Using resource modelling to inform decision making and service planning: the case of colorectal cancer screening in Ireland

Background - Organised colorectal cancer screening is likely to be cost-effective, but cost-effectiveness results alone may not help policy makers to make decisions about programme feasibility or service providers to plan programme delivery. For these purposes, estimates of the impact on the health services of actually introducing screening in the target population would be helpful. However, these types of analyses are rarely reported. As an illustration of such an approach, we estimated annual health service resource requirements and health outcomes over the first decade of a population-based colorectal cancer screening programme in Ireland. Methods - A Markov state-transition model of colorectal neoplasia natural history was used. Three core screening scenarios were considered: (a) flexible sigmoidoscopy (FSIG) once at age 60, (b) biennial guaiac-based faecal occult blood tests (gFOBT) at 55–74 years, and (c) biennial faecal immunochemical tests (FIT) at 55–74 years. Three alternative FIT roll-out scenarios were also investigated relating to age-restricted screening (55–64 years) and staggered age-based roll-out across the 55–74 age group. Parameter estimates were derived from literature review, existing screening programmes, and expert opinion. Results were expressed in relation to the 2008 population (4.4 million people, of whom 700,800 were aged 55–74). Results - FIT-based screening would deliver the greatest health benefits, averting 164 colorectal cancer cases and 272 deaths in year 10 of the programme. Capacity would be required for 11,095-14,820 diagnostic and surveillance colonoscopies annually, compared to 381–1,053 with FSIG-based, and 967–1,300 with gFOBT-based, screening. With FIT, in year 10, these colonoscopies would result in 62 hospital admissions for abdominal bleeding, 27 bowel perforations and one death. Resource requirements for pathology, diagnostic radiology, radiotherapy and colorectal resection were highest for FIT. Estimates depended on screening uptake. Alternative FIT roll-out scenarios had lower resource requirements. Conclusions - While FIT-based screening would quite quickly generate attractive health outcomes, it has heavy resource requirements. These could impact on the feasibility of a programme based on this screening modality. Staggered age-based roll-out would allow time to increase endoscopy capacity to meet programme requirements. Resource modelling of this type complements conventional cost-effectiveness analyses and can help inform policy making and service planning

Öppenhet och rymd i det tidiga 2000-talets villaarkitektur

The aim of this Master´s thesis in Art History and Visual Studies is to examine the existence and the expressions of openness and interior space in the contemporary Swedish architecture of singlefamily houses. Research has focused on open-plan housing with open connections between kitchen and living areas, large windows, walls of glass, high ceiling heights and entresol or loft levels, using two case studies and analyses of seven reference objects. Interpretation is based on phenomenological theoretical perspectives. Houses that are more or less transparent permit views from both the inside and the outside. A discussion of this potential dilemma is supported by sociological perspectives on identity, life-style, self-presentation, privacy and publicity

Vilse i bärskogen

I september 2013 samlades runt 200 thailändska bärplockare i protest på en grusparkering i Umeå. Trots att de plockat bär sex dagar i veckan under nästan två månader hade bärplockarna inte fått någon lön. För att finansiera resan till Sverige hade många av dem tagit stora lån i hemlandet och om de återvände de till Thailand utan pengar att kunna betala lånen med så skulle deras mark och bostäder beslagtas. Pressen blev så stor att en av de strejkande bärplockarna hängde sig inne på en toalett. Det är inte första gången bärplockare blir lurade på sina löner. Varje år kommer tusentals fattiga risbönder från Thailand till de svenska bärskogarna i tron om att tjäna pengar som motsvarar flera årslöner i deras hemland. Men i många fall slutar historien mindre lyckligt. Under decennier har media rapporterat om bärplockare som arbetat hårt från morgon till kväll, tvingats bo under miserabla förhållanden och fått åka hem till Thailand med knappt någon förtjänst alls. Varför återupprepas skandalerna år efter år? Och vem bär ansvaret för att det i höstas gick så långt att en bärplockare tog sitt liv