Pay for disease or invest in health?

To access publisher full text version of this article. Please click on the hyperlink in Additional Links field.Hjärt–kärlsjukdom är den ledande enskilda orsaken till död och ohälsa i vår del av världen. Den medicinska och ekonomiska bördan av dessa sjukdomar är enorm. Även om nyinsjuknandet och dödligheten i tex hjärtinfarkt har minskat i vårt land, liksom i många europeiska länder, är antalet människor som insjuknar i förtid och som lever med resttillstånd efter olika hjärt–kärlsjukdomar snarast i stigande, vilket sammanhänger med att vi lever längre och att överlevnaden efter hjärtinfarkt och slaganfall har ökat. Största delen av dessa sjukdomar liksom av andra kroniska, icke-smittsamma sjukdomar (cancer, lungsjukdom, diabetes osv) sammanhänger med påverkbara, livsstilsrelaterade riskfaktorer. Hälsosamma val, dvs bra mat, fysisk aktivitet, frånvaro av tobaksbruk och undvikande av överkonsumtion av alkohol, kan förhindra eller i vart fall fördröja ett insjuknande. Den medicinska professionen bör ta som sin uppgift att i samverkan med politiker, hälsovårdsadministratörer och medier upplysa allmänheten om dessa enkla fakta. Genom kloka policybeslut kan man underlätta för befolkningen att göra hälsosamma val redan från de tidiga barnaåren och genom hela livscykeln

Balancing Structure and Learning in an Open Prison

Leira Prison is a branch of Trondheim Prison, functioning as a relatively small,open prison with a maximum capacity of only 29 inmates. Leira Prison appliesthe method ‘consequence pedagogy.’ This article aims to pinpoint howconsequence pedagogy is executed at Leira. 50% of the Leira inmates arereleased back into society, while new ones enter the prison. It is thereforeinteresting to see how they balance structure and at the same time adjust tochanges, enabling Leira Prison to continue as a learning organization. This articleidentifies three items, consequence pedagogy and the view of humans,maintenance of the philosophy and coherence in the community, and selfregulationof justice through interaction. The use of consequence pedagogyis deeply aligned to their positive view of humans and has generated a constructiveorganization based on empowerment and involvement of both staffand inmates. Consequently, management, staff and inmates maintain thephilosophy of consequence pedagogy through interaction and self-regulation.However, questions regarding the fundamentals of the consequence pedagogyare not raised

A miniaturized neuroprosthesis suitable for implantation into the brain

This paper presents current research on a miniaturized neuroprosthesis suitable for implantation into the brain. The prosthesis is a heterogeneous integration of a 100-element microelectromechanical system (MEMS) electrode array, front-end complementary metal-oxide-semiconductor (CMOS) integrated circuit for neural signal preamplification, filtering, multiplexing and analog-to-digital conversion, and a second CMOS integrated circuit for wireless transmission of neural data and conditioning of wireless power. The prosthesis is intended for applications where neural signals are processed and decoded to permit the control of artificial or paralyzed limbs. This research, if successful, will allow implantation of the electronics into the brain, or subcutaneously on the skull, and eliminate all external signal and power wiring. The neuroprosthetic system design has strict size and power constraints with each of the front-end preamplifier channels fitting within the 400 x 400 µm pitch of the 100-element MEMS electrode array and power dissipation resulting in less than a 1° C temperature rise for the surrounding brain tissue. We describe the measured performance of initial micropower low-noise CMOS preamplifiers for the neuroprosthetic

Early outcome in diabetic patients following coronary artery bypass grafting

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnInngangur: Sykursýki er einn af helstu áhættuþáttum kransæðasjúkdóms. Sykursjúkir einstaklingar þróa gjarnan þriggja æða kransæðasjúkdóm sem er í flestum tilvikum meðhöndlaður með kransæðahjáveituaðgerð. Í þessari rannsókn voru könnuð áhrif sykursýki á snemmkomna fylgikvilla kransæðahjáveituaðgerða. Efniviður og aðferðir: Afturskyggn rannsókn á öllum sjúklingum sem gengust undir kransæðahjáveituaðgerð á Landspítala á árunum 2001-2012. Af 1626 sjúklingum voru 261 greindir með sykursýki (16%) og voru þeir bornir saman við 1365 sjúklinga án sykursýki. Forspárþættir fylgikvilla og dauða innan 30 daga voru metnir með aðhvarfsgreiningu. Niðurstöður: Aldur, kyn, útbreiðsla kransæðasjúkdóms og EuroSCORE voru sambærileg í báðum hópum, einnig hlutfall hjáveituaðgerða á sláandi hjarta (21%). Sjúklingar með sykursýki höfðu hærri líkamsþyngdarstuðul (30 á móti 28 kg/m2, p<0,01) og voru oftar með háþrýsting (82% á móti 60%, p<0,001) og gaukulsíunarhraða undir 60 ml/mín/1,73m2 (22% á móti 15%, p=0,01). Auk þess var aðgerðartími þeirra 16 mín lengri (p<0,001). Tíðni djúpra bringubeinssýkinga, heilaáfalls og hjartadreps var sambærileg í báðum hópum. Bráður nýrnaskaði var metinn samkvæmt RIFLE-skilmerkjum og voru sykursýkissjúklingar oftar í RISK-flokki (14% á móti 9%, p=0,02) og FAILURE-flokki (2% á móti 0,5%, p=0,01). Minniháttar fylgikvillar (gáttatif, lungnabólga, þvagfærasýking og yfirborðssýking í skurðsári) voru hins vegar svipaðir í báðum hópum. Dánartíðni innan 30 daga var marktækt hærri hjá sjúklingum með sykursýki, eða 5% borið saman við 2% í viðmiðunarhópi (p=0,01). Sykursýki reyndist ekki sjálfstæður áhættuþættur fyrir dauða innan 30 daga þegar leiðrétt var fyrir öðrum áhættuþáttum með fjölþáttaaðhvarfsgreiningu (OR=1,98, 95% ÖB: 0,72-4,95). Ályktanir: Sjúklingar með sykursýki eru í aukinni áhættu á að fá bráðan nýrnaskaða eftir kransæðahjáveituaðgerð en sykursýki virðist ekki vera sjálfstæður forspárþáttur 30 daga dánartíðni.Introduction: Diabetes is one of the most important risk factors for coronary artery disease. Diabetics often have severe three vessel disease and coronary bypass surgery is in most cases the preferred treatment of choice in these patients. We investigated early surgical complications and outcomes in diabetic patients following isolated CABG in Iceland and compared them to those of non-diabetic patients. Materials and methods: A retrospective study of 1626 consecutive CABG patients operated in Iceland 2001-2012. Diabetic patients were 261 (16%) and were compared to 1365 non-diabetics in terms of patient demographics, operative data, and postoperative outcomes. Logistic regression was used to identify risk factors for major complications and 30-day mortality. Results: The groups were similar in terms of age, gender and Euro-SCORE. Diabetic patients had a higher BMI (30 vs. 28 kg/m2, p<0.001), were more likely to have hypertension (82% vs. 60%, p<0.01) and glomerular filtration rate <60 ml/min/1.73m2 (22% vs. 15%, p=0.01). The rate of deep sternal wound infections, stroke and perioperative myo-cardial infarction was similar in both goups. Acute kidney injury, classified according to the RIFLE-criteria, was higher in diabetic patients, both in the RISK (14% vs. 9%, p=0.02) and FAILURE category (2% vs. 0.5%, p=0.01). Minor complications, (atrial fibrillation, pneumonia, urinary tract infections and superficial wound infections) were similar in both groups. 30-day mortality was 5.0% vs. 2% for diabetics and non-diabetics patients, respectively (p=0.01). Diabetes was not a significant risk factor for 30-day mortality when adjusted for other risk factors with logistic regression (OR=1.98, 95% CI 0.72-4.95). Conclusions: Diabetic patients that underwent CABG more often suffered acute renal injury but diabetes was not an independent prognostic factor of operative mortality

Magnetic ordering in electronically phase-separated La2-xSrxCuO4+y: Neutron diffraction experiments

We present results of magnetic neutron diffraction experiments on the codoped superoxygenated La2-xSrxCuO4+y (LSCO+O) system with x=0.09. We find that the magnetic phase is long-range ordered incommensurate antiferromagnetic with a Neacuteel temperature T-N coinciding with the superconducting ordering temperature T-c=40 K. The incommensurability value is consistent with a hole doping of n(h)approximate to 1>8 but in contrast to nonsuperoxygenated La2-xSrxCuO4 with hole doping close to n(h)approximate to 18 the magnetic-order parameter is not field dependent. We attribute this to the magnetic order being fully developed in LSCO+O as in the spin and charge ordered "stripe" compounds La1.48Nd0.40Sr0.12CuO4 and La7/8Ba1/8CuO4

When the unconscious joins the game:a psychoanalytic perspective on modernization and change

Abstract: The article presents a psychoanalytic and cultural perspective on the modernization of the welfare state in a Danish context. The article analyzes the processes of change and development in public welfare organizations through theoretical and empirical perspectives. The first statement argues, that development and change related to modernization cause anxiety, defensiveness, and ambivalence. The second statement shows how an analysis of transference provides significant insight into organizational and human dynamics, thereby refining our understanding of change and modernization. The third statement posits that in the setting of public welfare administration, the typical response to anxiety and defense mechanisms involves rational and instrumental measures rather than the establishment of a reflective, defense-reducing working environment. The fourth statement suggests that developmental work activates previous experiences that can either inhibit or facilitate development and change in a complex alternation. The fifth statement points to the economic, political, and cultural context and its influence on the intensity and extent of defense mechanisms. Key words: life history, modernization, change processes, transference, defense mechanis

Interaction, transference, and subjectivity:A psychoanalytic approach to fieldwork

Fieldwork is one of the important methods in educational, social, and organisational research. In fieldwork, the researcher takes residence for a shorter or longer period amongst the subjects and settings to be studied. The aim of this is to study the culture of people: how people seem to make sense of their lives and which moral, professional, and ethical values seem to guide their behaviour and attitudes. In fieldwork, the researcher has to balance participation and observation in her attempts at representation. Consequently, the researcher’s academic and life-historical subjectivity are important filters for fieldwork. In general, fieldwork can be understood as processes where field reports and field analysis are determined by how the researcher interacts with and experiences the field, the events and informants in it, and how she subsequently develops an ethnography. However, fieldwork is also subjected to psychodynamic processes. In this article, I draw upon a number of research inquiries to illustrate how psychodynamic processes influence research processes: data production, research questions and methodology, relations to informants, as well as interpretation and analysis. I further investigate through a case study how the psychoanalytical concepts of “transference” and “institutional transference” can provide insight into the dynamics of efficiency and democracy at a number of Danish human service organisations