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  • 101.
    Müller, Dieter K.
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History. Umeå University, Arctic Research Centre at Umeå University.
    Brouder, Patrick
    Mid Sweden University.
    Dynamic development ot destined to decline? The case of Arctic tourism businesses and local labour markets in Jokkmokk, Sweden2014In: Tourism Destination Development: Turns and Tactics / [ed] Arvid Viken & Brynhild Granås, Farnham: Ashgate, 2014, p. 227-244Chapter in book (Refereed)
  • 102.
    Müller, Dieter K.
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography.
    Hall, C. Michael
    Second home tourism: an introduction2018In: The Routledge handbook of second home tourism and mobilities / [ed] C. Michael Hall & Dieter K. Müller, London: Routledge, 2018, p. 3-14Chapter in book (Refereed)
  • 103.
    Müller, Dieter K.
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography.
    Hoppstadius, Fredrik
    Karlstads universitet.
    Sami tourism at the crossroads: globalization as a challenge for business, environment and culture in Swedish Sápmi2017In: Tourism and indigeneity in the Arctic / [ed] Arvid Viken and Dieter K. Müller, Bristol: Channel View Publications, 2017, p. 71-86Chapter in book (Refereed)
  • 104.
    Müller, Dieter K.
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography.
    Viken, Arvid
    UiT The Arctic University of Norway.
    Indigenous tourism in the Arctic2017In: Tourism and Indigeneity in the Arctic / [ed] Arvid Viken and Dieter K. Müller, Bristol: Channel View Publications, 2017, p. 3-15Chapter in book (Refereed)
  • 105.
    Müller, Dieter K.
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography.
    Viken, Arvid
    UiT The Arctic University of Norway.
    Toward a de-essentializing of indigenous tourism?2017In: Tourism and indigeneity in the Arctic / [ed] Arvid Viken and Dieter K. Müller, Bristol: Channel View Publications, 2017, p. 281-289Chapter in book (Refereed)
  • 106.
    Nilsson, Annika E.
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Stockholm Environm Inst, Box 24218, SE-10451 Stockholm, Sweden.
    Bay-Larsen, Ingrid
    Carlsen, Henrik
    van Oort, Bob
    Bjorkan, Maiken
    Jylha, Kirsti
    Klyuchnikova, Elena
    Masloboev, Vladimir
    van der Watt, Lize-Marie
    Umeå University, Arctic Research Centre at Umeå University. Royal Inst Technol KTH, Div Hist Sci Technol & Environm, Sch Architecture & Built Environm, SE-10044 Stockholm, Sweden.
    Towards extended shared socioeconomic pathways: A combined participatory bottom-up and top-down methodology with results from the Barents region2017In: Global Environmental Change, ISSN 0959-3780, E-ISSN 1872-9495, Vol. 45, p. 124-132Article in journal (Refereed)
    Abstract [en]

    A major challenge in planning for adaptation to climate change is to assess future development not only in relation to climate but also in relation to social, economic and political changes that affect the capacity for adaptation or otherwise play a role in decision making. One approach is to use scenario methods. This article presents a methodology that combines top-down scenarios and bottom-up approaches to scenario building, with the aim of articulating local so-called extended socio-economic pathways. Specifically, we used the Shared Socioeconomic Pathways (SSPs) of the global scenario framework as developed by the climate research community to present boundary conditions about potential global change in workshop discussion with local and regional actors in the Barents region. We relate the results from these workshops to the different elements of the global SSPs and discuss potential and limitations of the method in relation to use in decision making processes.

  • 107.
    Nilsson, Annika E.
    et al.
    Stockholm Environment Institute.
    Carlsen, Henrik
    Stockholm Environment Institute.
    van der Watt, Lize-Marié
    Umeå University, Arctic Research Centre at Umeå University.
    Uncertain futures: the changing global context of the European Arctic. Report from a scenario workshop in Pajala, Sweden2015Report (Other academic)
    Abstract [en]

    What does the future look like from the perspective of a small municipality in northern Sweden? What social and environmental challenges might there be and how might local people respond? This report presents findings from a workshop in which actors from Pajala municipality and the surrounding region in northern Sweden discussed, together with researchers, challenges for long-term planning posed by a rapidly changing and uncertain global context. The workshop piloted a new approach combining bottom-up participation with scenario work generated within the international climate change research community, in order to construct locally and regionally relevant narratives of possible futures. The resulting narratives feature some issues that do not figure prominently in the assessment of global futures, but also show that local development is perceived as closely linked to global processes, such as changes related to climate and demography. The report’s purpose is to document the workshop results and offer a description of and reflection on the methods employed as a basis for further development of the approach.

  • 108. Nilsson, Annika E.
    et al.
    Eklund, Niklas
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Jürisoo, Marie
    Klimenko, Ekaterina
    van der Watt, Lize-Marié
    Umeå University, Arctic Research Centre at Umeå University.
    Regional futures nested in global structures2019In: The politics of Arctic resources: change and continuity in the "Old North" of Northern Europe / [ed] Carina H. Keskitalo, Abingdon: Routledge, 2019, 1, p. 221-239Chapter in book (Refereed)
    Abstract [en]

    Chapter 12 places the development of northernmost Europe into a context of global change. It discusses the extent to which global shifts in resource markets, geopolitical reasoning and situations, and climate change may influence the region. Drawing on local scenario workshops, amongst other things, the chapter illustrates uncertainties about potential futures even in development paths where future change can largely be seen as related to established and relatively enduring features of the present system.

  • 109.
    Nilsson, Annika E
    et al.
    Stockholm Environment Institute.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Quinlan, Allyson
    Resilience Alliance.
    Evengård, Birgitta
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Food security in the Arctic: Preliminary reflections from a resilience perspective2013In: Arctic Resilience: Interim Report 2013 / [ed] Annika E Nilsson, Stockholm: Arctic Council , 2013, , p. 117p. 113-117Chapter in book (Other academic)
    Abstract [en]

    Chapter 10 discusses food security, which is emerging as a major cross-cutting issue in a changingArctic. The preliminary reflections presented in the chapter highlight that food security bringstogether concerns over a range of interacting environmental, social, economic, political andcultural changes. These include: food and water-borne diseases; increasing incidence of lifestylediseases; high costs of healthy foods; contamination; changing ecosystems that impede access tofood; high fuel costs; and loss of traditional knowledge. The chapter concludes that food security isintimately interlinked with social relations and cultural well-being.

  • 110.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    A call for improving health strategies regarding HLA-B27 carriers in the Arctic, considering traditional and scientific knowledge2016In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 75, article id 33200Article in journal (Refereed)
  • 111.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Aboriginal food security in the Arctic: a Utopia or a matter of attitude?2015In: EurSafe News, Vol. 17, no 3, p. 2-4Article in journal (Other academic)
    Abstract [en]

    In the discussion on food security in the Arctic, food sovereignty is increasingly emphasized. In many cases, the vision of aboriginal food security equals a the vision of a situation of unchanged access subsistence species from time to time. Unfortunately, this is a very unlikely scenario in the Arctic.

  • 112.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Boiled Coffee: An Arctic Example of Potential Residual and Unmeasured Confounding in Coffee Epidemiology2014In: Coffee in Health and Disease Prevention / [ed] Victor R. Preedy, London: Elsevier, 2014, p. 265-274Chapter in book (Other academic)
    Abstract [en]

    Coffee culture differs all over the world and affects the chemical composition of coffee, as well as quantities consumed and lifestyle factors associated with coffee drinking. Boiled coffee is a good example of residual or unmeasured confounding in an Arctic population with two heterogeneous coffee cultures. Although filtered coffee is the most common caffeine brew in this area today, for cultural reasons boiled coffee—traditionally prepared on a stove top or overan open fire—still plays an important role in the population. There are chemical differences between boiled coffee and drip-filtered coffee that might have an impact on public health regarding lifestyle-related diseases. There are certain lifestyle factors, such as leisure-time hunting and fishing, first full-term pregnancy at an early age, and low education level, that are positively associated with the consumption of boiled coffee and inversely associated with the consumption of filtered coffee. The Scandinavian Arctic boiled coffee example illustrates that, when interpreting chemical differences between different coffee brews, lifestyle factors related to coffee culture should always betaken into consideration or at least discussed as apparent candidates of residual or unmeasured confounding.

  • 113.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Dietary Patterns in a Circumpolar Context: A Cultural Approach to the Interpretation of Three Studies on Mediterranean, Traditional Sami, and Low-Carbohydrate Dietary Pattern Scores in Northernmost Sweden2014In: The Mediterranean Diet: An Evidence-Based Approach / [ed] Victor R. Preedy and Ronald Ross Watson, London: Elsevier, 2014, 1, p. 579-588Chapter in book (Other academic)
    Abstract [en]

    The Sami, the indigenous people of northern Sweden, have a life expectancy equal to the life expectancy of the country’s majority population and a reduced risk of cancer. Dietary score methodology is a way of applying a culturally defined dietary pattern to any population. Studies on Mediterranean and traditional Sami dietary patterns in a circumpolar context confirm evidence-based dietary guidelines, but the low-carbohydrate dietary pattern does not. Knowledge of food culture and nutritional transitions is important when interpreting risk associations connected to culturally defined dietary patterns.

  • 114.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. 2000.
    Food, nutrition, and health in Sápmi2018In: Nutritional and health aspects of food in Nordic countries / [ed] Veslemøy Andersen, Eirin Bar, Gun Wirtanen, London: Elsevier, 2018, 1, p. 179-195Chapter in book (Refereed)
    Abstract [en]

    Sápmi is the Sami homeland in northernmost Fennoscandia and the Kola Peninsula of Russia. The traditional diet in Sápmi is based on wild plants and animals available in this Arctic area. From a micronutrient perspective, this means a diet rich in fat and protein and poor in carbohydrates and fiber; thus there is a discrepancy between the traditional diet in Sápmi and current dietary recommendations. Despite this, the Sami people are known to be the healthiest indigenous population worldwide. If this, fully or partly, can be explained by dietary factors, it is still unclear. Nutrition epidemiology studies focusing specifically on traditional Sami dietary patterns as determinants of health are rare. This chapter summarizes current knowledge on the health aspects of some dietary patterns, food items, and preparation techniques of relevance in Sápmi.

  • 115.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    New governance for sustainable development in the European Arctic: annual report 20142015Collection (editor) (Other academic)
  • 116.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    New governance for sustainable development in the European Arctic: annual report 20152016Collection (editor) (Other academic)
  • 117.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    New governance for sustainable development in the European Arctic: annual report 20162017Collection (editor) (Other academic)
  • 118.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Samisk kost som hälsofaktor?2016In: Nordisk Nutrition, ISSN 1654-8337, no 2, p. 27-29Article in journal (Other academic)
    Abstract [sv]

    Historiska matvanor används ofta som modeller för hälsosam kost. Mot bakgrund av att samer ofta beskrivs som världens friskaste urfolk, är det intressant att studera samisk kost som en hälsofaktor. Det finns dock många fallgropar som behöver beaktas vid sådan forskning.

  • 119.
    Nilsson, Lena Maria
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Berner, James
    Dudarev, Alexey A.
    Mulvad, Gert
    Odland, Jon Oyvind
    Parkinson, Alan
    Rautio, Arja
    Tikhonov, Constantine
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Arctic Research Centre at Umeå University.
    Indicators of food and water security in an Arctic Health context - results from an international workshop discussion2013In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 72, p. 21530-Article in journal (Refereed)
    Abstract [en]

    In August 2012, a literature search with the aim of describing indicators on food and water security in an Arctic health context was initialized in collaboration between the Arctic Human Health Expert Group, SDWG/AHHEG and the AMAP (Arctic Monitoring and Assessment Programme within the Arctic Council) Human Health Assessment Group, AMAP/HHAG. In December 2012, workshop discussions were performed with representatives from both of these organizations, including 7 Arctic countries. The aim of this article is to describe the workshop discussions and the rational for the 12 indicators selected and the 9 rejected and to discuss the potential feasibility of these. Advantages and disadvantages of candidate indicators were listed. Informative value and costs for collecting were estimated separately on a 3-level scale: low, medium and high. Based on these reviews, the final selection of promoted and rejected indicators was performed and summarized in tables. Among 10 suggested indicators of food security, 6 were promoted: healthy weight, traditional food proportion in diet, monetary food costs, non-monetary food accessibility, food-borne diseases and food-related contaminants. Four were rejected: per-person dietary energy supply, food security modules, self-estimated food safety and healthy eating. Among 10 suggested indicators of water security, 6 were promoted: per-capita renewable water, accessibility of running water, waterborne diseases, drinking-water-related contaminants, authorized water quality assurance and water safety plans. Four were rejected: water consumption, types of water sources, periodic water shortages and household water costs.

  • 120.
    Nilsson, Lena Maria
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Destouni, Georgia
    Berner, James
    Dudarev, Alexey A
    Mulvad, Gert
    Odland, Jon Oyvind
    Parkinson, Alan
    Tikhonov, Constantine
    Rautio, Arja
    Evengård, Birgitta
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    A call for urgent monitoring of food and water security based on relevant indicators for the Arctic2013In: Ambio, ISSN 0044-7447, E-ISSN 1654-7209, Vol. 42, no 7, p. 816-822Article in journal (Refereed)
    Abstract [en]

    This perspective paper argues for an urgent need to monitor a set of 12 concrete, measurable indicators of food and water security in the Arctic over time. Such a quantitative indicator approach may be viewed as representing a reductionist rather than a holistic perspective, but is nevertheless necessary for actually knowing what reality aspects to monitor in order to accurately understand, quantify, and be able to project critical changes to food and water security of both indigenous and non-indigenous people in the Arctic. More relevant indicators may be developed in the future, taking us further toward reconciliation between reductionist and holistic approaches to change assessment and understanding. However, the potential of such further development to improved holistic change assessment is not an argument not to urgently start to monitor and quantify the changes in food and water security indicators that are immediately available and adequate for the Arctic context.

  • 121.
    Nilsson, Lena Maria
    et al.
    Umeå University, Arctic Research Centre at Umeå University.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Food security or food sovereignty: what is the main issue in the Arctic?2015In: The new Arctic / [ed] Birgitta Evengård, Joan Nymand Larsen, Øyvind Paasche, Springer, 2015, 1, p. 213-223Chapter in book (Refereed)
    Abstract [en]

    Food security and food sovereignty have been highlighted as a priority issues in the Arctic, since climate change and industrial processes likely will have a severe effect on living conditions in the north in the near future. Food security can be defined as situations where people have both physical and economic access to food that meets their dietary needs as well as their food preferences. Food sovereignty describes situations when local peoples are in control of the processes leading to food security. Of 12 previously suggested measurements of food security indicators for the Arctic, three were related to food sovereignty. In this chapter we discuss the concepts of food security and food sovereignty, and their interrelations and relevance from an Arctic perspective.

  • 122.
    Nilsson, Lena Maria
    et al.
    Umeå University, Arctic Research Centre at Umeå University.
    Hörnell, Agneta
    Umeå University, Faculty of Social Sciences, Department of Food and Nutrition.
    NEON – på väg mot en mer aktiv roll i kostdebatten2014In: Svepet. Medlemstidning för Svensk Epidemiologisk Förening (SVEP), ISSN 1101-4385, Vol. 32, no 3-4, p. 14-15Article in journal (Other (popular science, discussion, etc.))
  • 123.
    Nilsson, Lena Maria
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Winkvist, Anna
    Univ Gothenburg, Sahlgrenska Acad, Dept Internal Med & Clin Nutr, SE-40530 Gothenburg, Sweden.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology, Cariology.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Biobank Research.
    Lenner, Per
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Pathology.
    Low-carbohydrate, high-protein diet score and risk of incident cancer: a prospective cohort study2013In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 12, p. 58-Article in journal (Refereed)
    Abstract [en]

    Background: Although carbohydrate reduction of varying degrees is a popular and controversial dietary trend, potential long-term effects for health, and cancer in specific, are largely unknown. Methods: We studied a previously established low-carbohydrate, high-protein (LCHP) score in relation to the incidence of cancer and specific cancer types in a population-based cohort in northern Sweden. Participants were 62,582 men and women with up to 17.8 years of follow-up (median 9.7), including 3,059 prospective cancer cases. Cox regression analyses were performed for a LCHP score based on the sum of energy-adjusted deciles of carbohydrate (descending) and protein (ascending) intake labeled 1 to 10, with higher scores representing a diet lower in carbohydrates and higher in protein. Important potential confounders were accounted for, and the role of metabolic risk profile, macronutrient quality including saturated fat intake, and adequacy of energy intake reporting was explored. Results: For the lowest to highest LCHP scores, 2 to 20, carbohydrate intakes ranged from median 60.9 to 38.9% of total energy intake. Both protein (primarily animal sources) and particularly fat (both saturated and unsaturated) intakes increased with increasing LCHP scores. LCHP score was not related to cancer risk, except for a non-dose-dependent, positive association for respiratory tract cancer that was statistically significant in men. The multivariate hazard ratio for medium (9-13) versus low (2-8) LCHP scores was 1.84 (95% confidence interval: 1.05-3.23; p-trend = 0.38). Other analyses were largely consistent with the main results, although LCHP score was associated with colorectal cancer risk inversely in women with high saturated fat intakes, and positively in men with higher LCHP scores based on vegetable protein. Conclusion: These largely null results provide important information concerning the long-term safety of moderate carbohydrate reduction and consequent increases in protein and, in this cohort, especially fat intakes. In order to determine the effects of stricter carbohydrate restriction, further studies encompassing a wider range of macronutrient intakes are warranted.

  • 124.
    Nordin, Gabriella
    Umeå University, Arctic Research Centre at Umeå University.
    Familjelivet2016In: Samiska rötter: släktforska i svenska Sápmi / [ed] Per Axelsson, Elisabeth Engberg, Patrik Lantto & Maria J. Wisselgren, Sveriges släktforskarförbund , 2016, p. 117-126Chapter in book (Other (popular science, discussion, etc.))
  • 125.
    Nordlander, Marlene
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Perceptions of What Is Important for Appetite: An Interview Study With Older People Having Food Distribution2019In: Sage Open Nursing, ISSN 2377-9608, Vol. 5Article in journal (Refereed)
    Abstract [en]

    The proportion of older people in the population increases and more and more continue living in their own homes. Appetite among the elderly people is important to their nutrition and health. The increased risk of unintended weight loss and malnutrition is linked to food distribution among home-living elderly people. The aim was to describe experiences and perceptions of what matters to appetite among home-living elderly people having food distribution. The design was qualitative where interview data were collected among 13 interviewees in 2017 to 2018. Data were analyzed using qualitative content analysis. The results are presented in three domains: the food, the meal situation, and the adaptation to meal service with categories and themes responding to each domain. The six themes related to appetite among the elderly people concerned the following: eating tasty, savory, and culturally adapted food; eating healthy and sustainable food; eating alone or together with others; eating in a pleasant meal environment; having choices to make about the meal; and last, accepting disabilities and increased dependency. One conclusion is that many aspects should be taken into consideration when promoting appetites of people who also get food distribution. It is highly individual and an understanding of which aspects are relevant must be considered; consequently, person-centered care is suggested to promote appetite.

  • 126. Ordóñez-Me, J. M.
    et al.
    Walter, V.
    Schöttker, B.
    Jenab, M.
    O'Doherty, M. G.
    Kee, F.
    Bueno-de-Mesquita, B.
    Peeters, P. H. M
    Stricker, B. H.
    Ruiter, R.
    Hofman, A.
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Jousilahti, P.
    Kuulasmaa, K.
    Freedman, N. D.
    Wilsgaard, T.
    Wolk, A
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Tjønneland, A
    Quirós, J. R.
    van Duijnhoven, F. J. B.
    Siersema, P. D.
    Boffetta, P.
    Trichopoulou, A.
    Brenner, H.
    Impact of prediagnostic smoking and smoking cessation on colorectal cancer prognosis: a meta-analysis of individual patient data from cohorts within the CHANCES consortium2018In: Annals of Oncology, ISSN 0923-7534, E-ISSN 1569-8041, Vol. 29, no 2, p. 472-483Article in journal (Refereed)
    Abstract [en]

    Background: Smoking has been associated with colorectal cancer (CRC) incidence and mortality in previous studies and might also be associated with prognosis after CRC diagnosis. However, current evidence on smoking in association with CRC prognosis is limited.

    Patients and methods: For this individual patient data meta-analysis, sociodemographic and smoking behavior information of 12,414 incident CRC patients (median age at diagnosis: 64.3 years), recruited within 14 prospective cohort studies among previously cancer-free adults, was collected at baseline and harmonized across studies. Vital status and causes of death were collected for a mean follow-up time of 5.1 years following cancer diagnosis. Associations of smoking behavior with overall and CRC-specific survival were evaluated using Cox regression and standard meta-analysis methodology.

    Results: A total of 5,229 participants died, 3,194 from CRC. Cox regression revealed significant associations between former (hazard ratio (HR)=1.12; 95%-confidence interval (CI)=1.04-1.20) and current smoking (HR = 1.29; 95%CI=1.04-1.60) and poorer overall survival compared with never smoking. Compared with current smoking, smoking cessation was associated with improved overall (HR<10years=0.78; 95%CI=0.69-0.88; HR≥10years=0.78; 95%CI=0.63-0.97) and CRC-specific survival (HR≥10years=0.76; 95%CI=0.67-0.85).

    Conclusion: In this large meta-analysis including primary data of incident CRC patients from 14 prospective cohort studies on the association between smoking and CRC prognosis, former and current smoking were associated with poorer CRC prognosis compared with never smoking. Smoking cessation was associated with improved survival when compared with current smokers. Future studies should further quantify the benefits of non-smoking, both for cancer prevention and for improving survival among CRC patients, in particular also in terms of treatment response.

  • 127. Ordóñez-Mena, José Manuel
    et al.
    Schöttker, Ben
    Mons, Ute
    Jenab, Mazda
    Freisling, Heinz
    Bueno-de-Mesquita, Bas
    O'Doherty, Mark G.
    Scott, Angela
    Kee, Frank
    Stricker, Bruno H.
    Hofman, Albert
    de Keyser, Catherine E.
    Ruiter, Rikje
    Söderberg, Stefan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
    Jousilahti, Pekka
    Kuulasmaa, Kari
    Freedman, Neal D.
    Wilsgaard, Tom
    de Groot, Lisette C. P. G. M.
    Kampman, Ellen
    Håkansson, Niclas
    Orsini, Nicola
    Wolk, Alicja
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Tjønneland, Anne
    Pająk, Andrzej
    Malyutina, Sofia
    Kubínová, Růžena
    Tamosiunas, Abdonas
    Bobak, Martin
    Katsoulis, Michail
    Orfanos, Philippos
    Boffetta, Paolo
    Trichopoulou, Antonia
    Brenner, Hermann
    Quantification of the smoking-associated cancer risk with rate advancement periods: meta-analysis of individual participant data from cohorts of the CHANCES consortium2016In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 14, article id 62Article in journal (Refereed)
    Abstract [en]

    Background: Smoking is the most important individual risk factor for many cancer sites but its association with breast and prostate cancer is not entirely clear. Rate advancement periods (RAPs) may enhance communication of smoking related risk to the general population. Thus, we estimated RAPs for the association of smoking exposure (smoking status, time since smoking cessation, smoking intensity, and duration) with total and site-specific (lung, breast, colorectal, prostate, gastric, head and neck, and pancreatic) cancer incidence and mortality.

    Methods: This is a meta-analysis of 19 population-based prospective cohort studies with individual participant data for 897,021 European and American adults. For each cohort we calculated hazard ratios (HRs) for the association of smoking exposure with cancer outcomes using Cox regression adjusted for a common set of the most important potential confounding variables. RAPs (in years) were calculated as the ratio of the logarithms of the HRs for a given smoking exposure variable and age. Meta-analyses were employed to summarize cohort-specific HRs and RAPs.

    Results: Overall, 140,205 subjects had a first incident cancer, and 53,164 died from cancer, during an average follow-up of 12 years. Current smoking advanced the overall risk of developing and dying from cancer by eight and ten years, respectively, compared with never smokers. The greatest advancements in cancer risk and mortality were seen for lung cancer and the least for breast cancer. Smoking cessation was statistically significantly associated with delays in the risk of cancer development and mortality compared with continued smoking.

    Conclusions: This investigation shows that smoking, even among older adults, considerably advances, and cessation delays, the risk of developing and dying from cancer. These findings may be helpful in more effectively communicating the harmful effects of smoking and the beneficial effect of smoking cessation.

  • 128. Orfanos, P.
    et al.
    Naska, A.
    Rodrigues, S.
    Lopes, C.
    Freisling, H.
    Rohrmann, S.
    Sieri, S.
    Elmadfa, I.
    Lachat, C.
    Gedrich, K.
    Boeing, H.
    Katzke, V.
    Turrini, A.
    Tumino, R.
    Ricceri, F.
    Mattiello, A.
    Palli, D.
    Ocke, M.
    Engeset, D.
    Oltarzewski, M.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Key, T.
    Trichopoulou, A.
    Eating at restaurants, at work or at home. Is there a difference?: a study among adults of 11 European countries in the context of the HECTOR* project2017In: European Journal of Clinical Nutrition, ISSN 0954-3007, E-ISSN 1476-5640, Vol. 71, no 3, p. 407-419Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: To compare macronutrient intakes out of home-by location-to those at home and to investigate differences in total daily intakes between individuals consuming more than half of their daily energy out of home and those eating only at home.

    SUBJECTS/METHODS: Data collected through 24-h recalls or diaries among 23 766 European adults. Participants were grouped as 'non-substantial', 'intermediate' and 'very substantial out-of-home' eaters based on energy intake out of home. Mean macronutrient intakes were estimated at home and out of home (overall, at restaurants, at work). Study/cohort-specific mean differences in total intakes between the 'very substantial out-of-home' and the 'at-home' eaters were estimated through linear regression and pooled estimates were derived.

    RESULTS: At restaurants, men consumed 29% of their energy as fat, 15% as protein, 45% as carbohydrates and 11% as alcohol. Among women, fat contributed 33% of energy intake at restaurants, protein 16%, carbohydrates 45% and alcohol 6%. When eating at work, both sexes reported 30% of energy from fat and 55% from carbohydrates. Intakes at home were higher in fat and lower in carbohydrates and alcohol. Total daily intakes of the 'very substantial out-of-home' eaters were generally similar to those of individuals eating only at home, apart from lower carbohydrate and higher alcohol intakes among individuals eating at restaurants.

    CONCLUSIONS: In a large population of adults from 11 European countries, eating at work was generally similar to eating at home. Alcoholic drinks were the primary contributors of higher daily energy intakes among individuals eating substantially at restaurants.

  • 129. Perez-Cornago, Aurora
    et al.
    Appleby, Paul N.
    Boeing, Heiner
    Gil, Leire
    Kyrø, Cecilie
    Ricceri, Fulvio
    Murphy, Neil
    Trichopoulou, Antonia
    Tsilidis, Konstantinos K.
    Khaw, Kay-Tee
    Luben, Robert N.
    Gislefoss, Randi E.
    Langseth, Hilde
    Drake, Isabel
    Sonestedt, Emily
    Wallström, Peter
    Stattin, Pär
    Johansson, Anders
    Umeå University, Faculty of Medicine, Department of Odontology.
    Landberg, Rikard
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Department of Biology and Biological Engineering, Food and Nutrition Science, Chalmers University of Technology, Gothenburg, Sweden.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Ozasa, Kotaro
    Tamakoshi, Akiko
    Mikami, Kazuya
    Kubo, Tatsuhiko
    Sawada, Norie
    Tsugane, Shoichiro
    Key, Timothy J
    Allen, Naomi E.
    Travis, Ruth C.
    Circulating isoflavone and lignan concentrations and prostate cancer risk: a meta-analysis of individual participant data from seven prospective studies including 2828 cases and 5593 controls2018In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 143, no 11, p. 2677-2686Article in journal (Refereed)
    Abstract [en]

    Phytoestrogens may influence prostate cancer development. This study aimed to examine the association between pre-diagnostic circulating concentrations of isoflavones (genistein, daidzein, equol) and lignans (enterolactone and enterodiol) and the risk of prostate cancer. Individual participant data were available from seven prospective studies (two studies from Japan with 241 cases and 503 controls and five studies from Europe with 2,828 cases and 5,593 controls). Because of the large difference in circulating isoflavone concentrations between Japan and Europe, analyses of the associations of isoflavone concentrations and prostate cancer risk were evaluated separately. Prostate cancer risk by study-specific fourths of circulating concentrations of each phytoestrogen was estimated using multivariable-adjusted conditional logistic regression. In men from Japan, those with high compared to low circulating equol concentrations had a lower risk of prostate cancer (multivariable-adjusted OR for upper quartile [Q4] vs Q1=0.61, 95% confidence interval [CI]=0.39-0.97), although there was no significant trend (OR per 75 percentile increase=0.69, 95 CI=0.46-1.05, Ptrend =0.085); Genistein and daidzein concentrations were not significantly associated with risk (ORs for Q4 vs Q1=0.70, 0.45-1.10, and 0.71, 0.45-1.12, respectively). In men from Europe, circulating concentrations of genistein, daidzein and equol were not associated with risk. Circulating lignan concentrations were not associated with the risk of prostate cancer, overall or by disease aggressiveness or time to diagnosis. There was no strong evidence that pre-diagnostic circulating concentrations of isoflavones or lignans are associated with prostate cancer risk, although further research is warranted in populations where isoflavone intakes are high.

  • 130. Peters, P
    et al.
    Taylor, A
    Carson, Dean B.
    Umeå University, Arctic Research Centre at Umeå University.
    Brokensha, H
    Sources of data for settlement level analysis in sparsely populated areas2016In: Settlements at the edge: Remote human settlements in developed nations, Cheltenham, UK: Edward Elgar Publishing, 2016, p. 153-177Chapter in book (Refereed)
  • 131. Peters, P.A
    et al.
    Taylor, A
    Carson, Dean B.
    Umeå University, Arctic Research Centre at Umeå University.
    Koch, A
    Modelling settlement futures: techniques and challenges2016In: Settlements at the edge: remote human settlements in developed nations, Cheltenham, UK: Edward Elgar Publishing, 2016, p. 270-290Chapter in book (Refereed)
  • 132.
    Priebe, Janina
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies. Umeå University, Arctic Research Centre at Umeå University.
    Greenland's future: narratives of natural resource development in the 1900s until the 1960s2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This doctoral thesis identifies and analyzes narratives of Greenland's future that emerged in the context of developing and modernizing the dependency's natural resources industries in the 1900s until the 1960s. After almost two centuries of Danish colonial rule, the turn of the 20th century witnessed a profound change in Greenland's governance. Although contested at first, the notion of cultural progress increasingly linked developing a modern industry to a productive economy under Danish auspices. Ideas of modernity that connected rationalities of the market with political power and science were unparalleled in the colonial discourse on Greenland's future. How were the development of Greenland's natural resource industries and its role in Danish governance debated? Which narratives emerged in this context? As the studies in this compilation thesis suggest, the rationalities of science, markets, and power became entangled in an unprecedented way during these decades, creating new ways to imagine Greenland's future.

    The first paper analyzes the application of a private stakeholder group of Copenhagen's financial and economic elite for access to Greenland as a private, for-profit venture to extract and trade with the colony's living resources in 1905. The motif of an Arctic scramble was constructed through the authority of science, still resonating in the debate on rare earth mining today. The second paper identifies the business relationships between the group's members, connecting major Danish financial institutes and private economic interests in the late 19th and early 20th century. The third paper focuses on the commercialization of Greenlandic fisheries in the 1910s until the late 1920s and the fisheries scientist Adolf Severin Jensen (1866-1953). Jensen's work is an example of how applied sciences connected both scientific and political agendas, carried out in a colonial setting. The fourth paper focuses on the narrative analysis of (Danish-language) Greenlandic newspaper coverage of Qullissat between 1942 and 1968. Representations of the coal mine and nearby settlement on Greenland's west coast, which were closed down in 1972, are at the center of this study. While the coal mine was presented as a Danish success to establish an independent energy supply and to introduce modernization measures, it was presented as a Greenlandic failure to adapt to modern demands of economic productivity in the years leading up to its closure. 

  • 133.
    Priebe, Janina
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies. Umeå University, Arctic Research Centre at Umeå University.
    Science, Markets, and Power: Adolf Severin Jensen in the debate over Greenland's fisheries development during the early twentieth century2018In: Environment and History, ISSN 0967-3407, E-ISSN 1752-7023, Vol. 24, no 3, p. 349-375Article in journal (Refereed)
    Abstract [en]

    As a fisheries consultant to the colonial administration, Adolf Severin Jensen (1866-1953) followed, and was an active commentator on, all stages of the commercialisation of Greenland's fishing industry - from its early assessment shortly after 1900 to the sector's peak in the 1930s, and the first signs of a changing trend in the 1940s. This paper puts Jensen's perceptions of Greenlandic fisheries in dialogue with the ideas of scientific rationalisation, economic efficiency and colonial power. The accounts of the fisheries scientist offer a glimpse into the complicated interplay of applied science in natural resource exploitation and state interests at the turn of the twentieth century. His research agenda was coined by the goals of fisheries science to connect knowledge production to markets. However, Jensen's findings also merged with Denmark's aim to secure its colonial authority in Greenland and to exert effective power over both resources and people.

  • 134.
    Priebe, Janina
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies. Umeå University, Arctic Research Centre at Umeå University.
    The Arctic scramble revisited: the Greenland consortium and the imagined future of fisheries in 19052015In: Journal of Northern Studies, ISSN 1654-5915, Vol. 9, no 1, p. 13-32Article in journal (Refereed)
  • 135.
    Ramnemark, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Norberg, Margareta
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
    Pettersson-Kymmer, Ulrika
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Pharmacology.
    Eliasson, Mats
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Adequate vitamin D levels in a Swedish population living above latitude 63°N: The 2009 Northern Sweden MONICA study2015In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 74, no 1, article id 27963Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Even though vitamin D is mainly produced by exposure to sunlight, little is known regarding vitamin D levels in populations living in sub-Arctic areas with little or no daylight during winter.

    OBJECTIVE: We describe distributions of vitamin D3 and the prevalence of adequate levels in a population living above 63°N.

    DESIGN: We sampled 1,622 randomly selected subjects, aged 25-74 years, between January and May, 2009, as part of the Northern Sweden MONICA study (69.2% participation rate). By using HPLC, 25(OH) vitamin D3 was analysed. Levels used for definitions were deficient, D3<25 nmol/l (<10 ng/ml); insufficient, D3 25-49.9 nmol/l (10-20 ng/ml); and adequate, D3≥50 nmol/l (20 ng/ml).

    RESULTS: Mean (median) level of vitamin D3 was 65.2 (63.6) nmol/l in men and 71.0 (67.7) nmol/l in women. Adequate levels were found in 79.2%, more often in women (82.7%) than in men (75.6%). Only 0.7% of the population were vitamin D3-deficient but 23.1% of men and 17.1% of women had insufficient levels. Levels of vitamin D3 increased with age and insufficient status was most common among those aged 25-34 years, 41.0% in men and 22.3% in women. If subjects using vitamin D-supplementation are excluded, the population level of D3 is 1-2 nmol/l lower than in the general population across sex- and age groups. There were no differences between the northern or the southern parts, between urban or rural living or according to educational attainment. Those subjects born outside of Sweden or Finland had lower levels.

    CONCLUSION: The large majority living close to the Arctic Circle in Sweden have adequate D3 levels even during the second half of the dark winter. Subjects with D3 deficiency were uncommon but insufficient levels were often found among young men.

  • 136.
    Rantala, Outi
    et al.
    University of Lapland.
    de la Barre, Suzanne
    Vancouver Island University.
    Granås, Brynhild
    UiT Arctic University of Norway.
    Jóhannesson, Gunnar Thor
    University of Iceland.
    Müller, Dieter K.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Social Sciences, Department of Geography.
    Saarinen, Jarkko
    University of Oulu.
    Tervo-Kankare, Kaarina
    University of Oulu.
    Maher, Patrick T.
    Cape Breton University.
    Niskala, Maaria
    University of Lapland.
    Arctic tourism in times of change: Seasonality2019Report (Other academic)
  • 137.
    Roberts, Peder
    et al.
    Department for History of Science, Technology and Environment, KTH Royal Institute of Technology, Stockholm, Sweden.
    van der Watt, Lize-Marié
    Umeå University, Arctic Research Centre at Umeå University. Swedish Polar Research Secretariat.
    On past, present and future Arctic expeditions2015In: The new Arctic / [ed] Birgitta Evengård, Joan Nymand Larsen, Øyvind Paasche, Cham: Springer, 2015, p. 57-68Chapter in book (Refereed)
    Abstract [en]

    Today the term "Arctic expedition" conjures up images of heroic men chasing knowledge, but also personal and national glory. Geographical goals such as the North Pole, the Northwest and Northeast Passages and the discovery of new lands became major cultural touchstones during the nineteenth and early twentieth centuries. Individuals such as Sir John Franklin, Fridtjof Nansen, and Robert E. Peary became household names. Many smaller expeditions also ventured to the Arctic from Eurasia and North America. This chapter is about how large, publicity-friendly expeditions related to smaller, more prosaic ventures, and how the term expedition is used in the present to denote everything from seasonal fieldwork conducted by scientists to one-off feats of travel. We conclude with some reflections on how Arctic expeditions may look in the future – and how the term expedition continues to carry meaning in terms of culture and memory.

  • 138. Romaguera, Dora
    et al.
    Ward, Heather
    Wark, Petra A
    Vergnaud, Anne-Claire
    Peeters, Petra H
    van Gils, Carla H
    Ferrari, Pietro
    Fedirko, Veronika
    Jenab, Mazda
    Boutron-Ruault, Marie-Christine
    Dossus, Laure
    Dartois, Laureen
    Hansen, Camilla Plambeck
    Dahm, Christina Catherine
    Buckland, Genevieve
    Sánchez, María José
    Dorronsoro, Miren
    Navarro, Carmen
    Barricarte, Aurelio
    Key, Timothy J
    Trichopoulou, Antonia
    Tsironis, Christos
    Lagiou, Pagona
    Masala, Giovanna
    Pala, Valeria
    Tumino, Rosario
    Vineis, Paolo
    Panico, Salvatore
    Bueno-de-Mesquita, H Bas
    Siersema, Peter D
    Ohlsson, Bodil
    Jirström, Karin
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    Weiderpass, Elisabete
    Kühn, Tilman
    Katzke, Verena
    Khaw, Kay-Tee
    Wareham, Nick J
    Tjønneland, Anne
    Boeing, Heiner
    Quirós, José R
    Gunter, Marc J
    Riboli, Elio
    Norat, Teresa
    Pre-diagnostic concordance with the WCRF/AICR guidelines and survival in European colorectal cancer patients: a cohort study2015In: BMC Medicine, ISSN 1741-7015, E-ISSN 1741-7015, Vol. 13, article id 107Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Cancer survivors are advised to follow lifestyle recommendations on diet, physical activity, and body fatness proposed by the World Cancer Research Fund/American Institute of Cancer Research (WCRF/AICR) for cancer prevention. Previous studies have demonstrated that higher concordance with these recommendations measured using an index score (the WCRF/AICR score) was associated with lower cancer incidence and mortality. The aim of this study was to evaluate the association between pre-diagnostic concordance with WCRF/AICR recommendations and mortality in colorectal cancer (CRC) patients.

    METHODS: The association between the WCRF/AICR score (score range 0-6 in men and 0-7 in women; higher scores indicate greater concordance) assessed on average 6.4 years before diagnosis and CRC-specific (n = 872) and overall mortality (n = 1,113) was prospectively examined among 3,292 participants diagnosed with CRC in the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort (mean follow-up time after diagnosis 4.2 years). Multivariable Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality.

    RESULTS: The HRs (95% CIs) for CRC-specific mortality among participants in the second (score range in men/women: 2.25-2.75/3.25-3.75), third (3-3.75/4-4.75), and fourth (4-6/5-7) categories of the score were 0.87 (0.72-1.06), 0.74 (0.61-0.90), and 0.70 (0.56-0.89), respectively (P for trend <0.0001), compared to participants with the lowest concordance with the recommendations (category 1 of the score: 0-2/0-3). Similar HRs for overall mortality were observed (P for trend 0.004). Meeting the recommendations on body fatness and plant food consumption were associated with improved survival among CRC cases in mutually adjusted models.

    CONCLUSIONS: Greater concordance with the WCRF/AICR recommendations on diet, physical activity, and body fatness prior to CRC diagnosis is associated with improved survival among CRC patients.

  • 139.
    Sahlen, Klas-Göran
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health. Umeå University, Arctic Research Centre at Umeå University.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    A cost-effectiveness study of person-centered integrated heart failure and palliative home care: based on a randomized controlled trial2016In: Palliative Medicine: A Multiprofessional Journal, ISSN 0269-2163, E-ISSN 1477-030X, Vol. 30, no 3, p. 296-302Article in journal (Refereed)
    Abstract [en]

    Background: Previous economic studies of person-centered palliative home care have been conducted mainly among patients with cancer. Studies on cost-effectiveness of advanced home care for patients with severe heart failure are lacking when a diagnosis of heart failure is the only main disease as the inclusion criterion.

    Aim: To assess the cost-effectiveness of a new concept of care called person-centered integrated heart failure and palliative home care.

    Design: A randomized controlled trial was conducted from January 2011 to 2013 at a center in Sweden. Data collection included cost estimates for health care and the patients’ responses to the EQ-5D quality of life instrument.

    Setting/participants: Patients with chronic and severe heart failure were randomly assigned to an intervention (n = 36) or control (n = 36) group. The intervention group received the Palliative Advanced Home Care and Heart Failure Care intervention over 6 months. The control group received the same care that is usually provided by a primary health care center or heart failure clinic at the hospital.

    Results: EQ-5D data indicated that the intervention resulted in a gain of 0.25 quality-adjusted life years, and cost analysis showed a significant cost reduction with the Palliative Advanced Home Care and Heart Failure Care intervention. Even if costs for staffing are higher than usual care, this is more than made up for by the reduced need for hospital-based care. This intervention made it possible for the county council to use €50,000 for other needs.

    Conclusion: The Palliative Advanced Home Care and Heart Failure Care working mode saves financial resources and should be regarded as very cost-effective.

  • 140.
    Sanikini, Harinakshi
    et al.
    The Netherlands; Paris, France.
    Dik, Vincent K
    The Netherlands.
    Siersema, Peter D
    The Netherlands.
    Bhoo-Pathy, Nirmala
    Kuala Lumpur, Malaysia.
    Uiterwaal, Cuno S P M
    Utrecht, The Netherlands.
    Peeters, Petra H M
    Utrecht, The Netherlands.
    González, Carlos A
    Barcelona, Spain.
    Zamora-Ros, Raul
    Barcelona, Spain; Lyon, France.
    Overvad, Kim
    Aarhus, Denmark.
    Tjønneland, Anne
    Copenhagen, Denmark.
    Roswall, Nina
    Copenhagen, Denmark.
    Boutron-Ruault, Marie-Christine
    Paris, France.
    Fagherazzi, Guy
    Paris, France.
    Racine, Antoine
    Paris, France.
    Kühn, Tilman
    Heidelberg, Germany.
    Katzke, Verena
    Heidelberg, Germany.
    Boeing, Heiner
    Nuthetal, Germany.
    Trichopoulou, Antonia
    Athens, Greece.
    Trichopoulos, Dimitrios
    Athens, Greece; Boston, MA.
    Lagiou, Pagona
    Athens, Greece; Boston, MA;.
    Palli, Domenico
    Florence, Italy.
    Grioni, Sara
    Milano, Italy.
    Vineis, Paolo
    Torino, Italy; London, United Kingdom.
    Tumino, Rosario
    Cancer Registry and Histopathology Unit, Civic—M.P. Arezzo Hospital, Italy.
    Panico, Salvatore
    Naples, Italy.
    Weiderpass, Elisabete
    Tromsø, Norway; Oslo, Norway; Stockholm, Sweden; Helsinki, Finland.
    Skeie, Guri
    Tromsø, Norway.
    Braaten, Tonje
    Tromsø, Norway.
    Huerta, José María
    Madrid, Spain; Murcia, Spain.
    Sánchez-Cantalejo, Emilio
    Madrid, Spain; Granada, Spain.
    Barricarte, Aurelio
    Madrid, Spain; Pamplona, Spain.
    Sonestedt, Emily
    Malmö, Sweden.
    Wallstrom, Peter
    Malmö, Sweden.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Odontology.
    Bradbury, Kathryn E
    Oxford, United Kingdom.
    Khaw, Kay-Tee
    Cambridge, United Kingdom.
    Wareham, Nick
    Cambridge, United Kingdom.
    Huybrechts, Inge
    Lyon, France.
    Freisling, Heinz
    Lyon, France.
    Cross, Amanda J
    London, United Kingdom.
    Riboli, Elio
    London, United Kingdom.
    Bueno-de-Mesquita, H Bas
    London, United Kingdom; The Netherlands.
    Total, caffeinated and decaffeinated coffee and tea intake and gastric cancer risk: Results from the EPIC cohort study2015In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 136, no 6, p. E720-E730Article in journal (Refereed)
    Abstract [en]

    Prospective studies examining the association between coffee and tea consumption and gastric cancer risk have shown inconsistent results. We investigated the association between coffee (total, caffeinated and decaffeinated) and tea consumption and the risk of gastric cancer by anatomical site and histological type in the European Prospective Investigation into Cancer and Nutrition study. Coffee and tea consumption were assessed by dietary questionnaires at baseline. Adjusted hazard ratios (HRs) were calculated using Cox regression models. During 11.6 years of follow up, 683 gastric adenocarcinoma cases were identified among 477,312 participants. We found no significant association between overall gastric cancer risk and consumption of total coffee (HR 1.09, 95%-confidence intervals [CI]: 0.84-1.43; quartile 4 vs. non/quartile 1), caffeinated coffee (HR 1.14, 95%-CI: 0.82-1.59; quartile 4 vs. non/quartile 1), decaffeinated coffee (HR 1.07, 95%-CI: 0.75-1.53; tertile 3 vs. non/tertile 1) and tea (HR 0.81, 95%-CI: 0.59-1.09; quartile 4 vs. non/quartile 1). When stratified by anatomical site, we observed a significant positive association between gastric cardia cancer risk and total coffee consumption per increment of 100 mL/day (HR 1.06, 95%-CI: 1.03-1.11). Similarly, a significant positive association was observed between gastric cardia cancer risk and caffeinated coffee consumption (HR 1.98, 95%-CI: 1.16-3.36, p-trend=0.06; quartile 3 vs. non/quartile 1) and per increment of 100 mL/day (HR 1.09, 95%-CI: 1.04-1.14). In conclusion, consumption of total, caffeinated and decaffeinated coffee and tea is not associated with overall gastric cancer risk. However, total and caffeinated coffee consumption may be associated with an increased risk of gastric cardia cancer. Further prospective studies are needed to rule out chance or confounding.

  • 141. Schweitzer, Peter
    et al.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Arts, Centre for Sami Research.
    Ulturgasheva, Olga
    Cultures and identities2014In: Arctic human development report: regional processes and global linkages / [ed] Joan Nymand Larsen and Gail Fondahl, Köpenhamn: Nordic Council of Ministers , 2014, p. 105-150Chapter in book (Refereed)
  • 142.
    Silfverdal, Viktoria
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Rural Health Care Delivery and Population Dynamics: A qualitative interview study2016Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 143.
    Sjöström, Anna E.
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Hajdarevic, Senada
    Umeå University, Faculty of Medicine, Department of Nursing.
    Emmoth, Agneta
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Primary Health Care Nurses’ Experiences of Consultations With Internet-Informed Patients: Qualitative Study2019In: JMIR Nursing, ISSN 2562-7600, Vol. 2, no 1, article id e14194Article in journal (Refereed)
    Abstract [en]

    Background: Most people in modern societies now use the Internet to obtain health-related information. By giving patients knowledge, digital health information is considered to increase patient involvement and patient-centered interactions in health care. However, concerns are raised about the varying quality of health-related websites and low health literacy in the population. There is a gap in the current knowledge of nurses’ experiences with Internet-informed patients.

    Objective: The objective of this study was to explore primary health care nurses’ experiences of consultations with patients who present health-related information from the Internet.

    Methods: This is a qualitative study based on interviews with 9 primary health care nurses. Data were analyzed using qualitative content analysis. Results are reported according to the consolidated criteria for reporting qualitative research guidelines.

    Results: The phenomenon of Internet-informed patients was considered to change the usual rules in health care, affecting attributes and actions of patients, patterns of interactions in consultations, and roles of nurses and patients. Three categories were identified: (1) Facing the downsides of Googling, (2) Patients as main actors, and (3) Nurse role challenged. Although the benefits of health-related Internet information were described, its negative consequences were emphasized overall. The problems were mainly ascribed to inaccurate Internet information and patients’ inability to effectively manage the information.

    Conclusions: Our study suggests ambivalent attitudes among nurses toward health-related Internet information. In order to promote equitable care in the digital era, increased awareness in health care about useful strategies for overcoming the difficulties and embracing the benefits of conferring with Internet-informed patients seems to be a legitimate goal.

  • 144. Skeie, G.
    et al.
    Braaten, T.
    Olsen, A.
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Landberg, R.
    Asli, L. A.
    Bakken, T.
    Lund, E.
    Intake of whole grains and incidence of gastric and oesophageal cancer in the HELGA cohort2013In: Annals of Nutrition and Metabolism, ISSN 0250-6807, E-ISSN 1421-9697, Vol. 63, no Supplement 1, p. 198-199Article in journal (Other academic)
    Abstract [en]

    Background and objectives: Whole grains are a good sourceof dietary fibre, but beneficial effects might also stem fromother components of the grain. Very few studies exist on intakeof whole grains and incidence of stomach and oesophagealcancer, but studies on dietary fibre and these cancers suggesta protective effect. The objective of this work was to study theassociation between intake of whole grains and incidence ofoesophageal and gastric cancer. Methods: The Helga cohort has 120 000 participants fromthe Norwegian Women and Cancer study, The Northern Sweden Health and Disease study and the Danish Diet, Cancerand Health study, recruited in 1992-1999. After exclusions, 112cases of oesophageal cancer, 185 cases of gastric cancer and 113700 other cohort members were included in the analyses. Theyprovided dietary information in semi-quantitative FFQs at baseline,and also information about other risk factors. Cancer information was obtained by linkage to the respective cancerregistries. The association between whole grain intake and cancerwas analysed with Cox proportional hazards models. Results: The median whole-grain intake was 47.4 g/day(5th-95th percentile: 13.3-101.1) in the non-cases, 37.5 g/day(10.8-87.2) in oesophageal cancer cases, and 45.1 g/day (8.1-99.1) in gastric cancer cases. A decreased risk of oesophagealcancer was observed, HR=0.83 (CI 0.69-0.99) p=0.04 per 20g of whole grains. The HR for highest compared with lowesttertile of intake was 0.56 (0.32-0.97) p=0.03. The analyses wereadjusted for country, smoking status, age at baseline, sex, processedmeat, alcohol and vitamin C. No association was foundfor whole grains and gastric cancer.Conclusion: In this study, higher intake of whole grains wasassociated with lower risk of oesophageal cancer. Acknowledgements: This work was supported by NordForsk– Centre of excellence programme HELGA (070015).

  • 145. Skeie, Guri
    et al.
    Braaten, Tonje
    Olsen, Anja
    Kyrø, Cecilie
    Tjønneland, Anne
    Landberg, Rikard
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Overvad, Kim
    Åsli, Lene Angell
    Weiderpass, Elisabete
    Lund, Eiliv
    Intake of whole grains and incidence of oesophageal cancer in the HELGA Cohort2016In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 31, no 4, p. 405-414Article in journal (Refereed)
    Abstract [en]

    Few prospective studies have investigated the association between whole-grain consumption and incidence of oesophageal cancer. In the Scandinavian countries, consumption of whole grains is high and the incidence of oesophageal cancer comparably low. The aim of this paper was to study the associations between consumption of whole grains, whole-grain products and oesophageal cancer, including its two major histological subtypes. The HELGA cohort is a prospective cohort study consisting of three sub-cohorts in Norway, Sweden and Denmark. Information regarding whole-grain consumption was collected through country-specific food frequency questionnaires. Cancer cases were identified through national cancer registries. Cox proportional hazards ratios were calculated in order to assess the associations between whole grains and oesophageal cancer risk. The analytical cohort had 113,993 members, including 112 cases, and median follow-up time was 11 years. When comparing the highest tertile of intake with the lowest, the oesophageal cancer risk was approximately 45 % lower (adjusted HR 0.55, 95 % CI 0.31-0.97 for whole grains, HR 0.51, 95 % CI 0.30-0.88 for whole-grain products). Inverse associations were also found in continuous analyses. Whole-grain wheat was the only grain associated with lower risk (HR 0.32, 95 % CI 0.16-0.63 highest vs. lowest tertile). Among whole-grain products, the results were less clear, but protective associations were seen for the sum of whole-grain products, and whole-grain bread. Lower risk was seen in both histological subtypes, but particularly for squamous cell carcinomas. In this study, whole-grain consumption, particularly whole-grain wheat, was inversely associated with risk of oesophageal cancer.

  • 146.
    Skeie, Guri
    et al.
    Universitetet i Tromsö.
    Braaten, Tonje
    Olsen, Anja
    Kyrø, Cecilie
    Tjønneland, Anne
    Nilsson, Lena Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Arctic Research Centre at Umeå University.
    Landberg, Rikard
    Lund, Eiliv
    Whole Grain Intake and Survival Among Scandinavian Colorectal Cancer Patients2014In: Nutrition and Cancer, ISSN 0163-5581, E-ISSN 1532-7914, Vol. 66, no 1, p. 6-13Article in journal (Refereed)
    Abstract [en]

    To our knowledge, no studies of associations between intake of whole grain (WHG) and survival of colorectal cancer have been published, despite evidence that dietary fiber, and to some extent WHG, are associated with lower risk of colorectal cancer. Scandinavia is an area where the WHG consumption traditionally is high. We performed a case-only (N = 1119) study in the Scandinavian HELGA cohort of pre-diagnosis WHG intake (total WHG, WHG wheat, WHG rye, and WHG oats) and survival of colorectal cancer. Cox regression analyses were used to study the associations, both in categorical and continuous models, stratified by location (proximal, distal, rectum) and country. No evidence of an association was found, neither for total WHG intake (hazard ratio = 1.32, 95% confidence interval: 0.88-1.97 lowest vs. highest tertile, adjusted for age at diagnosis, metastasis status, smoking, folate, margarine, and energy), nor for specific grains. Prediagnosis consumption of WHG does not seem to improve survival of colorectal cancer in subjects diagnosed within this prospective population-based Scandinavian cohort.

  • 147.
    Skottheim, Andreas
    et al.
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Lövheim, Hugo
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation, Geriatric Medicine.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Sandman, Per-Olof
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University. Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Sweden; Department of Health Sciences, Luleå University of Technology, Sweden.
    Gustafsson, Maria
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.
    Insomnia symptoms among old people in nursing homes2018In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 30, p. 77-85Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Insomnia symptoms are common among old people, and hypnotics and sedative drugs are often prescribed in spite of small benefits. The aim of this study was to estimate the prevalence of insomnia symptoms and to analyze the association between insomnia symptoms, cognitive level, and prescription of hypnotics and sedatives among old people living in nursing homes.

    METHODS: The study comprised 2,135 people living in nursing homes in the county of Västerbotten, Sweden. Data concerning hypnotic and sedative drugs, cognitive function, and prevalence of insomnia symptoms were collected, using the Multi-Dimensional Dementia Assessment Scale (MDDAS).

    RESULTS: The three most common insomnia symptoms were "sleeps for long periods during the day," "interrupted night-time sleep," and "wakes up early in the morning" with 57.8%, 56.4%, and 48.0%, respectively, of the residents exhibiting the symptoms at least once a week. Different insomnia symptoms showed different association patterns with sex and age. Most insomnia symptoms were more common among people with cognitive impairment compared to those with no cognitive impairment and seemed to reach their peak prevalence in people with moderate to severe cognitive impairment, subsequently decreasing with further cognitive decline. Of the study population, 24.0% were prescribed hypnotics and sedatives. Prescriptions were more common among those without cognitive impairment, and among those exhibiting the symptom "difficulty initiating sleep."

    CONCLUSIONS: Insomnia symptoms and prescription of hypnotics and sedatives are common among old people living in nursing homes. Considering the risk of adverse effects, it is important to regularly re-evaluate the need for these drugs.

  • 148.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Arts, Centre for Sami Research.
    Förord2012In: Vid foten av fjället: forskning om samernas historia och samhälle / [ed] Peter Sköld, Umeå: Centrum för samisk forskning , 2012, p. 7-9Chapter in book (Other academic)
  • 149.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Arts, Centre for Sami Research.
    Förord: Forskningens förutsättningar och den traditionella kunskapens betydelse2012In: Långa perspektiv: samisk forskning och traditionell forskning / [ed] Peter Sköld och Krister Stoor, Umeå: Centrum för samisk forskning , 2012, p. 7-12Chapter in book (Other academic)
  • 150.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Arts, Centre for Sami Research.
    Perpetual adaption?: challanges for the Sami and reindeer husbandry in Sweden2015In: The new Arctic / [ed] Birgitta Evengård, Joan Nymand Larsen, Øyvind Paasche, Cham: Springer, 2015, p. 39-55Chapter in book (Refereed)
    Abstract [en]

    Reindeer husbandry is of vital importance for the Sami living in Sweden, Norway, Finland and Russia. With a focus on Sweden we can conclude that through a colonial history the reindeer herding Sami have achieved legal rights that to some extent guarantee their existence. This is largely due to a successful political mobilization. On the other hand conflicts over land use with non-Sami settlers and the Swedish state have been a frequent element in the industry. The Sami must also combat a stereotypical understanding of reindeer herding that often has difficulties in understanding the constant modernization and technical development. Today the reindeer herders compete with industries such as mines, hydropower, windmill parks, forestry and tourism. An additional threat is the predators and state policies around them. Reindeer herding is of vital importance to all Sami, but the legal system prohibits the large majority to be involved, something that has had recent political complications in the Sami society.

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