302 research outputs found
Natural Course of Aortic Stenosis in Older Subjects: Effects of COVID-19
No full textObjective: Both aortic stenosis (AS) and COVID-19 affect the morbidity and mortality burden among older adults. The aim of the study was to examine whether aortic stenosis (AS) affects the prognosis after SARS-CoV-2 infection and whether COVID-19 affects AS prognosis, in a cohort of older adults hospitalized with and without COVID-19. Design: Observational study. Setting and participants: Patients admitted to 9 geriatric clinics in Stockholm from March 2020 to November 2021. Methods: AS and COVID-19 diagnoses were identified by electronic health records; the outcomes were mortality at 30 days and any time during a median follow-up of 630 days. The associations between AS, COVID-19, and mortality were assessed by using Royston-Parmar models adjusting for age, sex, comorbidities, and admission waves. Results: Among 28,974 patients, 85 had concomitant AS and COVID-19, 529 had only AS, and 5033 had only COVID-19. Both at 30 days and at any time, as compared to patients without, concomitant AS and COVID-19 subjects had a higher mortality rate (438.4 per 100 py, 95% CI 296.2-648.8, and 72.9, 95% CI 53.7-99.0, respectively) and a higher death risk (adjusted HR 5.5, 95% CI 3.7-8.2; and 2.8, 95% CI 2.1-3.9). AS patients presented increased mortality HR both in the presence and absence of COVID-19 at 30 days (1.6, 95% CI 1.1-2.4; and 1.6, 95% CI 1.2-2.2, respectively) and at any time (1.6, 95% CI 1.1-2.1; 1.4, 95% CI 1.2-1.7, respectively). Conclusions and implications: AS was a significant mortality risk factor, independent of concomitant COVID-19. Careful AS management should always be pursued, even in acute and post-acute phases of COVID-19
Encyklopedi om demenssjukdom
No full textTitel: ”Om demens”Författare: Gunilla Armanius Björlin,Hans Basun, Barbro Beck-Friis,Sirkka-Lisa Ekman, Elisabet Englund,Maria Eriksdotter Jönhagen,Lars Gustafson, Lars Lannfelt, LouiseNygård, Karin Sparring Björkstén,Beata Terzis, Lars-Olof Wahlund ochAnders Wimo.Förlag: Liber förlag 2004
Dementia : preclinical stages and mortality in Swedish cohorts
No full textTesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Medicina, leída el 06-02-2015El aumento de la esperanza de vida de la población ha elevado exponencialmente la prevalencia de las demencias. Los estadios preclínicos de las enfermedades neurodegenerativas pueden durar años y la supervivencia tras el diagnóstico es variable. El objetivo de esta tesis es doble, primero, contribuir a la caracterización de los pacientes con deterioro cognitivo ligero (DCL) y quejas cognitivas subjetivas (QCS) que podrían estar en un estadio pre-demencia de la EA. Segundo, identificar qué factores influyen en la supervivencia en pacientes con demencia. El estudio I se centra en pacientes atendidos en la Unidad de Memoria del Hospital Universitario Karolinska, en Suecia, con datos retrospectivos. Se compararon características de 993 pacientes con diagnóstico de EA, DCL o SCI. Se creó un modelo de regresión logística (basado en edad, sexo y biomarcadores en líquido cefalorraquídeo) para analizar qué características de los grupos QCS o MCI aumentaban su similitud con la muestra EA. Los sujetos con QCS fueron más jóvenes, con más años de escolaridad, mejor cognición, menos atrofia global y cortical generalizada, y menos atrofia del lóbulo temporal medial que los sujetos con DCL o EA. Dentro del modelo de regresión logística, los marcadores de riesgo cardiovascular, las lesiones de sustancia blanca confluentes, la atrofia del lóbulo temporal medial y la atrofia central aumentaban la probabilidad de los pacientes con QSC de ser clasificados como similares a EA por el modelo. Los estudios II y III se basan en SveDem, el registro nacional de demencia sueco. Se analizaron qué factores se asociaban con mayor riesgo de mortalidad tras el diagnóstico. El estudio II incluyó 15 209 pacientes, la edad más avanzada, el sexo masculino, el peor nivel cognitivo basal medido por el Mini-Mental State Exam (MMSE), la institucionalización y el mayor consumo habitual de fármacos se asociaron con mayor riesgo de muerte. La EA presentó mejor supervivencia que otras demencias, mientras que en análisis ajustados, la demencia frontotemporal (FTD) presentó el mayor riesgo. El estudio III analizó la relación entre el índice de masa corporal (IMC) y mortalidad en 11 398 pacientes con demencia. Las cifras más altas de IMC se asociaron con menor riesgo de mortalidad, el mayor riesgo apareció en el grupo con IMC inferior a 18.5 kg m2 y el menor riesgo en pacientes en el grupo con obesidad (IMC 30 kg m2 o superior). Cada punto de incremento en IMC se asoció con una reducción del riesgo de mortalidad hasta un IMC de 29,9 en los varones y hasta un IMC de 24,9 en mujeres. Palabras clave. Demencia, quejas cognitivas subjetivas, deterioro cognitivo ligero, enfermedad de Alzheimer, demencia frontotemporal, demencia por cuerpos de Lewy, enfermedad de Parkinson con demencia, demencia de causa mixta Alzheimer y vascular, demencia vascular, epidemiología, mortalidad, registro de calidad, IMC.Depto. de MedicinaFac. de MedicinaTRUEunpu
Author Response: Long-term Effects of Cholinesterase Inhibitors on Cognitive Decline and Mortality
No full textAtt bestämma över sig själv : Christina Eriksdotter och myndighetslagstiftningen vid 1800-talets mitt
No full textThe Effect of Age Correction on Multivariate Classification in Alzheimer’s Disease, with a Focus on the Characteristics of Incorrectly and Correctly Classified Subjects
No full textThe similarity of atrophy patterns in Alzheimer’s disease (AD) and in normal aging suggests age as a confounding factor in multivariate models that use structural magnetic resonance imaging (MRI) data. To study the effect and compare different age correction approaches on AD diagnosis and prediction of mild cognitive impairment (MCI) progression as well as investigate the characteristics of correctly and incorrectly classified subjects. Data from two multi-center cohorts were included in the study [AD = 297, MCI = 445, controls (CTL) = 340]. 34 cortical thickness and 21 subcortical volumetric measures were extracted from MRI. The age correction approaches involved: using age as a covariate to MRI-derived measures and linear detrending of age-related changes based on CTL measures. Orthogonal projections to latent structures was used to discriminate between AD and CTL subjects, and to predict MCI progression to AD, up to 36-months follow-up. Both age correction approaches improved models’ quality in terms of goodness of fit and goodness of prediction, as well as classification and prediction accuracies. The observed age associations in classification and prediction results were effectively eliminated after age correction. A detailed analysis of correctly and incorrectly classified subjects highlighted age associations in other factors: ApoE genotype, global cognitive impairment and gender. The two methods for age correction gave similar results and show that age can partially masks the influence of other aspects such as cognitive impairment, ApoE-e4 genotype and gender. Age-related brain atrophy may have a more important association with these factors than previously believed.</p
Long-term effects of cholinesterase inhibitors and memantine on cognitive decline, cardiovascular events, and mortality in dementia with Lewy bodies: An up to 10-year follow-up study.
No full textINTRODUCTION
We aimed to assess the impact of cholinesterase inhibitors (ChEIs) and memantine on cognition, major adverse cardiovascular events (MACE) and mortality in dementia with Lewy bodies (DLB).
METHODS
A total of 1,095 incident DLB patients from the Swedish Registry on cognitive/dementia disorders were included. Using an inverse probability of treatment weighting, the effect of initiating ChEI or memantine within 90 days of DLB diagnosis and nonuse was evaluated on cognitive trajectories and risks of MACE and death.
RESULTS
The use of ChEIs significantly slowed cognitive decline at follow-ups (Mini-Mental State Examination [MMSE] -0.39 points/y; 95% confidence interval [CI], -0.96 to 0.18) compared to memantine (-2.49 points/y; -4.02 to -0.97) and nonuse (-2.50 points/y; -4.28 to -0.73). Treatment groups did not differ in MACE events. ChEI use was associated with lower risk of death in the first year after DLB diagnosis (adjusted hazard ratio [HR] 0.66, 95% CI 0.46, 0.94).
DISCUSSION
Our findings illuminate the potential benefits of ChEI treatment in DLB patients.
HIGHLIGHTS
Cholinesterase inhibitors slow cognitive decline over a 5-year follow-up period when compared to both memantine treatment and nonuse in patients with dementia with Lewy bodies. Cholinesterase Inhibitors reduce risk of mortality within the initial year, but this effect is not sustained after 1 year in patients with dementia with Lewy bodies
Handlingsplanens varande eller inte varande i förskolan
No full textForskningen inom handlingsplaner i förskolan är begränsad. Det kunskapsbidrag vi hoppas göra är att vidga perspektivet i arbetet med handlingsplaner i förskolan. Syftet är att belysa och i viss mån problematisera handlingsplanernas funktion i förskolan.
Undersökningens teoretiska perspektiv utgörs av systemteorin och professionsteori. Systemteorin ger ett helhetsperspektiv på organisationen och professionsteorin bidrar med en grund till de olika professionernas perspektiv på handlingsplanerna.
Vi har undersökt olika aktörers upplevelser och erfarenheter i de skilda nivåerna i förskolan. Intresset har riktats mot samsyn och olikheter i arbetet med handlingsplaner. Studien har haft en kvalitativ ansats. Den består av semistrukturerade intervjuer med en förskolechef, två förste förskollärare, två förskollärare samt en specialpedagog. För att öka förståelsen, inleddes studien med att göra en genomgång av litteratur, aktuell forskning och lokala riktlinjer från orten där intervjuerna gjorts.
Resultatet från studien visar att kompetens/utbildning, förhållningssätt och bemötande spelar en stor roll i verksamhetens arbete med att levandegöra handlingsplanerna. Under studien har det framkommit att detta arbete kan göras genom att ha en öppen dialog mellan de olika yrkesprofessionernas erfarenhetsutbyte. Detta kan ske om lyhördhet och kommunikation mellan de olika leden ökar - från barn till vårdnadshavare, arbetslag, förste förskollärare, specialpedagog och ledning.
När förskolans lärmiljöer kontinuerligt lyfts, gynnas alla barns utveckling och lärande vilket också gynnar att handlingsplanen blir ett levande redskap i det vardagliga arbetet. I resultatet framkom det att ett kontinuerligt arbete, reflektion och analys kring det pedagogiska arbetet i lärmiljöerna utgör en grund för arbetet med att se alla barn.
Kompetens och förhållningssätt har framstått i resultatet som extra viktiga i arbetet kring barn i behov av stöd/ särskilt stöd
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