Why is prior consultation not yet an effective tool for conflict resolution? : the case of Peru

Objective. To evaluate whether preoperative vaginal preparation routines influence postoperative infectious morbidity in vaginal hysterectomy and to analyze risk factors for postoperative infectious morbidity. Design. Retrospective, longitudinal cohort study. Setting. Forty -three hospitals in Sweden, participating in the Swedish National Register for Gynecological Surgery. Population. All 6,496 women who were enrolled in the Register and underwent vaginal or laparoscopically assisted vaginal hysterectomy between 1 January 2000 and 1 February 2008. Methods. Register data were collected prospectively using doctors forms and patient questionnaires. Information about vaginal preparation routines in the clinics were achieved retrospectively by an e-mail survey. Multiple logistic regression analyses models were used to determine associations and risk factors. Main outcome measures. Infectious morbidity within 6-8 weeks postoperatively. Results. No significant differences were seen in postoperative infectious morbidity in long term between vaginal preparation using saline or chlorhexidine solution or no cleansing. At discharge from hospital, those who had had vaginal cleansing using saline solution had a significantly higher risk of postoperative infections. Risk factors for infectious morbidity were young age, obesity, peroperative injury of the urinary bladder, operative time and duration of hospital stay. Protective were prophylactic antibiotics and concomitant prolapse surgery. Conclusions. Saline solution should not be used for vaginal cleansing due to a higher risk of infectious morbidity in the immediate postoperative period. Infectious morbidity may be reduced further by employing preventive measures such as meticulous surgical technique, preoperative weight reduction in obese women and minimizing time in hospital.Original Publication:Preben Kjölhede, Shefqet Halili and Mats Lofgren, Vaginal cleansing and postoperative infectious morbidity in vaginal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery, 2011, ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, (90), 1, 63-71.http://dx.doi.org/10.1111/j.1600-0412.2010.01023.xCopyright: Informa Healthcarehttp://informahealthcare.com

Biotechnology and governance in Australia and Sweden: path dependency or instutional convergence?

The development of new generic technologies occurs within traditional structures of industry-government interaction, but also unleashes a process of \u27creative destruction\u27 generating new institutional patterns. This article, focusing on biotechnology, describes and compares policy processes and institutional arrangements in Australia and Sweden. The Swedish biotechnology sector displays a pattern of fragmentation and relatively weak state steering. Australia, by contrast, has implemented a set of comparatively coordinated regulatory and other measures to foster the growth of biotechnology. This observation contradicts the characterisation of Sweden as a \u27strong state\u27 economy, and challenges the depiction of Australia as lacking in state steering capacity. The relative open-endedness of the search in these countries for a mode of regulation of biotechnology suggests that the role of the state in economic restructuring today is fundamentally distinct from that of earlier periods. <br /

A global knowledge economy? Biopolitical strategies in India and the European Union

This article critiques the notion of a cross-national convergence of institutional and policy responses to science-based technologies. The continued significance of institutional legacies is demonstrated through a comparative analysis of strategies for the biopharma industry in two radically different settings: India and the European Union (EU). Tensions are evident in both the EU 'high' route and the mixed strategy pursued in India. State promotion of biopharma is seen in India as a pathway to economic development, framed by a vision of India as a global power. Here, the 'low' route of cost advantages is combined with a 'global' rhetoric of innovation, modeled on US experience, and uneven forays into advanced R&D. The pursuit of product innovation was reinforced by India's adoption of TRIPS-mandated intellectual property rights. In the EU, the aim is an integrated policy and regulatory approach to sustain and legitimize European integration, with the ultimate intent of overtaking the USA

The bio-economy and the competition state : transcending the dichotomy between coordinated and liberal market economies

This article examines the role of the state in the emerging bio-economy. The starting point is that state interventions, including supportive regulatory arrangements and the shaping of public attitudes, constitute core assets in the evolution of bio-industrial complexes. Public policy in the bio-economy, across advanced industrial countries, is well captured by the &ldquo;competition state&rdquo; concept. This type of state takes different forms, analogously with the historical variants of the Keynesian welfare state. The article compares patterns of governance of the biotechnology sector in Finland and Sweden, the USA and the UK, and Australia. It is concluded that the bio-industry sector does not fit with the &ldquo;models of capitalism&rdquo; paradigm which postulates coherence within, and systemic divergences between, national models of economic governance. The bio-economy displays trends toward convergence, in particular mounting public investments in health care and in research and development. On the other hand, countries differ in their approach to market regulation, industrial support, and ethical restrictions. These differences do not follow the dichotomy between &ldquo;liberal&rdquo; and &ldquo;coordinated&rdquo; models of capitalism.<br /

Vaginal cleansing and postoperative infectious morbidity in vaginal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery

Objective. To evaluate whether preoperative vaginal preparation routines influence postoperative infectious morbidity in vaginal hysterectomy and to analyze risk factors for postoperative infectious morbidity. Design. Retrospective, longitudinal cohort study. Setting. Forty -three hospitals in Sweden, participating in the Swedish National Register for Gynecological Surgery. Population. All 6,496 women who were enrolled in the Register and underwent vaginal or laparoscopically assisted vaginal hysterectomy between 1 January 2000 and 1 February 2008. Methods. Register data were collected prospectively using doctors forms and patient questionnaires. Information about vaginal preparation routines in the clinics were achieved retrospectively by an e-mail survey. Multiple logistic regression analyses models were used to determine associations and risk factors. Main outcome measures. Infectious morbidity within 6-8 weeks postoperatively. Results. No significant differences were seen in postoperative infectious morbidity in long term between vaginal preparation using saline or chlorhexidine solution or no cleansing. At discharge from hospital, those who had had vaginal cleansing using saline solution had a significantly higher risk of postoperative infections. Risk factors for infectious morbidity were young age, obesity, peroperative injury of the urinary bladder, operative time and duration of hospital stay. Protective were prophylactic antibiotics and concomitant prolapse surgery. Conclusions. Saline solution should not be used for vaginal cleansing due to a higher risk of infectious morbidity in the immediate postoperative period. Infectious morbidity may be reduced further by employing preventive measures such as meticulous surgical technique, preoperative weight reduction in obese women and minimizing time in hospital.Original Publication:Preben Kjölhede, Shefqet Halili and Mats Lofgren, Vaginal cleansing and postoperative infectious morbidity in vaginal hysterectomy. A register study from the Swedish National Register for Gynecological Surgery, 2011, ACTA OBSTETRICIA ET GYNECOLOGICA SCANDINAVICA, (90), 1, 63-71.http://dx.doi.org/10.1111/j.1600-0412.2010.01023.xCopyright: Informa Healthcarehttp://informahealthcare.com

Comparison of the patient-derived modified Japanese Orthopaedic Association scale and the European myelopathy score

Purpose: To compare the patient-derived modified Japanese Orthopaedic Association (P-mJOA) scale with the European myelopathy score (EMS) for the assessment of patients with degenerative cervical myelopathy (DCM). Methods: In this register-based cohort study with prospectively collected data, included patients were surgically treated for DCM and had reported both P-mJOA and EMS scores at baseline, 1-year follow-up, and/or 2-year follow-up to the Swedish Spine Register. P-mJOA and EMS scores were defined as severe (P-mJOA 0-11 and EMS 5-8), moderate (P-mJOA 12-14 and EMS 9-12), or mild (P-mJOA 15-18 and EMS 13-18). P-mJOA and EMS mean scores were compared, and agreement was evaluated with Spearman's rank correlation coefficient (rho), the intraclass correlation coefficient (ICC), and kappa (kappa) statistics. Results: Included patients (n = 714, mean age 63.2 years, 42.2% female) completed 937 pairs of the P-mJOA and the EMS. The mean P-mJOA and EMS scores were 13.9 +/- 3.0 and 14.5 +/- 2.7, respectively (mean difference -0.61 [95% CI -0.72 to -0.51; p &lt; 0.001]). Spearman's rho was 0.84 (p &lt; 0.001), and intra-rater agreement measured with ICC was 0.83 (p &lt; 0.001). Agreement of severity level measured with unweighted and weighted kappa was fair (kappa = 0.22 [p &lt; 0.001]; kappa = 0.34 [p &lt; 0.001], respectively). Severity levels were significantly higher using the P-mJOA (p &lt; 0.001). Conclusion: The P-mJOA and the EMS had similar mean scores, and intra-rater agreement was high, whereas severity levels only demonstrated fair agreement. The EMS has a lower sensitivity for detecting severe myelopathy but shows an increasing agreement with the P-mJOA for milder disease severity. A larger interval to define severe myelopathy with the EMS is recommended

Influence of single nucleotide polymorphisms among cigarette smoking and non-smoking patients with coronary artery disease, urinary bladder cancer and lung cancer

Introduction Cigarette smoke is suggested to be a risk factor for coronary artery disease (CAD), urinary bladder cancer (UBCa) or lung cancer (LCa). However, not all heavy smokers develop these diseases and elevated cancer risk among first-degree relatives suggests an important role of genetic factor. Methods Three hundred and ten healthy blood donors (controls), 98 CAD, 74 UBCa and 38 LCa patients were included in this pilot study. The influence of 92 single nucleotide polymorphisms (SNPs) and impact of cigarette smoking were analysed. Results Out of 92 SNPs tested, differences in distribution of 14 SNPs were detected between controls and patient groups. Only CTLA4 rs3087243 showed difference in both CAD and UBCa patient group compared to control group. Stratified by smoking status, the impact of smoking was associated to frequencies of 8, 3 and 4 SNPs in CAD, UBCa, LCa patients, respectively. None of these 92 SNPs showed a statistically significant difference to more than one type of disease among smoking patients. In non-smoking patients, 7, 3 and 6 SNPs were associated to CAD, UBCa, LCa, respectively. Out of these 92 SNPs, CTLA4 rs3087243 was associated to both non-smoking CAD and UBCa. The XRCC1 rs25487 was associated to both non-smoking UBCa and LCa. Conclusion SNPs might be important risk factors for CAD, UBCa and LCa. Distribution of the SNPs was specific for each patient group, not a random event. Impact of cigarette smoking on the disease was associated to the specific SNP sequences. Thus, smoking individuals with SNPs associated to risk of these serious diseases is an important target group for smoking cessation programs.Funding Agencies|Jonko ping Clinical Cancer Research Foundation [110426-1]; Futurum the Academy for health and care [144631]; Medical Research Council of Southeast Sweden (FORSS) [567001]; Internal research Laboratory Medicine; Swedish Match AB</p

Biogeochemical data from terrestrial and aquatic ecosystems in a periglacial catchment, West Greenland

Global warming is expected to be most pronounced in the Arctic where permafrost thaw and release of old carbon may provide an important feedback mechanism to the climate system. To better understand and predict climate effects and feedbacks on the cycling of elements within and between ecosystems in northern latitude landscapes, a thorough understanding of the processes related to transport and cycling of elements is required. A fundamental requirement to reach a better process understanding is to have access to high-quality empirical data on chemical concentrations and biotic properties for a wide range of ecosystem domains and functional units (abiotic and biotic pools). The aim of this study is therefore to make one of the most extensive field data sets from a periglacial catchment readily available that can be used both to describe present-day periglacial processes and to improve predictions of the future. Here we present the sampling and analytical methods, field and laboratory equipment and the resulting biogeochemical data from a state-of-the-art whole-ecosystem investigation of the terrestrial and aquatic parts of a lake catchment in the Kangerlussuaq region, West Greenland. This data set allows for the calculation of whole-ecosystem mass balance budgets for a long list of elements, including carbon, nutrients and major and trace metals. The data set is freely available and can be downloaded from PANGAEA: doi: 10.1594/PANGAEA.860961