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- Andersson, Lotta, et al.
(författare)
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The Vulnerability Assessment Concept : A Tool for Prioritization of the Most Relevant Issues for Macro-regional Cooperation
- 2013
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- This report aims at identifying potential issues for collaboration related to climate adaptation through application of a tool for assessing macro-regional risks. The tool is intended to assist decision-makers and other stakeholders in the Baltic Sea Region (BSR) in discussions on how climate adaptation related cooperation would benefit most from macro-regional cooperation. It is based on four criteria: 1) confidence, 2) speed (determined by Baltadapt climate modellers), 3) importance of impacts and 4) macro-regional coverage (based on a questionnaires answered by 3-8 stakeholders from each of the nine riparian BSR states). Based on equal weighting of these factors, impacts related to biodiversity/eutrophication of the Baltic Sea, as well and impacts related to agriculture were given the highest rankings, which demonstrates the importance to include these sectors and their interrelationship as an important focus in macro-regional cooperation on climate adaptation in the BSR. Impacts related to biodiversity and agriculture have in common that they are caused by climate change that will occur or already has occurred with a high degree of certainty (e.g., linked to air and water temperatures and rising sea levels), as well as having a very large macro-regional spatial coverage, and being perceived as of high societal and/or environmental concern.
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- Andersson, Tobias, 1976, et al.
(författare)
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The effect of statins on mortality and cardiovascular disease in primary care hypertensive patients without other cardiovascular disease or diabetes.
- 2023
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Ingår i: European journal of preventive cardiology. - 2047-4881. ; 30:17, s. 1883-1894
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Tidskriftsartikel (refereegranskat)abstract
- Studies in primary health care (PHC) assessing the effect of primary prevention with statins on mortality and cardiovascular disease (CVD) are scarce. This study aimed to estimate the effect of statins on all-cause mortality, cardiovascular mortality, myocardial infarction (MI) and stroke in individuals in PHC with hypertension without CVD or diabetes.Using the Swedish PHC quality assurance register QregPV, the study included 13 193 individuals with hypertension without CVD or diabetes, who had filled a first statin prescription between 2010 and 2016, and 13 193 matched controls without a filled statin prescription at index date. Controls were matched on sex and propensity score using clinical data and data from national registers on co-morbidities, prescriptions, and socioeconomic status. The effect of statins was estimated in Cox regression models.During a median of 4.2 years of follow-up, 395 individuals in the statin group versus 475 in the control group died, 197 versus 232 died of cardiovascular disease, 171 versus 191 had a MI, and 161 versus 181 had a stroke. The treatment effect of statins was significant for all-cause mortality (HR 0.83, 95% confidence interval [CI] 0.74-0.93) and cardiovascular mortality (HR 0.85, 95% CI 0.72-0.998). Overall, no significant treatment effect of statins was seen for MI (HR 0.89, 95% CI 0.74-1.07), but there was a significant interaction with sex (p=0.008) with decreased risk of MI for women but not for men (HR 0.66, 95% CI 0.49-0.88 versus HR 1.09, 95% CI 0.86-1.38).Primary prevention with statins in PHC was associated with reduced risk of all-cause mortality, cardiovascular mortality, and in women, lower risk of MI.
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- Anheden, Marie, et al.
(författare)
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Value chains for production of Renewable Transportation Fuels Using Intermediates
- 2016
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- An increased share of renewable transportation fuels requires utilisation of new low-cost sources of bio-based raw materials other than what is currently used in the pulp and paper industry and for power and district heat generation in the bioenergy sector. Currently, proposed raw material includes forest residues (branches and tops), stumps, waste round wood and different by-products from pulp and pa-per industry and sawmills. Of these, forest residues and stumps have, by far, the largest potential for increased utilisation. However, these types of raw materials are often voluminous and heterogeneous and are difficult to handle in existing refineries for production of transportation fuels. The cost of transporting this type of raw material over large distances in order to supply a larger plant is often said to be high. This report includes an analysis of the possible advantages and disadvantages of transform-ing forest-based biomass to an intermediate product with a higher energy density that is more homo-geneous and easier to handle during transport and during final conversion to transportation fuel.Two value chains are investigated as case studies a) bio-SNG production using forest residues, bark and sawdust as raw material and b) bio-oil production from forest residues, lignin in black liquor and tall oil, which can be upgraded to transportation fuels at a refinery. In the study we have assumed that the conversion of the original biomass to an intermediate product mainly takes place at a pulp mill. The intermediate conversion technologies included for value chain a) are drying and pelletizing and for value chain b) pyrolysis and distillation. The final conversion to end product bio-SNG takes place in connection to a district heating system, and the final deoxygenation and upgrading of bio-oil to hydrodeoxygenated (HDO) oil takes place at an oil refinery. The value chains with intermediates are compared with value chains without intermediates where the entire conversion process to final product is located in connection to a district heating system in value chain a) and at a stand-alone plant near to a refinery in value chain b). The value chains are studied from a well-to-gate perspective, from extrac-tion of the forest biomass to produced bio-SNG/HDO bio-oil. A direct comparison between value chains for bio-SNG and bio-oil production should be avoided. They are based on different reference data that are not synchronized. A direct comparison between the chains should in addition be done in a well-to-wheel perspective.The results show that the initial hypothesis that local production of a more energy dense intermediate would reduce transportation costs could not be verified. The reason is primarily the introduction of a second transport step to transport the intermediate to the final conversion site in addition to the transport of the raw material. The transport costs are associated with relatively high fixed cost espe-cially for ship and train transport, so the introduction of a second relatively high fixed transport cost of the intermediate has a dominating effect. Further, it can be concluded that the transport cost make up a relatively small share of the total production cost of the final product, in the order of 10%, and in a few cases up to 20%. There is therefore a relatively small difference in total specific production cost for the final product between value chains with and without intermediates considering the level of uncer-tainty in the input data and the assumptions behind the scenarios studied.Summarizing, the results indicate that the production costs are highly sensitive to the economies of scale, oxygen content in the bio-crude oil and raw material costs (forest residues price or electricity price in the case where lignin is used as raw material). Transportation costs have, comparatively, a little effect in the total production cost.
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- Bager, Johan-Emil, et al.
(författare)
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Blood pressure levels and risk of haemorrhagic stroke in patients with atrial fibrillation and oral anticoagulants: results from The Swedish Primary Care Cardiovascular Database of Skaraborg.
- 2021
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Ingår i: Journal of hypertension. - 1473-5598. ; 39:8, s. 1670-1677
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Tidskriftsartikel (refereegranskat)abstract
- To assess the risk of haemorrhagic stroke at different baseline SBP levels in a primary care population with hypertension, atrial fibrillation and newly initiated oral anticoagulants (OACs).We identified 3972 patients with hypertension, atrial fibrillation and newly initiated OAC in The Swedish Primary Care Cardiovascular Database of Skaraborg. Patients were followed from 1 January 2006 until a first event of haemorrhagic stroke, death, cessation of OAC or 31 December 2016. We analysed the association between continuous SBP and haemorrhagic stroke with a multivariable Cox regression model and plotted the hazard ratio as a function of SBP with a restricted cubic spline with 130mmHg as reference.There were 40 cases of haemorrhagic stroke during follow-up. Baseline SBP in the 145-180mmHg range was associated with a more than doubled risk of haemorrhagic stroke, compared with a SBP of 130mmHg.In this cohort of primary care patients with hypertension and atrial fibrillation, we found that baseline SBP in the 145-180mmHg range, prior to initiation of OAC, was associated with a more than doubled risk of haemorrhagic stroke, as compared with an SBP of 130mmHg. This suggests that lowering SBP to below 145mmHg, prior to initiation of OAC, may decrease the risk of haemorrhagic stroke in patients with hypertension and atrial fibrillation.
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| 9. |
- Bager, Johan-Emil, et al.
(författare)
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Hypertension: sex-related differences in drug treatment, prevalence and blood pressure control in primary care.
- 2023
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Ingår i: Journal of human hypertension. - : Springer Science and Business Media LLC. - 1476-5527. ; 37, s. 662-670
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Forskningsöversikt (refereegranskat)abstract
- Antihypertensive treatment is equally beneficial for reducing cardiovascular risk in both men and women. Despite this, the drug treatment, prevalence and control of hypertension differ between men and women. Men and women respond differently, particularly with respect to the risk of adverse events, to many antihypertensive drugs. Certain antihypertensive drugs may also be especially beneficial in the setting of certain comorbidities - of both cardiovascular and extracardiac nature - which also differ between men and women. Furthermore, hypertension in pregnancy can pose a considerable therapeutic challenge for women and their physicians in primary care. In addition, data from population-based studies and from real-world data are inconsistent regarding whether men or women attain hypertension-related goals to a higher degree. In population-based studies, women with hypertension have higher rates of treatment and controlled blood pressure than men, whereas real-world, primary-care data instead show better blood pressure control in men. Men and women are also treated with different antihypertensive drugs: women use more thiazide diuretics and men use more angiotensin-enzyme inhibitors and calcium-channel blockers. This narrative review explores these sex-related differences with guidance from current literature. It also features original data from a large, Swedish primary-care register, which showed that blood pressure control was better in women than men until they reached their late sixties, after which the situation was reversed. This age-related decrease in blood pressure control in women was not, however, accompanied by a proportional increase in use of antihypertensive drugs and female sex was a significant predictor of less intensive antihypertensive treatment.
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| 10. |
- Bager, Johan-Emil, et al.
(författare)
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Long-term risk-factor control and secondary prevention are insufficient after first TIA: Results from QregPV.
- 2023
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Ingår i: European stroke journal. - 2396-9873 .- 2396-9881. ; 9:1, s. 154-161
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Tidskriftsartikel (refereegranskat)abstract
- Long-term risk-factor control and secondary prevention are not well characterized in patients with a first transient ischemic attack (TIA). With baseline levels as reference, we compared primary-care data on blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), smoking, and use of antihypertensives, statins and antiplatelet treatment/oral anticoagulation (APT/OAC) during 5years after a first TIA.Patients in QregPV, a Swedish primary-care register for the Region of Västra Götaland, with a first TIA discharge diagnosis from wards proficient in stroke care 2010 to 2012 were identified and followed up to 5years. BP, LDL-C, smoking, use of antihypertensives, statins, APT/OAC, and achievement of target levels were calculated. We used logistic mixed-effect models to analyze the effect of follow-up over time on risk-factor control and secondary prevention treatment.We identified 942 patients without prior cerebrovascular disease who had a first TIA. Compared to baseline, the first year of follow-up was associated with improvements in concomitant attainment of BP <140/90mmHg, LDL-C<2.6mmol/L and non-smoking, which rose from 20% to 33% (OR 2.08, 95% CI 1.38-3.13), but then stagnated in years 2-5. In the first year of follow-up, 47% of patients had complete secondary prevention treatment (antihypertensives, APT/OAC and statin), but continued follow-up was associated with a yearly decrease in secondary prevention treatment (OR 0.94, 95% CI 0.94-0.98).Risk-factor control was inadequate, leaving considerable potential for improved secondary prevention treatment after a first TIA in Swedish patients followed up to 5years.
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