Swedish Regional Research Articles

From Benefits to Value(s): Biogas Systems Valuation Practices from a Swedish Regional Perspective

Local and regional contexts are essential spaces to promote sustainable energy transitions. Within this space, biogas production and use are one choice considered part of a regional sustainable transition. The valuation of different options has become a recurrent and vital activity in connection with strategic energy decisions in the public sector. However, capturing the diverse benefits of biogas is challenging. This study scrutinises the socially and politically bounded practice that (re)produces value(s) by examining the valuation practices related to biogas performed by regional and national actors in Sweden. It finds that although the valuation practice has a degree of formality, it still reflects local needs and specific contexts. A wide range of benefits undergoes a translation process to produce value(s) using qualitative and quantitative rationalities. Still, there is tension between the desire to prioritise quantitative methods while at the same time acknowledging that some benefits are too difficult to quantify. This paper contributes to the literature on the valuation of non-market objects by highlighting the connections between established scientific and economic procedures and performative processes and the importance of rejecting a binary view of quantification and qualification.

Adherence to anti-seizure medications in the Swedish Prospective Regional Epilepsy Database and Biobank for Individualized Clinical Treatment (PREDICT)

The aim of this study was to describe the extent of, and risk factors for, non-adherence to anti-seizure medications (ASMs) in adult people with epilepsy (PWE) in Sweden.A cross-sectional multi-centre study was performed of PWEs in western Sweden, with data from medical records, and a questionnaire filled in by the participants including self-reports on how often ASM doses had been forgotten during the past year. Participants were categorized into adherent if they forgot at 0–1 occasion, and non-adherent if they forgot at 2–10 or >10 occasions. Demographic and clinical factors were compared by Chi2- or Fisher’s test and a logistic regression model was used to find risk factors for non-adherence.In the cohort of 416 PWE aged median 43, IQR 29–62 years, 398 patients were prescribed ASM treatment at inclusion, and 39 % (n = 154) were in the non-adherent group. Significant factors in the multivariable analysis were: younger age, seizure freedom the past year, valproate treatment and experiencing side effects.The rate of self-reported non-adherence was high, illustrating a need for continuous focus on fundamental aspects of epilepsy care. The identified risk factors could enable quality improvement projects and patient education to be directed to those at risk of non-adherence.

Cost-Effectiveness of Intravenous Iron Formulations in Patients with Iron Deficiency Anaemia and Inflammatory Bowel Disease, in a Swedish Regional Setting Using Real-World Tender Prices

Aims. A widespread complication of inflammatory bowel disease (IBD) is iron deficiency anaemia (IDA), which affects quality of life (QoL) and is associated with frequent hospitalizations. The intravenous iron therapies, ferric carboxymaltose (FCM), ferric derisomaltose (FD), and iron sucrose (IS), have previously been shown to replenish haemoglobin (Hb) levels more effectively than oral iron. However, they differ in both costs and efficacy (response to treatment), leading to differences in acquisition by health-care payers. We investigated the cost-effectiveness of FCM versus FD and IS, in terms of additional cost per additional responder, for the treatment of IBD-associated IDA in multiple Swedish regional settings, using current tender prices. Methods and Materials. A microsimulation model estimated the additional cost per patient achieving a response, based on Hb normalization or an increase of ≥2 g/dL in Hb levels. Efficacy estimates were taken from a previously published network meta-analysis. Treatment costs (2021 SEK) included current tender prices in Swedish health-care regions. Resource use depended partly on dosing, which was based on patient characteristics simulated in the model. Results. The analysis showed that FCM was associated with the highest number of responders (81%) compared to FD (74%) and IS (75%), while costing less per responder than its comparators, in included regions. Conclusions. These results suggest that regional health-care budget holders should consider more than drug prices when choosing which IV formulations to acquire and that they should use all available tools when deciding how to fulfil the needs of their patients.

Regional strategies for sustainable healthcare - the winding path of UN SDGs into Swedish regional healthcare systems

Sustainable development has been defined by 17 UN goals, with the third goal (SDG3) focusing on a universal healthcare system that ensures healthy lives and wellbeing. To implement these ambitions, the goal needs to fit a regional setting before it can achieve and support healthy lives and wellbeing amongst the population. This article analyses how four Swedish regions incorporate SDG target 3.4 on non-communicable diseases and mental health into their respective healthcare organisations. The comparative analysis applies the lens of normative institutional theory to policy documents and interviews. All the regions recognise SDG3.4 by acknowledging the need for health promotion. The results show a general absence of similarities in organisational practices and policy outcomes, which is explained by region-specific factors and a lack of governmental coordination. The analysis shows that local policy core values and the related logic of appropriateness predict local outcomes of implementation of general global policies.

Survival patterns of invasive lobular and invasive ductal breast cancer in a large population-based cohort with two decades of follow up

BackgroundInvasive lobular carcinoma (ILC) comprises 8–15 % of all invasive breast cancers and large population-based studies with >10 years of follow-up are rare. Whether ILC has a long-time prognosis different from that of invasive ductal carcinoma, (IDC) remains controversial. PurposeTo investigate the excess mortality rate ratio (EMRR) of patients with ILC and IDC and to correlate survival with clinical parameters in a large population-based cohort. Material and methodsFrom 1989 through 2006, we identified 17,481 patients diagnosed with IDC (n = 14,583) or ILC (n = 2898), younger than 76 years from two Swedish Regional Cancer Registries. Relative survival (RS) during 20 years of follow up was analysed. ResultsILC was significantly associated with older age, larger tumours, ER positivity and well differentiated tumours. We noticed an improved survival for patients with ILC during the first five years, excess mortality rate ratio (EMRR) 0.64 (CI 95 % 0.53–0.77). This was shifted to a significant decreased survival 10–15 years after diagnosis (EMRR 1.49, CI 95 % 1.16–1.93). After 20 years the relative survival rates were similar, 0.72 for ILC and 0.73 for IDC. ConclusionsDuring the first five years after surgery, the EMRR was lower for patients with ILC as compared to patients with IDC, but during the years 10–15 after surgery, we observed an increased EMRR for patients with ILC as compared to IDC. These EMRR between ILC and IDC were statistically significant but the absolute difference in excess mortality between the two groups was small.

Qualitative Stakeholder Analysis for a Swedish Regional Biogas Development: A Thematic Network Approach

The creation of pathways toward a societal transition to clean energy requires the engagement of multiple stakeholders with different and sometimes conflicting interests. In this connection, stakeholder analysis (SA) offers a technique for identifying, assessing and structuring different needs, interests and concerns related to different stakeholders within the context of sustainability. This article aims to present the findings from a qualitative stakeholder analysis (QSA) by using a thematic network approach (TNA), with the help of the ATLAS.ti software. It focuses on Project X, which was aimed at engaging multiple stakeholders and creating favorable conditions for small and medium-sized companies in a region situated in the central part of Sweden, with the potential to start biogas production. In this work, the findings and discussions of the QSA using TNA are structured by using the political, economic, social, technological, environmental and legal (PESTEL) themes of the model. The present study concludes that for the small-scale biogas industry to successfully develop an understanding of the possibilities of the biogas value chain, it is necessary to have analyzed the nature of the main themes by which various stakeholders relate to biogas production and envision their contribution to creating a sustainable society. Herein, we demonstrate that QSA by a TNA, combined with the application of a PESTEL model, are valuable analytical tools in sustainable project management. The lessons from Project X can be applied to other local biogas initiatives, as many identified threats and opportunities are shared by others.

Can sport clubs be represented? Pre-packed policy advocacy and the trade-offs for democratic responsiveness

ABSTRACT Federative sport organisations are increasingly conducting advocacy vis-à-vis public authorities on behalf of their membership, but the meaning and implications of such interest representation are unclear. The purpose of this paper is therefore to explore how representatives of sport federations understand interests in the context of sport advocacy, and the transformative effects on future representational and wider democratic practices that may follow from such conceptualisations. Drawing theoretically on a distinction between attached and objective interests, and empirically on interviews with 46 Swedish Regional Sport Federation representatives, we show that interests are understood as best derived from central policy documents and edicts rather than clubs’ immediate wishes. This centralised sourcing of advocacy issues may be explained with reference to the legitimacy representatives believe that the internal democratic system bestows on processes of issue prioritisation. In the absence of bottom-up practices outside of general assemblies to channel federated clubs’ interests, this issue prioritisation strategy involves a shift from accommodating interests attached to clubs to promoting understandings of sport’s collective and ‘objective’ interest. The significance of this shift is twofold. First, it enables the justification of a professionalised, bureaucratic and centralised advocacy dedicated to increasing advocacy impact rather than ‘downward’ representational authorisation and accountability. Second, it may shape what is perceived as legitimate subsequent representation, including the appropriate participatory practices associated with advocacy. More generally, if clubs and their members come to understand their interests as objective, their capacity and will to formulate their interests as attached may be further weakened.

Sport Advocacy: The Art of Persuasion and Its By-Products

Despite an increase of advocacy by established nongovernmental sport organizations, little is known about how advocacy is enacted and with what effects. Building conceptually on frame alignment theory and empirically on interview data from 19 Swedish Regional Sport Federations, this article investigates how advocates politicize sport to gain “insider status” and analyses the by-products of such efforts. This research demonstrates that the architecture of advocacy claims perpetuates a separation between organizations that “sell” sport from those that “produce” it. Framing also impels centralized authority because advocates safeguard their credibility as political actors by taking up a “leadership-position” vis-à-vis clubs. Advocacy frame alignment has further by-products insofar as they narrow advocates’ room for maneuver and become institutionalized over time.

Operationalising resilience for disaster medicine practitioners: capability development through training, simulation and reflection

Resilience has in recent decades been introduced as a term describing a new perspective within the domains of disaster management and safety management. Several theoretical interpretations and definitions of the essence of resilience have been proposed, but less work has described how to operationalise resilience and implement the concept within organisations. This case study describes the implementation of a set of general resilience management guidelines for critical infrastructure within a Swedish Regional Medical Command and Control Team. The case study demonstrates how domain-independent guidelines can be contextualised and introduced at an operational level, through a comprehensive capability development programme. It also demonstrates how a set of conceptual and reflective tools consisting of educational, training and exercise sessions of increasing complexity and realism can be used to move from high-level guidelines to practice. The experience from the case study demonstrates the value of combining (1) developmental learning of practitioners’ cognitive skills through resilience-oriented reflection and interaction with dynamic complex open-ended problems; (2) contextualisation of generic guidelines as a basis for operational methodological support in the operational environment; and (3) the use of simulation-based training as part of a capability development programme with increasing complexity and realism across mixed educational, training and exercise sessions. As an actual example of a resilience implementation effort in a disaster medicine management organisation, the study contributes to the body of knowledge regarding how to implement the concept of resilience in operational practice.

Postoperative pain and bleeding after adenotonsillectomy versus adenotonsillotomy in pediatric obstructive sleep apnea: an RCT

PurposeOur previous randomized controlled trial (RCT) of children with obstructive sleep apnea (OSA) showed no significant differences between adenotonsillectomy (ATE) and adenotonsillomy (ATE) in improving nocturnal respiration and symptoms after one year. This is the continuous report with the evaluation of postoperative morbidity concerning bleeding and pain.MethodsA double-blinded RCT including 79 children, aged 2–6 years, with moderate to severe OSA, randomized to either ATE (n = 40) or ATT (n = 39). From one to ten days postoperatively, parents filled in a logbook with six pain-related outcomes (parent and child grading pain at different levels, days of analgesic use and return to normal diet). Peri- and postoperative bleeding were also registered.Results63 patients (80%) returned the logbook. There were significant differences between groups in only two of the six pain-related outcomes in favor of the ATT group; first day when the children graded themselves as pain free (p = 0.021, Log Rank Test), and first day the caregiver estimated pain VAS ≤ 5 (p = 0.007, Log Rank Test). Two (5%) cases of postoperative bleeding occurred in the ATE group, one of which needed a return to theatre. No case of postoperative bleeding was seen in the ATT group.ConclusionsThe results from this RCT are in line with previous comparative studies between ATT and ATE. Children operated with ATT had significantly less postoperative pain in one-third of the outcomes, and less bleeding than ATE. However, as the differences in morbidity between the surgical methods were minor the clinical significance is uncertain.Trial registrationThis study was approved by the Swedish Regional Ethics Board in Stockholm, Sweden (Dnr 2011/925-32 and 2013/2274-32) and registered at ClinicalTrials.gov (Trial registration number NCT01676181).

Professionalization and its consequences: how active advocacy may undermine democracy

ABSTRACT Research question: The paper aims to build knowledge on the trade-offs and unintended consequences of professionalization in the context of sport policy advocacy. Two questions are addressed: (1) What institutional roles make up the sport policy ‘advocacy team’ and what trade-offs are inherent in the formation of this team? (2) How do the unintended consequences of this trade-off precipitate a cross-level diffusion of professionalization? Research methods: Data from interviews with 46 staff and elected representatives of 19 Swedish Regional Sport Federations forms the empirical base. Results and findings: The formation of the advocacy team points to an efficiency/democracy trade-off. An unintended consequence of this is a cross-level diffusion of professionalization that undermines the general standing of elected boards. Implications: Management should consider the trade-offs inherent in professionalization reforms, because in some cases they may contain the seed of their own reconstruction and reflect ill-considered management practice.

Process-oriented assessment of RCA4 regional climate model projections over the Congo Basin under $$1.5 \ ^{\circ }{\text {C}}$$ 1.5 ∘ C and $$2 \ ^{\circ }{\text {C}}$$ 2 ∘ C global warming levels: influence of regional moisture fluxes

Understanding the processes responsible for precipitation and its future change is important to develop plausible and sustainable climate change adaptation strategies, especially in regions with few available observed data like Congo Basin (CB). This paper investigates the atmospheric circulation processes associated with climate model biases in CB rainfall, and explores drivers of projected rainfall changes. Here we use an ensemble of simulations from the Swedish Regional Climate Model (RCM) RCA4, driven by eight General Circulation Models (GCMs) from the Coupled Model Intercomparison Project Phase 5 (CMIP5), for the $$1.5 \ ^{\circ }{\text {C}}$$ and $$2\ ^{\circ }{\text {C}}$$ global warming levels (GWLs), and under the representative concentration pathways (RCPs) 4.5 and 8.5. RCA4 captures reasonably well the observed patterns of CB rainfall seasonality, but shows dry biases independent of seasons and large scale driving atmospheric conditions. While simulations mimic observed peaks in transition seasons (March–May and September–November), the rain-belt is misplaced southward (northward) in December–February (June–August), reducing the latitudinal extent of rainfall. Moreover, ERA-Interim reanalysis driven RCM simulation and RCM–GCM combinations show similar results, indicating the dominance of systematic biases. Modelled dry biases are associated with dry upper-tropospheric layers, resulting from a western outflow stronger than the eastern inflow and related to the northern component of African Easterly Jet. From the analysis of the climate change signal, we found that regional scale responses to anthropogenic forcings vary across GWLs and seasons. Changes of rainfall and moisture divergence are correlated, with values higher in March–May than in September–November, and larger for global warming of $$2.0 \ ^{\circ }{\text {C}}$$ than at $$1.5 \ ^{\circ }{\text {C}}$$ . There is an increase of zonal moisture divergence fluxes in upper atmospheric layers ( $$> 700\,{\text {hPa}}$$ ) under RCP8.5 compared to RCP4.5. Moreover, it is found that additional warming of $$0.5 \ ^{\circ }{\text {C}}$$ will change the hydrological cycle and water availability in the CB, with potential to cause challenges to water resource management, agriculture, hydro-power generation, sanitation and ecosystems.

From ‘passive custodian’ to ‘active advocate’: tracing the emergence and sport-internal transformative effects of sport policy advocacy

ABSTRACT Organised sport has become a legitimate interest group, with potential influence in wider policy-making circles. Building on a distinction between because-of motives and in-order-to motives, the purpose of this study is to analyse why sport organisations conduct advocacy while offering an assessment of the sport-internal transformative effects of advocacy activities. The analysis is based on interviews with 46 elected and staff representatives of Swedish Regional Sport Federations, and it shows (1) that a perceived de-institutionalization of organised sport’s monopolistic position in Sweden underpins the imperative to conduct advocacy, and (2) that the overarching goal-oriented purpose of advocacy is to further sport organisations’ role as advocates in future policy processes. This indicates that sport organisations are transitioning from a ‘passive custodian’ to an ‘active advocate’ role in relation to the government. We propose that this latter role may include a professionalisation of advocacy activities, and that advocacy, therefore, may accentuate internal tensions related to the trade-off between efficiency and democracy, create a need for sport-internal advocacy, and undermine future advocacy claims and/or access to policy processes.

Continuous Increasing Prevalence of Chronic Lymphocytic Leukemia (CLL) with an Estimated Future Rise—a Nationwide Population-Based Study from Sweden

RationaleData on the prevalence of chronic lymphocytic leukemia (CLL) are scarce, and reliable population-based data as well as estimates of future changes in prevalence are neededAimsTo investigate previous and current prevalence of CLL in Sweden, the time it takes for new treatments to be implemented in clinical practice and to estimate the future prevalence of CLL.Patients and MethodsIndividuals in Sweden diagnosed with CLL (ICD7 and ICD9 204.1 and ICD10 C91.1) during 1958-2015 were identified through the National Cancer Registry. Background population sizes, prediction of future population sizes, death rates and data on emigration and immigration were obtained from Statistics Sweden. Clinical data on all cases diagnosed 2007-2015 (n=4742), including type of treatment for those requiring therapy (n=1459), were obtained from the Swedish National CLL-registry to which all healthcare units (n=73) diagnosing and treating CLL send reports.The number of prevalent cases at the end of each year was calculated from the total number of individuals diagnosed with CLL still alive and living in Sweden. Future age-specific incidence rates were assumed to be equal to the average age-specific incidence rates in the previous ten years. To estimate the proportion of individuals still alive many years into the future, estimates of relative survival along with expected mortality rates were calculated. These estimates were used in conjunction with predictions of future expected background mortality to predict overall survival among prevalent cases. Using a flexible parametric model (Lambert, Wilkes et al. 2017) with age at diagnosis included as a restricted cubic spline, relative survival was estimated for all ages.To create a “best case” scenario of future prevalence, a sensitivity analysis was performed assuming an increase in survival of newly diagnosed patients based on hazard ratios from randomized trials comparing new treatments with old. From the Swedish National CLL-registry we gathered data on treatments used and made assessments within three age groups (<65 years, 65-79 years and >80 years) on the proportion of patients that would benefit from a change to a more efficient treatment.ResultsIn 2015, the age-standardized incidence of CLL in Sweden was approximately 3/100 000 among males and 1.5-2/100 000 among females. This level had been stable since 1980.During the period 2000 to 2015 there was a continuous improvement in survival. In parallel there was a 42% increase in point prevalence from 33.3/100 000 to 47.4/100 000, corresponding to a 58% increase in the absolute number of prevalent cases from 2954 to 4668 (fig. 1A).Novel treatments were implemented in <5 years in general practice (fig. 1B).Using this information, we calculated a “best-case” scenario, applying survival figures based on recent published studies on novel treatments, and assuming that the maximum proportion of patients receiving the novel drugs would be reached within 5 years.Assuming unchanged relative survival, we estimated a 15% rise in the point prevalence to 54.6/100 000 in 2025 and a 26% rise to 59.5/100 000 in 2035, corresponding to an increase in the absolute number of cases with 28% (n=5980) and 49% (n=6938) during the same period of time.Based on the “best case” scenario, we estimated a 21% rise in the point prevalence to 57.3/100 000 in 2025 and a 45% rise to 68.9/100 000 in 2035. This corresponding to an increase in the absolute number of cases during the same period with 35% (n=6280) and 72% (n=8016), respectively. (fig. 1C)ConclusionUsing data from well-established national, population-based registries in Sweden, focusing on the time period 2000-2015, we found that there has been a continuous increase in the prevalence of CLL from 33.3/100 000 (2000) to 47.4/100 000 (2015). We also describe a fast implementation of new treatments. In parallel we observe a striking increase in survival. Using a model in which we assume further improvements in survival due to the introduction of novel and more efficient treatments, we estimate that the absolute number of cases may increase with as much as 72% in 20 years. These findings have important implications for health economy and planning.AcknowledgmentsThe Swedish Regional Cancer Centers and all hematologists reporting patients to the National CLL Registry. The Swedish CLL-group for their valuable support.FundingThis work was supported by funding from the Swedish CLL-group. [Display omitted] DisclosuresKimby:AbbVie: Membership on an entity's Board of Directors or advisory committees; Gilead: Honoraria; Janssen: Membership on an entity's Board of Directors or advisory committees; Roche: Honoraria; Roche: Honoraria.

Are Economic Upturns Bad for Military Recruitment? A Study on Swedish Regional Data 2011–2015

ABSTRACTThis paper represents the first effort to explore the relationship between civilian labour market conditions and the supply of labour to the military in the all-volunteer environment that Sweden entered after the abolishment of the peacetime draft in 2010. The paper investigates the effect of civilian unemployment on the rate of applications from individuals aged 18–25 to initiate basic military training, using panel data on Swedish counties for the period 2011–2015. A linear fixed-effects model is estimated to investigate the relationship, while controlling for a range of socio-demographic covariates, unobserved heterogeneity on the regional level, as well as aggregate trends on the national level. The results of the panel-data analysis indicate that the unemployment rate has a positive and statistically significant effect on the application rate. These results are robust to non-linear form specifications, as well as allowing the civilian unemployment rate to be endogenous. As such, the results suggest that the civilian labour market environment in Sweden can give rise to non-trivial fluctuations in the supply of applications to initiate basic military training within the Swedish Armed Forces.

Impact of diet and bariatric surgery on anti-Müllerian hormone levels.

Do serum levels of anti-Müllerian hormone (AMH) change in women of reproductive age following dietary and surgery-induced weight loss? AMH levels increased after very low-calorie diet (VLCD) before surgery and decreased at 6 and 12 months after Roux-en-Y gastric bypass (RYGB), beyond expected normal age-related decline. Obesity has negative effects on fertility and IVF outcomes, and possibly also on AMH levels. AMH correlates to the number of growing follicles and is used to predict the response to IVF treatment. However, AMH might decrease after bariatric surgery. A prospective cohort study of 48 women followed first for 8 weeks preoperatively, then operated with RYGB and followed postoperatively for 1 additional year. Women aged 18-35 years with a mean (SD) BMI 40.9 (3.6) kg/m2 were included at baseline (BL). After the VLCD, a RYGB was performed. Body weight and height were measured at BL and 1 year postoperatively. Hormones were analysed at BL, after VLCD on the day before surgery, and at 6 and 12 months postoperatively. Median AMH levels were 30.0 pmol/L at BL and rose significantly after VLCD (median: 35.0 pmol/L; P = 0.014). Median AMH at 6 and 12 months postoperatively were significantly lower (19.5 and 18.0 pmol/L, respectively; P = 0.001). Free androgen index (FAI) was significantly lower after 12 months, compared to BL (1.2 vs 3.5, P < 0.0005). Ultrasound for PCOS diagnosis was not performed. The change in laboratory methods for AMH analysis during the study might be a limitation. Obese young women might choose bariatric surgery also for fertility reasons, and the observed decrease in FAI is in line with improved fertility. More research is needed to evaluate the clinical effects of the decrease of AMH, and the effect of bariatric surgery prior to IVF treatment. Study-specific laboratory analyses were funded by the Swedish Regional Research Fund (ALF). Authors declare no competing interests. N/A.

The Openness Buzz in Metropolitan Regions: Swedish Regional Development Strategies

The Openness Buzz in Metropolitan Regions: Swedish Regional Development Strategies

Labour-market orientation and approaches to studying – a study of the first Bologna Students at a Swedish Regional University

This study investigated labour-market orientations of students at a Swedish University with a dual/diverse focus on vocational/academic objectives. The aim was to investigate whether and how levels of students' labour-market orientation vary with social background, change during the study period, and are related to approaches to studying and achievements. The design was a multiple panel time-series study. Labour-market orientation was studied on the basis of locally designed questionnaires. Approaches to studying were analysed deductively in accordance with dimensions previously found by Study Process Questionnaires and inductively using a principal component analysis. Results suggest that labour-market orientations co-varied to a higher degree with the study programme than with social background. Contrary to what was hypothesized, being labour-market oriented was only moderately related to surface-oriented approaches to studying. It is suggested that future research should pay more attention to disciplinary traditions and local teacher and programme cultures in understanding developmental paths in labour-market orientation.

Otázky regionálního rozvoje Švédského království a České republiky

The purpose of this paper is to analyze the regional problems of the Kingdom of at the beginning of the 21st century and to confront these findings with the regional policy of the Czech Republic. In the introduction the basic issues of Swedish regional development will be presented. In the text the tax issues will also be outlined, i.e. the system of taxes redistribution to the regional and local authorities in our republic and in Sweden. In the text a case study of regional association of Western Sweden follows (West the EU Project Analysis Service - WEPA). This association has established in Brussels its permanent representation and it promotes here the interests of individual cities and regions - for now only of mentioned Western Sweden, which is not a municipal Swedish region, just the association composed of three Swedish regions (Halland, Varmland and Vastra Gotaland) and 71 cities. In the paper current practice and principles are documented, and the question remains: Is it possible to use this model of Western Sweden also in the Czech Republic? This article was created within the research project Innovation Approach to Analysis of Disparities on Regional Level, realized under the state subsidy of The Ministry for Regional Development WD-30-07-1 at the Faculty of Economics, Technical University of Liberec, the Czech Republic.

“Learning is our Achilles heel”. Conditions for long-term environmental policy integration in Swedish regional development programming

The aim of this paper is to explore how the capacity to integrate environmental sustainability in Swedish regional development programming has evolved over time, particularly focusing on what facilitates and restricts change in different stages of implementation. The study builds on focus group and individual interviews in four Swedish regions carried out in 2005 and 2011. The results suggest temporary and partial, rather than enduring and substantial, environmental policy integration (EPI). In 2005 the main challenges were to allocate support, focus and prioritise beyond the national policy rhetoric of regional sustainable development, to identify regional applications beyond singular ‘pockets of good practice’ and to spread ownership and engagement for EPI from specific ambassadors to organisational mainstreaming. In 2011 we found evidence of a more mainstreamed approach of regional sustainable development, but with new challenges of policy diffusion and sectorisation as well as a strong sense of projectification. There is a need to develop arenas and processes for inter-sectoral exchange, interaction and learning to achieve a more systematic change – which is, in essence, what policy integration is all about.