| 1. |
- Eriksson Hägg, Hanna, et al.
(författare)
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Future nutrient load scenarios for the Baltic Sea due to climate and lifestyle changes
- 2014
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Ingår i: Ambio. - : Springer Science and Business Media LLC. - 0044-7447 .- 1654-7209. ; 43:3, s. 337--351
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Tidskriftsartikel (refereegranskat)abstract
- Dynamic model simulations of the future climate and projections of future lifestyles within the Baltic Sea Drainage Basin (BSDB) were considered in this study to estimate potential trends in future nutrient loads to the Baltic Sea. Total nitrogen and total phosphorus loads were estimated using a simple proxy based only on human population (to account for nutrient sources) and stream discharges (to account for nutrient transport). This population-discharge proxy provided a good estimate for nutrient loads across the seven sub-basins of the BSDB considered. All climate scenarios considered here produced increased nutrient loads to the Baltic Sea over the next 100 years. There was variation between the climate scenarios such that sub-basin and regional differences were seen in future nutrient runoff depending on the climate model and scenario considered. Regardless, the results of this study indicate that changes in lifestyle brought about through shifts in consumption and population potentially overshadow the climate effects on future nutrient runoff for the entire BSDB. Regionally, however, lifestyle changes appear relatively more important in the southern regions of the BSDB while climatic changes appear more important in the northern regions with regards to future increases in nutrient loads. From a whole-ecosystem management perspective of the BSDB, this implies that implementation of improved and targeted management practices can still bring about improved conditions in the Baltic Sea in the face of a warmer and wetter future climate
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| 2. |
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| 3. |
- Eriksson Hägg, Hanna, 1975-
(författare)
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Nitrogen land-sea fluxes in the Baltic Sea catchment : Empirical relationships and budgets
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In this thesis empirical relationships and modeling tools are used to describe the relationship between human activities and meso- and large scale riverine N fluxes from land to sea. On a large scale Paper I showed that by only having knowledge about human population size and runoff one can estimate the riverine export of DIN (r2= 0.76). In Paper II we included two other important anthropogenic N inputs, i.e. atmospheric deposition and primary emission (PE) from animals. In most of the catchments the PE from animals were larger than the PE from humans. Hence, development of livestock is important and increased animal protein consumption by humans might increase the riverine N export. Scenario analysis (Paper II) show that climate change is expected to both decrease and increase the riverine N export depending on which part of the catchment is modeled. In the southern and eastern parts of the Baltic Sea catchment there is large potential for N reductions from point sources (Papers III & V). The diffuse sources are more difficult to decrease and a reduction of mineral fertilizer does not always lead to reduced N loadings because the agricultural systems can buffer even a slight surplus (Paper III). There is inertia in the catchments which can be seen in for example in the northern part of the catchment. Here atmospheric N deposition is almost as high as in the southern part but the nitrogen flux from these rivers is not elevated. These northern river catchments have N exports of the same magnitude as the natural background (Paper IV), indicating that the atmospheric N deposition is retained in the system and probably taken up by N limited boreal forests. However, important reductions can be achieved in the agricultural sector by detailed management of the planted land and animal manure. The highest sensitivity is in catchments with high animal density and high specific discharge, primarily draining to Kattegat and Danish Straits (Paper II & IV).
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| 4. |
- Eriksson Hägg, Hanna, 1975-, et al.
(författare)
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Riverine nitrogen export in Swedish catchments dominated by atmospheric inputs
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- The net anthropogenic nitrogen input (NANI) approach addressing N loading from agricultural sources and the atmosphere were applied to 36 major Swedish catchments. We tested three alternatives of the empirical relationship between NANI and riverine N export using different ways of estimating atmospheric N deposition as the major N input (31-94 %) in these catchments. The relationship between riverine N export and NANI was strongest for the NANI calculation using NOy (r2 linear =0.704, r2 exponential =0.723) compared to NOy + net NHx (r2 linear =0.623, r2 exponential =0.670) and total NOy + NHx deposition (r2 linear =0.615, r2 exponential =0.658). The y-intercept (NANI= 0) of the linear and exponential regression models were between 40-160 kg N km-2 year-1 indicating a natural background flux from the catchment without anthropogenic inputs of some 100 kg N km-2 year-1. This agrees with similar results from North American boreal catchments. The slope of the three linear regressions varies from 0.24 (NOy + Net NHx) to 0.25 (NOy and NOy+ NHx), suggesting that in average 25% of the human inputs of nitrogen are exported by the rivers to the Baltic Sea. Agricultural catchments, in the middle and southern Sweden, have increased their riverine N export up to an order of magnitude compared to the inferred natural background flux as an effect of anthropogenic loading. Although, the relatively unperturbed northernmost catchments receive significant N loads from atmospheric deposition these catchments do not show any significant elevated riverine N export. The fact that nitrogen export in Swedish catchments appears to be higher in proportion to NANI at higher loads suggests that N retention could be saturating as loading rates increase. Such nonlinear or threshold responses have significant implications for nutrient management.
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| 5. |
- Eriksson Hägg, Hanna, et al.
(författare)
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Riverine nitrogen export in Swedish catchments dominated by atmospheric inputs
- 2012
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Ingår i: Biogeochemistry. - : Springer Science and Business Media LLC. - 0168-2563 .- 1573-515X. ; 111:1-3, s. 203-217
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Tidskriftsartikel (refereegranskat)abstract
- We present the first estimates of net anthropogenic nitrogen input (NANI) in European boreal catchments. In Swedish catchments, nitrogen (N) deposition is a major N input (31-94%). Hence, we used two different N deposition inputs to calculate NANI for 36 major Swedish catchments. The relationship between riverine N export and NANI was strongest when using only oxidized deposition (NOy) as atmospheric input (r(2) = 0.70) rather than total deposition (i.e., both oxidized and reduced nitrogen, NOy + NHx deposition, r(2) = 0.62). The y-intercept (NANI = 0) for the NANI calculated with NOy is significantly different from zero (p = 0.0042*) and indicates a background flux from the catchment of some 100 kg N km(-2) year(-1) in addition to anthropogenic inputs. This agrees with similar results from North American boreal catchments. The slope of the linear regressions was 0.25 for both N deposition inputs (NOy and NOy + NHx), suggesting that on average, 25% of the anthropogenic N inputs is exported by rivers to the Baltic Sea. Agricultural catchments in central and southern Sweden have increased their riverine N export up to tenfold compared to the inferred background flux. Although the relatively unperturbed northernmost catchments receive significant N loads from atmospheric deposition, these catchments do not show significantly elevated riverine N export. The fact that nitrogen export in Swedish catchments appears to be higher in proportion to NANI at higher loads suggests that N retention may be saturating as loading rates increase. In northern and western Sweden the export of nitrogen is largely controlled by the hydraulic load, i.e., the riverine discharge normalized by water surface area, which has units of distance time(-1). Besides hydraulic load the percent total forest cover also affects the nitrogen export primarily in the northern and western catchments.
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| 6. |
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| 7. |
- Eriksson Hägg, Hanna, et al.
(författare)
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Scenario Analysis on Protein Consumption and Climate Change Effects on Riverine N Export to the Baltic Sea
- 2010
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Ingår i: Environmental Science and Technology. - : American Chemical Society (ACS). - 0013-936X .- 1520-5851. ; 44:7, s. 2379-2385
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Tidskriftsartikel (refereegranskat)abstract
- This paper evaluates possible future nitrogen loadings from 105 catchments surrounding the Baltic Sea. Multiple regressions are used to model total nitrogen (TN) flux as a function of specific runoff (0), atmospheric nitrogen deposition, and primary emissions (PE) from humans and livestock. On average cattle contributed with 63%, humans with 20%, and pigs with 17% of the total nitrogen PE to land. Compared to the reference period (1992-1996) we then evaluated two types of scenarios for year 2070. i) An increased protein consumption scenario that led to 16% to 39% increased mean TN flux (kg per km(-2)). ii) Four climate scenarios addressing effects of changes in river discharge. These scenarios showed increased mean TN flux from the northern catchments draining into the Gulf of Bothnia (34%) and the Gulfs of Finland and Riga (14%), while the mean TN flux decreased (-27%) for catchments draining to the Baltic Proper. However, the net effect of the scenarios showed a possible increase in TN flux ranging from 3-72%. Overall an increased demand for animal protein will be instrumental for the Baltic Sea ecosystem and may be a major holdback to fulfill the environmental goals of the Baltic Sea Action Plan.
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| 8. |
- Gyllensten, Hanna, 1979, et al.
(författare)
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Comparing Methods for Estimating Direct Costs of Adverse Drug Events
- 2017
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Ingår i: Value in Health. - : Elsevier BV. - 1098-3015 .- 1524-4733. ; 20:10, s. 1299-1310
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To estimate how direct health care costs resulting from adverse drug events (ADEs) and cost distribution are affected by methodological decisions regarding identification of ADEs, assigning relevant resource use to ADEs, and estimating costs for the assigned resources. Methods: ADEs were identified from medical records and diagnostic codes for a random sample of 4970 Swedish adults during a 3-month study period in 2008 and were assessed for causality. Results were compared for five cost evaluation methods, including different methods for identifying ADEs, assigning resource use to ADEs, and for estimating costs for the assigned resources (resource use method, proportion of registered cost method, unit cost method, diagnostic code method, and main diagnosis method). Different levels of causality for ADEs and ADEs contribution to health care resource use were considered. Results: Using the five methods, the maximum estimated overall direct health care costs resulting from ADEs ranged from Sk10,000 (Sk = Swedish krona; similar to(sic)1,500 in 2016 values) using the diagnostic code method to more than Sk3,000,000 (similar to(sic)414,000) using the unit cost method in our study population. The most conservative definitions for ADEs contribution to health care resource use and the causality of ADEs resulted in average costs per patient ranging from Sk0 using the diagnostic code method to Sk4066 (similar to(sic)500) using the unit cost method. Conclusions: The estimated costs resulting from ADEs varied considerably depending on the methodological choices. The results indicate that costs for ADEs need to be identified through medical record review and by using detailed unit cost data. Copyright (C) 2017, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.
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| 9. |
- Gyllensten, Hanna, 1979, et al.
(författare)
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Economic Impact of Adverse Drug Events – A Retrospective Population-Based Cohort Study of 4970 Adults
- 2014
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Ingår i: PLoS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 9:3
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Tidskriftsartikel (refereegranskat)abstract
- Background The aim was to estimate the direct costs caused by ADEs, including costs for dispensed drugs, primary care, other outpatient care, and inpatient care, and to relate the direct costs caused by ADEs to the societal COI (direct and indirect costs), for patients with ADEs and for the entire study population. Methods We conducted a population-based observational retrospective cohort study of ADEs identified from medical records. From a random sample of 5025 adults in a Swedish county council, 4970 were included in the analyses. During a three-month study period in 2008, direct and indirect costs were estimated from resource use identified in the medical records and from register data on costs for resource use. Results Among 596 patients with ADEs, the average direct costs per patient caused by ADEs were USD 444.9 [95% CI: 264.4 to 625.3], corresponding to USD 21 million per 100 000 adult inhabitants per year. Inpatient care accounted for 53.9% of all direct costs caused by ADEs. For patients with ADEs, the average societal cost of illness was USD 6235.0 [5442.8 to 7027.2], of which direct costs were USD 2830.1 [2260.7 to 3399.4] (45%), and indirect costs USD 3404.9 [2899.3 to 3910.4] (55%). The societal cost of illness was higher for patients with ADEs compared to other patients. ADEs caused 9.5% of all direct healthcare costs in the study population. Conclusions Healthcare costs for patients with ADEs are substantial across different settings; in primary care, other outpatient care and inpatient care. Hence the economic impact of ADEs will be underestimated in studies focusing on inpatient ADEs alone. Moreover, the high proportion of indirect costs in the societal COI for patients with ADEs suggests that the observed costs caused by ADEs would be even higher if including indirect costs. Additional studies are needed to identify interventions to prevent and manage ADEs.
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| 10. |
- Gyllensten, Hanna, et al.
(författare)
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Modelling drug-related morbidity in Sweden using an expert panel of pharmacists
- 2012
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Ingår i: INTERNATIONAL JOURNAL OF CLINICAL PHARMACY. - : Springer Science and Business Media. - 2210-7703 .- 2210-7711. ; 34:4, s. 538-546
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Tidskriftsartikel (refereegranskat)abstract
- Background Drug-related morbidity (DRM) is common and to some extent preventable, and associated with considerable costs in patients attending hospital. In outpatients and in the general public corresponding data are limited, but pharmacists expert opinion has suggested high rates of DRM also in US ambulatory care. It is unknown if the results are applicable in Sweden today. Objective To estimate the proportions of patients with DRM and preventable DRM and the cost-of-illness (COI) of DRM in Sweden based on pharmacists expert opinion. Setting Swedish healthcare. Method The study applied a conceptual model of DRM based on a decision tree. An expert panel of pharmacists determined the probabilities of therapeutic outcomes of medication therapy. The COI analysis included direct costs from the healthcare perspective. Sensitivity analyses were performed for variations in probabilities and pathway costs. Main outcome measure DRM included new medical problems (adverse drug reactions, drug dependence and intoxications) and therapeutic failures (insufficient effects of medicines and morbidity due to untreated indication). Results The expert panel estimated that 61 +/- A 14 % (mean +/- A SD) of all patients attending healthcare suffered from DRM, of which 29 +/- A 8 % suffered from new medical problems, 18 +/- A 6 % from therapeutic failures, and 15 +/- A 7 % from a combination of both. The DRM was considered preventable in 45 +/- A 15 % of the patients with DRM. The estimated COI was EUR 997 per patient attending healthcare, corresponding to an annual cost of EUR 6,600 million to the Swedish healthcare system. The COI ranged from EUR 490 to EUR 1,314 when varying the participants probabilities of DRM and clinical outcomes from the first to the third quartile. Of the pathway costs, the COI was most sensitive to variation in the cost of prolonged hospital stay (COI range EUR 953-1,306). Conclusion According to pharmacists expert opinion, a large proportion of patients in Sweden experience DRM and preventable DRM, and the estimated COI of DRM is extensive. Since observational studies have not addressed the burden of DRM to the general public, this study adds the pharmacists perception on DRM. Other healthcare professionals perceptions on DRM need to be investigated in future studies.
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