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| 2. |
- Elmberg, Maria, et al.
(författare)
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Increased Mortality Risk in Patients With Phenotypic Hereditary Hemochromatosis But Not in Their First-Degree Relatives
- 2009
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Ingår i: Gastroenterology. - : Elsevier BV. - 0016-5085 .- 1528-0012. ; 137:4, s. 1301-1309
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND & AIMS: Hereditary hemochromatosis (HH) is an autosomal-recessive disorder characterized by iron overload. Relatives of HH patients were screened and those with HH-associated mutations and an increased iron load were identified. However, little is known about their mortality or strategies for their management. We assessed mortality among Swedish patients with HH and their first-degree relatives using health and census registers. METHODS: We performed a matched population-based cohort study of 3832 patients with HH and their 14,496 first-degree relatives using data collected from 1990 through 2007. Mortality data from these groups were compared with that of 38,969 population controls and their 143,349 first-degree relatives using Cox regression analyses. RESULTS: Patients identified on the basis of hospitalization with HH had an increased risk (relative risk [RR]) for death (RR, 2.45; 95% confidence interval [CI], 2.27-2.64; 857 deaths). Patients identified through other means had a mortality risk that was lower than those identified in the hospital but higher than controls (RR, 1.15; 95% CI, 1.00-1.33; 216 deaths). Their first-degree relatives had only a marginally increased mortality risk (RR, 1.05; 95% CI, 1.01-1.10); this RR was similar to that of patients' spouses (RR, 1.09; 95% CI, 0.86-1.38; 82 deaths). Patients with HH who also had a family history of HH did not have an increased mortality risk compared with other groups (RR, 1.05; 95% CI 0.67-1.62; 21 deaths). CONCLUSIONS: Patients with HH have a modestly increased mortality risk compared with controls. The mortality of relatives is increased marginally compared with controls, and is similar among biological and nonbiological relatives.
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| 3. |
- Elmberg, Maria, et al.
(författare)
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Increased Risk of Arthropathies and Joint Replacement Surgery in Patients With Genetic Hemochromatosis: A Study of 3,531 Patients and Their 11,794 First-Degree Relatives
- 2013
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Ingår i: Arthritis Care and Research. - : Wiley. - 2151-4658 .- 2151-464X. ; 65:5, s. 678-685
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Tidskriftsartikel (refereegranskat)abstract
- Objective Genetic hemochromatosis (GH) is an autosomal recessive disease in individuals of Northern and Western European descent. Heterozygosity for the C282Y mutation is common (620%). Arthropathy is one of the few complications of GH suggested not to be associated with iron body stores; synovial iron deposition remains in iron-depleted patients. Previous studies suggest an elevated prevalence of clinical and radiographic signs of arthropathy in patients with GH, and 2 smaller studies suggest a possibly elevated risk of joint replacement surgery, but more mixed results are shown regarding risks with HFE genotype. We therefore assessed the risks of arthropathy and joint replacement surgery in patients with GH and in their first-degree relatives (FDRs). Methods We performed a population-based cohort study of 3,531 patients with GH and of their 11,794 FDRs (assumed to be heterozygous for the C282Y mutation) using nationwide Swedish population-based health and census registers. Hazard ratios (HRs) of arthropathies and joint replacement surgeries among patients and their FDRs (versus the general population) were assessed using Cox regression. Results Between 1997 and 2005, 406 of 3,531 patients were reported/hospitalized with any noninfectious arthropathies, including osteoarthritis, corresponding to an HR of 2.38 (95% confidence interval [95% CI] 2.142.64). Patients were also at increased risk of hip replacement (HR 2.77, 95% CI 2.273.38) and knee replacement (HR 2.14, 95% CI 1.582.88) surgery. Among the 11,794 FDRs (patients excluded), we found no increased risk of any of the joint morbidities. Conclusion Patients with GH, but not their FDRs, are at increased risk of arthropathies, including the need for joint replacement surgery.
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| 4. |
- Elmberg, Maria
(författare)
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Mortality and co-morbidity among patients with hemochromatosis and their first-degree relatives
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Genetic hemochromatosis (GH) is an autosomal recessive disease caused by a C282Y mutation in the HFEgene, and is characterized by excess iron accumulation in multiple organs. Classical manifestations of GH include liver cirrhosis, liver cancer, diabetes mellitus, cardiomyopathy, and arthritis. Heterozygous mutation is common (1/5-1/15), and is associated with increased iron stores. In particular, siblings and twins of GHpatients have higher levels of iron compared to siblings and twins of preclinical GH- patients. Genetic screening of first-degree relatives (FDR) of GH-patients is common practice but little is known about morbidity, premature mortality, or strategies for their management. The aim of this thesis was to investigate the risk of all cause mortality, and morbidity due to cancer, ischemic heart disease (IHD), and joint disease in GH- patients and in their FDR using nationwide, population-based health and census registers. In the study on mortality (study II) a matched population-based cohort study of 3,832 GH-patients and their 14,496 FDRs was performed. 940 patients and 1,978 FDRs died during follow-up. Mortality data was compared with that of population controls and their FDRs. A markedly increased risk for death in patients hospitalized with GH was confirmed, but the risk was only modestly increased in GH-patients identified through other means than hospitalization. Among FDRs, we observed only a marginal increase in risk of death, which did not differ substantially from that of spouses of patients. In the study on risk for cancer (study I) 1,847 GH-patients were identified. During follow-up, 190 cancers were registered. In total, 529 cancers were registered in 5,973 FDRs. Standardized incidence ratio (SIR) was used as our measure of the relative risk (RR). The results for the patients and their FDRs were compared to specific cancer incidence rates from the general population. An elevated risk of primary liver cancer among GH-patients was confirmed. Among the FDRs, only a marginally increased (and historic) occurrence of liver cancer was observed, the histopathologic spectrum of which differed from that of the GH-patients. No support for increased occurrence of other cancers among GH-patients or their FDRs was provided. In the studies on risks for IHD, cardiomyopathy, joint disease, and joint replacement surgery among GHpatients and FDR 3,531; GH-patients and 11,794 FDRs were identified (study III and IV). The results were compared to controls and the FDRs to controls. An increased risk of cardiomyopathy among GH-patients was confirmed. By contrast, we found considerably weaker evidence of any altered risk of IHD among GHpatients and no evidence of any increased risks for cardiomyopathy or IHD among their FDRs. Besides the observation of an increased occurrence of arthropathy among GH-patients, our results indicate that patients were at particularly increased risks for joint replacement surgery. By contrast, there was no consistent pattern of increased or decreased risks of arthropathy, nor of joint replacement surgery, among their FDRs. In conclusion, patients with phenotypic GH are at increased risk for death, and diseases described above. FDRs of patients with GH, however, are neither at increased risk for death nor diseases associated with iron load or the most common diseases in the industrial world, IHD and malignancies. In the absence of other risk factors for liver disease and if their iron load is only moderately elevated this thesis did not find evidence to suggest monitoring these individuals on a regular basis.
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| 5. |
- Eriksson, Louise, 1973-, et al.
(författare)
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Adaptive capacity in the multi-level management system of migratory waterbirds : a case study of participatory goose management in Sweden
- 2024
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Ingår i: Journal of Environmental Planning and Management. - : Routledge. - 0964-0568 .- 1360-0559. ; 67:3, s. 522-541
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Tidskriftsartikel (refereegranskat)abstract
- Adaptive management (AM) is one approach to manage migratory waterbirds, but obstacles to the implementation of AM require adaptive capacities in the management system (rules, institutions, action situations). This study aims to examine the adaptive capacity of participatory goose management in Sweden. Considering the biophysical and institutional context, we analyzed how tangible, individual, and governance assets were associated with technical and social learning. Interviews with informants in the national council for geese, swans, and cranes, and local management groups (LMGs) were conducted, and documentation reviewed. Results revealed evidence of a local preparedness in areas with an LMG. Nevertheless, the study highlighted a need to formalize the evolving system, to consider a more systematic implementation of AM (including regulations allowing for adaptive responses), and to ensure stakeholder acceptance for management tools and visions. The study illustrates the need for a broad set of assets to ensure learning in participatory management.
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| 6. |
- Eriksson, Louise, 1973-, et al.
(författare)
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Are birdwatchers willing to participate in local goose management? : A case study from Sweden
- 2023
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Ingår i: European Journal of Wildlife Research. - : Springer. - 1612-4642 .- 1439-0574. ; 69:2
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Tidskriftsartikel (refereegranskat)abstract
- Stakeholder involvement in wildlife management is important and requires knowledge about factors motivating such participation. With several goose populations increasing in Europe and goose management incorporating multiple objectives, involvement of stakeholder groups with diverse interests is needed. In this study, we examined how evaluations of geese (attitude and acceptance capacity), but also experiences of birdwatching and birdwatcher identity, were associated with willingness to participate in local goose management. A survey among members of Sweden's largest birdwatching organization was conducted (n = 5010). The majority of respondents, 64%, displayed a divided evaluation of geese, most frequently in terms of an overall positive attitude towards geese but a low acceptance for current goose population levels (i.e. acceptance capacity). Birdwatchers' willingness to participate in goose management was generally low. Whereas they were more willing to take part in goose counts (i.e. monitoring) than to participate in local goose management groups, they were least willing to contribute to mitigating crop damage through scaring geese. Results further revealed that birdwatchers with a divided evaluation of geese and an entirely positive evaluation displayed the highest willingness to participate in goose management. However, a stronger distinct birdwatcher identity as a result of more birdwatching experiences was even more strongly associated with higher willingness to take part in goose management. The results highlight a need to intensify efforts to engage stakeholder groups with an interest in conservation issues in the participatory goose management system in Europe.
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| 7. |
- Eriksson, Louise, 1973-, et al.
(författare)
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Individuals and Multilevel Management : A Study of the Perceived Adaptive Capacity of the Goose Management System among Farmers in Sweden
- 2022
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Ingår i: Society and Natural Resources. - : Informa UK Limited. - 0894-1920 .- 1521-0723. ; 35:1, s. 1-19
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Tidskriftsartikel (refereegranskat)abstract
- Agricultural damage by geese is a growing problem in Europe and farmers play a key role in the emerging multilevel adaptive management system. This study explored how characteristics associated with the farmer and the farm, along with experience of damage, cognitive appraisals, emotions, and management beliefs were associated with the perceived adaptive capacity of the goose management system among farmers in the south of Sweden (n = 1,067). Survey results revealed that owning a larger farm, a farm closer to water or formally protected areas, along with cultivating cereal and root crops, were associated with geese evoking stronger negative emotions. Further, more previous experience of damage was related to stronger negative emotions and lower levels of perceived adaptive capacity. However, even more important determinants of perceived adaptive capacity were cognitive appraisals, emotions, and management beliefs. Bridging the ties between individual farmers and the system is important for improved multilevel management.
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| 8. |
- Eriksson, Louise, 1973-, et al.
(författare)
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The importance of structural, situational, and psychological factors for involving hunters in the adaptive flyway management of geese
- 2023
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Ingår i: Scientific Reports. - : Nature Publishing Group. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Adaptive flyway management of superabundant geese is emerging as a strategy to reduce damage to agricultural crops and other ecosystem disservices, while also ensuring sustainable use and conservation objectives. Given the calls for intensified hunting as part of flyway management in Europe, we need to increase the understanding of structural, situational, and psychological factors important for goose hunting among hunters. Our survey data, retrieved in southern Sweden, showed a higher potential to intensify hunting among goose hunters than other hunters. In response to hypothetical policy instruments (including regulations, collaborative, and others), hunters declared a minor increase in their intention to hunt geese, with the greatest expected increase among goose hunters should the hunting season be extended. Situational factors (e.g., access to hunting grounds) were associated with goose hunting (frequency, bag size, and intention to increase hunting). In addition, controlled motivation (derived from external pressures or to avoid guilt) and more importantly autonomous motivation (due to hunting being enjoyable or valuable) were along with goose hunter identity positively associated with goose hunting. Hunters’ involvement in flyway management may be encouraged by using policy instruments to remove situational barriers and facilitate their autonomous motivation.
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| 9. |
- Eriksson, Louise, et al.
(författare)
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The public and geese : a conflict on the rise?
- 2020
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Ingår i: Human Dimensions of Wildlife. - : Routledge. - 1087-1209 .- 1533-158X. ; 25:5, s. 421-437
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Tidskriftsartikel (refereegranskat)abstract
- Wild geese are increasing in agricultural and urban settings across Europe, leading to widespread human – geese interactions. This study examined how the public’s acceptance of geese (attitude and acceptance capacity) varied depending on place dimensions, interactions with geese in different settings (place-based experience), and psychological factors, including wildlife value orientations, beliefs about the ecosystem services and disservices geese provide, and emotions. A survey was conducted in two municipalities with large goose populations in Sweden; Kristianstad and Örebro (n = 898). Results revealed a favorable view of the occurrence of geese, although a substantial share believed the number of geese was too high. Place-based experiences of geese were correlated with acceptance (e.g., more experience on beaches was associated with a negative attitude) and the importance of psychological factors for acceptance was confirmed. The study highlights the need to consider the public’s experiences of geese for sustainable goose management.
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| 10. |
- Everhov, Åsa H., et al.
(författare)
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Changes in inflammatory bowel disease subtype during follow-up and over time in 44,302 patients
- 2019
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Ingår i: Scandinavian Journal of Gastroenterology. - : Taylor & Francis. - 0036-5521 .- 1502-7708. ; 54:1, s. 55-63
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To investigate inflammatory bowel disease (IBD) register-based subtype classifications over a patient's disease course and over time.METHODS: We examined International Classification of Diseases coding in patients with ≥2 IBD diagnostic listings in the National Patient Register 2002-2014 (n = 44,302).RESULTS: 18% of the patients changed diagnosis (17% of adults, 29% of children) during a median follow-up of 3.8 years. Of visits with diagnoses of Crohn's disease (CD) or ulcerative colitis (UC), 97% were followed by the same diagnosis, whereas 67% of visits with diagnosis IBD-unclassified (IBD-U) were followed by another IBD-U diagnosis. Patients with any diagnostic change changed mostly once (47%) or twice (31%), 39% from UC to CD, 33% from CD to UC and 30% to or from IBD-U. Using a classification algorithm based on the first two diagnoses ('incident classification'), suited for prospective cohort studies, the proportion adult patients with CD, UC, and IBD-U 2002-2014 were 29%, 62%, and 10% (43%, 45%, and 12% in children). A classification model incorporating additional information from surgeries and giving weight to the last 5 years of visits ('prevalent classification'), suited for description of a study population at end of follow-up, classified 31% of adult cases as CD, 58% as UC and 11% as IBD-U (44%, 38%, and 18% in children).CONCLUSIONS: IBD subtype changed in 18% during follow-up. The proportion with CD increased and UC decreased from definition at start to end of follow-up. IBD-U was more common in children.
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