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- Lennernäs, Bo, 1963, et al.
(author)
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Radical prostatectomy versus high-dose irradiation in localized/locally advanced prostate cancer: A Swedish multicenter randomized trial with patient-reported outcomes.
- 2015
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In: Acta oncologica (Stockholm, Sweden). - : Informa Healthcare. - 1651-226X .- 0284-186X. ; 54:6, s. 875-881
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Journal article (peer-reviewed)abstract
- Background. Treatment of localized prostate cancer (PC) is controversial. This is the first randomized study comparing an open surgery procedure (radical prostatectomy) with a combination of high-dose rate brachytherapy (2 × 10 Gy) and external beam radiotherapy (25 × 2 Gy) in PC patients in Sweden 1996-2001. The two randomization arms were compared regarding differences in patients-reported outcomes, such as complications and health-related quality of life (HRQoL). Material and methods. The patients had localized/locally advanced PC, clinical category T1b-T3a, N0, M0 and PSA ≤ 50 ng/ml. All underwent total androgen blockade (six months). Self-reported HRQoL and symptoms including urinary, bowel, and sexual side effects were investigated prospectively before randomization and 12 and 24 months after randomization. A total of 89 patients were randomized and completed the EORTC QLQ C-33 and EORTC PR-25 questionnaires. Results. Over the study period, there were no discernible differences in HRQoL, or complications between the two groups. Emotional functioning, however, improved statistically significantly over time, whereas Social functioning decreased, and financial difficulties increased. No statistically significant differences in group-by-time interactions were found. The survival rate was 76%. Only eight patients (9%) died of PC. Conclusion. Open radical prostatectomy and the combined high-dose rate brachytherapy with external beam radiation appeared to be comparable in the measured outcomes. It was not possible to draw any conclusion on the efficacy of the two treatments due to insufficient power of the study.
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| 3. |
- Moksnes, Per-Olav, et al.
(author)
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Fritidsbåtars påverkan på grunda kustekosystem i sverige
- 2019
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Reports (other academic/artistic)abstract
- Sveriges natursköna kust med vidsträckta skärgårdar erbjuder fantastiska förhållanden för fritidsbåtliv. Idag finns uppskattningsvis mer än 700 000 fritidsbåtar i Sverige, vilket är en av de högsta siffrorna i världen sett till befolkningsmängden. Kustens vågskyddade skärgård ger också goda förutsättningar att förvara fritidsbåtar vid bryggor, och idag täcks stora områden av bryggor och småbåtshamnar. Det stora antalet båtar och bryggor kan ge betydande effekter på miljön, men kunskapen om fritidsbåtlivets sammanlagda påverkan på Sveriges kustmiljöer har hittills varit bristfällig. Havsmiljöinstitutets mål med denna rapport har varit att sammanställa kunskapsläget kring hur fritidsbåtar påverkar grunda kustekosystem i Sverige, samt bedöma omfattningen av denna påverkan och om utveckling är hållbar. Syftet med rapporten är att bidra till utvecklingen av en mer hållbar förvaltning av fritidsbåtlivet genom att sammanställa vetenskaplig kunskap inom detta område på ett lättillgängligt sätt. Sammanställningen visar att det finns ett starkt stöd i den vetenskapliga litteraturen för att fritidsbåtar ger upphov till många negativa effekter på kustmiljön. Med fritidsbåtslivet följer en rad olika fysiska strukturer och aktiviteter som var och en ger upphov till flera olika typer av miljöpåverkan. En ökad utbredning av småbåtshamnar, bryggor och muddrade områden medför förluster av viktiga bottenmiljöer och leder ofta till en långvarig försämring av miljöförhållanden lokalt. Muddrings- och dumpningsaktiviteter leder till ökad uppgrumling och spridning av sediment, näringsämnen och miljögifter över stora områden, vilket bland annat påverkar bottenvegetation, fiskar och musslor negativt. Båttrafik och ankring leder till uppgrumling och erosion av sediment samt till skador på bottenmiljön. Undervattensbuller från båtarnas motorer stör också fiskar och däggdjur. Vidare medför användning av fritidsbåtar betydande utsläpp av giftiga ämnen och föroreningar från båtbottenfärger och förbränningsmotorer. Drygt 60 % av alla bryggor och småbåtshamnar återfinns i grunda (<3 m), vågskyddade områden med mjukbottnar, trots att de endast utgör en fjärdedel av kustens totala grundområden. Dessa områden lämpar sig väl för båtförvaring, men är också en av kustens mest produktiva och värdefulla miljöer. Grunda mjukbottnar är en viktig miljö för olika kärlväxter och kransalger, som i sin tur utgör viktiga uppväxthabitat för många olika fiskarter och kräftdjur. Rapporten visar att dessa miljöer är extra känsliga för en majoritet av de störningar som fritidsbåtlivet ger upphov till. Sammantaget medför detta att fritidsbåtslivet i förhållande till sin omfattning genererar stora skador på miljöer med höga naturvärden.
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| 4. |
- Moksnes, Per-Olav, et al.
(author)
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Fritidsbåtars påverkan på grunda kustekosystem i Sverige
- 2019
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Reports (other academic/artistic)abstract
- Sweden has a long and beautiful coastline with extensive archipelagos that offer exceptional conditions for recreational boating. There are more than 700 000 recreational boats in Sweden, which is one of the highest numbers in the world in relation to the population size. Small tidal differences and many sheltered bays also provide good conditions for storing boats at docks and piers and jetties. As a result, large areas of the Swedish coast are today covered with docks and marinas for recreational boats. The large number of boats and docks could have substantial negative effects on the environment. However, the understanding of the cumulative impact of recreational boating on Swedish coastal ecosystem has so far been incomplete. The goal with this report from the Swedish Institute for the Marine Environment has been to compile and summarize the present state of knowledge regarding how recreational boating affect shallow coastal ecosystems in Sweden, to determine the extent of the impact and if the development is sustainable. The aim has been to present scientific knowledge on these topics in an accessible way in order to facilitate the development of a more sustainable management of recreational boating in Sweden.The scientific literature strongly support that recreational boating generates many negative effects on the marine environment. Recreational boating requires a number of physical structures and generate a number activities that each results in several different pressures on the environment. An increased number of marinas, docks and dredged canals results in losses of important habitats, as well as long-term deterioration of the environmental conditions locally. Dredging and dumping of dredge material results in increased turbidity and dispersal of sediment, nutrients and pollutants over large areas with negative effects on many aquatic organisms, e.g. vegetation, fishes and mussels. Traffic from recreational boats and anchoring result in increased turbidity and sediment erosion as well as damage to habitats. Motor boats also create underwater noise that can disturb e.g. fishes, seals and porpoises. In addition, recreational boating result in substantial emissions of toxic substances and pollution from e.g. antifouling paint and combustion engines.More than 60% of all docks and marinas are found in wave sheltered, shallow (<3 m) areas with soft bottoms, despite that this environment only constitute 25% of shallow coastal areas in Sweden. These sheltered areas are well suited for storing boats, but also constitute one of the most productive and valuable environments along the coast. They are important environments for vegetation such as seagrass, pondweed and stoneworts, which in turn constitute important spawning and nursery areas for a large number of fish and invertebrates. The report shows that these shallow soft bottom environments are very sensitive to a majority of the stressors that recreational boating generate. Boating therefore create a disproportionally large impact on environments with high values.Although the impact from a single recreational boat or dock is limited, the cumulative effect is substantial because of the sheer number. According to recent inventories, there are today almost 110 000 docks along the Swedish coast covering almost 2 000 km of bottom. In comparison with the 1960s, the amount of docks has increased with almost 160%, which today constitutes an increase of 1 700 new docks per year. Recent studies show that vegetation is degraded as the number of docks and boats increase within shallow, wave sheltered areas. It is estimated that almost 20% of this important environment is negatively affected by recreational boating today; in the County of Stockholm and Västra Götaland around 30% of shallow, wave sheltered areas are estimated to be impacted. Despite several management measures in the last decades to decrease coastal exploitation, there are no signs that the rate of exploitation is decreasing.The large number of recreational boats with combustion engines, the trend of increasing engine size, and the fact that engines lack all forms of emission control result in substantial emissions of pollutants and greenhouse gases. Recent estimates suggest that the emissions from recreational boats are very high and comparable with other types of transport in Sweden. Emission of toxic copper from antifouling paint on recreational boats is also substantial and contributes to the high levels of copper in coastal waters, which is above the limit for good ecological status in 85% of the assessed coastal water bodies.Although most boat owners likely spend time at sea because they enjoy and care about the environment, the results presented in this report show that recreational boating have a substantial negative impact on the coastal environment, particularly in shallow, wave protected areas. In these areas, today’s use and development of recreational boating cannot be considered sustainable. However, the report also shows that there are ways to decrease the environmental impact from recreational boating. By changing the way we use and store recreational boats, and by improving management we can still allow coming generations to enjoy unexploited coastal environments with clear water and a rich plant and animal life.The report ends by discussing new, possible measures and solutions for a more sustainable use of recreational boats in Sweden, which could be a starting point for continuing such work. These include e.g. to identify vulnerable coastal environments in order to steer away exploitation and recreational boat traffic from these areas. By storing boats on land, the need for docks, dredging and toxic antifouling paint could decrease. Reduced speed limits and access limitations for recreational motorboats in certain areas could decrease negative impact on the most vulnerable habitats. Finally, new, environmentally friendly technology, and new financial instruments could be used to decrease negative impacts and create a more sustainable development of recreational boating.
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| 5. |
- Råmunddal, Truls, et al.
(author)
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Prognostic Impact of Chronic Total Occlusions : A Report From SCAAR (Swedish Coronary Angiography and Angioplasty Registry)
- 2016
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In: JACC: Cardiovascular Interventions. - : Elsevier BV. - 1936-8798. ; 9:15, s. 1535-1544
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Journal article (peer-reviewed)abstract
- Objectives The aim of this study was to determine the prognostic impact of chronic total occlusion (CTO) on long-term mortality in a large prospective cohort. Background CTO is present in many patients with coronary artery disease and is difficult to treat with percutaneous coronary intervention. Methods The study population consisted of all consecutive patients who underwent coronary angiography in Sweden between January 1, 2005 and January 1, 2012, who were registered in SCAAR (Swedish Coronary Angiography and Angioplasty Registry). The patient population was heterogeneous with regard to indication for angiography (stable angina, ST-segment elevation myocardial infarction [STEMI], unstable angina or non-STEMI, and other) and treatment options. The long-term mortality rates of patients with and without CTO were compared by using shared frailty Cox proportional hazards regression adjusted for confounders. Tests were conducted for interactions between CTO and several pre-specified characteristics: indication for angiography and percutaneous coronary intervention (stable angina, STEMI, unstable angina or non-STEMI, and other), severity of coronary artery disease (1-, 2-, and 3-vessel and/or left main coronary artery disease), age, sex, and diabetes. Results During the study period, 14,441 patients with CTO and 75,431 patients without CTO were registered in SCAAR. CTO was associated with higher mortality (hazard ratio: 1.29; 95% confidence interval: 1.22 to 1.37; p < 0.001). In subgroup analyses, the risk attributable to CTO was lowest in patients with stable angina and highest in those with STEMI. In addition, CTO was associated with highest risk in patients under 60 years of age and with lowest risk in octogenarians. There was no interaction between CTO and either diabetes or sex, suggesting an equally adverse effect in both groups. Conclusions In this large prospective observational study of patients with coronary artery disease, CTO was associated with increased mortality. This association was most prominent in younger patients and in those with acute coronary syndromes.
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