Introduction Researchers have, for decades, contributed to an increased collective understanding of the physiological demands in cross-country skiing; however, almost all of these studies have used either non-elite subjects and/or performances that emulate cross-country skiing. To establish the physiological demands of cross-country skiing, it is important to relate the investigated physiological variables to the competitive performance of elite skiers. The overall aim of this doctoral thesis was, therefore, to investigate the external validity of physiological test variables to determine the physiological demands in competitive elite cross-country skiing. Methods The subjects in Study I – IV were elite male (I – III) and female (III – IV) cross-country skiers. In all studies, the relationship between test variables (general and ski-specific) and competitive performances (i.e. the results from competitions or the overall ski-ranking points of the International Ski Federation (FIS) for sprint (FISsprint) and distance (FISdist) races) were analysed. Test variables reflecting the subject’s general strength, upper-body and whole-body oxygen uptake, oxygen uptake and work intensity at the lactate threshold, mean upper-body power, lean mass, and maximal double-poling speed were investigated. Results The ability to maintain a high work rate without accumulating lactate is an indicator of distance performance, independent of sex (I, IV). Independent of sex, high oxygen uptake in whole-body and upper-body exercise was important for both sprint (II, IV) and distance (I, IV) performance. The maximal double-poling speed and 60-s double-poling mean power output were indicators of sprint (IV) and distance performance (I), respectively. Lean mass was correlated with distance performance for women (III), whereas correlations were found between lean mass and sprint performance among both male and female skiers (III). Moreover, no correlations between distance performance and test variables were derived from tests of knee-extension peak torque, vertical jumps, or double poling on a ski-ergometer with 20-s and 360-s durations (I), whereas gross efficiency while treadmill roller skiing showed no correlation with either distance or sprint performance in cross-country skiing (IV). Conclusion The results in this thesis show that, depending on discipline and sex, maximal and peak oxygen uptake, work intensity at the lactate threshold, lean mass, double-poling mean power output, and double-poling maximal speed are all externally valid physiological test variables for evaluation of performance capability among elite cross-country skiers; however, to optimally indicate performance capability different test-variable expressions should be used; in general, the absolute expression appears to be a better indicator of competitive sprint performance whereas the influence of body mass should be considered when evaluating competitive distance performance capability of elite cross-country skiers.

Nitrogen use efficient (NUE) wheat varieties have potential to reduce input costs for growers, limit N runoff into water ways, and increase wheat adaptability to warmer environments. Previous studies have done little to explain the genetic basis for NUE and components, nitrogen uptake efficiency (NUpE) and nitrogen utilization efficiency (NUtE). Four studies were conducted to 1) determine genotypic stability of NUE under high and low N regimes and under warming 2) determine effect of warming on NUE 3) indentify QTL associated with NUE components 4) assess the utility of canopy spectral reflectance (CSR) as a high-throughput phenotyping device for NUE. Genotypic response to N stress or warming varied. Uptake efficiency was found to be more important than utilization efficiency to genotypic performance under high and low N environments and under warming. Selection under low N for NUpE and under high N for NUtE most efficiently identified NUE varieties. Uptake and utilization were lower under warming due to quickened development. No strong correlations between the CSR indices and NUE existed. No QTL were found to be significantly associated with NUE components. Further research into the mechanisms controlling NUE and to reveal plant response to N stress and under warming is necessary.

Challenges at hazardous waste and contaminated sites are persistent, complex, and multifactorial, and unfortunately the progress in implementing solutions is slow. This delay can be attributed to the lack of collaboration, information transfer to the end-user, and partnership building among academia, government and the affected community. As a solution, Environmental Research Translation (ERT), a framework that is rooted in existing participatory models, and encompasses many of the key principles from informal science education and community-based participatory research is proposed. The ERT framework lead to a community-academic partnership called: Gardenroots: The Dewey-Humboldt, Arizona Garden Project. Vegetable gardening in contaminated soils presents a health hazard. A controlled greenhouse study was conducted in parallel with a co-created citizen science program to characterize the uptake of arsenic by homegrown vegetables near the Iron King Mine and Humboldt Smelter Superfund Site in Arizona. Community members, after training, collected soil, water and vegetable samples from their household garden. The greenhouse and home garden arsenic soil concentrations ranged from 2.35 to 533 mg kg⁻¹. In the greenhouse experiment four vegetables were grown in three different soil treatments and a total of 63 home garden produce samples were obtained from 19 properties neighboring the site. All vegetables accumulated arsenic, ranging from 0.01 - 23.0 mg kg⁻¹ dry weight. Bioconcentration factors were determined and arsenic uptake decreased in the order: Asteraceae > Brassicaceae >> Amaranthaceae > Cucurbitaceae > Liliaceae > Solanaceae > Fabaceae. Concentrations of arsenic measured in potable water, soils and vegetable samples were used in conjunction with reported US intake rates to calculate daily dose, excess cancer risk and Hazard Quotient for arsenic. Relative arsenic intake dose decreased in order: potable water > garden soils > well washed homegrown vegetables, and on average, each accounted for 79, 14 and 7%, of a residential gardener's daily arsenic intake dose. The IELCR ranges for vegetables, garden soils and potable water were 10⁻⁸ to 10⁻⁴, 10⁻⁶ to 10⁻⁴; and 10⁻⁵ to 10⁻², respectively. The ERT framework improved environmental health research, information transfer, and risk communication efforts. Incorporating the community in the scientific process lead to individual learning and community-level outcomes.

This thesis describes the metallurgical and environmental factors that influence hydrogen embrittlement of super duplex stainless steels and presents a model to predict the rate at which embrittlement occurs. Super duplex stainless steel has an austenite and ferrite microstructure with an average fraction of each phase of approximately 50%. An investigation was carried out on the metallurgical and environmental factors that influence hydrogen embrittlement of super duplex stainless steels. Tensile specimens of super duplex stainless steel were pre-charged with hydrogen for two weeks in 3.5% NaCl solution at 50º C at a range of applied potentials to simulate the conditions that exist when subsea oilfield components are cathodically protected in seawater. The pre-charged specimens were then tested in a slow strain rate tensile test and their susceptibility to hydrogen embrittlement was assessed by the failure time, reduction in cross-sectional area and examination of the fracture surface. The ferrite and austenite in the duplex microstructures were identified by analysing their Cr, Ni, Mo and N contents in an electron microscope, as these elements partition in different concentrations in the two phases. It was shown that hydrogen embrittlement occurred in the ferrite phase, whereas the austenite failed in a ductile manner. An embrittled region existed around the circumference of each fracture surface and the depth of this embrittlement depended on the hydrogen charging time and the potential at which the charging had been carried out. The depth of embrittlement was shown to correlate with the rate of hydrogen diffusion in the alloy, which was measured electrochemically using hydrogen permeation and galvanostatic methods. A two-dimensional diffusion model was used to calculate the hydrogen distribution profiles for each experimental condition and the model could be employed to provide predictions of expected failure times in stressed engineering components.

Adrenergic signalling is part of the sympathetic nervous system and is activated upon stimulation by the catecholamines epinephrine and norepinephrine. This regulates heart rate, energy mobilization, digestion and helps to divert blood flow to important organs. Insulin is released to regulate metabolism of carbohydrates, fats and proteins, mainly by taking up glucose from the blood. The insulin and the catecholamine hormone systems are normally working as opposing metabolic regulators and are therefore thought to antagonize each other. One of the major regulators involved in insulin signalling is the mechanistic target of rapamycin (mTOR). There are two different complexes of mTOR; mTORC1 and mTORC2, and they are essential in the control of cell growth, metabolism and energy homeostasis. Since mTOR is one of the major signalling nodes for anabolic actions of insulin it was thought that catecholamines might oppose this action by inhibiting the complexes. However, lately there are studies demonstrating that this may not be the case. mTOR is for instance part of the adrenergic signalling pathway resulting in hypertrophy of cardiac and skeletal muscle cells and inhibition of smooth muscle relaxation and helps to regulate browning in white adipose tissue and thermogenesis in brown adipose tissue (BAT). In this thesis I show that β-adrenergic signalling leading to glucose uptake occurs independently of insulin in skeletal muscle and BAT, and does not activate either Akt or mTORC1, but that the master regulator of this pathway is mTORC2. Further, my co-workers and I demonstrates that β-adrenergic stimulation in skeletal muscle and BAT utilizes different glucose transporters. In skeletal muscle, GLUT4 is translocated to the plasma membrane upon stimulation. However, in BAT, β-adrenergic stimulation results in glucose uptake through translocation of GLUT1. Importantly, in both skeletal muscle and BAT, the role of mTORC2 in β-adrenergic stimulated glucose uptake is to regulate GLUT-translocation. / <p>At the time of the doctoral defense, the following paper was unpublished and had a status as follows: Paper 4: Manuscript.</p>

Le but de ce travail est de prouver la supériorité d’une technique alternative de propulsion manuelle non-conventionnelle basée sur le système à leviers. La faisabilité d’un prototype intégrant la technique non-conventionnelle ainsi que les avantages et les inconvénients sont également recherchés. Les évaluations objectives et subjectives en relation avec l’interface sujetprototype ainsi que les habiletés sur terrain et les paramètres physiologiques ont fait l’objet d’études expérimentales. Le prototype conçu pourrait constituer une tentative dans le domaine de l’handisport permettant aux sportifs handicapés de recourir à une stratégie de propulsion manuelle non-conventionnelle évitant les complications induites par la technique conventionnelle / Wheelchair propulsion has been reported to be responsible for musculoskeletal pain in the upper extremities. Epidemiological studies have shown a high prevalence of shoulder complaints in paraplegic and quadriplegic spinal cord injured (SCI) people. It has been argued that the high incidence of shoulder complaints in SCI was the result of the weightbearing or propulsion function of the upper extremity in those subjects. This work aimed at proposing an alternative wheelchair propulsion technique based on the levers’ system. The interface prototype-users, the wheelchair skills evaluation, the oxygen uptake and the cardiac frequency are investigated by an objective and subjective studies. Our prototype is designed to be an attempt in the field of disabled athletes having some advantages of a non-conventional manual wheelchair propulsion technique, avoiding complications induced by the conventional one

Les fortes teneurs en éléments traces métalliques (ETMs) présents dans les déblais miniers entraînent généralement une forte réduction de la diversité végétale et microbienne. Selon les caractéristiques physico-chimiques des sols, la nature des métaux, leur concentration et leur spéciation, seules certaines espèces végétales et microbiennes ont développé des mécanismes particuliers et se sont adaptées à la présence d'ETMs. C'est le cas d'Anthyllis vulneraria et d'Hedysarum coronarium, deux Fabacées qui sont présentes sur d'anciennes mines de Zn/ Pb respectivement au sud de la France et au nord de la Tunisie. L'étude de l'absorption du Zn chez quatre sous-espèces d'A. vulneraria a montré que seule la sous-espèce carpatica présente sur l'ancienne mine Zn/Pb des Avinières, peut croître en présence de teneurs élevées en Zn et accumule des quantités élevées de ce métal sans montrer de symptômes de toxicité. Les données obtenues ont révélé qu'A. vulneraria sous espèce carpatica est une plante hypertolérante et accumulatrice de Zn. L'inoculation d'A. vulneraria avec ses bactéries symbiotiques fixatrices d'azote, Mesorhizobium metallidurans STM2683 (souche métallicole) et Mesorhizobium sp. STM2682 (souche non métallicole), a induit une diminution très significative de la teneur en Zn dans la plante. Par contre, seule la souche métallicole a montré un effet protecteur vis-à-vis des sous espèces sensibles d'A. vulneraria lorsque celles-ci sont exposées à une concentration modérée en Zn. La diversité phylogénétique et phénotypique des bactéries symbiotiques fixatrices d'azote associées à H. coronarium isolées du substrat de l'ancienne mine de Zn/Pb de Fej El Hdoum et du sol d'une parcelle agricole à El Krib a mis en évidence (i) l'appartenance de tous les isolats étudiés au genre Rhizobium, (ii) l'existence de différents niveaux de tolérance au Cd et l'absence de tolérance au Zn pour les isolats issus du substrat de Fej El Hdoum (iii) le lien étroit entre la présence de la plante hôte, H. coronarium et de sa bactérie symbiotique fixatrice d'azote sur un site donné. Ainsi, compte tenu des contraintes imposées par la présence des ETMs, l'utilisation de Fabacées en première séquence de végétation pour favoriser l'entrée d'azote et faciliter l'installation d'une couverture végétale stable et pérenne à même de phytostabliser les déblais miniers, rend indispensable la sélection des associations les mieux adaptées aux conditions environnementales locales. / High contents of trace metals present in waste rock mining causes a significant reduction in plant and microbial diversity. According to soil physico-chemical characteristics, metal nature, concentration and speciation, only some plant and strain species have developed specific mechanisms to cope with trace metal toxicity. This is the case of Anthyllis vulneraria and Hedysarum coronarium, two Fabaceae that are present on Zn / Pb ancient mines respectively in southern France and northern Tunisia. The Zn absorption study in four subspecies of A. vulneraria showed that only the carpatica subspecies, present on the Zn / Pb ancient mine of Les Avinières, can grow with high Zn concentrations and accumulate high levels of this metal without showing toxicity symptoms. Thus, A. vulneraria subsp. carpatica should be considered as a Zn-hypertolerant and accumulator plant. Inoculation of A. vulneraria with a nitrogen-fixing symbiotic bacterium, Mesorhizobium metallidurans STM2683 (metallicolous strain) or Mesorhizobium sp. STM2682 (non- metallicolous strain), induced a significant decrease of Zn content in the plant. However, only the metallicolous strain showed a protective effect for sensitive A. vulneraria subspecies when symbiotic plants were exposed to a moderate Zn concentration. Phenotypic and phylogenetic diversity of nitrogen-fixing symbiotic bacteria associated with H. coronarium isolated from the Zn / Pb ancient mine of Fej El Hdoum and an agricultural parcel of El Krib highlighted (i) that all studied isolates belong to the genus of Rhizobium, (ii) the existence of different Cd tolerance levels and the absence of Zn tolerance for isolates from the Fej El Hdoum substrate (iii) the close link between the presence of the host plant, H. coronarium and their symbiotic nitrogen-fixing bacteria on a given site. Thus, given the constraints imposed by heavy metals, the use of Fabaceae in a first sequence of vegetation to promote nitrogen entrance and facilitate the installation of a sustainable plant cover able to phytostabilise waste rock mining, necessitates the selection of the best adapted associations to local environmental conditions.

La croissance des plantes est limitée par la toxicité métallique. Des études suggèrent que le stress métallique peut être limité par l'absorption de silicium (Si). Cependant la phytodisponibilité du silicium n'a pas encore été clairement évaluée. Ainsi dans un premier temps cette étude a pour objectifs d'évaluer la disponibilité de Si issu de différents minéraux du sol et la signification des différents extractants utilisés pour l'extraction de Si du sol en terme de disponibilité lors d'une culture en continu de blé dur. Pour ce faire, des extractants acides et alcalins ont été comparés sur une série de sols non contaminés de nature différente, puis la validité de Na2CO3 pour l'estimation de la fraction disponible de Si pour une culture continue de blé dur (Triticum turgidum L.) a été testée sur une série de sols contrastés. Ensuite on a tenté de déterminer le rôle spécifique de Si dans la croissance de plantules de blé dur et la suppression des stress associés à la présence de Cd et Cu dans le milieu de croissance, à la fois en conditions hydroponiques et sur support solide simplifié en comparant un alumino-silicate et une diatomite. Finalement, l'apport de silicium amorphe (ASi) (et disponible) a été testé en pot sur les plantes de blé ayant poussé sur des sols multi-contaminés ou contaminés en Cd. ASi extrait par Na2CO3 (ASiNa) est apparu bien corrélé aux concentrations dans les parties aériennes du blé dur ayant poussé en pot sur différents sols non contaminés et, pour cette raison, pourrait être utilisé pour l'évaluation de la fraction phytodisponible. / Plant growth is seriously limited by heavy metal toxicity. Studies suggest that silicon (Si) can alleviate the metal stress in plants but its bioavailability in soil is not well defined. This study aims at assessing the bioavailability of Si from different soil minerals, the meaning of various extractants in terms of availability in relation with continuous plant uptake, and the specific role of Si on the plant growth and alleviation of cadmium (Cd) and copper (Cu) toxicity in durum wheat. For this purpose a series of experiments were performed both in soil and hydroponic conditions. Firstly, the significance of acid and alkaline methods was assessed in order to determine the bioavailable Si in soil and the applicability of the Na2CO3 extraction method was determined by repeated croppings of durum wheat on a variety of soils. Secondly, two hydroponic experiments were carried out to study the physiological response of wheat under Cd and Cu stress treated or not with Si. Thirdly, efficiency of different minerals to release bioavailable silica and its effect on reducing Cd and Cu toxicity was assessed. Finally, the effects of amorphous silica (ASi) application were investigated on metal stressed wheat plant grown in uncontaminated and contaminated soils. ASi extracted with Na2CO3 (ASiNa) was well correlated with the Si in plants shoots in our pot experiment with different soils. We showed that ASiNa can also be used for a good proxy of Si bioavailable to plants. Si present as amorphous Si (diatomite) added to the soil is available for plant uptake. However, in soils with large clay content, clay may be a significant source of Si for plants.

Master of Science / Department of Grain Science and Industry / Sajid Alavi / Extrusion processing and frying are the two most commonly used methods to produce savory snacks. These snacks are mostly starch based and also contain high amounts of fat. Snacking percentage has increased drastically over the past few decades causing many health problems like obesity, hypertension and cardiovascular diseases. The overall objective of this study was to develop novel soy based savory snack that are high in protein and has less fat using both extrusion processing and frying. In the first part of this study both defatted soy (25-75%), wheat flour, monoglycerides (0.375 & 0.75%) and sodium bicarbonate (0 and 0.5%) were used to produce dense extrudates, which mimic the shape of lentils using pilot scale twin screw extruder. The extrudates were soaked in water and fried in corn oil to produced savory snacks. Soy influenced the water absorption during soaking and oil uptake during frying. The water uptake and % fat decreased with increase in soy and the amount of water uptake influenced the % fat absorption in the product. No significant differences were observed in overall acceptability and to summarize the increased protein and dense structure of the products challenge the texture of the products. In the second part of this research, dynamics of water and oil uptake were studied to see the role of texture modifiers like soy protein isolate (4, 8, & 12%), calcium bicarbonate (0.2, 0.4 & 0.6%) and pregelatinized wheat starch (4, 8, & 12%) on texture, water and oil uptake. Descriptive sensory analysis was conducted to study the sensory attributes of the products. Water holding capacity is influenced by the level of % starch addition and the degree of starch degradation during processing. Oil uptakes correlates to that of WHC and is also affected by the degree of gelatinization and crust formation. Degree of starch gelatinization, oil uptake and oil and starch matrix interactions had an impact on hardness. Among SPI, CaCO3 and PGWS, PGWS lowered the product hardness followed by SPI and CaCO3. Descriptive sensory results are similar to experimental results with PGWS samples having lower initial or substantial hardness and more oxidized or heated oil aroma and flavor.

Background Established in 1999, the Swedish Maternal Health Care Register (MHCR), collects data on pregnant women and their offspring. Since 2013, the MHCR has been a part of the Swedish Pregnancy Register (SPR). Data are entered manually into the MHCR by midwives in antenatal care (ANC). ANC is primarily organised within public primary health care in Sweden. Midwives are the primary providers of health care during pregnancy, and they are responsible for providing information about prenatal diagnosis to expecting parents. Aims This thesis investigated internal validity of MHCR data, and user’s experiences of the MHCR. Prenatal diagnosis was explored in regard to local guidelines and to background characteristics and pregnancy outcomes. Factors affecting the work situation for midwives in ANC, as well as their experiences on informing expecting parents about prenatal diagnosis were investigated. Methods Study I, II and III were cross-sectional studies. Study I included data from MHCR and medical records on 878 pregnancies during 2011. Study III analysed data from MHCR/SPR, in total 284,789 pregnancies for 2011 to 2013. Study II was a questionnaire study with a quantitative and a qualitative component, including 989 participants. Study IV was a qualitative study applying qualitative content analysis. Fifteen midwives participated in individual, telephone interviews. Main findings Overall, the degree of coverage of variables was high in the MHCR as well as in the medical records. For 17 of the 27 variables, agreement of data in both data sources reached 95% or more. Possible systematic errors were identified for two variables (Paper I). Midwives valued MHCR generally positively, although manual registration of data into the MHCR was perceived burdensome. Foremost midwives engaged in supervision regularly accessed data on pregnant women at their own ANC clinic (Paper II). Offers on prenatal diagnosis varied considerably between the 21 Swedish counties during 2011 to 2013. Maternal age and educational level demonstrated strong associations with uptake of prenatal diagnosis (Paper III). Midwives in ANC reported their work load as manageable. Clinical guidelines, continuing education, and collaboration in the chain of care of pregnant women, were supportive factors for midwives work situation in antenatal care. Administrative work load was perceived as strenuous and informing expecting parents about prenatal diagnosis was challenging (Paper IV). Conclusions Data in the MHCR demonstrated sufficient internal validity. MHCR was an underutilised source in operational planning of ANC. Offers and uptake on prenatal diagnosis was unequally distributed in Sweden. Midwives enjoyed their work in ANC. Administrative work was strenuous and informing expecting parents about prenatal diagnosis was challenging. The register can further develop its report systems to be used in a higher extent in evaluation and planning of Swedish maternal health care services. Expecting couples in Sweden should be offered the same opportunities on prenatal diagnosis. Pedagogical tools may facilitate midwives mission to inform expecting parents with varying pre-understanding about prenatal diagnosis / Bakgrund Det svenska Mödrahälsovårdsregistret är ett nationellt kvalitetsregister som används inom mödrahälsovården för uppföljning av verksamheten, i förbättringsarbete och som underlag för forskning. Mödrahälsovårdsregistret startade 1999 och samlar in data på gravida kvinnor, förlossningar och nyfödda barn. Sedan 2013 är Mödrahälsovårdsregistret en del av Graviditetsregistret, som består av tre delregister; Mödrahälsovårdsregistret, Fosterdiagnostikregistret och det Obstetriska registret. Barnmorskor inom svensk mödrahälsovård registrerar data manuellt vid två tillfällen i registret, dels i anslutning till inskrivningsbesöket, och dels efter avslutad graviditet, senast 16 veckor efter förlossningen. Barnmorskor inom svensk mödrahälsovård har skyldighet att erbjuda blivande föräldrar information om fosterdiagnostik. Däremot utförs de fosterdiagnostiska undersökningarna på särskilda mottagningar, vanligen inom ramen för Sveriges kvinnokliniker. Med tidig fosterdiagnostik avses rutinultraljud i graviditetsvecka 17 till 20, kombinerat ultraljud och biokemiskt test (KUB), samt de invasiva undersökningarna fostervattenprov (AC) och korionvillibiopsi (CVS). Nästan alla gravida kvinnor kontrolleras inom mödrahälsovården. Majoriteten av mödrahälsovårdsmottagningarna bedrivs inom den offentliga primärvården. Barnmorskan arbetar självständigt och är ansvarig för kvinnor med okomplicerade graviditeter. Övriga uppdrag för barnmorskor inom svensk mödrahälsovård är, föräldrastödsverksamhet, rådgivning och förskrivning av preventivmedel, screening för livmoderhalscancer, samt utåtriktat arbete. I barnmorskans arbete ingår därutöver olika patientadministrativa uppgifter. Syfte Det övergripande syftet med avhandlingen var att undersöka det svenska Mödrahälsovårdsregistret ur följande aspekter: intern validitet i registerdata, användarnas erfarenheter, synpunkter och användning av registret samt registerutfall. Ytterligare syften var att undersöka stödjande och belastande faktorer för barnmorskans arbetssituation inom svensk mödrahälsovård och barnmorskors erfarenheter och synpunkter av att informera blivande föräldrar om fosterdiagnostik. vii Metod Studie I, II och III var tvärsnittsstudier. I Studie I jämfördes data i den medicinska journalen med motsvarande uppgifter i Mödrahälsovårdsregistret över 879 gravida kvinnor med ett förlossningsdatum under maj till juni 2011. Studie II var en enkätundersökning som riktade sig till samtliga barnmorskor inom svensk mödrahälsovård (N=989). Undersökningen genomfördes januari till mars 2012. I Studie III analyserades data på totalt 284,789 gravida kvinnor och deras nyfödda barn under perioden 2011 till 2013. Statistiska analyser som användes i Studie I, II och III var Cohen’s Kappa, Pearson’s Chi-två test, sensitivitet och specificitet, samt univariat och multivariat logistisk regressionsanalys. Studie IV var en kvalitativ studie där data insamlades vid individuella telefonintervjuer med totalt 15 barnmorskor verksamma vid olika mödrahälsovårdsmottagningar. Materialet analyserades med kvalitativ innehållsanalys. Resultat Variablerna uppvisade överlag en hög täckningsgrad i både Mödrahälsovårdsregistret och den medicinska journalen. Variabler gällande fosterdiagnostik uppvisade en något lägre täckningsgrad på cirka 90 %. Andelen identiska data i de båda datakällorna varierade från 73,9 % till 99,7 %. För 17 av de 27 undersökta variablerna var överensstämmelsen mellan de båda datakällorna, 95 % eller högre. Variabler relaterade till förlossningen (”enkelbörd/flerbörd”, ”levande fött barn”, och ”barnets kön”) var de variabler som uppvisade högst andel identiska uppgifter i de båda datakällorna. Systematiska fel identifierades för två variabler, ”andra trimester serum screening”, och ”antal barnmorskebesök”. Barnmorskor var överlag positiva till Mödrahälsovårdsregistrets webbapplikation, däremot upplevde en majoritet (70,7 %) av barnmorskorna med enbart patientarbete att den manuella registreringen var en betungande arbetsuppgift. Mödrahälsovårdsregistrets ingående variabler uppfattades som relevanta. I fritext frågorna kommenterades att en del variabler var onödiga, till exempel frågor om fosterdiagnostik medan andra variabler saknades i registret, exempelvis frågor om sjukdomar och medicinska komplikationer under graviditet och förlossning. Barnmorskor med arbetsledande uppgifter rapporterade i jämförelse med de barnmorskor som enbart hade patientarbete att de i högre utsträckning regelbundet extraherade data från registret avseende den egna mottagningen (p&lt;0,001; OR=11,79 CI 95 % 7,43-18,69), och de uppvisade en minskad sannolikhet att ifrågasätta nyttan med registret (p&lt;0,001; OR=0,29 CI 95 % 0,16-0,49). Erbjudande om fosterdiagnostik till blivande föräldrar varierade betydligt mellan de 21 landstingen under åren 2011-2013. Sex landsting erbjöd KUB till alla gravida viii kvinnor, nio landsting erbjöd KUB på indikation och fem landsting erbjöd inte KUB till gravida kvinnor. Ett landsting hade inga skrivna riktlinjer. Under samma tidsperiod var andelen kvinnor som genomgick ultraljud i graviditetsvecka 17-20, 97,6 %, KUB 33,0 %, AC 2,6 % och CVS 1,1 %. Moderns ålder uppvisade störst inverkan på genom-gången fosterdiagnostik. Utbildningsnivå universitet i jämförelse med lägre utbildningsnivå var associerad med en ökad sannolikhet att genomgå KUB (OR 2,30, 95 % CI 2,26-2,35), AC (OR 1,54, 95 % CI 1,46-1,63) och CVS (OR 2,68, 95 % CI 2,44-2,93). Barnmorskor inom svensk mödrahälsovård ansåg att arbetsbelastningen var hanterbar även om den var hög. Kliniska riktlinjer, regelbunden fortbildning, och samarbetet med kollegor och läkare i vårdkedjan för den gravida kvinnan beskrevs som stödjande faktorer i arbete. Den administrativa arbetsbelastningen upplevdes som krävande och att informera blivande föräldrar om fosterdiagnostik som utmanande. Slutsats Data i Mödrahälsovårdsregistret uppvisade god till mycket god täckningsgrad, överensstämmelse och intern validitet för de flesta variablerna i registret. Barnmorskor var överlag positiva till Mödrahälsovårdsregistret, även om arbetsuppgiften att föra in uppgifter manuellt i registret upplevdes som betungande. Erbjudande om fosterdiagnostik varierade avsevärt mellan olika landsting. Moderns ålder och utbildningsnivå var de faktorer som uppvisade störst inverkan på genomgången fosterdiagnostik. Barnmorskor uppskattade sitt arbete inom mödrahälsovården, men det administrativa arbetet upplevdes som krävande. Att informera blivande föräldrar om fosterdiagnostik upplevdes som utmanande. Mödrahälsovårdsregistret har en utvecklingspotential vad gäller dess rapportfunktioner och registerdata skulle i högre grad kunna användas i planering och förbättring av innehållet i svensk mödrahälsovård. Erbjudande om fosterdiagnostik till blivande föräldrar borde vara likvärdiga i samtliga landsting i Sverige. Pedagogiska hjälpmedel skulle kunna underlätta för barnmorskor att informera blivande föräldrar med olika kunskapsnivå vad gäller fosterdiagnostik.