15 per cent.” Why do you think that is?  “It might partly be a generation issue, it might be more difficult to get messages across today because people have so many to deal with. I also think that the women have felt that it is easy to take part and that they get something back. In the early days, a mammography bus visited the different areas so that the women wouldn’t need to travel long distances, and they have been given feedback if their test results show anything abnormal. We’ve also limited the length of the questionnaires so that it doesn’t feel like such very hard work to answer them.” Will the cohort live to be a hundred? “Some of the women have passed the hundred mark. The oldest was 103 according to our latest information. But the answer is no, the cohort has no inflow of new individuals. However, we continue to collect new data on these women, we are inviting them to clinical examinations in Uppsala and Västerås and we plan to send a new questionnaire to all of them in 2018. The Mammography Cohort has a "twin-cohort" of about 50 000 Swedish men. Together they contain many married couples and it would be very interesting to begin a new cohort for the next generation that contains these people’s children, grandchildren and even great-grandchildren. We’re currently looking at if it can be done.” What would you like to say to all the women who have taken part over the years? “A big thank you! The results of the research are of benefit to all women in Sweden and in the world, and without you there would quite simply be no research.

A large study led by researchers at Karolinska Institutet, published in the scientific journal The BMJ, finds no increased risks to newborn babies associated with taking influenza drugs known as neuraminidase inhibitors during pregnancy. Seasonal influenza occurs every year and millions of pregnant women risk severe illness during seasons with a more aggressive strain. Regulatory agencies in Europe and the USA therefore recommend neuraminidase inhibitors for pregnant women to prevent and treat influenza, despite limited knowledge on their safety and effectiveness during pregnancy. The study, led by Sophie Graner at the Centre for Pharmacoepidemiology at the Department of Medicine, Karolinska Institutet, involved almost 6,000 women in Scandinavia and France who were prescribed any of the two neuraminidase inhibitors, oseltamivir (Tamiflu) or zanamivir (Relenza), during pregnancy – and almost 700,000 who did not receive prescriptions over the same period (2008 to 2010). This is the largest study to date to assess potential risks of taking antiviral drugs during pregnancy. Support previously reported findings After several health-related factors were taken into account, such as age, smoking and use of other medications, the team found no increased risks of adverse outcomes including low birth weight, low Apgar score (a test of a baby’s condition at birth), preterm birth, stillbirth, or birth defects. The researchers say their results “support previously reported findings that the use of neuraminidase inhibitors is not associated with increased risks of adverse fetal or neonatal outcomes.” The study was funded by Karolinska Institutet in Sweden, Université Toulouse III in France, Norwegian Institute of Public Health and University of Bergen in Norway, Statens Serum Institut in Denmark, the Novo Nordisk Foundation and the Danish Medical Research Council. This news article is an edited version of a press release from The BMJ. Publication 'Neuraminidase inhibitors during pregnancy and risk of adverse neonatal outcomes and congenital malformations: population based European register study'. Graner S, Svensson T, Beau A, Damsel-Michel C, Engeland A, Furu K, Hviid A, Eldevik Håberg S, Molgaard-Nielsen D, Pasternak B, Kieler H. The BMJ, open access 2017-02-28. doi: 10.1136/bmj.j629.

Dean of Doctoral Education Marianne Schultzberg, Silver Medal recipients Elisabeth Kjellén and Gunnar Lennerstrand and acting vice-chancellor Karin Dahlman-Wright after the ceremony. Photo: Ulf Sirborn Elisabeth Kjellén and Gunnar Lennerstrand have been awarded Karolinska Institutet’s Silver Medal for 2016. The medals were presented in conjunction with the “För nit och redlighet i rikets tjänst”, NOR, awarding ceremony, which took place on 15 February. The NOR award was presented at the same time to employees with 30 years in the service of the state.  The ceremony was held at the Swedish Society of Medicine and was followed by a dinner. Professor emeritus Gunnar Lennerstrand received the Silver Medal for his pioneering work over many years in ophthalmic research. Senior Lecturer Elisabeth Kjellén received the Silver Medal for her significant contributions to biomedical analyst education. The Silver Medal is awarded to people who have made particularly import contributions in support of the university’s activities. Acting vice-chancellor Karin Dahlman-Wright was also present at the ceremony, where 37 people also formally received the NOR 2016 award, 26 of whom were there in person: Kristina Alexanderson, Per Bengtsson, Marika Berglund, Carina Boström, Francesca Chiodi, Stefan Einhorn, Michael Elm, Susanne Fält, Henrik Garoff, Katarina Gell, Per Gerde, Annika Hanberg, Patricia Humire, Eva Kalmér, Catharina Larsson, Lilian Larsson, Carola ÅB Lidén, Lena Lilius, Eva Lindgren, Eva Lorentzon, Björn Meister, Silvia Nava, Gunnar P. Nilsson, Dulceaydee Norlander Gigliotti, Ingela Norström, Lena Palmberg, Marti Parker, Anna Persson, Sven Pettersson, Ann Roosaar, Staffan Sahlin, Martin Schalling, Helmi Siltala-Roos, Ulla Stenius, Lars-Olof Wahlund, Annica Wohlin Wottrich and Lena Von Koch.

Children born to mothers who gained too little weight during pregnancy were at increased risk for schizophrenia and other non-affective psychoses later in life, according to new epidemiological research from Karolinska Institutet. The findings, which are published in the journal JAMA Psychiatry, confirm the results of several important historical studies that showed a link between exposure to famine while in the womb and increased risk of schizophrenia later in life.   Non-affective psychoses are a set of severe psychiatric disorders including schizophrenia and other related illnesses. They can occur within families and are partly explained by genetics. However, research has also shown that a person’s environment at crucial stages of development can also play a large role in risk for these diseases. The studies of historical food shortages during the ‘Dutch Hunger Winter’ (1944-45), and ‘The Great Leap Forward’ in China (1959-1961) were radical for psychiatry in linking early life environmental factors to psychiatric illness. Children who had been in the womb while their mothers were exposed to famine had twice the risk of developing schizophrenia and associated disorders as adults. Although famine would not account for the occurrence psychiatric diagnoses in well-fed populations, this demonstrated that environmental exposures during early life may influence brain development with repercussions extending into adulthood. In the current study, researchers at Karolinska Institutet looked at individuals born in Sweden from 1982 to 1989 who were followed to adulthood, capitalising on Sweden’s extensive nationwide health and population registers. The researchers used an anonymized dataset where all personal identifiers had been removed. Over 500,000 people were included in the study, of which nearly 3,000 would go on to develop non-affective psychoses as adults. Focused on gestational weight gain To examine the nutrition of these individual’s mothers during pregnancy, the study focused on gestational weight gain, or the weight a woman gains over the course of her pregnancy. Healthy gestational weight gain is essential for safe pregnancies and for ensuring a child’s optimal development. Weight gain above and below medical guidelines has been shown to negatively impact children’s health in early life, increasing the risk physical illnesses and birth complications.   “Our results show that extremely low weight gain during pregnancy, less than 8 kilograms for normal-weight women, was associated with a 30 percent increased risk of offspring non-affective psychoses, compared to women who gained the recommended amount of weight for their body type,” says first author Euan Mackay, who presented the current study as a part of his thesis for Karolinska Institutet’s Master's Programme in Global Health. “The results were similar regardless of whether women had started pregnancy with larger or smaller body types, showing the importance of weight gain during pregnancy.” As weight gain is partly influenced by genetics, much like risks for mental illness, researchers also compared individuals with non-affective psychosis to their full siblings born during the same study years. Even when compared to their full siblings, who shared similar genetic and environmental backgrounds, children whose mothers gained an insufficient amount of weight during pregnancy were at increased risk of developing non-affective psychosis later in life. Decades later in life “Ideal weight gain during pregnancy has long been promoted in order prevent pregnancy and birth complications, such as gestational diabetes or need for caesarean section, and to ensure optimal birth weight,” says Assistant Professor Renee Gardner, principal investigator at the Department of Public Health Sciences, Karolinska Institutet. “This new study demonstrates that the current weight gain guidelines have benefits that extend beyond maternal and child health during pregnancy and delivery, with positive effects evident even decades later in life.” A key implication of the study is that even in a well-fed and affluent country such as Sweden, some mothers are unable to meet nutritional requirements to support their children’s safe development. Despite the problem of obesity in high-income settings, there remains a portion of the population that doesn’t gain enough weight during pregnancy. “This inadequate weight gain can occur because of an existing medical condition, but it can also reflect societal pressures for women to maintain an idealized body type, even when they are pregnant”, says Dr Gardner. “Interestingly, the study found no effect of excessive weight gain on offspring risk of non-affective psychoses, despite excessive weight gain in pregnancy being linked to a number of pregnancy and birth complications.” This work was funded by the Stanley Medical Research Institute and the Swedish Research Council. Publication Gestational weight gain, maternal body mass index in early pregnancy, and offspring risk of non-affective psychosis Euan Mackay, Christina Dalman, Håkan Karlsson, Renee M. Gardner JAMA Psychiatry, online 22 February 2017, doi:10.1001/jamapsychiatry.2016.4257

Heart failure patients registered in the Swedish Heart Failure Registry receive better medication and have a 35 percent lower risk of death than unregistered patients, according to a new study from Karolinska Institutet in Sweden. The findings are presented in the European Journal of Heart Failure. Health quality registries are used for many purposes including to report quality of care and to identify areas for quality improvement. Sweden has been a pioneer in the establishment of quality registries for a broad range of diseases. The Swedish Heart Failure Registry (SwedeHF; RiksSvikt) registers clinical and treatment data for patients with heart failure from most hospitals in Sweden. RiksSvikt is voluntary, so some but not other patients get registered, and this is determined largely by the availability of staff and resources at local hospitals. Over 200 000 patients In the current study, a Swedish team comprising researchers at Karolinska Institutet, Linköping University, and Uppsala Clinical Research Center analyzed data from 231,437 patients who were diagnosed with heart failure in Sweden 2006-2013. A comparison between those who were registered in RiksSvikt and those who were not showed that the registered patients had a remarkable 35 percent lower risk of death. The investment in quality registries in Sweden has provided helpful quality reporting and contributed to improved quality of care, but the concrete health benefits for patients have been less clear. “Now we also see that in heart failure, quality reporting translates directly into better survival,” says Associate Professor Lars H. Lund at Karolinska Institutet's Department of Medicine who led the study. “It is imperative that the investment in registries from the government, hospitals and clinicians continues to expand, as this will lead to better patient survival”. More likely to receive medication Further analyses showed that patients who were registered in RiksSvikt were more likely to receive heart failure medications than unregistered patients, and that this to a large extent explained the difference in survival. “There are several common treatments for heart failure which are known to cost-effectively reduce the risk of hospitalization and death, but these are underutilized,” says Associate Professor Lars H. Lund. Heart failure is a common condition in which the heart is unable to pump sufficient quantities of blood around the body. It is the most common cause of hospitalization in Sweden and is associated with a high risk of death. The study was financed by The Swedish Research Council, The Swedish Heart-Lung Foundation, The Stockholm County Council and AstraZeneca. There are no conflicts of interest declared related to the study. Outside the work submitted, some of the researchers have received research grants, speaker’s fees and/or consulting fees from AstraZeneca, Novartis, Bayer, Vifor Pharma, Relypsa, Boston Scientific, St Jude, Medtronic, HeartWare and Aspen Pharma. One of the researchers is employed as epidemiologist by AstraZeneca. Publication Association between enrolment in a heart failure quality registry and subsequent mortality – a nationwide cohort study Lund LH, Carrero J, Farahmand B, Henriksson KM, Jonsson Å, Jernberg T, Dahlström U. European Journal of Heart Failure, online 23 Feb 2017. doi: 10.1002/ejhf.762

On Tuesday 21 February Karolinska Institutet was visited by the Governor General of Canada David Johnston, his wife Sharon Johnston and the King and Queen of Sweden. The visit took place in conjunction with the state visit by the Governor General and his wife to Sweden at the invitation of the King. Queen Silvia and Mrs Johnston began the day with a visit to NASP, the National Centre for Suicide Research and Prevention of Mental Ill-Health, at Karolinska Institutet, where they were welcomed by professor Danuta Wasserman. The Queen and Mrs Johnston heard facts and figures about suicide and suicide prevention and among other things learned that researchers at NASP and Columbia University in New York have developed YAM, Youth Aware of Mental health, a school programme to promote discussion and develop skills to face life’s challenges and increase knowledge of mental ill-heath. “The way you work is rather special, that you go where the children are instead of expecting the children to come to you,“ said Mrs Johnston. Programme offered to schools Danuta Wasserman told the visitors that it can be difficult to get schools interested in the programme because they are afraid it will steal time from school work. There is also a certain resistance on the part of school staff to someone coming from outside and taking charge of their pupils, even if the pupils themselves prefer it. After the visit to NASP, the Queen and Mrs Johnson together with the King and the Governor General continued on to research group leader Anna Falk’s laboratory where they were welcomed by Karolinska Institutet’s acting Vice-Chancellor Karin Dahlman-Wright. Philanthropist and former NHL player Mats Sundin, Canada’s Minister of Science Kirsty Duncan, Nobel Laureate Art McDonald and Canada’s Ambassador to Sweden Heather Grant were also present. In the lab, researchers create 3D models of the brain to study differences between brain cells in patients with neurological diagnoses, such as autism or Alzheimer’s disease, and those in healthy people. Anna Falk told her visitors that one challenge for researchers is to find out why the neurons from people with Down’s syndrome are shorter and behave differently to the neurons rom other people. “One of our grandchildren is two years old and has Down’s syndrome. We wish you every success in your research,” said Governor General Johnston. Round tale discussions on exchanges The morning ended with talks and round tale discussions in the Nobel Forum, in which representatives from Karolinska Institutet and the Mats Sundin Fellowship in Developmental Health also took part. In 2012, he former NHL player Mats Sundin donated money to Karolinska Institutet and the University of Toronto to male scientific exchanges possible between the two countries. Governor General Johnston appreciated the visit and wants to see continued collaboration between our two countries. “We are very happy to have visited Karolinska Institutet to learn more about your work and vital collaboration with academic institutions in Canada. The Mats Sundin Fellowship is an excellent example of the type of partnership that can carry science forward. Sweden and Canada should continue their close and innovative collaboration,” said the Governor General. During the afternoon the Queen and Mrs Johnston also visited the Aging Research Center (ARC) at Karolinska Institutet. Text: Stina Moritz

The Karolinska Institutet University Board (Konsistoriet) decided today to propose Professor Ole Petter Ottersen, rector of Oslo University, as the new vice-chancellor of Karolinska Institutet. His candidacy will now be considered by the government, which takes the final decision on the matter. "He will be an experienced and competent permanent vice-chancellor for Karolinska Institutet and one with broad support in the faculty," says Mikael Odenberg, chairperson of the University Board. Today’s decision was unanimous. Professor Ottersen is currently rector of the University of Oslo, where he has held several leading positions, including dean of research for the medical faculty. His name will now be put to the government, which has ultimate say on who is to fill the post.

With the aid of thousands of skin biopsies and over a hundred kilograms of skin, researchers at Karolinska Institutet have observed how two subgroups of immune cell behave in healthy skin. This functional dichotomy is preserved in the inflammatory diseases psoriasis and vitiligo. The study, which is published in the journal Immunity, opens the way for more targeted local treatments for patchy inflammatory skin disorders. Healthy skin is protected against microbial attack by different kinds of immune cell, including T cells. Patchy inflammatory skin diseases throw the skin’s local immune system out of balance. In people with vitiligo, which causes patchy loss of pigmentation, a certain kind of T cell is dominant in the afflicted areas of skin; patients with psoriasis, on the other hand, exhibit an increase in another kind of T cell. In the present study, two research groups led by Yenan Bryceson and Liv Eidsmo show how these two subgroups of T cell operate to protect healthy skin from external attacks and retain their unique functions in psoriasis and vitiligo. Doctoral student Stanley Cheuk and colleagues used up to 1,500 skin biopsies per experiment and a total of several hundred kilograms of healthy skin for the critical parts of the study. Inflammation-causing protein  “By combining the genetic analysis of a small population of immune cells from healthy skin with functional experiments we were able to define two subgroups of memory immune cell and in detail decipher/dissect how these cells behave in healthy and inflamed skin,” explains Liv Eidsmo, researcher at Karolinska Institutet’s Department of Medicine, Solna. Vitiligo is characterised by the accumulation of a subgroup of T cells called CD49a+, which recognise and are ready to kill pigment cells. In psoriasis, another kind of T cell, CD49a- accumulates in the afflicted skin and produces the inflammation-causing protein IL-17. In healthy skin, CD49a+ and CD49a cells are dormant, but quickly respond with inflammatory and cytotoxic effects when stimulated by IL-15, a protein secreted from skin cells as a rapid-response defence against microbial attack. “If we can decipher the local immunological changes that give rise to the accumulation of one of the subgroups involved in these patchy skin disorders, we’ll be on the way to more targeted treatments,” says Dr Eidsmo. The study was financed with grants from the Swedish Research Council, the Ragnar Söderberg Foundation, the Wallenberg foundations, the Swedish Dermatology Foundation and the Swedish Psoriasis Association and through the ALF agreement with Stockholm County Council. Publication CD49a expression defines tissue-resident CD8+ T cells poised for cytotoxic function in human skin Stanley Cheuk, Heinrich Schlums, Irène Gallais Sérézal, Elisa Martini, Samuel Chiang, Nicole Marquardt, Anna Gibbs, Ebba Detlofsson, Andrea Introini, Marianne Forkel, Charlotte Höög, Annelie Tjernlund, Jakob Michaëlsson, Lasse Folkersen, Jenny Mjösberg, Lennart Blomqvist, Marcus Ehrström, Mona Ståhle, Yenan Bryceson, Liv Eidsmo Immunity, online 14 February 2017, DOI: 10.1016/j.immuni.2017.01.009

Researchers working at Karolinska Institutet and University of Southern Denmark have managed to produce short synthetic DNA analogues – oligonucleotides – that bind direct to the gene that is mutated in Huntington’s disease and prevent the production of a protein that damages the nerve cells. The discovery, published in the journal Nucleic Acids Research, opens the way for new approaches to treating the currently untreatable and deadly neurodegenerative disease. Huntington’s disease is a devastating inherited condition that produces a combination of neurological, motor, cognitive and psychiatric symptoms. It is caused by the multiple repetition in the genome of a specific DNA sequence (CAG/CTG) in the HTT gene, which codes for a protein called huntingtin. The protein and the messenger RNA (mRNA) formed by the mutated gene damage the nerve cells in the brain and cause them to degrade. Current treatments only alleviate the symptoms, as there is no way of halting the progressing of the disease. However, researchers are looking into a process called antisense therapy, in which short synthetic DNA analogues – oligonucleotides – bind to and inactivate mRNA to prevent it forming harmful proteins. “We’ve taken this a step further and created oligonucleotides that bind direct to the damaged DNA sequence and block the production of both mRNA and protein,” says Edvard Smith, senior physician and professor at Karolinska Institutet’s Department of Laboratory Medicine. “It was thought by many to be too difficult to target the double-stranded DNA, but we have demonstrated that it actually works.” Cell lines from patients The short oligonucleotides comprise a combination of DNA and LNA (locked nucleic acid) and binds to the repeated CTG sequence in the HTT gene. When the researchers delivered them into cell lines from patients with Huntington’s disease, they observed a substantial reduction in the production of mRNA and protein. The next step will be to test the method on mice. “We are fairly confident that this will also work since our oligonucleotides were taken up spontaneously by the cells,” says Professor Smith. “The idea is to administer them into the cerebrospinal fluid.” Antisense therapy is itself not a novel or untested method. The first oligonucleotide-based drugs were approved back in 1998 for the treatment of cytomegalovirus infection, and as recently as December 2016 another was approved in the USA for spinal muscular atrophy. The present study was a collaboration between researchers working at Karolinska Institutet, the University of Southern Denmark and Karolinska University Hospital. Seven of the authors have submitted a patent application related to their results. The study was financed with grants from the Swedish Research Council, the CHDI Foundation (USA), the Swedish Brain Fund, the Tore Nilson Foundation and the Swedish Cancer Society. Publication CTG repeat-targeting oligonucleotides for down-regulating Huntingtin expression Zaghloul EM, Gissberg O, Moreno PMD, Siggens L, Hällbrink M, Jørgensen AS, Ekwall K, Zain R, Wengel J, Lundin KE, Smith CIE Nucleic Acids Research, online 17 February 2017, doi: 10.1093/nar/gkx111

Using sterilised mosquito net instead of commercial mesh for repairing inguinal (groin) hernias opens the way for improved care without an increase in cost for low-income countries. This according to a study conducted in rural Uganda by researchers at Karolinska Institutet, Umeå University and Makerere University. The results are presented in the British Journal of Surgery and are a follow-up on earlier studies that established that sterilised mosquito net is just as safe as commercial mesh for repairing inguinal hernia.  With a total of approximately 20 million cases a year, groin hernia surgery is one of the world’s most common operations. Commercial hernia mesh, which is used routinely in high-income countries, is very expensive in low-income countries, where they often cost over USD 100 each. For this reason, patients in these countries are not operated on using mesh. Without surgery, an inguinal hernia can cause considerable suffering, particularly in terms of the pain it causes. Possible life-threatening complications claim the lives of some 40,000 people a year. Health economy analysis The results of this health economy analysis show not only that surgery for inguinal hernia using a sterilised mosquito net under local anaesthesia can be performed at a low cost, but also that it is highly cost-effective. Costs included in the analysis were those for staff, facilities, equipment, medicines, materials and overheads. Depending on the choice of mesh, the difference is over USD 120 (SEK 1,000) per operation. Using mosquito net, the operation costs no more than the routine, sutured repair that is currently performed. This means that repair with mesh could be available for the millions of people suffering from inguinal hernia in low-income countries, which would bring considerable patient benefit. Performed by local surgeons The study was conducted by a team of Swedish and Ugandan researchers. When the surgery-related costs of the Swedish participants are taken into account in the health economical analysis, the per-operation cost rises dramatically. One conclusion to be drawn from this is that routine surgery should be performed by local surgeons; international collaborations should aim to provide surgical training and support where necessary. “Now that we know that high-quality care for inguinal hernia surgery can be offered at a low cost in low-income countries, it’s time that we advanced our positions so that the many million of people suffering from inguinal hernias in these countries can get help,” says lead author Dr Jenny Löfgren, physician and researcher at Karolinska Institutet and Umeå University.  “In the meantime, we must focus on implementation, patient safety, knowledge transfer and surgical training.” The research was financed with grants from Region Jämtland Härjedalen’s R&D unit, the Swedish Research Council, the Capio Foundation, the Swedish Society of Medicine and Rotary. Publication Cost-effectiveness of groin hernia repair with commercial versus low-cost mesh in a low-income country J. Löfgren, A. Matovu, A. Wladis, C. Ibingira, P. Nordin, E. Galiwango and B. Forsberg Journal of British Surgery, online 16 February 2017, doi: 10.1002/bjs.10483

The consultative college gave the nomination committee strong support for a proposal to the government that Ole Petter Ottersen be appointed new vice-chancellor of Karolinska Institutet. Following discussion and a secret ballot, the voting figures were 85 in favour of Ottersen, 2 against and 3 abstentions. The consultative college, which represents the university, students and personnel organisations, had been convened for a consultation with the nomination committee on Tuesday evening. During the meeting, the chair of the consultative college, Sven-Erik Dahlén, the chair of the Board of Karolinska Institutet, Mikael Odenberg, and the chair of the search committee, Carl Johan Sundberg, each in turn presented their unanimous opinion that Ole Petter Ottersen was the strongest candidate. They said that none of the other candidates could match Ottersen’s qualifications with regard to KI’s requirement profile for the post of vice-chancellor and further presentations were therefore unnecessary. When asked by a member of the consultative college if their votes really anything and if the process could be considered to have been conducted properly, Mikael Odenberg replied that the process had been conducted “in an extraordinarily proper manner”. “And it is in your hands to decide if KI is to have him,” he said. He then pointed out that the consultative college’s role is an advisory one and that it is the board of the university that proposes a vice-chancellor to the government, but that no one wishes to have a vice-chancellor who has the wind against him/her. A final candidate with no competition “We are looking for broad acceptance on the part of the consultative college,” Mikael Odenberg said. He went on to declare his conviction that Ole Petter Ottersen is the right final candidate. A conviction that comes from the search committee’s extensive selective process and his own assessment after leadership tests and employment interviews. Ole Petter Ottersen, Vice-Chancellor of Oslo university, and earlier first choice for the post of vice-chancellor of the University of Gothenburg, is the only name that the nomination committee wishes to proceed with. “If you don’t want to have him, we’ll start the process again. But I hope that alternative won’t arise.” And it did not. Ottersen appeared himself Ole Petter Ottersen introduced himself before the ballot, for the first time in a larger assembly at Karolinska Institutet in the role of vice-chancellor candidate: “You can imagine how I’m feeling right now,” said Ole Petter Ottersen in melodious Norwegian. After the usual initial problems getting the auditorium’s microphone to work, he declared that he never would have dreamed that he would be considered for this post. “I try to speak Scandinavian and I see very quickly from people’s body language if it’s difficult to understand”, he went on. He had already made a programme declaration in a post on the internweb. Now he began with a slide of Hans Rosling, honorary doctor at Oslo University, whose death had deeply saddened him. He showed a slide of the longest line of students Oslo University has ever seen winding its way through campus to a lecture given by Hans Rosling. “It is tragic that he is no longer with us,” said Ole Petter Ottersen, who in his programme declaration speaks about KI needing to strengthen its profile in the field of global health. Summarised the vice-chancellor’s assignment But first he pointed out the milestones in his own career: Dean of Research at the Faculty of Medicine, Director of Norway’s Centres of Excellence (Centre for Molecular Biology and Neuroscience), and Vice-Chancellor of Oslo University since 2009. He summarised the university’s most important foundation as three columns: The first with the words research and education, “science communication and outreach” (“at which Hans Rosling was a master”), but also innovation and internationalisation, with a comment about far too few students travelling and that more should do so. The second column was about regional collaboration, where he emphasised interaction between the university and health and medical care, and a closer connection between clinical research and basic research. The third column underlined academic freedom, equality and diversity, and fundamental values, an ethical attitude and a good work environment. Enthusiasm most important of all “A good work environment constitutes the most important aspect,” said Ole Petter Ottersen – that if he were appointed KI’s next vice-chancellor – he would consider creating enthusiasm in the organisation to be his primary task. “People’s happiness in their work has suffered over the past year and as a researcher I know that happiness in your work is the most important aspect in getting things done. The consultative college’s students asked questions about what Ole Petter Ottersen thinks about student representation, to which he replied: “I don’t believe it’s possible to achieve high quality without the students. Students must have representatives on all decision-making bodies at a university.” When asked where he stands on external recruitment versus internal recruitment, he replied that Oslo University has focused on increasing external recruitment with the help of search committees but that it is also important that there are career paths for people already in the system. Another question concerned how he viewed the problems KI has in the borderland between healthcare’s responsibility and the university: Is there anything in your collaboration between Oslo University and the university hospital that KI can learn from? Ole Petter Ottersen wants to stimulate combinatory services and also spoke about the importance of physical proximity. “That’s when ideas and collaboration come. Clinical researchers and basic researchers must meet to a greater degree,” he replied. Leisure-time interests? Skiing and art. KI Petter Ottersen’s first choice A couple of members of the consultative college also wanted to know if Ole Petter Ottersen was a candidate for vice-chancellorship of other universities besides Karolinska Institutet considering his latest withdrawal at the University of Gothenburg. “KI was my first choice,” he replied. “The University of Gothenburg wanted me, and when KI suspended its search process that caused problems for me. Now there’s only one university I’m thinking about.” Are you going to learn Swedish? “I don’t think I’ll ever be able to speak perfect Swedish – the languages are too different. But I’ve never heard anyone from Sweden speak perfect Norwegian either,” answered the man who in all probability will be Karolinska Institutet’s new vice-chancellor.   Text: Madeleine Svärd Huss What happens next?  On Monday 20 February Karolinska Institutet’s board (konsistoriet) can take the formal decision to submit a proposal to the government that Ole Petter Ottersen be appointed vice-chancellor of the university.  It is the government who decides on KI’s new vice-chancellor.  The new vice-chancellor will probably be able to take up the post during the summer. Ole Petter Ottersen’s term as vice-chancellor of Oslo University comes to an end this summer.

Vitamin D supplements have been found to protect against acute respiratory infections including colds and flu, according to an international collaboration study in which researchers from Karolinska Institutet participated. This major global study provides the most robust evidence yet that vitamin D is beneficial for something other than bone and muscle health, and could have major implications for public health policy, including the fortification of foods with vitamin D to tackle high levels of deficiency in some countries. Conflicting results The results, published in the BMJ, are based on a new analysis of raw data from around 11,000 participants in 25 clinical trials conducted in 14 countries including the UK, USA, Japan, India, Afghanistan, Belgium, Italy, Australia and Canada. Individually, these trials yielded conflicting results, with some reporting that vitamin D protected against respiratory infections, and others showing no effect. In a press release from the Queen Mary University of London (QMUL), lead researcher Professor Adrian Martineau said: “This major collaborative research effort has yielded the first definitive evidence that vitamin D really does protect against respiratory infections. Our analysis of pooled raw data from each of the 10,933 trial participants allowed us to address the thorny question of why vitamin D ‘worked’ in some trials, but not in others.” Food fortification According to the current findings, the protective effects of vitamin D supplementation are strongest in those who have the lowest vitamin D levels, and when supplementation is given daily or weekly rather than in more widely spaced doses. Vitamin D fortification of foods provides a steady, low-level intake of vitamin D that has virtually eliminated profound vitamin D deficiency in several countries. By demonstrating this new benefit of vitamin D, the study strengthens the case for introducing food fortification to improve vitamin D levels in countries where profound vitamin D deficiency is common. Publication Vitamin D supplementation to prevent acute respiratory infections: systematic review and meta-analysis of individual participant data Adrian R Martineau, David A Jolliffe, Richard L Hooper, Lauren Greenberg, John F Aloia, Peter Bergman, Gal Dubnov-Raz, Susanna Esposito, Davaasambuu Ganmaa, Adit A Ginde, Emma C Goodall, Cameron C Grant, Christopher J Griffiths, Wim Janssens, Ilkka Laaksi, Semira Manaseki-Holland, David Mauger, David R Murdoch, Rachel Neale, Judy R Rees, Steve Simpson,Jr Iwona Stelmach, Geeta Trilok Kumar, Mitsuyoshi Urashima, Carlos A Camargo Jr BMJ, online 15 February 2017, doi: dx.doi.org/10.1136/bmj.i6583 View a press release from QMUL.

Sara Gredmark Russ, medical doctor and researcher at Karolinska Institutet’s Centre for Infectious Medicine, has been appointed Wallenberg Clinical Fellow, and will receive a little over SEK 3.6 million for her research on tick-borne encephalitis (TBE). She shares the award with Emma Niméus from Lund University. The aim of the Wallenberg Clinical Fellows programme is to encourage clinical research by Swedish doctors and to identify future research leaders in a clinical environment. It is targeted primarily at medial PhDs clinically active at a hospital or in primary care in Sweden with research connections to a Swedish university, and was established by Marianne and Marcus Wallenberg Foundation with the scientific support of the Royal Swedish Academy of Sciences.  Sara Gredmark Russ is a resident physician at Karolinska University Hospital and researcher at the Centre for Infectious Medicine on the KI Flemingsberg campus. She is running an innovative project to examine the immunological response to TBE, an acute virus infection transmitted to humans by infected ticks that can cause severe brain inflammation and lasting complications, such as headaches and concentration difficulties. There is currently no cure for TBE itself, only treatment for its symptoms. As a 2016 Wallenberg Clinical Fellow, Dr Sara Gredmark Russ will seek new insights into the underlying causes of the diseases which can lead to the development of new, targeted therapies. 

For 2017 medical student Max Kynning will be the chair of the Medical Students' Union (MF) and dental student Stephanie Ammerman chair of the Dental Students' Association (OF). These are the questions that they intend to focus on in their new roles. Stephanie Ammerman emphasises sustainable development, counteracting cheating and getting exchange students involved in student life at the university. In sustainable development she includes both sorting waste, “simple things really”, and well-being, “it’s important that our students feel good”.  The reason cheating is an issue, she says, is that it’s too easy for students to cheat on their programmes. “We’ve found that students take along cheat-sheets or their phone to their exams, so we need to have more invigilators. Students might also take someone else’s work and hand it in as their own,” Stephanie Ammerman says. The association will be working on this during the year, both in order to see how common it is and to influence the situation and find ways to stop people from cheating. With her third main issue, Stephanie Ammerman wants to get Swedish students to mix with exchange students and vice versa. “In the association we’ve seen that students in the two groups mostly hang out separately. We want to create a ‘buddy system’ and start more activities for our exchange students.” Greater involvement in the union important for MF  Max Kynning emphasises getting students involved in MF. Another major question is the Nobel Night Cap event, the after-party that follows the Nobel Banquet in the City Hall hosted by MF this year, and also collecting money to be able to renovate the union building, due to start some time in 2018. Vacant posts in MF are also being filled, Max Kynning tells us. “It’s fun to be a member of MF and it’s important to have student representatives in as many parts of the university as possible,” he goes on. Their roles might be new to both Max Kynning and Stephanie Ammerman. But they have both been involved in their unions’ work previously during their time at KI. Stephanie Ammerman says that five years at high school and college in the USA have meant that it’s natural for her. “Over there, being involved goes without saying and I brought that with me.” Others pushed her to stand for election as OF chair.  “When I come to the university and see all the students and teachers, that doesn’t give me a picture of a hard life. Studies are not only a matter of studying and worrying about exams; they’re fun too.” Max Kynning is of a similar opinion. He has spent the beginning of the spring term visiting student hangouts to introduce himself and talk about MF.  “And it’s a myth that there’s no student life in Stockholm. The union is a stable point right at the heart of it,” he says.

A new study from Karolinska Institutet shows that short-course preoperative radiotherapy combined with delayed surgery reduces the adverse side-effects of rectal cancer surgery without compromising its efficacy. The results are presented in the journal The Lancet Oncology. Rectal cancer affects some 2,000 men and women in Sweden every year. Preoperative radiotherapy was gradually introduced in the early 1990s, with a consequent improvement in prognosis for people with rectal cancer and reduction in the risk of local recurrence. “Back then we showed that preoperative radiotherapy reduces the risk of local recurrence by over 50 per cent for patients with rectal cancer,” says principal investigator Anna Martling, senior consultant surgeon and professor at Karolinska Institutet’s Department of Molecular Medicine and Surgery. “Thanks to our results, radiotherapy is recommended to many rectal cancer patients.” However, radiotherapy can cause adverse reactions and the optimal radiotherapeutic method and the interval between it and the ensuing surgery have been mooted. Lower doses of radiation The study now presented in The Lancet Oncology is based on the claim that the adverse effects of rectal cancer treatment can be reduced by administering more but lower doses of radiation for a longer time, or by increasing the interval between radiotherapy and surgery. These hypotheses have now been tested in a study in which rectal cancer patients were randomly assigned to three different treatment arms: Standard therapy, i.e. short-course (5x5 Gy) radiotherapy with direct surgery within a week. Delayed surgery with short-course (5x5 Gy) radiotherapy followed by surgery after 4-8 weeks. Delayed surgery with long-course (25x2 Gy) radiotherapy followed by surgery after 4-8 weeks. The results of the study show that patients with delayed surgery develop fewer complications with equally good oncological outcomes. It also showed that there is no difference between long-course and short-course radiotherapy other than that the former considerably lengthens the time for treatment. Improved therapeutic strategies “The results of the study will give rise to improved therapeutic strategies, fewer complications with a sustained low incidence of local recurrence, and better survival rates for rectal cancer patients,” says Professor Martling. “The results can now be immediately put to clinical use to the considerable benefit of the patients.” Eighteen Swedish hospitals took part in the study, which was financed by the Swedish Research Council and the Cancer Society in Stockholm, and through the regional ALF agreement between Stockholm County Council and Karolinska Institutet. Researchers from the universities in Lund, Uppsala and Linköping also contributed to findings. Publication Optimal fractionation of preoperative radiotherapy and timing to surgery for rectal cancer (Stockholm III): a multicentre, randomised, non-blinded, phase 3, non-inferiority trial Johan Erlandsson, Torbjörn Holm, David Pettersson, Åke Berglund, Björn Cedermark, Calin Radu, Hemming Johansson, Mikael Machado, Fredrik Hjern, Olof Hallböök, Ingvar Syk, Bengt Glimelius, Anna Martling The Lancet Oncology, online 9 February 2017, DOI: http://dx.doi.org/10.1016/S1470-2045(17)30086-4

The working memory and other cognitive functions in children and young people can be associated with how successful they are on the football pitch, a new study from Karolinska Institutet shows. Football clubs that focus too much on physical attributes therefore risk overlooking future stars. Physical attributes such as size, fitness and strength in combination with ball control have long been considered critical factors in the hunt for new football talent. The third, slightly elusive factor of “game intelligence” – to always be at the rights place at the right time – has been difficult to measure. In 2012, researchers at Karolinska Institutet provided a possible scientific explanation for the phenomenon, and showed that the so-termed “executive cognitive functions” in adult players could be associated with their success on the pitch. In a new study, which is published in the scientific journal PLOS ONE, they show that cognitive faculties can be similarly quantified and linked to how well children and young people do in the game. “This is interesting since football clubs focus heavily on the size and strength of young players,” says study leader Predrag Petrovic, at Karolinska Institutet’s Department of Clinical Neuroscience. “Young players who have still to reach full physical development rarely get a chance to be picked as potential elite players, which means that teams risk missing out on a new Iniesta or Xavi.” Special control functions Executive functions are special control functions in the brain that allow us to adapt to an environment in a perpetual state of change. They include creative thinking in order to quickly switch strategy, find new, effective solutions and repress erroneous impulses. The functions are dependent on the brain’s frontal lobes, which continue to develop until the age of 25. For this present study, the researchers measured certain executive functions in 30 elite footballers aged between 12 and 19, and then cross-referenced the results with the number of goals they scored during two years. The metrics were taken in part using the same standardised tests used in healthcare. Strong results for several executive functions were found to be associated with success on the pitch, even after controlling for other factors that could conceivably affect performance. The clearest link was seen for simpler forms of executive function, such as working memory, which develops relatively early in life. “This was expected since cognitive function is less developed in young people than it is in adults, which is probably reflected in how young people play, with fewer passes that lead to goals,” says Predrag Petrovic. Performed significantly better The young elite players also performed significantly better than the average population in the same age group on several tests of executive function. Whether these faculties are inherited or can be trained remains the object of future research, as does the importance of the different executive functions for the various positions on the field. “We think that the players’ positions on the pitch are linked to different cognitive profiles,” continues Dr Petrovic. “I can imagine that trainers will start to use cognitive tests more and more, both to find talented newcomers and to judge the position they should play in.” The study was funded by PRIMA Barn- och Vuxenpsykiatri AB and Karolinska Institutet. First author is Torbjörn Vestberg, graduate student at Karolinska Institutet’s Department of Clinical Neuroscience. Publication Core executive functions are associated with success in young elite soccer players Vestberg T, Reinebo G, Maurex L, Ingvar M, Petrovic P PLOS ONE, online open access 8 February 2017

Colleagues, friends and ministers today write their own tributes to Hans Rosling. Staffan Bergström, Professor Emeritus of International Health, remembers a fellow commuter from Uppsala, and Foreign Minister Margot Wallström a clear, pedagogical and vital voice. The world has improved in so many ways; but today, just today, it feels a little bereft, writes former doctoral student Christian Unge. ”A great friend, educator and true inspiration for our work. Melinda and I are saddened by the loss of Hans Rosling.” Bill Gates on Twitter. ”Hans Rosling was a personal hero, a gifted teacher, and a big-hearted, evidence-based optimist.” Melinda Gates on Twitter. ”A clear, instructive and important voice that helped us to better understand our world has passed away. Hans Rosling will be missed." Margot Wallström on Twitter (translated into English). ”So sad. Hans Rosling has passed away. With facts and passion he showed us there is great progress in the world.” Isabella Lövin på Twitter.   Helena Nordenstedt, Assistant professor and lecturer on global health at the Department of public health sciences, on Facebook: "We are many who feel this loss today" ”This is truly a sad day. Hans, who has been a friend, an advisor, a mentor to not only me, but to so many people around the world. Who could find the right words about just about anything, whether lecturing world leaders at the World Economic Forum or consoling someone heartbroken after a break-up (it’s true!). Brilliant, passionate, critical, challenging, warm, loyal, always true to his cause, always with a clear compass of right or wrong, no matter what other people would say. Who always had the time to teach, students, politicians, business leaders, journalists alike. And he would always try to find a way to come lecture for our Global Health students at KI, even if it was on Skype from Liberia. So you think you as a medical student can make a difference? I first met Hans Rosling in 2002, when as a young medical student I got to join my friend Katarina on a degree project in Tanzania. Before leaving we needed a document from KI stating our business, which Hans was to give me. I was a bit nervous when I stepped into his room and he immediately asked: – So you think you as a medical student can make a difference? Do you know what the people you will meet in southern Tanzania need most?? I think I replied (at least I figured it was not medical students and maybe not even medical doctors): – Economists...? – They need ’Försäkringskassor’ (social insurance agencies) and infrastructure!! Remember that! I did remember that, and the work in Tanzania was so revolving that I couldn’t let go of the idea of working within Global health. And 10 years later, that is in the past 4 years, I have the opportunity to do exactly that at KI, teaching Global health in Hans former research group. Many more can tell you stories about how Hans has influenced them in one way or another. How he found the time for everything he did I don’t know. But when suggested that he should rest, he would always say ”rest I can do when I die”. However, I find it unlikely that he is about to rest now, it is just contradictory to his person. We are many who feel this loss today, but also many who can carry on Hans Rosling’s and Gapminder’s work. For a world based on factfulness, and for a world where extreme poverty (the last 10 per cent of the world population that remains there) is finally eradicated. Please join in this mission, which might be more important today than ever before. And you can start by watching this TedTalk, by Hans and Ola Rosling.” Helena Nordenstedt   Johan von Schreeb, Senior Lecturer at the Department of public health sciences, medical doctor and specialist in general surgery and disaster medicine: “Learn from Hans. Be contemporary, humorous, factual and self-ironic" “Hans Rosling was a genius. He had a true talent for packaging fact-based knowledge in a way that held his audiences spellbound, be they professors or first-year medical students. It takes inspired pedagogical skills to summarise global population growth and its spread along axes of geography and age in a few minutes using ten toilet paper rolls. See for yourself! Hans was an inveterate optimist who was driven by a thirst for facts to explain difficult problems in the world. He was passionate about his mission of eradicating extreme poverty. And he knew what he was talking about. His father was a coffee bean roaster and his mother had had tuberculosis. He’d experienced the Swedish folkhemmets rise from the ashes of poverty. He put on airs and remained a professor at KI with his belt tightened above his navel. He found it hard to listen at times, but when he squatted down in front of the toothless old woman by her open fire out in rural Africa, he drank in her experiences, her woes and her wishes. I was Hans’s last doctoral student before he went on to devote himself fully to the Gapminder Foundation, where he and his son Ola and daughter-in-law Anna created new educational tools to illustrate how the world was changing. He put on airs and remained a professor at KI with his belt tightened above his navel. At the same time, he was happy not to have to wear stuffy academic robes.  It’s a delicate task for us at KI to preserve and grow Hans’s legacy. We must tear down the walls around KI, not build new ones. Teaching and education must be more highly valued. Much more. Learn from Hans. Be contemporary, humorous, factual and self-ironic and make sure to devote yourself to important issues. Do that and you can be a great global educationalist! Hans's legacy will be managed by many and his disciples are dispersed across the planet. His optimism planted seeds in us for of a new and better world. Let us make sure the seeds grow to become flowers that cast shade upon the weeds of ignorance. We owe it to Hans.” Johan von Schreeb   Anna Mia Ekström, Professor of global infection epidemiology at the Department of public health sciences and consultant "You never got the answer you were expecting" "Hans Rosling was a fantastic person and I feel very privileged to have worked with him. After meeting Hans 16 years ago, I changed my area of research. I had done my doctorate in medical epidemiology but had a strong interest in global issues. Hans taught a course in International Health and inspired me a lot so I went to see him at KI. The first time we met, he asked, "Are you religious or a communist? No other medical doctor wants to work with the poor for a low salary”. “If I must choose, I'm probably leaning more towards the left in that case”, I said. He began to interrogate me on global health using his famous chimpanzee test (5 questions on child mortality etc in different countries). Then he gave me the  World Bank "World Development Report" to read. I read it quickly but carefully and loved it! He apparently liked that and kept asking me questions about what I thought of the measurements used to estimate the burden of disease and national health expenditures. He wanted me to start working immediately. First he sent me for a trip to India as a teacher for Global Health course. Next he sent me to Geneva to collect datasets for the World Health Chart and pilot test this which later was developed into the Gapminder chart. Hans encouraged us to be on our toes and questioned everything we said, all the time. He used to turn everything upside down and would not accept empty words or stupidity. He often told me, "You're wrong! Completely wrong! Think again!"   Very few work as hard as Hans did Hans was interested in everything that happened in the world, including politics, and could always relate it to global health trends. He was a master at simplifying the complicated and often divided things into right or wrong. On the other hand he was also always open to change his mind if proven wrong. He was young at heart, curious and flexible. For example, he initially did not believe that large-scale HIV treatment in Africa would work, but when he saw that it did, he changed his mind. There was nothing arrogant or prestigious about him. His greatness was that he was so intelligent and able to think broadly and "out of the box" using unexpected comparisons that made you see things clearer. You never got the answer you expected. He refused to be politically correct. His motto was that if you can just support your ideas with good statistics, you both can, and should, say what you think in order to enable evidence-informed decisions. It is not only our duty but also the wonderful freedom of speech we have, as researchers and academics at the university. Very few work as hard as Hans did. Sometimes he nibbled sugar cubes to cope when working late in the evenings to prepare his lectures. He often asked us who were his closest colleagues at KI to give lectures he did not have time to do, but he also encouraged us to take our own initiatives. He loved the role as entertainer and took pride in his broad network of influential people. Hans could talk to everyone just because he respected all kinds of people regardless of their background. He gave everyone a chance and valued people for what they stood for regardless of status or position and never flattered anyone who did not deserve it.  I will miss him so much! He was such a huge source of inspiration to me, due to his unique macro-perspective, his youthfulness and because he was such a warm person. The world will be very empty without him. Anna Mia Ekström   Christian Unge, Consultant, graduated in 2010 with a PhD in global health when Hans Rosling was head of the Unit of global health (ICHAR): “Many are we who have been inspired and affected by you.” ”Hans! It was with immense sorrow that I heard that you had passed away. Meeting you as a medical student was an eye-opener for me, and I knew immediately what I wanted to do: follow your lead. Many are we who have been inspired and affected by you, as a researcher and as an educator, both for the layperson and the student. But most of all you’ve helped the people around you grow. Not only have you inundated us with statistics and facts, but you have also shown us that the world has improved in so many ways. But today, just today, it seems a little bereft. We will all miss your piles of oranges, your PowerPoint balls, your pointers and your acute, piercing gaze.” Christian Unge   Staffan Bergström, Professor Emeritus of International health at the Department of women's and children's health  "Hans Rosling – my co-commuter, the zealous didactician" “My very first memory of Hans is from the early 1970s in Uppsala: a head of tousled hair in the ‘Ackis’ refectory and an energetic voice announcing his intention to become a ‘professor of medical geography’. A somewhat odd celebrity, that Hans Rosling, who turned up in my life with increasing frequency: from Sandö School’s aid and development programme to the Africa Groups’ weekend seminars, and then as my student on the 10-week course at Professor Yngve Hofvander’s ICH, where we would later become fellow lecturers.  With his beloved Agneta, Hans prepared their work in Mozambique that was on the point of foundering due to his first cancer, but which he defeated and was able to speak openly about to the press. Undaunted by his struggle, the family travelled to Mozambique, where they were given a placement in Nacala. Many photos of Hans during their years there depict a tall, skinny man, his permanently ruffled hair probably having never been introduced to a comb. That was him all over: he had to be reminded to eat, and his work took all his energy. We arrived in Mozambique a couple of years later and during our five years there experienced the unimaginable mass poverty in the war-torn country through the same eyes as Agneta and Hans. Hans recounted to me on the phone just a few days before his death how the brutality of the most abject poverty only truly struck him in Nacala: that experience you can only get from the direct sensory perception of the inconceivable. There, in the midst of ‘the pathology of poverty’, Hans was marked for life and became the zealous didactician who wanted only to convey this pathology to everyone in unforgettable lectures and subsequently his Gapminder World Health Chart and Ted Talks. Hey Staffan! Is it spelt ‘proffesor’ or ‘professor’? On our route to KI I was one step ahead of Hans and was made professor of international health in 1996, but Erling Norrby soon sought my opinion on whether KI ought to recruit ‘that Hans Rosling’. ‘Sure,’ I thought, and then sat with Hans in our kitchen in Uppsala and received his consent. After that, we drove together daily back and forth between Uppsala and KI, where we would arrive at the crack of dawn. Without fail. And there was never a problem finding a parking space. Once at around midnight, when we were standing copying out factsheets for forthcoming lectures, I remember that a doctoral student who’d been gaping at us suddenly burst out – before we headed off for the midnight drive back to Uppsala: ‘You two are terrible role models for us junior researchers! You can’t live like this!’  So true. We were at a loss for words. I had the privilege to be Hans’s fellow traveller during the latter part of his life – and not just in the car. When we were late out of KI and I was due to collect my wife Birgitta from the surgery at Astrid Lindgren’s Children’s Hospital, I had to send in Hans to take the brunt of the blame – which he did superbly! He was self-ironic and honest about his problems, including his constant struggle with dyslexia. Once when we went together to get our new ID cards we had to write down our personal data on a form. We were each sitting in a room surrounded by auxiliary nurses and clinical support workers when Hans’s voice suddenly rang out asking for help with his spelling: ‘Hey, Staffan! Is it spelt ‘proffesor’ or ‘professor’?’ There were many indulgent smiles that day amongst those in the waiting room.” Staffan Bergström Honour Hans Rosling with a donation to UNICEF  ”Hans believed it was always important to remember the most vulnerable. Therefore, it was his wish that any donations made in conjunction with his passing be directed to UNICEF”, writes Hans Rosling’s wife Agneta Rosling regarding the family’s memorial collection.  To the memorial collection A condolence book for Hans Rosling A condolence book in rememberance of Hans Rosling is available in the entrance hall of Aula Medica during reception hours until 10 February. Opening hours are from 8-17, address Aula Medica, Nobels väg 6, Solna.

Commentary: Karolinska Institutet's Acting Vice-Chancellor Karin Dahlman-Wright is no longer part of the delegation traveling with Prime Minister Stefan Löfven to Iran. In an overall assessment, KI's Acting Vice-Chancellor decided not to take part in the official delegation.  

Three professors at KI – John Pernow, Jon Lundberg and Eddie Weitzberg – are boycotting the USA. “I have been following the news reports about Donald Trump’s immigration regulations and it just knocked the wind out of me and I felt, ‘No. I don’t want to go there’”, Jon Lundberg says. The three professors and their colleagues are cancelling several planned and already booked trips to the USA. “We were going to speak at congresses in February and during the spring. But now we’ve informed the organisers that we are cancelling and they’ve been very understanding, Jon Lundberg says. Their decision is totally a humanitarian one. “We can show our solidarity” “We can’t do anything to change the situation but we felt that we can show our solidarity with those people who are being denied entry to the USA by quite simply not going there. And obviously we’re clear about the fact that we feel that the restrictions are totally unacceptable,” Jon Lundberg goes on. He and his colleagues have informed KI’s acting vice-chancellor Karin Dahlman-Wright of their decision. “As an authority it is naturally impossible for KI to support us, but I feel that the vice-chancellor showed understanding for our making this decision on our own,” says Jon Lundberg. On Monday, several of the world’s biggest IT companies joined forces in an attempt to oppose president Trump’s immigration regulations by legal means. One of their arguments is that “Immigrants or their children founded more than 200 of the companies on the Fortune 500 list.” “Naturally, the same applies when it comes o our research. Good ideas have no limits as regards what nationality we have as human beings,” says Jon Lundberg.   The president’s executive decree: On 27 January Donald Trump signed an executive decree on regulations for immigrants and travellers. The decree suspends receiving refugees for 120 days. After these 120 days refugees fleeing religious persecution will be given priority. No refugees from Syria will be allowed into the USA for an indefinite period. For a period of 90 days, no visas will be issued to people from Iran, Iraq, Libya, Somalia, Sudan, Syria and Yemen. The latest information from the U.S. customs is that Swedish people with dual citizenship who are affected by the president’s travel ban will be allowed to enter the country. But it is not clear if this applies to everyone. According to Trita Parsi, president of the National Iranian American Council in Washington, 300,000 Swedish people may be affected by the president’s decree. Federal judge Jason Robart partially suspended the decree last Friday. The White House lodged an appeal against the decision but this was rejected by a U.S. court of appeals on Sunday. Text: PeKå Englund

Poor working conditions in a hot climate with regular dehydration and mineral deficiency is probably what causes the chronic kidney disease Mesoamerican nephropathy in Central American and Mexican agricultural workers, researchers at Karolinska Institutet and their colleagues in Nicaragua and El Salvador conclude. For their study, which is published in the scientific periodical The American Journal of Kidney Diseases, the researchers examined kidney tissue in people with this disease. Mesoamerican nephropathy (MeN) is a chronic kidney disease that affects many men in rural Central America engaged in physical labour in a hot climate. Over the past 20 years, several regions in Central America have seen a dramatic increase in chronic kidney disease that is unrelated to diabetes or high blood pressure. In some villages in El Salvador, up to 18 per cent of the working male population are affected. Chronic kidney disease was also the second most common cause of death amongst male nationals in 2009, most of whom were young plantation (mainly sugar) workers. “This is a serious health problem that deserves attention, research and preventative measures,” says principal investigator Julia Wijkström, doctoral student at the Department of Clinical Science, Intervention and Technology. Ms Wijkström and her colleagues from Karolinska Institutet, Nicaragua and El Salvador have studied kidney biopsies and blood and urine samples from 19 sugar cane workers with MeN in Nicaragua. She also looked at the long-term impact of the disease on kidney function in MeN patients in Nicaragua and El Salvador. Her results show that people with MeN have unique tissue morphology in kidney biopsies with indications of anoxia in the glomeruli and chronic damage to the renal tissue but normal vessel structures. The patients often display a salt imbalance with low levels of sodium, potassium and magnesium. The findings corroborate earlier work by the group on a smaller group of plantation workers in El Salvador with kidney disease. Deterioration continues The study also shows that kidney function in the affected people generally continues to deteriorate even when they stop becoming dehydrated in this working environment. Measures of prevention and early detection are therefore important. “Scientists are gradually becoming aware of the disease, as are the local health authorities,” says Ms Wijkström. “Hard physical labour in a hot climate has been identified as a strong risk factor in this disease, which is probably exacerbated by repeated dehydration and mineral deficiency. There are reports from other hot regions of the world of rising incidences of chronic kidney disease, and it’s not unlikely that we’re seeing a global epidemic propelled by global warming.” The study was financed by an ALF project grant and a grant from the Dutch National postcode lottery through the La Isla Foundation and the Martin Rinds Foundation. Publication “Renal Morphology, Clinical Findings, and Progression Rate in Mesoamerican Nephropathy” Julia Wijkström, Marvin Gonzalez-Quiroz, Mario Hernandez, Zulma Trujillo, Kjell Hultenby, Anneli Ring, Magnus Söderberg, Aurora Aragon, Carl-Gustaf Elinder and Annika Wernerson, American Journal of Kidney Diseases, published online: January 23, 2017, DOI:10.1053/j.ajkd.2016.10.036 Text: Maja Lundbäck