Relationships between demented elderly people and their families: a follow-up study of caregivers who had previously reported abuse when caring for their spouses and parents

The aim of the study was to elucidate how relationships develop over time in abusive families Family members of demented elderly people who previously reported abuse in the care of the elderly relatives are interviewed in a follow-up study In this current study the families did not mention any abusive behaviour They narrated their feelings toward their care recipient in the following main categories mothering, grieving, feeling guilty, distancing and objectifying When the family members expressed mothering thoughts, there were no expressions of guilt, objectifying or distancing, and the prior relationship was narrated as good The families who talked about the demented person at a distance or by objectifying did not express feelings of mothering or grief for the relative     

Immunity to rubella before and after vaccination against measles, mumps and rubella (MMR) at 12 years of age of the first generation offered MMR vaccination in Sweden at 18 months

In 1982, a two-dose programme of vaccination against measles, mumps and rubella (MMR) at the ages of 18 months and 12 years was introduced in Sweden. In 1992–1993, the first group of children vaccinated at 18 months reached the age of 12, i.e. the time for a second dose. In connection with this 12-year vaccination, 376 children were recruited, investigated concerning earlier MMR vaccination and bled prior to and 2 months after the immunization. Two hundred and twenty of them had a documented, earlier MMR vaccination and 156 had not. The latter were classified as unvaccinated. The antibody status against rubella was measured by the haemolysis-in-gel method. Prior to the present vaccination, 3% of the earlier vaccinated group totally lacked any sign of antibodies. In the presumably unvaccinated group, this figure was 76%. After the vaccination all children showed signs of antibody acitivity and all reached the antibody level of ≥15 international units, i.e. in our tests a zone dia. of approx 8 mm. However, the secondly vaccinated children ended up with a mean antibody level of 10.7 mm which was slightly lower than the level, i.e. 11.0 mm of those lacking earlier vaccination history and prevaccination seronegative. The earlier unvaccinated but pre-immune children reached a mean level of 11.2 mm. In general, those with relatively high, pre-vaccination, antibody levels reacted less to the booster than those with low or no pre-vaccination immunity. The booster thus appeared to restore the antibody levels of the low-titre children.     

Reduction in nicotine intake and oral mucosal changes among users of Swedish oral moist snuff after switching to a low-nicotine product

The purpose of this investigation was to assess nicotine regulation among users of portion-bag Swedish oral moist snuff (snus) when switching from an ordinary snus product (Brand A) to a low-nicotine product having only half the concentration of nicotine (Brand B). Two studies were performed to compare the short-term effects on consumption and nicotine intake of switching to low-nicotine snus with those of long-term effects. In Study 1, consumption data, soft tissue changes and nicotine intake were measured in a group of 24 habitual users of Swedish portion-bag snus, both during use of their ordinary snus (Brand A) for 2 weeks and during consumption of the low-nicotine product (Brand B) for 10 weeks. In study 2, the same data were measured during 2 weeks in a reference group of 18 snus users who had been habitual users of the low-nicotine snus (Brand B) for at least one year. Although there was no increase in number of hours of daily consumption, the amount of snus consumed increased on average by 2 grams a day (+15%) when switching from Brand A to the low-nicotine Brand B (Study 1). The Brand B reference group (Study 2) consumed about 3 grams less snus a day during the same number of hours as the subjects in Study 1 who had switched to Brand B. These results indicate that snus users compensate to a small extent for the lower nicotine delivery by increasing their consumption on short-term switching but the same does not apply to long-term users. There was a significant reduction in nicotine intake when switching to the low-nicotine brand. The individual average saliva cotinine levels decreased from 336 ng/ml to 153 ng/ml and total amounts of nicotine equivalents excreted during 24 h decreased from 25.2 mg to 14.4 mg (Study 1), reaching about the same levels found in the reference group in Study 2 (159 ng/ml and 14.3 mg, respectively). After switching from Brand A to Brand B in Study 1, there was a decrease in the frequency of Degree 3 clinical lesions and an increase in Degree 2 lesions. Also, Degree 3 lesions were less frequent, and Degree 1 lesions more frequent, in Study 2 than in Study 1. These observations point to the development of less pronounced changes after both long-term and short-term switching to a low-nicotine snus.     

Paternal nondisjunction in trisomy 21: excess of male patients

Paternal nondisjunction accounts for approximately 5% of casesof trisomy 21. We have studied 36 cases of free trisomy 21,in which the supernumerary chromosome was of paternal origin,with DNA markers in the pericentromeric region and along thelong arm of chromosome 21. Fifteen of the paternal cases wereconsistent with melosis II errors, 8 with mitotic errors andonly 7 with melosis I nondisjunction. This contrasts markedlywith maternally derived trisomy 21, in which meiosis I errorspredominate. An excess of males was observed in the meloticcases (21 maies:6 females), highly significantly different froma 1.06 ratio. A significant difference in mean maternal agewas found between cases of paternal origin (28.1 years) andthose of maternal origin (31.8 years, n=429). This indicatesthat the maternal age effect is confined to maternal nondisjunction.     

Vascular versus Myocardial Selectivity of Dihydropyridine Calcium Antagonists as Studied in Vivo and in Vitro

Abstract: The use of in vitro models for the study of cardiovascular effects of drugs may not be representative for the in vivo therapeutic effects. However, drug effects in vivo are often difficult to assess because of counteracting reflexes and auto-regulatory rearrangements. To solve this dilemma, the present study presents a two-step method using both in vivo and in vitro techniques to investigate vascular versus myocardial selectivity of three dihydropyridine calcium antagonists: amlodipine, felodipine and nifedipine. The ratio between intravenous drug doses causing 25% reduction in mean arterial blood pressure (vascular potency) and in heart rate (cardiac chronotropic potency) was determined in anaesthetised spontaneously hypertensive rats during autonomic cardiac blockade. In isolated hearts from spontaneously hypertensive rats, the inotropic versus chronotropic potency ratio was determined between the two drug concentrations producing a 25% reduction in cardiac contractility (dP/dt max) and in heart rate, respectively. The vascular versus chronotropic selectivity in vivo was higher for felodipine (121) than for nifedipine (47) and amlodipine (15). The inotropic versus chronotropic potency ratios obtained from the in vitro studies were: felodipine (1), amlodipine (2) and nifedipine (20). The in vitro results were used to extrapolate the vascular versus cardiac chronotropic selectivity obtained in vivo to a vascular versus myocardial selectivity drug ratio, being 20 and 60 times higher for felodipine than for amlodipine and nifedipine, respectively.     

Mortality and tumour morbidity among Swedish market gardeners and orchardists

Summary In order to investigate possible effects of exposure to pesticides, mainly fungicides and insecticides, we studied a cohort of 2370 subjects, who, during the period 1965–1982, had been members of a horticulturists' trade association (market gardeners and orchardists). Compared to a regional reference population, total mortality (542 deaths; standardized mortality morbidity ratio, SMR = 0.8; 95% confidence limits, CLs = 0.7, 0.9) and mortality due to malignant tumours (133 deaths, SMR = 0.9; CLs = 0.7, 1.0), and cardiovascular and respiratory deaths were somewhat decreased. Suggestive excesses in mortality were seen for mental disorders and tumours of the stomach, skin and nervous system. The tumours of the nervous system were in particular excess in the young and middle-aged horticulturists (below age 60; six cases, SMR = 2.9; CLs = 1.1, 6.2). During the period 1965–1986, the total tumour morbidity was slightly decreased (255 cases; SMR = 0.9; CLs = 0.8, 1.0), as were gastro-intestinal and respiratory tract tumours. The incidence of melanomas was increased (15 cases, SMR = 2.1; CLs = 1.2, 3.5), and tumours of the female genital organs, myelomas, and brain tumours (12 cases, SMR = 1.5; CLs = 0.8, 2.7) were slightly numerically elevated. Brain tumours in the young and middle-aged horticulturists (11 cases, SMR = 3.2; CLs = 1.6, 5.7), including meningiomas (four observed, SMR = 6.8; CLs = 1.9, 17.4), were increased, especially in the period 1975–1979. The mortality and tumour morbidity patterns in gardeners and orchardists, analysed separately, were similar to the patterns in all the horticulturists. The risk for brain tumours in the young and middle-aged subjects was increased about threefold in the gardeners, and about fivefold in the orchardists; in particular, meningiomas were in excess among the gardeners.     

Silicone-Adjustable Gastric Banding: Disappointing Results

Background: Silicone-adjustable Gastric banding (SAGB) has been popularized as a minimally invasive, completely reversible surgical treatment for morbid obesity. We report here out 3-year experience of SAGB with special reference to complications and side-effects. Methods: There were 90 patients in total, of whom 72 were women. Median age was 42 (range, 20-68) years and median body mass index (BMI) was 43 (range, 34-57) kg/m². Laparoscopy was attempted to position the band in 63 cases but had to be converted to laparotomy in 16 (25%). Twenty-seven patients were laparotomized. We used the Swedish band (AB Obtech) throughout the series. In addition to regular clinic visits, patients were followed-up with upper gastrointestinal series 6 months postoperatively and gastroscopy after 2 years or earlier when symptomatic. Results: Median BMI decreased to 32 kg/m² after 12 months and to 31 kg/m² after 24 months. With a median follow-up time of 35 months (range, 22-48), 32 patients (35%) have been re-operated usually with removal of the balloon system and conversion into a Roux-en-Y gastric bypass. The most common reasons for re-operation were band erosion (n = 10) and erosive esophagitis (n = 14). Additional indications for re-operation included pouch dilatation, invagination of distal gastric wall through the band, leakage from the balloon, patient dissatisfaction, and severe allergic reaction. When questioned 2 years postoperatively more than half of the patients reported vomiting, heartburn and regurgitation but 78% still pronounced themselves satisfied with the operation. Esophagitis was found in 56% of the patients at gastroscopy after 2 years. Conclusion: SAGB could be positioned with laparoscopy in 75% of the cases but the incidence of complications and side-effects postoperatively has been high.