| 1. |
- Bergkvist, Bo, et al.
(författare)
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Pools and fluxes of carbon in three Norway spruce ecosystems along a climatic gradient in Sweden
- 2008
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Ingår i: Biogeochemistry. - : Springer Science and Business Media LLC. - 0168-2563 .- 1573-515X. ; 89:1, s. 7-25
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Tidskriftsartikel (refereegranskat)abstract
- This paper presents an integrated analysis of organic carbon (C) pools in soils and vegetation, within-ecosystem fluxes and net ecosystem exchange (NEE) in three 40-year old Norway spruce stands along a north-south climatic gradient in Sweden, measured 2001-2004. A process-orientated ecosystem model (CoupModel), previously parameterised on a regional dataset, was used for the analysis. Pools of soil organic carbon (SOC) and tree growth rates were highest at the southernmost site (1.6 and 2.0-fold, respectively). Tree litter production (litterfall and root litter) was also highest in the south, with about half coming from fine roots (< 1 mm) at all sites. However, when the litter input from the forest floor vegetation was included, the difference in total litter input rate between the sites almost disappeared (190-233 g C m(-2) year(-1)). We propose that a higher N deposition and N availability in the south result in a slower turnover of soil organic matter than in the north. This effect seems to overshadow the effect of temperature. At the southern site, 19% of the total litter input to the O horizon was leached to the mineral soil as dissolved organic carbon, while at the two northern sites the corresponding figure was approx. 9%. The CoupModel accurately described general C cycling behaviour in these ecosystems, reproducing the differences between north and south. The simulated changes in SOC pools during the measurement period were small, ranging from -8 g C m(-2) year(-1) in the north to +9 g C m(-2) year(-1) in the south. In contrast, NEE and tree growth measurements at the northernmost site suggest that the soil lost about 90 g C m(-2) year(-1).
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| 2. |
- Alkner, Sara, et al.
(författare)
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Quality assessment of radiotherapy in the prospective randomized SENOMAC trial
- 2024
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Ingår i: Radiotherapy and Oncology. - 0167-8140 .- 1879-0887. ; 197
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose: Recommendations for regional radiotherapy (RT) of sentinel lymph node (SLN)-positive breast cancer are debated. We here report a RT quality assessment of the SENOMAC trial.Materials and Methods: The SENOMAC trial randomized clinically node-negative breast cancer patients with 1–2 SLN macrometastases to completion axillary lymph node dissection (cALND) or SLN biopsy only between 2015–2021. Adjuvant RT followed national guidelines. RT plans for patients included in Sweden and Denmark until June 2019 were collected (N = 1176) and compared to case report forms (CRF). Dose to level I (N = 270) and the humeral head (N = 321) was analyzed in detail.Results: CRF-data and RT plans agreed in 99.3 % (breast/chest wall) and in 96.6 % of patients (regional RT). Congruence for whether level I was an intended RT target was lower (78 %). In accordance with Danish national guidelines, level I was more often an intended target in the SLN biopsy only arm (N = 334/611, 55 %,) than in the cALND arm (N = 174/565, 31 %,). When an intended target, level I received prescribed dose to 100 % (IQR 98–100 %) of the volume. However, even when not an intended target, full dose was delivered to > 80 % of level I (IQR 75–90 %). The intentional inclusion of level I in the target volume more than doubled the dose received by ≥ 50 % of the humeral head.Conclusion: Congruence between CRF data and RT plans was excellent. Level I received a high dose coverage even when not intentionally included in the target. Including level I in target significantly increased dose to the humeral head.
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| 3. |
- Appelgren, M., et al.
(författare)
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Patient-reported outcomes one year after positive sentinel lymph node biopsy with or without axillary lymph node dissection in the randomized SENOMAC trial
- 2022
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Ingår i: Breast. - : Elsevier BV. - 0960-9776 .- 1532-3080. ; 63, s. 16-23
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: This report evaluates whether health related quality of life (HRQoL) and patient-reported arm morbidity one year after axillary surgery are affected by the omission of axillary lymph node dissection (ALND). Methods: The ongoing international non-inferiority SENOMAC trial randomizes clinically node-negative breast cancer patients (T1-T3) with 1-2 sentinel lymph node (SLN) macrometastases to completion ALND or no further axillary surgery. For this analysis, the first 1181 patients enrolled in Sweden and Denmark between March 2015, and June 2019, were eligible. Data extraction from the trial database was on November 2020. This report covers the secondary outcomes of the SENOMAC trial: HRQoL and patient-reported arm morbidity. The EORTC QLQC30, EORTC QLQ-BR23 and Lymph-ICF questionnaires were completed in the early postoperative phase and at one-year follow-up. Adjusted one-year mean scores and mean differences between the groups are presented corrected for multiple testing.
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| 4. |
- Bergkvist, Dan, et al.
(författare)
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Acute Achilles Tendon Rupture A Questionnaire Follow-up of 487 Patients
- 2012
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Ingår i: Journal of Bone and Joint Surgery. American Volume. - 1535-1386. ; 94:13, s. 1229-1233
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The optimum treatment of acute total Achilles tendon rupture remains controversial. In the present study, the outcomes of surgical and nonsurgical treatment in a large number of patients were compared on the basis of patient age and sex. METHODS: The records of all 487 patients with an acute total Achilles tendon rupture that had occurred between 2002 and 2006 and had been treated at one of two university hospitals in Sweden were manually reviewed. Surgical treatment was primarily used at Hospital 1, whereas nonoperative functional treatment was primarily used at Hospital 2. At one to seven years after the rupture, the majority of the patients were evaluated for complications, the Achilles Tendon Total Rupture Score was calculated, a heel-raise test was performed, and calf circumference was measured. The outcomes of surgical and nonsurgical treatment were compared on the basis of patient age and sex. RESULTS: The mean age at the time of the injury was forty-five years. In the surgical treatment group at Hospital 1, six (3%) of 201 patients had a re-rupture and three (1.5%) had an infection. In the nonsurgical treatment group at Hospital 2, the rate of re-rupture rate was 6.6% (fifteen of 227). When the results for the surgical treatment group at Hospital 1 were compared with those for the nonsurgical treatment group at Hospital 2, there was no significant difference in terms of the mean Achilles Tendon Total Rupture Score (81.7 compared with 78.9; p = 0.1), but both the difference in the heel-raise test (p = 0.01) and the difference in calf circumference (1.4 compared with 2.0 cm; p = 0.01) reached significance in favor of surgery. Nonsurgically managed female patients showed significant worsening of the Achilles Tendon Total Rupture Score and heel-raise test with increasing age at the time of injury. CONCLUSIONS: The good Achilles Tendon Total Rupture Score in the nonsurgically managed group, together with the relatively low rate of re-ruptures and other complications in these patients, makes this treatment a preferable option for most patients. However, the tendency for a lower re-rupture rate and better performance on the heel-raise test in surgically treated patients suggest surgery may be beneficial in selected patients. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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| 5. |
- Bergkvist, Dan, et al.
(författare)
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Knee arthroscopies: who gets them, what does the radiologist report, and what does the surgeon find?
- 2016
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Ingår i: Acta Orthopaedica. - : Informa UK Limited. - 1745-3682 .- 1745-3674. ; 87:1, s. 12-16
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Tidskriftsartikel (refereegranskat)abstract
- Background and purpose - Several randomized controlled trials have not shown any added benefit of arthroscopy over placebo surgery or physiotherapy in middle-aged patients with knee symptoms without trauma. We studied the characteristics of the knee arthroscopies performed in southern Sweden. Patients and methods - From the orthopedic surgical records from 2007-2009 in the Skåne region of Sweden (with a population of 1.2 million), we retrieved ICD-10 diagnostic codes and selected all 4,096 arthroscopies that were diagnosed peroperatively with code M23.2 (derangement of meniscus due to old tear or injury) or code M17 (knee osteoarthritis). We extracted information on cartilage and meniscus status at arthroscopy, and we also randomly sampled 502 of these patients from the regional archive of radiology and analyzed the preoperative prevalence of radiographic or magnetic resonance imaging (MRI)-defined osteoarthritis. Results - 2,165 (53%) of the 4,096 arthroscopies had the diagnostic code M23.2 or M17. In this subgroup, 1,375 cases (64%) had typical findings consistent with degenerative meniscal tear (i.e. that correspond to a degenerative meniscal tear in at least a third of all arthroscopies). Of the randomly sampled patients, the preoperative prevalence of radiological knee osteoarthritis was 46%. Interpretation - There is a discrepancy between evidence-based medicine treatment guidelines and clinical practice regarding the amount of knee arthroscopies performed in patients with symptoms of degenerative knee disease.
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| 6. |
- Bergkvist, Dan
(författare)
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Meniscus tear; Knee arthroscopy; clinical practice and sick leave
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Knäleden är kroppens största led och är påtagligt komplicerad. Den utsätts dagligen för stora krafter vid såväl böj och vridrörelser som stötkrafter vid stegisättning. För att den skall fungera optimalt måste flera olika komponenter samverka. Brosket som bekläder benändarna bidrar med stötdämpning och ger en mycket låg friktion vid rörelse. Flera olika ligament och muskler som löper över leden bidrar till dess stabilitet. Meniskerna, som denna avhandling handlar om, är likaledes viktiga för ledens funktion. Meniskerna fungerar stabiliserande, stötdämpande och kraftfördelande. Utan meniskerna blir således knäleden dels mera instabil samt kraften och därmed förslitningen på brosket ökar. Meniskskada, vare sig denna uppstår via våld mot knät eller som ett resultat avkirugi, ökar risken för ledsvikt, även kallat Artros. Traditionellt har meniskskada, vare sig den orsakats av våld eller är ett resultat av åldersförändringar, behandlats med att man helt eller delvis har tagit bort menisken.Delvis avlägsnande av en skadad menisk (partiell meniskectomi) har sedermera blivit ett mycket vanligt ingrepp bland medelålders patienter med knäsmärta och förmodad eller via magnetkamera bekräftad, meniskskada. Detta ingrepp uförs nästan alltid med titthålsteknik (knäartroskopi). Detta har man gjort i förhoppningen att detta skall minska knäsmärtan. Flera högkvalitativa studier har dock övertygande påvisat att dessa patienter via detta ingrepp inte förbättras mer än vad patienter som erhållitsjukgymnastik eller placebo-kirurgi gjort.Denna avhandling består av fyra delarbeten där jag sökt svar på frågor som; Vilka patienter blir behandlade med delvis borttagande av meniskvävnad, dvs opererar vi “rätt” patienter? Hur mycket sjukskrivning genereras av patienter med meniskskada, dels patienter som fått någon form av våld mot knät eller som har åldersbetingade förändringar i menisken, med eller utan kirurgi. Slutligen har jag undersökt huruvida utfärdande av nationella rekommendationer att inte operera medelålders patienter med artros har påverkat operationsfrekvensen.I mitt första delarbete analyserade jag tre årsproduktioner (2007-2009) avknäartroskopier utförda i Region Skåne, via det gemensamma journalsystemet Ortreg (4096 patienter). I speciell detalj studerades sådana diagnoser, som med hög sannolikhet rymmer sådana patienter, som man i tidigare studier konstaterat inte tjänar på operation. En slumpvis utvald undergrupp studerades med avseende på deras röntgen eller magnetkamerabilder, utförda före operation på det skadade knät. Jag fann att åtminstone en tredjedel av alla knä-artroskopier utförda i regionen, utfördes på patienter med sådana åldersförändringar i meniskerna samt general ledsvikt i knät, där studier konstaterat utebliven effekt av kirurgi. Från detta kan man dra slutsatsen att det finns en skiljaktighet mellan bevisbaserade rekommendationer och vad som utförs i praktiken. Detta borde kunna innebära möjligheter att vara mer restriktiv med artroskopi med partiell meniskectomi i denna patientgrupp framgent.I det andra delarbetet undersökte jag 604 patienter i Region Skåne med akutmeniskskada (utan några andra skador i drabbat knä), som blivit opererade med partiell meniskectomi. Med hjälp av sjukskrivningsdata från Försäkringskassan som sträckte sig från ett år före skadan, till två år efter skadan kunde andelen patienter sjukskrivna mer än två veckor, analyseras. Jag fann att två tredjedelar hade två veckors sjukskrivning eller mindre under operationstillfället. Då sjukskrivningen innehåller all sjukskrivning utan närmare specificerad orsak, är det sannolikt att själva operationen i sig, står för en mindre del av den totala sjukskrivningen. I det tredje delarbetet undersökte jag 4833 patienter i Region Skåne i åldersintervallet 40-60 år, med åldersförändringar i meniskerna. En andel blev opererade (1736 stycken) och en andel blev inte opererade (4826 stycken) Med hjälp av data från Försäkringskassan, kunde andelen sjukskrivna beräknas från ett år före diagnos eller operationsdatum, till två år efter. Vi fann att oavsett behandling, var andelen sjukskrivna vid diagnos eller operationstillfället, relativt låg. Kvinnor hade dock mer sjukskrivning än män, oavsett behandling. Vi fann inga bevis för att de patienter som behandlats med operation, har mindre sjukskrivning jämfört med de som inte opererats.I det fjärde delarbetet undersökte jag utfallet av Socialstyrelsens nationellarekommendationer utfärdade 2012, vilka avråder från artroskopisk meniskectomi på patienter med artros. Dessa rekommendationer utgår från bevis som visat att knä artroskopi utförd på patienter med artros, inte förbättrar patienternas smärta eller funktion. Jag mätte därför andelen patienter med diagnoserna “gammal meniskskada” och artros, som blivit opererade med partiell meniskectomi, före och efter rekommendationerna. Resultatet visar på en tydlig nedgång i antalet operationer och man kan därför dra slutsatsen, att professionella rekommendationer har effekt på den kliniska verksamheten.
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| 7. |
- Bergkvist, Dan, et al.
(författare)
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Sick leave before and after arthroscopic partial meniscectomy due to traumatic meniscal tear
- 2020
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Ingår i: Osteoarthritis and Cartilage Open. - : Elsevier BV. - 2665-9131. ; 2:2
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Tidskriftsartikel (refereegranskat)abstract
- Summary Objective There is limited knowledge on sick leave associated with arthroscopic partial meniscectomy (APM) due to traumatic meniscal tear and its potential gender differences. Thus, our aim was to determine gender-specific sick leave before and after APM. Method In Skåne region, Sweden, we identified patients, aged 18–59 years diagnosed with traumatic meniscal tear without ligament injury, who had APM during 2004–2012. For each patient, we randomly sampled four age- and sex-matched reference subjects from the general population. We retrieved social insurance register data of all-cause sick leave exceeding two weeks. We analyzed the proportions and duration of sick leave with respect to days of sick leave, age, and gender. Results The cohort comprised 604 patients (29% women), mean (SD) age 40 (11) years, and 2254 reference subjects. Thirty-nine percent of women and 27% of men had a sick leave period longer than 14 days after APM. Still, we found that a new period of sick leave longer than 14 days, initiated on the day of APM (and not before), was relatively uncommon and equally distributed (15%) between women and men. Conclusion About one-third of the patients have more than 2 weeks of sick leave after APM for a traumatic meniscal tear and women are overrepresented in this category. Prolonged sick leave initiated on the day of APM was relatively uncommon. Other factors than surgery seem to explain the prolonged sick leave.
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| 8. |
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| 9. |
- Dahlberg, Leif, et al.
(författare)
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Starkt samband övervikt/obesitas och ortopediska åkommor. Fetmaepidemins konsekvenser vidgas.
- 2008
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Ingår i: Läkartidningen. - 0023-7205. ; 105:34, s. 2246-2248
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Tidskriftsartikel (refereegranskat)abstract
- t is well known that overweight/obesity are risk factors for several important conditions of internal medicine. The positive correlation between gonarthrosis and a high BMI is also well investigated. However, the possible correlation between owerweight/obesitas and other orthopaedic conditions are less well studied and are therefore rarely discussed in either medical terms or economical considerations. Objective: To examine the relationship between owerweight/obesity and orthopaedic conditions. Patient BMI was compared with a reference population BMI in two assessments. In one we investigated patients who were diagnosed with ankle fracture in the emergency room (n=79). In the other we investigated outpatients with various orthopaedic conditions (n=647). In both assessments patients were recruited in a consecutive mode. The BMI of the patients with ankle fracture was self reported as were the BMI of the normal population. The outpatients were weighted and measured. Patients with ankle fractures differed significantly from the reference population, (1.92 units (p<0.001). The fracture odds ratio of BMI>30 was 3.46 (p<0.001). Similarly, the outpatients had 1.44 higher BMI units than the references (p<0,001). Odds ratio to become an orthopaedic outpatient if BMI>30 was 2.3 (p<0.001). In both investigations results were age and gender standardised. Both studies indicate that there is a positive correlation between BMI and the risk of sustaining orthopaedic conditions. Although there may be reporting-bias, results seem prominent enough to conclude that orthopaedic conditions may be added to other medical disciplines regarding negative consequences of overweight/obesity and strengthens the need for preventive measures aimed at the epidemic progress of overweight/obesity.
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| 10. |
- de Boniface, J., et al.
(författare)
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The generalisability of randomised clinical trials: an interim external validity analysis of the ongoing SENOMAC trial in sentinel lymph node-positive breast cancer
- 2020
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Ingår i: Breast Cancer Research and Treatment. - : Springer Science and Business Media LLC. - 0167-6806 .- 1573-7217. ; 180:1, s. 167-176
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Tidskriftsartikel (refereegranskat)abstract
- Purpose None of the key randomised trials on the omission of axillary lymph node dissection (ALND) in sentinel lymph-positive breast cancer have reported external validity, even though results indicate selection bias. Our aim was to assess the external validity of the ongoing randomised SENOMAC trial by comparing characteristics of Swedish SENOMAC trial participants with non-included eligible patients registered in the Swedish National Breast Cancer Register (NKBC). Methods In the ongoing non-inferiority European SENOMAC trial, clinically node-negative cT1-T3 breast cancer patients with up to two sentinel lymph node macrometastases are randomised to undergo completion ALND or not. Both breast-conserving surgery and mastectomy are eligible interventions. Data from NKBC were extracted for the years 2016 and 2017, and patient and tumour characteristics compared with Swedish trial participants from the same years. Results Overall, 306 NKBC cases from non-participating and 847 NKBC cases from participating sites (excluding SENOMAC participants) were compared with 463 SENOMAC trial participants. Patients belonging to the middle age groups (p = 0.015), with smaller tumours (p = 0.013) treated by breast-conserving therapy (50.3 versus 47.1 versus 65.2%, p < 0.001) and less nodal tumour burden (only 1 macrometastasis in 78.8 versus 79.9 versus 87.3%, p = 0.001) were over-represented in the trial population. Time trends indicated, however, that differences may be mitigated over time. Conclusions This interim external validity analysis specifically addresses selection mechanisms during an ongoing trial, potentially increasing generalisability by the time full accrual is reached. Similar validity checks should be an integral part of prospective clinical trials. Trial registration: NCT 02240472, retrospective registration date September 14, 2015 after trial initiation on January 31, 2015
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| 11. |
- Ekström, Sara, et al.
(författare)
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Effect of Acid Deposition on Quantity and Quality of Dissolved Organic Matter in Soil-Water.
- 2011
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Ingår i: Environmental Science & Technology. - : American Chemical Society (ACS). - 1520-5851 .- 0013-936X. ; 45:11, s. 4733-4739
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore how acid deposition may affect the concentration and quality of dissolved organic matter (DOM) in soil-water. This was done by a small-scale acidification experiment during two years where 0.5 × 0.5 m(2) plots were artificially irrigated with water with different sulfuric acid content, and soil-water was sampled using zero-tension lysimeters under the O-horizon. The DOM was characterized using absorbance, fluorescence, and size exclusion chromatography analyses. Our results showed lower mobility of DOM in the high acid treatment. At the same time, there was a significant change in the DOM quality. Soil-water in the high acid treatment exhibited DOM that was less colored, less hydrophobic, less aromatic, and of lower molecular weight, compared to the low acid treatment. This supports the hypothesis that reduction in sulfur deposition is an important driver behind the ongoing brownification of surface waters in many regions.
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| 12. |
- Friberg, Hanna, et al.
(författare)
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Preceding crop and tillage system affect winter survival of wheat and the fungal communities on young wheat roots and in soil
- 2019
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Ingår i: FEMS Microbiology Letters. - : Oxford University Press (OUP). - 0378-1097 .- 1574-6968. ; 366
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Tidskriftsartikel (refereegranskat)abstract
- Agricultural practices like tillage and cropping sequence have profound influence on soil-living and plant-associated fungi, and thereby on plant growth. In a field experiment, we studied the effects of preceding crop and tillage on fungal communities in the soil and on young winter wheat roots in relation to plant winter survival and grain yield. We hypothesized that plant performance and fungal communities (described by amplicon sequencing) differ depending on tillage system and preceding crop; that the effect of preceding crop differs depending on tillage system, and that differences in fungal communities are reflected in plant performance. In line with our hypotheses, effects of preceding crop on plant growth and fungal communities on plant roots and in soil were more pronounced under non-inversion tillage than under inversion tillage (ploughing). Fungal communities on plant roots in treatments with low winter survival were different from those with better survival. In soil, several fungal OTUs (operational taxonomic units) differed significantly between tillage systems. OTUs representing putative plant pathogens were either more abundant (Parastagonospora sp._27) or less abundant (Fusarium culmorum/graminearum 5) after non-inversion tillage. Our findings highlight the influence of cultural practices on fungal communities and thereby on plant health and yield.
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| 13. |
- Kiadaliri, Ali, et al.
(författare)
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Impact of a national guideline on use of knee arthroscopy : An interrupted time-series analysis
- 2019
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Ingår i: International Journal for Quality in Health Care. - : Oxford University Press (OUP). - 1464-3677 .- 1353-4505. ; 31:9, s. 113-118
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess the impact of the Swedish health authority recommendation against the use of knee arthroscopy in patients aged ≥40 years with knee osteoarthritis (OA).DESIGN: Interrupted time series analysis.SETTING: Public health care in Skåne region.PARTICIPANTS: Patients aged ≥40 years who underwent knee arthroscopy from January 2010 to December 2015.INTERVENTION(S): National guideline's recommendation against the use of knee arthroscopy in patients with knee OA.MAIN OUTCOME MEASURE(S): 1) proportion of patients aged ≥40 years with a main diagnosis of Knee OA and/or degenerative meniscal lesions (DML) who underwent knee arthroscopy, and 2) overall knee arthroscopy rate per 100,000 Skåne population aged ≥40 years.RESULTS: A total of 6,155 knee arthroscopy were performed among people aged ≥40 years during study period. Of 42,044 patients with Knee OA/DML, 3,728 had knee arthroscopy. The recommendation was associated with reductions in the use of knee arthroscopy and two years after the recommendation, there was a reduction of 28.6% (95% CI: 9.3, 47.8) and 34.7% (23.9, 45.4) in proportion of Knee OA/DML patients with knee arthroscopy and the overall knee arthroscopy rate, respectively, relative to that expected if pre-recommendation trend continued. Our sensitivity analysis showed that the use of total knee replacement was stable over the study period.CONCLUSION: The national recommendation was associated with reduction in use of knee arthroscopy in public health care in southern Sweden. However, still 4.5% of these patients underwent knee arthroscopy in 2015 implying that more efforts are required to achieve the recommended target.
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| 14. |
- Moberg, Christina, et al.
(författare)
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De unga gör helt rätt när de stämmer staten : 1 620 forskare och lärare i forskarvärlden: Vi ställer oss bakom Auroras klimatkrav
- 2022
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Ingår i: Aftonbladet. - : Aftonbladet. ; :2022-12-07
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Vi, 1 620 forskare samt lärare vid universitet och högskolor, är eniga med de unga bakom Auroramålet: De drabbas och riskerar att drabbas allvarligt av klimatkrisen under sin livstid. De klimatåtgärder vi vidtar i närtid avgör deras framtid. Sverige måste ta ansvar och göra sin rättvisa andel av det globala klimatarbetet. I strid med Parisavtalet ökar utsläppen av växthusgaser i en takt som gör att 1,5-gradersmålet kan överskridas om några år. De globala effekterna blir allt mer synliga med ständiga temperaturrekord, smältande isar, havshöjning och extremväder som torka, förödande bränder och skyfall med enorma översvämningar, som i Pakistan nyligen. Försörjningen av befolkningen utsätts för allvarliga hot i många länder.Minskningen av den biologiska mångfalden är extrem. Klimatkrisen är enligt WHO det största hotet mot människors hälsa i hela världen och barn utgör en särskilt sårbar grupp. Med Sveriges nordliga läge sker uppvärmningen här dubbelt så fort som det globala genomsnittet. Det förskjuter utbredningsområden för växtlighet och sjukdomsbärande insekter och ökar förekomsten av extremväder såsom värmeböljor, skogsbränder och översvämningar samt av många olika sorters infektioner och allergier. När extremväder ökar, ökar även stressen och risken för mental ohälsa. Värmeböljor ökar risken för sjukdom och död hos sårbara grupper som äldre, små barn och personer med kroniska sjukdomar. De negativa effekterna på hälsan kommer att öka i takt med klimatkrisen och barn riskerar att drabbas av ackumulerade negativa hälsoeffekter under hela sina liv. Redan i dag är mer än hälften av unga mellan 12 och 18 år i Sverige ganska eller mycket oroliga för klimat och miljö. Detta är förståeligt när våra beslutsfattare inte gör vad som krävs.Den juridiska och moraliska grunden för arbetet mot klimatförändringarna är att varje land måste göra sin rättvisa andel av det globala klimatarbetet. Centralt i det internationella klimatramverket är att rika länder med höga historiska utsläpp, däribland Sverige, måste gå före resten av världen. Dessa länder måste också bidra till att finansiera klimatomställningen i länderna i det Globala Syd, som är minst ansvariga för klimatkrisen men drabbas hårdast. Denna rättviseprincip är tydlig i Parisavtalet och var en het diskussionsfråga under COP27 i Sharm el-Sheikh, men lyser med sin frånvaro i det svenska klimatarbetet. Sverige har satt mål för att minska sina utsläpp. Men de är helt otillräckliga: minskningstakten är för låg och målen tillåter samtidigt att åtgärder skjuts på framtiden. Dessutom exkluderas merparten av Sveriges utsläpp från de svenska nationella utsläppsmålen; bland annat utelämnas utsläpp som svensk konsumtion orsakar utanför Sveriges gränser, utsläpp från utrikes transporter och utsläpp från markanvändning och skogsbruk, exempelvis utsläpp från förbränning av biobränslen eller utsläpp från dikade våtmarker (Prop. 2016/17:146 s.25-28).Sverige saknar dessutom ett eget mål för att öka upptaget av växthusgaser genom utökat skydd och restaurering av ekosystem, något som krävs för att begränsa de värsta konsekvenserna av klimatkrisen (IPCC s.32). Trots dessa låga ambitioner misslyckas Sverige med att nå sina utsläppsmål, konstaterar både Klimatpolitiska rådet och Naturvårdsverket. En klimatpolitik i linje med Parisavtalet kräver både att alla typer av växthusgasutsläpp minskar samtidigt som – inte i stället för – upptaget av växthusgaser maximeras: i dag misslyckas Sverige på bägge fronter.Slutsatsen är tydlig. Sverige vidtar inte de åtgärder som krävs för att skydda barns och ungdomars rättigheter enligt Europakonventionen till skydd för de mänskliga rättigheterna. Detta medför allvarliga risker för liv och hälsa för unga generationer, människor i andra länder och särskilt utsatta grupper. Detta kan inte fortsätta. Därför ställer vi oss bakom Auroras krav att Sverige börjar göra sin rättvisa andel och omedelbart sätter igång ett omfattande och långtgående klimatarbete som vilar på vetenskaplig grund och sätter rättvisa i centrum.
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| 15. |
- Wenger, Daniel, et al.
(författare)
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Fewer reoperations after posterolateral plate positioning compared with lateral plate positioning in ankle fractures—a retrospective study on 453 AO/OTA 44-B injuries
- 2021
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Ingår i: Injury. - : Elsevier BV. - 0020-1383. ; 52:7, s. 1999-2005
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Ankle fractures are commonly treated by open reduction and internal fixation with plate and screws. Unplanned return to theatre is common, in many cases to extract prominent osteosynthesis material from the lateral malleolus as swelling subsides. We hypothesised that patients operated with a posterolateral plate placement on the lateral malleolus would have fewer reoperations, and fewer complications, compared to patients with a lateral plate placement. Materials and Methods: From a prospectively collected database of all orthopaedic surgery performed at our institution, we identified 664 ankle fractures undergoing plate fixation between 2008-01-01 and 2012-04-30. Radiographs were analysed to only include AO/OTA 44-B-fractures (n = 453), and to define study groups based on plate positioning. Hospital files were assessed to identify possible confounding factors, and any unplanned reoperation or complication. Complications were classified according to Dindo-Clavien. Results: The risk of reoperation was 13% after posterolateral plating, compared with 24% after lateral plating; absolute risk reduction 10% (95% CI: 2.5–18), p = 0.02. After adjusting for possible confounders, the odds ratio of undergoing reoperation after lateral plating was 2.2 (95% CI: 1.17–4.1), p = 0.01. The two surgical methods did not differ with regard to complication frequency: 31% vs 34%, p = 0.6, but complications following lateral plate fixation were more serious, p = 0.03. Plate positioning depended on surgeon preference. Discussion: The two studied methods are both considered standard treatment of ankle fractures, and relatively simple surgical procedures. High rates of secondary surgery after plate fixation have been reported, but no study comparing plate positioning has been previously published to our knowledge. AO Sweden has recently switched to teaching posterolateral plating in group exercises during the AO Basic Fracture Surgery course, based on the belief that it may be safer than lateral plating. Our findings support this change in practice. Conclusions: Posterolateral plate positioning on the lateral malleolus in AO/OTA 44-B-fractures may be preferential to lateral plate positioning, due to a large difference in unplanned secondary surgery.
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| 16. |
- Åkerblom, Staffan, et al.
(författare)
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Partitioning of Hg between solid and dissolved organic matter in the humus layer of boreal forests
- 2008
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Ingår i: Water, Air and Soil Pollution. - : Springer Science and Business Media LLC. - 1573-2932 .- 0049-6979. ; 189:1-4, s. 239-252
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Tidskriftsartikel (refereegranskat)abstract
- The mobility of mercury (Hg) deposited on soils controls the concentration and toxicity of Hg within soils and in nearby streams and lakes, but has rarely been quantified under field conditions. We studied the in situ partitioning of Hg in the organic top layer (mor) of podsols at two boreal forest sites differing in Hg deposition and climatic regime (S. and N. Sweden, with pollution declining to the north). Soil solution leaching from the mor layer was repeatedly sampled using zero-tension lysimeters over 2 years, partly in parallel with tension lysimeters. Concentrations of Hg and dissolved organic carbon (DOC) were higher while pH was lower at the southern site (means +/- SD: Hg=44 +/- 15 ng L-1, DOC=63.0 +/- 31.3 mg L-1, pH=4.05 +/- 0.53) than at the northern site (Hg=22 +/- 6 ng L-1, DOC=41.8 +/- 12.1 mg L-1, pH=4.28 +/- 0.43). There was a positive correlation over time between dissolved Hg and DOC at both sites, even though the DOC concentration peaked during autumn at both sites, while the Hg concentration remained more constant. This correlation is consistent with the expected strong association of Hg with organic matter and supports the use of Hg/C ratios in assessments of Hg mobility. In the solid phase of the overlying O-f layer, both Hg concentrations and Hg/C ratios were higher at the southern site (means +/- SD: 0.34 +/- 0.06 mu g g(-1) dw and 0.76 +/- 0.14 mu g g(-1) C, respectively) than at the northern site (0.31 +/- 0.05 mu g g(-1) dw and 0.70 +/- 0.12 mu g g(-1) C, respectively). However, concentrations in the solid phase differed less than might be expected from the difference in current atmospheric input, suggesting that the fraction of natural Hg is still substantial. At both sites, Hg/C ratios in the upper half of the mor layer were only about two thirds of those in the lower half, suggesting that the recent decrease in anthropogenic Hg deposition onto the soil is offset by a natural downward enrichment of Hg due to soil decomposition or other processes. Most interestingly, comparison with soil leachate showed that the average Hg/C ratios in the dissolved phase of the mor layers at both sites did not differ from the average Hg/C ratios in the overlying solid organic matter. These results indicate a simple mobilisation with negligible fractionation, despite differences in Hg deposition patterns, soil chemistry and climatic regimes. Such a straight-forward linkage between Hg and organic matter greatly facilitates the parameterisation of watershed models for assessing the biogeochemical fate, toxic effect and critical level of atmospheric Hg input to forest soils.
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