Browsing by Author "Robertson, Josefina"

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Body mass index and mental health in young people - predictors of early heart failure and cardiomyopathy
(2019-11-18) Robertson, Josefina
Heart failure among young people is rare, but in contrast to decreasing incidence rates overall, recent studies have found increasing rates among the young over the last decades. Concomitantly, cardiomyopathies, which is a common underlying condition to heart failure at a young age, have more than doubled in Sweden for unknown reasons. Two phenomena that coincide with these trends are rising rates of overweight and mental illness in young people. The overall aim of this thesis was therefore to investigate if body mass index (BMI), nonpsychotic mental disorders, and stress resilience (susceptibility to stressful events) at a young age, are associated with early heart failure and cardiomyopathy. We obtained information on BMI and mental disorders from the Swedish Military Service Conscription Register, and the Medical Birth Register. By linking data to the National Patient and Cause of Death registers, which is a unique possibility in Sweden thanks to our personal identification numbers, we identified cases of early heart failure and cardiomyopathy in large population cohorts of 1.7 million men and 1.4 million women during a follow-up of up to 46 years. We found that elevated BMI in young people is associated with an increased risk of early heart failure and cardiomyopathy (Papers I, III, IV). The increased risk was detectable already at BMI-levels considered mid- to high-normal for adolescent men (BMI 20–25), whereas, for cardiomyopathy, women of childbearing age had an elevated risk from BMI 25. There was a gradual increase in risk with increasing BMI, regardless of gender, such that severe obesity (BMI ≥35) entailed a nine-fold increase in risk for early heart failure and cardiomyopathy among men, and a five-fold higher risk for cardiomyopathy among women. Furthermore, we found that nonpsychotic mental disorders in adolescent males, as well as low stress resilience, are associated with an elevated risk of early heart failure (Paper II). Given the current increase in body weight and mental illness among young people, physicians need to be aware of a potential future increase in heart failure and cardiomyopathy cases. The present findings emphasize the already marked importance of weight control in youth, which is essential to curb the obesity epidemic and to prevent the consequences related to it. This should go hand in hand with intensified efforts to prevent mental illness among young people.
Waiting Time at the Emergency Department from a Gender Equality Perspective
(2015-05-29) Robertson, Josefina; University of Gothenburg / Institute of Medicine; Göteborgs universitet / Institutionen för medicin
Master thesis, Programme in Medicine. TITLE: Waiting Time at the Emergency Department from a Gender Equality Perspective. Introduction Increasing patient load and longer waiting times at the emergency departments are well-known phenomena. A central function is the so-called triage system for prioritization of the patients. Only a few studies address the question if there is a gender bias in triaging and waiting time. Aim To quantify gender effects in a large mixed population of patients seeking health care at a large emergency department and, on the basis of the magnitude of the gender difference in subpopulations draw conclusions regarding possible causes of observed gender effects. Methods The patient material consisted of all cases seeking medical care at the emergency ward of the Östra Hospital during 2009-2012. They were divided into subgroups on the basis of gender, chief complaint, age and socioeconomic status. A standardized formula (RETTSTM) was used in the triaging process and the patients were prioritized with one of five colors. Three time registrations were recorded; time to triage (TTT), time to doctor (TTD) and total lead time (TLT). Results 135 417 patients were included in the study with a mean age of 54,2 years. They came from all parts of Gothenburg. Men were more often triaged red/orange and women more often green/yellow. There was no gender difference in TTT. The mean TTD and TLT were significantly longer for females than for males in the entire material, with an approximate magnitude of 15 minutes. The gender signal was seen independently of the chief complaint, in both medical and surgical cases. The signal disappeared among old seriously ill patients and among patients from residence areas with high socioeconomic status. Conclusion We observed differences in waiting times and triage priority levels that are hard to explain on the basis of presenting symptoms. The magnitude of the gender dependent signal was affected by age and socioeconomic status. Key words Waiting Time at the Emergency Department from a Gender Equality Perspective,, waiting times, gender, age, socioeconomy