| 1. |
- Jönsson, Elias, et al.
(författare)
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Pulmonary fibrosis in relation to genetic loci in an inception cohort of patients with early rheumatoid arthritis from northern Sweden
- 2022
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Ingår i: Rheumatology. - : British Society for Rheumatology. - 1462-0324 .- 1462-0332. ; 61:3, s. 943-952
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Pulmonary manifestations in RA are common comorbidities. Interstitial lung disease (ILD), both idiopathic and in RA, has been associated with several genetic variants. We assessed pulmonary fibrosis (PF) in an inception cohort of RA patients in relation to genetic variants and disease-related factors.METHODS: A total of 1466 early RA patients were consecutively included and followed prospectively from the index date until death or 31 December 2016. Clinical and laboratory data and treatment were continuously registered according to the Swedish Rheumatology Quality Register. DNA was available from 1184 patients and 571 151 genome-wide single-nucleotide polymorphisms (SNPs) were analysed. Thirteen identified genetic variants were extracted. At follow-up, the patients answered a questionnaire regarding disease progression and lung involvement that was validated by reviewing medical records and analysing radiological examinations.RESULTS: The prevalence of PF was 5.6% and the annualized incidence rate was 5.0/1000 (95% CI 3.80, 6.54). Four SNPs were associated with PF in RA: rs35705950 [MUC5B; OR 2.5 (95% CI 1.5, 4.0), adjusted P-value = 0.00016, q-value = 0.0021]; rs111521887 [TOLLIP; OR 1.9 (95% CI 1.3, 2.8), adjusted P-value = 0.0014, q-value = 0.0092]; rs2609255 [FAM13A; OR 1.7 (95% CI 1.1, 2.5), adjusted P-value = 0.013, q-value = 0.055] and rs2736100 [TERT; OR 1.5 (95% CI 1.0, 2.2), adjusted P-value = 0.046, q-value = 0.15]. Older age and RF positivity were associated with increased risk, while MTX treatment was associated with a lower risk of PF.CONCLUSIONS: Development of PF in an inception cohort of RA patients was associated with 4 of 12 ILD risk genes. RA-related factors except for age at diagnosis and RF positivity were of limited importance in PF development.
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| 2. |
- Amanda, Demir, et al.
(författare)
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The Influence of Mesenteric Defects Closure on the Use of Computed Tomography for Abdominal Pain 5 Years After Laparoscopic Gastric Bypass-a Post Hoc Analysis of a Randomized Clinical Trial
- 2022
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Ingår i: Obesity Surgery. - : Springer. - 0960-8923 .- 1708-0428. ; 32:2, s. 266-272
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Abdominal pain after laparoscopic Roux-en-Y gastric bypass (LRYGB) is a common and unwanted complication that typically leads to further exploration through radiology. Concerns have been raised regarding the consequences of this radiation exposure and its correlation with the lifetime risk of cancer. The aim of this study was to evaluate the differences in computed tomography (CT) use between LRYGB patients with open and closed mesenteric defects and to assess the radiological findings and radiation doses.METHODS: This subgroup analysis included 300 patients randomized to either closure (n = 150) or nonclosure (n = 150) of mesenteric defects during LRYGB. The total number of CT scans performed due to abdominal pain in the first 5 postoperative years was recorded together with the radiological findings and radiation doses.RESULTS: A total of 132 patients (44%) underwent 281 abdominal CT scans, including 133 scans for 67 patients with open mesenteric defects (45%) and 148 scans for 65 patients with closed mesenteric defects (43%). Radiological findings consistent with small bowel obstruction or internal hernia were found in 31 (23%) of the scans for patients with open defects and in 18 (12%) of the scans for patients with closed defects (p = 0.014). The other pathological and radiological findings were infrequent and not significantly different between groups. At the 5-year follow-up, the total radiation dose was 82,400 mGy cm in the nonclosure group and 85,800 mGy cm in the closure group.CONCLUSION: Closure of mesenteric defects did not influence the use of CT to assess abdominal pain.
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| 3. |
- Andresen, Erika, et al.
(författare)
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Non-medical formula use in newborn infants still common at two Swedish hospitals after a breastfeeding support program.
- 2023
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Ingår i: Acta Paediatrica. - 0803-5253 .- 1651-2227. ; 112:10, s. 2121-2128
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To evaluate the effectiveness of a breastfeeding support programme on reducing infant formula use and to investigate indications for formula in newborn infants in Sweden.METHODS: A quasi-experimental study design was carried out. It included 255 mother-infant pairs in a control group, who received standard care and 254 pairs in an intervention group, who took part in a breastfeeding support programme. Data were collected by reviewing patient records from two regional hospitals in Uppsala and Gotland and recruitment took place between 2017 and 2019.RESULTS: Median age of mothers were 31 years (range 20-49) and median gestational age of infants were 39 + 6 weeks/days (range 37 + 0 to 42 + 4). The intervention did not reduce infant formula use. In total, 87/507 (17%) of the infants received formula. Among children receiving formula 30/87 (34%) had a medical indication, whereas 57/87 (66%) had no medical indication. Main reasons for medically indicated formula use were hypoglycaemia, 13/30 (43%), and weight loss, 13/30 (43%). Main reasons for non-medical use were mothers'/parents' wishes, 25/57 (44%) and infants' dissatisfaction, 11/57 (19%).CONCLUSION: Continued efforts are needed to develop effective breastfeeding interventions with increased focus on infant formula reduction.
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| 4. |
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| 5. |
- Fuchtbauer, Laila, et al.
(författare)
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Increased Number of Retinal Vessels in Acromegaly.
- 2020
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Ingår i: European journal of endocrinology. - 1479-683X. ; 182:3, s. 293-302
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Tidskriftsartikel (refereegranskat)abstract
- Excess of growth hormone (GH) and insulin-like growth factor 1 (IGF-1), as in acromegaly, is associated with an increased risk of diabetes, but whether retinal vessels are altered is unknown. The aim of this study was to evaluate retinal vessel morphology in patients with acromegaly at diagnosis and after treatment and to describe the prevalence of diabetic retinopathy in patients with long-standing acromegaly and diabetes.Two independent observational studies, one being prospective and the other retrospective and cross-sectional.Retinal vessel morphology of 26 patients with acromegaly was examined at diagnosis and 1 year after treatment and compared to 13 healthy controls. Cross-sectional evaluation of 39 patients with long-standing acromegaly and diabetes was performed. Fundus photographs were digitally analyzed for vessel morphology.Patients with acromegaly had a median (interquartile range) of 34.3 (30.0-39.0) vessel branching points compared to 27.0 (24.0-29.0) for healthy controls (P < 0.001). Tortuosity of arterioles and venules remained unchanged. Vessel morphology did not change significantly after treatment. Patients with acromegaly and diabetes for a median of 14 years also had a high number of branching points [34.2 (32.5-35.6)], but the prevalence of diabetic retinopathy was not higher than expected in diabetic patients without acromegaly.Patients with acromegaly have an increased number of vascular branching points in the retina without an alteration of macroscopic vessel morphology. This is consistent with an angiogenic effect of GH/IGF-1 in humans. The prevalence of diabetic retinopathy was not increased in patients with acromegaly and diabetes.
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| 6. |
- Hunter, Erik, et al.
(författare)
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Quantifying differences in alternative food network supply chain activities and their relationship with socio-economic outcomes
- 2022
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Ingår i: International Food and Agribusiness Management Review. - 1559-2448. ; 25:1, s. 83-101
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Tidskriftsartikel (refereegranskat)abstract
- Alternative food networks (AFNs) have the potential to enhance and redistribute value in favour of producers and consumers through novel ways of organizing supply chain activities. What is more, AFNs are often characterized by their ‘sustainability promise’ – or the idea that their networks foster social, ecological or environmental improvements over conventional food networks. Based on a purposive sample of 286 producers across five Swedish AFNs (i.e. community supported agriculture, REKO-rings, farmers’ markets, farm stores and food nodes), we explore how differences in how supply chain activities are managed and relate them to profitability, fair wages, cooperation, logistics efforts, happiness and future beliefs. Using a combination of correlation analysis, linear regression and means comparisons, we challenge the notion that AFNs achieve their sustainability promise or enhance value through novel combinations of supply chain activities. Our findings include several key differences in how supply chain management (SCM) activities are organized across AFNs and their variant importance for profitability. Moreover, we find significant differences in happiness across AFNs that are better explained through beliefs about the future than profitability or fair wages. By exploring happiness and profitability, we offer insights into why some AFN actors thrive despite poor economic returns.
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| 7. |
- Molin, Fredrik, 1977-, et al.
(författare)
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Transformational Change and Digitalization-The Case of the Swedish Road and Transport Administration
- 2023
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Ingår i: Behavioral Sciences. - : MDPI. - 2076-328X. ; 13:2
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Tidskriftsartikel (refereegranskat)abstract
- Background: Digitalization is one of the drivers of change in both public and private organizations. It is therefore relevant to understand how a government agency like the Swedish Transport Administration manage and experience change.Methods: In this qualitative study, interviews (n = 15) with respondents with insight and connection to digitalization and change highlight factors related to digitalization and change-capacity within the agency.Results: The results of the interviews are presented in a thematic analysis. Five themes were identified: Digitalization, management control, stability requirements, organizational culture, and lack of a comprehensive view. The research literature in the field of change creates a fund for a discussion about the Administration's situation regarding digitalization, development, and transformational change.Conclusions: The results indicate that the Transport Administration still has a long way to travel in terms of organizational readiness for change. To address this issue, the Transport Administration should prioritize the development and implementation of a comprehensive change management strategy including clear communication, active engagement, and participation from all employees, and a focus on building a culture of adaptability and continuous improvement.
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| 8. |
- Norrman, Andreas, et al.
(författare)
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Logistikutmaningar, lönsamhet och tillfredsställelse i svenska alternativa korta matkanaler
- 2020
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Rapport (populärvet., debatt m.m.)abstract
- Projektet handlar om logistiska utmaningar för små matproducenter som prövar nya mer direkta distributionskanaler, s.k. alternativa korta matkanaler (AKM). Denna växande rörelse syftar till att kortsluta konventionella långa försörjningskedjor med stora livsmedelsproducenter, grossister och butikskedjor. AKM är t.ex. traditionella gårdsbutiker, torghandel (t.ex. i form av Bondens marknad) och andelsjordbruk (CSA) men även nya fenomen som Reko-ringar och Lokala matnoder har spridits snabbt senaste åren. Vissa små matproducenter försöker genom AKM få mer av ”matkronan” och öka sin lönsamhet. För andra aktörer kommer inte ekonomi i första hand, utan drivkrafterna kan vara mer ideologiskt värderingsgrundade. Oavsett drivkraft, borde AKM bidra till en mer levande landsbygd.Logistik och försörjningskedjor (SCM) är viktigt att förstå för att få mat från ”jord till bord” eller ”hage till mage”, och handlar om att skapa effektiva flöden av varor, information och betalningar. Vissa AKM innebär direktkontakt mellan producent och konsument, där bonden själv försöker utföra den logistik och försäljning som tidigare de större specialiserade aktörerna gjort. I andra AKM uppstår nya mellanhänder för att överbrygga gap i logistikflöden. Projektet undersöker erfarenheter från logistiska utmaningar som olika alternativa korta matkanaler skapar, och hur olika sätt att arbeta med logistik och SCM påverkar de mindre aktörernas upplevda lönsamhet och tillfredsställelse. Studien inleddes med en förstudie där över 1100 hemsidor (producenters och mellanhänders) hemsidor studerades avseende information kring sortiment, leveransalternativ, leveranstider, transporter, prissättning, betalningsalternativ m.m. Huvudstudien baseras sedan dels på en enkätstudie med svar från 286 olika producenter från olika AKM, samt parallella intervjustudier av både producenter och nya typer av mellanhänder. Resultatet ger en djupare kunskap om uppfattade logistiska styrkor och utmaningar för olika AKM, samt vilka logistikaktiviteter man lägger tid och energi på, och hur man uppfattar att detta leder till ökad konkurrenskraft, lönsamhet eller tillfredsställelse. Producentens bakomliggande motiv verkar påverka val av AKM, för olika AKM hur tid och energi läggs på olika logistikaktiviteter, vars bidrag till uppfattad konkurrenskraft sedan skiljer sig åt. Generellt läggs mer tid på att hantera kundrelationer och ge leveransinformation, men mindre på transport och lagring trots att man uppfattar sig som mindre konkurrenskraftiga på dessa aktiviteter. Medan t.ex. CSA i sin logik innebär att vissa logistikutmaningar förenklas, så hanteras utmaningar i andra (t.ex. Reko-ring och Lokala matnoder) genom att virtuella plattformar samordnar leveransplatser och tidpunkter. Dock upplevs ibland att mycket tid och energi då istället läggs på administration. I motsats till praxis inom andra branscher, eller rekommenderat i annan forskning, ser vi generellt lite utnyttjande av externa logistikaktörer eller logistiksamarbete mellan producenter, utan man sköter logistiken själva. Många producenter räknar dock inte med kostnad för egen arbetstid, och andra anser att man inte får en rättvis lön för det arbete man lägger ner. Man utnyttjar istället obetalda arbetsinsatser, något som ofta kallas ”sweat equity”.Producenter är generellt tillfredsställda oavsett AKM. Men skillnader finns, och olika aspekter förklarar tillfredsställelse för olika AKM. För många är framtidstro en viktig förklaringsvariabel, men för andra är det rättvis lön, eller om kanalen reducerar logistikarbete eller förenklar kundservice, som verkar viktigast. Dagens lönsamhet verkade generellt påverka mindre, och ibland (t.ex. för Reko-ringar) indikeras t.o.m. ett omvänt samband mellan dagens lönsamhet och producentens tillfredsställelse. Istället verkar producentens syn på framtidsmöjligheter påverka deras tillfredsställelse. Intervjustudier med andra aktörer, som försökt skapa nya roller som mellanhänder, visar att de inte sällan får omarbeta eller utveckla sin affärsmodell p.g.a. låg lönsamhet, begränsade möjligheter att skala upp, svårigheter att komma in på marknaden och få konsumenter att välja dem istället för konventionella butiker. Vissa har lämnat försöken att själva driva mellanhandsplattform till att istället utveckla IT-verktyg för producenterna. De mellanhänder som har utvecklat affärsmodellen siktar på ökad lönsamhet, men har också viljan att skapa alternativa matkanaler i samarbete med lokala producenter för att svara på den ökade efterfrågan av lokala produkter på marknaden. Projektet bidrar med fördjupad kunskap kring vikten av att förstå logistikutmaningar och nya kostnader det innebär att kortsluta konventionella matkanaler, men också en mer nyanserad syn där olika typer av alternativa korta matkanaler och deras olika utmaningar illustreras. Det bidrar till ökad förståelse kring vad som, ur producentens perspektiv, bidrar till tillfredsställelse och glädje vilket är nytt perspektiv. Avslutningsvis trycker vi på vikten av att försöka kombinera plattformar som kan skapa skalfördelar och samarbete i de logistiska flödena, utan att viktiga värderingsorienterade och lokala dimensioner försvinner. För att få sådana plattformar att fungera, och vara skalbara, kan dock ofta någon form av mellanhand behövas.
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| 9. |
- Norrman, Jenny, 1971, et al.
(författare)
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Enriching social and economic aspects in sustainability assessments of remediation strategies – Methods and implementation
- 2020
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Ingår i: Science of the Total Environment. - : Elsevier BV. - 0048-9697 .- 1879-1026. ; 707
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Tidskriftsartikel (refereegranskat)abstract
- Over the last decade, there has been rapid development in promoting and implementing sustainable remediation. It is now common to include at least some sustainability considerations in remediation projects. Specific challenges that have been highlighted often relate to economic and social aspects not receiving enough attention: broadening the social aspects, community and meaningful stakeholder engagement, understanding stakeholders' risk perception, and a need for better estimates of site-specific economic costs and benefits. This study presents an application of the Sustainable Choice of REmediation (SCORE) framework with special focus on (1) demonstrating the working process for a broad sustainability assessment and (2) sharing the lessons learned from its application. Specific objectives are to describe (a) the types of stakeholders involved in the assessment, (b) the methods for collection of social and economic sustainability data, (c) residents' perception of risks, (d) the use of the sustainability assessment results in the decision-making process, and (5) possibilities for improving the methods and working process. SCORE was applied and evaluated with input from, and together with, stakeholders at the BT Kemi industrial site in the village of Teckomatorp, south Sweden, a former pesticide production site associated with the most infamous Swedish environmental scandal. A questionnaire (n = 78) was used to collect input from residents regarding local acceptance and economic externalities of the remediation alternatives. Alternatives with a high degree of removal of contaminants received a high ranking in the assessment, primarily due to social and economic effects. The working process can be improved, specifically regarding workshop preparation and workshop structure. A broad representation of stakeholders and early establishment of communication channels to residents is key for robust assessment of social aspects. The information from the sustainability assessment was used in the decision-making process, not least for revising remediation options.
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