Emotional distress : a neglected topic among surgically treated oesophageal cancer patients

Swedish research council, Swedish cancer society, Stockholm cancer societyPublishe

Anaemia and the development of depressive symptoms following acute coronary syndrome: longitudinal clinical observational study

OBJECTIVE: Depressive symptoms are common following acute coronary syndrome (ACS) and predict subsequent cardiovascular morbidity. Depression in acute cardiac patients appears to be independent of clinical disease severity and other cardiovascular measures. One factor that has not been considered previously is anaemia, which is associated with fatigue and adverse cardiac outcomes. This study assessed the relationship between anaemia on admission and depressive symptoms following ACS. DESIGN: Longitudinal clinical observational study. SETTING: Coronary care unit. PATIENTS: 223 patients with documented ACS. MAIN OUTCOME MEASURES: Depressive symptoms measured with the Beck Depression Inventory 3 weeks after admission. RESULTS: Anaemia was defined with WHO criteria and was present in 30 (13.5%) patients. Anaemia predicted raised depression scores 3 weeks later independently of age, gender, marital status, educational attainment, smoking, Global Registry of Acute Cardiac Events (GRACE) risk scores, negative mood in hospital and history of depression (p=0.003). The odds of a Beck Depression Inventory score ≥10 among anaemic patients were 4.03 (95% CIs 1.48 to 11.00), adjusted for covariates. Sensitivity analyses indicated that effects were also present when haemoglobin was analysed as a continuous measure. Anaemia also predicted major adverse cardiac events over the subsequent 12 months. CONCLUSIONS: Anaemia appears to contribute to depression following ACS and is associated with future cardiac morbidity. Studies evaluating the effects of anaemia management will help delineate the role of this pathway more precisely

A Model for Reflective Participatory Design - The Role of Participation, Voice and Space

This paper aims to contribute to the participatory tradition in health informatics by presenting a model for reflective participatory design emerging from qualitative fieldwork in a participatory project aimed to improve the health and wellbeing of older people in the northern periphery regions of Europe, through new mobile services. The model brings together two established processes in novel ways: systems development and user participation. Within each process three concepts are presented to facilitate discussion and reflection at the concept level, the process level and the integrated process level

Social Return on Investment, SROI, the value added for families before and after using Solvatten in the Bungoma district in Western Kenya

The lack of fresh and clean water today causes severe problems, mostly in developing countries. Waterborne diseases like typhoid, cholera, amoebic dysentery and diarrhea create health problems and deaths among people. There is a need for low cost interventions like household-based water treatment and safe storage (HWTS). Solvatten AB is a Swedish company based in Stockholm. Their product, Solvatten, is a household water treatment unit that can treat water containing viruses, parasites and bacteria. The product does not need any chemicals or energy-sources such as charcoal or firewood, it only needs the sun. The focus of this study is to distinguish the specific effects Solvatten have on the people using it in the Bungoma district in western Kenya. This can be done by using a framework named Social Return on Investment (SROI) which has its origins from Impact Assessment (IA) and social Cost Benefit Analysis (CBA). The social added value from Solvatten AB can be calculated by conducting an evaluative SROI analysis. This will result in a ratio that can be used by Solvatten AB for fundraisings, scholarships and other recourses. Data will be collected by interviewing a target group in the Bungoma district. It will be one to one interviews and a questionnaire will be used. The target group consists of buyers of the unit from 2010. The SROI ratio has been calculated to 1: 26 KES. The calculations are based on 9 different outcomes that all are presumed to last five years. Solvatten is without any doubts a great invention and there is a constant need for HWTS solutions in developing countries where water is a scarcity. Solvatten is right in time, easy to use and small children can carry it. The problem is that the organization around Solvatten in the Bungoma district needs to be improved and better structured, the product itself works fine as it is today

Dairy producer attitudes to pain in cattle in relation to disbudding calves

Pain is an important indicator of poor welfare of livestock. Despite this, pain has largely gone unrecognized in farm animals due to attitudes of producers and veterinarians, although they play a key role in monitoring and managing the perception of animal pain. Producer attitudes toward animal welfare influence livestock management and production. The aim was to quantify dairy producer attitudes to the painfulness of various cattle diseases and disbudding, a painful routine procedure performed on farm to ensure safer handling of cattle. A questionnaire on disbudding-related opinions and practices was sent to 1,000 Finnish dairy producers (response rate: 45%). Attitudes toward disbudding were gauged using a 5-point Likert scale and attitudes to cattle pain scored on an 11-point numerical rating scale. Principal components analysis was used to assess the loadings, which were further tested for differences between producer gender and housing systems with Mann-Whitney U-tests, and between herd milk yield, herd size, and age and work experience of producers with a Kruskal-Wallis test. Four main factors were identified: factor I (“taking disbudding pain seriously”), factor II (“sensitivity to pain caused by cattle diseases”), factor III (“ready to medicate calves myself”), and factor IV (“pro horns”). Female producers took disbudding pain more seriously, were more sensitive to pain caused to cattle by diseases, and were more ready to medicate disbudded calves than male producers. Producers with tie-stalls favored horns over producers with freestalls. Male producers with tie-stalls were sensitive to cattle pain and preferred horns over male producers with freestalls. Female producers with freestalls were more ready to medicate calves, but did not prefer horns more than female producers with tie-stalls. Taking disbudding seriously correlated with sensitivity to pain caused by cattle diseases. Producers with low-milk-yielding herds were less willing to medicate calves and more willing to keep cattle with horns than producers with higher-yielding herds. Older producers were more sensitive to cattle pain than middle-aged and younger producers. No effect was established for taking disbudding pain seriously: the pro-horn factor was associated with work experience, age, and herd size. Women rated pain higher and were more positive toward pain medication for animals than men. Maintaining horns are more important for producers with tie-stalls than for those with freestalls.Peer reviewe

Education level influences long-term survival after esophageal cancer surgery in a nationwide Swedish cohort study

Objectives: This study aimed to investigate whether a higher education level is associated with an improved long-term survival after oesophagectomy for cancer. Design: A prospective, population-based cohort study. Setting: Sweden—nationwide. Participants: 90% of all patients with oesophageal and cardia cancer who underwent a resection in Sweden in 2001–2005 were enrolled in this study (N=600; 80.3% male) and followed up until death or the end of the study period (2012). The study exposure was level of education, defined as compulsory (≤9 years), moderate (10–12 years) or high (≥13 years). Outcome measures: The main outcome measure was overall 5-year survival after oesophagectomy. Cox regression was used to estimate the associations between education level and mortality, expressed as HRs with 95% CIs, with adjustment for sex, age, tumour stage, histological type, complications, comorbidities and annual surgeon volume. The patient group with highest education was used as the reference category. Results: Among the 600 included patients, 281 (46.8%) had compulsory education, 238 (39.7%) had moderate education and 81 (13.5%) had high education. The overall 5-year survival rate was 23.1%, 24.4% and 32.1% among patients with compulsory, moderate and high education, respectively. After adjustment for confounders, a slightly higher, yet not statistically significantly increased point HR was found among the compulsory educated patients (HR 1.08, 95% CI 0.80 to 1.47). In patients with tumour stage IV, increased adjusted HRs were found for compulsory (HR 2.88, 95% CI 1.07 to 7.73) and moderately (HR 2.83, 95% CI 1.15 to 6.95) educated patients. No statistically significant associations were found for the other tumour stages. Conclusions: This study provides limited evidence of an association between lower education and worse longterm survival after oesophagectomy for cancer.Swedish Research Council (SIMSAM)Swedish Cancer SocietyPublishe

Health and wellbeing in cities : Cultural contributions from urban form in the Global South context

Publisher Copyright: © 2021Urban public spaces, both natural and built, contribute to the liveability of urban spaces. Evidence shows that natural urban spaces can improve both physical and psychological wellbeing through providing cultural ecosystem services (CES), but there is a lack of evidence from Low and Middle Income Countries (LMIC). Recognising the pressures that public spaces are under in rapidly changing cities of the Global South, it is critical that research is done to strengthen the argument to maintain the availability and accessibility of these assets. This is particularly the case in secondary cities where pressures to redevelop are high due to rapidly growing populations, whilst governance and planning systems typically prioritise growth. This paper presents participatory geographic information system survey findings for two contrasting LMIC secondary cities (Nakuru, Kenya, and Udon Thani, Thailand). We explore the interlinkages between urban public spaces, CES, and residents’ wellbeing. Our findings show that both natural and built areas in these two very different ecosystems are important for promoting wellbeing. Key factors that enabled or prevented the use of public spaces were convenience: proximity, affordability, and usability. The results also highlight the effects of the inequitable distribution of inviting public realm spaces across the cities and consider the impacts on spatial justice. These findings strengthen the need to promote wellbeing considerations through urban planning in rapidly changing cities to ensure their future liveability.Peer reviewe

Fear of dying and inflammation following acute coronary syndrome

Aims Many patients are afraid of dying during acute coronary syndrome (ACS), but the origins and biological correlates of these emotional responses are poorly understood. This study evaluated the prevalence of fear of dying, associations with inflammatory responses during ACS, and later heart rate variability (HRV) and cortisol secretion. Methods and results Two hundred and eight patients admitted with clinically verified ACS rated their fear of dying on interview in hospital. Plasma tumour necrosis factor (TNF)α was recorded on admission, and HRV and salivary cortisol were assessed 3 weeks later. Intense distress and fear of dying was experienced by 21.7%, with moderate levels in 66.1% patients. Fear of dying was more common in younger, lower socioeconomic status, and unmarried patients. It was positively associated with plasma TNFα on admission after controlling for sociodemographic factors, clinical risk, and pain intensity (adjusted odds = 4.67, 95% C.I. 1.66-12.65). TNFα was associated with reduced HRV 3 weeks later, adjusting for clinical and sociodemographic factors and medication (P = 0.019), while fear of dying was associated with reduced cortisol output (P = 0.004). Conclusions Intense distress and fear of dying and heightened inflammation may be related manifestations of an acute biobehavioural response to severe cardiac injury, and have implications for prognostically significant biological risk processe

Health-related quality of life in long-term survivors of childhood brain tumors : a population-based cohort study

Purpose Survivors of childhood brain tumors (BT) are at high risk for long-term physical and psychological sequelae. Still, knowledge about health-related quality of life (HRQL) and associated factors in this population is sparse. This study investigated HRQL and its predictors in long-term survivors of childhood BT. Methods Survivors of childhood BT (mean age = 28.1 years, SD = 6.8, n = 60) underwent clinical examination and neurocognitive examination, and completed self-rating questionnaires assessing HRQL (RAND-36) and depressive symptoms (Beck Depression Inventory-II). Socio-demographic information was gathered via a questionnaire. Tumor- and treatment-related information was collected from medical records. Control group data were collected from age-matched controls (n = 146) without a history of cancer, randomly selected from the local population registry. Multiple linear regression models were used to investigate predictors of HRQL; separate models were fitted for each domain of the RAND-36. Results Male survivors (mean age = 27.0, SD = 6.0, n = 39) reported significantly lower HRQL than male controls in the domains of physical functioning, general health, vitality, social functioning, and role limitations-emotional. Female survivors (mean age = 30.2 years, SD = 7.6, n = 21) reported comparable levels as female controls in all domains except physical functioning. A higher burden of late effects, not working/studying, being diagnosed with BT during adolescence, and reporting current depressive symptoms were significant predictors of lower HRQL. Conclusion Our results highlight that male survivors of childhood BT are at particular risk of impaired HRQL. Also, results point to the close relation between symptoms of depression and impaired HRQL in survivors of childhood BT which should be acknowledged by long-term follow-up care.Peer reviewe

Cryopreserved platelets in bleeding management in remote hospitals: A clinical feasibility study in Sweden

BackgroundBalanced transfusions, including platelets, are critical for bleeding patients to maintain hemostasis. Many rural hospitals have no or limited platelet inventory, with several hours of transport time from larger hospitals. This study aimed to evaluate the feasibility of using cryopreserved platelets that can be stored for years, in remote hospitals with no or limited platelet inventory.Material and methodsThree remote hospitals participated in a prospective study including adult bleeding patients where platelet transfusions were indicated. Cryopreserved platelets were prepared in a university hospital, concentrated in 10 ml, transported on dry ice, and stored at −80°C at the receiving hospital. At request, the concentrated platelet units were thawed and diluted in fresh frozen plasma. The indications, blood transfusion needs, and laboratory parameters pre- and post-transfusion, as well as logistics, such as time from request to transfusion and work efforts in preparing cryopreserved platelets, were evaluated.ResultsTwenty-three bleeding patients were included. Nine patients (39%) were treated for gastrointestinal bleeding, five (22%) for perioperative bleeding, and four (17%) for trauma bleeding. The transfusion needs were 4.9 ± 3.3 red blood cell units, 3.2 ± 2.3 plasma units, and 1.9 ± 2.2 platelet units, whereof cryopreserved were 1.5 ± 1.1 (mean ± SD). One patient had a mild allergic reaction. We could not show the difference in laboratory results between pre- and post-transfusion of the cryopreserved units in the bleeding patients. The mean time from the order of cryopreserved platelets to transfusion was 64 min, with a range from 25 to 180 min.ConclusionCryopreserved platelets in remote hospitals are logistically feasible in the treatment of bleeding. The ability to have platelets in stock reduces the time to platelet transfusion in bleeding patients where the alternative often is many hours delay. Clinical effectiveness and safety previously shown in other studies are supported in this small feasibility study