| 1. |
- Lindvall, Daniel, et al.
(författare)
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Upphettning - Demokratin i klimatkrisens tid
- 2020
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- Vi står inför en existentiell utmaning med förändrade villkor för allt liv på jorden. Samtidigt genomgår den moderna demokratin sin värsta kris sedan andra världskriget. Är hotet mot demokratin och den globala upphettningen två kriser som går ihop till en ödesdiger storm? Eller finns det vägar mot minskade utsläpp och en stabil demokratisk framtid? Upphettning är en djupdykning i klimatförnekelse som politisk rörelse. Utifrån aktuell forskning diskuterar boken de utmaningar som den globala uppvärmningen ställer på vårt demokratiska styrelseskick utifrån frågeställningar som: Kan vi med demokratins hjälp hantera klimatfrågan? Varför motsätter sig den auktoritära nationaliströrelsen så aktivt klimatvetenskap? “Den här boken är angelägen för att den i detalj avslöjar sambanden mellan förnekelsen av klimathotet och undergrävandet av demokratin och det öppna samhället.” Sverker Sörlin, professor i miljöhistoria vid KTH ”Med imponerande kunskapsbredd ger boken en insiktsfull, engagerande och hoppingivande förståelse för hur demokratisk drivna samhällstransformationer kan övervinna fossilekonomins djupt rotade strukturer.” Björn-Ola Linnér, professor vid Tema Miljöförändring med inriktning internationell klimatpolitik ”Upphettning är en heltäckande och lärd exposé av klimatkrisen historia i världen och i Sverige, globalt och lokalt. Rekommenderad läsning för alla i klimatkrisens tidevarv.” Gustaf Arrhenius,VD, Institutet för framtidsstudier, professor i praktisk filosofi ”Detta är en efterfrågad och mycket viktig bok för alla som vill förstå en av samtidens viktigaste debatter: den av människan skapade globala klimatkrisen och hur det kommer sig att vissa grupper i samhället förnekar att krisen överhuvudtaget existerar.” Ann-Kristin Bergquist, docent i ekonomisk historia vid Umeå universitet
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| 2. |
- Fine, Kimberly L., et al.
(författare)
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Association Between Early Prescribed Opioid Initiation and Risk of Suicidal Behavior
- 2020
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Prescription opioid use has been linked to increased risk of suicidal behavior in adults. However, little research exists examining the role of prescription opioid use on risk of suicidal behavior in children and adolescents. This population is at high risk for suicidal behavior, as suicide is the second leading cause of death for people ages 10 to 34. Using healthcare data from Swedish population registers, we aimed to characterize the extent to which exposure to opioids at a young age leads to an increased risk of new onset suicidal behavior, for those with no history of suicidal behavior. Compared to demographically matched non-recipients, young people who initiated prescription opioids had just under three times the rate of subsequent suicidal behavior (HR = 2.64, 95% CI, 2.47-2.81). Compared to their unexposed siblings, young people who initiated prescription opioids had roughly two times the rate of subsequent suicidal behavior (HR = 1.83, 95% CI, 1.67-2.01). Finally, compared to young people initiating prescription NSAIDs, young people who initiated prescription opioids had only 19% relatively greater rates of suicidal behavior (HR, 1.19, 95% CI, 1.11-1.27). These results suggest the association between prescription opioids and suicidal behavior may be driven by the underlying pain indication.
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| 3. |
- Malmgren, Linnea
(författare)
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Kidney Function During Ageing and its Association with Bone Mass, Fracture and Mortality
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Osteoporosis and osteoporosis related fractures are a major health care challenge both in Sweden and globally. The cost and suffering from osteoporosis are expected to increase since the population of elderly is increasing. Bone health can be affected by altered mineral homeostasis, which in its turn can be affected by reduced kidney function. However, the course of age-related decline in kidney function and its association to osteoporosis andfracture in the very elderly need further investigation since longitudinal data are scarce. Therefore, this thesis has two main aims; 1) to investigate kidney function during ageing and 2) its association to bone health in a cohort ofelderly women.Data was collected through the Malmö Osteoporosis Prospective Risk Assessment (OPRA) cohort, a prospective cohort of 1044 community dwelling women, all aged 75 and followed for ten years with reinvestigations at age 80and 85. Data on BMD, fracture and blood biochemistry was available at all three time points.Estimated kidney function greatly depends on which marker and study equation is used. The discrepancies are to such an extent that could affect whether a person is diagnosed with chronic kidney disease (CKD) or not, of particular importance in the elderly. Only women with the worst kidney function, corresponding to CKD stage 3b-5, had continuously increased mortality risk. This indicates that an age-dependent CKD definition would be of valuein elderly women.Kidney function in elderly women was associated with markers of mineral homeostasis, bone loss and BMD, but the effect size was relatively small compared to other risk factors. Also, fracture risk was increased only in womenwith mild-moderate reduction of kidney function (CKD stage 3a) and not in women with the worst kidney function (CKD stage 3b-5). Low BMD was associated with increased fracture risk independent of kidney function. Havingboth reduced kidney function and osteoporosis could present an additional risk increase.In conclusion, estimated kidney function in elderly women greatly depends on method of estimation and the results advocate for an age-adapted CKD definition. Maintaining adequate kidney function is important formaintaining bone health, although in old age it is probable that the effect size of any single specific risk factor is smaller compared with younger individuals.
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| 4. |
- Brännström, Jon, 1977-
(författare)
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Adverse effects of psychotropic drugs in old age
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: With increasing age, the body and mind transform. Many of our organs gradually lose capacity, making them more sensitive to the effects of several drugs. In parallel, many of us accumulate an increasing burden of disease and other conditions warranting the use of medications. Hence, the use of most classes of drugs increases with age, especially so in elderly women.At the same time, medical science is lagging behind due to the fact that the oldest people in society often are excluded from pharmacological studies, where young males are the most coveted subjects.In the absence of strong evidence, much of the knowledge about the clinical and adverse effects of several drugs in the elderly is derived from observational studies, prone to bias and confounding. The use of psychotropic drugs in elderly people is particularly controversial, and even more so in people suffering from major neurocognitive disorders (NCD). Psychotropics have been associated with several adverse effects as well as limited clinical effect. Still, they are frequently prescribed to elderly patients.Aims: This thesis aims to explore the associations between several types of psychotropic drugs and two of the most severe adversities attributed to their use, increased mortality and the risk of hip fracture. It aims to explore mortality in data from well-controlled studies. It also aims to employ novel statistical methods to investigate the associations between drug exposure and hip fracture, in an attempt to gain information on possible causality from observational data.Methods: This thesis uses quantitative, comparative and epidemiological methods, prospective as well as retrospective. Two of the four papers are based on data collections conducted by the Department of Community Medicine and Rehabilitation, Umeå University, and include 992 and 1,037 individuals, respectively. The other two papers are based on Swedish nationwide registers and include 408,144 and 255,274 subjects, respectively. In all four papers multivariable regression models were used to investigate the associations between the exposures and outcomes, adjusted for possible confounding variables.Results: In a population-based sample of very old people, and in old people with major NCD, ongoing use of psychotropic drugs was not independently associated with increased mortality. Analyses did show, however, a significant impact of sex on the mortality risk, with tendencies for antidepressant drug use to be protective in men, but not in women, and for benzodiazepines to increase the mortality risk in men, but not in women. In two cohorts of old people, based on several nationwide registers, investigating the associations between psychotropic drug use and hip fracture revealed that users of antidepressants, as well as users of antipsychotics, had significantly increased risks of hip fracture, independent of a wide range of covariates. However, when studying how the risk changed over time, the strongest associations were found before the initiation of treatment with the respective drug, and no dose-response relationships were found.Discussion: The finding that psychotropic drug use was not independently associated with an elevated mortality risk was not in line with previous research, most of which have been based on data from large registers, and shown an increased risk of mortality. One reason for this difference is that the cohorts studied in this thesis were thoroughly investigated and characterised, making it possible to perform extensive adjusting for confounding variables. Hence, we expect a lesser amount of residual confounding, than in most other studies. Another explanation is that we studied ongoing drug use at baseline, rather than associations following initiation of treatment. This might have introduced a selection bias in our studies, where the individuals most sensitive to adverse effects would have discontinued treatment or passed away. The finding of a significant impact of sex on the risk of mortality adds to the unexplored field of sex differences in drug responses in old age, and warrants further investigation.In our register studies of psychotropic drug use and the risk of hip fracture, novel methods were applied. We have tried to overcome the hurdles of several types of confounding through the investigation of associations before and after the initiation of antidepressants, and antipsychotics, respectively. Our finding that the associations between psychotropic drug use and hip fracture were not only present, but indeed strongest, before the initiation of treatment indicates a strong presence of residual confounding and confounding by indication, and points toward the absence of a causal relationship between psychotropic drug use and hip fracture.Conclusion: The evidence supporting causal relationships between psychotropic drug use and serious adverse events in old age is insufficient. Our results point towards bias and confounding having strong influences on the observed associations between psychotropic drug use and mortality, and hip fracture, respectively.
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| 5. |
- Westgård, Theresa, 1969
(författare)
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Comprehending the Comprehensive Geriatric Assessment. Feasibility, outcomes and experiences of frail older people
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- ABSTRACT Despite existing knowledge on how to approach frail people in health care, the care they receive is commonly not designed to meet their complex needs and support them in maintaining their activities of daily living. One way to support frail older people when needing health care could be to enable them to share their life-stories and communicate their wants and wishes. Learning about a person’s social history can be a key element in comprehending older people in their care needs. The overall aim of this thesis was to evaluate the Comprehensive Geriatric Assessment (CGA) for frail older people aged 75 or older and to explore their experiences of care following a CGA. Methods: A pilot study with 30 frail older people (>75 years) was performed to determine the feasibility of the CGA, the process and procedures, instruments and proof of principle. Participants were included to the CGA intervention group or the control group that received regular medical care. After the pilot was determined to be feasible, the full RCT was carried out with an additional 125 participants. The 155 participants were followed up at one and six months. During the RCT 10 participants from the CGA ward partook in additional qualitative interviews, which explored through narratives 1) what personal resources they had and how they experienced health care services using three dimensional-analysis, and 2) how they experienced receiving a CGA, using a conventional content analysis. Results: Identifying and screening frail older people who might benefit from a CGA was successful, and those receiving the intervention were met by staff practicing increased attention to safety, ADLs, assistive devices, and discharge planning (Study I). The participants to a high extent agreed that the CGA care met their needs (Study II). The CGA participants experienced having a voice when receiving health care services by using their personal resources (Study III), and they felt respected as a person who could communicate, understand and participate in their care (Study IV). Conclusion: CGA provides care that is better adapted to frail older people’s needs, as they themselves felt that the care met their needs; however, no statistically significant effects for frail older people receiving care based on CGA were achieved. The lack of additional results supporting the CGA could be due to difficulties performing pragmatic intervention trials in clinical hospital settings leading to a risk of low statistical power. In addition, a CGA during a single hospital stay is probably not enough to have long-term effects, since frail older people are in need of integrated care provided by multidisciplinary teams. To best benefit frail older people when receiving health care, an organized continuum of care is needed. In order to secure the care is based on what people need, a person-centered approach is fundamental.
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| 6. |
- Hedegaard Sørensen, Claus, et al.
(författare)
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Kollektivtrafikmyndigheter och smart mobilitet: Nordiska erfarenheter och perspektiv på MaaS och autonoma bussar
- 2020
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Automatisering, elektrifiering, integrerad mobilitet samt plattforms- och delnings- ekonomin diskuteras i allt större omfattning. Smart mobilitet är en samlingsterm för dessa olika fenomen och trender. Smart mobilitet anses kunna bidra till ett mer hållbart transportsystem, attraktiva städer och levande landsbygd, men kan också leda till ökad privatbilism, mer trängsel och en försämrad stadsmiljö. Forskning visar att en central förutsättning för att smart mobilitet ska kunna bidra till ett mer hållbart transportsystem är att andelen kollektivtrafik och delade mobilitetstjänster ökar. Nya aktörer har dykt upp på transportområdet och erbjuder olika typer av mobilitetstjänster. Frågan är hur befintliga kollektivtrafikmyndigheter strategiskt ska positionera sig i detta nya och snabbt föränderliga landskap. Vilken typ av ansvarsfördelning och vilken typ av samverkan kommer att krävas för att uppnå attraktiva och hållbara transporter i en framtid präglad av smart mobilitet? Det är bakgrunden till detta forskningsprojekt, som har finansierats av K2. I projektets har vi genomfört fallstudier från (främst) nordiska storstäder om det som betecknas kombinerad mobilitet eller Mobility as a Service (MaaS), samt pågående försök med autonoma bussar. Hanteringen av MaaS har studerats i storstadsregionerna Stockholm, Västra Götaland, Skåne, Oslo, Helsingfors, Köpenhamn. Utblickar har även gjorts till Birmingham och Amsterdam. När det gäller autonoma bussar har merparten av det empiriska arbetet genomförts i Barkarby i Järfälla kommun (Region Stockholm). Därtill har vi även genom en workshop inhämtat erfarenheter från Oslo och Själland (Danmark) samt från ett utredningsarbete i Sjöbo och Tomelilla kommuner (Skåne). Vidare har vi studerat uppfattningar om autonoma bussar bland representanter för svenska bussförare. Analyserna i projektet har lett fram till en tydlig bild av att den offentliga sektorns organisationer spelar en viktig roll i utvecklingen, förmedlingen och integreringen av smart mobilitet. I praktiken har vi sett att olika kollektivtrafikmyndigheter har tagit olika roller; medan vissa är mycket aktiva och engagerade, håller sig andra mer avvaktande och försiktiga. Rapportens analyser visar att de nordiska RKM-erna ofta har liknande mål med att införa MaaS och autonoma bussar, men att de har valt olika ansatser för att realisera dessa mål. I samtliga fall präglas arbetet av en önskan att skapa bättre mobilitet och fler möjligheter för medborgarnas resande, samt en ambition att bidra till en så kallad ”modal shift” till mer hållbart resande och därmed en hållbar utveckling. Under den tidsperiod som vi har arbetat med detta projekt har MaaS framstått som en ”större” fråga och mer uttalat utvecklingsområde för de nordiska RKM-erna än autonoma bussar. Men autonoma bussar ingår också i deras arbete, och hanteras ibland som en mer eller mindre integrerad del av arbetet med MaaS. Det avsätts sammantaget stora resurser till arbetet med både MaaS och autonoma bussar, men initiativ med MaaS kräver, under för övrigt lika förhållanden, ett större samordningsarbete än initiativ med autonoma bussar. Introduktion av smart mobilitet är inte en neutral fråga, utan tvärtom en fråga med ett utpräglat politiskt innehåll, eftersom den rör formandet av framtidens mobilitet, samt makt och fördelning av resurser i samhället. Regionala kollektivtrafikmyndigheter är i grunden politiskt styrda organisationer, men vi kan notera att frågan om smart mobilitet trots detta inte diskuteras som den politiskt laddade fråga den är. Det finns idag en tendens att reducera den till en fråga om renodlad teknikutveckling, och det finns i flera fall en benägenhet att lämna över viktiga strategiska och principiella vägval till marknadsaktörer. Detta är problematiskt. Vi efterlyser en bredare politisk diskussion om smart mobilitet. Vi menar också att regionala kollektivtrafikmyndigheter skulle behöva komplettera sin verksamhet med nya kompetenser. Det är bland annat nödvändigt för samarbetet med nya aktörer och för att kunna ställa krav på nya leverantörer av mobilitetstjänster. Det är viktigt att RKM och andra politiska institutioner tar ställning till syftet med smart mobilitet som MaaS, autonoma bussar, privata självkörande bilar (delade eller ej), elsparkcyklar m.m. Om man inte kan precisera syftet med smart mobilitet är det kanske inte här man ska använda resurser. Bland de nordiska RKM-erna finns många olika strategier för hur myndigheterna förhåller sig till MaaS, och det är för närvarande inte möjligt att säga vilken strategi som är den mest förnuftiga. En medvetet återhållsam strategi kan om några år visa sig bättre än en mer aktiv strategi. Det motsatta är dock naturligtvis också möjligt.
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| 7. |
- Svensson, Martina
(författare)
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Physical exercise as a preventive strategy for disorders affecting the brain. The effect on neuroinflammation.
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Physical activity is associated with lower risks of developing dementia, Parkinson’s disease (PD) and depression. Furthermore, being physically active prior to brain ischemia appears to help the recovery process. However, previous studies do not differentiate between the two most common forms of dementia, Alzheimer’s disease (AD) and vascular dementia (VaD), when it comes to the association between physical activity and dementia. Also, these studies do not take into consideration the potential bias due to reverse causation when assessing these associations. Moreover, little is known about how exercise affects neuroinflammation and other pathological hallmarks of brain ischemia and AD.In this thesis, I investigate the potential of physical activity to act as a preventive strategy against common disorders affecting the brain. With a focus on translational medicine, I combined an epidemiological approach with experimental approaches. By using the Vasaloppet Registry together with the Swedish population and patient registries, we investigated if physically active skiers (n= 197,685) had lower risks of AD, VaD, PD and depression compared to an age and sex-matched general population (n=197,684) during an up to 21-year follow-up. Using experimental interventions, I investigated how running affected neuroinflammation and other aspects of the molecular pathology in mouse models of brain ischemia and AD.I discovered that forced running in mice prior to global brain ischemia may induce a stress response, leading to increased neuronal death in the hippocampus.We observed a lower risk of depression among both sex in our skiers (hazard ratio (HR)=0.50 (0.46-0.53), p<0.001). Among men, faster skiing was associated with an even lower risk compared to slower skiers (HR=0.65 (0.49-0.87), p=0.004), whereas faster female skiers did not have any difference in risk compared to slower counterparts (HR=1.14 (0.77-1.70), p=0.51). The reasons behind these differences require further investigation.Skiers also had a lower risk of developing PD compared to controls during the early follow-up period (HR=0.71 (0.55- 0.90), p=0.004), but this association became non-significant in sensitivity-analysis excluding persons diagnosed with PD within the first 5 years after inclusion (HR=0.80 (0.62-1.03), p=0.09). With longer follow-up times, the skiers’ cumulative PD incidence converged with that of the general population. These findings are in line with the motor reserve hypothesis, wherein physically active individuals may develop a motor reserve, allowing them to sustain PD pathology longer before symptoms appear.Moreover, skiers had a lower risk of VaD (HR=0.54 (0.37-0.80), p=0.002), but not AD (HR=0.88 (0.66-1.18), p=0.40). Experimentally, in the 5xFAD mouse model, 6 months of voluntary wheel running did not ameliorate their AD-like pathology. These findings question the general view of exercise as being protective against AD.Taken together, even though it is not equally effective against all disorders, a physically active lifestyle seems to be associated with a lower risk of developing disorders affecting the brain. Furthermore, the exact mechanisms behind these associations remain to be elucidated, and the optimal exercise settings need to be defined.
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| 8. |
- Åhlund, Kristina, 1978-
(författare)
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Physical Fitness in Hospitalized Frail Elderly Patients
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Demographic research shows that the proportion of older people in society is increasing. More people age well, but there are also more people getting old with disability and multimorbidity. The large diversity in functioning illustrates the heterogeneity of aging. Accelerated aging may lead to frailty, which is a geriatric syndrome, often used as a marker of biologic age and associated with decreased physiologic reserves, increased vulnerability and the risk of adverse health out- comes. Frail elderly people are frequent visitors within emergency hospital care and physical decline is common. Unfortunately, elderly patients with substantial multimorbidity are often excluded from clinical trials.Physical fitness comprises a set of measurable health- and skill-related outcomes, such as cardiorespiratory endurance and muscle strength. A decrease in physical fitness may affect the prognosis negatively. However, previous research indicates that it may be possible to reverse frailty and improve physical fitness. It is therefore of the utmost interest to identify frailty and study how care is best provided, in order to prevent, reduce and postpone adverse health consequences.The overall aim of this thesis is to study physical fitness in a group of frail elderly patients, within clinical hospital health care. The patients’ physical fitness will be evaluated and compared in different care settings during and after hospitalization. The aim is also to study the long-term consequences of changes in physical fitness in relation to mortality. To better understand the underlying factors for partici- pation in physical activity and exercise, patients’ perceptions of the phenomena will be explored.This thesis consists of four papers based on two studies comprising frail elderly patients with substantial multimorbidity, in connection with an in-hospital episode. Paper 1 was an observational study with a cross-sectional design (n=408). Different components of physical fitness were measured during an index hospital stay and the results showed that hospitalized frail elderly patients performed below previously described age-related reference values. Furthermore, physical fitness was associated with the degree of frailty, rather than the chronological age. Paper 2 was a prospective controlled trial, with two parallel groups. The patients included in the intervention group (n=206) were cared for at an emergency medical care unit providing care according to Comprehensive Geriatric Assessment and care (CGA). The control group (n=202) was cared for at conventional emergency medical care units. The multi-professional care approach at the CGA unit was shown to be beneficial, in terms of a greater proportion of patients who preserved or improved their function during the first three months after discharge from hospital, compared with conventional care. Paper 3 had a prospective approach when evaluating the association between physical fitness and oneyear mortality in those 390 patients discharged alive from a hospital care episode. The results showed that physical fitness during in-hospital care and the change in physical fitness during the first months after discharge were associated with one-year mortality.In Paper 4, the patients’ perspective in terms of physical activity and exercise was explored. The theme of “Meaningfulness and risk of harm in an aging body” emerged, followed by the three categories of physical activity as part of daily life, goals of physical activity and exercise and prerequisites for physical activity and exercise.These studies highlight the importance of a greater focus on physical fitness in hospitalized elderly patients. A careful assessment and a multi-professional approach may lead to beneficial results and better survival even in a group of frail elderly patients with severe multimorbidity. To increase physical activity and exercise in this group of patients, health care probably needs to improve the means of communicating the benefits and goals of exercise and facilitating them so that the risk of harm is reduced.
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| 9. |
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| 10. |
- Pettersson, Beatrice, et al.
(författare)
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Proposals for continued research to determine older adults’ falls risk
- 2020
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Ingår i: Journal of Frailty, Sarcopenia and Falls. - : Hylonome Publications. - 2459-4148. ; 5:4, s. 89-91
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Early detection of older adults with an increased risk of falling could enable early onset of preventative measures. Currently used fall risk assessment tools have not proven sufficiently effective in differentiating between high and low fall risk in community-living older adults. There are a number of tests and measures available, but many timed and observation-based tools are performed on a flat floor without interaction with the surrounding. To improve falls prediction, measurements in other areas that challenge mobility in dynamic conditions and that take a persons’ own perception of steadiness into account should be further developed and evaluated as single or combined measures. The tools should be easy to apply in clinical practice or used as a self-assessment by the older adults themselves.
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