| 1. |
- Andersson, Therese, 1983-
(författare)
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Acute Pulmonary Embolism : not just an acute condition after all
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Acute pulmonary embolism (PE) is the third most common cardiovascular disease following myocardial infarction and stroke. Despite diagnostic improvements, the diagnosis of PE is still associated with many difficulties, as the symptoms of an acute PE are nonspecific. Even though an acute PE is associated with a high short-term mortality, less attention has been given to long-term mortality. In addition, the clinical course following an acute PE may be accompanied by substantial morbidity, and one feared complication is chronic thromboembolic pulmonary hypertension (CTEPH), a progressive pulmonary vasculopathy. In addition to CTEPH, increasing evidence suggests that a large proportion of patients report persistent functional impairment several years after an acute PE. Recently, the term chronic thromboembolic pulmonary disease (CTEPD) has been proposed for those with remaining symptoms and signs of residual thrombotic material in the pulmonary arteries. Methods and Results: A nation-wide Swedish cohort of all patients (n= 5793) diagnosed with an acute PE in 2005 was identified. The incidence of PE was 0.6/1000 person-years, and during a 4-year follow-up, the mortality was more than doubled compared with an age- and sex-matched control group. We found that the acute PE associated with multiple comorbidities, and with cardiovascular diseases in particular. All surviving patients in 2007 (n=3510) were invited to answer a questionnaire regarding dyspnea and related comorbidities. We demonstrated a substantially higher prevalence of both exertional dyspnea (53.0% vs. 17.3%) and wake-up dyspnea (12% vs. 1.7%) in patients compared to controls from the Northern Sweden MONICA study. Furthermore, PE associated independently with dyspnea in a multivariable analysis. Through a manual review of approximately 10 % of the patient’s medical records, a positive predictive value of 79% was found for the PE diagnosis. Post-PE patients with remaining dyspnea and/or previously known risk factors for CTEPH development were referred for blood sampling and levels of N-terminal (NT)-prohormone (pro) brain-type natriuretic peptide (BNP) were determined. Thereafter, they were referred to their local hospital for a pulmonary ventilation/perfusion (V/Q) scintigraphy and echocardiography. Approximately 45% of the V/Q-scans showed perfusion defects and 27 % of echocardiographies showed signs of pulmonary hypertension. In total, 24 cases of CTEPH were identified, resulting in a prevalence of 0.4 % (95 % confidence interval 0.2 %–0.6 %). Conclusion: An acute PE is a serious event, associated with decreased survival, multiple comorbidities, frequent dyspnea, and pathological investigational findings. The term CTEPD seems reasonable as it captures that this is a disease of the pulmonary vasculature, and that pharmacological and surgical interventions used for CTEPH may be useful. Regardless, proper follow-up after acute PE is essential for timely identification of patients in need of appropriate investigations and care.
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| 2. |
- Anop, Sviatlana, 1974-
(författare)
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Apartment price determinants : A comparison between Sweden and Germany
- 2015
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Similar development of economic fundamentals in Germany over the last two decades did not lead to the same dramatic house price increases as it is in Sweden. What can explain this house price stability over a long period? This thesis attempts to find the answer this question.The first paper in this thesis contains an extended literature review on the studies focused on the factors affecting house prices in the short and in the long run. Existing literature adopts a broad variation of approaches and reaches different conclusions attempting to answer the question about what are the key drivers of house prices. Conclusions often depend on the model specifications and econometric methods applied. Though there is a considerable agreement in real estate economics theory regarding the main factors that affect house prices (or so called “fundamental determinants”), it is hard to find a consistent definition regarding what factors can be considered as “fundamentals” and what factors belong to “non-fundamentals”. The dominating factors that are presented in the majority of the studies are income, population, interest rate, housing stock and unemployment. Studies done after the recent financial crisis put more attention on such factors as the behavior of the market participants, financing conditions and regulations. The characteristics of the bank lending and valuation policies as well as regulations on the rental market have received attention in the research literature, but the impact of these factors on house price dynamics is not measured and not well described. Therefore the other two papers in this thesis aim to provide a better insight in to the factors that create fluctuations in housing markets.The second paper investigates the effects of macroeconomic indicators such as population, income housing stock, mortgage interest rate on house prices. Estimation is done by applying panel data methodology on regional data for major cities in Germany and Sweden and by using yearly observations from 1995 to 2010. Results suggest that the long-run development of apartment prices in Sweden can be explained by changes in such factors as population, disposable income per capita, mortgage interest rate, housing stock, and prices per square meter in the previous period. The price for the previous period has the highest impact in comparison with other factors in Sweden. At the same time for Germany this is the only factor that is valid for long-term house price development. Estimates for fundamental factors such as population, disposable income, mortgage interest rate and housing stock appeared as not significant in house price development in the long run in Germany. A closer analysis has shown that the fundamental factors developed in a similar way in both countries during the analyzed period, though the house prices dynamic is very different. The conclusion is that fundamental factors cannot provide an explanation for the differences in house price developments in two countries and further analysis of institutional differences in the housing markets is done in the third paper.Third paper applies a comparative analysis approach and hypothetico-deductive method in order to examine the differences in the banking policies on mortgage financing and approaches to valuation of mortgage properties in Germany and Sweden. The results suggest that the extreme rise in Swedish house prices above the long-term trend was created by expanding bank lending policies that was supported by the general macroeconomic factors and regulation environment on the housing market. The main difference between countries in approaches to valuation for mortgage purposes is that in Germany that mortgage is based not on the market value as it is in Sweden, but on the long-run sustainable value, so called “fundamental” value. Mortgage lending value is determined in such a way that is also develops in the same tempo as fundamentals in the long-run and is not that procyclical as market value. Using a long-term sustainable value has a restrictive effect on the housing prices and in such a way stabilizes the market. One more factor that gives stability to the housing market in Germany is the well-functioning rental market. Third paper contributes to a better understanding of necessary conditions for the house prices to rise in the long run above the fundamentals level and suggests policy solutions that can reduce the risks of housing bubbles and increase financial stability.
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| 3. |
- Bixby, H., et al.
(författare)
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Rising rural body-mass index is the main driver of the global obesity epidemic in adults
- 2019
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 0028-0836 .- 1476-4687. ; 569:7755, s. 260-4
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Tidskriftsartikel (refereegranskat)abstract
- Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities(.)(1,2) This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity(3-6). Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to 2017. We show that, contrary to the dominant paradigm, more than 55% of the global rise in mean BMI from 1985 to 2017-and more than 80% in some low- and middle-income regions-was due to increases in BMI in rural areas. This large contribution stems from the fact that, with the exception of women in sub-Saharan Africa, BMI is increasing at the same rate or faster in rural areas than in cities in low- and middle-income regions. These trends have in turn resulted in a closing-and in some countries reversal-of the gap in BMI between urban and rural areas in low- and middle-income countries, especially for women. In high-income and industrialized countries, we noted a persistently higher rural BMI, especially for women. There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.
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| 4. |
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| 5. |
- Hullgren, Maria, 1960-
(författare)
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Essays on mortgage rate choice in Sweden
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Buying a home is for many households the financially most important purchase they will make. The choice of mortgage instrument is also of importance in that it will determine a household’s financial exposure. In the aftermath of the 2007–2008 financial crisis in the United States, the potential consequences for borrowers and the financial system became apparent in many countries. Even though the choice of mortgage is described as a very complex transaction, international studies have found that borrowers are less than optimally knowledgeable about the possible future consequences of their choice. This lack of knowledge has raised concern and prompted calls for more research on differences between mortgage markets and factors affecting consumers’ mortgage choice.This thesis answers this call by empirically exploring the Swedish case and by offering an expanded knowledge about factors that influence borrowers’ mortgage choice. The thesis consists of five papers, and, in most cases, interviews and questionnaires were used to collect the data, depending on which type of data collection was considered best suited to serve the purpose of the individual paper. A close reading approach was also applied in one of the papers.The findings indicate that in a Swedish setting, there are factors affecting borrowers’ mortgage choice that have not previously been fully explored in the literature: the media and bank advisors. During the period studied, a negative correlation existed between the media and the choice of fixed rate mortgages, whereas a positive correlation existed between bank advisors and the choice of fixed rate mortgages. The study on advice given by a bank advisor also shows the advocacy of a mix of fixed and adjustable mortgage rates. Further findings corroborate those of earlier international studies, such as the impact of income, education, financial literacy and loan-to-value ratios on mortgage choice.A general conclusion that can be drawn from the findings in the Swedish context is that the most financially vulnerable borrowers—those with lower income, lower education and/or higher loan-to-value ratios—are more likely to choose higher levels of fixed rate mortgages (or lower levels of adjustable rate mortgages). In doing so, they avoid exposing themselves to liquidity problems, which can be caused by increasing mortgage rates, and make future mortgage expenditures more predictable. These findings contradict much of the concern that both scholars and financial authorities have expressed about households’ choice of mortgage instrument. Hence, these findings are of importance not only to research on mortgage choice but also to policymakers and the financial industry.
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| 6. |
- Taddei, C, et al.
(författare)
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Repositioning of the global epicentre of non-optimal cholesterol
- 2020
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Ingår i: Nature. - : Springer Science and Business Media LLC. - 1476-4687 .- 0028-0836. ; 582:7810, s. 73-
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Tidskriftsartikel (refereegranskat)abstract
- High blood cholesterol is typically considered a feature of wealthy western countries1,2. However, dietary and behavioural determinants of blood cholesterol are changing rapidly throughout the world3 and countries are using lipid-lowering medications at varying rates. These changes can have distinct effects on the levels of high-density lipoprotein (HDL) cholesterol and non-HDL cholesterol, which have different effects on human health4,5. However, the trends of HDL and non-HDL cholesterol levels over time have not been previously reported in a global analysis. Here we pooled 1,127 population-based studies that measured blood lipids in 102.6 million individuals aged 18 years and older to estimate trends from 1980 to 2018 in mean total, non-HDL and HDL cholesterol levels for 200 countries. Globally, there was little change in total or non-HDL cholesterol from 1980 to 2018. This was a net effect of increases in low- and middle-income countries, especially in east and southeast Asia, and decreases in high-income western countries, especially those in northwestern Europe, and in central and eastern Europe. As a result, countries with the highest level of non-HDL cholesterol—which is a marker of cardiovascular risk—changed from those in western Europe such as Belgium, Finland, Greenland, Iceland, Norway, Sweden, Switzerland and Malta in 1980 to those in Asia and the Pacific, such as Tokelau, Malaysia, The Philippines and Thailand. In 2017, high non-HDL cholesterol was responsible for an estimated 3.9 million (95% credible interval 3.7 million–4.2 million) worldwide deaths, half of which occurred in east, southeast and south Asia. The global repositioning of lipid-related risk, with non-optimal cholesterol shifting from a distinct feature of high-income countries in northwestern Europe, north America and Australasia to one that affects countries in east and southeast Asia and Oceania should motivate the use of population-based policies and personal interventions to improve nutrition and enhance access to treatment throughout the world.
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| 7. |
- Bellman, Lina, 1971-
(författare)
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Auktoriserade fastighetsvärderares syn på värdering : tankemönster om kommersiella fastigheter
- 2012
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Värdering av kommersiella fastigheter handlar om att samla in, analysera och bedöma information. Förutom att fastigheternas marknadsvärden har betydelse för samhället i stort är de av vikt för dem som fattar beslut som grundas på värdeutlåtanden. Syftet med denna licentiatavhandling är a) att kartlägga hur svenska auktoriserade fastighetsvärderare ser på de faktorer som avgör värdet på kommersiella fastigheter när värderingen görs inför upprättandet av årsredovisning samt b) att jämföra och dra slutsatser om fastighetsvärderarnas tankemönster vad gäller innehåll, komplexitet och homogenitet samt i vilken omfattning tankemönstren skiljer sig åt mellan olika grupper av fastighetsvärderare.För att kartlägga fastighetsvärderarnas tankemönster använder jag mig av Kellys (1955) gridteknik och kompletterande semistrukturerade intervjuer. Jag har intervjuat nära hälften (67) av Sveriges auktoriserade fastighetsvärderare. Resultatet visar tre tolkningsbara dimensioner som kan anses centrala i fastighetsvärderarnas tankemönster. Den första dimensionen avser värderingens fokus. Den handlar om att fastighetsvärderare uppfattar att olika sorters information och bedömning har olika påverkan på fastighetsvärdering på mikro- respektive makronivå. Med mikronivå menas då fastigheter i relation till deras fastighetsägare och makronivå avser fastigheter i relation till marknaden i stort. Den andra dimensionen ger uttryck för att fastighetsvärderare uppfattar att viss information är mer eller mindre verifierbar utifrån informationens karaktär. Den tredje dimensionen avser bedömningens komplexitet. Fastighetsvärderare uppfattar att olika typer av information är komplexare respektive enklare att bedöma.Resultaten tyder på att fastighetsvärderare har ett flerdimentionellt tankemönster. När de auktoriserade fastighetsvärderarna delas upp i grupper utifrån olika bakgrundsvariabler återkommer de tre dimensionerna i samtliga gruppers tankemönster. Detta tyder även på att auktoriserade fastighetsvärderare har relativt homogena tankestrukturer. Vissa skillnader i komplexitet och homogenitet framkommer dock. Dessa skillnader visar sig främst utifrån de auktoriserade fastighetsvärderarnas verksamhetsorter och vid vilka lärosäten de studerat.
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| 8. |
- Lind, Lars, et al.
(författare)
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Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)
- 2021
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Ingår i: eLife. - : eLife Sciences Publications Ltd. - 2050-084X. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions.
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| 9. |
- Sundström, Johan, Professor, 1971-, et al.
(författare)
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Weight gain and blood pressure
- 2020
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Ingår i: Journal of Hypertension. - : Lippincott Williams & Wilkins. - 0263-6352 .- 1473-5598. ; 38:3, s. 387-394
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Although the causality of the obesity—hypertension association is established, the potential for prevention is not. We hypothesized that weight gain between early adulthood and mid-life is associated with higher mid-life blood pressure.METHODS: We investigated the hypothesis using a large contemporaneous population-based mid-life cohort of men and women aged 50-64 years. Recalled body weight at age 20 years was self-reported, and mid-life body weight and office blood pressures were measured in accordance with a detailed protocol.RESULTS: On average, men had gained 14.9 (95% CI 14.6-15.2) kg of weight, and women 14.6 (95% CI 14.4-14.9) kg, between age 20 years and the mid-life examination, corresponding to 0.40 (95% CI 0.39-0.41) kg/year for men and women. Both weight at age 20 years and weight at the mid-life examination were associated with mid-life blood pressures. On average, a 10 kg weight increase between age 20 years and mid-life was associated with 2.2 (95% CI 0.9-3.5) mmHg higher systolic and 1.7 (95% CI 0.9-2.5) mmHg higher diastolic mid-life blood pressure in men, and 3.2 (2.5-4.0) mmHg higher systolic and 2.4 (1.9-2.9) mmHg higher diastolic mid-life blood pressure in women. Mid-life weight was more closely associated than weight at age 20 years with mid-life blood pressure. For a given mid-life weight, blood pressure was higher in persons with higher weight gain from age 20 years.CONCLUSION: In sum, weight gain between early adulthood and mid-life was associated with higher mid-life blood pressure. The magnitude of the association indicates a potentially great public health impact of strategies to prevent weight gain throughout adulthood.
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| 10. |
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