To curb the tobacco epidemic a combination of comprehensive interventions are needed at different levels. Smoking uptake is a multi-factorial process that includes societal factors as well as social and individual characteristics. An understanding of the process is essential in order to model interventions. The aim of this study was to explore the role of smoking for young smokers by focusing on the mechanisms that facilitate young people starting to smoke as well as what could have prevented them from starting.
A qualitative research design using focus group discussions was chosen as the basis for a content analysis approach. Eight focus groups were conducted with five to six participants in each (four groups with boys, four with girls). The informants were purposively selected to represent smokers in the age range of 15-16 years within the county. The total number of group participants was 44; 21 were girls and 23 boys. The study was performed at 7-9th grade schools in Västerbotten County in northern Sweden.
Three themes related to different aspects of youth smoking behaviour emerged from the analysis. Theme 1) "gaining control" reflects what makes young people become smokers; theme 2) "becoming a part of the self" focuses on what facilitates youths to start smoking; theme 3) "concerned adults make a difference" indicates what may prevent them from starting.
Young smokers described starting to smoke as a means of gaining control of feelings and situations during early adolescence. Smoking adolescents expect adults to intervene against smoking. Close relations with concerned adults could be a reason for less frequent smoking or trying to quit smoking. Interventions aimed at normative changes, with consistent messages from both schools and parents about the negative aspects of tobacco seem to be a feasible approach for preventing youth from using tobacco.
Cites: Health Place. 2005 Mar;11(1):55-6515550356
Cites: Health Educ Behav. 2004 Dec;31(6):702-1915539543
The Arctic area is a part of the globe where the increase in global temperature has had the earliest noticeable effect and indigenous peoples, including the Swedish reindeer herding Sami, are amongst the first to be affected by these changes.
To explore the experiences and perceptions of climate change among Swedish reindeer herding Sami.
In-depth interviews with 14 Swedish reindeer herding Sami were performed, with purposive sampling. The interviews focused on the herders experiences of climate change, observed consequences and thoughts about this. The interviews were analysed using content analysis.
One core theme emerged from the interviews: facing the limit of resilience. Swedish reindeer-herding Sami perceive climate change as yet another stressor in their daily struggle. They have experienced severe and more rapidly shifting, unstable weather with associated changes in vegetation and alterations in the freeze-thaw cycle, all of which affect reindeer herding. The forecasts about climate change from authorities and scientists have contributed to stress and anxiety. Other societal developments have lead to decreased flexibility that obstructs adaptation. Some adaptive strategies are discordant with the traditional life of reindeer herding, and there is a fear among the Sami of being the last generation practising traditional reindeer herding.
The study illustrates the vulnerable situation of the reindeer herders and that climate change impact may have serious consequences for the trade and their overall way of life. Decision makers on all levels, both in Sweden and internationally, need improved insights into these complex issues to be able to make adequate decisions about adaptive climate change strategies.
Cites: Int J Epidemiol. 2005 Jun;34(3):623-915737965
The aim of this study was to explore nurses' perceptions of climate and environmental issues and examine how nurses perceive their role in contributing to the process of sustainable development.
Climate change and its implications for human health represent an increasingly important issue for the healthcare sector. According to the International Council of Nurses Code of Ethics, nurses have a responsibility to be involved and support climate change mitigation and adaptation to protect human health.
This is a descriptive, explorative qualitative study.
Nurses (n = 18) were recruited from hospitals, primary care and emergency medical services; eight participated in semi-structured, in-depth individual interviews and 10 participated in two focus groups. Data were collected from April-October 2013 in Sweden; interviews were transcribed verbatim and analysed using content analysis.
Two main themes were identified from the interviews: (i) an incongruence between climate and environmental issues and nurses' daily work; and (ii) public health work is regarded as a health co-benefit of climate change mitigation. While being green is not the primary task in a lifesaving, hectic and economically challenging context, nurses' perceived their profession as entailing responsibility, opportunities and a sense of individual commitment to influence the environment in a positive direction.
This study argues there is a need for increased awareness of issues and methods that are crucial for the healthcare sector to respond to climate change. Efforts to develop interventions should explore how nurses should be able to contribute to the healthcare sector's preparedness for and contributions to sustainable development.
The aim of this study was to illuminate the meanings of district nurses' lived experiences of meeting significant others in the home when giving advanced home care to patients.
The data was collected through 10 audio-taped narrative focus-group interviews with 36 district nurses and interpreted using a phenomenological hermeneutic approach.
Three themes emerged. The first theme, Feeling close, consists of three subthemes: Being available, Sharing understanding and Being aware. The second theme, Mediating strength, contains the subthemes Being a resource and Sharing trust. Being emotionally influenced is the third theme and involves the subthemes Experiencing emotional distress and Experiencing emotional gratitude.
Meeting significant others as a district nurse in advanced home care means creating and maintaining a trustful relationship with significant others, both on a personal and family level, aiming to illuminate and respond to their needs and desires. The district nurses strive to reach a mutual understanding and co-operate to mediate support. Being a district nurse in advanced home care is both emotionally demanding and emotionally rewarding.
INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is suspected if the ratio between forced expired volume in 1 s (FEV(1)) and forced vital capacity is below 0.7 after bronchodilatation, according to the Global Initiative for Chronic Obstructive Lung Disease (GOLD). As this ratio varies with age and gender, the lower limit of normality (LLN) of appropriate reference equations appears more adequate. OBJECTIVES: To study the prevalences of suspected COPD according to the GOLD criterion and various reference equations in a well-defined population sample. METHODS: Spirometries obtained in a random population sample of 598 men, 50 or 60 years of age, were analysed. The prevalences of suspected COPD were calculated according to the GOLD criterion and the LLNs of four Nordic and two European reference equations. RESULTS: The GOLD criterion resulted in prevalences of COPD of 9.3% and 23.7% in the 50- and 60-year-old never-smokers, respectively. Depending on the reference equation, the calculated prevalences of COPD varied between 9.3% and 23.4% and 12.0% and 39.1% among all of the 50- and 60-year-old men, respectively. CONCLUSIONS: The GOLD criterion is inadequate because of substantial overestimation in 60-year-old never-smokers. LLNs of the various reference equations are unreliable because of obvious lack of consistency. Spirometric criteria for airway obstruction, and suspicion of COPD, therefore need to be revised.
The organization of aftercare is important for a successful outcome; still the optimal organization has not been fully explored. An intensive transitional post-discharge aftercare (TA) programme, for a mixed group of non-psychotic patients, was recently developed. Patients with non-psychotic diagnoses are often discharged with low well-being while still symptomatic, placing high demands on aftercare.
To evaluate retrospectively the short and long-term mental healthcare service use during and after the TA programme compared with the service use of a retrospective comparison group (RC), receiving less intensive outpatient aftercare.
Number of re-admissions, bed days and emergency visits after 10 weeks, 6 months and 1 year was retrospectively collected from electronic patient registers. Descriptive statistics, independent samples T-tests and repeated-measures analysis of variance was used to compare the groups.
The majority of patients in both groups suffered from affective disorders, followed by personality disorders and a small number of other psychiatric diagnoses. Service use in the TA group was lower than in the RC group with fewer bed days after 10 weeks (P = 0.01) and after 6 months (P = 0.003), and fewer re-admissions after 6-12 months (P = 0.04). Emergency contacts did not differ significantly between the two groups at any point.
The present study indicates beneficial effects of intensive TA, for a mixed group of non-psychotic patients. The lower service use in the TA programme group is in line with day treatment programme research for patients with affective disorders.
The healthcare sector is a significant contributor to global carbon emissions, in part due to extensive travelling by patients and health workers.
To evaluate the potential of telemedicine services based on videoconferencing technology to reduce travelling and thus carbon emissions in the healthcare sector.
A life cycle inventory was performed to evaluate the carbon reduction potential of telemedicine activities beyond a reduction in travel related emissions. The study included two rehabilitation units at Umeå University Hospital in Sweden. Carbon emissions generated during telemedicine appointments were compared with care-as-usual scenarios. Upper and lower bound emissions scenarios were created based on different teleconferencing solutions and thresholds for when telemedicine becomes favorable were estimated. Sensitivity analyses were performed to pinpoint the most important contributors to emissions for different set-ups and use cases.
Replacing physical visits with telemedicine appointments resulted in a significant 40-70 times decrease in carbon emissions. Factors such as meeting duration, bandwidth and use rates influence emissions to various extents. According to the lower bound scenario, telemedicine becomes a greener choice at a distance of a few kilometers when the alternative is transport by car.
Telemedicine is a potent carbon reduction strategy in the health sector. But to contribute significantly to climate change mitigation, a paradigm shift might be required where telemedicine is regarded as an essential component of ordinary health care activities and not only considered to be a service to the few who lack access to care due to geography, isolation or other constraints.
Cites: Int J Med Inform. 2006 Aug;75(8):565-7616298545
Significant climate change in the Arctic has been observed by indigenous peoples and reported in scientific literature, but there has been little research comparing these two knowledge bases. In this study, Sami reindeer herder interviews and observational weather data were combined to provide a comprehensive description of climate changes in Northern Sweden. The interviewees described warmer winters, shorter snow seasons and cold periods, and increased temperature variability. Weather data supported three of these four observed changes; the only change not evident in the weather data was increased temperature variability. Winter temperatures increased, the number of days in cold periods was significantly reduced, and some stations displayed a 2 month-shorter snow cover season. Interviewees reported that these changes to the wintertime climate are significant, impact their identity, and threaten their livelihood. If consistency between human observations of changing weather patterns and the instrumental meteorological record is observed elsewhere, mixed methods research like this study can produce a clearer, more societally relevant understanding of how the climate is changing and the impacts of those changes on human well-being.
Cites: Glob Health Action. 2011;4:null PMID 22043218
Cites: Int J Circumpolar Health. 2015 Sep 01;74:27669 PMID 26333721
Cites: Int J Circumpolar Health. 2010 Sep;69(4):383-93 PMID 20719108
Cites: Lancet. 2009 May 16;373(9676):1693-733 PMID 19447250
Cites: Int J Epidemiol. 2005 Jun;34(3):623-9 PMID 15737965
In Sweden, the smoking prevalence has declined. In 2007, it was among the lowest in the industrialized world. A steady increase in the use of Swedish oral moist snuff, snus, has occurred in parallel. This development is neither solicited by authorities nor the medical establishment, but rather has occurred along with increased awareness of the dangers of smoking, and has been promoted by product development and marketing of snus.
To evaluate time trends in patterns of tobacco use in northern Sweden during 1990-2007.
Cross-sectional (99,381 subjects) and longitudinal (26,867 subjects) data from the Västerbotten Intervention Programme (VIP) 1990-2007 were analyzed. All adults in Västerbotten County are invited to a VIP health examination at ages 40, 50, and 60 years, and until 1995 also 30 years. Smoking and use of snus were evaluated by gender, age and educational groups. Intermittent smoking was categorized as smoking.
From the period 1990-1995 to the period 2002-2007, smoking prevalence decreased from 26 to 16% among men and from 27 to 18% among women. The differences in prevalence increased between educational groups. The decline in smoking was less and the increase of snus use was greater among those with basic education. The use of snus among basic-educated 40-year-olds reached 35% among men and 14% among women during 2002-2007. Dual smoking and snus use increased among men and women with basic education. Smoking without snus use was more prevalent among women. Gender differences in total smoking prevalence (smoking only plus dual use) were small in all age groups, but increased among those with basic education reaching 7.3% during 2002-2007, with women being more frequent smokers. Smoking prevalences were similar among never, former and current snus users. Among the 30,000 former smokers, 38% of men and 64% of women had never used snus. Longitudinal data showed a decline in total tobacco use from baseline until follow-up and this was mainly due to a smoking cessation rate of
Studies on the association between heavy coffee consumption and risk of less frequently diagnosed cancers are scarce. We aimed to quantify the association between filtered, boiled, and total coffee consumption and the risk of bladder, esophageal, kidney, pancreatic, and stomach cancers. We used data from the Norwegian Women and Cancer Study and the Northern Sweden Health and Disease Study. Information on coffee consumption was available for 193,439 participants. We used multivariable Cox proportional hazards models to calculate hazard ratios (HR) with 95% confidence intervals (CI) for the investigated cancer sites by category of total, filtered, and boiled coffee consumption. Heavy filtered coffee consumers (= 4 cups/day) had a multivariable adjusted HR of 0.74 of being diagnosed with pancreatic cancer (95% CI 0.57-0.95) when compared with light filtered coffee consumers (= 1 cup/day). We did not observe significant associations between total or boiled coffee consumption and any of the investigated cancer sites, neither in the entire study sample nor in analyses stratified by sex. We found an increased risk of bladder cancer among never smokers who were heavy filtered or total coffee consumers, and an increased risk of stomach cancer in never smokers who were heavy boiled coffee consumers. Our data suggest that increased filtered coffee consumption might reduce the risk of pancreatic cancer. We did not find evidence of an association between coffee consumption and the risk of esophageal or kidney cancer. The increased risk of bladder and stomach cancer was confined to never smokers.