Higher Admittance to Specialized Palliative Care for Patients with High Education and Income: A Nationwide Register-Based Study.

Background: While associations between socioeconomic position, that is, income and education and admittance to specialized palliative care (SPC) have been investigated previously, no prior national studies have examined admittance to all types of SPC, that is, hospital-based palliative care team/units and hospice. Aim: To investigate whether cancer patients' education and income were associated with admittance to SPC (hospital-based palliative care team/unit, hospice). Design: Data sources were several nationwide registers. The association between SPC and education and income, respectively, was investigated using logistic regression analyses. Setting/Participants: Patients dying from cancer in Denmark 2010-12 (n = 41,741). Results: In the study population, 45% had lower secondary school, and 6% had an academic education. Patients with an academic education were more often admitted to SPC than those having lower secondary school (odds ratio [OR] = 1.69; 95% confidence interval [CI]: 1.51-1.89). Patients in the highest income quartile (Q4) were more often admitted than those in the lowest income quartile (Q1) (OR = 1.46; 95% CI: 1.37-1.56). This association was stronger for hospice (OR = 1.67 (95% CI: 1.54-1.81)) than for admittance to hospital-based palliative care team/unit (OR = 1.23 (95% CI: 1.14-1.31)). Compared with patients who had lower secondary school and the lowest income, the OR of admittance to SPC among the most affluent academics was 1.96 (95% CI: 1.71-2.25). Conclusion: This nationwide study indicates that admittance to SPC was clearly associated with education and income. We believe that the associations indicate inequity. Initiatives to improve access for patients with low education or income should be established.

The CHAOS-7 geomagnetic field model and observed changes in the South Atlantic Anomaly.

We present the CHAOS-7 model of the time-dependent near-Earth geomagnetic field between 1999 and 2020 based on magnetic field observations collected by the low-Earth orbit satellites Swarm, CryoSat-2, CHAMP, SAC-C and Ørsted, and on annual differences of monthly means of ground observatory measurements. The CHAOS-7 model consists of a time-dependent internal field up to spherical harmonic degree 20, a static internal field which merges to the LCS-1 lithospheric field model above degree 25, a model of the magnetospheric field and its induced counterpart, estimates of Euler angles describing the alignment of satellite vector magnetometers, and magnetometer calibration parameters for CryoSat-2. Only data from dark regions satisfying strict geomagnetic quiet-time criteria (including conditions on IMF B z and B y at all latitudes) were used in the field estimation. Model parameters were estimated using an iteratively reweighted regularized least-squares procedure; regularization of the time-dependent internal field was relaxed at high spherical harmonic degree compared with previous versions of the CHAOS model. We use CHAOS-7 to investigate recent changes in the geomagnetic field, studying the evolution of the South Atlantic weak field anomaly and rapid field changes in the Pacific region since 2014. At Earth's surface a secondary minimum of the South Atlantic Anomaly is now evident to the south west of Africa. Green's functions relating the core-mantle boundary radial field to the surface intensity show this feature is connected with the movement and evolution of a reversed flux feature under South Africa. The continuing growth in size and weakening of the main anomaly is linked to the westward motion and gathering of reversed flux under South America. In the Pacific region at Earth's surface between 2015 and 2018 a sign change has occurred in the second time derivative (acceleration) of the radial component of the field. This acceleration change took the form of a localized, east-west oriented, dipole. It was clearly recorded on ground, for example at the magnetic observatory at Honolulu, and was seen in Swarm observations over an extended region in the central and western Pacific. Downward continuing to the core-mantle boundary, we find this event originated in field acceleration changes at low latitudes beneath the central and western Pacific in 2017.

Cohabitation Status Influenced Admittance to Specialized Palliative Care for Cancer Patients: A Nationwide Study from the Danish Palliative Care Database.

BACKGROUND: The utilization of the health care system varies in relation to cohabitation status, but conflicting results have been found in studies investigating the association in relation to specialized palliative care (SPC). OBJECTIVE: To investigate the association between cohabitation status and admittance to SPC; to establish whether this association differed between hospital-based palliative care team/units (mainly outpatient/home care) and hospice (mainly inpatient care). DESIGN: A nationwide study based on the Danish Palliative Care Database, which is linked with additional registers. MEASUREMENTS: The study population included all patients dying from cancer in Denmark between 2010 and 2012 (n = 44,480). The associations were investigated using logistic regression analysis adjusted for sex, age, diagnosis, and geography and standardized absolute prevalences. RESULTS: Comparison with cohabiting patients showed that overall admittance to SPC was lowest among patients who were widows/widowers (odds ratio [OR] = 0.86; 95% confidence interval [CI]: 0.81-0.91) and those who had never married (OR = 0.74; 95% CI: 0.68-0.80). Patients living alone were more likely to be admitted to a hospice [e.g., divorced OR = 1.41 (95% CI: 1.31-1.52)] than to a hospital-based palliative care team/unit [e.g., never married OR = 0.64 (95% CI: 0.59-0.70)] compared with cohabiting patients. Standardized prevalences of overall admittance to SPC showed a similar pattern, for example, admittance was highest (41%) for patients cohabiting and lowest (30%) for patients who had never married. CONCLUSION: Cohabiting individuals were favored in admittance to SPC. Compared with cohabiting patients it is unlikely that patients living alone have lower needs for SPC: results point toward inequity in admittance to specialist health care, a problem that should be addressed.

A Comprehensive Model of Earth's Magnetic Field Determined From 4 Years of Swarm Satellite Observations.

The European Space Agency's three-satellite constellation Swarm, launched in November 2013, has provided unprecedented monitoring of Earth's magnetic field via a unique set of gradiometric and multi-satellite measurements from low Earth orbit. In order to exploit these measurements, an advanced "Comprehensive Inversion" (CI) algorithm has been developed to optimally separate the various major magnetic field sources in the near-Earth regime. The CI algorithm is used to determine Swarm Level-2 (L2) magnetic field data products that include the core, lithospheric, ionospheric, magnetospheric, and associated induced sources. In addition, it has become apparent that the CI is capable of extracting the magnetic signal associated with the oceanic principal lunar semi-diurnal tidal constituent M 2 to such an extent that it has been added to the L2 data product line. This paper presents the parent model of the Swarm L2 CI products derived with measurements from the first four years of the Swarm mission and from ground observatories, denoted as "CIY4", including the new product describing the magnetic signal of the M 2 oceanic tide.

[Surgery patients' intake of herbal preparations and dietary supplements]. / Kirurgiske patienters indtagelse af naturlaegemidler og kosttilskud.

INTRODUCTION: Herbal medicine is being frequently used by patients around the world. Several products may interact with ordinary medicine, so it is important for doctors to know what kind of herbal medicines their patients take. MATERIAL AND METHODS: A questionnaire was given to presurgery patients during a two-month period. RESULTS: A total of 115 consecutive patients responded, 69 women (60%) and 46 men (40%). 50.4% had taken or still took herbal medicine, with the following distribution of gender: women 69.8%, men 30.2%. The age group was 18-82 years. The frequently used herbal medicines were fish oil, ginkgo, Echinacea, Co-Q10, garlic, and hip. Twenty-five patients took nutritional supplements with the following spread of gender: 84% women and 16% men. The frequently used nutritional supplements were Gerimax, LongoVital, and Melbrosia. Not all patients would inform their doctor about their use of herbal medicine. 28.6% retained information because of the doctor and 64.3%, did not perceive herbal medicine as "real medicine". DISCUSSION: It is important for anaesthesiologists to know what specific kind of herbal medicines patients are using before they anaesthetize them as interactions between herbal medicine and anaesthesia are prevalent. Anaesthesiologists have to ask specific questions to receive full information regarding herbal medicines during the preoperative period.

Social differentiation and long-term origin of disasters

To explain both origin and outcome of disasters ('natural', technical' and 'war-bone') as well as social action during disasters proper, a macrosociological model of internal causation isss introduced (PERDUE). It consists of six stages of possible and of most likely paths of social change between these six ('Peace is founded','Everyday routine', Rising class struggle', Disasters strike', 'Unconditional surrender of collective defence' and Evaporation of common values'). The stages are developed by making use of three dimensions of social change ('rapidity','radicality',and'rituality') and described (AU)