| 1. |
- Befrits, Ragnar, et al.
(författare)
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Anemia and iron deficiency in inflammatory bowel disease: an open, prospective, observational study on diagnosis, treatment with ferric carboxymaltose and quality of life
- 2013
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Ingår i: Scandinavian Journal of Gastroenterology. - : Informa Healthcare. - 0036-5521 .- 1502-7708. ; 48:9, s. 1027-1032
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Tidskriftsartikel (refereegranskat)abstract
- Objective. Iron deficiency and anemia are being increasingly recognized as a complication of inflammatory bowel disease (IBD). The aim of this study was to observe, in a non-interventional way, how Swedish gastroenterologists adhere to guidelines in IBD outpatients treated with intravenous ferric carboxymaltose (FCM), and the result of treatment. Material and methods. Altogether 394 IBD patients (Crohns disease (CD) 60%, ulcerative colitis (UC) 40%) from 14 centers were included. Group A (n = 216) was observed from November 2008 and group B (n = 178) from March 2010. Time of observation ranged from 12 to 29 months. Results. S-Ferritin (mmol/l) and transferrin saturation (T-Sat; %) were recorded at baseline in 62% and 50% in group A. Median values for Hb, ferritin and T-Sat at baseline were 111 g/l, 10 mu mol/l and 10%, respectively, and 134 g/l, 121 mmol/l and 20% after iron treatment (p andlt; 0.001 for all three parameters). Similar results were found in group B. Approximately three-quarters of all patients had only one iron infusion during the study period. Median time to reinfusion was 6 (1-25) months. Only previously described infusion reactions occurred in 27 (7%) patients. Conclusions. Adherence to European guidelines was rather poor and needs to be improved. The effect on iron parameters of intravenous FCM was significant, and resulted in a ferritin level that indicates an effect on the iron stores. The effect was mostly sustained for a year since only one-quarter of the patients were given repeated iron infusions. No unforeseen safety concerns emerged during the observation period.
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| 2. |
- Carlsen, Henrik, et al.
(författare)
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Co-evolutionary scenarios for creative prototyping of future robot systems for civil protection
- 2014
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Ingår i: Technological forecasting & social change. - : Elsevier BV. - 0040-1625 .- 1873-5509. ; 84, s. 93-100
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Tidskriftsartikel (refereegranskat)abstract
- Co-evolutionary scenarios are used for creative prototyping with the purpose of assessing potential implications of future autonomous robot systems on civil protection. The methodology is based on a co-evolutionary scenario approach and the development of different evolutionary paths. Opportunities, threats and ethical aspects in connection with the introduction of robotics in the domestic security and safety sector are identified using an iterative participatory workshop methodology. Three creative prototypes of robotic systems are described: "RoboMall", "RoboButler" and "SnakeSquad". The debate in society that might follow the introduction of these three robot systems and society's response to the experienced ethical problems and opportunities are discussed in the context of two scenarios of different future societies.
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| 3. |
- Lindstrom, L., et al.
(författare)
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High dose ursodeoxycholic acid in primary sclerosing cholangitis does not prevent colorectal neoplasia
- 2012
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Ingår i: Alimentary Pharmacology and Therapeutics. - Malden : Wiley. - 0269-2813 .- 1365-2036. ; 35:4, s. 451-457
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Tidskriftsartikel (refereegranskat)abstract
- Background Patients with primary sclerosing cholangitis (PSC) and inflammatory bowel disease (IBD) have a high risk of developing colorectal cancer and dysplasia. Ursodeoxycholic acid (UDCA) has been suggested to have chemopreventive effects on the development of colorectal cancer and dysplasia but long-term data and larger trials are lacking. Aim To evaluate the effect of high dose (17-23 mg/kg/day) UDCA on colorectal neoplasia in a cohort of patients with PSC and IBD. Methods From our previous 5-year randomised controlled trial of UDCA vs. placebo in PSC, we performed a follow-up of 98 patients with concomitant IBD from entry of the trial 1996-1997 until 2009 for development of colorectal cancer or dysplasia. Results The total follow-up time was 760 person-years. Dysplasia/cancer-free survival was compared between placebo-(n = 50) and UDCA-treated (n = 48) patients. There was a similar frequency of dysplasia or cancer after 5 years between patients originally assigned to UDCA or placebo (13% vs. 16%) and no difference in dysplasia/cancer-free survival (P = 0.46, log rank test). At the end of 2009 no difference in cancer-free survival was detected, 30% of the placebo patients compared with 27% of UDCA patients had developed colorectal cancer or dysplasia. Conclusions Long-term high dose ursodeoxycholic acid does not prevent colorectal cancer or dysplasia in patients with primary sclerosing cholangitis-associated inflammatory bowel disease.
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| 4. |
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| 5. |
- Remberger, Mats, et al.
(författare)
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Improved survival after allogeneic hematopoietic stem cell transplantation in recent years : A single-center study
- 2011
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Ingår i: Biology of blood and marrow transplantation. - : Elsevier BV. - 1083-8791 .- 1523-6536. ; 17:11, s. 1688-1697
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Tidskriftsartikel (refereegranskat)abstract
- We analyzed the outcome of allogeneic hematopoietic stem cell transplantation (HSCT) over the past 2 decades. Between 1992 and 2009, 953 patients were treated with HSCT, mainly for a hematologic malignancy. They were divided according to 4 different time periods of treatment: 1992 to 1995, 1996 to 2000, 2001 to 2005, and 2006 to 2009. Over the years, many factors have changed considerably regarding patient age, diagnosis, disease stage, type of donor, stem cell source, genomic HLA typing, cell dose, type of conditioning, treatment of infections, use of granulocyte-colony stimulating factor (G-CSF), use of mesenchymal stem cells, use of cytotoxic T cells, and home care. When we compared the last period (2006-2009) with earlier periods, we found slower neutrophil engraftment, a higher incidence of acute graft-versus-host disease (aGVHD) of grades II-IV, and less chronic GVHD (cGHVD). The incidence of relapse was unchanged over the 4 periods (22%-25%). Overall survival (OS) and transplant-related mortality (TRM) improved significantly in the more recent periods, with the best results during the last period (2006-2009) and a 100-day TRM of 5.5%. This improvement was also apparent in a multivariate analysis. When correcting for differences between the 4 groups, the hazard ratio for mortality in the last period was 0.59 (95% confidence interval [CI]: 0.44-0.79; P < .001) and for TRM it was 0.63 (CI: 0.43-0.92; P = .02). This study shows that the combined efforts to improve outcome after HSCT have been very effective. Even though we now treat older patients with more advanced disease and use more alternative HLA nonidentical donors, OS and TRM have improved. The problem of relapse still has to be remedied. Thus, several different developments together have resulted in significantly lower TRM and improved survival after HSCT over the last few years.
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| 6. |
- von Oelreich, Jacob, 1978-, et al.
(författare)
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Framtida havsnivåhöjning i kommunal planering
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Ett varmare klimat innebär stigande havsnivåer. Samhället behöver förbereda sig på att hantera dessa, trots de osäkerheter som råder kring hur snabb och omfattande havsnivåhöjningen kommer att bli. I denna rapport kartlägger vi hur 33 kustkommuner i södra Sverige hanterar höjda havsnivåer i sin planering och vilka uppskattningar av framtida havsnivåer de utgår ifrån. Vi analyserar också svaren i ett antal intervjuer med handläggare ansvariga för havsnivåplanering vid kommuner, länsstyrelser, Myndigheten för samhällsskydd och beredskap (MSB), Sveriges meteorologiska och hydrologiska institut (SMHI) och ett konsultbolag.Den största osäkerheten i projektionerna av framtida havsnivåer är hur inlandsisarna på Grönland och Antarktis kommer att reagera på klimatförändringarna. Dessa har reagerat snabbare än vad man tidigare trodde. Under senare tid har allt högre värden angetts i flera artiklar publicerade i vetenskapliga tidskrifter. Här uppskattar man höjningen av havsnivån fram till år 2100 till 1–2 meter för de högsta utsläppsscenarierna. Havet kommer också fortsätta att stiga under många århundraden, även om utsläppen av växthusgaser upphör helt. Den lokala havsnivåhöjningen varierar från det globala medelvärdet och påverkas av flera olika faktorer.Kartläggningen av kommunala planeringsdokument visar att det finns stora brister i dagens planering för en framtida havsnivåhöjning. Nära en tredjedel av de studerade kommunerna saknar helt uppskattningar av framtida havsnivåer i sin planering. Av de kommuner som uppskattar kommande havsnivåer saknar sex av tio tydliga källor till sina uppskattningar.SMHI är den dominerande källan till kommunernas uppskattningar av framtida havsnivåer. Spridningen är dock stor mellan olika kommuners uppskattningar, vilket pekar på den osäkerhet som råder om vilken uppskattning av framtida havsnivåhöjning som är rimlig att förhålla sig till. De senaste åren kan en trend skönjas att kommuner utgår från SMHI:s uppskattning om "runt en meters" havsnivåhöjning fram till år 2100. De flesta kustkommunerna i södra Sverige planerar inte för havsnivåhöjning över en meter på hundra års sikt, trots att det finns vetenskapliga studier som tyder på högre nivåer.Idag saknas planering för stigande havsnivåer bortom år 2100. Främst SMHI, Länsstyrelsen i Skåne län och Helsingborgs kommun lyfter fram betydelsen av planering på längre än hundra års sikt. Mycket få kommuner planerar för ett längre tidsperspektiv och detta pekar på att samhällets långsiktiga planering för havsnivåhöjning behöver förbättras.Vår studie tydliggör en brist på beredskap för en mer omfattande havsnivåhöjning än de uppskattningar som dominerar inom planeringen i nuläget. Även om flera intervjuade efterfrågar planering även för värstascenarier, är det enbart MSB som tar med det i sitt arbete med stigande havsnivåer, enligt EU:s översvämningsdirektiv.Studien visar också att kommuner och länsstyrelser i södra Sverige efterfrågar en ökad tydlighet från statligt håll. Förutom konkret stöd i form av planeringsunderlag vill man även ha tydliga statliga riktlinjer för planeringen för stigande havsnivåer. Studien pekar därmed på behovet av en statlig strategi för havsnivåplaneringen i Sverige.
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| 7. |
- Wikman-Svahn, Per, 1972-
(författare)
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Ethical Aspects of Radiation Risk Management
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis is based on the assumption that the intersection of moral philosophy and practical risk management is a rewarding area to study. In particular, the thesis assumes that concepts, ideas, and methods that are used in moral philosophy can be of great benefit for risk analysis, but also that practices in risk regulation provide a useful testing ground for moral philosophical theories. The thesis consists of an introduction and five articles.Article I is a review article on social and ethical aspects of radiation protection related to nuclear power generation. The paper concludes that four areas of social and ethical issues stand out as central: The first is uncertainty and the influence of value judgments in scientific risk assessments. The second is the distributions of risks and benefits between different individuals, in both space and time. The third is the problem of setting limits when there is no known level of exposure associated with a zero risk. The fourth is related to stakeholder influence and risk communication.Article II discusses ethical issues related to the proposal that doses (or risks) below a certain level should be excluded from the system of radiation protection, without any regard for the number of people exposed. Different arguments for excluding small radiation doses from regulation are examined and a possible solution to the problem of regulating small risks is proposed in the article: Any exclusion of small doses (or risks) from radiation protection ought to be based on a case-by-case basis, with the condition that the expected value of harm remains small.Article III examines what makes one distribution of individual doses better than another distribution. The article introduces a mathematical framework based on preference logic, in which such assessments can be made precisely in terms of comparisons between alternative distributions of individual doses. Principles of radiation protection and from parallel discussions in moral philosophy and welfare economics are defined using this framework and their formal properties analyzed.Article IV argues that the ethical theory of “responsibility-catering prioritarianism” is well positioned to deal with the reasonable requirements in an ethical theory of risk. The article shows how responsibility-catering prioritarianism can be operationalized using a prioritarian social welfare function based on hypothetical utilities. For this purpose, a hypothetical utility measure called ‘responsibility-adjusted utility’ is proposed, which is based on the utility that would normally be expected given circumstances outside of the control of the individual.Article V was written as a response to the Fukushima disaster. Several authors have called the Fukushima disaster a ‘black swan.’ However, the article argues that the hazards of large earthquakes and tsunamis were known before the accident, and introduces and defines the concept of a ‘black elephant,’ as (i) a high-impact event that (ii) lies beyond the realm of regular expectations, but (iii) is ignored despite existing evidence.
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| 8. |
- Wikman-Svahn, Per, 1972-
(författare)
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Radiation protection issues related to the use of nuclear power
- 2012
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Ingår i: Wiley Interdisciplinary Reviews. - : John Wiley & Sons. - 2041-8396 .- 2041-840X. ; 1:3, s. 256-269
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Tidskriftsartikel (refereegranskat)abstract
- Nuclear power generation require protection against harmful effects of ionizing radiation. Radiation protection is based on the linear, no‐threshold model of health risks at low doses and three fundamental principles: justification, optimization, and limitation. The practical application of radiation protection is divided into three areas: planned, emergency, and existing exposure situations. Planned exposure situations include difficult social issues related to the exposure of large populations, exposure of future generations, protection against accidents, and protection of the environment. Emergency and existing exposure situations are both characterized by heterogeneous distributions of exposures and complex social and economic aspects, which make assessment and evaluation of protective strategies complicated and value laden. Four problem areas of social and ethical issues stand out as central for radiation protection: The first is uncertainty and the influence of value judgments in scientific risk assessments. The second is distributions of risks and benefits between different individuals, both in space and time. The third is the problem of setting limits when there is no known level of exposure that is associated with a zero risk. The fourth central problem area is related to stakeholder influence and risk communication.
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| 9. |
- Wikman Svahn, Per, et al.
(författare)
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Toward a Responsibility-catering Prioritarian Ethical Theory of Risk
- 2012
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- We argue that responsibility-catering prioritarianism is well positioned to deal with the basic requirements of an ethical theory of risk. We show how responsibility-catering prioritarianism can be operationalized using a prioritarian social welfare function based on hypothetical utili-ties. For this purpose, we propose a hypothetical utility measure based on the utility that would normally be expected given circumstances outside of the control of the individual. Finally, we argue that degrees of control and knowledge of risks and consequences should influence when and how people are considered responsible in social decisions on risk.
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