Ane Johannessen

In 2025, the Centre for Interprofessional Workplace Learning (TVEPS) co-designed a Blended Intensive Programme (BIP) with partners from Denmark, Sweden, and Norway as part of a NordPlus project. The aim was for students from different disciplines and countries to become agents of change for grand societal challenges through collaboration on wicked problems in a workshop with representatives from municipalities and educational institutions. Exploring real-life wicked problems without straightforward solutions can enable students, municipalities, and scientific staff to create social, environmental, and economic value and to contribute to the fulfilment of the UN Sustainable Development Goals, including the provision of ethical and responsible healthcare services. The workshop comprised two parts: an online week and a one-week on-site challenge workshop at Chalmers University of Technology. Stockholm, Sweden. The students were introduced to grand societal challenges from the municipalities of Øygarden (Norway), Kolding (Denmark), and Aarhus (Denmark). Their task was to explore wicked problems in interprofessional teams comprising students from health, social care, engineering, design, and entrepreneurship disciplines, using an innovation process to identify sustainable opportunities and hypotheses that could later be investigated, developed, and implemented in collaboration with the municipalities. During the challenge workshop, the student teams engaged in close dialogue with municipal representatives, experts in municipal economics, and facilitators from the educational institutions. Educational institutions derived significant benefits from the interprofessional, cross-sectoral, Nordic teaching format. Students gained valuable insight through reflection and close collaboration, developing innovative perspectives, potential opportunities, and hypotheses related to the societal challenges presented. These can be further developed and implemented to benefit the participating municipalities, whose representatives received input of potentially high societal value.

Background: Voice problems are frequently reported among users of inhaled corticosteroids (ICS), but it remains unclear whether these problems reflect pharmacological effects, asthma, or comorbid chronic cough. Aim: This study aimed to examine the association between ICS use and voice problems in a Nordic population-based cohort, accounting for asthma symptoms and chronic cough. Secondary aims included dose–response patterns and differences by inhaler device type. Methods: Cross-sectional data from adults in Sweden and Norway participating in the Respiratory Health in Northern Europe IV study (RHINE, n=5,986) were linked to national prescription registers. ICS exposure during 2021 was quantified using annual filled defined daily doses (FDDD), calculated from dispensed prescriptions based on the corticosteroid content per inhalation and number of dispensed doses. Associations between self-reported voice problems and ICS use, asthma symptoms, and chronic cough were analyzed using logistic regression, adjusted for multiple confounders. Dose–response, exposure overlap, and inhaler device type were examined in secondary analyses. Results: Voice problems increased with higher ICS exposure, from 15.5% among non-users to 59.7% in the highest dose category. The dose–response pattern showed a steep increase at lower doses with attenuation at higher exposure levels. In adjusted analyses including ICS use, asthma symptoms and chronic cough, ICS use remained associated with voice problems (aOR 1.54 [1.13– 2.10] for 1– 150 FDDD; 2.88 [1.98– 4.21] for 151– 300 FDDD; and 3.00 [2.03– 4.43] for > 300 FDDD); as did asthma symptoms (aOR 2.31 [1.90– 2.82] for one symptom; 3.14 [2.45– 4.03] for ≥ 2 symptoms); and chronic cough (aOR 2.03 [1.67– 2.46]). The highest prevalence was observed among participants with overlapping ICS use, asthma symptoms, and chronic cough. Inhaler device type did not affect voice problems, with reservation for low statistical power. Conclusion: ICS use, asthma symptoms, and chronic cough were independently associated with voice problems, with a clear dose–response for ICS, underscoring the need to consider both medication and respiratory symptoms in clinical assessment.

Background: Father's adolescent smoking and overweight affect respiratory health in offspring, suggesting that paternal puberty exposures may influence offspring biological ageing through preconception epigenetic mechanisms. Methods: We analyzed epigenetic age acceleration using four validated epigenetic clocks derived from blood DNA methylation in 892 RHINESSA offspring (mean age 27 years), linked to parental data on smoking and body shapes from RHINE/ECRHS. Linear regression examined parental smoking initiation (≤15 or >15 years) and overweight body shape (childhood/puberty or age 30) in relation to offspring epigenetic age acceleration, adjusting for offspring sex, age and parental socioeconomic status. Sensitivity analyses accounted for offspring smoking and BMI. Results: PCHorvath (β 1.53; 95% CI 0.02, 2.9), PCGrimAge (1.21; 0.03, 2.1), DunedinPACE (0.04; -0.001, 0.1) and PCPhenoAge (1.92; -0.3, 4.2) were accelerated in daughters of fathers who started smoking ≤15 years. Likewise, PCHorvath (2.25; 1.2, 3.3), PCGrimAge (1.36; -0.2, 2.9), DunedinPACE (0.07; 0.01, 0.1) and PCPhenoAge (3.11; 1.8, 4.4) were accelerated in daughters and sons of fathers who had been overweight in childhood and puberty. These results remained largely unchanged after additional adjustments or stratification in sensitivity analyses. No associations were found for maternal smoking or overweight in puberty. Conclusions: Epigenetic ageing is accelerated in offspring of fathers who smoked or were overweight in puberty, independent of offspring lifestyle. These findings suggest that adolescent boys' environment and lifestyle may be critical for next-generation health.

Evidence suggests that a father’s smoking in puberty may adversely impact respiratory health in offspring, possibly through epigenetic changes in germ cells. This study investigates whether snus use starting in or after puberty influences respiratory health in future offspring. We analysed Swedish data from RHINE (Respiratory Health in Northern Europe) parents and RHINESSA (Respiratory Health in Northern Europe, Spain and Australia) offspring by using mixed-effect logistic regression to assess the links between paternal snus initiation around puberty and offspring asthma, chronic bronchitis, rhinitis, and eczema, adjusting for paternal and offspring smoking. We identified 1090 offspring–father pairs. The offspring’s median age was 29 years (17–51) and 55% were women. The maternal line (n = 1421) was not analysed, as n = 89) had a higher risk of current allergic asthma [odds ratio (OR) 1.42; 95% confidence interval (CI) 1.02–1.97], at least three asthma symptoms with allergy (OR 1.13; 95% CI 1.10–1.21), chronic bronchitis (OR 2.17; 95% CI 1.04–4.54), and eczema (OR 1.45; 95% CI 1.27–1.65). Fathers’ snus use starting after puberty (n = 252) showed no consistent associations with offspring outcomes. The effect estimates were consistent after excluding offspring using snus in puberty. Paternal snus use starting in puberty was associated with a higher risk of asthma and other respiratory and allergic symptoms in offspring. These findings support the hypothesis that exposures in puberty may impact future generations’ respiratory health, possibly through epigenetic changes. This highlights the need for research on exposures during this period and actions to prevent habits that could negatively impact future offspring’s health.