Factors affecting long-survival of patients with esophageal cancer using non-mixture cure fraction model

Objective: Esophageal cancer (EC) is one of the gastrointestinal malignancies with a very high morbidity and mortality rate due to poor prognosis. This study aims to assess the effects of risk factors on survival and cure fraction of patients with EC in a population of Iranian patients using a non-mixture cure fraction model. Methods: This retrospective cohort study was conducted on 127 patients with EC who were diagnosed during 2009-2010 and were followed up for 5 years in East-Azarbaijan, Iran. Stepwise selection and non-mixture cure fraction model were used to find the risk factors of EC survival patients. Results: The mean (±standard deviation) diagnosis age of the EC was 66.92(±11.95). One, three and five-year survival probabilities were 0.44 (95% confidence interval (CI): 0.36-0.54), 0.2 (95% CI: 0.14-0.28) and 0.13 (95% CI: 0.08-0.2) respectively. Female sex (Estimate=-0.99; 95% confidence interval (CI): -1.41,-0.58; p-value<0.001), low level socioeconomic status (Estimate=0.39; 95%CI: 0.12,0.66; p-value=0.043), the group who did not do esophagectomy surgery (Estimate=0.58; 95%CI: 0.17,0.99; p-value=0.005) and unmarried group (Estimate=0.58; 95%CI: 0.11-1.05; p-value=0.015) were found as the significant predictor of survival and cure fraction of the EC patients. Population cure rate was 0.11 (95%CI: 0.07-0.19) and Cure fraction was estimated 5.11 percent. Conclusion: This study found gender, socioeconomic status, Esophagectomy surgery and marital status as the potential risk factors for survival and cure fraction of Iranian EC patients. Moreover, non- mixture cure fraction provides more accurate and more reliable insight into long-term advantages of EC therapy compared to standard classic survival analysis alternatives

Determining Risk Factors for Gastric and Esophageal Cancers between 2009-2015 in East-Azarbayjan, Iran Using Parametric Survival Models

BACKGROUND: Esophageal cancer (EC) and Gastric cancer (GC) have been identified as two of the most common cancers in the northeastern regions of Iran. The increasing rates of these types of cancers requires attention. This study aims to assess the potential risk factors for these two cancers and then determine shared risk factors between them in a population of Iranian patients using parametric survival models. METHODS: This retrospective cohort study was conducted using 127 patients with EC and 184 patients with GC in East Azarbaijan, Iran who were diagnosed and registered during the years 2009-2010 in Iran’s National Cancer Control Registration Program and were followed for five years. Parametric survival models were used to find the risk factors of the patients. Akaike Information Criteria was used to identify the best parametric model in this study. Interaction analysis was used to determine shared risk factors between EC and GC. RESULTS: The mean (±standard deviation) age of diagnoses for EC and GC were 66.92(±11.95) and 66.5(±11.5) respectively. The survival time ranges of GC patients was (0.07-70.33) and the survival time ranges were from 0.10 to 69.03 months for EC patients. Multivariable Log- logistic model showed that being married (OR=2.25, 95% CI: 1.33 - 3.81) for EC patients and Esophagectomy surgery for EC (OR: 1.62, 95% CI: 1.04 – 2.55) and GC (OR: 1.60, 95% CI: 1.02 – 2.53) had significant effects on survival. Age at the time of diagnosis, job status, and Esophagectomy surgery were statistically comparable regarding their magnitude of effect on survival of two cancers (all Ps>0.05). CONCLUSION: Esophagectomy surgery and being married were important risk factors in EC and GC. The log-logistic model was the most appropriate statistical approach to identify significant risk factors on survival of both cancers. Creative Commons Attribution License KEYWORDS: Esophageal neoplasm; stomach neoplasm; survival analysi

Height and body-mass index trajectories of school-aged children and adolescents from 1985 to 2019 in 200 countries and territories: a pooled analysis of 2181 population-based studies with 65 million participants

Summary Background Comparable global data on health and nutrition of school-aged children and adolescents are scarce. We aimed to estimate age trajectories and time trends in mean height and mean body-mass index (BMI), which measures weight gain beyond what is expected from height gain, for school-aged children and adolescents. Methods For this pooled analysis, we used a database of cardiometabolic risk factors collated by the Non-Communicable Disease Risk Factor Collaboration. We applied a Bayesian hierarchical model to estimate trends from 1985 to 2019 in mean height and mean BMI in 1-year age groups for ages 5–19 years. The model allowed for non-linear changes over time in mean height and mean BMI and for non-linear changes with age of children and adolescents, including periods of rapid growth during adolescence. Findings We pooled data from 2181 population-based studies, with measurements of height and weight in 65 million participants in 200 countries and territories. In 2019, we estimated a difference of 20 cm or higher in mean height of 19-year-old adolescents between countries with the tallest populations (the Netherlands, Montenegro, Estonia, and Bosnia and Herzegovina for boys; and the Netherlands, Montenegro, Denmark, and Iceland for girls) and those with the shortest populations (Timor-Leste, Laos, Solomon Islands, and Papua New Guinea for boys; and Guatemala, Bangladesh, Nepal, and Timor-Leste for girls). In the same year, the difference between the highest mean BMI (in Pacific island countries, Kuwait, Bahrain, The Bahamas, Chile, the USA, and New Zealand for both boys and girls and in South Africa for girls) and lowest mean BMI (in India, Bangladesh, Timor-Leste, Ethiopia, and Chad for boys and girls; and in Japan and Romania for girls) was approximately 9–10 kg/m2. In some countries, children aged 5 years started with healthier height or BMI than the global median and, in some cases, as healthy as the best performing countries, but they became progressively less healthy compared with their comparators as they grew older by not growing as tall (eg, boys in Austria and Barbados, and girls in Belgium and Puerto Rico) or gaining too much weight for their height (eg, girls and boys in Kuwait, Bahrain, Fiji, Jamaica, and Mexico; and girls in South Africa and New Zealand). In other countries, growing children overtook the height of their comparators (eg, Latvia, Czech Republic, Morocco, and Iran) or curbed their weight gain (eg, Italy, France, and Croatia) in late childhood and adolescence. When changes in both height and BMI were considered, girls in South Korea, Vietnam, Saudi Arabia, Turkey, and some central Asian countries (eg, Armenia and Azerbaijan), and boys in central and western Europe (eg, Portugal, Denmark, Poland, and Montenegro) had the healthiest changes in anthropometric status over the past 3·5 decades because, compared with children and adolescents in other countries, they had a much larger gain in height than they did in BMI. The unhealthiest changes—gaining too little height, too much weight for their height compared with children in other countries, or both—occurred in many countries in sub-Saharan Africa, New Zealand, and the USA for boys and girls; in Malaysia and some Pacific island nations for boys; and in Mexico for girls. Interpretation The height and BMI trajectories over age and time of school-aged children and adolescents are highly variable across countries, which indicates heterogeneous nutritional quality and lifelong health advantages and risks

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. Copyright (C) 2021 World Health Organization; licensee Elsevier

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants.

BACKGROUND: Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. METHODS: We used data from 1990 to 2019 on people aged 30-79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. FINDINGS: The number of people aged 30-79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306-359) million women and 317 (292-344) million men in 1990 to 626 (584-668) million women and 652 (604-698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55-62) of women and 49% (46-52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43-51) of women and 38% (35-41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20-27) for women and 18% (16-21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. INTERPRETATION: Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings. FUNDING: WHO

Worldwide trends in hypertension prevalence and progress in treatment and control from 1990 to 2019: a pooled analysis of 1201 population-representative studies with 104 million participants

Background Hypertension can be detected at the primary health-care level and low-cost treatments can effectively control hypertension. We aimed to measure the prevalence of hypertension and progress in its detection, treatment, and control from 1990 to 2019 for 200 countries and territories. Methods We used data from 1990 to 2019 on people aged 30–79 years from population-representative studies with measurement of blood pressure and data on blood pressure treatment. We defined hypertension as having systolic blood pressure 140 mm Hg or greater, diastolic blood pressure 90 mm Hg or greater, or taking medication for hypertension. We applied a Bayesian hierarchical model to estimate the prevalence of hypertension and the proportion of people with hypertension who had a previous diagnosis (detection), who were taking medication for hypertension (treatment), and whose hypertension was controlled to below 140/90 mm Hg (control). The model allowed for trends over time to be non-linear and to vary by age. Findings The number of people aged 30–79 years with hypertension doubled from 1990 to 2019, from 331 (95% credible interval 306–359) million women and 317 (292–344) million men in 1990 to 626 (584–668) million women and 652 (604–698) million men in 2019, despite stable global age-standardised prevalence. In 2019, age-standardised hypertension prevalence was lowest in Canada and Peru for both men and women; in Taiwan, South Korea, Japan, and some countries in western Europe including Switzerland, Spain, and the UK for women; and in several low-income and middle-income countries such as Eritrea, Bangladesh, Ethiopia, and Solomon Islands for men. Hypertension prevalence surpassed 50% for women in two countries and men in nine countries, in central and eastern Europe, central Asia, Oceania, and Latin America. Globally, 59% (55–62) of women and 49% (46–52) of men with hypertension reported a previous diagnosis of hypertension in 2019, and 47% (43–51) of women and 38% (35–41) of men were treated. Control rates among people with hypertension in 2019 were 23% (20–27) for women and 18% (16–21) for men. In 2019, treatment and control rates were highest in South Korea, Canada, and Iceland (treatment >70%; control >50%), followed by the USA, Costa Rica, Germany, Portugal, and Taiwan. Treatment rates were less than 25% for women and less than 20% for men in Nepal, Indonesia, and some countries in sub-Saharan Africa and Oceania. Control rates were below 10% for women and men in these countries and for men in some countries in north Africa, central and south Asia, and eastern Europe. Treatment and control rates have improved in most countries since 1990, but we found little change in most countries in sub-Saharan Africa and Oceania. Improvements were largest in high-income countries, central Europe, and some upper-middle-income and recently high-income countries including Costa Rica, Taiwan, Kazakhstan, South Africa, Brazil, Chile, Turkey, and Iran. Interpretation Improvements in the detection, treatment, and control of hypertension have varied substantially across countries, with some middle-income countries now outperforming most high-income nations. The dual approach of reducing hypertension prevalence through primary prevention and enhancing its treatment and control is achievable not only in high-income countries but also in low-income and middle-income settings

Heterogeneous contributions of change in population distribution of body mass index to change in obesity and underweight NCD Risk Factor Collaboration (NCD-RisC)

From 1985 to 2016, the prevalence of underweight decreased, and that of obesity and severe obesity increased, in most regions, with significant variation in the magnitude of these changes across regions. We investigated how much change in mean body mass index (BMI) explains changes in the prevalence of underweight, obesity, and severe obesity in different regions using data from 2896 population-based studies with 187 million participants. Changes in the prevalence of underweight and total obesity, and to a lesser extent severe obesity, are largely driven by shifts in the distribution of BMI, with smaller contributions from changes in the shape of the distribution. In East and Southeast Asia and sub-Saharan Africa, the underweight tail of the BMI distribution was left behind as the distribution shifted. There is a need for policies that address all forms of malnutrition by making healthy foods accessible and affordable, while restricting unhealthy foods through fiscal and regulatory restrictions

Early dialogues outside of consultation according to PBL : An in-depth study on how ten of Sweden's largest municipalities work with dialogues in the early stages of the detailed development plan process

I takt med Sveriges ökande befolkningsmängd tillkommer krav på att kommunen ska kunna planera städer som lämpar sig till befolkningen utifrån fundamentala men även personliga behov. Kommunerna är de som genom planbesked meddelar om de tänker påbörja planläggning. I detaljplaneprocessen syftar samrådet bland annat till att bidra med bra beslutsunderlag men förekommer i processen först efter att ställningstaganden och beslutsfattande moment redan har skett från kommunens håll. Syftet med denna studie är att med hjälp av kvalitativ undersökning ta reda på hur Sveriges, till invånarantal, största kommuner arbetar med dialoger i tidiga skeden av detaljplaneprocessen. För att uppnå studiens syfte formuleras och ställs semistrukturerade intervjufrågor till de deltagande respondenterna. En litteraturstudie kring medborgardeltagande, inflytande och dialog har även genomförts i syfte att ge studien ett teoretiskt angreppssätt. Litteraturstudien har visat att för att bäst uppnå kvalitativa och resultatgivande medborgardialoger krävs både strategier och metoder. Beroende på sakfråga finns det vissa strategier, metoder och/eller styrverktyg som lämpar sig bättre än andra. Resultaten från intervjuerna visar på att de utvalda kommunerna enligt respondenterna anser sig arbeta med dialoger i tidiga skeden men att det saknas både en tydlig metodik kring hur dialogerna genomförs och en brist på implementering av resultaten från dialogerna. Samtidigt finns en medvetenhet bland respondenterna kring fördelarna med att föra dialoger i tidiga skeden och stora utvecklingsmöjligheter för samtliga kommuner som undersökts.In line with Sweden's increasing population, there is a requirement that the municipality is able to plan cities suitable for the population based on fundamental as well as personal needs. The municipalities are the ones who, through planning notifications, announce if they intend to start planning or not. In the detailed development plan the consultation in planning aims, among other things, to contribute with a good decision-making basis. However the consultation occurs only after decisions have been made from the municipality's point of view. The purpose of this study is to use qualitative research to find out how Sweden's largest municipalities work with dialogues in the early stages of the detailed development planning process. In order to achieve the purpose of the study, semi-structured interview questions are formulated and asked to the participating respondents. A literature study on citizen participation, influence and dialogue has also been carried out with the aim of giving the study a theoretical approach. The literature study has shown that in order to best achieve qualitative and rewarding citizen dialogues, both strategies and methods are required. Depending on the subject matter there are certain strategies, methods and/or tools that are better suited than others. The results of the interviews show that according to the respondents, the selected municipalities consider themselves to be working with dialogues in the early stages, but that there is a lack of both a clear methodology regarding how the dialogues are carried out and a lack of implementation of the results of the dialogues. At the same time, there is an awareness among respondents about the benefits of dialogues in the early stages and furthermore great development opportunities for all municipalities that participated in the study

Early dialogues outside of consultation according to PBL : An in-depth study on how ten of Sweden's largest municipalities work with dialogues in the early stages of the detailed development plan process

I takt med Sveriges ökande befolkningsmängd tillkommer krav på att kommunen ska kunna planera städer som lämpar sig till befolkningen utifrån fundamentala men även personliga behov. Kommunerna är de som genom planbesked meddelar om de tänker påbörja planläggning. I detaljplaneprocessen syftar samrådet bland annat till att bidra med bra beslutsunderlag men förekommer i processen först efter att ställningstaganden och beslutsfattande moment redan har skett från kommunens håll. Syftet med denna studie är att med hjälp av kvalitativ undersökning ta reda på hur Sveriges, till invånarantal, största kommuner arbetar med dialoger i tidiga skeden av detaljplaneprocessen. För att uppnå studiens syfte formuleras och ställs semistrukturerade intervjufrågor till de deltagande respondenterna. En litteraturstudie kring medborgardeltagande, inflytande och dialog har även genomförts i syfte att ge studien ett teoretiskt angreppssätt. Litteraturstudien har visat att för att bäst uppnå kvalitativa och resultatgivande medborgardialoger krävs både strategier och metoder. Beroende på sakfråga finns det vissa strategier, metoder och/eller styrverktyg som lämpar sig bättre än andra. Resultaten från intervjuerna visar på att de utvalda kommunerna enligt respondenterna anser sig arbeta med dialoger i tidiga skeden men att det saknas både en tydlig metodik kring hur dialogerna genomförs och en brist på implementering av resultaten från dialogerna. Samtidigt finns en medvetenhet bland respondenterna kring fördelarna med att föra dialoger i tidiga skeden och stora utvecklingsmöjligheter för samtliga kommuner som undersökts.In line with Sweden's increasing population, there is a requirement that the municipality is able to plan cities suitable for the population based on fundamental as well as personal needs. The municipalities are the ones who, through planning notifications, announce if they intend to start planning or not. In the detailed development plan the consultation in planning aims, among other things, to contribute with a good decision-making basis. However the consultation occurs only after decisions have been made from the municipality's point of view. The purpose of this study is to use qualitative research to find out how Sweden's largest municipalities work with dialogues in the early stages of the detailed development planning process. In order to achieve the purpose of the study, semi-structured interview questions are formulated and asked to the participating respondents. A literature study on citizen participation, influence and dialogue has also been carried out with the aim of giving the study a theoretical approach. The literature study has shown that in order to best achieve qualitative and rewarding citizen dialogues, both strategies and methods are required. Depending on the subject matter there are certain strategies, methods and/or tools that are better suited than others. The results of the interviews show that according to the respondents, the selected municipalities consider themselves to be working with dialogues in the early stages, but that there is a lack of both a clear methodology regarding how the dialogues are carried out and a lack of implementation of the results of the dialogues. At the same time, there is an awareness among respondents about the benefits of dialogues in the early stages and furthermore great development opportunities for all municipalities that participated in the study