The Occupational Therapy Journal of Research, 1989
In this study of 75 long-term (4–6 years) survivors of stroke, motor function, perceptual functio... more In this study of 75 long-term (4–6 years) survivors of stroke, motor function, perceptual function, and the ability to manage self-care were assessed. In congruence with previous findings for a sample investigated within 2 weeks after a stroke, perceptual functions could be grouped into two distinct and statistically different factors. In terms of the ecological perceptual model, one of the factors reflects low-order perception and the other, high-order perception. Neither motor nor perceptual impairments occurred in more than half the sample. A regression analysis incorporating the motor dimension and the two perceptual dimensions explained 71% of the variance in self-care ability. This analysis showed that 4 to 6 years after a stroke, the influence of impairments in motor function is about as great as that of impairments in perceptual functions.
PILRA (rs1859788 A > G) has been suggested to be a protective variant for Alzheimer’s disease ... more PILRA (rs1859788 A > G) has been suggested to be a protective variant for Alzheimer’s disease (AD) and is an entry co-receptor for herpes simplex virus-1. We conducted a nested case–control study of 360 1:1-matched AD subjects. Interactions between the PILRA-A allele, APOE risk variants (ε3/ε4 or ε4/ε4) and GM17 for AD risk were modelled. The associations were cross-validated using two independent whole-genome sequencing datasets. We found negative interactions between PILRA-A and GM17 (OR 0.72, 95% CI 0.52–1.00) and between PILRA-A and APOE risk variants (OR 0.56, 95% CI 0.32–0.98) in the discovery dataset. In the replication cohort, a joint effect of PILRA and PILRA × GM 17/17 was observed for the risk of developing AD (p .02). Here, we report a negative effect modification by PILRA on APOE and GM17 high-risk variants for future AD risk in two independent datasets. This highlights the complex genetics of AD.
How acute hyperglycaemia affects memory functions and functional brain responses in individuals w... more How acute hyperglycaemia affects memory functions and functional brain responses in individuals with and without type 2 diabetes is unclear. Our aim was to study the association between acute hyperglycaemia and working, semantic, and episodic memory in participants with type 2 diabetes compared to a sex- and age-matched control group. We also assessed the effect of hyperglycaemia on working memory–related brain activity. A total of 36 participants with type 2 diabetes and 34 controls (mean age, 66 years) underwent hyperglycaemic clamp or placebo clamp in a blinded and randomised order. Working, episodic, and semantic memory were tested. Overall, the control group had higher working memory (mean z-score 33.15 ± 0.45) than the group with type 2 diabetes (mean z-score 31.8 ± 0.44, p = 0.042) considering both the placebo and hyperglycaemic clamps. Acute hyperglycaemia did not influence episodic, semantic, or working memory performance in either group. Twenty-two of the participants (10 ...
The overall aim of this thesis is twofold: first, to develop and validate questionnaires that cou... more The overall aim of this thesis is twofold: first, to develop and validate questionnaires that could be used for investigating relationships between perceptions of conscience, moral sensitivity and burnout and second, to describe patterns of self-comfort used to ease stress and illuminate meanings of living with a troubled conscience. The thesis comprises five studies and is based on both quantitative and qualitative data.In study I, a questionnaire was constructed to assess perceptions of conscience; the Perceptions of Conscience Questionnaire (PCQ). This 15 item-questionnaire was distributed to 444 care providers. Statistical analyses of responses showed sufficient distribution and a stable six factor solution congruent with reviewed literature. The six factors were labelled: ‘the voice of authority’, ‘warning signal’, ‘demanding sensitivity’, ‘asset’, ‘burden’ and ‘depending on culture’. The findings suggest that the PCQ is a valid questionnaire. The aim of study II was further development of an existing questionnaire assessing care providers’ moral sensitivity, enabling its use in various care contexts. The revised nine-item questionnaire, the Moral Sensitivity Questionnaire Revised version (MSQ-R), was distributed to 278 care providers with various professional backgrounds. Statistical analyses of responses showed sufficient distribution and a three-factor solution congruent with reviewed literature. The three factors were labelled: ‘sense of moral burden’, ‘sense of moral strength,’ and ‘sense of moral responsibility.’ The findings suggest that MSQ-R is valid for use in various healthcare contexts. In study III, the PCQ, the MSQ-R and the Maslach Burnout Inventory (MBI) were distributed to a population of psychiatric care providers (n=101) to investigate relationships between perceptions of conscience and moral sensitivity and levels of burnout. The hierarchical cluster analysis shows two clusters with Pearson’s r >.50. Cluster A comprising items such as: being sensitive, interpreting and following the voice of conscience that warns us against hurting other or ourselves and developing as human beings was labelled ‘experiencing a sense of moral integrity’. Cluster B comprising items such as: feeling inadequate, doing more than one has strengths for, feeling always responsible, having difficulties to deal with wearing feelings, perceiving that conscience gives wrong signals and express social values, having to deaden one’ conscience, were all related to scores of the MBI subscales emotional exhaustion (EE) and depersonalisation (DP). Cluster B was labelled ‘experiencing a burdening accountability’. The results show that levels of ‘experiencing a burdening accountability’ are closely related to levels of being at risk of burnout.The aim of study IV was to describe patterns of self-comforting measures used to ease stress. The written accounts of 168 care providers and healthcare students were analysed by means of qualitative content analysis. The findings disclose two dimensions: an ability to use early learned measures to take care of oneself (ingression) and an ability to feel intimately related to life, other human beings and universe or God (transcendence). The findings provide valuable knowledge about self-comfort as a coping strategy. The aim of study V was to illuminate meanings of living with a troubled conscience. Ten psychiatric care providers, respondents of study III with various perceptions of conscience were interviewed. The interviews were interpreted using a phenomenological - hermeneutical method. The findings show that one meaning of living with a troubled conscience is being confronted with inadequacy and struggling to view oneself as ‘good enough.’ The comprehensive understanding indicates that inadequacy, both one’s own and that of organization one represents, infuse feelings of shame rather than feelings of guilt. Shame concerns one’s identity and need of reconciliation.Conclusions: The results reveal two ways of encountering a troubled conscience. One is being unable to interpret the ethical demand from a troubled conscience. This is indicated by connections between levels of moral burden and levels of burnout. The other way is being able to interpret the ethical demand and using one’s troubled conscience to develop practical wisdom. This means facing shame of feeling inadequate, reconciling images of the ideal self and self-contempt, and becoming realistic about what one can do. In this process comfort seems to be a mediator of reconciliation.
In this paper we discuss various software engineering aspects of guideline computerisation, both ... more In this paper we discuss various software engineering aspects of guideline computerisation, both from domain oriented as well as technology driven points of view. The discussion includes case studies on pharmacological treatment of hypertension, diagnosis of ...
OBJECTIVE—Patients with type 2 diabetes have an increased risk of a reduction in cognitive functi... more OBJECTIVE—Patients with type 2 diabetes have an increased risk of a reduction in cognitive function. We investigated the hypothesis that plasma glucose is associated with a reduction in episodic and/or semantic memory already in nondiabetic subjects. RESEARCH DESIGN AND METHODS—We linked two large population-based datasets in Sweden: the Betula study, in which a random sample from the population aged 35–85 years was investigated for cognitive function, including episodic and semantic memory; and the Västerbotten Intervention Program, a health survey with subjects aged 40, 50, and 60 years, that includes measuring of fasting and 2-h plasma glucose, along with other risk factors for diabetes and cardiovascular disease. We identified 411 (179 men and 232 women, mean age 50.6 ± 8.0 years) nondiabetic subjects, free from dementia, who had participated in the two surveys within 6 months. RESULTS—Women had better episodic (score 7.37 ± 1.42) and semantic memory (score 16.05 ± 2.76) than m...
Objectives: To analyse and present regression models that can describe the long-term change in co... more Objectives: To analyse and present regression models that can describe the long-term change in cognitive function (MMSE and ADAS-cog) of patients treated with donepezil for three years (n=435). Methods: The Swedish Alzheimer Treatment Study (SATS) is an open, 3-year, multicentre study in a routine clinical setting. Patients with the diagnosis of Alzheimer’s Diseases received the cholinesterase inhibitor donepezil. The patients were assessed with several rating scales including MMSE, ADAS-cog at baseline and every 6 months for a total period of three years. In the first model we used a 6-month interval method. A regression model was fitted from the variables change in score between visits and the baseline score. For the 269 patients with at least 4 assessments each we also calculated a longitudinal regression model for the dependent variable ADAS-cog score at different intervals. In addition, we compared the scores from our model with those predicted by the Stern equation. Results: T...
Background: Amyloid-β (Aβ), the key constituent of Alzheimer’s disease (AD) plaques, has antimicr... more Background: Amyloid-β (Aβ), the key constituent of Alzheimer’s disease (AD) plaques, has antimicrobial properties. Objective: To investigate the association between plasma Aβ and antibodies against the AD-related pathogens herpes simplex virus (HSV), cytomegalovirus (CMV), and C. pneumoniae. Methods: Plasma from 339 AD cases, obtained on average 9.4 years (±4.00) before diagnosis, and their matched controls were analyzed for Aβ40 and Aβ42 concentrations with Luminex xMAP technology and INNOBIA plasma Aβ-form assays. Enzyme-linked immunosorbent assays were utilized for analyses of anti-HSV immunoglobulin (Ig) G, anti-HSV1 IgG, anti-HSV2 IgG, anti-CMV IgG, and anti-C. pneumoniae IgG. Follow-up samples were available for 150 of the cases. Results: Presence and levels of anti-HSV1 IgG, anti-HSV2 IgG, anti-CMV IgG, and anti-C. pneumoniae IgG did not correlate with concentrations of Aβ42 or Aβ40 in cases or controls. Conclusion: Levels of plasma Aβ were not associated with antibodies agai...
Journal of the American Dietetic Association, 1989
Eating problems and nutritional status were studied in a consecutive series of patients who had h... more Eating problems and nutritional status were studied in a consecutive series of patients who had had strokes. From this cohort, 32 subjects (mean age 73 years) with a hospital stay of 21 days or more are described. Eating problems were identified by direct participant observations of the patients' eating behavior, interviews on admission, inspections of the mouth, and discussions with the patients. Nutritional status was assessed by weight, triceps skinfold thickness (TSF), arm muscular circumference (AMC), plasma albumin, serum transferrin, and plasma prealbumin on admission and then weekly. Eating problems were identified in 27 patients. In a general linear hypothesis program, poor nutritional status 3 weeks after admission was found to be associated with (in decreasing order) low self-care performance, poor nutritional status on admission, male sex, intravenous energy-containing fluids, advanced age, paresis of the right arm, and eating problems. Factors other than eating problems seem to be important for undernutrition in patients with strokes during hospital stay.
Several environmental factors, including infectious agents, have been suggested to cause Alzheime... more Several environmental factors, including infectious agents, have been suggested to cause Alzheimer's disease (AD). Cytomegalovirus (CMV) has been associated with AD in several recent studies. To investigate whether carriage of CMV, alone or in combination with Herpes simplex virus (HSV), increased the risk of developing AD. Plasma samples from 360 AD cases (75.3% women, mean age 61.2 years), taken an average of 9.6 years before AD diagnosis, and 360 age-, sex-, cohort-, and sampling date matched dementia-free controls were analyzed to detect anti-CMV (immunoglobulin [Ig] G and IgM), group-specific anti-HSV (IgG and IgM), and specific anti-HSV1 and HSV2 IgG antibodies by enzyme-linked immunosorbent assays. AD cases and dementia-free controls were compared using conditional logistic regression analyses. The presence of anti-CMV IgG antibodies did not increase the risk of AD (odds ratio [OR], 0.857; p = 0.497). Among AD cases, an association between CMV and HSV1 carriage was detect...
The journals of gerontology. Series A, Biological sciences and medical sciences, Jan 19, 2018
The number of older people living with cancer and cardio-metabolic conditions is increasing but l... more The number of older people living with cancer and cardio-metabolic conditions is increasing but little is known about how specific combinations of these conditions impact mortality. A total of 22,692 participants aged 65 years and older from four international cohorts were followed-up for mortality for an average of 10 years (8,596 deaths). Data were harmonized across cohorts and mutually exclusive groups of disease combinations were created for cancer, MI, stroke, and diabetes at baseline. Cox proportional hazards models for all-cause mortality were used to estimate the age- and sex-adjusted hazard ratio (HR) and rate advancement period (RAP) (in years). At baseline, 23.6% (n=5,116) of participants reported having one condition and 4.2% (n=955) had two or more conditions. Data from all studies combined showed that the RAP increased with each additional condition. Diabetes advanced the rate of dying by the most years (5.26 years; 95% CI, 4.53-6.00), but the effect of any single cond...
Hyperosmolar non-ketotic coma in diabetes is a life-threatening condition. We describe three pati... more Hyperosmolar non-ketotic coma in diabetes is a life-threatening condition. We describe three patients, aged 59-67 years, who developed hyperosmolar coma during the first ten days after admission for stroke. Common to all three were normal plasma osmolality and slightly elevated plasma creatinine levels on admission, treatment with diuretics, parenteral dextrose administration before and low urinary glucose output during the coma. In the five days preceding the coma, total fluid deficits were 3.8, 6.5 and 9.4 1, respectively. In one patient the rate of glucose delivery had clearly exceeded utilization during adequate insulinization, in another a marked reduction in urinary glucose output preceded extreme hyperglycaemia and coma. Two of the three patients died, both from extensive thrombus formation in cerebral arteries and multiple emboli to the lungs. We conclude that enhanced endogenous glucose production and reduced renal clearance of glucose may contribute to precipitate hyperosmolar non-ketotic coma. A close monitoring of fluid and dextrose administration seems mandatory in diabetic stroke patients, in particular if renal function is impaired or if diuretics are given. Insulin treatment should be considered in all diabetic patients during the first days after a stroke.
The Occupational Therapy Journal of Research, 1989
In this study of 75 long-term (4–6 years) survivors of stroke, motor function, perceptual functio... more In this study of 75 long-term (4–6 years) survivors of stroke, motor function, perceptual function, and the ability to manage self-care were assessed. In congruence with previous findings for a sample investigated within 2 weeks after a stroke, perceptual functions could be grouped into two distinct and statistically different factors. In terms of the ecological perceptual model, one of the factors reflects low-order perception and the other, high-order perception. Neither motor nor perceptual impairments occurred in more than half the sample. A regression analysis incorporating the motor dimension and the two perceptual dimensions explained 71% of the variance in self-care ability. This analysis showed that 4 to 6 years after a stroke, the influence of impairments in motor function is about as great as that of impairments in perceptual functions.
PILRA (rs1859788 A > G) has been suggested to be a protective variant for Alzheimer’s disease ... more PILRA (rs1859788 A > G) has been suggested to be a protective variant for Alzheimer’s disease (AD) and is an entry co-receptor for herpes simplex virus-1. We conducted a nested case–control study of 360 1:1-matched AD subjects. Interactions between the PILRA-A allele, APOE risk variants (ε3/ε4 or ε4/ε4) and GM17 for AD risk were modelled. The associations were cross-validated using two independent whole-genome sequencing datasets. We found negative interactions between PILRA-A and GM17 (OR 0.72, 95% CI 0.52–1.00) and between PILRA-A and APOE risk variants (OR 0.56, 95% CI 0.32–0.98) in the discovery dataset. In the replication cohort, a joint effect of PILRA and PILRA × GM 17/17 was observed for the risk of developing AD (p .02). Here, we report a negative effect modification by PILRA on APOE and GM17 high-risk variants for future AD risk in two independent datasets. This highlights the complex genetics of AD.
How acute hyperglycaemia affects memory functions and functional brain responses in individuals w... more How acute hyperglycaemia affects memory functions and functional brain responses in individuals with and without type 2 diabetes is unclear. Our aim was to study the association between acute hyperglycaemia and working, semantic, and episodic memory in participants with type 2 diabetes compared to a sex- and age-matched control group. We also assessed the effect of hyperglycaemia on working memory–related brain activity. A total of 36 participants with type 2 diabetes and 34 controls (mean age, 66 years) underwent hyperglycaemic clamp or placebo clamp in a blinded and randomised order. Working, episodic, and semantic memory were tested. Overall, the control group had higher working memory (mean z-score 33.15 ± 0.45) than the group with type 2 diabetes (mean z-score 31.8 ± 0.44, p = 0.042) considering both the placebo and hyperglycaemic clamps. Acute hyperglycaemia did not influence episodic, semantic, or working memory performance in either group. Twenty-two of the participants (10 ...
The overall aim of this thesis is twofold: first, to develop and validate questionnaires that cou... more The overall aim of this thesis is twofold: first, to develop and validate questionnaires that could be used for investigating relationships between perceptions of conscience, moral sensitivity and burnout and second, to describe patterns of self-comfort used to ease stress and illuminate meanings of living with a troubled conscience. The thesis comprises five studies and is based on both quantitative and qualitative data.In study I, a questionnaire was constructed to assess perceptions of conscience; the Perceptions of Conscience Questionnaire (PCQ). This 15 item-questionnaire was distributed to 444 care providers. Statistical analyses of responses showed sufficient distribution and a stable six factor solution congruent with reviewed literature. The six factors were labelled: ‘the voice of authority’, ‘warning signal’, ‘demanding sensitivity’, ‘asset’, ‘burden’ and ‘depending on culture’. The findings suggest that the PCQ is a valid questionnaire. The aim of study II was further development of an existing questionnaire assessing care providers’ moral sensitivity, enabling its use in various care contexts. The revised nine-item questionnaire, the Moral Sensitivity Questionnaire Revised version (MSQ-R), was distributed to 278 care providers with various professional backgrounds. Statistical analyses of responses showed sufficient distribution and a three-factor solution congruent with reviewed literature. The three factors were labelled: ‘sense of moral burden’, ‘sense of moral strength,’ and ‘sense of moral responsibility.’ The findings suggest that MSQ-R is valid for use in various healthcare contexts. In study III, the PCQ, the MSQ-R and the Maslach Burnout Inventory (MBI) were distributed to a population of psychiatric care providers (n=101) to investigate relationships between perceptions of conscience and moral sensitivity and levels of burnout. The hierarchical cluster analysis shows two clusters with Pearson’s r >.50. Cluster A comprising items such as: being sensitive, interpreting and following the voice of conscience that warns us against hurting other or ourselves and developing as human beings was labelled ‘experiencing a sense of moral integrity’. Cluster B comprising items such as: feeling inadequate, doing more than one has strengths for, feeling always responsible, having difficulties to deal with wearing feelings, perceiving that conscience gives wrong signals and express social values, having to deaden one’ conscience, were all related to scores of the MBI subscales emotional exhaustion (EE) and depersonalisation (DP). Cluster B was labelled ‘experiencing a burdening accountability’. The results show that levels of ‘experiencing a burdening accountability’ are closely related to levels of being at risk of burnout.The aim of study IV was to describe patterns of self-comforting measures used to ease stress. The written accounts of 168 care providers and healthcare students were analysed by means of qualitative content analysis. The findings disclose two dimensions: an ability to use early learned measures to take care of oneself (ingression) and an ability to feel intimately related to life, other human beings and universe or God (transcendence). The findings provide valuable knowledge about self-comfort as a coping strategy. The aim of study V was to illuminate meanings of living with a troubled conscience. Ten psychiatric care providers, respondents of study III with various perceptions of conscience were interviewed. The interviews were interpreted using a phenomenological - hermeneutical method. The findings show that one meaning of living with a troubled conscience is being confronted with inadequacy and struggling to view oneself as ‘good enough.’ The comprehensive understanding indicates that inadequacy, both one’s own and that of organization one represents, infuse feelings of shame rather than feelings of guilt. Shame concerns one’s identity and need of reconciliation.Conclusions: The results reveal two ways of encountering a troubled conscience. One is being unable to interpret the ethical demand from a troubled conscience. This is indicated by connections between levels of moral burden and levels of burnout. The other way is being able to interpret the ethical demand and using one’s troubled conscience to develop practical wisdom. This means facing shame of feeling inadequate, reconciling images of the ideal self and self-contempt, and becoming realistic about what one can do. In this process comfort seems to be a mediator of reconciliation.
In this paper we discuss various software engineering aspects of guideline computerisation, both ... more In this paper we discuss various software engineering aspects of guideline computerisation, both from domain oriented as well as technology driven points of view. The discussion includes case studies on pharmacological treatment of hypertension, diagnosis of ...
OBJECTIVE—Patients with type 2 diabetes have an increased risk of a reduction in cognitive functi... more OBJECTIVE—Patients with type 2 diabetes have an increased risk of a reduction in cognitive function. We investigated the hypothesis that plasma glucose is associated with a reduction in episodic and/or semantic memory already in nondiabetic subjects. RESEARCH DESIGN AND METHODS—We linked two large population-based datasets in Sweden: the Betula study, in which a random sample from the population aged 35–85 years was investigated for cognitive function, including episodic and semantic memory; and the Västerbotten Intervention Program, a health survey with subjects aged 40, 50, and 60 years, that includes measuring of fasting and 2-h plasma glucose, along with other risk factors for diabetes and cardiovascular disease. We identified 411 (179 men and 232 women, mean age 50.6 ± 8.0 years) nondiabetic subjects, free from dementia, who had participated in the two surveys within 6 months. RESULTS—Women had better episodic (score 7.37 ± 1.42) and semantic memory (score 16.05 ± 2.76) than m...
Objectives: To analyse and present regression models that can describe the long-term change in co... more Objectives: To analyse and present regression models that can describe the long-term change in cognitive function (MMSE and ADAS-cog) of patients treated with donepezil for three years (n=435). Methods: The Swedish Alzheimer Treatment Study (SATS) is an open, 3-year, multicentre study in a routine clinical setting. Patients with the diagnosis of Alzheimer’s Diseases received the cholinesterase inhibitor donepezil. The patients were assessed with several rating scales including MMSE, ADAS-cog at baseline and every 6 months for a total period of three years. In the first model we used a 6-month interval method. A regression model was fitted from the variables change in score between visits and the baseline score. For the 269 patients with at least 4 assessments each we also calculated a longitudinal regression model for the dependent variable ADAS-cog score at different intervals. In addition, we compared the scores from our model with those predicted by the Stern equation. Results: T...
Background: Amyloid-β (Aβ), the key constituent of Alzheimer’s disease (AD) plaques, has antimicr... more Background: Amyloid-β (Aβ), the key constituent of Alzheimer’s disease (AD) plaques, has antimicrobial properties. Objective: To investigate the association between plasma Aβ and antibodies against the AD-related pathogens herpes simplex virus (HSV), cytomegalovirus (CMV), and C. pneumoniae. Methods: Plasma from 339 AD cases, obtained on average 9.4 years (±4.00) before diagnosis, and their matched controls were analyzed for Aβ40 and Aβ42 concentrations with Luminex xMAP technology and INNOBIA plasma Aβ-form assays. Enzyme-linked immunosorbent assays were utilized for analyses of anti-HSV immunoglobulin (Ig) G, anti-HSV1 IgG, anti-HSV2 IgG, anti-CMV IgG, and anti-C. pneumoniae IgG. Follow-up samples were available for 150 of the cases. Results: Presence and levels of anti-HSV1 IgG, anti-HSV2 IgG, anti-CMV IgG, and anti-C. pneumoniae IgG did not correlate with concentrations of Aβ42 or Aβ40 in cases or controls. Conclusion: Levels of plasma Aβ were not associated with antibodies agai...
Journal of the American Dietetic Association, 1989
Eating problems and nutritional status were studied in a consecutive series of patients who had h... more Eating problems and nutritional status were studied in a consecutive series of patients who had had strokes. From this cohort, 32 subjects (mean age 73 years) with a hospital stay of 21 days or more are described. Eating problems were identified by direct participant observations of the patients' eating behavior, interviews on admission, inspections of the mouth, and discussions with the patients. Nutritional status was assessed by weight, triceps skinfold thickness (TSF), arm muscular circumference (AMC), plasma albumin, serum transferrin, and plasma prealbumin on admission and then weekly. Eating problems were identified in 27 patients. In a general linear hypothesis program, poor nutritional status 3 weeks after admission was found to be associated with (in decreasing order) low self-care performance, poor nutritional status on admission, male sex, intravenous energy-containing fluids, advanced age, paresis of the right arm, and eating problems. Factors other than eating problems seem to be important for undernutrition in patients with strokes during hospital stay.
Several environmental factors, including infectious agents, have been suggested to cause Alzheime... more Several environmental factors, including infectious agents, have been suggested to cause Alzheimer's disease (AD). Cytomegalovirus (CMV) has been associated with AD in several recent studies. To investigate whether carriage of CMV, alone or in combination with Herpes simplex virus (HSV), increased the risk of developing AD. Plasma samples from 360 AD cases (75.3% women, mean age 61.2 years), taken an average of 9.6 years before AD diagnosis, and 360 age-, sex-, cohort-, and sampling date matched dementia-free controls were analyzed to detect anti-CMV (immunoglobulin [Ig] G and IgM), group-specific anti-HSV (IgG and IgM), and specific anti-HSV1 and HSV2 IgG antibodies by enzyme-linked immunosorbent assays. AD cases and dementia-free controls were compared using conditional logistic regression analyses. The presence of anti-CMV IgG antibodies did not increase the risk of AD (odds ratio [OR], 0.857; p = 0.497). Among AD cases, an association between CMV and HSV1 carriage was detect...
The journals of gerontology. Series A, Biological sciences and medical sciences, Jan 19, 2018
The number of older people living with cancer and cardio-metabolic conditions is increasing but l... more The number of older people living with cancer and cardio-metabolic conditions is increasing but little is known about how specific combinations of these conditions impact mortality. A total of 22,692 participants aged 65 years and older from four international cohorts were followed-up for mortality for an average of 10 years (8,596 deaths). Data were harmonized across cohorts and mutually exclusive groups of disease combinations were created for cancer, MI, stroke, and diabetes at baseline. Cox proportional hazards models for all-cause mortality were used to estimate the age- and sex-adjusted hazard ratio (HR) and rate advancement period (RAP) (in years). At baseline, 23.6% (n=5,116) of participants reported having one condition and 4.2% (n=955) had two or more conditions. Data from all studies combined showed that the RAP increased with each additional condition. Diabetes advanced the rate of dying by the most years (5.26 years; 95% CI, 4.53-6.00), but the effect of any single cond...
Hyperosmolar non-ketotic coma in diabetes is a life-threatening condition. We describe three pati... more Hyperosmolar non-ketotic coma in diabetes is a life-threatening condition. We describe three patients, aged 59-67 years, who developed hyperosmolar coma during the first ten days after admission for stroke. Common to all three were normal plasma osmolality and slightly elevated plasma creatinine levels on admission, treatment with diuretics, parenteral dextrose administration before and low urinary glucose output during the coma. In the five days preceding the coma, total fluid deficits were 3.8, 6.5 and 9.4 1, respectively. In one patient the rate of glucose delivery had clearly exceeded utilization during adequate insulinization, in another a marked reduction in urinary glucose output preceded extreme hyperglycaemia and coma. Two of the three patients died, both from extensive thrombus formation in cerebral arteries and multiple emboli to the lungs. We conclude that enhanced endogenous glucose production and reduced renal clearance of glucose may contribute to precipitate hyperosmolar non-ketotic coma. A close monitoring of fluid and dextrose administration seems mandatory in diabetic stroke patients, in particular if renal function is impaired or if diuretics are given. Insulin treatment should be considered in all diabetic patients during the first days after a stroke.
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