| 31. |
- Araghi, Marzieh, et al.
(författare)
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Smokeless tobacco (snus) use and colorectal cancer incidence and survival : Results from nine pooled cohorts
- 2017
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Ingår i: Scandinavian Journal of Public Health. - : SAGE Publications. - 1403-4948 .- 1651-1905. ; 45:8, s. 741-748
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: Although smoking is considered to be an established risk factor for colorectal cancer, the current evidence on the association between smokeless tobacco and colorectal cancer is scant and inconclusive. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess this association.METHODS: A total of 417,872 male participants from nine cohort studies across Sweden were followed up for incidence of colorectal cancer and death. Outcomes were ascertained through linkage to health registers. We used shared frailty models with random effects at the study level to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).RESULTS: During 7,135,504 person-years of observation, 4170 men developed colorectal cancer. There was no clear association between snus use and colorectal cancer overall. Exclusive current snus users, however, had an increased risk of rectal cancer (HR 1.40: 95% CI 1.09, 1.79). There were no statistically significant associations between snus use and either all-cause or colorectal cancer-specific mortality after colorectal cancer diagnosis.CONCLUSIONS: Our findings, from a large sample, do not support any strong relationships between snus use and colorectal cancer risk and survival among men. However, the observed increased risk of rectal cancer is noteworthy, and in merit of further attention.
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| 32. |
- Araghi, Marzieh, et al.
(författare)
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Use of moist oral snuff (snus) and pancreatic cancer : Pooled analysis of nine prospective observational studies
- 2017
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Ingår i: International Journal of Cancer. - : Wiley. - 0020-7136 .- 1097-0215. ; 141:4, s. 687-693
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Tidskriftsartikel (refereegranskat)abstract
- While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. We used pooled individual data from the Swedish Collaboration on Health Effects of Snus Use to assess the association between Swedish snus use and the risk of pancreatic cancer. A total of 424,152 male participants from nine cohort studies were followed up for risk of pancreatic cancer through linkage to health registers. We used shared frailty models with random effects at the study level, to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) adjusted for confounding factors. During 9,276,054 person-years of observation, 1,447 men developed pancreatic cancer. Compared to never-snus use, current snus use was not associated with risk of pancreatic cancer (HR 0.96, 95% CI 0.83-1.11) after adjustment for smoking. Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer. What's new? While smoking is a well-established risk factor for pancreatic cancer, the effect of smokeless tobacco is less well understood. Smokeless tobacco like snus yields lower exposure to tobacco carcinogens compared with smoking, because it does not undergo combustion, but delivers an equivalent dose of nicotine. Using pooled individual data from the Swedish Collaboration on Health Effects of Snus Use, here the authors show that Swedish snus use does not appear to be implicated in the development of pancreatic cancer in men. Tobacco smoke constituents other than nicotine or its metabolites may account for the relationship between smoking and pancreatic cancer.
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| 33. |
- Axelsson, Inge, 1947-, et al.
(författare)
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Satsa på cochrane i sverige
- 2018
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 115:39
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 34. |
- Axling, Ulrika, et al.
(författare)
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Green tea powder and Lactobacillus plantarum affect gut microbiota, lipid metabolism and inflammation in high-fat fed C57BL/6J mice
- 2012
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Ingår i: Nutrition & Metabolism. - : Springer Science and Business Media LLC. - 1743-7075. ; 9:105
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Tidskriftsartikel (refereegranskat)abstract
- Background: Type 2 diabetes is associated with obesity, ectopic lipid accumulation and low-grade inflammation. A dysfunctional gut microbiota has been suggested to participate in the pathogenesis of the disease. Green tea is rich in polyphenols and has previously been shown to exert beneficial metabolic effects. Lactobacillus plantarum has the ability to metabolize phenolic acids. The health promoting effect of whole green tea powder as a prebiotic compound has not been thoroughly investigated previously. Methods: C57BL/6J mice were fed a high-fat diet with or without a supplement of 4% green tea powder (GT), and offered drinking water supplemented with Lactobacillus plantarum DSM 15313 (Lp) or the combination of both (Lp + GT) for 22 weeks. Parameters related to obesity, glucose tolerance, lipid metabolism, hepatic steatosis and inflammation were examined. Small intestinal tissue and caecal content were collected for bacterial analysis. Results: Mice in the Lp + GT group had significantly more Lactobacillus and higher diversity of bacteria in the intestine compared to both mice in the control and the GT group. Green tea strongly reduced the body fat content and hepatic triacylglycerol and cholesterol accumulation. The reduction was negatively correlated to the amount of Akkermansia and/or the total amount of bacteria in the small intestine. Markers of inflammation were reduced in the Lp + GT group compared to control. PLS analysis of correlations between the microbiota and the metabolic variables of the individual mice showed that relatively few components of the microbiota had high impact on the correlation model. Conclusions: Green tea powder in combination with a single strain of Lactobacillus plantarum was able to promote growth of Lactobacillus in the intestine and to attenuate high fat diet-induced inflammation. In addition, a component of the microbiota, Akkermansia, correlated negatively with several metabolic parameters known to be risk factors for the development of type 2 diabetes.
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| 35. |
- Barber, R. M., et al.
(författare)
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Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : A novel analysis from the global burden of disease study 2015
- 2017
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Ingår i: The Lancet. - : Lancet Publishing Group. - 0140-6736 .- 1474-547X. ; 390:10091, s. 231-266
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Tidskriftsartikel (refereegranskat)abstract
- Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright © The Author(s). Published by Elsevier Ltd.
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| 36. |
- Baylis, Rebecca, et al.
(författare)
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Women's experiences of internet-delivered Cognitive Behaviour Therapy (iCBT) for Fear of Birth
- 2020
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Ingår i: Women and Birth. - : ELSEVIER. - 1871-5192 .- 1878-1799. ; 33:3, s. E227-E233
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Tidskriftsartikel (refereegranskat)abstract
- Background: Fear of Birth is common in pregnant women and associated with negative physical and mental health. There is a clear comorbidity with anxiety and depression. Internet-delivered Cognitive Behaviour Therapy has been suggested as a treatment option for Fear of Birth and a randomized controlled trial comparing internet-delivered Cognitive Behaviour Therapy with midwifery led counselling as standard care has been conducted.Objective: The aim of this study was to describe women's experiences of guided internet-delivered Cognitive Behaviour Therapy for Fear of Birth and to describe the content of their fear.Methods: The present study is a qualitative, follow-up interview study following the randomized controlled trial, the U-CARE Pregnancy Trial. In total 19 women allocated to internet-delivered Cognitive Behaviour Therapy for Fear of Birth were interviewed by telephone. A semi-structured interview guide was used and the transcripts were analyzed with thematic analysis.Results: The women's descriptions of Fear of Birth differed, however their fear was most often associated with fear of losing control, fear for the baby's life or health or own life threatening events. The experiences of internet-delivered Cognitive Behaviour Therapy for Fear of Birth varied, some women were positive to its flexibility although most women preferred a face-to face meeting. The treatment did not pin-point their fears, it was challenging to maintain motivation and to work with the treatment in solitude.Conclusions: Women's descriptions of Fear of Birth varied. Most women undergoing internet-delivered Cognitive Behaviour Therapy would have preferred a face-to-face meeting which they imagined would have soothed their fear. Internet-delivered Cognitive Behaviour Therapy for Fear of Birth may be an alternative for some women.
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| 37. |
- Becker, Per
(författare)
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Dependence, trust, and influence of external actors on municipal urban flood risk mitigation : The case of Lomma Municipality, Sweden
- 2018
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Ingår i: International Journal of Disaster Risk Reduction. - : Elsevier BV. - 2212-4209. ; 31, s. 1004-1012
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Tidskriftsartikel (refereegranskat)abstract
- Floods constitute a major problem that cross geopolitical, administrative, and sectoral boundaries, and must as such be jointly governed by a web of actors. The patterns of social relations among these actors are fundamental for society's capacity to mitigate flood risk. The purpose of this study is to contribute to our understanding of flood risk governance by investigating the social organization of formal actors that contribute to mitigating urban flood risk in Swedish municipalities. It applies Social Network Analysis to examine what patterns of dependence, trust, and influence of external actors emerge in the accounts of politicians and civil servants in Lomma Municipality, Sweden. The results indicate interesting patterns in type of input, as well as the role of personal relationships and different forms of authority for trust and influence. There is also a horizontal decoupling between municipalities along the river, as well as a vertical decoupling between the municipal and the national level, where withdrawing national authorities leave a void increasingly filled by private companies. These patterns of social relationships between municipal and external actors contributing to mitigate urban flood risk are important for understanding flood risk governance in society.
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| 38. |
- Becker, Per
(författare)
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Fragmentation, commodification and responsibilisation in the governing of flood risk mitigation in Sweden
- 2021
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Ingår i: Environment and Planning C. - : SAGE Publications. - 2399-6544 .- 2399-6552. ; 9:2, s. 393-413
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Tidskriftsartikel (refereegranskat)abstract
- The purpose of this paper is to increase our understanding of the governing of flood risk mitigation in advanced liberal society, through an in-depth Swedish case study. By combining social network analysis and genealogy, this paper investigates who is involved, how they organise, their modes of thinking, how they mitigate flood risk, as well as how such regime of practises have come into being. The findings suggest dominant rationalities that reduce the actual complexity of flood risk in spatial and temporal terms to fit the legal and institutional environment. The resulting fragmentation is associated with a commodification of flood risk mitigation, in which actors expect to be able to procure modules of safety and sustainability on the market. This commodification materialises in a vacuum of responsibilisation, when obligations are imposed without commensurate guidelines. These processes of fragmentation, commodification, and responsibilisation are core constituents of neoliberalisation, which is clearly shaping the governing of flood risk mitigation even in Sweden; a bastion of the strong welfare state. Regardless of the notable individual capacities of the involved actors, systemic constraints in the governmentality have generated these detrimental processes in the face of overwhelming complexity. These systemic constraints must be removed or overcome for the governing of flood risk mitigation to match the complexity of flood risk in the catchment area. This paper thus provides input that can inform policy changes for a more sustainable future in the face of unprecedented change.
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| 39. |
- Becker, Per
(författare)
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The Problem of Fit in Flood Risk Governance : Regulative, Normative, and Cultural-Cognitive Deliberations
- 2020
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Ingår i: Politics and Governance. - Lissabon : Cogitatio. - 2183-2463. ; 8:4, s. 281-293
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Tidskriftsartikel (refereegranskat)abstract
- Flood risk is a growing global concern that is not only affecting developing countries, but also the sustainable development of the most affluent liberal democracies. This has attracted attention to the systems governing flood risk across administrative levels, which vary between countries, but are relatively similar in the Nordic region, with both responsibilities and resources largely decentralized to the municipal level. However, floods tend not to be bounded by conventional borders but demand attention to the catchment area as a whole. Influential voices have long argued the importance of fit between the biophysical basis of an issue and the institutional arrangements of actors engaging in its governance. The article investigates such institutional fit in flood risk governance, based on a case study of flood risk mitigation in the Höje Å catchment area in Southern Sweden. Analyzing a unique dataset comprising 217 interviews with all individual formal actors actively engaged in flood risk mitigation in the catchment area illuminates a ’problem of fit’ between the hydrological system behind flood risk and the institutional arrangements of its governance. This ’problem of fit’ is not only visible along the borders of the municipalities composing the catchment area, but also of the spatial planning areas within them. The article deliberates on regulative, normative, and cultural-cognitive elements that align to lock flood risk governance into a regime of practices that, if not addressed, continues to undermine society’s ability to anticipate and adapt to the expected escalation of flood risk in a changing climate.
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| 40. |
- Becker, Per
(författare)
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Tightly coupled policies and loosely coupled networks in the governing of flood risk mitigation in municipal administrations
- 2021
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Ingår i: Ecology and Society. - : Resilience Alliance. - 1708-3087. ; 26:2
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Tidskriftsartikel (refereegranskat)abstract
- Flood risk is a complex and transboundary issue that is expected to escalate with climate change and requires to be governed by collaborative networks of actors. Municipal administrations have been suggested to have a particularly important and challenging role in such governance. Although collaborative governance has attracted intense scientific attention, empirical studies generally focus either on the macro-level institutions per se, or on the meso-level interaction between organizations, without corresponding attention to the micro-level interactions between the individual actors constituting the organizations and reproducing the institutions. The purpose of this paper is to contribute to the understanding of how flood risk is governed within municipal administrations, by studying how actors interact within them when implementing tightly coupled policies. The paper draws on comparative case study research of three Swedish municipal administrations (Lomma, Lund, and Staffanstorp). Data were collected through interviews with all 143 actors actively contributing to mitigating flood risk within the municipal administrations, and analyzed structurally and interpretatively using social network analysis and qualitative analysis. Although the Swedish legal framework consists of tightly coupled policies demanding coordination between the actors implementing them, there is a recurrent pattern of relative integration between actors implementing policies for planning and water and sewage, and substantial separation between them and actors implementing policy for risk and vulnerability. This cinderellic fragmentation generates a “problem of fit” between the legal framework and the collaborative networks implementing it, which undermines the effectiveness of flood risk mitigation in municipal administrations. It is not accidental but a consequence of a directional separation of institutionalization, where the more bottom-up and problem-oriented institutionalization of practices in planning and water and sewage, and the more top-down and compliance- oriented institutionalization of practices in risk and vulnerability pull the network of actors apart. I demonstrate how the mechanisms of increasing returns, commitments, and objectification may all operate simultaneously but to various degrees in different practices across any collaborative governance network. Hence, potentially undermining policy coherence, policy integration, and collaborative governance.
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