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| 2. |
- Alfvén, Tobias, et al.
(författare)
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Agenda 2030 och målen för en hållbar utveckling angår oss alla
- 2020
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Ingår i: Läkartidningen. - 0023-7205. ; 117
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Tidskriftsartikel (refereegranskat)abstract
- The 2030 Agenda for Sustainable Development and its seventeen Sustainable Development Goals were adopted by the United Nations General Assembly in 2015. It is a bold agenda for global social, environmental and economic development, with human health as a central theme. Even though substantial improvements in health have been achieved during the last decades, every year over 5 million children die, mostly from preventable causes, and 300 000 women die in conjunction with childbirth. Premature deaths from non-communicable diseases are increasing, and our ability to treat infections is under threat through widespread anti-microbial resistance. Climate change is recognized as the biggest threat to health in our time. When the world now starts to plan for how society and our health systems should be reorganized after the COVID-19 pandemic the 2030 Agenda could and should play a central role. In this context, Agenda 2030 provides an ambitious roadmap for development, with its emphasis on collaboration across borders and disciplines. The agenda is achievable but reaching its goals will require strong commitment at all levels and societal change on a large scale.
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| 3. |
- Alfvén, Tobias, et al.
(författare)
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Agenda 2030 och målen för en hållbar utveckling angår oss alla [The 2030 Agenda for Sustainable Development - an important opportunity to improve global health]
- 2020
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Ingår i: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 117
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Forskningsöversikt (refereegranskat)abstract
- The 2030 Agenda for Sustainable Development and its seventeen Sustainable Development Goals were adopted by the United Nations General Assembly in 2015. It is a bold agenda for global social, environmental and economic development, with human health as a central theme. Even though substantial improvements in health have been achieved during the last decades, every year over 5 million children die, mostly from preventable causes, and 300 000 women die in conjunction with childbirth. Premature deaths from non-communicable diseases are increasing, and our ability to treat infections is under threat through widespread anti-microbial resistance. Climate change is recognized as the biggest threat to health in our time. When the world now starts to plan for how society and our health systems should be reorganized after the COVID-19 pandemic the 2030 Agenda could and should play a central role. In this context, Agenda 2030 provides an ambitious roadmap for development, with its emphasis on collaboration across borders and disciplines. The agenda is achievable but reaching its goals will require strong commitment at all levels and societal change on a large scale.
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| 4. |
- Alfvén, Tobias
(författare)
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Bone and kidney effects from cadmium exposure : dose effect and dose response relationships
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cadmium is a heavy metal that has been dispersed in the environment during the last century due to human activity. It is well known that high cadmium exposure causes renal damage and in severe cases also osteoporosis and osteomalacia. Osteoporosis is a major cause of morbidity worldwide. A number of risk factors, such as age and gender, are well established, but little is known about the contribution of environmental risk factors. The aim of the present work was to investigate the effects of low cadmium exposure on bone and kidneys. A cross-sectional study was performed in 520 men and 544 women, aged 16-81, environmentally or occupationally exposed to cadmium. Cadmium in urine as well as in blood was used as the dose estimate, and protein HC was used as a marker of tubular proteinuria, an early sign of renal damage. Bone mineral density (BMD) in the forearm was measured using DXA (dual energy x-ray absorptiometry) technique. The study revealed that tubular proteinuria occurred in cadmium exposed persons at lower levels of cadmium doses than previously known. At levels between 0.3 and 0.5 nmol cadmium/mmol creatinine in urine, there was a two-fold increased risk of displaying elevated urinary protein HC, compared to the reference (<0.3). A dose-effect relationship was found between increasing cadmium dose and decreasing BMD for people aged 60 and older. In the older age group, there was a dose-response relationship, showing a three-fold increased risk of low BMD in the group with urinary cadmium higher than 3 nmol/mmol creatinine compared to the lowest dose group. The difference between the age groups may reflect that older bone is more sensitive to cadmium, or that it takes several decades for cadmium to affect bone. There was also evidence of an increased risk of forearm fractures with increasing cadmium levels. For the population aged 50 and over, the fracture hazard ratio increased by 18% per nmol cadmium/mmol creatinine. Renal tubular damage was negatively related to bone mineral density and increasing risk of forearm fractures, suggesting that the possible effect of cadmium on the bone may be an indirect effect mediated by the kidneys. Altogether the thesis reveals relationships between low cadmium doses and early kidney effects, decreased BMD and increased risk of forearm fractures. Although it is difficult to directly compare the cadmium levels in the present study with other groups having other exposure histories, the levels are in the same range as that of many people in the general population. Hereditary, endocrine and life-style factors are probably the primary causes of osteoporosis; however, a comparatively low increase in risk because of cadmium may have a large impact on public health, if a large part of the population has cadmium levels at which there is an increased risk.
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| 5. |
- Alfvén, Tobias, et al.
(författare)
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Dödligheten minskar, men fortfarande dör 7 miljoner barn varje år
- 2013
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 110:1-2, s. 28-30
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Millenniemål 4 lyder: »Barnadödligheten under de fem första levnadsåren ska minska med två tredjedelar till 2015 jämfört med år 1990«.Barnadödligheten minskar i stora delar av världen, men inte i tillräckligt snabb takt för att uppnå målet. Den skiljer sig också kraftigt mellan länder och mellan olika grupper inom länderna.Sex dödsorsaker står för mer än 90 procent av alla dödsfall före 5 års ålder: neonatal mortalitet, lunginflammation, diarré, malaria, mässling och HIV/aids. Undernäring beräknas vara delorsak till cirka en tredjedel av dessa dödsfall.Vi har kunskap och metoder att med kostnadseffektiva lösningar reducera barnadödligheten med två tredjedelar. Fortsatt internationellt samarbete, utökade resurser samt lokal, nationell politisk vilja krävs för att lyckas.
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| 6. |
- Alfvén, Tobias, et al.
(författare)
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Low-level cadmium exposure and osteoporosis.
- 2000
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Ingår i: Journal of Bone and Mineral Research. - 0884-0431 .- 1523-4681. ; 15, s. 1579-1586
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Tidskriftsartikel (refereegranskat)abstract
- Osteoporosis is a major cause of morbidity worldwide. A number of risk factors, such as age and gender, are well established. High cadmium exposure causes renal damage and in severe cases also causes osteoporosis and osteomalacia, We have examined whether long-term Pow-level cadmium exposure increases the risk of osteoporosis. Bone mineral density (BMD) in the forearm was measured in 520 men and 544 women, aged 16-81 years, environmentally or occupationally exposed to cadmium, using dual-energy X-ray absorptiometry (DXA) technique. Cadmium in urine was used as the dose estimate and protein HC was used: as a marker of renal tubular damage. There was a clear dose-response relation between cadmium dose and the prevalence of tubular proteinuria. Inverse relations were found between cadmium dose, tubular proteinuria, and BMD, particularly apparent in persons over 60 years of age, There was a dose-response relation between cadmium dose and osteoporosis. The odds ratios (ORs) for men were 2.2 (95% CI, 1.0-4.8) in the dose group 0.5-3 nmol Cd/mmol creatinine and 5.3 (2.0-14) in the highest dose category (greater than or equal to 3 nmol/mmol creatinine) compared with the lowest dose group (<0.5 nmol Cd/mmol creatinine). For women, the OR was 1.8 (0.65-5.3) in the dose group 0.53 nmol Cd/mmol creatinine. We conclude that exposure to low levels of cadmium is associated with an increased risk of osteoporosis.
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| 7. |
- Alfvén, Tobias, et al.
(författare)
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Mpox hos barn – svenskt perspektiv : Mpox and children - a Swedish perspective
- 2023
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Ingår i: Läkartidningen. - 0023-7205. ; 120
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Mpox (monkeypox) is an infection caused by the monkeypox virus, which belongs to the same family as the smallpox virus. Sporadic infections in humans have been known since the 1970s. Since spring 2022 there has been a global epidemic. The large majority of the mpox cases in the ongoing epidemic have been reported in adult men, the number of infected children is small. The typical manifestation of mpox includes a rash that initially presents as maculopapular lesions and then develops into vesicles and eventually crusts. Transmission of the virus primarily occurs through close contact with infected individuals, particularly through contact with unhealed blisters or wounds, as well as through sexual contacts and exposure to body fluids. In cases of documented close contact with an infected individual, post-exposure prophylaxis is recommended and may also be administered to children whose guardians have contracted mpox.
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| 8. |
- Axelson, Henrik, et al.
(författare)
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Inequalities in reproductive, maternal, newborn and child health in Vietnam: a retrospective study of survey data for 1997-2006
- 2012
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: Vietnam has achieved considerable success in economic development, poverty reduction, and health over a relatively short period of time. However, there is concern that inequalities in health outcomes and intervention coverage are widening. This study explores if inequalities in reproductive, maternal, newborn and child health and nutrition changed over time in Vietnam in 1997-2006, and if inequalities were different depending on the type of stratifying variable used to measure inequalities and on the type of outcome studied. Methods: Using data from four nationally representative household surveys conducted in 1997-2006, we study inequalities in reproductive, maternal, newborn and child health and nutrition outcomes and intervention coverage by computing concentration indices by living standards, maternal education, ethnicity, region, urban/rural residence, and sex of child. Results: Inequalities in maternal, newborn and child health persisted in 1997-2006. Inequalities were largest by living standards, but not trivial by the other stratifying variables. Inequalities in health outcomes generally increased over time, while inequalities in intervention coverage generally declined. The most equitably distributed interventions were family planning, exclusive breastfeeding, and immunizations. The most inequitably distributed interventions were those requiring multiple service contacts, such as four or more antenatal care visits, and those requiring significant support from the health system, such as skilled birth attendance. Conclusions: Three main policy implications emerge. First, persistent inequalities suggest the need to address financial and other access barriers, for example by subsidizing health care for the poor and ethnic minorities and by support from other sectors, for example in strengthening transportation networks. This should be complemented by careful monitoring and evaluation of current program design and implementation to ensure effective and efficient use of resources. Second, greater inequalities for interventions that require multiple service contacts imply that inequalities could be reduced by strengthening information and service provision by community and village health workers to promote and sustain timely care-seeking. Finally, larger inequalities for interventions that require a fully functioning health system suggest that investments in health facilities and human resources, particularly in areas that are disproportionately inhabited by the poor and ethnic minorities, may contribute to reducing inequalities.
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| 9. |
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| 10. |
- Dempsey, Tina, et al.
(författare)
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Endotracheal intubation performance at a large obstetric hospital delivery room, Hanoi, Vietnam
- 2022
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Ingår i: Resuscitation Plus. - : Elsevier. - 2666-5204. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Intrapartum-related events account for nearly 700,000 neonatal deaths globally yearly. Endotracheal intubation is a cornerstone in preventing many of these deaths, but it is a difficult skill to acquire. Previous studies have described intubation performances in high-income coun-tries, but data from low-and middle-income countries are lacking. We aimed to assess the performance of delivery room intubation in a lower middle -income country.Methods: This prospective observational study was conducted at the Phu San Hanoi Hospital, Vietnam, from September 2020 to January 2021. Video cameras were positioned above the resuscitation tables and data were extracted using adopted software (NeoTapAS). All neonates requiring positive pressure ventilation were included. Our main variables of interest were time to first intubation attempt, first intubation attempt duration, and successful first intubation attempt.Results: 18,107 neonates were born during the five months. Of these, 75 (0.4%) received positive pressure ventilation, and 36 (0.2%) required endotracheal intubation of whom 24 were captured on video. The median time to the first intubation attempt was 252 seconds (range 91-771 sec-onds), the median first attempt duration was 49 seconds (range 10-105 seconds), and the first attempt success rate was 75%.Conclusion: Incidences of positive pressure ventilation and endotracheal intubation were low in comparison to global estimates. Three out of four intubations were successful at the first attempt and the procedural duration was often longer than recommended. Future studies should focus on how to achieve and maintain intubation skills and could include considering alternative devices for airway management at birth.
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