Patterns of mortality risk among patients with substance use disorder: an opportunity for proactive patient safety?

BACKGROUND: Patients with substance use disorder (SUD) suffer from excess mortality compared to the overall population. This study aims to identify patterns in death rates among patients with SUD visiting a SUD emergency ward and to explore whether this knowledge can be used as input to identify patients at risk and increase patient safety. METHODS: Hospital visit data to a SUD emergency ward were collected between 2010 and 2020 through medical records. Data included gender, age, SUD diagnosis, and the time of death. The Kruskal-Wallis rank sum test was used to test between ordinal variables, and risk ratio was used to quantify the difference in mortality risk. All statistical tests were two-sided, with a 95% confidence interval and a minimum significance level of 0.05. RESULTS: The male patients in the study group had 1.41-1.59 higher mortality risk than the female patients. The study revealed an average death rate of 0.14 among all patients during the study period. Although patients with a diagnosed alcohol use disorder constituted 73.7% of the cohort, having an opioid use disorder or sedative hypnotics use disorder was associated with the highest death rates; 1.29-1.52 and 1.47-1.74 higher mortality risk than those without such diagnoses. CONCLUSION: This study demonstrates that data from visits to SUD emergency wards can be used to identify mortality risk factors, such as gender, type of diagnosis, number of diagnoses, and number of visits to the SUD emergency ward. Knowledge about patterns of patient visits and mortality risk could be used to increase patient safety through a decision support tool integrated with the electronic medical records. An improved system for early detection of increased mortality risk offers an opportunity for an adaptive patient safety system.

Correspondence to the supplementary opinions on alternative cooling technologies in hot climate.

At present, air conditioning (AC) is the most effective means for the cooling of indoor space. However, its increased global use is problematic for various reasons. This is a correspondence to the supplementary opinion provided by Dr. Bin Yang, Dr. Stefano Schiavon, and Dr. Faming Wang to our paper titled "Challenges of using air conditioning in an increasingly hot climate." The paper explored the challenges linked to increased AC use and discusses more sustainable alternatives. The supplementary opinion provides a great technical complement to our paper. However, there is a need for a more holistic view both when it comes to combining various solutions and involving various levels in society.

Challenges of using air conditioning in an increasingly hot climate.

At present, air conditioning (AC) is the most effective means for the cooling of indoor space. However, its increased global use is problematic for various reasons. This paper explores the challenges linked to increased AC use and discusses more sustainable alternatives. A literature review was conducted applying a transdisciplinary approach. It was further complemented by examples from cities in hot climates. To analyse the findings, an analytical framework was developed which considers four societal levels-individual, community, city, and national. The main challenges identified from the literature review are as follows: environmental, organisational, socio-economical, biophysical and behavioural. The paper also identifies several measures that could be taken to reduce the fast growth of AC use. However, due to the complex nature of the problem, there is no single solution to provide sustainable cooling. Alternative solutions were categorised in three broad categories: climate-sensitive urban planning and building design, alternative cooling technologies, and climate-sensitive attitudes and behaviour. The main findings concern the problems arising from leaving the responsibility to come up with cooling solutions entirely to the individual, and how different societal levels can work towards more sustainable cooling options. It is concluded that there is a need for a more holistic view both when it comes to combining various solutions as well as involving various levels in society.

Pandemic responses at the subnational level: Exploring politics, administration, and politicization in Swedish municipalities.

The Swedish response to the pandemic at the national level has attracted considerable international attention, but little focus has been placed on the way municipalities dealt with the crisis. Using Hay's dimensions of politicization, namely the capacity for human agency, deliberation in the public domain, and social context, we analyze the politicization of the municipal response to the pandemic in Sweden. We do this based on the analysis of the decision making process to activate (or not) an extraordinary crisis management committee. We find inter alia, that (i) only a quarter of the municipalities activated the committee while a majority of them had an alternate special organization in place; (ii) support to the existing organizational structure was more salient than creating an extraordinary organization, and (iii) a robust municipal structure was deemed to be one able to withstand shocks without resorting to extraordinary governance arrangements. We find a 'conditioned politicization' of the response, privileging administration over politics.

La respuesta sueca a la pandemia a nivel nacional ha atraído una atención internacional considerable, pero se ha prestado poca atención a la forma en que los municipios abordaron la crisis. Usando las dimensiones de politización de Hay, a saber, la capacidad de agencia humana, la deliberación en el dominio público. y contexto social, analizamos la politización de la respuesta municipal a la pandemia a nivel municipal en Suecia a través de la elección de activar un comité extraordinario de gestión de crisis. Encontramos, entre otras cosas, que (i) solo una cuarta parte de los municipios activaron el comité mientras que la mayoría de ellos tenían una organización especial alterna; (ii) el apoyo a la estructura organizativa existente era más importante que la creación de una organización extraordinaria, y (iii) se consideraba que una estructura municipal robusta era capaz de soportar los impactos sin recurrir a arreglos de gobernanza extraordinarios. Encontramos una "politización condicionada" de la respuesta, privilegiando la administración sobre la política.

'Too many mice make no lining for their nest' - Reasons and effects of parallel governmental structures for disaster risk reduction and climate change adaptation in Southern Africa.

Many African countries face escalating challenges of increasing disaster risk and anticipated impacts of climate change. Although disaster risk reduction (DRR) and climate change adaptation (CCA) are tightly linked and comprising virtually identical practices in vulnerable countries in Southern Africa, research has identified parallel governance structures across the region. This study applied comparative case study research, based on 27 semi-structured interviews, to investigate the reasons for and effects of such parallel structures for DRR and CCA in Botswana, Mozambique, the Seychelles, Tanzania and Zambia. It revealed overwhelmingly negative effects in terms of unclear mandates and leadership, uncoordinated efforts, duplication of efforts, suboptimal use of resources and competition over resources and control. The study identified both external reasons for the parallel structures, in terms of global or international initiatives or incentives, and internal reasons, with regard to the history and quality of the governance structures. Although the identified negative effects are common to a range of complex nexuses, there is a clear distinction with the DRR-CCA nexus comprising virtually indistinguishable practices in Southern Africa. There is, as such, no practical reason for keeping them apart. The parallel structures for DRR and CCA are instead the result of pervasive institutionalisation across the region, driven by coercive, mimetic and normative pressures coming from both within and abroad. Although much point to the difficulties of changing the studied institutional arrangements, these parallel structures for DRR and CCA must be addressed if the populations in Southern Africa are to enjoy safety and sustainable development.