Ett landskap i förändring - en analys av attityder kring planprogrammet för Hammarbyhöjden - Björkhagen

This essay aims to find out what attitudes might exist in relation to the planning of the city districts Hammarbyhöjden and Björkhagen, located in the southern parts of Stockholm. The theoretical framework is built around theories of landscape - how we define it and use it. The material used and analysed is partly constituted of the official planning documents created by Stockholms stad, and partly coming from interviews, Facebook and answers to a survey created by the author. What comes forth in the discussion of the material is that even though landscape might be difficult to put into words in its exact definition and use we are able to use it in other ways. Perhaps mainly in this specific case to locate what values in the landscape can be appreciated by the people who live there. This knowledge might be used to a further extent by urban city planners when trying to reach a dialogue with residents

Patient throughput times and inflow patterns in Swedish emergency departments. A basis for ANSWER, A National SWedish Emergency Registry

Objective: Quality improvement initiatives in emergency medicine (EM) often suffer from a lack of benchmarking data on the quality of care. The objectives of this study were twofold: 1. To assess the feasibility of collecting benchmarking data from different Swedish emergency departments (EDs) and 2. To evaluate patient throughput times and inflow patterns. Method: We compared patient inflow patterns, total lengths of patient stay (LOS) and times to first physician at six Swedish university hospital EDs in 2009. Study data were retrieved from the hospitals' computerized information systems during single on-site visits to each participating hospital. Results: All EDs provided throughput times and patient presentation data without significant problems. In all EDs, Monday was the busiest day and the fewest patients presented on Saturday. All EDs had a large increase in patient inflow before noon with a slow decline over the rest of the 24 h, and this peak and decline was especially pronounced in elderly patients. The average LOS was 4 h of which 2 h was spent waiting for the first physician. These throughput times showed a considerable diurnal variation in all EDs, with the longest times occurring 6-7 am and in the late afternoon. Conclusion: These results demonstrate the feasibility of collecting benchmarking data on quality of care targets within Swedish EM, and form the basis for ANSWER, A National SWedish Emergency Registry

Concomitant homozygosity for the prothrombin gene variant with mild deficiency of antithrombin III in a patient with multiple hepatic infarctions: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hereditary causes of visceral thrombosis or thrombosis should be sought among young patients. We present a case of a young man presenting with multiple hepatic infarctions resulting in portal hypertension due to homozygosity of the prothrombin gene mutation not previously described in literature.</p> <p>Case presentation</p> <p>A 42-year-old Caucasian man with a previous history of idiopathic deep vein thrombosis 11 years earlier presented with vague abdominal pains and mildly abnormal liver function tests. An ultrasound and computed tomography scan showed evidence of hepatic infarction and portal hypertension (splenic varices). A thrombophilia screen confirmed a homozygous mutation for the prothrombin gene mutation, with mildly reduced levels of anti-thrombin III (AT III). Subsequent testing of his father and brother revealed heterozygosity for the same gene mutation.</p> <p>Conclusion</p> <p>Hepatic infarction is unusual due to the rich dual arterial and venous blood supply to the liver. In the absence of an arterial or haemodynamic insult causing hepatic infarction, a thrombophilia should be considered. To our knowledge, this is the first reported case of a hepatic infarction due to homozygosity of the prothrombin gene mutation. It is unclear whether homozygotes have a higher risk of thrombosis than heterozygotes. In someone presenting with a first thrombosis with this mutation, the case for life-long anticoagulation is unclear, but it may be necessary to prevent a second and more severe second thrombotic event, as occurred in this case.</p

Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for the initial treatment of venous thromboembolism

Background: Low molecular weight heparins (LMWHs) have been shown to be effective and safe in preventing venous thromboembolism (VTE). They may also be effective for the initial treatment of VTE. This is the third update of the Cochrane Review first published in 1999. Objectives: To evaluate the efficacy and safety of fixed dose subcutaneous low molecular weight heparin compared to adjusted dose unfractionated heparin (intravenous or subcutaneous) for the initial treatment of people with venous thromboembolism (acute deep venous thrombosis or pulmonary embolism). Search methods: For this update the Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (15 September 2016). In addition the CIS searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 8) in the Cochrane Library (searched 15 September 2016) and trials' registries. Selection criteria: Randomised controlled trials comparing fixed dose subcutaneous LMWH with adjusted dose intravenous or subcutaneous unfractionated heparin (UFH) in people with VTE. Data collection and analysis: Two review authors independently selected trials for inclusion, assessed for quality and extracted data. Main results: Six studies were added to this update resulting in a total of 29 included studies (n = 10,390). The quality of the studies was downgraded as there was a risk of bias in some individual studies relating to risk of attrition and reporting bias; in addition several studies did not adequately report on the randomisation methods used nor on how the treatment allocation was concealed. During the initial treatment period, the incidence of recurrent venous thromboembolic events was lower in participants treated with LMWH than in participants treated with UFH (Peto odds ratio (OR) 0.69, 95% confidence intervals (CI) 0.49 to 0.98; 6238 participants; 18 studies; P = 0.04; moderate-quality evidence). After a follow-up of three months, the period in most of the studies for which oral anticoagulant therapy was given, the incidence of recurrent VTE was lower in participants treated with LMWH than in participants with UFH (Peto OR 0.71, 95% CI 0.56 to 0.90; 6661 participants; 16 studies; P = 0.005; moderate-quality evidence). Furthermore, at the end of follow-up, LMWH was associated with a lower rate of recurrent VTE than UFH (Peto OR 0.72, 95% CI 0.59 to 0.88; 9489 participants; 22 studies; P = 0.001; moderate-quality evidence). LMWH was also associated with a reduction in thrombus size compared to UFH (Peto OR 0.71, 95% CI 0.61 to 0.82; 2909 participants; 16 studies; P < 0.00001; low-quality evidence), but there was moderate heterogeneity (I2 = 56%). Major haemorrhages occurred less frequently in participants treated with LMWH than in those treated with UFH (Peto OR 0.69, 95% CI 0.50 to 0.95; 8780 participants; 25 studies; P = 0.02; moderate-quality evidence). There was no difference in overall mortality between participants treated with LMWH and those treated with UFH (Peto OR 0.84, 95% CI 0.70 to 1.01; 9663 participants; 24 studies; P = 0.07; moderate-quality evidence). Authors' conclusions: This review presents moderate-quality evidence that fixed dose LMWH reduced the incidence of recurrent thrombotic complications and occurrence of major haemorrhage during initial treatment; and low-quality evidence that fixed dose LMWH reduced thrombus size when compared to UFH for the initial treatment of VTE. There was no difference in overall mortality between participants treated with LMWH and those treated with UFH (moderate-quality evidence). The quality of the evidence was assessed using GRADE criteria and downgraded due to concerns over risk of bias in individual trials together with a lack of reporting on the randomisation and concealment of treatment allocation methods used. The quality of the evidence for reduction of thrombus size was further downgraded because of heterogeneity between studies

Strandskyddet inifrån : Individ, egendom och plats

This thesis asks how Swedish shore protection and its effect on usage and ownership of property can be understood from the perspective of individuals’ attachment to place. The theoretical run-down indicates the relevance of a geographical perspective when discussing property. This leads to the use of different categories of place attachments that describe in what ways an individual can connect to a place. Two different methods are used to obtain a relevant material: firstly, interviews are used, allowing a closing in on the individual’s perspective. Then, two different observations are used to partly observe interaction between individuals and partly observe the physical landscape. Through the combination of these methods the thesis identifies some insights on how the Swedish shore protection can be apprehended from an individual standpoint. Interpretation of the result leads to a discussion that is centered around how borders and distances, creation of identity and a time perspective are relevant themes in the thesis. These fields are identified as valuable to both the current and forthcoming discussion of Swedish shore protection in particular, and questions about property and geography in general.Den här uppsatsen undersöker hur det svenska strandskyddet och dess effekter på användning och ägande av egendom kan förstås genom det perspektiv som ges av individers anknytning till plats. Genomgången av teori visar på relevansen av ett geografiskt perspektiv när egendom diskuteras. Detta leder till användningen av olika kategorier av platsanknytningar som beskriver på vilka vis som en individ kan knyta an till en plats. Två olika metoder används för att få fram ett relevant material: först används intervjuer, vilket möjliggör ett närmande av det individuella perspektivet. Sedan används även två olika observationer, dels för att observera interaktionen mellan individer och dels för att observera det fysiska landskapet. Genom en kombination av de valda metoderna så identifierar uppsatsen en del insikter till hur det svenska strandskyddet kan förstås från en individuell ståndpunkt. Tolkningen av resultatet leder till en diskussion som centreras kring hur gränser och avstånd, skapande av identitet och användandet av ett tidsperspektiv utgör relevanta teman i uppsatsen. De här fälten identifieras som värdefulla både för den nuvarande och förestående diskussionen av svenskt strandskydd i synnerhet, och frågor om egendom och geografi i allmänhet

Treatment of deep vein thrombosis and risk of recurrent venous thromboembolism

A cute deep vein thrombosis (DVT) and pulmonary embolism (PE) are different clinical presentations of the same underlying disease, namely venous thromboembolism (VTE), which is a common and potentially fatal condition. Risk factors associated with the first and probably also subsequent events of VTE are hereditary or acquired. Regarding recurrent VTE the risk persists for many years after the first episode and is increased approximately 50 times compared with the risk of the first event in the general population. The traditional treatment of VTE has for decades been unfractionated. heparin (UFH) given intravenously (i.v.) or subcutaneously (s.c.). Low-molecular-mass hepatitis (LMMHs) have been developed and are characterized by the following pharmacokinetic benefits compared with UFH: higher bioavailability; longer half-life in plasma and an improved dose response after s.c. administration. The aims of our studies (Paper I-III) were to investigate the efficacy and safety in the treatment of acute DVT with a LMMH (dalteparin) administered s.c. once daily in the dose of 200 U per kg bodyweight compared with UFH i.v., and secondly, whether this new regimen could be utilized in an outpatient setting. We have demonstrated that the efficacy, assessed as changes of venograms between inclusion, after initial treatment and 6 months later, were similar in dalteparin (n=101) and UFH (n=103) treated patients (Paper I and III). The safety defined as frequency of bleeding events was also comparable. In a safety assessment and health economy outpatient study (Paper II) using this dalteparin regimen the combined frequency of major bleeding and recurrent VTE was 0.92% (95% confidence interval 0.25-2.35%), which is lower than in in-hospital trials. Deficiencies of the coagulation inhibitors antithrombin, protein C and protein S, as well as the mutations G1691->A and G20210->A in the coagulation factor V (FV) and prothrombin (FII) genes, respectively, are important risk factors for the first episode of VTE. Impaired fibrinolysis and the presence of antibodies against cardiolipin have also been associated with VTE. In a prospective open study (Paper IV) we intervened with recommendations of a changed lifestyle (low-fat diet, weight reduction, physical exercise, cessation of smoking) in patients with VTE and impaired fibrinolysis, defined as increased level of plasminogen activator inhibitor-1 (PAI-1) in plasma. In 65% of 144 patients at least one of four life-style improvements was achieved and the more improvements the greater reduction in PAI-1 levels. However, the frequency of recurrent VTE episodes during 6 years of follow-up did not correlate with these improvements. In an open randomized multicenter trial (DURAC-1) 902 patients with objectively verified VTE received oral anti- vitamin K therapy for 6 weeks or for 6 months after the acute event. We followed 534 of these patients aged <70 years at inclusion, for 48 months after their index event and obtained blood samples retrospectively for analyses of the G1691A and G20210A allele in the FV and FII genes, respectively (Paper V). The aim was to investigate the risk of recurrent VIE in carriers of these mutations. This risk in heterozygotes for the G1691A allele was not different from that in non-carriers (15.4% vs 13.0%). Homozygotes had an increased risk (p=0.036) of recurrent VTE. The risk of recurrent VTE for G20210A carriers was not different from that in non-carriers. However, this risk was significantly increased in patients with an idiopathic cause or a proximal extension of DVT or with PE at the index event, independent of the mutations discussed here. Of the patients in DURAC-1 trial with a first episode of DVT initially (n=790) 175 and 43 experienced recurrent DVT and PE, respectively (Paper VI). A recurrent thrombosis in the contra- and ipsilateral leg was diagnosed in 95 and 80 patients, respectively. No variable was associated with the side of recurrent event, except that ipsilateral DVT was significantly more frequent within 6 months only among those randomized to 6 weeks of oral anti-vitamin K therapy. In conclusion, the dalteparin regimen used in our studies is well tolerated and effective in defined patient categories in an outpatient setting and allows for substantial cost savings. Our studies emphasize the persistent and continuous risk of recurrent VTE in a long-term perspective for many patients. An increased risk of recurrent VTE has been documented in patients with an idiopathic cause, proximal DVT or PE at the index event and for homozygotes of the G1691A mutation. The risk of recurrent ipsi- and contralateral DVT was similar

Emergency shelter, Kungsholmen

Kommunen är enligt lag ansvarig för goda bostäder åt alla, men med Stockholms nuvarande markanvisningspolicy är det mycket svårt att producera bostäder åt låg- och medelinkomsttagare. Jag föreslår att vi inför en ny policy för markanvisning, där fokus ligger på att uppnå lagstadgade mål för kommunernas bostadspolitik. Istället för att fokusera på högsta försäljningsvärde, flyttas fokus till att erbjuda alla bostad. Den exploatör som på bäst sätt kan tillgodose Stockholms utbud av bostäder för samtliga samhällsgrupper tilldelas marken. Som ett förslag till att förse de som absolut mest akut behöver bostad med just det har jag ritat ett hus med 53 små lägenheter som hyrs ut under maximalt ett år. Lägenheterna tilldelas genom beslut av Socialstyrelsen personer som inte har möjlighet att skaffa bostad på annat sätt. I vissa fall är det en annan myndighet den som står för kostnaderna, oftast gör den boende det själv. Eftersom inte alla har eget bohag, så går det att hyra eller köpa möbler och husgeråd i andrahandsaffären i gatuplan - eller hyra ett möblerat rum och dela med andra. De korta hyrestiderna medför mycket flyttande och därför blir logistiken viktig. Hiss med entré direkt från utsidan och dubbla trapphus gör det lättare att bära upp sängar utan att göra sig illa. I huset finns även en lunchrestaurang där de boende kan utnyttja köket om kvällarna. The municipality is by law required to provide citizens with decent homes, but with the current land allocation policy of Stockholm it is very hard to build for people with low and medium incomes. I suggest a new policy, focusing on reaching the goals that the law sets for municipality development. Instead of, like now, striving towards maximum price when selling land, the idea would be to provide a home for everyone. The developer that in the best way suggests a solution to the problems on the real estate market is given the land. As an idea to give everybody a decent home I have designed a building with 53 small apartments – to be rented for no more than a year. People, who do not have other means of getting a place to live, can via the The National Board of Health and Welfare get an apartment for a shorter period of time. Since not everyone will have household furniture of their own, this can be rented or bought in the house’s second hand store, located at street level. There are as well a number of rooms that can be rented and shared with others – much like a hostel. The short contracts will lead to a lot of moving in and out, therefore logistics is important. Elevator with access from the street and stairs in both ends allow for safety and efficiency. There is also a lunch restaurant, with entrance from the park, where the tenants can use the kitchen in the evenings.

Strandskyddet inifrån : Individ, egendom och plats

This thesis asks how Swedish shore protection and its effect on usage and ownership of property can be understood from the perspective of individuals’ attachment to place. The theoretical run-down indicates the relevance of a geographical perspective when discussing property. This leads to the use of different categories of place attachments that describe in what ways an individual can connect to a place. Two different methods are used to obtain a relevant material: firstly, interviews are used, allowing a closing in on the individual’s perspective. Then, two different observations are used to partly observe interaction between individuals and partly observe the physical landscape. Through the combination of these methods the thesis identifies some insights on how the Swedish shore protection can be apprehended from an individual standpoint. Interpretation of the result leads to a discussion that is centered around how borders and distances, creation of identity and a time perspective are relevant themes in the thesis. These fields are identified as valuable to both the current and forthcoming discussion of Swedish shore protection in particular, and questions about property and geography in general.Den här uppsatsen undersöker hur det svenska strandskyddet och dess effekter på användning och ägande av egendom kan förstås genom det perspektiv som ges av individers anknytning till plats. Genomgången av teori visar på relevansen av ett geografiskt perspektiv när egendom diskuteras. Detta leder till användningen av olika kategorier av platsanknytningar som beskriver på vilka vis som en individ kan knyta an till en plats. Två olika metoder används för att få fram ett relevant material: först används intervjuer, vilket möjliggör ett närmande av det individuella perspektivet. Sedan används även två olika observationer, dels för att observera interaktionen mellan individer och dels för att observera det fysiska landskapet. Genom en kombination av de valda metoderna så identifierar uppsatsen en del insikter till hur det svenska strandskyddet kan förstås från en individuell ståndpunkt. Tolkningen av resultatet leder till en diskussion som centreras kring hur gränser och avstånd, skapande av identitet och användandet av ett tidsperspektiv utgör relevanta teman i uppsatsen. De här fälten identifieras som värdefulla både för den nuvarande och förestående diskussionen av svenskt strandskydd i synnerhet, och frågor om egendom och geografi i allmänhet

Cohabitation and mortality across the life course

The literature on marriage status and mortality have shown that the married individuals enjoy longer lives than their non-married counterparts. The few studies that included cohabitation have found cohabitants to have a longevity between the married and other non-married groups. There are indications that the cohabiting population is diverse in terms of mortality risk, however, very little is known about how the association is related to age and stages of the life course. This is the first study on mortality and cohabitation for the Swedish population, which is a highly relevant context since Sweden is one of the countries where cohabitation is the most widespread and it has been a forerunner in many family trends. Using Swedish register data this study investigates how different partnership statuses are related to mortality across stages of the life course. It uses cox proportional hazards regression for the years 2012 – 2018 for the adult Swedish born population. Cohabiters were found to have consistently lower mortality risk than all other partnership statuses but the married except premarital cohabiters aged 30-49 who showed no excess mortality compared to the married. Further, the study reproduced findings that the difference between the cohabiters and the married is larger for women compared to men. These results contribute to our understanding of who cohabits at different stages of life, and it underlines that future research must consider cohabiters not as a homogenous group but as a status with diverse meaning that changes across the life course.