Satisfaction with rehabilitation in relation to self‐perceived quality of life and function among patients with stroke – a 12 month follow‐up

Scand J Caring Sci; 2013; 27; 373–379 Satisfaction with rehabilitation in relation to self‐perceived quality of life and function among patients with stroke – a 12 month follow‐up Background and Purpose: Stroke causes complex disability and function, and perceived quality of life has been shown to correlate with satisfaction with care as well as with life in general among stroke patients. The aim of this study was to study the relation of satisfaction with how rehabilitation was provided with self‐perceived quality of life, self‐perceived function and rehabilitation received, 12 months after the incidence. Method: The subjects were assessed 12 months after the onset of stroke. The Barthel index was used to measure function, and the EuroQol‐5D to measure quality of life. To measure satisfaction with how rehabilitation was provided, a questionnaire from the Swedish Stroke Register was used. Results: Two hundred and eighty‐three patients participated in the follow‐up, 137 women and 146 men, aged between 42 and 95 years (mean age 75.2, SD 11.8). For the majority of patients rehabilitation was initiated at in‐hospital care (directly after onset). One hundred and sixty‐eight patients considered that rehabilitation was well provided for. Sixty‐six regarded that the rehabilitation was only partly provided for and 35 that it was not provided for at all. High value on Barthel Index was associated with satisfaction with how rehabilitation was provided for (OR 2.81). Also, rehabilitation on three or more levels was negatively associated with satisfaction with rehabilitation provision (OR 0.24) and so was being male (OR 0.49). Conclusion: In this study, patients with higher values on Barthel Index were more satisfied with how rehabilitation was provided for. However, male patients and patients who received rehabilitation on three or more levels of care were less satisfied. Given the assumption that patients with more severe dysfunction after stroke are being rehabilitated on more levels, this might imply that it is not the amount of rehabilitation that gives satisfaction but the patients self‐perceived function after rehabilitation.     

Early onset of sexual intercourse is an indicator for hazardous lifestyle and problematic life situation

Scand J Caring Sci; 2013; 27; 20–26 Early onset of sexual intercourse is an indicator for hazardous lifestyle and problematic life situation Background: In public health efforts, knowledge about risk‐groups is important for creating societal conditions to ensure good health on equal terms. Aim: To investigate differences in lifestyle and perceived health among 15‐year‐old teenagers with experience of sexual intercourse (self‐defined) and same‐aged teenagers without experience of sexual intercourse. Methods: A two‐cluster questionnaire study among 15‐year‐old Swedish students (n = 2170) in 2009/10. Chi‐squared test was used to identify differences between three groups: teenagers who had not had sexual intercourse; teenagers who had had sexual intercourse at age of 14 or younger; and teenagers who had had intercourse at an age of 15. Results: Thirty‐two per cent (n = 334) of girls and 31% (n = 324) of boys had had sexual intercourse. Teenagers with experience of sexual intercourse at 15 years or younger used more tobacco, alcohol and illicit drugs than same‐aged teenagers without intercourse experience did. Furthermore, teenagers with experience of intercourse, especially those with a debut at 14 year or younger, had less positive school experiences, more involvement in injuries and physical violence, were less (girls) and more (boys) physically active, and perceived a poorer health than teenagers without intercourse experience. Conclusion: Sexual intercourse at the age of 15 or younger is an indicator for a hazardous lifestyle and problematic life situation.     

A questionnaire on pelvic floor dysfunction postpartum

Introduction and hypothesis  

The incidence of obstetric anal sphincter injuries is used in Sweden as a measurement of quality of care and this might influence the reporting. However, the correlation between reported diagnosis of pelvic floor injury at delivery and pelvic floor symptoms a year later is unknown. A questionnaire could identify such symptoms and provide beneficial feedback to obstetrical practices.     

Pro-inflammatory response and adverse drug reactions: Mechanisms of action of ximelagatran on chemokine and cytokine activation in a monocyte in vitro model

There is a lack of suitable human in vitro systems which can predict drug hepatotoxicity that in many cases involves inflammatory responses mediated by macrophages. In the present investigation we used an in vitro model based on human THP-1 cells to evaluate the inflammatory cytokine/chemokine activation properties of ximelagatran, a drug previously shown to cause elevation of liver transferases in a subset of patients. Treatment of the cells with ximelagatran caused an intracellular accumulation of the metabolites hydroxymelagatran and melagatran. A decreased viability and increased release of the pro-inflammatory cytokines and chemokines IL-8, VEGF and MCP-1 was seen. Ximelagatran exposure caused activation of ERK1/2 and JNK as evident from determination of the phosphorylation status. In accordance, the release of IL-8 was attenuated by inhibitors of the ERK- and JNK-pathways. It is concluded that human monocytes might constitute a valuable additional in vitro model for monitoring the basis for cytotoxic action of drugs.     

Who is maintaining weight in a middle-aged population in Sweden? A longitudinal analysis over 10 years

Background  

Obesity has primarily been addressed with interventions to promote weight loss and these have been largely unsuccessful. Primary prevention of obesity through support of weight maintenance may be a preferable strategy although to date this has not been the main focus of public health interventions. The aim of this study is to characterize who is not gaining weight during a 10 year period in Sweden.     

Peritoneal fluid concentrations of cefoxitin in children during appendectomy

Fifteen children underwent appendectomy following administration of a single i.v. dose of cefoxitin (20 mg/kg). The mean cefoxitin concentration of peritoneal fluid prior to resection of the appendix was 9.3 ± 2.9 g/ml, representing 264% ± 47% of the concurrent serum concentration. All samples of appendiceal tissue contained less than 5.0 g/g. Peritoneal cefoxitin levels exceeded the usual minimal inhibitory concentration of Staphylococcus aureus and Escherichia coli, but were indadequate for Bacteroides fragilis. We recommend use of a higher cefoxitin dose (40 mg/kg) for the preoperative prophylaxis of appendectomy in children.     

Computer-assisted detection and intervention in adolescent high-risk health behaviors

Because adolescents avoid bringing sensitive issues, such as substance abuse, suicide, and sexual activity, to pediatricians, and may fail to realize that they need health education or services, a computer program was designed to facilitate reporting of high-risk psychosocial and health behaviors and to provide specific health advice and referral for timely professional intervention. Computer printouts done anonymously by a random sample of 265 adolescents after a physical examination were compared with those of a matched group of 294 who were predirected to share the printout with the clinician at their examinations. The former elicited more positive responses to sensitive health problems, but both computer groups responded significantly more often about most high-risk issues than a matched written questionnaire group of 251. Almost all adolescents said that they reported true information to the computer and read all the information it printed. Experience with 3327 teenagers demonstrated that 89% preferred the computer over a questionnaire or personal interview, but nearly all were willing to share the printout with the pediatrician, which should facilitate clinical evaluation. The nonjudgmental computer can identify problem areas and deliver automated medical advice and referral. Automated health assessment and education may become a useful adjunct for addressing adolescent health issues.     

Flat Serrated Adenomas and Flat Tubular Adenomas of the Colorectal Mucosa: Differences in the Pattern of Cell Proliferation

In the present work we have investigated the cell proliferation pattern of flat serrated adenomas and flat tubular adenomas. For this purpose tissue sections from 23 consecutive flat serrated adenomas and 22 consecutive flat tubular adenomas of the colorcctal mucosa were challenged with MID1, a monoclonal antibody directed against a proliferation-related antigen. The results (including semi-quantitative studies) demonstrated that, whereas flat serrated adenomas had a high cell proliferation at the lower part of the crypts, flat tubular adenomas had a high cell proliferation in the upper part of the crypts. In serrated adenomas with invasive adenocarcinoma, high cell proliferation was demonstrated both at the lower portion of the crypts and in the subjacent submucosa. This suggests that the cells of the lower portion of the crypts in serrated adenomas are truely neoplastic, with the capacity to evolve into invasive growth. The difference in cell proliferation betweeen the two types of flat lesions reported here is a new argument in favor of the classification of flat serrated adenomas as a novel and independent type of neoplastic change of the colorectal mucosa.     

Cancer incidence among male railway engine-drivers and conductors in Sweden, 1976–90

During recent years, the relationship between exposure to magnetic fields and cancer has attracted increasing interest. In Sweden, train personnel are exposed to comparatively strong magnetic fields in their work. The aim of the present study was to investigate cancer incidence, particularly leukemia and brain tumors, among male railway engine drivers and conductors, respectively, and to compare their cancer incidence with that of the general male population. The study population comprised all male railway engine drivers (n=7,466) and conductors (n=2,272) who were ever employed at the Swedish State Railways during the period 1976–90. The study population was observed with regard to cancer incidence by means of the National Cancer Register for the period 1976–90. The total cancer incidence (all tumors included) among railway engine drivers was lower than in the general Swedish population. An increased incidence of lymphocytic leukemia was observed among railway engine drivers and conductors combined (relative risk = 2.3; 95 percent confidence interval = 1.3–3.2), with the same point estimate for both occupational groups. For brain tumor (astrocytoma), the observed relative risk was close to one. The study provides evidence of an excess risk of lymphocytic leukemia in railway engine drivers and conductors, workers with known occupational exposure to magnetic fields.Drs Alfredsson and Hammar are with the Division of Epidemiology, Institute of Environmental Medicine, Karolinska Instituter, Stockholm, Sweden. Dr Alfredsson is also with the Department of Occupational Health, Karolinska Hospital, Stockholm, Sweden. Dr Karlehagen is with the National Occupational Health Services, Örebro, Sweden. Address correspondence to Dr Alfredsson, Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Box 210, S-171 77 Stockholm, Sweden. The study was supported by the Swedish State Railway Company.