Associations of pre-pandemic levels of physical function and physical activity with COVID-19-like symptoms during the outbreak

{ 'indexed': {'date-parts': [[2022, 4, 3]], 'date-time': '2022-04-03T16:44:26Z', 'timestamp': 1649004266676}, 'reference-count': 38, 'publisher': 'Springer Science and Business Media LLC', 'issue': '1', 'license': [ { 'start': { 'date-parts': [[2021, 10, 30]], 'date-time': '2021-10-30T00:00:00Z', 'timestamp': 1635552000000}, 'content-version': 'tdm', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}, { 'start': { 'date-parts': [[2021, 10, 30]], 'date-time': '2021-10-30T00:00:00Z', 'timestamp': 1635552000000}, 'content-version': 'vor', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by/4.0'}], 'funder': [ { 'DOI': '10.13039/501100004359', 'name': 'Vetenskapsrådet', 'doi-asserted-by': 'crossref', 'award': ['(2020-05931)', '(2017-06088)']}, { 'DOI': '10.13039/501100006636', 'name': 'Forskningsrådet om Hälsa, Arbetsliv och Välfärd', 'doi-asserted-by': 'publisher', 'award': ['(2016-07175)']}, { 'DOI': '10.13039/501100001861', 'name': 'Forskningsrådet för Arbetsliv och Socialvetenskap', 'doi-asserted-by': 'publisher', 'award': ['(2016-07175)']}, { 'DOI': '10.13039/501100004047', 'name': 'Karolinska Institute', 'doi-asserted-by': 'crossref'}], 'content-domain': {'domain': ['link.springer.com'], 'crossmark-restriction': False}, 'short-container-title': ['Aging Clin Exp Res'], 'published-print': {'date-parts': [[2022, 1]]}, 'abstract': '<jats:title>Abstract</jats:title><jats:sec>\n' ' <jats:title>Background</jats:title>\n' ' <jats:p>One’s physical function and physical activity levels can predispose ' 'or protect from the development of respiratory infections. We aimed to explore the ' 'associations between pre-pandemic levels of physical function and physical activity and the ' 'development of COVID-19-like symptoms in Swedish older adults.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Methods</jats:title>\n' ' <jats:p>We analyzed data from 904 individuals aged\u2009≥\u200968\xa0years ' 'from the population-based Swedish National study on Aging and Care in Kungsholmen. ' 'COVID-19-like symptoms were assessed by phone interview (March–June 2020) and included fever, ' 'cough, sore throat and/or a cold, headache, pain in muscles, legs and joints, loss of taste ' 'and/or odor, breathing difficulties, chest pain, gastrointestinal symptoms, and eye ' 'inflammation. Muscle strength, mobility, and physical activity were examined in 2016–2018 by ' 'objective testing. Data were analyzed using logistic regression models in the total sample ' 'and stratifying by age.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Results</jats:title>\n' ' <jats:p>During the first outbreak of the pandemic, 325 (36%) individuals from ' 'our sample developed COVID-19-like symptoms. Those with slower performance in the chair stand ' 'test had an odds ratio (OR) of 1.5 (95% confidence interval [CI] 1.1–2.1) for presenting with ' 'COVID-19-like symptoms compared to better performers, after adjusting for potential ' 'confounders. The association was even higher among people aged\u2009≥\u200980\xa0years (OR ' '2.6; 95% CI 1.5–4.7). No significant associations were found between walking speed or ' 'engagement in moderate-to-vigorous physical activity and the likelihood to develop ' 'COVID-19-like symptoms.</jats:p>\n' ' </jats:sec><jats:sec>\n' ' <jats:title>Conclusion</jats:title>\n' ' <jats:p>Poor muscle strength, a possible indicator of frailty, may predispose ' 'older adults to higher odds of developing COVID-19-like symptoms, especially among the ' 'oldest-old.</jats:p>\n' ' </jats:sec>', 'DOI': '10.1007/s40520-021-02006-7', 'type': 'journal-article', 'created': { 'date-parts': [[2021, 10, 30]], 'date-time': '2021-10-30T06:17:31Z', 'timestamp': 1635574651000}, 'page': '235-247', 'update-policy': 'http://dx.doi.org/10.1007/springer_crossmark_policy', 'source': 'Crossref', 'is-referenced-by-count': 0, 'title': [ 'Associations of pre-pandemic levels of physical function and physical activity with ' 'COVID-19-like symptoms during the outbreak'], 'prefix': '10.1007', 'volume': '34', 'author': [ { 'ORCID': 'http://orcid.org/0000-0002-2689-5784', 'authenticated-orcid': False, 'given': 'Marguerita', 'family': 'Saadeh', 'sequence': 'first', 'affiliation': []}, {'given': 'Amaia', 'family': 'Calderón-Larrañaga', 'sequence': 'additional', 'affiliation': []}, {'given': 'Davide Liborio', 'family': 'Vetrano', 'sequence': 'additional', 'affiliation': []}, {'given': 'Philip', 'family': 'von Rosen', 'sequence': 'additional', 'affiliation': []}, {'given': 'Laura', 'family': 'Fratiglioni', 'sequence': 'additional', 'affiliation': []}, {'given': 'Anna-Karin', 'family': 'Welmer', 'sequence': 'additional', 'affiliation': []}], 'member': '297', 'published-online': {'date-parts': [[2021, 10, 30]]}, 'reference': [ { 'key': '2006_CR1', 'unstructured': 'World Health Organization (2021) Coronavirus [Internet]. Available from: ' 'https://www.who.int/health-topics/coronavirus#tab=tab_3'}, { 'key': '2006_CR2', 'unstructured': 'Folkhälsomyndigheten (2021) Groups at risk of serious illness ' '[Internet]. Available from: ' 'https://www.folkhalsomyndigheten.se/the-public-health-agency-of-sweden/communicable-disease-control/covid-19/covid-19-and-at-risk-groups/'}, { 'key': '2006_CR3', 'doi-asserted-by': 'publisher', 'first-page': 'e21866', 'DOI': '10.2196/21866', 'volume': '6', 'author': 'F Adorni', 'year': '2020', 'unstructured': 'Adorni F, Prinelli F, Bianchi F et al (2020) Self-reported symptoms of ' 'SARS-CoV-2 infection in a nonhospitalized population in Italy: ' 'cross-sectional study of the EPICOVID19 Web-Based Survey. JMIR Public ' 'Health Surveill 6:e21866', 'journal-title': 'JMIR Public Health Surveill'}, { 'key': '2006_CR4', 'doi-asserted-by': 'publisher', 'first-page': '603', 'DOI': '10.1001/jama.2020.12603', 'volume': '324', 'author': 'A Carfì', 'year': '2020', 'unstructured': 'Carfì A, Bernabei R, Landi F (2020) Persistent symptoms in patients ' 'after acute COVID-19. JAMA 324:603', 'journal-title': 'JAMA'}, { 'key': '2006_CR5', 'doi-asserted-by': 'crossref', 'unstructured': 'Ekram ARMS, Woods RL, Britt C et al (2021) The association between ' 'frailty and all-cause mortality in community-dwelling older individuals: ' 'an umbrella review. J Frailty Aging 10:320–326', 'DOI': '10.21203/rs.3.rs-84994/v1'}, { 'key': '2006_CR6', 'doi-asserted-by': 'publisher', 'first-page': '44', 'DOI': '10.12965/jer.1836518.259', 'volume': '15', 'author': 'B Akınoğlu', 'year': '2019', 'unstructured': 'Akınoğlu B, Kocahan T, Özkan T (2019) The relationship between ' 'peripheral muscle strength and respiratory function and respiratory ' 'muscle strength in athletes. J Exerc Rehabil 15:44–49', 'journal-title': 'J Exerc Rehabil'}, { 'key': '2006_CR7', 'doi-asserted-by': 'publisher', 'first-page': '381', 'DOI': '10.1016/j.ebiom.2019.10.034', 'volume': '49', 'author': 'C Nelke', 'year': '2019', 'unstructured': 'Nelke C, Dziewas R, Minnerup J et al (2019) Skeletal muscle as potential ' 'central link between sarcopenia and immune senescence. EBioMedicine ' '49:381–388', 'journal-title': 'EBioMedicine'}, { 'key': '2006_CR8', 'doi-asserted-by': 'publisher', 'first-page': '46', 'DOI': '10.1519/00139143-200932020-00002', 'volume': '32', 'author': 'S Fritz', 'year': '2009', 'unstructured': 'Fritz S, Lusardi M (2009) White paper: “walking speed: the sixth vital ' 'sign.” J Geriatr Phys Ther 32:46–49', 'journal-title': 'J Geriatr Phys Ther'}, { 'key': '2006_CR9', 'doi-asserted-by': 'publisher', 'first-page': '29', 'DOI': '10.1016/j.mad.2019.03.004', 'volume': '180', 'author': 'DS Kehler', 'year': '2019', 'unstructured': 'Kehler DS, Theou O (2019) The impact of physical activity and sedentary ' 'behaviors on frailty levels. Mech Ageing Dev 180:29–41', 'journal-title': 'Mech Ageing Dev'}, { 'key': '2006_CR10', 'doi-asserted-by': 'publisher', 'first-page': '799', 'DOI': '10.1161/CIRCRESAHA.118.312669', 'volume': '124', 'author': 'CJ Lavie', 'year': '2019', 'unstructured': 'Lavie CJ, Ozemek C, Carbone S et al (2019) Sedentary behavior, exercise, ' 'and cardiovascular health. Circ Res 124:799–815', 'journal-title': 'Circ Res'}, { 'key': '2006_CR11', 'doi-asserted-by': 'publisher', 'first-page': '987', 'DOI': '10.1136/bjsm.2010.077875', 'volume': '45', 'author': 'DC Nieman', 'year': '2011', 'unstructured': 'Nieman DC, Henson DA, Austin MD et al (2011) Upper respiratory tract ' 'infection is reduced in physically fit and active adults. Br J Sports ' 'Med 45:987–992', 'journal-title': 'Br J Sports Med'}, { 'key': '2006_CR12', 'first-page': '157', 'volume': '91', 'author': 'D Cucinotta', 'year': '2020', 'unstructured': 'Cucinotta D, Vanelli M (2020) WHO declares COVID-19 a pandemic. Acta ' 'Biomed 91:157–160', 'journal-title': 'Acta Biomed'}, { 'key': '2006_CR13', 'doi-asserted-by': 'publisher', 'first-page': '1', 'DOI': '10.1186/s11556-020-00241-x', 'volume': '17', 'author': 'IM Dohrn', 'year': '2020', 'unstructured': 'Dohrn IM, Gardiner PA, Winkler E et al (2020) Device-measured sedentary ' 'behavior and physical activity in older adults differ by demographic and ' 'health-related factors. Eur Rev Aging Phys Act 17:1–11', 'journal-title': 'Eur Rev Aging Phys Act'}, { 'key': '2006_CR14', 'doi-asserted-by': 'publisher', 'author': 'M Saadeh', 'year': '2020', 'unstructured': 'Saadeh M, Welmer A-K, Dekhtyar S et al (2020) The role of psychological ' 'and social well-being on physical function trajectories in older adults. ' 'J Gerontol Ser A. https://doi.org/10.1093/gerona/glaa114', 'journal-title': 'J Gerontol Ser A', 'DOI': '10.1093/gerona/glaa114'}, { 'key': '2006_CR15', 'doi-asserted-by': 'publisher', 'first-page': '50', 'DOI': '10.1001/jama.2010.1923', 'volume': '305', 'author': 'S Studenski', 'year': '2011', 'unstructured': 'Studenski S (2011) Gait speed and survival in older adults. JAMA 305:50', 'journal-title': 'JAMA'}, { 'key': '2006_CR16', 'doi-asserted-by': 'publisher', 'first-page': '162', 'DOI': '10.1016/j.jshs.2016.02.002', 'volume': '6', 'author': 'CL Edwardson', 'year': '2017', 'unstructured': 'Edwardson CL, Winkler EAH, Bodicoat DH et al (2017) Considerations when ' 'using the activPAL monitor in field-based research with adult ' 'populations. J Sport Heal Sci 6:162–178', 'journal-title': 'J Sport Heal Sci'}, { 'key': '2006_CR17', 'unstructured': 'World Health Organization (2020 Public consultation on the draft WHO ' 'Guidelines on physical activity and sedentary behaviour for children and ' 'adolescents, adults and older adults 2020 [Internet]. Available from: ' 'https://www.who.int/news-room/articles-detail/public-consultation-on-the-draft-who-guidelines-on-physical-activity-and-sedentary-behaviour-for-children-and-adolescents-adults-and-older-adults-2020'}, { 'key': '2006_CR18', 'doi-asserted-by': 'publisher', 'first-page': '776', 'DOI': '10.1136/bjsports-2017-097628', 'volume': '52', 'author': 'C Tudor-Locke', 'year': '2018', 'unstructured': 'Tudor-Locke C, Han H, Aguiar EJ et al (2018) How fast is fast enough? ' 'Walking cadence (steps/min) as a practical estimate of intensity in ' 'adults: a narrative review. Br J Sports Med 52:776–788', 'journal-title': 'Br J Sports Med'}, { 'key': '2006_CR19', 'first-page': '1417', 'volume': '72', 'author': 'A Calderón-Larrañaga', 'year': '2017', 'unstructured': 'Calderón-Larrañaga A, Vetrano DL, Onder G et al (2017) Assessing and ' 'measuring chronic multimorbidity in the older population: a proposal for ' 'its operationalization. J Gerontol Ser A 72:1417–1423', 'journal-title': 'J Gerontol Ser A'}, { 'key': '2006_CR20', 'doi-asserted-by': 'publisher', 'first-page': '535', 'DOI': '10.1016/j.dsx.2020.04.044', 'volume': '14', 'author': 'A Kumar', 'year': '2020', 'unstructured': 'Kumar A, Arora A, Sharma P et al (2020) Is diabetes mellitus associated ' 'with mortality and severity of COVID-19? A meta-analysis. Diabetes Metab ' 'Syndr 14:535–545', 'journal-title': 'Diabetes Metab Syndr'}, { 'key': '2006_CR21', 'doi-asserted-by': 'publisher', 'first-page': '154378', 'DOI': '10.1016/j.metabol.2020.154378', 'volume': '113', 'author': 'Y Huang', 'year': '2020', 'unstructured': 'Huang Y, Lu Y, Huang Y-M et al (2020) Obesity in patients with COVID-19: ' 'a systematic review and meta-analysis. Metabolism 113:154378', 'journal-title': 'Metabolism'}, { 'key': '2006_CR22', 'doi-asserted-by': 'crossref', 'unstructured': 'Marengoni A, Zucchelli A, Vetrano DL et al (2021) Beyond chronological ' 'age: frailty and multimorbidity predict. J Gerontol A Biol Sci Med Sci ' '76: 38–45', 'DOI': '10.1093/gerona/glaa291'}, { 'key': '2006_CR23', 'doi-asserted-by': 'publisher', 'first-page': '1145', 'DOI': '10.1007/s40520-021-01809-y', 'volume': '33', 'author': 'B Unim', 'year': '2021', 'unstructured': 'Unim B, Palmieri L, Lo Noce C et al (2021) Prevalence of ' 'COVID-19-related symptoms by age group. Aging Clin Exp Res 33:1145–1147', 'journal-title': 'Aging Clin Exp Res'}, { 'key': '2006_CR24', 'doi-asserted-by': 'publisher', 'first-page': 'M146', 'DOI': '10.1093/gerona/56.3.M146', 'volume': '56', 'author': 'LP Fried', 'year': '2001', 'unstructured': 'Fried LP, Tangen CM, Walston J et al (2001) Frailty in older adults: ' 'evidence for a phenotype. J Gerontol Ser A 56:M146–M157', 'journal-title': 'J Gerontol Ser A'}, { 'key': '2006_CR25', 'doi-asserted-by': 'publisher', 'first-page': '104324', 'DOI': '10.1016/j.archger.2020.104324', 'volume': '93', 'author': 'R Pranata', 'year': '2021', 'unstructured': 'Pranata R, Henrina J, Lim MA et al (2021) Clinical frailty scale and ' 'mortality in COVID-19: a systematic review and dose-response ' 'meta-analysis: clinical frailty scale in COVID-19. Arch Gerontol Geriatr ' '93:104324', 'journal-title': 'Arch Gerontol Geriatr'}, { 'key': '2006_CR26', 'doi-asserted-by': 'publisher', 'first-page': '2106', 'DOI': '10.3390/jcm9072106', 'volume': '9', 'author': 'G Maltese', 'year': '2020', 'unstructured': 'Maltese G, Corsonello A, Di Rosa M et al (2020) Frailty and COVID-19: a ' 'systematic scoping review. J Clin Med 9:2106', 'journal-title': 'J Clin Med'}, { 'key': '2006_CR27', 'doi-asserted-by': 'publisher', 'first-page': 'e444', 'DOI': '10.1016/S2468-2667(20)30146-8', 'volume': '5', 'author': 'J Hewitt', 'year': '2020', 'unstructured': 'Hewitt J, Carter B, Vilches-Moraga A et al (2020) The effect of frailty ' 'on survival in patients with COVID-19 (COPE): a multicentre, European, ' 'observational cohort study. Lancet Public Heal 5:e444–e451', 'journal-title': 'Lancet Public Heal'}, { 'key': '2006_CR28', 'first-page': '1529', 'volume': '65', 'author': 'B Cheval', 'year': '2021', 'unstructured': 'Cheval B, Sieber S, Maltagliati S et al (2021) Muscle strength is ' 'associated with COVID-19 hospitalization in adults 50 years of age and ' 'older. medRxiv 65:1529', 'journal-title': 'medRxiv'}, { 'key': '2006_CR29', 'first-page': '1', 'volume': '200', 'author': 'T Yates', 'year': '2020', 'unstructured': 'Yates T, Razieh C, Zaccardi F et al (2020) Obesity, walking pace and ' 'risk of severe COVID-19: analysis of UK Biobank. medRxiv 200:1–11', 'journal-title': 'medRxiv'}, { 'key': '2006_CR30', 'doi-asserted-by': 'publisher', 'first-page': '1', 'DOI': '10.3389/fimmu.2018.00001', 'volume': '9', 'author': 'JP Campbell', 'year': '2018', 'unstructured': 'Campbell JP, Turner JE (2018) Debunking the myth of exercise-induced ' 'immune suppression: redefining the impact of exercise on immunological ' 'health across the lifespan. Front Immunol 9:1–21', 'journal-title': 'Front Immunol'}, { 'key': '2006_CR31', 'doi-asserted-by': 'publisher', 'first-page': '687', 'DOI': '10.1093/ageing/afu033', 'volume': '43', 'author': 'A Clegg', 'year': '2014', 'unstructured': 'Clegg A, Barber S, Young J et al (2014) The Home-based Older People’s ' 'Exercise (HOPE) trial: a pilot randomised controlled trial of a ' 'home-based exercise intervention for older people with frailty. Age ' 'Ageing 43:687–695', 'journal-title': 'Age Ageing'}, { 'key': '2006_CR32', 'doi-asserted-by': 'publisher', 'first-page': '201', 'DOI': '10.1016/j.jshs.2018.09.009', 'volume': '8', 'author': 'DC Nieman', 'year': '2019', 'unstructured': 'Nieman DC, Wentz LM (2019) The compelling link between physical activity ' 'and the body’s defense system. J Sport Heal Sci 8:201–217', 'journal-title': 'J Sport Heal Sci'}, { 'key': '2006_CR33', 'doi-asserted-by': 'publisher', 'first-page': 'M636', 'DOI': '10.1093/gerona/58.7.M636', 'volume': '58', 'author': 'ZF Kapasi', 'year': '2003', 'unstructured': 'Kapasi ZF, Ouslander JG, Schnelle JF et al (2003) Effects of an exercise ' 'intervention on immunologic parameters in frail elderly nursing home ' 'residents. J Gerontol Ser A 58:M636–M643', 'journal-title': 'J Gerontol Ser A'}, { 'key': '2006_CR34', 'doi-asserted-by': 'publisher', 'first-page': '1', 'DOI': '10.1016/S0047-6374(99)00014-7', 'volume': '109', 'author': 'JA Woods', 'year': '1999', 'unstructured': 'Woods JA, Ceddia MA, Wolters BW et al (1999) Effects of 6 months of ' 'moderate aerobic exercise training on immune function in the elderly. ' 'Mech Ageing Dev 109:1–19', 'journal-title': 'Mech Ageing Dev'}, { 'key': '2006_CR35', 'doi-asserted-by': 'publisher', 'first-page': '1547', 'DOI': '10.1007/s11357-020-00272-3', 'volume': '42', 'author': 'R Kirwan', 'year': '2020', 'unstructured': 'Kirwan R, McCullough D, Butler T et al (2020) Sarcopenia during COVID-19 ' 'lockdown restrictions: long-term health effects of short-term muscle ' 'loss. GeroScience 42:1547–1578', 'journal-title': 'GeroScience'}, { 'key': '2006_CR36', 'doi-asserted-by': 'publisher', 'first-page': '915', 'DOI': '10.1016/j.jamda.2020.05.045', 'volume': '21', 'author': 'C Bonanad', 'year': '2020', 'unstructured': 'Bonanad C, García-Blas S, Tarazona-Santabalbina F et al (2020) The ' 'effect of age on mortality in patients with COVID-19: a meta-analysis ' 'with 611,583 subjects. J Am Med Dir Assoc 21:915–918', 'journal-title': 'J Am Med Dir Assoc'}, { 'key': '2006_CR37', 'doi-asserted-by': 'publisher', 'first-page': '404', 'DOI': '10.1016/j.arr.2012.03.003', 'volume': '11', 'author': 'RJ Simpson', 'year': '2012', 'unstructured': 'Simpson RJ, Lowder TW, Spielmann G et al (2012) Exercise and the aging ' 'immune system. Ageing Res Rev 11:404–420', 'journal-title': 'Ageing Res Rev'}, { 'key': '2006_CR38', 'doi-asserted-by': 'publisher', 'first-page': '1870', 'DOI': '10.1093/gerona/gly229', 'volume': '74', 'author': 'H Cao Dinh', 'year': '2019', 'unstructured': 'Cao Dinh H, Njemini R, Onyema OO et al (2019) Strength endurance ' 'training but not intensive strength training reduces senescence-prone T ' 'cells in peripheral blood in community-dwelling elderly women. J ' 'Gerontol Ser A 74:1870–1878', 'journal-title': 'J Gerontol Ser A'}], 'container-title': ['Aging Clinical and Experimental Research'], 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://link.springer.com/content/pdf/10.1007/s40520-021-02006-7.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/article/10.1007/s40520-021-02006-7/fulltext.html', 'content-type': 'text/html', 'content-version': 'vor', 'intended-application': 'text-mining'}, { 'URL': 'https://link.springer.com/content/pdf/10.1007/s40520-021-02006-7.pdf', 'content-type': 'application/pdf', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2022, 1, 27]], 'date-time': '2022-01-27T10:27:37Z', 'timestamp': 1643279257000}, 'score': 1, 'resource': {'primary': {'URL': 'https://link.springer.com/10.1007/s40520-021-02006-7'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2021, 10, 30]]}, 'references-count': 38, 'journal-issue': {'issue': '1', 'published-print': {'date-parts': [[2022, 1]]}}, 'alternative-id': ['2006'], 'URL': 'http://dx.doi.org/10.1007/s40520-021-02006-7', 'relation': {}, 'ISSN': ['1720-8319'], 'issn-type': [{'value': '1720-8319', 'type': 'electronic'}], 'subject': ['Geriatrics and Gerontology', 'Aging'], 'published': {'date-parts': [[2021, 10, 30]]}, 'assertion': [ { 'value': '26 August 2021', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '15 October 2021', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '30 October 2021', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, {'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Declarations'}}, { 'value': 'The authors declare that they have no competing interests.', 'order': 2, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Conflict of interest'}}, { 'value': 'SNAC-K was approved by the Regional Ethical Review Board in Stockholm (Dnrs: ' '2001-114, 2004-929/3, 2007/279-31, 2010/2:4, 2013/3:6, 2016/730-31/1), and ' 'written informed consent was obtained from participants or their next of kin.', 'order': 3, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Statement of human and animal rights'}}, { 'value': 'The principles of autonomy and integrity, the rule of consent and the demand ' 'for research.', 'order': 4, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Informed consent'}}, { 'value': 'Not applicable.', 'order': 5, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Consent for publication'}}]}