52 research outputs found
How are Green National Accounts Produced in Practice?
No full textDuring the last part of the twentieth century, the effect of human activity upon the environment became an important policy issue. There is now a growing concern about how economic activity affects the environment and it has become more and more recognised that economic growth is dependent upon the provision of environ-mental services. To be able to combine economic growth with a healthy environment in terms of a sustainable use of natural resources, a better understanding of the rela-tionships between economy and ecology needs to be developed.
Training young engineers to see
No full textThis case study in the professional education of engineers is based on a Talent Programme at Combitech in Sweden, in association with the Royal Institute of Technology. The approach is based on use of the Dialogue Seminar Method. © 2011 The Author(s).</p
Psychosocial stressors and depression at a Swedish primary health care centre. A gender perspective study
No full textAbstract Background Psychosocial stress may account for the higher prevalence of depression in women and in individuals with a low educational background. The aim of this study was to analyse the association between depression and socio-demographic data, psychosocial stressors and lifestyle circumstances from a gender perspective in a relatively affluent primary care setting. Methods Patients, aged 18- 75 years, visiting a drop-in clinic at a primary care health centre were screened with Beck's Depression Inventory (BDI). The physicians used also targeted screening with BDI. A questionnaire on socio-demographic data, psychosocial stressors and use of alcohol and tobacco was distributed. Among patients, who scored BDI ≥10, DSM-IV-criteria were used to diagnose depression. Of the 404 participants, 48 men and 76 women were diagnosed with depression. The reference group consisted of patients with BDI score Results The same three psychosocial stressors: feeling very stressed, perceived poor physical health and being dissatisfied with one's family situation were associated with depression equally in men and women. The negative predictive values of the main effect models in men and women were 90.7% and 76.5%, respectively. Being dissatisfied with one's work situation had high ORs in both men and women. Unemployment and smoking were associated with depression in men only. Conclusions Three questions, frequently asked by physicians, which involve patient's family and working situation as well as perceived stress and physical health, could be used as depression indicators in early detection of depression in men and women in primary health care.</p
Knowledge of stroke risk factors among primary care patients with previous stroke or TIA: a questionnaire study
No full textAbstract Background Survivers of stroke or transient ischaemic attacks (TIA) are at risk of new vascular events. Our objective was to study primary health care patients with stroke/TIA regarding their knowledge about risk factors for having a new event of stroke/TIA, possible associations between patient characteristics and patients' knowledge about risk factors, and patients' knowledge about their preventive treatment for stroke/TIA. Methods A questionnaire was distributed to 240 patients with stroke/TIA diagnoses, and 182 patients (76%) responded. We asked 13 questions about diseases/conditions and lifestyle factors known to be risk factors and four questions regarding other diseases/conditions ("distractors"). The patients were also asked whether they considered each disease/condition to be one of their own. Additional questions concerned the patients' social and functional status and their drug use. The t-test was used for continuous variables, chi-square test for categorical variables, and a regression model with variables influencing patient knowledge was created. Results Hypertension, hyperlipidemia and smoking were identified as risk factors by nearly 90% of patients, and atrial fibrillation and diabetes by less than 50%. Few patients considered the distractors as stroke/TIA risk factors (3-6%). Patients with a family history of cardiovascular disease, and patients diagnosed with carotid stenosis, atrial fibrillation or diabetes, knew these were stroke/TIA risk factors to a greater extent than patients without these conditions. Atrial fibrillation or a family history of cardiovascular disease was associated with better knowledge about risk factors, and higher age, cerebral haemorrhage and living alone with poorer knowledge. Only 56% of those taking anticoagulant drugs considered this as intended for prevention, while 48% of those taking platelet aggregation inhibitors thought this was for prevention. Conclusions Knowledge about hypertension, hyperlipidemia and smoking as risk factors was good, and patients who suffered from atrial fibrillation or carotid stenosis seemed to be well informed about these conditions as risk factors. However, the knowledge level was low regarding diabetes as a risk factor and regarding the use of anticoagulants and platelet aggregation inhibitors for stroke/TIA prevention. Better teaching strategies for stroke/TIA patients should be developed, with special attention focused on diabetic patients.</p
Depression in primary care : detection, description and mortality
No full textAims: The aims of these studies were to explore the prevalence and severity of depression among unscheduled drop-in patients in primary care and to identify possible cues to depression in the consultation. Further aims were to analyze the association between depression and psychosocial stressors and lifestyle factors from a gender perspective and to evaluate the usefulness of the Gotland Male Depression Scale (GS) in screening for depression among men. A final aim was to analyze the long term mortality rate (MR) and the standardized mortality rate among the patients who had been diagnosed as having a major depressive disorder (MDD).Background: Depression is a common diagnosis in primary care, but had been reported to remain undetected in half of the consultations, especially among men despite the fact that men had higher rates of suicide. Detecting and diagnosing patients with depression in primary care is essential since depression reduces quality of life, functioning level, work ability and possibly also life expectancy.Patients and Methods: Patients visiting two primary care physicians’ drop-in clinics were screened using the Beck Depression Inventory (BDI) with a cut-off value of ≥ 10 and the men were screened also with the GS with a cut-off value of ≥ 13. A two-step screening method was used among patients aged 18–75 years visiting two primary care physicians’ drop-in clinics in opportunistic and targeted screenings. Patients with screening scores above the cut-off values were interviewed by the physicians at a repeat visit and the DSM-IV criteria for major depressive disorder (MDD) were applied. Severity of depression was measured with the Montgomery-Åsberg Depression Rating Scale (MADRS). The study population consisted of 404 patients (men n=235, women n=169) categorised as depressed (n=124) or non-depressed (n= 280). Their socio-demographic data, lifestyle and psychosocial stressors were obtained from a questionnaire. Symptoms mentioned at the screening visit were examined from the medical charts and categorised as somatic or mental.Twelve years after inclusion, the causes of death for the depressed patients were obtained from the National Cause of Death Register. Mortality data regarding the non-depressed patients were obtained from the Swedish National Register and data from the Life Tables Statistics Sweden were used to calculate standardised mortality rates (SMRs). The screenings among men with GS and BDI were compared, as were the outcomes from the opportunistic and targeted screenings. Differences between depressed and non-depressed men and women regarding socio-demographic and clinical data were analysed. The odds ratios (ORs) with 95% confidence intervals (95% CI) for being depressed were calculated for the psychosocial stressors and lifestyle factors. Multiple logistic regression modelling was used to obtain the main effect models separately for men and women for the risk factors for depression. Differences in the MRs between the depressed and the non-depressed patients were calculated as well as their SMRs. As a reference for comparison the SMRs in the Swedish population in the same age and in the same time period were calculated. Cox regression was applied to calculate the hazard ratios (HRs) for the mortality rate during the 12-year follow-up period for the depressed and the non-depressed patients in relation to the explanatory variables.Main results: The prevalence of depression was 25% among women and 11% among men. The severity of depression was mild or moderate and severe depression was very rare. Mentioning a mental symptom was a cue to detect depression among women but not consistently among men. The proportions as depressed patients were higher from the targeted screenings than from the opportunistic screenings. Screening with GS did not detect more depressed men than BDI. Smoking was associated with depression only among men. Three psychosocial stressors were equally associated with depression among the men and the women: being dissatisfied with family situation, being very stressed and perceiving poor physical health, and the ORs in the main effect models varied from 3.1 (95% CI 1.4–6.6) up to 22.4 (95% CI 5.8–86.8). Dissatisfaction with one’s working situation was also associated with depression: in men OR 13.2 (95% CI 4.7–37.5) and in women: OR 32.5 (95% CI 4.1–254.7). The MR among the depressed men was significantly higher than among the non-depressed. The SMRs among depressed men and women did not differ from those in the general Swedish population.Conclusions: The prevalence and severity of depression was comparable to that in other primary care settings. Depressed women had often mentioned mental symptoms. Questions about family and working situation, feeling very stressed and feelings about one’s physical health could be used as risk indicators for depression in clinical practice for both men and women. Moreover, the long-term follow-up underlines the importance of finding patients with depression and thoroughly examine them also regarding their somatic health.List of scientific papersI. Ranja Strömberg, Estera Wernering, Anna Åberg-Wistedt, Anna-Karin Furhoff, Sven-Erik Johansson and Lars G. Backlund. Screening and diagnosing depression in women visiting GP’s drop in clinic in Primary Health Care. BMC Family Practice. 2008; 9:21–7. https://doi.org/10.1186/1471-2296-9-34 II. Ranja Strömberg, Lars G. Backlund and Monica Löfvander. A comparison between the Beck’s Depression Inventory and the Gotland Male Depression Scale in detecting depression among men visiting a drop-in clinic in primary care. Nordic Journal of Psychiatry. 2009; 63:1–7. https://doi.org/10.3109/08039480903511407 III. Ranja Strömberg, Lars G. Backlund and Monica Löfvander. Psychosocial stressors and depression at a Swedish primary health care centre: A gender perspective study. BMC Family Practice. 2011; 12:120–8. https://doi.org/10.1186/1471-2296-12-120 IV. Ranja Strömberg, Lars G. Backlund, Sven-Erik Johansson and Monica Löfvander. Mortality in a cohort of depressed and non-depressed patients at a primary care centre in Stockholm, Sweden: A 12-year follow-up study. [Submitted]</p
Environmental Policy and Transboundary Externalities - Coordination and Commitment in Open Economies
No full textThis thesis consists of an introductory chapter and four papers, which relate to environmental policy in the presence of transboundary environmental damage. Paper [I] concerns public policy in a multi-jurisdiction framework with transboundary environmental damage. Each jurisdiction is assumed large in the sense that its government is able to inuence the world-market producer price of the externality-generating good. This gives rise to additional incentives of relevance for national public policy in the non-cooperative Nash equilibrium. With the uncoordinated equilibrium as the reference case, the welfare eects from coordinated changes in public policy variables are analyzed. Paper [II] analyses welfare eects of coordinated changes in environmental and capital taxation in the presence of transboundary environmental externalities and wage bargaining externalities. In the wage bargaining between rms and labor unions, rms use the threat of moving abroad to moderate wage claims, which means that domestic policy inuences wage formation abroad. The specic framework implies welfare eects of policy coordination that correspond to each of the respective international interaction mentioned above. In paper [III], national governments face political pressure from environmental and industrial lobby groups, while pollution taxes are determined in an international negotiation. It is shown that a general increase in the environmental concern and the weight the governments attach to social welfare both tend to increase the pollution tax. However, allowing for asymmetries between the countries means that a general increase in the environmental concern has the potential to reduce the pollution tax. Paper [IV] studies national environmental policies in an economic federation characterized by decentralized leadership. The federal government sets emission targets for each member country, which are implemented by the national governments. Although all national governments have commitment power vis-à-vis the federal government, one of them also has commitment power vis-à-vis the other member countries. This creates incentives to act strategically toward the federal government, as well as toward other members.environmental policy; transboundary externalities; lobbying; international negotiations; policy coordination; endogenous world-market prices; optimal taxation; economic federation
The Phase-Out of the Nuclear Family? Empirical Studies on the Economics and Structure of Modern Swedish Families.
No full textThis thesis consists of three papers on the economics and structure of Swedish families. Paper [I] examines the determinants of children’s educational achievement in Sweden. Special attention is given to the labour market work by mothers and fathers in terms of its influence on the educational outcome of their children, measured as grade point average (GPA) in compulsory as well as upper sec-ondary school. The results show that there is a positive relationship between parental income and GPA. Regarding the number of hours worked in the la-bour market, the results differ between mothers and fathers. Having a mother that works less than full time has positive effects on the child’s grades throughout the schooling of the child, whereas significant effects of the hours of work that the father puts in are found during upper secondary school only. Paper [II] explores the role of financial surprises and match quality in the dis-solution of relationships. The analysis is carried out both for surprises in the short term earnings and surprises in the long-run earnings capacity. It is found that positive surprises in short term earnings have a destabilizing effect for a relationship. Generally, a negative surprise in long-run earnings capacity for males has a destabilizing effect. However, if it is combined with a female positive surprise, the effect is stabilizing. Commitments become more stable the older the spouses are at the start, and if young children are present. Paper [III] studies the role of unemployment in the dissolu¬tion of relationships by applying a two-step estimation method to an extensive data set, which con-tains information about young Swedish males and females. Unemployment is recognized as endogenous in the separation decision, and the results show that the effect of unemploy¬ment on separation is biased when unemployment is assumed to be exo¬genous in the separation equation. The probability of sepa-ration is found to be increasing with male unemployment, while female un-employment decreases the probability of dissolution.Time allocation; labour-force participation; educational achievements; match quality; financial surprises; unemployment; divorce; family structure
Health problems and disability in long-term sickness absence: ICF coding of medical certificates
No full textAbstract Background The purpose of this study was to test the feasibility of International Classification of Functioning, Disability and Health (ICF) and to explore the distribution, including gender differences, of health problems and disabilities as reflected in long-term sickness absence certificates. Methods A total of 433 patients with long sick-listing periods, 267 women and 166 men, were included in the study. All certificates exceeding 28 days of sick-listing sent to the local office of the Swedish Social Insurance Administration of a municipality in the Stockholm area were collected during four weeks in 2004-2005. ICD-10 medical diagnosis codes in the certificates were retrieved and free text information on disabilities in body function, body structure or activity and participation were coded according to ICF short version. Results In 89.8% of the certificates there were descriptions of disabilities that readily could be classified according to ICF. In a reliability test 123/131 (94%) items of randomly chosen free text information were identically classified by two of the authors. On average 2.4 disability categories (range 0-9) were found per patient; the most frequent were 'Sensation of pain' (35.1% of the patients), 'Emotional functions' (34.1%), 'Energy and drive functions' (22.4%), and 'Sleep functions' (16.9%). The dominating ICD-10 diagnostic groups were 'Mental and behavioural disorders' (34.4%) and 'Diseases of the musculoskeletal system and connective tissue' (32.8%). 'Reaction to severe stress and adjustment disorders' (14.7%), and 'Depressive episode' (11.5%) were the most frequent diagnostic codes. Disabilities in mental functions and activity/participation were more commonly described among women, while disabilities related to the musculoskeletal system were more frequent among men. Conclusions Both ICD-10 diagnoses and ICF categories were dominated by mental and musculoskeletal health problems, but there seems to be gender differences, and ICF classification as a complement to ICD-10 could provide a better understanding of the consequences of diseases and how individual patients can cope with their health problems. ICF is feasible for secondary classifying of free text descriptions of disabilities stated in sick-leave certificates and seems to be useful as a complement to ICD-10 for sick-listing management and research.</p
Silvicultural regimes and early biomass thinning in young, dense pine stands
No full textThe aim of this work was to determine how early management activities in young, dense pine forests affect tree and stand characteristics and profitability and to assess the future potential for tree biomass harvesting and use. In this respect, the long-term effects of corridor pre-commercial thinning (PCT) and thinning on growth and yield were investigated in 11 Scots pine (Pinus sylvestris L.) stands (I). The potential for applying goal-oriented regimes at the PCT-stage was studied in a 20 year old direct seeded lodgepole pine (Pinus contorta) stand (II). The influence of management regime on fibre length (III) and profitability (IV) in Scots pine stands was analysed after destructive sampling and using simulations, respectively. The potential of future end-uses of the tree biomass were investigated through a survey and by analysing electricity prices with respect to different tree/wood assortments (V). The form and intensity of PCT influenced the mean diameter at breast height (DBH) and individual tree growth but had little impact on the mean DBH of the largest future crop trees. Stand management regimes with higher stem numbers than conventional options produced substantially larger amounts of stemwood and tree biomass (I, II) and increased the proportion of mature wood in stems that might be suitable for harvest in late silvicultural operations. High intensity early thinning of dense stands limited the proportion of juvenile wood when the stand matured (III). Corridor PCT/thinning did not significantly reduce volume growth or standing volume compared to selective treatments, and may be useful for obtaining biomass from dense stands. Stemwood production was relatively independent of the corridor area, indicating a certain amount of flexibility with respect to harvest intensity in early corridor thinning (I). Boom-corridor thinning at a mean height of 8-9 m instead of conventional PCT generally improved the land expectation value, demonstrating the economic potential of early biomass removal. The economic break-even harvest yield amounted to about 32-44 oven dry tonnes/ha with corridor areas of 40-50% (IV). The value of tree biomass was expected to increase over ten years, especially for raw materials refined into products such as transportation fuels, specialty celluloses, plastics, solid fuels, or chemicals (V). In conclusion, young stand management activities provide forest owners with diverse opportunities to increase biomass yields and uses, manipulate stand and future crop tree characteristics, and increase profitability. New end-uses of tree biomass may influence the profitability of early biomass thinning and the silvicultural regimes of the future
Coronary risk estimates and decisions on lipid-lowering treatment in primary prevention : Comparison between general practitioners, internists, and cardiologists
No full textBackground: Quantitative assessment of an individual's absolute cardiovascular risk is essential for primary prevention. Although risk-scoring tools have been developed for this task, risk estimates are usually made subjectively. We investigated whether general practitioners (GPs), internists and cardiologists differ in their quantitative estimates of cardiovascular risk and their recommendations about lipid-lowering treatment for the same set of patients. Methods: Mail survey. Nine written clinical vignettes, four rated high-risk and five rated low-risk according to the Framingham equation, were mailed to 90 randomly selected GPs and to the same number of internists and cardiologists in Sicily. The doctors were then asked to estimate the 10-year coronary risk in each case and to decide whether they would recommend a lipid-lowering treatment. Results: In the majority of the nine cases, the cardiologists' risk estimates were significantly lower than those of the other two groups. A higher proportion of internists (mean value 0.68) decided to start treatment than GPs (0.54) or cardiologists (0.57). In all three groups, the doctors' willingness to begin treatment was over 90% when their risk estimate was above 20%, and less than 50% when it fell below this level. Internists were more prone to treat than the other two groups even when their patients' estimated risk was below 20%. Conclusion: When presented with the same set of clinical cases, GPs, internists and cardiologists make different quantitative risk estimates and come to different conclusions about the need for lipid-lowering treatment. This may result in over- or under-prescription of lipid-lowering drugs and inconsistencies in the care provided by different categories of doctors.</p
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