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- Genell Andrén, Kjerstin
(författare)
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Social network, perceived ill health and use of an emergency department : a descriptive and experimental study
- 1987
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The contents of this thesis are focused on relationships between social integration, social network and social support, on the one hand, and perceived ill health and care utilization on the other. The aims of the thesis were to: investigate the relationship between social network, perceived ill health and utilization of an emergency department (ED); relate the frequency of ED use to socio-demographic risk indicators for social disintegration; describe the psycho-social and medical situation of a group of heavy users of ED services In comparison to the general population; relate changes in social network in a group of heavy users to utilization of ED; evaluate the effects of hospital social worker intervention for heavy users of ED. The hypothesis was that if the informal network fails or becomes insufficient or if the work sector is deleteriously affected, the individuals may choose to turn to public agencies such as health care and social welfare for help. This hypothesis was tested in one such agency, the somatic ED of a general hospital. The main findings were that social network variables such as perceived loneliness, lack of close friend, less contact with extended family, living alone, being outside the labour force and having economic problems were related to a higher utilization of ED resources. It was demonstrated that subjects living in areas characterized by high geographical mobility, high proportions of unemployed and of immigrants used ED services to a higher extent than those who lived in areas which did not show these socio-demographic risk indicators for social disintegration. Heavy users of ED were medically and psycho-socially more burdened than the general population of the catchment area. Individuals who originally recurrently visited the ED but whose access to support giving networks improved, reduced their number of ED visits in the course of time. Hospital social worker intervention for a group of heavy ED users reduced the effect of age, health problems and living alone on ED use, but did not affect total utilization rate. In conclusion, use of emergency care is a complex product of many, sometimes concomitant factors; medical, social, psychological and structural. Some of these factors lay within the reach of individual or professional actions and interventions, but some, such as employment opportunities, geographical mobility and organization of care, are only amenable on societal level.
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| 2. |
- Hansagi, Helen
(författare)
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Non-urgent and heavy use of the emergency department : intervention and follow-up studies
- 1989
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The "inappropriate" use of emergency departments (EDs) - for non urgent or minor ailments and high-frequency use, "heavy use" - is causing great concern to several Western countries, irrespective of differing health care systems. Through a trial at Huddinge Hospital, about a quarter of the patients who sought care at the ED during day-time were classified by the reception staff as non-urgent cases in the sense of not needing the special resources of an emergency department. Of these non-urgent cases, 55% patients could be referred by a registered nurse to more appropriate care providers. Seven per cent were found to need the resources of the ED after all, 11% did not agree to be referred and 27% could not be referred due to organizational hindrance, mostly insufficient capacity at the primary health care centres. The referred patients were found to have a more positive attitude to the ED than had patients who had been treated in the usual way at the ED (66% versus 48%). However, the attitudes to primary care were not more favourable in referred patients (45% versus 41%). The proportion of patients in the referred group who used the ED the year following the trial was significantly reduced. The users, however, continued to turn to the ED with non-urgent health problems. Heavy ED users were found also to consume considerable amounts of primary care at the health care centres. Long-term follow-up of a population sample showed that without any intervention, heavy ED users continue to have a high utilization of hospital care. Mortality among heavy ED users was significantly elevated: the Standardized Mortality Ratio was 2.0 (95% confidence interval: 1.9 to 2.1) and the risk of dying prematurely (before reaching age 65) was more than four-fold compared with non-users. Violent death, especially suicide and intoxication were six times that of the non-users.
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| 3. |
- Lindahl, B Ingemar B
(författare)
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Selection of the principal cause of death : studies on the basis of mortality statistics for rheumatoid arthritis
- 1985
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The official statistics of Sweden for 1971-75 show a 2.7-fold increase in mortality for men and a 3.0-fold increase for women attributed to rheumatoid arthritis (RA) as the underlying cause of death. In order to investigate the basis of this observed increase, all death certificates for 1971 and 1975 with a diagnosis of RA (N=1224) were studied. All information was re-coded according to the original entry on the death certificates. The aims of the study were to seek an explanation of the observed increase by investigating the National Central Bureau of Statistics' (NCBS) registration procedure, and to identify inadequacies in the completion of death certificates and major interpretation problems facing the certifiers and coders in the reporting and registration of the causes of death. The investigation showed that the observed increase was due to changes in the NCBS' registration procedure: An increased tendency by the NCBS to favour RA in the registration of the underlying cause of death even when RA was not reported as the underlying cause on the death certificates. Physicians had reported a slight decrease for men and practically no change at all for women between the years when RA was considered the underlying cause of death. The major inadequacies identified on the certificates were (1) an inadequate causal sequence, (2) diagnoses making the conditions difficult or impossible to code, (3) more than one diagnosis for each link in the causal sequence leading to death, and (4) an underlying condition not stated in accordance with other provisions of the official WHO instructions. The NCBS was found to have registered RA as the underlying cause instead of physicians' stated underlying condition (i) when RA was likely to have caused the stated underlying condition, (ii) when the non-RA diagnosis was the only entry in part I of the certificate and rendered an incomplete description of the fatal course of events, (iii) when the non-RA condition could only be classified by a rest-category code of the International Classification of Diseases (ICD), and (iv) when the non-RA condition was considered 'trivial'. The NCBS' increased registration of RA as the underlying cause of death in the period examined could not be explained by inadequately made out death certificates, nor by a strict application of the rules for coders on selection of the underlying cause of death issued in the ICD. Several interpretation problems were identified of significance to cause-of-death statistics in general and different interpretations were discussed. Some of these problems were caused by inadequacies on the certificates. Others concerned incompleteness, ambiguities, and manifold meanings of the basic concepts and rules governing the reporting and registration of causes of death.
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| 4. |
- Wahlgren, Mats
(författare)
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Antigens and antibodies involved in humoral immunity to plasmodium falciparum
- 1986
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Malaria plasmodiidae cause more death and disease than any other known human pathogen. The parasite still threatens half of the world population {2.5 billion) and 300 million people are considered to become infected every year. More than 1 million African children annually die from malaria and there are an estimated 80 million clinical cases/year in the world. How protection or immunity to the parasites is mounted in humans is still partially unknown, although both cellular and antibody mediated immunity has been implied. This thesis describes several aspects of the humoral immune response to Plasmodium falciparurn in humans. Sera from individuals with different degrees of exposure to the parasite or with clinical immunity were used to study antibodies to P. falciparum antigens by means of ELISA, indirect immunofluorescence, immunoprecipiation and immunoblotting. Antibodies of IgM and all four IgG isotypes were detected both in sera from immune donors and in those with their first infection. However, whereas high titered sera contained antibodies of IgM and IgG1-4 isotypes, IgG2 and IgG4 antibodies were frequently missing in low titered sera. This could indicate that the isotype expression, on the average, follows the downstreams order of the Igh-C genes and is correlated with the intensity of immunization as occurring in infection. Using the same methods for a detailed investigation of sera from children and adults living in a holoendemic area of Liberia, no (or weak) correlations between age-dependent acquisition of P.falciparum immunity and overall antibody activities or isotype expression were seen.
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