Analysing trade-offs in adaptation decision-making-agricultural management under climate change in Finland and Sweden

In light of the increased focus on climate change adaptation, there is a need to understand when and how adaptation decision-making generates trade-offs. This study presents a novel framework for adaptation trade-off assessments, which integrates (I) two trade-off mechanisms (direct and interactions) and (II) two types of trade-off characteristics (substantive and processual). Perspectives on adaptation trade-offs were collected from 37 Swedish and Finnish agricultural experts through semi-structured interviews supported by serious gaming and visualization. The data were thematically analysed based on the provided analytical framework. The results show that trade-offs in agricultural adaptation decision-making processes involve balancing a number of socio-ecological system aspects that are of different character and have different functions. The study identified 20 aspects generating trade-offs related to adaptation management in Swedish and Finnish agriculture, among which 'crop yield and profitability', 'farm economy', 'pest and weed robustness' and 'soil quality' were discussed as the most prominent by respondents. The framework enables an examination of complex trade-off structures that can have implications for adaptation management decisions. The results show that the identified aspects constitute different components and functions of trade-offs, including both processual and/or substantive ones. In conclusion, the 20 identified aspects and the framework together demonstrate the importance of the two types of adaptation trade-offs and the resulting complexity of climate change adaptation decision-making in Swedish and Finnish agriculture. Furthermore, the study asserts the potential of applying the framework for various strategic contexts-to recognize and cope with trade-offs in adaptation management.Peer reviewe

Incidence of Lower-Limb Amputation in the Diabetic and Nondiabetic General Population: A 10-year population-based cohort study of initial unilateral and contralateral amputations and reamputations

OBJECTIVE—The purpose of this study was to compare the incidence of vascular lower-limb amputation (LLA) in the diabetic and nondiabetic general population

Supporting Dialogue and Analysis on Trade-Offs in Climate Adaptation Research With the Maladaptation Game

Background. Serious games are gaining increasing prominence in environmental communication research, but their potential to form an integrated part of participatory research approaches is still strikingly understudied. This is particularly the case for applications of interactive digital formats in research on environmental challenges of high complexity, such as climate adaptation, which is a specifically suitable case as it involves complex interaction between climate systems and society, but where the response also involves trade-offs with potentially negative - maladaptive - outcomes. Intervention. This article presents the Maladaptation Game, which was designed to facilitate dialogue about potential negative outcomes of agricultural climate adaptation. Methods. We conducted test sessions with agricultural stakeholders in Finland and Sweden, and analysed quantitative and qualitative, audio-recorded and transcribed, material for opportunities and challenges related to dialogues, engagement, interactivity and experienced relevance. Results. The qualitative analysis of recorded dialogues shows that the Maladaptation Game has potential to support dialogue by challenging players to negotiate between options with negative outcomes. The gameplay itself presents opportunities in terms of creating engagement with options that provoke disagreement and debates between players, as well as interactivity, that players reflected upon as quick and easy, while challenges were related to the experienced relevance, in particular the options provided in the game, and its general framing. Conclusions. The results indicate a need for complementary approaches to this type of game but also suggest the importance of moderation when the game design is aimed at creating dialogue around a complex environmental challenge such as agricultural climate adaptation.Peer reviewe

First experiences in the implementation of biometric technology to link data from Health and Demographic Surveillance Systems with health facility data

BACKGROUND: In developing countries, Health and Demographic Surveillance Systems (HDSSs) provide a framework for tracking demographic and health dynamics over time in a defined geographical area. Many HDSSs co-exist with facility-based data sources in the form of Health Management Information Systems (HMIS). Integrating both data sources through reliable record linkage could provide both numerator and denominator populations to estimate disease prevalence and incidence rates in the population and enable determination of accurate health service coverage. OBJECTIVE: To measure the acceptability and performance of fingerprint biometrics to identify individuals in demographic surveillance populations and those attending health care facilities serving the surveillance populations. METHODOLOGY: Two HDSS sites used fingerprint biometrics for patient and/or surveillance population participant identification. The proportion of individuals for whom a fingerprint could be successfully enrolled were characterised in terms of age and sex. RESULTS: Adult (18-65 years) fingerprint enrolment rates varied between 94.1% (95% CI 93.6-94.5) for facility-based fingerprint data collection at the Africa Centre site to 96.7% (95% CI 95.9-97.6) for population-based fingerprint data collection at the Agincourt site. Fingerprint enrolment rates in children under 1 year old (Africa Centre site) were only 55.1% (95% CI 52.7-57.4). By age 5, child fingerprint enrolment rates were comparable to those of adults. CONCLUSION: This work demonstrates the feasibility of fingerprint-based individual identification for population-based research in developing countries. Record linkage between demographic surveillance population databases and health care facility data based on biometric identification systems would allow for a more comprehensive evaluation of population health, including the ability to study health service utilisation from a population perspective, rather than the more restrictive health service perspective

Costs of shoulder pain and resource use in primary health care: a cost-of-illness study in Sweden

<p>Abstract</p> <p>Background</p> <p>Painful shoulders pose a substantial socioeconomic burden. A prospective cost-of-illness study was performed to assess the costs associated with healthcare use and loss of productivity in patients with shoulder pain in primary health care in Sweden.</p> <p>Methods</p> <p>The study was performed in western Sweden, in a region with 24 000 inhabitants. Data were collected during six months from electronic patient records at three primary healthcare centres in two municipalities. All patients between 20 and 64 years of age who presented with shoulder pain to a general practitioner or a physiotherapist were included. Diagnostic codes were used for selection, and the cases were manually controlled. The cost for sick leave was calculated according to the human capital approach. Sensitivity analysis was used to explore uncertainty in various factors used in the model.</p> <p>Results</p> <p>204 (103 women) patients, mean age 48 (SD 11) years, were registered. Half of the cases were closed within six weeks, whereas 32 patients (16%) remained in the system for more than six months. A fifth of the patients were responsible for 91% of the total costs, and for 44% of the healthcare costs. The mean healthcare cost per patient was €326 (SD 389) during six months. Physiotherapy treatments accounted for 60%. The costs for sick leave contributed to 84% of the total costs. The mean annual total cost was €4139 per patient. Estimated costs for secondary care increased the total costs by one third.</p> <p>Conclusions</p> <p>The model applied in this study provides valuable information that can be used in cost evaluations. Costs for secondary care and particularly for sick leave have a major influence on total costs and interventions that can reduce long periods of sick leave are warranted.</p

Tallness is associated with risk of testicular cancer: evidence for the nutrition hypothesis

The pathogenesis of testicular germ cell tumours (GCTs) is potentially influenced by high-energy nutrition during infancy. As adult height is a proxy for childhood nutrition, we investigated the role of nutrition in GCT pathogenesis by comparing stature of patients with healthy men. In a matched case–control study, 6415 patients with GCT were compared with healthy army conscripts (1:6 matching modus) with regard to height (cm) and body mass index (BMI; kg/m2). Statistical analysis involved tabulation of descriptive height measures and BMI. Conditional logistic regression models were used to quantify the association of GCT with height, with odds ratios (OR) adjusted for BMI. The literature was searched for studies on stature in GCT patients. Body size is significantly associated with risk of GCT, very tall men (>195 cm) having a GCT risk of OR=3.35 (95% confidence intervals (CI): 2.88–3.90; adjusted). Short stature is protective (OR=0.798; 95% CI: 0.68–0.93). Both histologic subgroups are associated with tallness. Of 16 previous reports, 7 were confirmative, 5 had null and 4 equivocal results. The association of stature with GCT risk accords with the nutrition hypothesis of GCT. This study expands the current view of GCT tumorigenesis by suggesting that high-calorie intake in childhood promotes GCT precursors originating in utero

Protein Aggregation and Protein Instability Govern Familial Amyotrophic Lateral Sclerosis Patient Survival

The nature of the “toxic gain of function” that results from amyotrophic lateral sclerosis (ALS)-, Parkinson-, and Alzheimer-related mutations is a matter of debate. As a result no adequate model of any neurodegenerative disease etiology exists. We demonstrate that two synergistic properties, namely, increased protein aggregation propensity (increased likelihood that an unfolded protein will aggregate) and decreased protein stability (increased likelihood that a protein will unfold), are central to ALS etiology. Taken together these properties account for 69% of the variability in mutant Cu/Zn-superoxide-dismutase-linked familial ALS patient survival times. Aggregation is a concentration-dependent process, and spinal cord motor neurons have higher concentrations of Cu/Zn-superoxide dismutase than the surrounding cells. Protein aggregation therefore is expected to contribute to the selective vulnerability of motor neurons in familial ALS