| 1. |
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| 2. |
- Enblom, Anna, et al.
(author)
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Radiotherapy-induced Emesis in Patients Treated with Acupuncture, Sham Acupuncture or Standard Care : Effects of Unspecific Acupuncture Mechanisms
- 2010
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Journal article (other academic/artistic)abstract
- Background: It is not known if acupuncture or sham reduces radiotherapy-induced emesis more than standard care. Methods: Cancer patients were randomized to verum (skin penetrating) acupuncture (n = 109) in the alleged antiemetic acupuncture point PC6 or sham acupuncture (n = 106) performed with a telescopic nonpenetrating needle at a sham point during the whole radiotherapy period. The verum and sham treated patients were compared to a reference cohort receiving standard care only (n = 62). All patients received radiotherapy over abdominal or pelvic regions. The occurrence of emesis in each group was compared using replies documented in questionnaires after a mean dose of 27 Gray. Findings: Nausea (p=0.001) and vomiting were experienced during the preceding week by 37 and 7%, respectively, in the verum group, 38 and 7% in the sham group and 63 and 15% in the standard care group. The nausea intensity in the acupuncture cohort was lower (78% no nausea, 13% a little, 8% moderate, 1% much) compared to the standard care cohort (52% no nausea, 32% a little, 15% moderate, 2% much) (p=0.002). Almost all the verum and sham treated patients (95%) expected antiemetic effects from their treatment. Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (relative risk 1.6; 95 % confidence interval 1.2-2.4). Interpretations: Both verum acupuncture and nonpenetrating sham acupuncture seem to reduce nausea and vomiting during radiotherapy, possibly by psychobiological mechanisms related to the extra care and expectancy.
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| 3. |
- Börjeson, Lowe, 1968-
(author)
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A History under Siege : Intensive Agriculture in the Mbulu Highlands, Tanzania, 19th Century to the Present
- 2004
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Doctoral thesis (other academic/artistic)abstract
- This doctoral thesis examines the history of the Iraqw’ar Da/aw area in the Mbulu Highlands of northern Tanzania. Since the late nineteenth century this area has been known for its intensive cultivation, and referred to as an “island” within a matrix of less intensive land use. The conventional explanation for its characteristics has been high population densities resulting from the prevention of expansion by hostility from surrounding pastoral groups, leading to a siegelike situation. Drawing on an intensive programme of interviews, detailed field mapping and studies of aerial photographs, early travellers’ accounts and landscape photographs, this study challenges that explanation. The study concludes that the process of agricultural intensification has largely been its own driving force, based on self-reinforcing processes of change, and not a consequence of land scarcity.
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| 4. |
- de Bont, Chris, 1990-
(author)
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Modernisation and farmer-led irrigation development in Africa : A study of state-farmer interactions in Tanzania
- 2018
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Doctoral thesis (other academic/artistic)abstract
- After years of relatively low investment, irrigation development in Africa has been put back on the policy agenda as a way of increasing agricultural productivity. In spite of existing evidence of farmers’ irrigation initiatives across the African continent, current policy prescriptions still revolve around (large-scale) state intervention. Farmers’ irrigation initiatives are generally considered traditional, backward, and unable to contribute to the agrarian transformation that many African nations are after.This study aims to problematize this narrow notion of farmers’ irrigation initiatives, and explores how underlying ideas of modernity/modernisation influence irrigation policies and interactions between farmers and the state. Focusing on Tanzania, this thesis consists of an introductory chapter and three separate studies.The first study is a historical analysis of the state’s attitude towards irrigation development and farmers’ irrigation initiatives in Tanzania. It shows how historically, the development narrative of ‘modern’ irrigation as a driver for agricultural transformation has been successful in depoliticizing irrigation interventions and their actual contribution to development.The second study engages with a case where farmers have developed groundwater irrigation. The study analyses how differentiated access to capital leads to different modes of irrigated agricultural production, and shows the variation between and within farmers’ irrigation initiatives. It also illustrates how an irrigation area that does not conform to the traditional/modern policy dichotomy is invisible to the government.The third study concerns a farmer-initiated gravity-fed earthen canal system. It shows how the implementation of a demand-driven irrigation development policy model can (inadvertently), through self-disciplining by farmers and a persistent shared modernisation aspiration, turn a scheme initiated and managed by farmers into a government-managed scheme, without actually improving irrigation practices.Together, these studies show how modernisation thinking has pervaded irrigation development policy and practice in Tanzania, influencing both the state’s and farmers’ actions and attitudes, often to the detriment of farmers’ irrigation initiatives.
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| 5. |
- Ekendahl, Mats, 1971-
(author)
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Tvingad till vård : missbrukares syn på LVM, motivation och egna möjligheter
- 2001
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Doctoral thesis (other academic/artistic)abstract
- Compulsory treatment is regulated by the Care of Alcoholics and Drug Abusers Act (LVM; 1988:870), and aims, among other things, at motivating addicts to treatment. Research has, up til now, mostly disregarded the client-perspective on compulsory measures. This dissertation has its starting point in the experiences of 54 alcohol- and drug addicts. The intention is to describe and analyse their view on coercive care and the possibilities to become motivated for change and/or voluntary treatment in such a context.A central question during the interviews (which took place at five different institutions for compulsory commitments) is the addicts´ problem recognition, desire for help and willingness to participate in treatment. These dimensions are also illuminated quantitatively by use of a questionnaire. The results of this questionnaire form the basis of a division of the addicts into three groups with varying de-gree of treatment motivation. Comparisons between the groups are done with reference to the evaluation of present treatment context and of the institutions’ efforts to enhance motivation. In addition to this the groups are compared regarding how they perceive limita-tions in their freedom of action.The results showed that the three groups had different motiva-tional structures. The “least motivated” stated that the addiction was not their major problem and wanted no help with that aspect of their lives. The “middle-group” claimed to have alcohol-/drug problems that, however, were not too serious. They were not sure that the coercive care was adequate for their situation. The “most motivated” said that they had vast problems with their addiction, were help-seeking and satisfied with having the chance to participate in any kind of treatment program at all. Less differences between the groups were noticeable when it came to a direct evaluation of com-pulsory treatment. The majority reported that they, through the co-ercion, had been exposed to violations of their autonomy. Whether motivated for treatment or not, the interviewees were also sceptical about the possibilities of the institutions to enhance motivation among the incarcerated addicts.In the dissertation, addiction and motivation is furthermore dis-cussed from the perspective of rational choice and motivational the-ory. It is concluded that committed addicts think and act strategically in order to maximise their personal use of involuntary incarcerations. It is also asserted that their view on what happens during commit-ment, in some respects, is opposed to the “establishment’s”. For instance, the addicts claim that you don’t become motivated by way of compulsory treatment, while the opposite of their notion form the basis of the legislation.
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| 6. |
- Enblom, Anna, 1978-, et al.
(author)
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Acupuncture compared with placebo acupuncture in radiotherapy-induced nausea - a randomized controlled study.
- 2012
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In: Annals of oncology. - : Elsevier BV. - 1569-8041 .- 0923-7534. ; 23:5, s. 1353-1361
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Journal article (peer-reviewed)abstract
- BACKGROUND: It is not known if verum (real) acupuncture is effective for nausea and vomiting (emesis) during radiotherapy. PATIENTS AND METHODS: We randomly treated 215 blinded cancer patients with verum: penetrating 'deqi' creating acupuncture (n = 109) or non-penetrating sham needles (n = 106) two to three times per week. The patients documented emesis daily during the radiotherapy period. Primary end point was the number of patients with at least one episode of nausea. RESULTS: In the verum and the sham acupuncture group, 70% and 62% experienced nausea at least once during the radiotherapy period (relative risk 1.1, 95% CI 0.9-1.4) for a mean number of 10.1 and 8.7 days. Twenty five percent and 28% vomited, and 42% and 37% used antiemetic drugs at least once, respectively. Ninety-five percent in the verum acupuncture group and 96% in the sham acupuncture group believed that the treatment had been effective against nausea. In both groups, 67% experienced positive effects on relaxation, mood, sleep or pain reduction and 89% wished to receive the treatment again. CONCLUSION: Acupuncture creating deqi is not more effective than sham in radiotherapy-induced nausea, but in this study, nearly all patients in both groups experienced that the treatment was effective for nausea.
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| 7. |
- Enblom, Anna, 1978-, et al.
(author)
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Can individuals identify if needling was performed with an acupuncture needle or a non-penetrating sham needle?
- 2008
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In: Complementary Therapies in Medicine. - : Elsevier BV. - 0965-2299 .- 1873-6963. ; 16:5, s. 288-94
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Journal article (peer-reviewed)abstract
- A control treatment in acupuncture research must be credible, regardless if the needling is performed by one or by several therapists.Objective: To investigate if individuals could identify whether needling had been given with an acupuncture needle or a sham needle and if the therapist influenced this ability.Design: Eighty individuals were randomized to one single needling given by one of four physiotherapists using either an invasive needle or a non-penetrating telescopic sham needle.Results: An equal proportion of individuals, 27 (68%), in the acupuncture group and the sham group answered incorrectly or was not sure at all regarding needling type but the proportion varied between the therapists from 55 to 80% (ns). Bang's blinding index was 0.20 (95% CI 0.03-0.36) in the acupuncture group and 0.10 (95% CI 0.09-0.29) in the sham group (interpretation: 20 and 10% identified needling type beyond statistical chance). Acupuncture was on a four-grade scale rated as median "mildly painful" and sham as "not painful" (ns). Pain ratings varied from median "not" to "mildly painful" in the therapists (p = 0.01).Conclusions: Two thirds of individuals needled by acupuncture as well as sham could not identify needling type and only 10-20% of the individuals were unblinded beyond chance. The therapists, not the needling type, influenced how painful the needling was perceived. IMPLICATIONS: To achieve blinding success in acupuncture efficacy studies using the sham needle, the needling procedure must be strictly standardized in order to minimize differences between the therapists.
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| 8. |
- Enblom, Anna, 1978-
(author)
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Nausea and vomiting in patients receiving acupuncture, sham acupuncture or standard care during radiotherapy
- 2008
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Doctoral thesis (other academic/artistic)abstract
- Background and aim: Many patients with cancer experience emesis (nausea and vomiting) during radiotherapy. The overall aim of this thesis was to improve the situation for patients with risk for emesis during radiotherapy, by evaluating emesis in patients receiving verum (genuine) acupuncture, sham (simulated) acupuncture or standard care during radiotherapy.Methods: In study I, a cross-sectional sample (n=368) treated with radiotherapy over various fields answered a study-specific questionnaire. In study II, 80 healthy volunteers were randomized to receive needling with verum acupuncture or non-penetrating telescopic sham needles by one of four physiotherapists. In study III, 215 patients were randomly allocated to verum (n=109) or non-penetrating telescopic sham (n=106) acupuncture during their entire radiotherapy period over abdominal or pelvic fields. The same 215 patients were also included in study IV. They were compared to 62 patients irradiated over abdominal or pelvic fields, selected from study I.Results: In study I, the weekly prevalence of nausea was 39 % in all radiotherapy-treated patients and 63 % in abdominal or pelvic irradiated patients. Age younger than 40 years and previous experience of nausea in other situations were characteristics associated with an increased risk for nausea. Of the 145 nauseous patients, 34 % considered their antiemetic treatment as insufficient. Patients with nausea reported lower level of quality of life compared to patients free from nausea. In study II, most individuals needled with verum (68 %) or sham (68 %) acupuncture could not identify needling type, and that blinding result varied from 55 to 80 % between the four therapists. In study III, nausea was experienced by 70 % (mean number of days=10.1) and 25 % vomited during the radiotherapy period. In the sham group 62 % experienced nausea (mean number of days=8.7) and 28 % vomited. Ninety five percent in the verum and 96 % in the sham group believed that the treatment had been effective for nausea. In both groups, 67 % experienced other positive effects, on relaxation, mood, sleep or pain-reduction, and 89 % were interested in receiving the treatment again. In study IV, the weekly prevalence of nausea and vomiting was 38 and 8 % in the verum group, 37 and 7 % in the sham group and 63 and 15 % in the standard care group. The nausea difference between the acupuncture and the standard care cohort was statistically significant, also after overall adjustments for potential confounding factors. The nausea intensity in the acupuncture cohort was lower compared to the standard care cohort (p=0.002). Patients who expected nausea had increased risk for nausea compared to patients who expected low risk for nausea (Relative risk 1.6).Conclusions and implications: Nausea was common during abdominal or pelvic field irradiation in patients receiving standard care. Verum acupuncture did not reduce emesis compared to sham acupuncture, while reduced emesis was seen in both patients treated with verum or sham acupuncture. Health-care professionals may consider identifying and treating patients with increased risk for nausea in advance. The telescopic sham needle was credible. Researchers may thus use and standardize the sham procedure in acupuncture control groups. The choice of performing acupuncture during radiotherapy cannot be based on arguments that the specific characters of verum acupuncture have effects on nausea. It is important to further study what components in the acupuncture procedures that produce the dramatic positive but yet not fully understood antiemetic effect, making it possible to use those components to further increase quality of care during radiotherapy.
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| 9. |
- Enblom, Anna, et al.
(author)
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One third of patients with radiotherapy-induced nausea consider their antiemetic treatment insufficient
- 2009
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In: Supportive Care in Cancer. - : Springer. - 0941-4355 .- 1433-7339. ; 17:1, s. 23-32
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Journal article (peer-reviewed)abstract
- Objective: To describe the prevalence of nausea and vomiting during radiotherapy and to compare quality of life, psychological and functional status in patients experiencing or not experiencing nausea.Materials and methods: A cross-sectional selection of 368 cancer patients treated with radiotherapy answered a questionnaire (=93% answering rate) regarding nausea, vomiting, actual use of and interest in antiemetic treatment, quality of life and psychological and functional status during the preceding week of radiotherapy. Mean age was 60 years and 66% were women.Main results: Nausea was experienced by 39% ( 145) and vomiting by 7% ( 28) of patients in general, by 63% in abdominal or pelvic fields and by 48% in head/neck/brain fields. Abdominal/pelvic field (Relative risk (RR) 2.0), age <= 40 years (RR 1.9) and previous nausea in other situations (RR 1.8) implied an increased risk for nausea. Antiemetics were used by 17% and 78% were interested in or wanted more information about acupuncture treatment against nausea. Of the 145 nauseous patients only 25% felt that antiemetics had helped them and 34% would have liked additional treatment, although the nausea intensity was mild in 72%. The nauseous patients reported lower well-being and quality of life, lower satisfaction with aspects of daily living and more frequent anxiety and depressed mood than the patients without nausea.Conclusions: Of all patients undergoing radiotherapy, 39% experienced nausea and one third of them would have liked more treatment against the nausea. This study stresses the importance to identify and adequately treat patients with increased risk for nausea related to radiotherapy.
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| 10. |
- Enblom, Anna, et al.
(author)
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Pilot testing of methods for evaluation of acupuncture for emesis during radiotherapy: a randomised single subject experimental design
- 2011
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In: ACUPUNCTURE IN MEDICINE. - : The British Medical Acupuncture Society. - 0964-5284 .- 1759-9873. ; 29:2, s. 94-102
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Journal article (peer-reviewed)abstract
- Background Many acupuncture studies are of weak methodological quality, possibly due to lack of pilot testing. This pilot study tested design features, including test of feasibility, compliance to treatment and data collection, level of blinding success and the patients potential perceived effects of the treatment, in preparation for an efficacy study. Method A modified single subject experimental design was conducted. 10 cancer patients were randomised to verum penetrating acupuncture or non-penetrating sham needles for 30 min 2-3 times/week during radiotherapy over abdomen/pelvis. They answered test-retested emesis questions (r=0.527-1.0) covering nausea, vomiting, use of antiemetics, wellbeing and activities of daily living. Results Overall, the patients completed 98% of the 345 emesis-questionnaire days and 101 of the 115 offered treatments. All patients believed they received verum acupuncture. 10 patients experienced antiemetic effects, seven relaxation, five pain-reduction and five experienced sleep improvement. Two types of nausea questions showed absolute concordance (r=1.0) (n of observations=456). Nausea was experienced by one of five verum acupuncture treated patients (duration median 0% of the radiotherapy-days) and four of five sham acupuncture treated patients (duration median 24% of the radiotherapy-days). Patients experiencing nausea rated decreased wellbeing and performance of daily activities compared to patients free from nausea. Conclusions All patients were blinded, complied with verum/sham treatments and data-collection, and believed they had effects of the received treatment. The methods for verum/sham treatment and data collection may thus be used in an adequately powered randomised controlled study of the effect of acupuncture for radiotherapy-induced emesis.
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| 11. |
- Enblom, Anna, et al.
(author)
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Reduced Need for Rescue Antiemetics and Improved Capacity to Eat in Patients Receiving Acupuncture Compared to Patients Receiving Sham Acupuncture or Standard Care during Radiotherapy
- 2017
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In: Evidence-Based Complementary and Alternative Medicine. - : Hindawi Limited. - 1741-427X .- 1741-4288.
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Journal article (peer-reviewed)abstract
- Objective. To evaluate if consumption of emesis-related care and eating capacity differed between patients receiving verum acupuncture, sham acupuncture, or standard care only during radiotherapy. Methods. Patients were randomized to verum(n = 100) or sham (n = 100) acupuncture (telescopic blunt sham needle) (median 12 sessions) and registered daily their consumption of antiemetics and eating capacity. A standard care group (n = 62) received standard care only and delivered these data once. Results. More patients in the verum (n = 73 of 89 patients still undergoing radiotherapy; 82%, Relative Risk (RR) 1.23, 95% Confidence Interval (CI) 1.01-1.50) and the sham acupuncture group (n = 79 of 95; 83%, RR 1.24, CI 1.03-1.52) did not need any antiemetic medications, as compared to the standard care group (n = 42 out of 63; 67%) after receiving 27 Gray dose of radiotherapy. More patients in the verum (n = 50 of 89; 56%, RR 1.78, CI 1.31-2.42) and the sham acupuncture group (n = 58 of 94 answering patients; 62%, RR 1.83, CI 1.20-2.80) were capable of eating as usual, compared to the standard care group (n = 20 of 63; 39%). Conclusion. Patients receiving acupuncture had lower consumption of antiemetics and better eating capacity than patients receiving standard antiemetic care, plausible by nonspecific effects of the extra care during acupuncture.
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| 12. |
- Enblom, Anna, et al.
(author)
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The Nonpenetrating Telescopic Sham Needle may Blind Patients with Different Characteristics and Experiences when Treated by several Therapists.
- 2011
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In: Evidence-based Complementary and Alternative Medicine. - : Hindawi Publishing Corporation. - 1741-427X .- 1741-4288. ; , s. 1-12
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Journal article (peer-reviewed)abstract
- Background. Little is known which factors influence the blinding in acupuncture studies. Aim. To investigate if blinding variedbetween patients with different characteristics receiving verum or sham acupuncture. Methods. We randomised cancer patientsto verum (n = 109) or sham acupuncture (n = 106) with a nonpenetrating telescopic sham needle for nausea. Level of blindingwas compared between different sub-groups of patients using Bang’s blinding index (BI) ranged −1 to 1 (−1 = all state theopposite treatment, 1 = all identify treatment). Results. Most patients in the verum (74 of 95; 78%, BI 0.72) and the sham (68 of95; 72%, BI −0.60). acupuncture group believed they had received verum acupuncture. The probability for a patient to believehe/she received verum acupuncture was related to the received needling type (P = .003) and to the patient’s belief in receivedtreatment effects (P = .008). Hospital (P = .425), therapist (P = .434), previous acupuncture experience (P = .578), occurrenceof nausea (P = .157), gender (P = .760), and age (P = .357) did not affect blinding. Conclusions. Blinding was successfullyachieved irrespective of age, gender, acupuncture experience, treatment effect, or in which hospital or by which therapist thepatient received treatment. Patients with higher belief in the effect of the treatment were more likely to believe they had receivedverum acupuncture.
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| 13. |
- Holmgren, Karin, et al.
(author)
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The vulnerable continent (PLATINA) : Historical perspectives on Africa´s climate, environment and societies
- 2009
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In: Meeting global challenges in research cooperation. - Uppsala : Uppsala University. - 9789197574198 ; , s. 585-596
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Conference paper (peer-reviewed)abstract
- Our research, based on studies of different climate archives from Tanzania, Mozambique and South Africa, contributes information on changes in climate and vegetation over the past 24000 years. This time perspective, reaching beyond the information available from instrumental records is needed for a better understanding of regional global climate dynamics and issues surrounding environmental change, throughout Africa, and is a prerequisite for increasing climate forecasting capabilities for the region. We argue that African people have vast experience from living in a variable climate and research on past interactions between climate and societies demonstrate the significance of lessons learnt for present situations. Our findings, underline the complex interactions between climate/environment and societies that may lead to different developments in time and space. Considering the so called vulnerable continent, extended investigations of how African communities cope with and adapt to climatically driven changes is needed to increase the capability to realise the potential as well as the limitations, of modern African communities to adapt to future climate change.
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| 14. |
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| 15. |
- Lundström, Staffan, et al.
(author)
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Aspects of delayed chemotherapy-induced nausea : Dexamethasone and adrenal response patterns in patients and healthy volunteers
- 2000
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In: Supportive Care in Cancer. - : Springer. - 0941-4355 .- 1433-7339. ; 8:5, s. 431-434
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Journal article (peer-reviewed)abstract
- Delayed chemotherapy-induced nausea is still a clinical problem, and the underlying mechanisms are poorly understood. Previous studies have suggested that corticosteroids are involved, although the mechanisms by which corticosteroids exert their anti-emetic effect are largely unknown. We have previously found impaired control of delayed nausea after injection of dexamethasone. The possibility of differences in the recovery of the hypothalamic-pituitary-adrenal (HPA) axis after injection of dexamethasone was investigated in patients (n = 5) with gynaecological cancer being treated with platinum-based chemotherapy and in healthy female volunteers (n = 10). Urinary free cortisol was used to assess the levels of endogenous cortisol. Results showed that in both patients and controls injections of dexamethasone led to a significant decline in endogenous cortisol levels in 24 h and a subsequent significant recovery in the next 24 h. We conclude that the recovery of the HPA axis is rapid after a single dose of dexamethasone in patients and controls. The absence of an abnormal response pattern in patients makes it probable that the suppression and recovery of the HPA axis after injection of dexamethasone does not influence the corticosteroid-induced rebound effect on delayed platinum-induced nausea.
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| 16. |
- Pas Schrijver, Annemiek, 1985-
(author)
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Pastoralists, Mobility and Conservation : Shifting rules of access and control of grazing resources in Kenya's northern drylands
- 2019
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Doctoral thesis (other academic/artistic)abstract
- Pastoral mobility is seen as the most effective strategy to make use of constantly shifting resources. In northern Kenya, mobile pastoralism as a highly-valued strategy to manage grazing areas and exploit resource variability is becoming more complex. Policy and project implementation has historically been driven by the imperative to secure land tenure and improve pasture in bounded areas through State-led settlement schemes. Relatively recently, increased (inter)national interests in nature and wildlife conservation on community land in the northern pastoralist regions see conservation and development as crucial and urgent requirements for stimulating economic growth and security. This study presents the case of Samburu pastoral mobility within the context of such shifting social and environmental circumstances. It focuses on changing rules of access and control of livestock resources. These transformations are analysed in the context of the large-scale establishment of community conservancies and what role these conservancies play in the actual use and transformation of space for pastoralists. Empirically, this thesis is based on a total of eighteen months fieldwork including semi-structured interviews and observations in Samburu, Isiolo and Laikipia. It demonstrates how the principal of reciprocal access to pasture between pastoralists is giving way to conditional access based on membership of more formal, territory-based institutions such as community conservancies. It further shows how access to private land may be open for negotiation through the formation of grazing arrangements, which are also used to control pastoralists’ movements beyond enclosed land. In spite of a rhetoric acknowledging the multiple benefits of livestock mobility, current policy entails a continuation of past policy and project implementation where prescriptions still revolve around conservation enclosures and settlement politics. The thesis concludes that such processes of territoriality are likely to produce unexpected and potentially disappointing outcomes, while struggle and conflict persist.
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| 17. |
- Widgren, Mats, 1948-, et al.
(author)
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Introduction: Historical and Regional Perspectives on Landscape Transformations in Northeastern Tanzania, 1850-2000
- 2008
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In: International Journal of African Historical Studies. - Boston : African Studies Centre. - 0361-7882 .- 2326-3016. ; 41:3, s. 369-382
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Journal article (peer-reviewed)abstract
- The article focuses on the historical and regional views on landscape shift in northeastern Tanzania from 1850-2000. It highlights several perspectives on the impact of landscape transformation towards the social relation in the northeastern part of the country. Specifically, it discusses how regional historical method to land cover changes offers an analytical field to bridge social gap. It primarily considers the perspectives of a group of scholars, centering on their views on human-environmental relationships and political economy. In addition, it explores the history and spatial interactions in the region, regarding as well the economic determinants of land use.
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