Bariatric surgery and its impact on cardiovascular disease and mortality : A systematic review and meta-analysis

Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.Peer reviewedPostprin

Understanding sexual health literacy, gender egalitarian perspectives, and access to SRHR-care among migrants in Sweden

Improving access to SRHR-information and care among refugees and migrants remain a central issue. Countries with strong integration policies have significant reductions in the inequities in sexual and reproductive health outcomes. Securing access to SRHR is linked to the extent to which gender equality is fulfilled, including equal rights for men and women to learn the language and participate in society. Sexual health literacy is based on the concept of health literacy. The conceptualization of sexual health is closely related to sexual agency. Lack of contact with the mainstream population distort opportunities for inter-cultural dialogue and opportunities for negotiating cultural norms regarding sexuality. Intercultural mediation may be a useful tool for reaching migrants with SRHR-information early during resettlement. The aim of this doctoral thesis was to conceptualise sexual health literacy among migrants resettling in Sweden, and to further our understanding concerning cultural, social, and contextual factors that influence the direct and indirect access to information on sexual and reproductive health and rights, to prevention, and care. A multifaceted approach was employed, including qualitative studies and quantitative cross-sectional studies. Data was obtained from four sources: in-depth interviews with newly arrived refugee women (Paper I); in-depth interviews with intercultural mediators (Paper II); Migration World Values Survey 2018 (MWVS) on non-European migrants (Paper III); MILSA 2.5 survey 2018 on Syrian and Iraqi migrants (Paper IV). The findings revealed that the conceptualisation of sexuality among refugee women was reflected in a discourse of shame, and hindered uptake of SRHR-information. Sexual health literacy was achieved by facilitating critical discussions about the influence of culture, gender, and power on SRHR, placed in the context of migration and integration. The findings acknowledged the need for investing in training of the intercultural mediators to assure sustainability in activities and take advantage of the potential embedded in the role (Paper I, II). Trust was closely related with gender egalitarian attitudes among migrants in Scania and increased with higher education. The influence of trust was more important for men’s attitudes, suggesting that men may be more sensitive to the perception of the social environment for their approach towards gender equality (Paper III). Education was also directly associated with a higher probability of STI/HIV testing among migrants. This pathway was partially mediated by language skills. The pathways between other predisposing variables (age, marital status, sexuality) were mediated by the indirect effect of exposure to sexual coercion and alcohol consumption, indicating a risk awareness (Paper IV). The findings from this thesis can contribute to improving the quality of implementation of activities aiming at reaching migrants with SRHR-information, to build sexual health literacy, and promote sexual agency. Interventions needs to be placed in a broader framework of gender equality, participation, and integration, with specific approaches for reaching vulnerable migrant subgroups

Ecosystem properties and principles of living systems as foundation for sustainable agriculture – Critical reviews of environmental assessment tools, key findings and questions from a course process

With increasing demands on limited resources worldwide, there is a growing interest in sustainable patterns of utilisation and production. Ecological agriculture is a response to these concerns. To assess progress and compliance, standard and comprehensive measures of resource requirements, impacts and agro-ecological health are needed. Assessment tools should also be rapid, standardized, userfriendly, meaningful to public policy and applicable to management. Fully considering these requirements confounds the development of integrated methods. Currently, there are many methodologies for monitoring performance, each with its own foundations, assumptions, goals, and outcomes, dependent upon agency agenda or academic orientation. Clearly, a concept of sustainability must address biophysical, ecological, economic, and sociocultural foundations. Assessment indicators and criteria, however, are generally limited, lacking integration, and at times in conflict with one another. A result is that certification criteria, indicators, and assessment methods are not based on a consistent, underlying conceptual framework and often lack a management focus. Ecosystem properties and principles of living systems, including self-organisation, renewal, embeddedness, emergence and commensurate response provide foundation for sustainability assessments and may be appropriate focal points for critical thinking in an evaluation of current methods and standards. A systems framework may also help facilitate a comprehensive approach and promote a context for meaningful discourse. Without holistic accounts, sustainable progress remains an illdefined concept and an elusive goal. Our intent, in the work with this report, was to use systems ecology as a pedagogic basis for learning and discussion to: - Articulate general and common characteristics of living systems. - Identify principles, properties and patterns inherent in natural ecosystems. - Use these findings as foci in a dialogue about attributes of sustainability to: a. develop a model for communicating scientific rationale. b. critically evaluate environmental assessment tools for application in land-use. c. propose appropriate criteria for a comprehensive assessment and expanded definition of ecological land use

Modeling sludge accumulation rates in lined pit latrines in slum areas of Kampala City, Uganda

Disposal of faecal sludge particularly in slum areas is a difficult undertaking given the lack of space and resources. Inaccurate prediction of sludge accumulation rates (SAR) in pit latrines leads to unplanned pit latrine emptying. Given that the users and owners cannot afford the conventional emptying techniques frequently, inappropriate methods such as open defecation and emptying into storm drainages are employed which consequently contribute to environmental and health-related challenges. The main objective of this study was to develop a predictive model for sludge accumulation rates in lined pit latrines in slum areas of Kampala so as to guide routine management of pit latrines. This mathematical model was developed using a mass balance approach with a sample space of 55 lined pits. The developed model gave an average sludge accumulation rate of 81±25 litres/person/year with an efficiency of 0.52 and adjusted R2 value of 0.50. The model was found to be sufficient and most suited for rental and public pit latrines given their bigger percentage in the slums. Further studies should include geo-physical characterization of soil and drainage of pit latrine sites so as to improve model accuracy.Keywords: Faecal, sludge accumulation rates, slum areas, lined pit latrine

The 'WHO Safe Communities' model for the prevention of injury in whole populations

Background The safe communities approach has been embraced around the world as a model for coordinating community efforts to enhance safety and reduce injury. Over 80 communities throughout the world have been formally designated as' Safe Communities' by the World Health Organization. It is of public health interest to determine to what degree the model is successful, and whether its application does indeed reduce injury rates in communities to which it is introduced

The Architectural Competition. Research Inquiries and Experiences

This publication is an anthology featuring 26 papers presented at the Conference on Architectural Competitions organised by the School of Architecture and the Built Environment at KTH Royal Institute of Technology in Stockholm from the 16th to the 18th October 2008. What can be learnt from the Stockholm Conference? Firstly, whilst there is only limited research being carried out, at separate universities and institutions focusing on the study of architectural competitions in Europe, there is a vast potential for further research into how architectural firms, their affiliated architectural associations and the competition organisers can cooperate to improve competition processes and outcomes. Secondly, it has demonstrated that both researchers and professional practices can benefit from the development of robust, two-way communication aimed at bothdispelling the myths associated with the architectural competition and to test its perceived realities. For these reasons we hope this anthology will support the establishment and maintenance of a network that will promote communication between the various architectural competition stakeholders and further encourage the exchange of information and knowledge sharing. The conference has demonstrated that scientific research into the architectural competition can offer a multifaceted field of study of significant importance to university based researchers, practicing architects and urban planners alike. By learning from the Stockholm conference, we can reflect upon the various research challenges that will occur in the future and rethink the use of competitions as a design tool to facilitate the production of innovative ideas, improve standards and the commissioning of projects

Potential overtreatment during life-limiting illness and end of life in older adults

Background. A growing body of evidence suggests that older patients are subject to potential overtreatment at the end of life, characterised by disease modifying therapies, preventive medications, and frequent care transitions. This occurs even though many older patients express a preference for symptom management and tend to avoid curative therapies near death. Nowadays age-related chronic diseases and neurodegenerative conditions are the top causes of death leading to a more foreseeable trajectory of decline at the end of life compared to compared to those who die suddenly or prematurely due to global pandemics. However, drugs and procedures, with longer time-to-benefit than the seriously ill older patients’ life expectancy, are still administered causing potential adverse events, deteriorated quality of life and higher dependency. Aim. The present doctoral thesis aimed to evaluate the quality of end-of-life care in older adults, with a focus on potential overtreatment and life-limiting illness. The four individual studies of the thesis contributed to this aim from different, yet complimentary aspects. Study I. We identified overtreatment indicators in the existing literature and discovered that nearly half of them cannot be appropriately measured in administrative and healthcare data in Sweden. However, based on the 15 unique indicators that we could measure, we estimated that one third (36.9%) of patients with solid cancer received care in their last month of life deemed as potential overtreatment. Cancer-specific treatments were the most common form of potential overtreatment (27.0%), followed-by potentially futile non-cancer specific treatments (12.3%), and hospital transitions (9.4%). Study II. We found that older decedents had an average 1.7 unplanned hospitalisations during their last year of life, which corresponded to an incidence rate of 175 per 100 person-years. Those with a cancer trajectory had the highest incidence rate at 231 per 100 patient-years, whereas individuals on a trajectory of prolonged dwindling had the lowest rate at 99 per 100 patient-years. Unplanned hospitalisations were unevenly distributed throughout the last year of life. From the third month before death, the incidence rate started to increase, which is the point where the different patterns of hospitalisation between illness trajectories became evident. Study III. We reported that endocrine treatment, which is a systemic disease modifying treatment, was initiated by 5% in the last three months of life and continued by 39% of the older decedents with hormone receptor-positive metastatic breast cancer. We found several factors linked to continuation of treatment, for example, higher age (RR85+ years: 1.25 [1.12-1.41]), higher education (RRtertiary education: 0.89 [0.81-0.98]), and multi-dose drug dispensing (RR: 1.22 [1.13-1.32]). Initiation of treatment was associated with, for instance, number of hospitalised days (RR1-14 inpatient days: 1.81 [1.12-2.91]) and CDK4/6 use (3.16 [2.25- 4.44]). Study IV. Based on a self-controlled case series analysis, we discovered that the concomitant dispensation of cholinesterase inhibitors (ChEIs) and non-steroidal anti- inflammatory drugs (NSAIDs) resulted in a heightened risk of peptic ulcer disease (adjusted IRR: 9.0, 95% confidence interval: 6.8-11.8, E-value: 17.5) compared to periods without treatment. This risk was over and beyond the risks observed for NSAIDs alone (IRR 5.2, 4.4-6.0, E-value: 9.8). We found no evidence of increased risks associated with the use of ChEIs alone (IRR 1.0, 0.9-1.2, E-value: 1.2). Conclusions. Our findings suggest that older adults and seriously ill individuals are potentially exposed to various types of treatment near the end of life that may be deemed as overtreatment, which warrants further attention from policy makers, healthcare professionals, researchers, and the society as a whole. Overly intensive care, fuelled by disease modifying treatments, preventive therapies and frequent transitions close to death is generally against the preferences of older people. Important to note that reducing or eliminating these types of treatments is not about rationing healthcare or denying treatment, but rather about ensuring that patients spend their last months in good quality care, characterised by symptom management and avoidance of unnecessary and preventable risks factors and adverse effects