| 1. |
- Hellstrand, Stefan, 1955, et al.
(författare)
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A new approach to quantifying the sustainability effects of healthcare: Applied to the diabetic foot
- 2019
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Ingår i: The Foot and Ankle Online Journal. - 1941-6806. ; 12:3
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Tidskriftsartikel (refereegranskat)abstract
- A vital role for any society is to deliver health care considering: 1) the planetary boundaries, 2) the complexity of systems and 3) the 17 sustainable development goals (SDGs). The aim is to explore the feasibility of a method to quantify the sustainability effects in health-care services. A toolbox was explored in the prevention and care of foot complications in diabetes. People with diabetes run the risk of developing foot ulcers and undergoing amputations. Three relationships between ecosystems and human health and health-care systems were identified as: (i) The economic resources for health care have previously appropriated ecological resources in the economic process. (ii) Health-care systems consume natural resources. (iii) Ecosystems and the landscape affect human well-being. Some types of landscape support human well-being, while others do not. This category also includes the impact of emissions on human health. Diabetes is one of the non-communicable diseases with high mortality and foot complications. With health-promoting interventions, the risk of developing foot ulcers and undergoing amputations can be halved. The toolbox that was used could manage the complexity of systems. Several of the 17 SDGs can be calculated in the prevention of complications in diabetes: quality of life improves, while the costs of healthcare and the burden on the economy caused by people not being able to work decrease. The appropriation of natural resources and the wasted assimilated capacity for the same welfare level decreases, thereby offering an option to deliver health care within the planetary boundaries.
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| 2. |
- Hellstrand, Stefan, 1955, et al.
(författare)
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Measuring sustainability in healthcare: an analysis of two systems providing insoles to patients with diabetes
- 2021
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Ingår i: Environment, Development and Sustainability. - : Springer Science and Business Media LLC. - 1573-2975 .- 1387-585X. ; 23, s. 6987-7001
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Tidskriftsartikel (refereegranskat)abstract
- There is an increasing demand to quantify the footprints, ecological, economic and social, in terms of the effect of different interventions in healthcare. The aim of this study was to compare two systems providing patients with diabetes with insoles in terms of their eco-logical, economic and social footprints. Prefabricated insoles (PRI) were compared with custom-made insoles (CMI). Using a welfare-economic monetary approach, costs were estimated for (1) treatment, (2) travelling to and from the hospital in terms of both fuel and time consumed by the patients and (3) society through emissions contributing to climate change. The proportion of patients/year that could be supplied within the same budget, for each individual treatment, was calculated. The cost of the insoles was 825 SEK (PRI) and 1450 SEK (CMI), respectively. The cost, mean value/patient due to the consumption of patients’ time at the department, was 754 SEK (PRI) and 1508 SEK (CMI), respectively. Emissions, in terms of CO2 equivalent, were 13.7 (PRI) and 27.4 (CMI), respectively. Using PRI, a total of 928 patients could be provided/year compared with 500 patients if CMI are used. By using PRI, the cost/treatment was reduced by 46%. The cost of treatment dominated and the cost of time consumed by patients were also substantial. The societal cost of contributing to climate change was of low importance. By using PRI, the needs of 86% more patients could be met within the same budget. Using these methods, the contri-bution of healthcare systems to the 17 Sustainable Development Goals approved by the UN can be quantified.
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| 3. |
- Askarieh, Galia, 1983, et al.
(författare)
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Systemic and intrahepatic interferon-gamma-inducible protein 10 kDa predicts the first-phase decline in hepatitis C virus RNA and overall viral response to therapy in chronic hepatitis C.
- 2010
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Ingår i: Hepatology. - : Ovid Technologies (Wolters Kluwer Health). - 1527-3350 .- 0270-9139. ; 51:5, s. 1523-1530
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Tidskriftsartikel (refereegranskat)abstract
- High systemic levels of interferon-gamma-inducible protein 10 kDa (IP-10) at onset of combination therapy for chronic hepatitis C virus (HCV) infection predict poor outcome, but details regarding the impact of IP-10 on the reduction of HCV RNA during therapy remain unclear. In the present study, we correlated pretreatment levels of IP-10 in liver biopsies (n = 73) and plasma (n = 265) with HCV RNA throughout therapy within a phase III treatment trial (DITTO-HCV). Low levels of plasma or intrahepatic IP-10 were strongly associated with a pronounced reduction of HCV RNA during the first 24 hours of treatment in all patients (P < 0.0001 and P = 0.002, respectively) as well as when patients were grouped as genotype 1 or 4 (P = 0.0008 and P = 0.01) and 2 or 3 (P = 0.002, and P = 0.02). Low plasma levels of IP-10 also were predictive of the absolute reduction of HCV RNA (P < 0.0001) and the maximum reduction of HCV RNA in the first 4 days of treatment (P < 0.0001) as well as sustained virological response (genotype 1/4; P < 0.0001). To corroborate the relationship between early viral decline and IP-10, pretreatment plasma samples from an independent phase IV trial for HCV genotypes 2/3 (NORDynamIC trial; n = 382) were analyzed. The results confirmed an association between IP-10 and the immediate reduction of HCV RNA in response to therapy (P = 0.006). In contrast, pretreatment levels of IP-10 in liver or in plasma did not affect the decline of HCV RNA between days 8 and 29, i.e., the second-phase decline, or later time points in any of these cohorts. CONCLUSION: In patients with chronic hepatitis C, low levels of intrahepatic and systemic IP-10 predict a favorable first-phase decline of HCV RNA during therapy with pegylated interferon and ribavirin for genotypes of HCV.
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| 4. |
- Berndtsson, M., et al.
(författare)
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Is circular economy a magic bullet?
- 2017
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Ingår i: Natural Resources Available Today and in the Future: How to Perform Change Management for Achieving a Sustainable World. - Cham : Springer International Publishing. - 9783319542638 - 9783319542614 ; , s. 281-295
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 5. |
- Dahlquist, Erik, 1951-, et al.
(författare)
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System perspective
- 2017
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Ingår i: Natural Resources Available Today and in the Future. - Cham : Springer International Publishing. - 9783319542638 - 9783319542614 ; , s. 1-56
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Hellstrand, Stefan, et al.
(författare)
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A biophysically anchored production function
- 2010
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Ingår i: Environment, Development and Sustainability. - : Springer Science and Business Media LLC. - 1387-585X .- 1573-2975. ; 12:4, s. 573-596
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Tidskriftsartikel (refereegranskat)abstract
- The first part presents a conceptual model of the economic system in its ecological and social context. It is developed via an integration of basic concepts in physical resource theory, animal and human physiology, economic theory and systems ecology. The capacity of the model to support analysis of such complex systems where life is a key system characteristic is high. The conceptual model shows the dependency of the human economy on support by non-renewable and renewable resources from Nature (i. e. ecological source restrictions), as well as the capacity of ecosystems to assimilate wastes (ecological sink restrictions). The analysis focuses general principles; thus, the high level of abstraction results in an apparent simplicity. In the second part, we integrate traditional economic production functions and the conceptual model, which results in the formulation of a biophysically anchored production function (BAPF). The BAPF by itself, and through the system of ecological economic accounts that can be derived from it, represent a toolbox that supports the operationalisation of a sustainable development from micro to macro level. It is coherent with Impredicative Loop Analysis, existing management systems within agricultural sciences, OECD's principles for sustainable development and the approach of Millennium Ecosystem Assessment. Compared to analytical approaches used in the formulation of sustainability policies in the private and public sphere, based on conceptual models ignoring the complexity when life (bios) is a defining system characteristic, its relevance for the operationalisation of sustainable development approaches infinity. The third part presents results from statistical analysis of relations between gross domestic product and energy supply and some emissions, respectively, for different nations and time periods, delivering values on levels and trends for parameters in the BAPF as well as a first test of the relevance of the BAPF proposed. The paper is ended by a theoretical analysis of the costs of provoking an economic system working under ecological source and sink restrictions to follow exponential growth: The need to decouple economic growth from natural resource use and emissions is highlighted. Otherwise, the erosion of the ecological foundation of the economy with regard to source as well as sink aspects will be a function of exponential growth
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| 7. |
- Hellstrand, Stefan
(författare)
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Animal production in a sustainable agriculture
- 2013
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Ingår i: Environment, Development and Sustainability. - : Springer Science and Business Media LLC. - 1387-585X .- 1573-2975. ; 15:4, s. 999-1036
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Tidskriftsartikel (refereegranskat)abstract
- This paper discusses the role of animal production systems in a sustainable society; sustainability problems within animal production systems; and four measures for the improvement of the contribution to societal sustainability from animal production. Substantial potentials for improvements are identified that were not previously known. The methodological basis is multi-criteria multi-level analysis within integrated assessment where elements in Impredicative Loop Analysis are integrated with management tools in Swedish agriculture and forestry developed during thousands of years, during which the well-being of the Swedish society and its economic and military power were functions of the land-use skill. The issue-the sustainability footprint of global animal production-is complex and available data are limited. The Swedish case is used as a starting point for an analysis of international relevance. Data from FAO and OECD support the relevance of extrapolating results from the Swedish case to level. The four measures are (i) decrease the consumption of chicken meat in developed nations with 2.6 kg per capita and year; (ii) develop the capacity of ruminants to produce high-quality food from otherwise marginal agroecosystems; (iii) improve milk production per cow with a factor four on global level; and (iv) increase feeding efficiency in milk production globally would substantially improve the societal contribution in terms of increased food supply and decreased pressure on land. The impact of measures (i), (iii) and (iv) on increased global food security was estimated to in total 1.8 billion people in terms of protein supply and a decreased pressure on agricultural land of 217 million ha, of which 41 relate to tropical forests. The 41 million ha of tropical land are due to a decreased demand on soymeal, where this represents more than a halving of total area now used for the production of soymeal. These impacts are of the character either or. The quality of the measures is as first-time estimates, supporting choices of where to direct further efforts in analysis. Two areas were identified as critical for achieving this potential: Feeding strategies to dairy cows as well as methods commonly used to evaluate the sustainability contribution of animal production needs adjustment, so that they comply with the "laws" of diminishing returns, Liebig's "law" of the minimum and Shelford's "law" of tolerance, that is, in agreement with well-known principles for efficient natural resource management and the priorities of UN Millennium Development Goals. If not, global food security is at risk.
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| 8. |
- Hellstrand, Stefan, et al.
(författare)
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Biologic resources
- 2017
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Ingår i: Natural Resources Available Today and in the Future: How to Perform Change Management for Achieving a Sustainable World. - Cham : Springer International Publishing. - 9783319542638 - 9783319542614 ; , s. 93-156
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 9. |
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| 10. |
- Hellstrand, Stefan
(författare)
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On the value of land
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The issue of sustainable development is once again moving the production factor land into the focus of economic theory and practise. There are three production factors, capital, labour and land. Land is a synonym to ecosystems. During the major part of the 20th century land in economic theory has been handled as a peripheral issue. The sustainability context implies a challenge to take land in proper consideration. That means to in an adequate way consider system characteristics that result in complex systems, such as thresholds, resilience, irreversibilities, and interdependencies between systems and system levels. The thesis examineshow land can be understood and handled in the context of a sustainable development,the relations between land and society on a conceptual level and in operative terms,the relations between system levels and between the three sustainability dimensions ecological, economic and social,the importance of agriculture and animal production in a sustainable development. The major findings are that in contexts such as economically profitable and natural resource-efficient milk production; methods to measure sustainability performance of production systems generally; and societal strategies for management of natural resources that support economic and social development within ecological sustainability limits, three “laws” need to be handled appropriate: Liebig’s “Law” of the minimum, Shelford´s “Law” of tolerance, and the “Law” of diminishing return in biological-ecological productions systems.The thesis identifies examples within dairy sciences, systems ecology, and engineering sciences that affect or may affect policies in real world systems from local to global level that can be substantially improved. In order to suggest relevant measures a tool-kit supporting a sustainable development have been generated, integrating contributions from agricultural sciences, systems ecology, economic theory, economic geography, applied environmental sciences and theories of complex systems. The thesis summarises around 30 years of professional experiences mainly within advanced consultancy, during which this tool-kit has been developed and applied. Evaluation of some applications afterwards shows relevance. For some of the examples analysed in the thesis, found weaknesses are such that global food security literally is threatened within one to twenty years.
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