<p>Syftet med studien var att undersöka hur samarbetet för individer med samsjuklighet ser ut mellan kommun och landsting samt hur möjligheterna ser ut till samordnad vård och behandling. Frågeställningarna var att ta reda på hur samarbetet ser ut mellan kommun och landsting gällande individer med samsjuklighet samt vilka tillvägagångssätt som finns för att förbättra samordnad vård och behandling mellan kommun och landsting. Studien genomfördes med kvalitativa semistrukturerade intervjuer. Den teoretiska utgångspunkten var Fridolfs (2004) fyra motiv till ett bra samarbete. Utifrån det hermeneutiska synsättet tolkades intervjuerna inför resultatet med hjälp av innehållsanalys. Resultatet visar att det finns ett samarbete mellan kommun och landsting men för förbättring behövs det mer erfarenhet och kunskap om varandras arbetsuppgifter. Slutsatsen av resultatet är att mer forskning fordras om hur och på vilket sätt samarbete mellan kommun och landsting kan förbättras. Kan en gemensam huvudman vara ett alternativ?</p>

<p>Den sociala ångesten många känner i olika situationer kan leda till undvikande, isolering och ibland även kompliceras av depressiva symtom och/eller alkoholanvändning. Huruvida ett samband mellan dessa problem kan visa sig i 16-17 årsåldern undersöktes genom en enkät om nedstämdhet, alkoholanvändning och social ångest. Resultatet visade att nedstämdhet hade en inverkan på grad av social ångest hos båda könen. Dock var tjejer i högre grad än killar mer nedstämda. Tjejer som drack mindre uppvisade en högre grad av social ångest. Alkoholanvändning hängde inte ihop med killars hantering av social ångest. Resultatet tyder på att samband mellan variablerna kan visa sig tidigt. Därför borde resurser sättas in tidigt för att förhindra en negativ utveckling, så att personer kan fungera i samhället.</p> / <p>The social anxiety many people feel in different situations can lead to avoidance, isolation and be complicated with depressive symptoms and/or alcoholuse. Whether it’s possible to find relationships between these syndromes in age 16-17 was investigated through a survey about depression, alcoholuse and social anxiety. The result showed that depression had an impact on level of social anxiety for both sexes. Gals were more depressed than guys, though. Gals who drank less had a higher level of social anxiety. Alcoholuse had no impact in coping with social anxiety for guys. The result showes a connection between the variables that can be seen early. Therefore, resources should be available to prevent a negative development, so that people can function in society.</p>

<p>The aims of this project were to investigate the impact of perioperative myocardial damage on morbidity and mortality after coronary artery bypass grafting (CABG), to determine whether biochemical marker levels after CABG correlate to perioperative myocardial infarct size, and to assess the long-term morbidity after CABG, in particular to determine whether women do worse.</p><p>The studies were conducted in patients who had undergone isolated, primary CABG. The correlation of postoperative cardiac marker levels to early and late survival was evaluated in 4,911 consecutive patients; this showed that elevated cardiac markers implied a highly increased risk of both early cardiac death and late death. Hospital readmission for any cause and effect of gender on the readmission rate were analysed in 7,493 patients; it was found that the risk of readmission was higher in women than in men, because of greater co-morbidity and higher age. In the same patient cohort, it was clearly demonstrated that perioperative myocardial damage increased the risk of heart failure independently, and that late mortality was greatly increased in patients readmitted for heart failure. Finally, in a prospective, clinical trial, creatine kinase MB (CK-MB) and troponin I and T levels were found to correlate to infarction mass, as quantified by magnetic resonance imaging postoperatively. The findings strongly suggested that CK-MB above five times the upper normal limit was the result of perioperative myocardial infarction.</p><p>In conclusion, perioperative myocardial damage is an important adverse event with a highly negative effect on early and late survival after CABG, and also entails an increased risk of subsequent heart failure, which markedly impairs long-term survival. Gender differences may be explained by patient characteristics and risk factors and not by female sex per se. Increases in biochemical markers after CABG correspond to the amount of perioperatively infarcted myocardium. </p>

<p>The concept of exclusive breastfeeding in relation to daily feeding practices and to health and growth of infants in an affluent society was examined. In a descriptive longitudinal prospective study 506 mother-infant pairs were followed from birth through the greater part of the first year. Feeding was recorded daily, and health and growth were recorded fortnightly. </p><p>Large individual variations were seen in breastfeeding patterns. A wide discrepancy between the exclusive breastfeeding rates obtained from "current status" data and data "since birth" was found.</p><p>Using a strict definition of exclusive breastfeeding from birth and taking into account the reasons for giving complementary feeding, the study showed that many exclusively breastfed infants had infections early in life, the incidence of which increased with age, despite continuation of exclusive breastfeeding. However, truly exclusively breastfed infants seem less likely to suffer infections than infants who receive formula in addition to breast milk. Increasing formula use was associated with an increasing likelihood of suffering respiratory illnesses. The growth of exclusively breastfed infants was similar to that of infants who were not exclusively breastfed. </p><p>The health of newborn infants during the first year of life was associated with factors other than feeding practices alone. Some of these factors may be prenatal, since increasing birth weight was associated with an increasing likelihood of having respiratory symptoms, even in exclusively breastfed infants. However, exclusive breastfeeding was shown to be beneficial for the health of the infant even in an affluent society. </p>

There is an increased risk for cardiovascular (CV) comorbidity among patients with rheumatoid arthritis (RA), with premature atherosclerosis, and a higher incidence of CV events, compared with the general population. Disease related factors add to the CV risk, and interact with the traditional CV risk factors. The underlying mechanism for this is not completely understood. In active RA there is a loss of muscle mass and an increase in body fat content. Production of cytokines, i.e., adipokines, in the adipose tissue could link the inflammation with the CV system. Control of the inflammation has been suggested to modify the CV risk in RA, and the recently introduced biological drugs, such as the tumor necrosis factor inhibitors (TNFi), have opened up new treatment opportunities. The aim of this thesis was to evaluate aspects of the interaction between inflammation and CV comorbidity in RA using biochemical and epidemiological methods. Methods In the first two studies, patients with established RA were examined for clinical disease activity, and blood samples were analysed for cytokines and adipokines using ELISAs and multiplex technology. In Study I (n RA=23) anthropometric measurements were assessed and in Study II (n RA=51) measurements of intima-media thickness (IMT), and endothelial function (FMD). From a subgroup of patients (Study II, n RA=13) samples of abdominal subcutaneous adipose tissue (SAT) were analysed for content of adipokines. In study III and IV associations between treatment with TNFi and acute coronary syndromes (ACS) were analysed using data from the Swedish Rheumatology Register; in Study III regarding early RA (n TNFi exposed=1,271, n bionaïve RA=4,729), and in Study IV comprising patients with RA of all stages (n TNFi exposed=7,213, n bionaïve RA=17,769) and with a matched general population comparator cohort (n=32,161). Associations between response to TNFi therapy and risk for ACS in the early RA cohort were evaluated in a nested case-control design (cases n=24, controls n=81). Results Serum levels of the cytokines/adipokines interleukin-1 receptor antagonist (IL-1Ra), IL-6, osteopontin, visfatin and TNF were increased in patients compared with controls (p≤0.001-0.036). The amount of TNF receptor II extracted from SAT was greater in patients (p=0.006). The serum (s-) levels of IL-1Ra correlated with s-leptin (r=0.71, p≤0.001) and s-haptoglobin in RA patients (r=0.56, p≤0.01). The result from a factor analysis indicated IL-1Ra to be associated with both adipose tissue and inflammation. Levels of s-visfatin (p=0.019) and s-IL-1Ra (p=0.023), respectively, were positively associated with IMT independently of inflammatory activity and CV risk factors. PAI-1 and MCP-1 extracted from SAT showed inverse associations with IMT. Patients with RA, whether exposed to TNFi or bio-naïve, had a doubled risk for ACS compared with the general population; HR 2.09 (95%CI 1.58-2.76) and 1.80 (1.49-2.17), respectively. No significant associations between risk for ACS and TNFi exposure were detected after adjustments; HR 0.80 (0.52-1.24) in early RA and HR 1.08 (0.82-1.41) in RA of any duration. Furthermore, no association between the risk for ACS and response to TNFi treatment in patients with early RA was observed, OR 1.5 (0.3-6.9). Conclusions The results indicate that cytokines/adipokines may have a role in the development of atherosclerosis in RA patients. A continuing increase in the risk of ACS in RA compared with the general population, despite modern therapeutic strategies, was noted. Neither exposure nor response to treatment with TNFi was associated with any modification of the risk for ACS.

<p>The study proposed to conduct a descriptive study related to the correlation of infant feeding (EFF or EBF) and occurrence of morbidity diarrhoea and/or respiratory infections, in infants by 14 weeks of age. The study adopted a quantitative epistemological approach in seeking to describe the correlation of infant feeding and the occurrence of diarrhoea or respiratory infections by 14 weeks of age. The researcher embarked on a descriptive survey design and employed the questionnaire method during the data collection process. The Amathole District of the Eastern Cape Province was selected due to the accessibility of the targeted population. The unique demographic profile and rural-urban setting allows for a potentially rich data source whilst simultaneously reducing the potential incidence of bias in the data collection. The study sample was drawn from routine immunization and growth monitoring clinics in the Amathole district.</p>

The concept of exclusive breastfeeding in relation to daily feeding practices and to health and growth of infants in an affluent society was examined. In a descriptive longitudinal prospective study 506 mother-infant pairs were followed from birth through the greater part of the first year. Feeding was recorded daily, and health and growth were recorded fortnightly. Large individual variations were seen in breastfeeding patterns. A wide discrepancy between the exclusive breastfeeding rates obtained from "current status" data and data "since birth" was found. Using a strict definition of exclusive breastfeeding from birth and taking into account the reasons for giving complementary feeding, the study showed that many exclusively breastfed infants had infections early in life, the incidence of which increased with age, despite continuation of exclusive breastfeeding. However, truly exclusively breastfed infants seem less likely to suffer infections than infants who receive formula in addition to breast milk. Increasing formula use was associated with an increasing likelihood of suffering respiratory illnesses. The growth of exclusively breastfed infants was similar to that of infants who were not exclusively breastfed. The health of newborn infants during the first year of life was associated with factors other than feeding practices alone. Some of these factors may be prenatal, since increasing birth weight was associated with an increasing likelihood of having respiratory symptoms, even in exclusively breastfed infants. However, exclusive breastfeeding was shown to be beneficial for the health of the infant even in an affluent society.

The aims of this project were to investigate the impact of perioperative myocardial damage on morbidity and mortality after coronary artery bypass grafting (CABG), to determine whether biochemical marker levels after CABG correlate to perioperative myocardial infarct size, and to assess the long-term morbidity after CABG, in particular to determine whether women do worse. The studies were conducted in patients who had undergone isolated, primary CABG. The correlation of postoperative cardiac marker levels to early and late survival was evaluated in 4,911 consecutive patients; this showed that elevated cardiac markers implied a highly increased risk of both early cardiac death and late death. Hospital readmission for any cause and effect of gender on the readmission rate were analysed in 7,493 patients; it was found that the risk of readmission was higher in women than in men, because of greater co-morbidity and higher age. In the same patient cohort, it was clearly demonstrated that perioperative myocardial damage increased the risk of heart failure independently, and that late mortality was greatly increased in patients readmitted for heart failure. Finally, in a prospective, clinical trial, creatine kinase MB (CK-MB) and troponin I and T levels were found to correlate to infarction mass, as quantified by magnetic resonance imaging postoperatively. The findings strongly suggested that CK-MB above five times the upper normal limit was the result of perioperative myocardial infarction. In conclusion, perioperative myocardial damage is an important adverse event with a highly negative effect on early and late survival after CABG, and also entails an increased risk of subsequent heart failure, which markedly impairs long-term survival. Gender differences may be explained by patient characteristics and risk factors and not by female sex per se. Increases in biochemical markers after CABG correspond to the amount of perioperatively infarcted myocardium.

Syftet med studien var att undersöka hur samarbetet för individer med samsjuklighet ser ut mellan kommun och landsting samt hur möjligheterna ser ut till samordnad vård och behandling. Frågeställningarna var att ta reda på hur samarbetet ser ut mellan kommun och landsting gällande individer med samsjuklighet samt vilka tillvägagångssätt som finns för att förbättra samordnad vård och behandling mellan kommun och landsting. Studien genomfördes med kvalitativa semistrukturerade intervjuer. Den teoretiska utgångspunkten var Fridolfs (2004) fyra motiv till ett bra samarbete. Utifrån det hermeneutiska synsättet tolkades intervjuerna inför resultatet med hjälp av innehållsanalys. Resultatet visar att det finns ett samarbete mellan kommun och landsting men för förbättring behövs det mer erfarenhet och kunskap om varandras arbetsuppgifter. Slutsatsen av resultatet är att mer forskning fordras om hur och på vilket sätt samarbete mellan kommun och landsting kan förbättras. Kan en gemensam huvudman vara ett alternativ?

Four interrelated studies on drug users in prison are presented within the framework of a proposed model for approaching the enhancement of health for persons that builds on an existential view of prisoners’ needs, as well as the risk management and “good lives” perspectives. Risk management is the major focus in current offender rehabilitation based on research on “what works,” which has shown that focusing treatment on risk factors termed “criminogenic needs,” such as impulsivity, poor family relations and drug abuse, reduces recidivism by 10-15 percentage points. The “good lives” perspective proposes that offender rehabilitation should go beyond risk management and also address non-criminogenic needs such as autonomy, relatedness and competence as foundations for building personally meaningful lives. Study I explores the assessment of drug use problems, and describes the psychometric evaluation of the Drug Use Disorders Identification Test (DUDIT), a newly developed 11-item test for quick screening of drug-related problems. Studies II-IV explore treatment for offenders in prison identified as drug users. Study II is a randomized controlled trial of two auricular acupuncture treatments for men and women in prison, inconclusive with regard to point specificity but showing that participants in both groups reported reduced symptoms of discomfort and improved night-time sleep. Study III evaluates the Reasoning &amp; Rehabilitation program, an internationally widespread cognitive-behavioral program for groups of offenders. Results showed significant pro-social short-term changes in sense of coherence, impulsivity and attitudes towards the criminal justice system, as well as a 25% lower risk of reconviction among program completers compared to matched controls. However, the quasi-experimental nature of the study precludes any certainty regarding program effects; a selection bias whereby more motivated program participants are recruited could explain the findings. Study IV is a pilot project exploring the special needs of a subgroup of drug-using inmates with psychiatric and/or violent co-morbidity. Inmates housed in psychiatric prison units were offered long-term auricular acupuncture treatment. Half of the 22 inmates in the study received treatment twice a week for over eight weeks, and those treated over 25 times had lower psychopharmacological medication levels than untreated controls. Studies I-IV address individual facets of a proposed model for enhancing health among drug users in prison. The health enhancement model approaches offender rehabilitation from perspectives of existential psychology, good lives and risk management. Specific definitions of physical, social, psychological/personal and spiritual needs indicate a framework according to which prison treatment can help drug-using offenders find ways to secure healthy need satisfaction.