A retrospective population based trend analysis on hospital admissions for lower respiratory illness among Swedish children from 1987 to 2000

BACKGROUND: Data relating to hospital admissions of very young children for wheezing illness have been conflicting. Our primary aim was to assess whether a previous increase in hospital admissions for lower respiratory illness had continued in young Swedish children. We have included re-admissions in our analyses in order to evaluate the burden of lower respiratory illness in very young children. We have also assessed whether changes in the labelling of symptoms have affected the time trend. METHODS: A retrospective, population based study was conducted to assess the time trend in admissions and re-admissions for lower respiratory illness. Data were obtained from the Swedish Hospital Discharge Register for all children with a first hospital admission before nine years of age, a total of 109,176 children. The register covers more than 98% of all hospital admissions in Sweden. The coding of diagnoses was based on ICD-9 from 1987 to 1996 and ICD-10 from 1997. RESULTS: The first admission rates declined significantly in children with a first admission after two years of age. However, an increasing admission trend was observed in children aged less than one year and 35% of first admissions occurred in this age group. The annual increase was 3.8% (95% CI 1.3–6.3) in boys and 5.0% (95% CI 2.4–7.6) in girls. A diagnostic shift appeared to occur when ICD-10 was introduced in 1997. The asthma and pneumonia admission rate in children aged less than one year levelled off, whereas the increase in admissions for bronchitis continued. The re-admission rates for asthma decreased and the probability of re-admission was higher in boys. National drug statistics demonstrated a substantial increase in the delivery of inhaled steroids to all age groups but most prescriptions occurred to children aged one year or more. CONCLUSION: Hospital admissions for lower respiratory illness are still increasing in children aged <1 year. Our findings are in line with other recent studies suggesting a change in the responsiveness to viral infections in very young children, but changes in admission criteria cannot be excluded. An increased use of inhaled steroids may have contributed to decreasing re-admission rates

Strategier vid utvärdering av hälsorisker baserade på två arbetarekohorter från norra Sverige

Background: Studies based on a cohort design requires access to both subject-specific and period-specific information. In order to conduct an occupational cohort study, access to exposure information and the possibility and permission to link information on outcomes from other registers are generally necessary. The analysis phase is also aggravated by its added complexity because of the longitudinal dimension of the cohort’s data.This thesis aims at increasing the knowledge on hazards from work on fatalities and cancer within the domain of cohort studies on miners and metal refiners and to study the complexity of the analysis by discussing and suggesting analytical strategies. Methods: The study population for this thesis consisted of a cohort of 2264 blue-collar aluminium smelter workers (paper I) and a cohort of 13000 blue-collar iron-ore miners (papers II-IV), both followed for over 50 years. The outcomes were collected from the Swedish Cause of Death Register and the Swedish Cancer Register. The primary methods of analysis were either Standardized Morbidity Ratios (SMR) or internal comparisons based on Cox or Poisson regression modeling. In paper IV, a g-estimation based on an accelerated failure-time model was performed to estimate the survival ratio. Results: The results from paper I suggested that working as a blue-collar worker metal refiner was associated with increased rates of incidental lung cancer. Elevated rates among short term workers were observed for several outcomes. Paper I also showed that the choice of reference population when calculating SMR could influence the conclusions of the results. In paper II, several outcomes were elevated among the miners compared to the reference population from northern Sweden. However, no outcome except lung cancer was associated with cumulative employment time. The most recurrent pattern of the results was the negative association between cumulative employment time underground and several outcomes. The results from paper III showed that cumulative employment time working outdoors was associated with increased rates of cerebrovascular disease mortality. However, employment with heavy physical workloads did not explain the previously observed decreasing rates in the selected groups of outcomes. The adjustment for the healthy worker survivor effect by g-estimation in paper IV suggested that exposure from respirable dust was associated with elevated mortality risks that could not be observed with standard analytical methods. Conclusion: Our studies found several rates from the cohorts that were elevated compared to external refererence populations but also that long term employments generally were associated with decreasing rates. Furthermore, incidental lung cancer rates was found elevated for the metal refiners. Among the miners, mortality rates of cerebrovascular diseases depended on if work was performed outdoor (higher rates) or underground (lower rates). Methodologically, this thesis has discussed different analytical strategies for handling confounding in occupational cohort studies. Paper IV showed that the healthy worker survivor effect could be adjusted for by performing g-estimation

Myocardial infarction and cardiac regulation in relation to vibration exposure

The purpose of this thesis was to assess the possible risk of myocardial infarction in work entailing exposure to vibration, and to study whether there is any relation between short-term exposure to vibration and cardiac regulation. Epidemiological methods were applied to investigate a possible association between occupational exposure to vibration and myocardial infarction. Two study populations were used; one case-control study (n=475) and one cohort of iron-ore miners in Kiruna and Malmberget, Sweden (n=13621). In the former, the cases were first-time myocardial infarction patients and the controls were selected to match for sex, age and hospital catchment area. Job-exposure matrixes for vibration were established for both the case-control study and the cohort study. In order to study acute effects on cardiac regulation, an experimental study was conducted on healthy subjects (n=20) who were exposed to hand-arm vibration exclusively and in combination with exposure to noise. The effect on the autonomic balance was measured by heart rate-variability. In the case-control study, an increased risk of contracting myocardial infarction was found among occupations entailing vibration exposure. The results from the cohort show an increased risk of myocardial infarction mortality compared to a reference population. The increment was higher for those younger than 60 years. Relative risks for myocardial infarction mortality increased with increasing exposure to vibration in the group at working-age and the increased risk remained after adjusting for exposure to dust. In the experimental study, exposure to hand-arm vibration was found to acutely affect the autonomic nervous system as the total heart-rate variability decreased during exposure to hand-arm vibration. To conclude: work entailing exposure to vibration is a risk factor for myocardial infarction, increased myocardial infarction mortality attributed to exposure to vibration seems to be mainly observed at working-age, and exposure to hand-arm vibration acutely decreases heart-rate variability and thus affects heart-rate regulation

The elderly patient's experience of care based on a person-centered perspective : A literature review

Bakgrund: Den äldre individen kommer att bli en allt större grupp av befolkning. Med en stigande ålder ökar även risken av att drabbas av en eller flera sjukdomar, vilket kommer att ställa högre krav på sjukvården. Svensk lag säger att vården har en skyldighet att främja patientens integritet, delaktighet och självbestämmande, dock brister detta inom vården av de äldre. Många komplexa sjukdomstillstånd hos en äldre person gör att omvårdnaden behöver ges utifrån patientens individuella behov. Personcentrerad omvårdnad handlar om ett partnerskap mellan individen och vårdpersonalen, där individen sätts i centrum för vården. Syfte: Att belysa den äldre patientens upplevelse av vård utifrån ett personcentrerat perspektiv. Metod: Examensarbetet är utformat som en litteraturöversikt. Artiklar söktes fram via databaserna CINAHL och PubMed, 13 artiklar med kvalitativ metod valdes ut. Resultat: Resultatet visade att det fanns likheter och skillnader i hur den äldre upplevde sin vård: Dessa upplevelser kunde delas in i tre huvudkategorier, nämligen självbestämmande, delaktighet och integritet. Den äldre patienten hade en längtan efter självständighet och självbestämmande, dock slogs detta tillbaka på grund av en tids- och kompetensbristande vård. De äldre hade en önskan om att vara delaktiga i sin vård, där relationen och kommunikationen var en viktig grund för att skapa delaktighet. Många av de äldre kände sig ej bekräftade som en unik individ av omvårdnadspersonalen. Slutsats: För att kunna främja de äldres roll i en personcentrerad vård måste ett helhetsperspektiv och ett personcentrerat förhållningssätt appliceras, där den äldre respekteras som en unik individ. Med den äldre individen i centrum för sin vård, stärks dennes rätt till självbestämmande, delaktighet samt integritet, som i sin tur kan leda till en ökad livskvalité.Background: The elderly is a group that will be a major part of the population in the future. With increasing age, the risk of suffering from one or more diseases increases, which will place higher demands on healthcare. Swedish law states that healthcare has an obligation to promote patient integrity, participation and self-determination, but this is invalid in the care of the elderly. Many complex illnesses in an elderly person necessitate nursing based on the patient's individual needs. Person-centered nursing is about a partnership between the individual and healthcare staff, where the individual is at the center of care. Aim: To highlight the elderly patient's experience of care based on a person-centered perspective. Method: A literature review was conducted and the data was found in the databases CINAHL and PubMed, 13 articles with qualitative method were selected. Result: The results showed that there were similarities and differences in how the elderly patient experiences their care. These experiences can be divided into three main categories: self-determination, participation and integrity. The elderly patient had a longing for independence and self-determination, however, this was reversed due to a lack of time and competence shortage. The elderly had a desire to be involved in their care, where the relationship and communication were an important basis for creating participation. Many of the elderly did not feel confirmed as a unique individual of nursing staff. Conclusion: In order to promote the role of the elderly in their care, must a holistic perspective and a person-centered approach be applied, where the elderly is respected as a unique individual. With the older individual at the heart of his care, his right to self-determination, participation and integrity is strengthened, which in turn can lead to an increased quality of life

A retrospective population based trend analysis on hospital admissions for lower respiratory illness among Swedish children from 1987 to 2000

Abstract Background Data relating to hospital admissions of very young children for wheezing illness have been conflicting. Our primary aim was to assess whether a previous increase in hospital admissions for lower respiratory illness had continued in young Swedish children. We have included re-admissions in our analyses in order to evaluate the burden of lower respiratory illness in very young children. We have also assessed whether changes in the labelling of symptoms have affected the time trend. Methods A retrospective, population based study was conducted to assess the time trend in admissions and re-admissions for lower respiratory illness. Data were obtained from the Swedish Hospital Discharge Register for all children with a first hospital admission before nine years of age, a total of 109,176 children. The register covers more than 98% of all hospital admissions in Sweden. The coding of diagnoses was based on ICD-9 from 1987 to 1996 and ICD-10 from 1997. Results The first admission rates declined significantly in children with a first admission after two years of age. However, an increasing admission trend was observed in children aged less than one year and 35% of first admissions occurred in this age group. The annual increase was 3.8% (95% CI 1.3–6.3) in boys and 5.0% (95% CI 2.4–7.6) in girls. A diagnostic shift appeared to occur when ICD-10 was introduced in 1997. The asthma and pneumonia admission rate in children aged less than one year levelled off, whereas the increase in admissions for bronchitis continued. The re-admission rates for asthma decreased and the probability of re-admission was higher in boys. National drug statistics demonstrated a substantial increase in the delivery of inhaled steroids to all age groups but most prescriptions occurred to children aged one year or more. Conclusion Hospital admissions for lower respiratory illness are still increasing in children aged <1 year. Our findings are in line with other recent studies suggesting a change in the responsiveness to viral infections in very young children, but changes in admission criteria cannot be excluded. An increased use of inhaled steroids may have contributed to decreasing re-admission rates.</p

Klimatdeklaration i praktiken : En studie om tillämpning av klimatdeklarationen

Sweden has set a goal to be climate neutral by 2045. To be able to reach that goal, theconstruction and real estate sector must go through a change. In 2018 the construction and realestate sector produced one fifth of Sweden´s emissions of greenhouse gases. On the first ofJanuary 2022, a new law will be introduced in Sweden. The new law says that all new buildingsmust have a climate declaration. The Swedish government has hopes that the law will decreasethe emission of greenhouse gases.The purpose of this thesis is to investigate how the challenges that the law brings with it can behandled. Calculations have been made with the purpose to investigate uncertainties and flawswith the data supposed to be used for the calculations in a climate declaration.The study shows that the new law will not force the construction and real estate sector to makeany major changes, since there will not be any limits that regulates climate impact. Results fromthe theoretical study shows that the deviation that occurs when generic data is used instead ofspecific data is bigger than the potential reduction of environmental impact from measures thatreduces climate impact. When more construction products have an environmental productdeclaration and they are being used to a greater extent, the deviations will decrease. Itappeares in the calculations that most of the climate impact occurs during the supply of goodsand product manufacturing. The climate impact from transports is marginal in comparison

Hälsorelaterad miljöövervakning. : Cancerframkallande ämnen i tätortsluft i Umeå 2021

Undersökningen kartlägger allmänbefolkningens exponering via luften för vissa cancerframkallande ämnen (bensen, 1,3-butadien, formaldehyd) och kvävedioxid. Undersökningen genomfördes i centrala Umeå under hösten 2021, och inkluderade totalt 40 slumpvis utvalda personer i åldrarna 20-60 år.Mätningarna upprepades på 20 personer. Utöver de personburna mätningarna genomfördes även stationära mätningar på två platser utomhus. Svarsfrekvensen var 61% och medelåldern var 41 år. Medianhalten för personburna mätningar av bensen och 1,3-butadien var 0,57 µg/m3respektive 0,03µg/m3 vilket är lägre än tidigare mätomgångar i Umeå. Motsvarande medianhalt för formaldehyd var 8,3µg/m3, där halterna var högre bland de som bodde i radhus eller villa jämfört med lägenhet. Medianhalten för de personburna mätningarna av kvävedioxid var 7,6 µg/m3, vilket var i samma storleksordning uppmätt i Umeå 2001, men lägre än övriga mättillfällen. Ingen signifikant skillnad i halter för något av ämnena kunde påvisas mellan män och kvinnor.De stationära mätningarna genomfördes som veckomätningar vid kommunens urbana bakgrundsstationsamt vid en gatustation. Medianhalt av bensen, 1,3-butadien, formaldehyd samt kvävedioxid vid respektive mätstation var samtliga lägre jämfört med tidigare å