No consensus on gestational diabetes mellitus screening regimes in Sweden : pregnancy outcomes in relation to different screening regimes 2011 to 2012, a cross-sectional study

Background: Although associated adverse pregnancy outcomes, no international or Swedish consensus exists that identifies a cut-off value or what screening method to use for definition of gestational diabetes mellitus. This study investigates the following: i) guidelines for screening of GDM; ii) background and risk factors for GDM and selection to OGTT; and iii) pregnancy outcomes in relation to GDM, screening regimes and levels of OGTT 2 hour glucose values. Methods: This cross-sectional and population-based study uses data from the Swedish Maternal Health Care Register (MHCR) (2011 and 2012) combined with guidelines for GDM screening (2011-2012) from each Maternal Health Care Area (MHCA) in Sweden. The sample consisted of 184, 183 women: 88, 140 in 2011 and 96,043 in 2012. Chi-square and two independent samples t-tests were used. Univariate and multivariate logistic regression analyses were performed. Results: Four screening regimes of oral glucose tolerance test (OGTT) (75 g of glucose) were used: A) universal screening with a 2-hour cut-off value of 10.0 mmol/L; B) selective screening with a 2-hour cut-off value of 8.9 mmol/L; C) selective screening with a 2-hour cut-off value of 10.0 mmol/L; and D) selective screening with a 2-hour cut-off value of 12.2 mmol/L. The highest prevalence of GDM (2.9%) was found with a 2-hour cut-off value of 8.9 mmol/L when selective screening was applied. Unemployment and low educational level were associated with an increased risk of GDM. The OR was 4.14 (CI 95%: 3.81-4.50) for GDM in obese women compared to women with BMI <30 kg/m(2). Women with non-Nordic origin presented a more than doubled risk for GDM compared to women with Nordic origin (OR = 2.24; CI 95%: 2.06-2.43). Increasing OGTT values were associated with increasing risks of adverse pregnancy outcomes. Conclusions: There was no consensus regarding screening regimes for GDM from 2011 through 2012 when four different regimes were applied in Sweden. Increasing levels of OGTT 2-hour glucose values were strongly associated with adverse pregnancy outcomes. Based on these findings, we suggest that Sweden adopts the recent recommendations of the International Association of Diabetes and Pregnancy Study Group (IADPSG) concerning the performance of OGTT and the diagnostic criteria for GDM.

Violence and reproductive health preceding flight from war : accounts from Somali born women in Sweden

Background: Political violence and war are push factors for migration and social determinants of health among migrants. Somali migration to Sweden has increased threefold since 2004, and now comprises refugees with more than 20 years of war experiences. Health is influenced by earlier life experiences with adverse sexual and reproductive health, violence, and mental distress being linked. Adverse pregnancy outcomes are reported among Somali born refugees in high-income countries. The aim of this study was to explore experiences and perceptions on war, violence, and reproductive health before migration among Somali born women in Sweden. Method: Qualitative semi-structured individual interviews were conducted with 17 Somali born refugee women of fertile age living in Sweden. Thematic analysis was applied. Results: Before migration, widespread war-related violence in the community had created fear, separation, and interruption in daily life in Somalia, and power based restrictions limited access to reproductive health services. The lack of justice and support for women exposed to non-partner sexual violence or intimate partner violence reinforced the risk of shame, stigmatization, and silence. Social networks, stoicism, and faith constituted survival strategies in the context of war. Conclusions: Several factors reinforced non-disclosure of violence exposure among the Somali born women before migration. Therefore, violence-related illness might be overlooked in the health care system. Survival strategies shaped by war contain resources for resilience and

High female mortality resulting in herd collapse in free-ranging domesticated reindeer (Rangifer tarandus tarandus) in Sweden

Reindeer herding in Sweden is a form of pastoralism practised by the indigenous Sami population. The economy is mainly based on meat production. Herd size is generally regulated by harvest in order not to overuse grazing ranges and keep a productive herd. Nonetheless, herd growth and room for harvest is currently small in many areas. Negative herd growth and low harvest rate were observed in one of two herds in a reindeer herding community in Central Sweden. The herds (A and B) used the same ranges from April until the autumn gathering in October-December, but were separated on different ranges over winter. Analyses of capture-recapture for 723 adult female reindeer over five years (2007-2012) revealed high annual losses (7.1% and 18.4%, for herd A and B respectively). A continuing decline in the total reindeer number in herd B demonstrated an inability to maintain the herd size in spite of a very small harvest. An estimated breakpoint for when herd size cannot be kept stable confirmed that the observed female mortality rate in herd B represented a state of herd collapse. Lower calving success in herd B compared to A indicated differences in winter foraging conditions. However, we found only minor differences in animal body condition between the herds in autumn. We found no evidence that a lower autumn body mass generally increased the risk for a female of dying from one autumn to the next. We conclude that the prime driver of the on-going collapse of herd B is not high animal density or poor body condition. Accidents or disease seem unlikely as major causes of mortality. Predation, primarily by lynx and wolverine, appears to be the most plausible reason for the high female mortality and state of collapse in the studied reindeer herding community.

Perceptions of Sustainability and Functional Aspects on Liquid Carton Board Packaging Materials versus Competing Materials for Juice Applications in Sweden

This research explores the downstream perceptions of liquid carton board versus competing materials in packaging applications for juice. The methodology used is focus groups. The context is sustainability and functional performance, and related potential implications for the beverage industry value chain. The purpose is to get a deeper insight and understanding of functionality in relation to juice beverage packaging. The results confirm that there is no optimal packaging for every juice product, but a multitude, depending on the distribution channel, retail outlet, customer preferences, and context of consumption. There are some general packaging preferences, but the main deciding criteria for purchase seem to be the product characteristics in terms of quality, taste, brand, price and shelf life. For marketing reasons, packaging has to be adopted to the product and its positioning, liquid carton board packaging seem to have some functional advantages in distribution and is considered as sustainable and functional among many consumers. Major drawbacks seem to be shape limitations, lack of transparency, and lack of a “premium look”. To improve packaging performance and avoid sub-optimization, actors in the beverage industry value chain need to be integrated in development processes.

Geoprocessing journey-to-work data : delineating commuting regions in Dalarna, Sweden

Delineation of commuting regions has always been based on statistical units, often municipalities or wards. However, using these units has certain disadvantages as their land areas differ considerably. Much information is lost in the larger spatial base units and distortions in self-containment values, the main criterion in rule-based delineation procedures, occur. Alternatively, one can start from relatively small standard size units such as hexagons. In this way, much greater detail in spatial patterns is obtained. In this paper, regions are built by means of intrazonal maximization (Intramax) on the basis of hexagons. The use of geoprocessing tools, specifically developed for the processing ofcommuting data, speeds up processing time considerably. The results of the Intramax analysis are evaluated with travel-to-work area constraints, and comparisons are made with commuting fields, accessibility to employment, commuting flow density and network commuting flow size. From selected steps in the regionalization process, a hierarchy of nested commuting regions emerges, revealing the complexity of commuting patterns.

High expectations, varying outcomes: Decentralization and participation in Brazil, Japan, Russia and Sweden

In the past 20 years, decentralization has been proposed as a strategy for enhancing public participation. Aid-providing organizations, such as the World Bank, stimulated decentralization processes in several countries in the hope that this would promote civic empowerment, diminish corruption, enhance efficiency, and improve public service delivery. This assumption forms the basis for a comparative analysis into the relation between decentralization and participation at the local level in Brazil, Japan, Russia and Sweden. A multi-level regression analysis using the data of the Democracy and Local Governance Project was undertaken in order to test the 'one size fits all' and the 'diversity in development' hypotheses. The results show that the second hypothesis was corroborated. Perceived autonomy had a different impact on openness to participation depending on the country considered; in one country (Japan), perceived autonomy diminished public officials' willingness to be open to public participation.

Public policy for pensions, health and sickness insurance: potential lessons from Sweden for Latin America

Includes bibliography

Application of information and communication technologies for health systems in Belgium, Denmark, Spain, the United Kingdom and Sweden

Incluye Bibliografía

Sweden and Latin America: comments on the paper by professor Olof Ruin

Señala las diferencias históricas y estructurales y llama la atención sobre las semejanzas entre el desarrollo sociopolítico de Suecia y el de América Latina.

Development and social change in Sweden

Includes bibliography

Barshalder 1 : A cemetery in Grötlingbo and Fide parishes, Gotland, Sweden, c. AD 1-1100. Excavations and finds 1826-1971

The prehistoric cemetery of Barshalder is located along the main road on the boundary between Grötlingbo and Fide parishes, near the southern end of the island of Gotland in the Baltic Sea. The cemetery was used from c. AD 1-1100. The level of publication in Swedish archaeology of the first millennium AD is low compared to, for instance, the British and German examples. Gotland’s rich Iron Age cemeteries have long been intensively excavated, but few have received monographic treatment. This publication is intended to begin filling this gap and to raise the empirical level of the field. It also aims to make explicit and test the often somewhat intuitively conceived results of much previous research. The analyses deal mainly with the Migration (AD 375–540), Vendel (AD 520–790) and Late Viking (AD 1000–1150) Periods. The following lines of inquiry have been prioritised. 1. Landscape history, i.e. placing the cemetery in a landscape-historical context. (Vol. 1, section 2.2.6) 2. Migration Period typochronology, i.e. the study of change in the grave goods. (Vol. 2, chapter 2) 3. Social roles: gender, age and status. (Vol. 2, chapter 3) 4. Religious identity in the 11th century, i.e. the study of religious indicators in mortuary customs and grave goods, with particular emphasis on the relationship between Scandinavian paganism and Christianity.. (Vol. 2, chapter 4) Barshalder is found to have functioned as a central cemetery for the surrounding area, located on peripheral land far away from contemporary settlement, yet placed on a main road along the coast for maximum visibility and possibly near a harbour. Computer supported correspondence analysis and seriation are used to study the gender attributes among the grave goods and the chronology of the burials. New methodology is developed to distinguish gender-neutral attributes from transgressed gender attributes. Sub-gender grouping due to age and status is explored. An independent modern chronology system with rigorous type definitions is established for the Migration Period of Gotland. Recently published chronology systems for the Vendel and Viking Periods are critically reviewed, tested and modified to produce more solid models. Social stratification is studied through burial wealth with a quantitative method, and the results are tested through juxtaposition with several other data types. The Late Viking Period graves of the late 10th and 11th centuries are studied in relation to the contemporary Christian graves at the churchyards. They are found to be symbolically soft-spoken and unobtrusive, with all pagan attributes kept apart from the body in a space between the feet of the deceased and the end of the over-long inhumation trench. A small number of pagan reactionary graves with more forceful symbolism are however also identified. The distribution of different 11th century cemetery types across the island is used to interpret the period’s confessional geography, the scale of social organisation and the degree of allegiance to western and eastern Christianity. 11th century society on Gotland is found to have been characterised by religious tolerance, by an absence of central organisation and by slow piecemeal Christianisation.

Glaciers and climate in northern Sweden during the 19th and 20th century

Our understanding of the climate of northern Sweden during the late Holocene is largely dependent on proxy-data series. These datasets remain spatially and temporally sparse and instrumental series are rare prior to the mid 19th century. Nevertheless, the glaciology and paleo-glaciology of the region has a strong potential significance for the exploration of climate change scenarios, past and future. The aim of this thesis is to investigate the 19th and 20th century climate in the northern Swedish mountain range. This provides a good opportunity to analyse the natural variability of the climate before the onset of the industrial epoch. Developing a temporal understanding of fluctuations in glacier front positions and glacier mass balance that is linked to a better understanding of their interaction and relative significance to climate is fundamental in the assessment of past climate. I have chosen to investigate previously unexplored temperature data from northern Sweden from between 1802 and 1860 and combined it with a temperature series from a synoptic station in Haparanda, which began operation in 1859, in order to create a reliable long temperature series for the period 1802 to 2002. I have also investigated two different glaciers, Pårteglaciären and Salajekna, which are located in different climatic environments. These glaciers have, from a Swedish perspective, long observational records. Furthermore, I have investigated a recurring jökulhlaup at the glacier Sälkaglaciären in order to analyse glacier-climate relationships with respect to the jökulhlaups. A number of datasets are presented, including: glacier frontal changes, in situ and photogrammetric mass balance data, in situ and satellite radar interferometry measurements of surface velocity, radar measurements, ice volume data and a temperature series. All these datasets are analysed in order to investigate the response of the glaciers to climatic stimuli, to attribute specific behaviour to particular climates and to analyse the 19th and 20th century glacier/climate relationships in northern Sweden. The 19th century was characterized by cold conditions in northern Sweden, particularly in winter. Significant changes in the amplitude of the annual temperature cycle are evident. Through the 19th century there is a marked decreasing trend in the amplitude of the data, suggesting a change towards a prevalence of maritime (westerly) air masses, something which has characterised the 20th century. The investigations on Salajekna support the conclusion that the major part of the 19th century was cold and dry. The 19th century advance of Salajekna was probably caused by colder climate in the late 18th and early 19th centuries, coupled with a weakening of the westerly airflow. The investigations on Pårteglaciären show that the glacier has a response time of ~200 years. It also suggests that there was a relatively high frequency of easterly winds providing the glacier with winter precipitation during the 19th century. Glaciers have very different response times and are sensitive to different climatic parameters. Glaciers in rather continental areas of the Subarctic and Arctic can have very long response times because of mass balance considerations and not primarily the glacier dynamics. This is of vital importance for analyzing Arctic and Subarctic glacier behaviour in a global change perspective. It is far from evident that the behaviour of the glacier fronts today reflects the present climate.

Dynamics of the cold surface layer of polythermal Storglaciären, Sweden

Polythermal glaciers, i.e. glaciers with a combination of ice at and below the freezing point, are widespread in arctic and subarctic environments. The polythermal structure has major implications for glacier hydrology, ice flow and glacial erosion. However, the interplay of factors governing its spatial and temporal variations such as net mass balance, ice advection and water content in the ice is poorly investigated and as yet not fully understood. This study deals with a thorough investigation of the polythermal regime on Storglaciären, northern Sweden, a small valley glacier with a cold surface layer in the ablation area. Extensive field work was performed including mapping of the cold surface layer using ground-penetrating radar, ice temperature measurements, mass balance and ice velocity measurements. Analyses of these data combined with numerical modelling were used specifically to investigate the spatial and temporal variability of the cold surface layer, the spatial distribution of the water content just below the cold surface layer transition, the effect of radar frequency on the detection of the surface layer, and the sensitivity of the cold surface layer to changes in forcing. A comparison between direct temperature measurements in boreholes and ground-penetrating surveys shows that the radar-inferred cold-temperate transition depth is within ±1 m from the melting point of ice at frequencies above ~300 MHz. At frequencies below ~155 MHz, the accuracy degrades because of reduced scattering efficiency that occurs when the scatterers become much smaller compared to the wavelength. The mapped spatial pattern of the englacial cold-temperate transition boundary is complex. This pattern reflects the observed spatial variation in net loss of ice at the surface by ablation and vertical advection of ice, which is suggested to provide the predominant forcing of the cold surface layer thickness pattern. This is further supported by thermomechanical modeling of the cold surface layer, which indicates high sensitivity of the cold surface layer thickness to changes in vertical advection rates. The water content is the least investigated quantity that is relevant for the thermal regime of glaciers, but also the most difficult to assess. Spatial variability of absolute water content in the temperate ice immediately below the cold surface layer on Storglaciären was determined by combining relative estimates of water content from ground-penetrating radar data with absolute determination from temperature measurements and the thermal boundary condition at the freezing front. These measurements indicate large-scale spatial variability in the water content, which seems to arise from variations in entrapment of water at the firn-ice transition. However, this variability cannot alone explain the spatial pattern in the thermal regime on Storglaciären. Repeated surveys of the cold surface layer show a 22% average thinning of the cold surface layer on Storglaciären between 1989 and 2001. Transient thermomechanical modeling results suggest that the cold surface layer adapts to new equilibrium conditions in only a few decades after a perturbation in the forcing is introduced. An increased winter air temperature since mid-1980s seems to be the cause of the observed thinning of the cold surface layer. Over the last decades, mass balance measurements indicate that the glacier has been close to a steady state. The quasi-steady state situation is also reflected in the vertical advection, which shows no significant changes during the last decades. Increased winter temperatures at the ice surface would result in a slow-down of the formation of cold ice at the base of the cold surface layer and lead to a larger imbalance between net loss of ice at the surface and freezing of temperate ice at the cold-temperate transition.

Democracy Reconsidered : Britain, France, Sweden, and the EU

The purpose of this thesis is to investigate whether some positions in democratic theory should be adjusted or abandoned in view of internationalisation; and if adjusted, how. More specifically it pursues three different aims: to evaluate various attempts to explain levels of democracy as consequences of internationalisation; to investigate whether the taking into account of internationalisation reveals any reason to reconsider what democracy is or means; and to suggest normative interpretations that cohere with the adjustments of conceptual and explanatory democratic theory made in the course of meeting the other two aims. When empirical methods are used, the scope of the study is restricted to West European parliamentary democracies and their international affairs. More particularly, the focus is on the making of budget policy in Britain, France, and Sweden after the Second World War, and recent budget policy in the European Union. The aspects of democracy empirically analysed are political autonomy, participation, and deliberation. The material considered includes parliamentary debates, official statistics, economic forecasts, elections manifestos, shadow budgets, general election turnouts, regulations of budget decision-making, and staff numbers in government and parliament budgetary divisions. The study reaches the following conclusions among others. (i) The fact that internationalisation increases the divergence between those who make and those who are affected by decisions is not by itself a democratic problem that calls for political reform. (ii) That international organisations may have authorities delegated to them from democratic states is not sufficient to justify them democratically. Democratisation still needs to be undertaken. (iii) The fear that internationalisation dissolves a social trust necessary for political deliberation within nations seems to be unwarranted. If anything, views argued by others in domestic budgetary debate are taken increasingly serious during internationalisation. (iv) The major difficulty with deliberation seems to be its inability to transcend national boundaries. International deliberation at state level has not evolved in response to internationalisation and it is undeveloped in international institutions. (v) Democratic political autonomy diminishes during internationalisation with regard to income redistribution and policy areas taken over by international organisations, but it seems to increase in public spending. (vi) In the area of budget policy-making there are no signs that governments gain power at the expense of parliaments during internationalisation. (vii) To identify crucial democratic issues in a time of internationalisation and to make room for theoretical virtues like general applicability and normative fruitfulness, democracy may be defined as a kind of politics where as many as possible decide as much as possible.