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  • 151.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Arts, Centre for Sami Research.
    Problems of indigenous peoples of the North: health care, rights and identity2014In: Международная конференция представителей государств - членов Арктического совета, стран - наблюдателей Арктического совета и зарубежной научной общественности: "Актуальные проблемы устойчивого развития и обеспечения безопасности в Арктике", Нарьян-Мар, 5-7 августа 2014 года = International Conference of Representatives of the States-Members of the Arctic Council, the States-Observers to the Arctic Council and the Foreign Scientific Community : Topical Problems of Sustainable Development and Security Maintenance in the Arctic, Naryan-Mar, 5-7 August, 2014, Moskow: Arctic Council Office , 2014, p. 104-105Conference paper (Refereed)
  • 152.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Arts, Centre for Sami Research.
    Urfolk i norr: samisk forskning vid Umeå universitet2013In: Umeå 1314-2014: 100 berättelser om 700 år / [ed] Lars-Gunnar Olsson och Susanne Haugen; Lars-Erik Edlund & Lars-Göran Tedebrand, Skellefteå: Artos & Norma bokförlag, 2013, p. 321-324Chapter in book (Other academic)
  • 153.
    Sköld, Peter
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Arts, Centre for Sami Research.
    Nordin, Gabriella
    Umeå University, Arctic Research Centre at Umeå University.
    Metodologiska utmaningar vid studier av urfolk i en nordisk kontext2015In: City-Saami: Same i byen eller bysame? Skandinaviske byer i et samisk perspektiv / [ed] Paul Pedersen & Torill Nyseth, Kárášjohka: ČálliidLágádusas , 2015, p. 31-57Chapter in book (Refereed)
  • 154.
    Sköld, Peter
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Arts, Centre for Sami Research.
    Stoor, KristerUmeå University, Faculty of Arts, Department of language studies.
    Rivers to cross: Sami land use and the human dimension2012Collection (editor) (Other academic)
  • 155. Sobek, Sebastian
    et al.
    Gudasz, Cristian
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences. Umeå University, Arctic Research Centre at Umeå University. Department of Ecology and Genetics/Limnology, Uppsala University, Uppsala, Sweden.
    Koehler, Birgit
    Tranvik, Lars J.
    Bastviken, David
    Morales-Pineda, Maria
    Temperature dependence of apparent respiratory quotients and oxygen penetration depth in contrasting lake sediments2017In: Journal of Geophysical Research - Biogeosciences, ISSN 2169-8953, E-ISSN 2169-8961, Vol. 122, no 11, p. 3076-3087Article in journal (Refereed)
    Abstract [en]

    Lake sediments constitute an important compartment in the carbon cycle of lakes, by burying carbon over geological timescales and by production and emission of greenhouse gases. The degradation of organic carbon (OC) in lake sediments is linked to both temperature and oxygen (O-2), but the interactive nature of this regulation has not been studied in lake sediments in a quantitative way. We present the first systematic investigation of the effects of temperature on the apparent respiratory quotient (RQ, i.e., the molar ratio between carbon dioxide (CO2) production and O-2 consumption) in two contrasting lake sediments. Laboratory incubations of sediment cores of a humic lake and an eutrophic lake across a 1-21 degrees C temperature gradient over 157days revealed that both CO2 production and O-2 consumption were positively, exponentially, and similarly dependent on temperature. The apparent RQ differed significantly between the lake sediments (0.630.26 and 0.990.28 in the humic and the eutrophic lake, respectively; meanSD) and was significantly and positively related to temperature. The O-2 penetration depth into the sediment varied by a factor of 2 over the 1-21 degrees C temperature range and was significantly, negatively, and similarly related to temperature in both lake sediments. Accordingly, increasing temperature may influence the overall extent of OC degradation in lake sediments by limiting O-2 supply to aerobic microbial respiration to the topmost sediment layer, resulting in a concomitant shift to less effective anaerobic degradation pathways. This suggests that temperature may represent a key controlling factor of the OC burial efficiency in lake sediments.

  • 156. Solans, Marta
    et al.
    Benavente, Yolanda
    Saez, Marc
    Agudo, Antonio
    Jakszyn, Paula
    Naudin, Sabine
    Hosnijeh, Fatemeh Saberi
    Gunter, Marc
    Huybrechts, Inge
    Ferrari, Pietro
    Besson, Caroline
    Mahamat-Saleh, Yahya
    Boutron-Ruault, Marie-Christine
    Kühn, Tilman
    Kaaks, Rudolf
    Boeing, Heiner
    Lasheras, Cristina
    Sánchez, Maria-Jose
    Amiano, Pilar
    Chirlaque, María Dolores
    Ardanaz, Eva
    Schmidt, Julie A
    Vineis, Paolo
    Riboli, Elio
    Trichopoulou, Antonia
    Karakatsani, Anna
    Valanou, Elisavet
    Masala, Giovanna
    Agnoli, Claudia
    Tumino, Rosario
    Sacerdote, Carlotta
    Mattiello, Amalia
    Skeie, Guri
    Weiderpass, Elisabete
    Jerkeman, Mats
    Dias, Joana Alves
    Späth, Florentin
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    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.
    Dahm, Christina C
    Overvad, Kim
    Petersen, Kristina Elin Nielsen
    Tjønneland, Anne
    de Sanjose, Silvia
    Vermeulen, Roel
    Nieters, Alexandra
    Casabonne, Delphine
    Inflammatory potential of diet and risk of lymphoma in the European Prospective Investigation into Cancer and Nutrition.2019In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215Article in journal (Refereed)
    Abstract [en]

    Introduction: Chronic inflammation plays a critical role in lymphomagenesis and several dietary factors seem to be involved its regulation. The aim of the current study was to assess the association between the inflammatory potential of the diet and the risk of lymphoma and its subtypes in the European Investigation into Cancer and Nutrition (EPIC) study.

    Methods: The analysis included 476,160 subjects with an average follow-up of 13.9 years, during which 3,136 lymphomas (135 Hodgkin lymphoma (HL), 2606 non-Hodgkin lymphoma (NHL) and 395 NOS) were identified. The dietary inflammatory potential was assessed by means of an inflammatory score of the diet (ISD), calculated using 28 dietary components and their corresponding inflammatory weights. The association between the ISD and lymphoma risk was estimated by hazard ratios (HR) and 95% confidence intervals (CI) calculated by multivariable Cox regression models adjusted for potential confounders.

    Results: The ISD was not associated with overall lymphoma risk. Among lymphoma subtypes, a positive association between the ISD and mature B-cell NHL (HR for a 1-SD increase: 1.07 (95% CI 1.01; 1.14), p trend = 0.03) was observed. No statistically significant association was found among other subtypes. However, albeit with smaller number of cases, a suggestive association was observed for HL (HR for a 1-SD increase = 1.22 (95% CI 0.94; 1.57), p trend 0.13).

    Conclusions: Our findings suggested that a high ISD score, reflecting a pro-inflammatory diet, was modestly positively associated with the risk of B-cell lymphoma subtypes. Further large prospective studies on low-grade inflammation induced by diet are warranted to confirm these findings.

  • 157. Solans, Marta
    et al.
    Benavente, Yolanda
    Saez, Marc
    Agudo, Antonio
    Naudin, Sabine
    Hosnijeh, Fatemeh Saberi
    Noh, Hwayoung
    Freisling, Heinz
    Ferrari, Pietro
    Besson, Caroline
    Mahamat-Saleh, Yahya
    Boutron-Ruault, Marie-Christine
    Kühn, Tilman
    Kaaks, Rudolf
    Boeing, Heiner
    Lasheras, Cristina
    Rodríguez-Barranco, Miguel
    Amiano, Pilar
    Maria Huerta, Jose
    Barricarte, Aurelio
    Schmidt, Julie A.
    Vineis, Paolo
    Riboli, Elio
    Trichopoulou, Antonia
    Bamia, Christina
    Peppa, Eleni
    Masala, Giovanna
    Agnoli, Claudia
    Tumino, Rosario
    Sacerdote, Carlotta
    Panico, Salvatore
    Skeie, Guri
    Weiderpass, Elisabete
    Jerkeman, Mats
    Ericson, Ulrika
    Späth, Florentin
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    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.
    Dahm, Christina C.
    Overvad, Kim
    Bolvig, Anne Katrine
    Tjønneland, Anne
    de Sanjose, Silvia
    Buckland, Genevieve
    Vermeulen, Roel
    Nieters, Alexandra
    Casabonne, Delphine
    Adherence to the mediterranean diet and lymphoma risk in the european prospective investigation into cancer and nutrition2019In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 145, no 1, p. 122-131Article in journal (Refereed)
    Abstract [en]

    There is a growing evidence of the protective role of the Mediterranean diet (MD) on cancer. However, no prospective study has yet investigated its influence on lymphoma. We evaluated the association between adherence to the MD and risk of lymphoma and its subtypes in the European Prospective Investigation into Cancer and Nutrition (EPIC) study. The analysis included 476,160 participants, recruited from 10 European countries between 1991 and 2001. Adherence to the MD was estimated through the adapted relative MD (arMED) score excluding alcohol. Cox proportional hazards regression models were used while adjusting for potential confounders. During an average follow-up of 13.9 years, 3,136 lymphomas (135 Hodgkin lymphoma [HL], 2,606 non-HL and 395 lymphoma not otherwise specified) were identified. Overall, a 1-unit increase in the arMED score was associated with a 2% lower risk of lymphoma (95% CI: 0.97; 1.00, p-trend = 0.03) while a statistically nonsignificant inverse association between a high versus low arMED score and risk of lymphoma was observed (hazard ratio [HR]: 0.91 [95% CI 0.80; 1.03], p-trend = 0.12). Analyses by lymphoma subtype did not reveal any statistically significant associations. Albeit with small numbers of cases (N = 135), a suggestive inverse association was found for HL (HR 1-unit increase = 0.93 [95% CI: 0.86; 1.01], p-trend = 0.07). However, the study may have lacked statistical power to detect small effect sizes for lymphoma subtype. Our findings suggest that an increasing arMED score was inversely related to the risk of overall lymphoma in EPIC but not by subtypes. Further large prospective studies are warranted to confirm these findings.

  • 158.
    Sonntag-Öström, Elisabet
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Dolling, Ann
    Sveriges lantbruksuniversitet.
    Lundell, Ylva
    Sveriges lantbruksuniversitet.
    Nilsson, Leif
    Umeå University, Faculty of Science and Technology, Department of Mathematics and Mathematical Statistics.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Can rehabilitation in boreal forests help recovery from exhaustion disorder?: the randomised clinical trial ForRest2015In: Scandinavian Journal of Forest Research, ISSN 0282-7581, E-ISSN 1651-1891, Vol. 30, no 8, p. 732-748Article in journal (Refereed)
    Abstract [en]

    Modern society is faced with increasing incidence of mental and behavioural disorders. The objective of this study was to evaluate whether visits to boreal forests can be utilised for rehabilitation from exhaustion disorder (ED). This randomised controlled trial comprised of a forest rehabilitation group (n = 35) and a waiting list group (control group) (n = 43) with subsequent cognitive behavioural rehabilitation (CBR) for all participants in both groups. The recovery from ED was compared between the forest rehabilitation and the control group at baseline, after the forest rehabilitation (3 months), and at the end of the CBR (1 year). Both groups had enhanced recovery from ED after the 3-month intervention period and at the end of the CBR (1 year), and there were no significant differences between the groups in terms of psychological health measures. Mental state, attention capacity and preferences for different forest environments were studied during the forest visits. Mental state was improved, but it showed some seasonal differences. A significant effect on attention capacity was found for single forest visits, but there was no effect found for the rehabilitation period as a whole. The most popular forest environments contained easily accessible, open and bright settings with visible water and/or shelter. Forest rehabilitation did not enhance the recovery from ED compared to the control group, but the participants’ well-being was improved after single forest visits.

  • 159.
    Sonntag-Öström, Elisabet
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundell, Ylva
    Dolling, Ann
    Wiklund, Urban
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Karlsson, Marcus
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Carlberg, Bo
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Restorative effects of visits to urban and forest environments in patients with exhaustion disorder2014In: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 13, no 2, p. 344-354Article in journal (Refereed)
    Abstract [en]

    This experimental study investigated differences in perceived restorativeness, mood, attention capacity and physiological reactions when visiting city and forest environments. Twenty female patients diagnosed with exhaustion disorder visited three different forest environments and one city environment in randomized order. They performed a standardized 90-min test procedure in each of these environments. Evaluation of the environments and psychological effects in mood were studied with self-administered questionnaires. Attention capacity was studied with Necker Cube Pattern Control task. Physiological responses were measured with regularly scheduled controls of heart rate and blood pressure, and a single test of heart rate recovery. Visits to the forest environments were perceived as significantly more restorative, enhancing mood and attention capacity compared to the city. This also applies to the results of heart rate and to some extent to the results of the diastolic blood pressure. The results from this experimental study support our hypothesis that short visits to forest environments enhance both psychological and physiological recovery and that visits to forest environments are likely to be beneficial when suffering from exhaustion disorder. 

  • 160.
    Sonntag-Öström, Elisabet
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundell, Ylva
    Department of Forest Ecology and Management, Swedish University of Agricultural Sciences, S-901 83 Umeå, Sweden.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Fjellman-Wiklund, Annchristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dolling, Ann
    Department of Forest Ecology and Management, Swedish University of Agricultural Sciences, S-901 83 Umeå, Sweden.
    “Nature's effect on my mind”: patients’ qualitative experiences of a forest-based rehabilitation programme2015In: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 14, no 3, p. 607-614Article in journal (Refereed)
    Abstract [en]

    Aim: The aim of this study was to investigate the personal experiences and perceived effects on mind from visits to forest environments in a subset of patients with severe exhaustion disorder (ED), who participated in a randomized controlled trial for evaluation of forest-based rehabilitation.

    Participants: A subsample of 19 patients with diagnosed ED, who completed the three-month forest-based rehabilitation programme in the ForRest project, was interviewed. Method: The forest-based rehabilitation consisted of repeated forest visits with the main objective of spending time in rest and solitude in a chosen forest setting. Semi-structured interviews were carried out and analysed using Grounded Theory.

    Result: A core category and five subcategories were set up to describe the patients’ experiences and development during the forest-based rehabilitation. As patients mostly reported that they strove to achieve peace of mind during the forest visits, Striving for serenity was chosen to be the core category. At first the patients were frustrated when left alone with their own thoughts in an unfamiliar forest environment. They gradually became familiar with the forest environments and also found their favourite places where they experienced peace of mind. They were then able to rest and begin reflective thinking about their life situation, which led to ambitions to change it.The preferred forest environments were characterised by openness, light and a good view, and were felt to be undemanding, peaceful and stimulating.

    Conclusion: Visits to the forest provided favourite places for rest, were experienced as restorative, seemed to improved reflection and may have contributed to starting the coping process for these patients. However, forest visits, as the only treatment option, are not sufficient as rehabilitation from severe and long-term ED. We suggest that forest visits should be integrated with cognitive behavioural therapy to further improve the recovery and enhance coping in daily life for these patients.

  • 161.
    Sonntag-Öström, Elisabet
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Stenlund, Therese
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Nordin, Maria
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Lundell, Ylva
    Sveriges lantbruksuniversitet.
    Ahlgren, Christina
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Fjellman-Wiklund, Anncristine
    Umeå University, Faculty of Medicine, Department of Community Medicine and Rehabilitation.
    Slunga Järvholm, Lisbeth
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Dolling, Ann
    Sveriges lantbruksuniversitet.
    "Nature's effect on my mind". Patients' experiences of nature based rehabilitation: a qualitative inquiry.2015In: Urban Forestry & Urban Greening, ISSN 1618-8667, E-ISSN 1610-8167, Vol. 14, no 3, p. 607-14Article in journal (Refereed)
  • 162. Stepien, Magdalena
    et al.
    Duarte-Salles, Talita
    Fedirko, Veronika
    Trichopoulou, Antonia
    Lagiou, Pagona
    Bamia, Christina
    Overvad, Kim
    Tjønneland, Anne
    Hansen, Louise
    Boutron-Ruault, Marie-Christine
    Fagherazzi, Guy
    Severi, Gianluca
    Kühn, Tilman
    Kaaks, Rudolf
    Aleksandrova, Krasimira
    Boeing, Heiner
    Klinaki, Eleni
    Palli, Domenico
    Grioni, Sara
    Panico, Salvatore
    Tumino, Rosario
    Naccarati, Alessio
    Bueno-de-Mesquita, H. Bas
    Peeters, Petra H.
    Skeie, Guri
    Weiderpass, Elisabete
    Parr, Christine L.
    Quirós, José Ramón
    Buckland, Genevieve
    Molina-Montes, Esther
    Amiano, Pilar
    Chirlaque, Maria-Dolores
    Ardanaz, Eva
    Sonestedt, Emily
    Ericson, Ulrika
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    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.
    Khaw, Kay-Tee
    Wareham, Nick
    Bradbury, Kathryn E.
    Ward, Heather A.
    Romieu, Isabelle
    Jenab, Mazda
    Consumption of soft drinks and juices and risk of liver and biliary tract cancers in a European cohort2016In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 55, no 1, p. 7-20Article in journal (Refereed)
    Abstract [en]

    PURPOSE: The aim of the study was to assess associations between intake of combined soft drinks (sugar sweetened and artificially sweetened) and fruit and vegetable juices and the risk of hepatocellular carcinoma (HCC), intrahepatic bile duct (IHBC) and biliary tract cancers (GBTC) using data from the European Prospective Investigation into Cancer and Nutrition cohort of 477,206 participants from 10 European countries.

    METHODS: After 11.4 years of follow-up, 191 HCC, 66 IHBC and 236 GBTC cases were identified. Hazard ratios and 95 % confidence intervals (HR; 95 % CI) were estimated with Cox regression models with multivariable adjustment (baseline total energy intake, alcohol consumption and intake pattern, body mass index, physical activity, level of educational attainment and self-reported diabetes status).

    RESULTS: No risk associations were observed for IHBC or GBTC. Combined soft drinks consumption of >6 servings/week was positively associated with HCC risk: HR 1.83; 95 % CI 1.11-3.02, p trend = 0.01 versus non-consumers. In sub-group analyses available for 91 % of the cohort artificially sweetened soft drinks increased HCC risk by 6 % per 1 serving increment (HR 1.06, 95 % CI 1.03-1.09, n cases = 101); for sugar-sweetened soft drinks, this association was null (HR 1.00, 95 % CI 0.95-1.06; n cases = 127, p heterogeneity = 0.07). Juice consumption was not associated with HCC risk, except at very low intakes (<1 serving/week: HR 0.60; 95 % CI 0.38-0.95; p trend = 0.02 vs. non-consumers).

    CONCLUSIONS: Daily intake of combined soft drinks is positively associated with HCC, but a differential association between sugar and artificially sweetened cannot be discounted. This study provides some insight into possible associations of HCC with sugary drinks intake. Further exploration in other settings is required.

  • 163. Talabani, Naghada
    et al.
    Hellström Ängerud, Karin
    Umeå University, Faculty of Medicine, Department of Nursing.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Research Unit Skellefteå, Department of Medicine, Umeå University, Skellefteå, Sweden.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University. Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.
    Patients' experiences of person-centred integrated heart failure care and palliative care at home: an interview study2017In: BMJ Supportive & Palliative Care, ISSN 2045-435X, E-ISSN 2045-4368Article in journal (Refereed)
    Abstract [en]

    Objectives Patients with severe heart failure (HF) suffer from a high symptom burden and high mortality. European and Swedish guidelines for HF care recommend palliative care for these patients. Different models for integrated palliative care and HF care have been described in the literature. No studies were found that qualitatively evaluated these models. The purpose of this study is to describe patients' experiences of a new model of person-centred integrated HF and palliative care at home.

    Method Interviews were conducted with 12 patients with severe HF (New York Heart Association class III–IV) and included in the research project of Palliative advanced home caRE and heart FailurE caRe (PREFER). Qualitative content analysis was used for data analysis.

    Results Two themes and a total of five categories were identified. The first theme was feeling secure and safe through receiving care at home with the categories: having access to readily available care at home, being followed up continuously and having trust in the team members' ability to help. The second theme was being acknowledged as both a person and a patient, with the following two categories: being met as a person, participating in decisions about one's care and receiving help for symptoms of both HF and comorbidities.

    Conclusions Person-centred integrated HF and palliative care provides a secure environment and holistic care for patients with severe HF. This approach is a way to improve the care management in this population.

  • 164.
    Taylor, Andrew
    et al.
    Charles Darwin University.
    Carson, Dean B.
    Umeå University, Arctic Research Centre at Umeå University. Charles Darwin University.
    Carson, Doris A.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography. Centre for Rural Health & Community Development, University of South Australia, Whyalla, SA, 5601, Australia.
    Brokensha, Huw
    Charles Darwin University.
    ‘Walkabout’ tourism: The Indigenous tourism market for Outback Australia2015In: Journal of Hospitality and Tourism Management, ISSN 1447-6770, Vol. 24, p. 9-17Article in journal (Refereed)
    Abstract [en]

    Tourism development for remote Indigenous ‘places’ is globally expounded for the potential to garner economic benefits for socio-economically disadvantaged Indigenous citizens. In remote 'Outback' areas of Australia, where half the population are First Australians, tourism is an important industry but has been in decline in recent decades. Whilst Indigenous tourism product development has been pursued it has, along with other niche markets, delivered at best limited and isolated successes. But Indigenous people in Outback Australia are themselves highly mobile, making frequent and regular trips away from home communities and towns. In the past these trips were labelled derogatorily as ‘walkabout’, in spite of trip characteristics positing those ‘on the move’ firmly within accepted definitions of tourism. Few studies to date have explicitly considered Indigenous citizens as tourists, and there has been no systematic research on the potential size or characteristics of the ‘market’, an awkward contradiction given the historical focus on generating tourism at places where Indigenous people live. This research analyses Census data for Australia from the perspective of providing baseline information about the potential of the Indigenous tourist market to support Outback tourism, focusing on identifying the size and characteristics of the internal Outback market and the flows and characteristics of people to and from other meta regions. The results clearly demonstrate there is a potential, with the profile of Indigenous visitors to Outback areas being very different to those travelling away. With financial gains being only one of the potential benefits, this should prompt a re-envisioning of the phenomenon of Indigenous mobility as it may relate to tourism and encourage a research agenda examining market development.

  • 165. Tognon, Gianluca
    et al.
    Nilsson, Lena M.
    Umeå University, Arctic Research Centre at Umeå University.
    Shungin, Dmitry
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Umeå University, Faculty of Medicine, Department of Odontology.
    Lissner, Lauren
    Jansson, Jan-Håkan
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Renstrom, Frida
    Wennberg, Maria
    Winkvist, Anna
    Johansson, Ingegerd
    Nonfermented milk and other dairy products: associations with all-cause mortality 1,22017In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 105, no 6, p. 1502-1511Article in journal (Refereed)
    Abstract [en]

    Background: A positive association between nonfermented milk intake and increased all-cause mortality was recently reported, but overall, the association between dairy intake and mortality is inconclusive. Objective: We studied associations between intake of dairy products and all-cause mortality with an emphasis on nonfermented milk and fat content. Design: A total of 103,256 adult participants (women: 51.0%) from Northern Sweden were included (7121 deaths; mean follow-up: 13.7 y). Associations between all-cause mortality and reported intakes of nonfermented milk (total or by fat content), fermented milk, cheese, and butter were tested with the use of Cox proportional hazards models that were adjusted for age, sex, body mass index, smoking status, education, energy intake, examination year, and physical activity. To circumvent confounding, Mendelian randomization was applied in a subsample via the lactase LCT-13910 C/T single nucleotide polymorphism that is associated with lactose tolerance and milk intake. Results: High consumers of nonfermented milk (>= 2.5 times/d) had a 32% increased hazard (HR: 1.32; 95% CI: 1.18, 1.48) for all-cause mortality compared with that of subjects who consumed milk <= 1 time/wk. The corresponding value for butter was 11% (HR: 1.11; 95% CI: 1.07, 1.21). All nonfermented milk-fat types were independently associated with increased HRs, but compared with full-fat milk, HRs were lower in consumers of medium-and low-fat milk. Fermented milk intake (HR: 0.90; 95% CI: 0.86, 0.94) and cheese intake (HR: 0.93; 95% CI: 0.91, 0.96) were negatively associated with mortality. Results were slightly attenuated by lifestyle adjustments but were robust in sensitivity analyses. Mortality was not significantly associated with the LCT-13910 C/T genotype in the smaller subsample. The amount and type of milk intake was associated with lifestyle variables. Conclusions: In the present Swedish cohort study, intakes of nonfermented milk and butter are associated with higher all-cause mortality, and fermented milk and cheese intakes are associated with lower all-cause mortality. Residual confounding by lifestyle cannot be excluded, and Mendelian randomization needs to be examined in a larger sample.

  • 166.
    van der Watt, Lize-Marie
    et al.
    Umeå University, Arctic Research Centre at Umeå University.
    Swart, Sandra
    Falling off the Map: South Africa, Antarctica and Empire, c. 1919-592015In: Journal of Imperial and Commonwealth History, ISSN 0308-6534, E-ISSN 1743-9329, Vol. 43, no 2, p. 267-291Article in journal (Refereed)
    Abstract [en]

    During the first half of the twentieth century, despatches about the coldest corner of the British Empire were circulated to three, sometimes four, of its southern neighbours under the British crown: Australia, New Zealand, South Africa and the Falklands. Of these four, South Africa seemed the least interested in Antarctica, despite the keen interest of some influential individuals and a strategy of bringing Antarctica into the imperial fold through British dominions that were proximate to Antarctica. In this context, we ask how South Africa viewed itself in relation to the Antarctic to the south and the British metropole to the north. We discuss the key activities that connected South Africa to Antarctica-whaling and weather forecasting. Moreover, we consider some of the enterprising plans for a South African National Antarctic expedition, and what these plans reveal of South Africa's perception of itself as a southern country. This article interlinks with a growing scholarship that is critical of treating Antarctic history as politically and culturally isolated, including showing how the relatively simple natural and political ecology of the Antarctic can throw into relief multiple national and international concerns.

  • 167.
    van der Watt, Lize-Marié
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Kungliga Tekniska Högskolan (KTH).
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    Hållbar utveckling i norra Sverige: bundna mönster och historiska brytpunkter2017Report (Other academic)
  • 168.
    van der Watt, Lize-Marié
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Swedish Polar Research Secretariat.
    Riedel, Arne
    Dahlbäck, Björn
    Tedsen, Elizabeth
    Jagodziński, Kamil
    Kankaanpää, Paula
    European Arctic initiatives: capacities, gaps and future opportunities2016In: The changing Arctic and the European Union / [ed] Adam Stępień, Timo Koivurova and Paula Kankaanpää, Amsterdam: Brill Nijhoff, 2016, p. 243-295Chapter in book (Other academic)
  • 169.
    Viken, Arvid
    et al.
    UiT The Arctic University of Norway.
    Müller, Dieter K.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography.
    Indigeneity and indigenous tourism2017In: Tourism and indigeneity in the Arctic / [ed] Arvid Viken and Dieter K. Müller, Bristol: Channel View Publications, 2017, p. 16-32Chapter in book (Refereed)
  • 170.
    Viken, Arvid
    et al.
    UiT The Arctic University of Norway.
    Müller, Dieter K.Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography.
    Tourism and indigeneity in the Arctic2017Collection (editor) (Refereed)
  • 171.
    Vikström, Lotta
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies. Umeå University, Arctic Research Centre at Umeå University.
    Vulnerability among paupers: determinants of individuals receiving poor relief in nineteenth-century northern Sweden2006In: The History of the Family, ISSN 1081-602X, E-ISSN 1873-5398, Vol. 11, no 4, p. 223-239Article in journal (Refereed)
    Abstract [en]

    This study combines computerized parish registers with parish meeting records that account for individuals who received poor relief in the nineteenth-century Sundsvall region, Sweden. The combination of sources especially helps to explore the recipients who are overlooked in the literature or difficult to trace in historical data. Their demographic characteristics in relation to relief allocation and experiences prior to it are analyzed and show that they did not only share the occurrence of entitlement. Vast but insufficient family networks failed to give the recipients support to manage their distressed situation. Deaths and births of relatives jeopardized their capability to guarantee subsistence for them or their family, and so did also their gender and phase in the lifecycle. The multi-dimensional concept of vulnerability is employed to comprehend the dynamic determinants of poverty represented by individuals granted poor relief. It is argued that this concept has to be further developed but nevertheless helps to identify and stratify some of the vulnerabilities that characterized paupers in the past.

  • 172.
    Vikström, Lotta
    et al.
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies. Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Häggström Lundevaller, Erling
    Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR). Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Statistics. Umeå Universitet.
    Junkka, Johan
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies. Umeå University, Faculty of Social Sciences, Centre for Demographic and Ageing Research (CEDAR).
    Haage, Helena
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Ett annorlunda liv?: Följder av funktionsnedsättningar i 1800-talets Sverige2019In: Funktionsnedsättning i arbetsliv och välfärd: rapport från forskarseminariet i Umeå 16–17 januari 2019, Försäkringskassan, Analys och prognos , 2019, p. 15-29Chapter in book (Other academic)
    Abstract [sv]

    Vad innebar funktionsnedsättningar för människors delaktighet i 1800-talets samhälle? Studien besvarar frågan genom att undersöka över 35,000 unga personers chanser att hitta ett första jobb där levnadsbanan för 15-åringar följs upp närmare. Funktionsnedsättningar medförde svårigheter på både arbets- och partnermarknaden även om det inte var omöjligt att skaffa jobb, gifta sig och bilda familj. Det vittnar om att nedsatt funktionsförmåga innebar ett annorlunda liv och möjligen socialt utanförskap, men inte alltid. Följderna varierade beroende på typ av nedsättning där omgivningens attityder till olika funktionsnedsättningar och könsbundna förväntningar tycks ha spelat roll. Fysiska nedsättningar hade inte lika negativa effekter för arbete, giftermål och överlevnad som psykiska nedsättningar. Resultaten bygger på kyrkböcker digitaliserade av Demografiska Databasens (DDB), Umeå Universitet, där prästerna noterade funktionsavvikelser och händelser i församlingsbornas liv (t.ex. yrke, giftermål, barnafödande). Studien belyser hur levnadsvillkor och möjligheter till delaktighet i samhället via arbete gestaltade sig för individer i historisk tid till följd av funktionsnedsättningar – förhållanden som dröjer sig kvar än idag.

  • 173.
    Vuin, Ana
    et al.
    Charles Darwin University, Australia.
    Carson, Doris Anna
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History. School of Natural and Built Environments, University of South Australia, Adelaide, SA 5001, Australia.
    Carson, Dean Bradley
    Umeå University, Arctic Research Centre at Umeå University. The Northern Institute, Charles Darwin University, Casuarina, NT 0810, Australia; Flinders Rural Clinical School, Flinders University, Bedford Park, SA 5042, Australia.
    Garrett, Jaimee
    Flinders University, Australia.
    The role of heritage tourism in attracting "active" in-migrants to "low amenity" rural areas2016In: Rural Society, ISSN 1037-1656, Vol. 25, no 2, p. 134-153Article in journal (Refereed)
    Abstract [en]

    Tourism can influence in-migration to rural areas by enhancing the attractiveness of rural communities and providing opportunities for employment, entrepreneurship and volunteer engagement appealing to in-migrants. Much research on the rural tourism-migration nexus has focused on “high amenity” areas characterized by scenic environments and well-developed tourism and service infrastructures. Many communities in inland Australia, however, are in “low amenity” areas where tourism opportunities are limited to exploiting industrial and cultural heritage assets. This article examines the role of heritage tourism in facilitating in-migration to such areas based on interviews with in-migrants to three communities in South Australia’s Mid-North, focusing on the experiences of “active” in-migrants who get economically or socially involved in their new communities. Findings suggest heritage tourism minimally affected migration decisions. Key attractors were housing, employment, cost of living and easy access to the city. Business opportunities in tourism were attractors where the tourism industry was relatively well developed. Overall, the factors influencing in-migration differed among communities suggesting locally, not regionally, focused place marketing strategies are required to target in-migrants.

  • 174.
    Väisänen, Maria
    et al.
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences. Umeå University, Arctic Research Centre at Umeå University.
    Gavazov, Konstantin
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences. Umeå University, Arctic Research Centre at Umeå University.
    Krab, Eveline J
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences. Umeå University, Arctic Research Centre at Umeå University. Department of Soil and Environment, Swedish University of Agricultural Sciences, Lennart Hjelms väg 9, SE-750 07 Uppsala, Sweden.
    Dorrepaal, Ellen
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences. Umeå University, Arctic Research Centre at Umeå University.
    The Legacy Effects of Winter Climate on Microbial Functioning After Snowmelt in a Subarctic Tundra2019In: Microbial Ecology, ISSN 0095-3628, E-ISSN 1432-184X, Vol. 77, no 1, p. 186-190Article in journal (Refereed)
    Abstract [en]

    Warming-induced increases in microbial CO2 release in northern tundra may positively feedback to climate change. However, shifts in microbial extracellular enzyme activities (EEAs) may alter the impacts of warming over the longer term. We investigated the in situ effects of 3years of winter warming in combination with the in vitro effects of a rapid warming (6days) on microbial CO2 release and EEAs in a subarctic tundra heath after snowmelt in spring. Winter warming did not change microbial CO2 release at ambient (10 degrees C) or at rapidly increased temperatures, i.e., a warm spell (18 degrees C) but induced changes (P<0.1) in the Q(10) of microbial respiration and an oxidative EEA. Thus, although warmer winters may induce legacy effects in microbial temperature acclimation, we found no evidence for changes in potential carbon mineralization after spring thaw.

  • 175.
    Winkvist, Anna
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research. Department of Internal Medicine and Clinical Nutrition, Sahlgenska Academy, University of Gothenburg, Box 459SE-405 30 Gothenburg, Sweden.
    Klingberg, Sofia
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Renström, Frida
    Umeå University, Faculty of Medicine, Department of Biobank Research. Department of Clinical Sciences, Genetic & Molecular Epidemiology Unit, Lund University, Malmö, Sweden.
    Hallmans, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Longitudinal 10-year changes in dietary intake and associations with cardio-metabolic risk factors in the Northern Sweden Health and Disease Study2017In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 16, article id 20Article in journal (Refereed)
    Abstract [en]

    Background: Dietary risks today constitute the largest proportion of disability-adjusted life years (DALYs) globally and in Sweden. An increasing number of people today consume highly processed foods high in saturated fat, refined sugar and salt and low in dietary fiber, vitamins and minerals. It is important that dietary trends over time are monitored to predict changes in disease risk.

    Methods: In total, 15,995 individuals with two visits 10 (±1) years apart in the population-based Västerbotten Intervention Programme 1996–2014 were included. Dietary intake was captured with a 64-item food frequency questionnaire. Percent changes in intake of dietary components, Healthy Diet Score and Dietary Inflammatory Index were calculated and related to body mass index (BMI), serum cholesterol and triglyceride levels and blood pressure at the second visit in multivariable regression analyses.

    Results: For both sexes, on group level, proportion of energy intake (E%) from carbohydrates and sucrose decreased (largest carbohydrate decrease among 40 year-olds) and E% protein and total fat as well as saturated and poly-unsaturated fatty acids (PUFA) increased (highest protein increase among 30 year-olds and highest fat increase among 60 year-olds) over the 10-year period. Also, E% trans-fatty acids decreased. On individual basis, for both sexes decreases in intake of cholesterol and trans-fatty acids were associated with lower BMI and serum cholesterol at second visit (all P < 0.05). For men, increases in intake of whole grain and Healthy Diet Score were associated with lower BMI and serum cholesterol at second visit (all P < 0.05). Also for men, decreases in intake of trans-fatty acids and increases in Healthy Diet Score were associated with lower systolic blood pressure at second visit (P = 0.002 and P < 0.000). For women, increases in intake of PUFA and Healthy Diet Score were associated with lower BMI at second visit (P = 0.01 and P < 0.05). Surprisingly, increases in intake of sucrose among women were associated with lower BMI at second visit (P = 0.02).

    Conclusions: In this large population-based sample, dietary changes over 10 years towards less carbohydrates and more protein and fat were noted. Individual changes towards the Nordic dietary recommendations were associated with healthier cardio-metabolic risk factor profile at second visit.

  • 176. Zamora-Ros, R
    et al.
    Sacerdote, C
    Ricceri, F
    Weiderpass, E
    Roswall, N
    Buckland, G
    St-Jules, D E
    Overvad, K
    Kyrø, C
    Fagherazzi, G
    Kvaskoff, M
    Severi, G
    Chang-Claude, J
    Kaaks, R
    Nöthlings, U
    Trichopoulou, A
    Naska, A
    Trichopoulos, D
    Palli, D
    Grioni, S
    Mattiello, A
    Tumino, R
    Gram, I T
    Engeset, D
    Huerta, J M
    Molina-Montes, E
    Argüelles, M
    Amiano, P
    Ardanaz, E
    Ericson, U
    Lindkvist, B
    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.
    Kiemeney, L A
    Ros, M
    Bueno-de-Mesquita, H B
    Peeters, P H M
    Khaw, K-T
    Wareham, N J
    Knaze, V
    Romieu, I
    Scalbert, A
    Brennan, P
    Wark, P
    Vineis, P
    Riboli, E
    González, C A
    Flavonoid and lignan intake in relation to bladder cancer risk in the European Prospective Investigation into Cancer and Nutrition (EPIC) study2014In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 111, no 9, p. 1870-1880Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: There is growing evidence of the protective role of dietary intake of flavonoids and lignans on cancer, but the association with bladder cancer has not been thoroughly investigated in epidemiological studies. We evaluated the association between dietary intakes of total and subclasses of flavonoids and lignans and risk of bladder cancer and its main morphological type, urothelial cell carcinoma (UCC), within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. METHODS: A cohort of 477 312 men and women mostly aged 35-70 years, were recruited in 10 European countries. At baseline, dietary flavonoid and lignan intakes were estimated using centre-specific validated questionnaires and a food composition database based on the Phenol-Explorer, the UK Food Standards Agency and the US Department of Agriculture databases. RESULTS: During an average of 11 years of follow-up, 1575 new cases of primary bladder cancer were identified, of which 1425 were UCC (classified into aggressive (n=430) and non-aggressive (n=413) UCC). No association was found between total flavonoid intake and bladder cancer risk. Among flavonoid subclasses, significant inverse associations with bladder cancer risk were found for intakes of flavonol (hazard ratio comparing fifth with first quintile (HRQ5-Q1) 0.74, 95% confidence interval (CI): 0.61-0.91; P-trend=0.009) and lignans (HRQ5-Q1 0.78, 95% CI: 0.62-0.96; P-trend=0.046). Similar results were observed for overall UCC and aggressive UCC, but not for non-aggressive UCC. CONCLUSIONS: Our study suggests an inverse association between the dietary intakes of flavonols and lignans and risk of bladder cancer, particularly aggressive UCC.

  • 177. Zamora-Ros, Raul
    et al.
    Barupal, Dinesh K.
    Rothwell, Joseph A.
    Jenab, Mazda
    Fedirko, Veronika
    Romieu, Isabelle
    Aleksandrova, Krasimira
    Overvad, Kim
    Kyro, Cecilie
    Tjonneland, Anne
    Affret, Aurelie
    His, Mathilde
    Boutron-Ruault, Marie-Christine
    Katzke, Verena
    Kuehn, Tilman
    Boeing, Heiner
    Trichopoulou, Antonia
    Naska, Androniki
    Kritikou, Maria
    Saieva, Calogero
    Agnoli, Claudia
    de Magistris, Maria Santucci
    Tumino, Rosario
    Fasanelli, Francesca
    Weiderpass, Elisabete
    Skeie, Guri
    Merino, Susana
    Jakszyn, Paula
    Sanchez, Maria-Jose
    Dorronsoro, Miren
    Navarro, Carmen
    Ardanaz, Eva
    Sonestedt, Emily
    Ericson, Ulrika
    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.
    Bodén, Stina
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Bueno-de-Mesquita, H. B. (as)
    Peeters, Petra H.
    Perez-Cornago, Aurora
    Wareham, Nicholas J.
    Khaw, Kay-Thee
    Freisling, Heinz
    Cross, Amanda J.
    Riboli, Elio
    Scalbert, Augustin
    Dietary flavonoid intake and colorectal cancer risk in the European prospective investigation into cancer and nutrition (EPIC) cohort2017In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 140, no 8, p. 1836-1844Article in journal (Refereed)
    Abstract [en]

    Flavonoids have been shown to inhibit colon cancer cell proliferation in vitro and protect against colorectal carcinogenesis in animal models. However, epidemiological evidence on the potential role of flavonoid intake in colorectal cancer (CRC) development remains sparse and inconsistent. We evaluated the association between dietary intakes of total flavonoids and their subclasses and risk of development of CRC, within the European Prospective Investigation into Cancer and Nutrition (EPIC) study. A cohort of 477,312 adult men and women were recruited in 10 European countries. At baseline, dietary intakes of total flavonoids and individual subclasses were estimated using centre-specific validated dietary questionnaires and composition data from the Phenol-Explorer database. During an average of 11 years of follow-up, 4,517 new cases of primary CRC were identified, of which 2,869 were colon (proximal = 1,298 and distal = 1,266) and 1,648 rectal tumours. No association was found between total flavonoid intake and the risk of overall CRC (HR for comparison of extreme quintiles 1.05, 95% CI 0.93-1.18; p-trend = 0.58) or any CRC subtype. No association was also observed with any intake of individual flavonoid subclasses. Similar results were observed for flavonoid intake expressed as glycosides or aglycone equivalents. Intake of total flavonoids and flavonoid subclasses, as estimated from dietary questionnaires, did not show any association with risk of CRC development.

  • 178. Zamora-Ros, Raul
    et al.
    Knaze, Viktoria
    Rothwell, Joseph A.
    Hémon, Bertrand
    Moskal, Aurelie
    Overvad, Kim
    Tjønneland, Anne
    Kyrø, Cecilie
    Fagherazzi, Guy
    Boutron-Ruault, Marie-Christine
    Touillaud, Marina
    Katzke, Verena
    Kühn, Tilman
    Boeing, Heiner
    Förster, Jana
    Trichopoulou, Antonia
    Valanou, Elissavet
    Peppa, Eleni
    Palli, Domenico
    Agnoli, Claudia
    Ricceri, Fulvio
    Tumino, Rosario
    de Magistris, Maria Santucci
    Peeters, Petra H. M.
    Bueno-de-Mesquita, H Bas
    Engeset, Dagrun
    Skeie, Guri
    Hjartåker, Anette
    Menéndez, Virginia
    Agudo, Antonio
    Molina-Montes, Esther
    Huerta, José María
    Barricarte, Aurelio
    Amiano, Pilar
    Sonestedt, Emily
    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
    Key, Timothy J.
    Khaw, Kay-Thee
    Wareham, Nicholas J.
    Lu, Yunxia
    Slimani, Nadia
    Romieu, Isabelle
    Riboli, Elio
    Scalbert, Augustin
    Dietary polyphenol intake in Europe: the European Prospective Investigation into Cancer and Nutrition (EPIC) study2016In: European Journal of Nutrition, ISSN 1436-6207, E-ISSN 1436-6215, Vol. 55, no 4, p. 1359-1375Article in journal (Refereed)
    Abstract [en]

    BACKGROUND/OBJECTIVES: Polyphenols are plant secondary metabolites with a large variability in their chemical structure and dietary occurrence that have been associated with some protective effects against several chronic diseases. To date, limited data exist on intake of polyphenols in populations. The current cross-sectional analysis aimed at estimating dietary intakes of all currently known individual polyphenols and total intake per class and subclass, and to identify their main food sources in the European Prospective Investigation into Cancer and Nutrition cohort.

    METHODS: Dietary data at baseline were collected using a standardized 24-h dietary recall software administered to 36,037 adult subjects. Dietary data were linked with Phenol-Explorer, a database with data on 502 individual polyphenols in 452 foods and data on polyphenol losses due to cooking and food processing.

    RESULTS: Mean total polyphenol intake was the highest in Aarhus-Denmark (1786 mg/day in men and 1626 mg/day in women) and the lowest in Greece (744 mg/day in men and 584 mg/day in women). When dividing the subjects into three regions, the highest intake of total polyphenols was observed in the UK health-conscious group, followed by non-Mediterranean (non-MED) and MED countries. The main polyphenol contributors were phenolic acids (52.5-56.9 %), except in men from MED countries and in the UK health-conscious group where they were flavonoids (49.1-61.7 %). Coffee, tea, and fruits were the most important food sources of total polyphenols. A total of 437 different individual polyphenols were consumed, including 94 consumed at a level >1 mg/day. The most abundant ones were the caffeoylquinic acids and the proanthocyanidin oligomers and polymers.

    CONCLUSION: This study describes the large number of dietary individual polyphenols consumed and the high variability of their intakes between European populations, particularly between MED and non-MED countries.

  • 179. Zamora-Ros, Raul
    et al.
    Luján-Barroso, Leila
    Bueno-de-Mesquita, H Bas
    Dik, Vincent K
    Boeing, Heiner
    Steffen, Annika
    Tjønneland, Anne
    Olsen, Anja
    Bech, Bodil Hammer
    Overvad, Kim
    Boutron-Ruault, Marie-Christine
    Racine, Antoine
    Fagherazzi, Guy
    Kuhn, Tilman
    Katzke, Verena
    Trichopoulou, Antonia
    Lagiou, Pagona
    Trichopoulos, Dimitrios
    Tumino, Rosario
    Panico, Salvatore
    Vineis, Paolo
    Grioni, Sara
    Palli, Domenico
    Weiderpass, Elisabete
    Skeie, Guri
    Huerta, José María
    Sánchez, María-José
    Argüelles, Marcial
    Amiano, Pilar
    Ardanaz, Eva
    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.
    Wallner, Bengt
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Lindkvist, Björn
    Wallström, Peter
    Peeters, Petra H M
    Key, Timothy J
    Khaw, Kay-Thee
    Wareham, Nicholas J
    Freisling, Heinz
    Stepien, Magdalena
    Ferrari, Pietro
    Gunter, Marc J
    Murphy, Neil
    Riboli, Elio
    González, Carlos A
    Tea and coffee consumption and risk of esophageal cancer: the European Prospective Investigation into Cancer and Nutrition (EPIC) study2014In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 135, no 6, p. 1470-1479Article in journal (Refereed)
    Abstract [en]

    Epidemiological data regarding tea and coffee consumption and risk of esophageal cancer (EC) is still inconclusive. We examined the association of tea and coffee consumption with EC risk among 442,143 men and women without cancer at baseline from 9 countries of the European Prospective Investigation into Cancer and Nutrition (EPIC). Tea and coffee intakes were recorded using country-specific validated dietary questionnaires. Cox regression models were used to analyze the relationships between tea and coffee intake and EC risk. During a mean follow-up of 11.1 years, 339 participants developed EC, of which 142 were esophageal adenocarcinoma (EAC) and 174 were esophageal squamous cell carcinoma (ESCC). In the multivariable models, no significant associations between tea (mostly black tea), and coffee intake and risk of EC, EAC and ESCC were observed. In stratified analyses, among men coffee consumption was inversely related to ESCC (HR for comparison of extreme tertiles 0.42, 95% CI 0.20-0.88; P-trend=0.022), but not among women. In current smokers, a significant and inverse association was observed between ESCC risk and tea (HR 0.46, 95% CI 0.23-0.93; P-trend=0.053) and coffee consumption (HR 0.37, 95% CI 0.19-0.73; P-trend=0.011). However, no statistically significant findings were observed using the continuous variable (per 100mL/d). These data did not show a significant association between tea and coffee consumption and EC, EAC and ESCC, although a decreased risk of ESCC among men and current smokers is suggested, but need to be confirmed in further prospective studies including more cases.

  • 180.
    Öberg, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Jutterström, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Orre, Carl-Johan
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Perceptions of Persons With Type 2 Diabetes Treated in Swedish Primary Health Care: Qualitative Study on Using eHealth Services for Self-Management Support2018In: JMIR Diabetes, ISSN 2371-4379, Vol. 3, no 1, article id e7Article in journal (Refereed)
    Abstract [en]

    Background: Digital health services are increasing rapidly worldwide. Strategies to involve patients in self-monitoring of type 2 diabetes (T2D) on a daily basis is of crucial importance, and there is a need to optimize the delivery of care such as self-management support. Digitalized solutions have the potential to modify and personalize the way in which people use primary health services, both by increasing access to information and providing other forms of support at a distance. It is a challenge to integrate core values of person-centered care into digitalized health care services.

    Objective: The objective of this study was to describe perceptions of using electronic health (eHealth) services and related technologies for self-management support among people with T2D treated in Swedish primary health care.

    Methods: This is a qualitative study based on interviews analyzed using qualitative content analysis conducted among people diagnosed with T2D.

    Results: Findings suggest that the participants had mixed feelings regarding the use of digital health services for self-management support. They experienced potentials such as increased involvement, empowerment, and security, as well as concerns such as ambivalence and uncertainty.

    Conclusions: Digital health services for self-management are easily accessible and have the potential to reach a wide population. However, targeted training to increase digital skills is required, and personalized devices must be adapted and become more person-centered to improve patients’ involvement in their own care.

  • 181.
    Öberg, Ulrika
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Orre, Carl Johan
    Hörnsten, Åsa
    Umeå University, Faculty of Medicine, Department of Nursing.
    Jutterström, Lena
    Umeå University, Faculty of Medicine, Department of Nursing.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Using the Self‐Management Assessment Scale (SMASc) as an instrument for screening self-management support needs in type 2 diabetes: experiences from nurse-led digital self-management support in Swedish primary health careManuscript (preprint) (Other academic)
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