| 1. |
- Agardh, Emilie E, et al.
(författare)
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Burden of type 2 diabetes attributed to lower educational levels in Sweden
- 2011
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Ingår i: Population Health Metrics. - : Springer Science and Business Media LLC. - 1478-7954. ; 9, s. 60-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Type 2 diabetes is associated with low socioeconomic position (SEP) in high-income countries. Despite the important role of SEP in the development of many diseases, no socioeconomic indicator was included in the Comparative Risk Assessment (CRA) module of the Global Burden of Disease study. We therefore aimed to illustrate an example by estimating the burden of type 2 diabetes in Sweden attributed to lower educational levels as a measure of SEP using the methods applied in the CRA.METHODS: To include lower educational levels as a risk factor for type 2 diabetes, we pooled relevant international data from a recent systematic review to measure the association between type 2 diabetes incidence and lower educational levels. We also collected data on the distribution of educational levels in the Swedish population using comparable criteria for educational levels as identified in the international literature. Population attributable fractions (PAF) were estimated and applied to the burden of diabetes estimates from the Swedish burden of disease database for men and women in the separate age groups (30-44, 45-59, 60-69, 70-79, and 80+ years).RESULTS: The PAF estimates showed that 17.2% of the diabetes burden in men and 20.1% of the burden in women were attributed to lower educational levels in Sweden when combining all age groups. The burden was, however, most pronounced in the older age groups (70-79 and 80+), where lower educational levels contributed to 22.5% to 24.5% of the diabetes burden in men and 27.8% to 32.6% in women.CONCLUSIONS: There is a considerable burden of type 2 diabetes attributed to lower educational levels in Sweden, and socioeconomic indicators should be considered to be incorporated in the CRA.
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| 2. |
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| 3. |
- Alayon Glazunov, Andres, et al.
(författare)
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Cost analysis of smart antenna systems deployment
- 2005
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Ingår i: Proc. VTC 2005-Spring Vehicular Technology Conf. 2005 IEEE 61st. ; , s. 329-333
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Konferensbidrag (refereegranskat)abstract
- 3G networks and services are being launched all over the world The basic investments on equipment have already been done according to preliminary traffic forecasts. However, if the mobile data traffic acquires "internet- like" proportions, network capacity shortage will become a reality in densely populated areas, such as city centers and business parks. In that case smart antennas may be the solution. Based on this assumption the financial aspects of the deployment of smart antenna systems in the 3G UMTS networks have been evaluated. We have evaluated the potential CAPEX and OPEX savings provided by such a system compared to more conventional antenna systems. Despite their indicative nature, our calculations show that cost savings of the order of 10% to 25% are feasible if the cost increase of the smart antenna equipment is of the order of 100% to 50% of the conventional antennas equipment costs, respectively.
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| 4. |
- Alnersson, Gustaf
(författare)
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Towards 3D modelling of Compression Moulding of SMC
- 2021
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The automotive industry is facing ever increasing demands for reduced emissions, and lightweight solutions are thusly required. One field that has significant potential in this regard is composite materials, which can offer a good combination of weight reduction and mechanical properties. However, the rapid development cycles in the automotive industry mean that tools for numerical modeling are necessary, both regarding manufacturing processes and prediction of mechanical properties. The material that has been of interest for this work is Sheet Moulding Compound (SMC). SMC consists of sheets of resin and chopped fibres. When used for manufacturing the sheets are cut into appropriate size and shape. The cut sheets are then placed in a pre-heated mould. When this mould is closed, the sheets melt and the fibre-filled resin flows out and fills the mould cavity; the resin then cures and solidifies. A significant advantage of SMC compared to other composite solutions is that the process has comparatively short cycle times, which is a necessity for automotive applications. However, it is a rather complicated process to model numerically for a number of reasons, including the complex rheological properties of the charge, the often rather significant temperature gradients throughout the thickness, often complicated three-dimensional effects in the flow, and the chopped fibres present in the charge. These fibres will move and change orientation as the charge is pressed, which is a significant challenge to model properly.The first part of this work is a review and discussion of the difficulties described above, and some solutions that have been suggested. The second part concerns a suggestion for a three-dimensional flow model for the compression moulding process, which takes into account factors that have been suggested to influence the flow behavior, such as temperature distribution and shear strain rate. Some simulation results are presented along with comparison to previous experimental results, and similar flow patterns are observed serving as a qualitative validation. The third part concerns the expansion of this model to include the effects of the flow on the fibre orientation.
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| 5. |
- Bandstein, Nadia, et al.
(författare)
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Survival and resource utilization in patients with chest pain evaluated with cardiac troponin T compared with high-sensitivity cardiac troponin T
- 2017
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 245, s. 43-48
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Tidskriftsartikel (refereegranskat)abstract
- Background:It is uncertain how the implementation of high-sensitivity cardiac troponin T (hs-cTnT) has affected the survival of patients with chest pain in the emergency department (ED). We studied prognosis and resource utilization in terms of coronary angiographies and revascularizations (percutaneous coronary intervention or coronary artery bypass grafting) in patients evaluated with hs-cTnT compared with conventional troponin T (cTnT).Methods:All patients >25 years presenting with chest pain and at least one troponin level analyzed in the ED at the Karolinska University Hospital, Sweden, were included. Hazard ratios (HR) for all-cause mortality, coronary angiographies and revascularizations were adjusted for age, sex and comorbidities during 1 year of follow-up comparing patients tested with hs-cTnT (December 10, 2010 to December 31, 2013) with patients tested with cTnT (January 1, 2009 to December 9, 2010).Results:In total, 31,904 patients were included (n=12,485 tested with cTnT and n=24,729 using hs-cTnT). Patient characteristics, comorbidities, and medications were similar during the study period. The absolute risk of all-cause mortality was 3.7% for those tested with cTnT compared with 3.4% for hs-cTnT. After adjustment for confounders, an increased all-cause mortality was observed for patients tested with hs-cTnT (HR 1.15; 95% confidence interval (CI) 1.02-1.29). Coronary angiographies increased by 13% (HR 1.13; 95% CI 1.00-1.28) and revascularizations by 18% (HR 1.18; 95% CI 1.01-1.37) when using hs-cTnT.Conclusions:In an observational cohort study including patients with chest pain in the ED we found a small increase in mortality, coronary angiographies and revascularizations after the introduction of hs-cTnT.
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| 6. |
- Barbulescu, Andrei, et al.
(författare)
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Oral metronidazole use and risk of acute pancreatitis : a population-based case-control study.
- 2018
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Ingår i: Clinical Epidemiology. - 1179-1349. ; 10, s. 1573-1581
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Oral metronidazole used in combined regimens for Helicobacter pylori eradication has been associated with an increased risk of acute pancreatitis; however, it is less clear whether a similar association exists for single-regimen metronidazole. We, therefore, examined the association of single and combined regimens of oral metronidazole with risk of acute pancreatitis.METHODS: In this population-based case-control study, all individuals in Sweden (aged 40-84 years) hospitalized with acute pancreatitis between January 2006 and December 2008 were identified from a national hospital register (n=5,996). Controls, matched for calendar year, age, and sex, were randomly sampled from a national population register (n=60,681). Data on oral metronidazole and covariates were extracted from national health and prescription registers. Odds ratios (ORs) of acute pancreatitis, according to timing of the latest metronidazole prescription before hospitalization, were estimated using logistic regression models. Confounding by indication was examined by contrasting the main results with the association when amoxicillin was used as exposure. The robustness of results was examined by calculating incidence rate ratios using a self-controlled case series approach.RESULTS: After adjustment for potential confounders, there was a substantially increased risk of acute pancreatitis within 30 days of oral metronidazole exposure, both for single (OR: 4.06; 95% confidence interval [CI]: 1.90-8.64) and combined (OR: 11.80; 95% CI: 6.86-20.28) regimens, compared to nonexposure. In contrast, the adjusted OR was 1.79 (95% CI: 1.25-2.54) for current use of amoxicillin compared to nonexposure. These results were supported by the self-controlled cases series analysis (incidence rate ratio: 3.30; 95% CI: 2.69-4.06, for single and combined regimens of oral metronidazole pooled). There was no strong association between oral metronidazole and acute pancreatitis more than 30 days after exposure.CONCLUSION: There was an increased risk of acute pancreatitis within 30 days of exposure to single and combined regimens of oral metronidazole. While reverse causality and confounding by indication cannot be entirely excluded, they are unlikely to fully explain the association. These results warrant an increased awareness among physicians.
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| 7. |
- Bjorkenstam, Charlotte, et al.
(författare)
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An Association between Initiation of Selective Serotonin Reuptake Inhibitors and Suicide - A Nationwide Register-Based Case-Crossover Study
- 2013
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Ingår i: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 8:9, s. e73973-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Treatment with selective serotonin reuptake inhibitors (SSRI) is one of the most common treatments for depression. It is however not clear whether or not there is an increased short-term suicide risk during initiation with SSRI. Methods: A register-based nationwide case-crossover study including 5,866 suicides, 1,698 women and 4,168 men, from the Death Register 2007-2010 in Sweden. SSRI initiation was defined as a dispensed prescription of SSRI within 28 days prior to the date of suicide with no previous dispensed prescription of SSRI within 4 months prior that prescription. The control period took place one year earlier. Odds ratio (OR) was estimated using conditional logistic regression. Result: During the 28 day period prior to suicide 48 women and 138 men were exposed to SSRI initiation (while not being exposed in the control period) and 22 women and 43 men were exposed in the control period (while not being exposed in the case period). The OR for suicide after initiation with SSRI was 2.7 (95% CI: 1.6-44) for women, and 4.3 (95% CI: 3.0-6.1) for men. The highest OR was found 8-11 days after initiation with SSRI 9.7 (95% CI: 3.0-31.7) for women and men combined. Conclusion: The main limitation in this study is confounding by indication, but the descriptive question is however not confounded by indication. Together with plausible biological mechanisms and previous clinical and epidemiological observations our findings, linking initiation of SSRI to increased short-term suicide risk, deserve further attention specifically in the clinical setting.
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| 8. |
- Björkenstam, Charlotte, et al.
(författare)
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Suicide or undetermined intent? : A register-based study of signs of misclassification
- 2014
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Ingår i: Population Health Metrics. - : Springer Science and Business Media LLC. - 1478-7954. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Several studies have concluded that some deaths classified as undetermined intent are in fact suicides, and it is common in suicide research in Europe to include these deaths. Our aim was to investigate if information on background variables would be helpful in assessing if deaths classified as undetermined intent should be included in the analyses of suicides. Methods: We performed a register study of 31,883 deaths classified as suicides and 9,196 deaths classified as undetermined intent in Sweden from 1987 to 2011. We compared suicide deaths with deaths classified as undetermined intent with regard to different background variables such as sex, age, country of birth, marital status, prior inpatient care for self-inflicted harm, alcohol and drug abuse, psychiatric inpatient care, and use of psychotropics. We also performed a multivariate analysis with logistic regression. Results: Our results showed differences in most studied background factors. Higher education was more common in suicides; hospitalization for self-inflicted harm was more common among female suicides as was prior psychiatric inpatient care. Deaths in foreign-born men were classified as undetermined intent in a higher degree and hospitalization for substance abuse was more common in undetermined intents of both sexes. Roughly 50% of both suicide and deaths classified as undetermined intent had a filled prescription of psychotropics during their last six months. Our multivariate analysis showed male deaths to more likely be classified as suicide than female: OR: 1.13 (1.07-1.18). The probability of a death being classified as suicide was also increased for individuals aged 15-24, being born in Sweden, individuals who were married, and for deaths after 1987-1992. Conclusion: By analyzing Sweden's unique high-validity population-based register data, we found several differences in background variables between deaths classified as suicide and deaths classified as undetermined intent. However, we were not able to clearly distinguish these two death manners. For future research we suggest, separate analyses of the two different manners of death.
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| 9. |
- Björkenstam, Emma, et al.
(författare)
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Juvenile delinquency, social background and suicide-a Swedish national cohort study of 992 881 young adults
- 2011
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Ingår i: International Journal of Epidemiology. - : Oxford University Press (OUP). - 0300-5771 .- 1464-3685. ; 40:6, s. 1585-1592
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Tidskriftsartikel (refereegranskat)abstract
- Background As the suicide rates in young adults do not show a clear decline, it is important to elucidate possible risk factors. Juvenile delinquency has been pointed out as a possible risk behaviour. Methods This register-based cohort study comprises the birth cohorts between 1972 and 1981 in Sweden. We followed 992 881 individuals from the age of 20 years until 31 December 2006, generating 10 210 566 person-years and 1482 suicides. Juvenile delinquency was defined as being convicted of a crime between the ages of 15 and 19 years. Estimates of risk of suicide were calculated as incidence rate ratio (IRR) with 95% confidence intervals (CIs) using Poisson regression analysis with adjustment for potential confounding by their own and their parents' mental illness or substance abuse, parental education, single parenthood, social assistance, adoption and foster care. Results Among females, 5.9%, and among males, 17.9%, had at least one conviction between the ages 15 and 19 years. In the fully adjusted model, females with one conviction had a suicide risk of 1.7 times higher (95% CI 1.2-2.4), the corresponding IRR for men was 2.0 (95% CI 1.7-2.4) and 5.7 (95% CI 2.5-13.1) and 6.6 (95% CI 5.2-8.3), for women and men with five or more convictions. The effect of severe delinquency on suicide was independent of parental educational level. Conclusions This study supports the hypothesis that individuals with delinquent behaviour in late adolescence have an increased risk of suicide as young adults. Regardless of causality issues, repeated juvenile offenders should be regarded by professionals in health, social and correctional services who come into contact with this group as a high-risk group for suicide.
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| 10. |
- Björkenstam, Emma, et al.
(författare)
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Quality of medical care and excess mortality in psychiatric patients : a nationwide register-based study in Sweden
- 2012
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 2:1, s. e000778-
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To assess overall and cause-specific mortality and the quality of somatic care among psychiatric patients.DESIGN: A register-based cohort study.SETTING: All individuals aged 20-79 years in Sweden in 2005.PARTICIPANTS: In total 6 294 339 individuals.PRIMARY OUTCOME MEASURE: The individuals were followed for mortality in 2006 and 2007, generating 72 187 deaths. Psychiatric patients were grouped according to their diagnosis in the National Patient Register. Mortality risk of psychiatric patients was compared with that of non-psychiatric patients. Estimates of RR of mortality were calculated as incidence rate ratios (IRRs) with 95% CIs using Poisson regression analysis. Psychiatric patients were compared with non-psychiatric patients for three healthcare quality indicators: the proportion of avoidable hospitalisations, case death rate after myocardial infarction and statin use among diabetic patients.RESULTS: Compared with individuals with no episodes of treatment for mental disorder, psychiatric patients had a substantially increased risk of all studied causes of death as well as death from conditions considered amenable to intervention by the health service, that is, avoidable mortality. The highest mortality was found among those with another mental disorder, predominantly substance abuse (for women, an IRR of 4.7 (95% CI 4.3 to 5.0) and for men, an IRR of 4.8 (95% CI 4.6 to 5.0)). The analysis of quality of somatic care revealed lower levels of healthcare quality for psychiatric patients, signalling failures in public health and medical care.CONCLUSION: This study shows a marked increase in excess mortality, suggesting a lower quality of somatic healthcare in psychiatric patients.
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