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- Bjordal, Kristin, et al.
(författare)
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A prospective study of quality of life in head and neck cancer patients. Part II: Longitudinal data
- 2001
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Ingår i: Laryngoscope. - 1531-4995. ; 111:8, s. 1440-1452
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To evaluate the health-related quality of life (HRQL) of patients with head and neck cancer during and after treatment with radiotherapy, surgery, and chemotherapy. STUDY DESIGN: Prospective, descriptive study. METHODS: All new patients in four institutions in Norway and Sweden were asked to participate. Health-related quality of life was assessed at baseline and at 1, 2, 3, 6, and 12 months after start of treatment by means of the European Organization for Research and Treatment of Cancer (EORTC) Core Quality of Life Questionnaire and the EORTC head and neck cancer-specific questionnaire. Baseline results are described elsewhere; longitudinal results are presented in the current article. Three hundred fifty-seven patients with cancer in the oral cavity, pharynx, larynx, nose, sinuses, and salivary glands and neck node metastases from unknown primaries filled in the questionnaires at baseline. RESULTS: Seventy-eight percent of the patients who were alive after 12 months filled in all questionnaires (218/280). The general trend was that HRQL deteriorated significantly during treatment, followed by a slow recovery until the 12-month follow-up with few exceptions (senses, dry mouth, and sexuality). Patients who later died reported worse HRQL at each assessment point compared with patients who filled in all six questionnaires, whereas those who dropped out of the study for other reasons were quite similar to patients who filled in all questionnaires. The patients with pharyngeal cancer in general reported worse HRQL compared with the other groups and did not reach pretreatment values in several domains. Stage was also an important factor for HRQL in patients with head and neck cancer. CONCLUSION: Detailed knowledge about the differences between groups and changes over time may aid us in the communication with patients and in the design of intervention studies focusing on improvement of the support and rehabilitation of patients with head and neck cancer.
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| 2. |
- Elmqvist, Thomas, et al.
(författare)
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The Dynamics of Social-Ecological Systems in Urban Landscapes
- 2004
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Ingår i: Annals of the New York Academy of Sciences. - : Wiley. - 0077-8923 .- 1749-6632. ; 1023, s. 308-322
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Tidskriftsartikel (refereegranskat)abstract
- This study addresses social-ecological dynamics in the greater metropolitan area of Stockholm County, Sweden, with special focus on the National Urban Park (NUP). It is part of the Millennium Ecosystem Assessment (MA) and has the following specific objectives: (1) to provide scientific information on biodiversity patterns, ecosystem dynamics, and ecosystem services generated; (2) to map interplay between actors and institutions involved in management of ecosystem services; and (3) to identify strategies for strengthening social-ecological resilience. The green areas in Stockholm County deliver numerous ecosystem services, for example, air filtration, regulation of microclimate, noise reduction, surface water drainage, recreational and cultural values, nutrient retention, and pollination and seed dispersal. Recreation is among the most important services and NUP, for example, has more than 15 million visitors per year. More than 65 organizations representing 175,000 members are involved in management of ecosystem services. However, because of population increase and urban growth during the last three decades, the region displays a quite dramatic loss of green areas and biodiversity. An important future focus is how management may reduce increasing isolation of urban green areas and enhance connectivity. Comanagement should be considered where locally managed green space may function as buffer zones and for management of weak links that connect larger green areas; for example, there are three such areas around NUP identified. Preliminary results indicate that areas of informal management represent centers on which to base adaptive comanagement, with the potential to strengthen biodiversity management and resilience in the landscape.
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| 3. |
- Hammerlid, Eva, 1957, et al.
(författare)
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A prospective study of quality of life in head and neck cancer patients. Part I: At diagnosis
- 2001
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Ingår i: Laryngoscope. - : Wiley. - 0023-852X. ; 111:4 Pt 1, s. 669-680
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: A Swedish and Norwegian study was designed to examine health-related quality of life (HQL) in patients with head and neck cancer (head and neck) at diagnosis and during treatment and rehabilitation. The overall aim was to examine the impact on HQL at diagnosis depending on tumor location, stage, sex, and age (part I) and to describe HQL longitudinally and determine for which patients and during which period HQL deteriorated most (part II), This article presents the results at diagnosis. Method Patients with head and neck cancer at five hospitals in Sweden and Norway were consecutively requested to participate, They were asked to answer the EORTC QLQ-C30 and QLQ-H&N35 (the European Organization for Research and Treatment of Cancer, Core 30 questionnaire and head and neck cancer module) repeatedly during I year. A total of 357 patients (mean age, 63 y; 72% males) were included, Results: Patients with different tumor locations all had their special problems at diagnosis, for example, those with tumors in the larynx with communication, those with oral tumors with pain, and those with pharyngeal tumors with nutrition and pain. The patients with hypopharyngeal cancer reported the worst HQL. Stage appeared to have the strongest impact on HQL. Patients with a more advanced tumor stage reported significantly worse HQL scores for 24 of 32 variables reflecting functioning or problems. The females scored worse than the males for some areas, in particular, emotional functioning. The older patients scored significantly better for emotional and social functioning than patients <65 years but worse for physical functioning and various symptoms. The traditional way of grouping the tumor locations into oral, pharyngeal, laryngeal, and "other" tumors (salivary gland, sinus and nose, and unknown primary) was tested from a HQL point of view and found to be consistent. Conclusions: The chosen questionnaires differentiated between different sites of head and neck cancer at diagnosis. Tumor stage had the most powerful impact on HQL score.
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| 4. |
- Lindborg, Regina, 1966-
(författare)
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Land Use Change in Space and Time : implications for plant species conservation in semi-natural grasslands
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Land use change has during the last century altered the traditional rural landscape in Sweden, resulting in a major decline in species diversity. Traditional small-scale farming, with a remarkably high small-scale species richness, has changed in favour of rationalized agriculture, and many semi-natural grasslands, i.e. traditionally managed pastures and meadows, have become abandoned. In this thesis I examine how spatio-temporal processes affect plant species in Swedish semi-natural grasslands exposed to habitat degradation as well as recovery (restoration). I also discuss how to conserve plant species associated with semi-natural grasslands. In general, species responded slowly to habitat degradation, but quickly to improvement of habitat quality. Population viability analysis (PVA) of the grazing favoured herb Primula farinosa suggested, in contrast to historical records, that populations in abandoned grasslands performed better than populations in traditionally managed grasslands, a result questioning the accuracy of PVAs. Restoration of grasslands counteracted species richness decline and the number of species increased within seven years after restoration. It was possible to recruit grassland species in grazed former arable fields by artificial seed-sowing. This may help to speed up the natural recruitment, which often is low due to dispersal limitations in modern fragmented landscapes. Studies at larger regional scales showed century long time-lags in the response of plant species richness to land use change. Species richness was not related to present-day connectivity of grasslands, but positive effects appeared for grassland configuration in 1950s and 1900s. Thus, making conservation guidelines based solely on present-day data may be strongly misleading and under-estimate the actual risk of species loss. To secure long-term survival of species, it is important to focus on processes associated with larger spatial scales. This may benefit natural dynamics at longer time-scales, where abandoned and restored grasslands, together with species-rich semi-natural grasslands, could become natural parts of sustainable landscape management.
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| 5. |
- Tengö, Maria, 1974-
(författare)
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Management Practices for Dealing with Uncertainty and Change : Social-Ecological Systems in Tanzania and Madagascar
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The development of human societies rests on functioning ecosystems. This thesis builds on integrated theories of linked social-ecological systems and complex adaptive systems to increase the understanding of how to strengthen the capacity of ecosystems to generate services that sustain human well-being. In this work, I analyze such capacity in human-dominated production ecosystems in Tanzania and Madagascar, and how this capacity is related to local management practices. Resilience of social-ecological systems refers to the capacity to buffer change, to re-organize following disruption, and for adaptation and learning. In Papers I and II, qualitative interview methods are used for mapping and analyses of management practices in the agroecosystem of the Mbulu highlands, Northern Tanzania. Practices such as soil and water conservation, maintenance of habitats for pollinators and predators of pests, intercropping, and landscape diversification, act to buffer food production in a variable environment and sustain underlying ecological processes. The practices are embedded in a decentralized but nested system of institutions, such as communal land rights and social networks, that can buffer for localized disturbances such as temporary droughts. Paper II compares these findings with practices in a farming system in Sweden, and suggests that similar mechanisms for dealing with uncertainty and change can exist in spite of different biophysical conditions. In Papers III and IV, interviews are combined with GIS tools and vegetation sampling to study characteristics and dynamics of the dry forests of Androy, southern Madagascar. Paper III reports on a previously underestimated capacity of the dry forest of southern Madagascar to regenerate, showing areas of regeneration roughly equal areas of degenerated forest (18 700 ha). The pattern of forest regeneration, degradation, and stable cover during the period 1986-2000 was related to the enforcement of customary property rights (Paper III). Paper IV reports on a network of locally protected forest patches in Androy that is embedded in a landscape managed for agricultural or livestock production and contributes to the generation of ecosystem services and ecosystem resilience at a landscape scale. Forest protection is secured by local taboos that provide a well-functioning and legitimate sanctioning system related to religious beliefs. In Paper V, two spatial modeling tools are used to assess the generation of two services, crop pollination and seed dispersal, by the protected forest patches in southern Androy. The functioning of these services is dependent on the spatial configuration of protected patches in the fragmented landscape and can be highly vulnerable to even small changes in landscape forest cover. In conclusion, many of the identified practices are found to make ecological sense in the context of complex systems and contribute to the resilience of social-ecological systems. The thesis illustrates that the capacity of human-dominated production ecosystems to sustain a flow of desired ecosystem services is strongly associated with local management practices and the governance system that they are embedded in, and that, contrary to what is often assumed, local management can and does add resilience for desired ecosystem services. These findings have substantial policy implications, as insufficient recognition of the dynamics of social-ecological interactions is likely to lead to failure of schemes for human development and biodiversity conservation.
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