Browsing by Author "Stenman, Caroline"

Filter results by typing the first few letters
Now showing 1 - 2 of 2
  • No Thumbnail Available
    Item
    Cancer in organ transplant recipients
    (2021-08-27) Stenman, Caroline
    Tens of thousands of transplantations are performed around the world each year. Organ transplant recipients (OTR) are obliged to receive life-long medical treatment with immunosuppressive drugs to ensure graft function. However, such medications entail an increased risk of developing a broad spectrum of malignancies, especially skin cancer. This thesis aims to study cancer in OTRs from different aspects such as cancer incidence, survival, risk factors and prevention. Also, differentiation of squamous cell carcinoma (SCC) among OTRs. Study I: The aim of this study was to investigate the degree of differentiation of SCC in OTRs compared to immunocompetent individuals. The degree of differentiation refers to how cancer cells look and function compared to normal cells. Data from the Swedish Cancer Registry (SCR) were cross-checked with data from the Transplant Registry (TR). Only patients with a diagnosis (SCC, Basosquamous Carcinoma and/or SCC in situ) from the Department of Dermatology, SUH, between 2002-2010 were included. The control group consisted of those who were diagnosed with the same diagnosis at the same time period at SUH as OTRs. No significant differences were observed in the degree of tumour differentiation in SCCs appearing in OTRs compared to those in the control group (p=0.4). In conclusion: SCCs in OTRs do not seem to be more aggressive than in the general population. Study II: The aim of this study was to investigate whether specialized OTR clinics with dermatological follow-up, as has been suggested, provide additional benefit. In this descriptive study, in total, 696 OTRs and non-organ transplant patients (non-TPs) completed a sun exposure questionnaire between 2011 and 2015. The control group, the non-TPs, were recruited among outpatients at the Department of Dermatology SUH. We also compared OTRs with dermatological follow-up to OTRs with no follow-up. Fewer OTRs than non-TPs had experienced ≥1 sunburn in the past year (20% vs 46% p<.0001). There were more frequent users of sunscreen among OTRs with follow-up than among other OTRs (63% vs 44%, p=0.006). More OTRs with follow-up used ≥1 sun protection measure (covering clothes etc.) than other OTRs (54% vs 34%, p=0.016). Thus, OTRs reported less sun exposure compared to non-TPs, consolidating the positive effect of sun protection advice following transplantation. Today, post-transplant sun protection advice is standard. Study III. The aim of this study was to investigate cancer incidence and survival in 664 patients who underwent heart transplantation (HTx) at SUH between 1985-2017. Data was retrieved from SCR and the Cause of Death Registry. The median follow-up time was 7.7 years. We found in total 279 malignancies in 90 patients. Of all patients, 19% had experienced malignancy after almost seven years after HTx. We found an overall risk of cancer to be over 6.2-fold higher than the general population and 2.9-fold higher when excluding non-melanoma skin cancer (NMSC). Study IV. The aim of this study was to investigate cancer incidence and survival in 614 patients who underwent lung transplantation (LTx) at SUH between 1990-2016. Data was retrieved from SCR and the Cause of Death Registry. The median follow-up time was 5.1 years. We found 159 malignancies in 111 patients which corresponds to 18% of the total study population. We found an overall risk of cancer to be 5.56-fold higher than the general population and 2.76-fold higher when excluding NMSC.
  • No Thumbnail Available
    Item
    The Development of the MARPOL and EU Regulations to Phase out Single Hulled Oil Tankers
    (2005) Stenman, Caroline; Göteborgs universitet/Juridiska institutionen
    In 1990, the US adopted the OPA 90 in response to the Exxon Valdez grounding outside the Alaskan coast in 1989. The OPA 90 was the first legislation demanding double hull on oil tankers in order to prevent the spillage of oil in case of a grounding or collision. The IMO adopted amendments to MARPOL 73/78 in 1992, which for example required all new tankers of 600 dwt and above to have double sides or double bottom and tankers of 5,000 dwt and above to have both double bottom and double sides. The Erika accident outside the French coast shook the EU and a stricter regulation, in comparison with the MARPOL, on double hull tankers was adopted. The Prestige accident in 2002 further spurred the EU to put pressure on the IMO to implement the same accelerated phase out scheme of single hulled tankers as the EU had already adopted. This developed into a battle between the EU and the IMO on the jurisdictional right to prevent marine pollution by phasing out single hulled tankers. The thesis is a descriptive and analytical study of the development of the MARPOL and EU phase out schemes. By presenting the relevant UNCLOS articles it is analyzed how unilateral legislation may prevent single hulled tankers by using the jurisdiction of flag, port, and coastal states. The EU has taken an independent initiative to regulate the phase out stricter than the IMO and chapter 2 examines the jurisdiction of the EU in the field of maritime pollution prevention. The study shows that the EU member states may, by using their flag and port state jurisdiction given to them by the UNCLOS, implement the EU regulation. Chapter 3 describes how the MARPOL and EU schemes on the phasing out of single hulled tankers developed. These schemes came about during a process lasting a decade when both organizations wanted to prove their efficiency to respond quickly to the problems of oil pollution. Finally, the EU, after political pressure from the EU member states and the public opinion, had the IMO adopting the same phase out scheme as the EU but with some exemptions. The shipping industry is vulnerable to unilateral legislation since shipping is an international business and EU politicians are not considered to be as competent in the maritime field as experts of the IMO. Therefore, the IMO needs to take the initiative back from the EU on all matters concerning marine legislation. The last chapter analyzes the possible consequences for the shipping industry due to the phasing out of single hulled tankers. The phase out require, among other things, new tonnage to be built and old tonnage to be scrapped. There are many consequences for the shipping industry when new legislation is made and some of them may be very costly for some of the actors in the shipping industry.