Primary care consultation, hospital admission, sick leave and disability pension owing to neck and low back pain: a 12-year prospective cohort study in a rural population

BACKGROUND: Neck and low back pain are common musculoskeletal complaints generating large societal costs in Western populations. In this study we evaluate the magnitude of long-term health outcomes for neck and low back pain, taking possible confounders into account. METHOD: A cohort of 2,351 Swedish male farmers and rural non-farmers (40–60 years old) was established in 1989. In the first survey, conducted in 1990–91, 1,782 men participated. A 12-year follow-up survey was made in 2002–03 and 1,405 men participated at both times. After exclusion of 58 individuals reporting a specific back diagnosis in 1990–91, the study cohort encompassed 1,347 men. The health outcomes primary care consultation, hospital admission, sick leave and disability pension were assessed in structured interviews in 2002–03 (survey 2). Symptoms and potential confounders were assessed at survey 1, with the exception of rating of depression and anxiety, which was assessed at survey 2. Multiple logistic regression generating odds ratios (OR) with 95% confidence intervals (95% CI) was performed to adjust the associations between reported symptoms and health outcomes for potential confounders (age, farming, workload, education, demand and control at work, body mass index, smoking, snuff use, alcohol consumption, psychiatric symptoms and specific back diagnoses during follow up). RESULTS: Of the 836 men reporting current neck and/or low back pain at survey 1, 21% had had at least one primary care consultation for neck or low back problems, 7% had been on sick leave and 4% had disability pension owing to the condition during the 12 year follow up. Current neck and/or low back pain at survey 1 predicted primary care consultations (OR = 4.10, 95% CI 2.24–7.49) and sick leave (OR = 3.22, 95% CI 1.13–9.22) after potential confounders were considered. Lower education and more psychiatric symptoms were independently related to sick leave. Lower education and snuff use independently predicted disability pension. CONCLUSION: Few individuals with neck or low back pain were on sick leave or were granted a disability pension owing to neck or low back problems during 12 years of follow up. Symptoms at baseline independently predicted health outcomes. Educational level and symptoms of depression/anxiety were important modifiers

The forgotten story of the landscape : mapping of old structures in Marielund outside Uppsala

Denna uppsats handlar om små, ofta förbisedda, strukturer som finns i vardagslandskapet. Gamla vägar, hägnader (gärdesgårdar), ägogränser och hävdad mark berättar alla en historia om svunna tider och kan spåras via historiska kartor. Landskapsarkitekter kan ta fram och berätta denna vardagliga historia och ge de boende på en plats, gammal eller nyligen bebyggd, en historisk förankring som de kan knyta an till. Marielund utanför Uppsala är en plats med höga kulturmiljövärden, främst beträffande sina stora sommarhus från 1900-talets början, och utreds nu för utökad bebyggelse. Men finns det fler värden där som inte lyfts upp? Kan de små strukturerna från vardagslandskapet utgöra ett komplement till de redan kända kulturmiljövärdena? Syftet med uppsatsen är att jämföra den karterade markanvändningen från olika tidpunkter inom kommunens utredningsområde i Marielund för att identifiera vardagslandskapets strukturer. Frågan är: Vilka strukturer så som vägar, hägnader, ägogränser och hävdad mark går att identifiera via en analys av de historiska kartorna i Marielund? Metoden med kartöverlägg kompletteras av en analys med platsbesök för att se hur platsen ser ut i dag. Resultatet visar att många gamla strukturer fortfarande finns kvar men att de kan ha ändrat karaktär och betydelse i dagens landskap. Detta kan utgöra ett diskussionsunderlag inför kommande exploateringar av området.This essay is about small, often neglected, structures in the everyday-landscape. Old roads, fences, property-borders, cultivated land, meadows and grazing grounds all tell a story about past times and they can be traced through old maps. Landscape architects are able to bring this story up and tell it to the people living in that place. Weather this place is old or new, the story of the small structures can give it a historic connection and the inhabitants can connect to it. Marielund outside Uppsala is a place with high cultural values, mainly because of its big summerhouses from the beginning of the twentieth century. It is now being investigated for further buildings. But are there more values there that are not brought up? Can the small structures from the everyday-landscape be complementary to the already known cultural values? The aim of the essay is to compare the mapped land-use from different point of times in history, in the area investigated for further buildings in Marielund, to identify the structures in the everyday-landscape. The question is: Which structures, such as roads, fences, property-borders, cultivated land, meadows and grazing grounds, can be identified through analysis of the old maps in Marielund? The method of map-overlay is complemented by an analysis and a visit at the place to see how it looks like today. The results show that many old structures still exist but they might have changed their character and importance in the landscape of today. This can form a basis of discussion to coming development of the area

Undersöka genom att skissa

Landskapsarkitekter använder ofta skissen för att utforska och att förmedla idéer. Men skissandet kan även vara en del av ett analysskede, exempelvis vid ett platsbesök där en befintlig plats analyseras med dess skala, linjer, topografi med mera. I denna typ av utforskande skisser är det själva undersökningen som står i fokus och skissen är ett hjälpmedel i att fokusera och bli medveten om platsens karaktär och sammanhang. Denna typ av utforskande skisser som fungerar som en metod att uppleva en plats är vad denna uppsats handlar om. Själva syftet är att undersöka hur olika skisstekniker påverkar tecknarens uppfattning av en plats. Frågan som ställs är hur valet av skissteknik påverkar mina intryck av en plats samt den fördjupade frågan hur jag uppfattar skillnaden mellan att använda en enskild teknik jämfört med att blanda en svartvit teknik med färg. Platsen där undersökningarna utfördes var i en parkmiljö, Källparken i Uppsala. Skisserna utfördes med olika material: blyerts, tusch, akvarell och färgpennor. Dessa skisstekniker har olika uttryck och egenskaper vilka undersöktes och utvärderades. Eftersom ett platsbesök kan variera i tid undersöktes även tidsaspekten och skisserna utfördes under olika lång tid. Skisserna i de enskilda teknikerna utfördes under två veckor då jag samtidigt skrev ned vilka intryck jag fick för varje skiss. Efter en utvärdering fördjupades sedan undersökningen till blandtekniker. Resultaten visar att intrycken påverkas främst av om man använder sig av en svartvit skissteknik eller skissar med färg. Att skissa med akvarell i en färg ger en tydlig inblick i platsens valörer. Med färgpennor dras blicken till det som sticker ut färgmässigt jämfört med en svartvit skissteknik då intrycken blir mer generella. Skisser i färg tar längre tid att utföra och jämfört med skisser i blyerts eller tusch undersöker skisser i färg oftast några få färgrika objekt med deras olika färgnyanser. Blyertspennornas olika hårdhetsgrader kan utnyttjas för att utforska detaljer och skuggor. Skisser med tusch förenklar motivet och är en hjälp i att se de grundläggande strukturerna på platsen. Att blanda färgpennor med tusch resulterar i att mer av platsens sammanhang kan utforskas när de grundläggande strukturerna i förgrunden snabbt kan skissas upp med tusch. Platsens färger och nyanser dominerar intrycken men är nu starkare sammankopplade med omgivningen. Skisser kombinerade med tusch och akvarell i en färg kan undersöka omgivningens skala och volymer på ett bättre sätt än övriga skisstekniker. Snabba skisser visar sig bra för att studera övergripande karaktärer som linjer samt de mest utmärkande färgerna. Skisser på en timme ger möjlighet att bli närvarande på platsen, se hur skuggorna vandrar samt utforska detaljer och färger. Skisser som utförs på 15 minuter är lämpliga för att studera både de övergripande karaktärerna på platsen samt delar av dess sammanhang.Landscape Architects often use the sketch to explore and communicate ideas. The sketch can however also be part of an analysis, for example at a site visit, to study scale, lines, topography and so on. In these exploratory sketches the survey itself is at the center. The sketch is a tool to help focus and understand the features and context of a place. This kind of exploratory sketches is what this paper is about. The purpose is to examine how various sketch techniques can influence the sketcher´s perception of a place. The research question is how the choice of sketch techniques will influence my impressions of a place. Later on I go into deeper studies and ask how I will perceive the difference between using one single sketch technique compared with mixing a black-and-white technique with a colour sketch technique. The area where these studies were made is in a park, Källparken in Uppsala. The sketches were made in different sketch techniques: pencil, ink, watercolor and color pencils. These techniques have different expressions and characteristics which were studied and examined. Since a site visit may vary in time, the time aspect was also investigated and the sketches were made during different time limits. The sketches in the individual techniques were made during two weeks and after every finished sketch I wrote down impressions and reflections I got while sketching. The sketches and reflections were then evaluated followed by deeper studies into mixed techniques. The results show that the impressions are mainly influenced if using a black-and-white technique or a colour technique. Black-and-white techniques provide more general impressions compared to colour pencils which draw the attention to (a few) colourful objects and their tints. Sketches in colour also require more time to perform. To sketch with watercolour in one colour provides a clear insight of different values. The different hardness of pencils can be used to explore details and shadows. To help understand the basic structures of a place it works to sketch with ink, since ink needs to simplify the motif. The context of a place can be further explored if mixing colour pencils with ink, since ink can be used to rapidly sketch the basic structures in the foreground. The colours and tints of the place dominate the impression but will be better connected to the surrounding area. Sketches mixed with ink and watercolor in one colour investigate the volumes and the scale of the surrounding better than other techniques. Quick sketches focus on basic structures such as lines and the most characteristic colours of a place. Sketches made during 60 minutes make it possible to be present and experience how the light changes and to study details and colours at a place. 15 minutes are suitable for sketching and studying basic structures as well as some of the context of a place

Brain stem audiometry may supply markers for diagnostic and therapeutic control in psychiatry

The purpose of the present study is to try an alternative way of analyzing the ABR (Auditory Brainstem Response). The stimuli were complex sounds (c-ABR) as used in earlier studies. It was further aimed at corroborating earlier findings that this method can discriminate several neuropsychiatric states. Forty healthy control subjects, 26 subjects with the diagnosis schizophrenia (Sz) and 33 with ADHD (Attention deficit hyperactivity disorder) were recruited for the study. The ABRs were recorded. The analysis was based on calculation of areas of significantly group different time spans in the waves. Both latency and amplitude were thereby influential. The spans of differences were quantified for each subject in relation to the total area of the curve which made comparisons balanced. The results showed highly significant differences between the study groups. The results are important for future work on identifying markers for neuropsychiatric clinical use. To reach that goal calls for more extensive studies than this preliminary one

Svåra samtal inom sjukvården - ur kuratorns perspektiv

Abstract Author: Madelene Holmberg & Sara Knutsson Title: Difficult conversations in healthcare - from the counselor’s perspective. Supervisor: Anett Schenk Assessor: Anna Rypi The aim of this study was to investigate the healthcare counselor’s perspective on difficult conversations in their work, through interviews. More specific the aim was to examine how the counselors experience conversations with patients and dependants. Also, the aim was to find out if the counselors prepare themselves before a conversation and if they do, how they do it. What approaches they have towards patients and dependants and how the counselors handle reactions from them, and last but not least, if the counselors have a possibility to process their emotions and thoughts from a conversation, was also a part of the aim in this study. The main outcomes of the study was that the counselors described the value of supervision in their work, to have the possibility to reflect on their thoughts and feelings and difficulties in various patient cases. Also, to take part and learn from other counselors’ experiences. When it comes to the counselors’ approaches and professionality, they expressed the importance of flexibility, openness, and empathy as well as being able to keep the boundary between being private and personal. The different approaches helps the counselors to handle emotions and reactions from patients and dependants, as well as handling counselors’ own feelings and reactions. The counselors expressed that preparation before conversations are important and that they can be of both practical and emotional nature, such as reading patient’s journal or reflect on the patient case. On the question of whether social work education has prepared the counselors for their work in healthcare, only one of them said that she felt prepared. Instead, they expressed that they have learned through experience. Key words: preparation, approaches, professional attitude, supervision, professional theor

Food Choices and Coronary Heart Disease: A Population Based Cohort Study of Rural Swedish Men with 12 Years of Follow-up

Coronary heart disease is associated with diet. Nutritional recommendations are frequently provided, but few long term studies on the effect of food choices on heart disease are available. We followed coronary heart disease morbidity and mortality in a cohort of rural men (N = 1,752) participating in a prospective observational study. Dietary choices were assessed at baseline with a 15-item food questionnaire. 138 men were hospitalized or deceased owing to coronary heart disease during the 12 year follow-up. Daily intake of fruit and vegetables was associated with a lower risk of coronary heart disease when combined with a high dairy fat consumption (odds ratio 0.39, 95% CI 0.21–0.73), but not when combined with a low dairy fat consumption (odds ratio 1.70, 95% CI 0.97–2.98). Choosing wholemeal bread or eating fish at least twice a week showed no association with the outcome

Clinical and MRI Features of Cerebral Small-Vessel Disease in Type 1 Diabetes

OBJECTIVETo assess the prevalence of cerebral small-vessel disease (SVD) in subjects with type 1 diabetes compared with healthy control subjects and to characterize the diabetes-related factors associated with SVD.RESEARCH DESIGN AND METHODSThis substudy was cross-sectional in design and included 191 participants with type 1 diabetes and median age 40.0 years (interquartile range 33.0-45.1) and 30 healthy age- and sex-matched control subjects. All participants underwent clinical investigation and brain MRIs, assessed for cerebral SVD.RESULTSCerebral SVD was more common in participants with type 1 diabetes than in healthy control subjects: any marker 35% vs. 10% (P = 0.005), cerebral microbleeds (CMBs) 24% vs. 3.3% (P = 0.008), white matter hyperintensities 17% vs. 6.7% (P = 0.182), and lacunes 2.1% vs. 0% (P = 1.000). Presence of CMBs was independently associated with systolic blood pressure (odds ratio 1.03 [95% CI 1.00-1.05], P = 0.035).CONCLUSIONSCerebral SVD, CMBs in particular, is more common in young people with type 1 diabetes compared with healthy control subjects.Peer reviewe

Galaxy Pairs in the Sloan Digital Sky Survey - II: The Effect of Environment on Interactions

We use a sample of close galaxy pairs selected from the Sloan Digital Sky Survey Data Release 4 (SDSS DR4) to investigate in what environments galaxy mergers occur and how the results of these mergers depend on differences in local galaxy density. The galaxies are quantified morphologically using two-dimensional bulge-plus-disk decompositions and compared to a control sample matched in stellar mass, redshift and local projected density. Lower density environments have fractionally more galaxy pairs with small projected separations (r_p) and relative velocities (Delta v), but even high density environments contain significant populations of pairs with parameters that should be conducive to interactions. Metrics of asymmetry and colour are used to identify merger activity and triggered star formation. The location of star formation is inferred by distinguishing bulge and disk colours and calculating bulge fractions from the SDSS images. Galaxies in the lowest density environments show the largest changes in star formation rate, asymmetry and bulge-total fractions at small separations, accompanied by bluer bulge colours. At the highest local densities, the only galaxy property to show an enhancement in the closest pairs is asymmetry. We interpret these results as evidence that whilst interactions (leading to tidal distortions) occur at all densities, triggered star formation is seen only in low-to-intermediate density environments. We suggest that this is likely due to the typically higher gas fractions of galaxies in low density environments. Finally, by cross-correlating our sample of galaxy pairs with a cluster catalogue, we investigate the dependence of interactions on clustercentric distance. It is found that for close pairs the fraction of asymmetric galaxies is highest in the cluster centres.Comment: Accepted by MNRAS, 15 page