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  • 1. Aleksandrova, Krasimira
    et al.
    Bamia, Christina
    Drogan, Dagmar
    Lagiou, Pagona
    Trichopoulou, Antonia
    Jenab, Mazda
    Fedirko, Veronika
    Romieu, Isabelle
    Bueno-de-Mesquita, H. Bas
    Pischon, Tobias
    Tsilidis, Kostas
    Overvad, Kim
    Tjønneland, Anne
    Bouton-Ruault, Marie-Christine
    Dossus, Laure
    Racine, Antoine
    Kaaks, Rudolf
    Kuehn, Tilman
    Tsironis, Christos
    Papatesta, Eleni-Maria
    Saitakis, George
    Palli, Domenico
    Panico, Salvatore
    Grioni, Sara
    Tumino, Rosario
    Vineis, Paolo
    Peeters, Petra H.
    Weiderpass, Elisabete
    Lukic, Marko
    Braaten, Tonje
    Ramon Quiros, J.
    Lujan-Barroso, Leila
    Sanchez, Mara-Jose
    Chilarque, Maria-Dolores
    Ardanas, Eva
    Dorronsoro, Miren
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Wallström, Peter
    Ohlsson, Bodil
    Bradbury, Kathryn E.
    Khaw, Kay-Tee
    Wareham, Nick
    Stepien, Magdalena
    Duarte-Salles, Talita
    Assi, Nada
    Murphy, Neil
    Gunter, Marc J.
    Riboli, Elio
    Boeing, Heiner
    Trichopoulos, Dimitrios
    The association of coffee intake with liver cancer risk is mediated by biomarkers of inflammation and hepatocellular injury: data from the European Prospective Investigation into Cancer and Nutrition2015In: American Journal of Clinical Nutrition, ISSN 0002-9165, E-ISSN 1938-3207, Vol. 102, no 6, p. 1498-1508Article in journal (Refereed)
    Abstract [en]

    Background: Higher coffee intake has been purportedly related to a lower risk of liver cancer. However, it remains unclear whether this association may be accounted for by specific biological mechanisms. Objective: We aimed to evaluate the potential mediating roles of inflammatory, metabolic, liver injury, and iron metabolism biomarkers on the association between coffee intake and the primary form of liver cancer-hepatocellular carcinoma (HCC). Design: We conducted a prospective nested case-control study within the European Prospective Investigation into Cancer and Nutrition among 125 incident HCC cases matched to 250 controls using an incidence-density sampling procedure. The association of coffee intake with HCC risk was evaluated by using multivariable-adjusted conditional logistic regression that accounted for smoking, alcohol consumption, hepatitis infection, and other established liver cancer risk factors. The mediating effects of 21 biomarkers were evaluated on the basis of percentage changes and associated 95% CIs in the estimated regression coefficients of models with and without adjustment for biomarkers individually and in combination. Results: The multivariable-adjusted RR of having >= 4 cups (600mL) coffee/d compared with <2 cups (300 mL)/d was 0.25 (95% CI: 0.11, 0.62; P-trend = 0.006). A statistically significant attenuation of the association between coffee intake and HCC risk and thereby suspected mediation was confirmed for the inflammatory biomarker IL-6 and for the biomarkers of hepatocellular injury glutamate dehydrogenase, alanine aminotransferase, aspartate aminotransferase (AST), gamma-glutamyltransferase (GGT), and total bilirubin, which-in combination-attenuated the regression coefficients by 72% (95% CI: 7%, 239%). Of the investigated biomarkers, IL-6, AST, and GGT produced the highest change in the regression coefficients: 40%, 56%, and 60%, respectively. Conclusion: These data suggest that the inverse association of coffee intake with HCC risk was partly accounted for by biomarkers of inflammation and hepatocellular injury.

  • 2. Allard, Christina
    et al.
    Axelsson, Per
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Brännlund, Isabelle
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Cocq, Coppélie
    Umeå University, Faculty of Arts, Department of language studies.
    Hjortfors, Lis-Mari
    Umeå University, Faculty of Arts, Department of language studies. Umeå University, Faculty of Arts, Centre for Sami Research.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences.
    Ledman, Anna-Lill
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Löf, Annette
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Johansson Lönn, Eva
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Moen, Jon
    Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    Nordin, Gabriella
    Umeå University, Arctic Research Centre at Umeå University.
    Nordlund, Christer
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Norlin, Björn
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Outakoski, Hanna
    Umeå University, Faculty of Arts, Department of language studies.
    Reimerson, Elsa
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Sandström, Camilla
    Umeå University, Faculty of Social Sciences, Department of Political Science.
    Sandström, Moa
    Umeå University, Faculty of Arts, Centre for Sami Research. Umeå University, Faculty of Arts, Department of language studies.
    Sehlin MacNeil, Kristina
    Umeå University, Faculty of Arts, Department of culture and media studies.
    Sköld, Peter
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Stoor, Krister
    Umeå University, Faculty of Arts, Department of language studies.
    Storm Mienna, Christina
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Svonni, Charlotta
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies.
    Vinka, Mikael
    Össbo, Åsa
    Umeå University, Faculty of Arts, Department of language studies.
    Rasbiologiskt språkbruk i statens rättsprocess mot sameby2015In: Dagens Nyheter, ISSN 1101-2447Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Statens hantering av forskningsresultat i rättsprocessen med Girjas sameby utgör ett hot mot Sverige som rättsstat och kunskapsnation. Åratal av svensk och internationell forskning underkänns och man använder ett språkbruk som skulle kunna vara hämtat från rasbiologins tid. Nu måste staten ta sitt ansvar och börja agera som en demokratisk rättsstat, skriver 59 forskare.

  • 3. Alvariza, Anette
    et al.
    Årestedt, Kristofer
    Boman, Kurt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Family members' experiences of integrated palliative advanced home and heart failure care: a qualitative study of the PREFER intervention2018In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 16, no 3, p. 278-285Article in journal (Refereed)
    Abstract [en]

    Objective: Chronic heart failure is a disease with high morbidity and symptom burden for patients, and it also places great demands on family members. Patients with heart failure should have access to palliative care for the purpose of improving quality of life for both patients and their families. In the PREFER randomized controlled intervention, patients with New York Heart Association classes III–IV heart failure received person-centered care with a multidisciplinary approach involving collaboration between specialists in palliative and heart failure care. The aim of the present study was to describe family members' experiences of the intervention, which integrated palliative advanced home and heart failure care.

    Method: This study had a qualitative descriptive design based on family member interviews. Altogether, 14 family members participated in semistructured interviews for evaluation after intervention completion. The data were analyzed by means of content analysis.

    Results: Family members expressed gratitude and happiness after witnessing the patient feeling better due to symptom relief and empowerment. They also felt relieved and less worried, as they were reassured that the patient was being cared for properly and that their own responsibility for care was shared with healthcare professionals. However, some family members also felt as though they were living in the shadow of severe illness, without receiving any support for themselves.

    Significance of results: Several benefits were found for family members from the PREFER intervention, and our results indicate the significance of integrated palliative advanced home and heart failure care. However, in order to improve this intervention, psychosocial professionals should be included on the intervention team and should contribute by paying closer attention and providing targeted support for family members.

  • 4.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Karlsson, Stig
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University. Center for Disaster Medicine, Umeå University, Umeå, Sweden.
    Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients' temperatures in prehospital emergency care - an intervention study2015In: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 74, article id 28878Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients' exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients' temperatures in the prehospital emergency care.

    METHODS: A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30) was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30) no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS), subjective comments on cold experiences, and finger, ear and air temperatures.

    RESULTS: Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001) but decreased in the control group (p=0.014). A significant higher proportion (57%) of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001). At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes.

    CONCLUSIONS: The use of active heat from underneath increases the patients' thermal comfort and may prevent the negative consequences of cold stress.

  • 5.
    Aléx, Jonas
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Uppstu, Tom
    Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Nursing.
    The opinions of ambulance personnel regarding using a heated mattress for patients being cared for in a cold climate - An intervention study in ambulance care2017In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 76, article id 1379305Article in journal (Refereed)
    Abstract [en]

    The purpose of the study was to describe the opinions of ambulance personnel regarding differences between using a heated mattress and a standard ambulance mattress. This study was an intervention study with pre- and post-evaluation. Evaluations of the opinions of personnel regarding the standard unheated mattress were conducted initially. After the intervention with new heated mattresses, follow-up evaluations were conducted. Ambulance personnel (n=64) from an ambulance station in northern Sweden took part in the study, which ran from October 2014 until February 2016. There were differences in opinions regarding the standard unheated mattress and the new heated mattress. The evaluation of the proxy ratings by the personnel showed that the heated mattress was warmer than the standard mattress, more pleasant to lie on and that patients were happier and more relaxed than when the standard mattress was used. The ambulance personnel in this study rated the experience of working with the heated mattress as very positive and proxy rated that it had a good effect on patient comfort. A heated mattress can be recommended for patients in ambulance care, even if more research is needed to receive sufficient evidence.

  • 6. Anderson, Ian
    et al.
    Robson, Bridget
    Connolly, Michele
    Al-Yaman, Fadwa
    Bjertness, Espen
    King, Alexandra
    Tynan, Michael
    Madden, Richard
    Bang, Abhay
    Coimbra, Carlos E. A., Jr.
    Pesantes, Maria Amalia
    Amigo, Hugo
    Andronov, Sergei
    Armien, Blas
    Obando, Daniel Ayala
    Axelsson, Per
    Umeå University, Faculty of Arts, Centre for Sami Research.
    Bhatti, Zaid Shakoor
    Bhutta, Zulfi Qar Ahmed
    Bjerregaard, Peter
    Bjertness, Marius B.
    Briceno-Leon, Roberto
    Broderstad, Ann Ragnhild
    Bustos, Patricia
    Chongsuvivatwong, Virasakdi
    Chu, Jiayou
    Deji, .
    Gouda, Jitendra
    Harikumar, Rachakulla
    Htay, Thein Thein
    Htet, Aung Soe
    Izugbara, Chimaraoke
    Kamaka, Martina
    King, Malcolm
    Kodavanti, Mallikharjuna Rao
    Lara, Macarena
    Laxmaiah, Avula
    Lema, Claudia
    Taborda, Ana Maria Leon
    Liabsuetrakul, Tippawan
    Lobanov, Andrey
    Melhus, Marita
    Meshram, Indrapal
    Miranda, J. Jaime
    Mu, Thet Thet
    Nagalla, Balkrishna
    Nimmathota, Arlappa
    Popov, Andrey Ivanovich
    Poveda, Ana Maria Penuela
    Ram, Faujdar
    Reich, Hannah
    Santos, Ricardo V.
    Sein, Aye Aye
    Shekhar, Chander
    Sherpa, Lhamo Y.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University.
    Tano, Sofia
    Umeå University, Faculty of Social Sciences, Umeå School of Business and Economics (USBE), Business Administration.
    Tanywe, Asahngwa
    Ugwu, Chidi
    Ugwu, Fabian
    Vapattanawong, Patama
    Wan, Xia
    Welch, James R.
    Yang, Gonghuan
    Yang, Zhaoqing
    Yap, Leslie
    Indigenous and tribal peoples' health (The Lancet-Lowitja Institute Global Collaboration): a population study2016In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 388, no 10040, p. 131-157Article in journal (Refereed)
    Abstract [en]

    Background: International studies of the health of Indigenous and tribal peoples provide important public health insights. Reliable data are required for the development of policy and health services. Previous studies document poorer outcomes for Indigenous peoples compared with benchmark populations, but have been restricted in their coverage of countries or the range of health indicators. Our objective is to describe the health and social status of Indigenous and tribal peoples relative to benchmark populations from a sample of countries.

    Methods: Collaborators with expertise in Indigenous health data systems were identified for each country. Data were obtained for population, life expectancy at birth, infant mortality, low and high birthweight, maternal mortality, nutritional status, educational attainment, and economic status. Data sources consisted of governmental data, data from non-governmental organisations such as UNICEF, and other research. Absolute and relative differences were calculated.

    Findings: Our data (23 countries, 28 populations) provide evidence of poorer health and social outcomes for Indigenous peoples than for non-Indigenous populations. However, this is not uniformly the case, and the size of the rate difference varies. We document poorer outcomes for Indigenous populations for: life expectancy at birth for 16 of 18 populations with a difference greater than 1 year in 15 populations; infant mortality rate for 18 of 19 populations with a rate difference greater than one per 1000 livebirths in 16 populations; maternal mortality in ten populations; low birthweight with the rate difference greater than 2% in three populations; high birthweight with the rate difference greater than 2% in one population; child malnutrition for ten of 16 populations with a difference greater than 10% in five populations; child obesity for eight of 12 populations with a difference greater than 5% in four populations; adult obesity for seven of 13 populations with a difference greater than 10% in four populations; educational attainment for 26 of 27 populations with a difference greater than 1% in 24 populations; and economic status for 15 of 18 populations with a difference greater than 1% in 14 populations.

    Interpretation: We systematically collated data across a broader sample of countries and indicators than done in previous studies. Taking into account the UN Sustainable Development Goals, we recommend that national governments develop targeted policy responses to Indigenous health, improving access to health services, and Indigenous data within national surveillance systems.

  • 7.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm, Sweden.
    Fürst, Carl-Johan
    The Institute for Palliative Care, Lund University and Region Skåne, Lund, Sweden.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Care professional's experiences about using Liverpool Care Pathway in end-of-life care in residential care homes2018In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 32, no 1, p. 299-308Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Residential care homes (RCHs) play an important role in end-of-life care, being the most common place of death for elderly people in several European countries. Care pathways such as the Liverpool Care Pathway for the Dying Patient (LCP) are used to improve and ensure quality care at the end of life. There is a lack of scientific evidence supporting the use of care pathways.

    DESIGN: A descriptive qualitative study.

    OBJECTIVE: The aim was to describe care professionals' experiences of using the Liverpool Care Pathway for the Dying Patient in the care of dying residents in residential care homes.

    METHODS: Five focus group interviews and two individual interviews with enrolled nurses (n = 10), Registered Nurses (n = 9) and general practitioners (n = 5) were carried out and analysed using qualitative content analysis.

    RESULTS: Care professionals expressed that they became confident through a shared approach to care, were supported to tailor the care according to the residents' individual needs, were supported to involve family members in decision-making and care and became more aware of the care environment.

    CONCLUSION: The results of this study indicate that the LCP might be a useful tool for care professionals in improving end-of-life care in RCHs through increased attention to the goals of care, the individual needs of residents and family involvement.

  • 8.
    Andersson, Sofia
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Årestedt, Kristofer
    Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
    Lindqvist, Olav
    Umeå University, Faculty of Medicine, Department of Nursing. Department of Learning, Informatics, Management and Ethics/MMC, Karolinska Institutet, Stockholm.
    Fürst, Carl Johan
    The Institute for Palliative Care, Faculty of Medicine, Department of Clinical Science, Lund University and Region Skåne, Lund, Sweden.
    Brännström, Margareta
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University. Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg.
    Factors associated with symptom relief in end-of-life care in residential care homes: a national register-based study2018In: Journal of Pain and Symptom Management, ISSN 0885-3924, E-ISSN 1873-6513, Vol. 55, no 5, p. 1304-1312Article in journal (Refereed)
    Abstract [en]

    Context: Residential care homes (RCHs) are a common place of death. Previous studies have reported a high prevalence of symptoms such as pain and shortness of breath among residents in the last week of life.

    Objectives: The aim of the study was to explore the presence of symptoms and symptom relief and identify factors associated with symptom relief of pain, nausea, anxiety, and shortness of breath among RCH residents in end-of-life care.

    Methods: The data consisted of all expected deaths at RCHs registered in the Swedish Register of Palliative Care (N = 22,855). Univariate and multiple logistic regression analyses were conducted.

    Results: Pain was reported as the most frequent symptom of the four symptoms (68.8%) and the one that most often had been totally relieved (84.7%) by care professionals. Factors associated with relief from at least one symptom were gender; age; time in the RCH; use of a validated pain or symptom assessment scale; documented end-of-life discussions with physicians for both the residents and family members; consultations with other units; diseases other than cancer as cause of death; presence of ulcers; assessment of oral health; and prescribed pro re nata injections for pain, nausea, and anxiety.

    Conclusion: Our results indicate that use of a validated pain assessment scale, assessment of oral health, and prescribed pro re nata injections for pain, nausea, and anxiety might offer a way to improve symptom relief. These clinical tools and medications should be implemented in the care of the dying in RCHs, and controlled trials should be undertaken to prove the effect.

  • 9. Asli, Lene A.
    et al.
    Braaten, Tonje
    Olsen, Anja
    Tjonneland, Anne
    Overvad, Kim
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Renstrom, Frida
    Umeå University, Faculty of Medicine, Department of Biobank Research. Department of Clinical Sciences, Lund University, Sweden.
    Lund, Eiliv
    Skeie, Guri
    Potato consumption and risk of pancreatic cancer in the HELGA cohort2018In: British Journal of Nutrition, ISSN 0007-1145, E-ISSN 1475-2662, Vol. 119, no 12, p. 1408-1415Article, review/survey (Refereed)
    Abstract [en]

    Potatoes have been a staple food in many countries throughout the years. Potatoes have a high glycaemic index (GI) score, and high GI has been associated with several chronic diseases and cancers. Still, the research on potatoes and health is scarce and contradictive, and we identified no prospective studies that had investigated the association between potatoes as a single food and the risk of pancreatic cancer. The aim of this study was to prospectively investigate the association between potato consumption and pancreatic cancer among 114 240 men and women in the prospective HELGA cohort, using Cox proportional hazard models. Information on diet (validated FFQ's), lifestyle and health was collected by means of a questionnaire, and 221 pancreatic cancer cases were identified through cancer registries. The mean follow-up time was 11.4 (95 % CI 0.3, 169) years. High consumption of potatoes showed a non-significantly higher risk of pancreatic cancer in the adjusted model (hazard ratio (HR) 1.44; 95 % CI 0.93, 2.22, P-for trend 0.030) when comparing the highest v. the lowest quartile of potato consumption. In the sex-specific analyses, significant associations were found for females (HR 2.00; 95 % CI 1.07, 3.72, P-for trend 0.020), but not for males (HR 1.01; 95 % CI 0.56, 1.84, P-for trend 0.34). In addition, we explored the associations by spline regression, and the absence of dose-response effects was confirmed. In this study, high potato consumption was not consistently associated with a higher risk of pancreatic cancer. Further studies with larger populations are needed to explore the possible sex difference.

  • 10. Auer, K.
    et al.
    Carson, Dean
    Umeå University, Arctic Research Centre at Umeå University.
    How can general practitioners establish 'place attachment' in Australia's Northern Territory?: Adjustment trumps adaptation2010In: Rural and remote health, ISSN 1445-6354, Vol. 10, no 1476Article in journal (Refereed)
    Abstract [en]

    Introduction: Retention of GPs in the more remote parts of Australia remains an important issue in workforce planning. The Northern Territory of Australia experiences very high rates of staff turnover. This research examined how the process of forming 'place attachment' between GP and practice location might influence prospects for retention. It examines whether GPs use 'adjustment' (short term trade-offs between work and lifestyle ambitions) or 'adaptation' (attempts to change themselves and their environment to fulfil lifestyle ambitions) strategies to cope with the move to new locations. Methods: 19 semi-structured interviews were conducted mostly with GPs who had been in the Northern Territory for less than 3 years. Participants were asked about the strategies they used in an attempt to establish place attachment. Strategies could be structural (work related), personal, social or environmental. Results: There were strong structural motivators for GPs to move to the Northern Territory. These factors were seen as sufficiently attractive to permit the setting aside of other lifestyle ambitions for a short period of time. Respondents found the environmental aspects of life in remote areas to be the most satisfying outside work. Social networks were temporary and the need to re-establish previous networks was the primary driver of out migration. Conclusion: GPs primarily use adjustment strategies to temporarily secure their position within their practice community. There were few examples of adaptation strategies that would facilitate a longer term match between the GPs' overall life ambitions and the characteristics of the community. While this suggests that lengths of stay will continue to be short, better adjustment skills might increase the potential for repeat service and limit the volume of unplanned early exits.

  • 11. Bamia, C.
    et al.
    Lagiou, P.
    Jenab, M.
    Aleksandrova, K.
    Fedirko, V.
    Trichopoulos, D.
    Overvad, K.
    Tjonneland, A.
    Olsen, A.
    Clavel-Chapelon, F.
    Boutron-Ruault, M-C
    Kvaskoff, M.
    Katzke, V. A.
    Kuehn, T.
    Boeing, H.
    Noethlings, U.
    Palli, D.
    Sieri, S.
    Panico, S.
    Tumino, R.
    Naccarati, A.
    Bueno-de-Mesquita, H. B(As)
    Peeters, P. H. M.
    Weiderpass, E.
    Skeie, G.
    Quiros, J. R.
    Agudo, A.
    Chirlaque, M-D
    Sanchez, M-J
    Ardanaz, E.
    Dorronsoro, M.
    Ericson, U.
    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.
    Khaw, K-T
    Wareham, N.
    Key, T. J.
    Travis, R. C.
    Ferrari, P.
    Stepien, M.
    Duarte-Salles, T.
    Norat, T.
    Murphy, N.
    Riboli, E.
    Trichopoulou, A.
    Fruit and vegetable consumption in relation to hepatocellular carcinoma in a multi-centre, European cohort study2015In: British Journal of Cancer, ISSN 0007-0920, E-ISSN 1532-1827, Vol. 112, no 7, p. 1273-1282Article in journal (Refereed)
    Abstract [en]

    Background:Vegetable and/or fruit intakes in association with hepatocellular carcinoma (HCC) risk have been investigated in case-control studies conducted in specific European countries and cohort studies conducted in Asia, with inconclusive results. No multi-centre European cohort has investigated the indicated associations. Methods: In 486 799 men/women from the European Prospective Investigation into Cancer and nutrition, we identified 201 HCC cases after 11 years median follow-up. We calculated adjusted hazard ratios (HRs) for HCC incidence for sex-specific quintiles and per 100 g d(-1) increments of vegetable/fruit intakes. Results: Higher vegetable intake was associated with a statistically significant, monotonic reduction of HCC risk: HR (100 g d(-1) increment): 0.83; 95% CI: 0.71-0.98. This association was consistent in sensitivity analyses with no apparent heterogeneity across strata of HCC risk factors. Fruit intake was not associated with HCC incidence: HR (100 g d(-1) increment): 1.01; 95% CI: 0.92-1.11. Conclusions: Vegetable, but not fruit, intake is associated with lower HCC risk with no evidence for heterogeneity of this association in strata of important HCC risk factors. Mechanistic studies should clarify pathways underlying this association. Given that HCC prognosis is poor and that vegetables are practically universally accessible, our results may be important, especially for those at high risk for the disease.

  • 12. Bamia, Christina
    et al.
    Lagiou, Pagona
    Jenab, Mazda
    Trichopoulou, Antonia
    Fedirko, Veronika
    Aleksandrova, Krasimira
    Pischon, Tobias
    Overvad, Kim
    Olsen, Anja
    Tjønneland, Anne
    Boutron-Ruault, Marie-Christine
    Fagherazzi, Guy
    Racine, Antoine
    Kuhn, Tilman
    Boeing, Heiner
    Floegel, Anna
    Benetou, Vasiliki
    Palli, Domenico
    Grioni, Sara
    Panico, Salvatore
    Tumino, Rosario
    Vineis, Paolo
    Bueno-de-Mesquita, H B As
    Dik, Vincent K
    Bhoo-Pathy, Nirmala
    Uiterwaal, Cuno S P M
    Weiderpass, Elisabete
    Lund, Eiliv
    Quirós, J Ramón
    Zamora-Ros, Raul
    Molina-Montes, Esther
    Chirlaque, Maria-Dolores
    Ardanaz, Eva
    Dorronsoro, Miren
    Lindkvist, Björn
    Wallström, Peter
    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.
    Sund, Malin
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Khaw, Kay-Tee
    Wareham, Nick
    Bradbury, Kathryn E
    Travis, Ruth C
    Ferrari, Pietro
    Duarte-Salles, Talita
    Stepien, Magdalena
    Gunter, Marc
    Murphy, Neil
    Riboli, Elio
    Trichopoulos, Dimitrios
    Coffee, tea and decaffeinated coffee in relation to hepatocellular carcinoma in a European population: multicentre, prospective cohort study2015In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 136, no 8, p. 1899-1908Article in journal (Refereed)
    Abstract [en]

    Inverse associations of coffee and/or tea in relation to hepatocellular carcinoma (HCC) risk have been consistently identified in studies conducted mostly in Asia where consumption patterns of such beverages differ from Europe. In the European Prospective Investigation into Cancer and nutrition (EPIC), we identified 201 HCC cases among 486,799 men/women, after a median follow-up of 11 years. We calculated adjusted hazard ratios (HRs) for HCC incidence in relation to quintiles/categories of coffee/tea intakes. We found that increased coffee and tea intakes were consistently associated with lower HCC risk. The inverse associations were substantial, monotonic and statistically significant. Coffee consumers in the highest compared to the lowest quintile had lower HCC risk by 72% [HR: 0.28; 95% confidence intervals (CIs): 0.16-0.50, p-trend < 0.001]. The corresponding association of tea with HCC risk was 0.41 (95% CI: 0.22-0.78, p-trend = 0.003). There was no compelling evidence of heterogeneity of these associations across strata of important HCC risk factors, including hepatitis B or hepatitis C status (available in a nested case-control study). The inverse, monotonic associations of coffee intake with HCC were apparent for caffeinated (p-trend = 0.009), but not decaffeinated (p-trend = 0.45) coffee for which, however, data were available for a fraction of subjects. Results from this multicentre, European cohort study strengthen the existing evidence regarding the inverse association between coffee/tea and HCC risk. Given the apparent lack of heterogeneity of these associations by HCC risk factors and that coffee/tea are universal exposures, our results could have important implications for high HCC risk subjects.

  • 13. Berendsen, Agnes A M
    et al.
    Kang, Jae H
    van de Rest, Ondine
    Jankovic, Nicole
    Kampman, Ellen
    Kiefte-de Jong, Jessica C
    Franco, Oscar H
    Ikram, M Arfan
    Pikhart, Hynek
    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.
    Brenner, Hermann
    Boffetta, Paolo
    Rafnsson, Snorri Bjorn
    Gustafson, Deborah
    Kyrozis, Andreas
    Trichopoulou, Antonia
    Feskens, Edith J M
    Grodstein, Francine
    de Groot, Lisette C P G M
    Association of Adherence to a Healthy Diet with Cognitive Decline in European and American Older Adults: A Meta-Analysis within the CHANCES Consortium2017In: Dementia and Geriatric Cognitive Disorders, ISSN 1420-8008, E-ISSN 1421-9824, Vol. 43, no 3-4, p. 215-227Article in journal (Refereed)
    Abstract [en]

    AIM: To examine the association between a healthy diet, assessed by the Healthy Diet Indicator (HDI), and cognitive decline in older adults. METHODS: Data from 21,837 participants aged ≥55 years from 3 cohorts (Survey in Europe on Nutrition and the Elderly, a Concerted Action [SENECA], Rotterdam Study [RS], Nurses' Health Study [NHS]) were analyzed. HDI scores were based on intakes of saturated fatty acids, polyunsaturated fatty acids, mono- and disaccharides, protein, cholesterol, fruits and vegetables, and fiber. The Telephone Interview for Cognitive Status in NHS and Mini-Mental State Examination in RS and SENECA were used to assess cognitive function from multiple repeated measures. Using multivariable-adjusted, mixed linear regression, mean differences in annual rates of cognitive decline by HDI quintiles were estimated. RESULTS: Multivariable-adjusted differences in rates in the highest versus the lowest HDI quintile were 0.01 (95% CI -0.01, 0.02) in NHS, 0.00 (95% CI -0.02, 0.01) in RS, and 0.00 (95% CI -0.05, 0.05) in SENECA with a pooled estimate of 0.00 (95% CI -0.01, 0.01), I2 = 0%. CONCLUSIONS: A higher HDI score was not related to reduced rates of cognitive decline in European and American older adults.

  • 14. Bergkvist, Per Henrik
    et al.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kling, Sofia
    Silviken, Anne
    Sköld, Peter
    Umeå University, Faculty of Arts, Centre for Sami Research. Umeå University, Arctic Research Centre at Umeå University.
    Stoor, Jon Petter
    Breaking the silence: suicide prevention through storytelling among indigenous Sami2016In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 75, p. 56-56Article in journal (Refereed)
  • 15.
    Bergqvist, Joakim
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Forsman, Oscar
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Larsson, Pär
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Näslund, Jonas
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Lilja, Tobias
    Engdahl, Cecilia
    Umeå University, Faculty of Science and Technology, Department of Chemistry.
    Lindström, Anders
    Gylfe, Åsa
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Ahlm, Clas
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology.
    Evander, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology. Umeå University, Arctic Research Centre at Umeå University.
    Bucht, Göran
    [ 1 ] CBRN Def & Secur, Swedish Def Res Agcy, SE-90182 Umea, Sweden.
    Detection and Isolation of Sindbis Virus from Mosquitoes Captured During an Outbreak in Sweden, 20132015In: Vector Borne and Zoonotic Diseases, ISSN 1530-3667, E-ISSN 1557-7759, Vol. 15, no 2, p. 133-140Article in journal (Refereed)
    Abstract [en]

    Mosquito-borne alphaviruses have the potential to cause large outbreaks throughout the world. Here we investigated the causative agent of an unexpected Sindbis virus (SINV) outbreak during August-September, 2013, in a previously nonendemic region of Sweden. Mosquitoes were collected using carbon dioxide-baited CDC traps at locations close to human cases. The mosquitoes were initially screened as large pools by SINV-specific quantitative RT-PCR, and the SINV-positive mosquitoes were species determined by single-nucleotide polymorphism (SNP) analysis, followed by sequencing the barcoding region of the cytochrome oxidase I gene. The proportion of the collected mosquitoes was determined by a metabarcoding strategy. By using novel strategies for PCR screening and genetic typing, a new SINV strain, Lovanger, was isolated from a pool of 1600 mosquitoes composed of Culex, Culiseta, and Aedes mosquitoes as determined by metabarcoding. The SINV-positive mosquito Culiseta morsitans was identified by SNP analysis and sequencing. After whole-genome sequencing and phylogenetic analysis, the SINV Lovanger isolate was shown to be most closely similar to recent Finnish SINV isolates. In conclusion, within a few weeks, we were able to detect and isolate a novel SINV strain and identify the mosquito vector during a sudden SINV outbreak.

  • 16.
    Bodén, Stina
    et al.
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Wennberg, Maria
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Van Guelpen, Bethany
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Johansson, Ingegerd
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Nutritional Research.
    Lindahl, Bernt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine.
    Andersson, Jonas
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Shivappa, Nitin
    Hebert, James R
    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.
    Dietary inflammatory index and risk of first myocardial infarction: a prospective population-based study2017In: Nutrition Journal, ISSN 1475-2891, E-ISSN 1475-2891, Vol. 16, article id 21Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chronic, low-grade inflammation is an established risk factor for cardiovascular disease. The inflammatory impact of diet can be reflected by concentrations of inflammatory markers in the bloodstream and the inflammatory potential of diet can be estimated by the dietary inflammatory index (DII(TM)), which has been associated with cardiovascular disease risk in some previous studies. We aimed to examine the association between the DII and the risk of first myocardial infarction (MI) in a population-based study with long follow-up.

    METHOD: We conducted a prospective case-control study of 1389 verified cases of first MI and 5555 matched controls nested within the population-based cohorts of the Northern Sweden Health and Disease Study (NSHDS), of which the largest is the ongoing Västerbotten Intervention Programme (VIP) with nearly 100 000 participants during the study period. Median follow-up from recruitment to MI diagnosis was 6.4 years (6.2 for men and 7.2 for women). DII scores were derived from a validated food frequency questionnaire (FFQ) administered in 1986-2006. Multivariable conditional logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using quartile 1 (most anti-inflammatory diet) as the reference category. For validation, general linear models were used to estimate the association between the DII scores and two inflammatory markers, high-sensitivity C-reactive protein (hsCRP) and interleukin 6 (IL-6) in a subset (n = 605) of the study population.

    RESULTS: Male participants with the most pro-inflammatory DII scores had an increased risk of MI [ORQ4vsQ1 = 1.57 (95% CI 1.21-2.02) P trend = 0.02], which was essentially unchanged after adjustment for potential confounders, including cardiovascular risk factors [ORQ4vsQ1 = 1.50 (95% CI 1.14-1.99), P trend = 0.10]. No association was found between DII and MI in women. An increase of one DII score unit was associated with 9% higher hsCRP (95% CI 0.03-0.14) and 6% higher IL-6 (95% CI 0.02-0.11) in 605 controls with biomarker data available.

    CONCLUSION: A pro-inflammatory diet was associated with an elevated risk of first myocardial infarction in men; whereas for women the relationship was null. Consideration of the inflammatory impact of diet could improve prevention of cardiovascular disease.

  • 17.
    Buckland, Philip I.
    et al.
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies, Environmental Archaeology Lab. Umeå University, Arctic Research Centre at Umeå University.
    Buckland, Paul C.
    Species found as fossils in Quaternary sediments2012In: Checklist of Beetles of the British Isles / [ed] A.G. Duff, United Kingdom: Pemberley Books , 2012, 2nd, p. 127-130Chapter in book (Refereed)
    Abstract [en]

    This new checklist is the most up-to-date and comprehensive checklist of the beetle fauna of the British Isles, representing many man-years of effort by leading British coleopterists. The main checklist is fully annotated with detailed endnotes.

  • 18. Bulgakova, Tatiana
    et al.
    Sundström, Olle
    Umeå University, Faculty of Arts, Department of historical, philosophical and religious studies. Umeå University, Arctic Research Centre at Umeå University.
    Repression of shamans and shamanism in Khabarovsk Krai: 1920s to the early 1950s2017In: Ethnic and Religious Minorities in Stalin's Soviet Union: New Dimensions of Research / [ed] Andrej Kotljarchuk & Olle Sundström, Huddinge: Södertörns högskola, 2017, p. 225-262Chapter in book (Refereed)
  • 19.
    Burström, Lage
    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.
    Björ, Bodil
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Nilsson, Tohr
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Pettersson, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Rödin, Ingemar
    Wahlström, Jens
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Thermal perception thresholds among workers in a cold climate2017In: International Archives of Occupational and Environmental Health, ISSN 0340-0131, E-ISSN 1432-1246, Vol. 90, no 7, p. 645-652Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To investigate whether exposure to cold could influence the thermal perception thresholds in a working population.

    METHODS: This cross-sectional study was comprised of 251 males and females and was carried out at two mines in the northern part of Norway and Sweden. The testing included a baseline questionnaire, a clinical examination and measurements of thermal perception thresholds, on both hands, the index (Digit 2) and little (Digit 5) fingers, for heat and cold.

    RESULTS: The thermal perception thresholds were affected by age, gender and test site. The thresholds were impaired by experiences of frostbite in the fingers and the use of medication that potentially could affect neurosensory functions. No differences were found between the calculated normative values for these workers and those in other comparative investigations conducted in warmer climates.

    CONCLUSIONS: The study provided no support for the hypothesis that living and working in cold climate will lead to impaired thermal perception thresholds. Exposure to cold that had caused localized damage in the form of frostbite was shown to lead to impaired thermal perception.

  • 20.
    Burström, Lage
    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.
    Hyvärinen, Ville
    Johnsen, Magnar
    Pettersson, Hans
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine. Umeå University, Arctic Research Centre at Umeå University.
    Exposure to whole-body vibration in open-cast mines in the Barents region2016In: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 75, article id 29373Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: We aimed to measure and evaluate whole-body vibration (WBV) exposure among drivers of mining vehicles in the Barents region.

    STUDY DESIGN: In the period from November 2012 to August 2014, this cross-sectional study was carried out at 3 mines in Finland, Norway and Sweden as part of the MineHealth project.

    METHODS: Measurements of WBV were conducted on the surface of the driver's seat during normal work in accordance with international standards. Personal data on daily exposure times were collected by a questionnaire.

    RESULTS: Measurements were conducted on 95 different mining vehicles both as root mean square (RMS) value and vibration dose value (VDV) representing different manufacturers, models and capacities. Of the 453 miners who answered the questionnaire, 232 indicated that they were exposed to WBV during their working day. The results show that the mean daily exposure time varies between 1.9 and 6.7 h for different vehicles. The calculated mean A(8) could be found in an interval between 0.2 and 1.0 m/s(2) and the corresponding 8-h VDV fell between 7 and 17 m/s(1.75).

    CONCLUSIONS: Exposure to WBV among operators of mining vehicles may be a serious health and safety problem in the mines studied. The employers ought, therefore, take active steps to reduce exposure in accordance with the European vibration directive. Moreover, since some groups of drivers are exposed to vibration that is close to or exceeds the exposure limit values, the employer should take immediate action to reduce exposure below these values.

  • 21.
    Byström, Joakim
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography. Umeå University, Arctic Research Centre at Umeå University.
    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 labor market impacts of national parks: the case of Swedish Lapland2014In: Zeitschrift für Wirtschaftsgeographie, ISSN 0044-3751, Vol. 58, no 2-3, p. 115-126Article in journal (Refereed)
    Abstract [en]

    In a Nordic context, economic impacts of tourism in national parks remained largely unknowndue to lacking implementation of standardized comparative measurements. For this reason,we want to investigate the economic impacts of national parks in a peripheral Scandinavian contextby analyzing employment in tourism. Theoretically, the paper addresses the idea of nature protectionas a tool for regional development. The scientific literature suggests that nature can be considered acommodity that can be used for the production of tourism experiences in peripheries. In this contextnature protection is applied as a label for signifying attractive places for tourists leading to increasedtourist numbers and employment. This argument follows mainly North American experiences pointingat a positive impact of protected areas on regional development. Meanwhile European studies aremore skeptical regarding desired economic benefits. A major challenge is the assessment of tourism’seconomic impacts. This paper suggests an approach that reveals the impacts on the labor market.This is particularly applicable since data is readily available and, moreover from a public perspective,employment and tax incomes are of uppermost importance in order to sustain population figures andlocal demand for public services. At the same time accessibility and low visitor numbers form majorchallenges for tourism stakeholders and complicate the assessment of economic impacts throughquestionnaires and interviews. The paper shows that the assumption that nature protection promotespositive economic development through tourism is not applicable in a northern Swedish context.Hence, it rejects the often suggested positive relationship between nature protection and tourism labormarket development.

  • 22. Cael, B. B.
    et al.
    Heathcote, A. J.
    Seekell, David
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Science and Technology, Department of Ecology and Environmental Sciences. Climate Impacts Research Centre, Umeå University, Abisko, Sweden.
    The volume and mean depth of Earth's lakes2017In: Geophysical Research Letters, ISSN 0094-8276, E-ISSN 1944-8007, Vol. 44, no 1, p. 209-218Article in journal (Refereed)
    Abstract [en]

    Global lake volume estimates are scarce, highly variable, and poorly documented. We developed a rigorous method for estimating global lake depth and volume based on the Hurst coefficient of Earth's surface, which provides a mechanistic connection between lake area and volume. Volume-area scaling based on the Hurst coefficient is accurate and consistent when applied to lake data sets spanning diverse regions. We applied these relationships to a global lake area census to estimate global lake volume and depth. The volume of Earth's lakes is 199,000km(3) (95% confidence interval 196,000-202,000km(3)). This volume is in the range of historical estimates (166,000-280,000km(3)), but the overall mean depth of 41.8m (95% CI 41.2-42.4m) is significantly lower than previous estimates (62-151m). These results highlight and constrain the relative scarcity of lake waters in the hydrosphere and have implications for the role of lakes in global biogeochemical cycles.

  • 23. Caini, Saverio
    et al.
    Masala, Giovanna
    Saieva, Calogero
    Kvaskoff, Marina
    Sacerdote, Carlotta
    Savoye, Isabelle
    Hemmingsson, Oskar
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Bech, Bodil Hammer
    Overvad, Kim
    Tjonneland, Anne
    Petersen, Kristina E. N.
    Mancini, Francesca Romana
    Boutron-Ruault, Marie-Christine
    Cervenka, Iris
    Kaaks, Rudolf
    Kuehn, Tilman
    Boeing, Heiner
    Floegel, Anna
    Trichopoulou, Antonia
    Valanou, Elisavet
    Kritikou, Maria
    Tagliabue, Giovanna
    Panico, Salvatore
    Tumino, Rosario
    Bueno-de-Mesquita, H. B(as)
    Peeters, Petra H.
    Veierod, Marit B.
    Ghiasvand, Reza
    Lukic, Marko
    Ramon Quiros, Jose
    Chirlaque, Maria-Dolores
    Ardanaz, Eva
    Salamanca Fernandez, Elena
    Larranaga, Nerea
    Zamora-Ros, Raul
    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.
    Ljuslinder, Ingrid
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Jirstrom, Karin
    Sonestedt, Emily
    Key, Timothy J.
    Wareham, Nick
    Khaw, Kay-Tee
    Gunter, Marc
    Huybrechts, Inge
    Murphy, Neil
    Tsilidis, Konstantinos K.
    Weiderpass, Elisabete
    Palli, Domenico
    Coffee, tea and melanoma risk: findings from the European Prospective Investigation into Cancer and Nutrition2017In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 140, no 10, p. 2246-2255Article in journal (Refereed)
    Abstract [en]

    What's new? Laboratory studies suggest that coffee and tea protect against melanoma, but epidemiological findings are inconsistent. Here the authors studied more than 400,000 participants within the European Prospective Investigation into Cancer and Nutrition (EPIC) and confirmed an inverse association between caffeinated coffee consumption and melanoma risk. No association was found with decaffeinated coffee or tea. Interestingly, drinking coffee only protected men, but not women, from developing the often fatal skin cancer, raising interesting questions about gender-specific hormones or coffee habits influencing this association. In vitro and animal studies suggest that bioactive constituents of coffee and tea may have anticarcinogenic effects against cutaneous melanoma; however, epidemiological evidence is limited to date. We examined the relationships between coffee (total, caffeinated or decaffeinated) and tea consumption and risk of melanoma in the European Prospective Investigation into Cancer and Nutrition (EPIC). EPIC is a multicentre prospective study that enrolled over 500,000 participants aged 25-70 years from ten European countries in 1992-2000. Information on coffee and tea drinking was collected at baseline using validated country-specific dietary questionnaires. We used adjusted Cox proportional hazards regression models to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for the associations between coffee and tea consumption and melanoma risk. Overall, 2,712 melanoma cases were identified during a median follow-up of 14.9 years among 476,160 study participants. Consumption of caffeinated coffee was inversely associated with melanoma risk among men (HR for highest quartile of consumption vs. non-consumers 0.31, 95% CI 0.14-0.69) but not among women (HR 0.96, 95% CI 0.62-1.47). There were no statistically significant associations between consumption of decaffeinated coffee or tea and the risk of melanoma among both men and women. The consumption of caffeinated coffee was inversely associated with melanoma risk among men in this large cohort study. Further investigations are warranted to confirm our findings and clarify the possible role of caffeine and other coffee compounds in reducing the risk of melanoma.

  • 24. Callaghan, Terry V.
    et al.
    Johansson, Margareta
    Brown, Ross D.
    Groisman, Pavel Ya
    Labba, Niklas
    Radionov, Vladimir
    Bradley, Raymond S.
    Blangy, Sylvie
    Bulygina, Olga N.
    Christensen, Torben R.
    Colman, Jonathan E.
    Essery, Richard L. H.
    Forbes, Bruce C.
    Forchhammer, Mads C.
    Golubev, Vladimir N.
    Honrath, Richard E.
    Juday, Glenn P.
    Meshcherskaya, Anna V.
    Phoenix, Gareth K.
    Pomeroy, John
    Rautio, Arja
    Robinson, David A.
    Schmidt, Niels M.
    Serreze, Mark C.
    Shevchenko, Vladimir P.
    Shiklomanov, Alexander I.
    Shmakin, Andrey B.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Arts, Centre for Sami Research.
    Sturm, Matthew
    Woo, Ming-ko
    Wood, Eric F.
    Multiple effects of changes in arctic snow cover2011In: Ambio, ISSN 0044-7447, E-ISSN 1654-7209, Vol. 40, p. 32-45Article in journal (Refereed)
    Abstract [en]

    Snow cover plays a major role in the climate, hydrological and ecological systems of the Arctic and other regions through its influence on the surface energy balance (e.g. reflectivity), water balance (e.g. water storage and release), thermal regimes (e.g. insulation), vegetation and trace gas fluxes. Feedbacks to the climate system have global consequences. The livelihoods and well-being of Arctic residents and many services for the wider population depend on snow conditions so changes have important consequences. Already, changing snow conditions, particularly reduced summer soil moisture, winter thaw events and rain-on-snow conditions have negatively affected commercial forestry, reindeer herding, some wild animal populations and vegetation. Reductions in snow cover are also adversely impacting indigenous peoples' access to traditional foods with negative impacts on human health and well-being. However, there are likely to be some benefits from a changing Arctic snow regime such as more even run-off from melting snow that favours hydropower operations.

  • 25.
    Carson, Dean B.
    Umeå University, Arctic Research Centre at Umeå University.
    Conclusion2016In: Settlements at the edge: remote human settlements in developed nations, Cheltenham, UK: Edward Elgar Publishing, 2016, p. 427-434Chapter in book (Other academic)
  • 26.
    Carson, Dean B.
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Charles Darwin University, Australia.
    Carson, Doris A.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Nordin, Gabriella
    Umeå University, Arctic Research Centre at Umeå University.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University.
    Lessons from the Arctic past: The resource cycle, hydro energy development, and the human geography of Jokkmokk, Sweden2016In: Energy Research & Social Science, ISSN 2214-6296, E-ISSN 2214-6326, Vol. 16, p. 13-24Article in journal (Refereed)
    Abstract [en]

    Recent research has identified a series of human geography impacts of natural resource developments in sparsely populated areas like the Arctic. These impacts can be mapped to the 'resource cycle', and arise from periods of population growth and decline, changing patterns of human migration and mobility, changing patterns of settlement, and changes in the demographic 'balance' between males and females, young and old, Indigenous and non-Indigenous. This paper examines the applicability of the resource cycle model in the case of hydro energy development in the Jokkmokk municipality of Sweden. Using quantitative demographic data, media reports, and contemporary accounts of hydro development, the paper describes the human geography of Jokkmokk since the late 19th century. The paper concludes that changes in human geography in Jokkmokk mirror what has been observed in regions dependent on non-renewable resources, although it is difficult to distinguish many impacts from those that might have occurred under alternative development scenarios. The paper identifies a 'settlement cycle' with phases of integrated and separated habitation for populations specifically associated with the development. Settlement dynamics, and the impacts of hydro on Sami geography are areas for further research.

  • 27.
    Carson, Dean B.
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Charles Darwin University, Australia.
    Carson, Doris A.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Porter, Rob
    Charles Darwin University, Australia.
    Yoshida Ahlin, Celia
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University.
    Decline, Adaptation or Transformation: New Perspectives on Demographic Change in Resource Peripheries in Australia and Sweden2016In: Comparative Population Studies, ISSN 1869-8980, E-ISSN 1869-8999, Vol. 41, no 3-4, p. 1-29Article in journal (Refereed)
    Abstract [en]

    Many sparsely populated resource peripheries in developed countries are perceived to suffer from periods of demographic decline due to loss of employment opportunities and services, youth out-migration and population ageing. While these trends tend to apply at broad regional scales and for particular time periods, diverse patterns of demographic change may be apparent if different spatial, temporal and social scales of analysis are taken into consideration. Comparing the experiences of two case study regions in northern Sweden and inland South Australia, this paper proposes an alternative conceptual framework to the ‘discourse of decline’, which could be used to examine the nuances of demographic change within resource peripheries. The framework includes spatial scale considerations that contrast broader regional demographic patterns with the experiences of sub-regions and individual settlements. It also includes temporal scale aspects, examining demographic change over different time periods to understand the pace, duration and frequency of population growth and decline. The framework finally includes social unit considerations, emphasising that demographic change affects different social groups in different ways. The results of the case studies suggest that considering demographic change as adaptation or transformation rather than decline may be more useful for identifying new – and qualitatively different – demographic pathways that emerge over time. 

  • 28.
    Carson, Dean B.
    et al.
    Umeå University, Arctic Research Centre at Umeå University. Northern Institute, Charles Darwin University, Darwin, Australia; Glesbygdsmedicinskt Centrum, Storuman, Sweden .
    Schoo, Adrian
    Berggren, Peter
    The 'rural pipeline' and retention of rural health professionals in Europe's northern peripheries2015In: Health Policy, ISSN 0168-8510, E-ISSN 1872-6054, Vol. 119, no 12, p. 1550-1556Article in journal (Refereed)
    Abstract [en]

    The major advance in informing rural workforce policy internationally over the past 25 years has been the recognition of the importance of the 'rural pipeline'. The rural pipeline suggests that people with 'rural origin' (who spent some childhood years in rural areas) and/or 'rural exposure' (who do part of their professional training in rural areas) are more likely to select rural work locations. What is not known is whether the rural pipeline also increases the length of time professionals spend in rural practice throughout their careers. This paper analyses data from a survey of rural health professionals in six countries in the northern periphery of Europe in 2013 to examine the relationship between rural origin and rural exposure and the intention to remain in the current rural job or to preference rural jobs in future. Results are compared between countries, between different types of rural areas (based on accessibility to urban centres), different occupations and workers at different stages of their careers. The research concludes that overall the pipeline does impact on retention, and that both rural origin and rural exposure make a contribution. However, the relationship is not strong in all contexts, and health workforce policy should recognise that retention may in some cases be improved by recruiting beyond the pipeline.

  • 29.
    Carson, Dean B
    et al.
    Umeå University, Arctic Research Centre at Umeå University.
    Sköld, Peter
    Umeå University, Arctic Research Centre at Umeå University.
    Carson, Doris A.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Nilsson, Lena Maria
    Umeå University, Arctic Research Centre at Umeå University.
    The local demography of resource economies: long term implications of natural resource industries for demographic development in sparsely populated areas2016In: Settlements at the edge: remote human settlements in developed nations / [ed] Andrew Taylor, Dean B. Carson, Prescott C. Ensign, Lee Huskey, Rasmus Ole Rasmussen, Gertrude Saxinger, Cheltenham, UK: Edward Elgar Publishing, 2016, p. 357-378Chapter in book (Other academic)
    Abstract [en]

    Settlements at the Edge examines the evolution, characteristics, functions and shifting economic basis of settlements in sparsely populated areas of developed nations. With a focus on demographic change, the book features theoretical and applied cases which explore the interface between demography, economy, well-being and the environment. This book offers a comprehensive and insightful knowledge base for understanding the role of population in shaping the development and histories of northern sparsely populated areas of developed nations including Alaska (USA), Australia, Canada, Greenland, Norway, Russia, Sweden, Finland and other nations with territories within the Arctic Circle.

  • 30.
    Carson, Dean B.
    et al.
    Umeå University, Arctic Research Centre at Umeå University.
    Wenghofer, E.F
    Timony, P.E
    Schoo, A
    Berggren, P
    Charters, B
    White, D
    Vuin, A
    Garrett, J
    Recruitment and retention of professional labour: the health workforce at settlement level2016In: Settlements at the edge: remote human settlements in developed nations / [ed] Andrew Taylor, Dean B. Carson, Prescott C. Ensign, Lee Huskey, Rasmus O. Rasmussen and Gertrude Saxinger, Cheltenham, UK: Edward Elgar Publishing, 2016Chapter in book (Refereed)
  • 31.
    Carson, Doris A.
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Brouder, Patrick
    Umeå University, Arctic Research Centre at Umeå University. School of Tourism & Hospitality, University of Johannesburg, South Africa.
    de la Barre, Suzanne
    Vancouver Island University.
    Editorial: Communities and New Development Paths in the Sparsely Populated North2017In: Journal of Rural and Community Development, ISSN 1712-8277, E-ISSN 1712-8277, Vol. 12, no 2-3, p. i-xiArticle in journal (Other academic)
  • 32.
    Carson, Doris A.
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History. The Northern Institute, Charles Darwin University, Darwin, Australia.
    Carson, Dean B.
    Umeå University, Arctic Research Centre at Umeå University. The Northern Institute, Charles Darwin University, Darwin, Australia.
    International lifestyle immigrants and their contributions to rural tourism innovation: Experiences from Sweden's far north2018In: Journal of Rural Studies, ISSN 0743-0167, E-ISSN 1873-1392, Vol. 64, p. 230-240Article in journal (Refereed)
    Abstract [en]

    This paper discusses the contributions of international lifestyle immigrants to new tourism development and innovation in the sparsely populated north of Sweden. Based on a qualitative case study, the paper examines how lifestyle immigrants contributed as tourism entrepreneurs to the formation of local capital in tourism, and stimulated local learning and innovation spillover through networks of interaction and collaboration. The theoretical framework integrates concepts from rural lifestyle migration, local community development, and local tourism innovation systems. The results document how immigrants emerged as important drivers of new tourism products, processes and markets, and introduced a range of new ideas, skills and external networks to the region. Yet, an in-depth social network analysis reveals that immigrants made more limited contributions to networks, collaborations and knowledge exchange with local tourism stakeholders, thus limiting learning outcomes and innovation spillover at a broader local system level. Reasons for this lack of systemic interaction included socio-cultural distance between immigrants and locals, limited levels of trust and reciprocity, diverging development and lifestyle priorities, and issues around exclusive immigrant networking. Finally, the relevance of the theoretical framework is discussed in relation to its applicability to other immigrant mobilities in sparsely populated rural areas.

    The full text will be freely available from 2019-08-12 00:00
  • 33.
    Carson, Doris A
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Carson, Dean BUmeå University, Arctic Research Centre at Umeå University.Lundmark, LindaUmeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Tourism, mobilities, and development in sparsely populated areas2016Collection (editor) (Refereed)
    Abstract [en]

    Tourism 'mobilities' are not restricted to the movement of tourists between places of origin and destinations. Particularly in more peripheral, remote, or sparsely populated destinations, workers and residents are also likely to be frequently moving between locations. Such destinations attract seasonal or temporary residents, sometimes with only loose ties to the tourism industry. These flows of mobile populations are accompanied by flows of other resources – money, knowledge, ideas and innovations – which can be used to help the economic and social development of the destination. This book examines key aspects of the human mobilities associated with tourism in sparsely populated areas, and investigates how new mobility patterns inspired by technological, economic, political, and social change provide both opportunities and risks for those areas. Examples are drawn from the northern peripheries of Europe and the north of Australia, and the book provides a framework for continuing research into the role that tourism and 'new mobilities' can play in regional development in these locations.

  • 34.
    Carson, Doris Anna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History. University of South Australia, Australia.
    Carson, Dean Bradley
    Umeå University, Arctic Research Centre at Umeå University. Charles Darwin University, Australia; Flinders University, Australia.
    Mobilities and path dependence: challenges for tourism and "attractive" industry development in a remote company town2016In: Tourism, mobilities and development in sparsely populated areas / [ed] Doris Carson, Dean B. Carson, Linda Lundmark, Routledge, 2016, p. 108-127Chapter in book (Refereed)
  • 35.
    Carson, Doris Anna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History. The Northern Institute, Charles Darwin University, Darwin, Australia.
    Carson, Dean Bradley
    Umeå University, Arctic Research Centre at Umeå University. The Northern Institute, Charles Darwin University, Darwin, Australia.
    Eimermann, Marco
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    International winter tourism entrepreneurs in northern Sweden: understanding migration, lifestyle, and business motivations2018In: Scandinavian Journal of Hospitality and Tourism, ISSN 1502-2250, E-ISSN 1502-2269, Vol. 18, no 2, p. 183-198Article in journal (Refereed)
    Abstract [en]

    This paper examines the migration, lifestyle and business motivations of international winter tourism entrepreneurs who have moved to a “low-amenity” rural area in northern Sweden. Low-amenity areas are characterised by economic decline, outmigration and limited tourism development. Based on qualitative interviews, the research applied a multi-dimensional framework to the study of migrant tourism entrepreneurship, considering personal migration drivers, the value of location-specific amenities, desired consumptive experiences, previous familiarity with the destination, business-related goals, as well as temporal and technological dimensions of mobility and self-employment. The findings suggest that the northern winter and the undeveloped low-amenity character of the place were key factors in migration choices. Consumptive lifestyle interests around counter-urban living and winter outdoor hobbies were prominent, yet there was diversity in terms of business aspirations and considerable seasonal lifestyle-business balancing. Despite noticeable contributions to winter tourism development in the low-amenity north, the study also identified a sense of temporariness and expected onward migration among migrants, raising questions about the longevity of this development.

  • 36.
    Carson, Doris Anna
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History. University of South Australia, Australia.
    Carson, Dean Bradley
    Umeå University, Arctic Research Centre at Umeå University. Charles Darwin University, Darwin, Australia; Flinders University, Burra, Australia.
    Lundmark, Linda
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Tourism and mobilities in sparsely populated areas: towards a framework and research agenda2016In: Tourism, mobilities and development in sparsely populated areas / [ed] Doris Carson, Dean B. Carson, Linda Lundmark, Routledge, 2016, p. 1-12Chapter in book (Refereed)
  • 37.
    de la Barre, Suzanne
    et al.
    Department of Recreation and Tourism, Vancouver Island University.
    Maher, Patrick
    Department of Community Studies, Cape Breton University.
    Dawson, Jackie
    Department of Geography, Institute for Science, Society and Policy, University of Ottawa.
    Hillmer-Pegram, Kevin
    Department of Geosciences, University of Alaska Fairbanks.
    Huijbens, Edward
    Icelandic Tourism Research Centre, University of Akureyri.
    Lamers, Machiel
    Environmental Policy Group, Department of Social Sciences, Wageningen University.
    Liggett, Daniela
    Gateway Antarctica, University of Canterbury.
    Müller, Dieter K.
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Social Sciences, Department of Geography and Economic History.
    Pashkevich, Albina
    Department of Human Geography, School of Technology and Business Studies, Dalarna University.
    Stewart, Emma
    Department of Tourism, Sport and Society, Faculty of Environment, Society & Design, Lincoln University.
    Tourism and Arctic Observation Systems: exploring the relationships2016In: Polar Research, ISSN 0800-0395, E-ISSN 1751-8369, Vol. 35, article id 24980Article in journal (Refereed)
    Abstract [en]

    The Arctic is affected by global environmental change and also by diverseinterests from many economic sectors and industries. Over the last decade,various actors have attempted to explore the options for setting up integratedand comprehensive trans-boundary systems for monitoring and observing theseimpacts. These Arctic Observation Systems (AOS) contribute to the planning,implementation, monitoring and evaluation of environmental change andresponsible social and economic development in the Arctic. The aim of thisarticle is to identify the two-way relationship between AOS and tourism. On theone hand, tourism activities account for diverse changes across a broad spectrumof impact fields.Onthe other hand, due to its multiple and diverse agents and farreachingactivities, tourism is also well-positioned to collect observational dataand participate as an actor in monitoring activities. To accomplish our goals, weprovide an inventory of tourism-embedded issues and concerns of interest toAOS from a range of destinations in the circumpolar Arctic region, includingAlaska, Arctic Canada, Iceland, Svalbard, the mainland European Arctic andRussia. The article also draws comparisons with the situation in Antarctica. Onthe basis of a collective analysis provided by members of the International PolarTourism Research Network from across the polar regions, we conclude that thepotential role for tourism in the development and implementation of AOS issignificant and has been overlooked.

  • 38. Dik, Vincent K
    et al.
    Bueno-de-Mesquita, H Bas
    Van Oijen, Martijn GH
    Siersema, Peter D
    Uiterwaal, Cuno SPM
    Van Gils, Carla H
    Van Duijnhoven, Fränzel JB
    Cauchi, Stéphane
    Yengo, Loic
    Froguel, Philippe
    Overvad, Kim
    Bech, Bodil H
    Tjønneland, Anne
    Olsen, Anja
    Boutron-Ruault, Marie-Christine
    Racine, Antoine
    Fagherazzi, Guy
    Kühn, Tilman
    Campa, Daniele
    Boeing, Heiner
    Aleksandrova, Krasimira
    Trichopoulou, Antonia
    Peppa, Eleni
    Oikonomou, Eleni
    Palli, Domenico
    Grioni, Sara
    Vineis, Paolo
    Tumino, Rosaria
    Panico, Salvatore
    Peeters, Petra HM
    Weiderpass, Elisabete
    Engeset, Dagrun
    Braaten, Tonje
    Dorronsoro, Miren
    Chirlaque, María-Dolores
    Sánchez, María-José
    Barricarte, Aurelio
    Zamora-Ros, Raul
    Argüelles, Marcial
    Jirström, Karin
    Wallström, Peter
    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.
    Ljuslinder, Ingrid
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology. Umeå University, Arctic Research Centre at Umeå University.
    Travis, Ruth C
    Khaw, Kay-Tee
    Wareham, Nick
    Freisling, Heinz
    Licaj, Idlir
    Jenab, Mazda
    Gunter, Marc J
    Murphy, Neil
    Romaguera-Bosch, Dora
    Riboli, Elio
    Coffee and tea consumption, genotype based CYP1A2 and NAT2 activity, and colorectal cancer risk: results from the EPIC cohort study2014In: International Journal of Cancer, ISSN 0020-7136, E-ISSN 1097-0215, Vol. 135, no 2, p. 401-412Article in journal (Refereed)
    Abstract [en]

    Coffee and tea contain numerous antimutagenic and antioxidant components and high levels of caffeine that may protect against colorectal cancer (CRC). We investigated the association between coffee and tea consumption and CRC risk and studied potential effect modification by CYP1A2 and NAT2 genotypes, enzymes involved in the metabolization of caffeine. Data from 477,071 participants (70.2% female) of the European Investigation into Cancer and Nutrition (EPIC) cohort study were analyzed. At baseline (1992-2000) habitual (total, caffeinated and decaffeinated) coffee and tea consumption was assessed with dietary questionnaires. Cox proportional hazards models were used to estimate adjusted hazard ratio's (HR) and 95%-confidence intervals (95%-CI). Potential effect modification by genotype-based CYP1A2 and NAT2 activity was studied in a nested case-control set of 1,252 cases and 2,175 controls. After a median follow-up of 11.6 years, 4,234 participants developed CRC (mean age 64.7±8.3 years). Total coffee consumption (high vs. non/low) was not associated with CRC risk (HR 1.06, 95%-CI 0.95-1.18) or subsite cancers, and no significant associations were found for caffeinated (HR 1.10, 95%-CI 0.97-1.26) and decaffeinated coffee (HR 0.96, 95%-CI 0.84-1.11) and tea (HR 0.97, 95%-CI 0.86-1.09). High coffee and tea consuming subjects with slow CYP1A2 or NAT2 activity had a similar CRC risk compared to non/low coffee and tea consuming subjects with a fast CYP1A2 or NAT2 activity, which suggest that caffeine metabolism does not affect the link between coffee and tea consumption and CRC risk. This study shows that coffee and tea consumption is not likely to be associated with overall CRC.

  • 39. Dik, Vincent K
    et al.
    Murphy, Neil
    Siersema, Peter D
    Fedirko, Veronika
    Jenab, Mazda
    Kong, So Y
    Hansen, Camilla P
    Overvad, Kim
    Tjønneland, Anne
    Olsen, Anja
    Dossus, Laure
    Racine, Antoine
    Bastide, Nadia
    Li, Kuanrong
    Kühn, Tilman
    Boeing, Heiner
    Aleksandrova, Krasimira
    Trichopoulou, Antonia
    Trichopoulos, Dimitrios
    Barbitsioti, Antonia
    Palli, Domenico
    Contiero, Paolo
    Vineis, Paolo
    Tumino, Rosaria
    Panico, Salvatore
    Peeters, Petra H M
    Weiderpass, Elisabete
    Skeie, Guri
    Hjartåker, Anette
    Amiano, Pilar
    Sánchez, María-José
    Fonseca-Nunes, Ana
    Barricarte, Aurelio
    Chirlaque, María-Dolores
    Redondo, Maria-Luisa
    Jirström, Karin
    Manjer, Jonas
    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.
    Bradbury, Kathryn E
    Khaw, Kay-Tee
    Wareham, Nicholas
    Cross, Amanda J
    Riboli, Elio
    Bueno-de-Mesquita, H Bas
    Prediagnostic intake of dairy products and dietary calcium and colorectal cancer survival-results from the EPIC Cohort Study2014In: Cancer Epidemiology, Biomarkers and Prevention, ISSN 1055-9965, E-ISSN 1538-7755, Vol. 23, no 9, p. 1813-1823Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: We investigated whether prediagnostic reported intake of dairy products and dietary calcium is associated with colorectal cancer survival.

    METHODS: Data from 3,859 subjects with colorectal cancer (42.1% male; mean age at diagnosis, 64.2 ± 8.1 years) in the European Investigation into Cancer and Nutrition cohort were analyzed. Intake of dairy products and dietary calcium was assessed at baseline (1992-2000) using validated, country-specific dietary questionnaires. Multivariable Cox regression models were used to calculate HR and corresponding 95% confidence intervals (CI) for colorectal cancer-specific death (n = 1,028) and all-cause death (n = 1,525) for different quartiles of intake.

    RESULTS: The consumption of total dairy products was not statistically significantly associated with risk of colorectal cancer-specific death (adjusted HR Q4 vs. Q1, 1.17; 95% CI, 0.97-1.43) nor that of all-cause death (Q4 vs. Q1, 1.16; 95% CI, 0.98-1.36). Multivariable-adjusted HRs for colorectal cancer-specific death (Q4 vs. Q1) were 1.21 (95% CI, 0.99-1.48) for milk, 1.09 (95% CI, 0.88-1.34) for yoghurt, and 0.93 (95% CI, 0.76-1.14) for cheese. The intake of dietary calcium was not associated with the risk of colorectal cancer-specific death (adjusted HR Q4 vs. Q1, 1.01; 95% CI, 0.81-1.26) nor that of all-cause death (Q4 vs. Q1, 1.01; 95% CI, 0.84-1.21).

    CONCLUSIONS: The prediagnostic reported intake of dairy products and dietary calcium is not associated with disease-specific or all-cause risk of death in patients diagnosed with colorectal cancer.

    IMPACT: The impact of diet on cancer survival is largely unknown. This study shows that despite its inverse association with colorectal cancer risk, the prediagnostic intake of dairy and dietary calcium does not affect colorectal cancer survival.

  • 40.
    Doohan, Isabelle
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Björnstig, Ulf
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery.
    Östtlund, Ulrika
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Exploring Injury Panorama, Consequences, and Recovery among Bus Crash Survivors: A Mixed-Methods Research Study2017In: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, no 2, p. 165-174Article in journal (Refereed)
    Abstract [en]

    Objective The aim of this study was to explore physical and mental consequences and injury mechanisms among bus crash survivors to identify aspects that influence recovery. Methods The study participants were the total population of survivors (N=56) from a bus crash in Sweden. The study had a mixed-methods design that provided quantitative and qualitative data on injuries, mental well-being, and experiences. Results from descriptive statistics and qualitative thematic analysis were interpreted and integrated in a mixed-methods analysis. Results Among the survivors, 11 passengers (20%) sustained moderate to severe injuries, and the remaining 45 (80%) had minor or no physical injuries. Two-thirds of the survivors screened for posttraumatic stress disorder (PTSD) risk were assessed, during the period of one to three months after the bus crash, as not being at-risk, and the remaining one-third were at-risk. The thematic analysis resulted in themes covering the consequences and varying aspects that affected the survivors' recoveries. The integrated findings are in the form of four core cases of survivors who represent a combination of characteristics: injury severity, mental well-being, social context, and other aspects hindering and facilitating recovery. Core case Avery represents a survivor who had minor or no injuries and who demonstrated a successful mental recovery. Core case Blair represents a survivor with moderate to severe injuries who experienced a successful mental recovery. Core case Casey represents a survivor who sustained minor injuries or no injuries in the crash but who was at-risk of developing PTSD. Core case Daryl represents a survivor who was at-risk of developing PTSD and who also sustained moderate to severe injuries in the crash. Conclusion The present study provides a multi-faceted understanding of mass-casualty incident (MCI) survivors (ie, having minor injuries does not always correspond to minimal risk for PTSD and moderate to severe injuries do not always correspond to increased risk for PTSD). Injury mitigation measures (eg, safer roadside material and anti-lacerative windows) would reduce the consequences of bus crashes. A well-educated rescue team and a compassionate and competent social environment will facilitate recovery.

  • 41.
    Doohan, Isabelle
    et al.
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing.
    Saveman, Britt-Inger
    Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Surgery. Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Arctic Research Centre at Umeå University.
    Need for compassion in prehospital and emergency care: a qualitative study on bus crash survivors' experiences2015In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 23, no 2, p. 115-119Article in journal (Refereed)
    Abstract [en]

    Aim: To explore the survivors' experiences after a major bus crash. Background: Survivors' experiences of emergency care after transportation related major incidents are relatively unexplored, with research involving survivors mainly focused on pathological aspects or effects of crisis support. Methods: Semi-structured telephone interviews were conducted with 54 out of 56 surviving passengers 5 years after a bus crash in Sweden. Interviews were analyzed using qualitative content analysis. Results: Prehospital discomfort, lack of compassionate care, dissatisfaction with crisis support and satisfactory initial care and support are the categories. Lack of compassion in emergency departments was identified as a main finding. Lack of compassion caused distress among survivors and various needs for support were not met. Survivors' desire to be with their fellow survivors the day of the crash was not facilitated after arriving at emergency departments. Conclusions: Connectedness among survivors ought to be promoted upon arrival at emergency departments. There is a need for emergency department professionals to be sufficiently educated in compassionate care.

  • 42.
    Dudarev, Alexey A
    et al.
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Alloyarov, Pavel R
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Chupakhin, Valery S
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Dushkina, Eugenia V
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Sladkova, Yuliya N
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Dorofeyev, Vitaliy M
    Dubna City Hospital, Moscow oblast, Russia.
    Kolesnikova, Tatijana A
    Northwest Public Health Research Center, St. Petersburg, Russia.
    Fridman, Kirill B
    Northwest Public Health Research Center, St. Petersburg, Russia.
    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.
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Arctic Research Centre at Umeå University.
    Food and water security issues in Russia I: Food security in the general population of the Russian Arctic, Siberia and the Far East2013In: International Journal of Circumpolar Health, ISSN 1239-9736, E-ISSN 2242-3982, Vol. 72, p. 1-10, article id 21848Article in journal (Refereed)
    Abstract [en]

    Background. Problems related to food security in Russian Arctic (dietary imbalance, predominance ofcarbohydrates, shortage of milk products, vegetables and fruits, deficit of vitamins and microelements,chemical, infectious and parasitic food contamination) have been defined in the literature. But no standardprotocol of food security assessment has been used in the majority of studies.

    Objectives. Our aim was to obtain food security indicators, identified within an Arctic collaboration,for selected regions of the Russian Arctic, Siberia and the Far East, and to compare food safety in theseterritories.

    Study design and methods. In 18 regions of the Russian Arctic, Siberia and the Far East, the followingindicators of food security were analyzed: food costs, food consumption, and chemical and biological foodcontamination for the period 2000-2011.

    Results. Food costs in the regions are high, comprising 2343% of household income. Only 4 out of 10 foodgroups (fish products, cereals, sugar, plant oil) are consumed in sufficient amounts. The consumption of milkproducts, eggs, vegetables, potatoes, fruits (and berries) is severely low in a majority of the selected regions.There are high levels of biological contamination of food in many regions. The biological and chemicalcontamination situation is alarming, especially in Chukotka. Only 7 food pollutants are under regularcontrol; among pesticides, only DDT. Evenki AO and Magadan Oblast have reached peak values in foodcontaminants compared with other regions. Mercury in local fish has not been analyzed in the majority of theregions. In 3 regions, no monitoring of DDToccurs. Aflatoxins have not been analyzed in 5 regions. Nitrateshad the highest percentage in excess of the hygienic threshold in all regions. Excesses of other pollutants indifferent regions were episodic and as a rule not high.

    Conclusion. Improvement of the food supply and food accessibility in the regions of the Russian Arctic,Siberia and the Far East is of utmost importance. Both quantitative and qualitative control of chemical andbiological contaminants in food is insufficient and demands radical enhancement aimed at improving foodsecurity.

  • 43. Dudarev, Alexey
    et al.
    Dorofeyey, Vitaliy
    Dushkina, Eugenia
    Alloyarov, Pavel
    Chupakhin, Valery
    Sladkova, Yuliya
    Kolesnikova, Tatjana
    Fridman, Kirill
    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.
    Evengård, Birgitta
    Umeå University, Arctic Research Centre at Umeå University. Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases.
    Food and water security issues in Russia III: food- and waterborne diseases in the Russian Arctic, Siberia and the Far East, 2000-20112013In: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 72, p. 21856-Article in journal (Refereed)
    Abstract [en]

    Background. The food- and waterborne disease situation in Russia requires special attention. Poor quality of centralized water supplies and sewage systems, biological and chemical contamination of drinking water, as well as contamination of food products, promote widespread infectious diseases, significantly exceeding nationwide rates in the population living in the two-thirds of Russian northern territories.Objectives. The general aim was to assess the levels of food- and waterborne diseases in selected regions of Russian Arctic, Siberia and the Far East (for the period 2000ᅵ2011), and to compare disease levels among regions and with national levels in Russia.Study design and methods. This study is the first comparative assessment of the morbidity in these fields of the population of 18 selected regions of Russian Arctic, Siberia and the Far East, using official statistical sources. The incidences of infectious and parasitic food- and waterborne diseases among the general population (including indigenous peoples) have been analyzed in selected regions (per 100,000 of population, averaged for 2000ᅵ2011).Results. Among compulsory registered infectious and parasitic diseases, there were high rates and widespread incidences in selected regions of shigellosis, yersiniosis, hepatitis A, tularaemia, giardiasis, enterobiasis, ascariasis, diphyllobothriasis, opistorchiasis, echinococcosis and trichinellosis.Conclusion. Incidences of infectious and parasitic food- and waterborne diseases in the general population of selected regions of the Russian Arctic, Siberia and the Far East (2000ᅵ2011) are alarmingly high. Parallel solutions must be on the agenda, including improvement of sanitary conditions of cities and settlements in the regions, modernization of the water supply and of the sewage system. Provision and monitoring of the quality of the drinking water, a reform of the general healthcare system and the epidemiological surveillance (including gender-divided statistics), enhancement of laboratory diagnostics and the introduction of preventive actions are urgently needed.

  • 44. Dudarev, Alexey
    et al.
    Dushkina, Eugenia
    Sladkova, Yuliya
    Alloyarov, Pavel
    Chupakhin, Valeriy
    Dorofeyey, Vitaliy
    Kolesnikova, Tatijana
    Fridman, Kirill
    Evengård, Birgitta
    Umeå University, Faculty of Medicine, Department of Clinical Microbiology, Infectious Diseases. Umeå University, Arctic Research Centre at Umeå University.
    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.
    Food and water security issues in Russia II: Water security in general population of Russian Arctic, Siberia and Far East, 2000-20112013In: International Journal of Circumpolar Health, ISSN 2242-3982, E-ISSN 2242-3982, Vol. 72, p. 22646-Article in journal (Refereed)
    Abstract [en]

    Background. Poor state of water supply systems, shortage of water purification facilities and disinfection systems, low quality of drinking water generally in Russia and particularly in the regions of the Russian Arctic, Siberia and Far East have been defined in the literature. However, no standard protocol of water security assessment has been used in the majority of studies.Study design and methods. Uniform water security indicators collected from Russian official statistical sources for the period 2000ᅵ2011 were used for comparison for 18 selected regions in the Russian Arctic, Siberia and Far East. The following indicators of water security were analyzed: water consumption, chemical and biological contamination of water reservoirs of Categories I and II of water sources (centralized ᅵ underground and surface, and non-centralized) and of drinking water.Results. Water consumption in selected regions fluctuated from 125 to 340 L/person/day. Centralized water sources (both underground and surface sources) are highly contaminated by chemicals (up to 40ᅵ80%) and biological agents (up to 55% in some regions), mainly due to surface water sources. Underground water sources show relatively low levels of biological contamination, while chemical contamination is high due to additional water contamination during water treatment and transportation in pipelines. Non-centralized water sources are highly contaminated (both chemically and biologically) in 32ᅵ90% of samples analyzed. Very high levels of chemical contamination of drinking water (up to 51%) were detected in many regions, mainly in the north-western part of the Russian Arctic. Biological contamination of drinking water was generally much lower (2.5ᅵ12%) everywhere except Evenki AO (27%), and general and thermotolerant coliform bacteria predominated in drinking water samples from all regions (up to 17.5 and 12.5%, correspondingly). The presence of other agents was much lower: Coliphages ᅵ 0.2ᅵ2.7%, Clostridia spores, Giardia cysts, pathogenic bacteria, Rotavirus ᅵ up to 0.8%. Of a total of 56 chemical pollutants analyzed in water samples from centralized water supply systems, 32 pollutants were found to be in excess of hygienic limits, with the predominant pollutants being Fe (up to 55%), Cl (up to 57%), Al (up to 43%) and Mn (up to 45%).Conclusion. In 18 selected regions of the Russian Arctic, Siberia and Far East Category I and II water reservoirs, water sources (centralized ᅵ underground, surface; non-centralized) and drinking water are highly contaminated by chemical and biological agents. Full-scale reform of the Russian water industry and water security system is urgently needed, especially in selected regions.

  • 45.
    Edlund, Lars-Erik
    Umeå University, Arctic Research Centre at Umeå University.
    Ortnamn och identitetsprocesser. Diskussionen kring några samiska ortnamn i Västerbotten.2017In: Norna-rapporter, ISSN 0346-6728, Vol. 94, p. 195-230Article in journal (Refereed)
    Abstract [en]

    Toponyms and identity processes. Discussions on some Saami toponyms in Västerbotten, northern Sweden.

     The implementation of the Swedish minority policy has implied that the national minority languages spoken in an area have come to be visualised more than before. This exposure signals the value of the minority languages. The commission to the Swedish Transport Administration (‘Trafikverket’) implies strengthening the work with displaying toponyms in minority languages, since the toponyms are regarded as a valuable part of the cultural heritage. But what minority language toponyms should be put on the road signs parallel with the Swedish names? And what reactions could a toponym in a minority language cause?

    In an ongoing research project at Umeå University, ‘Naming and Narrating Places: Empowering Saami Traditions and Identities through Popular Place-Making Processes,’ the work with strengthening the use of the Saami toponyms and the reactions that this work cause is analysed. In this article is focused on three toponyms: Ubmeje (for Umeå), Likssjuo/Liksjoe (for Lycksele) and Birjevahne/Döörte/Kraapohke (for Dorotea). These examples illustrate complicated questions that arise in the work with the toponyms in the minority languages and the identity processes associated with them.

  • 46.
    Eimermann, Marco
    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.
    Karlsson, Svante
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History. Department of Geography, Media and Communication, Karlstad University, Karlstad, Swede.
    Globalising Swedish countrysides?: A relational approach to rural immigrant restaurateurs with refugee backgrounds2018In: Norsk Geografisk Tidsskrift, ISSN 0029-1951, E-ISSN 1502-5292, Vol. 72, no 2, p. 82-96Article in journal (Refereed)
    Abstract [en]

    The main purpose of the article is to connect rural immigrants’ business ventures and development in Sweden to relational perspectives on their proximate and distant family and co-ethnic networks at structural and individual levels. Accordingly, the authors employ a relational approach and draw on in-depth interviews. In the context of urban–rural relationships’ meanings for the restaurateurs’ business benefits and constraints, they address two questions: (1) What does embeddedness in proximate and distant family and co-ethnic networks mean for the interviewed restaurateurs and for their businesses? and (2) How do previous and anticipated transitions in the restaurateurs' families influence their business decisions and migration trajectories? The results suggest that the interviewees employed transnational dimensions in their social embeddedness and that they maintained material and emotional relationships with their countries of origin. This relational approach thus contributes to a better understanding of what the studied businesses mean for the entrepreneurs and the selected localities. The restaurateurs contribute to a globalisation of Swedish countrysides, but their socio-economic potential for countering rural depopulation in Sweden is not fully realised. Additionally, the study illuminates how individuals influence, and are influenced by, place-to-place mobilities on a daily basis and during their life course.

  • 47.
    Eimermann, Marco
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography. Umeå University, Arctic Research Centre at Umeå University.
    Kordel, Stefan
    Friedrich-Alexander University Erlangen-Nuremberg, Germany.
    International lifestyle migrant entrepreneurs in two New Immigration Destinations: Understanding their evolving mix of embeddedness2018In: Journal of Rural Studies, ISSN 0743-0167, E-ISSN 1873-1392Article in journal (Refereed)
    Abstract [en]

    This article focuses on consumption and production in lifestyle migration to New Immigration Destinations (NIDs). The aim is to understand how and why lifestyle migrants' structural and individual peculiarities affect socio-economic changes in NIDs. Data are drawn from biographical interviews with lifestyle migrants in rural Slovenia and Sweden, adding issues of production to the otherwise prevailing focus on consumption in lifestyle migration studies. We ask how the ongoing quest for a better life and the lifestyle migrants' embedding processes in various contexts affect each other. Studying lifestyle migrants’ strives for better lives implies both an implicit and an explicit focus on temporality, which can result in a complex mix of embeddedness. Although our participants desire social relations with local populations, they establish them to only a limited degree, deploying multiple local and social networks in various locations for business purposes. As such, this article contributes to discussions on the incorporation of novel populations in NIDs and how to evaluate their contributions to local rural development.

  • 48.
    Eimermann, Marco
    et al.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History, Economic and social geography. Umeå University, Arctic Research Centre at Umeå University.
    Tillberg Mattsson, Karin
    Centre for Research and Development,Uppsala University/Region Gävleborg, Gävle,Sweden.
    Carson, Doris A.
    Umeå University, Faculty of Social Sciences, Department of Geography and Economic History. Umeå University, Arctic Research Centre at Umeå University.
    International tourism entrepreneurs in Swedish peripheries: compliance and collision with public tourism strategies2018In: Regional Science Policy & Practice, E-ISSN 1757-7802Article in journal (Refereed)
    Abstract [en]