Towards more realistic measures of accessibility to emergency departments in Sweden.

BACKGROUND: Assuring that emergency health care (EHC) is accessible is a key objective for health care planners. Conventional accessibility analysis commonly relies on resident population data. However, the allocation of resources based on stationary population data may lead to erroneous assumptions of population accessibility to EHC. METHOD: Therefore, in this paper, we calculate population accessibility to emergency departments in Sweden with a geographical information system based network analysis. Utilizing static population data and dynamic population data, we investigate spatiotemporal patterns of how static population data over- or underestimates population sizes derived from temporally dynamic population data. RESULTS: Our findings show that conventional measures of population accessibility tend to underestimate population sizes particularly in rural areas and in smaller ED's catchment areas compared to urban, larger ED's-especially during vacation time in the summer. CONCLUSIONS: Planning based on static population data may thus lead to inequitable distributions of resources. This study is motivated in light of the ongoing centralization of ED's in Sweden, which largely depends on population sizes in ED's catchment areas.

Fear of Sexual Harassment and Its Impact on Safety Perceptions in Transit Environments: A Global Perspective.

This study reports variation in safety perceptions in transit environments, based on samples of university students in 18 cities on six continents who responded to an identical 45-question survey (N= 13,323 university students). We explore potential links between students' fears and sexual victimization and conclude that sexual harassment affects their behavior and mobility. Student mobility was affected by avoidance strategies prompting some transit riders to travel at particular times, on travel routes and settings that are deemed especially risky, or even avoiding using transit completely. Findings highlight the importance of city-country contexts for transit safety.

Socio-spatial disparities in access to emergency health care-A Scandinavian case study.

Having timely access to emergency health care (EHC) depends largely on where you live. In this Scandinavian case study, we investigate how accessibility to EHC varies spatially in order to reveal potential socio-spatial disparities in access. Distinct measures of EHC accessibility were calculated for southern Sweden in a network analysis using a Geographical Information System (GIS) based on data from 2018. An ANOVA test was carried out to investigate how accessibility vary for different measures between urban and rural areas, and negative binominal regression modelling was then carried out to assess potential disparities in accessibility between socioeconomic and demographic groups. Areas with high shares of older adults show poor access to EHC, especially those in the most remote, rural areas. However, rurality alone does not preclude poor access to EHC. Education, income and proximity to ambulance stations were also associated with EHC accessibility, but not always in expected ways. Despite indications of a well-functioning EHC, with most areas served within one hour, socio-spatial disparities in access to EHC were detected both between places and population groups.

Malignant mixes: The overlap of motor vehicle crashes and crime in Stockholm, Sweden.

Places that concentrate both motor vehicle crashes and crime in Stockholm, Sweden were examined for common socio-economic, land use, and neighborhood characteristics. Using vehicle crash (N = 3,700) and non-traffic crime (N = 605,052) data from 2016 to 2018, hot spots of these two sets of events and their overlap were identified. Crash hot spots captured 14% of the crashes in only 0.5% of Stockholm's area while crime hot spots captured 27% of the recorded offences in less than 1% of the area. There was overlap in these hot spots for 7% of the crashes and 10% of the crimes. To model predictors, the events were allocated to roadway segments (N = 5511) and tested using a Poisson-Gamma-CAR spatial regression model. Both crashes and crimes exhibit a clear center-periphery pattern that varies over time and by type of crashes and crimes. Crashes tended to occur on roadways with higher average daily traffic (ADT) while crimes tend to occur on roadways with lower ADT with around half occurring on residential streets. Both types of incidents tended to be higher in lower income neighborhoods. Land uses common to both types of harm were the location of underground stations, ATM machines, and alcohol-serving businesses. These are places where people and cars converge at particular times. The effect of these events on police, emergency, and medical services is discussed.

Anabolic steroid excess promotes hydroelectrolytic and autonomic imbalance in adult male rats: Is it enough to alter blood pressure?

AIM: The present study investigated the effects of anabolic steroid (AS) excess on blood pressure regulation. METHODS: Male Wistar rats were treated with nandrolone decanoate (AS) or vehicle (CTL) for 8 or 10 weeks. Saline (1.8%) and water intake were measured in metabolic cages. Urinary volume, osmolarity, Na+ and K+ concentrations, and plasma osmolarity were measured. The autonomic balance was estimated by heart rate variability at baseline or after icv injection of losartan. Cardiac function was assessed by echocardiography and ex vivo recordings. Myocardial collagen deposition was evaluated by Picrosirius-Red staining. Vascular reactivity and wall thickness were investigated in aortic sections. Blood pressure (BP) was assessed by tail-cuff plethysmography. Angiotensin II type I receptor (AT1R), renin, and mineralocorticoid receptor (MR) mRNA expression was measured in the kidneys and whole hypothalamus. RESULTS: AS group exhibited decreased urinary volume and Na+ concentration, while urinary K+ concentration, plasma osmolarity, and renal AT1R and renin mRNA levels were increased compared to CTL (p < 0.05). Water intake was increased, and saline intake was decreased in the AS group (p < 0.01). AS group exhibited increased low-frequency/high-frequency-ratio, while it was decreased by icv injection of losartan (p < 0.05) compared to baseline. Neither cardiac function nor vascular reactivity/morphology was affected by AS excess (p > 0.05). Ultimately, BP levels were not altered by AS excess (p > 0.05). CONCLUSION: AS excess promoted hydroelectrolytic and autonomic imbalance but did not alter vascular or cardiac function/morphology.

Women's Mobility and the Situational Conditions of Rape: Cases Reported to Hospitals.

A third of all rapes in Stockholm, the capital of Sweden, take place in public outdoor places. Yet, little is known about the events that precede this type of sexual offence and less about the situational context of rape. This study aims to improve the understanding of the nature of situational conditions that immediately precede events of rape. Using medical records of 147 rape victims during 2012 and 2013, we constructed time- and place-specific records of the places women traveled through or spent time at, the activities they engaged in, and the people they interacted with sequentially over the course of the day when they were raped. The analysis uses visualization tools (VISUAL-TimePAcTS), Geographical Information Systems, and conditional logistic regression to identify place-, context-, and social interaction-related factors associated with the onset of rape. Results for this sample of cases reported to hospitals show that being outdoors was not necessarily riskier for women when compared with indoor public settings; some outdoor environments were actually protective, such as streets. Being in a risky social context and engaging in a risky activity before the event was associated with an increased risk of rape, and the risk escalated over the day. Among those women who never drank alcohol, the results were similar to what was observed in the overall sample, which suggests that risky social interaction and risky activity made independent contributions to the risk of rape. The article finishes with suggestions for rape prevention.

Suicides in commuting railway systems: The case of Stockholm county, Sweden.

The objective of this study is to understand the spatial and temporal dynamics of suicides in commuting railway environments. Data on suicides in Stockholm commuting railway from 2006 to 2013 was analysed. The study sets out to identify significant clusters in suicides then evaluate whether commuting railway environments affect variations in suicide rates. Fieldwork inspection, spatial cluster techniques (NNHC and Getis-Ord statistics) and regression models underlie the methodology of study. Findings show no seasonality was observed in suicide cases, but winter months concentrate a larger share of events. Suicides do not occur evenly throughout the day but tend to take place more often in weekdays. Modelling findings shows that suicide rates increase with speed trains and decrease where barriers along tracks are installed. Although high speed trains are still a motive of concern for suicide prevention, findings call for a whole railway-approach to safety - one that extends maintenance beyond the platforms and stations' vicinities.

Temporal and spatial patterns of suicides in Stockholm's subway stations.

This paper investigates the potential temporal and spatial variations of suicides in subway stations in Stockholm, Sweden. The study also assesses whether the variation in suicide rates is related to the station environments by controlling for each station's location and a number of contextual factors using regression models and geographical information systems (GIS). Data on accidents are used as references for the analysis of suicides. Findings show that suicides tend to occur during the day and in the spring. They are concentrated in the main transportation hubs but, interestingly, during off-peak hours. However, the highest rates of suicides per passenger are found in Stockholm's subway stations located in the Southern outskirts. More than half of the variation in suicide rates is associated with stations that have walls between the two sides of the platform but still allow some visibility from passers-by. The surrounding environment and socioeconomic context show little effect on suicide rates, but stations embedded in areas with high drug-related crime rates tend to show higher suicide rates.

Applying Geostatistical Analysis to Crime Data: Car-Related Thefts in the Baltic States.

Geostatistical methods have rarely been applied to area-level offense data. This article demonstrates their potential for improving the interpretation and understanding of crime patterns using previously analyzed data about car-related thefts for Estonia, Latvia, and Lithuania in 2000. The variogram is used to inform about the scales of variation in offense, social, and economic data. Area-to-area and area-to-point Poisson kriging are used to filter the noise caused by the small number problem. The latter is also used to produce continuous maps of the estimated crime risk (expected number of crimes per 10,000 habitants), thereby reducing the visual bias of large spatial units. In seeking to detect the most likely crime clusters, the uncertainty attached to crime risk estimates is handled through a local cluster analysis using stochastic simulation. Factorial kriging analysis is used to estimate the local- and regional-scale spatial components of the crime risk and explanatory variables. Then regression modeling is used to determine which factors are associated with the risk of car-related theft at different scales.