Sweden's tastiest defense? : dairy farmers' view of their role as a vital societal function in the event of crisis or war

Svenskt lantbruk och livsmedelsproduktion är sårbara i de flesta krissituationer. Från ett beredskapsperspektiv är mjölkproduktion en viktig primärproducent till ett flertal livsmedel, samtidigt som produktionen är helt beroende av ständiga transporter främst i form av mjölkbilen som hämtar mjölk varannan dag. Den här uppsatsen har som syfte att bidra med kunskap och insikt i hur svenska mjölkbönder ser på sina möjligheter att upprätthålla produktion i händelse av krig. Resultaten bygger på semi-strukturerade intervjuer med femton mjölkbönder på totalt tio mjölkgårdar i Sverige. För att understödja intervjuerna har ett fiktivt scenario där Sverige befinner sig i ett gråzonstillstånd mellan krig och fred använts. Mjölkbönderna i studien har ett starkt försvarsstödjande beteende, utifrån de förutsättningar som finns skulle de med sin kunskap och anpassningsförmåga försöka upprätthålla mjölkproduktion så långt det är möjligt. Samstämmigt med tidigare forskning visar studien att beroendet av diesel och den låga lönsamheten inom lantbrukssektorn utgör de största sårbarheterna, vilket ger negativa följdeffekter för både lantbrukarnas och samhällets livsmedelsberedskap. För en bättre beredskap önskar sig mjölkbönderna en ökad förståelse för deras produktion, tydligare styrmedel och bättre förutsättningar, så de kan fortsätta producera livsmedel även i kris eller krig.Swedish agriculture and food production are vulnerable in most crises. From the perspective of food security dairy production is an important primary producer of food. At the same time the production depends on constant transport, mainly in the form of the milk tanker collecting milk every other day. The purpose of this thesis is to provide knowledge and insight into how Swedish dairy farmers view their opportunities to maintain milk production in the event of war. The results are based on semi-structured interviews with fifteen dairy farmers on a total of ten dairy farms in Sweden. A fictional scenario in which Sweden is placed under a gray zone threat, was used to support the interviews. The dairy farmers in this study have a strong defense-supportive behavior and based on their existing conditions they would try to maintain their milk production as long as possible with help from their knowledge and adaptability. Consistent with earlier research this study shows that the dependence on diesel and the low profitability in the agricultural sector are the biggest vulnerabilities, leading to negative consequences for both farmers and society's food security. For a better preparedness, the dairy farmers wish for an increased understanding of their production, better policy instruments and better conditions, to be able to produce food also in a crisis or war

Genome-wide transcriptional profiling of Neisseria Meningitidis in ex vivo models of Septicaemia

Neisseria meningitidis is a Gram negative bacterium that commonly colonizes the nasopharyngeal mucosa of 10% of the population at any given time. Infrequently it invades to cause life threatening septicaemia and/or meningitis. I have used microarray technology to study the repertoire of meningococcal gene expression in the course of prolonged incubation in human plasma and blood, with the aim of identifying genes that are progressively up-regulated during sepsis, especially those encoding surface antigens. I hypothesize that any surface exposed gene products that are expressed at a higher level in the bloodstream than on the mucosal surface, where immune selection pressure drives antigenic diversity, should be less variable, and so, attractive as cross-protective vaccine candidates. In my thesis research I explored experimental methods for modelling meningococcal bacteraemia ex vivo. I characterised the transcriptional response of a serogroup B strain of N. meningitidis during prolonged incubation (up to 4 hours) in fresh frozen non-bactericidal plasma from two individuals. Subsequently the meningococcal transcriptome was examined during incubation in fresh, anticoagulated non-bactericidal whole human blood for di erent periods up to 4 hours, using microarrays and realtime PCR technology. The cellular localisation of proteins encoded by genes con rmed to be signi cantly di erentially expressed in plasma and/or blood, both by microarray technology and by real-time PCR, was explored using bioinformatic resources, and those predicted (or established) to be surface-exposed were brought forward for further evaluation. Amongst these, I selected genes up-regulated in bacteria incubated in plasma and/or blood, but down-regulated (according to data previously obtained) for organisms isolated from an experimental system modelling the nasopharyngeal carriage state, for examination of sequence diversity. Using serogroup B meningococcal strains of established (multi locus sequence type) diversity; I have used direct sequencing to address the starting hypothesis that these are comparatively invariant genes

Motståndskraftiga lantbrukare i ett sårbart samhälle

Strukturrationaliseringen av lantbruket tillsammans med de alltmer globala förbindelserna länder emellan gör att risken för snabb och vidsträckt smittspridning vid ett sjukdomsutbrott ökar. Syftet med denna uppsats är att undersöka lantbrukares inställning till smittsamma djursjukdomar och analysera deras riskuppfattning och resiliens i förhållande till ett allvarligt sjukdomsutbrott. Resultatet bygger på semistrukturerade intervjuer med fyra mjölkgårdar i Uppland. I intervjuerna användes ett scenario där mul- och klövsjuka bryter ut i Sverige för att belysa de intervjuade lantbrukarnas riskuppfattning och bedömning av hur de skulle hantera smittsamma djursjukdomar. Slutsatserna från studien är att ett allvarligt sjukdomsutbrott kan ge stora konsekvenser för lantbrukarnas arbetsmiljö, för deras produktion och för djurvälfärden. I förlängningen kan det ha stor påverkan på svensk livsmedelsförsörjning. Lantbrukarna som intervjuats har trots detta ett lugn inför det oväntade samtidigt som de upplever att de har stor anpassningsförmåga och villighet att agera i krissituationer. Studiens huvudsakliga slutsats är därför att lantbrukare tycks vara motståndskraftiga, medan samhället blivit mer sårbart.Structural rationalization of agriculture together with the increasingly global connections between countries increases the risk of rapid and widespread infection in the event of a disease outbreak. The purpose of this essay is to explore farmers' attitude toward infectious animal diseases and to analyze their risk perception and resilience relative to a serious disease outbreak. The results are based on semi-structured interviews with four dairy farms in Uppland. A scenario with an outbreak of foot-and-mouth disease in Sweden was used to highlight the interviewed farmers' risk perception and their assessment of infectious animal diseases. The conclusions from the study are that a serious disease outbreak can have major consequences for the farmers' working environment, for their production and for animal welfare. In the long run, it could also have a major impact on Swedish food supply. Notwithstanding, the farmers who were interviewed appear calm in the face of the unexpected, and as having the adaptability and willingness to act in crisis situations at the same time. The main conclusion of the study is therefore that farmers seem to be resilient, while society has become more vulnerable

Krisen som flydde till Europa - En kritisk diskursanalys av flyktingkrisen 2015

Texten vill genom att utföra en kritiska diskursanalys av svensk medierapportering kring flyktingkrisen under hösten 2015 undersöka vad som utgör flyktingkrisen och i vilket avseende det är en kris. Analysen utgår ifrån nationen som föreställd gemenskap och visar att ett hierarkiskt ”vi och dem” konstrueras i diskursen och att tanken om nationen och nationalism är höst relevant för att förstå flyktingkrisen. Författarna menar att flyktingkrisen i själva verket kan handla om något större, ett krisande samhälle där de liberala värderingar som västvärlden vilat på håller på att utmanas och att de åtgärder som följer i krisens spår kan tolkas som ett tecken på detta

Randomised, blinded, cross-over evaluation of the palatability of and preference for different potassium binders in participants with chronic hyperkalaemia in the USA, Canada and Europe: the APPETIZE study

OBJECTIVES: Traditional potassium (K+) binders for treating hyperkalaemia are unpalatable and poorly tolerated. Newer K+ binders are reportedly better tolerated; however, no published data describe their palatability, a determinant of long-term adherence. This study evaluated the palatability of and preference for three K+ binders: sodium and calcium polystyrene sulfonate (S/CPS), sodium zirconium cyclosilicate (SZC) and calcium patiromer sorbitex (patiromer).// DESIGN: Phase 4, randomised, participant-blinded, cross-over study. Participants were randomised to one of six taste sequences and, using a 'sip and spit' approach, tasted each K+ binder before completing a survey.// SETTING: 17 centres across the USA, Canada and European Union. // PARTICIPANTS: 144 participants with chronic kidney disease, hyperkalaemia and no recent use of K+ binders. // MAIN OUTCOME MEASURES: For the primary (USA) and key secondary (Canada and European Union) endpoints, participants rated palatability attributes (taste, texture, smell and mouthfeel) and willingness to take each K+ binder on a scale of 0-10 (rational evaluation). Feelings about each attribute, and the idea of taking the product once daily, were evaluated using a non-verbal, visual measure of emotional response. Finally, participants ranked the K+ binders according to palatability.// RESULTS: In each region, SZC and patiromer outperformed S/CPS on overall palatability (a composite of taste, texture, smell and mouthfeel), based on rational evaluation and emotional response. Taking the product once daily was more appealing for SZC and patiromer, creating greater receptivity than the idea of taking S/CPS. The emotional response to mouthfeel had the strongest influence on feelings about taking each product. In each region, a numerically greater proportion of participants ranked SZC as the most preferred K+ binder versus patiromer or S/CPS.// CONCLUSIONS: Preference for more palatable K+ binders such as SZC and patiromer may provide an opportunity to improve adherence to long-term treatment of hyperkalaemia. // TRIAL REGISTRATION NUMBER: NCT04566653

Predicting risk of cardiovascular events 1 to 3 years post-myocardial infarction using a global registry.

BACKGROUND: Risk prediction tools are lacking for patients with stable disease some years after myocardial infarction (MI). HYPOTHESIS: A practical long-term cardiovascular risk index can be developed. METHODS: The long-Term rIsk, Clinical manaGement and healthcare Resource utilization of stable coronary artery dISease in post-myocardial infarction patients prospective global registry enrolled patients 1 to 3 years post-MI (369 centers; 25 countries), all with ≥1 risk factor (age ≥65 years, diabetes mellitus requiring medication, second prior MI, multivessel coronary artery disease, or chronic non-end-stage kidney disease [CKD]). Self-reported health was assessed with EuroQoL-5 dimensions. Multivariable Poisson regression models were used to determine key predictors of the primary composite outcome (MI, unstable angina with urgent revascularization [UA], stroke, or all-cause death) over 2 years. RESULTS: The primary outcome occurred in 621 (6.9%) of 9027 eligible patients: death 295 (3.3%), MI 195 (2.2%), UA 103 (1.1%), and stroke 58 (0.6%). All events accrued linearly. In a multivariable model, 11 significant predictors of primary outcome (age ≥65 years, diabetes, second prior MI, CKD, history of major bleed, peripheral arterial disease, heart failure, cardiovascular hospitalization (prior 6 months), medical management (index MI), on diuretic, and poor self-reported health) were identified and combined into a user-friendly risk index. Compared with lowest-risk patients, those in the top 16% had a rate ratio of 6.9 for the primary composite, and 18.7 for all-cause death (overall c-statistic; 0.686, and 0.768, respectively). External validation was performed using the Australian Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events registry (c-statistic; 0.748, and 0.849, respectively). CONCLUSIONS: In patients >1-year post-MI, recurrent cardiovascular events and deaths accrue linearly. A simple risk index can stratify patients, potentially helping to guide management

Health-related quality of life 1–3 years post-myocardial infarction: its impact on prognosis

ObjectiveTo assess associations of health-related quality of life (HRQoL) with patient profile, resource use, cardiovascular (CV) events and mortality in stable patients post-myocardial infarction (MI).MethodsThe global, prospective, observational TIGRIS Study enrolled 9126 patients 1–3 years post-MI. HRQoL was assessed at enrolment and 6-month intervals using the patient-reported EuroQol-5 dimension (EQ-5D) questionnaire, with scores anchored at 0 (worst possible) and 1 (perfect health). Resource use, CV events and mortality were recorded during 2-years’ follow-up. Regression models estimated the associations of index score at enrolment with patient characteristics, resource use, CV events and mortality over 2-years’ follow-up.ResultsAmong 8978 patients who completed the EQ-5D questionnaire, 52% reported ‘some’ or ‘severe’ problems on one or more health dimensions. Factors associated with a lower index score were: female sex, older age, obesity, smoking, higher heart rate, less formal education, presence of comorbidity (eg, angina, stroke), emergency room visit in the previous 6 months and non-ST-elevation MI as the index event. Compared with an index score of 1 at enrolment, a lower index score was associated with higher risk of all-cause death, with an adjusted rate ratio of 3.09 (95% CI 2.20 to 4.31), and of a CV event, with a rate ratio of 2.31 (95% CI 1.76 to 3.03). Patients with lower index score at enrolment had almost two times as many hospitalisations over 2-years’ follow-up.ConclusionsClinicians managing patients post-acute coronary syndrome should recognise that a poorer HRQoL is clearly linked to risk of hospitalisations, major CV events and death.Trial registration numberClinicalTrials.gov Registry (NCT01866904) (https://clinicaltrials.gov).</jats:sec

Identity, Empathy and Argument: Immigrants in Culture and Entertainment Journalism in the Scandinavian Press

Cultural and entertainment journalism deals with aesthetic experiences, advice on cultural consumption, as well as reflection and debate on ethical and moral humanistic issues. Does this sub-field of journalism systematically represent immigrants and integration differently than the other news and commentary articles? Comparing immigration discourse in a representative sample of six Scandinavian newspapers between 1970 and 2016 using content analysis we find that cultural journalism, while clearly reverbing with the dominant national issues at the time, did provide alternative perspectives. It not only brought up themes like racism, multiculturalism, national identity and religion more often, but was also more positive, more gender-balanced and more often gave a voice to immigrants than other news did. A closer qualitative reading further suggests a typology of ten main story-types, varying relatively little over time and across national borders. Cultural journalism in this case illustrates how the cultural public sphere can positively contribute to the debate of complicated issues in the public sphere by offering resources for identification, empathy and arguments for specific points of view.publishedVersio

Diabetes association with self-reported health, resource utilization, and prognosis post-myocardial infarction.

BACKGROUND: Diabetes mellitus (DM) is associated with increased cardiovascular (CV) risk. We compared health-related quality of life (HRQoL), healthcare resource utilization (HRU), and clinical outcomes of stable post-myocardial infarction (MI) patients with and without DM. HYPOTHESIS: In post-MI patients, DM is associated with worse HRQoL, increased HRU, and worse clinical outcomes. METHODS: The prospective, observational long-term risk, clinical management, and healthcare Resource utilization of stable coronary artery disease study obtained data from 8968 patients aged ≥50 years 1 to 3 years post-MI (369 centers; 25 countries). Patients with ≥1 of the following risk factors were included: age ≥65 years, history of a second MI >1 year before enrollment, multivessel coronary artery disease, creatinine clearance ≥15 and <60 mL/min, and DM treated with medication. Self-reported health status was assessed at baseline, 1 and 2 years and converted to EQ-5D scores. The main outcome measures were baseline HRQoL and HRU during follow-up. RESULTS: DM at enrollment was 33% (2959 patients, 869 insulin treated). Mean baseline EQ-5D score (0.86 vs 0.82; P < .0001) was higher; mean number of hospitalizations (0.38 vs 0.50, P < .0001) and mean length of stay (LoS; 9.3 vs 11.5; P = .001) were lower in patients without vs with DM. All-cause death and the composite of CV death, MI, and stroke were significantly higher in DM patients, with adjusted 2-year rate ratios of 1.43 (P < .01) and 1.55 (P < .001), respectively. CONCLUSIONS: Stable post-MI patients with DM (especially insulin treated) had poorer EQ-5D scores, higher hospitalization rates and LoS, and worse clinical outcomes vs those without DM. Strategies focusing specifically on this high-risk population should be developed to improve outcomes. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01866904 (https://clinicaltrials.gov)

Two-year outcomes among stable high-risk patients following acute MI. Insights from a global registry in 25 countries.

BACKGROUND: Evidence is lacking on long-term outcomes in unselected patients surviving the first year following myocardial infarction (MI). METHODS AND RESULTS: The TIGRIS (long-Term rIsk, clinical manaGement and healthcare Resource utilization of stable coronary artery dISease in post-myocardial infarction patients) prospective registry enrolled 9176 eligible patients aged ≥50 years, 1-3 years post-MI, from 25 countries. All had ≥1 risk factor: age ≥ 65 years, diabetes mellitus, second prior MI, multivessel coronary artery disease, chronic kidney disease (CKD). Primary outcome was a composite of MI, unstable angina with urgent revascularization, stroke, or all-cause death at 2-year follow-up. Bleeding requiring hospitalization was also recorded. 9027 patients (98.4%) provided follow-up data: the primary outcome occurred in 621 (7.0%), all-cause mortality in 295 (3.3%), and bleeding in 109 (1.2%) patients. Events accrued linearly over time. In multivariable analyses, qualifying risk factors were associated with increased risk of primary outcome (incidence rate ratio [RR] per 100 patient-years [95% confidence interval]): CKD 2.06 (1.66, 2.55), second prior MI 1.71 (1.38, 2.10), diabetes mellitus 1.63 (1.39, 1.92), age ≥ 65 years 1.53 (1.28, 1.83), and multivessel disease 1.24 (1.05, 1.48). Risk of bleeding events was greater in older patients (vs <65 years) 65-74 years 2.68 (1.53, 4.70), ≥75 years 4.62 (2.57, 8.28), and those with CKD 1.99 (1.18, 3.35). CONCLUSION: In stable patients recruited 1-3 years post-MI, recurrent cardiovascular and bleeding events accrued linearly over 2 years. Factors independently predictive of ischemic and bleeding events were identified, providing a context for deciding on treatment options