The EU's Normative Role: The Use of Political Conditionality in Relations with Cuba, China and Zimbabwe

The European Union (EU) is a unique foreign policy actor, because of its history and the diversity of its member states. The EU has developed a distinct approach to promoting human rights and democracy in third states. Its focus lies on positive engagement through constructive dialogue. This preference for using positive rather than negative engagement is the subject of this thesis. It is argued that it is necessary for the EU to judge and conducts its relations with each individual state on a case by case basis. Case specific considerations need to be taken into account as it provides the foundation on which the relationship is based on and continues to shape the negotiations and any use of political conditionality throughout the relationship. This does not diminish the EU¨s normative basis that continues to be well founded in the international human rights treaties. This thesis proceeds to analyse three distinct cases by focusing on the evolution of the Unions relationship with the Peoples Republic of China, Cuba and Zimbabwe. They demonstrate the fragile nature of political dialogue regarding human rights and democratisation and underline the need to constructively engage the recipient state

Screening with low dose CT for early diagnosis in patients with increased risk for lung cancer

Inledning: Lungcancer är den vanligaste cancerformen globalt. Var femte person som dör av cancer, dör av lungcancer. Den främsta orsaken till lungcancer är tobaksrökning. De första stadierna av lungcancer är ofta symptomfria, vilket betyder att när cancern väl upptäcks är den i ett framskridet stadium och därmed ofta svår att behandla kurativt. Detta innebär att prognosen för överlevnad är dålig. Standarddatortomografi ger för hög stråldos för att på ett försvarbart sätt kunna användas i förebyggande syfte. Lågdosdatortomografi (LDDT) ger endast en femtedel såhög stråldos, samtidigt som det ger mer diagnostiskt användbara bilder jämfört med slätröntgen. Syfte: Syftet med denna litteraturöversikt var att utröna om lågdosdatortomografiscreening av thorax effektiviserar tidigare diagnostik vid lungcancer och därmed minskar mortaliteten, samt vilka aspekter som bör beaktas vid införandet av ett eventuellt screeningprogram. Metod: Studien genomfördes som en allmän litteraturöversikt. Elva kvantitativa studier inkluderades i arbetet. Resultat: Litteraturöversiktens resultat visar att screening med lågdosdatortomografi är effektivt för att upptäcka lungcancer i ett tidigare skede vilket möjliggör kurativ behandling av fler drabbade patienter. Vidare indikerar resultatet att mortaliteten minskar bland screenade patienter, då merparten av studierna i litteraturöversikten visar på det. Slutsats: Vid eventuellt införande av ett screeningprogram behöver negativa aspekter såsom kostnad, behov av vårdresurser och falskt positiva svar som leder till oro och onödiga invasiva ingrepp hos patienterna ställas mot positiva effekter såsom tidig upptäckt och minskad mortalitet. Tydliga kriterier vad gäller urval av deltagare, screeningintervall samt hantering av positiva fynd måste fastställas. Att genomgå screening kan upplevas emotionellt krävande för patienten. Röntgensjuksköterskans roll skulle därmed bli central i ett screeningprogram vad gäller information, uppmuntran och stöd vid undersökningen och genom hela processen

Nature enthusiasts' thoughts and experiences regarding nature's impact on well-being : A contribution to use in school?

Studiens syfte är att undersöka naturentusiasters syn på naturens hälsofrämjande effekter på människans välbefinnande.  Forskningsfrågor: 1. Vilken roll har människans relation till natur för upplevt välbefinnande? 2. Vilka är de potentiella hälsoeffekterna av vistelser i naturen? Tanken är också att få en djupare förståelse för hur naturens hälsofrämjande effekter kan användas i en skolkontext. Studien tar avstamp i den fenomenologiska inriktningen med fokus på fenomenens essens. Det empiriska materialet består av semistrukturerade intervjuer som genomfördes i form av walk-and-talks utomhus. Intervjupersonerna var naturentusiaster som studerar ett masterprogram med inriktning på friluftsliv. För analysen användes tematisk analys för att fånga upp de teman som var gemensamt för intervjupersonerna.  Resultaten visar att intervjupersonernas tidiga upplevelser av naturen var i sällskap med deras föräldrar och med tiden blev något de gjorde på egen hand. Intervjupersonerna nämner även att olika landskap i naturen ger olika känslor av välbefinnande. Naturen används för att reducera stress (till exempel från teknologi) och för att komma bort från samhället i största allmänhet. Den används även för att finna sig själv genom självförstärkning.  Slutsatsen blir att det krävs en relation till naturen för dess hälsofrämjande effekter på välbefinnandet, där tidig exponering till naturupplevelser kan bidra med att säkerställa en god naturrelation även senare i livet. Slutsatsen bör dock inte generaliseras för stort, utan blir den sanning som råder för den grupp som undersökts.The purpose of the study is to investigate nature enthusiasts' view of nature's health promoting effects on human well-being. Research questions: 1. What does humans’ relation to nature mean for perceived well-being? 2. What are the potential health effects of being in nature? The idea is also to gain a deeper understanding of how nature's health-promoting effects can be used in a school context. The study is based on the phenomenological orientation with a focus on the essence of the phenomena. The empirical material based of semi-structured interviews that were conducted in the form of walk-and-talks outdoors. The interviewees were nature enthusiasts studying a master's program with a focus on friluftsliv. For the analysis, thematic analysis was used to capture the themes that were in common for the interviewees. The results show that the interviewees' first experiences of nature were in the company of their parents and over time became something they did on their own. The interviewees also mention that different landscapes in nature give different impressions of well-being. Nature is used to reduce stress (for example from technology) and to get away from society in general. It is also used to find oneself through self-empowerment. The conclusion is that a relationship with nature is required for its health-promoting effects on well-being, where early exposure to nature experiences can help ensure a good relationship with nature even later in life. However, the conclusion should not be generalized too widely, but becomes the truth that prevails for the group that were investigated

Mobility device use and exploration of housing accessibility for powered mobility device users among people ageing with spinal cord injury

Aim: To describe the use of mobility devices among people ageing with spinal cord injury (SCI), with a specific focus on use of powered mobility devices (PMD) and housing accessibility. Method: Data on the use of walking aids (cane, crutch/es or rollator), manual wheelchair and powered wheelchair/scooter were utilized. To describe functional limitations, environmental barriers and the magnitude of accessibility problems in the home and the closest exterior surroundings for each individual, the Housing Enabler instrument was used. Descriptive statistics were used for data analysis. Results: Mobility devices: Among participants with paraplegia, the manual wheelchair was the most frequently used mobility device indoors, and among participants with tetraplegia, it was the PMD. The PMD was the most common mobility device used outdoors among those with tetraplegia, and among participants with paraplegia. Housing accessibility: In exterior surroundings, refuse bin difficult to reach was the environmental barrier that generated the most accessibility problems, while at entrances doors that cannot be fastened in open position was identified as the most severe environmental barrier. Indoors, the environmental barrier that generated the most accessibility problems was wall-mounted cupboard and shelves placed high. Conclusion: To enable optimal use of the PMD in the home and close neighborhoods, and support everyday activity and participation for people ageing with SCI, it is vital to take into account not only personal and environmental aspects but also the mobility device in question. Though, it could be discussed if all the environmental barriers identified in this study, actually are problems for users of a PMD, since some of them might be possible to overcome. © 2013 The authors and IOS Press. All rights reserved

Risk factors for depressive disorders in the Lundby cohort - A 50 year prospective clinical follow-up.

BACKGROUND: Depressive disorders are common and disabling. The Lundby Study is a prospective study of a community sample that started in 1947(N=2550). In 1957, 1013 newcomers were added. The latest field investigation was carried out in 1997. AIM: To identify risk factors for depressive disorders. METHOD: The Lundby database contains clinical assessments of the subjects made by psychiatrists. It also includes information about socio-demographic factors and episodes of somatic and mental disorders. Two different but partly overlapping cohorts from the same geographical area in 1947 (N=2470) and in 1957 (N=3310) were investigated. During follow-up 418 individuals experienced their first depressive disorder. For each cohort, possible risk factors were analysed by means of Cox regression analyses for the whole sample and for each sex separately. CONCLUSION: The personality trait nervous/tense and anxiety disorders were statistically significant risk factors for depression for both genders. For males, the diagnoses alcohol disorders and tiredness disorder were risk factors. The personality trait subvalidity (low grade of energy) and nervous symptoms as a child were also risk factors for males. For females personality traits such as being easily hurt, abnormal/antisocial and tired/distracted were associated with depressive disorders. CLINICAL RELEVANCE: Knowledge of risk factors may help to reduce incidence of depression

Longitudinal enumeration and cluster evaluation of circulating tumor cells improve prognostication for patients with newly diagnosed metastatic breast cancer in a prospective observational trial

Abstract Background Circulating tumor cells (CTCs) carry independent prognostic information in patients with metastatic breast cancer (MBC) on different lines of therapy. Moreover, CTC clusters are suggested to add prognostic information to CTC enumeration alone but their significance is unknown in patients with newly diagnosed MBC. We aimed to evaluate whether longitudinal enumeration of circulating tumor cells (CTCs) and CTC clusters could improve prognostication and monitoring of patients with metastatic breast cancer (MBC) starting first-line therapy. Methods This prospective study included 156 women with newly diagnosed MBC. CTCs and CTC clusters were detected using CellSearch technology at baseline (BL) and after 1, 3, and 6 months of systemic therapy. The primary end point was progression-free survival (PFS) and the secondary end point overall survival (OS). Median follow-up time was 25 (7–69) months. Results There were 79 (52%) and 30 (20%) patients with ≥ 5 CTCs and ≥ 1 CTC cluster at baseline, respectively; both factors were significantly associated with impaired survival. Landmark analyses based on follow-up measurements revealed increasing prognostic hazard ratios for ≥ 5 CTCs and CTC clusters during treatment, predicting worse PFS and OS. Both factors added value to a prognostic model based on clinicopathological variables at all time points and ≥ 5 CTCs and presence of CTC clusters enhanced the model’s C-index to > 0.80 at 1, 3, and 6 months. Importantly, changes in CTCs during treatment were significantly correlated with survival and patients with a decline from ≥ 5 CTCs at BL to < 5 CTCs at 1 month had a similar odds ratio for progression to patients with < 5 CTCs at BL and 1 month. Stratification of patients based on CTC count and CTC clusters into four groups (0 CTCs, 1–4 CTCs, ≥ 5 CTCs, and ≥ 1 CTC + CTC clusters) demonstrated that patients with CTC clusters had significantly worse survival compared to patients without clusters. Conclusions Longitudinal evaluation of CTC and CTC clusters improves prognostication and monitoring in patients with MBC starting first-line systemic therapy. The prognostic value increases over time, suggesting that changes in CTC count are clinically relevant. The presence of CTC clusters adds significant prognostic value to CTC enumeration alone. Trial registration NCT01322893. Registered on 25 March 2011

Additional file 1: of Longitudinal enumeration and cluster evaluation of circulating tumor cells improve prognostication for patients with newly diagnosed metastatic breast cancer in a prospective observational trial

Supplementary information: power calculation performed before initiation of the study. (PDF 483 kb

Additional file 6: of Longitudinal enumeration and cluster evaluation of circulating tumor cells improve prognostication for patients with newly diagnosed metastatic breast cancer in a prospective observational trial

Table S4. Unadjusted Cox regression analyses of patient and tumor characteristics at baseline. (PDF 146 kb