[Thrombolysis in stroke. An evaluation by the SBU Alert].
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Cerebrovascular Disorders↗
Biomedical subjects
K Asplund
Publications and source records attributed to K Asplund.
[When salicylates do not help. Practice in recurrent TIA (Transient Ischemic Attack) varies at Swedish hospitals].
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Aged↗
[Public health work needs new evaluation models. Primary care projects are more effective than large scale campaigns].
The need both of critical assessment of community intervention programmes and of alternatives to randomised controlled studies is discussed in the article. Examples are drawn from a review recently completed for the Swedish Council on Technology Assessment in Health Care [Statens Beredning för Utvärdering av medicinsk metodik (SBU)], and from the evaluation of a cardiovascular disease prevention programme currently in progress in northern Sweden.
Cardiovascular Diseases↗
[Prejudices on efficiency of Swedish health care].
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Cerebrovascular Disorders↗
Intense nonpharmacological intervention in subjects with multiple cardiovascular risk factors: decreased fasting insulin levels but only a minor effect on plasma plasminogen activator inhibitor activity.
Increased plasma levels of insulin and the fibrinolytic inhibitor, plasminogen activator inhibitor type 1 (PAI-1), are two new cardiovascular risk factors. The extent to which these two risk factors can be affected by nonpharmacological intervention modalities has not been convincingly proven in subjects at high risk for cardiovascular disease. This study assesses the effects on fasting plasma insulin and plasma PAI-1 activity of an intervention program including a low-fat, high-fiber diet and regular daily physical exercise. The intervention was implemented by a 1-month learning and training session in a full-boarding wellness center and included a follow-up evaluation after 12 months. The study was conducted on 108 subjects (31 men and 77 women) referred for multiple risk factor treatment. After 1 month of intense intervention, the physical condition improved significantly, and this effect was maintained during the year. The body mass index (BMI), fasting plasma insulin, and plasma lipids were significantly decreased. In women, PAI-1 activity was significantly reduced. At follow-up study in both sexes, the BMI and fasting insulin were still significantly decreased. In women, PAI-1 activity reverted to the preintervention level. In subjects with multiple risk factors, ie, the insulin resistance syndrome, the plasma insulin level can be reduced by an intense nonpharmacological program. Also, at least in women, plasma PAI-1 activity can be modestly modified. However, the magnitude of the decrease in PAI-1 activity was probably too small to reverse the hypofibrinolytic state characteristic of these subjects.
Adolescent↗
Evaluation of pulsed-field gel electrophoresis of genomic restriction fragments in the discrimination of Yersinia enterocolitica O:3.
One hundred and six Yersinia enterocolitica serogroup O:3, biotype 4 isolated from human and porcine samples in 1984 and in the years 1993 5 were examined by pulsed-field gel electrophoresis (PFGE). The genomic profiles produced by the enzymes NotI and XbaI were studied. Sixteen (A-P) and 8 (1-8) different pulsotypes were obtained, respectively. By combining the pulsotypes produced by both NotI and XbaI 24 different types were distinguished. The two major types, designated as A1 and B1, comprised 36% of all strains tested. The proportions of pulsotypes A1 and B1 were, 35.9 and 25.6%, respectively, among strains isolated in 1984. The corresponding figures among the strains isolated in 1993-5 were 35.8 and 41.8%. Nine pulsotypes were found only in 1984 and nine only in 1993-5. The proportions of the major pulsotypes, A1 and B1, in human isolates were 42.9 and 35.7% and in porcine isolates 22.2 and 36.1% respectively. Six types were found among both human and porcine isolates, 8 only among human strains and 10 only among porcine strains.
Animals↗
Episodes of lucidity in people with severe dementia as narrated by formal carers.
Twenty formal carers employed in three nursing homes narrated 92 episodes of lucidity (ELs) in people with severe dementia. Sixty-two episodes concerned speech, nine concerned actions and 21 episodes concerned both speech and actions. Most ELs were said to occur spontaneously when the patients were acting closely together with a carer who did not make demands on them and regarded them as valuable human beings whose behaviour was a meaningful expression of their experiences. The narrations showed characteristics that indicated trustworthiness and the episodes described in three separate nursing homes were very similar and resembled descriptions given in previous research reports as well as in relatives' reports. Further research seems necessary and the assumption that severe dementia implies the destruction of the self or personhood must be questioned.
Adult↗
Effects of growth-promoting antimicrobials on inhibition of Yersinia enterocolitica O:3 by porcine ileal microflora.
The survival of Yersinia enterocolitica serotype O:3 was examined in an in vitro model of the porcine ileum in the presence of normal ileal microflora using a medium supplemented with the growth-promoting antimicrobials avoparcin, spiramycin, tylosin, carbadox and olaquindox, or without any antimicrobials, at 39 degrees C for 5 d. Growth of Y. enterocolitica was inhibited in all trials in the following order: avoparcin < carbadox < spiramycin < no feed additives < tylosin < olaquindox. The media supplemented with avoparcin, carbadox and spiramycin supported the survival of Y. enterocolitica up to 5 d. When incubated with the normal ileal microflora without any growth-promoting antimicrobials, Y. enterocolitica could not be isolated after 4 d. With olaquindox and tylosin, Y. enterocolitica was not detected after 3 d.
Animals↗
From optimism to pessimism. A case study of a psychiatric patient.
This article focuses on the results of a single case study which illuminates an understanding of phases in nursing care for a patient in a psychiatric setting in Sweden. The focus of this study is a 50-year-old man who showed progressive deterioration from increased motor activity to oral, sexual, destructive and aggressive actions. Data collection using five methods occurred during a 21-month period. Results of the content analysis processes identified four distinct but non-discrete phases of the patient's complex condition. Medical and nursing care was categorized in three approaches: optimistic, strategic and resigned. The results raise the question of whether there is action that is without any meaning as an expression of the patient's wishes, thoughts and feelings. It seems clear that the patient in this study felt really angry and in despair. However, during moments of lucidity, he also indicated that he felt this was not an authentic expression of his 'real' self. His experience was that of a splintered world.
Aggression↗
Secular trends in social patterning of cardiovascular risk factor levels in Sweden. The Northern Sweden MONICA Study 1986-1994. Multinational Monitoring of Trends and Determinants in Cardiovascular Disease.
OBJECTIVES: In the Northern Sweden MONICA Study, levels of cardiovascular risk factors were determined in 1986, 1990 and 1994. The aim of this study was to assess the trends in cardiovascular risk factors, and to analyse the relationship between levels of risk factors and level of education. DESIGN: Cardiovascular risk factors were determined in cross-sectional population studies of randomly selected 25-64 year old men and women in 1986, 1990 and 1994 (a total of 4742 individuals). RESULTS: Throughout the years 1986 to 1994, cardiovascular risk factor levels showed a marked social pattern, generally being more favourable among people with a university education. Serum cholesterol levels declined in all educational groups, but blood pressure declined significantly only in women with a university education. Body mass index increased, most markedly in men with university and in women with a secondary school education. Prevalence of cigarette smoking decreased significantly in young men. It increased markedly in low-educated women so that the social gaps in smoking widened substantially over time. The improved level of education in the population at large was calculated to explain only a little of the risk factor changes between 1986 and 1994. CONCLUSIONS: Trends in risk factor levels in different educational groups have been more diverging for women than for men. The most marked change in risk factor levels has been the decline in total serum cholesterol for both men and women in all educational groups.
Adult↗
Comparison of effects of quinapril and metoprolol on glycaemic control, serum lipids, blood pressure, albuminuria and quality of life in non-insulin-dependent diabetes mellitus patients with hypertension. Swedish Quinapril Group.
OBJECTIVE: To compare the long-term effects of the angiotensin-converting enzyme (ACE)-inhibitor quinapril and the cardioselective beta-adrenergic blocking agent metoprolol on glycaemic control, with glycosylated haemoglobin (HbA1c) as the principal variable, in non-insulin-dependent diabetes mellitus (NIDDM) patients with hypertension. DESIGN: A randomized, double-blind, double-dummy, multicentre study during 6 months preceded by a 4 week wash-out and a 3 week run-in placebo period. Quinapril (20 mg) and metoprolol (100 mg, conventional tablets) were given once daily. No change was made in the treatment of diabetes (diet and hypoglycaemic agents). SUBJECTS: Seventy-two patients fulfilling the criteria were randomized and entered the double-blind period. Twelve patients did not complete the study. Sixty patients, 26 on quinapril and 34 on metoprolol, were available for the final analysis. MAIN OUTCOME MEASURES: The effect was assessed by changes in HbA1c, the fasting serum glucose and the post-load serum glucose, C-peptide and insulin levels during the oral glucose tolerance test. RESULTS: In the quinapril group, the fasting serum glucose, oral glucose tolerance and the C-peptide and insulin responses, determined as the incremental area under the curves (AUC), showed no change, but the mean HbA1c level increased from 6.2 +/- 1.1% to 6.5 +/- 1.3% (P < 0.05). In the metoprolol group, the rise in the mean level of HbA1c, from 6.3 +/- 1.0% to 6.8 +/- 1.3% (P < 0.01), tended to be more marked than after quinapril, although there was no significant difference between the increments. The mean fasting serum glucose showed an increase from 9.1 +/- 1.9 mM to 10.1 +/- 2.8 mM (P < 0.01) which correlated significantly with the duration of diabetes (P < 0.01) and the increase in fasting serum triglycerides (P < 0.001). Moreover, in the metoprolol group we found significant decreases in the oral glucose tolerance as well as C-peptide and insulin responses to the glucose load. CONCLUSIONS: Treatment with quinapril for 6 months appears to have advantages over metoprolol in NIDDM patients with hypertension. Although treatment with quinapril or metoprolol over 6 months was concomitant with a rise in the HbA1c, increased fasting blood glucose, decreased oral glucose tolerance and decreased C-peptide and insulin responses to a glucose challenge were observed only in patients treated with metoprolol.
Adrenergic beta-Antagonists↗
The meaning of caring for patients on a long-term psychiatric ward as narrated by formal care providers.
Seventeen care providers were interviewed about their caring experiences on a hospital psychiatric ward. The interviews focused on the meaning of their work, including the care they provide and the nature of the patient as a person. The study was guided by a phenomenological hermeneutic perspective inspired by Ricoeur (1976). The analysis focused on context and form. Three themes illuminate the meaning of care provided. These themes are as follows; being in the midst of human storage, moving towards a human care of relations, and struggling with 'the old' and 'the new'. Experiencing work as being in the midst of a human storage reflects the historical and human situation of warehousing psychiatric patients. The care providers are experiencing a shift in their view of the patient and the meaning of their work, towards a more human care of relations. For these care providers, there is a struggle between the past, the present and the future. This struggle between 'the old' and 'the new' conveys a struggle between doing as a nurse, which dominates the past, and relating, which is, or needs to be, the current and future focus in psychiatric care. The shift in view distinguished itself by the care providers viewing the patient as being vulnerable and having problems with relations. The results have been interpreted and discussed in the light of a previously published interview study with the patients, carried out at the same time on the same ward. Attending to ingrained attitudes of the past and their influence on new approaches to care is essential to understanding not only changes in ways of doing nursing tasks, but also ways of relating.
Adult↗
Time trends in long-term survival after stroke: the Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, 1985-1994.
BACKGROUND AND PURPOSE: Stroke mortality rates and case fatality of stroke have declined since the beginning of the 1970s in Sweden, but the incidence of stroke has been stable. The aim of this study was to analyze trends in long-term survival after stroke. METHODS: Within the framework of the population-based WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project, all acute stroke events were recorded in the age group 25 to 74 years in northern Sweden during the period 1985 to 1994. All first-ever stroke patients were followed for information on vital status (minimum follow-up time was 1 year). Survival time was related to time period of stroke onset, stroke diagnosis, and concomitant diseases. RESULTS: Survival times for a total of 6819 first-ever stroke patients (4057 men and 2762 women) were analyzed. Age-adjusted odds ratio for death within 1 year after stroke was 0.70 (95% confidence interval [CI], 0.55 to 0.88) in the period 1993 to 1994 as compared with the period 1985 to 1986 in men and 0.69 (95% CI, 0.53 to 0.90) in women. Corresponding odds ratios were 0.73 in men and 0.70 in women among those who survived the first 28 days. Similar improvements were seen for 3- and 5-year survival. Improvements in survival over time were most marked among patients with ischemic stroke. There was no improvement in survival over time among patients with the most severe deficits at onset. CONCLUSIONS: Gradually improved survival, both short and long term, was observed during the 10-year study period. The improvements are not explained by changes in known confounding prognostic factors.
Adult↗
Bovine mastitis in Finland in 1988 and 1995--changes in prevalence and antimicrobial resistance.
Two surveys were carried out (during 1988 and 1995) to estimate the prevalence of bovine mastitis in Finland. In 1988, 17,111 quarter milk samples were obtained from 4495 cows, and in 1995 the corresponding figures were 10,410 and 2648. Antimicrobial susceptibility of mastitis pathogens was studied. Prevalence of mastitis on cow basis decreased from 47.8% in 1988 to 37.8% in 1995. Staphylococci was the largest group of pathogens isolated. The proportion of Staphylococcus aureus decreased and that of coagulase-negative staphylococci (CNS) increased. The proportion of strains resistant to at least one antibacterial drug increased with regard to S. aureus from 36.9% in 1988, to 63.6% in 1995 and with CNS from 26.6% to 49.7%. Most of the increase in antibacterial resistance was due to a higher number of beta-lactamase producing strains. Multiresistance also increased, but it was proportional to the overall increase in resistance. All the predominant mastitis streptococci were susceptible to beta-lactams tested.
Animals↗
Two variants of extracellular-superoxide dismutase: relationship to cardiovascular risk factors in an unselected middle-aged population.
OBJECTIVE: Description of the distribution of plasma levels of two variants of extracellular-superoxide dismutase (EC-SOD) and their relationship to cardiovascular risk factors in the general population. DESIGN: A cross-sectional study. SETTING: Norrbotten and Västerbotten counties in northern Sweden. SUBJECTS: Four thousand, nine hundred 25-74-year-old randomly selected subjects. MAIN OUTCOME MEASURES: Plasma levels of EC-SOD. Genotyping by an allele-specific PCR method. RESULTS: Plasma EC-SOD levels showed a distinct bimodal distribution with the smaller group (3.8%) having a variant of the enzyme with about eight-fold-higher plasma levels. Genotyping was performed in 65 individuals with the high-level variant. All but one were found to carry the same mutation, Arg213Gly, affecting the heparin-binding domain of EC-SOD. Subjects with the high-level variant of EC-SOD had modestly higher body mass index and higher levels of serum cholesterol, serum triglycerides and plasma fibrinogen than those with the common EC-SOD phenotype. Within the population with common EC-SOD, the plasma levels were lower in men than in women and increased with age. Low levels of common phenotype EC-SOD were associated with smoking, high plasma levels of fibrinogen and low activity of tissue plasminogen activator in both univariate and multivariate analyses. Obesity and total serum cholesterol were associated with high common phenotype EC-SOD levels. CONCLUSIONS: A high-level variant of EC-SOD caused by one and the same mutation and with low tissue binding and high plasma levels is present in approximately four per cent of an unselected middle-aged population in northern Sweden. Plasma levels of EC-SOD may be modulated by lifestyle factors such as smoking and show a complex covariation with many of the conventional cardiovascular risk factors.
Adult↗
Age-period-cohort effects on ischaemic heart disease mortality in Sweden from 1969 to 1993, and forecasts up to 2003.
AIMS: Mortality from ischaemic heart disease has been decreasing in most industrialized countries since the 1960s. The aim of this study was to analyse ischaemic heart disease mortality during 1969-1993 in Sweden, and to predict mortality trends until 2003. METHODS AND RESULTS: Age-period cohort models were used to analyse ischaemic heart disease mortality in Sweden between 1969 and 1993, and to predict age-specific death rates and total number of deaths for the periods 1994-1998 and 1999-2003. Mortality rates in the age group 25-89 years decreased from 719 to 487 per 100,000 for men, and from 402 to 215 per 100,000 for women over the study period (average annual decrease of 1.5% for men and 2.2% for women). The decline started earlier for women than for men. The ratio of age-adjusted mortality between men and women increased steadily over the study period. Predictions based on the full age-period cohort model for the period 1999-2003 gave mortality rates of 346 and 155 per 100,000 for men and women, respectively. Despite the ageing of the population, the total numbers of ischaemic heart disease deaths in Sweden are predicted to decline by approximately 25% in both men and women from 1989-93 to 1999-2003. CONCLUSION: A major decline in ischaemic heart disease mortality has been observed in the last 15 years in Sweden. Both factors, cohort and calendar period, contain information which helps explain the decline in ischaemic heart disease mortality trends in Sweden. Predictions indicate that the decline of both age-specific and total mortality is to continue.
Adult↗
Increased levels of tissue plasminogen activator antigen in essential hypertension. A population-based study in Sweden.
OBJECTIVE: To investigate components of the haemostatic and fibrinolytic system in borderline hypertensives and hypertensives, drug-treated or not, from a defined population. DESIGN AND METHODS: A randomly selected sample of the population of northern Sweden, 1558 subjects aged 25-64 years, was studied. Eight per cent of them were being treated with antihypertensive drugs (trHT). Remaining subjects were classified according to their mean diastolic blood pressure (DBP). Normotension, DBP < 85 mmHg, was found in 63%, borderline hypertension (bHT), DBP 85-94 mmHg, in 21% and untreated hypertension (uHT), DBP > or = 95 mmHg, in 8% of the subjects. RESULTS: Mean age increased from the normotensive group through the bHT and uHT groups to the trHT group, members of which were the oldest. Age-adjusted values for the body mass index, waist: hip ratio, serum triglyceride and Phadeseph plasma insulin levels increased with each level of hypertension. Plasma fibrinogen levels and plasminogen activator inhibitor type 1 activity (in men) increased stepwise from normotensives through bHT and uHT to the highest values found in the trHT group. The tissue plasminogen activator (tPA) activity in men declined strongly across the groups, trHT having the lowest fibrinolytic activity (P < 0.001). tPA antigen levels increased strongly from normotensives through bHT to uHT, but then were lower in the trHT group. Even after adjustment for possible confounders, men in the uHT group had 21% higher (P = 0.027) tPA antigen levels than did the normotensives. In bHT men, the tPA antigen and plasminogen activator inhibitor type 1 activities were 14 and 24% respectively, higher (P < 0.01) than those in the normotensives. CONCLUSION: Hypertension is associated with multiple metabolic and fibrinolytic disturbances that are accentuated in drug-treated hypertensives and already discernible in subjects with borderline hypertension. Decreased fibrinolysis is associated with, and possibly secondary to, metabolic disturbances linked to the insulin-resistance syndrome. The independent increase in tPA antigen in hypertensive men might indicate an endothelial dysfunction.
Adult↗
Stroke incidence and mortality correlated to stroke risk factors in the WHO MONICA Project. An ecological study of 18 populations.
BACKGROUND: The aim of the present study was to determine the extent to which the variation in conventional risk factors contributed to the variation in stroke incidence among these populations. METHODS: Within the WHO MONICA Project, stroke has been recorded in 18 populations in 11 countries. In population surveys, risk factors for cardiovascular diseases have been examined in the age group 35 to 64 years. Over a 3-year period, 12,224 acute strokes were registered in men and women within the same age range. RESULTS: The highest stroke attack rates were found in Novosibirsk in Siberia, Russia, and Finland, with a more than three-fold higher incidence than in Friuli, Italy. The mean diastolic blood pressure among the populations differed by 15 mm Hg between Novosibirsk (highest) and Denmark (lowest). In multiple regression analyses, the presence of conventional cardiovascular risk factors (smoking and elevated blood pressure) explained 21% of the variation in stroke incidence among the population in men and 42% in women. In Finland, in China, and in men in Lithuania, the stroke incidence rates were higher than expected from the population risk factor levels. CONCLUSION: Prevalence of smoking and elevated blood pressure explain a substantial proportion of the variation of stroke attack rates between populations. However, other risk factors for stroke that were not measured in the present study also contribute considerably to interpopulation differences in stroke rates.
Adult↗