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- Berglund, Sara, et al.
(author)
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Cardiorenal function and survival in in-hospital cardiac arrest : A nationwide study of 22,819 cases
- 2022
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In: Resuscitation. - : Elsevier BV. - 0300-9572 .- 1873-1570. ; 172, s. 9-16
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Journal article (peer-reviewed)abstract
- Background: We studied the association between cardiorenal function and survival, neurological outcome and trends in survival after in-hospital Methods: We included cases aged 18 years in the Swedish Cardiopulmonary Resuscitation Registry during 2008 to 2020. The CKD-EPI equation was used to calculate estimated glomerular filtration rate (eGFR). A history of heart failure was defined according to contemporary guideline criteria. Logistic regression was used to study survival. Neurological outcome was assessed using cerebral performance category (CPC). Results: We studied 22,819 patients with IHCA. The 30-day survival was 19.3%, 16.6%, 22.5%, 28.8%, 39.3%, 44.8% and 38.4% in cases with eGFR < 15, 15-29, 30-44, 45-59, 60-89, 90-130 and 130-150 ml/min/1.73 m2, respectively. All eGFR levels below and above 90 ml/min/1.73 m2 were associated with increased mortality. Probability of survival at 30 days was 62% lower in cases with eGFR < 15 ml/min/1.73 m2, compared with normal kidney function. At every level of eGFR, presence of heart failure increased mortality markedly; patients without heart failure displayed higher mortality only at eGFR below 30 ml/min/1.73 m2. Among survivors with eGFR < 15 ml/min/1.73 m2, good neurological outcome was noted in 87.2%. Survival increased in most groups over time, but most for those with eGFR < 15 ml/min/1.73 m2, and least for those with normal eGFR. Conclusions: All eGFR levels below and above normal range are associated with increased mortality and this association is modified by the presence of heart failure. Neurological outcome is good in the majority of cases, across kidney function levels and survival is increasing.
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- Dellve, Lotta, et al.
(author)
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The impact of systematic occupational health and safety management for occupational disorders and long-term work attendance
- 2008
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In: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 67:6, s. 965-970
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Journal article (peer-reviewed)abstract
- Despite several years of conducting formalized systematic occupational health and safety management (SOHSM), as required by law in Sweden and most other industrialized countries, there is still little evidence on how SOHSM should be approached to have an impact on employees' health. The aim of this study was to investigate the importance of SOHSM, considering structured routines and participation processes. for the incidence of occupational disorders and the prevalence of long-term work attendance among home care workers (HCWs). Municipal human service organizations were compared concerning (a) their structured routines and participation processes for SOHSM and (b) employee health, i.e. the municipal five-year incidence of occupational disorders and prevalence of work attendance among HCWs. National register-based data from the whole population of HCWs (n = 154773) were linked to register-data of occupational disorders and prevalence of long-term work attendance. The top managers and safety representatives in selected high- and low-incidence organizations (n = 60) answered a questionnaire about structure and participation process of SOHSM. The results showed that prevalence of long-term work attendance was higher where structure and routines for SOHSM (policy, goals and plans for action) were well organized. Highly structured SOHSM and human resource management were also related to high organizational incidence of reported occupational disorders. Allocated budget and routines related to HCWs' influence in decisions concerning performance of care were also related to long-term work attendance. The participation processes had a weak effect on occupational disorders and work attendance among HCWs. Reporting occupational disorders may be a functional tool to stimulate the development of effective SOHSM, to improve the work environment and sustainable work ability.
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- Herlitz, Johan, 1949, et al.
(author)
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Impact of a history of diabetes on the improvement of symptoms and quality of life during 5 years after coronary artery bypass grafting.
- 2000
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In: Journal of diabetes and its complications. - : Elsevier Inc.. - 1056-8727 .- 1873-460X. ; 14:6, s. 314-21
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Journal article (peer-reviewed)abstract
- To describe the impact of a history of diabetes mellitus on the improvement of symptoms and various aspects of quality of life (QoL) during 5 years after coronary artery bypass grafting (CABG). Patients who underwent CABG between 1988 and 1991 in western Sweden were approached with an inquiry prior to surgery and 5 years after the operation. QoL was estimated with three different instruments: Physical Activity Score (PAS), Nottingham Health Profile (NHP) and Psychological General Well-Being (PGWB) index. 876 patients participated in the evaluation, of whom 87 (10%) had a history of diabetes. Symptoms of dyspnea and chest pain improved both in diabetic and non-diabetic patients. Diabetic patients scored worse than non-diabetic patients both prior to and 5 years after CABG, but without any major difference in improvement between the two groups with all three measures of QoL. PAS tended to improve more in non-diabetic than in diabetic patients, whereas improvement in NHP and PGWB was similar regardless of a history of diabetes. Diabetic patients differ from non-diabetic patients having an inferior QoL both prior to and 5 years after CABG. Both diabetic and non-diabetic patients improve in symptoms and QoL after the operation. In some aspects improvement tended to be less marked in the diabetic patients but on the whole improvement was similar compared to non-diabetic patients.
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- Herlitz, Johan, 1949, et al.
(author)
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Symptoms of chest pain and dyspnoea during a period of 15 years after coronary artery bypass grafting.
- 2010
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In: European journal of cardio-thoracic surgery. - : Elsevier. - 1873-734X .- 1010-7940. ; 37:1, s. 112-118
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Journal article (peer-reviewed)abstract
- AIM: To describe changes in chest pain and dyspnoea during a period of 15 years after coronary artery bypass grafting (CABG) and to define factors at the time of operation that were associated with the occurrence of these symptoms after 15 years. DESIGN: Prospective observational study in western Sweden. SUBJECTS: All patients who underwent first-time CABG, without simultaneous valve surgery, between 1 June 1988 and 1 June 1991. There were no exclusion criteria. FOLLOW-UP: All patients were followed up prospectively for 15 years. The evaluation of symptoms took place through postal questionnaires prior to and 5, 10 and 15 years after the operation. RESULTS: Totally, 2000 patients were included in the survey and 904 (45%) of them survived to 15 years. Among these 904 survivors, the percentage of patients with chest pain increased from 44% to 50% between the 5- and 15-year follow-up (p=0.004). The percentage of patients who reported symptoms of dyspnoea increased from 60% after 5 years to 74% after 15 years (p<0.001). Factors at the time of surgery that independently tended to predict chest pain after 15 years were higher age (p=0.04) and prolonged duration of symptoms prior to surgery (p=0.04). Predictors of dyspnoea after 15 years were higher age (p<0.0001), the use of inotropic drugs at the time of surgery (p=0.001), a history of diabetes (p=0.01) and obesity (p=0.01). CONCLUSION: After CABG, relief from chest pain and dyspnoea is generally maintained over a long period of time. Eventually, however, functional-limiting symptoms tend to recur and about half the patients report symptoms of chest pain, while three-quarters report dyspnoea after 15 years. Even if no clear predictor of chest pain was found at the time of surgery, age, the use of inotropic drugs, diabetes and obesity predicted dyspnoea.
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- Pettersson, Anita, et al.
(author)
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Application of chemical fractionation methods for characterisation of biofuels, waste derived fuels and CFB co-combustion fly ashes
- 2008
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In: Fuel. - : Elsevier Ltd. - 0016-2361 .- 1873-7153. ; 87:15-16, s. 3183-3193
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Journal article (peer-reviewed)abstract
- In the important efforts to decrease the net CO2 emissions to the atmosphere, new, alternative fuels are being included in the fuel mixes used in utility boilers. However, these fuels have ash properties that are different from those of the traditionally used fuels and in some cases technical problems, such as ash fouling and corrosion occur due to this. Therefore, diagnostic and predictive methods are developed and used to avoid such problems. Determination of the chemical association forms of important elements, such as potassium and sodium, in the fuel by chemical fractionation is a method well defined for coal and biofuels, such as wood pellets, bark and forest residues. Chemical fractionation is a step by step leaching method extracting water soluble salts in the first step, ion exchangeable elements, such as organically associated sodium, calcium and magnesium in the second step and acid soluble compounds such as carbonates and sulfates in the third step. The solid residue fraction consists of silicates, oxides, sulfides and other minerals. The compound extracted in the two first steps is considered reactive in the combustion with a few exceptions. In this work, it has been applied to some waste fuels, i.e. sewage sludge, straw and refuse derived fuel (RDF), as well as to coal and wood. The present work also includes results from combustion tests in a fluidised bed boiler where three blends of the investigated fuels were used. The fractionation results for the fuel blends are weighted results of the fractionations of the pure fuels discussed above which are compared with fractionations of their corresponding fly ashes. The co-combustion strategy gave very good results in reducing ash problems. Possible chemical mechanisms involved are discussed in the article.
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| 8. |
- Pettersson, Anita, et al.
(author)
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Chemical fractionation for the characterisation of fly ashes from co-combustion of biofuels using different methods for alkali reduction
- 2009
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In: Fuel. - : Elsevier BV. - 0016-2361 .- 1873-7153. ; 88:9, s. 1758-1772
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Journal article (peer-reviewed)abstract
- a b s t r a c tChemical fractionation, SEM–EDX and XRD was used for characterisation of fly ashes from different cocombustiontests in a 12MW circulating fluidized bed boiler. The fuels combusted were wood pellets asbase fuel and straw pellets as co-fuel in order to reach a fuel blend with high alkali and chlorine concentrations.This fuel blend causes severe problems with both agglomeration of bed material if silica sand isused and with deposits in the convection section of the boiler. Counter measures to handle this situationand avoiding expensive shut downs, tests with alternative bed materials and additives were performed.Three different bed materials were used; silica sand, Olivine sand and blast furnace slag (BFS) and differentadditives were introduced to the furnace of the boiler; Kaolin, Zeolites and Sulphur with silica sand asbed material. The results of the study are that BFS gives the lowest alkali load in the convection pass comparedwith Silica and Olivine sand. In addition less alkali and chlorine was found in the fly ashes in theBFS case. The Olivine sand however gave a higher alkali load in the convection section and the chemicalfractionation showed that the main part of the alkali in the fly ashes was soluble, thus found as KCl whichwas confirmed by the SEM–EDX and XRD.The comparison of the different additives gave that addition of Kaolin and Zeolites containing aluminium-silicates captured 80% of the alkali in the fly ash as insoluble alkali–aluminium-silikates and reducedthe KCl load on the convection section. Addition of sulphur reduced the KCl load in the flue gas even morebut the K2SO4 concentration was increased and KCl was found in the fly ashes anyhow. The chemical fractionationshowed that 65% of the alkali in the fly ashes of the Sulphur case was soluble.
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