Smoking in context – a multilevel approach to smoking among females in Helsinki

<p>Abstract</p> <p>Background</p> <p>Smoking is associated with disadvantage. As people with lower social status reside in less privileged areas, the extent of contextual influences for smoking remains unclear. The aims were to examine the spatial patterning of daily smoking within the city of Helsinki, to analyse whether contextual variation can be observed and which spatial factors associate with current daily smoking in the employed female population.</p> <p>Methods</p> <p>Data from a cross-sectional questionnaire were collected for municipal employees of Helsinki (aged 40–60 years). The response rate was 69%. As almost 4/5 of the employees are females, the analyses were restricted to women (n = 5028). Measures included smoking status, individual level socio-demographic characteristics (age, occupational social class, education, family type) and statistical data describing areas in terms of social structure (unemployment rate, proportion of manual workers) and social cohesion (proportions of single parents and single households). Logistic multilevel analysis was used to analyse data.</p> <p>Results</p> <p>After adjusting for the individual-level composition, smoking was significantly more prevalent according to all social structural and social cohesion indicators apart from the proportion of manual workers. For example, high unemployment in the area of domicile increased the risk of smoking by almost a half. The largest observed area difference in smoking – 8 percentage points – was found according to the proportion of single households.</p> <p>Conclusion</p> <p>The large variation in smoking rates between areas appears mainly to result from variation in the characteristics of residents within areas. Yet, living in an area with a high level of unemployment appears to be an additional risk for smoking that cannot be fully accounted for by individual level characteristics even in a cohort of female municipal employees.</p

To be an immigrant and a patient in Sweden: A study with an individualised perspective

The aim is to describe how experiences of being an immigrant can influence the situation when becoming a patient in Swedish health care. A hermeneutic approach was used. Sixteen persons born in non-Nordic countries were interviewed. The data was analysed with an empirical hermeneutical method. The findings indicate that positive experiences (i.e., establishing oneself in a new home country) enhance the possibilities of taking part in caring situations and vice versa. Hence, there is a need for individually adapted care that takes one's whole life situation into consideration. Consequently, it is suggested that the concept, “cultural competence” merely serves the purpose of illuminating caregivers' need for categorisation. It does not illuminate individual needs in a caring situation

Eprotirome in patients with familial hypercholesterolaemia (the AKKA trial): a randomised, double-blind, placebo-controlled phase 3 study

Eprotirome is a liver-selective thyroid hormone receptor agonist that has been shown to lower plasma LDL cholesterol concentrations in previous phase 1 and 2 studies of patients with dyslipidaemia. We aimed to assess the long-term safety and efficacy of 50 μg and 100 μg eprotirome in patients with familial hypercholesterolaemia. Methods For this randomised, double-blind, placebo-controlled, parallel-group, phase 3 clinical trial, we enrolled patients between Oct 3, 2011, and Feb 14, 2012, at 53 sites in 11 countries in Europe, Africa, and south Asia. Patients were eligible for enrolment if they were aged 18 years or older, diagnosed with heterozygous familial hypercholesterolaemia, and had not reached target LDL cholesterol concentrations after at least 8 weeks of statin therapy with or without ezetimibe. We used a computer-generated randomisation sequence to allocate patients to one of three groups: 50 μg eprotirome, 100 μg eprotirome, or placebo. This trial was planned for 52–76 weeks, with primary efficacy analysis at 12 weeks, but it was prematurely terminated when another study found that eprotirome causes cartilage damage in dogs. Although it was impossible to meet the predefined study outcomes, we analysed changes in the concentrations of LDL cholesterol and other lipids, liver parameters, thyroid hormone concentrations, and adverse effects of treatment with eprotirome versus placebo at 6 weeks of treatment. Analysis was done in all patients who received 6 weeks of treatment. This study is registered with ClinicalTrials.gov, number NCT01410383. Findings We enrolled 236 patients, randomly allocating 80 to receive placebo, 79 to receive 50 μg eprotirome, and 77 to receive 100 μg eprotirome. 69 patients reached the 6 week timepoint (23 given placebo, 24 given 50 μg eprotirome, and 22 given 100 μg eprotirome). Mean LDL cholesterol concentrations increased by 9% (95% CI −2 to 20) in the placebo group, decreased by 12% (−28 to 4%; p=0·0677 vs placebo) in the 50 μg eprotirome group, and decreased by 22% (−32 to −13%; p=0·0045 vs placebo) in the 100 μg eprotirome group. We noted statistically significant increases between both eprotirome groups and placebo in aspartate aminotransferase (AST; p<0·0001), alanine aminotransferase (ALT; p<0·0001), conjugated bilirubin (p=0·0006), and gamma-glutamyltranspeptidase (p<0·0001). Four patients had to discontinue or interrupt study treatment before trial termination due to AST increases between the upper limit of normal (ULN) and six times ULN, and ALT concentrations between three and seven times ULN. Although we detected no changes in serum concentrations of thyroid-stimulating hormone or free tri-iodothyronine, free tetra-iodothyronine decreased by 19% (23 to 16) in the 50 μg eprotirome group and 27% (30 to 23) in the 100 μg eprotirome group (p<0·0001 vs placebo for both groups). Interpretation Our findings show that eprotirome can lower LDL cholesterol concentrations in patients with familial hypercholesterolaemia when added to conventional statin treatment with or without ezetimibe, but that it has the potential to induce liver injury. These findings, along with findings of cartilage damage in dogs, raise serious doubts about selective thyroid hormone mimetics as a therapeutic approach to lower LDL cholesterol concentrations.B. Sjouke, G. Langslet, R. Ceska, S.J. Nicholls, S.E. Nissen, M. Öhlander, P.W. Ladenson, A.G. Olsson, G.K. Hovingh and J.J.P. Kastelei

The Paleoproterozoic Hedesunda granite complex, east‑central Sweden, a composite intrusion.

The Hedesunda granite complex covers a rectangular area of ca 800 km2 within the Bergslagen lithotectonic unit of the Paleoproterozoic Svecofennian orogen in east-central Sweden. It is dominated by coarse porphyritic and generally undeformed granitoids whose position within the Svecofennian orogenic evolution has been controversial. New U–Pb SIMS dating of zircon confirms earlier TIMS results, showing that it is a composite intrusion made up of an older phase at ca 1865 Ma, forming the bulk of the massif, and a younger phase at ca 1785 Ma, forming a circular intrusion in the north-central area and an elongated body further west. The two generations have very different geochemistry. The older Hedesunda I intrusion ranges from diorite through tonalite and granodiorite to granite in composition, is dominantly metaluminous, calc-alkaline, magnesian, I-type and volcanic arc-related, and probably formed by melting of juvenile Svecofennian lower crust due to basaltic underplating during an extensional ‘intra-orogenic’ phase shortly after the main subduction-related early-orogenic Svecofennian magmatism. The younger Hedesunda II intrusions are purely granitic, dominantly peraluminous, alkali-calcic, K-rich, and ferroan, with A-type and within-plate-type characteristics, and formed penecontemporaneously with post-collisional shoshonitic intrusions in southern Finland, again presumably by crustal melting due to basaltic underplating in an extensional setting towards the end of the Svecofennian orogeny

The Palaeoproterozoic perturbation of the Global Carbon Cycle : the Lomagundi-Jatuli Isotopic Event

On Earth, carbon cycles through the land, ocean, atmosphere, living and dead biomass and the planet’s interior. The global carbon cycle can be divided into the tectonically driven geological cycle and the biological/physicochemical cycles. The former operates over millions of years, whereas the latter operate over much shorter time scales (days to thousands of years). Within the geological cycle, atmospheric carbon dioxide concentration is controlled by the balance between weathering, biological drawdown, size of sedimentary reservoir, subduction, metamorphism and volcanism over time periods of hundreds of millions of year