Intelligence and cardiovascular health : epidemiological studies of swedish men

Aim: A first aim of this thesis was to examine the relationship between intelligence in early adulthood and health outcomes, mainly cardiovascular morbidity and mortality, CVD, later in life using register-based data on Swedish men. A second aim was to increase understanding of the pathways between intelligence and CVD morbidity/mortality by studying the association between intelligence and smoking habits and nicotine dependence, who might act as mediators of the association between intelligence and mortality. Material and methods: The study populations in this thesis were created through record linkage of several national registers where IQ was collected from the Military Conscription Register. The analyses were based on all Swedish men born 1951 to 1984, depending on the paper, that went through conscription examinations. Also, for paper II parents of the men were analysed. Paper IV and V were based on Swedish male twins. The association between IQ and mortality was analyzed with Cox proportional hazards regression and conditional logistic regression models. The association between IQ and smoking status was analysed with linear, logistic and polytomous regression models and the association between IQ and nicotine dependence with quantitative genetic analyses. Results: In general, paper I-III support previous research about inverse associations between IQ and CVD morbidity/mortality. In addition to previous research our results revealed that IQ was associated with coronary heart disease, CHD, independently of socioeconomic position, SEP, (paper I) and that IQ was inversely and significantly associated with major subtypes of stroke (paper III). The strongest association found for hemorrhagic stroke. Further, the effect of IQ on mortality was found to be present also when offspring IQ was used as a proxy for parental IQ (paper II). In paper IV and V when the association of IQ and smoking and nicotine dependence was studied no evidence of a causal association was found. In paper IV smoking was associated with IQ but appeared to be the result of early environmental factors rather than resulting from a causal effect of intelligence. In paper V both IQ and nicotine dependence showed moderate heritability (0.58 and 0.39 respectively); however the phenotypic correlation was marginal (-0.08) and the overlap between genetic factors influencing IQ and nicotine dependence was small (-0.19). Conclusion: In this thesis, inverse associations between IQ score at the age of 18 and mortality later in life, mainly CVD, is presented. These associations were found within all socioeconomic strata, were robust to adjustment for indicators of SEP in childhood and adulthood and were present also when using offspring IQ as a proxy for parental IQ. Further, our results gave no support for IQ to be causally associated with smoking or that smoking or nicotine dependence act as important mediators of the IQ-CVD association. Finally, no evidence was provided for a common genetic factor behind IQ and nicotine dependence. This thesis provides information about the pathways of intelligence and mortality. However, more research is needed before any conclusions can be drawn with regard to public health policy

Energy management in Swedish pulp and paper industry - the daily grind that matters

The Swedish pulp and paper industry (PPI) accounts for almost 50 percent of industrial final energy use. It is an energy-intensive industry and process optimization is seen as prerequisite to compete on the global market. This alone should motivate company boards and on-site organisations to put energy management high on the agenda. Definitely, from time to time, energy issues (e.g. fuel shifts, selling of generation capacity, and more lately increasing auto-produced electricity) have been managed with respect to combined effects of policies and market forces. Yet, it was first after 2004 that the industry implemented energy management systems (EnMS), with particular focus on energy efficiency, and received certification according to the Swedish and later the European standard. This was required by the Programme for improving energy efficiency in energy-intensive industries (PFE), a five-year voluntary agreement in which some 100 companies reported gross annual electricity savings of 1.45 TWh, equal to 5 percent of base year consumption. This result highlights the potential role of an EnMS in raising awareness and facilitating investments. In this paper we analyse the case of the Swedish PPI; its relation to energy issues in previous periods and the formalised EnMS practices of recent years. We pose the questions: How are standardised EnMS structured and put into practice? What are the measurable effects and other discernible outcomes? The results are based on in-depth interviews with energy management coordinators at eight pulp and paper mills. The experiences with EnMS are found to be predominantly positive. EnMS has changed organisational structures and created greater focus on energy efficiency, which has resulted in quantified energy savings. Considering that EnMS implementation and certification is at a pioneering stage and that the international ISO 50001 standard is currently being developed, these are important results for the future of EnMS in industry

Number of siblings and survival from childhood leukaemia : a national register-based cohort study from Sweden

Background: Previous studies suggest worse leukaemia survival for children with siblings, but the evidence is sparse, inconsistent and does not consider clinical factors. We explored the associations between number of siblings in the household, birth order, and survival from childhood acute lymphoid leukaemia (ALL) and acute myeloid leukaemia (AML). Methods: In this nationwide register-based study we included all children aged 1-14, diagnosed with ALL and AML between 1991-mid 2015 in Sweden (n=1692). Using Cox regression models, we estimated hazard ratios (HRs) and 95% confidence intervals (CIs) according to number of siblings and birth order, adjusting for known prognostic and sociodemographic factors. Results: A tendency towards better ALL survival among children with one, or ≥2, siblings was observed, adjHRs (95% CI): 0.73 (0.49-1.10) and 0.63 (0.40-1.00), respectively. However, this was mainly limited to children with low risk profiles. An indication of better AML survival among children with siblings was seen, adjHRs (95% CI) 0.68 (0.36-1.29) and 0.71 (0.34-1.48) but diminished after adjusting for birth order. Conclusion: Our results do not support previous findings that a larger number of siblings is associated with poorer survival. Inconsistencies might be explained by underlying mechanisms that differ between settings, but chance cannot be ruled out.The Swedish Research Council for Health, Working Life and Welfare (contract no. 2013-1072)Accepte

Declining incidence trends for hip fractures have not been accompanied by improvements in lifetime risk or post-fracture survival – A nationwide study of the Swedish population 60years and older

Background: Hip fracture is a common cause of disability and mortality among the elderly. Declining incidence trends have been observed in Sweden. Still, this condition remains a significant public health problem since Sweden has one of the highest incidences worldwide. Yet, no Swedish lifetime risk or survival trends have been presented. By examining how hip fracture incidence, post-fracture survival, as well as lifetime risk have developed between 1995 and 2010 in Sweden, this study aims to establish how the burden hip fractures pose on the elderly changed over time, in order to inform initiatives for improvements of their health. Material and Methods: The entire Swedish population 60 years-old and above was followed between 1987 and 2010 in the National Patient Register and the Cause of Death Register. Annual age-specific hip fracture cumulative incidence was estimated using hospital admissions for hip fractures. Three-month and one-year survival after the first hip fracture were also estimated. Period life table was used to assess lifetime risk of hip fractures occurring from age 60 and above, and the expected mean age of the first hip fracture. Results: The age-specific hip fracture incidence decreased between 1995 and 2010 in all ages up to 94 years, on average by 1% per year. The lifetime risk remained almost stable, between 9% and 11% for men, and between 18% and 20% for women. The expected mean age of a first hip fracture increased by 2.5 years for men and by 2.2 years for women. No improvements over time were observed for the 3-month survival for men, while for women a 1% decrease per year was observed. The 1-year survival slightly increased over time for men (0.4% per year) while no improvement was observed for women. Conclusions: The age-specific hip fracture incidence has decreased over time. Yet the lifetime risk of a hip fracture has not decreased because life expectancy in the population has increased in parallel. Overall, survival after hip fracture has not improved

Survival After Childhood Cancer–Social Inequalities in High-Income Countries

Despite substantial improvements in survival from childhood cancer during the last decades, there are indications that survival rates for several cancer types are no longer improving. Moreover, evidence accumulates suggesting that socioeconomic and sociodemographic factors may have an impact on survival also in high-income countries. The aim of this review is to summarize the findings from studies on social factors and survival in childhood cancer. Several types of cancer and social factors are included in order to shed light on potential mechanisms and identify particularly affected groups. A literature search conducted in PubMed identified 333 articles published from December 2012 until June 2018, of which 24 fulfilled the inclusion criteria. The findings are diverse; some studies found no associations but several indicated a social gradient with higher mortality among children from families of lower socioeconomic status (SES). There were no clear suggestions of particularly vulnerable subgroups, but hematological malignancies were most commonly investigated. A wide range of social factors have been examined and seem to be of different importance and varying between studies. However, potential underlying mechanisms linking a specific social factor to childhood cancer survival was seldom described. This review provides some support for a relationship between lower parental SES and worse survival after childhood cancer, which is a finding that needs further attention. Studies investigating predefined hypotheses involving specific social factors within homogenous cancer types are lacking and would increase the understanding of mechanisms involved, and allow targeted interventions to reduce health inequalities

Municipal policies and plans of action aiming to promote physical activity and healthy eating habits among schoolchildren in Stockholm, Sweden: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Promoting physical activity and healthy eating habits by structural measures that reach most children in a society is presumably the most sustainable way of preventing development of overweight and obesity in childhood. The main purpose of the present study was to analyse whether policies and plans of action at the central level in municipalities increased the number of measures that aim to promote physical activity and healthy eating habits among schoolchildren aged six to 16. Another purpose was to analyse whether demographic and socio-economic characteristics were associated with the level of such measures.</p> <p>Methods</p> <p>Questionnaires were used to collect data from 25 municipalities and 18 town districts in Stockholm County, Sweden. The questions were developed to capture municipal structural work and factors facilitating physical activity and the development of healthy eating habits for children. Local policy documents and plans of action were gathered. Information regarding municipal demographic and socio-economic characteristics was collected from public statistics.</p> <p>Results</p> <p>Policy documents and plans of action in municipalities and town districts did not seem to influence the number of measures aiming to promote physical activity and healthy eating habits among schoolchildren in Stockholm County. Municipal demographic and socio-economic characteristics were, however, shown to influence the number of measures. In town districts with a high total population size, and in municipalities and town districts with a high proportion of adults with more than 12 years of education, a higher level of health-promoting measures was found. In municipalities with a high annual population growth, the number of measures was lower than in municipalities with a lower annual population growth. Another key finding was the lack of agreement between what was reported in the questionnaires regarding existence and contents of local policies and plans of action and what was actually found when these documents were scrutinized.</p> <p>Conclusion</p> <p>Policy documents and plans of action aiming to promote physical activity and healthy eating habits among schoolchildren aged six to 16 in municipalities and town districts in Stockholm County did not seem to have an impact on the local level of measures. Demographic and socio-economic characteristics of the municipalities and town districts were on the other hand associated with local health-promoting measures.</p

The rise in the number of long-term survivors from different diseases can slow the increase in life expectancy of the total population

Background!#!Recent improvements in life expectancy in many countries stem from reduced mortality from cardiovascular disease and cancer above the age of 60. This is the combined result of decreased incidence and improved survival among those with disease. The latter has led to a higher proportion in the population of people with a past history of disease. This is a group with higher mortality than the general population. How growing shares of persons with past history of disease and improved survival with disease have affected changes in life expectancy of the total population is the objective of this paper.!##!Methods!#!Using register data for the total Swedish population, we stratified the population based on whether individuals have been diagnosed with myocardial infarction, stroke, hip fracture, colon cancer, or breast cancer. Using a novel decomposition approach, we decomposed the changes in life expectancy at age 60 between 1994 and 2016 into contributions from improved survival with disease and from changes in proportion of people with past history of disease.!##!Results!#!Improvements in survival from disease resulted in gains of life expectancy for the total population. However, while the contributions to life expectancy improvements from myocardial infarction, stroke and breast cancer were substantial, the contributions from the other diseases were minor. These gains were counteracted, to various degrees, by the increasing proportion of people with raised mortality due to a past history of disease. For instance, the impact on life expectancy by improved survival from breast cancer was almost halved by the increasing share of females with a past history of breast cancer.!##!Conclusion!#!Rising numbers of survivors of different diseases can slow the increase in life expectancy. This dynamic may represent the costs associated with successful treatment of diseases, and thus, a potential 'failure of success.' This dynamic should be considered when assessing mortality and life expectancy trends. As populations are aging and disease survival continues to improve, this issue is likely to become even more important in the future

Nationwide data on home care and care home residence: presentation of the Swedish Social Service Register, its content and coverage

Aims: All Swedish municipalities are legally obliged to provide publicly funded eldercare to individuals in need. The Swedish Social Service Register collects data on such care. It is the only nationwide source of information on care home residency and use of home care but has rarely been used for research. This study aims to present the content and coverage of the Social Service Register and to provide guidance for researchers planning to use these data. Methods: For each month between 2013and 2020, we examined which of Sweden’s 290 municipalities reported data to the Social Service Register. We calculated proportions of the population (restricted to ages 80–89 years to enable comparison) that were reported to the Social ServiceRegister in each municipality and presented the types and amount of care recorded in the register. Results: The proportion of municipalities reporting to the Social Service Register increased from 82% to 98% during the study period but several municipalities reported fragmentarily and inconsistently, particularly during earlier years. Among municipalities reporting to the Social Service Register, 9% of the population aged 80–89 years resided in care homes and 19% received home care, but the registered amount and types of care varied substantially between municipalities and over time. Conclusions: The Swedish Social Service Register provides valuable data for research on aging and eldercare utilization, but data should be selected and vetted carefully, especially for earlier years. The amount and types of care may not always be comparable between geographical regions and different time periods. In recent years, however, the coverage of the Social Service Register is good