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- Sundström, Johan, Professor, 1971-, et al.
(författare)
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Risk factors for subarachnoid haemorrhage : a nationwide cohort of 950 000 adults
- 2019
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Ingår i: International Journal of Epidemiology. - : Oxford University Press. - 0300-5771 .- 1464-3685. ; 48:6, s. 2018-2025
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Subarachnoid haemorrhage (SAH) is a devastating disease, with high mortality rate and substantial disability among survivors. Its causes are poorly understood. We aimed to investigate risk factors for SAH using a novel nationwide cohort consortium.METHODS: We obtained individual participant data of 949 683 persons (330 334 women) between 25 and 90 years old, with no history of SAH at baseline, from 21 population-based cohorts. Outcomes were obtained from the Swedish Patient and Causes of Death Registries.RESULTS: During 13 704 959 person-years of follow-up, 2659 cases of first-ever fatal or non-fatal SAH occurred, with an age-standardized incidence rate of 9.0 [95% confidence interval (CI) (7.4-10.6)/100 000 person-years] in men and 13.8 [(11.4-16.2)/100 000 person-years] in women. The incidence rate increased exponentially with higher age. In multivariable-adjusted Poisson models, marked sex interactions for current smoking and body mass index (BMI) were observed. Current smoking conferred a rate ratio (RR) of 2.24 (95% CI 1.95-2.57) in women and 1.62 (1.47-1.79) in men. One standard deviation higher BMI was associated with an RR of 0.86 (0.81-0.92) in women and 1.02 (0.96-1.08) in men. Higher blood pressure and lower education level were also associated with higher risk of SAH.CONCLUSIONS: The risk of SAH is 45% higher in women than in men, with substantial sex differences in risk factor strengths. In particular, a markedly stronger adverse effect of smoking in women may motivate targeted public health initiatives.
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| 2. |
- Blomquist, Tomas, 1963-, et al.
(författare)
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Ekonomisk styrning för förändring : en studie av ekonomiska styrinitiativ i hälso- och sjukvården
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Since the end of the 1980’s Swedish county council managers has been preoccupied with planning and implementing organisational change in order to alleviate the financial problems and to create more efficient production systems. Many of these efforts to change have implied changing the systems for management accounting and control, changes that have been inspired both by market-oriented ideologies and by the governance principles of large corporations in the private sector. Literature on management accounting and control indicates however, that management is unintentionally contributing to the creation of organisational inertia and conservatism. This contradiction is formulated as a change dilemma; ”How can managerial principles that make organizations subject to bureaucratization and inertia be used as important strategies for organizational change?” The purpose of the study is thus to analyze the use of management control systems as organizational change strategies in health care, employing a change perspective on management control.When used as a change strategy, management accounting and control becomes manifest as management control initiatives. Actors handle these control inititatives by organising themselves around the issue at hand. This organising process ends or fades away when there are no need for further attention to the control initiative.Empirical studies were made in the councils of Västerbotten, Sörmland and Uppsala counties. Management control initiatives investigated were performance-related pay, quality improvement work, systematic planning procedures, provider/purchaser-models, downsizing projects and profit center systems.The systems for management accounting and control appeared to structure health care organisations in terms of spatial structuring temporal structuring and actor categorization. The management control initiatives introduced were structured as extraordinary organising processes delimited in terms of space, time and involved actors. Actors in the administrative norm system participated with the intention to change the organisation, while those in the medical norm system aimed at just handling the initiative.Management control initiatives can therefore be seen as passing opportunities to change, passing in the sense that the organising processes are temporary by nature, opportunities in the sense that temporary re-coupling can be used to achieve long-term change. One such opportunity is the formulation of control initiatives; the possibility of using simple and standardized change strategies can be useful, but only if they are also linked to the medical norm system. A second opportunity is the temporary organising processes; if the project form of organising change can also be conveyed to the medical norm system, management control initiatives could result in short, intense courses of events that actually change things. The third opportunity s the recurrent cyc ica pro perties of management accounting and control systems, enabling recurrent activities around the same themes, thereby keeping them alive.
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