| 1. |
- Engström, Gunnar, et al.
(author)
-
The Swedish CArdioPulmonary BioImage Study : objectives and design
- 2015
-
In: Journal of Internal Medicine. - : Wiley. - 0954-6820 .- 1365-2796. ; 278:6, s. 645-659
-
Journal article (peer-reviewed)abstract
- Cardiopulmonary diseases are major causes of death worldwide, but currently recommended strategies for diagnosis and prevention may be outdated because of recent changes in risk factor patterns. The Swedish CArdioPulmonarybioImage Study (SCAPIS) combines the use of new imaging technologies, advances in large-scale 'omics' and epidemiological analyses to extensively characterize a Swedish cohort of 30 000 men and women aged between 50 and 64 years. The information obtained will be used to improve risk prediction of cardiopulmonary diseases and optimize the ability to study disease mechanisms. A comprehensive pilot study in 1111 individuals, which was completed in 2012, demonstrated the feasibility and financial and ethical consequences of SCAPIS. Recruitment to the national, multicentre study has recently started.
|
|
| 2. |
- Bergström, Göran, 1964, et al.
(author)
-
Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
-
In: Circulation. - Philadelphia : American Heart Association. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
-
Journal article (peer-reviewed)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
|
|
| 3. |
- Bergström, Göran, et al.
(author)
-
Prevalence of Subclinical Coronary Artery Atherosclerosis in the General Population
- 2021
-
In: Circulation. - : Wolters Kluwer. - 0009-7322 .- 1524-4539. ; 144:12, s. 916-929
-
Journal article (peer-reviewed)abstract
- Background: Early detection of coronary atherosclerosis using coronary computed tomography angiography (CCTA), in addition to coronary artery calcification (CAC) scoring, may help inform prevention strategies. We used CCTA to determine the prevalence, severity, and characteristics of coronary atherosclerosis and its association with CAC scores in a general population.Methods: We recruited 30 154 randomly invited individuals age 50 to 64 years to SCAPIS (the Swedish Cardiopulmonary Bioimage Study). The study includes individuals without known coronary heart disease (ie, no previous myocardial infarctions or cardiac procedures) and with high-quality results from CCTA and CAC imaging performed using dedicated dual-source CT scanners. Noncontrast images were scored for CAC. CCTA images were visually read and scored for coronary atherosclerosis per segment (defined as no atherosclerosis, 1% to 49% stenosis, or ≥50% stenosis). External validity of prevalence estimates was evaluated using inverse probability for participation weighting and Swedish register data.Results: In total, 25 182 individuals without known coronary heart disease were included (50.6% women). Any CCTA-detected atherosclerosis was found in 42.1%; any significant stenosis (≥50%) in 5.2%; left main, proximal left anterior descending artery, or 3-vessel disease in 1.9%; and any noncalcified plaques in 8.3% of this population. Onset of atherosclerosis was delayed on average by 10 years in women. Atherosclerosis was more prevalent in older individuals and predominantly found in the proximal left anterior descending artery. Prevalence of CCTA-detected atherosclerosis increased with increasing CAC scores. Among those with a CAC score >400, all had atherosclerosis and 45.7% had significant stenosis. In those with 0 CAC, 5.5% had atherosclerosis and 0.4% had significant stenosis. In participants with 0 CAC and intermediate 10-year risk of atherosclerotic cardiovascular disease according to the pooled cohort equation, 9.2% had CCTA-verified atherosclerosis. Prevalence estimates had excellent external validity and changed marginally when adjusted to the age-matched Swedish background population.Conclusions: Using CCTA in a large, random sample of the general population without established disease, we showed that silent coronary atherosclerosis is common in this population. High CAC scores convey a significant probability of substantial stenosis, and 0 CAC does not exclude atherosclerosis, particularly in those at higher baseline risk.
|
|
| 4. |
- Cole, Scott, et al.
(author)
-
Environmental compensation for biodiversity and ecosystem services : A flexible framework that addresses human wellbeing
- 2021
-
In: Ecosystem Services. - : Elsevier BV. - 2212-0416 .- 2212-0416. ; 50
-
Journal article (peer-reviewed)abstract
- Environmental compensation should address negative impacts from human activities on nature, including loss of biodiversity and ecosystem services. However, successful compensation, achieving no net loss, requires broad quantitative information on different types of losses and gains. We find that the scope of compensatory schemes varies in what is considered compensable, which makes it challenging to apply a conceptual approach consistently across schemes with different needs. We propose a flexible yet structured framework for determining which values should be compensated and how. Our framework focuses specifically on habitat deterioration and is illustrated with a case study involving loss of eelgrass habitat. The framework helps identify compensation needs and selects among suitable compensation options, merging science-based information with normative issues and local concerns. By integrating the ecosystem services cascade model, it encompasses aspects from biodiversity structure to human wellbeing. The framework prefers in-kind compensation because this targets the structure level and thus meets compensation needs in all subsequent levels of the cascade model; further, it is more likely to capture non-instrumental values (i.e. in nature) and reduce exposure to uncertainty. We highlight the importance of spatial aspects of ecosystem functions, services and their subsequent impacts on wellbeing. Although our selection hierarchy assumes a similar and nearby principle for habitat restoration (preference for in-kind/on-site), this criterion is not universal. We underscore the hierarchy's implicit normative assumptions and suggest that apparent disagreement about who should benefit may be traced to an unresolved conflict between egalitarianism and utilitarianism.
|
|
| 5. |
- Edenius, Lars, et al.
(author)
-
The effects of changing land use and browsing on aspen abundance and regeneration: a 50-year perspective from Sweden
- 2011
-
In: Journal of Applied Ecology. - : Wiley. - 0021-8901 .- 1365-2664. ; 48, s. 301-309
-
Journal article (peer-reviewed)abstract
- 5. Synthesis and applications. Our results suggest that changes in land use practices are the main cause of changes in aspen abundance at regional and national scales in Sweden during the last 50 years. Restoring regeneration niches, most importantly emulating natural disturbance processes, viz. fire at various spatial scales, and retaining aspen in cleaning and pre-commercial thinnings are the most important management recommendations to secure regeneration of aspen. Protecting established aspen ramets at designated sites from browsing either by fencing or reducing ungulate numbers could be used as complementary management tools.
|
|
| 6. |
|
|
| 7. |
- Madestam, Jenny, et al.
(author)
-
Public or Private – Does It Matter? How School Leaders in Public and Private Schools Perceive Their Roles
- 2018
-
In: Scandinavian Journal of Public Administration. - : University of Gothenburg. - 2001-7405 .- 2001-7413. ; 22:3, s. 129-152
-
Journal article (peer-reviewed)abstract
- This article takes its stand in an international discussion about how NPM reforms affect public servants’ notions about core public values. More specifically, it analyses how school leaders relate to the values of political control, rule of law, economic efficiency, professionalism and users’ influence. It raises the question whether it matters, in terms of how they embrace these values, their organisation beeing public or private. 975 school leaders (481 working for public schools and 472 for private schools) have completed a written questionnaire containing 15 postulations linked to the five core values. The study’s main finding is that the differences between the two categories of school leaders are quite small although differences exist. The similarities could reflect a development in recent decades where private schools have undergone politicisation and public schools companyisation. The study indicates that school leaders on both sides try to defend all values simultaneously, in some way. Furthermore, when trying to handle value conflicts they seem to avail themselves of other strategies than those connected to dominating models of rationality, which often conceptualise public actors’ response to value conflicts as a matterof balancing or striking trade-offs.
|
|
| 8. |
- Mohammad, Moman A., et al.
(author)
-
On the Natural History of Coronary Artery Disease : A Longitudinal Nationwide Serial Angiography Study
- 2022
-
In: Journal of the American Heart Association. - : John Wiley & Sons. - 2047-9980 .- 2047-9980. ; 11:21
-
Journal article (peer-reviewed)abstract
- Background: The long-term course of coronary atherosclerosis has not been studied in large nationwide cohorts. Understanding the natural history of coronary atherosclerosis could help identify patients at risk for future coronary events.Methods and Results: All coronary artery segments with <50% luminal stenosis in patients with a first-time coronary angiogram between 1989 and 2017 were identified (n=2 661 245 coronary artery segments in 248 736 patients) and followed until a clinically indicated angiography within 15 years was performed or until death or end of follow-up (April 2018) using SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The stenosis progression and incidence rates were 2.6% and 1.45 (95% CI, 1.43-1.46) per 1000 segment-years, respectively. The greatest progression rate occurred in the proximal and middle segments of the left anterior descending artery. Male sex and diabetes were associated with a 2-fold increase in risk, and nearly 70% of new stenoses occurred in patients with baseline single-vessel disease (hazard ratio, 3.86 [95% CI, 3.69-4.04]). Coronary artery segments in patients with no baseline risk factors had a progression rate of 0.6% and incidence rate of 0.36 (95% CI, 0.34-0.39), increasing to 8.1% and 4.01 (95% CI, 3.89-4.14) per 1000 segment-years, respectively, in patients with ≥4 risk factors. The prognostic impact of risk factors on stenosis progression was greatest in younger patients and women.Conclusions: Coronary atherosclerosis progressed slowly but more frequently in the left coronary artery in men and in the presence of traditional risk factors. Coronary artery segments in patients without risk factors had little or no risk of stenosis progression, and the relative impact of risk factors appears to be of greater importance in younger patients and women. These findings help in the understanding the long-term course of coronary atherosclerosis.
|
|
| 9. |
- Sundblad, Göran, et al.
(author)
-
Predicting the effects of eutrophication mitigation on predatory fish biomass and the value of recreational fisheries
- 2020
-
In: AMBIO: A Journal of the Human Environment. - : Springer Science and Business Media LLC. - 0044-7447 .- 1654-7209. ; 49, s. 1090-1099
-
Journal article (peer-reviewed)abstract
- Improving water clarity is a core objective for eutrophication management in the Baltic Sea, but may influence fisheries via effects on fish habitat suitability. We apply an ensemble of species distribution models coupled with habitat productivity functions and willingness-to-pay estimates to assess these effects for two coastal predatory fish species, European perch (Perca fluviatilis) and pikeperch (Sander lucioperca). The models predicted a 37% increase in perch and 59% decrease in pikeperch biomass if reaching the reference level for water clarity in the Baltic Sea Action Plan. Reaching the target level was predicted to increase perch biomass by 13%. However, the associated economic gain for the recreational fisheries sector was countervailed by an 18% pikeperch reduction. Still, a net benefit was predicted since there are six times more fishing days for perch than pikeperch. We exemplify how ecological modelling can be combined with economic analyses to map and evaluate management alternatives.
|
|
| 10. |
- Wang, Gang, et al.
(author)
-
Assessment of chronic bronchitis and risk factors in young adults : results from BAMSE
- 2020
-
In: European Respiratory Journal. - Stockholm : Karolinska Institutet, Dept of Clinical Science and Education, Södersjukhuset. - 0903-1936 .- 1399-3003.
-
Journal article (peer-reviewed)abstract
- BACKGROUND: Chronic bronchitis is associated with substantial morbidity among elderly adults, but little is known about its prevalence and risk factors in young adults. Our aim was to assess the prevalence and early life risk factors for chronic bronchitis in young adults. METHODS: Questionnaire data and clinical measures from the 24-year follow-up of the Swedish BAMSE cohort were used. We assessed chronic bronchitis (CB) as the combination of cough and mucus production in the morning during winter. Environmental and clinical data from birth and onwards were used for analyses of risk factors. RESULTS: At the 24-year follow-up, 75% (n=3064) participants completed the questionnaire and 2030 performed spirometry. The overall prevalence of CB was 5.5% (n=158) with similar estimates in males and females. Forty-nine percent of CB cases experienced more than 3 self-reported respiratory infections in the last year compared to 18% in non-CB subjects (p<0.001), and 37% of cases were current smokers (versus 19%). Statistically significant lower post-FEV(1)/FVC were observed in CB compared to non-CB subjects (mean z-score -0.06 versus 0.13, p=0.027). Daily smoking (adjusted Odds Ratio, aOR=3.85, p<0.001), air pollution exposure (black carbon during ages 1-4 years old, aOR=1.71 per 1 μg·m(3) increase, p=0.009) and exclusive breast-feeding during four months or more (aOR=0.66, p=0.044) were associated with CB. CONCLUSION: Chronic bronchitis in young adults is associated with recurrent respiratory infections. Besides smoking, our results support role of early life exposures, such as air pollution and exclusive breast-feeding, for respiratory health later in life.
|
|
