Sepsis är ett livshotande tillstånd som kan drabba patienter inom hela sjukvården där sjuksköterskans arbete är av stor betydelse. Dödligheten vid sepsis är oroväckande hög och är därmed ett viktigt område att uppmärksamma. Syftet med litteraturöversikten var att belysa hur sjuksköterskan med hjälp av omvårdnadsinsatser kan identifiera patienter med sepsis på en somatisk vårdavdelning. Metod: en litteraturöversikt med systematisk ansats har genomförts i databaserna PubMed och Cinahl. Resultatet baseras på tio kvantitativa artiklar där fyra teman uppkommit som innefattade sjuksköterskans kompetens, utbildning, samverkan och fysiologiska parametrar och instrument. Den slutsats som framkom var att det krävs hög kompetens hos sjuksköterskan, god samverkan och tillgängliga instrument för att tidig identifiering av patienter med sepsis ska kunna vara möjligt. / Sepsis is one of the most life-threatening conditions that can affect patients in the whole healthcare sector. Therefore it is important to early identify the symptoms, where the nurse's work is of great importance. The mortality rate for sepsis is alarmingly high and is an important area to touch. The aim of this literature review was to highlight how nurses with nursing care can identify patients with sepsis in a somatic ward. Method: a literature review with a systematic approach has been implemented in the databases PubMed and Cinahl. The results are based on ten quantitative articles that four themes emerged as including nursing skills, education, collaboration and physiological parameters and tools. The conclusion that emerged was that it required great competence of the nurse; good interaction and available instruments for early identification of patients with sepsis should be possible.

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The aim of the following study is to depict the causes of death that were most common during a time period between 1880–1949 in the small villages Ivetofta, Ivö, Rinkaby and Vinslöv. The results will be presented in different time intervals of 10 years. Furthermore, the surge will analyse the variations over time and explain why causes of death may altern. In addition, it will also highlight specific aspects of the subject such as age, gender, birth, violent death, suicide and the Spanish flue. The results in the different areas will be compared to each other to illuminate similarities and differences. Moreover it will also be compared to national statistics to see if the different villages comply or oppose with the results. In order to improve the study, the conclusion will also be compared and connected to the two theories the demographic transition and The Epidemiologic Transition. They offer an explaination to the outcome and allow us to integrate this study in a greater context.   The results of this survey, show that the most common cause of death was that of age. Furthermore, there was a huge up-swing in heart diseases, brain diseases and cancer in the later time periods. At the beginning, most people that died were very young. This changed however and as time passed, more and more people began to decease at an older age and this complied with national statistics. There was a slight majority of women that passed away although almost all persons that occured in cases of violent death, were men and this category increased with time. Even though a lot of people died, a lot more were born and therefore the small societies had a positive birth ratio. There occured cases of the Spanish flue although it did not influence the vast statistics.

<p>Under det gångna århundradet ökade den förväntade livslängden avsevärt såväl i Sverige som i övriga världen. 1900-talets förbättrade livslängd drevs inledningsvis av en minskad barnadödlighet medan de senare årtiondena kännetecknades av minskad dödlighet i höga åldrar.</p><p>En åldrande befolkning innebär ökade krav på sjukvård, äldreomsorg och inte minst pensionssystem. Pålitliga prognoser för vår framtida livslängd behövs för att beräkna de resurser som nämnda verksamheter kommer att ta i anspråk och utgör förutsättningen för en rättvis prissättning av försäkringsprodukter med levnadsrisk.</p><p>Lee-Carter-modellen är en av vår tids tongivande modeller för mortalitetsprognostisering. Modellen används här för att göra livslängdsprognoser utifrån svenska mortalitetsdata; prognoserna jämförs sedan med observerade utfall.</p><p>Mot bakgrund av resultatet diskuteras levnadsrisk med fokus på pensioner.</p><p>Inte oväntat presterar prognoserna ingen felfri bild av verkligheten och prognosfelet varierar i storlek mellan skattningarna; att använda dem som underlag för pensionsberäkningar hade i förlängningen varit ohållbart. Exemplet illustrerar på samma gång vår osäkerhet inför framtidens livslängdsutveckling och svårigheten i att prognostisera den.</p> / <p>During the past century, Sweden along with many other countries experienced a sharp decline in mortality rates. The increased life expectancy was initially propelled by mortality reductions among infants and subsequently by a survival improvement in advanced ages.</p><p>An ageing population has large implications for those providing services to the elderly, such as medical care and pensions, whilst also addressing the need for accurate and reliable mortality forecasts and projection methods.</p><p>The Lee-Carter model is the current gold standard for mortality forecasting and has been widely adopted in several studies. Here, the model is applied on Swedish mortality data; the projections are then compared to the observed lifespan development. Against this backdrop, a discussion on longevity risk in pensions schemes follows.</p><p>The forecasts performed in this study do not perfectly reflect the observed mortality change in the examined period; furthermore, the variation of the estimation errors limits the actuarial value of the projections. The findings illuminate the uncertainty that surrounds our future life expectancy as well as the difficulties associated with forecasting it.</p>

<p>Hronična opstruktivna bolest pluća (HOBP) spada u bolesti sa rastućom stopom morbiditeta i mortaliteta uprkos svim preventivnim strategijama koje se aktivno sprovode. S obzirom na to da se radi o bolesti hroničnog, progresivnog toka, periodi remisije i egzacerbacija, deo su njenog &bdquo;prirodnog&ldquo; toka. Epizode egzacerbacija (pogor&scaron;anja) bolesti mogu zahtevati ambulantno ili pak hospitalno lečenje i značajno utiču na kvalitet života ali i smrtnost u ovoj populaciji bolesnika. Težina egzacerbacije odredjena je izmedju ostalog i uticajem pridruženih bolesti (komorbiditeta). U nekim slučajevima nije lako razgraničiti uticaj komorbiditeta na tok i ishod osnovne HOBP bolesti, naročito kada se simptomi i znaci pogor&scaron;anja preklapaju kao &scaron;to je to slučaj sa pridruženim kardiovaskularnim bolestima. U većini ovakvih slučajeva potrebno je brzo i adekvatno zbrinjavanje pacijenata. Stoga su nam potrebne precizne metode dijagnostike kojima bi se na relativno brz način mogla izvr&scaron;iti diferencijacija ovih pacijenata a samim tim i sprovodjenje odgovarajućeg nivoa lečenja. Kardijalni biomarkeri kao &scaron;to su NT-proBNP i troponin I, pokazali su u dosada&scaron;njim istraživanjima dobru korelaciju sa stepenom srčane insuficijencije i ishemije miokarda. S obzirom da egzacerbacija HOBP-a u nekom smislu predstavlja i kardiovaskularan dogadjaj s obzirom na hipoksemiju i povećan srčani napor, moguće je da se isti biomarkeri mogu koristiti i u predikciji stepena težine pogor&scaron;anja, odnosno mortaliteta. Primarni ciljevi ovog istraživanja su bili da se odredi uticaj kardijalnih biomarkera, NT-proBNP i troponin I markera, u odnosu na stepen pogor&scaron;anja (srednje te&scaron;ko ili te&scaron;ko) i ishod akutne egzacerbacije HOBP-a. Sekundarni cilj bilo je odredjivanje granične (cut-off) vrednosti NT-proBNP markera koja bi poredjeno sa ehokardiografskim nalazom ukazivala na disfunkciju isključivo &bdquo;desnog srca&ldquo;. U istraživanje je bilo uključeno 209 pacijenata koji su zbog akutne egzacerbacije HOBP-a bili hospitalizovani u Institutu za plućne bolesti Vojvodine, u periodu od juna 2013. do oktobra 2014.godine. U odnosu na stepen težine pogor&scaron;anja HOBP-a, 44% pacijenata je imalo srednje te&scaron;ko, a 55% pacijenata te&scaron;ko pogor&scaron;anje osnovne bolesti. Vrednosti NT-proBNP markera pokazale su pozitivnu korelaciju u odnosu na ove procente. Prosečna vrednost NT-proBNP markera iznosila je 1589 pg/ml. Vrednosti NT-proBNP markera takodje su bile statistički značajne i u odnosu na ishod hospitalizacije (pozitivan ili negativan). Vi&scaron;e vrednosti zabeležene su kod pacijenata sa negativnim odnosno smrtnim ishodom. Prema ehokardiografskim kriterijumima 60% pacijenata je imalo znake hroničnog plućnog srca. Vrednosti NT-proBNP markera bile su statistički značajno vi&scaron;e kod pacijenata sa smanjenom sistolnom funkcijom leve komore. Odredjena granična, tzv &bdquo;cut off&ldquo; vrednost NT proBNP markera u diferencijaciji pacijenata sa HOBP-om i pridruženom insuficijencijom &bdquo;levog srca&ldquo; je iznosila 1505 pg/l. Senzitivnost i specifičnost ovog testa su iznosile: 76,6% I 83,3%. Pozitivna (PPV) i negativna prediktivna (NPV) vrednost ovog testa su iznosile 57,14% i 92,4%. Istraživanje predstavlja detaljnu analizu slučajeva pacijenata u akutnoj egzacerbaciji HOBP-a na na&scaron;oj teritoriji i moglo bi biti od koristi u boljem razumevanju difierencijalnodijagnostičkih problema vezano za navedenu populaciju pacijenata, naročito sa pridruženim kardiovaskularnim bolestima.</p> / <p>Chronic Obstructive Pulmonary Disease (COPD) is still among diseases with an increasing rate of morbidity and mortality despite all preventive and actively involved treatment strategies. Considering that this is a disease with a chronic and progressive course, periods of reemission and exacerbation are inevitable part. Episodes of exacerbation of the disease may be treated ambulatory or in hospital which has significant influence on quality of life as and survival rate for this group of patience. Severity of exacerbation is defined, among other, by concomitant diseases. In some cases, it is hard to distinguish between symptoms and signs of basic disease and comorbidity. That is especially in the case of concomitant cardiovascular diseases. Most of these patients require adequate treatment as soon as possible due to severity of disease. There is a need for rapid and precise diagnostic approach to this problem. Cardiac biomarkers, NT/proBNP and troponin I, are well known biomarkers of cardiac insufficiency and ischemia. As the COPD exacerbation represents also a cardiovascular event due to increased cardiac stress and effort these biomarkers may be also used as markers of severity and mortality prediction. Primary goal of this research was to investigate the influenze of cardiac biomarkers on sverety and intrahospital mortality in pacients admitted to the hospital due to acute exacerbation of COPD. Secondary goal was to determined cut off value of NT/proBNP marker which will be significant in differentiation of patients with left heart failure at COPD exacerbation. We include 209 consecutive patients hospitalized at the Institute of Pulmonary Diseases of Vojvodine due to acute exacerbation of COPD. There were 44% of patients with moderate and</p>

<p>Uvod: Pravovremena i pouzdana stratifikacija rizika pacijenata sa akutnim ST eleviranim infarktom miokarda (STEMI) je važna zbog adekvatnog zbrinjavanja ovih bolesnika. Primarna perkutana koronarna intervencija (pPCI) je dovela do značajnog pobolj&scaron;anja ishoda pacijenata sa STEMI, a time moguće i do promene prediktivne važnosti različitih faktora rizika. Jung variabla je jednostavan klinički indeks rizika koji se koristi tokom inicijalne prezentacije pacijenata. Pokazana je prediktivna vrednost Jung varijable za hospitalni mortalitet pacijenata sa STEMI lečenih fibrinolitičkom terapijom, dok uloga Jung varijable u dugoročnoj prognozi pacijenata lečenih putem pPCI nije razja&scaron;njena. Cilj: Dokazati prediktivni značaj i odrediti najbolju vrednost Jung varijable u predviđanju jednogodi&scaron;njeg neželjenog kliničkog ishoda kod pacijenata sa STEMI lečenih pPCI, kao i dokazati njenu validnost na nezavisnoj populaciji. Metode: Sprovedena je prospektivna studija praćenja pacijenata sa STEMI lečenih pPCI tokom godinu dana; primarna studija je sprovedena u Institutu za kardiovaskularne bolesti Vojvodine (IKVBV), a validaciona u Vojnomedicinskoj akademiji (VMA). Ishodi studije: smrtni ishod, akutna srčana insuficijencija (AHF) i zbirni neželjeni ishod. Jung varijabla je računata prema formuli: sistolni krvni pritisak / (srčana frekvencija &times; godine života) &times; 100. Prediktivna vrednost Jung variable i prethodno etabliranih skorova rizika TIMI, PAMI i Zwolle je evaluiarana adekvatnim statističkim metodama. Rezultati: Od 647 pacijenata uključenih u primarnu studiju, umrlo je 70 (10.8%), dok je AHF imalo 42 (6.5%); od 418 pacijenata uključenih u validacionu studiju umrlo je 33 (7.9%), a 52 (12.4%) pacijenta je imalo AHF. U primarnoj studiji Jung variabla je bila prediktor smrtnog ishoda i zbirnog neželjenog ishoda, dok je u validacionoj studiji Jung varijabla bila nezavisni prediktor nastanka AHF (p&lt;0.01). Za mortalitet, Jung variabla &lt;= 2.35 je imala sensitivnost 74.3% i specifičnost 77.3%. U primarnoj studiji, C-statistike i 95% interval poverenja Jung varijable za jednogodi&scaron;nji mortalitet i zbirni neželjeni ishod su bile dobre (0.784 (0.750-0.815) i 0.764 (0.729-0.796)) i poredive sa TIMI, PAMI i Zwolle skorovima (p&gt;0.05). C-statistika za predikciju AHF i zbirnog neželjenog ishoda u validacionoj studiji je bila dobra (0.732 (0.655-0.809) i 0.721 (0.655-0.788)), ali manja u odnosu na ostale ispitivane skorove (p&lt;0.01). Zaključak: Jung varijabla je nezavisni prediktor jednogodi&scaron;njeg smrtnog ishoda i zbirnog neželjenog ishoda pacijenata sa STEMI lečenih pPCI u IKVBV i nezavisni prediktor AHF u validacionoj studiji. Jung varijabla, TIMI, PAMI i ZWOLLE skorovi imaju dobar i porediv diskriminatorni kapacitet za sve praćene ishode u primarnoj studiji, dok je u validacionoj studiji Jung varijabla imala dobar diskriminatorni kapacitet za AHF i zbirni neželjeni ishod, ali manji u odnosu na ostale ispitivane skorove.</p> / <p>Background: Accurate eary risk stratification of patients with ST-elevation myocardial infarction (STEMI) is important in the management of this patients. Primary percutaneous coronary intervention (pPCI) in patients with STEMI has improved the outcome significantly and might have changed the relative contribution of different risk factors. Jung variable is a simple clinical risk index, designed to be used at initial presentation. It is predictive of in hospital mortality in STEMI patients treated with fibrinolysis, but it&#39;s long term predictive power in patients treated with pPCI is not elucidated. Aim: To determine the prognostic accuracy and cut off value of Jung variable for one year clinical outcomes in STEMI patients treated with pPCI, and to validate it in independent STEMI patients. Methods: Two prospective studies of consecutive patients treated with pPCI were conducted; primary study in Institute of Cardiovascular diseases of Vojvodina and validation study in Military medical academy. One-year clinical outcomes (all-cause mortality, acute heart failure (AHF) and combined end point) were assessed. The Jung variable was calculated using the equation: systolic blood/ (heart rate&times;age)&times;100. The predictive value of Jung variable and previously established scores TIMI, PAMI, and Zwolle were evaluated with adequate statistical analyses. Results: Out of 647 patients 70 (10.8%) died and 42 (6.5%) had AHF in primary, while out of 418 patients 33 (7.9%) died and 52 (12.4%) had AHF in validation study. In primary study Jung variable was independent predictor of mortality and combined end point, while it was independent predictor of AHF in validation study (p&lt;0.01). Jung variable &lt;= 2.35 had sensitivity 74.3% and specificity 77.3% for mortality. In a primary study, C-statistic and 95% confidence intervals of Jung variable for one-year mortality and for combined end point were well (0.784 (0.750-0.815) and 0.764 (0.729-0.796), respectively) and comparable to TIMI, PAMI and Zwolle risk score (p&gt;0.05). C-statistic for predicting one-year AHF and combined clinical endpoint in a validation study was well (0.732 (0.655-0.809) and 0.721 (0.655-0.788), respectively), but lower than other risk scores (p&lt;0.01). Conclusion: The Jung variable was independent predictor of one year mortality and combined end point in primary study STEMI patients treated with pPCI and independent predictor of AHF in validation study. The Jung variable, TIMI, PAMI, and Zwolle risk scores performed well and comparable for all clinical outcomes in primary, while in a validation study Jung variable performed well for AHF and combined end point, but significantly lower than other risk scores.</p>

Under det gångna århundradet ökade den förväntade livslängden avsevärt såväl i Sverige som i övriga världen. 1900-talets förbättrade livslängd drevs inledningsvis av en minskad barnadödlighet medan de senare årtiondena kännetecknades av minskad dödlighet i höga åldrar. En åldrande befolkning innebär ökade krav på sjukvård, äldreomsorg och inte minst pensionssystem. Pålitliga prognoser för vår framtida livslängd behövs för att beräkna de resurser som nämnda verksamheter kommer att ta i anspråk och utgör förutsättningen för en rättvis prissättning av försäkringsprodukter med levnadsrisk. Lee-Carter-modellen är en av vår tids tongivande modeller för mortalitetsprognostisering. Modellen används här för att göra livslängdsprognoser utifrån svenska mortalitetsdata; prognoserna jämförs sedan med observerade utfall. Mot bakgrund av resultatet diskuteras levnadsrisk med fokus på pensioner. Inte oväntat presterar prognoserna ingen felfri bild av verkligheten och prognosfelet varierar i storlek mellan skattningarna; att använda dem som underlag för pensionsberäkningar hade i förlängningen varit ohållbart. Exemplet illustrerar på samma gång vår osäkerhet inför framtidens livslängdsutveckling och svårigheten i att prognostisera den. / During the past century, Sweden along with many other countries experienced a sharp decline in mortality rates. The increased life expectancy was initially propelled by mortality reductions among infants and subsequently by a survival improvement in advanced ages. An ageing population has large implications for those providing services to the elderly, such as medical care and pensions, whilst also addressing the need for accurate and reliable mortality forecasts and projection methods. The Lee-Carter model is the current gold standard for mortality forecasting and has been widely adopted in several studies. Here, the model is applied on Swedish mortality data; the projections are then compared to the observed lifespan development. Against this backdrop, a discussion on longevity risk in pensions schemes follows. The forecasts performed in this study do not perfectly reflect the observed mortality change in the examined period; furthermore, the variation of the estimation errors limits the actuarial value of the projections. The findings illuminate the uncertainty that surrounds our future life expectancy as well as the difficulties associated with forecasting it.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Veteran trees such as large Quercus robur L. function as biodiversity hotspots and provide a number of valuable ecological functions. This study aimed to increase knowledge about the mechanisms that influence the longevity of Q. robur by: (i) describing the status of veteran Q. robur in Linköping municipality, (ii) describing findings of valuable lichens among these trees, (iii) examine whether land use, nature type, crown layer closure, land management, or overgrowth of brushwood or forest in 2018 or an earlier year could explain girdle growth or crown vitality in Q. robur, and (iv) predict the future population of veteran Q. robur. Data was collected from 51 Q. robur with a circumference larger than 450 cm in April 2018 in Linköping municipality, Sweden. Out of these, 28 individuals could be compared to data from a previous inventory. These were the basis for statistical analyses of correlations between environmental factors, growth and crown vitality. Generally, most Q. robur individuals were standing in pastures, had high crown vitality, had a low amount of overgrowth of brushwood or forest around them, and many of them hosted indicator lichens. The main correlation found was between crown vitality and overgrowth of brushwood. The girdle growth was 1.81 cm year-1 and the mortality was 0.18 % year-1 on average. Based on these growth and mortality numbers, and data from other studies, the future population of veteran Q. robur was predicted to increase from 471 to 2996 individuals in the area in the next 100 years (1615-3433 pcs). / Grova, gamla träd som Quercus robur L. (skogsek) kan fungera som s.k. hotspots för biologisk mångfald och tillhandahåller en mängd värdefulla ekologiska funktioner. Denna studie syftade till att öka förståelsen kring de mekanismer som påverkar livslängden för Q. robur genom fyra syften: (i) att beskriva status för grova Q. robur i området, (ii) att beskriva förekomster av värdefulla lavar hos dessa träd, (iii) att undersöka om någon av omgivningsfaktorerna markanvändning, naturtyp, slutenhet i kronskikt, markskötsel, eller igenväxning av sly eller skog vid 2018 års inventering eller tidigare inventering kan förklara tillväxt eller kronvitalitet hos Q. robur, och (iv) förutsäga framtidens tillgång av grova Q. robur. Data samlades in genom fältinventering av 51 Q. robur större än 450 cm i omkrets i april 2018 i Linköpings kommun. Av dessa kunde 28 jämföras med data från en tidigare inventering. Dessa 28 individer låg till grund för statistiska analyser av samband mellan omgivningsfaktorer och tillväxt och kronvitalitet. De flesta individer av Q. robur stod i betesmark, hade hög kronvitalitet, hade låg grad av igenväxning av sly eller skog runt sig, och på många av individerna förekom signalartslavar. Det huvudsakliga sambandet som konstaterades var att igenväxning av sly var negativt för kronvitalitet. Hos grova ekar var omkretstillväxten 1,81 cm år-1 och mortaliteten 0,18 % år-1. Baserat på dessa tillväxt- och mortalitetsdata samt data från andra studier beräknades populationen av grova Q. robur öka från 471 till 2996 (1615-3433 st) individer de kommande 100 åren.