Evidence from Sweden: how local governments shape migration policies

While migration policies are typically set by national governments, local governments play a key role in managing the settlement of migrants and their integration into society. Based on an analysis of Swedish migration policy in the aftermath of the 2015-16 migration crisis, Jon Nyhlén and Gustav Lidén shed light on the significance of the local level of government for migration policy

Laktester för riskbedömning av förorenad mark

Using leaching test is a way to get a picture of pollutants retention and leaching in a risk assessment on contaminated land. There are several different types of standardised leaching tests today, where the natural leaching processes are speeded up to make it possible to predict the leaching of pollutants. These leaching tests have been developed for waste and there are no specific guidelines on how to judge the results from the tests, when making a risk assessment on contaminated land. This work is an investigation on how to use leaching test in this type of risk assessments. The strengths and weaknesses of the different types of tests are discussed. Depending on what type of information you want from your leaching test, different types of tests are suitable. One benefit of using standardised tests is that you can easily compare results since the methods are the same. When you dispose contaminated soil, there will also be a law to make leaching tests before determining to what type of dump the waste can be classified. So if standardised leaching tests are already made during the risk assessment, it does not have to be done later if the risk assessment indicates that the soil will be disposed. A disadvantage, however, is that the standardised tests cannot reflect all the processes that will affect the leaching of pollutants. The cheapest test (batch test), which is also the most common test, does not show what will happen if parameters, such as pH and the redox potential of the soil, change. Therefore long term predictions of the effect on the environment made from this type of test are uncertain. A possible alternative to the standardised tests is a sequential test that considers leaching in a changing environment. In this work I made a case study where results from leaching test on five inorganic substances were studied. One of the parameters, which I looked specifically at, was the partition coefficient, Kd that can be calculated from the leaching test. I compared the Kd from the leaching test with literature values used in the general model when calculating guide values (tolerable total concentration) on contaminated land. The case study confirms the fact that it is hard to predict leaching from a total concentration of the pollutant. If the total concentration is high the leaching might be low, or the other way round. The study also shows that the literature Kd-value is very low compared to the Kd you get from the leaching test. From the Kd of a leaching test you can often calculate higher site-specific guide values. When doing so you have to be cautious, however, and choose one of the lowest Kd from the test. To sum up, leaching test is a good tool to predict leaching of pollutants, if you are aware of the defects and uncertainties associated with the tests.Ett sätt att bedöma föroreningars fastläggning och spridning i samband med riskbedömning av förorenad mark är att använda sig av laktest. Det finns idag flera olika standardiserade laktestmetoder, där det naturliga lakningsförloppet påskyndas inne på labb i syfte att förutse utlakning. Dessa laktester är emellertid utvecklade för avfall och det finns inga riktlinjer för hur man ska tolka resultatet från laktest vid riskbedömning av förorenad mark. I det här arbetet, som är en utredande studie om hur laktester kan användas på förorenad mark, tas laktesters för- och nackdelar upp och problematiken kring hur man ska bedöma resultaten behandlas. Olika typer av laktester passar olika bra beroende på hur omfattande information man vill ha ut och beroende av förhållandena på platsen som undersöks. En stor fördel med de standardiserade laktesterna är att det lätt går att jämföra resultat mellan olika lakförsök eftersom testmetoderna är desamma. En annan fördel är att det i samband med deponering av avfall, t.ex. förorenad jord, kommer att krävas laktest för att bestämma till vilken typ av deponi avfallet ska klassas. Om man då redan från början i samband med riskbedömningen av den förorenade marken gjort laktest, slipper man göra det vid en eventuell deponering. En sådan samordning av laktest sparar både tid och pengar. En stor nackdel med de standardiserade laktesterna är emellertid att de inte speglar alla de processer som kan komma att påverka utlakningen. Den vanligaste metoden (tvåstegs skaktest) säger ingenting om hur utlakningen skulle kunna komma att förändras om pH eller redoxförhållandena i marken ändrades. Det är därför ganska osäkert att förutse utlakningen på lång sikt från dessa typer av tester. Ett möjligt alternativ till de standardiserade testerna är sekventiella laktest som tar hänsyn till utlakning vid förändrade förhållanden såsom oxidation, reduktion och pHförändringar. I arbetet har en fallstudie gjorts där resultaten från laktest för några utvalda oorganiska ämnen studerats. Bland annat har fördelningskoefficienten (Kd) utifrån laktest jämförts med det Kdvärde som används i Naturvårdsverkets generella modell för beräkning av riktvärden (tillåtna totalhalter). Fallstudien bekräftar tidigare erfarenhet att det är svårt att förutse utlakning från totalhalten och även om totalhalten överstiger de generella riktvärdena så kan utlakningen vara väldigt låg och vice versa. Fallstudien visar också att det generella Kd-värde som använts vid framräknandet av de generella riktvärdena är lågt satt och med ett nytt Kd beräknat från laktest kan ofta högre platsspecifika riktvärden räknas fram. Vid val av ett platsspecifikt Kdvärde bör man emellertid vara lite försiktig och välja ett Kd i den lägre regionen p.g.a. de osäkerheter som finns med laktest. Sammanfattningsvis är laktest ett bra verktyg för att ge en bild av utlakningen från ett område, dock bör man vid en riskbedömning vara medveten om de osäkerheter och brister som finns

Drogförebyggande arbete riktat mot barn och ungdom : Vad som görs i skola och kommun i två kommuner i Skåne

This paper is about drug prevention. In my paper the aim is to examine when, where and how the drug prevention work, by law, is being realized, on local levels, in school and municipality, towards youth. My central questions are among others: What does it imply, how the municipality and school value the drug prevention work?, Which prevention programs do the municipality and school use? and Does the drug prevention work give any results? The method I've been using is qualitative interviews and studies of literature and research. The main results I gained with my studie are, that the work of politicians is not in phase with the development in society. And in spite of the fact that drug prevention programs are used, the young ones are using drugs and alcohol more than ever

Det digitala vårdmötet: En kvalitativ studie om hur Min Doktor arbetar med varumärkesbyggande och relationsskapande marknadskommunikation

Health care has always been based on the physical encounter and the relationship between doctor and patient, but the development of digital healthcare has changed these conditions. Therefore, this study intends to explore how Swedish digital healthcare centers are trying to create and maintain relationships with their patients, and how they communicate with their external stakeholders in order to position their brand. To find this out, one of the largest players in digital primary care in Sweden, Min Doktor, and their marketing communications is investigated. The study thus intends to increase knowledge about brand and relationship building communications in the development of Sweden’s digital healthcare. With a hermeneutic approach, a qualitative triangulation has been conducted through analysis of interviews and documents. Based on relevant theories and concepts within the field of strategic communication, the empirical material has been contextualised. The analysis shows that Min Doktor works actively with branding to strengthen their position as a digital healthcare provider in the Swedish market. This is primarily done online and by having a quality that permeates both the communication and the service itself, by actively respond to criticism and by a clear identity system. Furthermore, it appears that Min Doktor is making several communicative actions that are positive for their relationship building, which include the organisation’s name and logotype, a personal tone and offering additional free services. Finally, the fact that the digital healthcare has contributed to the ongoing change in the power balance between doctor and patient is highlighted

Good practices for take-back and disposal of unused pharmaceuticals in the Baltic Sea region. Clear Waters from Pharmaceuticals (CWPharma) Activity 4.1 Report

Appropriate collection and disposal of medicine-related waste has been identified as one of the main ways to decrease the emission of active pharmaceutical ingredients (APIs) into the environment. Improvement to the take-back and treatment of collected pharmaceutical waste may be considered low-hanging fruit when one is considering measures to reduce API emissions. However, comparable information that would enable estimating the potential impact of these efforts has not been available. Directive 2004/27/EC, related to medicinal products for human use, mandates that EU member states implement appropriate collection schemes for unused or expired human-use medicinal products. However, it does not provide any guidelines on practical implementation of these schemes. Several studies have pointed out significant differences among Member States in this regard. In March 2019, the European Commission published the European Union Strategic Approach to Pharmaceuticals in the Environment. The actions specified therein cover all stages of the pharmaceutical life cycle, from design and production to disposal and waste management. It emphasizes such elements as sharing good practices, co-operating at international level, and improving understanding of the risks. This report is aimed at filling knowledge gaps and proposing good practices for take-back and disposal of unused human and veterinary medicines and other pharmaceutical waste. The report is targeted to e.g. ministries, environment and medicines agencies, supervisory authorities, municipalities, hospitals, NGOs, pharmacists, doctors, and veterinarians. For the report, current national practices for take-back and disposal of unused medicines and other pharmaceutical waste in Denmark, Estonia, Finland, Germany, Latvia, Lithuania, Poland, Russia, and Sweden were evaluated. The pharmaceutical waste originating from households, hospitals and other health care institutions, the pharmaceutical industry, and veterinary use was considered. The proportion of citizens who return unused pharmaceuticals via designated collection points varies greatly between Baltic Sea countries, from about 10% to 70%, with 16–80% disposing of them of as mixed household waste and 3–30% flushing them down the drain. The most commonly cited reason for improper disposal of medicines on households’ part is lack of information about their environmental impacts and how to get rid of them in an environmentally sound manner. Separate collection of unused household pharmaceuticals does not exist in Russia, and the collection mechanism functions poorly in Latvia, Lithuania and Poland. Information on the take-back schemes for unused human medicines is more readily available than is corresponding information on veterinary medicines. We identified, all told, 21 good practices and recommendations for take-back and disposal of unused pharmaceuticals and other pharmaceutical waste and for promoting the rational use of pharmaceuticals in the Baltic Sea region. Nevertheless, implementing them at national level requires particular consideration due to differences in national legislation and other characteristics of the EU Baltic Sea countries and Russia. The good practices identified in this report answer the call issued in the EU strategic approach for an efficient risk-reduction strategy

Substance abuse and psychiatric co-morbidity as predictors of premature mortality in Swedish drug abusers a prospective longitudinal study 1970 - 2006

<p>Abstract</p> <p>Background</p> <p>Few longitudinal cohort studies have focused on the impact of substances abused and psychiatric disorders on premature mortality. The aim of the present study was to identify predictors of increased risk of drug related death and non drug related death in substance abusers of opiates, stimulants, cannabis, sedatives/hypnotics, hallucinogens and alcohol over several decades.</p> <p>Methods</p> <p>Follow-up study of a consecutive cohort of 561 substance abusers, admitted to a detoxification unit January 1970 to February 1978 in southern Sweden, and followed up in 2006. Demographic and clinical data, substance diagnoses and three groups of psychiatric diagnoses were identified at first admission. Causes of death were coded according to ICD-10 and classified as drug related deaths or non drug related deaths. To identify the incidence of some probable risk factors of drug related premature death, the data were subjected to a competing risks Cox regression analysis.</p> <p>Results</p> <p>Of 561 patients in the cohort, 11 individuals had either emigrated or could not be located, and 204/561 patients (36.4%) were deceased by 2006. The cumulative risk of drug related death increased more in the first 15 years and leveled out later on when non drug related causes of death had a similar incidence. In the final model, male gender, regular use of opiates or barbiturates at first admission, and neurosis were associated with an increased risk of drug related premature death, while cannabis use and psychosis were associated with a decreased risk. Neurosis, mainly depression and/or anxiety disorders, predicted drug related premature death while chronic psychosis and personality disorders did not. Chronic alcohol addiction was associated with increased risk of non drug related death.</p> <p>Conclusions</p> <p>The cohort of drug abusers had an increased risk of premature death to the age of 69. Drug related premature death was predicted by male gender, the use of opiates or barbiturates and depression and anxiety disorders at first admission. The predicted cumulative incidence of drug related death was significantly higher in opiate and barbiturate abusers over the observed period of 37 years, while stimulant abuse did not have any impact. Alcohol contributed to non drug related death.</p

Hypothalamic-pituitary-adrenal (HPA) axis suppression after treatment with glucocorticoid therapy for childhood acute lymphoblastic leukaemia

Background Glucocorticoids play a major role in the treatment of acute lymphoblastic leukaemia (ALL). However, supraphysiological doses may cause suppression of the hypothalamic-pituitary-adrenal (HPA) axis. HPA axis suppression resulting in reduced cortisol response may cause an impaired stress response and an inadequate host defence against infections, which remains a cause of morbidity and death. The exact occurrence and duration of HPA axis suppression after glucocorticoid therapy for childhood ALL are unclear. Objectives To examine the occurrence and duration of HPA axis suppression after (each cycle of) glucocorticoid therapy for childhood ALL. Search methods We searched the Cochrane Central Register of Controlled Trials (in The Cochrane Library, issue 3, 2010), MEDLINE/PubMed (from 1945 to July 2010) and EMBASE/Ovid (from 1980 to July 2010). In addition, we searched reference lists of relevant articles, conference proceedings and ongoing trial databases. Selection criteria All study designs, except case reports and patient series with fewer than 10 patients, examining the effect of glucocorticoid therapy for childhood ALL on the HPA axis function. Data collection and analysis Two review authors independently performed the study selection. One review author performed the data extraction and 'Risk of bias' assessment, which was checked by another review author. Main results We identified seven studies (total number of participants = 189), including one randomised controlled trial (RCT), which assessed the adrenal function. None of the studies assessed the HPA axis at the level of the hypothalamus, pituitary, or both. Due to substantial differences between studies, results could not be pooled. All studies had some methodological limitations. The included studies demonstrated that adrenal insufficiency occurs in nearly all patients in the first days after cessation of glucocorticoid treatment for childhood ALL. The majority of patients recovered within a few weeks, but a small amount of patients had ongoing adrenal insufficiency lasting up to 34 weeks. In the RCT, the occurrence and duration of adrenal insufficiency did not differ between the prednisolone and dexamethasone arms. In one study included in the review it appeared that treatment with fluconazole prolonged the duration of adrenal insufficiency. Authors' conclusions Based on the available evidence, we conclude that adrenal insufficiency commonly occurs in the first days after cessation of glucocorticoid therapy for childhood ALL, but the exact duration is unclear. Since no data on the level of the hypothalamus and the pituitary were available we cannot make any conclusions regarding those outcomes. Clinicians should consider prescribing glucocorticoid replacement therapy during periods of serious stress in the first weeks after cessation of glucocorticoid therapy for childhood ALL, to reduce the risk of life-threatening complications. However, more high-quality research is needed for evidence-based guidelines for glucocorticoid replacement therapy. Special attention should be paid to patients receiving fluconazole therapy, and perhaps similar antifungal drugs, as this may prolong the duration of adrenal insufficienc

Paquinimod reduces skin fibrosis in tight skin 1 mice, an experimental model of systemic sclerosis

AbstractBackgroundSystemic Sclerosis (SSc) is an autoimmune disease characterized by vascular and immune dysfunction. A hallmark of SSc is the excessive accumulation of extracellular matrix in the skin and in internal organs. There is a high and unmet medical need for novel therapies in this disease. The pathogenesis of SSc is complex and still poorly understood, but the innate immune system has emerged as an important factor in the disease. SSc patients show increased numbers of macrophages/monocytes in the blood and in the skin compared to healthy individuals and these cells are important sources of profibrotic cytokines and chemokines. Paquinimod belongs to a class of orally active quinoline-3-carboxamide (quinoline) derivatives with immunomodulatory properties and has shown effects in several models of autoimmune/inflammatory disorders. Paquinimod is currently in clinical development for treatment of SSc. The immunomodulatory effects of paquinimod is by targeting the myeloid cell compartment via the S100A9 protein.ObjectiveIn this study we investigate whether targeting of myeloid cells by paquinimod can effect disease development in an experimental model of SSc, the tight skin 1 (Tsk-1) mouse model.MethodsSeven weeks old female B6.Cg-Fbn1Tsk/J (Tsk-1) mice were treated with vehicle or paquinimod at the dose of 5 or 25mg/kg/day in the drinking water for 8 weeks. The effect of paquinimod on the level of skin fibrosis and on different subpopulations within the myeloid cell compartment in skin biopsies were evaluated by using histology, immunohistochemisty, a hydroxyproline assay and real-time PCR. Furthermore, the level of IgG in serum from treated animals was also analysed. The statistical analyses were performed using Mann-Whitney nonparametric two tailed rank test.ResultsThe results show that treatment with paquinimod reduces skin fibrosis measured as reduction of skin thickness and decreased number of myofibroblasts and total hydroxyproline content. The effect on fibrosis was associated with a polarization of macrophages in the skin from a pro-fibrotic M2 to a M1 phenotype. Paquinimod treatment also resulted in a reduced TGFβ-response in the skin and an abrogation of the increased auto-antibody production in this SSc model.ConclusionsPaquinimod reduces skin fibrosis in an experimental model of SSc, and this effect correlates with local and systemic effects on the immune system