Excess use of Temporary Parental Benefit

In this report we examine the excess use of Temporary Parental Benefit for parents who need to stay home from work when their children are sick. This study is based on a randomized experiment that took place during the spring 2006. The method used is rather new and more ambitious than those used in similar studies in the past. One advantage with this more elaborate technique is that a larger part of the veiled excessive use can be discovered. The result points to that as much as 22.5 percent of the costs for this social insurance are due to excess use. There are significant gender differences; women’s excess use amounts to 19 percent of their total use while the corresponding figure for men is 28 percent.Temporary Parental Benefit; randomized experiment

Influence of human caregiving-style on dogs´ reaction to a sudden noise

The bond between an owner and its dog have remarkable similarities with the one between a child and a parent. The attachment between a child and its parent is considered as a fundamental constitution that is based upon that a child needs a safe haven for support and comfort and a secure base to explore the world, even in new and strange situations. Different caregiving -styles in the parent provide different attachment styles for the child. A secure attachment can be seen in children who have a parent that is sensitive for the child’s needs and makes an effort trying to provide for them properly. There are indications that the same types of attachment styles are to be seen between owners and their dogs. It is a possibility that the owners´ caregiving -style affect the dogs´ attachment style and thereby the dogs´ reaction to stressful situations. In the ”Strange Situations Procedure” (SSP), developed by Mary Ainsworth, the attachment between a child and parent can be assessed and categorised into four different styles; secure, insecure avoidant, insecure ambivalent and unpredictable/disorganized. Lately this procedure has been modified and used for studies trying to observe the same types of attachment between an owner and its dog. In this study it was tested if two different caregiving -styles, the secure and the unpredictable/disorganized, affected the dogs to show different responses in a situation with a sudden noise stressor. The results did not show any difference in heart rate changes which could have been a physiological indicator for stress in the dogs. Some differences could be seen in the behaviour of dogs in presence of the different handlers. During the noise stressor the dogs were more focused on the noise in presence of the secure handler. This could be seen as they were trying to find out the source of the noise. After the noise had stopped the dogs showed more behaviours of exploration, as sniffing and manipulating in the environment, and kept themselves closer to the unpredictable handler. Possibly because they felt more distressed in the situation since the handlers´ behaviour indicated vigilance. The results suggested that the secure handler promoted the dogs to more calm behaviours since the dogs showed more signs of distress, as restlessness and lip-licking, in the presence of the unpredictable handler in general. The differences were not completely according to the ones that has been seen between a child and a parent with secure and unpredictable attachment respectively and thereby do not support the theory that they show the same kind of attachment. It is necessary to further study the possibility that human caregiving -style can affect attachment -style and coping strategies in dogs to help them better handle stressful situations. That could promote better welfare for the dogs and a better human-dog relationship

How does comorbidity influence healthcare costs? A population-based cross-sectional study of depression, back pain and osteoarthritis

Objectives To analyse how comorbidity among patients with back pain, depression and osteoarthritis influences healthcare costs per patient. A special focus was made on the distribution of costs for primary healthcare compared with specialist care, hospital care and drugs. Design Population-based cross-sectional study. Setting The County of Östergötland, Sweden. Patients Data on diagnoses and healthcare costs for all 266 354 individuals between 20 and 75 years of age, who were residents of the County of Östergötland, Sweden, in the year 2006, were extracted from the local healthcare register and the national register of drug prescriptions. Main outcome measures The effects of comorbidity on healthcare costs were estimated as interactions in regression models that also included age, sex, number of other health conditions and education. Results The largest diagnosed group was back pain (11 178 patients) followed by depression (7412 patients) and osteoarthritis (5174 patients). The largest comorbidity subgroup was the combination of back pain and depression (772 patients), followed by the combination of back pain and osteoarthritis (527 patients) and the combination of depression and osteoarthritis (206 patients). For patients having both a depression diagnosis and a back pain diagnosis, there was a significant negative interaction effect on total healthcare costs. The average healthcare costs among patients with depression and back pain was SEK 11 806 lower for a patient with both diagnoses. In this comorbidity group, there were tendencies of a positive interaction for general practitioner visits and negative interactions for all other visits and hospital days. Small or no interactions at all were seen between depression diagnoses and osteoarthritis diagnoses. Conclusions A small increase in primary healthcare visits in comorbid back pain and depression patients was accompanied with a substantial reduction in total healthcare costs and in hospital costs. Our results can be of value in analysing the cost effects of comorbidity and how the coordination of primary and secondary care may have an impact on healthcare costs

COPD and the Risk of Tuberculosis - A Population-Based Cohort Study

BACKGROUND: Both chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) primarily affect the lungs and are major causes of morbidity and mortality worldwide. COPD and TB have common risk factors such as smoking, low socioeconomic status and dysregulation of host defence functions. COPD is a prevalent co-morbid condition, especially in elderly with TB but in contrast to other diseases known to increase the risk of TB, relatively little is known about the specific relationship and impact from COPD on TB-incidence and mortality. METHODS AND FINDINGS: All individuals > or = 40 years of age, discharged with a diagnosis of COPD from Swedish hospitals 1987-2003 were identified in the Swedish Inpatient Register (n = 115,867). Records were linked to the Swedish Tuberculosis Register 1989-2007 and the relative risk of active TB in patients with COPD compared to control subjects randomly selected from the general population (matched for sex, year of birth and county of residence) was estimated using Cox regression. The analyses were stratified by year of birth, sex and county of residence and adjusted for immigration status, socioeconomic status (SES) and inpatient co-morbidities previously known to increase the risk of TB. COPD patients had a three-fold increased hazard ratio (HR) of developing active TB (HR 3.0 (95% confidence interval 2.4 to 4.0)) that was mainly dependent on an increased risk of pulmonary TB. In addition, logistic regression estimates showed that COPD patients who developed active TB had a two-fold increased risk of death from all causes within first year after the TB diagnosis compared to the general population control subjects with TB (OR 2.2, 95% confidence interval 1.2 to 4.1). CONCLUSIONS: This population-based study comprised of a large number of COPD patients shows that these patients have an increased risk of developing active TB compared to the general population. The results raise concerns that the increasing global burden of COPD will increase the incidence of active TB. The underlying contributory factors need to be disentangled in further studies

Does paying pay off?

The ongoing degradation of ecosystems threaten future food production and the international community thus urgently has to plan for how to secure fundamental life-support services for the future, so called ecosystem services (ES). Examples of such ES are climate regulation, nutrient cycles, fresh water provision, etc.This report is focused on two distinct strategies to make land users in tropical rainforest areas continue to provide ecosystem services. The first approach, Payment for Ecosystem Services (PES), is an economic instrument designed at global and national levels. Several PES schemes are currently implemented in a global context where increasing human demands for food, fibre and fuel are accelerating competition for land. The overall aim of the PES projects covered by this report is to lower the emission of green house gas on national and global levels and they are especially directed towards forest areas. The PES projects specify that specific rural groups are paid if they agree to protect, manage or restore the ecosystem service provisioning system within their forest territories. This report highlights that many PES initiatives are being implemented with a ‘conservation perspective’, rather than seeing ecosystem services as integrated with production and livelihoods. There are also alternative strategies to manage ecosystem services. In this report we put an emphasis on an approach where production and conservation are planned for within the same landscape and production systems. Many smallholders already integrate and maintain ecosystem services in their agricultural/forest production systems in a long-term perspective, while producing food, fibre and fuel for the households’ own consumption as well as for sale. In such a system, the local communities are totally dependent on the ecosystem services to re-generate conditions for their agricultural production and/or forest extraction. The focus in such farming-forestry systems, using little or no inputs, which are totally dependent on renewable resources, is on how to increase agricultural/forest production by supporting local ecosystem services, such as soil fertility and structure, pollination, micro climate, biological control of crop pests, etc. The ecosystem services functions, such as carbon sequestration, then emerge as a ‘by-product’ out of these production systems. Increased soil humus in the soil and biomass accumulation are other examples of such ‘by-products’. We want to illustrate potentials and challenges with the aforementioned two approaches to secure ecosystem provisions, and how they are articulated within their specific contexts. This report explores these two approaches by examining case-studies in tropical forest areas in Peru, Brazil, Tanzania and Vietnam, as well as the experiences of EU-designed PES schemes for subsidies/support so as to achieve environmental protection in Sweden

In Silico Detection of Sequence Variations Modifying Transcriptional Regulation

Identification of functional genetic variation associated with increased susceptibility to complex diseases can elucidate genes and underlying biochemical mechanisms linked to disease onset and progression. For genes linked to genetic diseases, most identified causal mutations alter an encoded protein sequence. Technological advances for measuring RNA abundance suggest that a significant number of undiscovered causal mutations may alter the regulation of gene transcription. However, it remains a challenge to separate causal genetic variations from linked neutral variations. Here we present an in silico driven approach to identify possible genetic variation in regulatory sequences. The approach combines phylogenetic footprinting and transcription factor binding site prediction to identify variation in candidate cis-regulatory elements. The bioinformatics approach has been tested on a set of SNPs that are reported to have a regulatory function, as well as background SNPs. In the absence of additional information about an analyzed gene, the poor specificity of binding site prediction is prohibitive to its application. However, when additional data is available that can give guidance on which transcription factor is involved in the regulation of the gene, the in silico binding site prediction improves the selection of candidate regulatory polymorphisms for further analyses. The bioinformatics software generated for the analysis has been implemented as a Web-based application system entitled RAVEN (regulatory analysis of variation in enhancers). The RAVEN system is available at http://www.cisreg.ca for all researchers interested in the detection and characterization of regulatory sequence variation

Development of an electronic frailty index for hospitalized older adults in Sweden

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Two Years with COVID-19 : The Electronic Frailty Index Identifies High-Risk Patients in the Stockholm GeroCovid Study

INTRODUCTION: Frailty, a measure of biological aging, has been linked to worse COVID-19 outcomes. However, as the mortality differs across the COVID-19 waves, it is less clear whether a medical record-based electronic frailty index (eFI) that we have previously developed for older adults could be used for risk stratification in hospitalized COVID-19 patients. OBJECTIVES: The aim of the study was to examine the association of frailty with mortality, readmission, and length of stay in older COVID-19 patients and to compare the predictive accuracy of the eFI to other frailty and comorbidity measures. METHODS: This was a retrospective cohort study using electronic health records (EHRs) from nine geriatric clinics in Stockholm, Sweden, comprising 3,980 COVID-19 patients (mean age 81.6 years) admitted between March 2020 and March 2022. Frailty was assessed using a 48-item eFI developed for Swedish geriatric patients, the Clinical Frailty Scale, and the Hospital Frailty Risk Score. Comorbidity was measured using the Charlson Comorbidity Index. We analyzed in-hospital mortality and 30-day readmission using logistic regression, 30-day and 6-month mortality using Cox regression, and the length of stay using linear regression. Predictive accuracy of the logistic regression and Cox models was evaluated by area under the receiver operating characteristic curve (AUC) and Harrell's C-statistic, respectively. RESULTS: Across the study period, the in-hospital mortality rate decreased from 13.9% in the first wave to 3.6% in the latest (Omicron) wave. Controlling for age and sex, a 10% increment in the eFI was significantly associated with higher risks of in-hospital mortality (odds ratio = 2.95; 95% confidence interval = 2.42-3.62), 30-day mortality (hazard ratio [HR] = 2.39; 2.08-2.74), 6-month mortality (HR = 2.29; 2.04-2.56), and a longer length of stay (β-coefficient = 2.00; 1.65-2.34) but not with 30-day readmission. The association between the eFI and in-hospital mortality remained robust across the waves, even after the vaccination rollout. Among all measures, the eFI had the best discrimination for in-hospital (AUC = 0.780), 30-day (Harrell's C = 0.733), and 6-month mortality (Harrell's C = 0.719). CONCLUSION: An eFI based on routinely collected EHRs can be applied in identifying high-risk older COVID-19 patients during the continuing pandemic.publishedVersionPeer reviewe