The effect of fish consumption on the risk of cardiovascular disease has been extensively studied. Omega-3 fatty acids present in fish, namely eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), have been found to have beneficial effects through several mechanisms. In addition, selenium, an antioxidant, may be protective. Fish also represents the main human exposure source to the pollutant methylmercury (MeHg), which is associated with elevated cardiovascular risk in previous studies. The aim of this thesis was to evaluate whether MeHg is associated with the risk of myocardial infarction (MI) or stroke, whether EPA+DHA or selenium (Se) have protective associations, and if the overall association between fish consumption and risk of stroke or MI is detrimental or protective. A prospective incident case-control study design was used to study effects on stroke or MI. Three hundred and sixty-nine cases with twice as many matched controls were included in the study on stroke, while 431 cases with 499 controls participated in the MI study, all from the Northern Sweden Health and Disease Study. The data was collected from health examinations of the population from 1986 until 1999. Also, time trends in burdens of mercury (Hg), lead (Pb) and cadmium (Cd) in erythrocytes (Ery) from 1990 to 1999 were examined. The food frequency questionnaire (FFQ) used in the case-control studies was correlated with measurements of fatty acids in erythrocyte membranes as biomarkers of intake. In this northern Swedish population, levels of Ery-Hg and Ery-Pb decreased during the 1990´s, but Ery-Cd decreased only in smoking men. No significant associations were found between Ery-Hg or levels of EPA+DHA and the risk of stroke. Men reporting fish consumption >3 meals/week had an elevated risk of stroke. In the MI study, higher levels of Ery-Hg were associated with lower risk of MI. No clear associations were found for reported fish consumption, levels of EPA+DHA or Ery-Se. The validated FFQ has a fair reliability in estimating intake of fatty acids EPA and DHA. However, the low variation in fish consumption in the general population in combination with different versions of the FFQ (with pre-defined, multiple choice alternatives) decreased the reliability of self-reported fish consumption in the case-control studies on risk of stroke or MI. In conclusion, MeHg has no harmful association regarding the risk of stroke or MI in this population with generally low exposure levels. The protective association regarding risk of MI is probably due to Ery-Hg being a biomarker for consumption of fish, a source of other beneficial nutrients. Thus, in this population the benefits of the nutrients in fish appear to overcome the potential harm of MeHg. The finding of elevated stroke risk related to high fish consumption in men will be investigated further. / PHIME; Public health impact of long-term, low-level mixed element exposure in susceptible population strata

<p>Legislation on benefit sharing dates back to 1992 and the commandment of the UNConvention on Biological Diversity, hence implementation still has few cases to fall back on(CBD, 1992). The case study of the project ProBenefit presented by the thesis highlights howlack of deliberation can undermine a democratic process. The objective of the thesis is thatProBenefit’s attempt to implement the standards of the CBD on access and benefit sharingwill highlight not only problems met by this specific project, but difficulties that generallymeet democratic processes in contexts of high inequality. To define if the project ProBenefitsucceeded in carrying out a deliberative process the project will be analyzed by the criteria:access to information, representation, legitimacy and involvement.The population in the project area of ProBenefit had a long history of social marginalization,which made it hard for foreign projects to gain legitimacy. The lack of independentorganizations and the late establishment of the project, which resulted in time shortage, madeit impossible to prevent the distrust of the local population. The failure of the projectcoordinators to ensure active participation of all stakeholders resulted in a late and lowinvolvement of the local participants. The absence of independent organization also madedemocratic legitimacy of the process questionable. Even if ProBenefit had a vision ofdemocratic deliberation the project was unable to break down the prevailing unequal powerdistribution which resulted in an unsustainable process and failure. The conclusion of thethesis is that the attainment of deliberation foremost depends on how a project deals with theexisting distribution of power and how it succeeds in involving all stakeholders.</p>