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1.
J Environ Manage ; 261: 110139, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32148254

RESUMEN

The biosphere faces an uncertain future! Embracing change, uncertainty and complexity calls for creative transformative pathways. Biosphere stewardship provides a novel multi actor approach towards sustainability. Despite the critical role of individual environmental stewards, biosphere stewardship emphasizes the importance of collective action, and therefore governance. Biosphere stewardship denotes novel governance configurations with the capacity to effectively approach to sustainability transformation. In this paper we seek to advance understanding of how biosphere stewardship actively shapes trajectories of change to foster social-ecological resilience and human wellbeing. Considering the crucial role of governance and more specifically its two pillars of collaboration and learning, we conduct our study of biosphere stewardship through the lens of adaptive co-management. We first set out a framework for diagnosing and analyzing the process of biosphere stewardship. Secondly, we provide evidenced-based insights from applying the framework in four UNESCO biosphere reserves situated in Canada and Sweden to shed light on how active collective shaping of biosphere stewardship occurs and what it produces. In view of the lack of framework for environmental stewardship, we suggest that the present study makes a considerable contribution by providing an appropriate holistic and systemic framework with operational measures. The study also highlights how the comprehensive and consensual understanding of stewardship is proving to be a means of catalyzing biosphere stewardship by enabling effective crafting of policy design and strategic interventions. Moreover, the application of the framework to four case studies reveals the importance of the governance process attributes (collaboration and learning) in mediating outcomes from biosphere stewardship. Finally, the framework provides the basis to address new stewardship enquiries, which require further research in this field.


Asunto(s)
Conservación de los Recursos Naturales , Ecología , Canadá , Humanos , Cambio Social , Suecia
2.
N Engl J Med ; 382(11): 1018-1028, 2020 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-32160663

RESUMEN

BACKGROUND: More information is needed about the long-term effects of low-dose aspirin (≤160 mg) on incident hepatocellular carcinoma, liver-related mortality, and gastrointestinal bleeding in persons with chronic hepatitis B or hepatitis C virus infection. METHODS: Using nationwide Swedish registries, we identified all adults who received a diagnosis of chronic hepatitis B or hepatitis C from 2005 through 2015 and who did not have a history of aspirin use (50,275 patients). Patients who were starting to take low-dose aspirin (14,205 patients) were identified by their first filled prescriptions for 90 or more consecutive doses of aspirin. We constructed a propensity score and applied inverse probability of treatment weighting to balance baseline characteristics between groups. Using Cox proportional-hazards regression modeling, we estimated the risk of hepatocellular carcinoma and liver-related mortality, accounting for competing events. RESULTS: With a median of 7.9 years of follow-up, the estimated cumulative incidence of hepatocellular carcinoma was 4.0% among aspirin users and 8.3% among nonusers of aspirin (difference, -4.3 percentage points; 95% confidence interval [CI], -5.0 to -3.6; adjusted hazard ratio, 0.69; 95% CI, 0.62 to 0.76). This inverse association appeared to be duration-dependent; as compared with short-term use (3 months to <1 year), the adjusted hazard ratios were 0.90 (95% CI, 0.76 to 1.06) for 1 to less than 3 years of use, 0.66 (95% CI, 0.56 to 0.78) for 3 to less than 5 years of use, and 0.57 (95% CI, 0.42 to 0.70) for 5 or more years of use. Ten-year liver-related mortality was 11.0% among aspirin users and 17.9% among nonusers (difference, -6.9 percentage points [95% CI, -8.1 to -5.7]; adjusted hazard ratio, 0.73 [95% CI, 0.67 to 0.81]). However, the 10-year risk of gastrointestinal bleeding did not differ significantly between users and nonusers of aspirin (7.8% and 6.9%, respectively; difference, 0.9 percentage points; 95% CI, -0.6 to 2.4). CONCLUSIONS: In a nationwide study of patients with chronic viral hepatitis in Sweden, use of low-dose aspirin was associated with a significantly lower risk of hepatocellular carcinoma and lower liver-related mortality than no use of aspirin, without a significantly higher risk of gastrointestinal bleeding. (Funded by the National Institutes of Health and others.).


Asunto(s)
Antiinflamatorios no Esteroideos/administración & dosificación , Aspirina/administración & dosificación , Carcinoma Hepatocelular/mortalidad , Hemorragia Gastrointestinal/inducido químicamente , Hepatitis B Crónica/complicaciones , Hepatitis C Crónica/complicaciones , Neoplasias Hepáticas/mortalidad , Adulto , Antiinflamatorios no Esteroideos/uso terapéutico , Aspirina/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Riesgo , Suecia/epidemiología
3.
Water Res ; 174: 115640, 2020 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-32145556

RESUMEN

Pesticides are frequently detected in surface waters, sometimes at levels exceeding ecotoxicological guidelines. We screened for almost 100 pesticides in 32 streams from intense agricultural areas in Southern Sweden, in concert with water chemistry parameters. In addition, we investigated the communities of benthic macroinvertebrates, biofilm nematodes and algae and calculated multiple bioassessment metrics. The number of pesticides found in each stream ranged between 2 and 52, but the sum of Toxic Units (ΣTU) for the mixtures was generally low, and exceeded the European Uniform Principles only in a single sample for algae and in 2% of the samples for Daphnia. Only nematode communities were significantly correlated with the ΣTU, potentially due to their higher pesticide exposure in biofilms. Diatom metrics showed that most streams were impacted by eutrophication and macroinvertebrate metrics showed good status in most streams, whereas the SPEARpesticides (SPEcies At Risk) index, specifically designed to indicate pesticide effects, showed that about half of the samples were at risk. Interestingly, SPEARpesticides was not correlated to ΣTUDaphnia, and this discrepancy suggests that redefining the boundaries for quality classes might be necessary for this index. Moreover, SPEARpesticides was positively correlated with the commonly used macroinvertebrate index ASPT, although disparate results were found for several streams. We argue that this questions the scaling of both metrics and the specificity of their responses. We discuss that the overall good/moderate status of the streams, despite the intense agriculture in the catchments, can be due to the fact that i) a sampling strategy with repeated grab samples did not capture peak pesticide concentrations, thus underestimating acute exposure, ii) pesticide run-off indeed was low, due to measures such as buffer strips, and iii) the nutrient-rich conditions and high sediment loads counteracted pesticide toxicity. We conclude that agricultural land use was the overriding stressor in the investigated streams, including strong effects of nutrients, less apparent effects of pesticides and likely impact of hydromorphological alterations (not specifically addressed in this study).


Asunto(s)
Nematodos , Plaguicidas , Contaminantes Químicos del Agua , Agricultura , Animales , Biopelículas , Monitoreo del Ambiente , Invertebrados , Ríos , Suecia
4.
Lancet Psychiatry ; 7(4): 327-336, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32145763

RESUMEN

BACKGROUND: Elevated risk of psychotic disorders in migrant groups is a public mental health priority. We investigated whether living in areas of high own-region migrant density was associated with reduced risk of psychotic disorders among migrants and their children, and whether generation status, probable visible minority status, or region-of-origin affected this relationship. METHODS: We used the Swedish registers to identify migrants and their children born between Jan 1, 1982, and Dec 31, 1996, and living in Sweden on or after their 15th birthday. We tracked all included participants from age 15 years or date of migration until emigration, death, or study end (Dec 31, 2016). The outcome was an ICD-10 diagnosis of non-affective psychosis (F20-29). We calculated own-region and generation-specific own-region density within the 9208 small areas for market statistics neighbourhoods in Sweden, and estimated the relationship between density and diagnosis of non-affective psychotic disorders using multilevel Cox proportional hazards models, adjusting for individual confounders (generation status, age, sex, calendar year, lone dwelling, and time since migration [migrants only]), family confounders (family income, family unemployment, and social welfare), and neighbourhood confounders (deprivation index, population density, and proportion of lone dwellings), and using the Akaike information criterion (AIC) to compare model fit. FINDINGS: Of 468 223 individuals included in the final cohort, 4582 (1·0%) had non-affective psychotic disorder. Lower own-region migrant density was associated with increased risk of psychotic disorders among migrants (hazard ratio [HR] 1·05, 95% CI 1·02-1·07 per 5% decrease) and children of migrants (1·03, 1·01-1·06), after adjustment. These effects were stronger for probable visible minority migrants (1·07, 1·04-1·11), including migrants from Asia (1·42, 1·15-1·76) and sub-Saharan Africa (1·28, 1·15-1·44), but not migrants from probable non-visible minority backgrounds (0·99, 0·94-1·04). Among migrants, adding generation status to the measure of own-region density provided a better fit to the data than overall own-region migrant density (AIC 36 103 vs 36 106, respectively), with a 5% decrease in generation-specific migrant density corresponding to a HR of 1·07 (1·04-1·11). INTERPRETATION: Migrant density was associated with non-affective psychosis risk in migrants and their children. Stronger protective effects of migrant density were found for probable visible minority migrants and migrants from Asia and sub-Saharan Africa. For migrants, this risk intersected with generation status. Together, these results suggest that this health inequality is socially constructed. FUNDING: Wellcome Trust, Royal Society, Mental Health Research UK, University College London, National Institute for Health Research, Swedish Research Council, and FORTE.


Asunto(s)
Trastornos Psicóticos/etnología , Migrantes/psicología , Migrantes/estadística & datos numéricos , Adolescente , Adulto , África del Sur del Sahara/etnología , Anciano , Asia/etnología , Femenino , Disparidades en el Estado de Salud , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Densidad de Población , Modelos de Riesgos Proporcionales , Sistema de Registros , Distribución por Sexo , Factores Socioeconómicos , Suecia/epidemiología , Adulto Joven
5.
Eur J Endocrinol ; 182(4): 423-428, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32061160

RESUMEN

Objectives: Male hypogonadism is associated with higher risk of co-morbidity and premature mortality. It is, therefore, of utmost importance to identify young men who are at the highest risk of testosterone deficiency and who may benefit from preventive measures. In this context, infertile men constitute a high-risk group. The extent of testosterone replacement therapy (TRT) among infertile men, defined as men who have to undergo assisted reproduction for fatherhood, is currently unknown. Therefore, we evaluated the pattern of prescription of TRT in the years following child conception among men who have fathered children with the help of intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF). Design: By sourcing data from national population registries, hazard ratio (HR) for subsequent TRT was assessed for IVF and ICSI-treated men and compared to those who conceived spontaneously with age Cox regression analysis adjusted for age, educational level and previous intake of medicines for metabolic diseases. Results: ICSI and IVF fathers had increased incidence of newly prescribed TRT compared to fathers conceiving spontaneously (ICSI: HR = 3.81, 95% CI = 3.09-4.69, P < 0.001; IVF: HR = 1.54, 95% CI = 1.15-2.05, P = 0.003). After adjustment for prescription of medication for one or more components of the MetS prior to TRT, the risk estimates attenuated but remained robust both for ICSI-treated (HR = 3.17 (95% CI: 2.56-3.9) and IVF-treated men (HR = 1.06 (95% CI: 1.05-1.07). Conclusion: Men who have to utilise powerful techniques, such as ICSI for fathering children, may be at risk for testosterone deficiency. Routine endocrine evaluation of men seeking fertility treatment is hence warranted.


Asunto(s)
Prescripciones de Medicamentos/estadística & datos numéricos , Terapia de Reemplazo de Hormonas/estadística & datos numéricos , Infertilidad Masculina/terapia , Inyecciones de Esperma Intracitoplasmáticas/estadística & datos numéricos , Testosterona/uso terapéutico , Adulto , Fertilización In Vitro/estadística & datos numéricos , Humanos , Infertilidad Masculina/etiología , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Sistema de Registros , Suecia , Testosterona/deficiencia
6.
Sci Total Environ ; 713: 136353, 2020 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-31955071

RESUMEN

Environmental contamination with metals and organic compounds is of increasing concern for ecosystem and human health. Still, our knowledge about spatial distribution, temporal changes and ecotoxicological fate of metals and organic contaminants in wildlife is limited. We studied concentrations of 69 elements and 50 organic compounds in 300 bank voles (Myodes glareolus), Europe's most common mammal, sampled in spring and autumn 2017-2018 in five monitoring areas, representing three biogeographic regions. In addition, we compared measured concentrations with previous results from bank voles sampled within the same areas in 1995-1997 and 2001. In general, our results show regional differences, but no consistent patterns among contaminants and study areas. The exception was for the lowest concentrations of organic contaminants (e.g. perfluorooctane sulfonate, PFOS), which were generally found in the northern Swedish mountain area. Concentrations of metals and organic contaminants in adults varied seasonally with most organic contaminants being higher in spring; likely induced by diet shifts but potentially also related to age differences. In addition, metal concentrations varied between organs (liver vs. kidney), age classes (juveniles vs. adults; generally higher in adults) as well as between males and females. Concentrations of chromium and nickel in kidney and liver in the northernmost mountain area were lower in 2017-2018 than in 1995-1997 and in three of four areas, lead concentrations were lower in 2017-2018 than in 2001. Current metal concentrations (except mercury) are not expected to negatively affect the voles. Concentrations of hexachlorobenzene displayed highest concentrations in 2001 in the mountains, while it was close to detection limit in 2017-2018. Likewise, PFOS concentrations decreased in the mountains and in south-central lowland forests between 2001 and 2017-2018. Our results suggest that season, age class and sex need to be considered when designing and interpreting results from monitoring programs targeting inorganic and organic contaminants in wildlife.


Asunto(s)
Arvicolinae , Ecosistema , Animales , Monitoreo del Ambiente , Europa (Continente) , Femenino , Masculino , Metales , Suecia
7.
BMC Neurol ; 20(1): 4, 2020 Jan 07.
Artículo en Inglés | MEDLINE | ID: mdl-31910805

RESUMEN

BACKGROUND: Stroke is one of the most common cause of disability worldwide. Pain is common in both stroke survivors and in the general population. Consequences of post-stroke pain (PSP) include reduced quality of life and are important to consider. The aim of the current study was to explore the experience of pain 5 years after stroke, and factors associated with the experience of pain. METHODS: Inclusion criteria were: First ever stroke, treated at Sahlgrenska University Hospital, Sweden, during an 18 months period in 2009-2010, aged 18 years or older. Furthermore, the participants had to respond to a set of questionnaires 5 years post-stroke. Baseline data were collected from medical records and follow-up data from the set of questionnaires. The primary outcome was based on the question Do you experience pain? Predictors and explanatory factors for experiencing more frequent pain were analysed with logistic regression. RESULTS: A total of 281 participants were included. Almost 40% experienced pain to some degree 5 years post-stroke (15% reported pain frequently), and 25% felt that their needs for pain treatment were not met. The participants experiencing more frequent pain reported poorer quality of life, self-perceived health status and recovery post-stroke. Functional dependency at discharge from hospital, experiencing depression at follow up and restricted mobility at follow up were all associated with more frequent pain. CONCLUSION: Pain is common 5 years post-stroke and the treatment is not perceived as optimal. The persons experiencing more frequent pain seem to rate their health and recovery worse than the persons experiencing less frequent pain. Most of the factors associated with more frequent pain were treatable and this emphasize the importance of standardised follow-up care that takes pain into consideration.


Asunto(s)
Dolor , Accidente Cerebrovascular , Anciano , Estudios Transversales , Femenino , Estudios de Seguimiento , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Dolor/epidemiología , Dolor/etiología , Dolor/psicología , Calidad de Vida , Accidente Cerebrovascular/complicaciones , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/psicología , Encuestas y Cuestionarios , Suecia/epidemiología
8.
J Environ Radioact ; 213: 106141, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31983450

RESUMEN

A powerful neutron source, the European Spallation Source (ESS), is currently under construction in Lund, Sweden (~90 000 inhabitants). Levels of tritium (3H) in urine were estimated in members of the public in Lund and employees at the ESS using liquid scintillation counting, to obtain baseline levels before the start of operation of the ESS. These were compared with levels in other occupationally exposed radiation workers. Both the spallation reaction in the ESS tungsten target and the activation of various materials by the protons produced by the 5 MW linear accelerator will generate tritium, which will be released into the atmosphere mainly as tritiated water (HTO). Urinary HTO activity concentrations were determined in a total of 55 individuals belonging to four different categories: ESS employees, neighbours of the ESS, members of the general public in Lund and exposed workers from other facilities. The participants were asked to provide information on their beverage intake the day before urine sampling. The urine samples were filtered on activated charcoal and distilled before analysis. The effect of sample preparation on the isotope fractionation of urine samples was investigated by isotope ratio mass spectrometry (IRMS) of 2H/1H, which showed no influence. IRMS was also used to investigate if the ratio between the stable hydrogen isotopes (2H/1H) could provide useful data of the origin, and hence the tritium concentration, of various types of drinking water. Urinary HTO activity concentrations determined using liquid scintillation counting (LSC) were found to be below the minimum detectable activity (MDA) of 2.1 Bq⋅L-1 for most of the participants. Five of the workers actively handling organic tritiated material were found to have activity concentrations between 3.5 and 11 Bq⋅L-1, which were higher than the average value in local tap water of 1.5 ± 0.6 Bq⋅L-1. The results will be used to evaluate the radiological impact on the population from future releases of tritium resulting from the operation of the ESS.


Asunto(s)
Monitoreo de Radiación , Humanos , Espectrometría de Masas , Exposición Profesional , Aceleradores de Partículas , Suecia , Tritio
9.
J Cardiothorac Surg ; 15(1): 5, 2020 Jan 08.
Artículo en Inglés | MEDLINE | ID: mdl-31915020

RESUMEN

BACKGROUND: The saphenous vein is the most commonly used conduit for coronary artery bypass grafting (CABG). Wound healing complications related to saphenous vein harvesting are common, with reported surgical site infection rates ranging from 2 to 20%. Patients' risk factors, perioperative hygiene routines, and surgical technique play important roles in wound complications. Here we describe the perioperative routines and surgical methods of Swedish operating theatre (OT) nurses and cardiac surgeons. METHODS: A national cross-sectional survey with descriptive design was conducted to evaluate perioperative hygiene routines and surgical methods associated with saphenous vein harvesting in CABG. A web-based questionnaire was sent to OT nurses and cardiac surgeons at all eight hospitals performing CABG surgery in Sweden. RESULTS: Responses were received from all hospitals. The total response rate was 62/119 (52%) among OT nurses and 56/111 (50%) among surgeons. Chlorhexidine 5 mg/mL in 70% ethanol was used at all eight hospitals. The OT nurses almost always (96.8%) performed the preoperative skin disinfection, usually for three to 5 minutes. Chlorhexidine was also commonly used before dressing the wound. Conventional technique was used by 78.6% of the surgeons, "no-touch" by 30.4%, and both techniques by 9%. None of the surgeons used endoscopic vein harvesting. Type of suture and technique used for closing the wound differed markedly between the centres. CONCLUSIONS: In this article we present insights into the hygiene routines and surgical methods currently used by OT nurses and cardiac surgeons in Sweden. The results indicate both similarities and differences between the centres. Local traditions might be the most important factors in determining which procedures are employed in the OT. There is a lack of evidence-based hygiene routines and surgical methods.


Asunto(s)
Antiinfecciosos Locales/uso terapéutico , Clorhexidina/uso terapéutico , Vena Safena/trasplante , Recolección de Tejidos y Órganos/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Puente de Arteria Coronaria , Estudios Transversales , Humanos , Enfermería de Quirófano/métodos , Atención Perioperativa/métodos , Pautas de la Práctica en Medicina , Factores de Riesgo , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/prevención & control , Encuestas y Cuestionarios , Técnicas de Sutura , Suturas , Suecia , Recolección de Tejidos y Órganos/efectos adversos , Procedimientos Quirúrgicos Vasculares/efectos adversos
10.
BMC Public Health ; 20(1): 8, 2020 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-31907012

RESUMEN

BACKGROUND: Poor health could influence how individuals are sorted into occupational classes. Health selection has therefore been considered a potential modifier to the mortality class gradient through differences in social mobility. Direct health selection in particular may operate in the short-term as poor health may lead to reduced work hours or achievement, downward social mobility, unemployment or restricted upward mobility, and death. In this study, the relationship between social mobility and mortality (all-cause, cancer-related, cardiovascular disease-related (CVD), and suicide) is explored when the relationship is adjusted for poor health. METHODS: Using Swedish register data (1996-2012) and discrete time event-history analysis, odds ratios and average marginal effects (AME) of social mobility and unemployment on mortality are observed before and after accounting for sickness absence in the previous year. RESULTS: After adjusting for sickness absence, all-cause mortality remained lower for men after upward mobility in comparison to not being mobile (OR 0.82, AME -0.0003, CI - 0.0003 to - 0.0002). Similarly, upward mobility continued to be associated with lower cancer-related mortality for men (OR 0.85, AME -0.00008, CI - 0.00002 to - 0.0002), CVD-related mortality for men (OR 0.76, AME -0.0001, CI - 0.00006 to - 0.0002) and suicide for women (OR 0.67, AME -0.00002, CI - 0.000002 to - 0.00003). The relationship between unemployment and mortality also persisted across most causes of death for both men and women after controlling for previous sickness absence. In contrast, adjusting for sickness absence renders the relationship between downward mobility and cancer-related mortality not statistically different from the non-mobile. CONCLUSIONS: Health selection plays a role in how downward mobility is linked to cancer related deaths. It additionally accounts for a portion of why upward mobility is associated with lower mortality. That health selection plays a role in how social mobility and mortality are related may be unexpected in a context with strong job protection. Job protection does not, however, equalize opportunities for upward mobility, which may be limited for those who have been ill. Because intra-generational upward mobility and mortality remained related after adjusting for sickness absence, other important mechanisms such as indirect selection or social causation should be explored.


Asunto(s)
Absentismo , Mortalidad/tendencias , Ausencia por Enfermedad/estadística & datos numéricos , Movilidad Social/estadística & datos numéricos , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Sistema de Registros , Suecia/epidemiología , Adulto Joven
11.
BMJ ; 368: l7057, 2020 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-31996343

RESUMEN

OBJECTIVE: To study the impact of maternal smoking during pregnancy on fractures in offspring during different developmental stages of life. DESIGN: National register based birth cohort study with a sibling comparison design. SETTING: Sweden. PARTICIPANTS: 1 680 307 people born in Sweden between 1983 and 2000 to women who smoked (n=377 367, 22.5%) and did not smoke (n=1 302 940) in early pregnancy. Follow-up was until 31 December 2014. MAIN OUTCOME MEASURE: Fractures by attained age up to 32 years. RESULTS: During a median follow-up of 21.1 years, 377 970 fractures were observed (the overall incidence rate for fracture standardised by calendar year of birth was 11.8 per 1000 person years). The association between maternal smoking during pregnancy and risk of fracture in offspring differed by attained age. Maternal smoking was associated with a higher rate of fractures in offspring before 1 year of age in the entire cohort (birth year standardised fracture rates in those exposed and unexposed to maternal smoking were 1.59 and 1.28 per 1000 person years, respectively). After adjustment for potential confounders the hazard ratio for maternal smoking compared with no smoking was 1.27 (95% confidence interval 1.12 to 1.45). This association followed a dose dependent pattern (compared with no smoking, hazard ratios for 1-9 cigarettes/day and ≥10 cigarettes/day were 1.20 (95% confidence interval 1.03 to 1.39) and 1.41 (1.18 to 1.69), respectively) and persisted in within-sibship comparisons although with wider confidence intervals (compared with no smoking, 1.58 (1.01 to 2.46)). Maternal smoking during pregnancy was also associated with an increased fracture incidence in offspring from age 5 to 32 years in whole cohort analyses, but these associations did not follow a dose dependent gradient. In within-sibship analyses, which controls for confounding by measured and unmeasured shared familial factors, corresponding point estimates were all close to null. Maternal smoking was not associated with risk of fracture in offspring between the ages of 1 and 5 years in any of the models. CONCLUSION: Prenatal exposure to maternal smoking is associated with an increased rate of fracture during the first year of life but does not seem to have a long lasting biological influence on fractures later in childhood and up to early adulthood.


Asunto(s)
Fracturas Óseas , Mujeres Embarazadas/psicología , Efectos Tardíos de la Exposición Prenatal/epidemiología , Fumar , Adulto , Factores de Edad , Niño , Correlación de Datos , Femenino , Fracturas Óseas/diagnóstico , Fracturas Óseas/epidemiología , Humanos , Lactante , Masculino , Embarazo , Sistema de Registros/estadística & datos numéricos , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Fumar/efectos adversos , Fumar/epidemiología , Suecia/epidemiología
12.
Lakartidningen ; 1172020 01 21.
Artículo en Sueco | MEDLINE | ID: mdl-31990360

RESUMEN

Headache disorders are the most common neurological disorders during active life. They cause a great impact on health and well-being of many individuals in Sweden as well as large social costs and impact on private and working life. A new drug, monoclonal antibodies towards the CGRP receptor, is on the market and brings new opportunities to migraine care. The article summarizes a new treatment plan for the basic care of migraine patients and how the new drug should be managed. We also highlight how the introduction of new advanced therapies needs a well-organized health care organization.


Asunto(s)
Péptido Relacionado con Gen de Calcitonina , Trastornos Migrañosos , Anticuerpos Monoclonales , Humanos , Trastornos Migrañosos/genética , Trastornos Migrañosos/terapia , Receptores de Péptido Relacionado con el Gen de Calcitonina , Suecia
13.
Lakartidningen ; 1172020 01 28.
Artículo en Sueco | MEDLINE | ID: mdl-31990363

RESUMEN

In Sweden, there are currently no consensus guidelines aimed at the management of patients with mild traumatic brain injury (mTBI) in a primary care setting. The aim of this study was to assess the need for such guidelines by a web-based, multiple choice, case-based survey asking primary care physicians how they manage mTBI patients in the early (acute) and late (persistent symptoms) stage. The survey demonstrated a more uniform patient management pattern in the acute stage of mTBI, while it revealed a more heterogenous pattern in the later stage. This illustrates the need for consensus guidelines in the management of this patient category in the primary care setting, which was further substantiated by the request for such guidelines by 85% of the physicians participating in the survey.


Asunto(s)
Conmoción Encefálica , Atención Primaria de Salud , Conmoción Encefálica/diagnóstico , Conmoción Encefálica/terapia , Humanos , Guías de Práctica Clínica como Asunto , Encuestas y Cuestionarios , Suecia
15.
Lancet ; 395(10218): 123-131, 2020 01 11.
Artículo en Inglés | MEDLINE | ID: mdl-31929014

RESUMEN

BACKGROUND: Ulcerative colitis (UC) is a risk factor for colorectal cancer (CRC). However, available studies reflect older treatment and surveillance paradigms, and most have assessed risks for incident CRC without taking surveillance and lead-time bias into account, such as by assessing CRC incidence by tumour stage, or stage-adjusted mortality from CRC. We aimed to compare both overall and country-specific risks of CRC mortality and incident CRC among patients with UC. METHODS: In this population-based cohort study of 96 447 patients with UC in Denmark (n=32 919) and Sweden (n=63 528), patients were followed up for CRC incidence and CRC mortality between Jan 1, 1969, and Dec 31, 2017, and compared with matched reference individuals from the general population (n=949 207). Patients with UC were selected from national registers and included in the analysis if they had two or more records with a relevant International Classification of Disease in the patient register (in the country in question) or one such record plus a colorectal biopsy report with a morphology code suggestive of inflammatory bowel disease. For every patient with UC, we selected matched reference individuals from the total population registers of Denmark and Sweden, who were matched for sex, age, birth year, and place of residence. We used Cox regression to compute hazard ratios (HRs) for incident CRC, and for CRC mortality, taking tumour stage into account. FINDINGS: During follow-up, we observed 1336 incident CRCs in the UC cohort (1·29 per 1000 person-years) and 9544 incident CRCs in reference individuals (0·82 per 1000 person-years; HR 1·66, 95% CI 1·57-1·76). In the UC cohort, 639 patients died from CRC (0·55 per 1000 person-years), compared with 4451 reference individuals (0·38 per 1000 person-years; HR 1·59, 95% CI 1·46-1·72) during the same time period. The CRC stage distribution in people with UC was less advanced (p<0·0001) than in matched reference individuals, but taking tumour stage into account, patients with UC and CRC remained at increased risk of CRC death (HR 1·54, 95% CI 1·33-1·78). The excess risks declined over calendar periods: during the last 5 years of follow-up (2013-17, Sweden only), the HR for incident CRC in people with UC was 1·38 (95% CI 1·20-1·60, or one additional case per 1058 patients with UC per 5 years) and the HR for death from CRC was 1·25 (95% CI 1·03-1·51, or one additional case per 3041 patients with UC per 5 years). INTERPRETATION: Compared with those without UC, individuals with UC are at increased risk of developing CRC, are diagnosed with less advanced CRC, and are at increased risk of dying from CRC, although these excess risks have declined substantially over time. There still seems to be room for improvement in international surveillance guidelines. FUNDING: The Swedish Medical Society, Karolinska Institutet, Stockholm County Council, Swedish Research Council, Swedish Foundation for Strategic Research, Independent Research Fund Denmark, Forte Foundation, Swedish Cancer Foundation.


Asunto(s)
Colitis Ulcerosa/epidemiología , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/patología , Adulto , Anciano , Estudios de Cohortes , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/mortalidad , Neoplasias Colorrectales/mortalidad , Dinamarca/epidemiología , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Sistema de Registros , Suecia/epidemiología , Adulto Joven
16.
Nat Ecol Evol ; 4(1): 122-131, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31900452

RESUMEN

Factors that drive continental-scale variation in root microbiota and plant adaptation are poorly understood. We monitored root-associated microbial communities in Arabidopsis thaliana and co-occurring grasses at 17 European sites across 3 years. We observed strong geographic structuring of the soil biome, but not of the root microbiota. A few phylogenetically diverse and geographically widespread bacteria consistently colonized plant roots. Among-site and across-year similarity in microbial community composition was stronger for the bacterial root microbiota than for filamentous eukaryotes. In a reciprocal transplant between two A. thaliana populations in Sweden and Italy, we uncoupled soil from location effects and tested their contributions to root microbiota variation and plant adaptation. Community differentiation in plant roots was explained primarily by location for filamentous eukaryotes and by soil origin for bacteria, whereas host genotype effects were marginal. Strong local adaptation between the two A. thaliana populations was observed, with differences in soil properties and microbes of little importance for the observed magnitude of adaptive differentiation. Our results suggest that, across large spatial scales, climate is more important than soil conditions for plant adaptation and variation in root-associated filamentous eukaryotic communities, whereas soil properties are primary drivers of bacterial community differentiation in roots.


Asunto(s)
Arabidopsis , Microbiota , Italia , Raíces de Plantas , Suecia
17.
PLoS One ; 15(1): e0225318, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31978099

RESUMEN

Improved knowledge on the risk in ecologically important habitats on a regional scale from multiple stressors is critical for managing functioning and resilient ecosystems. This risk assessment aimed to identify seagrass ecosystems in southern Sweden that will be exposed to a high degree of change from multiple global change stressors in mid- and end-of-century climate change conditions. Risk scores were calculated from the expected overlap of three stressors: sea surface temperature increases, ocean acidification and wind driven turbid conditions. Three high-risk regions were identified as areas likely to be exposed to a particularly high level of pressure from the global stressors by the end of the century. In these areas it can be expected that there will be a large degree of stressor change from the current conditions. Given the ecological importance of seagrass meadows for maintaining high biodiversity and a range of other ecosystem services, these risk zones should be given high priority for incorporation into management strategies, which can attempt to reduce controllable stressors in order to mitigate the consequences of some of the impending pressures and manage for maintained ecosystem resilience.


Asunto(s)
Biodiversidad , Cambio Climático , Ecosistema , Monitoreo del Ambiente , Ecología/tendencias , Humanos , Concentración de Iones de Hidrógeno , Medición de Riesgo , Salinidad , Agua de Mar , Suecia , Temperatura Ambiental
18.
Water Res ; 169: 115217, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-31675608

RESUMEN

The reducing capacity (RC) of natural organic matter plays an important role in the carbon cycle and biogeochemical fates of environmental contaminants in the aquatic system. However, the electron donation potentials of dissolved organic matter (DOM) from high-latitude lakes are still uncertain. In this study, we collected DOM samples from high-latitude lakes across the Arctic and boreal regions in Sweden and Norway to investigate the effects of the DOM concentration and characteristics on its ambient reducing capacity (ARC). Mercury (Hg(II)) abiotic reduction in darkness was used to determine the ARC. The results showed that the DOM in Arctic lakes is less terrestrial-dominant than in reference sites (i.e., forest lakes). Between the two categories of Arctic lakes, tundra lakes are more terrestrial-influenced compared to mountain lakes. Additionally, terrestrial-originated DOM is a main controlling factor for enhancing the ambient reducing capacity, whereas the DOM concentration, i.e., dissolved organic carbon (DOC), resulted in variations in the Hg/DOC ratios that also cause the variations of the observed ARC values. Thus, comparisons of the ARC values can be conducted while oxidant/DOC ratios are kept the same and reported through the method using heavy metals as a chemical probe. After correction for Hg/DOC ratio interference, the ambient reducing capacity of DOM followed the order: boreal forest lakes > Arctic tundra lakes > Arctic mountain lakes. This study highlights that the DOM concentration should also be considered when estimating the ARC as compared to the previous that mainly focusing on the properties of DOM such as its origins. As climate change is projected to be severe in high latitudes, this study demonstrates a significant connection between aquatic DOM geochemical reactivity and terrestrial inputs, which is crucial for a better prediction of the role of DOM in high-latitude lakes in the context of climate change.


Asunto(s)
Lagos , Mercurio , Carbono , Noruega , Suecia
19.
Waste Manag ; 102: 550-560, 2020 Feb 01.
Artículo en Inglés | MEDLINE | ID: mdl-31765975

RESUMEN

This study has demonstrated the use of weighted-linear-combination approach in connection with fuzzy set functions of Total Population, Total Distance, Annual income per person and Total number of opening hours of Recycling Centers (RCs), in ArcGIS environment, to generate risk maps and characterize RCs based on risk for improper sorting of waste. Analysis of data shows that there are 73 RCs, at which, risk for improper sorting of waste is highest. On average, there is one RC for every 19,402 individuals in Sweden and a single round trip made by Swedes to nearest RC, results in emission of 1340 ktons of CO2. Furthermore, it is found that strategies needed (e.g. installation of new RCs or shifting of RCs closer to densely populated areas (DPAs) or increase in number of opening hours or availability of pre-visit sorting information etc.), to reduce risk for improper sorting of waste, are different for RCs that are operated under different management forms. Variations in tariffs, limited number of waste fractions to be collected per RC, confusing terminologies, design parameters of RCs and non-implementation of EU Directive 2018/851 with respect to packaging waste, are other factors that are affecting quality of waste sorting at RCs, and are discussed in the article. Results from this research can be utilized to identify site specific needs for improving sorting of waste and to identify priority areas for installation of new RCs.


Asunto(s)
Eliminación de Residuos , Administración de Residuos , Humanos , Embalaje de Productos , Reciclaje , Suecia
20.
J Stroke Cerebrovasc Dis ; 29(2): 104476, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31806450

RESUMEN

BACKGROUND AND PURPOSE: To search for novel pathophysiological pathways related to ischemic stroke using a metabolomics approach. METHODS: We identified 204 metabolites in plasma by liquid chromatography mass spectrometry in 3 independent population-based samples (TwinGene, Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS) and Uppsala Longitudinal Study of Adult Men). TwinGene was used for discovery and the other 2 samples were meta-analyzed as replication. In PIVUS, traditional cardiovascular (CV) risk factors, multiple markers of subclinical CV disease, markers of coagulation/fibrinolysis were measured and analyzed in relation to top metabolites. RESULTS: In TwinGene (177 incident cases, median follow-up 4.3 years), levels of 28 metabolites were associated with incident ischemic stroke at a false discover rate (FDR) of 5%. In the replication (together 194 incident cases, follow-up 10 and 12 years, respectively), only sphingomyelin (32:1) was significantly associated (HR .69 per SD change, 95% CI .57-0.83, P value = .00014; FDR <5%) when adjusted for systolic blood pressure, diabetes, smoking, low density lipoportein (LDL)- and high density lipoprotein (HDL), body mass index (BMI) and atrial fibrillation. In PIVUS, sphingomyelin (32:1) levels were significantly related to both LDL- and HDL-cholesterol in a positive fashion, and to serum triglycerides, BMI and diabetes in a negative fashion. Furthermore, sphingomyelin (32:1) levels were related to vasodilation in the forearm resistance vessels, and inversely to leukocyte count (P < .0069 and .0026, respectively). CONCLUSIONS: An inverse relationship between sphingomyelin (32:1) and incident ischemic stroke was identified, replicated, and characterized. A possible protective role for sphingomyelins in stroke development has to be further investigated in additional experimental and clinical studies.


Asunto(s)
Isquemia Encefálica/sangre , Metabolómica/métodos , Esfingomielinas/sangre , Accidente Cerebrovascular/sangre , Anciano , Biomarcadores/sangre , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiología , Cromatografía Liquida , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Pronóstico , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Suecia/epidemiología , Espectrometría de Masas en Tándem , Factores de Tiempo
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