Sleep deprivation, cognitive performance, and hormone therapy in postmenopausal women

OBJECTIVE: To study the effects of sleep deprivation on cognitive performance in postmenopausal women and to evaluate whether hormone therapy (HT) has a modifying effect on coping. DESIGN: Twenty-six postmenopausal women, aged 58 to 72 years (mean 64 years), volunteered for the study (HT users, n = 16; nonusers, n = 10). They spent four consecutive nights in the sleep laboratory. The cognitive tests were performed three times: after the baseline night, after one night of sleep deprivation, and after the rebound night. The cognitive measures included visual episodic memory, visuomotor performance, verbal attention, and shared attention. RESULTS: The practice effect typically occurring in cognitive tests was blunted during sleep deprivation, which indicated deterioration of performance. At rebound, performance improved in visual episodic memory (immediate recall P < 0.01; delayed recall P < 0.05), visuomotor performance (P < 0.001), verbal attention (P < 0.0001), and shared attention (P < 0.05). HT users performed better than nonusers in the visual episodic memory test (P < 0.05) and in one of three subtests of shared attention (cancellation P = 0.040). Otherwise hormone therapy did not influence the results. CONCLUSIONS: In postmenopausal women, sleep deprivation impaired visual functions and attention. However, this effect was not prolonged because after one rebound night the performance was improved, compared with baseline. Hormone therapy did not modify the cognitive performance during sleep deprivation.     

Cardiorespiratory Fitness and Metabolic Syndrome in Older Men and Women: The Dose Responses to Exercise Training (DR's EXTRA) study

OBJECTIVE

We studied the association of maximum oxygen uptake (Vo_2max) with the development and resolution of metabolic syndrome (MetS) for 2 years in older individuals.

RESEARCH DESIGN AND METHODS

Subjects were a population sample of 1,226 men and women aged 57–78 years. We assessed Vo_2max directly by respiratory gas analysis during maximum exercise testing and used dichotomous and continuous variables for MetS.

RESULTS

One SD increase in baseline Vo_2max associated with 44% (95% CI 24–58) decreased risk of developing MetS. Individuals in the highest third of baseline Vo_2max were 68% (37–84) less likely to develop MetS than those in the lowest third. One SD increase in Vo_2max increased the likelihood to resolve MetS 1.8 (1.2–2.8) times. Individuals in the highest Vo_2max third were 3.9 (1.5–9.9) times more likely to resolve MetS than those in the lowest third.

CONCLUSIONS

Higher levels of cardiorespiratory fitness protect against MetS and may resolve it in older individuals.Cross-sectional population studies have shown an inverse association between cardiorespiratory fitness (CRF) and the metabolic syndrome (MetS) in middle-aged and older men and women (1,2). There are few prospective population studies on the association between CRF and the development of MetS (3–6) and no such studies on the resolution of MetS. None of these studies have been conducted in older men and women. Evidence of the association between changes in CRF and metabolic risk rely on relatively small prospective studies among middle-aged or high-risk individuals (6,7). We therefore studied the association of maximum oxygen uptake (Vo_2max) with the development and resolution of MetS and changes in Vo_2max and metabolic risk in a population sample of older men and women.     

Finnish nurses' and nursing students' pharmacological skills

Purposes and objectives. The purposes of this study were to investigate the pharmacological skills of Finnish nurses and graduating nursing students, to determine how pharmacological skills are related to background factors and to identify differences between nurses and students and, finally, to examine how the instrument used, the Medication Calculation Skills Test, works. Background. Pharmacology is a relevant and topical subject. In several studies, however, pharmacological skills of nurses and nursing students have been found insufficient. In addition, pharmacology as a subject is found to be difficult for both nursing students and nurses. Design and methods. The study was evaluative in nature; the data were collected using the Medication Calculation Skills Test, developed for the purposes of this study. The instrument was used to gather information on background factors and self‐rated pharmacological and mathematical skills and to test actual skills in these areas. Results. Results concerning pharmacological skills are reported in this paper. The maximum Medication Calculation Skills Test score was 24 points. The mean score for nurses was 18.6 and that for students 16.3. Half of (50%) the students attained a score of 67% and 57% of nurses attained a score of 79%. Conclusions. Nurses and students had some deficiencies in their pharmacological skills. Nurses had better pharmacological skills than students according to both self‐ratings and actual performance on the test. Relevance to clinical practice. It is vitally important that nurses have adequate pharmacological skills to administer medicines correctly. This study showed that the Medication Calculation Skills Test seems to work well in measuring pharmacological skills, even though it needs further evaluation. Findings from this study can be used when planning the nursing curriculum and further education for Registered Nurses.     

Model for the self-care of home-dwelling elderly

The aim of this study was to develop a model to clarify the existing knowledge concerning the self-care of home-dwelling elderly people. The data were collected in Oulu, a medium-sized city in northern Finland, by interviewing 40 home-dwelling elderly persons aged 75 or more. Data were analysed using the constant comparative method of the grounded theory approach. The model consists of four modes of self-care with different conditions for action and different meanings: responsible self-care consists of responsible activity by the elderly person based on a positive orientation towards the future and a positive experience of ageing. The meaning of responsible self-care is a desire to continue living as an active agent. Formally guided self-care consists of uncritical observance of instructions and routine performance of daily tasks. This approach is based on life experiences of taking care of others and realistic awareness of the effects of old age. The meaning of formally guided self-care is a tendency to accept life as it comes. Independent self-care is based on the person's desire to listen to his/her own internal voice. These persons aim to manage in life independently and deny the prospect of growing old. The meaning of independent self-care is an attempt to maintain the constancy of life. Abandoned self-care is characterized by helplessness and lack of responsibility. It involves bitterness and a negative attitude towards ageing. The meaning of abandonment is a desire to 'give up'. According to this study, self-care is not a separate part of old men's or women's lives, it is associated closely with their past life and with the future. As an activity, self-care is not just a rational way to maintain health. It also reflects the person's overall attitude towards health care, illnesses and manner of living.     

Expression of the markers BDCA‐2 and BDCA‐4 and production of interferon‐α by plasmacytoid dendritic cells in systemic lupus erythematosus

Objective

To study the expression of blood dendritic cell antigen 2 (BDCA‐2) and BDCA‐4 molecules by plasmacytoid dendritic cells (PDCs) in the blood of patients with systemic lupus erythematosus (SLE), and to study PDC production of interferon‐α (IFNα) and its inhibition by anti–BDCA‐2 and anti–BDCA‐4 antibodies.

Methods

Peripheral blood mononuclear cells (PBMCs) from SLE patients (SLE PBMCs) and from healthy controls were induced to produce IFNα in vitro by SLE serum containing an endogenous IFNα‐inducing factor (SLE‐IIF) or by herpes simplex virus type 1 (HSV‐1). The frequencies and numbers of BDCA‐2–, BDCA‐3–, and BDCA‐4–expressing cells were analyzed by flow cytometry, and the effects of anti–BDCA‐2 and anti–BDCA‐4 monoclonal antibodies (mAb) on IFNα production were investigated.

Results

IFNα production by SLE PBMCs induced by SLE‐IIF or HSV‐1 was decreased compared with that of healthy control PBMCs (P = 0.002 and P = 0.0007, respectively). The proportions of BDCA‐2– and BDCA‐3–expressing cells in SLE PBMCs were reduced compared with those in PBMCs from healthy controls (P = 0.01 and P = 0.004, respectively). IFNα producers in culture, especially among SLE PBMCs, displayed reduced BDCA‐2 expression and constituted only a minority of the BDCA‐2–positive cells, at least in healthy control PBMCs (median 18%). IFNα production by both SLE and healthy control PBMCs stimulated by SLE‐IIF or HSV‐1 was markedly reduced by anti–BDCA‐2 mAb (median 81–98% inhibition). Anti–BDCA‐4 mAb only partially inhibited SLE‐IIF–induced IFNα production.

Conclusion

SLE patients had a reduced number of BDCA‐2–expressing PDCs, also termed natural IFNα‐producing cells, and their IFNα production could be inhibited by anti–BDCA‐2/4 mAb. Such mAb may be a therapeutic option for inhibiting the ongoing IFNα production in SLE patients.

     

Long-term outcome of infective endocarditis: A study on patients surviving over one year after the initial episode treated in a Finnish teaching hospital during 25 years

Background  

Only a few previous studies have focused on the long-term prognosis of the patients with infective endocarditis (IE). Our purpose was to delineate factors potentially associated with the long-term outcome of IE, recurrences of IE and requirement for late valve surgery.     

Diagnostic Value of Transluminal Attenuation Gradient for the Presence of Ischemia as Defined by Fractional Flow Reserve and Quantitative Positron Emission Tomography

Objectives

The aim of this study was to investigate the incremental diagnostic value of transluminal attenuation gradient (TAG), TAG with corrected contrast opacification (TAG-CCO), and transluminal diameter gradient (TDG) over coronary computed tomography angiography (CTA)–derived diameter stenosis alone for the identification of ischemia as defined by both the invasive reference standard fractional flow reserve (FFR) and the noninvasive reference standard quantitative positron emission tomography (PET).

Factors strengthening and weakening vaccination competence

The purpose of this study was to describe factors strengthening and weakening vaccination competence. The data were collected by focus group and individual interviews with 40 participants, consisting of health-care professionals, students and clients, and were then analysed by content analysis. The results could be classified into four categories: vaccinator professional conduct, education, client conduct and the vaccination environment. Successful client encounters, comprehensive knowledge of vaccinating, adequate education, clients' positive attitude, suitable physical environment and centralization of vaccinations were considered strengthening factors, whereas their opposites weakened vaccination competence. The two most important factors were vaccinator professional conduct and education, and therefore these factors should be considered the most in education, clinical practice and administration. Further research is necessary to determine how well current education, clinical practice and administration support factors strengthening, and help alleviate factors weakening vaccination competence.     

Effects of dietary counselling on micronutrient intakes in pregnant women in Finland

The intake of some micronutrients is still a public health challenge for pregnant women in Finland. This study examined the effects of dietary counselling on micronutrient intakes among pregnant women at increased risk of gestational diabetes mellitus in Finland. This study utilised data from was a cluster‐randomised controlled trial (n = 399), which aimed to prevent gestational diabetes. In the intervention group, the dietary counselling was carried out at four routine visits to maternity care and focused on dietary fat, fibre and saccharose intake. A validated 181‐item food frequency questionnaire was used for evaluating the participants'' food consumption and nutrient intakes. The differences in changes in micronutrient intakes from baseline (pre‐pregnancy) to 36–37 weeks'' gestation were compared between the intervention and the usual care groups using multilevel mixed‐effects linear regression models, adjusted for confounders. Based on the multiple‐adjusted model, the counselling increased the intake of niacin equivalent (coefficient 0.50, 95% confidence interval [CI] 0.03–0.97), vitamin D (0.24, CI 0.05–0.43), vitamin E (0.46, CI 0.26–0.66) and magnesium (5.05, CI 0.39–9.70) and maintained the intake of folate (6.50, CI 1.44–11.56), from early pregnancy to 36 to 37 weeks'' gestation. Except for folate and vitamin D, the mean intake of the micronutrients from food was adequate in both groups at baseline and the follow‐up. In conclusion, the dietary counselling improved the intake of several vitamins and minerals from food during pregnancy. Supplementation on folate and vitamin D is still needed during pregnancy.