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Sample records for dementia a nationwide register

  1. Delusional disorder in old age and the risk of developing dementia: a nationwide register-based study

    DEFF Research Database (Denmark)

    Kørner, Alex; Lopez, Ana G; Lauritzen, Lise

    2008-01-01

    OBJECTIVE: To examine whether very late first-contact delusional disorder carries a risk for later development of dementia. METHODS: By linkage of the psychiatric and the somatic nationwide registers of all out- and in-patients with hospital contact in Denmark, we included all 60+ patients with f...

  2. Hospital-diagnosed dementia and suicide: a longitudinal study using prospective, nationwide register data

    DEFF Research Database (Denmark)

    Erlangsen, Annette; Zarit, S.H.; Conwell, Yeates

    2008-01-01

    OBJECTIVE: The current study aims to examine the risk of suicide in persons diagnosed with dementia during a hospitalization and its relationship to mood disorders. DESIGN: Event-history analysis using time-varying covariates. SETTING: Population-based record linkage. PARTICIPANTS: All individuals...... who are aged 70 or older with dementia have a threefold higher risk than persons with no dementia. The time shortly after diagnosis is associated with an elevated suicide risk. The risk among persons with dementia remains significant when controlling for mood disorders. As many as 26% of the men...... aged 50+ living in Denmark (N=2,474,767) during January 1, 1990 through December 31, 2000. MEASUREMENTS: Outcome of interest is suicide. Relative risks are calculated based on person-days spent in each stratum. RESULTS: A total of 18,648,875 person-years were observed during the 11-year study period...

  3. Validity of dementia diagnoses in the danish hospital registers

    DEFF Research Database (Denmark)

    Phung, T.K.T.; Andersen, B.B.; Phung, T.K.T.

    2007-01-01

    .24-0.48). Conclusion: The validity of dementia syndrome in the Danish hospital registers was high and allows for epidemiological studies about dementia. Alzheimer's disease, although underregistered, also had a good validity once the diagnosis was registered. In general, other ICD-10 dementia subtypes in the registers......Background:The validity of dementia diagnoses in the Danish nationwide hospital registers was evaluated to determine the value of these registers in epidemiological research about dementia. Methods: Two hundred patients were randomly selected from 4,682 patients registered for the first time...... with a dementia diagnosis in the last 6 months of 2003. The patients' medical journals were reviewed to evaluate if they fulfilled ICD-10 and/or DSM-IV criteria for dementia and specific dementia subtypes. The patients who were still alive in 2006 were invited to an interview. Results: One hundred and ninety...

  4. Validity of dementia diagnoses in the danish hospital registers

    DEFF Research Database (Denmark)

    Phung, T.K.T.; Andersen, B.B.; Phung, T.K.T.

    2007-01-01

    Background:The validity of dementia diagnoses in the Danish nationwide hospital registers was evaluated to determine the value of these registers in epidemiological research about dementia. Methods: Two hundred patients were randomly selected from 4,682 patients registered for the first time...... with a dementia diagnosis in the last 6 months of 2003. The patients' medical journals were reviewed to evaluate if they fulfilled ICD-10 and/or DSM-IV criteria for dementia and specific dementia subtypes. The patients who were still alive in 2006 were invited to an interview. Results: One hundred and ninety......-seven journals were available for review and 51 patients were interviewed. A registered diagnosis of dementia was found to be correct in 169 (85.8%) cases. Regarding dementia subtypes, the degree of agreement between the registers and the results of the validating process was low with a kappa of 0.36 (95% CI 0...

  5. Older people dying with dementia: a nationwide study

    NARCIS (Netherlands)

    Meeussen, K.; van den Block, L.; Echteld, M.; Boffin, N.; Bilsen, J.; van Casteren, V.; Deliens, L.

    2012-01-01

    Background: Large-scale nationwide data describing the end-of-life characteristics of older people with dementia are lacking. This paper describes the dying process and end-of-life care provided to elderly people with mild or severe dementia in Belgium. It compares with elderly people dying without

  6. Prenatal Maternal Smoking and Tourette Syndrome: A Nationwide Register Study.

    Science.gov (United States)

    Leivonen, Susanna; Chudal, Roshan; Joelsson, Petteri; Ekblad, Mikael; Suominen, Auli; Brown, Alan S; Gissler, Mika; Voutilainen, Arja; Sourander, Andre

    2016-02-01

    This is the first nationwide register-based study to examine the relationship between prenatal maternal smoking and Tourette syndrome. A total of 767 children diagnosed with Tourette syndrome were identified from the Finnish Hospital Discharge Register. Each case was matched to four controls. Information on maternal smoking during pregnancy was obtained from the Finnish Medical Birth Register. Conditional logistic regression models were used for statistical analyses. Prenatal maternal smoking was associated with Tourette syndrome when comorbid with ADHD (OR 4.0, 95 % CI 1.2-13.5, p = 0.027 for exposure during first trimester, OR 1.7, 95 % CI, 1.05-2.7, p = 0.031 for exposure for the whole pregnancy). There was no association between maternal smoking during pregnancy and Tourette syndrome without comorbid ADHD (OR 0.5, 95 % CI 0.2-1.3, p = 0.166, OR 0.9, 95 % CI 0.7-1.3, p = 0.567). Further research is needed to elucidate the mechanisms behind the association between prenatal maternal smoking and Tourette syndrome with comorbid ADHD.

  7. Dementia and Traffic Accidents: A Danish Register-Based Cohort Study.

    Science.gov (United States)

    Petersen, Jindong Ding; Siersma, Volkert; Nielsen, Connie Thurøe; Vass, Mikkel; Waldorff, Frans Boch

    2016-09-27

    As a consequence of a rapid growth of an ageing population, more people with dementia are expected on the roads. Little is known about whether these people are at increased risk of road traffic-related accidents. Our study aims to investigate the risk of road traffic-related accidents for people aged 65 years or older with a diagnosis of dementia in Denmark. We will conduct a nationwide population-based cohort study consisting of Danish people aged 65 or older living in Denmark as of January 1, 2008. The cohort is followed for 7 years (2008-2014). Individual's personal data are available in Danish registers and can be linked using a unique personal identification number. A person is identified with dementia if the person meets at least one of the following criteria: (1) a diagnosis of the disease in the Danish National Patient Register or in the Danish Psychiatric Central Research Register, and/or (2) at least one dementia diagnosis-related drug prescription registration in the Danish National Prescription Registry. Police-, hospital-, and emergency room-reported road traffic-related accidents occurred within the study follow-up are defined as the study outcome. Cox proportional hazard regression models are used for the main analysis. Our study protocol has 3 phases including data collection, data analysis, and reporting. The first phase of register-based data collection of 853,228 individual's personal information was completed in August, 2016. The next phase is data analysis, which is expected to be finished before December 2016, and thereafter writing publications based on the findings. The study started in January 2016 and will end in December 2018. This study covers the entire elderly population of Denmark, and thereby will avoid selection bias due to nonparticipation and loss to follow-up. Furthermore, this ensures that the study results are reliable and generalizable. However, underreporting of traffic-related accidents may occur, which will limit estimation

  8. Reliability of Nationwide Prevalence Estimates of Dementia: A Critical Appraisal Based on Brazilian Surveys.

    Directory of Open Access Journals (Sweden)

    Flávio Chaimowicz

    Full Text Available The nationwide dementia prevalence is usually calculated by applying the results of local surveys to countries' populations. To evaluate the reliability of such estimations in developing countries, we chose Brazil as an example. We carried out a systematic review of dementia surveys, ascertained their risk of bias, and present the best estimate of occurrence of dementia in Brazil.We carried out an electronic search of PubMed, Latin-American databases, and a Brazilian thesis database for surveys focusing on dementia prevalence in Brazil. The systematic review was registered at PROSPERO (CRD42014008815. Among the 35 studies found, 15 analyzed population-based random samples. However, most of them utilized inadequate criteria for diagnostics. Six studies without these limitations were further analyzed to assess the risk of selection, attrition, outcome and population bias as well as several statistical issues. All the studies presented moderate or high risk of bias in at least two domains due to the following features: high non-response, inaccurate cut-offs, and doubtful accuracy of the examiners. Two studies had limited external validity due to high rates of illiteracy or low income. The three studies with adequate generalizability and the lowest risk of bias presented a prevalence of dementia between 7.1% and 8.3% among subjects aged 65 years and older. However, after adjustment for accuracy of screening, the best available evidence points towards a figure between 15.2% and 16.3%.The risk of bias may strongly limit the generalizability of dementia prevalence estimates in developing countries. Extrapolations that have already been made for Brazil and Latin America were based on a prevalence that should have been adjusted for screening accuracy or not used at all due to severe bias. Similar evaluations regarding other developing countries are needed in order to verify the scope of these limitations.

  9. Cardiovascular disease in patients with osteogenesis imperfecta — a nationwide, register-based cohort study

    OpenAIRE

    Folkestad, Lars; Hald, Jannie Dahl; Gram, Jeppe; Langdahl, Bente L.; Hermann, Anne Pernille; Diederichsen, Axel CP; Abrahamsen, Bo; Brixen, Kim

    2016-01-01

    BACKGROUND: Osteogenesis imperfecta (OI) is a hereditary connective tissue disease often due to mutations in genes coding for type 1 collagen. Collagen type 1 is important in the development of the heart and vasculature. Little is known about the risk of cardiovascular disease (CVD) in OI.OBJECTIVE: To investigate the risk of symptomatic CVD in OI.DESIGN: A Danish nationwide, population-based and register-based longitudinal open cohort study.PARTICIPANTS: All patients registered with the diag...

  10. Epilepsy in Individuals with a History of Asperger's Syndrome: A Danish Nationwide Register-Based Cohort Study

    Science.gov (United States)

    Mouridsen, Svend Erik; Rich, Bente; Isager, Torben

    2013-01-01

    We performed a nationwide, register-based retrospective follow-up study of epilepsy in all people who were born between January 1, 1980 and June 29, 2006 and registered in the Danish Psychiatric Central Register with Asperger's syndrome on February 7, 2011. All 4,180 identified cases with AS (3,431 males and 749 females) were screened through the…

  11. Inadequate Diagnostic Evaluation in Young Patients Registered with a Diagnosis of Dementia

    DEFF Research Database (Denmark)

    Salem, Lise Cronberg; Andersen, Birgitte Bo; Nielsen, T Rune

    2014-01-01

    BACKGROUND: Establishing a diagnosis of dementia in young patients may be complex and have significant implications for the patient. The aim of this study was to evaluate the quality of the diagnostic work-up in young patients diagnosed with dementia in the clinical routine. METHODS: Two hundred...... patients were randomly selected from 891 patients aged ≤65 years registered with a diagnosis of dementia for the first time in 2008 in Danish hospitals, and 159 medical records were available for review. Three raters evaluated their medical records for the completeness of the diagnostic work-up on which...... the diagnosis of dementia had been based, using evidence-based guidelines for the diagnostic evaluation of dementia as reference standards. RESULTS: According to the rater review, only 111 (70%) patients met the clinical criteria for dementia. An acceptable diagnostic work-up including all items of recommended...

  12. A Nationwide Study of the Impact of Dysphagia on Hospital Outcomes Among Patients With Dementia.

    Science.gov (United States)

    Paranji, Suchitra; Paranji, Neethi; Wright, Scott; Chandra, Shalini

    2017-02-01

    To assess the impact of dysphagia on clinical and operational outcomes in hospitalized patients with dementia. Retrospective cohort study. 2012 Nationwide Inpatient Sample. All patients discharged with a diagnosis of dementia (N = 234,006) from US hospitals in 2012. Univariate and multivariate regression models, adjusting for stroke and patient characteristics, to assess the impact of dysphagia on the prevalence of comorbidities, including pneumonia, sepsis, and malnutrition; complications, including mechanical ventilation and death; and operational outcomes, including length of stay (LOS) and total charges for patients with dementia. Patients having dementia with dysphagia (DWD) had significantly higher odds of having percutaneous endoscopic gastrostomy placement during the admission (odds ratio [OR]: 13.68, 95% confidence interval [CI]: 12.53-14.95, P dysphagia. Dysphagia is a significant predictor of worse clinical and operational outcomes including a 38% longer LOS and a 30% increase in charge per case among hospitalized patients with dementia. Although these findings may not be surprising, this new evidence might bring heightened awareness for the need to more thoughtfully support patients with dementia and dysphagia who are hospitalized.

  13. Fibromyalgia and Risk of Dementia-A Nationwide, Population-Based, Cohort Study.

    Science.gov (United States)

    Tzeng, Nian-Sheng; Chung, Chi-Hsiang; Liu, Feng-Cheng; Chiu, Yu-Hsiang; Chang, Hsin-An; Yeh, Chin-Bin; Huang, San-Yuan; Lu, Ru-Band; Yeh, Hui-Wen; Kao, Yu-Chen; Chiang, Wei-Shan; Tsao, Chang-Hui; Wu, Yung-Fu; Chou, Yu-Ching; Lin, Fu-Huang; Chien, Wu-Chien

    2018-02-01

    Fibromyalgia is a syndrome of chronic pain and other symptoms and is associated with patient discomfort and other diseases. This nationwide matched-cohort population-based study aimed to investigate the association between fibromyalgia and the risk of developing dementia, and to clarify the association between fibromyalgia and dementia. A total of 41,612 patients of age ≥50 years with newly diagnosed fibromyalgia between January 1, and December 31, 2000 were selected from the National Health Insurance Research Database of Taiwan, along with 124,836 controls matched for sex and age. After adjusting for any confounding factors, Fine and Gray competing risk analysis was used to compare the risk of developing dementia during the 10 years of follow-up. Of the study subjects, 1,704 from 41,612 fibromyalgia patients (21.23 per 1,000 person-years) developed dementia when compared to 4,419 from 124,836 controls (18.94 per 1,000 person-years). Fine and Gray competing risk analysis revealed that the study subjects were more likely to develop dementia (hazard ratio: 2.29, 95% CI: 2.16-2.42; P dementia in this study. The study subjects with fibromyalgia had a 2.77-fold risk of dementia in comparison to the control group. Therefore, further studies are needed to elucidate the underlying mechanisms of the association between fibromyalgia and the risk of dementia. Copyright © 2018 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  14. Risk of Dementia in Patients with Spinal Cord Injury: A Nationwide Population-Based Cohort Study.

    Science.gov (United States)

    Huang, Shih-Wei; Wang, Wei-Te; Chou, Lin-Chuan; Liou, Tsan-Hon; Lin, Hui-Wen

    2017-02-01

    Spinal cord injury (SCI) can cause physical disability and psychological distress; however, whether SCI is a risk factor for dementia is unclear. This study evaluated the incidence of dementia in patients with SCI. Study participants were recruited from a nationwide cohort during 2004-2007 and categorized into SCI (patients diagnosed with SCI; n = 941) and non-SCI (age- and sex-matched controls; n = 5060) cohorts. Each participant was followed for 7 years until diagnosis of dementia or December 31, 2010, whichever occurred first. Data were subjected to Kaplan-Meier and Cox regression analyses. The incidence of dementia was significantly higher in the SCI cohort (1106 per 100,000 person-years) than in the non-SCI cohort (p < 0.001). Patients with SCI had a significantly higher risk of dementia than did those without SCI (crude hazard ratio [HR] = 2.14, 95% confidence interval [CI], 1.57-2.92, p < 0.001 vs. adjusted HR = 1.95, 95% CI, 1.43-2.67, p < 0.001). Further analysis found that there is no statistical significance of higher risk for developing Alzheimer's disease among SCI patients, but that SCI patients were at higher risk of developing other types of dementia than the control cohort (crude HR = 1.88, 95% CI, 1.33-2.63, p < 0.001 vs. adjusted HR = 1.90, 95% CI, 1.35-2.68, p < 0.001). In conclusion, patients with SCI are at high risk of dementia, and effective dementia prevention strategies are recommended for comprehensive SCI care.

  15. Quality of dementia diagnostic evaluation for ethnic minority patients: a nationwide study

    DEFF Research Database (Denmark)

    Nielsen, T Rune; Andersen, Birgitte Bo; Kastrup, Marianne

    2011-01-01

    Background/Aims: Diagnostic evaluation of dementia for ethnic minority patients may be challenging. This study aimed to evaluate the quality of diagnostic evaluation of dementia for patients from ethnic minorities in Denmark. Methods: The Danish national hospital registers were used to identify p......: There are significant ethnic disparities in the quality of diagnostic evaluations and outcome of dementia in the secondary healthcare sector....

  16. Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study

    DEFF Research Database (Denmark)

    Andell, Pontus; Li, Xinjun; Martinsson, Andreas

    2017-01-01

    OBJECTIVE: Transitions in the spectrum of valvular heart diseases (VHDs) in developed countries over the 20th century have been reported from clinical case series, but large, contemporary population-based studies are lacking. METHODS: We used nationwide registers to identify all patients...

  17. Dementia and traffic accidents: a Danish register-based cohort study

    DEFF Research Database (Denmark)

    Petersen, Jindong Ding; Siersma, Volkert Dirk; Nielsen, CT

    2016-01-01

    BACKGROUND: As a consequence of a rapid growth of an ageing population, more people with dementia are expected on the roads. Little is known about whether these people are at increased risk of road traffic-related accidents. OBJECTIVE: Our study aims to investigate the risk of road traffic...... Central Research Register, and/or (2) at least one dementia diagnosis-related drug prescription registration in the Danish National Prescription Registry. Police-, hospital-, and emergency room-reported road traffic-related accidents occurred within the study follow-up are defined as the study outcome...... selection bias due to nonparticipation and loss to follow-up. Furthermore, this ensures that the study results are reliable and generalizable. However, underreporting of traffic-related accidents may occur, which will limit estimation of absolute risks....

  18. Differences in knowledge of dementia among older adults with normal cognition, mild cognitive impairment, and dementia: A representative nationwide sample of Korean elders.

    Science.gov (United States)

    Lee, Jun-Young; Park, Soowon; Kim, Ki Woong; Kwon, Ji Eyon; Park, Joon Hyuk; Kim, Moon Doo; Kim, Bong-Jo; Kim, Jeong Lan; Moon, Seok Woo; Bae, Jae Nam; Ryu, Seung-Ho; Yoon, Jong Chul; Lee, Nam-Jin; Lee, Dong Young; Lee, Dong Woo; Lee, Seok Bum; Lee, Jung Jae; Lee, Chang-Uk; Jhoo, Jin Hyeong; Cho, Maeng Je

    2016-01-01

    Lack of knowledge about a disease could impede early diagnosis and may lead to delays in seeking appropriate medical care. The aim of this study was to explore knowledge of dementia (KOD) and to find the determinants of KOD among three groups: older adults with normal cognition, mild cognitive impairment (MCI), and dementia. A representative nationwide sample of 6141 Korean elders aged 65 years or older participated in face-to-face interviews and answered 14 questions pertaining to general information, etiology, symptoms, and treatment of dementia. Stepwise multiple regressions and path analyses probed the relationships between various sociodemographic variables and KOD. The percentage of correct responses was only 62%. The item 'A person who remembers things that happened in the past does not have dementia' was answered correctly (false) by only 24.8-27% of the respondents in all groups. Older adults with normal cognition had higher KOD scores than those with MCI or dementia. In the normal-cognition group, KOD scores were higher among highly educated, younger, and literate women with no depression and a family history of dementia. In contrast with the determinants in the normal-cognition group, only the ability to read and write predicted KOD scores in the dementia group. Efforts to enhance KOD in elder adults are needed. Public education regarding the differences between dementia and healthy aging may increase KOD among normal elders and those with MCI. Among elders with dementia, educational materials that do not require literacy may be more helpful in increasing KOD with the aim of preventing treatment delay. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  19. Risk factors of coercion among psychiatric inpatients: a nationwide register-based cohort study.

    Science.gov (United States)

    Thomsen, Christoffer; Starkopf, Liis; Hastrup, Lene Halling; Andersen, Per Kragh; Nordentoft, Merete; Benros, Michael Eriksen

    2017-08-01

    Reducing the use of coercion among patients with mental disorders has long been a political priority. However, risk factors for coercive measures have primarily been investigated in smaller studies. To reduce the use of coercion, it is crucial to identify people at risk which we aim to do in this first large-scale study. A cohort study was conducted among all psychiatric inpatients in Denmark, following 112,233 individuals during 1999-2014. Data from Danish registers were analysed using logistic regression for repeated measures. 24,594 inpatients were exposed to a coercive measure (21.9%). Clinical characteristics were the foremost predictors of coercion and patients with organic mental disorder had the highest increased risk of being subjected to a coercive measure (OR = 5.56; 95% CI = 5.04, 6.14). The risk of coercion was the highest in the first admission and decreased with the number of admissions (all p < 0.001). The following socioeconomic variables were associated with an increased risk of coercion: male sex, unemployment, lower social class and immigrants from low and middle income countries (all p < 0.001). Early retirement and social relations, such as being married and having children, reduced the risk of being subjected to coercive measure (all p < 0.05). From our nationwide data, we identified a broad range of risk factors associated with coercive measures. Our findings can assist researchers in identifying patients at risk of coercion and thereby help targeting new coercion reduction programs.

  20. Disability pension after coronary revascularization: a prospective nationwide register-based Swedish cohort study.

    Science.gov (United States)

    Zetterström, Katharina; Vaez, Marjan; Alexanderson, Kristina; Ivert, Torbjörn; Pehrsson, Kenneth; Hammar, Niklas; Voss, Margaretha

    2015-03-01

    Scientific knowledge on disability pension (DP) after revascularization by coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) is scarce. The aim was to study the incidence of and risk factors for being granted DP in the 5 years following a first CABG or PCI, accounting for socio-demographic and medical factors. This is a nationwide population-based study using Swedish registers including all patients 30-63 years of age (n = 34,643, 16.4% women) who had a first CABG (n = 14,107) or PCI (n = 20,536) during 1994-2003. All were alive and without reintervention 30 days after the procedure and were not on DP or old-age pension. Multivariable adjusted Cox proportional hazard ratios (HR) for DP were estimated with 95% confidence intervals (CI). In 5 years following revascularization, 32.4% had been granted DP and the hazard ratio (HR) was higher in women (HR 1.55, 95% CI 1.48-1.62), and in CABG patients compared with PCI patients (HR 1.35, 95% CI 1.30-1.40). Long-term sick leave in the year before intervention was the strongest predictor for DP following revascularization. After adjustments for socio-demographic factors and sick-leave days in the 12 months before revascularization, HR remained high in all patients with diabetes mellitus regardless of type of revascularization. DP after coronary revascularization was common, especially among women and CABG patients. Most studied medical covariates, including mental and musculoskeletal disorders, were risk factors for future DP, especially long-term sickness absence. © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  1. Hyperthyroidism and psychiatric morbidity: evidence from a Danish nationwide register study.

    Science.gov (United States)

    Brandt, Frans; Thvilum, Marianne; Almind, Dorthe; Christensen, Kaare; Green, Anders; Hegedüs, Laszlo; Brix, Thomas Heiberg

    2014-02-01

    Thyroid hormones are essential for the normal development of the fetal brain, while hyperthyroidism in adults is associated with mood symptoms and reduced quality of life. In this study, we aimed to investigate the association and temporal relationship between hyperthyroidism and psychiatric morbidity. Register-based nationwide cohort study. Data on hyperthyroidism and psychiatric morbidity were obtained by record linkage of the Danish National Patient Registry and the Danish National Prescription Registry. A total of 2631 hyperthyroid individuals were identified and matched 1:4 with non-hyperthyroid controls and followed for a mean duration of 6 years (range 0-13). Logistic and Cox regression models were used to assess the risk of psychiatric morbidity before and after the diagnosis of hyperthyroidism respectively. BEFORE THE DIAGNOSIS OF HYPERTHYROIDISM, SUCH INDIVIDUALS HAD AN INCREASED RISK OF BEING HOSPITALIZED WITH PSYCHIATRIC DIAGNOSES (ODDS RATIO (OR): 1.33; 95% CI: 0.98-1.80) and an increased risk of being treated with antipsychotics (OR: 1.17; 95% CI: 1.00-1.38), antidepressants (OR: 1.13; 95% CI: 1.01-1.27), or anxiolytics (OR: 1.28; 95% CI: 1.16-1.42). After the diagnosis of hyperthyroidism, there was a higher risk of being hospitalized with psychiatric diagnoses (hazard ratio (HR): 1.51; 95% CI: 1.11-2.05) and an increased risk of being treated with antipsychotics (HR: 1.46; 95% CI: 1.20-1.79), antidepressants (HR: 1.54; 95% CI: 1.36-1.74), or anxiolytics (HR: 1.47; 95% CI: 1.27-1.69). Hyperthyroid individuals have an increased risk of being hospitalized with psychiatric diagnoses and being treated with antipsychotics, antidepressants, and anxiolytics, both before and after the diagnosis of hyperthyroidism.

  2. Epidemiology of valvular heart disease in a Swedish nationwide hospital-based register study.

    Science.gov (United States)

    Andell, Pontus; Li, Xinjun; Martinsson, Andreas; Andersson, Charlotte; Stagmo, Martin; Zöller, Bengt; Sundquist, Kristina; Smith, J Gustav

    2017-11-01

    Transitions in the spectrum of valvular heart diseases (VHDs) in developed countries over the 20th century have been reported from clinical case series, but large, contemporary population-based studies are lacking. We used nationwide registers to identify all patients with a first diagnosis of VHD at Swedish hospitals between 2003 and 2010. Age-stratified and sex-stratified incidence of each VHD and adjusted comorbidity profiles were assessed. In the Swedish population (n=10 164 211), the incidence of VHD was 63.9 per 100 000 person-years, with aortic stenosis (AS; 47.2%), mitral regurgitation (MR; 24.2%) and aortic regurgitation (AR; 18.0%) contributing most of the VHD diagnoses. The majority of VHDs were diagnosed in the elderly (68.9% in subjects aged ≥65 years), but pulmonary valve disease incidence peaked in newborns. Incidences of AR, AS and MR were higher in men who were also more frequently diagnosed at an earlier age. Mitral stenosis (MS) incidence was higher in women. Rheumatic fever was rare. Half of AS cases had concomitant atherosclerotic vascular disease (48.4%), whereas concomitant heart failure and atrial fibrillation were common in mitral valve disease and tricuspid regurgitation. Other common comorbidities were thoracic aortic aneurysms in AR (10.3%), autoimmune disorders in MS (24.5%) and abdominal hernias or prolapse in MR (10.7%) and TR (10.3%). Clinically diagnosed VHD was primarily a disease of the elderly. Rheumatic fever was rare in Sweden, but specific VHDs showed a range of different comorbidity profiles . Pronounced sex-specific patterns were observed for AR and MS, for which the mechanisms remain incompletely understood. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Increased Risk of Dementia in Patients with Tension-Type Headache: A Nationwide Retrospective Population-Based Cohort Study.

    Directory of Open Access Journals (Sweden)

    Fu-Chi Yang

    Full Text Available The association between primary headaches, including tension-type headache (TTH as one of the most common primary headache disorders, and dementia remains controversial. In this nationwide, population-based, retrospective, cohort study, we explored the potential association between TTH and dementia and examined sex, age, and comorbidities as risk factors for dementia.Using the Taiwan National Health Insurance Research Database (NHIRD claims data, the sample included 13908 subjects aged ≥20 years with newly-diagnosed TTH in 2000-2006. The non-TTH group included 55632 randomly selected sex- and age-matched TTH-free individuals. All subjects were followed until dementia diagnosis, death, or the end of 2011. Patients with dementia, including vascular and non-vascular (including Alzheimer's subtypes, were identified using International Classification of Diseases Ninth Revision, Clinical Modification codes. Multivariate Cox proportional hazards regression models were used to assess the risk of dementia and dementia-associated risk factors, such as migraine and other medical comorbidities.During the average follow-up of 8.14 years, the incidence density rates of dementia were 5.30 and 3.68/1,000 person-years in the TTH and non-TTH groups, respectively. Compared with the non-TTH group, the risks of dementia were 1.25 (95% confidence interval [CI], 1.11-1.42 and 1.13 (95% CI, 1.01-1.27 times higher in the women and >65-year-old TTH group, respectively. TTH patients with comorbidities had a higher risk of dementia. TTH patients had a greater risk of non-vascular dementia (hazard ratio, 1.21; 95% CI, 1.09-1.34 than the non-TTH group.TTH patients have a future risk of dementia, indicating a potentially linked disease pathophysiology that warrants further study. The association between TTH and dementia is greater in women, older adults, and with comorbidities. Clinicians should be aware of potential dementia comorbidity in TTH patients.

  4. Morbidity before and after the Diagnosis of Hyperthyroidism: A Nationwide Register-Based Study

    Science.gov (United States)

    Brandt, Frans; Thvilum, Marianne; Almind, Dorthe; Christensen, Kaare; Green, Anders; Hegedüs, Laszlo; Brix, Thomas Heiberg

    2013-01-01

    Background Hyperthyroidism has been linked with different morbidities, like atrial fibrillation, stroke and diabetes mellitus. However, our knowledge regarding the extent and temporal relation between hyperthyroidism and other diseases is fragmented. Here, we aimed at evaluating various morbidities before and after the diagnosis of hyperthyroidism. Methods Observational cohort study. From nationwide Danish health registers 2631 hyperthyroid singletons and 375 twin pairs discordant for hyperthyroidism were identified and followed for an average of 6 years (range 0–13). Data on the occurrence of cardiovascular diseases, lung diseases, diabetes mellitus, rheumatic diseases and malignant diseases was obtained by person-to-person record linkage with the National Danish Patient Register and/or the Danish National Prescription Registry (lung diseases and diabetes mellitus). Logistic and Cox regression models were used to assess the risk of morbidity before and after the diagnosis of hyperthyroidism, respectively. All Cox regression analyses were adjusted for the degree of co-morbidity preceding the diagnosis of hyperthyroidism, using the Charlson score. Results Hyperthyroid individuals had a significantly higher risk of being diagnosed with cardiovascular diseases (odds ratio (OR) 1.65; 95% confidence interval (CI): 1.45–1.87), lung diseases (OR 1.53; 95% CI: 1.29–1.60), and diabetes mellitus (OR 1.43, 95% CI: 1.20–1.72), but not with malignant diseases (OR 1.16, 95% CI: 0.99–1.36) prior to the diagnosis of hyperthyroidism. After the diagnosis of hyperthyroidism, subjects had a significantly higher risk of being diagnosed with cardiovascular diseases (hazard ratio (HR) 1.34; 95% CI: 1.15–1.56), lung diseases (HR 1.28; 95% CI: 1.10–1.49), and diabetes mellitus (HR 1.46; 95% CI: 1.16–1.84), but not with rheumatic diseases (HR 1.39, 95% CI: 0.92–2.09) or malignant diseases (HR 1.18, 95% CI 0.97–1.42). Conclusions We demonstrate a significantly increased

  5. Drug use in patients with dementia: a register-based study in the health region of Girona (Catalonia/Spain).

    Science.gov (United States)

    Avila-Castells, Pilar; Garre-Olmo, Josep; Calvó-Perxas, Laia; Turró-Garriga, Oriol; Alsina, Elisabet; Carmona, Olga; Perkal, Héctor; Roig, Anna Maria; Cuy, Josep Ma; Lozano, Manuela; Molins, Albert; Vallmajó, Natàlia; López-Pousa, Secundino

    2013-05-01

    To describe the pattern of drug consumption among patients with dementia in a geographically defined general population in Catalonia (Spain), and to determine its association with age, gender, type of dementia and severity indicators. Cross-sectional study that included 1,894 cases of dementia registered by the Registry of Dementias of Girona from 2007 to 2009. Prescribed drugs were categorized according to the Anatomical Therapeutic Chemical (ATC) classification. A descriptive analysis of drug consumption was stratified according to age, gender, dementia subtypes and dementia severity. Binary logistic regression models were adjusted to detect the association of these variables with drug consumption according to the ATC groups. The most commonly prescribed drugs were for the central nervous system (CNS) (96.4 %), cardiovascular system (79.4 %) and digestive and metabolic system categories (77.7 %). No significant differences were found between the use of nervous system drugs and age, gender, dementia subtypes or dementia severity. The use of alimentary tract and metabolism related drugs, as well as cardiovascular and blood system drugs, were positively correlated with age and secondary dementia. The prevalence of use of cardiovascular and musculoskeletal drugs was higher in women than in men (OR: 1.34; OR: 1.26 respectively). A negative association was found between the severity of dementia and the use of musculoskeletal drugs (OR: 0.71), while its use was significantly higher in the youngest patients (OR: 1.71). Almost all patients with dementia received a CNS drug, being at risk of inappropriate treatment. Treatment for comorbidities in patients with dementia should not be withheld on the basis of age or dementia severity, but rather on the benefit/risk ratio of its prescription. Further studies are needed to evaluate potentially inappropriate drug use and possible untreated conditions in this population.

  6. Gender-Specific Risk Factors for Intimate Partner Homicide: A Nationwide Register-Based Study

    Science.gov (United States)

    Weizmann-Henelius, Ghitta; Gronroos, Matti; Putkonen, Hanna; Eronen, Markku; Lindberg, Nina; Hakkanen-Nyholm, Helina

    2012-01-01

    The present study examined gender differences in intimate partner homicide (IPH) and offender characteristics with the focus on putative gender-specific risk factors in a nationwide consecutive sample of homicide offenders. Data on all offenders (N = 642; 91 females, 551 males) convicted of homicide and subjected to a forensic psychiatric…

  7. Increased psychiatric morbidity before and after the diagnosis of hypothyroidism: a nationwide register study.

    Science.gov (United States)

    Thvilum, Marianne; Brandt, Frans; Almind, Dorthe; Christensen, Kaare; Brix, Thomas Heiberg; Hegedüs, Laszlo

    2014-05-01

    Thyroid hormones are necessary for fetal brain development, and hypothyroidism in adults has been associated with mood symptoms and reduced quality of life. Nevertheless, our knowledge regarding the association and temporal relation between hypothyroidism and mental disorders is ambiguous. Our objective was to investigate, at a nationwide level, whether a diagnosis of hypothyroidism is associated with psychiatric morbidity. This is an observational cohort study. On the basis of record linkage between different Danish health registers, 2822 hypothyroid singletons each matched with 4 nonhypothyroid controls were identified and followed over a mean period of 6 years (range 1-13). Additionally, we included 385 same-sex twin pairs discordant for hypothyroidism. Diagnoses of psychiatric disorders as well as treatment with antidepressants, antipsychotics, and anxiolytics were recorded. Logistic and cox regression models were used to assess the risk of psychiatric morbidity before and after the diagnosis of hypothyroidism, respectively. Before the diagnosis of hypothyroidism, such individuals had an increased prevalence of diagnoses with psychiatric disorders (odds ratio, OR, 1.51; 95% confidence interval [CI 1.12-2.04]) and increased prevalence of treatment with antipsychotics (OR 1.49 [CI 1.29-1.73]), antidepressants (OR 1.50 [CI 1.35-1.67]), and anxiolytics (OR 1.28 [CI 1.16-1.41]). After the diagnosis of hypothyroidism, patients had a higher risk of being diagnosed with a psychiatric disorder (hazard ratio, HR, 2.40 [CI 1.81-3.18]), and an increased risk of being treated with antidepressants (HR 1.30 [CI 1.15-1.47]) and anxiolytics (HR 1.27 [CI 1.10-1.47]), but not antipsychotics (HR 1.13 [CI 0.91-1.41]). On the basis of the twin data, we could not demonstrate genetic confounding. Subjects with hypothyroidism have an increased risk of being diagnosed with a psychiatric disorder as well as being treated with antidepressants, antipsychotics, and anxiolytics both before

  8. Multimorbidity and Its Patterns according to Immigrant Origin. A Nationwide Register-Based Study in Norway.

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    Esperanza Diaz

    Full Text Available As the flows of immigrant populations increase worldwide, their heterogeneity becomes apparent with respect to the differences in the prevalence of chronic physical and mental disease. Multimorbidity provides a new framework in understanding chronic diseases holistically as the consequence of environmental, social, and personal risks that contribute to increased vulnerability to a wide variety of illnesses. There is a lack of studies on multimorbidity among immigrants compared to native-born populations.This nationwide multi-register study in Norway enabled us i to study the associations between multimorbidity and immigrant origin, accounting for other known risk factors for multimorbidity such as gender, age and socioeconomic levels using logistic regression analyses, and ii to identify patterns of multimorbidity in Norway for immigrants and Norwegian-born by means of exploratory factor analysis technique.Multimorbidity rates were lower for immigrants compared to Norwegian-born individuals, with unadjusted odds ratios (OR and 95% confidence intervals 0.38 (0.37-0.39 for Eastern Europe, 0.58 (0.57-0.59 for Asia, Africa and Latin America, and 0.67 (0.66-0.68 for Western Europe and North America. Results remained significant after adjusting for socioeconomic factors. Similar multimorbidity disease patterns were observed among Norwegian-born and immigrants, in particular between Norwegian-born and those from Western European and North American countries. However, the complexity of patterns that emerged for the other immigrant groups was greater. Despite differences observed in the development of patterns with age, such as ischemic heart disease among immigrant women, we were unable to detect the systematic development of the multimorbidity patterns among immigrants at younger ages.Our study confirms that migrants have lower multimorbidity levels compared to Norwegian-born. The greater complexity of multimorbidity patterns for some immigrant groups

  9. Periodontitis as a Modifiable Risk Factor for Dementia: A Nationwide Population-Based Cohort Study.

    Science.gov (United States)

    Lee, Yao-Tung; Lee, Hsin-Chien; Hu, Chaur-Jongh; Huang, Li-Kai; Chao, Shu-Ping; Lin, Chia-Pei; Su, Emily Chia-Yu; Lee, Yi-Chen; Chen, Chu-Chieh

    2017-02-01

    To determine whether periodontitis is a modifiable risk factor for dementia. Prospective cohort study. National Health Insurance Research Database in Taiwan. Individuals aged 65 and older with periodontitis (n = 3,028) and an age- and sex-matched control group (n = 3,028). Individuals with periodontitis were compared age- and sex-matched controls with for incidence density and hazard ratio (HR) of new-onset dementia. Periodontitis was defined according to International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 523.3-5 diagnosed by dentists. To ensure diagnostic validity, only those who had concurrently received antibiotic therapies, periodontal treatment other than scaling, or scaling more than twice per year performed by certified dentists were included. Dementia was defined according to ICD-9-CM codes 290.0-290.4, 294.1, 331.0-331.2. After adjustment for confounding factors, the risk of developing dementia was calculated to be higher for participants with periodontitis (HR = 1.16, 95% confidence interval = 1.01-1.32, P = .03) than for those without. Periodontitis is associated with greater risk of developing dementia. Periodontal infection is treatable, so it might be a modifiable risk factor for dementia. Clinicians must devote greater attention to this potential association in an effort to develop new preventive and therapeutic strategies for dementia. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

  10. A nationwide register study of the characteristics, incidence and validity of diagnosed Tourette syndrome and other tic disorders.

    Science.gov (United States)

    Leivonen, Susanna; Voutilainen, Arja; Hinkka-Yli-Salomäki, Susanna; Timonen-Soivio, Laura; Chudal, Roshan; Gissler, Mika; Huttunen, Jukka; Sourander, Andre

    2014-09-01

    The aim of this study was to describe the characteristics and incidence rates of diagnosed tic disorders in the Finnish Hospital Discharge Register, including changing incidence rates between 1991 and 2010. We also aimed to validate the diagnoses of Tourette's syndrome recorded in the register. Children born between January 1, 1991 and December 31, 2010, who were diagnosed with tic disorders, were identified from the Finnish Hospital Discharge Register (n = 3003). We studied the validity of the Tourette's syndrome diagnoses by reviewing the medical charts of 88 children born since 1997 and carrying out telephone interviews with 55 of their guardians. The incidence rates of all diagnosed tic disorders increased during the study period. A comorbid diagnosis of hyperkinetic disorder diagnosis was recorded in 28.2% of the children with Tourette's syndrome, and the validity of the register-based Tourette's syndrome diagnosis was approximately 95%. This is the first nationwide study to demonstrate the increasing incidence of all register-based tic disorder diagnoses. The validity of the Tourette's syndrome diagnoses in the Finnish Hospital Discharge Register was good, and the data provided are suitable for use in further register-based studies of tic disorders. ©2014 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  11. Herpes Zoster and Dementia: A Nationwide Population-Based Cohort Study.

    Science.gov (United States)

    Chen, Vincent Chin-Hung; Wu, Shu-I; Huang, Kuo-You; Yang, Yao-Hsu; Kuo, Ting-Yu; Liang, Hsin-Yi; Huang, Kuan-Lun; Gossop, Michael

    Some infectious diseases have been found to be associated with cognitive impairment and dementia. However, the relationship between herpes zoster and dementia has received little attention. This study aimed to investigate this association as well as associations of antiviral treatments for herpes zoster and incident dementia using a large national sample. Cases were identified from the Taiwan National Health Insurance Research Database with a new diagnosis of herpes zoster (ICD-9-CM code: 053) between 1997 and 2013. Each identified individual with a case of herpes zoster was compared with 1 sex-, age-, and residence-matched control subject. Both groups were followed until the first diagnosis of dementia (ICD-9-CM codes: 290.0 to 290.4, 294.1, 331.0 to 331.2, and 331.82), withdrawal from the registry, or the end of 2013. Cox regression analyses and competing risk model were applied, adjusting for sex, age, residence, depression, autoimmune disease, ischemic stroke, traumatic brain injury, alcohol use disorder, and antiviral treatments for herpes zoster to evaluate the risk of interest. A total of 39,205 cases with herpes zoster were identified. Of the 78,410 study and comparison subjects, 4,204 were diagnosed as having dementia during a mean (SD) follow-up period of 6.22 (4.05) years. Herpes zoster was associated with a slightly increased risk of dementia in the fully adjusted model (hazard ratio [HR] = 1.11; 95% CI, 1.04-1.17). Prescriptions of antiviral therapy were associated with a reduced risk of developing dementia following the diagnosis of herpes zoster (HR = 0.55; 95% CI, 0.40-0.77). Herpes zoster was associated with an increased risk of dementia, independent of potential confounding factors. Antiviral treatment might be protective in preventing dementia in patients with herpes zoster. © Copyright 2017 Physicians Postgraduate Press, Inc.

  12. A Doctor's Name as a Brand: A Nationwide Survey on Registered Clinic Names in Taiwan.

    Science.gov (United States)

    Chu, Feng-Yuan; Dai, Ying-Xiu; Liu, Jui-Yao; Chen, Tzeng-Ji; Chou, Li-Fang; Hwang, Shinn-Jang

    2018-06-01

    In countries where the private clinics of physicians can be freely named, registering a clinic with a physician's name is one way to make patients familiar with the physician. No previous study had investigated how clinics make use of this method of personal branding. Therefore, the current study analyzed 10,847 private physician Western medicine clinics in Taiwan. Of those clinics, 31.0% ( n = 3363) were named with a physician's full name, 8.9% ( n = 960) with a surname, and 8.1% ( n = 884) with a given name. The proportion of clinics registered with a physician's name was lower in rural areas (37.3%) than in urban (48.5%) and suburban areas (49.2%), respectively. Among clinics with only one kind of specialist, a physician's name was used most frequently in clinics of obstetrics and gynecology (64.9%), otorhinolaryngology (64.1%), and dermatology (63.4%). In Taiwan, fewer than half of clinics used a physician's name as a brand. The sociocultural or strategic factors and real benefits of doing so could be further studied in the future for a better understanding of healthcare services management.

  13. Ethnic Variations in Prognosis of Patients with Dementia: A Prospective Nationwide Registry Linkage Study in The Netherlands.

    Science.gov (United States)

    Agyemang, Charles; van de Vorst, Irene E; Koek, Huiberdina L; Bots, Michiel L; Seixas, Azizi; Norredam, Marie; Ikram, Umar; Stronks, Karien; Vaartjes, Ilonca

    2017-01-01

    Data on dementia prognosis among ethnic minority groups are limited in Europe. We assessed differences in short-term (1-year) and long-term (3-year) mortality and readmission risk after a first hospitalization or first ever referral to a day clinic for dementia between ethnic minority groups and the ethnic Dutch population in the NetherlandsMethods: Nationwide prospective cohorts of first hospitalized dementia patients (N = 55,827) from January 1, 2000 to December 31, 2010 were constructed. Differences in short-term and long-term mortality and readmission risk following hospitalization or referral to the day clinic between ethnic minority groups (Surinamese, Turkish, Antilleans, Indonesians) and the ethnic Dutch population were investigated using Cox proportional hazard regression models with adjustment for age, sex, and comorbidities. Age-sex-adjusted short-term and long-term risks of death following a first hospitalization with dementia were comparable between the ethnic minority groups and the ethnic Dutch. Age- and sex-adjusted risk of admission was higher only in Turkish compared with ethnic Dutch (HR 1.57, 95% CI,1.08-2.29). The difference between Turkish and the Dutch attenuated and was no longer statistically significant after further adjustment for comorbidities. There were no ethnic differences in short-term and long-term risk of death, and risk of readmission among day clinic patients. Compared with Dutch patients with a comparable comorbidity rate, ethnic minority patients with dementia did not have a worse prognosis. Given the poor prognosis of dementia, timely and targeted advance care planning is essential, particularly in ethnic minority groups who are mired by cultural barriers and where uptake of advance care planning is known to be low.

  14. No evidence of a causal relationship between hypothyroidism and glaucoma: A Danish nationwide register-based cohort study.

    Science.gov (United States)

    Thvilum, Marianne; Brandt, Frans; Brix, Thomas Heiberg; Hegedüs, Laszlo

    2018-01-01

    An interrelationship between hypothyroidism and glaucoma, due to a shared autoimmune background or based on deposition of mucopolysaccharides in the trabecular meshwork in the eye, has been suggested but is at present unsubstantiated. Therefore, our objective was to investigate, at a nationwide and population-based level, whether there is such an association. Observational cohort study using record-linkage data from nationwide Danish health registers. 121,799 individuals diagnosed with a first episode of hypothyroidism were identified and were matched with 4 non-hypothyroid controls according to age and sex. Prevalence of glaucoma was recorded and cases and controls were followed over a mean of 7.1 years (range 0-17). Logistic and Cox regression models were used to assess the risk of glaucoma before and after the diagnosis of hypothyroidism, respectively. Overall, we found a higher prevalence of glaucoma in subjects with hypothyroidism as compared to controls (4.6% vs. 4.3%, p glaucoma [1.09; 95% confidence interval (CI): 1.04-1.13]. Based on the Cox regression model, there was no increased risk of glaucoma after the diagnosis of hypothyroidism [hazard ratio (HR) 1.00; 95% CI: 0.96-1.06], and the HR decreased further after adjusting for pre-existing co-morbidity (0.88; 95% CI: 0.84-0.93). There was an increased risk of glaucoma before but not after the diagnosis of hypothyroidism, suggesting that screening for glaucoma in hypothyroid individuals is unwarranted.

  15. Analysis of risk factors for schizophrenia with two different case definitions: a nationwide register-based external validation study.

    Science.gov (United States)

    Sørensen, Holger J; Larsen, Janne T; Mors, Ole; Nordentoft, Merete; Mortensen, Preben B; Petersen, Liselotte

    2015-03-01

    Different case definitions of schizophrenia have been used in register based research. However, no previous study has externally validated two different case definitions of schizophrenia against a wide range of risk factors for schizophrenia. We investigated hazard ratios (HRs) for a wide range of risk factors for ICD-10 DCR schizophrenia using a nationwide Danish sample of 2,772,144 residents born in 1955-1997. We compared one contact only (OCO) (the case definition of schizophrenia used in Danish register based studies) with two or more contacts (TMC) (a case definition of at least 2 inpatient contacts with schizophrenia). During the follow-up, the OCO definition included 15,074 and the TMC 7562 cases; i.e. half as many. The TMC case definition appeared to select for a worse illness course. A wide range of risk factors were uniformly associated with both case definitions and only slightly higher risk estimates were found for the TMC definition. Choosing at least 2 inpatient contacts with schizophrenia (TMC) instead of the currently used case definition would result in almost similar risk estimates for many well-established risk factors. However, this would also introduce selection and include considerably fewer cases and reduce power of e.g. genetic studies based on register-diagnosed cases only. Copyright © 2015 Elsevier B.V. All rights reserved.

  16. No evidence of a causal relationship between hypothyroidism and glaucoma: A Danish nationwide register-based cohort study

    Science.gov (United States)

    2018-01-01

    Background An interrelationship between hypothyroidism and glaucoma, due to a shared autoimmune background or based on deposition of mucopolysaccharides in the trabecular meshwork in the eye, has been suggested but is at present unsubstantiated. Therefore, our objective was to investigate, at a nationwide and population-based level, whether there is such an association. Subjects and methods Observational cohort study using record-linkage data from nationwide Danish health registers. 121,799 individuals diagnosed with a first episode of hypothyroidism were identified and were matched with 4 non-hypothyroid controls according to age and sex. Prevalence of glaucoma was recorded and cases and controls were followed over a mean of 7.1 years (range 0–17). Logistic and Cox regression models were used to assess the risk of glaucoma before and after the diagnosis of hypothyroidism, respectively. Results Overall, we found a higher prevalence of glaucoma in subjects with hypothyroidism as compared to controls (4.6% vs. 4.3%, p hypothyroidism, the odds ratio (OR) was significantly increased for glaucoma [1.09; 95% confidence interval (CI): 1.04–1.13]. Based on the Cox regression model, there was no increased risk of glaucoma after the diagnosis of hypothyroidism [hazard ratio (HR) 1.00; 95% CI: 0.96–1.06], and the HR decreased further after adjusting for pre-existing co-morbidity (0.88; 95% CI: 0.84–0.93). Conclusions There was an increased risk of glaucoma before but not after the diagnosis of hypothyroidism, suggesting that screening for glaucoma in hypothyroid individuals is unwarranted. PMID:29444121

  17. Associations between partial sickness benefit and disability pensions: initial findings of a Finnish nationwide register study.

    Science.gov (United States)

    Kausto, Johanna; Virta, Lauri; Luukkonen, Ritva; Viikari-Juntura, Eira

    2010-06-23

    Timely return to work after longterm sickness absence and the increased use of flexible work arrangements together with partial health-related benefits are tools intended to increase participation in work life. Although partial sickness benefit and partial disability pension are used in many countries, prospective studies on their use are largely lacking. Partial sickness benefit was introduced in Finland in 2007. This register study aimed to investigate the use of health-related benefits by subjects with prolonged sickness absence, initially on either partial or full sick leave. Representative population data (13 375 men and 16 052 women either on partial or full sick leave in 2007) were drawn from national registers and followed over an average of 18 months. The registers provided information on the study outcomes: diagnoses and days of payment for compensated sick leaves, and the occurrence of disability pension. Survival analysis and multinomial regression were carried out using sociodemographic variables and prior sickness absence as covariates. Approximately 60% of subjects on partial sick leave and 30% of those on full sick leave had at least one recurrent sick leave over the follow up. A larger proportion of those on partial sick leave (16%) compared to those on full sick leave (1%) had their first recurrent sick leave during the first month of follow up. The adjusted risks of the first recurrent sick leave were 1.8 and 1.7 for men and women, respectively, when subjects on partial sick leave were compared with those on full sick leave. There was no increased risk when those with their first recurrent sick leave in the first month were excluded from the analyses. The risks of a full disability pension were smaller and risks of a partial disability pension approximately two-fold among men and women initially on partial sick leave, compared to subjects on full sick leave. This is the first follow up study of the newly adopted partial sickness benefit in

  18. Associations between partial sickness benefit and disability pensions: initial findings of a Finnish nationwide register study

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    Luukkonen Ritva

    2010-06-01

    Full Text Available Abstract Background Timely return to work after longterm sickness absence and the increased use of flexible work arrangements together with partial health-related benefits are tools intended to increase participation in work life. Although partial sickness benefit and partial disability pension are used in many countries, prospective studies on their use are largely lacking. Partial sickness benefit was introduced in Finland in 2007. This register study aimed to investigate the use of health-related benefits by subjects with prolonged sickness absence, initially on either partial or full sick leave. Methods Representative population data (13 375 men and 16 052 women either on partial or full sick leave in 2007 were drawn from national registers and followed over an average of 18 months. The registers provided information on the study outcomes: diagnoses and days of payment for compensated sick leaves, and the occurrence of disability pension. Survival analysis and multinomial regression were carried out using sociodemographic variables and prior sickness absence as covariates. Results Approximately 60% of subjects on partial sick leave and 30% of those on full sick leave had at least one recurrent sick leave over the follow up. A larger proportion of those on partial sick leave (16% compared to those on full sick leave (1% had their first recurrent sick leave during the first month of follow up. The adjusted risks of the first recurrent sick leave were 1.8 and 1.7 for men and women, respectively, when subjects on partial sick leave were compared with those on full sick leave. There was no increased risk when those with their first recurrent sick leave in the first month were excluded from the analyses. The risks of a full disability pension were smaller and risks of a partial disability pension approximately two-fold among men and women initially on partial sick leave, compared to subjects on full sick leave. Conclusions This is the first follow

  19. Resource allocation of in vitro fertilization: a nationwide register-based cohort study

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    Sevón Tiina

    2007-12-01

    Full Text Available Abstract Background Infertility is common and in vitro fertilization (IVF is a widely used treatment. In IVF the need increases and the effectiveness and appropriateness decrease by age. The purpose of this study was to describe allocation of resources for IVF by women's age, socioeconomic position, area of residence and treatment sector (public vs. private and to discuss how fairly the IVF resources are allocated in Finland. Methods Women who received IVF between 1996 and 1998 (N = 9175 were identified from the reimbursement records of the Social Insurance Institution (SII. Information on IVF women's background characteristics came from the Central Population Register and the SII, on treatment costs from IVF clinics and the SII, and on births from the Medical Birth Register. The main outcome measures were success of IVF by number of cycles and treated women, expenditures per IVF cycles, per women, per live-birth, and per treatment sector, and private and public expenditures. Expenditures were estimated from health care visits and costs. Results During a mean period of 1.5 years, older women (women aged 40 or older received 1.4 times more IVF treatment cycles than younger women (women aged below 30. The success rate decreased by age: from 22 live births per 100 cycles among younger women to 6 per 100 among older women. The mean cost of a live birth increased by age: compared to younger women, costs per born live birth of older women were 3-fold. Calculated by population, public expenditure was allocated most to young women and women from the highest socioeconomic position. Regional differences were not remarkable. Conclusion Children of older infertile women involve more expense due to the lower success rates of IVF. Socioeconomic differences suggest unfair resource allocation in Finland.

  20. Resource allocation of in vitro fertilization: a nationwide register-based cohort study

    Science.gov (United States)

    Klemetti, Reija; Gissler, Mika; Sevón, Tiina; Hemminki, Elina

    2007-01-01

    Background Infertility is common and in vitro fertilization (IVF) is a widely used treatment. In IVF the need increases and the effectiveness and appropriateness decrease by age. The purpose of this study was to describe allocation of resources for IVF by women's age, socioeconomic position, area of residence and treatment sector (public vs. private) and to discuss how fairly the IVF resources are allocated in Finland. Methods Women who received IVF between 1996 and 1998 (N = 9175) were identified from the reimbursement records of the Social Insurance Institution (SII). Information on IVF women's background characteristics came from the Central Population Register and the SII, on treatment costs from IVF clinics and the SII, and on births from the Medical Birth Register. The main outcome measures were success of IVF by number of cycles and treated women, expenditures per IVF cycles, per women, per live-birth, and per treatment sector, and private and public expenditures. Expenditures were estimated from health care visits and costs. Results During a mean period of 1.5 years, older women (women aged 40 or older) received 1.4 times more IVF treatment cycles than younger women (women aged below 30). The success rate decreased by age: from 22 live births per 100 cycles among younger women to 6 per 100 among older women. The mean cost of a live birth increased by age: compared to younger women, costs per born live birth of older women were 3-fold. Calculated by population, public expenditure was allocated most to young women and women from the highest socioeconomic position. Regional differences were not remarkable. Conclusion Children of older infertile women involve more expense due to the lower success rates of IVF. Socioeconomic differences suggest unfair resource allocation in Finland. PMID:18154645

  1. Resource allocation of in vitro fertilization: a nationwide register-based cohort study.

    Science.gov (United States)

    Klemetti, Reija; Gissler, Mika; Sevón, Tiina; Hemminki, Elina

    2007-12-21

    Infertility is common and in vitro fertilization (IVF) is a widely used treatment. In IVF the need increases and the effectiveness and appropriateness decrease by age. The purpose of this study was to describe allocation of resources for IVF by women's age, socioeconomic position, area of residence and treatment sector (public vs. private) and to discuss how fairly the IVF resources are allocated in Finland. Women who received IVF between 1996 and 1998 (N = 9175) were identified from the reimbursement records of the Social Insurance Institution (SII). Information on IVF women's background characteristics came from the Central Population Register and the SII, on treatment costs from IVF clinics and the SII, and on births from the Medical Birth Register. The main outcome measures were success of IVF by number of cycles and treated women, expenditures per IVF cycles, per women, per live-birth, and per treatment sector, and private and public expenditures. Expenditures were estimated from health care visits and costs. During a mean period of 1.5 years, older women (women aged 40 or older) received 1.4 times more IVF treatment cycles than younger women (women aged below 30). The success rate decreased by age: from 22 live births per 100 cycles among younger women to 6 per 100 among older women. The mean cost of a live birth increased by age: compared to younger women, costs per born live birth of older women were 3-fold. Calculated by population, public expenditure was allocated most to young women and women from the highest socioeconomic position. Regional differences were not remarkable. Children of older infertile women involve more expense due to the lower success rates of IVF. Socioeconomic differences suggest unfair resource allocation in Finland.

  2. Nutritional rickets in Norway: a nationwide register-based cohort study.

    Science.gov (United States)

    Meyer, Haakon E; Skram, Kristina; Berge, Ingvill Almås; Madar, Ahmed A; Bjørndalen, Hilde Johanne

    2017-05-29

    Poor vitamin D status has been reported to be highly prevalent in many non-western immigrant groups living in Norway and other western countries. However, data on rickets are scarce, and the aim of the current study was to identify new cases of nutritional rickets in Norway in the period 2008-2012 among children under the age of 5 years. Register-based cohort study. The Norwegian population from 2008 to 2012. Children with nutritional rickets under the age of 5 years. Nutritional rickets. Patients with ICD10 (International Statistical Classification of Diseases and Related Health Problems, 10th revision) diagnosis code E55.0 (active rickets) treated at all Norwegian hospitals were identified in the Norwegian Patient Registry. We were able to review 85% of the medical records for diagnosis confirmation. In addition, we identified patients with the diagnoses E55.9, E64.3 and E83.3 to identify individuals with rickets who had been given other diagnoses. Nutritional rickets was confirmed in 39 children aged 0-4 years with the diagnosis of E55.0. In addition, three patients with the diagnosis of unspecified vitamin D deficiency (E55.9) were classified as having nutritional rickets, giving a total of 42 patients. Mean age at diagnosis was 1.40 years (range 0.1-3.5 years), and 93% had a non-western immigrant background. The incidence rate of rickets was estimated to be 0.3 per 10 000 person-years in the total Norwegian child population under the age of 5 years and 3.1 per 10 000 person-years in those with an immigrant background from Asia or Africa. The number of children with nutritional rickets in Norway remained low in the period 2008-2012. Nearly all children had a non-western immigrant background. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  3. Death by Suicide in Graves' Disease and Graves' Orbitopathy: A Nationwide Danish Register Study.

    Science.gov (United States)

    Ferløv-Schwensen, Charlotte; Brix, Thomas Heiberg; Hegedüs, Laszlo

    2017-12-01

    Graves' disease (GD) is associated with excess morbidity and mortality, but little is known about unnatural manners of death and the potential relation with Graves' orbitopathy (GO). This study investigated the risk of unnatural death in Graves' patients with and without orbitopathy compared to matched control populations. This was a cohort study covering all adult Danes (≥18 years) diagnosed with GD or GO during 1995-2012. Median follow-up time was 7.9 years (range 0-17.5 years). Utilizing the Danish Register of Causes of Death and the Danish National Patient Registry, 28,461 subjects with GD and 3965 with GO were identified and matched for age and sex with four subjects from the background population. The manner of death was identified, and hazard ratios (HR) for mortality due to unnatural deaths (accident, suicide, violence/homicide, and unknown) were calculated using Cox regression analyses, adjusted for pre-existing somatic and psychiatric morbidity. In Graves' disease overall (GD + GO), there was an increased risk of death from unknown unnatural manners (HR = 2.01 [confidence interval (CI) 1.17-3.45], p = 0.012) and of suicide, although the latter difference was not with certainty statistically significant (HR = 1.43 [CI 1.00-2.04], p = 0.053). There was no significant difference in risk of death from suicide in GD subjects compared to their controls (HR = 1.27 [CI 0.85-1.89], p = 0.253). However, GO patients had a significantly higher risk of death from suicide (HR = 2.71 [CI 1.16-6.32], p = 0.022). Mortality by suicide was increased in Graves' disease overall, most significantly in patients with GO, also after adjustment for pre-existing somatic and psychiatric disease. These findings indicate that GD and GO may have a significant role in the pathophysiological mechanisms of suicidal behavior. Beyond independent confirmation, reasons for this need to be explored in order to introduce preventive measures.

  4. Association between alcohol, cannabis, and other illicit substance abuse and risk of developing schizophrenia: a nationwide population based register study.

    Science.gov (United States)

    Nielsen, S M; Toftdahl, N G; Nordentoft, M; Hjorthøj, C

    2017-07-01

    Several studies have examined whether use of substances can cause schizophrenia. However, due to methodological limitations in the existing literature (e.g. selection bias and lack of adjustment of co-abuse) uncertainties still remain. We aimed to investigate whether substance abuse increases the risk of developing schizophrenia, addressing some of these limitations. The longitudinal, nationwide Danish registers were linked to establish a cohort of 3 133 968 individuals (105 178 673 person-years at risk), identifying 204 505 individuals diagnosed with substance abuse and 21 305 diagnosed with schizophrenia. Information regarding substance abuse was extracted from several registers and did not include psychotic symptoms caused by substance abuse in the definition. This resulted in a large, generalizable sample of exposed individuals. The data was analysed using Cox regression analyses, and adjusted for calendar year, gender, urbanicity, co-abuse, other psychiatric diagnosis, parental substance abuse, psychiatric history, immigration and socioeconomic status. A diagnosis of substance abuse increased the overall risk of developing schizophrenia [hazard ratio (HR) 6.04, 95% confidence interval (CI) 5.84-6.26]. Cannabis (HR 5.20, 95% CI 4.86-5.57) and alcohol (HR 3.38, 95% CI 3.24-3.53) presented the strongest associations. Abuse of hallucinogens (HR 1.86, 95% CI 1.43-2.41), sedatives (HR 1.68, 95% CI 1.49-1.90), and other substances (HR 2.85, 95% CI 2.58-3.15) also increased the risk significantly. The risk was found to be significant even 10-15 years subsequent to a diagnosis of substance abuse. Our results illustrate robust associations between almost any type of substance abuse and an increased risk of developing schizophrenia later in life.

  5. An association between initiation of selective serotonin reuptake inhibitors and suicide - a nationwide register-based case-crossover study.

    Directory of Open Access Journals (Sweden)

    Charlotte Björkenstam

    Full Text Available BACKGROUND: Treatment with selective serotonin reuptake inhibitors (SSRI is one of the most common treatments for depression. It is however not clear whether or not there is an increased short-term suicide risk during initiation with SSRI. METHODS: A register-based nationwide case-crossover study including 5,866 suicides, 1,698 women and 4,168 men, from the Death Register 2007-2010 in Sweden. SSRI initiation was defined as a dispensed prescription of SSRI within 28 days prior to the date of suicide with no previous dispensed prescription of SSRI within 4 months prior that prescription. The control period took place one year earlier. Odds ratio (OR was estimated using conditional logistic regression. RESULT: During the 28 day period prior to suicide 48 women and 138 men were exposed to SSRI initiation (while not being exposed in the control period and 22 women and 43 men were exposed in the control period (while not being exposed in the case period. The OR for suicide after initiation with SSRI was 2.7 (95% CI: 1.6-44 for women, and 4.3 (95% CI: 3.0-6.1 for men. The highest OR was found 8-11 days after initiation with SSRI 9.7 (95% CI: 3.0-31.7 for women and men combined. CONCLUSION: The main limitation in this study is confounding by indication, but the descriptive question is however not confounded by indication. Together with plausible biological mechanisms and previous clinical and epidemiological observations our findings, linking initiation of SSRI to increased short-term suicide risk, deserve further attention specifically in the clinical setting.

  6. Determinants of duration of untreated psychosis among first-episode psychosis patients in Denmark: A nationwide register-based study.

    Science.gov (United States)

    Hastrup, Lene Halling; Haahr, Ulrik Helt; Jansen, Jens Einar; Simonsen, Erik

    2018-02-01

    Information on determinants of duration of untreated psychosis (DUP) is still needed to inform campaigns targeting people with first episode psychosis (FEP). This nation-wide study analysed the association between demographic factors (age, sex, ethnicity, marital status, and geographic area), premorbid and illness-related factors (global functional level, substance misuse, and contact to police), healthcare factors (referral source and first FEP contact) and DUP. The study population of 1266 patients aged 15-25years diagnosed with FEP (ICD10 F20.0-F20.99) was drawn from the Danish National Indicator Project during 2009-2011. The study population was combined with data from national administrative registers. A multinomial regression model was estimated to analyse the impact of demographic, premorbid and illness-related, and healthcare factors on DUP. One third of the population had a DUP below 6months. DUP longer than 12months was associated with older age at onset, being female, having cannabis misuse, and living in peripheral municipalities. Being charged by the criminal authorities during one year before FEP was associated with a DUP over 6months. DUP is related to a number of demographic, premorbid and healthcare factors. These findings suggest that future information campaigns should focus on increasing the awareness of early signs of psychosis not only among mental health professionals but also other professionals in contact with adolescents such as the police. It may also be useful to consider how to target information campaigns towards persons living in peripheral areas. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Cardiovascular disease in patients with osteogenesis imperfecta - a nationwide, register-based cohort study

    DEFF Research Database (Denmark)

    Folkestad, Lars; Hald, Jannie Dahl; Gram, Jeppe

    2016-01-01

    BACKGROUND: Osteogenesis imperfecta (OI) is a hereditary connective tissue disease often due to mutations in genes coding for type 1 collagen. Collagen type 1 is important in the development of the heart and vasculature. Little is known about the risk of cardiovascular disease (CVD) in OI...

  8. Mean Daily Dosage of Aspirin and the Risk of Incident Alzheimer’s Dementia in Patients with Type 2 Diabetes Mellitus: A Nationwide Retrospective Cohort Study in Taiwan

    Directory of Open Access Journals (Sweden)

    Cheng-Wei Chang

    2016-01-01

    Full Text Available Background. Type 2 diabetes mellitus patients are known to have higher risk of developing dementia while aspirin use has been shown to prevent incident dementia. This study was conducted to evaluate the potential benefits of aspirin use on dementia in patients with type 2 diabetes mellitus and identify the appropriate dosage of aspirin that provides the most benefit. Method. A Taiwan nationwide, population-based retrospective 8-year study was employed to analyze the association between the use of aspirin and incidence of dementia including Alzheimer’s disease and non-Alzheimer’s dementia using multivariate Cox-proportional hazards regression model and adjusting for several potential confounders. Results. Regular aspirin use in mean daily dosage of within 40 mg was associated with a decreased risk of developing incident Alzheimer’s dementia in patients with type 2 diabetes mellitus (adjusted HR of 0.51 with 95% CI of 0.27–0.97, p value 0.041. Conclusion. A mean daily dosage of aspirin use within 40 mg might decrease the risk of developing Alzheimer’s disease in patients with type 2 diabetes mellitus.

  9. Dying in Hospital with Dementia and Pneumonia: A Nationwide Study Using Death Certificate Data

    NARCIS (Netherlands)

    Houttekier, D.; Reyniers, T.; Deliens, L.; Den Noortgate, N.; Cohen, J.

    2014-01-01

    Background: For people with dementia dying from pneumonia, hospitalization at the end of life may be of little benefit and result in unfavourable outcomes such as hospital death. Objective: The aim of this study is to estimate the incidence of and factors associated with hospital death in people

  10. Ethnic Variations in Prognosis of Patients with Dementia : A Prospective Nationwide Registry Linkage Study in The Netherlands

    NARCIS (Netherlands)

    Agyemang, Charles; van de Vorst, Irene E; Koek, Huiberdina L; Bots, Michiel L; Seixas, Azizi; Norredam, Marie; Ikram, Umar; Stronks, Karien; Vaartjes, Ilonca

    2017-01-01

    BACKGROUND: Data on dementia prognosis among ethnic minority groups are limited in Europe. OBJECTIVE: We assessed differences in short-term (1-year) and long-term (3-year) mortality and readmission risk after a first hospitalization or first ever referral to a day clinic for dementia between ethnic

  11. Ethnic Variations in Prognosis of Patients with Dementia: A Prospective Nationwide Registry Linkage Study in The Netherlands

    NARCIS (Netherlands)

    Agyemang, Charles; van de Vorst, Irene E.; Koek, Huiberdina L.; Bots, Michiel L.; Seixas, Azizi; Norredam, Marie; Ikram, Umar; Stronks, Karien; Vaartjes, Ilonca

    2017-01-01

    Background: Data on dementia prognosis among ethnic minority groups are limited in Europe. Objective: We assessed differences in short-term (1-year) and long-term (3-year) mortality and readmission risk after a first hospitalization or first ever referral to a day clinic for dementia between ethnic

  12. Are Chronic Periodontitis and Gingivitis Associated with Dementia? A Nationwide, Retrospective, Matched-Cohort Study in Taiwan.

    Science.gov (United States)

    Tzeng, Nian-Sheng; Chung, Chi-Hsiang; Yeh, Chin-Bin; Huang, Ren-Yeong; Yuh, Da-Yo; Huang, San-Yuan; Lu, Ru-Band; Chang, Hsin-An; Kao, Yu-Chen; Chiang, Wei-Shan; Chou, Yu-Ching; Chien, Wu-Chien

    2016-01-01

    Chronic periodontitis and gingivitis are associated with various diseases; however, their impact on dementia is yet to be elucidated. This study is aimed at investigating the association between chronic periodontitis and gingivitis, and the risk of developing dementia. A total of 2,207 patients, with newly diagnosed chronic periodontitis and gingivitis between January 1, 2000 and December 31, 2000, were selected from the National Health Insurance Research Database of Taiwan, along with 6,621 controls matched for sex and age. After adjusting for confounding factors, Cox proportional hazards analysis was used to compare the risk of developing dementia during the 10-year follow-up period. Of the study subjects, 25 (1.13%) developed dementia compared to 61 (0.92%) in the control group. Cox proportional hazards regression analysis revealed that the study subjects were more likely to develop dementia (hazard ratio (HR) 2.085, 95% CI 1.552-4.156, p gingivitis have a higher risk of developing dementia. However, further studies on other large or national data sets are required to support the current findings. © 2016 S. Karger AG, Basel.

  13. A Doctor’s Name as a Brand: A Nationwide Survey on Registered Clinic Names in Taiwan

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    Feng-Yuan Chu

    2018-06-01

    Full Text Available In countries where the private clinics of physicians can be freely named, registering a clinic with a physician’s name is one way to make patients familiar with the physician. No previous study had investigated how clinics make use of this method of personal branding. Therefore, the current study analyzed 10,847 private physician Western medicine clinics in Taiwan. Of those clinics, 31.0% (n = 3363 were named with a physician’s full name, 8.9% (n = 960 with a surname, and 8.1% (n = 884 with a given name. The proportion of clinics registered with a physician’s name was lower in rural areas (37.3% than in urban (48.5% and suburban areas (49.2%, respectively. Among clinics with only one kind of specialist, a physician’s name was used most frequently in clinics of obstetrics and gynecology (64.9%, otorhinolaryngology (64.1%, and dermatology (63.4%. In Taiwan, fewer than half of clinics used a physician’s name as a brand. The sociocultural or strategic factors and real benefits of doing so could be further studied in the future for a better understanding of healthcare services management.

  14. Risk of subsequent dementia among patients with bipolar disorder or major depression: a nationwide longitudinal study in Taiwan.

    Science.gov (United States)

    Chen, Mu-Hong; Li, Cheng-Ta; Tsai, Chia-Fen; Lin, Wei-Chen; Chang, Wen-Han; Chen, Tzeng-Ji; Pan, Tai-Long; Su, Tung-Ping; Bai, Ya-Mei

    2015-06-01

    Both major depression and bipolar disorder are associated with an increased risk of developing dementia. However, the differential risk of dementia between major depression and bipolar disorder is rarely investigated. Using the Taiwan National Health Insurance Research Database, a total of 2291 patients aged ≥ 55 years (major depression: 1946 and bipolar disorder: 345) and 2291 age-and sex-matched controls were enrolled between 1998 and 2008, and followed to the end of 2011. Participants who developed dementia during the follow-up were identified. Both patients with bipolar disorder [hazard ratio (HR) 5.58, 95% confidence interval (CI) 4.26-7.32] and those with major depression (HR 3.02, 95% CI 2.46-3.70) had an increased risk of developing dementia in later life, after adjusting for demographic data and medical comorbidities. The sensitivity tests after excluding the 1-year (bipolar disorder: HR 4.73, 95% CI 3.50-6.35; major depression: HR 2.62, 95% CI 2.11-3.25) and 3-year (HR 3.92, 95% CI 2.78-5.54; HR 2.21, 95% CI 1.73-2.83, respectively) follow-up duration also revealed consistent findings. Furthermore, patients with bipolar disorder were associated with an 87% increased risk (HR 1.87, 95% CI 1.48-2.37) of subsequent dementia compared with patients with major depression. Midlife individuals with bipolar disorder or major depression were associated with an elevated risk of developing dementia in later life. Further studies may be required to clarify the underlying mechanisms among major depression, bipolar disorder, and dementia, and to investigate whether prompt intervention may decrease this risk. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  15. Schizophrenia Spectrum Disorders in a Danish 22q11.2 Deletion Syndrome Cohort Compared to the Total Danish Population-A Nationwide Register Study

    DEFF Research Database (Denmark)

    Vangkilde, Anders; Olsen, Line; Hoeffding, Louise K

    2016-01-01

    OBJECTIVE: Cross-sectional studies have shown associations between 22q11.2 deletion syndrome and schizophrenia. However, large-scale prospective studies have been lacking. We, therefore, conducted the first large-scale population based study on the risk of being diagnosed with schizophrenia...... in persons identified with 22q11.2 deletion syndrome. METHODS: Danish nationwide registers were linked to establish a cohort consisting of all Danish citizens born during 1955-2004 and the cohort was followed from January 1, 1994 until December 31, 2013. Data were analyzed using survival analyses...... and adjusted for calendar year, age, sex, and parental mental health history. RESULTS: A total of 156 individuals with 22q11.2 deletion syndrome were identified, out of which 6 individuals were diagnosed with schizophrenia spectrum disorders following identification with 22q11 deletion syndrome. Identified...

  16. Quality of dying in nursing home residents dying with dementia: does advanced care planning matter? A nationwide postmortem study.

    Directory of Open Access Journals (Sweden)

    An Vandervoort

    Full Text Available Advance care planning is considered a central component of good quality palliative care and especially relevant for people who lose the capacity to make decisions at the end of life, which is the case for many nursing home residents with dementia. We set out to investigate to what extent (1 advance care planning in the form of written advance patient directives and verbal communication with patient and/or relatives about future care and (2 the existence of written advance general practitioner orders are related to the quality of dying of nursing home residents with dementia.Cross-sectional study of deaths (2010 using random cluster-sampling. Representative sample of nursing homes in Flanders, Belgium. Deaths of residents with dementia in a three-month period were reported; for each the nurse most involved in care, GP and closest relative completed structured questionnaires.We identified 101 deaths of residents with dementia in 69 nursing homes (58% response rate. A written advance patient directive was present for 17.5%, GP-orders for 56.7%. Controlling for socio-demographic/clinical characteristics in multivariate regression analyses, chances of having a higher mean rating of emotional well-being (less fear and anxiety on the Comfort Assessment in Dying with Dementia scale were three times higher with a written advance patient directive and more specifically when having a do-not-resuscitate order (AOR 3.45; CI,1.1-11 than for those without either (AOR 2.99; CI,1.1-8.3. We found no association between verbal communication or having a GP order and quality of dying.For nursing home residents with dementia there is a strong association between having a written advance directive and quality of dying. Where wishes are written, relatives report lower levels of emotional distress at the end of life. These results underpin the importance of advance care planning for people with dementia and beginning this process as early as possible.

  17. Use of acid-suppressive therapy before anti-reflux surgery in 2922 patients: a nationwide register-based study in Denmark.

    Science.gov (United States)

    Lødrup, A; Pottegård, A; Hallas, J; Bytzer, P

    2015-07-01

    Guidelines recommend that patients with gastro-oesophageal reflux disease are adequately treated with acid-suppressive therapy before undergoing anti-reflux surgery. Little is known of the use of acid-suppressive drugs before anti-reflux surgery. To determine the use of proton pump inhibitors and H2 -receptor antagonists in the year before anti-reflux surgery. A nationwide retrospective study of all patients aged ≥18 undergoing first-time anti-reflux surgery in Denmark during 2000-2012 using data from three different sources: the Danish National Register of Patients, the Danish National Prescription Register, and the Danish Person Register. The study population thus included 2922 patients (median age: 48 years, 55.7% male). The annual proportion of patients redeeming ≥180 DDD of acid-suppressive therapy increased from 17.0% 5 years before anti-reflux surgery to 64.9% 1 year before. The probability for inadequate dosing 1 year before surgery (reflux surgery, as a high proportion of patients receive inadequate dosing of acid-suppressive therapy prior to the operation. © 2015 John Wiley & Sons Ltd.

  18. A Japanese nationwide survey on the FDG-PET scans for dementia. Analysis on the predicted costs and benefits of FDG-PET for early diagnosis of Alzheimer

    International Nuclear Information System (INIS)

    Senda, Michio; Ouchi, Yasuomi; Ishii, Kazunari

    2003-01-01

    A nation-wide survey was carried out on the FDG-PET scans for the diagnosis of dementia by the FDG-PET Working Group organized by both the Japan Radioisotope Association and the Japanese Society of Nuclear Medicine. A total of 406 case reports were presented by 15 PET centers for one year. The purpose of the PET scans included early diagnosis of Alzheimer-type Dementia (154 cases, group A) and differential diagnosis of degenerative dementia (144 cases, group B), which was achieved by the PET scan in most cases. The PET scan turned out to allow omitting cerebral blood flow (CBF)-SPECT scans. Since donepezil treatment of the Alzheimer patients prevents the progress of the disease and reduces the care cost, an economic evaluation was performed on the two-year projected cost and benefit of FDG-PET. The reduction of the total cost by incorporating PET into the protocol was predicted to be 61500 yen (group A) and 13700 yen (group B) per person. The increase of the quality adjusted life year (QALY) was predicted to be 0.0442 (group A) and 0.0137 (group B). Therefore, incorporation of PET into the clinical pass was shown to be an economically dominant. As the number of potential subjects for early diagnosis of dementia is estimated to be 9000 across the country every year, PET is expected to increase their quality of life equivalent to 398 intact persons per year while reducing the cost of health care by 554 million yen. (author)

  19. Early-onset inguinal hernia as risk factor for schizophrenia or related psychosis: a nationwide register-based cohort study.

    Science.gov (United States)

    Melkersson, Kristina; Wernroth, Mona-Lisa

    2017-10-01

    In an earlier interview study, we found that more men with familial schizophrenia had undergone inguinal hernia operation, than men with sporadic schizophrenia. However, there are no other studies published specifically on inguinal hernia and schizophrenia. Therefore, the aim of this study was to carry out a Swedish register-based cohort study on the association between inguinal hernia and schizophrenia or related psychosis. Data from the Total Population- and Medical Birth-Registers were used to create a cohort of all individuals born in Sweden 1987-1999 (n=1 406 168). The cohort individuals were linked with the In- and Out-patient Registers and followed from birth to 2015 to identify onset of schizophrenia, schizoaffective disorder and inguinal hernia. Cox proportional hazards regression models were used to assess the association between inguinal hernia before age 13 and risk of developing schizophrenia or schizoaffective disorder during a follow-up from age 13. Inguinal hernia before age 13 was identified in 21 095 individuals, and during the follow-up in total 1314 individuals developed schizophrenia or schizoaffective disorder. The risk of schizophrenia or schizoaffective disorder was higher among individuals with inguinal hernia before age 13, than among individuals without such a diagnosis, especially among the men [adjusted hazard ratio (95% confidence interval); all: 1.44 (1.01-2.06), p=0.0452, men: 1.46 (1.01-2.12), p=0.0460, women: 0.56 (0.14-2.27), p=0.4173]. This study shows that early-onset inguinal hernia is associated with increased risk of developing schizophrenia or schizoaffective disorder, especially in men. Such an association may point to a common biological basis for the development of inguinal hernia and schizophrenia or related psychosis.

  20. The Incidence of Eating Disorders in a Danish Nationwide Register Study Associations with Suicide Risk and Mortality

    Science.gov (United States)

    Zerwas, Stephanie; Larsen, Janne Tidselbak; Petersen, Liselotte; Thornton, Laura M.; Mortensen, Preben Bo; Bulik, Cynthia M.

    2015-01-01

    Our aim was to characterize the incidence rates and cumulative incidence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), and examine associations among eating disorder diagnoses, suicide attempts, and mortality. Individuals born in Denmark between 1989 and 2006 were included (N=966,141, 51.3% male). Eating disorders diagnoses (AN, Broad AN, BN, EDNOS) were drawn from the Danish Psychiatric Central Research Register (PCRR) and Danish National Patient Register (NPR). Suicide attempts and deaths were captured in the NPR, the PCRR, and the Danish Civil Registration System (CRS). In females, AN had a peak hazard at approximately age 15 years, BN at 22 years, and EDNOS had an extended peak that spanned 18 years to 22 years. Eating disorder diagnoses predicted a significantly higher hazard for death and suicide attempt compared with the referent of individuals with no eating disorders. In males, peak hazard for diagnosis was earlier than in females. The present study represents one of the largest and longest studies of eating disorder incidence and suicide attempts and death in both females and males. Eating disorders are accompanied by increased hazard of suicide attempts and death even in young adults. PMID:25958083

  1. Type and Extent of Somatic Morbidity before and after the Diagnosis of Hypothyroidism. A Nationwide Register Study

    Science.gov (United States)

    Thvilum, Marianne; Brandt, Frans; Almind, Dorthe; Christensen, Kaare; Brix, Thomas Heiberg; Hegedüs, Laszlo

    2013-01-01

    Background Hypothyroidism has been linked with an increased risk of other morbidities, such as cardiovascular diseases and diabetes mellitus. However, the temporal relationship between these diseases and the diagnosis of hypothyroidism is not well illuminated. Such information may provide insight into causal relationships between hypothyroidism and other morbidities. Aim To investigate the type and extent of somatic morbidity before and after a diagnosis of hypothyroidism. Methods Observational cohort study. From official Danish health registers, 2822 hypothyroid singletons were identified and matched 1:4 with non-hypothyroid controls and observed over a mean period of 6 years. Frequency of different morbidities was obtained by person-to-person linking in the registers. Logistic and Cox regression models were used to assess the risk of morbidity before and after the diagnosis of hypothyroidism, respectively. Results Prior to the diagnosis of hypothyroidism there was a significantly increased risk of being diagnosed with cardiovascular diseases (odds ratio (OR) 1.37; 95% confidence interval (CI): 1.19–1.58), lung diseases (OR 1.25; 95% CI: 1.13–1.39), diabetes mellitus (OR 1.92; 95% CI: 1.61–2.29), as well as malignant diseases (OR 1.24; 95% CI: 1.06–1.45). Following the diagnosis of hypothyroidism there was a significantly increased risk of being diagnosed with cardiovascular diseases (hazard ratio (HR) 1.36; 95% CI: 1.15–1.60); lung diseases (HR 1.51; 95% CI: 1.30–1.75); and diabetes mellitus (HR 1.40; 95% CI: 1.11–1.77). Conclusions Prior to the diagnosis of hypothyroidism there is an excess risk of being diagnosed with cardiovascular diseases, lung diseases, diabetes mellitus, and malignant diseases. Following the diagnosis of hypothyroidism we demonstrate an increased frequency of cardiovascular diseases, lung diseases, and diabetes mellitus. PMID:24066186

  2. Adherence to drug label recommendations for avoiding drug interactions causing statin-induced myopathy--a nationwide register study.

    Directory of Open Access Journals (Sweden)

    Jennifer Settergren

    Full Text Available To investigate the extent to which clinicians avoid well-established drug-drug interactions that cause statin-induced myopathy. We hypothesised that clinicians would avoid combining erythromycin or verapamil/diltiazem respectively with atorvastatin or simvastatin. In patients with statin-fibrate combination therapy, we hypothesised that gemfibrozil was avoided to the preference of bezafibrate or fenofibrate. When combined with verapamil/diltiazem or fibrates, we hypothesized that the dispensed doses of atorvastatin/simvastatin would be decreased.Cross-sectional analysis of nationwide dispensing data. Odds ratios of interacting erythromycin, verapamil/diltiazem versus respective prevalence of comparator drugs doxycycline, amlodipine/felodipine in patients co-dispensed interacting statins simvastatin/atorvastatin versus patients unexposed (pravastatin/fluvastatin/rosuvastatin was calculated. For fibrates, OR of gemfibrozil versus fenofibrate/bezafibrate in patients co-dispensed any statin was assessed.OR of interacting erythromycin versus comparator doxycycline did not differ between patients on interacting and comparator statins either in patients dispensed high or low statin doses (adjusted OR 0.87; 95% CI 0.60-1.25 and 0.92; 95% CI 0.69-1.23. Interacting statins were less common among patients dispensed verapamil/diltiazem as compared to patients on amlodipine/felodipine (OR high dose 0.62; CI 0.56-0.68 and low dose 0.63; CI 0.58-0.68. Patients on any statin were to a lesser extent dispensed gemfibrozil compared to patients not dispensed a statin (OR high dose 0.65; CI 0.55-0.76 and low dose 0.70; CI 0.63-0.78. Mean DDD (SD for any statin was substantially higher in patients co-dispensed gemfibrozil 178 (149 compared to patients on statin monotherapy 127 (93, (p<0.001.Prescribers may to some extent avoid co-prescription of statins with calcium blockers and fibrates with an increased risk of myopathy. We found no evidence for avoiding co

  3. Depression and Anxiety in the Postpartum Period and Risk of Bipolar Disorder: A Danish Nationwide Register-Based Cohort Study.

    Science.gov (United States)

    Liu, Xiaoqin; Agerbo, Esben; Li, Jiong; Meltzer-Brody, Samantha; Bergink, Veerle; Munk-Olsen, Trine

    2017-05-01

    The first-onset affective episode requiring inpatient treatment in the postpartum period can be a marker of bipolar disorder, but it is unknown whether milder postpartum affective episodes are also indicators of underlying bipolarity. Therefore, we aimed to study whether women with a nonpsychotic postpartum affective episode treated with antidepressants have an increased risk of bipolar disorder. A register-based cohort study was conducted in Denmark of 122,622 parous women without psychiatric history who received a first-time antidepressant prescription during 1997-2012. We compared women with a first-time antidepressant prescription, which was our indicator of a first-onset affective disorder, within 1 year postpartum to women with a first-time antidepressant prescription outside the postpartum period. Our outcome was psychiatric contact for bipolar disorder (ICD-10 criteria) during follow-up, and we estimated hazard ratios using Cox regressions. The risk of bipolar disorder among women with a postpartum affective episode was higher than that in women with an affective episode outside the postpartum period. The risk of bipolar disorder was 1.66 (95% CI, 1.12-2.48) for postpartum antidepressant monotherapy and 10.15 (95% CI, 7.13-14.46) for postpartum antidepressant therapy plus a subsequent prescription for anxiolytics when these therapies were compared to antidepressant monotherapy outside the postpartum period. First-onset nonpsychotic postpartum affective disorder can be a marker of underlying bipolarity. Women who fill an antidepressant prescription following childbirth should be asked about hypomanic or manic symptoms and monitored long term. Clinically, when antidepressant monotherapy is ineffective or the individual woman experiences persistent and concerning symptoms, health professionals should consider a possible bipolar spectrum disorder. © Copyright 2017 Physicians Postgraduate Press, Inc.

  4. Comorbidity of autoimmune thyroid disorders and psychiatric disorders during the postpartum period: a Danish nationwide register-based cohort study.

    Science.gov (United States)

    Bergink, V; Pop, V J M; Nielsen, P R; Agerbo, E; Munk-Olsen, T; Liu, X

    2018-06-01

    The postpartum period is well-known risk period for the first onset of autoimmune thyroid disorders (AITDs) as well as first onset of psychiatric disorders. These two disorders are some of the most prevalent medical conditions postpartum, often misdiagnosed and disabling if left untreated. Our study was designed to explore the possible bidirectional association between AITDs and psychiatric disorders during the postpartum period. A population-based cohort study through linkage of Danish national registers, which comprised 312 779 women who gave birth to their first child during 1997-2010. We conducted Poisson regression analysis to estimate the incidence rate ratio (IRR) of psychiatric disorders among women with first-onset AITDs, the IRR of AITDs among women with first-onset psychiatric disorders as well as the overlap between these disorders using a comorbidity index. Women with first-onset AITDs postpartum were more likely to have first-onset psychiatric disorders than women who did not have postpartum AITDs (IRR = 1.88, 95% confidence interval (CI): 1.25-2.81). Women with first-onset postpartum psychiatric disorders had a higher risk of AITDs than women with no psychiatric disorders (IRR = 2.16, 95% CI: 1.45-3.20). The comorbidity index 2 years after delivery was 2.26 (95% CI: 1.61-2.90), indicating a comorbidity between first-onset AITDs and psychiatric disorders. First-onset AITDs and psychiatric disorders co-occur in the postpartum period, which has relevance to further studies on the etiologies of these disorders and why childbirth in particular triggers the onset.

  5. The Incidence of Eating Disorders in a Danish Nationwide Register Study Associations with Suicide Risk and Mortality

    OpenAIRE

    Zerwas, Stephanie; Larsen, Janne Tidselbak; Petersen, Liselotte; Thornton, Laura M.; Mortensen, Preben Bo; Bulik, Cynthia M.

    2015-01-01

    Our aim was to characterize the incidence rates and cumulative incidence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), and examine associations among eating disorder diagnoses, suicide attempts, and mortality. Individuals born in Denmark between 1989 and 2006 were included (N=966,141, 51.3% male). Eating disorders diagnoses (AN, Broad AN, BN, EDNOS) were drawn from the Danish Psychiatric Central Research Register (PCRR) and Danish Nationa...

  6. Risk of psychiatric disorders in offspring of parents with a history of homelessness during childhood and adolescence in Denmark: a nationwide, register-based, cohort study.

    Science.gov (United States)

    Nilsson, Sandra Feodor; Laursen, Thomas Munk; Hjorthøj, Carsten; Thorup, Anne; Nordentoft, Merete

    2017-12-01

    Children and adolescents from deprived backgrounds have high rates of psychiatric problems. Parental and social factors are crucial for children's healthy and positive development, but whether psychiatric morbidity is associated with parental social marginalisation is unknown. We aimed to analyse the association between mother's and father's history of homelessness and the offspring's risk of psychiatric disorders, including substance use disorder, during childhood and adolescence. We did a nationwide, register-based cohort study of 1 072 882 children and adolescents aged 0-16 years, who were living or born in Denmark between Jan 1, 1999, and Dec 31, 2015. Parental homelessness was the primary exposure, data on which were obtained from the Danish Homeless Register. The Danish Civil Registration System was used to extract the population and link offspring to parental information, and the outcome, psychiatric disorders in the offspring, was obtained from the Danish Psychiatric Central Research Register and the Danish National Patient Register. We analysed the association between parental history of homelessness and risk of psychiatric disorders in offspring by survival analysis using Poisson regression and incidence rate ratios (IRRs), adjusted for year and offspring characteristics, and additionally adjusted for parental factors (age at offspring's birth and parental psychiatric disorders). 17 238 (2%) offspring had either one or two parents with a history of homelessness, and 56 330 (5%) children and adolescents were diagnosed with any psychiatric disorder during the study period. The incidence of any psychiatric disorder was 15·1 cases per 1000 person-years (95% CI 14·4-15·8) in offspring with at least one parent with a history of homelessness, compared with 6·0 per 1000 person-years (95% CI 6·0-6·1) in those whose parents had no such history (IRR 2·5 [95% CI 2·3-2·7] for mother homeless, 2·3 [2·2-2·5] for father homeless, and 2·8 [2·4-3·2

  7. Risk of psychiatric disorders in offspring of parents with a history of homelessness during childhood and adolescence in Denmark: a nationwide, register-based, cohort study

    Directory of Open Access Journals (Sweden)

    Sandra Feodor Nilsson, MSc

    2017-12-01

    Full Text Available Summary: Background: Children and adolescents from deprived backgrounds have high rates of psychiatric problems. Parental and social factors are crucial for children's healthy and positive development, but whether psychiatric morbidity is associated with parental social marginalisation is unknown. We aimed to analyse the association between mother's and father's history of homelessness and the offspring's risk of psychiatric disorders, including substance use disorder, during childhood and adolescence. Methods: We did a nationwide, register-based cohort study of 1 072 882 children and adolescents aged 0–16 years, who were living or born in Denmark between Jan 1, 1999, and Dec 31, 2015. Parental homelessness was the primary exposure, data on which were obtained from the Danish Homeless Register. The Danish Civil Registration System was used to extract the population and link offspring to parental information, and the outcome, psychiatric disorders in the offspring, was obtained from the Danish Psychiatric Central Research Register and the Danish National Patient Register. We analysed the association between parental history of homelessness and risk of psychiatric disorders in offspring by survival analysis using Poisson regression and incidence rate ratios (IRRs, adjusted for year and offspring characteristics, and additionally adjusted for parental factors (age at offspring's birth and parental psychiatric disorders. Findings: 17 238 (2% offspring had either one or two parents with a history of homelessness, and 56 330 (5% children and adolescents were diagnosed with any psychiatric disorder during the study period. The incidence of any psychiatric disorder was 15·1 cases per 1000 person-years (95% CI 14·4–15·8 in offspring with at least one parent with a history of homelessness, compared with 6·0 per 1000 person-years (95% CI 6·0–6·1 in those whose parents had no such history (IRR 2·5 [95

  8. [Topics on Which Relatives of Persons with Dementia Seek Counseling Over Telephone or Email: Current Results of a Nationwide Counseling Service of the German Alzheimer Society].

    Science.gov (United States)

    Pendergrass, Anna; Weiß, Saskia; Gräßel, Elmar

    2018-04-19

    Since 15 years, the Alzheimer 's Telephone of the German Alzheimer Society (Deutsche Alzheimer Gesellschaft e.V.; DAlzG), a nationwide psychosocial counseling service, has been offering support for people with dementia (PwD) and their families. The aim of this study was to evaluate: a) why informal PwD caregivers seek telephone counseling, b) whether these telephone calls are one-time counseling or long-term support, and c) whether the telephone inquiries differ from the email-based inquiries with regard to the addressed issues. The data are based on the inquiries of 3,744 informal caregivers, which consulted the DAlzG in 2015. Sociodemographic data on the informal caregivers and the PwD, the characteristics of the telephone call, and the topics addressed in the email inquiries were collected. 70.3% of the callers were female. Most of them (59.9%) were the children (in-law) of and half of them (49.7%) lived with PwD. More than two-thirds of the callers (70%) were seeking help in dealing with the person with dementia (e. g. challenging behavior) and 36.5% of the relatives needed recommendations for further local help and assistance. In the third place, the calls were related to financial and legal topics (23.5%). 92.2% of the calls were one-time consultations. The addressed issues in the email inquiries did not significantly differ from the topics discussed over the telephone. On many topics there is a need for further "on site" consultation. Doctors and other health professionals should therefore be actively involved in counseling relatives of PwD. © Georg Thieme Verlag KG Stuttgart · New York.

  9. Trends in socioeconomic inequalities in oral health among 15-year-old Danish adolescents during 1995-2013: A nationwide, register-based, repeated cross-sectional study.

    Science.gov (United States)

    Sengupta, Kaushik; Christensen, Lisa Bøge; Mortensen, Laust Hvas; Skovgaard, Lene Theil; Andersen, Ingelise

    2017-10-01

    Scandinavian welfare states, despite having better population oral health than less egalitarian societies, are characterized by ubiquitous social gradients and large relative socioeconomic inequalities in oral health. However, trends in these inequalities among Scandinavian children and adolescents have not been studied in detail. To describe the associations between socioeconomic position (SEP) and oral health in adolescents and to investigate the trends in these associations between 1995 and 2013. Nationwide repeated cross-sectional studies (using individual-level data) were conducted on 15-year-olds in Denmark from 1995, 2003, and 2013 (N=154,750). Dental data were obtained from the national dental register of the Danish Health Authority (Sundhedsstyrelsens Centrale Odontologiske Register [SCOR]) and data on social variables from administrative registers at Statistics Denmark. SEP measures included previous year's parental education (highest attained educational level by either of the parents), income (equivalized household disposable income), and occupational social class (highest recorded occupational class between the parents). Covariates were immigration status, country of origin, number of children and persons in the family, and household type. The outcome was dental caries experience, represented by the decayed, missing, and filled surfaces (DMFS) index. Negative binomial regression models were used to examine the association between DMFS count and each of the explanatory variables separately while accounting for cluster-correlated family data. Furthermore, hierarchical multiple regressions of DMFS on SEP indicators-using the zero-inflated negative binomial (ZINB) distribution as the outcome distribution-were estimated while successively adjusting for the potential effects of the included covariates. Caries prevalence declined from 71% in 1995 to 63% in 2003 and 45% in 2013. Separate assessment of each covariate showed statistically significant graded

  10. The Danish nationwide clinical register for patients with rheumatoid arthritis

    DEFF Research Database (Denmark)

    Ibfelt, Else Helene; Jensen, Dorte Vendelbo; Hetland, Merete Lund

    2016-01-01

    the following: patient-reported outcomes for disease activity, pain, fatigue, functional status, and physician-reported objective measures of disease activity, treatment, C-reactive protein, and, when indicated, imaging. For subgroups of patients, the variables such as quality of life, sociodemographic factors...... original papers as well as annual reports of clinical quality (since 2005) have been published. Conclusion: DANBIO is a powerful register for research in rheumatologic diseases and furthermore serves as a Clinical Quality Register with the aim of monitoring treatment quality in patients with RA in Denmark....

  11. Fracture Rates and Fracture Sites in Patients With Osteogenesis Imperfecta: A Nationwide Register-Based Cohort Study

    DEFF Research Database (Denmark)

    Folkestad, Lars; Hald, Jannie Dahl; Ersbøll, Annette Kjaer

    2017-01-01

    Osteogenesis imperfecta (OI) is a hereditary, clinically heterogeneous, connective tissue disorder. The population prevalence of OI in Denmark is 10.6 in 100,000. A hallmark of the disease is frequent fractures that are often precipitated by minimal trauma. The aim of the current study...

  12. Increasing incidence of statin treatmentamong the elderly and those withoutprevious cardiovascular conditions. A nationwide register study

    DEFF Research Database (Denmark)

    Kildemoes, Helle Wallach; Andersen, Morten

      Background: Supported by the growing evidence of the beneficial effects of statins in a range of conditions, statin utilization has increased considerably in most Western countries over the last decade. Objectives: To estimate to what extent a widening of indication scope for statins accounts...... with discharge diagnoses and surgical procedures performed during 1977-2005. The disease status for all cohort members was assigned by means of disease markers for seven cardiovascular conditions, corresponding to a hierarchy of broad indications for statin therapy. Using the indication hierarchy, we computed...

  13. Mortality and Causes of Death in Patients With Osteogenesis Imperfecta: A Register-Based Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Folkestad, Lars; Hald, Jannie Dahl; Canudas-Romo, Vladimir

    2016-01-01

    Osteogenesis imperfecta (OI) is a hereditary connective tissue disease that causes frequent fractures. Little is known about causes of death and length of survival in OI. The objective of this work was to calculate the risk and cause of death, and the median survival time in patients with OI...... five to one to the OI cohort. We calculated hazard ratios for all-cause mortality and subhazard ratios for cause-specific mortality in a comparison of the OI cohort and the reference population. We also calculated all-cause mortality hazard ratios for males, females, and age groups (0 to 17.99 years......, 18.00 to 34.99 years, 35.00 to 54.99 years, 55.00 to 74.99 years, and >75 years). We identified 687 cases of OI (379 women) and included 3435 reference persons (1895 women). A total of 112 patients with OI and 257 persons in the reference population died during the observation period. The all-cause...

  14. Fractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders--a nationwide register study.

    Science.gov (United States)

    Vestergaard, Peter; Emborg, Charlotte; Støving, René K; Hagen, Claus; Mosekilde, Leif; Brixen, Kim

    2002-11-01

    To study fracture risk in patients with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorders not otherwise specified (EDNOS). Cohort study including all Danes diagnosed with AN (n = 2,149), BN (n = 1,294), or EDNOS (n = 942) between 1977 and 1998. Each patient was compared with three randomly drawn age- and gender-matched control subjects. Fracture risk was increased in AN after diagnosis compared to controls (incidence rate ratio: 1.98, 95% CI: 1.60-2.44), but not before. The increased fracture risk persisted more than 10 years after diagnosis. A significant increase in fracture risk was found before diagnosis in BN (1.31, 95% CI: 1.04-1.64), with a trend towards an increase after diagnosis (1.44, 95% CI: 0.93-2.22). EDNOS patients had a significant increase in fracture risk before (1.39, 95% CI: 1.06-1.81) and after diagnosis (1.77, 95% CI: 1.25-2.51). The increased fracture risk many years after diagnosis indicates permanent skeletal damage. Copyright 2002 by Wiley Periodicals, Inc.

  15. Excess Mortality in Hyperthyroidism: The Influence of Preexisting Comorbidity and Genetic Confounding: A Danish Nationwide Register-Based Cohort Study of Twins and Singletons

    Science.gov (United States)

    Brandt, Frans; Almind, Dorthe; Christensen, Kaare; Green, Anders; Brix, Thomas Heiberg

    2012-01-01

    Context: Hyperthyroidism is associated with severe comorbidity, such as stroke, and seems to confer increased mortality. However, it is unknown whether this increased mortality is explained by hyperthyroidism per se, comorbidity, and/or genetic confounding. Objective: The objective of the study was to investigate whether hyperthyroidism is associated with an increased mortality and, if so, whether the association is influenced by comorbidity and/or genetic confounding. Methods: This was an observational cohort study using record-linkage data from nationwide Danish health registers. We identified 4850 singletons and 926 twins from same-sex pairs diagnosed with hyperthyroidism. Each case was matched with four controls for age and gender. The Charlson score was calculated from discharge diagnoses on an individual level to measure comorbidity. Cases and controls were followed up for a mean of 10 yr (range 0–31 yr), and the hazard ratio (HR) for mortality was calculated using Cox regression analyses. Results: In singletons there was a significantly higher mortality in individuals diagnosed with hyperthyroidism than in controls [HR 1.37; 95% confidence interval (CI) 1.30–1.46]. This persisted after adjustment for preexisting comorbidity (HR 1,28; 95% CI 1.21–1.36). In twin pairs discordant for hyperthyroidism (625 pairs), the twin with hyperthyroidism had an increased mortality compared with the corresponding cotwin (HR 1.43; 95% CI 1.09–1.88). However, this was found only in dizygotic pairs (HR 1.80; 95% CI 1.27–2.55) but not in monozygotic pairs (HR 0.95; 95% CI 0.60–1.50). Conclusions: Hyperthyroidism is associated with an increased mortality independent of preexisting comorbidity. The study of twin pairs discordant for hyperthyroidism suggests that genetic confounding influences the association between hyperthyroidism and mortality. PMID:22930783

  16. Danish nationwide registers for public health and health-related research

    DEFF Research Database (Denmark)

    Erlangsen, Annette; Fedyszyn, Izabela

    2015-01-01

    AIMS: The Nordic countries have a strong tradition of using nationwide social and health registers for research purposes. The aim of the current paper is to provide an overview of the Danish population-based registers in public health and health-related research, and to discuss their strengths...... and limitations. METHODS: Danish registers on somatic and psychiatric hospital contacts as well as care provided by general practitioners were reviewed. The availability of demographic, individual-level variables of relevance for health-related research was summarized. RESULTS: Since 1968, every person living...... of prescribed medications, and a complete follow-up with respect to causes of death support public health studies surveying trends of prevalence and incidence. Historical data on psychiatric and somatic hospitalizations since 1969 and 1977, respectively, allow an in-depth assessment of the burden of disease...

  17. The Danish nationwide clinical register for patients with rheumatoid arthritis: DANBIO.

    Science.gov (United States)

    Ibfelt, Else Helene; Jensen, Dorte Vendelbo; Hetland, Merete Lund

    2016-01-01

    DANBIO is a research register and a data source for rheumatologic diseases (rheumatoid arthritis [RA], axial spondyloarthritis, and psoriatic arthritis) for monitoring clinical quality at the national, regional, and hospital levels. The register includes patients with rheumatologic diseases who are treated at a hospital or a private rheumatologic clinic. Registration is mandatory for all patients with RA regardless of treatment and also for patients with other diagnoses if treated with biological disease-modifying antirheumatic drugs. Since 2006, the registration has been done electronically, including patient-reported outcome measures registered electronically by the patients with the use of touch screens. Core variables such as diagnosis, year of diagnosis, age, and sex are registered at the beginning. Data entered at later visits included the following: patient-reported outcomes for disease activity, pain, fatigue, functional status, and physician-reported objective measures of disease activity, treatment, C-reactive protein, and, when indicated, imaging. For subgroups of patients, the variables such as quality of life, sociodemographic factors, lifestyle, and comorbidity are also registered. The DANBIO cohort comprised ∼26,000 patients with RA, 3,200 patients with axial spondyloarthritis, and 6,200 patients with psoriatic arthritis in 2015. DANBIO has high nationwide coverage and completeness on key data variables. More than 60 original papers as well as annual reports of clinical quality (since 2005) have been published. DANBIO is a powerful register for research in rheumatologic diseases and furthermore serves as a Clinical Quality Register with the aim of monitoring treatment quality in patients with RA in Denmark.

  18. Low Vocational Outcome Among People Diagnosed With Borderline Personality Disorder During First Admission to Mental Health Services in Denmark: A Nationwide 9-Year Register-Based Study.

    Science.gov (United States)

    Hastrup, Lene Halling; Kongerslev, Mickey T; Simonsen, Erik

    2018-03-05

    Earlier studies report that although people with borderline personality disorder (BPD) experience symptom reduction in the long term, they continue to have difficulties in work recovery. This nationwide 9-year register-based study (N = 67,075) investigated the long-term labor-market attachment of all individuals diagnosed with BPD during first admission to Danish mental health services in comparison with other psychiatric disorders. Controlling for baseline characteristics and co-occurring secondary psychiatric diagnoses, the BPD group had 32% lower odds (OR = 0.68; 95% CI [0.61, 0.76]) of being in work/under education after 9 years. Individuals diagnosed with BPD also showed more impairment in long-term vocational outcome than other personality disorders, and lower labor-market attachment than other psychiatric disorders except for schizophrenia, schizotypal and delusional disorders, and mental and behavioral disorders due to psychoactive substance use. Intervention programs addressing social psychiatric aspects of BPD in terms of work functioning is henceforth an important area for future research.

  19. Does the Addenbrooke's Cognitive Examination-revised add to the Mini-Mental State Examination in established Alzheimer disease? Results from a national dementia research register.

    Science.gov (United States)

    Law, Emma; Connelly, Peter J; Randall, Emma; McNeill, Catriona; Fox, Helen C; Parra, Mario A; Hudson, Justine; Whyte, Leigh-Ann; Johnstone, Jane; Gray, Sarah; Starr, John M

    2013-04-01

    To evaluate how much the Addenbrooke's Cognitive Examination-revised (ACE-R) improves the estimate of cognitive ability from the Mini-Mental State Examination (MMSE) in people with Alzheimer disease (AD). We examined itemized data in people with AD who were on the Scottish Dementia Research Interest Register drawn from eight centres across Scotland, covering 75% of the Scottish population. ACE-R items that comprise the MMSE and those that did not (non-MMSE items) were summed separately. We residualized MMSE total on non-MMSE total and vice versa to derive a measure of the variance unique to each. Five hundred and one (258 male, 243 female) participants, mean age 75.7 (range 52-94) years were on the register, of whom 329 (160 men, 169 women) had AD. Of those with AD, 309 had a mean MMSE of 20.5 and mean ACE-R of 57.5 measured with Pearson r = 0.92 between MMSE and ACE-R totals, and the regression equation ACE-R score = 3.0 × MMSE - 4.1. The unique non-MMSE items score correlated with ACE-R total r = 0.40 (16% of ACE-R variance). The ACE-R and MMSE total scores are highly correlated. In this clinical sample of people with established AD, for an MMSE score of 24, the predicted ACE-R score was 67.9 with 95% confidence intervals of 61.6-75.4. The extra non-MMSE ACE-R items improve estimates of cognitive ability by 16%. Copyright © 2012 John Wiley & Sons, Ltd.

  20. Development and validation of the Korea Dementia Comorbidity Index (KDCI): A nationwide population-based cohort study from 2002 to 2013.

    Science.gov (United States)

    Kim, Jae-Hyun; Yoo, Ki-Bong; Lee, Yunhwan

    2017-09-01

    This study develop and validate a simple and accessible measure of comorbidity, named the Korean Dementia Comorbidity index (KDCI), to assist in predicting the onset of dementia. This study used the National Health Insurance Service-Cohort Sample Database from 2002 to 2013 (n=23,856). Cox proportional hazard model was used to estimate incident dementia (International Classification of Disease, 10th edition (ICD-10) codes: F00-F03, G30, G311), with a hazard ratio higher than 1.05 for each comorbid condition being assigned a score. Scores ranging from 1 to 4 were assigned based on the magnitude of the hazard ratio (HR): 1 (1.050≤HR≤1.099), 2 (1.100≤HR≤1.149), 3 (1.150≤HR≤1.199), and 4 (HR≥1.200) Summated scores of comorbidities for each individual constituted the Korean Dementia Comorbidity Index (KDCI). Five patterns were extracted: (1) disease of the eye and adnexa; (2) endocrine and metabolic disease, and disease of circulatory system; (3) disease of the musculoskeletal system and connective tissue; (4) disease of the respiratory system; and (5) disease of the nervous system, and mental and behavioral disorders through factor analysis. Fitting performance by Akaike information criterion (AIC) of CCI by Charlson, CCI by Quan and KDCI adjusting for age and sex was 29,486, 29,488 and 29,444, respectively. Our analysis results on discriminatory abilities provided evidence that KDCI is superior to other comorbidity indices on incident dementia in terms of comorbidity adjustment. Therefore, KDCI can be a useful tool to identify incident dementia. This has implications for clinical management of patients with multimorbidity as well as risk adjustment for database studies. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. The Danish nationwide clinical register for patients with rheumatoid arthritis: DANBIO

    Directory of Open Access Journals (Sweden)

    Ibfelt EH

    2016-10-01

    ,200 patients with psoriatic arthritis in 2015. DANBIO has high nationwide coverage and completeness on key data variables. More than 60 original papers as well as annual reports of clinical quality (since 2005 have been published. Conclusion: DANBIO is a powerful register for research in rheumatologic diseases and furthermore serves as a Clinical Quality Register with the aim of monitoring treatment quality in patients with RA in Denmark. Keywords: rheumatoid arthritis, axial spondyloarthritis, psoriatic arthritis, DANBIO register clinical quality, epidemiology

  2. Clinical and Neuropsychological Characteristics of a Nationwide Hospital-Based Registry of Frontotemporal Dementia Patients in Korea: A CREDOS-FTD Study

    Directory of Open Access Journals (Sweden)

    Eun-Joo Kim

    2014-07-01

    Full Text Available Background: We investigated the demographic, clinical, and neuropsychological characteristics of frontotemporal dementia (FTD from the Clinical Research Center for Dementia of South Korea (CREDOS-FTD registry. Methods: A total of 200 consecutive patients with FTD recruited from 16 neurological clinics in Korea were evaluated by cognitive and functional assessments, a screening test for aphasia, behavioral questionnaires, motor assessments, and brain MRI or PET. Results: In our registry, 78 patients were classified as having been diagnosed with behavioral-variant FTD (bvFTD, 70 with semantic dementia (SD, 33 with progressive nonfluent aphasia (PNFA, and 8 with motor neuron disease plus syndrome (MND-plus. The patients with language variants of dementia were older than those with bvFTD. There were no differences in sex ratio, duration of illness, or level of education among the four subgroups. Overall, the patients with bvFTD showed a significantly better performance in cognitive tests. A higher frequency of motor symptoms and a lower frequency of behavioral symptoms were found in PNFA than in bvFTD and SD. The Global Language Index was significantly lower in SD than in bvFTD and PNFA. The MND-plus group had a poorer performance than all the others in all cognitive domains. Conclusion: The neuropsychological, behavioral, motor, and language characteristics of the four subtypes are comparable with those from other series. However, the proportion of SD (37.0%, which was similar to that of bvFTD (41.3%, was higher in our registry than in other series.

  3. An observational nationwide register based cohort study on lamotrigine versus lithium in bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Hellmund, Gunnar; Andersen, Per Kragh

    2012-01-01

    It is not clear whether the effectiveness of lamotrigine versus lithium differs for patients with bipolar disorder treated in clinical practice. We compared rates of switch to, or add on of, another psychotropic, and rates of psychiatric hospitalization for patients treated with lamotrigine...... or lithium in clinical practice. Using linkage of nationwide Danish registers we identified 730 patients who received lamotrigine and 3518 patients received lithium subsequent to a diagnosis of bipolar disorder in psychiatric hospital settings during a period from 1995 to 2006. The overall rate of switch...... to or add on of another psychotropic (the opposite drug of interest (lithium or lamotrigine), antidepressants, antipsychotics or other anticonvulsants than lamotrigine) was increased for lamotrigine compared with lithium (HR = 2.60, 95% CI: 2.23-3.04), regardless of whether the index episode was depressive...

  4. An observational nationwide register based cohort study on lamotrigine versus lithium in bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Hellmund, Gunnar; Andersen, Per Kragh

    2011-01-01

    It is not clear whether the effectiveness of lamotrigine versus lithium differs for patients with bipolar disorder treated in clinical practice. We compared rates of switch to, or add on of, another psychotropic, and rates of psychiatric hospitalization for patients treated with lamotrigine...... or lithium in clinical practice. Using linkage of nationwide Danish registers we identified 730 patients who received lamotrigine and 3518 patients received lithium subsequent to a diagnosis of bipolar disorder in psychiatric hospital settings during a period from 1995 to 2006. The overall rate of switch...... to or add on of another psychotropic (the opposite drug of interest (lithium or lamotrigine), antidepressants, antipsychotics or other anticonvulsants than lamotrigine) was increased for lamotrigine compared with lithium (HR = 2.60, 95% CI: 2.23-3.04), regardless of whether the index episode was depressive...

  5. Diagnostic evaluation of dementia in the secondary health care sector

    DEFF Research Database (Denmark)

    Phung, Thien Kieu Thi; Andersen, Birgitte Bo; Kessing, Lars Vedel

    2009-01-01

    BACKGROUND: We conducted a nationwide registry-based study of the quality of diagnostic evaluation for dementia in the secondary health care sector. METHOD: Two hundred patients were randomly selected from the patient population (4,682 patients) registered for the first time with a dementia...... diagnosis in the nationwide hospital registries during the last 6 months of 2003. Through medical record review, we evaluated the completeness of the work-up on which the dementia diagnosis was based, using evidence-based dementia guidelines as reference standards. RESULTS: Satisfactory or acceptable...... completion of the basic dementia work-up was documented in 51.3% of the patients. Only 11.5% of those with unsatisfactory work-up were referred to follow-up investigations. Dementia syndrome was confirmed in 88.5% of the cases, but correct subtypes were diagnosed in only 35.1%. CONCLUSION: The adherence...

  6. Do immigrants from Turkey, Pakistan and Ex-Yugoslavia with newly diagnosed type 2 diabetes initiate recommended statin therapy to the same extent as Danish-born residents? A nationwide register study

    DEFF Research Database (Denmark)

    Sanchez-Ramirez, Diana; Krasnik, Allan; Kildemoes, Helle Wallach

    2012-01-01

    PURPOSE: To explore whether newly diagnosed type 2 diabetes patients without previous cardiovascular disease (CVD) initiate preventive statin therapy regardless of ethnic background. METHODS: Using nationwide individual-level registers, we followed a cohort of Danish-born residents and immigrants...... the odds ratios (ORs) of early statin therapy initiation (within 180 days after first GLM dispensing) are the same regardless of ethnic background. While age and gender were included as confounders in the basic model, income was included in the second model as a potential mediating variable. RESULTS....... CONCLUSIONS: Immigrants from Turkey, Pakistan and Ex-Yugoslavia with type 2 diabetes were less likely to initiate statin therapy than Danish-born residents-despite a similar or even higher risk of CVD. The treatment inequities associated with ethnicity were more pronounced in women than men...

  7. Serious delinquency and later schizophrenia: A nationwide register-based follow-up study of Finnish pretrial 15- to 19-year-old offenders sent for a forensic psychiatric examination.

    Science.gov (United States)

    Lindberg, N; Miettunen, J; Heiskala, A; Kaltiala-Heino, R

    2017-07-01

    Aggressive and disruptive behaviors often precede the onset of schizophrenia. In this register-based follow-up study with a case-control design, we wanted to investigate if serious delinquency was associated with future diagnoses of schizophrenia or schizoaffective disorder (here, broadly defined schizophrenia) among a nationwide consecutive sample of 15- to 19-year-old Finnish delinquents sent for a forensic psychiatric examination in 1989-2010. The sample comprised 313 delinquents with no past or current psychotic disorder. For each delinquent, four age-, gender- and place of birth -matched controls were randomly selected from the Central Population Register. Five controls (0.4%) had been treated for schizophrenia before their respective index-dates and were thus excluded from further analysis, leaving us with a control population of 1247 individuals. The subjects were followed till death, emigration or the end of 2015, whichever occurred first. Diagnoses were obtained from the Care Register for Health Care. Forty (12.8%) of the delinquents and 11 (0.9%) of the controls were diagnosed with schizophrenia later in life (HR 16.6, 95% CI 8.53-32.39, Pdelinquency and later schizophrenia. Accurate psychiatric assessments should be made in correctional services but also later in life so that any possible psychotic symptoms can be detected in individuals with a history of serious delinquency even if there were no signs of psychosis before or at the time of the crime. Future research should explore which factors influence the delinquent's risk of developing later schizophrenia. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  8. Longterm Work Productivity Costs Due to Absenteeism and Permanent Work Disability in Patients with Early Rheumatoid Arthritis: A Nationwide Register Study of 7831 Patients.

    Science.gov (United States)

    Martikainen, Janne A; Kautiainen, Hannu; Rantalaiho, Vappu; Puolakka, Kari T

    2016-12-01

    To estimate the development and potential disproportional distribution of longterm productivity costs (PC) and their determinants leading to work absenteeism and permanent work disability in working-aged patients with early rheumatoid arthritis (RA). A cohort of subjects with early RA was created by identifying the new cases of RA from the national drug reimbursement register that had been granted a special reimbursement for their antirheumatic medications for RA from 2000-2007. The dataset was enriched by cross-linking with other national registries detailing work absenteeism days and permanent disability pensions. In the base case, the human capital approach was applied to estimate PC based on subjects' annual number of absenteeism days and incomes. Hurdle regression analysis was applied to study the determinants of PC. Among the 7831 subjects with early RA, the mean (bootstrapped 95% CI) annual PC per person-observation year was €4800 (4547-5070). The annual PC declined after the first year of RA diagnosis, but increased significantly in subsequent years. In addition, the PC was heavily disproportionally concentrated in a small fraction of patients with RA, because only around 20% of patients accounted for the majority of total annual PC. The initiation of active drug treatment during the first 3 months after RA diagnosis significantly reduced the cumulative PC when compared with no drug treatment. The longterm PC increased significantly in parallel with years elapsing after RA diagnosis. Further, the majority of these PC are incurred by a small proportion of patients.

  9. Risk of new psychiatric episodes in the year following divorce in midlife: cause or selection? A nationwide register-based study of 703,960 individuals.

    Science.gov (United States)

    Björkenstam, Emma; Hallqvist, Johan; Dalman, Christina; Ljung, Rickard

    2013-12-01

    To examine if divorce is associated with an increased risk of psychiatric disorder. A register-based cohort study of all married or divorced individuals aged 45-54 in Sweden in 2006. After exclusion of 129,669 individuals with a history of psychiatric care in 1987-2005, we followed 703,960 persons for psychiatric disorder during 2007, measured as psychiatric inpatient care, outpatient care and use of psychotropic medication. Marital trajectories were taken into consideration. Data were analysed using Poisson regression. Divorced women and men had a higher risk for psychiatric inpatient care compared to married (ORwomen = 3.2, 95%CI = 1.6-6.3, ORmen = 3.3, 95%CI = 2.0-5.4). The longer the marriage, the lower the risk for psychiatric disorders. Lower educational level increased the risk for psychiatric inpatient care. In conclusion, our study supports both the selection hypothesis, linking healthy individuals to long and stable marriages, and the social causation hypothesis, linking the stress of recent divorce to increased psychiatric disorder for both women and men.

  10. Written reminders increase vaccine coverage in Danish children - evaluation of a nationwide intervention using The Danish Vaccination Register, 2014 to 2015.

    Science.gov (United States)

    Suppli, Camilla Hiul; Rasmussen, Mette; Valentiner-Branth, Palle; Mølbak, Kåre; Krause, Tyra Grove

    2017-04-27

    We evaluated a national intervention of sending written reminders to parents of children lacking childhood vaccinations, using the Danish Vaccination Register (DDV). The intervention cohort included the full birth cohort of 124,189 children born in Denmark who reached the age of 2 and 6.5 years from 15 May 2014 to 14 May 2015. The reference cohort comprised 124,427 children who reached the age of 2 and 6.5 years from 15 May 2013 to 14 May 2014. Vaccination coverage was higher in the intervention cohort at 2.5 and 7 years of age. The differences were most pronounced for the second dose of the measles-mumps-rubella vaccine (MMR2) and the diphtheria-tetanus-pertussis-polio vaccine DTaP-IPV4 among the 7-year-olds, with 5.0 percentage points (95% confidence interval (CI): 4.5-5.4) and 6.4 percentage points (95% CI: 6.0-6.9), respectively. Among the 2.5 and 7-year-olds, the proportion of vaccinations in the preceding 6 months was 46% and three times higher, respectively, in the intervention cohort than the reference cohort. This study indicates a marked effect of personalised written reminders, highest for the vaccines given later in the schedule in the older cohort. In addition, the reminders increased awareness about correct registration of vaccinations in DDV. This article is copyright of The Authors, 2017.

  11. Development of the CHARIOT Research Register for the Prevention of Alzheimer's Dementia and Other Late Onset Neurodegenerative Diseases.

    Directory of Open Access Journals (Sweden)

    Mark E Larsen

    Full Text Available Identifying cognitively healthy people at high risk of developing dementia is an ever-increasing focus. These individuals are essential for inclusion in observational studies into the natural history of the prodromal and early disease stages and for interventional studies aimed at prevention or disease modification. The success of this research is dependent on having access to a well characterised, representative and sufficiently large population of individuals. Access to such a population remains challenging as clinical research has, historically, focussed on patients with dementia referred to secondary and tertiary services. The primary care system in the United Kingdom allows access to a true prodromal population prior to symptoms emerging and specialist referral. We report the development and recruitment rates of the CHARIOT register, a primary care-based recruitment register for research into the prevention of dementia. The CHARIOT register was designed specifically to support recruitment into observational natural history studies of pre-symptomatic or prodromal dementia stages, and primary or secondary prevention pharmaceutical trials or other prevention strategies for dementia and other cognitive problems associated with ageing.Participants were recruited through searches of general practice lists across the west and central London regions. Invitations were posted to individuals aged between 60 and 85 years, without a diagnosis of dementia. Upon consent, a minimum data set of demographic and contact details was extracted from the patient's electronic health record.To date, 123 surgeries participated in the register, recruiting a total of 24,509 participants-a response rate of 22.3%. The age, gender and ethnicity profiles of participants closely match that of the overall eligible population. Higher response rates tended to be associated with larger practices (r = 0.34, practices with a larger older population (r = 0.27, less

  12. Hospital organizational factors influence work-family conflict in registered nurses: Multilevel modeling of a nation-wide cross-sectional survey in Sweden.

    Science.gov (United States)

    Leineweber, C; Chungkham, H S; Westerlund, H; Tishelman, C; Lindqvist, R

    2014-05-01

    The present shortage of registered nurses (RNs) in many European countries is expected to continue and worsen, which poses a substantial threat to the maintenance of healthcare in this region. Work-family conflict is a known risk factor for turnover and sickness absence. This paper empirically examines whether the nurse practice environment is associated with experienced work-family conflict. A multilevel model was fit with the individual RN at the 1st, and the hospital department at the 2nd level using cross-sectional RN survey data from the Swedish part of RN4CAST, an EU 7th framework project. The data analyzed here is based on a national sample of 8356 female and 592 male RNs from 369 hospital departments. We found that 6% of the variability in work-family conflict experienced by RNs was at the department level. Organizational level factors significantly accounted for most of the variability at this level with two of the work practice environment factors examined, staffing adequacy and nurse involvement in hospital affairs, significantly related to work-family conflict. Due to the design of the study, factors on ward and work group levels could not be analyzed, but are likely to account for additional variance which in the present analysis appears to be on the individual level, with private life factors likely explaining another major part. These results suggest that higher level organizational factors in health care have a significant impact on the risk of work-family conflict among RNs through their impact on the nurse practice environment. Lower level organizational factors should be investigated in future studies using hierarchical multilevel sampling. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

  13. Extent and quality of drug use in community-dwelling people aged ≥75 years: A Swedish nationwide register-based study.

    Science.gov (United States)

    Lagerin, Annica; Törnkvist, Lena; Nilsson, Gunnar; Johnell, Kristina; Fastbom, Johan

    2017-12-01

    It is important for district nurses and other health professionals in primary care to gain more insight into the patterns and quality of drug use in community-dwelling older people, particularly in 75-year-olds, who have been the target of preventive home visits. This study aimed to examine the extent and quality of drug use in community-dwelling older people and to compare drug use in 75-year-olds with that of older age groups. Data from 2013 on people aged ≥75 years were obtained from the Swedish Prescribed Drug Register. Those living in the community (671,940/739,734 people aged ≥75 years) were included in the study. Quality of drug use was assessed by using a selection of indicators issued by the Swedish National Board of Health and Welfare. The prevalence of polypharmacy and of many drug groups increased with age, as did several indicators of inappropriate drug use. However some drug groups, as well as inappropriate drugs, were prevalent in 75-year-olds and declined with age, for example diabetes drugs, drugs with major anticholinergic effects and nonsteroidal anti-inflammatory drugs. The substantial use of some drugs as early as 75 years of age confirms the value of including drug use as a topic in preventive home visits to 75-year-olds. The finding that polypharmacy and many measures of inappropriate drug use increased with age in community-dwelling older people also underscores the importance of district nurses' role in continuing to promote safe medication management at higher ages.

  14. Immigrants' utilization of specialist mental healthcare according to age, country of origin, and migration history: a nation-wide register study in Norway.

    Science.gov (United States)

    Abebe, Dawit Shawel; Lien, Lars; Elstad, Jon Ivar

    2017-06-01

    As the immigrant population rises in Norway, it becomes ever more important to consider the responsiveness of health services to the specific needs of these immigrants. It has been questioned whether access to mental healthcare is adequate among all groups of immigrants. This study aims to examine the use of specialist mental healthcare services among ethnic Norwegians and specific immigrants groups. Register data were used from the Norwegian Patient Registry and Statistics Norway. The sample (age 0-59) consisted of 3.3 million ethnic Norwegians and 200,000 immigrants from 11 countries. Poisson regression models were applied to examine variations in the use of specialist mental healthcare during 2008-2011 according to country of origin, age group, reason for immigration, and length of stay. Immigrant children and adolescents had overall significantly lower use of specialist mental healthcare than ethnic Norwegians of the same age. A distinct exception was the high utilization rate among children and youth from Iran. Among adult immigrants, utilization rates were generally lower than among ethnic Norwegians, particularly those from Poland, Somalia, Sri Lanka, and Vietnam. Adult immigrants from Iraq and Iran, however, had high utilization rates. Refugees had high utilization rates of specialist mental healthcare, while labour immigrants had low use. Utilization rates of specialist mental healthcare are lower among immigrants than Norwegians. Immigrants from Poland, Somalia, Sri Lanka, and Vietnam, had generally quite low rates, while immigrants from Iran had high utilization rates. The findings suggest that specialist mental healthcare in Norway is underutilized among considerable parts of the immigrant population.

  15. Risk factors for suicidal behaviour in individuals on disability pension due to common mental disorders - a nationwide register-based prospective cohort study in Sweden.

    Directory of Open Access Journals (Sweden)

    Syed Rahman

    Full Text Available BACKGROUND: Common mental disorders (CMD have become one of the leading causes for disability pension (DP. Studies on predictors of adverse health outcome following DP are sparse. This study aimed to examine the association of different socio-demographic factors and health care consumption with subsequent suicidal behaviour among individuals on DP due to CMD. METHOD: This is a population-based prospective cohort study based on register data. All individuals aged 18-64 years, living in Sweden on 31-Dec-2004 who in 2005 were on DP due to CMD (N = 46 745 were followed regarding suicide attempt and suicide (2006-10. Univariate and multivariate hazard ratios (HR and 95% confidence intervals (CI for suicidal behaviour were estimated by Cox regression. RESULTS: During the five-year follow-up, 1 046 (2.2% and 210 (0.4% individuals attempted and committed suicide, respectively. Multivariate analyses showed that young age (18-24 years and low education predicted suicide attempt, while living alone was associated with both higher suicide attempt and suicide (range of HRs 1.23 to 1.68. Combined prescription of antidepressants with anxiolytics during 2005 and inpatient care due to mental diagnoses or suicide attempt (2001-05 were strongly associated with suicide attempt and suicide (range of HRs 1.3 to 4.9, while inpatient care due to somatic diagnoses and specialized outpatient care due to mental diagnoses during 2001-05 only predicted suicide attempt (HR 1.45; 95% CI: 1.3-1.7; HR 1.30; 95% CI: 1.1-1.7. CONCLUSIONS: Along with socio-demographic factors, it is very important to consider type of previous healthcare use and medication history when designing further research or intervention aiming at individuals on DP due to CMD. Further research is warranted to investigate both characteristics of disability pension due to CMD, like duration, diagnoses and grade as well as mechanisms to subsequent suicidal behavior, taking potential gender differences into

  16. Is postoperative cognitive dysfunction a risk factor for dementia?

    DEFF Research Database (Denmark)

    Steinmetz, J; Siersma, Volkert Dirk; Kessing, L V

    2013-01-01

    BACKGROUND: /st>Postoperative cognitive dysfunction (POCD) is a common complication in elderly patients after major surgery. An association between POCD and the development of dementia has been suspected. In this study, we assessed if POCD was a risk factor for the occurrence of dementia. METHODS...... surgery, using a neuropsychological test battery. The time of (first) occurrence of dementia after surgery was assessed using the National Patient Register and the Psychiatric Central Research Register. Recorded dementia diagnoses (ICD-8 and ICD-10) were: Alzheimer's disease, vascular dementia......, frontotemporal dementia, or dementia without specification. The risk of dementia according to POCD was assessed in the Cox regression models. RESULTS: /st>A total of 686 patients with a median age of 67 [inter-quartile range (IQR) 61-74] yr were followed for a median of 11.1 (IQR 5.2-12.6) yr. Only 32 patients...

  17. Trends in Off-Label Prescribing of Sedatives, Hypnotics and Antidepressants among Children and Adolescents - A Danish, Nationwide Register-Based Study

    DEFF Research Database (Denmark)

    Nielsen, Eva Skovslund; Rasmussen, Lotte; Poulsen, Maja Hellfritzsch

    2016-01-01

    In recent years, psychotropic drug use among children and adolescents in Europe and USA has increased. However, the majority of psychotropic drugs are not formally approved for use in children and adolescents, and consequently, use is often off-label. The objectives were to describe time trends...... in off-label prescribing rates and the most commonly used types of psychotropic drugs by age and gender in Danish children and adolescents. Using the Register of Medicinal Product Statistics, we identified all prescriptions for sedatives, hypnotics and antidepressants filled for children and adolescents......, we found decreasing trends in off-label rates over time [range 94.5-65.6% (girls), 93.8-71.2% (boys)]. Off-label prescribing of psychotropic drugs to Danish children and adolescents is common. Off-label rates for sedatives and hypnotics increased in the period of 2006-2012, whereas off-label rates...

  18. The effect of implementation of an early detection team: A nationwide register-based study of characteristics and help-seeking behavior in first-episode schizophrenia in Denmark.

    Science.gov (United States)

    Hastrup, Lene Halling; Haahr, Ulrik Helt; Nordgaard, Julie; Simonsen, Erik

    2018-04-26

    In an effort to make people with signs of psychosis seek help as early as possible, Region Zealand launched in 2012 an early detection team project as the first and only in Denmark. The project consisted of a combination of easy access and an information campaign targeting the public. This nation-wide study examined characteristics and help-seeking behavior of patients with first-episode schizophrenia (FES) in the early detection region in comparison with other Danish regions. Data from the Danish National Schizophrenia register on all Danish patients diagnosed with first-episode schizophrenia during 2012 to 2015 were linked to demographic and health care data drawn from official national registers. Binary logistic regression analyses examined the difference between the early detection region and other regions controlling for demographic characteristics and utilization of mental health care services and contacts to general practitioner (GP). Patients in the early detection region were younger (OR = 0.51; CI: 0.42-0.62; p < 0.000) than in regions without early detection teams. Furthermore, they were more likely to be of Danish origin, and less likely to have contact with mental health services and GPs prior to FES. The study suggests that implementing an early detection team in combination with an information campaign contributed to detecting patients with first-episode schizophrenia earlier than in regions without the early detection team. The study gives an indication of different pathways among patients in the early detection region. Copyright © 2018. Published by Elsevier B.V.

  19. ABO Blood Group and Dementia Risk--A Scandinavian Record-Linkage Study.

    Directory of Open Access Journals (Sweden)

    Senthil K Vasan

    Full Text Available Dementia includes a group of neuro-degenerative disorders characterized by varying degrees of cognitive impairment. Recent data indicates that blood group AB is associated with impaired cognition in elderly patients. To date there are no large-scale studies that have examined the relationship between ABO blood group and dementia-related disorders in detail.We used data from the SCANDAT2 database that contains information on over 1.6 million blood donors from 1968 in Sweden and 1981 from Denmark. The database was linked with health outcomes data from nationwide patient and cause of death registers to investigate the relationship between blood groups and risk of different types of dementia. The incident rate ratios were estimated using log-linear Poisson regression models.Among 1,598,294 donors followed over 24 million person-years of observation we ascertained 3,615 cases of Alzheimer's disease, 1,842 cases of vascular dementia, and 9,091 cases of unspecified dementia. Overall, our study showed no association between ABO blood group and risk of Alzheimer's disease, vascular dementia or unspecified dementia. This was also true when analyses were restricted to donors aged 70 years or older except for a slight, but significantly decreased risk of all dementia combined in subjects with blood group A (IRR, 0.93; 95% confidence interval [CI], 0.88-0.98, compared to those with blood group O.Our results provide no evidence that ABO blood group influences the risk of dementia.

  20. Advance Care Planning and Physician Orders in Nursing Home Residents With Dementia: A Nationwide Retrospective Study Among Professional Caregivers and Relatives

    NARCIS (Netherlands)

    Vandervoort, A.; Houttekier, D.; Block, L.; van der Steen, J.T.; van der Stichele, R.; Deliens, L.

    2014-01-01

    Context: Advance care planning (ACP) is key to good palliative care for nursing home (NH) residents with dementia. Objectives: We examined the extent to which the family physicians (FPs), nurses, and the relative most involved in the resident's care are informed about ACP, written advance

  1. Comorbidities, mortality and causes of death among patients with tuberculosis in Denmark 1998–2010: a nationwide, register-based case–control study

    DEFF Research Database (Denmark)

    Fløe, Andreas; Hilberg, Ole; Wejse, Christian

    2017-01-01

    -olds). While overall mortality increased with Deyo-Charlson comorbidity (DCC) score, relative mortality among cases was highest in the low-DCC group. Additionally, male gender, low income and central nervous system TB were risk factors for death among TB cases. The most common cause of death in both groups...... was non-lung cancers, among TB cases followed by COPD, TB and lung cancer, all being significantly more common among TB cases. Conclusion: In Denmark, TB carries substantial mortality. Among those who die, 12% are reported to die from TB. A high relative mortality among younger adults underscores...

  2. A Dutch Nationwide Bariatric Quality Registry: DATO.

    Science.gov (United States)

    Poelemeijer, Youri Q M; Liem, Ronald S L; Nienhuijs, Simon W

    2017-12-22

    In the Netherlands, the number of bariatric procedures increased exponentially in the 90s. To ensure and improve the quality of bariatric surgery, the nationwide Dutch Audit for Treatment of Obesity (DATO) was established in 2014. The audit was coordinated by the Dutch Institute for Clinical Auditing (DICA). This article provides a review of the aforementioned process in establishing a nationwide registry in the Netherlands. In collaboration with the DATO's scientific committee and other stakeholders, an annual list of several external quality indicators was formulated. This list consists of volume, process, and outcome indicators. In addition to the annual external indicators, the database permits individual hospitals to analyze their own data. The dashboard provides several standardized reports and detailed quality indicators, which are updated on a weekly base. Since the start, all 18 Dutch bariatric centers participated in the nationwide audit. A total of 21,941 cases were registered between 2015 and 2016. By 2016, the required variables were registered in 94.3% of all cases. A severe complicated course was seen in 2.87%, and mortality in 0.05% in 2016. The first-year follow-up shows a > 20% TWL in 86.1% of the registered cases. The DATO has become rapidly a mature registry. The well-organized structure of the national audit institution DICA and governmental funding were essential. However, most important were the bariatric teams themselves. The authors believe reporting the results from the registry has already contributed to more knowledge and acceptance by other health care providers.

  3. Heritability of Schizophrenia and Schizophrenia Spectrum Based on the Nationwide Danish Twin Register

    DEFF Research Database (Denmark)

    Hilker, Rikke; Helenius, Dorte; Fagerlund, Birgitte

    2018-01-01

    sample. The estimated 79% heritability of SZ is congruent with previous reports and indicates a substantial genetic risk. The high genetic risk also applies to a broader phenotype of SZ spectrum disorders. The low concordance rate of 33% in monozygotic twins demonstrates that illness vulnerability......BACKGROUND: Twin studies have provided evidence that both genetic and environmental factors contribute to schizophrenia (SZ) risk. Heritability estimates of SZ in twin samples have varied methodologically. This study provides updated heritability estimates based on nationwide twin data...... the heritability of SZ to be 79%. When expanding illness outcome to include SZ spectrum disorders, the heritability estimate was almost similar (73%). CONCLUSIONS: The key strength of this study is the application of a novel statistical method accounting for censoring in the follow-up period to a nationwide twin...

  4. Trajectories of disposable income among people of working ages diagnosed with multiple sclerosis: a nationwide register-based cohort study in Sweden 7 years before to 4 years after diagnosis with a population-based reference group.

    Science.gov (United States)

    Murley, Chantelle; Mogard, Olof; Wiberg, Michael; Alexanderson, Kristina; Karampampa, Korinna; Friberg, Emilie; Tinghög, Petter

    2018-05-09

    To describe how disposable income (DI) and three main components changed, and analyse whether DI development differed from working-aged people with multiple sclerosis (MS) to a reference group from 7 years before to 4 years after diagnosis in Sweden. Population-based cohort study, 12-year follow-up (7 years before to 4 years after diagnosis). Swedish working-age population with microdata linked from two nationwide registers. Residents diagnosed with MS in 2009 aged 25-59 years (n=785), and references without MS (n=7847) randomly selected with stratified matching (sex, age, education and country of birth). DI was defined as the annual after tax sum of incomes (earnings and benefits) to measure individual economic welfare. Three main components of DI were analysed as annual sums: earnings, sickness absence benefits and disability pension benefits. We found no differences in mean annual DI between people with and without MS by independent t-tests (p values between 0.15 and 0.96). Differences were found for all studied components of DI from diagnosis year by independent t-tests, for example, in the final study year (2013): earnings (-64 867 Swedish Krona (SEK); 95% CI-79 203 to -50 528); sickness absence benefits (13 330 SEK; 95% CI 10 042 to 16 500); and disability pension benefits (21 360 SEK; 95% CI 17 380 to 25 350). A generalised estimating equation evaluated DI trajectory development between people with and without MS to find both trajectories developed in parallel, both before (-4039 SEK; 95% CI -10 536 to 2458) and after (-781 SEK; 95% CI -6988 to 5360) diagnosis. The key finding of parallel DI trajectory development between working-aged MS and references suggests minimal economic impact within the first 4 years of diagnosis. The Swedish welfare system was responsive to the observed reductions in earnings around MS diagnosis through balancing DI with morbidity-related benefits. Future decreases in economic welfare may be experienced as the

  5. Studying Hospitalizations and Mortality in the Netherlands: Feasible and Valid Using Two-Step Medical Record Linkage with Nationwide Registers.

    Directory of Open Access Journals (Sweden)

    Elske Sieswerda

    Full Text Available In the Netherlands, the postal code is needed to study hospitalizations of individuals in the nationwide hospitalization register. Studying hospitalizations longitudinally becomes troublesome if individuals change address. We aimed to report on the feasibility and validity of a two-step medical record linkage approach to examine longitudinal trends in hospitalizations and mortality in a study cohort. First, we linked a study cohort of 1564 survivors of childhood cancer with the Municipal Personal Records Database (GBA which has postal code history and mortality data available. Within GBA, we sampled a reference population matched on year of birth, gender and calendar year. Second, we extracted hospitalizations from the Hospital Discharge Register (LMR with a date of discharge during unique follow-up (based on date of birth, gender and postal code in GBA. We calculated the agreement of death and being hospitalized in survivors according to the registers and to available cohort data. We retrieved 1477 (94% survivors from GBA. Median percentages of unique/potential follow-up were 87% (survivors and 83% (reference persons. Characteristics of survivors and reference persons contributing to unique follow-up were comparable. Agreement of hospitalization during unique follow-up was 94% and agreement of death was 98%. In absence of unique identifiers in the Dutch hospitalization register, it is feasible and valid to study hospitalizations and mortality of individuals longitudinally using a two-step medical record linkage approach. Cohort studies in the Netherlands have the opportunity to study mortality and hospitalization rates over time. These outcomes provide insight into the burden of clinical events and healthcare use in studies on patients at risk of long-term morbidities.

  6. Psychotropic Polypharmacy in Patients with Dementia

    DEFF Research Database (Denmark)

    Nørgaard, Ane; Jensen-Dahm, Christina; Gasse, Christiane

    2017-01-01

    classes (psychotropic polypharmacy) may also pose a risk for patients. OBJECTIVE: To investigate the prevalence and predictors associated with use of psychotropic polypharmacy in patients with dementia. METHODS: A population-based study using nationwide registers. Patients with dementia were identified...... to evaluate factors independently associated with the prescription of other psychotropic drug classes among patients already using antipsychotics. RESULTS: Among all patients registered with dementia (34,553), 25.3% (8,728) used ≥2 psychotropic drugs. Among patients treated with antipsychotics 75.8% (5...... of psychotropic drugs was antipsychotics and antidepressants. CONCLUSION: Concomitant use of psychotropic drugs was frequent in dementia patients. Patients living in nursing homes had the highest risk of receiving a combination of antipsychotics and other psychotropic drugs. Concomitant use of psychotropics may...

  7. Frontotemporal Dementias: A Review

    Directory of Open Access Journals (Sweden)

    Wilkins Kirsten

    2007-06-01

    Full Text Available Abstract Dementia is a clinical state characterized by loss of function in multiple cognitive domains. It is a costly disease in terms of both personal suffering and economic loss. Frontotemporal dementia (FTD is the term now preferred over Picks disease to describe the spectrum of non-Alzheimers dementias characterized by focal atrophy of the frontal and anterior temporal regions of the brain. The prevalence of FTD is considerable, though specific figures vary among different studies. It occurs usually in an age range of 35–75 and it is more common in individuals with a positive family history of dementia. The risk factors associated with this disorder include head injury and family history of FTD. Although there is some controversy regarding the further syndromatic subdivision of the different types of FTD, the three major clinical presentations of FTD include: 1 a frontal or behavioral variant (FvFTD, 2 a temporal, aphasic variant, also called Semantic dementia (SD, and 3 a progressive aphasia (PA. These different variants differ in their clinical presentation, cognitive deficits, and affected brain regions. Patients with FTD should have a neuropsychiatric assessment, neuropsychological testing and neuroimaging studies to confirm and clarify the diagnosis. Treatment for this entity consists of behavioral and pharmacological approaches. Medications such as serotonin reuptake inhibitors, antipsychotics, mood stabilizer and other novel treatments have been used in FTD with different rates of success. Further research should be directed at understanding and developing new diagnostic and therapeutic modalities to improve the patients' prognosis and quality of life.

  8. Long-term Risk of Dementia in Persons With Schizophrenia: A Danish Population-Based Cohort Study.

    Science.gov (United States)

    Ribe, Anette Riisgaard; Laursen, Thomas Munk; Charles, Morten; Katon, Wayne; Fenger-Grøn, Morten; Davydow, Dimitry; Chwastiak, Lydia; Cerimele, Joseph M; Vestergaard, Mogens

    2015-11-01

    Although schizophrenia is associated with several age-related disorders and considerable cognitive impairment, it remains unclear whether the risk of dementia is higher among persons with schizophrenia compared with those without schizophrenia. To determine the risk of dementia among persons with schizophrenia compared with those without schizophrenia in a large nationwide cohort study with up to 18 years of follow-up, taking age and established risk factors for dementia into account. This population-based cohort study of more than 2.8 million persons aged 50 years or older used individual data from 6 nationwide registers in Denmark. A total of 20 683 individuals had schizophrenia. Follow-up started on January 1, 1995, and ended on January 1, 2013. Analysis was conducted from January 1, 2015, to April 30, 2015. Incidence rate ratios (IRRs) and cumulative incidence proportions (CIPs) of dementia for persons with schizophrenia compared with persons without schizophrenia. During 18 years of follow-up, 136 012 individuals, including 944 individuals with a history of schizophrenia, developed dementia. Schizophrenia was associated with a more than 2-fold higher risk of all-cause dementia (IRR, 2.13; 95% CI, 2.00-2.27) after adjusting for age, sex, and calendar period. The estimates (reported as IRR; 95% CI) did not change substantially when adjusting for medical comorbidities, such as cardiovascular diseases and diabetes mellitus (2.01; 1.89-2.15) but decreased slightly when adjusting for substance abuse (1.71; 1.60-1.82). The association between schizophrenia and dementia risk was stable when evaluated in subgroups characterized by demographics and comorbidities, although the IRR was higher among individuals younger than 65 years (3.77; 3.29-4.33), men (2.38; 2.13-2.66), individuals living with a partner (3.16; 2.71-3.69), those without cerebrovascular disease (2.23; 2.08-2.39), and those without substance abuse (1.96; 1.82-2.11). The CIPs (95% CIs) of developing

  9. Aortic events in a nationwide Marfan syndrome cohort

    DEFF Research Database (Denmark)

    Groth, Kristian A; Krag, Kirstine Stochholm; Hove, Hanne

    2017-01-01

    BACKGROUND: Marfan syndrome is associated with morbidity and mortality due to aortic dilatation and dissection. Preventive aortic root replacement has been the standard treatment in Marfan syndrome patients with aortic dilatation. In this study, we present aortic event data from a nationwide Marfan...... syndrome cohort. METHOD: The nationwide cohort of Danish Marfan syndrome patients was established from the Danish National Patient Registry and the Cause of Death Register, where we retrieved information about aortic surgery and dissections. We associated aortic events with age, sex, and Marfan syndrome...

  10. A survey of the Queensland healthcare workforce: attitudes towards dementia care and training.

    Science.gov (United States)

    Travers, Catherine M; Beattie, Elizabeth; Martin-Khan, Melinda; Fielding, Elaine

    2013-09-30

    Positive attitudes of healthcare staff towards people with dementia promote higher quality care, although little is known about important factors that underlie positive attitudes. Key aims of this project were to explore the relationships between staff attitudes towards dementia, self-confidence in caring for people with dementia, experience and dementia education and training. A brief online survey was developed and widely distributed to registered nurses and allied health professionals working in Queensland in 2012. Regression analyses were performed to identify important predictors of self-confidence in caring for people with dementia and positive attitudes towards people with dementia. Five hundred and twenty-four surveys were completed by respondents working in a range of care settings across Queensland. Respondents were predominantly female (94.1%), and most were registered nurses (60%), aged between 41 and 60 years (65.6%). Around 40% regularly worked with people with dementia and high levels of self-confidence in caring for this population and positive attitudes towards people with dementia were reported. The majority of respondents (67%) had participated in a dementia education/training activity in the past 12 months. More experience working with people with dementia predicted greater self-confidence while recent participation in a dementia education/training and higher self-confidence in caring for a person with dementia significantly predicted more positive attitudes towards people with dementia. These results confirm the importance of self-confidence and dementia education in fostering positive attitudes and care practices towards people with dementia. Our results also indicate that the demand for ongoing dementia education is high amongst health care workers and it is recommended that regular dementia education/ training be provided and promoted for all healthcare personnel who work with people with dementia.

  11. Familial Risks of Kidney Failure in Sweden: A Nationwide Family Study

    OpenAIRE

    Akrawi, Delshad Saleh; Li, Xinjun; Sundquist, Jan; Sundquist, Kristina; Zöller, Bengt

    2014-01-01

    BACKGROUND: The value of family history as a risk factor for kidney failure has not been determined in a nationwide setting. AIM: This nationwide family study aimed to determine familial risks for kidney failure in Sweden. METHODS: The Swedish multi-generation register on 0-78-year-old subjects were linked to the Swedish patient register and the Cause of death register for 1987-2010. Individuals diagnosed with acute kidney failure (n = 10063), chronic kidney failure (n = 18668), or unspecifie...

  12. Associations between substance use disorders and suicide or suicide attempts in people with mental illness: a Danish nation-wide, prospective, register-based study of patients diagnosed with schizophrenia, bipolar disorder, unipolar depression or personality disorder.

    Science.gov (United States)

    Østergaard, Marie L D; Nordentoft, Merete; Hjorthøj, Carsten

    2017-07-01

    To estimate and test associations between substance use disorders (SUDs) and both completed suicides and suicide attempts in a population with severe mental illness. Register-based cohort study with adjusted Cox regression of substance use disorders as time-varying covariates. Denmark. People born in Denmark since 1955 with a diagnosis of schizophrenia (n = 35 625), bipolar disorder (n = 9279), depression (n = 72 530) or personality disorder (n = 63 958). Treated SUDs of alcohol and illicit substances identified in treatment registers; suicide attempt identified in treatment registers; and completed suicides identified in the Cause of Death register. Covariates were sex and age at diagnosis. Having any SUD was associated with at least a threefold increased risk of completed suicide when compared with those having no SUD. Alcohol misuse was associated with an increased risk of completed suicide in all populations with hazard ratios (HR) between 1.99 [95% confidence interval (CI) = 1.44-2.74] and 2.70 (95% CI = 2.40-3.04). Other illicit substances were associated with a two- to threefold risk increase of completed suicide in all populations except bipolar disorder, and cannabis was associated with increased risk of attempted suicide only in people with bipolar disorder (HR = 1.86, 95% CI = 1.15-2.99). Alcohol and other illicit substances each displayed strong associations with attempted suicide, HR ranging from 3.11 (95% CI = 2.95-3.27) to 3.38 (95% CI = 3.24-3.53) and 2.13 (95% CI = 2.03-2.24) to 2.27 (95% CI = 2.12-2.43), respectively. Cannabis was associated with suicide attempts only in people with schizophrenia (HR = 1.11, 95% CI = 1.03-1.19). Substance use disorders are associated strongly with risk of completed suicides and suicide attempts in people with severe mental illness. © 2017 Society for the Study of Addiction.

  13. Trichotillomania in a dementia case

    Directory of Open Access Journals (Sweden)

    Leonardo Caixeta

    Full Text Available Abstract We report an 87-year-old male case of hair pulling associated with a white-matter vascular dementia (Binswanger's disease. Trichotillomania in our case did not resolve using mirtazapine or anticholinesterasic medication. Trichotillomania seems to be related to a form of perseveration associated with dementia. The findings in this case suggest the abnormality involving white matter in the pathogenesis of trichotillomania, may constitute a defect in connectivity in the right frontal-subcortical circuit.

  14. Trichotillomania in a dementia case

    OpenAIRE

    Caixeta, Leonardo; Lopes, Danielly Bandeira

    2011-01-01

    Abstract We report an 87-year-old male case of hair pulling associated with a white-matter vascular dementia (Binswanger's disease). Trichotillomania in our case did not resolve using mirtazapine or anticholinesterasic medication. Trichotillomania seems to be related to a form of perseveration associated with dementia. The findings in this case suggest the abnormality involving white matter in the pathogenesis of trichotillomania, may constitute a defect in connectivity in the right frontal-s...

  15. ABO Blood Group and Dementia Risk--A Scandinavian Record-Linkage Study

    DEFF Research Database (Denmark)

    Vasan, Senthil K; Rostgaard, Klaus; Ullum, Henrik

    2015-01-01

    ,615 cases of Alzheimer's disease, 1,842 cases of vascular dementia, and 9,091 cases of unspecified dementia. Overall, our study showed no association between ABO blood group and risk of Alzheimer's disease, vascular dementia or unspecified dementia. This was also true when analyses were restricted to donors......BACKGROUND: Dementia includes a group of neuro-degenerative disorders characterized by varying degrees of cognitive impairment. Recent data indicates that blood group AB is associated with impaired cognition in elderly patients. To date there are no large-scale studies that have examined...... the relationship between ABO blood group and dementia-related disorders in detail. METHODS: We used data from the SCANDAT2 database that contains information on over 1.6 million blood donors from 1968 in Sweden and 1981 from Denmark. The database was linked with health outcomes data from nationwide patient...

  16. A review of ethical issues in dementia.

    Science.gov (United States)

    Johnson, Rebecca A; Karlawish, Jason

    2015-10-01

    Dementia raises many ethical issues. The present review, taking note of the fact that the stages of dementia raise distinct ethical issues, focuses on three issues associated with stages of dementia's progression: (1) how the emergence of preclinical and asymptomatic but at-risk categories for dementia creates complex questions about preventive measures, risk disclosure, and protection from stigma and discrimination; (2) how despite efforts at dementia prevention, important research continues to investigate ways to alleviate clinical dementia's symptoms, and requires additional human subjects protections to ethically enroll persons with dementia; and (3) how in spite of research and prevention efforts, persons continue to need to live with dementia. This review highlights two major themes. First is how expanding the boundaries of dementias such as Alzheimer's to include asymptomatic but at-risk persons generate new ethical questions. One promising way to address these questions is to take an integrated approach to dementia ethics, which can include incorporating ethics-related data collection into the design of a dementia research study itself. Second is the interdisciplinary nature of ethical questions related to dementia, from health policy questions about insurance coverage for long-term care to political questions about voting, driving, and other civic rights and privileges to economic questions about balancing an employer's right to a safe and productive workforce with an employee's rights to avoid discrimination on the basis of their dementia risk. The review highlights these themes and emerging ethical issues in dementia.

  17. Decreased systolic blood pressure is associated with increased risk of all-cause mortality in patients with type 2 diabetes and renal impairment: A nationwide longitudinal observational study of 27,732 patients based on the Swedish National Diabetes Register.

    Science.gov (United States)

    Svensson, Maria K; Afghahi, Henri; Franzen, Stefan; Björk, Staffan; Gudbjörnsdottir, Soffia; Svensson, Ann-Marie; Eliasson, Björn

    2017-05-01

    Previous studies have shown a U-shaped relationship between systolic blood pressure and risk of all-cause of mortality in patients with type 2 diabetes and renal impairment. To evaluate the associations between time-updated systolic blood pressure and time-updated change in systolic blood pressure during the follow-up period and risk of all-cause mortality in patients with type 2 diabetes and renal impairment. A total of 27,732 patients with type 2 diabetes and renal impairment in the Swedish National Diabetes Register were followed for 4.7 years. Time-dependent Cox models were used to estimate risk of all-cause mortality. Time-updated mean systolic blood pressure is the average of the baseline and the reported post-baseline systolic blood pressures. A time-updated systolic blood pressure blood pressure > 10 mmHg between the last two observations was associated with higher risk of all-cause mortality (-10 to -25 mmHg; hazard ratio: 1.24, 95% confidence interval: 1.17-1.32). Both low systolic blood pressure and a decrease in systolic blood pressure during the follow-up are associated with a higher risk of all-cause mortality in patients with type 2 diabetes and renal impairment.

  18. Dementia.

    Science.gov (United States)

    Nardone, Raffaele; Golaszewski, Stefan; Trinka, Eugen

    2013-01-01

    Transcranial magnetic stimulation (TMS) has been used extensively to characterize motor system pathophysiology in Alzheimer's disease (AD) and other forms of dementia, as well to monitor the effects of certain pharmacological agents. Among the studies focusing on motor cortical excitability measures, the most consistent finding is a significant reduction of short-latency afferent inhibition (SAI) in AD and other forms of dementia in which the cholinergic system is affected, such as dementia with Lewy bodies. SAI evaluation may thus provide a reliable biomarker of cortical cholinergic dysfunction in dementias. Moreover, most TMS studies have demonstrated cortical hyperexcitability and asymptomatic motor cortex functional reorganization in the early stages of the disease. Integrated approaches utilizing TMS together with high-density EEG have indicated impaired cortical plasticity and functional connectivity across different neural networks in AD. Paired associative stimulation-induced plasticity has also been found to be abnormal in patients with AD. The development of novel noninvasive methods of brain stimulation, in particular repetitive TMS (rTMS) and transcranial direct current stimulation (tDCS), has increased the interest in neuromodulatory techniques as potential therapeutic tools for cognitive rehabilitation in AD. Preliminary studies have revealed that rTMS and tDCS can induce beneficial effects on specific cognitive functions in AD. Future studies are warranted to replicate and extend the initial findings. © 2013 Elsevier B.V. All rights reserved.

  19. Causes of Death According to Death Certificates in Individuals with Dementia: A Cohort from the Swedish Dementia Registry.

    Science.gov (United States)

    Garcia-Ptacek, Sara; Kåreholt, Ingemar; Cermakova, Pavla; Rizzuto, Debora; Religa, Dorota; Eriksdotter, Maria

    2016-11-01

    The causes of death in dementia are not established, particularly in rarer dementias. The aim of this study is to calculate risk of death from specific causes for a broader spectrum of dementia diagnoses. Cohort study. Swedish Dementia Registry (SveDem), 2007-2012. Individuals with incident dementia registered in SveDem (N = 28,609); median follow-up 741 days. Observed deaths were 5,368 (19%). Information on number of deaths and causes of mortality was obtained from death certificates. Odds ratios for the presence of dementia on death certificates were calculated. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox hazards regression for cause-specific mortality, using Alzheimer's dementia (AD) as reference. Hazard ratios for death for each specific cause of death were compared with hazard ratios of death from all causes (P-values from t-tests). The most frequent underlying cause of death in this cohort was cardiovascular (37%), followed by dementia (30%). Dementia and cardiovascular causes appeared as main or contributory causes on 63% of certificates, followed by respiratory (26%). Dementia was mentioned less in vascular dementia (VaD; 57%). Compared to AD, cardiovascular mortality was higher in individuals with VaD than in those with AD (HR = 1.82, 95% CI = 1.64-2.02). Respiratory death was higher in individuals with Lewy body dementia (LBD, including Parkinson's disease dementia and dementia with Lewy bodies, HR = 2.16, 95% CI = 1.71-2.71), and the risk of respiratory death was higher than expected from the risk for all-cause mortality. Participants with frontotemporal dementia were more likely to die from external causes of death than those with AD (HR = 2.86, 95% CI = 1.53-5.32). Dementia is underreported on death certificates as main and contributory causes. Individuals with LBD had a higher risk of respiratory death than those with AD. © 2016 The Authors. The Journal of the American Geriatrics Society published by Wiley

  20. Dementia.

    Science.gov (United States)

    Butler, Rob; Radhakrishnan, Raghavakurup

    2012-09-10

    Dementia is characterised by chronic, global, non-reversible deterioration in memory, executive function, and personality. Speech and motor function may also be impaired. We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of treatments on cognitive symptoms of dementia (Alzheimer's, Lewy body, or vascular)? What are the effects of treatments on behavioural and psychological symptoms of dementia (Alzheimer's, Lewy body, or vascular)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2011 (Clinical Evidence reviews are updated periodically; please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). We found 49 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. In this systematic review, we present information relating to the effectiveness and safety of the following interventions: acetylcholinesterase inhibitors (donepezil, galantamine, rivastigmine), antidepressants (clomipramine, fluoxetine, imipramine, sertraline), antipsychotics (haloperidol, olanzapine, quetiapine, risperidone), aromatherapy, benzodiazepines (diazepam, lorazepam), cognitive behavioural therapy (CBT), cognitive stimulation, exercise, ginkgo biloba, memantine, mood stabilisers (carbamazepine, sodium valproate/valproic acid), music therapy, non-steroidal anti-inflammatory drugs (NSAIDs), omega 3 (fish oil), reminiscence therapy, and statins.

  1. Dementia

    Science.gov (United States)

    ... aging. Many different diseases can cause dementia, including Alzheimer's disease and stroke. Drugs are available to treat some of these diseases. While these drugs cannot cure dementia or repair brain damage, they may improve ...

  2. Dementia

    Science.gov (United States)

    ... continue to look for new genes that may be responsible for the development of Alzheimer’s disease and other forms of dementia. Several research projects hope to identify dementia biomarkers (measurable biological signs ...

  3. Familial aggregation of congenital hydrocephalus in a nationwide cohort

    DEFF Research Database (Denmark)

    Munch, Tina Nørgaard; Rostgaard, Klaus; Rasmussen, Marie-Louise Hee

    2012-01-01

    The objective of the study was to investigate familial aggregation of primary congenital hydrocephalus in an unselected, nationwide population. Based on the Danish Central Person Register, we identified all children born in Denmark between 1978 and 2008 and their family members (up to third......-degree relatives). Information on primary congenital hydrocephalus was obtained from the National Patient Discharge Register. Using binomial log-linear regression, we estimated recurrence risk ratios of congenital hydrocephalus. An alternative log-linear regression model was applied to quantify the genetic effect...... and the maternal effect. Of 1 928 683 live-born children, 2194 had a diagnosis of idiopathic congenital hydrocephalus (1.1/1000). Of those, 75 (3.4%) had at least one other family member with primary congenital hydrocephalus. Significantly increased recurrence risk ratios of primary congenital hydrocephalus were...

  4. [Depression: A predictor of dementia].

    Science.gov (United States)

    Deví Bastida, Josep; Puig Pomés, Núria; Jofre Font, Susanna; Fetscher Eickhoff, Albert

    2016-01-01

    Many studies suggest that in 10-25% of cases of Alzheimer's, the most common dementia in our society, can be prevented with the elimination of some risk factors. Barnes and Yaffe found that one-third of Alzheimer's cases are attributable to depression, but in the scientific literature it is not clear if it has a real causal effect on the development of dementia. The purpose of this study is to analyse the scientific evidence on the hypothesis that depression increases the risk of developing dementia. A systematic review and a meta-analysis were performed on the scientific literature published up until the present day, searching articles that were published between 1990 and 2014. Ten of the studies found met the selection criteria -similar to a) size and characteristics of the sample (origin, age…), b) process of gathering data c) method of studying the relationship (within and/or between group comparison), and d) statistical analysis of the results- and the previously established quality. The value of odds ratio varied from 1.72 to 3.59, and the hazard ratio from 1,72 to 5.44. This indicates that the subjects with a history of depression have a higher risk of developing dementia than others who did not suffer depression. Copyright © 2015 SEGG. Published by Elsevier Espana. All rights reserved.

  5. AIDS dementia complex: a review

    NARCIS (Netherlands)

    Portegies, P.

    1994-01-01

    AIDS dementia complex (ADC) is a constellation of cognitive, motor, and behavioral dysfunctions frequently observed in persons with AIDS. Estimates of its prevalence vary. ADC may occur at any stage of AIDS but is usually associated with later stages of disease. Its severity varies among patients

  6. Increased risk of developing dementia in patients with major affective disorders compared to patients with other medical illnesses

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Nilsson, Flemming Mørkeberg

    2003-01-01

    BACKGROUND: The association between affective disorder and subsequent dementia is unclear. Our aim was to investigate whether patients with unipolar or bipolar affective disorder have an increased risk of developing dementia compared to patients with other chronic illnesses. METHOD: By linkage...... of the psychiatric and somatic nation-wide registers of all hospitalised patients in Denmark, 2007 patients with mania, 11741 patients with depression, 81380 patients with osteoarthritis and 69149 patients with diabetes were identified according to diagnosis at first-ever discharge from a psychiatric or somatic...... hospital between 1 January 1977 and 31 December 1993. The risk of receiving a diagnosis of dementia on subsequent re-admission was estimated with the use of survival analyses. RESULTS: Patients with unipolar or bipolar affective disorder had a greater risk of receiving a diagnosis of dementia than patients...

  7. Validity and completeness of rheumatoid arthritis diagnoses in the nationwide DANBIO clinical register and the Danish National Patient Registry

    DEFF Research Database (Denmark)

    Ibfelt, Else Helene; Sørensen, Jan; Jensen, Dorte V

    2017-01-01

    registry. Study design and setting: Patients registered for the first time in 2011 with a diagnosis of RA were identified in DANBIO and DNPR in January 2013. For DNPR, filters were applied to reduce false-positive cases. The diagnosis was verified by a review of patient records. We calculated the positive...

  8. Dementia pugilistica 1a. parte

    OpenAIRE

    OTERO SILICEO, ENRIQUE; PADILLA RUBIO, JOEL

    2004-01-01

    Sports is considered a synonym for body and mind health. However, the so called contaet sports, the main example being boxing, more or less go beyond this definition. Contemporary boxing is a spetacle, who is a continuation of historical fights of gladiators. For many years, several complications and head alterations have been related to boxing involving both the face and the skull. And, because of their outcome, some of the most important alterations are neuropsychiatric such as dementia pug...

  9. A Dementia Case Presenting with Psychotic Symptoms

    Directory of Open Access Journals (Sweden)

    Osman Ozdemir

    2013-06-01

    Full Text Available Dementia is a progressive clinical syndrome in which affected areas of brain function may be affected, such as memory, language, abstract thinking, problem solving and attention. Psychotic symptoms include auditory and visual hallucinations and delusions, which usually occur in the dementia. In this paper, a dementia case presenting with psychotic symptoms is presented. [Cukurova Med J 2013; 38(3.000: 482-486

  10. Short-term and long-term effects of psychosocial therapy for people after deliberate self-harm: a register-based, nationwide multicentre study using propensity score matching

    DEFF Research Database (Denmark)

    Lind, Bertel; Erlangsen, Anette; Stuart, Elisabeth

    2014-01-01

    Background Although deliberate self-harm is a strong predictor of suicide, evidence for effective interventions is missing. The aim of this study was to examine whether psychosocial therapy after self-harm was linked to lower risks of repeated self-harm, suicide, and general mortality. Methods...... In this matched cohort study all people who, after deliberate self-harm, received a psychosocial therapy intervention at suicide prevention clinics in Denmark during 1992—2010 were compared with people who did not receive the psychosocial therapy intervention after deliberate self-harm. We applied propensity...... score matching with a 1:3 ratio and 31 matching factors, and calculated odds ratios for 1, 5, 10, and 20 years of follow-up. The primary endpoints were repeated self-harm, death by suicide, and death by any cause. Findings 5678 recipients of psychosocial therapy (followed up for 42·828 person...

  11. A Nationwide Register-Based Survey of Baclofen Toxicity

    DEFF Research Database (Denmark)

    Kiel, Louise Bendix; Hoegberg, Lotte Christine Groth; Jansen, Tejs

    2015-01-01

    was conducted with ICD-10 codes for poisoning, self-harm and suicide, and coupled with the baclofen ATC code. All enquiries about baclofen to the Danish Poison Information Centre (DPIC) in the same period were evaluated. Demographic and clinical data were extracted, and the poisonings were classified according...

  12. Validation of a Cerebral Palsy Register

    DEFF Research Database (Denmark)

    Topp, Monica; Langhoff-Roos, Jens; Uldall, P.

    1997-01-01

    OBJECTIVES: To analyse completeness and validity of data in the Cerebral Palsy Register in Denmark, 1979-1982. METHODS: Completeness has been assessed by comparing data from The Danish National Patient Register (DNPR) with the cases included in the Cerebral Palsy Register (CPR). Agreement between......, but gestational age was subject to a systematic error, and urinary infections in pregnancy (kappa = 0.43) and placental abruption (kappa = 0.52) were seriously under-reported in the CPR. CONCLUSIONS: Completeness of the Cerebral Palsy Register in Denmark, 1979-1982, has been assessed to maximal 85%, emphasizing...

  13. Dysejaculation after laparoscopic inguinal herniorrhaphy: a nationwide questionnaire study

    DEFF Research Database (Denmark)

    Bischoff, Joakim Mutahi; Linderoth, Gitte; Aasvang, Eske Kvanner

    2012-01-01

    or genitals during sexual activity was reported by 88 patients (10.9%), and 19 patients (2.4%) reported that the pain had impaired their sexual activity to a moderate or severe degree. Older patients and patients with longer follow-up had lower prevalence of pain during sexual activity. CONCLUSIONS......BACKGROUND: Dysejaculation and pain from the groin and genitals during sexual activity represent a clinically significant problem in up to 4% of younger males after open inguinal herniorrhaphy. The aim of this questionnaire study is to assess the prevalence of dysejaculation and pain during sexual...... activity after laparoscopic inguinal herniorrhaphy on a nationwide basis. METHODS: The study population comprised all men aged 18-50 years registered in the Danish Hernia Database (n = 1,671) who underwent primary laparoscopic herniorrhaphy between January 1, 1998 and November 30, 2009. Questionnaires...

  14. Dementia

    Science.gov (United States)

    ... Poor judgment and loss of ability to recognize danger Using the wrong word, not pronouncing words correctly, ... disease and other dementias. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine . 25th ed. Philadelphia, PA: ...

  15. Enteral Nutrition in Dementia: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Joanne Brooke

    2015-04-01

    Full Text Available The aim of this systematic review is to evaluate the role of enteral nutrition in dementia. The prevalence of dementia is predicted to rise worldwide partly due to an aging population. People with dementia may experience both cognitive and physical complications that impact on their nutritional intake. Malnutrition and weight loss in dementia correlates with cognitive decline and the progress of the disease. An intervention for long term eating difficulties is the provision of enteral nutrition through a Percutaneous Endoscopic Gastrostomy tube to improve both nutritional parameters and quality of life. Enteral nutrition in dementia has traditionally been discouraged, although further understanding of physical, nutritional and quality of life outcomes are required. The following electronic databases were searched: EBSCO Host, MEDLINE, PubMed, Cochrane Database of Systematic Reviews and Google Scholar for publications from 1st January 2008 and up to and including 1st January 2014. Inclusion criteria included the following outcomes: mortality, aspiration pneumonia, pressure sores, nutritional parameters and quality of life. Each study included separate analysis for patients with a diagnosis of dementia and/or neurological disease. Retrospective and prospective observational studies were included. No differences in mortality were found for patients with dementia, without dementia or other neurological disorders. Risk factors for poor survival included decreased or decreasing serum albumin levels, increasing age or over 80 years and male gender. Evidence regarding pneumonia was limited, although did not impact on mortality. No studies explored pressure sores or quality of life.

  16. Pain treatment and its cost in old people with dementia: a descriptive analysis from the Registry of Dementias of Girona (ReDeGi).

    Science.gov (United States)

    Calvó-Perxas, Laia; López-Pousa, Secundino; Turró-Garriga, Oriol; de Eugenio, Rosa; Linares, Marta; Fernández, Maria Del Mar; Castellanos, Mar; Casas, Isabel; Turón-Estrada, Antoni; Casadevall, Teresa; Coromina, Joan; Vilalta-Franch, Joan; Garre-Olmo, Josep

    2013-05-01

    Pain prevalence is high among elderly people, and equally prevalent in those with dementia. The aim of this study was to describe the use analgesics, as well as the cost of these treatments in old people with dementia. We used a cross-sectional design using 1186 cases registered by the Registry of Dementias of Girona from 2007 to 2008. All drugs were categorized following the Anatomic Therapeutic Chemical classification and grouped according to the World Health Organization (WHO) analgesic ladder steps. Descriptive statistical methods were used. Analgesics were prescribed to 78.6% (95% CI, 76.2-81.0) of the registered cases. Of them, 80.6% (95% CI, 78.0-83.2) were treated following step 1 of the WHO analgesic ladder, 16.8% (95% CI, 14.4-19.3) following step 2 and 2.6% (95% CI, 1.5-3.6) following step 3. Pain treatment in old people with dementia had a cost of 42.1 € per patient and year, with no significant differences depending on the subtype of dementia. The use of analgesics in our sample was not associated to age or to dementia severity, which are themselves risk factors for increased pain. Moreover, no differences were detected depending on the subtype of dementia.

  17. Knowledge gap regarding dementia care among nurses in Taiwanese acute care hospitals: A cross-sectional study.

    Science.gov (United States)

    Lin, Pei-Chao; Hsieh, Mei-Hui; Chen, Meng-Chin; Yang, Yung-Mei; Lin, Li-Chan

    2018-02-01

    The quality of dementia care in hospitals is typically substandard. Staff members are underprepared for providing care to older people with dementia. The objective of the present study was to examine dementia care knowledge, attitude and behavior regarding self-education about dementia care among nurses working in different wards. This was a descriptive cross-sectional study. The present study was carried out from July 2013 to December 2013. In total, 387 nurses working in different wards were recruited from two hospitals in Taiwan by using convenience sampling. The nurses completed a self-report questionnaire on demographic data, experience and learning behavior, and attitude towards dementia care, and a 16-item questionnaire on dementia care knowledge. Descriptive and inferential statistics were used to analyze the status and differences in dementia care knowledge among nurse in different wards. The average dementia care knowledge score was 10.46 (SD 2.13), with a 66.5% mean accuracy among all nurses. Dementia care knowledge was significantly associated with age, nursing experience, possession of a registered nurse license, holding a bachelor's degree, work unit, training courses and learning behavior towards dementia care. The dementia care knowledge of the emergency room nurses was significantly lower than that of the psychiatric and neurology ward nurses. A significantly lower percentage of emergency room nurses underwent dementia care training and actively searched for information on dementia care, compared with the psychiatric and neurology ward nurses. Hospital nurses show a knowledge gap regarding dementia care, especially emergency room nurses. Providing dementia care training to hospital nurses, particularly emergency room nurses, is crucial for improving the quality of care for patients with dementia. Geriatr Gerontol Int 2018; 18: 276-285. © 2017 Japan Geriatrics Society.

  18. The Danish Hip Arthroplasty Register

    DEFF Research Database (Denmark)

    Gundtoft, Per Hviid; Varnum, Claus; Pedersen, Alma Becic

    2016-01-01

    AIM OF DATABASE: The aim of the Danish Hip Arthroplasty Register (DHR) is to continuously monitor and improve the quality of treatment of primary and revision total hip arthroplasty (THA) in Denmark. STUDY POPULATION: The DHR is a Danish nationwide arthroplasty register established in January 1995...

  19. Prevalence and etiology of dementia in a Japanese community.

    Science.gov (United States)

    Ueda, K; Kawano, H; Hasuo, Y; Fujishima, M

    1992-06-01

    We sought to determine the type-specific prevalence of dementia and its risk factors in elderly persons from the Japanese community of Hisayama. We studied the prevalence of dementia in 887 Hisayama residents (353 men and 534 women) aged 65 years or older (screening rate, 94.6%) using various items of clinical information, neurological examination, and dementia scales. We also studied brain morphology in 50 of 59 determined to have dementia by computed tomography or autopsy during the subsequent 54-month period. Factors relevant to dementia were compared between 27 patients with vascular dementia and 789 control subjects without dementia in a retrospective fashion. The prevalence rate of dementia among Hisayama residents aged 65 or older was estimated at 6.7%, with a females to males ratio of 1:2. Among 50 cases of dementia in which brain morphology was examined, the frequency of vascular dementia was 56%; this rate was 2.2 times higher than that for senile dementia of the Alzheimer type. Aging, hypertension, electrocardiographic abnormalities, and high hematocrit were significantly (p less than 0.05) and independently associated with the occurrence of vascular dementia. Prevalence of dementia among the Hisayama residents was relatively identical to that previously reported, but vascular dementia was more predominant. Risk factors for vascular dementia were similar to those for lacunar infarcts. Control of hypertension may be a key to reducing dementia among the Japanese population.

  20. Debug register rootkits : A study of malicious use of the IA-32 debug registers

    OpenAIRE

    Persson, Emil; Mattsson, Joel

    2012-01-01

    The debug register rootkit is a special type of rootkit that has existed for over a decade, and is told to be undetectable by any scanning tools. It exploits the debug registers in Intel’s IA-32 processor architecture. This paper investigates the debug register rootkit to find out why it is considered a threat, and which malware removal tools have implemented detection algorithms against this threat. By implementing and running a debug register rootkit against the most popular Linux tools, ne...

  1. Incidence of hip and knee replacement in patients with rheumatoid arthritis following the introduction of biological DMARDs: an interrupted time-series analysis using nationwide Danish healthcare registers.

    Science.gov (United States)

    Cordtz, René Lindholm; Hawley, Samuel; Prieto-Alhambra, Daniel; Højgaard, Pil; Zobbe, Kristian; Overgaard, Søren; Odgaard, Anders; Kristensen, Lars Erik; Dreyer, Lene

    2018-05-01

    To study the impact of the introduction of biological disease-modifying anti-rheumatic drugs (bDMARDs) and associated rheumatoid arthritis (RA) management guidelines on the incidence of total hip (THR) and knee replacements (TKR) in Denmark. Nationwide register-based cohort and interrupted time-series analysis. Patients with incident RA between 1996 and 2011 were identified in the Danish National Patient Register. Patients with RA were matched on age, sex and municipality with up to 10 general population comparators (GPCs). Standardised 5-year incidence rates of THR and TKR per 1000 person-years were calculated for patients with RA and GPCs in 6-month periods. Levels and trends in the pre-bDMARD (1996-2001) were compared with the bDMARD era (2003-2016) using segmented linear regression interrupted by a 1-year lag period (2002). We identified 30 404 patients with incident RA and 297 916 GPCs. In 1996, the incidence rate of THR and TKR was 8.72 and 5.87, respectively, among patients with RA, and 2.89 and 0.42 in GPCs. From 1996 to 2016, the incidence rate of THR decreased among patients with RA, but increased among GPCs. Among patients with RA, the incidence rate of TKR increased from 1996 to 2001, but started to decrease from 2003 and throughout the bDMARD era. The incidence of TKR increased among GPCs from 1996 to 2016. We report that the incidence rate of THR and TKR was 3-fold and 14-fold higher, respectively among patients with RA compared with GPCs in 1996. In patients with RA, introduction of bDMARDs was associated with a decreasing incidence rate of TKR, whereas the incidence of THR had started to decrease before bDMARD introduction. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  2. Aortic events in a nationwide Marfan syndrome cohort.

    Science.gov (United States)

    Groth, Kristian A; Stochholm, Kirstine; Hove, Hanne; Kyhl, Kasper; Gregersen, Pernille A; Vejlstrup, Niels; Østergaard, John R; Gravholt, Claus H; Andersen, Niels H

    2017-02-01

    Marfan syndrome is associated with morbidity and mortality due to aortic dilatation and dissection. Preventive aortic root replacement has been the standard treatment in Marfan syndrome patients with aortic dilatation. In this study, we present aortic event data from a nationwide Marfan syndrome cohort. The nationwide cohort of Danish Marfan syndrome patients was established from the Danish National Patient Registry and the Cause of Death Register, where we retrieved information about aortic surgery and dissections. We associated aortic events with age, sex, and Marfan syndrome diagnosis prior or after the first aortic event. From the total cohort of 412 patients, 150 (36.4 %) had an aortic event. Fifty percent were event free at age 49.6. Eighty patients (53.3 %) had prophylactic surgery and seventy patients (46.7 %) a dissection. The yearly event rate was 0.02 events/year/patient in the period 1994-2014. Male patients had a significant higher risk of an aortic event at a younger age with a hazard ratio of 1.75 (CI 1.26-2.42, p = 0.001) compared with women. Fifty-three patients (12.9 %) were diagnosed with MFS after their first aortic event which primarily was aortic dissection [n = 44 (83.0 %)]. More than a third of MFS patients experienced an aortic event and male patients had significantly more aortic events than females. More than half of the total number of dissections was in patients undiagnosed with MFS at the time of their event. This emphasizes that diagnosing MFS is lifesaving and improves mortality risk by reducing the risk of aorta dissection.

  3. A clinical registry of dementia based on the principle of epidemiological surveillance

    Directory of Open Access Journals (Sweden)

    Turbau Josefina

    2009-01-01

    Full Text Available Abstract Background Traditional epidemiological studies do not allow elucidating the reality of referral and diagnosis patterns of dementia in routine clinical practice within a defined territory. This information is useful and necessary in order to plan and allocate healthcare resources. This paper presents the results from a dementia case registry based on epidemiological surveillance fundamentals. Methods Standardised registry of dementia diagnoses made in 2007 by specialised care centres in the Health Region of Girona (RSG (Spain, which encompasses an area of 5,517 sq. km and a reference population of 690,207 inhabitants. Results 577 cases of dementia were registered, of which 60.7% corresponded to cases of Alzheimer's disease. Presenile dementia accounted for 9.3% of the cases. Mean time between the onset of symptoms and clinical diagnosis was 2.4 years and the severity of the dementia was mild in 60.7% of the cases. High blood pressure, a family history of dementia, dislipidemia, and a past history of depression were the most common conditions prior to the onset of the disease (>20%. Conclusion The ReDeGi is a viable epidemiological surveillance device that provides information about the clinical and demographic characteristics of patients diagnosed with dementia in a defined geographical area.

  4. A clinical registry of dementia based on the principle of epidemiological surveillance

    Science.gov (United States)

    Garre-Olmo, Josep; Flaqué, Margarita; Gich, Jordi; Pulido, Teresa Osuna; Turbau, Josefina; Vallmajo, Natalia; Viñas, Marta; López-Pousa, Secundí

    2009-01-01

    Background Traditional epidemiological studies do not allow elucidating the reality of referral and diagnosis patterns of dementia in routine clinical practice within a defined territory. This information is useful and necessary in order to plan and allocate healthcare resources. This paper presents the results from a dementia case registry based on epidemiological surveillance fundamentals. Methods Standardised registry of dementia diagnoses made in 2007 by specialised care centres in the Health Region of Girona (RSG) (Spain), which encompasses an area of 5,517 sq. km and a reference population of 690,207 inhabitants. Results 577 cases of dementia were registered, of which 60.7% corresponded to cases of Alzheimer's disease. Presenile dementia accounted for 9.3% of the cases. Mean time between the onset of symptoms and clinical diagnosis was 2.4 years and the severity of the dementia was mild in 60.7% of the cases. High blood pressure, a family history of dementia, dislipidemia, and a past history of depression were the most common conditions prior to the onset of the disease (>20%). Conclusion The ReDeGi is a viable epidemiological surveillance device that provides information about the clinical and demographic characteristics of patients diagnosed with dementia in a defined geographical area. PMID:19175921

  5. Dural arteriovenous fistula as a treatable dementia.

    Science.gov (United States)

    Enofe, Ikponmwosa; Thacker, Ike; Shamim, Sadat

    2017-04-01

    Dementia is a chronic loss of neurocognitive function that is progressive and irreversible. Although rare, dural arteriovenous fistulas (DAVFs) could present with a rapid decline in neurocognitive function with or without Parkinson-like symptoms. DAVFs represent a potentially treatable and reversible cause of dementia. Here, we report the case of an elderly woman diagnosed with a DAVF after presenting with new-onset seizures, deteriorating neurocognitive function, and Parkinson-like symptoms.

  6. Fractures in Individuals with and without a History of Infantile Autism. A Danish Register Study Based on Hospital Discharge Diagnoses

    Science.gov (United States)

    Mouridsen, Svend Erik; Rich, Bente; Isager, Torben

    2012-01-01

    We compared the prevalence and types of fractures in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with 336 matched controls from the general population. All participants were screened through the nationwide Danish National Hospital Register. The average observation time was 30.3 years (range 27.3-30.4…

  7. Prestroke Mobility and Dementia as Predictors of Stroke Outcomes in Patients Over 65 Years of Age: A Cohort Study From The Swedish Dementia and Stroke Registries.

    Science.gov (United States)

    Garcia-Ptacek, Sara; Contreras Escamez, Beatriz; Zupanic, Eva; Religa, Dorota; von Koch, Lena; Johnell, Kristina; von Euler, Mia; Kåreholt, Ingemar; Eriksdotter, Maria

    2018-02-01

    To explore the association between prestroke mobility dependency and dementia on functioning and mortality outcomes after stroke in patients>65 years of age. Longitudinal cohort study based on SveDem, the Swedish Dementia Registry and Riksstroke, the Swedish Stroke Registry. A total of 1689 patients with dementia >65 years of age registered in SveDem and suffering a first stroke between 2007 and 2014 were matched with 7973 controls without dementia with stroke. Odds ratios (ORs) and 95% confidence intervals (CIs) for intrahospital mortality, and functioning and mortality outcomes at 3 months were calculated. Functioning included level of residential assistance (living at home without help, at home with help, or nursing home) and mobility dependency (independent, needing help to move outdoors, or needing help indoors and outdoors). Prestroke dependency in activities of daily living and mobility were worse in patients with dementia than controls without dementia. In unadjusted analyses, patients with dementia were more often discharged to nursing homes (51% vs 20%; P mobility (OR 2.57; 2.20-3.02). Patients with dementia who were independent for mobility prestroke were more likely to be discharged to a nursing home compared with patients without dementia with the same prestroke mobility (37% vs 16%; P mobility limitations were associated with higher odds for poorer mobility, needing more residential assistance, and death. Patients with mobility impairments and/or dementia present a high burden of disability after a stroke. There is a need for research on stroke interventions among these populations. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  8. Prevalence of dementia and major dementia subtypes in Spanish populations: A reanalysis of dementia prevalence surveys, 1990-2008

    Directory of Open Access Journals (Sweden)

    Boix Raquel

    2009-10-01

    Full Text Available Abstract Background This study describes the prevalence of dementia and major dementia subtypes in Spanish elderly. Methods We identified screening surveys, both published and unpublished, in Spanish populations, which fulfilled specific quality criteria and targeted prevalence of dementia in populations aged 70 years and above. Surveys covering 13 geographically different populations were selected (prevalence period: 1990-2008. Authors of original surveys provided methodological details of their studies through a systematic questionnaire and also raw age-specific data. Prevalence data were compared using direct adjustment and logistic regression. Results The reanalyzed study population (aged 70 year and above was composed of Central and North-Eastern Spanish sub-populations obtained from 9 surveys and totaled 12,232 persons and 1,194 cases of dementia (707 of Alzheimer's disease, 238 of vascular dementia. Results showed high variation in age- and sex-specific prevalence across studies. The reanalyzed prevalence of dementia was significantly higher in women; increased with age, particularly for Alzheimer's disease; and displayed a significant geographical variation among men. Prevalence was lowest in surveys reporting participation below 85%, studies referred to urban-mixed populations and populations diagnosed by psychiatrists. Conclusion Prevalence of dementia and Alzheimer's disease in Central and North-Eastern Spain is higher in females, increases with age, and displays considerable geographic variation that may be method-related. People suffering from dementia and Alzheimer's disease in Spain may approach 600,000 and 400,000 respectively. However, existing studies may not be completely appropriate to infer prevalence of dementia and its subtypes in Spain until surveys in Southern Spain are conducted.

  9. Association between recognizing dementia as a mental illness and dementia knowledge among elderly Chinese Americans.

    Science.gov (United States)

    Zheng, Xin; Woo, Benjamin K P

    2016-06-22

    To investigate whether older Chinese Americans perceive dementia as a mental illness and the relationship between such perception and their general understanding of dementia remains unclear. Our study aims to understand this relationship and its future implication on improving dementia literacy among ethnic minorities. Elderly Chinese American participants from the Greater Los Angeles were asked to complete an 11-item dementia questionnaire, following a community health seminar. Cross-sectional survey data was analyzed using standard statistical methods. The questionnaire received an 88.3% response rate. Among 316 responders, only 28.8% (n = 91) of elderly Chinese Americans identified dementia as a mental illness, and 71.2% (n = 225) did not recognize its mental disease origin. Furthermore, in comparison between these two groups, the first group demonstrated significantly higher level of baseline knowledge of the disease. This study reveals that only approximately 1 out of 4 older Chinese Americans recognized dementia as a mental illness, consistent with previous studies on Asian Americans. Our study however showed that when dementia was being perceived as a mental illness, such perception was associated with a higher level of baseline dementia understanding. The current study suggested the potential of improving older Chinese Americans dementia literacy by increasing awareness of its mental illness origin.

  10. Fertility Treatment and Childhood Epilepsy - a Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Kettner, Laura Ozer; Kesmodel, Ulrik Schiøler; Ramlau-Hansen, Cecilia Høst

    2017-01-01

    BACKGROUND: Fertility treatment includes hormonal stimulation of the woman and in vitro manipulation of gametes and embryos that may influence prenatal brain development. We aimed to investigate the association between fertility treatment and childhood epilepsy, including specific types of treatm......BACKGROUND: Fertility treatment includes hormonal stimulation of the woman and in vitro manipulation of gametes and embryos that may influence prenatal brain development. We aimed to investigate the association between fertility treatment and childhood epilepsy, including specific types...... of treatment and indications, as well as subtypes of epilepsy. METHODS: In this nationwide birth cohort study, we included all pregnancies in Denmark resulting in live-born singletons, 1995-2003. Children conceived by fertility treatment and children developing epilepsy (until 2013) were identified from Danish...... national registers. RESULTS: A total of 565,116 pregnancies were included; 8,071 children (1.4%) developed epilepsy. Children conceived after ovulation induction or intrauterine insemination had a slightly higher risk of childhood epilepsy (hazard ratio [HR]: 1.15; 95% confidence interval [CI]: 1.00, 1...

  11. Dementia and functional cerebral imaging a reevaluation

    International Nuclear Information System (INIS)

    Steinling, M.; Lecouffe, P.; Pham, T.; Charpentier, P.; Delebvre, L.; Lavenu, I.; Pasquier, F.; Charpentier, P.; Duhamel, A.

    2000-01-01

    New concepts which concerned especially the nosologic classification of dementia as for example Dementia with Lewy Bodies (DLB) incite to revalue the main characteristics of the regional cerebral blood flow measurements studied by SPECT in several forms of dementia. SPECT analysis with 99m-Technetium HMPAO (555 MBq) was performed to 20 patients with probable DLB, 20 patients with probable Alzheimer's disease (AD) and 20 patients with Fronto-Temporal dementia (FTD). Ten pairs of regions of interest were analysed. Tracer uptake was expressed as a cortico-cerebellar activity ratio. Statistical analysis of index of fixation was performed using an univariate analysis of variance, and a selection of significative ROIs was performed using two cut-off values (80 and 82.5 %). In the FTD group, a decrease of HMPAO uptake in frontal cortical regions of interest (internal, lateral and posterior) was observed. In the DLB group the decrease of HMPAO uptake was widespread and concerned all the cortical regions of interest except the posterior frontal and occipital regions. Finally in the AD group there was a limited temporal and parietal hypoperfusion more marked on the left side without frontal hypoperfusion. This last result was obtained whatever the cognitive impairment. Consequently it seems that the frontal hypoperfusion previously reported in AD groups was induced by the fact that patients with DLB were also included because the diagnosis was not established. In conclusion we estimate that SPECT studies could be used more often in clinical research especially for a classification approach of dementia. (authors)

  12. Infections as risk factor for autoimmune diseases - A nationwide study

    DEFF Research Database (Denmark)

    Nielsen, Philip Rising; Kragstrup, Tue Wenzel; Deleuran, Bent Winding

    2016-01-01

    Viruses, bacteria and other infectious pathogens are the major postulated environmental triggers of autoimmunity. In the present nation-wide study we describe the association between infections and 29 autoimmune diseases. We used the Danish Civil Registration System to identify 4.5 million persons...... to the etiology of autoimmune diseases together with genetic factors....... born between 1945 and 2000. Information on infections and autoimmune diseases was obtained from the Danish Hospital Register. The cohort was followed from 1977 to 2012. Incidence rate ratios for developing an autoimmune disease were estimated using poisson regression. We found an association between...

  13. Partners in Dementia Care: A Care Coordination Intervention for Individuals with Dementia and Their Family Caregivers

    Science.gov (United States)

    Judge, Katherine S.; Bass, David M.; Snow, A. Lynn; Wilson, Nancy L.; Morgan, Robert; Looman, Wendy J.; McCarthy, Catherine; Kunik, Mark E.

    2011-01-01

    Purpose: This article provides a detailed description of a telephone-based care coordination intervention, Partners in Dementia Care (PDC), for veterans with dementia and their family caregivers. Essential features of PDC included (a) formal partnerships between Veterans Affairs (VA) medical centers and Alzheimer's Association Chapters; (b) a…

  14. Antidepressants and dementia

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Søndergård, Lars; Forman, Julie Lyng

    2009-01-01

    BACKGROUND: It has been suggested that antidepressants may have neuroprotective abilities but it has newer been investigated lately whether treatment with antidepressants reduces the risk of dementia. METHOD: Linkage of registers of all prescribed antidepressants and diagnoses of dementia...... in Denmark during a period from 1995 to 2005. RESULTS: Persons who purchased antidepressants once (N=687,552) had an increased rate of dementia compared to persons unexposed to antidepressants (N=779,831). Nevertheless, the rate of dementia changed over time; thus during the initial prescription periods...... the rate increased with the number of prescriptions but continued long-term antidepressants treatment was associated with a reduction in the rate of dementia, however, not to the same level as the rate for the general population. This pattern was found for all classes of antidepressants (SSRIs, newer non...

  15. Development of a dementia assessment quality database

    DEFF Research Database (Denmark)

    Johannsen, P.; Jørgensen, Kasper; Korner, A.

    2011-01-01

    OBJECTIVE: Increased focus on the quality of health care requires tools and information to address and improve quality. One tool to evaluate and report the quality of clinical health services is quality indicators based on a clinical database. METHOD: The Capital Region of Denmark runs a quality...... database for dementia evaluation in the secondary health system. One volume and seven process quality indicators on dementia evaluations are monitored. Indicators include frequency of demented patients, percentage of patients evaluated within three months, whether the work-up included blood tests, Mini...... for the data analyses. RESULTS: The database was constructed in 2005 and covers 30% of the Danish population. Data from all consecutive cases evaluated for dementia in the secondary health system in the Capital Region of Denmark are entered. The database has shown that the basic diagnostic work-up programme...

  16. Progression to dementia in memory clinic patients without dementia: a latent profile analysis

    NARCIS (Netherlands)

    Kohler, S.; Hamel, R.; Sistermans, N.; Koene, T.; Pijnenburg, Y.A.L.; van der Flier, W.M.; Scheltens, P.; Visser, P.J.; Aalten, P.; Verhey, F. R. J.; Ramakers, I.

    2013-01-01

    Objective: To identify the existence of discrete cognitive subtypes among memory clinic patients without dementia and test their prognostic values. Methods: In a retrospective cohort study of 635 patients without dementia visiting the Alzheimer centers in Maastricht or Amsterdam, latent profile

  17. Knowledge of Dementia: Do family members understand dementia as a terminal condition?

    Science.gov (United States)

    Andrews, Sharon; McInerney, Fran; Toye, Christine; Parkinson, Camillus-Anthony; Robinson, Andrew

    2017-07-01

    Current research identifies advanced dementia to be the terminal phase of this progressive and incurable condition. However, there has been relatively little investigation into how family members of people with advanced dementia understand their relative's condition. In this article, we report on semi-structured interviews with 10 family members of people with advanced dementia, in a residential aged care facility. Using a qualitative, descriptive design, we explored family members' understandings of dementia, whether they were aware that it was a terminal condition, and the ways they developed their understandings. Findings revealed that the majority of family members could not recognize the terminal nature of dementia. Relying on predominantly lay understandings, they had little access to formal information and most failed to conceptualize a connection between dementia and death. Moreover, family members engaged in limited dialogue with aged care staff about such issues, despite their relatives being in an advanced stage of the disease. Findings from our study suggest that how family members understand their relative's condition requires greater attention. The development of staff/family partnerships that promote shared communication about dementia and dying may enhance family members' understandings of the dementia trajectory and the types of decisions they may be faced with during the more advanced stages of the disease.

  18. SveDem, the Swedish Dementia Registry - a tool for improving the quality of diagnostics, treatment and care of dementia patients in clinical practice.

    Directory of Open Access Journals (Sweden)

    Dorota Religa

    Full Text Available The Swedish Dementia Registry (SveDem was developed with the aim to improve the quality of diagnostic work-up, treatment and care of patients with dementia disorders in Sweden.SveDem is an internet based quality registry where several indicators can be followed over time. It includes information about the diagnostic work-up, medical treatment and community support (www.svedem.se. The patients are diagnosed and followed-up yearly in specialist units, primary care centres or in nursing homes.The database was initiated in May 2007 and covers almost all of Sweden. There were 28 722 patients registered with a mean age of 79.3 years during 2007-2012. Each participating unit obtains continuous online statistics from its own registrations and they can be compared with regional and national data. A report from SveDem is published yearly to inform medical and care professionals as well as political and administrative decision-makers about the current quality of diagnostics, treatment and care of patients with dementia disorders in Sweden.SveDem provides knowledge about current dementia care in Sweden and serves as a framework for ensuring the quality of diagnostics, treatment and care across the country. It also reflects changes in quality dementia care over time. Data from SveDem can be used to further develop the national guidelines for dementia and to generate new research hypotheses.

  19. Depression in dementia: development and testing of a nursing guideline.

    NARCIS (Netherlands)

    Verkaik, R.

    2009-01-01

    Guideline for pleasure in dementia care Depression in nursing home residents with dementia can be decreased by the introduction of a nursing guideline. This is the main conclusion of the PhD thesis on depression in dementia that was presented by researcher Renate Verkaik on April 20th at the

  20. A qualitative study of older and middle-aged adults' perception and attitudes towards dementia and dementia risk reduction.

    Science.gov (United States)

    Kim, Sarang; Sargent-Cox, Kerry A; Anstey, Kaarin J

    2015-07-01

    To investigate perceptions of dementia and dementia risk reduction held by people without dementia. Dementia does not only affect individuals with dementia, but also has an impact on family and friends, society and healthcare professionals. Recent research has identified modifiable risk and protective factors for dementia. However, it is unclear what knowledge people without dementia have about these risk factors and their attitudes towards addressing these risk factors to achieve dementia risk reduction are not known. Qualitative descriptive study using focus group methodology. A focus group study was conducted in February 2011 with 34 older adults aged between 52-90 years. The long-table approach was used to identify themes and categorize data on dementia knowledge, risk and attitudes. Participants correctly identified dementia risk factors as a group. Participants' responses about their perceived likelihood of developing dementia could be classified into three distinctive themes; fear, rational and cynical perceptions. Both fear of developing dementia and the need to improve dementia knowledge were considered major motivators towards adopting healthier lifestyle and health behaviours. Lack of knowledge on risk factors for dementia was identified as a major barrier for behavioural and lifestyle change. These findings can be used to develop effective and personalized interventions that increase motivators and reduce barriers by tailoring interventions to individual's dementia risk reduction literacy and motivations to change behaviours. Greater public-health promotion and education about risk and protective factors for dementia are also necessary to increase dementia health literacy and to reduce overall dementia prevalence. © 2015 John Wiley & Sons Ltd.

  1. A comprehensive approach to reablement in dementia

    NARCIS (Netherlands)

    Poulos, Christopher J; Bayer, Antony; Beaupre, Lauren; Clare, Linda; Poulos, Roslyn G; Wang, Rosalie H; Zuidema, Sytse; McGilton, Katherine S

    As society grapples with an aging population and increasing prevalence of disability, "reablement" as a means of maximizing functional ability in older people is emerging as a potential strategy to help promote independence. Reablement offers an approach to mitigate the impact of dementia on

  2. Nonliteral language in Alzheimer dementia: a review.

    Science.gov (United States)

    Rapp, Alexander M; Wild, Barbara

    2011-03-01

    The use of nonliteral language in clinical assessment, especially testing the patients' ability to interpret proverbs, has a long tradition in psychiatry. However, its diagnostic sensitivity and specificity in dementias is not yet clear. The aim of this review article is to examine the current evidence on nonliteral/figurative language (proverb, metaphor, metonymy, idiom, irony, sarcasm) comprehension in Alzheimer's disease and related disorders. A comprehensive literature search identified 25 studies (16 proverb, 3 metaphor, 0 metonymy, 5 idiom, 3 sarcasm) on nonliteral language comprehension in dementia. Studies predominantly indicate a deficit. Most studies investigated Alzheimer's dementia. Applied correctly, nonliteral language is a worthwhile diagnostic tool to evaluate language and abstract thinking in dementias. During assessment, familiarity testing (e.g., by asking "are you familiar with the proverb XY") is obligatory. Still, future research is needed in several areas: evidence on decline of nonliteral language over the course of the illness is limited. So far, almost no studies delineated proverb comprehension in high risk populations such as patients with mild cognitive impairment. Currently, there is a lack of studies addressing performance in direct comparison to relevant differential diagnosis like older-age depression, delirium, brain lesion, or other psychiatric conditions.

  3. Hypothyroidism incidence in and around pregnancy: a Danish nationwide study.

    Science.gov (United States)

    Andersen, S L; Carlé, A; Olsen, J; Laurberg, P

    2016-11-01

    Immunological changes in and after a pregnancy may influence the onset of autoimmune diseases. An increased incidence of hyperthyroidism has been observed both in early pregnancy and postpartum, but it remains to be studied if the incidence of hypothyroidism varies in a similar way. Population-based cohort study using Danish nationwide registers. All women who gave birth to a singleton live-born child in Denmark from 1999 to 2008 (n = 403 958) were identified, and data on hospital diagnosis of hypothyroidism and redeemed prescriptions of thyroid hormone were extracted. The overall incidence rate (IR) of hypothyroidism during 1997-2010 and the IR in three-month intervals before, during and after the woman's first pregnancy in the study period were calculated and compared with the IR of hyperthyroidism. Altogether 5220 women were identified with onset of hypothyroidism from 1997 to 2010 (overall IR 92.3/100 000/year) and 1572 women developed hypothyroidism in the period from 2 years before to 2 years after birth of the first child in the study period. The incidence of hypothyroidism decreased during the pregnancy (incidence rate ratio (IRR) vs overall IR in the rest of the study period: first trimester: 0.89 (95% CI: 0.66-1.19), second trimester: 0.71 (0.52-0.97), third trimester: 0.29 (0.19-0.45)) and increased after birth with the highest level at 4-6 months postpartum (IRR 3.62 (2.85-4.60)). These are the first population-based data on the incidence of hypothyroidism in and around pregnancy. The incidence declined during pregnancy followed by a sharp increase postpartum. Notably, hypothyroidism as opposed to hyperthyroidism showed no early pregnancy increase. © 2016 European Society of Endocrinology.

  4. Implementing a nationwide criteria-based emergency medical dispatch system

    DEFF Research Database (Denmark)

    Andersen, Mikkel S; Johnsen, Søren Paaske; Sørensen, Jan Nørtved

    2013-01-01

    A criteria-based nationwide Emergency Medical Dispatch (EMD) system was recently implemented in Denmark. We described the system and studied its ability to triage patients according to the severity of their condition by analysing hospital admission and case-fatality risks.......A criteria-based nationwide Emergency Medical Dispatch (EMD) system was recently implemented in Denmark. We described the system and studied its ability to triage patients according to the severity of their condition by analysing hospital admission and case-fatality risks....

  5. Dementia and Hospital Readmission Rates: A Systematic Review

    Directory of Open Access Journals (Sweden)

    Sabrina Pickens

    2017-10-01

    Full Text Available Background: Although community-dwelling persons with dementia have an increased risk of hospital readmission, no systematic review has examined the contribution of dementia to readmissions. Summary: We examined articles in English, with no restrictions on publication dates, from Medline, PubMed, PsycINFO, CINAHL, and EMBASE. Keywords used were dementia, Alzheimer disease, frontotemporal lobar degeneration, elderly, frontotemporal dementia, executive function, brain atrophy, frontal lobe atrophy, cognitive impairment, readmission, readmit, rehospitalization, patient discharge, and return visit. Of 404 abstracts identified, 77 articles were retrieved; 12 were included. Four of 5 cohort studies showed significantly increased readmission rates in patients with dementia. On average the absolute increase above the comparison groups was from 3 to 13%. Dementia was not associated with readmission in 7 included case-control studies. Key Message: Findings suggest a small increased risk of hospital readmission in individuals with dementia. More study is needed.

  6. Tools to Detect Delirium Superimposed on Dementia: A Systematic Review

    Science.gov (United States)

    Morandi, Alessandro; McCurley, Jessica; Vasilevskis, Eduard E.; Fick, Donna M.; Bellelli, Giuseppe; Lee, Patricia; Jackson, James C.; Shenkin, Susan D.; Trabucchi, Marco; Schnelle, John; Inouye, Sharon K.; Ely, Wesley E.; MacLullich, Alasdair

    2012-01-01

    Background Delirium commonly occurs in patients with dementia. Though several tools for detecting delirium exist, it is unclear which are valid in patients with delirium superimposed on dementia. Objectives Identify valid tools to diagnose delirium superimposed on dementia Design We performed a systematic review of studies of delirium tools, which explicitly included patients with dementia. Setting In-hospital patients Participants Studies were included if delirium assessment tools were validated against standard criteria, and the presence of dementia was assessed according to standard criteria that used validated instruments. Measurements PubMed, Embase, and Web of Science databases were searched for articles in English published between January 1960 and January 2012. Results Nine studies fulfilled the selection criteria. Of the total of 1569 patients, 401 had dementia, and 50 had delirium superimposed on dementia. Six delirium tools were evaluated. One studyusing the Confusion Assessment Method (CAM) with 85% patients with dementia showed a high specificity (96–100%) and moderate sensitivity (77%).Two intensive care unit studies that used the CAM for the Intensive Care Unit (CAM-ICU) ICU reported 100% sensitivity and specificity for delirium among 23 dementia patients. One study using electroencephalography reported a sensitivity of 67% and a specificity of 91% among a population with 100% prevalence of dementia. No studies examined potential effects of dementia severity or subtype upon diagnostic accuracy. Conclusions The evidence base on tools for detection of delirium superimposed on dementia is limited, although some existing tools show promise. Further studies of existing or refined tools with larger samples and more detailed characterization of dementia are now required to address the identification of delirium superimposed on dementia. PMID:23039270

  7. Dementia Population Risk Tool (DemPoRT): study protocol for a predictive algorithm assessing dementia risk in the community

    OpenAIRE

    Fisher, Stacey; Hsu, Amy; Mojaverian, Nassim; Taljaard, Monica; Huyer, Gregory; Manuel, Douglas G; Tanuseputro, Peter

    2017-01-01

    Introduction The burden of disease from dementia is a growing global concern as incidence increases dramatically with age, and average life expectancy has been increasing around the world. Planning for an ageing population requires reliable projections of dementia prevalence; however, existing population projections are simple and have poor predictive accuracy. The Dementia Population Risk Tool (DemPoRT) will predict incidence of dementia in the population setting using multivariable modellin...

  8. When is audit and feedback effective in dementia care? A systematic review.

    Science.gov (United States)

    Sykes, Michael J; McAnuff, Jennifer; Kolehmainen, Niina

    2018-03-01

    Evidence-based care for people with dementia is a priority for patients, carers and clinicians and a policy priority. There is evidence that people with dementia do not always receive such care. Audit and feedback, also known as clinical audit, is an extensively-used intervention to improve care. However, there is uncertainty about the best way to use it. To investigate whether audit and feedback is effective for improving health professionals' care of people with dementia. To investigate whether the content and delivery of audit and feedback affects its effectiveness in the context of health professionals' care for people with dementia. Systematic review DATA SOURCES: The Cochrane Central Register of Controlled Trials, Prospero, Medline (1946-December week 1 2016), PsycInfo (1967-January 2017), Cinahl (1982-January 2017), HMIC (1979-January 2017), Embase (1974-2017 week 1) databases and the Science Citation Index and Social Science Citation Index were searched combining terms for audit and feedback, health personnel, and dementia. Following screening, the data were extracted using the Template for Intervention Description and Replication (TIDieR), and synthesised graphically using harvest plots and narratively. Thirteen studies met the inclusion criteria. Published studies of audit and feedback in dementia rarely described more than one cycle. None of the included studies had a comparison group: 12 were before and after designs and one was an interrupted time series without a comparison group. The median absolute improvement was greater than in studies beyond dementia which have used stronger designs with fewer risks of bias. Included studies demonstrated large variation in the effectiveness of audit and feedback. Whilst methodological and reporting limitations in the included studies hinder the ability to draw strong conclusions on the effectiveness of audit and feedback in dementia care, the large interquartile range indicates further work is needed to

  9. Experience of Dementia-related Anxiety in Middle-aged Female Caregivers for Family Members with Dementia: A Phenomenological Study

    Directory of Open Access Journals (Sweden)

    Jeong Sun Kim, RN, PhD

    2016-06-01

    Conclusions: The study provides the essential structure of the experience on dementia-related anxiety that caregivers of a family member with dementia have. The findings could help healthcare providers and researchers have better understanding of dementia-related anxiety and give more attention to the caregivers to relieve their anxiety.

  10. A Diagnostic Model for Dementia in Clinical Practice-Case Methodology Assisting Dementia Diagnosis.

    Science.gov (United States)

    Londos, Elisabet

    2015-04-02

    Dementia diagnosis is important for many different reasons. Firstly, to separate dementia, or major neurocognitive disorder, from MCI (mild cognitive impairment), mild neurocognitive disorder. Secondly, to define the specific underlying brain disorder to aid treatment, prognosis and decisions regarding care needs and assistance. The diagnostic method of dementias is a puzzle of different data pieces to be fitted together in the best possible way to reach a clinical diagnosis. Using a modified case methodology concept, risk factors affecting cognitive reserve and symptoms constituting the basis of the brain damage hypothesis, can be visualized, balanced and reflected against test results as well as structural and biochemical markers. The model's origin is the case method initially described in Harvard business school, here modified to serve dementia diagnostics.

  11. Frontotemporal dementia and neurocysticercosis: a case report

    Directory of Open Access Journals (Sweden)

    Corina Satler

    Full Text Available ABSTRACT We report a case of a 67-year-old woman with frontotemporal dementia (FTD and a history of neurocysticercosis. After her retirement she showed progressive behavioral changes and neuropsychiatric symptoms with relative preservation of cognitive functioning. During the next three years, the patient manifested progressive deterioration of verbal communication gradually evolving to mutism, a hallmark of cases of progressive nonfluent aphasia.

  12. Registers of multiple sclerosis in Denmark

    DEFF Research Database (Denmark)

    Koch-Henriksen, N; Magyari, M; Laursen, B

    2015-01-01

    between a number of different environmental exposures in the past and the subsequent risk of MS. Some of these studies have been able to exonerate suspected risk factors. The other register, the nationwide Danish Multiple Sclerosis Treatment Register, is a follow-up register for all patients who have......There are two nationwide population-based registers for multiple sclerosis (MS) in Denmark. The oldest register is The Danish Multiple Sclerosis Registry (DMSR), which is an epidemiological register for estimation of prevalence and incidence of MS and survival, and for identifying exposures earlier...... received disease-modifying treatments since 1996. It has, in particular, contributed to the knowledge of the role of antibodies against the biological drugs used for the treatment of MS....

  13. Dementia as a predictor of mortality in adult trauma patients.

    Science.gov (United States)

    Jordan, Benjamin C; Brungardt, Joseph; Reyes, Jared; Helmer, Stephen D; Haan, James M

    2018-01-01

    The specific contribution of dementia towards mortality in trauma patients is not well defined. The purpose of the study was to evaluate dementia as a predictor of mortality in trauma patients when compared to case-matched controls. A 5-year retrospective review was conducted of adult trauma patients with a diagnosis of dementia at an American College of Surgeons-verified level I trauma center. Patients with dementia were matched with non-dementia patients and compared on mortality, ICU length of stay, and hospital length of stay. A total of 195 patients with dementia were matched to non-dementia controls. Comorbidities and complications (11.8% vs 12.4%) were comparable between both groups. Dementia patients spent fewer days on the ventilator (1 vs 4.5, P = 0.031). The length of ICU stay (2 days), hospital length of stay (3 days), and mortality (5.1%) were the same for both groups (P > 0.05). Dementia does not appear to increase the risk of mortality in trauma patients. Further studies should examine post-discharge outcomes in dementia patients. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. Performance of clinical mammography: a nationwide study from Denmark

    DEFF Research Database (Denmark)

    Jensen, Allan; Vejborg, Ilse; Severinsen, Niels

    2006-01-01

    that clinical mammography worked best in patient populations of purely symptomatic women. Our data indicate that to increase the accuracy of clinical mammography at the community level, the presence of an experienced radiologist should be prioritized ahead of raising the clinic size.......Clinical mammography is the key tool for breast cancer diagnosis, but little is known about the impact of the organisational set-up on the performance. We evaluated whether organisational factors influence the performance of clinical mammography. Clinical mammography data from all clinics...... in Denmark in the year 2000 were collected and linked to cancer outcome. Use of the National Institute of Radiation Hygiene register for identification of radiology clinics ensured comprehensive nationwide registration. We used the final mammographic assessment at the end of the imaging work-up to determine...

  15. Predictors of dementia caregiver depressive symptoms in a population: the Cache County dementia progression study.

    Science.gov (United States)

    Piercy, Kathleen W; Fauth, Elizabeth B; Norton, Maria C; Pfister, Roxane; Corcoran, Chris D; Rabins, Peter V; Lyketsos, Constantine; Tschanz, JoAnn T

    2013-11-01

    Previous research has consistently reported elevated rates of depressive symptoms in dementia caregivers, but mostly with convenience samples. This study examined rates and correlates of depression at the baseline visit of a population sample of dementia caregivers (N = 256). Using a modified version of Williams (Williams, I. C. [2005]. Emotional health of black and white dementia caregivers: A contextual examination. The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences, 60, P287-P295) ecological contextual model, we examined 5 contexts that have contributed to dementia caregiver depression. A series of linear regressions were performed to determine correlates of depression. Rates of depressive symptoms were lower than those reported in most convenience studies. We found fewer depressive symptoms in caregivers with higher levels of education and larger social support networks, fewer health problems, greater likelihood of using problem-focused coping, and less likelihood of wishful thinking and with fewer behavioral disturbances in the persons with dementia. These results suggest that depression may be less prevalent in populations of dementia caregivers than in clinic-based samples, but that the correlates of depression are similar for both population and convenience samples. Interventions targeting individuals with small support networks, emotion-focused coping styles, poorer health, low quality of life, and those caring for persons with higher numbers of behavioral problems need development and testing.

  16. Multi-Infarct Dementia: A Historical Perspective

    Directory of Open Access Journals (Sweden)

    Erin McKay

    2017-05-01

    Full Text Available Background: Multi-infarct dementia (MID, a prominent subtype of vascular dementia (VaD, has only achieved recognition in the last 4 decades. Since its original description, the characterization, etiological understanding, and therapeutic direction of MID and other VaD subtypes has progressed at an astounding rate. Summary: This paper divides the landmark discoveries and emergence of new research strategies for MID into decade-defining patterns so that a condensed picture of the total history of MID and its eventual inclusion as a VaD subtype emerges. This paper follows the first descriptive decade, a shift to a preventative focus, a renewed interest coinciding with timely advances in research technology, and a hopeful return to treatment possibilities for VaD. Key Message: Concisely tracing the historical lineage of the modern understanding of MID, both as a singular entity and as part of the VaD con­stellation of disorders, provides a novel perspective on the foundation upon which future advances in combating vascular contributions to dementia will be based.

  17. Senile dementia of the Binswanger type: a vascular form of dementia in the elderly

    International Nuclear Information System (INIS)

    Roman, G.C.

    1987-01-01

    Computed tomography and magnetic resonance imaging in the elderly have demonstrated the common occurrence of deep white-matter lesions in the aging brain. These radiologic lesions (leukoaraiosis) may represent an early marker of dementia. At autopsy, an ischemic periventricular leukoencephalopathy (Binswanger's disease) has been found in most cases. The clinical spectrum of Binswanger's disease appears to range from asymptomatic radiologic lesions to dementia with focal deficits, frontal signs, pseudobulbar palsy, gait difficulties, and urinary incontinence. The name senile dementia of the Binswanger type (SDBT) is proposed for this poorly recognized, vascular form of subcortical dementia. The SDBT probably results from cortical disconnections most likely caused by hypoperfusion. In contrast, multi-infarct dementia is correlated with multiple large and small strokes that cause a loss of over 50 to 100 mL of brain volume. The periventricular white matter is a watershed area irrigated by long, penetrating medullary arteries. Risk factors for SDBT are small-artery diseases, such as hypertension and amyloid angiopathy, impaired autoregulation of cerebral blood flow in the elderly, and periventricular hypoperfusion due to cardiac failure, arrhythmias, and hypotension. The SDBT may be a potentially preventable and treatable form of dementia

  18. Awareness of dementia by family carers of nursing home residents dying with dementia: a post-death study.

    Science.gov (United States)

    Penders, Yolanda W H; Albers, Gwenda; Deliens, Luc; Vander Stichele, Robert; Van den Block, Lieve

    2015-01-01

    High-quality palliative care for people with dementia should be patient-centered, family-focused, and include well-informed and shared decision-making, as affirmed in a recent white paper on dementia from the European Association for Palliative Care. To describe how often family carers of nursing home residents who died with dementia are aware that their relative has dementia, and study resident, family carer, and care characteristics associated with awareness. Post-death study using random cluster sampling. Structured questionnaires were completed by family carers, nursing staff, and general practitioners of deceased nursing home residents with dementia in Flanders, Belgium (2010). Of 190 residents who died with dementia, 53.2% of family carers responded. In 28% of cases, family carers indicated they were unaware their relative had dementia. Awareness by family carers was related to more advanced stages of dementia 1 month before death (odds ratio = 5.4), with 48% of family carers being unaware when dementia was mild and 20% unaware when dementia was advanced. The longer the onset of dementia after admission to a nursing home, the less likely family carers were aware (odds ratio = 0.94). Family carers are often unaware that their relative has dementia, that is, in one-fourth of cases of dementia and one-fifth of advanced dementia, posing considerable challenges for optimal care provision and end-of-life decision-making. Considering that family carers of residents who develop dementia later after admission to a nursing home are less likely to be aware, there is room for improving communication strategies toward family carers of nursing home residents. © The Author(s) 2014.

  19. Reminiscence in dementia: a concept analysis.

    Science.gov (United States)

    Dempsey, Laura; Murphy, Kathy; Cooney, Adeline; Casey, Dympna; O'Shea, Eamon; Devane, Declan; Jordan, Fionnuala; Hunter, Andrew

    2014-03-01

    This paper is a report of an analysis of the concept of reminiscence in dementia and highlights its uses as a therapeutic intervention used on individuals with dementia. No single definition of reminiscence exists in healthcare literature; however, definitions offered have similar components. The term life review is commonly used when discussing reminiscence; however, both terms are quite different in their goals, theory base and content. This concept analysis identified reminiscence as a process which occurs in stages, involving the recalling of early life events and interaction between individuals. The antecedents of reminiscence are age, life transitions, attention span, ability to recall, ability to vocalise and stressful situations. Reminiscence can lead to positive mental health, enhanced self esteem and improved communication skills. It also facilitates preparation for death, increases interaction between people, prepares for the future and evaluates a past life. Reminiscence therapy is used extensively in dementia care and evidence shows when used effectively it helps individuals retain a sense of self worth, identity and individuality.

  20. A small trapped-ion quantum register

    International Nuclear Information System (INIS)

    Kielpinski, D

    2003-01-01

    We review experiments performed at the National Institute of Standards and Technology on entanglement, Bell's inequality and decoherence-free subspaces (DFSs) in a quantum register of trapped 9 Be + ions. The group of Dr David Wineland has demonstrated entanglement of up to four ions using the technique of Molmer and Sorensen. This method produces the state (|↓↓> + |↑↑>)/√2 for two ions and the state (|↓↓↓↓> + |↑↑↑↑>)/√2 for four ions. The entanglement was generated deterministically in each shot of the experiment. Measurements on the two-ion entangled state violate Bell's inequality at the 8σ level. Because of the high detector efficiency of the apparatus, this experiment closes the detector loophole for Bell's inequality measurements for the first time. This measurement is also the first violation of Bell's inequality by massive particles that does not implicitly assume results from quantum mechanics. The group also demonstrated measurement of an interferometric phase with precision better than the shot-noise limit using a two-ion entangled state. A large-scale version of this scheme could improve the signal-to-noise ratio of atomic clocks by orders of magnitude. Further experiments demonstrated reversible encoding of an arbitrary qubit, originally contained in one ion, into a DFS of two ions. The DFS-encoded qubit resists applied collective dephasing noise and retains coherence under ambient conditions 3.6 times longer than does an unencoded qubit. The encoding method, which uses single-ion gates and the two-ion entangling gate, demonstrates all the elements required for two-qubit universal quantum logic. Finally, we describe an architecture for a large-scale ion trap quantum computer. By performing logic gates on small numbers of ions trapped in separate regions of the array, we take advantage of existing techniques for manipulating small trapped-ion quantum registers while enabling massively parallel gate operation. Encoding the

  1. Electroencephalography Is a Good Complement to Currently Established Dementia Biomarkers

    DEFF Research Database (Denmark)

    Ferreira, Daniel; Jelic, Vesna; Cavallin, Lena

    2016-01-01

    , 135 Alzheimer's disease (AD), 15 dementia with Lewy bodies/Parkinson's disease with dementia (DLB/PDD), 32 other dementias]. The EEG data were recorded in a standardized way. Structural imaging data were visually rated using scales of atrophy in the medial temporal, frontal, and posterior cortex......BACKGROUND/AIMS: Dementia biomarkers that are accessible and easily applicable in nonspecialized clinical settings are urgently needed. Quantitative electroencephalography (qEEG) is a good candidate, and the statistical pattern recognition (SPR) method has recently provided promising results. We......EEG to the diagnostic workup substantially increases the detection of AD pathology even in pre-dementia stages and improves differential diagnosis. EEG could serve as a good complement to currently established dementia biomarkers since it is cheap, noninvasive, and extensively applied outside academic centers....

  2. Care needs and clinical outcomes of older people with dementia: a population-based propensity score-matched cohort study.

    Directory of Open Access Journals (Sweden)

    Fei-Yuan Hsiao

    Full Text Available To explore the healthcare resource utilization, psychotropic drug use and mortality of older people with dementia.A nationwide propensity score-matched cohort study.National Health Insurance Research database.A total of 32,649 elderly people with dementia and their propensity-score matched controls (n=32,649.Outpatient visits, inpatient care, psychotropic drug use, in-hospital mortality and all-cause mortality at 90 and 365 days.Compared to the non-dementia group, a higher proportion of patients with dementia used inpatient services (1 year after index date: 20.91% vs. 9.55%, and the dementia group had more outpatient visits (median [standard deviation]: 7.00 [8.87] vs. 3.00 [8.30]. Furthermore, dementia cases with acute admission had the highest psychotropic drug utilization both at baseline and at the post-index dates (difference-in-differences: all <0.001. Dementia was associated with an increased risk of all-cause mortality (90 days, Odds ratio (OR=1.85 [95%CI 1.67-2.05], p<0.001; 365 days, OR=1.59 [1.50-1.69], p<0.001 and in-hospital mortality (90 days, OR=1.97 [1.71-2.27], p<0.001; 365 days, OR=1.82 [1.61-2.05], p<0.001 compared to matched controls.When older people with dementia are admitted for acute illnesses, they may increase their use of psychotropic agents and their risk of death, particularly in-hospital mortality.

  3. Nursing staff and euthanasia in the Netherlands. A nation-wide survey on attitudes and involvement in decision making and the performance of euthanasia.

    NARCIS (Netherlands)

    Francke, A.L.; Albers, G.; Bilsen, J.; Veer, A.J.E. de; Onwuteaka-Philipsen, B.D.

    2016-01-01

    Objectives: To give insight into Dutch nursing staff’s attitudes and involvement regarding euthanasia. Methods: The sample was recruited from a nation-wide existent research panel of registered nurses and certified nursing assistants. Descriptive analyses and multivariate logistic regression

  4. IDENTIFYING DEMENTIA IN ELDERLY POPULATION : A CAMP APPROACH

    OpenAIRE

    Anand P; Chaukimath; Srikanth; Koli

    2015-01-01

    BACKGROUND: Dementia is an emerging medico social problem affecting elderly, and poses a challenge to clinician and caregivers. It is usually identified in late stage where management becomes difficult. AIM: The aim of camp was to identify dementia in elderly population participating in screening camp. MATERIAL AND METHODS : The geriatric clinic and department of psychiatry jointly organised screening camp to detect dementia in elderly for five days in Sept...

  5. Observed Hearing Loss and Incident Dementia in a Multiethnic Cohort.

    Science.gov (United States)

    Golub, Justin S; Luchsinger, José A; Manly, Jennifer J; Stern, Yaakov; Mayeux, Richard; Schupf, Nicole

    2017-08-01

    To determine whether observed hearing loss (OHL) is associated with incident dementia in a multiethnic population. Prospective epidemiological cohort study. Community in northern Manhattan. Participants in the Washington Heights-Inwood Columbia Aging Project, a longitudinal study on aging and dementia in an ethnically diverse community (n = 1,881). OHL was defined when the examiner observed it or according to self-reported hearing aid use. A consensus panel diagnosed dementia using standard research criteria. A Cox proportional hazards model was used to examine the relationship between OHL at baseline and risk of incident dementia (mean 7.3 ± 4.4 years of longitudinal followup, range 0.9-20 years). OHL was associated with 1.69 (95% confidence interval (CI) = 1.3-2.3, P < .010) times the risk of incident dementia, adjusting for demographic characteristics, cardiovascular risk factors, apolipoprotein E4 genotype, and stroke. When stratified according to race, the association between OHL and incident dementia was high in all groups but was statistically significant only in blacks (hazard ratio = 2.62, 95% CI = 1.5-4.5, P < .010). OHL was associated with greater risk of incident dementia in a multiethnic cohort. More study is needed to determine whether HL contributes to dementia and whether treating HL can reduce the risk of dementia. © 2017, Copyright the Authors Journal compilation © 2017, The American Geriatrics Society.

  6. Cost Effective Community Based Dementia Screening: A Markov Model Simulation

    Directory of Open Access Journals (Sweden)

    Erin Saito

    2014-01-01

    Full Text Available Background. Given the dementia epidemic and the increasing cost of healthcare, there is a need to assess the economic benefit of community based dementia screening programs. Materials and Methods. Markov model simulations were generated using data obtained from a community based dementia screening program over a one-year period. The models simulated yearly costs of caring for patients based on clinical transitions beginning in pre dementia and extending for 10 years. Results. A total of 93 individuals (74 female, 19 male were screened for dementia and 12 meeting clinical criteria for either mild cognitive impairment (n=7 or dementia (n=5 were identified. Assuming early therapeutic intervention beginning during the year of dementia detection, Markov model simulations demonstrated 9.8% reduction in cost of dementia care over a ten-year simulation period, primarily through increased duration in mild stages and reduced time in more costly moderate and severe stages. Discussion. Community based dementia screening can reduce healthcare costs associated with caring for demented individuals through earlier detection and treatment, resulting in proportionately reduced time in more costly advanced stages.

  7. A Nationwide Census of ICU Capacity and Admissions in Mongolia.

    Directory of Open Access Journals (Sweden)

    Naranpurev Mendsaikhan

    Full Text Available In Mongolia, a Central Asian lower-middle income country, intensive care medicine is an under-resourced and-developed medical specialty. The burden of critical illness and capacity of intensive care unit (ICU services in the country is unknown. In this nationwide census, we collected data on adult and pediatric/neonatal ICU capacities and the number of ICU admissions in 2014. All hospitals registered to run an ICU service in Mongolia were surveyed. Data on the availability of an adult and/or pediatric/neonatal ICU service, the number of available ICU beds, the number of available functional mechanical ventilators, the number of patients admitted to the ICU, and the number of patients admitted to the study hospital were collected. In total, 70 ICUs with 349 ICU beds were counted in Mongolia (11.7 ICU beds/100,000 inhabitants; 1.7 ICU beds/100 hospital beds. Of these, 241 (69% were adult and 108 (31% pediatric/neonatal ICU beds. Functional mechanical ventilators were available for approximately half of the ICU beds (5.1 mechanical ventilators/100,000 inhabitants. While all provincial hospitals ran a pediatric/neonatal ICU, only dedicated pediatric hospitals in Ulaanbaatar did so. The number of adult and pediatric/neonatal ICU admissions varied between provinces. The number of adult ICU beds and adult ICU admissions per 100,000 inhabitants correlated (r = 0.5; p = 0.02, while the number of pediatric/neonatal ICU beds and pediatric/neonatal ICU admissions per 100,000 inhabitants did not (r = 0.25; p = 0.26. In conclusion, with 11.7 ICU beds per 100,000 inhabitants the ICU capacity in Mongolia is higher than in other low- and lower-middle-income countries. Substantial heterogeneities in the standardized ICU capacity and ICU admissions exist between Mongolian provinces. Functional mechanical ventilators are available for only half of the ICU beds. Pediatric/neonatal ICU beds make up one third of the national ICU capacity and appear to meet or even

  8. Familial clustering and genetic risk for dementia in a genetically isolated Dutch population.

    NARCIS (Netherlands)

    K. Sleegers (Kristel); F. Forey; J. Theuns (Jessie); Y.S. Aulchenko (Yurii); S. Rademakers (Suzanne); M. Cruts (Marc); W.A. van Gool (Willem); P. Heutink (Peter); B.A. Oostra (Ben); J.C. van Swieten (John); C.M. van Duijn (Cornelia); C. van Broeckhoven (Christine)

    2004-01-01

    textabstractDespite advances in elucidating the genetic epidemiology of Alzheimer's disease and frontotemporal dementia, the aetiology for most patients with dementia remains unclear. We examined the genetic epidemiology of dementia in a recent genetically isolated Dutch population founded around

  9. Familial clustering and genetic risk for dementia in a genetically isolated Dutch population

    NARCIS (Netherlands)

    Sleegers, K.; Roks, G.; Theuns, J.; Aulchenko, Y. S.; Rademakers, R.; Cruts, M.; van Gool, W. A.; van Broeckhoven, C.; Heutink, P.; Oostra, B. A.; van Swieten, J. C.; van Duijn, C. M.

    2004-01-01

    Despite advances in elucidating the genetic epidemiology of Alzheimer's disease and frontotemporal dementia, the aetiology for most patients with dementia remains unclear. We examined the genetic epidemiology of dementia in a recent genetically isolated Dutch population founded around 1750. The

  10. Polydrug use among college students in Brazil: a nationwide survey

    OpenAIRE

    Oliveira,Lúcio Garcia de; Alberghini,Denis Guilherme; Santos,Bernardo dos; Andrade,Arthur Guerra de

    2013-01-01

    Objective: To estimate the frequency of polydrug use (alcohol and illicit drugs) among college students and its associations with gender and age group. Methods: A nationwide sample of 12,544 college students was asked to complete a questionnaire on their use of drugs according to three time parameters (lifetime, past 12 months, and last 30 days). The co-use of drugs was investigated as concurrent polydrug use (CPU) and simultaneous polydrug use (SPU), a subcategory of CPU that involves the ...

  11. Dancing as an Intervention Tool for People with Dementia: A Mini-Review Dancing and Dementia.

    Science.gov (United States)

    Klimova, Blanka; Valis, Martin; Kuca, Kamil

    2017-01-01

    Research studies show a positive impact of physical activities such as dancing on the improvement of cognitive reserves of people with dementia. The purpose of this study is to explore dancing efficacy on people with dementia and list the key benefits and limitations of dancing therapy for these people. The methods used in this study include a method of literature review of available Englishwritten sources with respect to the dancing therapy and dementia in the acknowledged databases Pub- Med, Web of Science, Springer, and Scopus, and a method of comparison and evaluation of their findings. The findings of this mini review confirm positive efficacy of dancing therapy on cognitive, physical, emotional and social performance of people with dementia. More randomized controlled clinical trials should be conducted in this field, as well as other non-pharmacological therapies should be employed in order to holistically contribute to the prevention and treatment of dementia. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  12. Risk Factors for Fatal Hyperglycaemia Confirmed by Forensic Postmortem Examination - A Nationwide Cohort in Sweden

    Science.gov (United States)

    Walz, Lotta; Jönsson, Anna K.; Zilg, Brita; Östgren, Carl Johan; Druid, Henrik

    2016-01-01

    Aims/Hypothesis The aim of this study was to identify risk factors associated with confirmed fatal hyperglycaemia, which could predispose potentially preventable deaths in individuals on glucose lowering drugs. Methods A retrospective register-based case-control study conducted on a nationwide cohort with individuals who died due to hyperglycaemia as determined by forensic postmortem examination, in Sweden August 2006 to December 2012. Vitreous glucose was used to diagnose hyperglycaemia postmortem. The forensic findings stored in the National Forensic Medicine Database were linked to nationwide registers. Cases that died due to confirmed hyperglycemia with dispensed glucose lowering drugs were identified and living controls with dispensed glucose lowering drugs were randomly selected in the Swedish prescribed drug register and matched on age and sex. Information on comorbidities, dispensed pharmaceuticals, clinical data and socioeconomic factors were obtained for cases and controls. Adjusted multiple logistic regression models were used to identify risk factors associated with fatal hyperglycaemia. Results During the study period 322 individuals, mostly males (79%) with the mean age of 53.9 years (SD.± 14) died due to confirmed hyperglycaemia. Risk factors for fatal hyperglycaemia included; insulin treatment (OR = 4.40; 95%CI,1.96, 9.85), poor glycaemic control (OR = 2.00 95%CI,1.23, 3.27), inadequate refill-adherence before death (OR = 3.87; 95%CI,1.99, 7.53), microvascular disease (OR = 3.26; 95% CI, 1.84, 5.79), psychiatric illness (OR = 2.30; 95% CI,1.32, 4.01), substance abuse (OR = 8.85; 95%CI,2.34, 35.0) and/or living alone (OR = 2.25; 95%CI,1.21, 4.18). Conclusions/Interpretation Our results demonstrate the importance of clinical attention to poor glycaemic control in subjects with psychosocial problems since it may indicate serious non-adherence, which consequently could lead to fatal hyperglycaemia. PMID:27768720

  13. Development of a Late-Life Dementia Prediction Index with Supervised Machine Learning in the Population-Based CAIDE Study.

    Science.gov (United States)

    Pekkala, Timo; Hall, Anette; Lötjönen, Jyrki; Mattila, Jussi; Soininen, Hilkka; Ngandu, Tiia; Laatikainen, Tiina; Kivipelto, Miia; Solomon, Alina

    2017-01-01

    This study aimed to develop a late-life dementia prediction model using a novel validated supervised machine learning method, the Disease State Index (DSI), in the Finnish population-based CAIDE study. The CAIDE study was based on previous population-based midlife surveys. CAIDE participants were re-examined twice in late-life, and the first late-life re-examination was used as baseline for the present study. The main study population included 709 cognitively normal subjects at first re-examination who returned to the second re-examination up to 10 years later (incident dementia n = 39). An extended population (n = 1009, incident dementia 151) included non-participants/non-survivors (national registers data). DSI was used to develop a dementia index based on first re-examination assessments. Performance in predicting dementia was assessed as area under the ROC curve (AUC). AUCs for DSI were 0.79 and 0.75 for main and extended populations. Included predictors were cognition, vascular factors, age, subjective memory complaints, and APOE genotype. The supervised machine learning method performed well in identifying comprehensive profiles for predicting dementia development up to 10 years later. DSI could thus be useful for identifying individuals who are most at risk and may benefit from dementia prevention interventions.

  14. Art and the brain: a view from dementia.

    Science.gov (United States)

    Gretton, Cosima; ffytche, Dominic H

    2014-02-01

    Art making encompasses a range of perceptual and cognitive functions involving widely distributed brain systems. The dementias impact on these systems in different ways, raising the possibility that each dementia has a unique artistic signature. Here we use a review of the visual art of 14 artists with dementia (five Alzheimer's disease, seven fronto-temporal dementia and two dementia with Lewy bodies) to further our understanding of the neurobiological constituents of art production and higher artistic function. Artists with Alzheimer's disease had prominent changes in spatial aspects of their art and attributes of colour and contrast. These qualities were preserved in the art of fronto-temporal dementia, which was characterised by perseverative themes and a shift towards realistic representation. The art of dementia with Lewy Bodies was characterised by simple, bizarre content. The limitations of using visual aspects of individual artworks to infer the impact of dementia on art production are discussed with the need for a wider perspective encompassing changes in cognition, emotion, creativity and artistic personality. A novel classificatory scheme is presented to help characterise neural mechanisms of higher artistic functions in future studies. Copyright © 2013 John Wiley & Sons, Ltd.

  15. Resourse Use and Disease Couse in dementia - Nursing Home (REDIC-NH), a longitudinal cohort study; design and patient characteristics at admission to Norwegian nursing homes.

    Science.gov (United States)

    Røen, Irene; Selbæk, Geir; Kirkevold, Øyvind; Engedal, Knut; Testad, Ingelin; Bergh, Sverre

    2017-05-22

    Earlier studies of nursing home patients show a high prevalence of dementia, neuropsychiatric symptoms (NPS), pain, and dependency in activities of daily living. The REDIC-NH cohort was set up to study the disease course and the resources used in patients with dementia in Norway. The aim of this paper was to describe the methods and the data collection, and to present selected data about patients at admission to a nursing home. We included 696 patients at admission to a nursing home and followed them with biannual assessments until death. Baseline data were collected between March 2012 and November 2014. In October 2016, patients had either completed an 18-month follow-up (n = 349), passed 18 months without assessments (n = 22), or left the study (n = 324). Data on demographics, cognition, NPS, activities of daily living (ADL) functioning, physical health, medication, Quality of Life (QoL), resource use, and caregiver burden, in addition to DNA samples were collected. Mean age of the participants at inclusion was 84.5 years (SD 7.5, range 50 - 105), 63.9% were women. According to data collected in the study, 83.8% had dementia, but only 55.9% of them had a diagnosis of dementia registered in their records. The most frequent dementia diagnosis was Alzheimer's disease, which was present in 71% of those with dementia. Patients with dementia more often experienced delusions, hallucinations, agitation, anxiety, disinhibition, irritability, and aberrant motor behaviour compared to patients without dementia. Depression and anxiety were the most common NPS symptoms. Dementia and NPS were highly prevalent among persons admitted to nursing homes. Only 55.9% of the patients with dementia had a diagnosis of dementia registered in their records.

  16. A Landscape for Training in Dementia Knowledge Translation (DKT)

    Science.gov (United States)

    Illes, Judy; Chahal, Neil; Beattie, B. Lynn

    2011-01-01

    Meaningful translation of dementia research findings from the bench to the bedside is dependent on the quality of the knowledge to transfer and the availability and skills of investigators engaged in the knowledge translation process. Although there is no shortage of research on dementia, the latter has been more challenging. Results from a survey…

  17. Nature and dementia: development of a person-centered approach

    NARCIS (Netherlands)

    Hendriks, I.H.; Vliet, D. van; Gerritsen, D.L.; Droes, R.M.

    2016-01-01

    BACKGROUND: The aim of this study is to develop and try out an approach for personalized nature activities for people with dementia. METHODS: A qualitative descriptive study using focus group interviews with people with dementia was conducted. Based on the results of the focus groups and the

  18. Family aggregation and risk factors in substance use disorders over three generations in a nation-wide study

    DEFF Research Database (Denmark)

    Steinhausen, Hans-Christoph; Jakobsen, Helle; Munk-Jørgensen, Povl

    2017-01-01

    and were registered in the Danish Psychiatric Central Research Register (DPCRR) had a mental disorder before the age of 18 and developed SUD at some point during their life-time. In addition, N = 7472 controls without any psychiatric diagnosis before age 18 and matched for age, sex, and residential region...... were included. Psychiatric diagnoses of the first-degree relatives were also obtained. A family load component was assessed. RESULTS: SUD occurred significantly more often in case families than in control families. SUD risk factors included SUD, depression, anxiety disorders, personality disorders......OBJECTIVE: This nation-wide register-based study investigated how often substance use disorders (SUD) and co-morbid disorders occurred in affected families compared to control families. METHOD: A total of N = 2504 child and adolescent psychiatric participants who were born between 1969 and 1986...

  19. Euthanasia and physician-assisted suicide in dementia: A qualitative study of the views of former dementia carers.

    Science.gov (United States)

    Tomlinson, Emily; Spector, Aimee; Nurock, Shirley; Stott, Joshua

    2015-09-01

    Despite media and academic interest on assisted dying in dementia, little is known of the views of those directly affected. This study explored the views of former carers on assisted dying in dementia. This was a qualitative study using thematic analysis. A total of 16 former carers of people with dementia were recruited through national dementia charities and participated in semi-structured interviews. While many supported the individual's right to die, the complexity of assisted dying in dementia was emphasized. Existential, physical, psychological and psychosocial aspects of suffering were identified as potential reasons to desire an assisted death. Most believed it would help to talk with a trained health professional if contemplating an assisted death. Health workers should be mindful of the holistic experience of dementia at the end of life. The psychological and existential aspects of suffering should be addressed, as well as relief of physical pain. Further research is required. © The Author(s) 2015.

  20. IDENTIFYING DEMENTIA IN ELDERLY POPULATION : A CAMP APPROACH

    Directory of Open Access Journals (Sweden)

    Anand P

    2015-06-01

    Full Text Available BACKGROUND: Dementia is an emerging medico social problem affecting elderly, and poses a challenge to clinician and caregivers. It is usually identified in late stage where management becomes difficult. AIM: The aim of camp was to identify dementia in elderly population participating in screening camp. MATERIAL AND METHODS : The geriatric clinic and department of psychiatry jointly organised screening camp to detect dementia in elderly for five days in September 2014 to commemorate world Alzheimer’s day. The invitation regarding camp was sent to all senio r citizen forums and also published in leading Kannada daily newspaper. Mini Mental Status Examination and Diagnostic and Statistical Manual of Mental Disorders, 4 th edition criteria (DSM IV was used to identify dementia. RESULTS: Elderly male participate d in camp in more number than females and dementia was identified in 36% elderly with education less than 9 th standard. Dementia was found in 18% in our study population. CONCLUSION: The camp help identify elderly suffering from dementia and also created a wareness about it. Hypertension and diabetes mellitus were common co morbidity in study population. Our study suggested organising screening camp will help identify elderly living with dementia.

  1. Dementia and serious coexisting medical conditions: a double whammy.

    Science.gov (United States)

    Maslow, Katie

    2004-09-01

    Research-based information about the prevalence of other serious medical conditions in people with dementia has become available only recently, and the true prevalence is not known, primarily because many people with dementia do not have a diagnosis. The existing information is sufficient, however, to show that these other conditions are common in people with dementia. It is also clear that coexisting medical conditions increase the use and cost of health care services for people with dementia, and conversely, dementia increases the use and cost of health care services for people with other serious medical conditions. Nurses and other healthcare professionals should expect to see these relationships in their elderly patients. They should know how to recognize possible dementia and assess, or obtain an assessment of, the patient's cognitive status. They should expect the worsening of cognitive and related symptoms in acutely ill people with dementia and try to eliminate factors that cause this worsening, to the extent possible, while assuring the family that the symptoms are likely to improve once the acute phase of illness or treatment is over. Families, nurses, and other health care professionals are challenged by the complex issues involved in caring for a person with both dementia and other serious medical conditions. Greater attention to these issues by informed and thoughtful clinicians will improve outcomes for the people and their family and professional caregivers.

  2. Doll therapy for dementia sufferers: A systematic review.

    Science.gov (United States)

    Ng, Qin Xiang; Ho, Collin Yih Xian; Koh, Shawn Shao Hong; Tan, Wei Chuan; Chan, Hwei Wuen

    2017-02-01

    Dementia affects more than 47.5 million people worldwide, and the number is expected to continue to increase as the population ages. Doll therapy is an emerging nonpharmacologic management strategy for patients with advanced dementia, especially in patients with challenging behaviours. A total of 12 published studies (mainly cohort and observational studies) were identified and discussed in this systematic review. In most instances, cognitive, behavioural and emotional symptoms were alleviated and overall wellbeing was improved with doll therapy, and dementia sufferers were found to be able to better relate with their external environment. Despite the relative paucity of empirical data and ethical concerns, we are of the opinion that doll therapy is effective for dementia care, is well-aligned with the ethos of person-centred care and should be applied in the management of dementia patients. Future research should include more robust randomized controlled trials. Copyright © 2016 Elsevier Ltd. All rights reserved.

  3. Dementia RED (Respect Empathy Dignity): Collaborating to build dementia supportive communities in North Wales--reporting on a pilot project (innovative practice).

    Science.gov (United States)

    Chalk, Annabel; Page, Sean

    2016-03-01

    There is increasing interest in developing dementia supportive communities world wide. Dementia RED (Respect Empathy Dignity) is a unique example from North Wales which is based on the twin concepts of people living with dementia as citizens in their community and developing 'bottom up' rather than 'top down' approaches to dementia supportive communities. Most people with dementia prefer to live at home thus making community connectivity key to maintaining healthy relationships and wellbeing. For those living with dementia, the community plays a pivotal role in providing value, meaning, purpose and acceptance. Building dementia supportive communities helps to raise awareness about dementia in the community through engagement and from identifying champions in the locality to voice issues. Dementia RED is an initiative and service which helps to develop such a philosophy in creating a dementia supportive community. © The Author(s) 2014.

  4. A new self-rating questionnaire for dementia screening

    Directory of Open Access Journals (Sweden)

    Jin WANG

    2015-07-01

    Full Text Available Background The AD8 plays an important role in the early diagnosis of dementia. However, because of cultural and language difference, it is difficult for Chinese subjects to understand and answer questions in AD8. This paper aims to make a new dementia self-rating questionnaire for Chinese people based on the AD8, and to determine its value for dementia screening.  Methods According to early symptoms of dementia and life style of old Chinese people, a dementia self-rating questionnaire was made based on the AD8. The new questionnaire includes 10 questions, and can be finished in 3 min. The reliability and validity was validated by a questionnaire survey in senior citizens older than 50 years in urban Xi'an. All patients were screened by Mini-Mental State Examination (MMSE and dementia was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders Forth Edition (DSM-Ⅳ criteria.  Results A total of 620 patients finished the new questionnaire, and among them 17 patients (2.74% were diagnosed as dementia. The score of each question in the questionnaire was positively correlated with the total score (rs = 0.300-0.709; P = 0.000, for all. The Cronbach α was 0.795, indicating that the questionnaire got good internal consistency reliability. Two principal components were extracted, and the cumulative variance contribution ratio was 49.771%. Factor loading of each subitem was > 0.500, indicating a good construct validity. According to receiver operating characteristic (ROC curve, the critical value was 2, with the sensitivity 94.10% and specificity 82.10%. Youden index was 0.762.  Conclusions The new dementia self-rating questionnaire can detect dementia patients sensitively and correctly, and is very useful for early screening of dementia. DOI: 10.3969/j.issn.1672-6731.2015.07.009

  5. A correlation of clinical, MRI and brain SPECT in dementia

    International Nuclear Information System (INIS)

    Shelley, S.; Indirani, M.; Gokhale, S.; Anirudhan, N.; Sivakumar, M.R.; Jaganathan, K.

    2004-01-01

    Background: Dementia is a clinical syndrome characterised by acquired impairment in multiple neuropsycologic and behavior domains including memory, language, speech, visuospatial ability, cognition and mood/personality. Dementia produces deficits in perfusion reflecting decreased metabolic needs. Neuroimaging techniques help in determining whether the cognitive symptoms are organic and in which pattern of cognitive loss the patient may evolve. AIM: To differentiate various types of Dementia, based on the regional perfusion abnormalities seen in Brain SPECT and correlate this with Clinical and MRI findings. Material and methods: Patients suffering from memory impairment and memory loss were referred to our department for Brain SPECT as a part of work up for Dementia. They had undergone a detailed clinical examination, psychometry, mini mental status examination (MMSE), memory/cognitive testing and an MRI. Brain SPECT was done after injecting Tc 99m ECD (Ethylene Cysteinate Dimer ) and imaging after 45 minutes. The images obtained were reconstructed in a conventional way. The various patterns of perfusion abnormalities seen in the SPECT images was studied and correlated with MRI and clinical findings. The patients were thus classified as having Multi Infarct Dementia, Alzheimer's disease, Fronto-Temporal Dementia and Mixed variety. Results: Twenty One Patients were included in our study from February 2003 to February 2004. The mean age of the patients was 73 years ( 37 to 81). 15 were males and 6 were females. Out of 21 patients, 12 had Multi Infarct Dementia, 4 had Alzheimer's disease, 1 had Fronto- Temporal Dementia and 4 had Mixed variety. Conclusion: Brain SPECT aids in substantiating the clinical findings and in correlation with MRI helps in distinguishing various types of Dementia and thus has prognostic implications and helps in instituting early appropriate treatment to the patient. In our study, the majority of the patients have Multi Infarct Dementia

  6. The Association between Infections and General Cognitive Ability in Young Men - A Nationwide Study

    DEFF Research Database (Denmark)

    Benros, Michael E; Sørensen, Holger Jelling; Nielsen, Philip Finn Rising

    2015-01-01

    nationwide registers were linked to establish a cohort of all 161,696 male conscripts during the years 2006-2012 who were tested for cognitive ability, which was based on logical, verbal, numerical and spatial reasoning at a mean age of 19.4 years. Test scores were converted to a mean of 100.......00 and with a standard deviation (SD) of 15. Data were analyzed as a cohort study with severe infections requiring hospitalization as exposure using linear regression. RESULTS: Adjusted effect sizes were calculated with non-exposure to severe infections as reference, ranging from 0.12 SD to 0.63 SD on general cognitive...... of infections (Mean: -9.44; 95%CI: -13.2 to -5.69; corresponding to 0.63 SD). Hospital contacts with infections had occurred in 35% of the individuals prior to conscription. CONCLUSIONS: Independent of a wide range of possible confounders, significant associations between infections and cognitive ability were...

  7. A Scandinavian Experience of Register Collaboration: The Nordic Arthroplasty Register Association (NARA)

    DEFF Research Database (Denmark)

    Havelin, Leif I; Robertsson, Otto; Fenstad, Anne M

    2011-01-01

    The Nordic (Scandinavian) countries have had working arthroplasty registers for several years. However, the small numbers of inhabitants and the conformity within each country with respect to preferred prosthesis brands and techniques have limited register research.......The Nordic (Scandinavian) countries have had working arthroplasty registers for several years. However, the small numbers of inhabitants and the conformity within each country with respect to preferred prosthesis brands and techniques have limited register research....

  8. Evaluation of and quality assurance in HER2 analysis in breast carcinomas from patients registered in Danish Breast Cancer Group (DBCG) in the period of 2002-2006. A nationwide study including correlation between HER-2 status and other prognostic variables.

    Science.gov (United States)

    Rasmussen, Birgitte Bruun; Andersson, Michael; Christensen, Ib J; Møller, Susanne

    2008-01-01

    In Denmark, analysis for HER2 is situated in the pathology laboratories dealing with breast pathology. The analysis was introduced during the late 1990's, and was gradually intensified in the following years up to now. The present study deals with the experience with the analysis during the last 5 years, from 2002 - 2006. All patients, registered in DBCG (Danish Breast Cancer Group) and with a HER2-test were included. The analysis followed international recommendations, with an initial immunohistochemical (IHC) analysis with a semiquantitative grading of the reaction in four grades, 0 and 1+, defined as HER2-negative, 2+, equivocal and 3+, HER2-positive. In the 2+ group, a FISH-test was applied to identify the presence of gene amplification, defined as a ratio >/=2. We investigated the number of analyses performed, the number of positive cases and the relation between the result of IHC and the result of FISH. Furthermore we looked at the relation to other prognostic factors. The number of analyses gradually increased during the years of investigation, from 30% of patients in 2002 to 71% in 2006. The increase was seen in all laboratories resulting in all laboratories but one having a substantial number of analyses. Sixty-two percent of all cases were HER2-negative, 18% were equivocal and 21% positive in the IHC-analysis. Of the 2+, equivocal cases, 23% had gene-amplification. Thus, 23% of patients were defined as HER2-positive and eligible for treatment with trastuzumab. There was a significant correlation to other prognostic factors. The results are in accordance with what is found elsewhere. The quality of the test is further assured by all laboratories participating in external quality assurance schemes.

  9. Implementing Dementia Care Mapping as a practice development tool in dementia care services: a systematic review

    Directory of Open Access Journals (Sweden)

    Surr CA

    2018-01-01

    Full Text Available Claire A Surr, Alys W Griffiths, Rachael Kelley Centre for Dementia Research, School of Health and Community Studies, Leeds Beckett University, Leeds, UK Abstract: Dementia Care Mapping (DCM is an observational tool set within a practice development process. Following training in the method, DCM is implemented via a cyclic process of briefing staff, conducting mapping observations, data analysis and report preparation, feedback to staff and action planning. Recent controlled studies of DCM’s efficacy have found heterogeneous results, and variability in DCM implementation has been indicated as a potential contributing factor. This review aimed to examine the primary research evidence on the processes and the barriers and facilitators to implementing DCM as a practice development method within formal dementia care settings. PUBMED, PsycINFO, CINAHL, The Cochrane Library-Cochrane reviews, HMIC (Ovid, Web of Science and Social Care Online were searched using the term “Dementia Care Mapping”. Inclusion criterion was primary research studies in any formal dementia care settings where DCM was used as a practice development tool and which included discussion/critique of the implementation processes. Assessment of study quality was conducted using the Mixed Methods Appraisal Tool. Twelve papers were included in the review, representing nine research studies. The papers included discussion of various components of the DCM process, including mapper selection and preparation; mapping observations; data analysis, report writing and feedback; and action planning. However, robust evidence on requirements for successful implementation of these components was limited. Barriers and facilitators to mapping were also discussed. The review found some consensus that DCM is more likely to be successfully implemented if the right people are selected to be trained as mappers, with appropriate mapper preparation and ongoing support and with effective leadership for

  10. Exposure to Mebendazole and Pyrvinium during Pregnancy: A Danish Nationwide Cohort Study

    Directory of Open Access Journals (Sweden)

    A. Torp-Pedersen

    2012-01-01

    Full Text Available Purpose. Families with children are frequently exposed to pinworm infection and treatment involves the whole family. Information on consequences of exposure during, pregnancy is limited. The aim of this study was to investigate the exposure to pyrvinium and mebendazole before, during, and after pregnancy in a Danish nationwide cohort. Methods. From nationwide administrative registers, we identified 718, 900 births in Denmark between January 1997 and December 2007 as well as maternal prescription data of anthelmintics and maternal characteristics. Redemption of a prescription for pyrvinium or mebendazole was used to identify exposure. Results. 4715 women redeemed a prescription for pyrvinium or mebendazole during pregnancy; 1606 for pyrvinium, 2575 for mebendazole, and 534 for both drugs. Having >2 children compared to having no previous children was associated with exposure to pyrvinium (OR: 7.1, 95% CI: 5.8–8.7 and mebendazole (OR: 20.8, 95% CI: 17.3–24.9. Conclusion. 4715 pregnant women redeemed a prescription for either mebendazole or pyrvinium. We believe the exposure to be even higher since pyrvinium is also sold over-the-counter. Limited information on birth outcomes is available at present time, and considering the number of exposed pregnancies, we recommend that studies are to be undertaken to assess the safety of pyrvinium and mebendazole during pregnancy.

  11. A nationwide analysis of socioeconomic outcomes after hip and knee replacement

    DEFF Research Database (Denmark)

    Kjellberg, Jakob; Kehlet, Henrik

    2016-01-01

    INTRODUCTION: Total hip and knee replacement (THA and TKA) are successful operations based on patient-reported outcomes and short-term socioeconomic evaluations. However, other data have shown problems regarding persistent pain and function. No detailed large-scale, long-term socioeconomic data...... exist on income and total health expenses before and after THA and TKA compared with a matched reference population (RP). METHODS: From the unique nationwide Danish registers, a total of 128,109 patients undergoing primary THA and TKA were followed from up to 12 years before to up to 12 years after...... surgery. The economic analysis of the total costs before and after surgery were divided into annual healthcare costs (outpatient services, inpatient admissions, prescription drugs and physician office visits), home care and loss of income and compared with a matched RP. RESULTS: Healthcare costs increased...

  12. Use of Pregabalin - A Nationwide Pharmacoepidemiological Drug Utilization Study with Focus on Abuse Potential

    DEFF Research Database (Denmark)

    Schjerning, O; Pottegård, A; Damkier, P

    2016-01-01

    INTRODUCTION: Pregabalin is currently approved for the treatment of epilepsy, generalized anxiety disorder and neuropathic pain with a licensed dosage range of 150 mg to 600 mg/day. Growing concern about the abuse potential of pregabalin is partly based on reports of pregabalin being used...... in dosages that exceed the approved therapeutic range. METHODS: To identify predictors of pregabalin use above recommended dosage, we conducted a pharmacoepidemological drug utilization study using the Danish nationwide registers. We deployed 4 measures of abuse: high use (≥600 mg/day) or very high use (≥1...... 200 mg/day) over a 6- or 12-month period, respectively. Multiple logistic regression was used to identify patient and treatment characteristics that were associated with either abuse marker. RESULTS: Out of 42 520 pregabalin users 4 090 (9.6%) were treated with more than 600 mg/day for 6 months and 2...

  13. The practice of continuous sedation until death in nursing homes in Flanders, Belgium: a nationwide study.

    Science.gov (United States)

    Rys, Sam; Mortier, Freddy; Deliens, Luc; Bilsen, Johan

    2014-10-01

    To investigate how continuous sedation until death (CSD), the reduction or removal of consciousness of an incurably ill individual until death to relieve refractory suffering, is practiced in nursing homes. Nationwide cross-sectional retrospective survey. Nursing homes in Flanders, Belgium. Palliative care nurses (N = 660) in all nursing homes in Flanders. Nurse reports of their most recent patient treated with CSD. The response rate was 65.5%, and 249 nurses reported a case of CSD (57.6%). Most individuals had cancer (33.6%) or dementia (32.8%); lacked competence (65.7%); and had severe pain (71.2%), fatigue (62.3%), loss of dignity (59%), anxiety (58.4%), and longing for death (58.4%). Intractable pain (70.7%) and physical exhaustion (63.9%) were the most decisive symptoms for initiating CSD. Life expectancy was generally limited to 1 week (64.9%), and 88.4% had insufficient nutritional oral intake before the start of CSD. CSD was rarely combined with artificial nutrition or hydration. Benzodiazepines were most frequently used (84.8%). Overall, according to the reporting nurses, CSD provided adequate symptom relief and good quality of dying. In nursing homes, CSD is typically used in residents with cancer or dementia and severe, intractable physical symptoms. Lack of competence prevents most residents from being involved in the decision-making process, which illustrates the importance of advance care planning in nursing homes in Flanders. © 2014, Copyright the Authors Journal compilation © 2014, The American Geriatrics Society.

  14. Risk of psoriasis in patients with childhood asthma: a Danish nationwide cohort study.

    Science.gov (United States)

    Egeberg, A; Khalid, U; Gislason, G H; Mallbris, L; Skov, L; Hansen, P R

    2015-07-01

    Psoriasis and asthma are disorders driven by inflammation. Psoriasis may carry an increased risk of asthma, but the reverse relationship has not been investigated. To investigate the risk of psoriasis in subjects with childhood asthma in a nationwide Danish cohort. Data on all Danish individuals aged 6-14 years at study entry between 1 January 1997 and 31 December 2011 (n = 1,478,110) were linked at an individual level in nationwide registers. Incidence rates per 10,000 person-years were calculated, and incidence rate ratios (IRRs) adjusted for age, sex, concomitant medication and comorbidity were estimated by Poisson regression models. There were 21,725 cases of childhood asthma and 6586 incident cases of psoriasis. There were 5697 and 889 incident cases of mild and severe psoriasis, respectively. The incidence rates of overall, mild and severe psoriasis were 4.49, 3.88 and 0.61 for the reference population, and 5.95, 5.18 and 0.83 for subjects with childhood asthma, respectively. The IRRs for overall, mild and severe psoriasis were 3.94 [95% confidence interval (CI) 2.16-7.17], 5.03 (95% CI 2.48-10.21) and 2.27 (95% CI 0.61-8.42) for patients with childhood asthma. Childhood asthma was associated with a significantly increased risk of psoriasis. Further studies are warranted to determine the clinical significance and effects of therapeutic interventions on this association. © 2015 British Association of Dermatologists.

  15. A nationwide low-level waste management system

    International Nuclear Information System (INIS)

    1985-01-01

    The National Governors' Association, in conjunction with the Department of Energy's National Low-Level Waste Management Program, invited various representatives of states, regions, and federal agencies to comment on their perceptions of what major features would constitute a nationwide low-level waste management system. Three meetings were conducted and this report summarizes results of those meetings. The Low-Level Radioactive Waste Policy Act of 1980 placed primary responsibility on the states for disposal of low-level waste. Although initial efforts of states have been directed toward establishing compacts, it is evident that a successful long term system requires significant cooperation and communication among states, regions, federal agencies, and Congress

  16. A nationwide modelling approach to decommissioning - 16182

    International Nuclear Information System (INIS)

    Kelly, Bernard; Lowe, Andy; Mort, Paul

    2009-01-01

    In this paper we describe a proposed UK national approach to modelling decommissioning. For the first time, we shall have an insight into optimizing the safety and efficiency of a national decommissioning strategy. To do this we use the General Case Integrated Waste Algorithm (GIA), a universal model of decommissioning nuclear plant, power plant, waste arisings and the associated knowledge capture. The model scales from individual items of plant through cells, groups of cells, buildings, whole sites and then on up to a national scale. We describe the national vision for GIA which can be broken down into three levels: 1) the capture of the chronological order of activities that an experienced decommissioner would use to decommission any nuclear facility anywhere in the world - this is Level 1 of GIA; 2) the construction of an Operational Research (OR) model based on Level 1 to allow rapid what if scenarios to be tested quickly (Level 2); 3) the construction of a state of the art knowledge capture capability that allows future generations to learn from our current decommissioning experience (Level 3). We show the progress to date in developing GIA in levels 1 and 2. As part of level 1, GIA has assisted in the development of an IMechE professional decommissioning qualification. Furthermore, we describe GIA as the basis of a UK-Owned database of decommissioning norms for such things as costs, productivity, durations etc. From level 2, we report on a pilot study that has successfully tested the basic principles for the OR numerical simulation of the algorithm. We then highlight the advantages of applying the OR modelling approach nationally. In essence, a series of 'what if...' scenarios can be tested that will improve the safety and efficiency of decommissioning. (authors)

  17. A Nationwide Survey of Environmental Protection.

    Science.gov (United States)

    Erdos & Morgan, Inc., New York, NY.

    This study was made in two phases. Phase I was conducted to obtain extensive information about "The Wall Street Journal's" subscribers on their business activities, purchasing influence, involvement in pollution control, personal resources, etc. Those personally active in anti-pollution programs received a second survey dealing with environmental…

  18. A Model for Nationwide Patient Tracking

    Science.gov (United States)

    2009-09-01

    SUBJECT TERMS Patient Tracking, Public Health, Emergency Medical Services, Patient Movement, Evacuation, Public Health Preparedness 16. PRICE CODE 17...Emergency Medical Services................................................................................................19 2. Ideal Patient Tracking... Medical Services ............................................................36 a. Patient Flow in Field-Based Casualty Care—Current Process

  19. A break-even analysis for dementia care collaboration: Partners in Dementia Care.

    Science.gov (United States)

    Morgan, Robert O; Bass, David M; Judge, Katherine S; Liu, C F; Wilson, Nancy; Snow, A Lynn; Pirraglia, Paul; Garcia-Maldonado, Maurilio; Raia, Paul; Fouladi, N N; Kunik, Mark E

    2015-06-01

    Dementia is a costly disease. People with dementia, their families, and their friends are affected on personal, emotional, and financial levels. Prior work has shown that the "Partners in Dementia Care" (PDC) intervention addresses unmet needs and improves psychosocial outcomes and satisfaction with care. We examined whether PDC reduced direct Veterans Health Administration (VHA) health care costs compared with usual care. This study was a cost analysis of the PDC intervention in a 30-month trial involving five VHA medical centers. Study subjects were veterans (N = 434) 50 years of age and older with dementia and their caregivers at two intervention (N = 269) and three comparison sites (N = 165). PDC is a telephone-based care coordination and support service for veterans with dementia and their caregivers, delivered through partnerships between VHA medical centers and local Alzheimer's Association chapters. We tested for differences in total VHA health care costs, including hospital, emergency department, nursing home, outpatient, and pharmacy costs, as well as program costs for intervention participants. Covariates included caregiver reports of veterans' cognitive impairment, behavior problems, and personal care dependencies. We used linear mixed model regression to model change in log total cost post-baseline over a 1-year follow-up period. Intervention participants showed higher VHA costs than usual-care participants both before and after the intervention but did not differ significantly regarding change in log costs from pre- to post-baseline periods. Pre-baseline log cost (p ≤ 0.001), baseline cognitive impairment (p ≤ 0.05), number of personal care dependencies (p ≤ 0.01), and VA service priority (p ≤ 0.01) all predicted change in log total cost. These analyses show that PDC meets veterans' needs without significantly increasing VHA health care costs. PDC addresses the priority area of care coordination in the National Plan to Address Alzheimer

  20. Morbidity and GH deficiency: a nationwide study

    DEFF Research Database (Denmark)

    Stochholm, K.; Laursen, T.; Green, A.

    2008-01-01

    identified in the National Patient Registry. Lag time until first admission was used as a measure of morbidity. Patients were divided into childhood onset (CO) and adult onset (AO), discriminated by an age cut-off of 18 years at onset of GHD. Method: Sex- and cause-specific hazard ratios (HRs) in CO and AO......Objective: To estimate morbidity in Denmark in all patients with GH deficiency (GHD). Design: Morbidity was analyzed in 1794 GHD patients and 8014 controls matched on age and gender. All records in the GHD patients were studied and additional morbidity noted. Diagnoses and dates of admissions were...

  1. Storytelling in dementia: embodiment as a resource.

    Science.gov (United States)

    Hydén, Lars-Christer

    2013-05-01

    In narrative research about persons with dementia, much research focuses on individual storytellers and their stories often stressing the discursive or textual aspects of stories. As persons with Alzheimer's disease generally have difficulties in telling stories according to often implicit narrative norms, they may appear to be less competent and agentive than what is actually the case. In the article, I argue for a change of focus from the textual aspects of narratives and the story as a product, to a focus on performative aspects and the embodied aspects of storytelling. A focus on the storytelling activity implies a change from the individual storyteller to the interaction with other participants in the storytelling situation. Drawing on two particular cases of storytelling, I stress the collaborative and embodied aspects of storytelling and argue that embodiment is less an individual expressive phenomenon than it is an interactive resource.

  2. Pediatric radiation therapy. A Japanese nationwide survey

    International Nuclear Information System (INIS)

    Nemoto, Kenji; Nagata, Yasushi; Hirokawa, Yutaka

    2006-01-01

    A national survey on the current status of pediatric radiation therapy was performed in October 2004. We sent questionnaires to 638 radiotherapy facilities in Japan (except for Kansai area) and 245 responses were analyzed. According to the database of committee of Japanese Society of Therapeutic Radiology and Oncology (JASTRO), the number of pediatric patients who received radiation therapy during 2003 in Japan was 1,101. The most frequent pediatric malignancy was brain tumor, followed by leukemia and lymphoma. The total effort of radiation therapy for children was two to six times larger than that for adult patients. An additional fee seems to be necessary for the highly technical and laborious radiation therapy required for children. (author)

  3. Structured physical exercise improves neuropsychiatric symptoms in acute dementia care: a hospital-based RCT.

    Science.gov (United States)

    Fleiner, Tim; Dauth, Hannah; Gersie, Marleen; Zijlstra, Wiebren; Haussermann, Peter

    2017-08-29

    The primary objective of this trial is to investigate the effects of a short-term exercise program on neuropsychiatric signs and symptoms in acute hospital dementia care. Within a hospital-based randomized controlled trial, the intervention group conducted a 2-week exercise program with four 20-min exercise sessions on 3 days per week. The control group conducted a social stimulation program. Effects on neuropsychiatric signs and symptoms were measured via the Alzheimer's Disease Cooperative Study-Clinical Global Impression of Change, the Neuropsychiatric Inventory, and the Cohen-Mansfield Agitation Inventory. The antipsychotic and sedative dosage was quantified by olanzapine and diazepam equivalents. Eighty-five patients were randomized via minimization to an intervention group (IG) and a control group (CG). Seventy patients (82%) (mean age 80 years, 33 females, mean Mini Mental State Examination score 18.3 points) completed the trial. As compared to the CG (n = 35), the IG (n = 35) showed significantly reduced neuropsychiatric signs and symptoms. Especially, agitated behavior and lability improved. There were no between-group differences concerning antipsychotic and benzodiazepine medication. This exercise program is easily applicable in hospital dementia care and significantly reduces neuropsychiatric signs and symptoms in patients suffering from predominantly moderate stages of dementia. German Clinical Trial Register DRKS00006740 . Registered 28 October 2014.

  4. Case management considerations of progressive dementia in a home setting.

    Science.gov (United States)

    Pierce, Mary Ellen

    2010-01-01

    Nursing theory, research, and best practice guidelines contribute substantially to the field of dementia care. Interventional plans are challenged most by those dementias considered progressive and deteriorative in nature, requiring ongoing reassessment and modification of care practices as the clinical course changes. The purpose of this article is to provide guidelines for case managers in the development of effective, individualized care plans for clients with progressive dementia residing in a home setting. The application of these guidelines is illustrated through the presentation of an actual case. The practice setting is a private home in the Pacific Northwest. Geriatric case management is provided by an RN case manager. Progressive dementia presents challenges to home care. Professional case management using comprehensive, holistic assessment, collaborative approaches, and best practice fundamentals serve to create an effective, individualized plan of care. The increasing geriatric population presents great opportunities for case managers in strategic management for creating successful home care models in clients with progressive dementia. Use of nursing diagnoses, dementia research, and collaborative approaches with families and other medical providers creates a viable alternative for clients with progressive dementia.

  5. A Review of Behavioural Gerontology and Dementia Related Interventions

    Directory of Open Access Journals (Sweden)

    Josling, Megan

    2015-12-01

    Full Text Available Behavioural Gerontology is concerned with the interaction of the aging individual and their environment. One aspect of behavioural gerontology has focussed on the use of behaviourist methods to improve the functioning and quality of life of individuals with dementia. Positive reinforcement techniques have shown to have an effect on dementia related behavioural excesses (wandering, disruptive vocalisations, behavioural deficits (incontinence, self feeding and mood changes (depression. One of the major concerns of using reinforcement techniques in the case of dementia is maintenance of the behavioural changes with the continual implementation of the intervention. Research has indicated that individuals with dementia meet behavioural extinction criteria at an advanced rate in comparison with individuals without dementia. Thus for a behavioural change to be successfully maintained it requires diligence on the part of the caregiver and/or nursing home staff. In the case of dementia care centres and nursing homes, when using behavioural interventions to modify the behavioural symptoms of dementia, there needs to be a considerable overlap between Behavioural Gerontology and Organisational Behavioural Management to ensure the successful maintenance of behavioural change.

  6. Activities in dementia care: A comparative assessment of activity types.

    Science.gov (United States)

    Lokon, Elizabeth; Sauer, Philip E; Li, Yue

    2016-12-05

    This exploratory study compares the impact of five activity types on the well-being of institutionalized people with dementia: the intergenerational art program Opening Minds through Art, art and music therapies, creative activities, non-creative activities, and no activities at all. We validated the Scripps Modified Greater Cincinnati Chapter Well-Being Observational Tool, and used that instrument to systematically observe N = 67 people with dementia as they participated in different activity types. People with dementia showed the highest well-being scores during Opening Minds through Art compared to all other activities. No significant well-being differences were found between creative activities led by licensed art/music therapist versus regular activity staff. Furthermore, no significant well-being differences were found between creative and non-creative activities that were both led by regular activity staff. Overall, people with dementia benefit from participating in activities, regardless of the type (creative or non-creative), or who conducts them (licensed therapists or activity staff). However, in order for people with dementia to reach significantly high levels of overall well-being, we recommend that activities are specifically designed for people with dementia and incorporate a 1:1 ratio between people with dementia and well-trained volunteers/staff members. © The Author(s) 2016.

  7. Knowledge and pharmacological management of Alzheimer's disease by managing community pharmacists: a nationwide study.

    Science.gov (United States)

    Zerafa, Natalie; Scerri, Charles

    2016-12-01

    Background Managing community pharmacists can play a leading role in supporting community dwelling individuals with Alzheimer's disease and their caregivers. Objective The main purpose of this study was to assess knowledge of managing community pharmacists towards Alzheimer's disease and its pharmacological management. Setting Community pharmacies in the Maltese islands. Method A nationwide survey was conducted with full-time managing community pharmacists in possession of a tertiary education degree in pharmacy studies. The level of knowledge was investigated using the Alzheimer's Disease Knowledge Scale and the Alzheimer's Disease Pharmacotherapy Measure. Participants were also asked to rate a number of statements related to disease management. Results Maltese managing community pharmacists (57 % response rate) had inadequate knowledge on risk factors, caregiving issues and pharmacological management of Alzheimer's disease. Age and number of years working in a community pharmacy setting were found to be negatively correlated with increased knowledge. Conclusion The findings highlight the need of providing training and continued educational support to managing community pharmacists in order to provide quality advice to individuals with dementia and their caregivers in the community.

  8. Dementia in affective disorder

    DEFF Research Database (Denmark)

    Kessing, L V; Olsen, E W; Mortensen, P B

    1999-01-01

    OBJECTIVE: The aim of the study was to investigate whether patients with affective disorder have increased risk of developing dementia compared to other groups of psychiatric patients and compared to the general population. METHOD: In the Danish psychiatric central register, 3363 patients...... with unipolar affective disorder, 518 patients with bipolar affective disorder, 1025 schizophrenic and 8946 neurotic patients were identified according to the diagnosis at the first ever discharge from psychiatric hospital during the period from 1970 to 1974. The rate of discharge diagnosis of dementia...... on readmission was estimated during 21 years of follow-up. In addition, the rates were compared with the rates for admission to psychiatric hospitals with a discharge diagnosis of dementia for the total Danish population. RESULTS: Patients with unipolar and with bipolar affective disorder had a greater risk...

  9. MR spectroscopy in dementia

    International Nuclear Information System (INIS)

    Hauser, T.; Gerigk, L.; Giesel, F.; Schuster, L.; Essig, M.

    2010-01-01

    With an increasingly aging population we are faced with the problem of an increasing number of dementia patients. In addition to clinical, neuropsychological and laboratory procedures, MRI plays an important role in the early diagnosis of dementia. In addition to various morphological changes functional changes can also help in the diagnosis and differential diagnosis of dementia. Overall the diagnosis of dementia can be improved by using parameters from MR spectroscopy. This article focuses on MR spectroscopic changes in the physiological aging process as well as on changes in mild cognitive impairment a precursor of Alzheimer's dementia, in Alzheimer's dementia, frontotemporal dementia, vascular dementia and Lewy body dementia. (orig.) [de

  10. Psychosocial outcomes in adult men born with hypospadias: A register-based study.

    Directory of Open Access Journals (Sweden)

    Anna Skarin Nordenvall

    Full Text Available In this nationwide matched cohort study, we have investigated whether being born with hypospadias affect subsequent psychosocial outcomes in adulthood. We analyzed prospectively collected data from national Swedish registers. Data on the diagnoses were collected from the National Patient Register and the Medical Birth Register. Data on psychosocial outcomes such as educational and income level, marital status and disability pension were collected from Statistics Sweden. The effects of covariates, such as age, county of birth, presence of other malformations and psychiatric illness, were taken into account. The associations between hypospadias and psychosocial outcomes were calculated using conditional logistic regression and expressed as odds ratios (OR and 95% confidence intervals (CI. We included 4378 men diagnosed with hypospadias, born between 1969 and 1993 in Sweden. Patients with hypospadias were matched with unaffected men by year of birth and birth county. We did not detect any differences in educational or income level. The probability of entering marriage (OR 1.02, 95% CI 0.90-1.14 did not differ, regardless of phenotype. We did, however, detect a 40% increased probability of receiving a disability pension, (OR 1.39, 95% CI 1.20-1.61. In conclusion, men born with hypospadias in Sweden do not differ from unaffected men with respect to the majority of psychosocial outcomes studied. They are, however, at increased risk of receiving a disability pension, which motivates further investigations.

  11. Subdural hematoma cases identified through a Danish patient register

    DEFF Research Database (Denmark)

    Poulsen, Frantz Rom; Halle, Bo; Pottegård, Anton

    2016-01-01

    PURPOSE: This study aimed to assess the usefulness of Danish patient registers for epidemiological studies of subdural hematoma (SDH) and to describe clinical characteristics of validated cases. METHODS: Using a patient register covering a geographically defined area in Denmark, we retrieved...... use did not vary by SDH type (OR 0.9, 95%CI 0.6-1.2). CONCLUSIONS: Danish patient registers are a useful resource for SDH studies. However, choice of International Classification of Diseases code markedly influences diagnostic validity. Distinction between cSDH and aSDH is not possible based on SDH...

  12. Developing eHealth technology for people with dementia : towards a supportive decision tool facilitating shared decision making in dementia

    NARCIS (Netherlands)

    Span, M.; Smits, C.; Groen-van der Ven, L.; Jukema, J.; Cremers, A.H.M.; Vernooij-Dassen, M.; Eefsting, J.; Hettinga, M.

    2013-01-01

    People with dementia are confronted with many decisions. However, they are often not involved in the process of the decision-making. Shared Decision-Making (SDM) enables involvement of persons with dementia in the decision-making process. In our study, we develop a supportive IT application aiming

  13. Awareness of dementia by family carers of nursing home residents dying with dementia: A post-death study

    NARCIS (Netherlands)

    Penders, Y.W.H.; Albers, G.; Deliens, L.; van der Stichele, R.; Block, L.

    2015-01-01

    Background: High-quality palliative care for people with dementia should be patient-centered, family-focused, and include well-informed and shared decision-making, as affirmed in a recent white paper on dementia from the European Association for Palliative Care. Aim: To describe how often family

  14. CAMCOG as a screening instrument for dementia

    DEFF Research Database (Denmark)

    Lolk, A; Nielsen, H; Andersen, K

    2000-01-01

    The Cambridge Cognitive Examination (CAMCOG) score is correlated with age and sociodemographic variables. The aim of the study was to determine an individualized CAMCOG cut-off score for dementia, taking such correlates into account.......The Cambridge Cognitive Examination (CAMCOG) score is correlated with age and sociodemographic variables. The aim of the study was to determine an individualized CAMCOG cut-off score for dementia, taking such correlates into account....

  15. Risk of post-pregnancy hypertension in women with a history of hypertensive disorders of pregnancy: nationwide cohort study

    OpenAIRE

    Behrens, Ida; Basit, Saima; Melbye, Mads; Lykke, Jacob A; Wohlfahrt, Jan; Bundgaard, Henning; Thilaganathan, Baskaran; Boyd, Heather A

    2017-01-01

    Objectives To determine how soon after delivery the risk of post-pregnancy hypertension increases in women with hypertensive disorders of pregnancy and how the risk evolves over time.Design Nationwide register based cohort study.Setting Denmark.Populations 482 972 primiparous women with a first live birth or stillbirth between 1995 and 2012 (cumulative incidence analyses), and 1 025 118 women with at least one live birth or stillbirth between 1978 and 2012 (Cox regression analyses).Main outco...

  16. Sexual offending runs in families: A 37-year nationwide study.

    Science.gov (United States)

    Långström, Niklas; Babchishin, Kelly M; Fazel, Seena; Lichtenstein, Paul; Frisell, Thomas

    2015-04-01

    Sexual crime is an important public health concern. The possible causes of sexual aggression, however, remain uncertain. We examined familial aggregation and the contribution of genetic and environmental factors to sexual crime by linking longitudinal, nationwide Swedish crime and multigenerational family registers. We included all men convicted of any sexual offence (N = 21,566), specifically rape of an adult (N = 6131) and child molestation (N = 4465), from 1973 to 2009. Sexual crime rates among fathers and brothers of sexual offenders were compared with corresponding rates in fathers and brothers of age-matched population control men without sexual crime convictions. We also modelled the relative influence of genetic and environmental factors to the liability of sexual offending. We found strong familial aggregation of sexual crime [odds ratio (OR) = 5.1, 95% confidence interval (CI) = 4.5-5.9] among full brothers of convicted sexual offenders. Familial aggregation was lower in father-son dyads (OR = 3.7, 95% CI = 3.2-4.4) among paternal half-brothers (OR = 2.1, 95% CI = 1.5-2.9) and maternal half-brothers (OR = 1.7, 95% CI = 1.2-2.4). Statistical modelling of the strength and patterns of familial aggregation suggested that genetic factors (40%) and non-shared environmental factors (58%) explained the liability to offend sexually more than shared environmental influences (2%). Further, genetic effects tended to be weaker for rape of an adult (19%) than for child molestation (46%). We report strong evidence of familial clustering of sexual offending, primarily accounted for by genes rather than shared environmental influences. Future research should possibly test the effectiveness of selective prevention efforts for male first-degree relatives of sexually aggressive individuals, and consider familial risk in sexual violence risk assessment.

  17. Linking a research register to clinical records in older adults' mental health services:a mixed-methods study

    OpenAIRE

    Robotham, Dan; Evans, Joanne; Watson, Andrew; Perdue, Iain; Craig, Thomas; Rose, Diana; Wykes, Til

    2015-01-01

    INTRODUCTION: Patients can provide consent to have their clinical records linked to a research register, a process known as consent for contact (C4C). There is evidence about how to engage people with mental illness in C4C, but nothing specific to older adults. This is a priority area for research (for example, dementia trials), although sign-up rates to C4C are lower than for younger populations. Through this study we seek to understand these disparities.METHODS: This was a two-stage cross-s...

  18. What's in a Name? AIDS Dementia Complex, HIV-associated ...

    African Journals Online (AJOL)

    Key words: HIV; AIDS; HIV-associated dementia (HAD); HIV-associated neurocognitive disorder (HAND) .... increased survival a mixed picture is becoming more common. ... alternating sequence and memory recall of the four objects.

  19. A dementia first aid course for family carers.

    Science.gov (United States)

    Pogson, Richard

    Many people with dementia are cared for by family members, who may receive little advice or support. This article describes a course developed to help carers deal with frustrating and challenging behaviour.

  20. Does lithium protect against dementia?

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Forman, Julie Lyng; Andersen, Per Kragh

    2010-01-01

    OBJECTIVE: To investigate whether treatment with lithium in patients with mania or bipolar disorder is associated with a decreased rate of subsequent dementia. METHODS: Linkage of register data on prescribed lithium in all patients discharged from psychiatric health care service with a diagnosis...... exposed to lithium (50.4%), 1,781 to anticonvulsants (36.7%), 4,280 to antidepressants (88.1%), and 3,901 to antipsychotics (80.3%) during the study period. A total of 216 patients received a diagnosis of dementia during follow-up (103.6/10,000 person-years). During the period following the second...... prescription of lithium, the rate of dementia was decreased compared to the period following the first prescription. In contrast, the rates of dementia during multiple prescription periods with anticonvulsants, antidepressants, or antipsychotics, respectively, were not significantly decreased compared...

  1. Inequalities in Access to Treatment and Care for Patients with Dementia and Immigrant Background

    DEFF Research Database (Denmark)

    Stevnsborg, Lea; Jensen-Dahm, Christina; Nielsen, Thomas R

    2016-01-01

    BACKGROUND: Previous studies demonstrated lower quality diagnostic assessment of dementia in immigrant populations, but knowledge about the quality of treatment and care for dementia is still lacking. OBJECTIVE: To conduct a nationwide registry-based study to determine whether inequality exists...... in a nursing home were compared among Danish-born and Western and non-Western immigrants with dementia. Logistic regression analysis was done with adjustment for age, sex, comorbidity, marital status, basis of inclusion, and time since dementia diagnosis. RESULTS: Immigrant background was associated...

  2. Dementia--epidemiological considerations, nomenclature, and a tacit consensus definition.

    Science.gov (United States)

    Breitner, John C S

    2006-09-01

    Epidemiologic inquiry requires the definition of a "case." Dementia may be defined clinically or alternatively by inference of irreversible brain pathology. Several iterations of the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Diseases have skirted this issue by using criteria that are at once syndromic and neuropathological. The limitations of this compromise are revealed by large discrepancies in case identification when the various published criteria are strictly applied. Despite this problem, neuroepidemiologists have produced convergent estimates of the prevalence and incidence of dementia and its association with risk factors. This progress has reflected the tacit reliance of investigators on a simple definition of dementia as the syndrome of substantial global cognitive decline not attributable to alteration in level of consciousness. Beyond this description, our knowledge of pathology and, ultimately, the etiology of individual cases is extremely variable. Whatever its antecedents, syndromically defined dementia presents a looming public health crisis.

  3. Family-focused dementia care - a qualitative interview study

    DEFF Research Database (Denmark)

    Mohrsen Busted, Laila; Nielsen, Dorthe; Birkelund, Regner

    to decrease the experienced burden that relatives to persons with dementia experience. The qualitative research project consists of three parts; 1) An interview study to investigate the problem area as experienced by 24 relatives. 2) Initiate family intervention, conducted by professional caregivers......Relatives to persons with dementia are in the literature described as the "invisible second patients." They get a more burdensome responsibility to the family’s everyday life and relation within the family. Furthermore, relatives as caregivers provide most of the assistance and supervision...... to fulfill the basic needs of the person with dementia. The experience of being close to a person with dementia may seem as a burden that involves emotional chaos and uncertainty which can lead to stress and depressions. Family health therapeutic conversations may be an intervention to relieve the suffering...

  4. Danish Register of chronic obstructive pulmonary disease

    DEFF Research Database (Denmark)

    Lange, Peter; Tøttenborg, Sandra Søgaard; Sorknæs, Anne Dichmann

    2016-01-01

    AIM OF DATABASE: The Danish Register of Chronic Obstructive Pulmonary Disease (DrCOPD) is a nationwide database aiming to describe the quality of treatment of all patients with chronic obstructive pulmonary disease (COPD) in Denmark. STUDY POPULATION: DrCOPD comprises data on all patients...

  5. Lewy Body Dementia Diagnosis

    Science.gov (United States)

    ... provide an experienced diagnostic team skilled in Lewy body dementia. A thorough dementia diagnostic evaluation includes physical ... a good way to benefit others with Lewy body dementia. Medications Medications are one of the most ...

  6. A Resilience Training Module for Caregivers of Dementia Patients

    OpenAIRE

    Huey Wah Tze; Hashim Shahabuddin

    2015-01-01

    As life span increases, society is facing an aging population and one of the major aging problems is dementia. Caregivers of dementia patients are usually family members who juggle work, family commitments and caring for the patients. The caregivers are at risk of depression, suicide and abusing their patients. As resilience has a positive relationship with surviving life crises, enhancing resilience will provide them with skills to cope and decrease depression. The purpose of this article is...

  7. Life story resources in dementia care: a review.

    Science.gov (United States)

    Kindell, Jacqueline; Burrow, Simon; Wilkinson, Ray; Keady, John David

    2014-01-01

    Life story work has a relatively long tradition in the caring sciences and is recognised as an important component of dementia care and practice. However, to date, there has not been a review of accessible life story resources. The paper aims to discuss these issues. Following a systematic approach to identification and inclusion, 11 life story resources were reviewed to ascertain areas of commonality and divergence between the materials. The authors were able to group the analysis under eight areas and at the end of this process, it was uncertain if life story work is a formal staff intervention or an informal activity that people with dementia and their families could engage in. Resources also varied in terms of whether the life story information was organised in a chronological way, or with topics of interest/discussion or with a combination of both. Life story evaluation and its impact on the life of the person with dementia is in need of development. Across the resources the authors identified four reasons to do life story work which the authors have named as: emotional connections; interactional connections; building new connections and practical care connections. There was limited guidance aimed at helping people with dementia to develop and compile their own life story. This paper provides new insights into the usefulness, future directions and content of life story resources in dementia care. It will be of interest to those in health and social care as well as people living with dementia.

  8. Dementia in Eastern Mediterranean countries: A systematic review.

    Science.gov (United States)

    Yaghmour, Sara Mahmoud; Bartlett, Ruth; Brannelly, Tula

    2018-01-01

    Globally, there is an increase in the older population, whose lives are affected by local cultural norms. In Eastern Mediterranean countries, dementia is conventionally hidden from view with few dedicated services or recognition for diagnosis. The aim of this systematic review is to explore the limited literature on dementia and cognitive impairment among older people in Eastern Mediterranean countries to present an evaluation of current practices and to consolidate knowledge for future planning. Thirty-three studies were identified for inclusion in the review, and four themes were apparent. Firstly, prevalence, comorbidity and gender: In Eastern Mediterranean countries, many studies identify that the prevalence of dementia is high. As is the case elsewhere, many older adults in Eastern Mediterranean countries have at least one coexisting long-term condition, and some experience low life-satisfaction. Secondly, culture: In Eastern Mediterranean countries, the older adult is highly respected, and placement outside of the family home is considered an abandonment of family duty. The term dementia carries stigma, and it is widely believed that dementia is caused by 'fate'. Thirdly, recognition and tools: There is a lack of verified assessment instruments to assess for dementia. Despite concerns about the cultural appropriateness of the Mini-Mental State Exam, particularly for people who have low literacy levels, and low literacy being the norm in Eastern Mediterranean countries, the Mini-Mental State Examination is the main assessment instrument. Translation and transition of non-Arabic assessment instruments and tools with psychometric properties presents a challenge for clinicians. Finally, workforce issues: health care workers lack knowledge about dementia, as dementia care is a relatively recent addition to the nursing and medical syllabi. While there were some inconsistencies in the papers published, many of the articles call for increasing educational programmes

  9. Internet use in radiology: results of a nationwide survey

    Energy Technology Data Exchange (ETDEWEB)

    Vorbeck, F; Zimmermann, C; Vorbeck-Meister, I; Kainberger, F; Imhof, H

    1999-08-01

    Purpose: To determine the number of radiologists who currently have Internet access, their use patterns on the Internet for Radiology purposes, the web sites they would recommend, and the potential site access to the Internet that they would like to see in the future. In addition, this study analyzed the best way to find nationwide radiological sites and their content. Materials and Methods: In a nationwide survey, 854 Austrian radiologist were asked to fill out and return a questionnaire about Internet access, current problems, current and future use, which web site they recommend, and about the use of e-mail. Next, the available nationwide radiological sites were searched with seven major search engines using 37 different keywords, as well as by category search, and by searching for links on the homepages of the radiological departments of all Universities of Austria. Then, the offered information of the founded pages was classified in categories. Results: Of the 210 (24.6%) radiologists who returned the questionnaire, 154 (73%) had Internet access. Time expenditure was considered the main problem using the Internet. The Internet was used for literature research by 69% of the radiologists with Internet access, for e-mail by 60%, and for congress information by 57%. In future, 43% would like to read electronic journals more often and 39% would like to use the web more intensively for scientific congresses. At the present time, we found 17 radiological web sites in Austria. The most promising way to find these sites was to use the search engines Alta Vista and Hotbot. Fifteen (88%) sites offered information for patients, seven (41%) for radiologists, five (29%) for students, and four (24%) for researchers. Summary: Many radiologists in Austria already have Internet access, although time expenditure was considered the main problem with Internet use. Survey responses showed a need for electronic journals. To our point of view, Universities and radiological societies

  10. Internet use in radiology: results of a nationwide survey

    International Nuclear Information System (INIS)

    Vorbeck, F.; Zimmermann, C.; Vorbeck-Meister, I.; Kainberger, F.; Imhof, H.

    1999-01-01

    Purpose: To determine the number of radiologists who currently have Internet access, their use patterns on the Internet for Radiology purposes, the web sites they would recommend, and the potential site access to the Internet that they would like to see in the future. In addition, this study analyzed the best way to find nationwide radiological sites and their content. Materials and Methods: In a nationwide survey, 854 Austrian radiologist were asked to fill out and return a questionnaire about Internet access, current problems, current and future use, which web site they recommend, and about the use of e-mail. Next, the available nationwide radiological sites were searched with seven major search engines using 37 different keywords, as well as by category search, and by searching for links on the homepages of the radiological departments of all Universities of Austria. Then, the offered information of the founded pages was classified in categories. Results: Of the 210 (24.6%) radiologists who returned the questionnaire, 154 (73%) had Internet access. Time expenditure was considered the main problem using the Internet. The Internet was used for literature research by 69% of the radiologists with Internet access, for e-mail by 60%, and for congress information by 57%. In future, 43% would like to read electronic journals more often and 39% would like to use the web more intensively for scientific congresses. At the present time, we found 17 radiological web sites in Austria. The most promising way to find these sites was to use the search engines Alta Vista and Hotbot. Fifteen (88%) sites offered information for patients, seven (41%) for radiologists, five (29%) for students, and four (24%) for researchers. Summary: Many radiologists in Austria already have Internet access, although time expenditure was considered the main problem with Internet use. Survey responses showed a need for electronic journals. To our point of view, Universities and radiological societies

  11. Parental occupation and preterm births: a nationwide epidemiological study in Sweden.

    Science.gov (United States)

    Li, Xinjun; Sundquist, Jan; Kane, Kimberly; Jin, Qianren; Sundquist, Kristina

    2010-11-01

    The hypothesis was that some occupations could lead to preterm birth (PTB) because of potential exposures to various agents. The objective in this nationwide follow-up study was to analyse the association between PTB and parental occupational groups, controlling for potential confounders. Data from the Swedish Medical Birth Register, in which all children born in Sweden from 1990 onward are registered with their parents, were linked to census data. Inclusion criteria for the study population were employment (both women and men) and age >20 years (women). There were 816,743 first singleton live births from 1990 to 2004, of whom 43,956 were PTBs. A total of 7659 of the 43,956 PTBs were very PTBs. Odds ratios (ORs) with 95% confidence intervals were calculated separately for mothers and fathers to estimate the odds of PTB and very PTB in 51 occupational groups (reference groups: mothers or fathers who were 'Technical, science research-related workers and physicians') and by family income level. Women and men with low family incomes had increased ORs of PTB and very PTB. Significantly increased ORs of PTB (including very PTB) were found in four maternal and nine paternal occupational groups after accounting for family income, geographic region of residence, civil status, smoking habits, maternal age at infant's birth and period of birth. Further studies should examine specific agents in those parental occupations that were associated with increased odds of PTB and very PTB. © 2010 Blackwell Publishing Ltd.

  12. Improving the identification of people with dementia in primary care: evaluation of the impact of primary care dementia coding guidance on identified prevalence.

    Science.gov (United States)

    Russell, Paul; Banerjee, Sube; Watt, Jen; Adleman, Rosalyn; Agoe, Belinda; Burnie, Nerida; Carefull, Alex; Chandan, Kiran; Constable, Dominie; Daniels, Mark; Davies, David; Deshmukh, Sid; Huddart, Martin; Jabin, Ashrafi; Jarrett, Penelope; King, Jenifer; Koch, Tamar; Kumar, Sanjoy; Lees, Stavroula; Mir, Sinan; Naidoo, Dominic; Nyame, Sylvia; Sasae, Ryuichiro; Sharma, Tushar; Thormod, Clare; Vedavanam, Krish; Wilton, Anja; Flaherty, Breda

    2013-12-23

    Improving dementia care is a policy priority nationally and internationally; there is a 'diagnosis gap' with less than half of the cases of dementia ever diagnosed. The English Health Department's Quality and Outcomes Framework (QOF) encourages primary care recognition and recording of dementia. The codes for dementia are complex with the possibility of underidentification through miscoding. We developed guidance on coding of dementia; we report the impact of applying this to 'clean up' dementia coding and records at a practice level. The guidance had five elements: (1) identify Read Codes for dementia; (2) access QOF dementia register; (3) generate lists of patients who may have dementia; (4) compare search with QOF data and (5) review cases. In each practice, one general practitioner conducted the exercise. The number of dementia QOF registers before and after the exercise was recorded with the hours taken to complete the exercise. London primary care. 23 (85%) of 27 practices participated, covering 79 312 (19 562 over 65 s) participants. The number on dementia QOF registers; time taken. The number of people with dementia on QOF registers increased from 1007 to 1139 (χ(2)=8.17, p=0.004), raising identification rates by 8.8%. It took 4.7 h per practice, on an average. These data demonstrate the potential of a simple primary care coding exercise, requiring no specific training, to increase the dementia identification rate. An improvement of 8.8% between 2011 and 2012 is equivalent to that of the fourth most improved primary care trust in the UK. In absolute terms, if this effects were mirrored across the UK primary care, the number of cases with dementia identified would rise by over 70 000 from 364 329 to 434 488 raising the recognition rate from 46% to 54.8%. Implementing this exercise appears to be a simple and effective way to improve recognition rates in primary care.

  13. Undertreatment of osteoporosis in persons with dementia? A population-based study.

    Science.gov (United States)

    Haasum, Y; Fastbom, J; Fratiglioni, L; Johnell, K

    2012-03-01

    In this population-based study of more than 2,600 elderly, people with dementia received less preventive treatment for osteoporosis compared to people without dementia, although osteoporotic fractures were more common in patients with dementia. Thus, our results indicate an undertreatment of osteoporosis in dementia. This study compares the use of osteoporosis drugs in elderly with and without dementia, taking into account osteoporotic fractures and type of housing. We analyzed data from the baseline examination (2001-2004) of The Swedish National Study on Aging and Care- Kungsholmen (SNAC-K), Stockholm, Sweden. Participants were aged ≥ 66 years (n = 2610). We analysed the use of bisphosphonates, raloxifene, and calcium/vitamin D combinations in relation to clinically based dementia diagnosis. Information about osteoporotic fractures during the previous 4 years was obtained from the Swedish National Patient Register. We used logistic regression to analyze the association between dementia status and use of osteoporosis drugs. Osteoporosis drugs (mainly calcium/vitamin D combinations) were used by 5% of the persons with dementia and 12% of the persons without dementia. Furthermore, 25% of the persons with dementia and 7% of the persons without dementia had had at least one osteoporotic fracture during the past 4 years. After controlling for age, sex, osteoporotic fractures, and type of housing (own home or institution), persons with dementia were less likely to use osteoporosis drugs than persons without dementia (OR = 0.34; 95% CI, 0.19-0.59). Our results indicate an undertreatment of osteoporosis in persons with dementia, although osteoporotic fractures are common among these patients.

  14. Ambulatory Care Visits to Pediatricians in Taiwan: A Nationwide Analysis

    Directory of Open Access Journals (Sweden)

    Ling-Yu Yang

    2015-11-01

    Full Text Available Pediatricians play a key role in the healthy development of children. Nevertheless, the practice patterns of pediatricians have seldom been investigated. The current study analyzed the nationwide profiles of ambulatory visits to pediatricians in Taiwan, using the National Health Insurance Research Database. From a dataset that was randomly sampled one out of every 500 records among a total of 309,880,000 visits in 2012 in the country, 9.8% (n = 60,717 of the visits were found paid to pediatricians. Children and adolescents accounted for only 69.3% of the visits to pediatricians. Male pediatricians provided 80.5% of the services and the main workforces were those aged 40–49 years. The most frequent diagnoses were respiratory tract diseases (64.7% and anti-histamine agents were prescribed in 48.8% of the visits to pediatricians. Our detailed results could contribute to evidence-based discussions on health policymaking.

  15. Caring for people with dementia in hospital: findings from a survey to identify barriers and facilitators to implementing best practice dementia care.

    Science.gov (United States)

    Tropea, Joanne; LoGiudice, Dina; Liew, Danny; Roberts, Carol; Brand, Caroline

    2017-03-01

    Best practice dementia care is not always provided in the hospital setting. Knowledge, attitudes and motivation, practitioner behavior, and external factors can influence uptake of best practice and quality care. The aim of this study was to determine hospital staff perceived barriers and enablers to implementing best practice dementia care. A 17-item survey was administered at two Australian hospitals between July and September 2014. Multidisciplinary staff working in the emergency departments and general medical wards were invited to participate in the survey. The survey collected data about the respondents' current role, work area, and years of experience, their perceived level of confidence and knowledge in dementia care and common symptoms of dementia, barriers and enablers to implementing best practice dementia care, job satisfaction in caring for people with dementia, and to rate the hospital's capacity and available resources to support best practice dementia care. A total of 112 survey responses were received. The environment, inadequate staffing levels and workload, time, and staff knowledge and skills were identified as barriers to implementing best practice dementia care. Most respondents rated their knowledge of dementia care and common symptoms of dementia, and confidence in recognizing whether a person has dementia, as moderate or high dementia. Approximately, half the respondents rated access to training and equipment as low or very low. The survey findings highlighted hospital staff perceived barriers to implementing best practice dementia care that can be used to inform locally tailored improvement interventions.

  16. Profile of clinically-diagnosed dementias in a neuropsychiatric ...

    African Journals Online (AJOL)

    Alzheimer's disease (AD) and Vascular dementia (VaD) were the predominant phenotypes seen in 62 (57.4%) and 18 (16.7%) subjects respectively. Others include mixed dementia (4 cases), frontotemporal dementia (4 cases), Lewy body dementia (3 cases), alcohol-related dementia (3 cases), PD dementia (1 case) and ...

  17. A nationwide study on anastomotic leakage after colonic cancer surgery

    DEFF Research Database (Denmark)

    Krarup, Peter-Martin; Jorgensen, L N; Andreasen, A H

    2012-01-01

    Aim: Anastomotic leakage (AL) is a major challenge in colorectal cancer surgery due to increased morbidity and mortality. Possible risk factors should be investigated differentially, distinguishing between rectal and colonic surgery in large-scale studies to avoid selection bias and confounding....... Method: The incidence and risk factors associated with AL were analysed in an unselected nation-wide prospective cohort of patient subjected to curative colonic cancer surgery with primary anastomosis and entered into The Danish Colorectal Cancer Group database between May 2001 and December 2008. Results......: AL occurred in 593 (6.4%) of 9333 patients. Laparoscopic surgery (odds ratio [OR], 1.34; 95% confidence interval [CI], 1.05-1.70; P = 0.03); left hemicolectomy (OR, 2.02; 95% CI, 1.50-2.72) or sigmoid colectomy (OR, 1.69; 95% CI, 1.32-2.17; P = 0.01); intraoperative blood loss (OR, 1.04; 95% CI, 1...

  18. Cholecystectomy in Danish children--a nationwide study

    DEFF Research Database (Denmark)

    Langballe, Karen Oline; Bardram, Linda

    2014-01-01

    into the secure Web site by the surgeon immediately after the operation. In the present analysis, we have included children ≤ 15 years from the five year period January 1, 2006, to December 31, 2010. RESULTS: In the study period 35,444 patients were operated with a cholecystectomy. Of these, 196 (0.5%) were ≤ 15......BACKGROUND: An increase in the frequency of cholecystectomy in children has been described during the last decades. Part of the reason is that more cholecystectomies in children are performed for dyskinesia of the gallbladder and not only for gallstone disease. We conducted the first nationwide...... study to describe outcome of cholecystectomies performed in children in Denmark by using data from the national Danish Cholecystectomy Database (DCD). METHODS: In the DCD, two data sources were combined: administrative data from the National Patient Registry (NPR) and clinical data entered...

  19. Anger and Impulsivity Among Japanese Adolescents: A Nationwide Representative Survey.

    Science.gov (United States)

    Itani, Osamu; Kaneita, Yoshitaka; Munezawa, Takeshi; Ikeda, Maki; Osaki, Yoneatsu; Higuchi, Susumu; Kanda, Hideyuki; Nakagome, Sachi; Suzuki, Kenji; Ohida, Takashi

    2016-07-01

    This study aimed to clarify the prevalence of anger and impulsivity and its associated factors through a nationwide survey of junior and senior high school adolescent students in Japan. A self-administered questionnaire covering (1) personal data, (2) lifestyle, (3) mental health status, and (4) feelings of anger and impulsivity was distributed to junior and senior high school students in Japan. Among the total of 10,955 junior high schools and 5,115 senior high schools nationwide, 130 and 110 were randomly selected, respectively. Of those, 92 junior and 80 senior high schools participated in the survey. The survey period was from December 2008 to the end of January 2009. A total of 95,680 questionnaires were collected. After excluding invalid responses, the remaining 94,777 responses (response rate: 62.3%) were analyzed. From the questions regarding anger and impulsivity, 8.7% (95% CI, 8.5%-8.9%) and 7.5% (95% CI, 7.3%-7.7%) of the participants were considered to have experienced intense anger and impulsivity, respectively. Logistic regression analysis indicated that the odds ratios for experiencing intense feelings of anger were significantly higher (all P values breakfast, did not wish to go to university, had short sleep duration, had decreased positive feelings, had increased depressive feelings, or used mobile phones for longer hours. The odds ratios for experiencing intense impulsivity were significantly higher among students who smoked, consumed alcohol, skipped breakfast, did not participate in club activities, had short sleep duration, had decreased positive feelings, had increased depressive feelings, or used mobile phones for longer hours. The results suggest that healthy lifestyle habits, good sleep habits, and improved mental health are important for preventing intense feelings of anger and impulsivity among adolescents. © Copyright 2016 Physicians Postgraduate Press, Inc.

  20. The accuracy of family physicians' dementia diagnoses at different stages of dementia: a systematic review

    NARCIS (Netherlands)

    van den Dungen, Pim; van Marwijk, Harm W. M.; van der Horst, Henriëtte E.; Moll van Charante, Eric P.; Macneil Vroomen, Janet; van de Ven, Peter M.; van Hout, Hein P. J.

    2012-01-01

    Objective: Optimising care for dementia patients and their informal carers is imperative in light of the impending dementia epidemic. An important aspect of care is accurate recognition and diagnosis of dementia. The aim of this review was to estimate family physicians' diagnostic accuracy at the

  1. The accuracy of family physicians' dementia diagnoses at different stages of dementia: a systematic review

    NARCIS (Netherlands)

    van den Dungen, P.; van Marwijk, H.W.J.; van der Horst, H.E.; van Charante, E.P.M.; Vroomen, J.M.; van de Ven, P.M.; van Hout, H.P.J.

    2012-01-01

    Objective Optimising care for dementia patients and their informal carers is imperative in light of the impending dementia epidemic. An important aspect of care is accurate recognition and diagnosis of dementia. The aim of this review was to estimate family physicians' diagnostic accuracy at the

  2. Dementia in Parkinson's disease: a Brazilian sample

    Directory of Open Access Journals (Sweden)

    Beatriz Baldivia

    2011-10-01

    Full Text Available To determine the prevalence of dementia associated with Parkinson's disease (PD-D in a Brazilian sample adopting clinical and diagnostic procedures recommended by the Movement Disorders Society (MDS. Sixty-seven patients were consecutively submitted to neurological, neuropsychological and functional examinations. PD-D was established according to MDS clinical criteria (Level II and clinical procedures for PD-D (Level I and prevalence rate was compared between the levels adopted. Ten patients (14.9% were diagnosed as demented by Level I criteria whereas sixteen (23.8% were diagnosed based on Level II criteria. Level I criteria had low sensitivity in detecting PD-D (31.25%, but greater specificity (90.19. The PD-D group had significantly worse performance on all neuropsychological tests, were older (p<0.001, had an older age of onset ofdisease (p<0.01, had lower educational level (p<0.02 and had higher scores on functional scales. Current age (p=0.046 and Hoehn & Yahr score (p=0.048 were predictors for developing PD-D.

  3. Progranulin as a therapeutic target for dementia.

    Science.gov (United States)

    Galimberti, Daniela; Fenoglio, Chiara; Scarpini, Elio

    2018-06-22

    Progranulin (PGRN) is an acrosomal glycoprotein that is synthesized during spermatogenesis. It is overexpressed in tumors and has anti-inflammatory properties. The protein may be cleaved into granulins which display pro-inflammatory properties. In 2006, mutations in progranulin gene (GRN) that cause haploinsufficiency were found in familial cases of frontotemporal dementia (FTD). Patients with null mutations in GRN display very low-plasma PGRN levels; this analysis is useful for identifying mutation carriers, independent of the clinical presentation, and in those before the appearance of symptoms. Areas covered: Here, we review the current knowledge of PGRN physiological functions and GRN mutations associated with FTD; we also summarize state of the art clinical trials and those compounds able to replace PGRN loss in preclinical models. Expert opinion: PGRN represents a promising therapeutic target for FTD. Cohorts suitable for treatment, ideally at the preclinical stage, where pathogenic mechanisms ongoing in the brain are targeted, are available. However, PGRN may have side effects, such as the risk of tumorigenesis, and the risk/benefit ratio of any intervention cannot be predicted. Furthermore, at present, the situation is complicated by the absence of adequate outcome measures.

  4. Translation of the Care of Persons with Dementia in their Environments (COPE) intervention in a publicly-funded home care context: Rationale and research design.

    Science.gov (United States)

    Fortinsky, Richard H; Gitlin, Laura N; Pizzi, Laura T; Piersol, Catherine Verrier; Grady, James; Robison, Julie T; Molony, Sheila

    2016-07-01

    Dementia is the leading cause of loss of independence in older adults worldwide. In the U.S., approximately 15 million family members provide care to relatives with dementia. This paper presents the rationale and design for a translational study in which an evidence-based, non-pharmacologic intervention for older adults with dementia and family caregivers (CGs) is incorporated into a publicly-funded home care program for older adults at risk for nursing home admission. The 4-month Care of Persons with Dementia in their Environments (COPE) intervention is designed to optimize older adults' functional independence, and to improve CG dementia management skills and health-related outcomes. COPE features 10 in-home occupational therapy visits, and 1 in-home visit and 1 telephone contact by an advanced practice nurse. COPE was deemed efficacious in a published randomized clinical trial. In the present study, older adults with dementia enrolled in the Connecticut Home Care Program for Elders (CHCPE) and their CGs are randomly assigned to receive COPE plus their ongoing CHCPE services, or to continue receiving CHCPE services only. The primary outcome for older adults with dementia is functional independence; secondary outcomes are activity engagement, quality of life, and prevention or alleviation of neuropsychiatric symptoms. CG outcomes include perceived well-being and confidence in using activities to manage dementia symptoms. Translational outcomes include net financial benefit of COPE, and feasibility and acceptability of COPE implementation into the CHCPE. COPE has the potential to improve health-related outcomes while saving Medicaid waiver and state revenue-funded home care program costs nationwide. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Dog ownership and the risk of cardiovascular disease and death - a nationwide cohort study.

    Science.gov (United States)

    Mubanga, Mwenya; Byberg, Liisa; Nowak, Christoph; Egenvall, Agneta; Magnusson, Patrik K; Ingelsson, Erik; Fall, Tove

    2017-11-17

    Dogs may be beneficial in reducing cardiovascular risk in their owners by providing social support and motivation for physical activity. We aimed to investigate the association of dog ownership with incident cardiovascular disease (CVD) and death in a register-based prospective nation-wide cohort (n = 3,432,153) with up to 12 years of follow-up. Self-reported health and lifestyle habits were available for 34,202 participants in the Swedish Twin Register. Time-to-event analyses with time-updated covariates were used to calculate hazard ratios (HR) with 95% confidence intervals (CI). In single- and multiple-person households, dog ownership (13.1%) was associated with lower risk of death, HR 0.67 (95% CI, 0.65-0.69) and 0.89 (0.87-0.91), respectively; and CVD death, HR 0.64 (0.59-0.70), and 0.85 (0.81-0.90), respectively. In single-person households, dog ownership was inversely associated with cardiovascular outcomes (HR composite CVD 0.92, 95% CI, 0.89-0.94). Ownership of hunting breed dogs was associated with lowest risk of CVD. Further analysis in the Twin Register could not replicate the reduced risk of CVD or death but also gave no indication of confounding by disability, comorbidities or lifestyle factors. In conclusion, dog ownership appears to be associated with lower risk of CVD in single-person households and lower mortality in the general population.

  6. Excess Mortality in Patients Diagnosed With Hypothyroidism: A Nationwide Cohort Study of Singletons and Twins

    Science.gov (United States)

    Thvilum, Marianne; Brandt, Frans; Almind, Dorthe; Christensen, Kaare; Brix, Thomas Heiberg

    2013-01-01

    Background: Although hypothyroidism is associated with increased morbidity, an association with increased mortality is still debated. Our objective was to investigate, at a nationwide level, whether a diagnosis of hypothyroidism influences mortality. Methods: In an observational cohort study from January 1, 1978 until December 31, 2008 using record-linkage data from nationwide Danish health registers, 3587 singletons and 682 twins diagnosed with hypothyroidism were identified. Hypothyroid individuals were matched 1:4 with nonhypothyroid controls with respect to age and gender and followed over a mean period of 5.6 years (range 0–30 years). The hazard ratio (HR) for mortality was calculated using Cox regression analyses. Comorbidity was evaluated using the Charlson score (CS). Results: In singletons with hypothyroidism, the mortality risk was increased (HR 1.52; 95% confidence interval [CI]: 1.41–1.65). Although the effect attenuated, hypothyroidism remained associated with increased mortality when evaluating subjects with a CS = 0 (HR 1.23; 95% CI: 1.05–1.44). In twin pairs discordant for hypothyroidism, the hypothyroid twin had excess mortality compared with the corresponding euthyroid cotwin (HR 1.40; 95% CI 0.95–2.05). However, after stratifying for zygosity, hypothyroidism was associated with excess mortality in dizygotic twin pairs (HR 1.61; 95% CI 1.00–2.58), whereas the association attenuated in monozygotic pairs (HR 1.06; 95% CI 0.55–2.05). Conclusions: Hypothyroidism is associated with an excess mortality of around 50%, which to some degree is explained by comorbidity. In addition, the finding of an association between hypothyroidism and mortality within disease discordant dizygotic but not monozygotic twin pairs indicates that the association between hypothyroidism and mortality is also influenced by genetic confounding. PMID:23365121

  7. Parental and perinatal risk factors for sexual offending in men: a nationwide case-control study.

    Science.gov (United States)

    Babchishin, K M; Seto, M C; Sariaslan, A; Lichtenstein, P; Fazel, S; Långström, N

    2017-01-01

    Prior studies suggest parental and perinatal risk factors are associated with later offending. It remains uncertain, however, if such risk factors are similarly related to sexual offending. We linked socio-demographic, family relations, and perinatal (obtained at birth) data from the nationwide Swedish registers from 1973 to 2009 with information on criminal convictions of cases and control subjects. Male sex offenders (n = 13 773) were matched 1:5 on birth year and county of birth in Sweden to male controls without sexual or non-sexual violent convictions. To examine risk-factor specificity for sexual offending, we also compared male violent, non-sexual offenders (n = 135 953) to controls without sexual or non-sexual violent convictions. Predictors included parental (young maternal or paternal age at son's birth, educational attainment, violent crime, psychiatric disorder, substance misuse, suicide attempt) and perinatal (number of older brothers, low Apgar score, low birth weight, being small for gestational age, congenital malformations, small head size) variables. Conditional logistic regression models found consistent patterns of statistically significant, small to moderate independent associations of parental risk factors with sons' sexual offending and non-sexual violent offending. For perinatal risk factors, patterns varied more; small for gestational age and small head size exhibited similar risk effects for both offence types whereas a higher number of older biological brothers and any congenital malformation were small, independent risk factors only for non-sexual violence. This nationwide study suggests substantial commonalities in parental and perinatal risk factors for the onset of sexual and non-sexual violent offending.

  8. Registered indians and tobacco taxation: a culturally-appropriate strategy?

    Science.gov (United States)

    Wardman, A E Dennis; Khan, Nadia A

    2005-01-01

    Taxation of tobacco is a widely-used strategy that prompts smoking cessation among adults and reduces cigarette consumption among continuing smokers. Registered Indian tobacco use prevalence is at least double that of the rest of Canadians and is in part due to the lower cost of tobacco products purchased on reserve by Registered Indians (RIs) as they are tax exempt. Although registered Indian communities have the ability to collect tax on tobacco products and direct the use of these revenues, this strategy is rarely utilized. Tobacco taxation could have substantial health and economic benefits to RI communities, but perhaps is not culturally-appropriate. In order to better support RI communities, governments and other organizations need to examine this policy instrument in the context of RI populations.

  9. Validation of the Arabic Rowland Universal Dementia Assessment Scale (A-RUDAS) in elderly with mild and moderate dementia

    DEFF Research Database (Denmark)

    Chaaya, M; Phung, T.K.T.; El Asmar, K

    2016-01-01

    Dementia Assessment Scale (RUDAS) was especially designed to minimize the effects of cultural learning and education. The aim of this study was to validate the RUDAS in the Arabic language (A-RUDAS), evaluate its ability to screen for mild and moderate dementia, and assess the effect of education, sex, age......OBJECTIVES: Validated screening tests for dementia in Arabic are lacking. Given the low levels of education among elderly in the Middle East and North Africa region, the commonly used screening instrument, the Mini Mental State Examination, is not best suited. Alternatively, the Rowland Universal......-RUDAS exhibited good sensitivity (83%) and specificity (85%) with an area under the receiver operating characteristic curve of 83.95%. Adjusting for age, sex, education, depression, and recruitment site, A-RUDAS score demonstrated a high level of accuracy in screening for mild and moderate dementia against DSM...

  10. Antioxidants and Dementia Risk: Consideration through a Cerebrovascular Perspective

    Directory of Open Access Journals (Sweden)

    Virginie Lam

    2016-12-01

    Full Text Available A number of natural and chemical compounds that exert anti-oxidative properties are demonstrated to be beneficial for brain and cognitive function, and some are reported to reduce the risk of dementia. However, the detailed mechanisms by which those anti-oxidative compounds show positive effects on cognition and dementia are still unclear. An emerging body of evidence suggests that the integrity of the cerebrovascular blood-brain barrier (BBB is centrally involved in the onset and progression of cognitive impairment and dementia. While recent studies revealed that some anti-oxidative agents appear to be protective against the disruption of BBB integrity and structure, few studies considered the neuroprotective effects of antioxidants in the context of cerebrovascular integrity. Therefore, in this review, we examine the mechanistic insights of antioxidants as a pleiotropic agent for cognitive impairment and dementia through a cerebrovascular axis by primarily focusing on the current available data from physiological studies. Conclusively, there is a compelling body of evidence that suggest antioxidants may prevent cognitive decline and dementia by protecting the integrity and function of BBB and, indeed, further studies are needed to directly examine these effects in addition to underlying molecular mechanisms.

  11. Energy expenditure in frontotemporal dementia: a behavioural and imaging study

    Science.gov (United States)

    Ahmed, Rebekah M; Landin-Romero, Ramon; Collet, Tinh-Hai; van der Klaauw, Agatha A; Devenney, Emma; Henning, Elana; Kiernan, Matthew C; Piguet, Olivier; Farooqi, I Sadaf; Hodges, John R

    2017-01-01

    Abstract See Finger (doi:10.1093/aww312) for a scientific commentary on this article. Abnormal eating behaviour and metabolic parameters including insulin resistance, dyslipidaemia and body mass index are increasingly recognized as important components of neurodegenerative disease and may contribute to survival. It has previously been established that behavioural variant frontotemporal dementia is associated with abnormal eating behaviour characterized by increased sweet preference. In this study, it was hypothesized that behavioural variant frontotemporal dementia might also be associated with altered energy expenditure. A cohort of 19 patients with behavioural variant frontotemporal dementia, 13 with Alzheimer’s disease and 16 (age- and sex-matched) healthy control subjects were studied using Actiheart devices (CamNtech) to assess resting and stressed heart rate. Actiheart devices were fitted for 7 days to measure sleeping heart rate, activity levels, and resting, active and total energy expenditure. Using high resolution structural magnetic resonance imaging the neural correlates of increased resting heart rate were investigated including cortical thickness and region of interest analyses. In behavioural variant frontotemporal dementia, resting (P = 0.001), stressed (P = 0.037) and sleeping heart rate (P = 0.038) were increased compared to control subjects, and resting heart rate (P = 0.020) compared to Alzheimer disease patients. Behavioural variant frontotemporal dementia was associated with decreased activity levels compared to controls (P = 0.002) and increased resting energy expenditure (P = 0.045) and total energy expenditure (P = 0.035). Increased resting heart rate correlated with behavioural (Cambridge Behavioural Inventory) and cognitive measures (Addenbrooke’s Cognitive Examination). Increased resting heart rate in behavioural variant frontotemporal dementia correlated with atrophy involving the mesial temporal cortex, insula, and amygdala

  12. Dementia Caregiver Burden: a Research Update and Critical Analysis.

    Science.gov (United States)

    Cheng, Sheung-Tak

    2017-08-10

    This article provides an updated review of the determinants of caregiver burden and depression, with a focus on care demands and especially the differential effects of various neuropsychiatric symptoms or symptom clusters. Moreover, studies on caregivers for frontotemporal and Lewy body dementias were referred to in order to identify differences and similarities with the mainstream literature based largely on Alzheimer caregivers. As a group, neuropsychiatric symptoms are most predictive of caregiver burden and depression regardless of dementia diagnosis, but the effects appear to be driven primarily by disruptive behaviors (e.g., agitation, aggression, disinhibition), followed by delusions and mood disturbance. Disruptive behaviors are more disturbing partly because of the adverse impact on the emotional connection between the caregiver and the care-recipient and partly because they exacerbate difficulties in other domains (e.g., caring for activities of daily living). In behavioral variant frontotemporal dementia, not only are these disruptive behaviors more prominent but they are also more disturbing due to the care-recipient's insensitivity to others' feelings. In Lewy body dementia, visual hallucinations also appear to be distressing. The disturbing nature of disruptive behaviors cuts across dementia conditions, but the roles played by symptoms that are unique or particularly serious in a certain condition need to be explored further.

  13. Association between diabetes and causes of dementia: Evidence from a clinicopathological study

    Directory of Open Access Journals (Sweden)

    Maria Niures Pimentel dos Santos Matioli

    Full Text Available ABSTRACT. Background: Diabetes mellitus is a risk factor for dementia, especially for vascular dementia (VaD, but there is no consensus on diabetes as a risk factor for Alzheimer's disease (AD and other causes of dementia. Objective: To explore the association between diabetes and the neuropathological etiology of dementia in a large autopsy study. Methods: Data were collected from the participants of the Brain Bank of the Brazilian Aging Brain Study Group between 2004 and 2015. Diagnosis of diabetes was reported by the deceased's next-of-kin. Clinical dementia was established when CDR ≥ 1 and IQCODE > 3.41. Dementia etiology was determined by neuropathological examination using immunohistochemistry. The association of diabetes with odds of dementia was investigated using multivariate logistic regression. Results: We included 1,037 subjects and diabetes was present in 279 participants (27%. The prevalence of dementia diagnosis was similar in diabetics (29% and non-diabetics (27%. We found no association between diabetes and dementia (OR = 1.22; 95%CI = 0.81-1.82; p = 0.34 on the multivariate analysis. AD was the main cause of dementia in both groups, while VaD was the second-most-frequent cause in diabetics. Other mixed dementia was the second-most-common cause of dementia and more frequent among non-diabetics (p = 0.03. Conclusion: Diabetes was not associated with dementia in this large clinicopathological study.

  14. Electroconvulsive therapy and risk of dementia in patients with affective disorders: a cohort study.

    Science.gov (United States)

    Osler, Merete; Rozing, Maarten Pieter; Christensen, Gunhild Tidemann; Andersen, Per Kragh; Jørgensen, Martin Balslev

    2018-04-01

    Electroconvulsive therapy (ECT) is the most effective treatment for severe episodes of mood disorders. Temporary memory loss is a common side-effect, but ongoing discussions exist regarding potential long-term adverse cognitive outcomes. Only a few studies have examined the frequency of dementia in patients after ECT. The aim of this study was to examine the association between ECT and risk of subsequent dementia in patients with a first-time hospital diagnosis of affective disorder. We did a cohort study of patients aged 10 years and older in Denmark with a first-time hospital contact for an affective disorder from Jan 1, 2005, through Dec 31, 2015, identified in the Danish National Patient Registry with ICD-10 codes F30.0 to F39.9. From the registry we retrieved information on all ECTs registered for patients and followed up patients for incidental dementia (defined by hospital discharge diagnoses or acetylcholinesterase inhibitor use) until Oct 31, 2016. We examined the association between ECT and dementia using Cox regression analyses with multiple adjustments and propensity-score matching on sociodemographic and clinical variables. Of 168 015 patients included in the study, 5901 (3·5%) patients had at least one ECT. During the median follow-up of 4·9 years (IQR 2·4-7·8) and 872 874 person years, the number of patients who developed dementia was 111 (0·1%) of 99 045 patients aged 10-49 years, 965 (2·7%) of 35 945 aged 50-69 years, and 4128 (12·5%) of 33 025 aged 70-108 years. 217 (3·6%) of the 5901 patients treated with ECT developed dementia, whereas of 162 114 patients not treated with ECT 4987 (3·1%) developed dementia. The corresponding incidences were 70·4 cases per 10 000 person-years (95% CI 61·6-80·5) and 59·2 per 10 000 person-years (57·6-60·8). In patients younger than 50 years and 50-69 years, ECT was not associated with a risk of dementia compared with age-matched patients who were not given ECT (age-adjusted hazard

  15. Poor Gait Performance and Prediction of Dementia: Results From a Meta-Analysis.

    Science.gov (United States)

    Beauchet, Olivier; Annweiler, Cédric; Callisaya, Michele L; De Cock, Anne-Marie; Helbostad, Jorunn L; Kressig, Reto W; Srikanth, Velandai; Steinmetz, Jean-Paul; Blumen, Helena M; Verghese, Joe; Allali, Gilles

    2016-06-01

    Poor gait performance predicts risk of developing dementia. No structured critical evaluation has been conducted to study this association yet. The aim of this meta-analysis was to systematically examine the association of poor gait performance with incidence of dementia. An English and French Medline search was conducted in June 2015, with no limit of date, using the medical subject headings terms "Gait" OR "Gait Disorders, Neurologic" OR "Gait Apraxia" OR "Gait Ataxia" AND "Dementia" OR "Frontotemporal Dementia" OR "Dementia, Multi-Infarct" OR "Dementia, Vascular" OR "Alzheimer Disease" OR "Lewy Body Disease" OR "Frontotemporal Dementia With Motor Neuron Disease" (Supplementary Concept). Poor gait performance was defined by standardized tests of walking, and dementia was diagnosed according to international consensus criteria. Four etiologies of dementia were identified: any dementia, Alzheimer disease (AD), vascular dementia (VaD), and non-AD (ie, pooling VaD, mixed dementias, and other dementias). Fixed effects meta-analyses were performed on the estimates in order to generate summary values. Of the 796 identified abstracts, 12 (1.5%) were included in this systematic review and meta-analysis. Poor gait performance predicted dementia [pooled hazard ratio (HR) combined with relative risk and odds ratio = 1.53 with P analysis provides evidence that poor gait performance predicts dementia. This association depends on the type of dementia; poor gait performance is a stronger predictor of non-AD dementias than AD. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  16. Association between periodontal disease and dementia: A literature review.

    Science.gov (United States)

    Pazos, P; Leira, Y; Domínguez, C; Pías-Peleteiro, J M; Blanco, J; Aldrey, J M

    2016-10-22

    Periodontal disease and dementia are very prevalent, especially in elderly populations. Multiple studies have shown a link between these diseases; however, the conditions are highly heterogeneous and so is the diagnostic methodology, which may hinder interpretation and comparison of the results. The aim of this article is to provide a critical review of the literature linking these 2 processes. We retrieved 22 studies, most of which were retrospective, and analysed various methodological variables including study population, diagnosis of periodontitis, definition of dementia, adjusted variables, and results. The different aetiopathogenic mechanisms that may affect the progression and interaction of these 2 conditions were also analysed. Although available evidence indicates a positive association between periodontitis and dementia, both the strength of that association and the presence of a causal relationship have yet to be determined. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. From narcissistic personality disorder to frontotemporal dementia: a case report.

    Science.gov (United States)

    Poletti, Michele; Bonuccelli, Ubaldo

    2011-01-01

    Premorbid personality characteristics could have a pathoplastic effect on behavioral symptoms and personality changes related to neurodegenerative diseases. Patients with personality disorders, in particular of the dramatic cluster, may present functional frontolimbic abnormalities. May these neurobiological vulnerabilities linked to a premorbid personality disorder predispose or represent a risk factor to subsequently develop a neurodegenerative disorder? Are subjects with personality disorders more at risk to develop a dementia than mentally healthy subjects? This topic is discussed presenting the clinical case of a patient who suffered of a probable Narcissistic Personality Disorder and subsequently developed a clinically diagnosed Frontotemporal Dementia.

  18. Validity, reliability, and feasibility of clinical staging scales in dementia: a systematic review

    DEFF Research Database (Denmark)

    Rikkert, Marcel G M Olde; Tona, Klodiana Daphne; Janssen, Lieneke

    2011-01-01

    New staging systems of dementia require adaptation of disease management programs and adequate staging instruments. Therefore, we systematically reviewed the literature on validity and reliability of clinically applicable, multidomain, and dementia staging instruments. A total of 23 articles...

  19. Frontotemporal dementia and primary progressive aphasia, a review

    Directory of Open Access Journals (Sweden)

    Kirshner HS

    2014-06-01

    Full Text Available Howard S KirshnerDepartment of Neurology, Vanderbilt University Medical Center, Nashville, TN, USAAbstract: Frontotemporal dementias are neurodegenerative diseases in which symptoms of frontal and/or temporal lobe disease are the first signs of the illness, and as the diseases progress, they resemble a focal left hemisphere process such as stroke or traumatic brain injury, even more than a neurodegenerative disease. Over time, some patients develop a more generalized dementia. Four clinical subtypes characterize the predominant presentations of this illness: behavioral or frontal variant FTD, progressive nonfluent aphasia, semantic dementia, and logopenic primary progressive aphasia. These clinical variants correlate with regional patterns of atrophy on brain imaging studies such as MRI and PET scanning, as well as with biochemical and molecular genetic variants of the disorder. The treatment is as yet only symptomatic, but advances in molecular genetics promise new therapies.Keywords: FTD, behavior variant or frontal variant FTD, pick's disease, PPA, progressive nonfluent aphasia

  20. 49 CFR 592.6 - Duties of a registered importer.

    Science.gov (United States)

    2010-10-01

    ... marking requirements of the theft prevention standard (part 541 of this chapter); or (ii) The vehicle... SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) REGISTERED IMPORTERS OF VEHICLES NOT ORIGINALLY MANUFACTURED TO CONFORM TO THE FEDERAL MOTOR VEHICLE SAFETY STANDARDS § 592.6 Duties of a...

  1. A Database of Registered, Textured Models of the Human Face

    DEFF Research Database (Denmark)

    Sjöstrand, Karl; Lading, Brian

    2005-01-01

    This note describes a data set of 24 registered human faces represented by both shape and texture. The data was collected during 2003 as part of the preparation of the master thesis of Karl Sjöstrand (former name Karl Skoglund). The data is ready to be used in shape, appearance and data analysis....

  2. Current status of collaborative relationships between dialysis facilities and dental facilities in Japan: results of a nationwide survey.

    Science.gov (United States)

    Yoshioka, Masami; Shirayama, Yasuhiko; Imoto, Issei; Hinode, Daisuke; Yanagisawa, Shizuko; Takeuchi, Yuko

    2015-02-12

    Recent studies have reported an association between periodontal disease and mortality among dialysis patients. Therefore, preventive dental care should be considered very important for this population. In Japan, no systematic education has been undertaken regarding the importance of preventive dental care for hemodialysis patients--even though these individuals tend to have oral and dental problems. The aim of this study was to investigate the current state of collaborative relationships between hemodialysis facilities and dental services in Japan and also to identify strategies to encourage preventive dental visits among hemodialysis outpatients. A nationwide questionnaire on the collaborative relationship between dialysis facilities and dental facilities was sent by mail to all medical facilities in Japan offering outpatient hemodialysis treatment. Responses were obtained from 1414 of 4014 facilities (35.2%). Among the 1414 facilities, 272 (19.2%) had a dental service department. Approximately 100,000 dialysis outpatients were receiving treatment at these participating facilities, which amounts to one-third of all dialysis patients in Japan. Of those patients, 82.9% received hemodialysis at medical facilities without dental departments. Only 87 of 454 small clinics without in-house dental departments (19.2%) had collaborative registered dental clinics. Medical facilities with registered dental clinics demonstrated a significantly more proactive attitude to routine collaboration on dental matters than facilities lacking such clinics. Our nationwide survey revealed that most dialysis facilities in Japan have neither an in-house dental department nor a collaborative relationship with a registered dental clinic. Registration of dental clinics appears to promote collaboration with dental facilities on a routine basis, which would be beneficial for oral health management in hemodialysis patients.

  3. Major Vascular Neurocognitive Disorder: A Reappraisal to Vascular Dementia

    Directory of Open Access Journals (Sweden)

    Emre Kumral

    2017-03-01

    Full Text Available Major vascular neurocognitive disorder (NCD is the second leading form of dementia after Alzheimer’s disease, accounting for 17-20% of all dementias. Vascular NCD is a progressive disease caused by reduced cerebral blood flow related to multiple large volume or lacunar infarcts that induce a sudden onset and stepwise decline in cognitive abilities. Despite its prevalence and clinical importance, there is still controversy in the terminology of vascular NCD. Only after the release of Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5 (2013 did the American Psychiatric Association define vascular dementia as “major vascular NCD”. This review includes an overview of risk factors, pathophysiology, types, diagnostic and clinical features of major vascular NCD, and current treatment options of vascular NCD regarding to DSM-5 criteria

  4. Risk of postpartum psychosis after IVF treatment: a nationwide case-control study.

    Science.gov (United States)

    Vikström, Josefin; Josefsson, Ann; Hammar, Mats; Bladh, Marie; Sydsjö, Gunilla

    2017-01-01

    Is the risk of postpartum psychosis (PPP) increased in women who give birth after IVF treatment compared to after spontaneous conception? The risk of PPP is not higher in the group of women who give birth after IVF treatment compared with women who give birth after spontaneous conception. Women who conceive using IVF treatment can experience higher levels of pregnancy-specific distress and are at increased risk of pre-eclampsia, an immune-related condition which in turn has been linked to PPP, as well as other pregnancy and delivery complications, which also serve as PPP risk factors. It is not known whether the risk of PPP is increased in women who have conceived using IVF treatment. A nationwide, register-based, case-control study of all primiparous women who had given birth after IVF treatment between 1988 and 2012. Information about 10 412 women was collected from the Swedish IVF register. A control group of women who had given birth after spontaneous conception was selected from the Swedish Medical Birth Register (n = 18 624). PPP diagnoses, identified using ICD-10 diagnostic codes F20-31 and F531 the first year postpartum, were collected from the National Patient Register. Associations between PPP and IVF/spontaneous conception were evaluated using chi-square tests and logistic regression analyses while controlling for known risk factors of PPP. There were no differences in PPP prevalence between the IVF group and the control group (0.3%, n = 29 versus 0.4%, n = 77) in the chi-square analysis (P = 0.169) or the multiple logistic regression analyses (P = 0.646; odds ratio (OR): 1.178; 95% CI: 586-2.365). No associations between pregnancy or delivery complications and PPP were found. A history of any psychiatric disorder (P IVF treatment, more studies are needed to verify these results. The generalizability is restricted to primiparous women in western countries. This study confirms the results of previous studies in showing a history of mental illness to be

  5. A longitudinal study of CMRGlu in dementia of Alzheimer type

    Energy Technology Data Exchange (ETDEWEB)

    Kuwabara, Yasuo; Ichiya, Yuichi; Ichimiya, Atsushi; Sasaki, Masayuki; Akashi, Yuko; Yoshida, Tsuyoshi; Fukumura, Toshimitsu; Masuda, Kouji [Kyushu Univ., Fukuoka (Japan). Faculty of Medicine

    1994-10-01

    We studied the serial changes of CMRGlu in 6 patients with dementia of Alzheimer type. All patients demonstrated moderately severe dementia at the initial PET scan. Serial PET scans were performed at an interval of 12 to 24 months. Five of the 6 patients showed a deterioration of clinical symptoms at the second scan. The global CMRGlu serially decreased in all patients. An asymmetry of CMRGlu in both the frontal and parietal regions was observed at the initial PET scan, while the direction of asymmetry was preserved at the second PET scan. The ratios (frontal/parietal and parietal/striatum) of CMRGlu showed no interval change. Therefore, CMRGlu was considered to decrease progressively throughout the entire brain in patients with moderately severe dementia of Alzheimer type. (author).

  6. A longitudinal study of CMRGlu in dementia of Alzheimer type

    International Nuclear Information System (INIS)

    Kuwabara, Yasuo; Ichiya, Yuichi; Ichimiya, Atsushi; Sasaki, Masayuki; Akashi, Yuko; Yoshida, Tsuyoshi; Fukumura, Toshimitsu; Masuda, Kouji

    1994-01-01

    We studied the serial changes of CMRGlu in 6 patients with dementia of Alzheimer type. All patients demonstrated moderately severe dementia at the initial PET scan. Serial PET scans were performed at an interval of 12 to 24 months. Five of the 6 patients showed a deterioration of clinical symptoms at the second scan. The global CMRGlu serially decreased in all patients. An asymmetry of CMRGlu in both the frontal and parietal regions was observed at the initial PET scan, while the direction of asymmetry was preserved at the second PET scan. The ratios (frontal/parietal and parietal/striatum) of CMRGlu showed no interval change. Therefore, CMRGlu was considered to decrease progressively throughout the entire brain in patients with moderately severe dementia of Alzheimer type. (author)

  7. Polydrug use among college students in Brazil: a nationwide survey.

    Science.gov (United States)

    Oliveira, Lúcio Garcia de; Alberghini, Denis Guilherme; Santos, Bernardo dos; Andrade, Arthur Guerra de

    2013-01-01

    To estimate the frequency of polydrug use (alcohol and illicit drugs) among college students and its associations with gender and age group. A nationwide sample of 12,544 college students was asked to complete a questionnaire on their use of drugs according to three time parameters (lifetime, past 12 months, and last 30 days). The co-use of drugs was investigated as concurrent polydrug use (CPU) and simultaneous polydrug use (SPU), a subcategory of CPU that involves the use of drugs at the same time or in close temporal proximity. Almost 26% of college students reported having engaged in CPU in the past 12 months. Among these students, 37% had engaged in SPU. In the past 30 days, 17% college students had engaged in CPU. Among these, 35% had engaged in SPU. Marijuana was the illicit drug mostly frequently used with alcohol (either as CPU or SPU), especially among males. Among females, the most commonly reported combination was alcohol and prescribed medications. A high proportion of Brazilian college students may be engaging in polydrug use. College administrators should keep themselves informed to be able to identify such use and to develop educational interventions to prevent such behavior.

  8. Catatonia in dementia managed with electroconvulsive therapy: A case report and review of the evidence

    Directory of Open Access Journals (Sweden)

    Sandeep Grover

    2017-01-01

    Full Text Available There is limited literature on catatonia as a presenting manifestation of dementia. Further, whenever catatonia occurs in patients with dementia, it often responds to lorazepam. There is limited literature on use of electroconvulsive therapy for management of catatonia among patients with dementia. In this report, we present a case of catatonia occurring during dementia of Lewy body which did not respond to lorazepam but responded to use of electroconvulsive therapy.

  9. The 10/66 Dementia Research Group's fully operationalised DSM-IV dementia computerized diagnostic algorithm, compared with the 10/66 dementia algorithm and a clinician diagnosis: a population validation study

    Directory of Open Access Journals (Sweden)

    Krishnamoorthy ES

    2008-06-01

    Full Text Available Abstract Background The criterion for dementia implicit in DSM-IV is widely used in research but not fully operationalised. The 10/66 Dementia Research Group sought to do this using assessments from their one phase dementia diagnostic research interview, and to validate the resulting algorithm in a population-based study in Cuba. Methods The criterion was operationalised as a computerised algorithm, applying clinical principles, based upon the 10/66 cognitive tests, clinical interview and informant reports; the Community Screening Instrument for Dementia, the CERAD 10 word list learning and animal naming tests, the Geriatric Mental State, and the History and Aetiology Schedule – Dementia Diagnosis and Subtype. This was validated in Cuba against a local clinician DSM-IV diagnosis and the 10/66 dementia diagnosis (originally calibrated probabilistically against clinician DSM-IV diagnoses in the 10/66 pilot study. Results The DSM-IV sub-criteria were plausibly distributed among clinically diagnosed dementia cases and controls. The clinician diagnoses agreed better with 10/66 dementia diagnosis than with the more conservative computerized DSM-IV algorithm. The DSM-IV algorithm was particularly likely to miss less severe dementia cases. Those with a 10/66 dementia diagnosis who did not meet the DSM-IV criterion were less cognitively and functionally impaired compared with the DSMIV confirmed cases, but still grossly impaired compared with those free of dementia. Conclusion The DSM-IV criterion, strictly applied, defines a narrow category of unambiguous dementia characterized by marked impairment. It may be specific but incompletely sensitive to clinically relevant cases. The 10/66 dementia diagnosis defines a broader category that may be more sensitive, identifying genuine cases beyond those defined by our DSM-IV algorithm, with relevance to the estimation of the population burden of this disorder.

  10. Antithyroid Drugs and Congenital Malformations: A Nationwide Korean Cohort Study.

    Science.gov (United States)

    Seo, Gi Hyeon; Kim, Tae Hyuk; Chung, Jae Hoon

    2018-03-20

    Untreated or insufficiently treated Graves disease in pregnancy may pose risks to both mother and fetus. Antithyroid drugs (ATDs) are the treatment mainstay, but the potential teratogenic effect of these drugs has prompted clinicians to question the safe management of this vulnerable population. To examine the association between maternal prescriptions for ATDs and congenital malformations in live births. Nationwide cohort study. Korean National Health Insurance database. A cohort of 2 886 970 completed pregnancies linked to live-born infants in 2 210 253 women between 2008 and 2014. Maternal prescriptions for ATDs in the first trimester. The risk for overall and organ-specific congenital malformations in offspring, with logistic regression models used to control for potential confounders. 12 891 pregnancies (0.45%) were exposed to ATDs during the first trimester. The prevalence of malformations in exposed offspring was 7.27%, compared with 5.94% in offspring of women who were not prescribed ATDs during pregnancy (P 495 mg) during the first trimester was associated with an increased risk for malformations compared with a low dose (1 to 126 mg) (adjusted odds ratio, 1.87 [CI, 1.06 to 3.30]). The study used a prescription claims database to assess ATD exposure. Exposure to ATDs during the first trimester was associated with increased risk for congenital malformations, particularly for pregnancies in which women received prescriptions for MMI or both ATDs. None.

  11. A 32-bit NMOS microprocessor with a large register file

    Science.gov (United States)

    Sherburne, R. W., Jr.; Katevenis, M. G. H.; Patterson, D. A.; Sequin, C. H.

    1984-10-01

    Two scaled versions of a 32-bit NMOS reduced instruction set computer CPU, called RISC II, have been implemented on two different processing lines using the simple Mead and Conway layout rules with lambda values of 2 and 1.5 microns (corresponding to drawn gate lengths of 4 and 3 microns), respectively. The design utilizes a small set of simple instructions in conjunction with a large register file in order to provide high performance. This approach has resulted in two surprisingly powerful single-chip processors.

  12. Endoscopic training: A nationwide survey of French fellows in gastroenterology.

    Science.gov (United States)

    Amiot, Aurélien; Conroy, Guillaume; Le Baleur, Yann; Winkler, Jérôme; Palazzo, Maxime; Treton, Xavier

    2018-04-01

    During their 4 years of training, French fellows in gastroenterology should acquire theoretical and practical competency in gastrointestinal (GI) endoscopy. To evaluate the delivery of endoscopy training to French GI fellows and perception of learning. A nationwide electronic survey was carried out of French GI fellows using an anonymous, 17-item electronic questionnaire. A total of 291 out of 484 (60%) GI fellows responded to the survey. Only 40% of subjects had access to theoretical training and/or virtual simulators. Only 49% and 35% of fourth year fellows had reached the threshold numbers of EGD and colonoscopies recommended by the European section and Board of gastroenterology and hepatology. Sixty-two percent and 57% of trainees reported having insufficient knowledge in interpreting gastric and colic lesions. Access to dedicated endoscopy activity for at least 8 weeks during the year was the only independent factor associated with the achievement of the recommended annual threshold number of procedures. The access of fellows to theoretical training and to preclinical virtual simulators is still insufficient. Personalized support and regular assessment of cognitive and technical acquisition over the 4 years of training seems to be necessary. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  13. Towards a systematic nationwide screening strategy for MODY.

    Science.gov (United States)

    Shields, Beverley; Colclough, Kevin

    2017-04-01

    MODY is an early-onset monogenic form of diabetes. Correctly identifying MODY is of considerable importance as diagnosing the specific genetic subtype can inform the optimal treatment, with many patients being able to discontinue unnecessary insulin treatment. Diagnostic molecular genetic testing to confirm MODY is expensive, so screening strategies are required to identify the most appropriate patients for testing. In this issue of Diabetologia, Johansson and colleagues (DOI 10.1007/s00125-016-4167-1 ) describe a nationwide systematic screening approach to identify individuals with MODY in the paediatric age range. They focused testing on patients negative for both GAD and islet antigen 2 (IA-2) islet autoantibodies, thereby ruling out those with markers of type 1 diabetes, the most common form of diabetes in this age group. This commentary discusses the advantages and limitations of the approach, and the caution required when interpreting variants of uncertain pathogenicity identified from testing whole populations rather than targeting only patients with a strong MODY phenotype.

  14. Sunray project - A long-term, nationwide educational process

    International Nuclear Information System (INIS)

    Nikula, Anneli

    2000-01-01

    The Sunray project is a nationwide educational process coordinated by the Economic Information Bureau (TaT Group) for ninth graders in Finnish comprehensive schools. The project aims at giving thorough and versatile information on radiation within the framework of various subjects (physics, biology, domestic science, history, European languages, mother tongue, health education etc.). The Sunray project covers all ninth graders of the existing 600 Finnish comprehensive schools; in all involving some 65 000 pupils. The project, which has been repeated five times, was initiated as part of the European Science and Technology week in 1995. During the first two years it was strongly linked with the science week as natural sciences were seen as a good framework for the chosen perspective. Since 1997, the project has been run as an event in its own right. The project has applied the method of processing integrated groups of themes, which is an objective of the comprehensive school system and the experimental method of science. As schools make their own decisions about the educational programmes to be adopted every semester, the project has been marketed to schools at the beginning of May. The TaT Group has arranged marketing events in some 10 localities in Finland. The Economic Information Bureau of Finland coordinates the project and in 1995-2000 the Radiation and Nuclear Safety Authority (STUK), the Finnish Energy Industries' Federation, the Finnish Electricity Association, Fortum Oyj and Teollisuuden Voima Oy have participated in the project

  15. A nationwide survey of pediatric acquired demyelinating syndromes in Japan

    Science.gov (United States)

    Yamaguchi, Y.; Kira, R.; Ishizaki, Y.; Sakai, Y.; Sanefuji, M.; Ichiyama, T.; Oka, A.; Kishi, T.; Kimura, S.; Kubota, M.; Takanashi, J.; Takahashi, Y.; Tamai, H.; Natsume, J.; Hamano, S.; Hirabayashi, S.; Maegaki, Y.; Mizuguchi, M.; Minagawa, K.; Yoshikawa, H.; Kira, J.; Kusunoki, S.; Hara, T.

    2016-01-01

    Objective: To investigate the clinical and epidemiologic features of pediatric acquired demyelinating syndromes (ADS) of the CNS in Japan. Methods: We conducted a nationwide survey and collected clinical data on children with ADS aged 15 years or younger, who visited hospitals between 2005 and 2007. Results: Among 977 hospitals enrolled, 723 (74.0%) responded to our inquiries and reported a total of 439 patients as follows: 244 with acute disseminated encephalomyelitis (ADEM), 117 with multiple sclerosis (MS), 14 with neuromyelitis optica (NMO), and 64 with other ADS. We collected and analyzed detailed data from 204 cases, including those with ADEM (66), MS (58), and NMO (10). We observed the following: (1) the estimated annual incidence rate of pediatric ADEM in Japan was 0.40 per 100,000 children (95% confidence interval [CI], 0.34–0.46), with the lowest prevalence in the north; (2) the estimated prevalence rate of MS was 0.69 per 100,000 children (95% CI, 0.58–0.80), with the lowest prevalence in the south; (3) NMO in Japan was rare, with an estimated prevalence of 0.06 per 100,000 children (95% CI, 0.04–0.08); and (4) the sex ratio and mean age at onset varied by ADS type, and (5) male/female ratios correlated with ages at onset in each ADS group. Conclusions: Our results clarify the characteristic clinical features of pediatric ADS in the Japanese population. PMID:27742816

  16. Type 2 diabetes mellitus as a risk factor for dementia in a Mexican population.

    Science.gov (United States)

    Salinas, Rosa María; Hiriart, Marcia; Acosta, Isaac; Sosa, Ana Luisa; Prince, Martin J

    2016-01-01

    Type 2 diabetes mellitus (T2DM) and dementia increase with age. Different studies have explored their association, but the possible relationship between them is still unclear. This is an analysis of the 10/66 Dementia Research Group (DRG) Mexico database; the sample comprised 1193 subjects ≥65 years old followed-up for three years. We calculated the incidence of dementia in subjects with diabetes using three models of analysis. T2DM patients have nearly twice the risk of developing dementia (RR 1.9; 95% CI 1.3-2.6) after three years of follow-up. The incidence of dementia is higher in subjects with undiagnosed diabetes. Higher serum glucose levels have a stronger association with dementia. It is important to implement early evaluation and monitoring cognitive performance in elders with diabetes to identify minor cognitive impairment and undertake timely interventions to prevent or delay the onset of dementia. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. What is it to be a daughter? Identities under pressure in dementia care

    NARCIS (Netherlands)

    Goldsteen, M.; Abma, T.; Oeseburg, B.; Verkerk, M.; Verhey, F.; Widdershoven, G.

    This article concentrates on the care for people who suffer from progressive dementia. Dementia has a great impact on a person's well-being as well as on his or her social environment. Dealing with dementia raises moral issues and challenges for participants, especially for family members. One of

  18. Functional Neuroimaging in Dementia

    NARCIS (Netherlands)

    J.M. Papma (Janne)

    2012-01-01

    textabstractDementia refers to a clinical syndrome of cognitive deterioration and difficulty in the performance of activities of daily living. The most common cause of dementia is Alzheimer’s disease (AD), followed by vascular dementia (VaD) at old age and frontotemporal dementia (FTD) at young

  19. Workplace Victimization and Discrimination in China: A Nationwide Survey.

    Science.gov (United States)

    Zhang, Huiping

    2017-09-01

    Workplace victimization and discrimination have been intensively studied in the West, especially on the antecedents and consequences of this phenomenon. Surprisingly, little is known about the incidence and associated health problems of workplace victimization and discrimination in contemporary China. Using a representative nationwide sample of 1,138 Chinese employees conducted in 2015, this study attempted to estimate the prevalence, risk factors, and associated consequences of workplace victimization and discrimination in China. It is found that the prevalence rate of preceding 5-year workplace discrimination and victimization was 33% and 12.9%, respectively. Male employees who perceived higher work gains were less likely to experience workplace victimization and those who had higher career efficacy and unemployment anxiety were more likely to experience job discrimination or victimization. Female employees who received tertiary education were less likely to experience job discrimination and being married tended not to experience workplace victimization. Perceived job discrimination had negative impact on male employees' job satisfaction as well as on female employees' happiness. The implications of these findings are finally discussed in the Chinese context.

  20. Fractures in Patients with Anorexia Nervosa, Bulimia Nervosa, and Other Eating Disorders - A Nationwide Register Study

    DEFF Research Database (Denmark)

    Vestergaard, P.; Emborg, C.; Støving, R.K.

    2002-01-01

    OBJECTIVE: To study fracture risk in patients with anorexia nervosa (AN), bulimia nervosa (BN), or eating disorders not otherwise specified (EDNOS). METHOD: Cohort study including all Danes diagnosed with AN (n = 2,149), BN (n = 1,294), or EDNOS (n = 942) between 1977 and 1998. Each patient...

  1. Primary Care Use before Cancer Diagnosis in Adolescents and Young Adults - A Nationwide Register Study

    DEFF Research Database (Denmark)

    Ahrensberg, Jette Møller; Fenger-Grøn, Morten; Vedsted, Peter

    2016-01-01

    Unge med kræft går hyppigere til lægen end deres raske jævnaldrende i tiden før en kræftdiagnose. Et nyt studie viser, at unge med kræft oftere end kontrolgruppen søger deres praktiserende læge allerede 8 måneder før diagnosetidspunktet. Forskerne fandt, at unge med modermærkekræft oftere søgte d...

  2. Increased dementia risk predominantly in diabetes mellitus rather than in hypertension or hyperlipidemia: a population-based cohort study.

    Science.gov (United States)

    Fan, Yen-Chun; Hsu, Jung-Lung; Tung, Hong-Yi; Chou, Chia-Chi; Bai, Chyi-Huey

    2017-02-06

    The pathophysiology of insulin resistance-induced hypertension and hyperlipidemia might entail differences in dementia risk in cases with hypertension and hyperlipidemia without prior diabetes mellitus (DM). This study investigated whether incident hypertension, incident hyperlipidemia, or both, increased the dementia risk in patients with and without DM. A nationwide retrospective cohort study was conducted. The study sample was obtained from the National Health Insurance Research Database. We enrolled 10,316 patients with a new diagnosis of DM between 2000 and 2002 in the DM cohort. For the same period, we randomly selected 41,264 patients without DM in the non-DM cohort (matched by age and sex at a 1:4 ratio with the DM cohort). Both cohorts were then separately divided into four groups on the basis of incident hypertension or incident hyperlipidemia status. In total, 51,580 patients aged between 20 and 99 years were enrolled. The dementia risk was higher in the DM cohort than in the non-DM cohort (adjusted hazard ratio (HR) = 1.47, 95% confidence interval (CI) = 1.30-1.67, p hypertension and hyperlipidemia did not significantly increase compared with that in those without hypertension and hyperlipidemia (p = 0.529). Similar results were observed in those with either hypertension (p = 0.341) or hyperlipidemia (p = 0.189). In the non-DM cohort, patients with both hypertension and hyperlipidemia had a higher dementia risk (adjusted HR = 1.33, 95% CI = 1.09-1.63, p = 0.006). The results remained largely unchanged in patients with only hypertension (adjusted HR = 1.22, 95% CI = 1.05-1.40, p = 0.008). However, the dementia risk did not increase significantly in patients with only hyperlipidemia (p = 0.187). The development of hypertension, hyperlipidemia, or both, following a diagnosis of incident diabetes is secondary to diabetes onset and likely mediated through insulin resistance associated with diabetes, which

  3. Building a population-based diabetes register: an Italian experience.

    Science.gov (United States)

    Ballotari, Paola; Chiatamone Ranieri, Sofia; Vicentini, Massimo; Caroli, Stefania; Gardini, Andrea; Rodolfi, Rossella; Crucco, Roberto; Greci, Marina; Manicardi, Valeria; Giorgi Rossi, Paolo

    2014-01-01

    To describe the methodology used to set up the Reggio Emilia (northern Italy) Diabetes Register. The prevalence estimates on December 31st, 2009 are also provided. The Diabetes Register covers all residents in the Reggio Emilia province. The register was created by deterministic linkage of six routinely collected data sources through a definite algorithm able to ascertain cases and to distinguish type of diabetes and model of care: Hospital Discharge, Drug Dispensation, Biochemistry Laboratory, Disease-specific Exemption, Diabetes Outpatient Clinics, and Mortality databases. Using these data, we estimated crude prevalence on December 31st, 2009 by sex, age groups, and type of diabetes. There were 25,425 ascertained prevalent cases on December 31st, 2009. Drug Dispensation and Exemption databases made the greatest contribution to prevalence. Analyzing overlapping sources, more than 80% of cases were reported by at least two sources. Crude prevalence was 4.8% and 5.9% for the whole population and for people aged 18 years and over, respectively. Males accounted for 53.6%. Type 1 diabetes accounted for 3.8% of cases, while people with Type 2 diabetes were the overriding majority (91.2%), and Diabetes Outpatient Clinics treated 75.4% of people with Type 2 diabetes. The Register is able to quantify the burden of disease, the first step in planning, implementing, and monitoring appropriate interventions. All data sources contributed to completeness and/or accuracy of the Register. Although all cases are identified by deterministic record linkage, manual revision and General Practitioner involvement are still necessary when information is insufficient or conflicting. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  4. 'The stigma attached isn't true of real life': Challenging public perception of dementia through a participatory approach involving people with dementia (Innovative Practice).

    Science.gov (United States)

    Reynolds, Laura; Innes, Anthea; Poyner, Christopher; Hambidge, Sarah

    2017-02-01

    This paper discusses the potential impact of viewing public performances of an orchestra comprising people with dementia, family members, student volunteers and professional symphony orchestra members in contributing to challenging negative perceptions of dementia. Negative perceptions of dementia abound despite recent policy attempts to challenge the stigma associated with the condition. This paper reports on the findings from the performance element of a music project for people with dementia, known as the BUDI Orchestra, designed to replicate the traditional rehearse and perform cycle of musicians. Data were collected via self-completion questionnaires from audience members ( N = 109) at three public performances. The performances exceeded the expectations of the general public, and findings suggest a positive impact on perceptions of dementia, demonstrating the power and potential of participatory approaches showcasing the achievements of those living with dementia when attempting to raise awareness of dementia and challenge negative perceptions.

  5. Trends in the incidence rate, type and treatment of surgically verified endometriosis - a nationwide cohort study.

    Science.gov (United States)

    Saavalainen, Liisu; Tikka, Tuulia; But, Anna; Gissler, Mika; Haukka, Jari; Tiitinen, Aila; Härkki, Päivi; Heikinheimo, Oskari

    2018-01-01

    To study the trends in incidence rate, type and surgical treatment, and patient characteristics of surgically verified endometriosis during 1987-2012. This is a register-based cohort study. We identified women receiving their first diagnosis of endometriosis in surgery from the Finnish Hospital Discharge Register (FHDR). Quality of the FHDR records was assessed bidirectionally. The age-standardized incidence rates of the first surgically verified endometriosis was assessed by calendar year. The cohort comprises 49 956 women. The quality assessment suggested the FHDR data to be of good quality. The most common diagnosis, ovarian endometriosis (46%), was associated with highest median age 38.5 years (interquartile range 31.0-44.8) and the second most common diagnosis, peritoneal endometriosis (40%), with median age 34.9 years (28.6-41.7). Between 1987 and 2012, a decrease was observed in the median age, from 38.8 (32.3-43.6) to 34.0 (28.9-41.0) years, and in the age-standardized incidence rate from 116 [95% confidence interval (CI) 112-121] to 45 (42-48) per 100 000 women. The proportion of hysterectomy as a first surgical treatment decreased from 38 to 19%, whereas that of laparoscopy increased from 42 to 73% when comparing 1987-1995 with 1996-2012. This nationwide cohort of surgically verified endometriosis showed a decrease in the incidence rate and in the patient age at the time of first diagnosis, even though the proportion of laparoscopy has increased. The number of hysterectomies has decreased. These changes are likely to reflect the evolving diagnostics, increasing awareness of endometriosis, and effective use of medical treatment before surgery. © 2017 Nordic Federation of Societies of Obstetrics and Gynecology.

  6. Reversible dementia: more than 10% or less than 1%? A quantitative review

    NARCIS (Netherlands)

    Weytingh, M. D.; Bossuyt, P. M.; van Crevel, H.

    1995-01-01

    Dementia is reversible in some cases and these should be diagnosed without over-investigating the many others with irreversible disease. To estimate how often dementia can be reversed, we carried out a quantitative review of studies reported between 1972 and 1994 in which reversible dementia was

  7. Barriers, motivators, and facilitators of physical activity in dementia patients : A systematic review

    NARCIS (Netherlands)

    van Alphen, Helena J. M.; Hortobagyi, Tibor; van Heuvelen, Marieke J. G.

    2016-01-01

    Purpose: Physical activity (PA) has the potential to slow the progression of dementia patients' cognitive and physical decline. A better understanding of the factors that facilitate or hamper dementia patients' PA participation will increase the success rate of implementing PA in dementia patients'

  8. Design of a website for home modifications for older persons with dementia

    NARCIS (Netherlands)

    Dr. H.S.M. Kort; Joost van Hoof

    2014-01-01

    At present, persons with dementia and their family caregivers in the Netherlands are not adequately supported to modify their dwellings to match their personal needs.To facilitate aging-in-place for persons with dementia, a website was designed. The website was designed with persons with dementia

  9. Design of a website for home modifications for older persons with dementia

    NARCIS (Netherlands)

    J. van Hoof; Dr. H.S.M. Kort

    2014-01-01

    At present, persons with dementia and their family caregivers in the Netherlands are not adequately supported to modify their dwellings to match their personal needs. To facilitate aging-in-place for persons with dementia, a website was designed. The website was designed with persons with dementia

  10. A Quest for Meaning: Hospice Social Workers and Patients with End-Stage Dementia

    Science.gov (United States)

    Sanders, Sara; Swails, Peggy

    2011-01-01

    Research shows that few social workers are interested in working with cognitively impaired older adults, such as those with Alzheimer's disease or a related dementia. As the number of individuals with dementia grows, the demand for social workers to provide services to patients with dementia will increase. Although much attention has been given to…

  11. A population-based study examining injury among older adults with and without dementia

    Directory of Open Access Journals (Sweden)

    Lynn Meuleners

    2017-04-01

    Older adults with dementia were at increased risk of an admission for an injury compared to those without dementia. Multifactorial injury prevention programs should target older people with dementia, those over 85 years, living alone and with a history of previous falls.

  12. Quantitative Electroencephalography as a Diagnostic Tool for Alzheimer's Dementia in Adults with Down Syndrome

    DEFF Research Database (Denmark)

    Salem, Lise Cronberg; Sabers, Anne; Kjaer, Troels W

    2015-01-01

    be used as a diagnostic marker for dementia. The aim of this study was to examine the value of qEEG in the diagnostic evaluation of dementia in patients with Down syndrome (DS). METHOD: The study included 21 patients with DS and mild-to-moderate dementia due to Alzheimer's disease (DS-AD) and 16 age...

  13. [Frontal dementia or dementia praecox? A case report of a psychotic disorder with a severe decline].

    Science.gov (United States)

    Vanderzeypen, F; Bier, J C; Genevrois, C; Mendlewicz, J; Lotstra, F

    2003-01-01

    Many authors have described these last years the difficulty to establish a differential diagnosis between schizophrenia and frontotemporal dementia. However treatment and prognosis of these two separate diseases are not the same. Schizophrenia is a chronic syndrome with an early onset during teenage or young adulthood period and the major features consist of delirious ideas, hallucinations and psychic dissociation. However a large variety of different symptoms describes the disease and creates a heterogeneous entity. The diagnosis, exclusively defined by clinical signs, is then difficult and has led to the research of specific symptoms. These involve multiple psychological processes, such as perception (hallucinations), reality testing (delusions), thought processes (loose associations), feeling (flatness, inappropriate affect), behaviour (catatonia, disorganization), attention, concentration, motivation (avolition), and judgement. The characteristic symptoms of schizophrenia have often been conceptualised as falling into three broad categories including positive (hallucination, delision), negative (affective flattening, alogia, avolition) and disorganised (poor attention, disorganised speech and behaviour) symptoms. No single symptom is pathogonomonic of schizophrenia. These psychological and behavioural characteristics are associated with a variety of impairments in occupational or social functioning. Cognition impairments are also associated with schizophrenia. Since the original clinical description by Kraepelin and Bleuler, abnormalities in attentional, associative and volitional cognitive processes have been considered central features of schizophrenia. Long term memory deficits, attentional and executive dysfunctions are described in the neurocognitive profile of schizophrenic patients, with a large degree of severity. The pathophysiology of schizophrenia is not well known but may be better understood by neuronal dysfunctions rather than by a specific

  14. Exercise for Individuals with Lewy Body Dementia: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Michael Inskip

    Full Text Available Individuals with Lewy body Dementia (LBD, which encompasses both Parkinson disease dementia (PDD and Dementia with Lewy Bodies (DLB experience functional decline through Parkinsonism and sedentariness exacerbated by motor, psychiatric and cognitive symptoms. Exercise may improve functional outcomes in Parkinson's disease (PD, and Alzheimer's disease (AD. However, the multi-domain nature of the LBD cluster of symptoms (physical, cognitive, psychiatric, autonomic results in vulnerable individuals often being excluded from exercise studies evaluating physical function in PD or cognitive function in dementia to avoid confounding results. This review evaluated existing literature reporting the effects of exercise interventions or physical activity (PA exposure on cluster symptoms in LBD.A high-sensitivity search was executed across 19 databases. Full-length articles of any language and quality, published or unpublished, that analysed effects of isolated exercise/physical activity on indicative Dementia with Lewy Bodies or PD-dementia cohorts were evaluated for outcomes inclusive of physical, cognitive, psychiatric, physiological and quality of life measures. The protocol for this review (Reg. #: CRD42015019002 is accessible at http://www.crd.york.ac.uk/PROSPERO/.111,485 articles were initially retrieved; 288 full articles were reviewed and 89.6% subsequently deemed ineligible due to exclusion of participants with co-existence of dementia and Parkinsonism. Five studies (1 uncontrolled trial, 1 randomized controlled trial and 3 case reports evaluating 16 participants were included. Interventions were diverse and outcome homogeneity was low. Habitual gait speed outcomes were measured in 13 participants and increased (0.18m/s, 95% CI -0.02, 0.38m/s, exceeding moderate important change (0.14m/s for PD cohorts. Other outcomes appeared to improve modestly in most participants.Scarce research investigating exercise in LBD exists. This review confirms

  15. Mortality and cardiovascular risk associated with different insulin secretagogues compared with metformin in type 2 diabetes, with or without a previous myocardial infarction: a nationwide study

    DEFF Research Database (Denmark)

    Schramm, Tina Ken; Gislason, Gunnar Hilmar; Vaag, Allan

    2011-01-01

    Aims The impact of insulin secretagogues (ISs) on long-term major clinical outcomes in type 2 diabetes remains unclear. We examined mortality and cardiovascular risk associated with all available ISs compared with metformin in a nationwide study. Methods and results All Danish residents >20 years......, initiating single-agent ISs or metformin between 1997 and 2006 were followed for up to 9 years (median 3.3 years) by individual-level linkage of nationwide registers. All-cause mortality, cardiovascular mortality, and the composite of myocardial infarction (MI), stroke, and cardiovascular mortality...... associated with individual ISs were investigated in patients with or without previous MI by multivariable Cox proportional-hazard analyses including propensity analyses. A total of 107 806 subjects were included, of whom 9607 had previous MI. Compared with metformin, glimepiride (hazard ratios and 95...

  16. Mortality in patients with diabetes mellitus and Addison's disease: a nationwide, matched, observational cohort study.

    Science.gov (United States)

    Chantzichristos, Dimitrios; Persson, Anders; Eliasson, Björn; Miftaraj, Mervete; Franzén, Stefan; Bergthorsdottir, Ragnhildur; Gudbjörnsdottir, Soffia; Svensson, Ann-Marie; Johannsson, Gudmundur

    2017-01-01

    Our hypothesis was that patients with diabetes mellitus obtain an additional risk of death if they develop Addison's disease (AD). Nationwide, matched, observational cohort study cross-referencing the Swedish National Diabetes Register with Inpatient, Cancer and Cause of Death Registers in patients with diabetes (type 1 and 2) and AD and matched controls with diabetes. Clinical characteristics at baseline, overall, and cause-specific mortality were assessed. The relative risk of death was assessed using a Cox proportional hazards regression model. Between January 1996 and December 2012, 226 patients with diabetes and AD were identified and matched with 1129 controls with diabetes. Median (interquartile range) follow-up was 5.9 (2.7-8.6) years. When patients with diabetes were diagnosed with AD, they had an increased frequency of diabetes complications, but both medical history of cancer and coronary heart disease did not differ compared with controls. Sixty-four of the 226 patients with diabetes and AD (28%) died, while 112 of the 1129 controls (10%) died. The estimated relative risk increase (hazard ratio) in overall mortality in the diabetes and AD group was 3.89 (95% confidence interval 2.84-5.32) compared with controls with diabetes. The most common cause of death was cardiovascular in both groups, but patients with diabetes and AD showed an increased death rate from diabetes complications, infectious diseases and unknown causes. Patients with the rare combination of diabetes and AD showed a markedly increased mortality and died more frequently from infections and unknown causes than patients with diabetes alone. Improved strategy for the management of this combination of metabolic disorders is needed. © 2017 European Society of Endocrinology.

  17. Patient-controlled hospital admission for patients with severe mental disorders: a nationwide prospective multicentre study.

    Science.gov (United States)

    Thomsen, C T; Benros, M E; Maltesen, T; Hastrup, L H; Andersen, P K; Giacco, D; Nordentoft, M

    2018-04-01

    To assess whether implementing patient-controlled admission (PCA) can reduce coercion and improve other clinical outcomes for psychiatric in-patients. During 2013-2016, 422 patients in the PCA group were propensity score matched 1:5 with a control group (n = 2110) that received treatment as usual (TAU). Patients were followed up for at least one year using the intention to treat principle utilising nationwide registers. In a paired design, the outcomes of PCA patients during the year after signing a contract were compared with the year before. No reduction in coercion (risk difference = 0.001; 95% CI: -0.038; 0.040) or self-harming behaviour (risk difference = 0.005; 95% CI: -0.008; 0.018) was observed in the PCA group compared with the TAU group. The PCA group had more in-patient bed days (mean difference = 28.4; 95% CI: 21.3; 35.5) and more medication use (P < 0.0001) than the TAU group. Before and after analyses showed reduction in coercion (P = 0.0001) and in-patient bed days (P = 0.0003). Implementing PCA did not reduce coercion, service use or self-harm behaviour when compared with TAU. Beneficial effects of PCA were observed only in the before and after PCA comparisons. Further research should investigate whether PCA affects other outcomes to better establish its clinical value. © 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  18. Clinic characteristics of psoriasis in China: a nationwide survey in over 12000 patients.

    Science.gov (United States)

    Chen, Kun; Wang, Gang; Jin, Hongzhong; Xu, Jinhua; Zhu, Xuejun; Zheng, Min; Gu, Heng

    2017-07-11

    Psoriasis is a worldwide chronic inflammatory disease, involving both skin and joints. In order to characterize psoriasis in Han Chinese population, we conducted this nationwide prospective and hospital based survey, in which 56 hospitals with departments of dermatology participated, located in 33 cities across China. A total of 12,031 outpatients with psoriasis were registered during 2009 to 2010, which the data was collected by standard questionnaires. The main data acquisition included demographics, family history, disease status and other comorbidities. Physical and dermatological examination, including body surface area (BSA) and psoriasis area severity index (PASI) were applied to evaluate the disease severity. Descriptive statistics, 2 tailed t-test and chi-square test were used appropriately for the statistical analysis. From the study, we found that the male and female ratio of the patients was 1.49:1. Mean age of onset was 30.2 ± 14.5 years for males and 27.1 ± 15.6 years for females (P psoriasis and the majority was psoriasis vulgaris (96.5%). Among 12,031 patients, 23.1% had a family history of psoriasis,16.1% had comorbidities, and 29.9% had nail changes. The most important aggravation factor was season change (60.2%), followed by psychological stress (34.5%), and there significant differences between genders on trigger factors. In conclusion, this study characterizing psoriasis in Han Chinese population, could be used as basic data for future study.

  19. Context Switching with Multiple Register Windows: A RISC Performance Study

    Science.gov (United States)

    Konsek, Marion B.; Reed, Daniel A.; Watcharawittayakul, Wittaya

    1987-01-01

    Although previous studies have shown that a large file of overlapping register windows can greatly reduce procedure call/return overhead, the effects of register windows in a multiprogramming environment are poorly understood. This paper investigates the performance of multiprogrammed, reduced instruction set computers (RISCs) as a function of window management strategy. Using an analytic model that reflects context switch and procedure call overheads, we analyze the performance of simple, linearly self-recursive programs. For more complex programs, we present the results of a simulation study. These studies show that a simple strategy that saves all windows prior to a context switch, but restores only a single window following a context switch, performs near optimally.

  20. Topical review: orofacial pain in dementia patients: a diagnostic challenge

    NARCIS (Netherlands)

    Lobbezoo, F.; Weijenberg, R.A.F.; Scherder, E.J.A.

    2011-01-01

    This article presents a comprehensive review of the literature on the diagnosis of pain in the orofacial region of patients suffering from a cognitive impairment or a dementia. This review was based on a literature search yielding 74 papers, most of which dealt with the assessment of pain in general

  1. Advance directives for future dementia can be modified by a brief video presentation on dementia care: An experimental study.

    Directory of Open Access Journals (Sweden)

    Theresia Volhard

    Full Text Available To investigate whether life-sustaining measures in medical emergency situations are less accepted for an anticipated own future of living with dementia, and to test whether a resource-oriented, in contrast to a deficit-oriented video about the same demented person, would increase the acceptance of such life-saving measures.Experimental study conducted between September 2012 and February 2013.Community dwelling female volunteers living in the region of Bonn, Germany.278 women aged 19 to 89 (mean age 53.4 years.Presentation of a video on dementia care focusing either on the deficits of a demented woman (negative framing, or focusing on the remaining resources (positive framing of the same patient.Approval of life-sustaining treatments in five critical medical scenarios under the assumption of having comorbid dementia, before and after the presentation of the brief videos on care.At baseline, the acceptance of life-sustaining measures in critical medical situations was significantly lower in subjects anticipating their own future life with dementia. Participants watching the resource-oriented film on living with dementia had significantly higher post-film acceptance rates compared to those watching the deficit-oriented negatively framed film. This effect particularly emerges if brief and efficient life-saving interventions with a high likelihood of physical recovery are available (eg, antibiotic treatment for pneumonia.Anticipated decisions regarding life-sustaining measures are negatively influenced by the subjective imagination of living with dementia, which might be shaped by common, unquestioned stereotypes. This bias can be reduced by providing audio-visual information on living with dementia which is not only centred around cognitive and functional losses but also focuses on remaining resources and the apparent quality of life. This is particularly true if the medical threat can be treated efficiently. These findings have implications for the

  2. Dementia as a determinant of social and health service use in the last two years of life 1996-2003

    Directory of Open Access Journals (Sweden)

    Raitanen Jani

    2011-04-01

    Full Text Available Abstract Background Dementia is one of the most common causes of death among old people in Finland and other countries with high life expectancies. Dementing illnesses are the most important disease group behind the need for long-term care and therefore place a considerable burden on the health and social care system. The aim of this study was to assess the effects of dementia and year of death (1998-2003 on health and social service use in the last two years of life among old people. Methods The data were derived from multiple national registers in Finland and comprise all those who died in 1998, 2002 or 2003 and 40% of those who died in 1999-2001 at the age of 70 or over (n = 145 944. We studied the use of hospitals, long-term care and home care in the last two years of life. Statistics were performed using binary logistic regression analyses and negative binomial regression analyses, adjusting for age, gender and comorbidity. Results The proportion of study participants with a dementia diagnosis was 23.5%. People with dementia diagnosis used long-term care more often (OR 9.30, 95% CI 8.60, 10.06 but hospital (OR 0.33, 95% CI 0.31, 0.35 and home care (OR 0.50, 95% CI 0.46, 0.54 less often than people without dementia. The likelihood of using university hospital and long-term care increased during the eight-year study period, while the number of days spent in university and general hospital among the users decreased. Differences in service use between people with and without dementia decreased during the study period. Conclusions Old people with dementia used long-term care to a much greater extent and hospital and home care to a lesser extent than those without dementia. This difference persisted even when controlling for age, gender and comorbidity. It is important that greater attention is paid to ensuring that old people with dementia have equitable access to care.

  3. Socioeconomic and occupational risk factors for venous thromboembolism in Sweden: a nationwide epidemiological study.

    Science.gov (United States)

    Zöller, Bengt; Li, Xinjun; Sundquist, Jan; Sundquist, Kristina

    2012-05-01

    Our aims were to investigate possible associations between hospitalisation for venous thromboembolism (VTE) and socioeconomic and occupational factors. A nationwide database was constructed by linking Swedish census data to the Hospital Discharge Register (1990-2007). Hospital diagnoses of VTE were based on the International Classification of Diseases. Standardised incidence ratios were calculated for different socioeconomic and occupational groups. A total of 43063 individuals aged >20 years were hospitalised for VTE. Individuals with >12 years of education were at lower risk for VTE. Blue-collar workers, farmers, and non-employed individuals had higher risks for VTE, and white collar workers and professionals lower risks. In males and/or females, risks for VTE were increased for assistant nurses; farmers; miners and quarry workers; mechanics, iron and metalware workers; wood workers; food manufacture workers; packers; loaders and warehouse workers; public safety and protection workers; cooks and stewards; home helpers; building caretakers; and cleaners. Decreased risks were observed for technical, chemical, physical, and biological workers; physicians; dentists; nurses; other health and medical workers; teachers, religious, juridical, and other social science-related workers; artistic workers; clerical workers; sale agents; and fishermen, whalers and sealers. High educational level and several occupations requiring high levels of education were protective against VTE, while the risks for VTE were increased for farmers, blue-collar workers and non-employed individuals. The mechanisms are unknown but it might involve persistent psychosocial stress related to low socioeconomic and occupational status. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Dementia Population Risk Tool (DemPoRT): study protocol for a predictive algorithm assessing dementia risk in the community.

    Science.gov (United States)

    Fisher, Stacey; Hsu, Amy; Mojaverian, Nassim; Taljaard, Monica; Huyer, Gregory; Manuel, Douglas G; Tanuseputro, Peter

    2017-10-24

    The burden of disease from dementia is a growing global concern as incidence increases dramatically with age, and average life expectancy has been increasing around the world. Planning for an ageing population requires reliable projections of dementia prevalence; however, existing population projections are simple and have poor predictive accuracy. The Dementia Population Risk Tool (DemPoRT) will predict incidence of dementia in the population setting using multivariable modelling techniques and will be used to project dementia prevalence. The derivation cohort will consist of elderly Ontario respondents of the Canadian Community Health Survey (CCHS) (2001, 2003, 2005 and 2007; 18 764 males and 25 288 females). Prespecified predictors include sociodemographic, general health, behavioural, functional and health condition variables. Incident dementia will be identified through individual linkage of survey respondents to population-level administrative healthcare databases (1797 and 3281 events, and 117 795 and 166 573 person-years of follow-up, for males and females, respectively, until 31 March 2014). Using time of first dementia capture as the primary outcome and death as a competing risk, sex-specific proportional hazards regression models will be estimated. The 2008/2009 CCHS survey will be used for validation (approximately 4600 males and 6300 females). Overall calibration and discrimination will be assessed as well as calibration within predefined subgroups of importance to clinicians and policy makers. Research ethics approval has been granted by the Ottawa Health Science Network Research Ethics Board. DemPoRT results will be submitted for publication in peer-review journals and presented at scientific meetings. The algorithm will be assessable online for both population and individual uses. ClinicalTrials.gov NCT03155815, pre-results. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No

  5. A nation-wide study of the family aggregation and risk factors in anorexia nervosa over three generations

    DEFF Research Database (Denmark)

    Steinhausen, Hans-Christoph; Jakobsen, Helle; Helenius, Dorte

    2015-01-01

    OBJECTIVE: This nation-wide register-based study investigated how often anorexia nervosa (AN) and co-morbid disorders occur in affected families compared with control families. Furthermore, the study addressed the impact of sex, year of birth, and degree of urbanization in terms of risk factors...

  6. Family aggregation and risk factors of obsessive-compulsive disorders in a nationwide three-generation study

    DEFF Research Database (Denmark)

    Steinhausen, Hans-Christoph; Bisgaard, Charlotte; Munk-Jørgensen, Povl

    2013-01-01

    This nationwide register-based study investigates how often obsessive-compulsive disorders (OCD) with different age at diagnosis occur in affected families compared to control families. Furthermore, the study addresses the impact of certain risk factors, that is, sex, degree of urbanization, year...

  7. The prevalence of dementia in a Portuguese community sample: a 10/66 Dementia Research Group study.

    Science.gov (United States)

    Gonçalves-Pereira, Manuel; Cardoso, Ana; Verdelho, Ana; Alves da Silva, Joaquim; Caldas de Almeida, Manuel; Fernandes, Alexandra; Raminhos, Cátia; Ferri, Cleusa P; Prina, A Matthew; Prince, Martin; Xavier, Miguel

    2017-11-07

    Dementia imposes a high burden of disease worldwide. Recent epidemiological studies in European community samples are scarce. In Portugal, community prevalence data is very limited. The 10/66 Dementia Research Group (DRG) population-based research programmes are focused in low and middle income countries, where the assessments proved to be culture and education fair. We applied the 10/66 DRG prevalence survey methodology in Portugal, where levels of illiteracy in older populations are still high. A cross-sectional comprehensive one-phase survey was conducted of all residents aged 65 and over of two geographically defined catchment areas in Southern Portugal (one urban and one rural site). Nursing home residents were not included in the present study. Standardized 10/66 DRG assessments include a cognitive module, an informant interview and the Geriatric Mental State-AGECAT, providing data on dementia diagnosis and subtypes, mental disorders including depression, physical health, anthropometry, demographics, disability/functioning, health service utilization, care arrangements and caregiver strain. We interviewed 1405 old age participants (mean age 74.9, SD = 6.7 years; 55.5% women) after 313 (18.2%) refusals to participate. The prevalence rate for dementia in community-dwellers was 9.23% (95% CI 7.80-10.90) using the 10/66 DRG algorithm and 3.65% (95% CI 2.97-4.97) using DSM-IV criteria. Pure Alzheimer's disease was the most prevalent dementia subtype (41.9%). The prevalence of dementia was strongly age-dependent for both criteria, but there was no association with sex. Dementia prevalence was higher than previously reported in Portugal. The discrepancy between prevalence according to the 10/66 DRG algorithm and the DSM-IV criteria is consistent with that observed in less developed countries; this suggests potential underestimation using the latter approach, although relative validity of these two approaches remains to be confirmed in the European context. We

  8. The prevalence of dementia in a Portuguese community sample: a 10/66 Dementia Research Group study

    Directory of Open Access Journals (Sweden)

    Manuel Gonçalves-Pereira

    2017-11-01

    Full Text Available Abstract Background Dementia imposes a high burden of disease worldwide. Recent epidemiological studies in European community samples are scarce. In Portugal, community prevalence data is very limited. The 10/66 Dementia Research Group (DRG population-based research programmes are focused in low and middle income countries, where the assessments proved to be culture and education fair. We applied the 10/66 DRG prevalence survey methodology in Portugal, where levels of illiteracy in older populations are still high. Methods A cross-sectional comprehensive one-phase survey was conducted of all residents aged 65 and over of two geographically defined catchment areas in Southern Portugal (one urban and one rural site. Nursing home residents were not included in the present study. Standardized 10/66 DRG assessments include a cognitive module, an informant interview and the Geriatric Mental State-AGECAT, providing data on dementia diagnosis and subtypes, mental disorders including depression, physical health, anthropometry, demographics, disability/functioning, health service utilization, care arrangements and caregiver strain. Results We interviewed 1405 old age participants (mean age 74.9, SD = 6.7 years; 55.5% women after 313 (18.2% refusals to participate. The prevalence rate for dementia in community-dwellers was 9.23% (95% CI 7.80–10.90 using the 10/66 DRG algorithm and 3.65% (95% CI 2.97–4.97 using DSM-IV criteria. Pure Alzheimer’s disease was the most prevalent dementia subtype (41.9%. The prevalence of dementia was strongly age-dependent for both criteria, but there was no association with sex. Conclusions Dementia prevalence was higher than previously reported in Portugal. The discrepancy between prevalence according to the 10/66 DRG algorithm and the DSM-IV criteria is consistent with that observed in less developed countries; this suggests potential underestimation using the latter approach, although relative validity of these two

  9. Depression as a Risk Factor or Prodomal Feature for Dementia? Findings in a Population-Based Sample of Swedish Twins

    OpenAIRE

    Brommelhoff, Jessica A.; Gatz, Margaret; Johansson, Boo; McArdle, John J.; Fratiglioni, Laura; Pedersen, Nancy L.

    2009-01-01

    This study tested whether history of depression is associated with an increased likelihood of having dementia, and to verify whether a first depressive episode earlier in life is associated with an increased likelihood of dementia, or whether only depressive episodes occurring close in time to dementia diagnosis are related to dementia. Depression information was collected from national hospital discharge registries, medical history, and medical records. Dementia was clinically diagnosed usin...

  10. Depression in dementia : Development and testing of a nursing guideline

    NARCIS (Netherlands)

    Verkaik, Renate

    2009-01-01

    It is widely acknowledged that depression in dementia is a burden for patients as well as for their caregivers. A pro-active attitude among caregivers is needed to recognize this severe health problem in demented residents and to respond to it. This thesis firstly provides greater insight into

  11. Dementia and Depression: A Process Model for Differential Diagnosis.

    Science.gov (United States)

    Hill, Carrie L.; Spengler, Paul M.

    1997-01-01

    Delineates a process model for mental-health counselors to follow in formulating a differential diagnosis of dementia and depression in adults 65 years and older. The model is derived from empirical, theoretical, and clinical sources of evidence. Explores components of the clinical interview, of hypothesis formation, and of hypothesis testing.…

  12. A potentially treatable cause of dementia | Katsidzira | Central ...

    African Journals Online (AJOL)

    A potentially treatable cause of dementia. L Katsidzira, T Machiridza, A Ndlovu. Abstract. No Abstract. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals Online. HOW TO USE AJOL... for Researchers · for Librarians · for Authors · FAQ's · More about ...

  13. Efficient Ada multitasking on a RISC register window architecture

    Science.gov (United States)

    Kearns, J. P.; Quammen, D.

    1987-01-01

    This work addresses the problem of reducing context switch overhead on a processor which supports a large register file - a register file much like that which is part of the Berkeley RISC processors and several other emerging architectures (which are not necessarily reduced instruction set machines in the purest sense). Such a reduction in overhead is particularly desirable in a real-time embedded application, in which task-to-task context switch overhead may result in failure to meet crucial deadlines. A storage management technique by which a context switch may be implemented as cheaply as a procedure call is presented. The essence of this technique is the avoidance of the save/restore of registers on the context switch. This is achieved through analysis of the static source text of an Ada tasking program. Information gained during that analysis directs the optimized storage management strategy for that program at run time. A formal verification of the technique in terms of an operational control model and an evaluation of the technique's performance via simulations driven by synthetic Ada program traces are presented.

  14. Das sprachliche Register (Speech Registers)

    Science.gov (United States)

    Hess-Luttich, Ernest W. B.

    1974-01-01

    The linguistic behavior of a given individual varies; he will on different occasions speak (or write) differently according to what may be roughly described as different social situations: he will use a number of different registers. The application of such registers both in the field of text analysis and in the preparation of teaching materials…

  15. Workplace violence experienced by registered nurses: a concept analysis.

    Science.gov (United States)

    Ventura-Madangeng, Judee; Wilson, Denise

    2009-11-01

    Workplace violence toward nurses has increased during the last decade with serious consequences that may extend beyond individual nurses to an entire health care organisation. The variety of definitions of workplace violence experienced by registered nurses contribute to a lack of clarity about what it constitutes, which in turn jeopardizes the reporting of incidences by nurses. Drawing on the relevant literature from 1990 to 2005, a concept analysis using Walker and Avant's framework was undertaken to develop an operational definition of this phenomenon as experienced by registered nurses (excluding mental health nurses). Having a clear understanding of workplace violence assists with the creation of strategies aimed at preventing and/or resolving this problem.

  16. [Adverse events in neonatology, contribution of a standardised register].

    Science.gov (United States)

    Normand, Marie-Madeleine; Ejarque Albuquerque, Margarida; Grouazel, Anne-Laure; Cottereau, Marie-Noëlle

    Despite the recommendation to report all adverse events to the risk management unit, such reporting is far from consistent. An internal, standardised register of adverse events, was put in place in a neonatology unit for six months. An analysis of the reports has led to the reorganisation of the unit and practices as part of a drive to improve the quality of care. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  17. Dementia knowledge transfer project in a rural area.

    Science.gov (United States)

    Stark, C; Innes, A; Szymczynska, P; Forrest, L; Proctor, K

    2013-01-01

    Rural Scotland has an ageing population. There has been an increase in the number of people with dementia and as the proportion of people aged over 75 years continues to rise, this will increase still further. The Scottish Government has produced a dementia strategy and implementing this will be a challenge for rural Scotland. Transferring academic knowledge into practice is challenging. A Knowledge Transfer Partnership was formed between NHS Highland and the University of Stirling. A literature review was undertaken of the rural dementia literature; local services were surveyed and described; and interviews were undertaken with people with dementia and carers. Work was conducted on training, diagnostic service provision and local policy. Throughout the project, a collaborative approach was used, which aimed at the joint production of knowledge. Involving University staff in local service development had a substantial impact. Reviewing existing research knowledge and setting it in the context of local services, and of experience of service use, allowed the relevant priorities to be identified. As well as identifying training needs and providing training, the work influenced local decisions on diagnostic service design and standards, and on policy. This embedded engagement model appeared to produce more rapid change than traditional models of use of academic knowledge.

  18. REVIEW: Towards a risk register for natural capital.

    Science.gov (United States)

    Mace, Georgina M; Hails, Rosemary S; Cryle, Philip; Harlow, Julian; Clarke, Stewart J

    2015-06-01

    Natural capital is essential for goods and services on which people depend. Yet pressures on the environment mean that natural capital assets are continuing to decline and degrade, putting such benefits at risk. Systematic monitoring of natural assets is a major challenge that could be both unaffordable and unmanageable without a way to focus efforts. Here we introduce a simple approach, based on the commonly used management tool of a risk register, to highlight natural assets whose condition places benefits at risk.We undertake a preliminary assessment using a risk register for natural capital assets in the UK based solely on existing information. The status and trends of natural capital assets are assessed using asset-benefit relationships for ten kinds of benefits (food, fibre (timber), energy, aesthetics, freshwater (quality), recreation, clean air, wildlife, hazard protection and equable climate) across eight broad habitat types in the UK based on three dimensions of natural capital within each of the habitat types (quality, quantity and spatial configuration). We estimate the status and trends of benefits relative to societal targets using existing regulatory limits and policy commitments, and allocate scores of high, medium or low risk to asset-benefit relationships that are both subject to management and of concern.The risk register approach reveals substantial gaps in knowledge about asset-benefit relationships which limit the scope and rigour of the assessment (especially for marine and urban habitats). Nevertheless, we find strong indications that certain assets (in freshwater, mountain, moors and heathland habitats) are at high risk in relation to their ability to sustain certain benefits (especially freshwater, wildlife and climate regulation). Synthesis and applications . With directed data gathering, especially to monitor trends, improve metrics related to asset-benefit relationships, and improve understanding of nonlinearities and thresholds, the

  19. Shine on: achieving career satisfaction as a registered nurse.

    Science.gov (United States)

    Perry, Beth

    2008-01-01

    This phenomenological study focuses on the experience of career satisfaction among registered nurses. Potential participants were asked, "Do you love your work as a nurse?" A random sample of eight nurses who answered yes to this question was questioned further during semistructured conversations. Conversations were recorded and transcribed. Data collected were in the form of descriptions of times during the participants' careers when they felt most professionally fulfilled. Through narrative and poetic analysis, themes of "upholding the vulnerable," "going the extra mile," and "attending to the essential ordinary" were identified. Nurse educators play an important role facilitating career satisfaction for registered nurses. Practical implications for continuing education for educators and practicing nurses are addressed.

  20. Horticultural therapy in dementia care: a literature review.

    Science.gov (United States)

    Blake, Marianne; Mitchell, Gary

    2016-01-20

    Aim To present a narrative review of the empirical literature on the use of horticultural therapy in dementia care. Method A comprehensive literature search, conducted in December 2014, resulted in the selection of 15 primary research articles for review. Of these, three used qualitative methods, five used quantitative methods and seven used mixed methodology. The articles were critically appraised, and the narrative synthesis used a thematic approach whereby prominent themes from the articles were grouped to form representative themes. Findings Three main themes emerged from the narrative synthesis: the emotional health of people living with dementia, their perceived self-identity and their levels of engagement. Conclusion Horticultural therapy can be beneficial. At a macro-level, it is an inexpensive therapy that does not require specialist training to deliver. At a micro-level, it enhances the wellbeing of people living with dementia. Recommendations are made to promote access to appropriate horticultural therapy for people living with dementia, and for further research in this area.

  1. Mesh hernia repair and male infertility: a retrospective register study.

    Science.gov (United States)

    Hallén, Magnus; Westerdahl, Johan; Nordin, Pär; Gunnarsson, Ulf; Sandblom, Gabriel

    2012-01-01

    Previous studies have suggested that the use of mesh in groin hernia repair may be associated with an increased risk for male infertility as a result of inflammatory obliteration of structures in the spermatic cord. In a recent study, we could not find an increased incidence of involuntary childlessness. The aim of this study was to evaluate this issue further. Men born between 1950 and 1989, with a hernia repair registered in the Swedish Hernia Register between 1992 and 2007 were cross-linked with all men in the same age group with the diagnosis of male infertility according to the Swedish National Patient Register. The cumulative and expected incidences of infertility were analyzed. Separate multivariate logistic analyses, adjusted for age and years elapsed since the first repair, were performed for men with unilateral and bilateral repair, respectively. Overall, 34,267 men were identified with a history of at least 1 inguinal hernia repair. A total of 233 (0.7%) of these had been given the diagnosis of male infertility after their first operation. We did not find any differences between expected and observed cumulative incidences of infertility in men operated with hernia repair. Men with bilateral hernia repair had a slightly increased risk for infertility when mesh was used on either side. However, the cumulative incidence was less than 1%. Inguinal hernia repair with mesh is not associated with an increased incidence of, or clinically important risk for, male infertility. Copyright © 2012 Mosby, Inc. All rights reserved.

  2. Internet addiction among Iranian adolescents: a nationwide study.

    Directory of Open Access Journals (Sweden)

    Khodabakhsh Ahmadi

    2014-06-01

    Full Text Available Problematic use of the Internet by children and adolescents is a newly emerging disorder that has alerted health authorities throughout the world. In Iran, despite the very high speed rate of Internet spread, there is not enough data on the rate of Internet addiction among the adolescents. This study is the first nationwide study that addresses this issue. Overall 4500 students of high school or pre-college schools were recruited from 13/31 provinces of Iran by a cluster sampling method and 4342 (96% participated. Two self-rated questionnaires (one demographics and one Young's Internet addiction scale were filled b the participants. Data were analyzed by SPSS software. 962 (22.2% of the study participants were labeled as having "internet addiction." Males were significantly more likely to be an internet addict (P<0.001. Students whose father and/or mother had a doctorate degree were most likely to have Internet addiction (P<0.001 for both. Job engagement of mothers was significantly associated with students' internet addiction, and the least rate of addiction was observed when the mother was a housewife (P<0.001; having no exercise was associated with the highest rate of Internet addiction (P<0.001. Stepwise logistic regression models showed gender (male, older age, mother's occupation, family's financial status (either very high or very low, low quality of family relationship, and students' lower levels of religious devotion were significantly associated with having Internet addiction. This study showed that Internet addiction in Iranian adolescents is prevalent, and has several independent factors, from which, family relations is most likely to be modifiable. Improvements in family relations and more strict parental supervision, especially when mothers have active job employment, are recommended.

  3. Dementia in intellectual disability: a review of diagnostic challenges ...

    African Journals Online (AJOL)

    The evaluation of dementia in individuals with intellectual disability (ID), which will guide subsequent intervention, care and management depends on the systematic review of a number of factors: (1) the individual historical context, obtained from multiple sources, (2) evaluation of the pre-existing cognitive, behavioural, ...

  4. A communication support system for older people with dementia

    OpenAIRE

    Alm, N; Dye, R; Gowans, G; Campbell, J; Astell, Arlene Jean; Ellis, M

    2007-01-01

    CIRCA lets those with short-term memory loss draw on reminiscences to converse with relatives and caregivers. The system, which software engineers, psychologists, and designers developed with caregiver input, features a touch screen that displays photos, music, video, text, and other materials to help those with dementia access long-term memory. Publisher PDF Peer reviewed

  5. Awareness in dementia: a review of clinical correlates

    NARCIS (Netherlands)

    Aalten, Pauline; van Valen, Evelien; Clare, Linda; Kenny, Geraldine; Verhey, Frans

    2005-01-01

    This article provides a review of the literature on clinical correlates of awareness in dementia. Most inconsistencies were found with regard to an association between depression and higher levels of awareness. Dysthymia, but not major depression, is probably related to higher levels of awareness.

  6. Birth order and paediatric allergic disease: A nationwide longitudinal survey.

    Science.gov (United States)

    Kikkawa, T; Yorifuji, T; Fujii, Y; Yashiro, M; Okada, A; Ikeda, M; Doi, H; Tsukahara, H

    2018-05-01

    Environmental factors seem to be related to the incidence of allergic disease. Children with a later birth order are often exposed to environments, where pathogens and endotoxins can be found, and thus have a higher risk of developing infectious diseases. Therefore, birth order is regarded as an indicator that reflects post-natal environment. However, longitudinal studies are limited on this subject. This study sought to elucidate the relationships between birth order and allergic disease. From a nationwide longitudinal study that followed children born in 2001 (n = 47 015), we selected doctors' visits for 3 types of allergic disease-bronchial asthma, food allergy and atopic dermatitis-from infancy to 12 years of age and conducted binomial log-linear regression analysis to evaluate the associations between birth order and these diseases. We adjusted for the child and parental factors and estimated risk ratio (RR) and 95% confidence interval (CI) for each outcome. The associations between birth order and bronchial asthma were diverse; later birth order increased the risk in early childhood, but decreased the risks during school age. For example, the adjusted RR comparing third-born or higher and first-born children was 1.19 (95% CI, 1.05-1.35) between 30 and 42 months of age, but was 0.76 (95% CI, 0.65-0.89) between 10 and 11 years. Later birth order was generally protective for food allergy but increased the risk of atopic dermatitis. The influence of birth order depended on the type of allergic disease and the childhood period. Childhood is unique in terms of physical and immunological development, and the immune response to the post-natal environment in childhood appears to be heterogeneous. © 2018 John Wiley & Sons Ltd.

  7. Ethnic Variations in Prognosis of Patients with Dementia

    DEFF Research Database (Denmark)

    Agyemang, Charles; van de Vorst, Irene E.; Koek, Huiberdina L.

    2017-01-01

    BACKGROUND: Data on dementia prognosis among ethnic minority groups are limited in Europe. OBJECTIVE: We assessed differences in short-term (1-year) and long-term (3-year) mortality and readmission risk after a first hospitalization or first ever referral to a day clinic for dementia between ethnic...... minority groups and the ethnic Dutch population in the NetherlandsMethods: Nationwide prospective cohorts of first hospitalized dementia patients (N = 55,827) from January 1, 2000 to December 31, 2010 were constructed. Differences in short-term and long-term mortality and readmission risk following......-term and long-term risks of death following a first hospitalization with dementia were comparable between the ethnic minority groups and the ethnic Dutch. Age- and sex-adjusted risk of admission was higher only in Turkish compared with ethnic Dutch (HR 1.57, 95% CI,1.08-2.29). The difference between Turkish...

  8. Identifying risk for dementia across populations: A study on the prevalence of dementia in tribal elderly population of Himalayan region in Northern India

    Directory of Open Access Journals (Sweden)

    Sunil Kumar Raina

    2013-01-01

    Full Text Available Introduction: Studies have suggested that dementia is differentially distributed across populations with a lower prevalence in developing regions than the developed ones. A comparison in the prevalence of dementia across populations may provide an insight into its risk factors. Keeping this in view, a study was planned to evaluate the prevalence of dementia in tribal elderly population. Materials and Methods: A cross-sectional comprehensive two-phase survey of all residents aged 60 years and older was conducted. Phase one involved screening of all individuals aged 60 and above with the help of a cognitive screen specifically developed for the tribal population. Phase two involved clinical examination of individuals who were suspected of dementia as per the developed cognitive screening test. Results: The results revealed that no individual above 60 years of age in the studied population was diagnosed as a case of dementia. Thereby, pointing out at some unknown factors, which are responsible for prevention of dementia. Discussion: The differences between the prevalence rate in this study and other studies in India appear to be a function of a valid regional difference. Environmental, phenotypic and genetic factors may contribute to regional and racial variations in dementia. Societies living in isolated hilly and tribal areas seem less predisposed to dementia, particularly age related neurodegenerative and vascular dementia, which are the most common causes for dementia in elderly. This may be because some environmental risk factors are much less prevalent in these settings.

  9. The Cross-Cultural Dementia Screening (CCD): A new neuropsychological screening instrument for dementia in elderly immigrants.

    Science.gov (United States)

    Goudsmit, Miriam; Uysal-Bozkir, Özgül; Parlevliet, Juliette L; van Campen, Jos P C M; de Rooij, Sophia E; Schmand, Ben

    2017-03-01

    Currently, approximately 3.9% of the European population are non-EU citizens, and a large part of these people are from "non-Western" societies, such as Turkey and Morocco. For various reasons, the incidence of dementia in this group is expected to increase. However, cognitive testing is challenging due to language barriers and low education and/or illiteracy. The newly developed Cross-Cultural Dementia Screening (CCD) can be administered without an interpreter. It contains three subtests that assess memory, mental speed, and executive function. We hypothesized the CCD to be a culture-fair test that could discriminate between demented patients and cognitively healthy controls. To test this hypothesis, 54 patients who had probable dementia were recruited via memory clinics. Controls (N = 1625) were recruited via their general practitioners. All patients and controls were aged 55 years and older and of six different self-defined ethnicities (Dutch, Turkish, Moroccan-Arabic, Moroccan-Berber, Surinamese-Creole, and Surinamese-Hindustani). Exclusion criteria included current or previous conditions that affect cognitive functioning. There were performance differences between the ethnic groups, but these disappeared after correcting for age and education differences between the groups, which supports our central hypothesis that the CCD is a culture-fair test. Receiver-operating characteristic (ROC) and logistic regression analyses showed that the CCD has high predictive validity for dementia (sensitivity: 85%; specificity: 89%). The CCD is a sensitive and culture-fair neuropsychological instrument for dementia screening in low-educated immigrant populations.

  10. Religious beliefs and alcohol control policies: a Brazilian nationwide study

    Directory of Open Access Journals (Sweden)

    Giancarlo Lucchetti

    2014-03-01

    Full Text Available Objective: The connection between lower alcohol use and religiousness has been extensively examined. Nevertheless, few studies have assessed how religion and religiousness influence public policies. The present study seeks to understand the influence of religious beliefs on attitudes toward alcohol use. Methods: A door-to-door, nationwide, multistage population-based survey was carried out. Self-reported religiousness, religious attendance, and attitudes toward use of alcohol policies (such as approval of public health interventions, attitudes about drinking and driving, and attitudes toward other alcohol problems and their harmful effects were examined. Multiple logistic regression was used to control for confounders and to assess explanatory variables. Results: The sample was composed of 3,007 participants; 57.3% were female and mean age was 35.7 years. Religiousness was generally associated with more negative attitudes toward alcohol, such as limiting hours of sale (p < 0.01, not having alcohol available in corner shops (p < 0.01, prohibiting alcohol advertisements on TV (p < 0.01, raising the legal drinking age (p < 0.01, and raising taxes on alcohol (p < 0.05. Higher religious attendance was associated with less alcohol problems (OR: 0.61, 95%CI 0.40-0.91, p = 0.017, and self-reported religiousness was associated with less harmful effects of drinking (OR: 0.61, 95%CI 0.43-0.88, p = 0.009. Conclusions: Those with high levels of religiousness support more restrictive alcohol policies. These findings corroborate previous studies showing that religious people consume less alcohol and have fewer alcohol-related problems.

  11. Mini-Mental State Examination (MMSE) for the detection of dementia in clinically unevaluated people aged 65 and over in community and primary care populations

    OpenAIRE

    Creavin, Sam T; Wisniewski, Susanna; Noel-Storr, Anna H; Trevelyan, Clare M; Hampton, Thomas; Rayment, Dane; Thom, Victoria M; Nash, Kirsty J E; Elhamoui, Hosam; Milligan, Rowena; Patel, Anish S; Tsivos, Demitra V; Wing, Tracey; Phillips, Emma; Kellman, Sophie M

    2016-01-01

    BACKGROUND: The Mini Mental State Examination (MMSE) is a cognitive test that is commonly used as part of the evaluation for possible dementia.OBJECTIVES: To determine the diagnostic accuracy of the Mini-Mental State Examination (MMSE) at various cut points for dementia in people aged 65 years and over in community and primary care settings who had not undergone prior testing for dementia.SEARCH METHODS: We searched the specialised register of the Cochrane Dementia and Cognitive Improvement G...

  12. Dietary Patterns, Cognitive Decline, and Dementia: A Systematic Review12

    Science.gov (United States)

    van de Rest, Ondine; Berendsen, Agnes AM; Haveman-Nies, Annemien; de Groot, Lisette CPGM

    2015-01-01

    Nutrition is an important modifiable risk factor that plays a role in the strategy to prevent or delay the onset of dementia. Research on nutritional effects has until now mainly focused on the role of individual nutrients and bioactive components. However, the evidence for combined effects, such as multinutrient approaches, or a healthy dietary pattern, such as the Mediterranean diet, is growing. These approaches incorporate the complexity of the diet and possible interaction and synergy between nutrients. Over the past few years, dietary patterns have increasingly been investigated to better understand the link between diet, cognitive decline, and dementia. In this systematic review we provide an overview of the literature on human studies up to May 2014 that examined the role of dietary patterns (derived both a priori as well as a posteriori) in relation to cognitive decline or dementia. The results suggest that better adherence to a Mediterranean diet is associated with less cognitive decline, dementia, or Alzheimer disease, as shown by 4 of 6 cross-sectional studies, 6 of 12 longitudinal studies, 1 trial, and 3 meta-analyses. Other healthy dietary patterns, derived both a priori (e.g., Healthy Diet Indicator, Healthy Eating Index, and Program National Nutrition Santé guideline score) and a posteriori (e.g., factor analysis, cluster analysis, and reduced rank regression), were shown to be associated with reduced cognitive decline and/or a reduced risk of dementia as shown by all 6 cross-sectional studies and 6 of 8 longitudinal studies. More conclusive evidence is needed to reach more targeted and detailed guidelines to prevent or postpone cognitive decline. PMID:25770254

  13. The Effects of Anti-Dementia and Nootropic Treatments on the Mortality of Patients with Dementia: A Population-Based Cohort Study in Taiwan.

    Directory of Open Access Journals (Sweden)

    Chen-Yi Wu

    Full Text Available Few studies have examined the contribution of treatment on the mortality of dementia based on a population-based study.To investigate the effects of anti-dementia and nootropic treatments on the mortality of dementia using a population-based cohort study.12,193 incident dementia patients were found from 2000 to 2010. Their data were compared with 12,193 age- and sex-matched non-dementia controls that were randomly selected from the same database. Dementia was classified into vascular (VaD and degenerative dementia. Mortality incidence and hazard ratios (HRs were calculated.The median survival time was 3.39 years (95% confidence interval [CI]: 2.88-3.79 for VaD without medication, 6.62 years (95% CI: 6.24-7.21 for VaD with nootropics, 3.01 years (95% CI: 2.85-3.21 for degenerative dementia without medication, 8.11 years (95% CI: 6.30-8.55 for degenerative dementia with anti-dementia medication, 6.00 years (95% CI: 5.73-6.17 for degenerative dementia with nootropics, and 9.03 years (95% CI: 8.02-9.87 for degenerative dementia with both anti-dementia and nootropic medications. Compared to the non-dementia group, the HRs among individuals with degenerative dementia were 2.69 (95% CI: 2.55-2.83 without medication, 1.46 (95% CI: 1.39-1.54 with nootropics, 1.05 (95% CI: 0.82-1.34 with anti-dementia medication, and 0.92 (95% CI: 0.80-1.05 with both nootropic and anti-dementia medications. VaD with nootropics had a lower mortality (HR: 1.25, 95% CI: 1.15-1.37 than VaD without medication (HR: 2.46, 95% CI: 2.22-2.72.Pharmacological treatments have beneficial effects for patients with dementia in prolonging their survival.

  14. The Effects of Anti-Dementia and Nootropic Treatments on the Mortality of Patients with Dementia: A Population-Based Cohort Study in Taiwan.

    Science.gov (United States)

    Wu, Chen-Yi; Hu, Hsiao-Yun; Chow, Lok-Hi; Chou, Yiing-Jenq; Huang, Nicole; Wang, Pei-Ning; Li, Chung-Pin

    2015-01-01

    Few studies have examined the contribution of treatment on the mortality of dementia based on a population-based study. To investigate the effects of anti-dementia and nootropic treatments on the mortality of dementia using a population-based cohort study. 12,193 incident dementia patients were found from 2000 to 2010. Their data were compared with 12,193 age- and sex-matched non-dementia controls that were randomly selected from the same database. Dementia was classified into vascular (VaD) and degenerative dementia. Mortality incidence and hazard ratios (HRs) were calculated. The median survival time was 3.39 years (95% confidence interval [CI]: 2.88-3.79) for VaD without medication, 6.62 years (95% CI: 6.24-7.21) for VaD with nootropics, 3.01 years (95% CI: 2.85-3.21) for degenerative dementia without medication, 8.11 years (95% CI: 6.30-8.55) for degenerative dementia with anti-dementia medication, 6.00 years (95% CI: 5.73-6.17) for degenerative dementia with nootropics, and 9.03 years (95% CI: 8.02-9.87) for degenerative dementia with both anti-dementia and nootropic medications. Compared to the non-dementia group, the HRs among individuals with degenerative dementia were 2.69 (95% CI: 2.55-2.83) without medication, 1.46 (95% CI: 1.39-1.54) with nootropics, 1.05 (95% CI: 0.82-1.34) with anti-dementia medication, and 0.92 (95% CI: 0.80-1.05) with both nootropic and anti-dementia medications. VaD with nootropics had a lower mortality (HR: 1.25, 95% CI: 1.15-1.37) than VaD without medication (HR: 2.46, 95% CI: 2.22-2.72). Pharmacological treatments have beneficial effects for patients with dementia in prolonging their survival.

  15. A comparative study of behavioral and psychological signs and symptoms of dementia in patients with dementia referred to psychogeriatric services in Korea and the United Kingdom.

    Science.gov (United States)

    Shah, Ajit; Ellanchenny, Nalini; Suh, Guk-Hee

    2004-06-01

    There is a paucity of cross-cultural studies of behavioral and psychological symptoms of dementia (BPSD). BPSD were examined in a consecutive series of referrals to a psychogeriatric service in the United Kingdom (U.K.) and in Korea, using the BEHAVE-AD, the Cornell Scale for Depression in Dementia and the Mini-mental State Examination (MMSE). The U.K. service served a well-defined geographical catchment area with a multidisciplinary team and emphasis on home assessments. The Korean service was a nationwide service with limited community resources. The correlates of individual BPSD in each country and the differences between the two countries were examined. Koreans were younger, were more likely to be married, less likely to be single, had a greater number of people in their household and were more likely to live in their own homes than the U.K. sample. Koreans were more likely to be referred by general psychiatrists or family members, and the U.K. sample was more likely to be referred by general practitioners. Koreans were more likely to have Alzheimer's disease and the U.K. sample to have vascular dementia. The Korean sample had a lower MMSE score than the U.K. sample. In both countries, the total BEHAVE-AD score and most subscale scores were negatively correlated with the MMSE score. The total BEHAVE-AD score and all subscale scores were higher in the Korean sample than in the U.K. sample. The prevalence of all BPSD measured with the BEHAVE-AD were higher in the Korean sample (except aggressivity). These differences may be explained by differing interpretation and administration of the measurement instruments, models of service delivery, availability of primary and secondary care services, health seeking behavior of patients and families, cultural influences, and knowledge, expectations and recognition of BPSD by professionals in primary and secondary care. However, despite this, there was possible evidence of genuine differences worthy of further cross

  16. The process of disclosing a diagnosis of dementia and mild cognitive impairment

    DEFF Research Database (Denmark)

    Nielsen, T Rune; Svensson, Birthe Hjorth; Rohr, Gitte

    2018-01-01

    aspects of disclosing a diagnosis of dementia and mild cognitive impairment. Method A total of 54 specialist physicians in Danish dementia diagnostic departments completed an online survey on their practices regarding diagnostic disclosure of dementia and mild cognitive impairment. The influence...... of respondent characteristics was assessed, and differences on key aspects of disclosing a diagnosis of dementia and mild cognitive impairment were analyzed. Results The results suggest that among Danish specialist physicians, there is a general consensus regarding the organization of diagnostic disclosure...... meetings. However, differences in employed terminology and information provided when disclosing a dementia diagnosis were evident. Significant differences were present on key aspects of the diagnostic disclosure of dementia and mild cognitive impairment. For instance, 91% would use the term dementia during...

  17. Dementia care mapping to support staff in the care of people with intellectual disability and dementia: a feasibility study.

    Science.gov (United States)

    Schaap, Feija D; Fokkens, Andrea S; Dijkstra, Geke J; Reijneveld, Sijmen A; Finnema, Evelyn J

    2018-04-24

    The number of people with intellectual disability and dementia increases; this combination causes behavioural changes. Dementia Care Mapping (DCM) supports staff in dementia care in nursing homes and may be useful in intellectual disability-care. This qualitative study examines the feasibility of DCM for older people with intellectual disability and dementia. The present authors obtained data in focus groups and interviews with professional users and analysed using a framework for feasibility studies. With experts in dementia and intellectual disability researches, the present authors determined the overall feasibility. DCM was found to be feasible in intellectual disability-care, regarding five domains of feasibility. Staff reported DCM to be useful and valuable and addresses to their demand for skills and knowledge. All professional users found DCM feasible in intellectual disability-care, which was confirmed by experts. DCM is feasible in intellectual disability-care. When fully tailored to intellectual disability-care, DCM is useful and provides opportunities to assess its effectiveness. © 2018 The Authors. Journal of Applied Research in Intellectual Disabilities Published by John Wiley & Sons Ltd.

  18. Barriers and facilitators in accessing dementia care by ethnic minority groups: a meta-synthesis of qualitative studies.

    Science.gov (United States)

    Kenning, Cassandra; Daker-White, Gavin; Blakemore, Amy; Panagioti, Maria; Waheed, Waquas

    2017-08-30

    It is estimated that there are about 25,000 people from UK ethnic minority groups with dementia. It is clear that there is an increasing need to improve access to dementia services for all ethnic groups to ensure that everyone has access to the same potential health benefits. The aim was to systematically review qualitative studies and to perform a meta-synthesis around barriers and facilitators to accessing care for dementia in ethnic minorities. Databases were searched to capture studies on barriers and facilitators to accessing care for dementia in ethnic minorities. Analysis followed the guidelines for meta-ethnography. All interpretations of data as presented by the authors of the included papers were extracted and grouped into new themes. Six hundred and eighty four papers were identified and screened. Twenty eight studies were included in the meta-synthesis. The analysis developed a number of themes and these were incorporated into two overarching themes: 'inadequacies' and 'cultural habitus'. The two overarching themes lend themselves to interventions at a service level and a community level which need to happen in synergy. The review was registered with PROSPERO: CRD42016049326 .

  19. Relation of Periodontitis to Risk of Cardiovascular and All-Cause Mortality (from a Danish Nationwide Cohort Study)

    DEFF Research Database (Denmark)

    Hansen, Gorm Mørk; Egeberg, Alexander; Holmstrup, Palle

    2016-01-01

    Periodontitis and atherosclerosis are highly prevalent chronic inflammatory diseases, and it has been suggested that periodontitis is an independent risk factor of cardiovascular disease (CVD) and that a causal link may exist between the 2 diseases. Using Danish national registers, we identified...... a nationwide cohort of 17,691 patients who received a hospital diagnosis of periodontitis within a 15-year period and matched them with 83,003 controls from the general population. We performed Poisson regression analysis to determine crude and adjusted incidence rate ratios of myocardial infarction, ischemic...... stroke, cardiovascular death, major adverse cardiovascular events, and all-cause mortality. The results showed that patients with periodontitis were at higher risk of all examined end points. The findings remained significant after adjustment for increased baseline co-morbidity in periodontitis patients...

  20. Gender differences in psychiatric diagnoses in older people with intellectual disability: a register study.

    Science.gov (United States)

    Axmon, Anna; Sandberg, Magnus; Ahlström, Gerd

    2017-05-22

    Gender differences regarding psychiatric ill-health are well known in the general population. However, not much research is done on people with intellectual disability, and especially not among older people with intellectual disability. People with intellectual disability aged 55+ years in 2012 in Sweden were identified through a register containing information on those receiving support and service for this type of disability. The cohort comprised 3609 women and 4327 men with mean age 65 and 64 years, respectively. Information on psychiatric diagnoses was collected from the National Patient Register for the period 2002-2012. Potential gender differences were evaluated both for diagnostic categories (e.g. affective disorders) and single diagnoses (e.g. depressive episodes). The most common diagnoses among women were in the diagnostic category affective disorders, and among men in psychotic disorders. The majority of both women (72%) and men (71%) had diagnoses in only one diagnostic category. Women were more likely than men to have at least one diagnosis of dementia (odds ratio 1.40, 95% confidence interval 1.06-1.83) or affective disorders (1.33, 1.21-1.58) during the study period. They were, however, less likely to have at least one diagnosis of alcohol/substance use related disorder (0.59, 0.43-0.80). No gender differences were found for diagnoses of psychotic (1.04, 0.86-1.27) or anxiety disorders (1.15, 0.94-1.40). Regarding single diagnoses, women were more likely than men to have had at least one diagnosis of unspecified nonorganic psychosis (1.75, 1.23-2.50), depressive episode (1.47, 1.19-1.82), recurrent depressive disorder (1.53, 1.06-2.22), other anxiety disorder (1.34, 1.06-1.69), or dementia in Alzheimer disease (2.50, 1.40-4.49), but less likely to be diagnosed with psychiatric and behavioral disorders due to use of alcohol (0.41, 0.27-0.61). As in the general population, there seem to be gender differences with respect to several types of

  1. Associations Between Body Mass Index and Development of Metabolic Disorders in Fertile Women—A Nationwide Cohort Study

    DEFF Research Database (Denmark)

    Schmiegelow, Michelle Dalgas; Andersson, Charlotte; Køber, Lars

    2014-01-01

    BACKGROUND: Metabolic disorders are relatively uncommon in young women, but may increase with obesity. The associations between body mass index (BMI) and risks of diabetes, hypertension, and dyslipidemia in apparently healthy, young women have been insufficiently investigated, and are the aims...... of this study. METHODS AND RESULTS: Women giving birth during the years 2004-2009, with no history of cardiovascular disease, renal insufficiency, pregnancy-associated metabolic disorders, diabetes, hypertension, or dyslipidemia were identified in nationwide registers. Women were categorized as underweight (BMI......). The cohort comprised 252 472 women with a median age of 30.4 years (IQR=27.2;33.7) and a median follow-up of 5.5 years (IQR=3.9;6.8). In total, 2029 women developed diabetes, 3133 women developed hypertension, and 1549 women developed dyslipidemia. Rate ratios (RRs) of diabetes were: 0.84 (95% confidence...

  2. Neurodegenerative Dementia

    International Nuclear Information System (INIS)

    Allard, Michelle

    2006-01-01

    Full text: With increasing life expectancy across the world, the number of elderly people at risk of developing dementia is growing rapidly. Thus, progressive neurodegenerative disorders such as dementia represent a growing public health concern. These diseases are characterized by a progressive loss in most of the cognitive functions. The promise, possibly in a near future, of disease-modifying therapies has made the characterization of the early stages of dementia a topic of major interest. The assessment of these early stages is a challenge for neuroimaging studies. In order to conceive prevention trials; it is of major outcome to fully understand the mechanisms of the cognitive system impairment and its evolution, with a particular reference to the symptomatic pre-dementia stage, when subjects just begin to depart from normality. In this article we review recent progress in neuroimaging, and their potentiality for increasing a diagnostic accuracy. (author)

  3. Implementation of anaphylaxis management guidelines: a register-based study.

    Directory of Open Access Journals (Sweden)

    Linus Grabenhenrich

    Full Text Available BACKGROUND: Anaphylaxis management guidelines recommend the use of intramuscular adrenaline in severe reactions, complemented by antihistamines and corticoids; secondary prevention includes allergen avoidance and provision of self-applicable first aid drugs. Gaps between recommendations and their implementation have been reported, but only in confined settings. Hence, we analysed nation-wide data on the management of anaphylaxis, evaluating the implementation of guidelines. METHODS: Within the anaphylaxis registry, allergy referral centres across Germany, Austria and Switzerland provided data on severe anaphylaxis cases. Based on patient records, details on reaction circumstances, diagnostic workup and treatment were collected via online questionnaire. Report of anaphylaxis through emergency physicians allowed for validation of registry data. RESULTS: 2114 severe anaphylaxis patients from 58 centres were included. 8% received adrenaline intravenously, 4% intramuscularly; 50% antihistamines, and 51% corticoids. Validation data indicated moderate underreporting of first aid drugs in the Registry. 20% received specific instructions at the time of the reaction; 81% were provided with prophylactic first aid drugs at any time. CONCLUSION: There is a distinct discrepancy between current anaphylaxis management guidelines and their implementation. To improve patient care, a revised approach for medical education and training on the management of severe anaphylaxis is warranted.

  4. Epidemiology of early-onset dementia: a review of the literature

    Science.gov (United States)

    Vieira, Renata Teles; Caixeta, Leonardo; Machado, Sergio; Silva, Adriana Cardoso; Nardi, Antonio Egidio; Arias-Carrión, Oscar; Carta, Mauro Giovanni

    2013-01-01

    Presenile Dementia or Early Onset Dementia (EOD) is a public health problem, it differs from Senile Dementia, and encloses a significant number of cases; nevertheless, it is still poorly understood and underdiagnosed. This study aims to review the prevalence and etiology of EOD, comparing EOD with Senile Dementia, as well as to show the main causes of EOD and their prevalence in population and non-population based studies. The computer-supported search used the following databases: Pubmed/Medline, ISI Web of Knowledge and Scielo. The search terms were alcohol-associated dementia, Alzheimer’s disease, dementia, Creutzfeldt-jakob disease, dementia with lewy bodies, early onset dementia, frontotemporal lobar degeneration, Huntington’s disease, mixed dementia, neurodegenerative disorders, Parkinson’s disease dementia, presenile dementia, traumatic brain injury, vascular dementia. Only papers published in English and conducted from 1985 up to 2012 were preferentially reviewed. Neurodegenerative diseases are the most common etiologies seen in EOD. Among the general population, the prevalence of EOD was found to range between 0 to 700 per 100.000 habitants in groups of 25-64 years old, with an increasing incidence with age. The progression of EOD was found to range between 8.3 to 22.8 new cases per 100.000 in those aged under 65 years. Alzheimer's disease (AD) is the major etiology, followed by Vascular Dementia (VaD) and Frontotemporal Lobar Degeneration (FTLD). A larger number of epidemiological studies to elucidate how environmental issues contribute to EOD are necessary, thus, we can collaborate in the planning and prevention of services toward dementia patients. PMID:23878613

  5. Accuracy of a heart failure diagnosis in administrative registers

    DEFF Research Database (Denmark)

    Kümler, Thomas; Gislason, Gunnar Hilmar; Kirk, Vibeke

    2008-01-01

    BACKGROUND: The incidence of heart failure is frequently reported using hospital discharge diagnoses. The specificity of a diagnosis has been shown to be high but the sensitivity of a reported diagnosis is unknown. PURPOSE: To study the accuracy of a heart failure diagnosis reported to the Danish...... a specificity of 99% and a sensitivity of 29% for all patients. The positive predictive value was 81%, the negative predictive value 90%. CONCLUSION: The diagnosis of Heart Failure in the Danish National Registers is underreported, but very specific....

  6. Should We Refer for a Dementia Assessment? A Checklist to Help Know when to Be Concerned about Dementia in Adults with Down Syndrome and Other Intellectual Disabilities

    Science.gov (United States)

    Whitwham, Sarah; McBrien, Judith; Broom, Wendy

    2011-01-01

    The aim of this research was to develop a simple screening checklist to help carers and professionals know when to make a referral for a dementia assessment. A checklist was completed for all new referrals to a dementia service for people with intellectual disabilities. The obtained scores were compared to the diagnostic outcome of a comprehensive…

  7. Trends in the prevalence of periodontitis in Taiwan from 1997 to 2013: A nationwide population-based retrospective study.

    Science.gov (United States)

    Yu, Hui-Chieh; Su, Ni-Yu; Huang, Jing-Yang; Lee, Shiuan-Shinn; Chang, Yu-Chao

    2017-11-01

    Periodontitis is one of the most prevalent oral diseases. In this study, we probed the nationwide registered database to assess the time trends of prevalence of periodontitis in Taiwan.A retrospective study was conducted to analyze the registered database compiled by the National Health Insurance provided by the Department of Health, Taiwan, from 1997 to December 2013.We found that the prevalence of periodontitis significantly increased from 11.5% in 1997 to 19.59% in 2013 (P for trend periodontitis from 1997 to 2013 was 54.46 ± 14.47 and 45.51 ± 16.58 years old, respectively. The proportion of individuals with periodontitis in age group >65 years old decreased markedly. The proportion of individuals with periodontitis in age groups periodontitis (male: RR, 67.42, 95% confidence interval [CI], 17.04-266.76; female: RR, 65.85, 95% CI, 16.70-259.70). Both male and female groups showed the similar age-effect pattern in the cross-sectional age curve from age-period-cohort model. There was an upturn with advancing age up to 40 to 50 years old and then a downward trend in both genders. Population dwelling in suburban area (RR, 0.95; 95% CI, 0.94-0.97) and rural area (RR, 0.97; 95% CI, 0.95-0.99) had the lower risk of periodontitis than those who lived in urban area. The higher income group revealed the higher risk of periodontitis compared with lower income group (RR, 1.20; 95% CI, 1.18-1.23).The prevalence of periodontitis significantly increased in Taiwan over past 17 years. The mean age with periodontitis was shown in a decreased pattern. The use of a nationwide population-based database could provide sufficient sample size, generalizability, and statistical power to assess the periodontal status in Taiwan.

  8. A molecular shift register based on electron transfer

    Science.gov (United States)

    Hopfield, J. J.; Onuchic, Josenelson; Beratan, David N.

    1988-01-01

    An electronic shift-register memory at the molecular level is described. The memory elements are based on a chain of electron-transfer molecules and the information is shifted by photoinduced electron-transfer reactions. This device integrates designed electronic molecules onto a very large scale integrated (silicon microelectronic) substrate, providing an example of a 'molecular electronic device' that could actually be made. The design requirements for such a device and possible synthetic strategies are discussed. Devices along these lines should have lower energy usage and enhanced storage density.

  9. Occurrence and in vitro bioactivity of estrogen, androgen, and glucocorticoid compounds in a nationwide screen of United States stream waters

    Data.gov (United States)

    U.S. Environmental Protection Agency — In vitro bioactivity concentrations and chemical concentrations of estrogens, androgens, and glucocorticoids from a nationwide screen of United States stream water...

  10. Toward a methodology for substate projections of registered nurse supply and demand in New York.

    Science.gov (United States)

    McGinnis, Sandra; Martiniano, Robert; Moore, Jean

    2010-01-01

    Even as concerns about nursing shortages continue nationwide and for individual states in the United States, there is little information on the impact of nursing shortages at substate levels, such as counties or groups of small counties. National and state level assessments can mask wide geographic variation in the distribution of registered nurses (RNs). The Center for Health Workforce Studies at the School of Public Health, University at Albany, developed a practical approach to projecting RN supply and demand at substate levels. The experimental model used in this research was adapted from a methodology utilized for the RN National Supply Model and National Demand Model developed by the Health Resources and Services Administration in the department of Health and Human Services to make RN supply and demand projections at the broader national and state levels. The Center's research highlighted the value of substate analyses in the identification of RN supply and demand gaps and found that supply and demand gaps vary greatly by region and within regions. This study also provided an in-depth understanding of the dynamics that drive substate labor markets for RNs as well as the need for substate analyses to help policymakers better allocate scarce resources to address nursing shortages.

  11. Identifying victims of violence using register-based data

    DEFF Research Database (Denmark)

    Kruse, Marie; Sørensen, Jan; Brønnum-Hansen, Henrik

    2010-01-01

    AIMS: The aim of this study was twofold. Firstly we identified victims of violence in national registers and discussed strengths and weaknesses of this approach. Secondly we assessed the magnitude of violence and the characteristics of the victims using register-based data. METHODS: We used three...... nationwide registers to identify victims of violence: The National Patient Register, the Victim Statistics, and the Causes of Death Register. We merged these data and assessed the degree of overlap between data sources. We identified a reference population by selecting all individuals in Denmark over 15....... RESULTS: In 2006, 22,000 individuals were registered as having been exposed to violence. About 70% of these victims were men. Most victims were identified from emergency room contacts and police records, and few from the Causes of Death Register. There was some overlap between the two large data sources...

  12. Competence of newly qualified registered nurses from a nursing college

    Directory of Open Access Journals (Sweden)

    BG Morolong

    2005-09-01

    Full Text Available The South African education and training system, through its policy of outcomesbased education and training, has made competency a national priority. In compliance to this national requirement of producing competent learners, the South African Nursing Council ( 1999 B require that the beginner professional nurse practitioners and midwives have the necessary knowledge, skills, attitudes and values which will enable them to render efficient professional service. The health care system also demands competent nurse practitioners to ensure quality in health care. In the light of competency being a national priority and a statutory demand, the research question that emerges is, how competent are the newly qualified registered nurses from a specific nursing college in clinical nursing education? A quantitative, non-experimental contextual design was used to evaluate the competence of newly qualified registered nurses from a specific nursing college. The study was conducted in two phases. The first phase dealt with the development of an instrument together with its manual through the conceptualisation process. The second phase focused on the evaluation of the competency of newly qualified nurses using the instrument based on the steps of the nursing process. A pilot study was conducted to test the feasibility of the items of the instrument. During the evaluation phase, a sample of twenty-six newly qualified nurses was selected by simple random sampling from a target population of thirty-six newly qualified registered nurses. However, six participants withdrew from the study. Data was collected in two general hospitals where the newly qualified registered nurses were working. Observation and questioning were used as data collection techniques in accordance with the developed instrument. Measures were taken to ensure internal validity and reliability of the results. To protect the rights of the participants, the researcher adhered to DENOSA’S (1998

  13. Imaging dementias

    Energy Technology Data Exchange (ETDEWEB)

    Savoiardo, M.; Grisoli, M. [Dept. of Neuroradiology, Istituto Nazionale Neurologico, Milan (Italy)

    2001-03-01

    Dementia is the progressive loss of intellectual functions due to involvement of cortical or subcortical areas. Specific involvement of certain brain areas in the different diseases leads to impairment of different functions, e. g., memory, language, visuospatial abilities, and behavior. Magnetic resonance imaging and other neuroradiological studies may indicate which structures are mainly or selectively involved in a demented patient, thus allowing clinical-radiological correlations. Clinical presentation and evolution of the disease, supported by imaging studies, may lead to a highly probable diagnosis. The most common disorders, or the most relevant from the neuroradiological point of view, such as Alzheimer's disease, frontotemporal dementia, vascular dementias, dementia associated with parkinsonism, Huntington's disease, Creutzfeldt-Jakob disease, and normal-pressure hydrocephalus, are briefly discussed. (orig.)

  14. Imaging dementias

    International Nuclear Information System (INIS)

    Savoiardo, M.; Grisoli, M.

    2001-01-01

    Dementia is the progressive loss of intellectual functions due to involvement of cortical or subcortical areas. Specific involvement of certain brain areas in the different diseases leads to impairment of different functions, e. g., memory, language, visuospatial abilities, and behavior. Magnetic resonance imaging and other neuroradiological studies may indicate which structures are mainly or selectively involved in a demented patient, thus allowing clinical-radiological correlations. Clinical presentation and evolution of the disease, supported by imaging studies, may lead to a highly probable diagnosis. The most common disorders, or the most relevant from the neuroradiological point of view, such as Alzheimer's disease, frontotemporal dementia, vascular dementias, dementia associated with parkinsonism, Huntington's disease, Creutzfeldt-Jakob disease, and normal-pressure hydrocephalus, are briefly discussed. (orig.)

  15. Aromatherapy for dementia.

    Science.gov (United States)

    Forrester, Lene Thorgrimsen; Maayan, Nicola; Orrell, Martin; Spector, Aimee E; Buchan, Louise D; Soares-Weiser, Karla

    2014-02-25

    Complementary therapy has received great interest within the field of dementia treatment and the use of aromatherapy and essential oils is increasing. In a growing population where the majority of patients are treated by US Food and Drug Administration (FDA)-approved drugs, the efficacy of treatment is short term and accompanied by negative side effects. Utilisation of complimentary therapies in dementia care settings presents as one of few options that are attractive to practitioners and families as patients often have reduced insight and ability to verbally communicate adverse reactions. Amongst the most distressing features of dementia are the behavioural and psychological symptoms. Addressing this facet has received particular interest in aromatherapy trials, with a shift in focus from reducing cognitive dysfunction to the reduction of behavioural and psychological symptoms in dementia. To assess the efficacy of aromatherapy as an intervention for people with dementia. ALOIS, the Cochrane Dementia and Cognitive Improvement Group Specialized Register, was searched on 26 November 2012 and 20 January 2013 using the terms: aromatherapy, lemon, lavender, rose, aroma, alternative therapies, complementary therapies, essential oils. All relevant randomised controlled trials were considered. A minimum length of a trial and requirements for follow-up were not included, and participants in included studies had a diagnosis of dementia of any type and severity. The review considered all trials using fragrance from plants defined as aromatherapy as an intervention with people with dementia and all relevant outcomes were considered. Titles and abstracts extracted by the searches were screened for their eligibility for potential inclusion in the review. For Burns 2011, continuous outcomes were estimated as the mean difference between groups and its 95% confidence interval using a fixed-effect model. For Ballard 2002, analysis of co-variance was used for all outcomes, with the

  16. Volunteering in dementia care – a Norwegian phenomenological study

    Directory of Open Access Journals (Sweden)

    Söderhamn U

    2012-02-01

    Full Text Available Ulrika Söderhamn1, Bjørg Landmark2,3, Live Aasgaard2, Hilde Eide3, Olle Söderhamn11Center for Caring Research – Southern Norway, Faculty of Health and Sport Sciences, University of Agder, Grimstad, Norway; 2Institute of Research and Development for Nursing and Care Services, Municipality of Drammen, Drammen, Norway; 3Faculty of Health Sciences, Buskerud University College, Drammen, NorwayIntroduction: The number of people suffering from dementia will increase dramatically in the future, and this will be a great challenge and concern for health care services. It is assumed that volunteers will strengthen community health care services more in the future than they do today.Aim: The aim of this study was to elucidate lived experiences of working as a volunteer in an activity center with adapted activities for home-dwelling people with early stage dementia.Methods: Qualitative interviews were implemented in a group of nine female volunteers from an activity center in southern Norway. The interviews were recorded, transcribed verbatim, and analyzed with a descriptive phenomenological method. Results: Volunteering in an activity center for home-dwelling people with early stage dementia was reported to provide experiences of being useful and feeling satisfied with performing a good job. It was an advantage for the volunteers to have had experiences from life in general, but also as a health professional or as being the next of kin of a dementia sufferer. It was important for the volunteers to focus on the dementia sufferer and show caring behavior, and interaction with and the appreciation of the health care professionals were also important. The volunteers were motivated by being able to have influence and participate in the planning of the work, to be a part of the social setting, and to learn. However, for some volunteers it was difficult to adjust to an appropriate role.Conclusion: In order to promote volunteering in a caring context, mutual

  17. Awareness of Diagnostic Error among Japanese Residents: a Nationwide Study.

    Science.gov (United States)

    Nishizaki, Yuji; Shinozaki, Tomohiro; Kinoshita, Kensuke; Shimizu, Taro; Tokuda, Yasuharu

    2018-04-01

    Residents' understanding of diagnostic error may differ between countries. We sought to explore the relationship between diagnostic error knowledge and self-study, clinical knowledge, and experience. Our nationwide study involved postgraduate year 1 and 2 (PGY-1 and -2) Japanese residents. The Diagnostic Error Knowledge Assessment Test (D-KAT) and General Medicine In-Training Examination (GM-ITE) were administered at the end of the 2014 academic year. D-KAT scores were compared with the benchmark scores of US residents. Associations between D-KAT score and gender, PGY, emergency department (ED) rotations per month, mean number of inpatients handled at any given time, and mean daily minutes of self-study were also analyzed, both with and without adjusting for GM-ITE scores. Student's t test was used for comparisons with linear mixed models and structural equation models (SEM) to explore associations with D-KAT or GM-ITE scores. The mean D-KAT score among Japanese PGY-2 residents was significantly lower than that of their US PGY-2 counterparts (6.2 vs. 8.3, p ITE scores correlated with ED rotations (≥6 rotations: 2.14; 0.16-4.13; p = 0.03), inpatient caseloads (5-9 patients: 1.79; 0.82-2.76; p ITE scores (ß = 0.37, 95% CI: 0.34-0.41) and indirectly associated with ED rotations (ß = 0.06, 95% CI: 0.02-0.10), inpatient caseload (ß = 0.04, 95% CI: 0.003-0.08), and average daily minutes of study (ß = 0.13, 95% CI: 0.09-0.17). Knowledge regarding diagnostic error among Japanese residents was poor compared with that among US residents. D-KAT scores correlated strongly with GM-ITE scores, and the latter scores were positively associated with a greater number of ED rotations, larger caseload (though only up to 15 patients), and more time spent studying.

  18. FDG PET imaging dementia

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Byeong Cheol [Kyungpook National University Medical School and Kyungpook National University Hospital, Daegu (Korea, Republic of)

    2007-04-15

    Dementia is a major burden for many countries including South Korea, where life expectancy is continuously growing and the proportion of aged people is rapidly growing. Neurodegenerative disorders, such as, Alzheimer disease, dementia with Lewy bodies, frontotemporal dementia. Parkinson disease, progressive supranuclear palsy, corticobasal degeneration, Huntington disease, can cause dementia, and cerebrovascular disease also can cause dementia. Depression or hypothyroidism also can cause cognitive deficits, but they are reversible by management of underlying cause unlike the forementioned dementias. Therefore these are called pseudodementia. We are entering an era of dementia care that will be based upon the identification of potentially modifiable risk factors and early disease markers, and the application of new drugs postpone progression of dementias or target specific proteins that cause dementia. Efficient pharmacologic treatment of dementia needs not only to distinguish underlying causes of dementia but also to be installed as soon as possible. Therefore, differential diagnosis and early diagnosis of dementia are utmost importance. F-18 FDG PET is useful for clarifying dementing diseases and is also useful for early detection of the disease. Purpose of this article is to review the current value of FDG PET for dementing diseases including differential diagnosis of dementia and prediction of evolving dementia.

  19. FDG PET imaging dementia

    International Nuclear Information System (INIS)

    Ahn, Byeong Cheol

    2007-01-01

    Dementia is a major burden for many countries including South Korea, where life expectancy is continuously growing and the proportion of aged people is rapidly growing. Neurodegenerative disorders, such as, Alzheimer disease, dementia with Lewy bodies, frontotemporal dementia. Parkinson disease, progressive supranuclear palsy, corticobasal degeneration, Huntington disease, can cause dementia, and cerebrovascular disease also can cause dementia. Depression or hypothyroidism also can cause cognitive deficits, but they are reversible by management of underlying cause unlike the forementioned dementias. Therefore these are called pseudodementia. We are entering an era of dementia care that will be based upon the identification of potentially modifiable risk factors and early disease markers, and the application of new drugs postpone progression of dementias or target specific proteins that cause dementia. Efficient pharmacologic treatment of dementia needs not only to distinguish underlying causes of dementia but also to be installed as soon as possible. Therefore, differential diagnosis and early diagnosis of dementia are utmost importance. F-18 FDG PET is useful for clarifying dementing diseases and is also useful for early detection of the disease. Purpose of this article is to review the current value of FDG PET for dementing diseases including differential diagnosis of dementia and prediction of evolving dementia

  20. Priorities for the professional development of registered nurses in nursing homes: a Delphi study.

    Science.gov (United States)

    Cooper, Emily; Spilsbury, Karen; McCaughan, Dorothy; Thompson, Carl; Butterworth, Tony; Hanratty, Barbara

    2017-01-08

    To establish a consensus on the care and professional development needs of registered nurses (RNs) employed by UK care homes. Two-stage, online modified Delphi study. A panel (n = 352) of individuals with experience, expertise or interest in care home nursing: (i) care home nurses and managers; (ii) community healthcare professionals (including general practitioners, geriatricians, specialist and district nurses); and (iii) nurse educators in higher education. RNs employed by nursing homes require particular skills, knowledge, competence and experience to provide high-quality care for older residents. The most important responsibilities for the nursing home nurse were: promoting dignity, personhood and wellbeing, ensuring resident safety and enhancing quality of life. Continuing professional development priorities included personal care, dementia care and managing long-term conditions. The main barrier to professional development was staff shortages. Nursing degree programmes were perceived as inadequately preparing nurses for a nursing home role. Nursing homes could improve by providing supportive learning opportunities for students and fostering challenging and rewarding careers for newly RNs. If nurses employed by nursing homes are not fit for purpose, the consequences for the wider health and social-care system are significant. Nursing homes, the NHS, educational and local authorities need to work together to provide challenging and rewarding career paths for RNs and evaluate them. Without well-trained, motivated staff, a high-quality care sector will remain merely an aspiration.

  1. A security framework for nationwide health information exchange based on telehealth strategy.

    Science.gov (United States)

    Zaidan, B B; Haiqi, Ahmed; Zaidan, A A; Abdulnabi, Mohamed; Kiah, M L Mat; Muzamel, Hussaen

    2015-05-01

    This study focuses on the situation of health information exchange (HIE) in the context of a nationwide network. It aims to create a security framework that can be implemented to ensure the safe transmission of health information across the boundaries of care providers in Malaysia and other countries. First, a critique of the major elements of nationwide health information networks is presented from the perspective of security, along with such topics as the importance of HIE, issues, and main approaches. Second, a systematic evaluation is conducted on the security solutions that can be utilized in the proposed nationwide network. Finally, a secure framework for health information transmission is proposed within a central cloud-based model, which is compatible with the Malaysian telehealth strategy. The outcome of this analysis indicates that a complete security framework for a global structure of HIE is yet to be defined and implemented. Our proposed framework represents such an endeavor and suggests specific techniques to achieve this goal.

  2. Compilation of a soil map for Nigeria: a nation-wide soil resource ...

    African Journals Online (AJOL)

    This paper presents the results of a nation-wide soil and land form inventory of Nigeria. The data compilation was conducted in the framework of two projects with the objective to calculate agricultural production potential under different input levels and assess the water erosion hazard. The information on spatial distribution ...

  3. Evaluating a nationwide recreational football intervention: Recruitment, attendance, adherence, exercise intensity, and health effects

    DEFF Research Database (Denmark)

    Fløtum, Liljan av; Ottesen, Laila; Krustrup, Peter

    2016-01-01

    The present study evaluated a nationwide exercise intervention with Football Fitness in a small-scale society. In all, 741 adult participants (20–72 yrs) were successfully recruited for Football Fitness training in local football clubs, corresponding to 2.1% of the adult population. A preinterven......-promoting nationwide training intervention for adult participants with an extraordinary recruitment, a high attendance rate, moderate adherence, high exercise intensity, and marked benefits in cardiovascular health profile and fitness.......The present study evaluated a nationwide exercise intervention with Football Fitness in a small-scale society. In all, 741 adult participants (20–72 yrs) were successfully recruited for Football Fitness training in local football clubs, corresponding to 2.1% of the adult population......). RHR was lowered (푃 health...

  4. Animal-Assisted Intervention and Dementia: A Systematic Review.

    Science.gov (United States)

    Yakimicki, Michelle L; Edwards, Nancy E; Richards, Elizabeth; Beck, Alan M

    2018-02-01

    This review discusses the relationship between animal-assisted interventions (AAI) and behavioral and psychological symptoms of dementia (BPSD). A systematic search was conducted within CINAHL, Web of Science CAB Abstracts, PubMed, Abstracts in Social Gerontology, Google Scholar, and PsycINFO for primary research articles. A total of 32 studies were included in the final review. Variation was noted in study designs and in study setting. Twenty-seven of 32 studies used dogs as the intervention. Agitation/aggression showed a significant decrease in nine of 15 studies. Eleven of 12 studies demonstrated increased social interaction with AAI. Mood had mixed results in nine studies. Quality of life was increased in three of four studies. Resident activity and nutritional intake were each increased in two studies. Animal assisted activities/interventions showed a strong positive effect on social behaviors, physical activity, and dietary intake in dementia patients and a positive effect on agitation/aggression and quality of life.

  5. Cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome: a nationwide Danish cohort study.

    Science.gov (United States)

    Dalbøge, Annett; Frost, Poul; Andersen, Johan Hviid; Svendsen, Susanne Wulff

    2014-11-01

    The primary aim was to examine exposure-response relationships between cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome (SIS), and to compare sex-specific exposure-response relationships. The secondary aim was to examine the time window of relevant exposures. We conducted a nationwide register study of all persons born in Denmark (1933-1977), who had at least 5 years of full-time employment. In the follow-up period (2003-2008), we identified first-time events of surgery for SIS. Cumulative exposure estimates for a 10-year exposure time window with a 1-year lag time were obtained by linking occupational codes with a job exposure matrix. The exposure estimates were expressed as, for example, arm-elevation-years in accordance with the pack-year concept of tobacco consumption. We used a multivariable logistic regression technique equivalent to discrete survival analysis. The adjusted OR (ORadj) increased to a maximum of 2.1 for arm-elevation-years, repetition-years and force-years, and to 1.5 for hand-arm-vibration-years. Sex-specific exposure-response relationships were similar for men and women, when assessed using a relative risk scale. The ORadj increased gradually with the number of years contributing to the cumulative exposure estimates. The excess fraction was 24%. Cumulative occupational shoulder exposures carried an increase in risk of surgery for SIS with similar exposure-response curves for men and women. The risk of surgery for SIS increased gradually, when the period of exposure assessment was extended. In the general working population, a substantial fraction of all first-time operations for SIS could be related to occupational exposures. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Being a team leader: newly registered nurses relate their experiences.

    Science.gov (United States)

    Ekström, Louise; Idvall, Ewa

    2015-01-01

    This paper presents a study that explores how newly qualified registered nurses experience their leadership role in the ward-based nursing care team. A nurse's clinical leadership affects the quality of care provided. Newly qualified nurses experience difficulties during the transition period from student to qualified professional and find it challenging to lead nursing care. Twelve nurses were interviewed and the transcribed texts analysed using qualitative content analysis to assess both manifest and latent content. Five themes were identified: feeling stranded; forming well-functioning teams; learning to lead; having the courage, strength, and desire to lead; and ensuring appropriate care. The findings indicate that many factors limit nurses' leadership but some circumstances are supportive. The leadership prerequisites for newly registered nurses need to improve, emphasizing different ways to create a supportive atmosphere that promotes professional development and job satisfaction. To increase nurse retention and promote quality of care, nurse managers need to clarify expectations and guide and support newly qualified nurses in a planned way. © 2013 John Wiley & Sons Ltd.

  7. Register-based studies of cardiovascular disease

    DEFF Research Database (Denmark)

    Abildstrøm, Steen Z; Torp-Pedersen, Christian; Madsen, Mette

    2011-01-01

    Introduction: The use of the unique personal identification number in the Nordic database systems enables the researchers to link the registers at the individual level. The registers can be used for both defining specific patient populations and to identify later events during follow-up. This rev...... the hospitalisation rate and treatment of cardiovascular disease. The risk of unmeasured factors affecting the results calls for cautious interpretation of the results.......-up. This review gives three examples within cardiovascular epidemiology to illustrate the use of the national administrative registers available to all researchers upon request. Research topics: The hospitalisation rate of acute myocardial infarction (AMI) was expected to be increased and case-fatality rate......-based treatment increased significantly over time and adherence to treatment was high. Finally, use of specific nonsteroidal antiinflammatory drugs by healthy subjects was associated with a dose-dependent increase in cardiovascular risk. CONCLUSION: The nationwide registers have proven very useful in monitoring...

  8. General Practice Clinical Data Help Identify Dementia Hotspots: A Novel Geospatial Analysis Approach.

    Science.gov (United States)

    Bagheri, Nasser; Wangdi, Kinley; Cherbuin, Nicolas; Anstey, Kaarin J

    2018-01-01

    We have a poor understanding of whether dementia clusters geographically, how this occurs, and how dementia may relate to socio-demographic factors. To shed light on these important questions, this study aimed to compute a dementia risk score for individuals to assess spatial variation of dementia risk, identify significant clusters (hotspots), and explore their association with socioeconomic status. We used clinical records from 16 general practices (468 Statistical Area level 1 s, N = 14,746) from the city of west Adelaide, Australia for the duration of 1 January 2012 to 31 December 2014. Dementia risk was estimated using The Australian National University-Alzheimer's Disease Risk Index. Hotspot analyses were applied to examine potential clusters in dementia risk at small area level. Significant hotspots were observed in eastern and southern areas while coldspots were observed in the western area within the study perimeter. Additionally, significant hotspots were observed in low socio-economic communities. We found dementia risk scores increased with age, sex (female), high cholesterol, no physical activity, living alone (widow, divorced, separated, or never married), and co-morbidities such as diabetes and depression. Similarly, smoking was associated with a lower dementia risk score. The identification of dementia risk clusters may provide insight into possible geographical variations in risk factors for dementia and quantify these risks at the community level. As such, this research may enable policy makers to tailor early prevention strategies to the correct individuals within their precise locations.

  9. Living with early-stage dementia: a review of qualitative studies.

    Science.gov (United States)

    Steeman, Els; de Casterlé, Bernadette Dierckx; Godderis, Jan; Grypdonck, Mieke

    2006-06-01

    This paper presents a literature review whose aim was to provide better understanding of living with early-stage dementia. Even in the early stages, dementia may challenge quality of life. Research on early-stage dementia is mainly in the domain of biomedical aetiology and pathology, providing little understanding of what it means to live with dementia. Knowledge of the lived experience of having dementia is important in order to focus pro-active care towards enhancing quality of life. Qualitative research is fundamentally well suited to obtaining an insider's view of living with early-stage dementia. We performed a meta-synthesis of qualitative research findings. We searched MEDLINE, CINAHL, and PsycINFO and reviewed the papers cited in the references of pertinent articles, the references cited in a recently published book on the subjective experience of dementia, one thesis, and the journal Dementia. Thirty-three pertinent articles were identified, representing 28 separate studies and 21 different research samples. Findings were coded, grouped, compared and integrated. Living with dementia is described from the stage a person discovers the memory impairment, through the stage of being diagnosed with dementia, to that of the person's attempts to integrate the impairment into everyday life. Memory loss often threatens perceptions of security, autonomy and being a meaningful member of society. At early stages of memory loss, individuals use self-protecting and self-adjusting strategies to deal with perceived changes and threats. However, the memory impairment itself may make it difficult for an individual to deal with these changes, thereby causing frustration, uncertainty and fear. Our analysis supports the integration of proactive care into the diagnostic process, because even early-stage dementia may challenge quality of life. Moreover, this care should actively involve both the individual with dementia and their family so that both parties can adjust positively

  10. Approaching target: A service for nationwide deformation monitoring in Denmark using Sentinel-1

    DEFF Research Database (Denmark)

    Fredenslund Levinsen, Joanna; Sørensen, Carlo Sass; Broge, Niels Henrik

    processes in both the public and private sectors. This will inevitably lead to significant economic savings. The test study makes up part of the foundation for establishing a nationwide service. As such, the results over the test sites will be presented to a broad range of end-users to identify their needs...... tailored to specific needs, which increases the probability of its implementation in both the public and private sectors. Presenting the results obtained on the road to setting up a nationwide deformation monitoring will clearly demonstrate the potentials arising with the continuous stream of Sentinel-1......Building upon decades of experience with deformation monitoring from repeated precision leveling and GNSS measurements as well as more recent time series analyses of ERS, Envisat, and Sentinel-1 imagery, we are now working towards a nationwide mapping using Sentinel-1 Interferometric Wide Swath...

  11. Increasing incidence of statin prescribing for the elderly without previous cardiovascular conditions:  A nation wide register study

    DEFF Research Database (Denmark)

    Kildemoes, Helle Wallach; Andersen, Morten

    Supported by the growing evidence of the beneficial effects of statins in a range of conditions, statin utilization has increased considerably in most Western countries over the last decade. Objectives To estimate to what extent a widening of indication scope for statins accounts for the increasing...... Danish statin utilization during 1996-2005, applying treatment incidence as a measure of changing prescribing behaviour Methods From three nationwide registers, we retrieved individual records on demographics, dispensed prescription drugs and hospital discharges. Danish inhabitants were followed...... for seven cardiovascular conditions, corresponding to a hierarchy of statin indications. Poisson regression analyses were applied to quantify the incidence growth, according to age and indication.  Results Treatment incidence increased from 4/1000 person years in 2000 to 17/1000 in 2005, the increase being...

  12. Gender differences in sudden cardiac death in the young-a nationwide study

    DEFF Research Database (Denmark)

    Winkel, Bo Gregers; Risgaard, Bjarke; Bjune, Thea

    2017-01-01

    Background: Hitherto, sudden cardiac death (SCD) in the young has been described with no distinction between genders. SCD occurs more often in men (SCDm) than women (SCDw), but this disparity is not understood and has not been investigated systematically in a nationwide setting. Our objective......=0.02) and died less often in a public place (16 vs. 26%, p=0.01). Age at death, ratios of autopsies and sudden unexplained deaths, and comorbidities, did not differ. Causes of SCD were largely comparable between genders. The incidence rate of SCDw was half of that of SCDm (1.8 vs. 3.6 per 100...... was to report gender differences in SCD in the young in a nationwide (Denmark) setting. Methods: All deaths in persons aged 1-35 years nationwide in Denmark between 2000 and 2009 were included. Death certificates and autopsy reports were obtained. The extensive health care registries in Denmark were used...

  13. Pain Intervention for people with Dementia in nursing homes (PID): study protocol for a quasi-experimental nurse intervention.

    Science.gov (United States)

    Koppitz, Andrea; Bosshard, Georg; Blanc, Geneviève; Hediger, Hannele; Payne, Sheila; Volken, Thomas

    2017-04-21

    It is estimated that 19 to 83% of people with dementia suffer from pain that is inadequately treated in the last months of life. A large number of healthcare workers who care for these people in nursing homes lack appropriate expertise and may therefore not always recognise, assess and treat pain in those with dementia who have complex problems on time, properly and efficiently. The aim of this intervention trial is to identify care needs of people with dementia suffering from pain living in a nursing home. A quasi-experimental nurse-led intervention trial based on a convenience sample of four nursing homes in the Swiss Canton of Zurich examines the effects on dementia patients (n = 411), the healthcare institution and the qualification level of the healthcare workers compared to historical controls, using an event analysis and a multilevel analysis. Healthcare workers will be individually trained how to assess, intervene and evaluate acute and chronic pain. There are three data-monitoring cycles (T0, T1, T2) and two intervention cycles (I1, I2) with a total study duration of 425 days. There is also a process evaluation based on Dobbins analyses that analyse in particular the potentials for change in clinical practice of change agents. The aim of the intervention trial is to improve pain management strategies in older people with dementia in nursing homes. Clinically significant findings will be expected that will help reduce suffering in the sense of "total pain" for people with dementia. The joint intra- and interdisciplinary collaboration between practice and supply-oriented (nursing) research will have both a lasting effect on the efficiency measurement and provide scientifically sound results. Nursing homes can integrate the findings from the intervention trial into their internal quality control process. The potential for improvements can be directly influenced by the nursing home itself. Registration trial number: DRKS00009726 on DRKS, registered 10

  14. Coexistence of Schizophrenia and Frontotemporal Dementia: A Case Report

    OpenAIRE

    Zafer Subasi

    2014-01-01

    With this case, it is aimed to present a patient who was followed up with a diagnosis of schizophrenia nearly 30 years, had personality and behaviour changes added to clinical course for the last 4-5 years, had diagnostic confusion and was finally diagnosed with frontotemporal dementia superimposed on schizophrenia.Neurodegenerative diseases should be considered as either differential diagnosis or coexistence in case of symptoms such as cognitive decline or personality and behavior changes oc...

  15. Measuring quality of life of people with predementia and dementia and their caregivers: a systematic review protocol

    Science.gov (United States)

    Landeiro, Filipa; Walsh, Katie; Ghinai, Isaac; Mughal, Seher; Nye, Elsbeth; Wace, Helena; Roberts, Nia; Lecomte, Pascal; Wittenberg, Raphael; Wolstenholme, Jane; Handels, Ron; Roncancio-Diaz, Emilse; Potashman, Michele H; Tockhorn-Heidenreich, Antje

    2018-01-01

    Introduction Dementia is the fastest growing major cause of disability globally and may have a profound impact on the health-related quality of life (HRQoL) of both the patient with dementia and those who care for them. This review aims to systematically identify and synthesise the measurements of HRQoL for people with, and their caregivers across the full spectrum of, dementia from its preceding stage of predementia to end of life. Methods and analysis A systematic literature review was conducted in Medical Literature Analysis and Retrieval System Online, ExcerptaMedicadataBASE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effect, National Health Service Economic Evaluation Database and PsycINFO between January 1990 and the end of April 2017. Two reviewers will independently assess each study for inclusion and disagreements will be resolved by a third reviewer. Data will be extracted using a predefined data extraction form following best practice. Study quality will be assessed with the Effective Public Health Practice Project quality assessment tool. HRQoL measurements will be presented separately for people with dementia and caregivers by instrument used and, when possible, HRQoL will be reported by disease type and stage of the disease. Descriptive statistics of the results will be provided. A narrative synthesis of studies will also be provided discussing differences in HRQoL measurements by instrument used to estimate it, type of dementia and disease severity. Ethics and dissemination This systematic literature review is exempt from ethics approval because the work is carried out on published documents. The findings of the review will be disseminated in a related peer-reviewed journal and presented at conferences. They will also contribute to the work developed in the Real World Outcomes across the Alzheimer’s disease spectrum for better care: multimodal data access platform

  16. A nationwide survey of factors influencing adherence to ocular hypotensive eyedrops in Japan.

    Science.gov (United States)

    Tsumura, Toyoaki; Kashiwagi, Kenji; Suzuki, Yasuyuki; Yoshikawa, Keiji; Suzumura, Hirotaka; Maeda, Toshine; Takeda, Ryuji; Saito, Hitomi; Araie, Makoto

    2018-01-12

    Few reports have investigated the status of adherence in Japan on a large scale. We aimed to investigate the status of adherence to topical glaucoma treatment and its associated factors. A nationwide survey was conducted as a prospective fashion. Participants in this survey were subjects with primary open-angle glaucoma, normal-tension glaucoma, or ocular hypertension or pseudoexfoliation glaucoma who had been prescribed anti-glaucoma ophthalmic eyedrops and whose ophthalmologist considered prescribing any fixed combination of ocular hypotensive eyedrops for the first time between 2011 and 2012. Subjects and their attending ophthalmologists independently completed a questionnaire by utilizing a fixed combination of ocular hypotensive eyedrops. A total of 1358 ophthalmologists from 1071 medical institutions participated in this survey. We registered 4430 subjects (2049 males and 2381 females). In total, data from 3853 subjects (87.6%) were analyzed after inclusion of subjects based on inclusion and exclusion criteria. Good adherence was defined as not forgetting instillation during the past week. Rates of good adherence reported by subjects and ophthalmologists were 72.4 and 78.5%, respectively (P < 0.0001). The consistency of adherence evaluation between subjects and ophthalmologists was moderate [kappa score 0.5025 (95% confidence interval 0.4740-0.5309)]. Significant factors associated with adherence were size of clinic, age, gender, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge of glaucoma. Adherence to ocular hypotensive eyedrops among Japanese subjects was relatively good. Concordance of adherence between subjects' reports and ophthalmologists' responses was moderate. Size of clinic, number of types of ocular hypotensive eyedrops, ease of instillation, preferred number of eyedrops, preferred frequency of instillation of eyedrops, and knowledge

  17. Integrating medical humanities into a pharmaceutical care seminar on dementia.

    Science.gov (United States)

    Zimmermann, Martina

    2013-02-12

    Objective. To design, integrate, and assess the effectiveness of a medical humanities teaching module that focuses on pharmaceutical care for dementia patients.Design. Visual and textual dementia narratives were presented using a combination of teacher and learner-centered approaches with the aim being to highlight patients' and caregivers' needs for empathy and counselling.Assessment. As gauged from pre- and post-experience questionnaires, students highly rated this approach to teaching medical humanities. In-class presentations demonstrated students' increased sensitivity to patient and caregiver needs, while objective learning outcomes demonstrated students' increased knowledge and awareness.Conclusions. Pharmacy students were open to and successfully learned from reading and discussing patient and caregiver narratives, which furthers the discussion on the value of integrating the medical humanities into the curricula of pharmacy and other health sciences.

  18. A nationwide study of the association between celiac disease and the risk of autistic spectrum disorders.

    Science.gov (United States)

    Ludvigsson, Jonas F; Reichenberg, Abraham; Hultman, Christina M; Murray, Joseph A

    2013-11-01

    Most case reports suggest an association between autistic spectrum disorders (ASDs) and celiac disease (CD) or positive CD serologic test results, but larger studies are contradictory. To examine the association between ASDs and CD according to small intestinal histopathologic findings. Nationwide case-control study in Sweden. Through 28 Swedish biopsy registers, we collected data about 26,995 individuals with CD (equal to villous atrophy, Marsh stage 3), 12,304 individuals with inflammation (Marsh stages 1-2), and 3719 individuals with normal mucosa (Marsh stage 0) but positive CD serologic test results (IgA/IgG gliadin, endomysium, or tissue transglutaminase) and compared them with 213,208 age- and sex-matched controls. Conditional logistic regression estimated odds ratios (ORs) for having a prior diagnosis of an ASD according to the Swedish National Patient Register. In another analysis, we used the Cox proportional hazards regression model to estimate hazard ratios (HRs) for future ASDs in individuals undergoing small intestinal biopsy. A prior ASD was not associated with CD (OR, 0.93; 95% CI, 0.51-1.68) or inflammation (OR 1.03; 95% CI, 0.40-2.64) but was associated with a markedly increased risk of having a normal mucosa but a positive CD serologic test result (OR, 4.57; 95% CI, 1.58-13.22). Restricting our data to individuals without a diagnosis of an ASD at the time of biopsy, CD (HR, 1.39; 95% CI, 1.13-1.71) and inflammation (HR, 2.01; 95% CI, 1.29-3.13) were both associated with moderate excess risks of later ASDs, whereas the HR for later ASDs in individuals with normal mucosa but positive CD serologic test results was 3.09 (95% CI, 1.99-4.80). Although this study found no association between CD or inflammation and earlier ASDs, there was a markedly increased risk of ASDs in individuals with normal mucosa but a positive CD serologic test result.

  19. Dance movement therapy for dementia.

    Science.gov (United States)

    Karkou, Vicky; Meekums, Bonnie

    2017-02-03

    Dementia is a collective name for different degenerative brain syndromes which, according to Alzheimer's Disease International, affects approximately 35.6 million people worldwide. The latest NICE guideline for dementia highlights the value of diverse treatment options for the different stages and symptoms of dementia including non-pharmacological treatments. Relevant literature also argues for the value of interventions that acknowledge the complexity of the condition and address the person as a whole, including their physical, emotional, social and cognitive processes. At the same time, there is growing literature that highlights the capacity of the arts and embodied practices to address this complexity. Dance movement therapy is an embodied psychological intervention that can address complexity and thus, may be useful for people with dementia, but its effectiveness remains unclear. To assess the effects of dance movement therapy on behavioural, social, cognitive and emotional symptoms of people with dementia in comparison to no treatment, standard care or any other treatment. Also, to compare different forms of dance movement therapy (e.g. Laban-based dance movement therapy, Chacian dance movement therapy or Authentic Movement). Searches took place up to March 2016 through ALOIS, Cochrane Dementia and Cognitive Improvement's Specialized Register, which covers CENTRAL, a number of major healthcare databases and trial registers, and grey literature sources. We checked bibliographies of relevant studies and reviews, and contacted professional associations, educational programmes and experts from around the world. We considered randomised controlled trials (RCTs) in any language, including cross-over design and cluster-RCTs for inclusion. Studies considered had to include people with dementia, in any age group and in any setting, with interventions delivered by a dance movement therapy practitioner who (i) had received formal training (ii) was a dance movement

  20. Everyday ethical problems in dementia care: a teleological model.

    Science.gov (United States)

    Bolmsjö, Ingrid Agren; Edberg, Anna-Karin; Sandman, Lars

    2006-07-01

    In this article, a teleological model for analysis of everyday ethical situations in dementia care is used to analyse and clarify perennial ethical problems in nursing home care for persons with dementia. This is done with the aim of describing how such a model could be useful in a concrete care context. The model was developed by Sandman and is based on four aspects: the goal; ethical side-constraints to what can be done to realize such a goal; structural constraints; and nurses' ethical competency. The model contains the following main steps: identifying and describing the normative situation; identifying and describing the different possible alternatives; assessing and evaluating the different alternatives; and deciding on, implementing and evaluating the chosen alternative. Three ethically difficult situations from dementia care were used for the application of the model. The model proved useful for the analysis of nurses' everyday ethical dilemmas and will be further explored to evaluate how well it can serve as a tool to identify and handle problems that arise in nursing care.

  1. [Resilience in caregivers of patients with dementia: A preliminary study].

    Science.gov (United States)

    Fernández-Lansac, Violeta; Crespo López, María; Cáceres, Rebeca; Rodríguez-Poyo, María

    2012-01-01

    Caring for a relative with dementia often has negative effects on the caregiver's physical and psychological health. However, many caregivers successfully cope with the stress factors arising from care, and even have uplifts during their experience, showing high resilience levels. This study presents a preliminary analysis of resilience in caregivers of patients with dementia, exploring its relationship with different variables. Resilience was assessed (by CD-RISC) in 53 family caregivers of patients with dementia. Resilience was correlated to the following variables: caregiving context, stressors (e.g., cognitive impairment), appraisals (e.g., burden), moderators (e.g., personality traits and resources), and caregiving consequences (physical and psychological health). The participants showed moderate scores on resilience. Resilience was associated with poor emotional and physical status (significant inverse correlations with anxiety, depression, psycho-active drug use, health habits…). High resilience scores were significantly correlated to burden, neuroticism and extraversion, self-efficacy, self-esteem and less use of emotion focused coping strategies. Higher resilience relates to a good emotional and physical status in caregivers. Moreover, resilience is more associated with caregiver variables (e.g., appraisal and coping with care, personality features), than to situational variables. The data highlight the strengthening of these types of appraisal and coping as a way to improve caregivers' resilience and, consequently, their health. Copyright © 2011 SEGG. Published by Elsevier Espana. All rights reserved.

  2. A dementia care management intervention: which components improve quality?

    Science.gov (United States)

    Chodosh, Joshua; Pearson, Marjorie L; Connor, Karen I; Vassar, Stefanie D; Kaisey, Marwa; Lee, Martin L; Vickrey, Barbara G

    2012-02-01

    To analyze whether types of providers and frequency of encounters are associated with higher quality of care within a coordinated dementia care management (CM) program for patients and caregivers. Secondary analysis of intervention-arm data from a dementia CM cluster-randomized trial, where intervention participants interacted with healthcare organization care managers (HOCMs), community agency care managers (CACMs), and/ or healthcare organization primary care providers (HOPCPs) over 18 months. Encounters of 238 patient/caregivers (dyads) with HOCMs, CACMs, and HOPCPs were abstracted from care management electronic records. The quality domains of assessment, treatment, education/support, and safety were measured from medical record abstractions and caregiver surveys. Mean percentages of met quality indicators associated with exposures to each provider type and frequency were analyzed using multivariable regression, adjusting for participant characteristics and baseline quality. As anticipated, for all 4 domains, the mean percentage of met dementia quality indicators was 15.5 to 47.2 percentage points higher for dyads with HOCM--only exposure than for dyads with none (all P < .008); not anticipated were higher mean percentages with increasing combinations of provider-type exposure-up to 73.7 percentage points higher for safety (95% confidence interval 65.2%-82.1%) with exposure to all 3 provider types compared with no exposure. While greater frequency of HOCM-dyad encounters was associated with higher quality (P < .04), this was not so for other provider types. HOCMs' interactions with dyads was essential for dementia care quality improvement. Additional coordinated interactions with primary care and community agency staff yielded even higher quality.

  3. The VOICE study - A before and after study of a dementia communication skills training course.

    Science.gov (United States)

    O'Brien, Rebecca; Goldberg, Sarah E; Pilnick, Alison; Beeke, Suzanne; Schneider, Justine; Sartain, Kate; Thomson, Louise; Murray, Megan; Baxendale, Bryn; Harwood, Rowan H

    2018-01-01

    A quarter of acute hospital beds are occupied by persons living with dementia, many of whom have communication problems. Healthcare professionals lack confidence in dementia communication skills, but there are no evidence-based communication skills training approaches appropriate for professionals working in this context. We aimed to develop and pilot a dementia communication skills training course that was acceptable and useful to healthcare professionals, hospital patients and their relatives. The course was developed using conversation analytic findings from video recordings of healthcare professionals talking to patients living with dementia in the acute hospital, together with systematic review evidence of dementia communication skills training and taking account of expert and service-user opinion. The two-day course was based on experiential learning theory, and included simulation and video workshops, reflective diaries and didactic teaching. Actors were trained to portray patients living with dementia for the simulation exercises. Six courses were run between January and May 2017. 44/45 healthcare professionals attended both days of the course. Evaluation entailed: questionnaires on confidence in dementia communication; a dementia communication knowledge test; and participants' satisfaction. Video-recorded, simulated assessments were used to measure changes in communication behaviour. Healthcare professionals increased their knowledge of dementia communication (mean improvement 1.5/10; 95% confidence interval 1.0-2.0; pskills learned in clinical practice. Blind-ratings of simulated patient encounters demonstrated behaviour change in taught communication behaviours to close an encounter, consistent with the training, but not in requesting behaviours. We have developed an innovative, evidence-based dementia communication skills training course which healthcare professionals found useful and after which they demonstrated improved dementia communication

  4. 77 FR 10183 - Reissuance of Nationwide Permits

    Science.gov (United States)

    2012-02-21

    ... Civil Works Program (Engineer Circular 1165- 2-211). The current Engineer Circular applies to Corps..., Corps of Engineers Reissuance of Nationwide Permits; Notice #0;#0;Federal Register / Vol. 77 , No. 34..., Corps of Engineers RIN 0710-AA71 Reissuance of Nationwide Permits AGENCY: Army Corps of Engineers, DoD...

  5. [A case of multiple cavernous angioma with dementia].

    Science.gov (United States)

    Kariya, S; Kawahara, M; Suzumura, A

    2000-10-01

    We reported a 65-year-old man who developed dementia since 50 years of age. His consciousness was clear but he was indifferent to his illness. Also, the luck of attention was recognized when we underwent examinations and the result of intellectual test varied every time we performed. His memory function was almost normal on the examination which was performed when he was cooperative. Magnetic resonance imaging (MRI) disclosed multiple tiny lesions (more than 130 in all) in cerebrum, brainstem, cerebellum and spinal cord. These lesions were compatible with multiple cavernous angioma. Most of lesions manifested high-density area on cranial CT. Though the multiplicity of foci indicated the possibility of familial occurrence, he was considered to be a sporadic case on his lineage investigation and the brain MRI of his only son. In this case, neither headache nor seizures which were known as the major clinical features of intracerebral cavernous angioma was observed. He was diagnosed as having white matter dementia characterized by attentional dysfunction, decrement of volition and less memory disturbance. We speculated that he developed symptomatic dementia by the sum of multiple minor degeneration, especially in frontal lobe white matter, caused by repeated minor bleeding from cavernous angiomas.

  6. Cancer risk in patients with alopecia areata: a nationwide population-based matched cohort study.

    Science.gov (United States)

    Chen, Chih-Chiang; Chang, Yun-Ting; Liu, Han-Nan; Chen, Yi-Ju

    2018-05-01

    Alopecia areata (AA) is an organ-specific autoimmune disorder. Defective immune system related disorders are prone to increase the risk of cancer formation. However, the association among AA and variety of cancer types had never been studied. A nationwide population-based matched cohort study was conducted to evaluate the cancer risk in patients with AA. Records from Taiwan National Health Insurance Research Database were analyzed. Cases of AA from 1997 to 2013 and cancers registered in the catastrophic illness profile from the same time period were collected. The standard incidence ratio (SIR) of each cancer was calculated. In total, 2099 cancers among 162,499 patients with AA and without prior cancers were identified. The overall cancer risks in AA patients were slightly decreased, especially among male subjects (SIR: 0.89). Refer to individual cancer, the cancer risk of nonmelanoma skin cancer (NMSC) (SIR: 0.59), upper GI cancer (SIR: 0.70), liver cancer (SIR: 0.82), uterine, and cervix cancer (SIR: 0.84) were significantly lower in patients with AA. In contrast, AA patients were inclined to have lymphoma, breast cancer, kidney, and urinary bladder cancer with the SIR of 1.55, 2.93, and 2.95, respectively. Age stratified analyses revealed female AA patients younger than 50 years old have even higher risk of breast cancer (SIR: 3.37). Further sensitivity analysis showed similar results after excluding major autoimmune disorders. Cancer risk in AA patients is organ specific, and it is not associated with the underlying autoimmune disorders in patients with AA. © 2018 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

  7. Incidence of ovarian cancer after hysterectomy: a nationwide controlled follow up.

    Science.gov (United States)

    Loft, A; Lidegaard, O; Tabor, A

    1997-11-01

    To estimate the risk of developing ovarian cancer after abdominal (total or subtotal) hysterectomy on benign indication. Prospective historical cohort study with 12.5 years of follow up. Denmark, nationwide. All Danish women (aged 0 to 99 years) having undergone hysterectomy with conservation of at least one ovary for a benign indication from 1977 to 1981 (n = 22,135). Follow up was conducted from 1977 to 1991. The reference group included all Danish women who had not undergone hysterectomy, age-standardised according to the hysterectomy group (n = 2,554,872). Registry data derived from the Danish National Register of Patients (diagnoses and operation codes) and the Civil Registration System (information about general population, including time of death). Incidence rate of ovarian cancer, lifetime risk of ovarian cancer, relative risk of ovarian cancer. Seventy-one women developed ovarian cancer on average 7.0 years after hysterectomy and 10,659 women in the reference group had ovarian cancer diagnosed after on average 6.4 years. The incidence rate of ovarian cancer was 0.27 per 1000 person-years in the group that had undergone hysterectomy and 0.34 per 1000 person-years in the general population (age-standardised). The extrapolated lifetime risk of developing ovarian cancer was 2.1% after hysterectomy and 2.7% in the general population (RR 0.78; 95% CI 0.60-0.96). The risk of ovarian cancer is lower among women who have undergone hysterectomy compared with those who have not. The protection seems to decrease with time.

  8. Fractures in Individuals With and Without a History of Infantile Autism. A Danish Register Study Based on Hospital Discharge Diagnoses

    DEFF Research Database (Denmark)

    Mouridsen, Svend-Erik; Rich, Bente; Isager, Torben

    2012-01-01

    observation time was 30.3 years (range 27.3-30.4 years), and mean age at follow-up was 42.7 years (range 27.3-57.3 years). Of the 118 individuals with IA, 14 (11.9%) were registered with at least one fracture diagnosis against 83 (24.7%) in the comparison group (p = 0.004; OR = 0.41; 95%CI 0......We compared the prevalence and types of fractures in a clinical sample of 118 individuals diagnosed as children with infantile autism (IA) with 336 matched controls from the general population. All participants were screened through the nationwide Danish National Hospital Register. The average.......22-0.76), but the nature of their fractures seems somewhat different. Epilepsy was a risk factor, but only in the comparison group. Our results lend no support to the notion that fracture is a common comorbid condition in a population of people diagnosed with IA as children....

  9. Higher education is associated with a lower risk of dementia after a stroke or TIA : The Rotterdam study

    NARCIS (Netherlands)

    S.S. Mirza (Saira); M.L.P. Portegies (Marileen); F.J. Wolters (Frank J.); A. Hofman (Albert); P.J. Koudstaal (Peter Jan); H.W. Tiemeier (Henning); M.A. Ikram (Arfan)

    2016-01-01

    markdownabstract__Background:__ Higher education is associated with a lower risk of dementia, possibly because of a higher tolerance to subclinical neurodegenerative pathology. Whether higher education also protects against dementia after clinical stroke or transient ischemic attack (TIA) remains

  10. Exploring the Impact of a Culturally Tailored Short Film in Modifying Dementia Stigma Among Chinese Americans: A Pilot Study.

    Science.gov (United States)

    Zheng, Xin; Chung, Jamie O P; Woo, Benjamin K P

    2016-04-01

    Chinese Americans, one of the fastest growing ethnic groups among the US elderly population, perceive high levels of dementia stigma. The authors examined the extent of the stigma and explored the impact of media through a culturally tailored short film to modify dementia stigma. Chinese American participants were asked to answer a dementia questionnaire. A short film was then used to address the impact of media on dementia stigma. Among 90 randomly selected participants, 89% (n = 80) found the short film to be a useful way to modify their misconceptions about dementia. In the comparison between the group who felt less influenced by the short film and the group who recognized the short film to be extremely helpful, the latter group had a higher baseline of stigma toward dementia, as well as a shorter duration of residence in the USA. Chinese Americans still perceive severe dementia stigma. Nevertheless, a culturally tailored short film demonstrated promising impact in modifying stigma toward dementia.

  11. Dementia: Diagnosis and Tests

    Science.gov (United States)

    ... our e-newsletter! Aging & Health A to Z Dementia Diagnosis & Tests If you or someone you care ... To determine whether an older adult might have dementia, a healthcare professional will: Ask about the person’s ...

  12. Preferences regarding disclosure of a diagnosis of dementia: a systematic review

    NARCIS (Netherlands)

    van den Dungen, P.; van Kuijk, L.; van Marwijk, H.W.J.; van der Wouden, J.C.; van Charante, E.M.; van der Horst, H.E.; van Hout, H.P.J.

    2014-01-01

    Background: Studies in memory clinics suggest that the majority of patients would like to know of a diagnosis of dementia. It is less clear what preferences are in the community. Our objective was to review the literature on preferences regarding disclosure of a diagnosis of dementia and to assess

  13. Preferences regarding disclosure of a diagnosis of dementia: a systematic review

    NARCIS (Netherlands)

    van den Dungen, Pim; van Kuijk, Lisa; van Marwijk, Harm; van der Wouden, Johannes; Moll van Charante, Eric; van der Horst, Henriette; van Hout, Hein

    2014-01-01

    Studies in memory clinics suggest that the majority of patients would like to know of a diagnosis of dementia. It is less clear what preferences are in the community. Our objective was to review the literature on preferences regarding disclosure of a diagnosis of dementia and to assess key arguments

  14. A clinical study on the usefulness of CT and MRI imaging in evaluating differential diagnosis and the degree of dementia in vascular dementia

    Energy Technology Data Exchange (ETDEWEB)

    Hagiwara, Mariko [Nippon Medical School, Tokyo (Japan)

    1990-06-01

    In a retrospective review of 117 computed tomography (CT) scans and 56 magnetic resonance imaging (MRI) scans sequentially performed for dementia patients, CT and MRI were compared for assessment of the usefulness in the differential diagnosis and determination of the functional prognosis of vascular dementia. The correlation between CT findings and the degree of mental function was also examined. Since MRI had a higher sensitivity than CT in detecting small infarcts or lacunaes in the perforating area or white matter, it should differentiate vascular dementia from dementia of Alzheimer type. When both dementia of Alzheimer type was clinically diagnosed and infarct areas were detected on either CT or MRI, activity of daily living tended to be poor. Even when mixed type of dementia or vascular dementia was clinically diagnosed in spite of negative findings on either CT or MRI, troublesome behavior was frequently observed, posing the likelihood of dementia of Alzheimer type. The ability of CT and MRI to detect lesions was not correlated with the degree of dementia or aging, even if MRI was capable of detecting smaller lesions. CT was thus considered to be more specific modality for evaluating mental function. The size of lesions on CT was found to be more significant than the number and localization of lesions in determining the degree of dementia in the chronic stage of cerebrovascular disease. The ability of MRI to detect smaller lesions, as well as clinically determined ischemic scores, may assist in the diagnostic differentiation. Lesion size on CT may be an important factor for determining the degree of dementia and functional prognosis. (N.K.).

  15. A clinical study on the usefulness of CT and MRI imaging in evaluating differential diagnosis and the degree of dementia in vascular dementia

    International Nuclear Information System (INIS)

    Hagiwara, Mariko

    1990-01-01

    In a retrospective review of 117 computed tomography (CT) scans and 56 magnetic resonance imaging (MRI) scans sequentially performed for dementia patients, CT and MRI were compared for assessment of the usefulness in the differential diagnosis and determination of the functional prognosis of vascular dementia. The correlation between CT findings and the degree of mental function was also examined. Since MRI had a higher sensitivity than CT in detecting small infarcts or lacunaes in the perforating area or white matter, it should differentiate vascular dementia from dementia of Alzheimer type. When both dementia of Alzheimer type was clinically diagnosed and infarct areas were detected on either CT or MRI, activity of daily living tended to be poor. Even when mixed type of dementia or vascular dementia was clinically diagnosed in spite of negative findings on either CT or MRI, troublesome behavior was frequently observed, posing the likelihood of dementia of Alzheimer type. The ability of CT and MRI to detect lesions was not correlated with the degree of dementia or aging, even if MRI was capable of detecting smaller lesions. CT was thus considered to be more specific modality for evaluating mental function. The size of lesions on CT was found to be more significant than the number and localization of lesions in determining the degree of dementia in the chronic stage of cerebrovascular disease. The ability of MRI to detect smaller lesions, as well as clinically determined ischemic scores, may assist in the diagnostic differentiation. Lesion size on CT may be an important factor for determining the degree of dementia and functional prognosis. (N.K.)

  16. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial

    Science.gov (United States)

    2012-01-01

    Background The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursing-home dementia care. Methods/Design The study is a cluster-randomised controlled trial, with nursing homes grouped in clusters. Studywise minimisation is the allocation method. Nursing homes in the intervention group will receive a dementia-care-mapping intervention, while the control group will receive usual care. The primary outcome measure is resident agitation, to be assessed with the Cohen-Mansfield Agitation Inventory. The secondary outcomes are resident neuropsychiatric symptoms, assessed with the Neuropsychiatric Inventory - Nursing Homes and quality of life, assessed with Qualidem and the EQ-5D. The staff outcomes are stress reactions, job satisfaction and job-stress-related absenteeism, and staff turnover rate, assessed with the Questionnaire about Experience and Assessment of Work, the General Health Questionnaire-12, and the Maastricht Job Satisfaction Scale for Health Care, respectively. We will collect the data from the questionnaires and electronic registration systems. We will employ linear mixed-effect models and cost-effectiveness analyses to evaluate the outcomes. We will use structural equation modelling in the secondary analysis to evaluate the plausibility of a theoretical model regarding the effectiveness of the dementia-care mapping intervention. We will set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementia-care mapping broadly. Discussion A novelty of dementia-care mapping is that it offers an integral person

  17. Improving person-centred care in nursing homes through dementia-care mapping: design of a cluster-randomised controlled trial

    Directory of Open Access Journals (Sweden)

    van de Ven Geertje

    2012-01-01

    Full Text Available Abstract Background The effectiveness and efficiency of nursing-home dementia care are suboptimal: there are high rates of neuropsychiatric symptoms among the residents and work-related stress among the staff. Dementia-care mapping is a person-centred care method that may alleviate both the resident and the staff problems. The main objective of this study is to evaluate the effectiveness and cost-effectiveness of dementia-care mapping in nursing-home dementia care. Methods/Design The study is a cluster-randomised controlled trial, with nursing homes grouped in clusters. Studywise minimisation is the allocation method. Nursing homes in the intervention group will receive a dementia-care-mapping intervention, while the control group will receive usual care. The primary outcome measure is resident agitation, to be assessed with the Cohen-Mansfield Agitation Inventory. The secondary outcomes are resident neuropsychiatric symptoms, assessed with the Neuropsychiatric Inventory - Nursing Homes and quality of life, assessed with Qualidem and the EQ-5D. The staff outcomes are stress reactions, job satisfaction and job-stress-related absenteeism, and staff turnover rate, assessed with the Questionnaire about Experience and Assessment of Work, the General Health Questionnaire-12, and the Maastricht Job Satisfaction Scale for Health Care, respectively. We will collect the data from the questionnaires and electronic registration systems. We will employ linear mixed-effect models and cost-effectiveness analyses to evaluate the outcomes. We will use structural equation modelling in the secondary analysis to evaluate the plausibility of a theoretical model regarding the effectiveness of the dementia-care mapping intervention. We will set up process analyses, including focus groups with staff, to determine the relevant facilitators of and barriers to implementing dementia-care mapping broadly. Discussion A novelty of dementia-care mapping is that it offers an

  18. Features of the Japanese national dementia strategy in comparison with international dementia policies: How should a national dementia policy interact with the public health- and social-care systems?

    Science.gov (United States)

    Nakanishi, Miharu; Nakashima, Taeko

    2014-07-01

    The Ministry of Health, Labour, and Welfare of the Japanese national government announced a "Five-Year Plan for Promotion of Measures Against Dementia (Orange Plan)" in September 2012. This article described features of the Japanese dementia strategy in comparison with international dementia policies. An international comparative study was implemented on national dementia policies to seek suggestions for Japanese national strategy. The study consisted of a bibliographical survey, a field survey, and an online case vignette survey in several countries. The Japanese health- and social-care system had multiple access points in the dementia care pathway, as did Australia, France, South Korea, and the Netherlands. Contrary to Japan, a simplified access point was observed in Denmark, England, and Sweden. The Orange Plan aimed to establish specific health-care services, social-care services, and the coordination of agencies for persons with dementia. However, fragmentation remains in the dementia care pathway. The national government should examine fundamental revisions in health, social-care services, and advocacy in joint initiatives with Alzheimer's Association Japan to improve the national dementia strategy. Copyright © 2014 The Alzheimer's Association. Published by Elsevier Inc. All rights reserved.

  19. Frontotemporal Dementia Complicated by Comorbid Borderline Personality Disorder: A Case Report

    OpenAIRE

    Salzbrenner, LCDR Stephen; Brown, Jaime; Hart, Gavin; Dettmer, Ens Jonathan; Williams, LT Raquel; Ormeno, LT Monica; O’Neal, LCDR Ethel; Shippy, LT Jennifer

    2009-01-01

    Frontotemporal dementia is the fourth most common cause of dementia in the United States and characteristically presents with an early decline in social conduct, impaired regulation of interpersonal conduct, emotional blunting, and general loss of insight, with relative preservation of memory. This a case of frontotemporal dementia in a 46-year-old woman who presented with existing diagnoses of borderline personality disorder and major depressive disorder. She had been repeatedly evaluated fo...

  20. BMI and risk of dementia in two million people over two decades: a retrospective cohort study.

    Science.gov (United States)

    Qizilbash, Nawab; Gregson, John; Johnson, Michelle E; Pearce, Neil; Douglas, Ian; Wing, Kevin; Evans, Stephen J W; Pocock, Stuart J

    2015-06-01

    Dementia and obesity are increasingly important public health issues. Obesity in middle age has been proposed to lead to dementia in old age. We investigated the association between BMI and risk of dementia. For this retrospective cohort study, we used a cohort of 1,958,191 individuals derived from the United Kingdom Clinical Practice Research Datalink (CPRD) which included people aged 40 years or older in whom BMI was recorded between 1992 and 2007. Follow-up was until the practice's final data collection date, patient death or transfer out of practice, or first record of dementia (whichever occurred first). People with a previous record of dementia were excluded. We used Poisson regression to calculate incidence rates of dementia for each BMI category. Our cohort of 1,958,191 people from UK general practices had a median age at baseline of 55 years (IQR 45-66) and a median follow-up of 9·1 years (IQR 6·3-12·6). Dementia occurred in 45,507 people, at a rate of 2·4 cases per 1000 person-years. Compared with people of a healthy weight, underweight people (BMI risk of dementia. Furthermore, the incidence of dementia continued to fall for every increasing BMI category, with very obese people (BMI >40 kg/m(2)) having a 29% lower (95% CI 22-36) dementia risk than people of a healthy weight. These patterns persisted throughout two decades of follow-up, after adjustment for potential confounders and allowance for the J-shape association of BMI with mortality. Being underweight in middle age and old age carries an increased risk of dementia over two decades. Our results contradict the hypothesis that obesity in middle age could increase the risk of dementia in old age. The reasons for and public health consequences of these findings need further investigation. None. Copyright © 2015 Elsevier Ltd. All rights reserved.

  1. Family Aggregation and Risk Factors in Phobic Disorders over Three-Generations in a Nation-Wide Study.

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Steinhausen

    Full Text Available This nation-wide register-based study investigated how often phobic disorders (PHO and co-morbid disorders occur in affected families compared to control families. Furthermore, the study addressed the impact of sex, year of birth, and degree of urbanization in terms of risk factors.A total of N = 746 child and adolescent psychiatric participants born between 1969 and 1986 and registered in the Danish Psychiatric Central Research Register (DPCRR with a diagnosis of a mental disorder before the age of 18, and developed PHO at some point during their life-time until a maximum age of 40 years were included. In addition, N = 2229 controls without any diagnosis of mental disorders before age 18 and that were matched for age, sex, and residential region were included. Diagnoses of mental disorders were also obtained from the first- degree relatives as a part of the Danish Three Generation Study (3GS. A family load component was obtained by using various mixed regression models.PHO occurred significantly more often in case than in control families, in particular, in mothers and siblings. Substance use disorders (SUD, Depressive disorders (DEP, anxiety disorders (ANX and personality disorders (PERS in the family were significantly associated with specific phobia in the case-probands. After controlling for various mental disorders comorbid to PHO it was found that some of the family transmission could be caused by various other mental disorders in family members rather than the PHO itself. Female sex and more recent year of birth were further risk factors while region of residence was not related to the manifestation of PHO. Case-relatives did not develop PHO earlier than control relatives. After adjusting for various additional explanatory variables, the family load explained only 0.0013% of the variance in the manifestation of PHO in the case-probands.These findings, based on a very large and representative dataset, provide evidence for the family

  2. The nursing staff's opinion of falls among older persons with dementia. a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Slaasletten Randi

    2011-06-01

    Full Text Available Abstract The aim of this study was to describe the nursing staff's opinion of caring for older persons with dementia with the focus on causes of falls, fall-preventing interventions, routines of documentation and report and the nursing staff's experiences and reactions when fall incidents occur. A further aim was to compare these areas between registered nurses (RNs and enrolled nurses (ENs and staff with ≤5 and >5 years of employment in the care units in question. Background Falls are common among older people and persons with dementia constitute an additional risk group. Methods The study had a cross-sectional design and included nursing staff (n = 63, response rate 66% working in four special care units for older persons with dementia. Data collection was conducted with a questionnaire consisting of 64 questions. Results The respondents reported that the individuals' mental and physical impairment constitute the most frequent causes of falls. The findings also revealed a lack of, or uncertainty about, routines of documentation and reporting fall-risk and fall-preventing interventions. Respondents who had been employed in the care units more than five years reported to a higher degree that colours and material on floors caused falls. RNs considered the residents' autonomy and freedom of movement as a cause of falls to a significantly higher degree than ENs. RNs also reported a significantly longer time than ENs before fall incidents were discovered, and they used conversation and closeness as fall-preventing interventions to a significantly higher degree than ENs. Conclusions Individual factors were the most common causes to falls according to the nursing staff. RNs used closeness and dialog as interventions to a significantly higher degree to prevent falls than ENs. Caring of for older people with dementia consisted of a comprehensive on-going assessment by the nursing staff to balance the residents' autonomy-versus-control to minimise fall

  3. A Descriptive Study of Registers Found in Spoken and Written Communication (A Semantic Analysis

    Directory of Open Access Journals (Sweden)

    Nurul Hidayah

    2016-07-01

    Full Text Available This research is descriptive study of registers found in spoken and written communication. The type of this research is Descriptive Qualitative Research. In this research, the data of the study is register in spoken and written communication that are found in a book entitled "Communicating! Theory and Practice" and from internet. The data can be in the forms of words, phrases and abbreviation. In relation with method of collection data, the writer uses the library method as her instrument. The writer relates it to the study of register in spoken and written communication. The technique of analyzing the data using descriptive method. The types of register in this term will be separated into formal register and informal register, and identify the meaning of register.

  4. Cumulative dosages of antipsychotic drugs are associated with increased mortality rate in patients with Alzheimer's dementia

    DEFF Research Database (Denmark)

    Nielsen, R E; Lolk, A; Valentin, J B

    2016-01-01

    OBJECTIVE: We wished to investigate the effects of cumulative dosages of antipsychotic drug in Alzheimer's dementia, when controlling for known risk factors, including current antipsychotic exposure, on all-cause mortality. METHOD: We utilized a nationwide, population-based, retrospective cohort...... study design with mortality as outcome in individual patients diagnosed with Alzheimer's dementia. RESULTS: We included a total of 45 894 patients and followed them for 3 803 996 person-years in total, presenting 27 894 deaths in the study population. Cumulative antipsychotic exposure increased...... or equal to 730 DDDs: HR 1.06, 95% CI (0.95-1.18), P = 0.322, when controlling for proxy markers of severity, somatic and mental comorbid disorders. CONCLUSION: In this nationwide cohort study of 45 894 patients diagnosed with Alzheimer's dementia, we found that cumulative dosages of antipsychotic drugs...

  5. Predictors of recurrence in affective disorder. A case register study

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Andersen, Per Kragh; Mortensen, P.B.

    1998-01-01

    BACKGROUND: The risk of recurrence in affective disorder is affected by socio-demographic variables such as gender, age at onset and marital status and by illness related factors as the length of previous episodes and the total duration of the illness. The present study investigated how the effect...... of these variables changed with the progression of the illness. METHOD: Using survival analysis, the risk of recurrence was estimated in a case register study including all hospital admissions with primary affective disorder in Denmark during 1971-1993. RESULTS: Totally, 20350 first admission patients had been...... disorder socio-demographic variables such as gender, age at onset and marital status act as risk factors for further recurrence. Later, however, the illness itself seem to follow its own rhythm regardless of prior predictors. LIMITATION: The data relate to re-admissions rather than recurrence...

  6. Cognitive impairment of dementias

    OpenAIRE

    Medina, L. D.; Rodríguez-Agudelo, Yaneth

    2012-01-01

    Dementia is a clinical syndrome characterized by a loss of cognitive and emotional abilities of sufficient severity to infer with social or occupational functioning, or both. Although the causes of dementia and characteristics are not always fully understood, it is understood that it is not a natural part of aging. Definitive diagnosis of dementia is made only through the autopsy and although the diagnosis of probable or possible dementia is complex is achieved by the intervention of several ...

  7. Celiac Disease and Anorexia Nervosa: A Nationwide Study.

    Science.gov (United States)

    Mårild, Karl; Størdal, Ketil; Bulik, Cynthia M; Rewers, Marian; Ekbom, Anders; Liu, Edwin; Ludvigsson, Jonas F

    2017-05-01

    Previous research suggests an association of celiac disease (CD) with anorexia nervosa (AN), but data are mostly limited to case reports. We aimed to determine whether CD is associated with the diagnosis of AN. Register-based cohort and case-control study including women with CD ( n = 17 959) and sex- and age-matched population-based controls ( n = 89 379). CD (villous atrophy) was identified through the histopathology records of Sweden's 28 pathology departments. Inpatient and hospital-based outpatient records were used to identify AN. Hazard ratios for incident AN diagnosis were estimated by using stratified Cox regression with CD diagnosis as a time-dependent exposure variable. In the secondary analyses, we used conditional logistic regression to estimate odds ratios for being diagnosed with AN before CD. Median age of CD diagnosis was 28 years. During 1 174 401 person-years of follow-up, 54 patients with CD were diagnosed with AN (27/100 000 person-years) compared with 180 matched controls (18/100 000 person-years). The hazard ratio for later AN was 1.46 (95% confidence interval [CI], 1.08-1.98) and 1.31 beyond the first year after CD diagnosis (95% CI, 0.95-1.81). A previous AN diagnosis was also associated with CD (odds ratio, 2.18; 95% CI, 1.45-3.29). Estimates remained largely unchanged when adjusted for socioeconomic characteristics and type 1 diabetes. The bidirectional association between AN diagnosis and CD warrants attention in the initial assessment and follow-up of these conditions because underdiagnosis and misdiagnosis of these disorders likely cause protracted and unnecessary morbidity. Copyright © 2017 by the American Academy of Pediatrics.

  8. Nationwide and population-based prescription patterns in bipolar disorder

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Vradi, Eleni; Andersen, Per Kragh

    2016-01-01

    OBJECTIVES: The aim of the present study was to describe prescription patterns and changes in these patterns over the last decade for patients diagnosed with bipolar disorder in mental healthcare, using population-based and nationwide data, and to relate the findings to recommendations from...... international guidelines. METHODS: A population-based, nationwide study was carried out. It included register-based longitudinal data on all patients with a first-ever contact with mental healthcare with a diagnosis of mania/bipolar disorder from the entire Danish population, and all prescription data...

  9. Family Caregivers' Experiences of Caring for a Relative With Younger Onset Dementia: A Qualitative Systematic Review.

    Science.gov (United States)

    Cabote, Christy Joy; Bramble, Marguerite; McCann, Damhnat

    2015-08-01

    Family caregiving for people with younger onset dementia affects everyone in the family unit. This article presents findings of a qualitative systematic review exploring the experiences of family caregivers of persons with younger onset dementia. A systematic search resulted in the inclusion of five relevant articles, and two groups within the family unit were identified-child caregivers and adult and spousal caregivers. Using the thematic synthesis approach, five themes emerged: dementia damage, grief for loss of relationship, changes in family roles, positive and negative impacts of family caregiving, and transition to formal care. The review findings support increasing evidence that despite the stress of caring for a person with dementia damage, family members have the capacity to cope, adapt, and grow through their experiences. Nurses can assist families to identify their unique strengths and enhance family resiliency so they can navigate the "lonely road" of younger onset dementia. © The Author(s) 2015.

  10. Palliative sedation at home in the Netherlands: a nationwide survey among nurses

    NARCIS (Netherlands)

    Brinkkemper, T.; Klinkenberg, M.; Deliens, L.; Eliel, M.; Rietjens, J.A.C.; Zuurmond, W.W.A.; Perez, R.S.G.M.

    2011-01-01

    Aim. This paper is a report of a nationwide study conducted to assess experiences of nurses involved in palliative sedation at home after introduction of a physicians' guideline for palliative sedation. Background. Most studies investigating the practice of palliative sedation focus on physicians'

  11. Prevalence of dementia-associated disability among Chinese older adults: results from a national sample survey.

    Science.gov (United States)

    Li, Ning; Zhang, Lei; Du, Wei; Pang, Lihua; Guo, Chao; Chen, Gong; Zheng, Xiaoying

    2015-03-01

    Due to rapid population aging and a tidal wave of dementia, dementia has become an urgent public health issue in China. Few large-scale surveys on dementia have been conducted in China and little was known about the magnitude of dysfunction and disability caused by dementia. In this study, using national sample survey data, we aimed to describe the prevalence rate of dementia-associated disability, its associated factors, and daily activities and social functions of people with dementia-associated disability in Chinese older adults. We used the second China National Sample Survey on Disability, comprising 2,526,145 persons from 771,797 households. Identification for dementia was based on consensus manuals. Standard weighting procedures were used to construct sample weights considering the multistage stratified cluster sampling survey scheme. Population weighted numbers, weighted prevalence, and the odd ratios (ORs) were calculated. The prevalence rate of dementia-associated disability was 4.64% (95% CI: 4.26-5.01) and it accounted for 41.03% of mental disability among Chinese older adults. Urban residence (OR: 1.33 [1.12-1.57]), older age (80+ years) (OR: 4.12 [3.38-.03]), illiteracy (OR: 1.79 [1.27-2.53]), and currently not married (OR: 1.15 [1.00-1.32]) were associated with increased risk of dementia-associated disability. Compared with those with mental disability of other causes and those with other types of disabilities, older adults with dementia-asscoiated disability were more likely to have severe or extreme difficulty in daily activities and social functions. Countermeasures are warranted to obtain a more precise overview of dementia in China, and strategies on enhancing early identification, treatment, and rehabilitation should be developed for people with dementia. Copyright © 2015 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  12. Social relationships and risk of dementia: a population-based study.

    Science.gov (United States)

    Sörman, Daniel Eriksson; Rönnlund, Michael; Sundström, Anna; Adolfsson, Rolf; Nilsson, Lars-Göran

    2015-08-01

    The objective was to examine whether aspects of social relationships in old age are associated with all-cause dementia and Alzheimer's disease (AD). We studied 1,715 older adults (≥ 65 years) who were dementia-free at baseline over a period of up to 16 years. Data on living status, contact/visit frequency, satisfaction with contact frequency, and having/not having a close friend were analyzed using Cox proportional hazards regressions with all-cause dementia or AD as the dependent variable. To control for reverse causality and to identify potential long-term effects, we additionally performed analyses with delayed entry. We identified 373 incident cases of dementia (207 with AD) during follow-up. The variable visiting/visits from friends was associated with reduced risk of all-cause dementia. Further, a higher value on the relationships index (sum of all variables) was associated with reduced risk of all-cause dementia and AD. However, in analyses with delayed entry, restricted to participants with a survival time of three years or more, none of the social relationship variables was associated with all-cause dementia or AD. The results indicate that certain aspects of social relationships are associated with incident dementia or AD, but also that these associations may reflect reverse causality. Future studies aimed at identifying other factors of a person's social life that may have the potential to postpone dementia should consider the effects of reverse causality.

  13. Association between human herpesvirus infections and dementia or mild cognitive impairment: a systematic review protocol.

    Science.gov (United States)

    Warren-Gash, Charlotte; Forbes, Harriet; Breuer, Judith; Hayward, Andrew C; Mavrodaris, Angelique; Ridha, Basil H; Rossor, Martin; Thomas, Sara L; Smeeth, Liam

    2017-06-23

    Persisting neurotropic viruses are proposed to increase the risk of dementia, but evidence of association from robust, adequately powered population studies is lacking. This is essential to inform clinical trials of targeted preventive interventions. We will carry out a comprehensive systematic review of published and grey literature of the association between infection with, reactivation of, vaccination against or treatment of any of the eight human herpesviruses and dementia or mild cognitive impairment. We will search the Cochrane Library, Embase, Global Health, Medline, PsycINFO, Scopus, Web of Science, clinical trials registers, the New York Academy of Medicine Grey Literature Report, Electronic Theses Online Service through the British Library and the ISI Conference Proceedings Citation Index for randomised controlled trials, cohort, caseâ€"control, case crossover or self-controlled case series studies reported in any language up to January 2017. Titles, abstracts and full-text screening will be conducted by two researchers independently. Data will be extracted systematically from eligible studies using a piloted template. We will assess risk of bias of individual studies in line with the Cochrane Collaboration tool. We will conduct a narrative synthesis, grouping studies by exposure and outcome definitions, and will describe any differences by population subgroups and dementia subtypes. We will consider performing meta-analyses if there are adequate numbers of sufficiently homogeneous studies. The overall quality of cumulative evidence will be assessed using selected Grading of Recommendations, Assessment, Development and Evaluations criteria. As this is a review of existing studies, no ethical approval is required. Results will be disseminated through a peer-reviewed publication and at national and international conferences. We anticipate the review will clarify the current extent and quality of evidence for a link between herpesviruses and dementia

  14. Seeing the first-person perspective in dementia : a qualitative personal evaluation game to evaluate assistive technology for people affected by dementia in the home context

    NARCIS (Netherlands)

    Suijkerbuijk, S.; Brankaert, R.G.A.; Kort, de Y.A.W.; Snaphaan, L.J.A.E.; Ouden, den P.H.

    2015-01-01

    The number of people with dementia is increasing rapidly. As a result, care has to be extended towards the home context. This increases the burden on both informal caregivers and persons affected by dementia. To support these people more effectively, technology could play an important role. However,

  15. A Nationwide Random Sampling Survey of Potential Complicated Grief in Japan

    Science.gov (United States)

    Mizuno, Yasunao; Kishimoto, Junji; Asukai, Nozomu

    2012-01-01

    To investigate the prevalence of significant loss, potential complicated grief (CG), and its contributing factors, we conducted a nationwide random sampling survey of Japanese adults aged 18 or older (N = 1,343) using a self-rating Japanese-language version of the Complicated Grief Brief Screen. Among them, 37.0% experienced their most significant…

  16. Methods of Suicide among Cancer Patients: A Nationwide Population-Based Study

    Science.gov (United States)

    Chung, Kuo-Hsuan; Lin, Herng-Ching

    2010-01-01

    A 3-year nationwide population-based data set was used to explore methods of suicide (violent vs. nonviolent) and possible contributing factors among cancer patients in Taiwan. A total of 1,065 cancer inpatients who committed suicide were included as our study sample. The regression shows that those who had genitourinary cancer were 0.55 times (p…

  17. A Nationwide Survey of Nonspeech Oral Motor Exercise Use: Implications for Evidence-Based Practice

    Science.gov (United States)

    Lof, Gregory L.; Watson, Maggie M.

    2008-01-01

    Purpose: A nationwide survey was conducted to determine if speech-language pathologists (SLPs) use nonspeech oral motor exercises (NSOMEs) to address children's speech sound problems. For those SLPs who used NSOMEs, the survey also identified (a) the types of NSOMEs used by the SLPs, (b) the SLPs' underlying beliefs about why they use NSOMEs, (c)…

  18. Trends in birth asphyxia, obstetric interventions and perinatal mortality among term singletons: a nationwide cohort study

    NARCIS (Netherlands)

    Ensing, Sabine; Abu-Hanna, Ameen; Schaaf, Jelle M.; Mol, Ben Willem J.; Ravelli, Anita C. J.

    2015-01-01

    The objective of the present study is to investigate trends in birth asphyxia and perinatal mortality in the Netherlands over the last decade. A nationwide cohort study among women with a term singleton pregnancy. We assessed trends in birth asphyxia in relation to obstetric interventions for fetal

  19. Problem behavior of individuals with down syndrome in a nationwide cohort assessed in late adolescence

    NARCIS (Netherlands)

    Gameren-Oosterom, H.B.M.; Fekkes, M.; Wouwe, J.P. van; Detmar, S.B.; Oudesluys-Murphy, A.M.; Verkerk, P.H.

    2013-01-01

    OBJECTIVE: To assess problem behavior in adolescents with Down syndrome and examine the association with sex and severity of intellectual disability. STUDY DESIGN: Cross-sectional data of a Dutch nationwide cohort of Down syndrome children aged 16-19 years were collected using a written parental

  20. Old age and forgoing treatment: a nationwide mortality follow-back study in the Netherlands

    NARCIS (Netherlands)

    Martins Pereira, S.; Pasman, H.R.W.; Heide, A.; van Delden, J.J.M.; Onwuteaka-Philipsen, B.D.

    2015-01-01

    Background The ageing of the population raises the need to study forgoing treatment decisions among older people. Aim To describe the incidence and decision-making of forgoing treatment and identify age-related differences. Methods A nationwide study of a stratified sample from the Statistics

  1. Old age and forgoing treatment : a nationwide mortality follow-back study in the Netherlands

    NARCIS (Netherlands)

    Pereira, Sandra Martins; Pasman, H. Roeline; van der Heide, Agnes; van Delden, Johannes J. M.; Onwuteaka-Philipsen, Bregje D.

    Background The ageing of the population raises the need to study forgoing treatment decisions among older people. Aim To describe the incidence and decision-making of forgoing treatment and identify age-related differences. Methods A nationwide study of a stratified sample from the Statistics

  2. CSF/serum albumin ratio in dementias: a cross-sectional study on 1861 patients.

    Science.gov (United States)

    Skillbäck, Tobias; Delsing, Louise; Synnergren, Jane; Mattsson, Niklas; Janelidze, Shorena; Nägga, Katarina; Kilander, Lena; Hicks, Ryan; Wimo, Anders; Winblad, Bengt; Hansson, Oskar; Blennow, Kaj; Eriksdotter, Maria; Zetterberg, Henrik

    2017-11-01

    A connection between dementias and blood-brain barrier (BBB) dysfunction has been suggested, but previous studies have yielded conflicting results. We examined cerebrospinal fluid (CSF)/serum albumin ratio in a large cohort of patients diagnosed with Alzheimer's disease (AD, early onset [EAD, n = 130], late onset AD [LAD, n = 666]), vascular dementia (VaD, n = 255), mixed AD and VaD (MIX, n = 362), Lewy body dementia (DLB, n = 50), frontotemporal dementia (FTD, n = 56), Parkinson's disease dementia (PDD, n = 23), other dementias (other, n = 48), and dementia not otherwise specified (NOS, n = 271). We compared CSF/serum albumin ratio to 2 healthy control groups (n = 292, n = 20), between dementia diagnoses, and tested biomarker associations. Patients in DLB, LAD, VaD, MIX, other, and NOS groups had higher CSF/serum albumin ratio than controls. CSF/serum albumin ratio correlated with CSF neurofilament light in LAD, MIX, VaD, and other groups but not with AD biomarkers. Our data show that BBB leakage is common in dementias. The lack of association between CSF/serum albumin ratio and AD biomarkers suggests that BBB dysfunction is not inherent to AD but might represent concomitant cerebrovascular pathology. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Models of home care services for persons with dementia: a narrative review.

    Science.gov (United States)

    Low, Lee-Fay; Fletcher, Jennifer

    2015-10-01

    Worldwide trends of increasing dementia prevalence, have put economic and workforce pressures to shifting care for persons with dementia from residential care to home care. We reviewed the effects of the four dominant models of home care delivery on outcomes for community-dwelling persons with dementia. These models are: case management, integrated care, consumer directed care, and restorative care. This narrative review describes benefits and possible drawbacks for persons with dementia outcomes and elements that comprise successful programs. Case management for persons with dementia may increase use of community-based services and delay nursing home admission. Integrated care is associated with greater client satisfaction, increased use of community based services, and reduced hospital days however the clinical impacts on persons with dementia and their carers are not known. Consumer directed care increases satisfaction with care and service usage, but had little effect on clinical outcomes. Restorative models of home care have been shown to improve function and quality of life however these trials have excluded persons with dementia, with the exception of a pilot study. There has been a little research into models of home care for people with dementia, and no head-to-head comparison of the different models. Research to inform evidence-based policy and service delivery for people with dementia needs to evaluate both the impact of different models on outcomes, and investigate how to best deliver these models to maximize outcomes.

  4. 78 FR 69539 - Removal of Attestation Process for Facilities Using H-1A Registered Nurses

    Science.gov (United States)

    2013-11-20

    ... of Attestation Process for Facilities Using H-1A Registered Nurses AGENCY: Employment and Training... registered nurses under the H-1A visa program. These subparts became obsolete after the authorizing statute... nonimmigrant classification exclusively for the temporary admission and employment of registered nurses, which...

  5. Dementia incidence and mortality in middle-income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study

    Science.gov (United States)

    Prince, Martin; Acosta, Daisy; Ferri, Cleusa P; Guerra, Mariella; Huang, Yueqin; Rodriguez, Juan J Llibre; Salas, Aquiles; Sosa, Ana Luisa; Williams, Joseph D; Dewey, Michael E; Acosta, Isaac; Jotheeswaran, Amuthavalli T; Liu, Zhaorui

    2012-01-01

    Summary Background Results of the few cohort studies from countries with low incomes or middle incomes suggest a lower incidence of dementia than in high-income countries. We assessed incidence of dementia according to criteria from the 10/66 Dementia Research Group and Diagnostic and Statistical Manual of Mental Disorders (DSM) IV, the effect of dementia at baseline on mortality, and the independent effects of age, sex, socioeconomic position, and indicators of cognitive reserve. Methods We did a population-based cohort study of all people aged 65 years and older living in urban sites in Cuba, the Dominican Republic, and Venezuela, and rural and urban sites in Peru, Mexico, and China, with ascertainment of incident 10/66 and DSM-IV dementia 3–5 years after cohort inception. We used questionnaires to obtain information about age in years, sex, educational level, literacy, occupational attainment, and number of household assets. We obtained information about mortality from all sites. For participants who had died, we interviewed a friend or relative to ascertain the likelihood that they had dementia before death. Findings 12 887 participants were interviewed at baseline. 11 718 were free of dementia, of whom 8137 (69%) were reinterviewed, contributing 34 718 person-years of follow-up. Incidence for 10/66 dementia varied between 18·2 and 30·4 per 1000 person-years, and were 1·4–2·7 times higher than were those for DSM-IV dementia (9·9–15·7 per 1000 person-years). Mortality hazards were 1·56–5·69 times higher in individuals with dementia at baseline than in those who were dementia-free. Informant reports suggested a high incidence of dementia before death; overall incidence might be 4–19% higher if these data were included. 10/66 dementia incidence was independently associated with increased age (HR 1·67; 95% CI 1·56–1·79), female sex (0·72; 0·61–0·84), and low education (0·89; 0·81–0·97), but not with occupational attainment (1

  6. Incidence and outcomes of bulimia nervosa : a nationwide population-based study

    NARCIS (Netherlands)

    Keski-Rahkonen, A.; Hoek, H. W.; Linna, M. S.; Raevuori, A.; Sihvola, E.; Bulik, C. M.; Rissanen, A.; Kaprio, J.

    Background. Little is known about the epidemiology of bulimia nervosa outside clinical settings. We report the incidence, prevalence and outcomes of bulimia nervosa using for the first time a nationwide Study design. Method. To assess the incidence and natural course and outcomes of DSM-IV bulimia

  7. Mortality in myasthenia gravis: A nationwide population-based follow-up study in Denmark

    DEFF Research Database (Denmark)

    Hansen, Julie S; Danielsen, Ditte H; Somnier, Finn E

    2016-01-01

    INTRODUCTION: In previous studies of myasthenia gravis (MG), increased mortality has been reported. The aim of this study was to estimate mortality in patients with acetylcholine receptor antibody-positive (AChR-Ab-seropositive) MG in a nationwide population-based, long-term follow-up study...

  8. Statin use after acute myocardial infarction: a nationwide study in Denmark

    DEFF Research Database (Denmark)

    Rasmussen, Jeppe Nørgaard; Gislason, Gunnar H; Abildstrom, Steen Z

    2005-01-01

    AIMS: To study outpatient statin use after first acute myocardial infarction (AMI) in Denmark between 1995 and 2002 and to determine the predictors of statin use. METHODS: This is a nationwide population-based study using administrative registries. Patients with first AMI between 1995 and 2002 ol...

  9. Fat watch: A nationwide campaign in the Netherlands to reduce fat intake-effect evaluation

    NARCIS (Netherlands)

    Wechem, S.N. van; Brug, J.; Assema, P. van; Kistemaker, C.; Riedstra, M.; Löwik, M.R.H.

    1998-01-01

    In the Netherlands, the nationwide Fat Watch campaign aiming at a reduction in fat consumption was organized from 1991 onwards. This study describes the effects of the first three consecutive campaign years on attention to fat, diet and health, attitudes, self-efficacy expectations and intentions

  10. Impact of a Nationwide Training Program in Minimally Invasive Distal Pancreatectomy (LAELAPS)

    NARCIS (Netherlands)

    de Rooij, Thijs; van Hilst, Jony; Boerma, Djamila; Bonsing, Bert A.; Daams, Freek; van Dam, Ronald M.; Dijkgraaf, Marcel G.; van Eijck, Casper H.; Festen, Sebastiaan; Gerhards, Michael F.; Koerkamp, Bas Groot; van der Harst, Erwin; de Hingh, Ignace H.; Kazemier, Geert; Klaase, Joost; de Kleine, Ruben H.; van Laarhoven, Cornelis J.; Lips, Daan J.; Luyer, Misha D.; Molenaar, I. Quintus; Patijn, Gijs A.; Roos, Daphne; Scheepers, Joris J.; van der Schelling, George P.; Steenvoorde, Pascal; Vriens, Menno R.; Wijsman, Jan H.; Gouma, Dirk J.; Busch, Olivier R.; Hilal, Mohammed Abu; Besselink, Marc G.; de Boer, Marieke T.

    2016-01-01

    Objective:To study the feasibility and impact of a nationwide training program in minimally invasive distal pancreatectomy (MIDP).Summary of Background Data:Superior outcomes of MIDP compared with open distal pancreatectomy have been reported. In the Netherlands (2005 to 2013) only 10% of distal

  11. Mass Communication and Journalism Faculty and Their Electronic Communication with College Students: A Nationwide Examination

    Science.gov (United States)

    Brunner, Brigitta R.; Yates, Bradford L.; Adams, Jennifer Wood

    2008-01-01

    Nearly 700 U.S. journalism and mass communication faculty reported their perceptions of student e-mail use via a Web-based survey. This nationwide study focused on content of e-mail received by faculty and made comparisons based on faculty gender. Nearly half of the respondents reported that they occasionally receive e-mails from students before a…

  12. A nationwide registry-based cohort study of incidence of tonsillectomy in Denmark, 1991-2012

    DEFF Research Database (Denmark)

    Juul, Marie Louise; Rasmussen, Eva Rye; Rasmussen, Stig Hebbelstrup Rye

    2018-01-01

    OBJECTIVE: To update tonsillectomy incidence rates in Denmark and identify whether the incidence rates vary between geographical areas in the country during the period 1991-2012. DESIGN: This was a retrospective nationwide cohort study using data from the comprehensive Danish patient registries. ...

  13. Presentation of a nationwide multicenter registry of intestinal failure and intestinal transplantation

    NARCIS (Netherlands)

    Neelis, E. G.; Roskott, A. M.; Dijkstra, G.; Wanten, G. J.; Serlie, M. J.; Tabbers, M. M.; Damen, G.; Olthof, E. D.; Jonkers, C. F.; Kloeze, J. H.; Ploeg, R. J.; Imhann, F.; Nieuwenhuijs, V. B.; Rings, E. H. H. M.

    2016-01-01

    Exact data on Dutch patients with chronic intestinal failure (CIF) and after intestinal transplantation (ITx) have been lacking. To improve standard care of these patients, a nationwide collaboration has been established. Objectives of this study were obtaining an up-to-date prevalence of CIF and

  14. Presentation of a nationwide multicenter registry of intestinal failure and intestinal transplantation

    NARCIS (Netherlands)

    Neelis, E. G.; Roskott, A. M.; Dijkstra, G.; Wanten, G. J.; Serlie, M. J.; Tabbers, M. M.; Damen, G.; Olthof, E. D.; Jonkers, C. F.; Kloeze, J. H.; Ploeg, R. J.; Imhann, F.; Nieuwenhuijs, V. B.; Rings, E. H. H. M.

    Background & aims: Exact data on Dutch patients with chronic intestinal failure (CIF) and after intestinal transplantation (ITx) have been lacking. To improve standard care of these patients, a nationwide collaboration has been established. Objectives of this study were obtaining an up-to-date

  15. Presentation of a nationwide multicenter registry of intestinal failure and intestinal transplantation

    NARCIS (Netherlands)

    Neelis, E.G.; Roskott, A.M.; Dijkstra, G.; Wanten, G.J.A.; Serlie, M.J.; Tabbers, M.M.; Damen, G.M.; Olthof, E.D.; Jonkers, C.F.; Kloeze, J.H.; Ploeg, R.J.; Imhann, F.; Nieuwenhuijs, V.B.; Rings, E.H.

    2016-01-01

    BACKGROUND & AIMS: Exact data on Dutch patients with chronic intestinal failure (CIF) and after intestinal transplantation (ITx) have been lacking. To improve standard care of these patients, a nationwide collaboration has been established. Objectives of this study were obtaining an up-to-date

  16. Asthma and Attention-Deficit/Hyperactivity Disorder: A Nationwide Population-Based Prospective Cohort Study

    Science.gov (United States)

    Chen, Mu-Hong; Su, Tung-Ping; Chen, Ying-Sheue; Hsu, Ju-Wei; Huang, Kai-Lin; Chang, Wen-Han; Chen, Tzeng-Ji; Bai, Ya-Mei

    2013-01-01

    Background: Previous cross-sectional studies have suggested an association between asthma and attention-deficit/hyperactivity disorder (ADHD), but the temporal relationship was not determined. Using a nationwide population-based prospective case-control cohort study (1:4, age-/gender-matched), we hypothesized that asthma in infanthood or early…

  17. Differences in investigations of sudden unexpected deaths in young people in a nationwide setting

    DEFF Research Database (Denmark)

    Winkel, Bo Gregers; Holst, Anders Gaarsdal; Theilade, Juliane

    2012-01-01

    BACKGROUND: Inherited disease may be causative in many young sudden unexpected death cases. Autopsy is essential in the counselling of the bereaved, as the family of the victim may be at risk too. In a nationwide setting operating under the same set of laws, we hypothesized that regional differen...

  18. Change in quality of life in older people with dementia participating in Paro-activity: a cluster-randomized controlled trial.

    Science.gov (United States)

    Jøranson, Nina; Pedersen, Ingeborg; Rokstad, Anne Marie Mork; Ihlebaek, Camilla

    2016-12-01

    The aim of this study was to investigate effects of robot-assisted group activity with Paro on quality of life in older people with dementia. Nursing home residents with severe dementia often experience social withdrawal and lower quality of life, which are suggested to be enhanced by non-pharmacological interventions. A cluster-randomized controlled trial. Ten nursing home units were randomized to robot-assisted intervention or control group (treatment as usual). Data were collected between March 2013-September 2014. 27 participants participated in group activity for 30 minutes twice a week over 12 weeks, 26 participated in the control group. Change in quality of life was assessed by local nurses through the Quality of Life in Late-Stage Dementia scale at baseline, after end of intervention and at 3 months follow-up. The scale and regular psychotropic medication were analysed stratified by dementia severity. Analysis using mixed model, one-way anova and linear regression were performed. An effect was found among participants with severe dementia from baseline to follow-up showing stable quality of life in the intervention group compared with a decrease in the control group. The intervention explained most of the variance in change in the total scale and in the subscales describing Tension and Well-being for the group with severe dementia. The intervention group used significantly less psychotropic medication compared with the control group after end of intervention. Pleasant and engaging activities facilitated by nursing staff, such as group activity with Paro, could improve quality of life in people with severe dementia. The trial is in adherence with the CONSORT statement and is registered at www.clinicaltrials.gov (study ID number: NCT02008630). © 2016 John Wiley & Sons Ltd.

  19. A nation-wide study of the family aggregation and risk factors in anorexia nervosa over three generations.

    Science.gov (United States)

    Steinhausen, Hans-Christoph; Jakobsen, Helle; Helenius, Dorte; Munk-Jørgensen, Povl; Strober, Michael

    2015-01-01

    This nation-wide register-based study investigated how often anorexia nervosa (AN) and co-morbid disorders occur in affected families compared with control families. Furthermore, the study addressed the impact of sex, year of birth, and degree of urbanization in terms of risk factors. A total of N = 2,370 child and adolescent psychiatric subjects born between 1951 and 1996 and registered in the Danish Psychiatric Central Research Register (DPCRR) had any mental disorder before the age of 18 and developed AN at some point during their life-time. In addition, N = 7,035 controls without any psychiatric diagnosis before age 18 and matched for age, sex, and residential region were included. Psychiatric diagnoses were also obtained on the first-degree relatives as a part of the Danish Three Generation Study (3GS). A family load component was obtained by using various mixed regression models. AN occurred significantly more often in case than in control families. AN Risk factors included having a sibling with AN, affective disorders in family members, and co-morbid affective, anxiety, obsessive-compulsive, personality, or substance use disorders. Furthermore, female sex, and ascending year of birth were significantly associated with having AN. Urbanization was not related to the family load of AN and case-relatives did not develop AN earlier than control relatives. These findings based on a very large and representative dataset provide evidence for the family aggregation and further risk factors in AN. © 2014 Wiley Periodicals, Inc.

  20. Family aggregation and risk factors in substance use disorders over three generations in a nation-wide study.

    Directory of Open Access Journals (Sweden)

    Hans-Christoph Steinhausen

    Full Text Available This nation-wide register-based study investigated how often substance use disorders (SUD and co-morbid disorders occurred in affected families compared to control families.A total of N = 2504 child and adolescent psychiatric participants who were born between 1969 and 1986 and were registered in the Danish Psychiatric Central Research Register (DPCRR had a mental disorder before the age of 18 and developed SUD at some point during their life-time. In addition, N = 7472 controls without any psychiatric diagnosis before age 18 and matched for age, sex, and residential region were included. Psychiatric diagnoses of the first-degree relatives were also obtained. A family load component was assessed.SUD occurred significantly more often in case families than in control families. SUD risk factors included SUD, depression, anxiety disorders, personality disorders, or conduct disorders in the family. Furthermore, male sex, more recent year of birth, and living in the capital city of Copenhagen were also significantly associated with having SUD. The family load explained 30% of the SUD manifestation in the case-probands. The findings in the total SUD group were mostly replicated in the two major subgroups of pure alcohol or multiple substance use disorders.These findings based on a very large and representative dataset provide additional evidence for the strong family aggregation and further risk factors in SUD. The pattern of risk factors is largely the same for the total group of SUD and the major subgroups of pure alcohol and multiple substance use disorders.

  1. A study of the clinical and the neuroradiological findings in multi-infarct dementia and Alzheimer type dementia

    International Nuclear Information System (INIS)

    Endo, Riuko

    1989-01-01

    In forty patients with dementia, a comparison of the clinical and the neuroradiological findings between 15 Alzheimer type dementia (ATD) and 21 multi-infarct dementia (MID) were made. MID had significantly (p<0.01) higher Hachinski's Ischemic Score (HIS) (mean ±S.D., 9.7±1.8) compared with ATD (3.6±1.5). The HIS was a useful diagnostic aid in differential diagnosis between the two groups. MID significantly (p<0.01) had cerebrovascular risk factors such as hypertension, diabetes mellitus and increase of platelet aggregation. The morphometric analysis of the ratios of the ventricular dilatation, the cortical atrophy, and the white matter changes was performed on the CT scan and the magnetic resonance imaging. This was the first time the method of having the cortical atrophy analyzed by the ratio of the area of the sylvian sulci and the area of the whole brain had been used. It was found that the degrees of the ventricular dilatation, the cortical atrophy, and the white matter changes were more increased in MID than in ATD (p<0.01∼0.05). In ATD, there was a positive correlation between Hasegawa's Dementia Scale and both the ratios of the ventricular dilatation, and the cortical atrophy (r=-0.62, p<0.05, r=-0.63, p<0.05, respectively). Also a comparative study between MID and 9 patients with multiple infarction, without dementia (MI). MID had the mean infarct numbers of 6.5±2.5, and MI had 4.1±2.2. The white matter changes were more increased in MID than MI (p<0.05). The incidence of the dementia was significantly higher in cases with left lenticular nucleus (p<0.01) or main lesions of the white matter in the left frontal lobe (p<0.05), and in cases with bilateral lenticular nucleus (p<0.01), compared to cases without lesions. (J.P.N.)

  2. Rapidly increasing use of proton pump inhibitors prescribed in primary care: a nationwide observational study

    DEFF Research Database (Denmark)

    Haastrup, Peter; Hansen, Jane Møller; Jarbøl, Dorte Ejg

    2013-01-01

    Background: Antisecretory drugs (ADs) are often prescribed in primary care for upper gastrointestinal symptoms. Reimbursement modifications have been made in Denmark to minimize costs related to use of ADs. However knowledge about development in use of ADs over the past decade and the impacts...... of the reimbursement modifications is sparse. Research questions: How has use of ADs developed in Denmark 2001-2011? Which impacts have the reimbursement modifications had on the use of ADs? Methods: The Register of Medicinal Product Statistics includes all sales and redeemed prescriptions nationwide covering...... through the years 2001-2011 were used. Data from prescriptions redeemed by persons younger than 20 years were excluded. Prescriptions for ulcerogenic drugs (acetylsalicylic acid and non-steroidal anti-inflammatory drugs) redeemed by persons aged 65 years and older were included since ulcer prophylaxis...

  3. Cardiovascular disease in a nationwide population of Danish women with polycystic ovary syndrome

    DEFF Research Database (Denmark)

    Glintborg, Dorte; Rubin, Katrine Hass; Nybo, Mads

    2018-01-01

    , or dyslipidemia. PCOS Denmark (N = 18,112) included women with PCOS in the Danish National Patient Register. PCOS Odense University Hospital (OUH, N = 1165) was an embedded cohort including premenopausal women with PCOS and clinical and biochemical examination. Three age-matched controls were included per patient...... in PCOS Denmark (N = 52,769). The main study outcome was CVD events including hypertension and dyslipidemia defined according to nationwide in- and outpatient hospital contact diagnosis codes and/or inferred from filled medicine prescriptions. RESULTS: The age at inclusion was median (quartiles) 29 (23...... Denmark regarding risk of CVD. Age, BMI, blood pressure, lipid status, and glycemic status predicted development of CVD in PCOS OUH. CONCLUSION: The event rate of CVD including hypertension and dyslipidemia was higher in PCOS compared to controls. The risk of developing CVD must be considered even...

  4. Frequent use of opioids in patients with dementia and nursing home residents

    DEFF Research Database (Denmark)

    Jensen-Dahm, Christina; Gasse, Christiane; Astrup, Aske

    2014-01-01

    BACKGROUND: Pain is believed to be undertreated in patients with dementia; however, no larger studies have been conducted. The aim was to investigate prevalent use of opioids in elderly with and without dementia in the entire elderly population of Denmark. METHOD: A register-based cross-sectional......BACKGROUND: Pain is believed to be undertreated in patients with dementia; however, no larger studies have been conducted. The aim was to investigate prevalent use of opioids in elderly with and without dementia in the entire elderly population of Denmark. METHOD: A register-based cross......-sectional study in the entire elderly (≥65 years) population in 2010 was conducted. Opioid use among elderly with dementia (N = 35,455) was compared with elderly without (N = 870,645), taking age, sex, comorbidity, and living status into account. RESULTS: Nursing home residents (NHRs) used opioids most frequently...

  5. Retaining early career registered nurses: a case study.

    Science.gov (United States)

    Mills, Jane; Chamberlain-Salaun, Jennifer; Harrison, Helena; Yates, Karen; O'Shea, Andrea

    2016-01-01

    A core objective of the Australian health system is to provide high quality, safe health care that meets the needs of all Australians. To achieve this, an adequate and effective workforce must support the delivery of care. With rapidly changing health care systems and consumer demographics, demand for care is increasing and retention of sufficient numbers of skilled staff is now a critical priority to meet current and future health care demands. Nurses are the largest cohort of professionals within the health workforce. Reducing the rates at which nurses leave the profession and supporting nurses to practice in their profession longer will have beneficial implications for the sustainability of a nursing workforce and, ultimately, to patient outcomes. The aim of the study was to describe and explain early career registered nurses' (ECRNs) experiences and support requirements during the first five years of practice for the purposes of identifying strategies that would support greater retention of ECRNs. A single case study design focused on early career registered nurses (ECRNs) working in a hospital and health service in northern Australia. The research team adopted Djukic et al's definition of ECRNs as "RNs who have practiced for less than 5 years". Data was collected via three individual interviews and two focus groups. Thirty-five ECRNs participated in the study. Qualitative analysis of data generated during interviews and focus groups, identified the key themes of receiving career advice and choice or no choice . Analysis of study data in the context of the broader literature resulted in the researchers identifying six areas of focus for ECRN retention: 1) well-planned, supported and structured transition periods; 2) consideration of rotation through different areas with a six month minimum for skills development; 3) empowering decision making; 4) placement opportunities and choice in decisions of where to work; 5) career advice and support that considers ECRNs

  6. Fast event recorder utilizing a CCD analog shift register

    International Nuclear Information System (INIS)

    Ducar, R.J.; McIntyre, P.M.

    1978-01-01

    A system of electronics has been developed to allow the capture and recording of relatively fast, low-amplitude analog events. The heart of the system is a dual 455-cell analog shift register charge-coupled device, Fairchild CCD321ADC-3. The CCD is operated in a dual clock mode. The input is sampled at a selectable clock rate of .25-20 MHz. The stored analog data is then clocked out at a slower rate, typically about .25 MHz. The time base expansion of the analog data allows for analog-to-digital conversion and memory storage using conventional medium-speed devices. The digital data is sequentially loaded into a static RAM and may then be block transferred to a computer. The analog electronics are housed in a single-width NIM module, and the RAM memory in a single-width CAMAC module. Each pair of modules provides six parallel channels. Cost is about $200.00 per channel. Applications are described for ionization imaging (TPC, IRC) and long-drift calorimetry in liquid argon

  7. Semantic amnesia without dementia: documentation of a case.

    Science.gov (United States)

    Rusconi, M L; Zago, S; Basso, A

    1997-06-01

    We described the case of a patient affected by a progressive semantic memory disorder associated with prevalent temporal lobe atrophy. This deficit seems to be "pure" in the sense that it has not been found to overlap with other cognitive deficits (intellectual, linguistic, perceptual, visuo-spatial etc.) for a long time. Furthermore, despite his impaired semantic knowledge, the autobiographical memory of the patient was largely intact. This case therefore represents a form of "semantic amnesia" without dementia, and supports the hypothesis that there is a partial distinction between "semantic" and "episodic" memory.

  8. Risk factors for vascular dementia: Hypotension as a key point

    Directory of Open Access Journals (Sweden)

    Rita Moretti

    2008-04-01

    Full Text Available Rita Moretti, Paola Torre, Rodolfo M Antonello, Davide Manganaro, Cristina Vilotti, Gilberto PizzolatoDepartment of Internal Medicine and Clinical Neurology University of Trieste, ItalyAbstract: Physiologically, the cerebral autoregulation system allows maintenance of constant cerebral blood flow over a wide range of blood pressure. In old people, there is a progressive reshape of cerebral autoregulation from a sigmoid curve to a straight line. This implies that any abrupt change in blood pressure will result in a rapid and significant change in cerebral blood flow. Hypertension has often been observed to be a risk factor for vascular dementia (VaD and sometimes for Alzheimer disease although not always. Indeed, high blood pressure may accelerate cerebral white matter lesions, but white matter lesions have been found to be facilitated by excessive fall in blood pressure, including orthostatic dysregulation and postprandial hypotension. Many recent studies observed among other data, that there was a correlation between systolic pressure reduction and cognitive decline in women, which was not accounted for by other factors. Baseline blood pressure level was not significantly related to cognitive decline with initial good cognition. Some researchers speculate that blood pressure reduction might be an early change of the dementing process. The most confounding factor is that low pressure by itself might be a predictor of death; nevertheless, the effect of low blood pressure on cognition is underestimated because of a survival bias. Another explanation is that clinically unrecognized vascular lesions in the brain or atherosclerosis are responsible for both cognitive decline and blood pressure reduction. We discuss the entire process, and try to define a possible mechanism that is able to explain the dynamic by which hypotension might be related to dementia.Keywords: vascular dementia, hypotension, low blood pressure, alzheimer disease

  9. Is drug treatment for dementia followed up in primary care? A Swedish study of dementia clinics and referring primary care centres.

    Directory of Open Access Journals (Sweden)

    Lars Sonde

    Full Text Available PURPOSE: It is largely unknown how the medical treatment of patients diagnosed with dementia is followed up in primary care. Therefore, we studied patient medical records from two dementia clinics and from the referring primary care centres. METHODS: A retrospective study of 241 patients was conducted from April to October 2011 in north west Stockholm, Sweden. Over half (51.5% of the patients had Alzheimer's disease (AD, the remainder had mixed AD/vascular dementia (VaD. Eighty-four medical reports from primary care (35% of the study group were analysed at follow-up 18 months after diagnosis. RESULTS: All four dementia drugs available on the Swedish market (three cholinesterase inhibitors [donepezil, rivastigmine and galantamine] and memantine were prescribed at the two dementia clinics. The most commonly used dementia drug was galantamine. There were differences between the two dementia clinics in preference and combination of drugs and of treatment given to male and female patients. At follow-up, 84% were still on dementia medication. Drug use was followed up by the general practitioners (GPs in two-thirds of the cases. Eighteen per cent of the GPs' medical records made no reference to the patient's dementia or treatment even though dementia drugs were included in the list of medications prescribed. CONCLUSIONS: The results indicate that the Swedish guidelines for treatment of cognitive symptoms in AD are being followed in primary care. However, documentation of follow-up of drug treatment was sometimes insufficient, which calls for development of guidelines for complete medical records and medication lists.

  10. The intersection of culture in the provision of dementia care: A systematic review.

    Science.gov (United States)

    Brooke, Joanne; Cronin, Camille; Stiell, Marlon; Ojo, Omorogieva

    2017-08-09

    To understand the intersection of healthcare professionals' and care workers' culture and their provision of person-centred care for people with dementia. Due to the nature of global immigration and recruitment strategies, health care is provided by a culturally diverse workforce. Consequently, there is a need to understand healthcare professionals' and care workers' cultural values of illness, disease and dementia. Cultural values and beliefs regarding dementia and care of the older person differ, and currently, there is a lack of clarity regarding the intersection of culture in the provision of person-centred dementia care. A search of the following databases was completed: Medline, CINAHL, Psychology and Behavioural Sciences, PsycINFO and PubMed for papers published from 1st January 2006 to 31st July 2016. A total of seven qualitative studies met the inclusion and exclusion criteria, all explored the impact of healthcare professionals' and care workers' culture in relation to their provision of person-centred dementia care. A meta-synthesis of the data from these studies identified four themes: cultural perceptions of dementia, illness and older people; impact of cultural perceptions on service use; acculturation of the workforce; and cross-cultural communication. Limited evidence was found on the impact of healthcare professionals' and care workers' culture on their provision of person-centred dementia care. The intersection of culture and dementia included the understanding of dementia, care and family roles. Acculturation of migrant healthcare workers to the culture of the host country, workplace, and support with the communication was identified as necessary for the provision of person-centred dementia care. Open access education and training to support communication is required, alongside the development of robust interventions to support the process of acculturation of migrant healthcare professionals and care workers to provide culturally competent person

  11. Prevalence of Dementia and Cognitive Complaints in the Context of High Cognitive Reserve: A Population-Based Study

    Science.gov (United States)

    Perquin, Magali; Diederich, Nico; Pastore, Jessica; Lair, Marie-Lise; Stranges, Saverio; Vaillant, Michel

    2015-01-01

    Objectives This study aimed to assess the prevalence of dementia and cognitive complaints in a cross-sectional sample of Luxembourg seniors, and to discuss the results in the societal context of high cognitive reserve resulting from multilingualism. Methods A population sample of 1,377 people representative of Luxembourg residents aged over 64 years was initially identified via the national social insurance register. There were three different levels of contribution: full participation in the study, partial participation, and non-participation. We examined the profiles of these three different samples so that we could infer the prevalence estimates in the Luxembourgish senior population as a whole using the prevalence estimates obtained in this study. Results After careful attention to the potential bias and of the possibility of underestimation, we considered the obtained prevalence estimates of 3.8% for dementia (with corresponding 95% confidence limits (CL) of 2.8% and 4.8%) and 26.1% for cognitive complaints (CL = [17.8–34.3]) as trustworthy. Conclusion Based on these findings, we postulate that high cognitive reserve may result in surprisingly low prevalence estimates of cognitive complaints and dementia in adults over the age of 64 years, which thereby corroborates the longer disability-free life expectancy observed in the Luxembourg population. To the best of our knowledge, this study is the first to report such Luxembourgish public health data. PMID:26390288

  12. Validity of a hospital-based obstetric register using medical records as reference

    DEFF Research Database (Denmark)

    Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Johansen, Nanna Roed

    2015-01-01

    BACKGROUND: Data from hospital-based registers and medical records offer valuable sources of information for clinical and epidemiological research purposes. However, conducting high-quality epidemiological research requires valid and complete data sources. OBJECTIVE: To assess completeness...... and validity of a hospital-based clinical register - the Obstetric Database - using a national register and medical records as references. METHODS: We assessed completeness of a hospital-based clinical register - the Obstetric Database - by linking data from all women registered in the Obstetric Database...... Database therefore offers a valuable source for examining clinical, administrative, and research questions....

  13. General life satisfaction predicts dementia in community living older adults: a prospective cohort study.

    Science.gov (United States)

    Peitsch, Lorraine; Tyas, Suzanne L; Menec, Verena H; St John, Philip D

    2016-07-01

    Low life satisfaction predicts adverse outcomes, and may predict dementia. The objectives were: (1) to determine if life satisfaction predicts dementia over a five year period in those with normal cognition at baseline; and (2) to determine if different aspects of life satisfaction differentially predict dementia. Secondary analysis of an existing population-based cohort study with initial assessment in 1991 and follow-up five years later. Initially, 1,751 adults age 65+ living in the community were sampled from a representative sampling frame. Of these, 1,024 were alive and had complete data at time 2, of whom 96 were diagnosed with dementia. Life satisfaction was measured using the Terrible-Delightful scale, which measures overall life satisfaction on a 7-point scale, as well as various aspects of life satisfaction (e.g. friendships, finances, etc.) Dementia was diagnosed by clinical examination using DSM-IIIR criteria. Logistic regression models were constructed for the outcome of dementia at time 2, and adjusted for age, gender, education, and comorbidities. Overall life satisfaction predicted dementia five years later, at time 2. The unadjusted Odds Ratio (OR; 95% confidence interval) for dementia at time 2 was 0.72 (0.55, 0.95) per point. The adjusted OR for dementia was 0.70 (0.51, 0.96). No individual item on the life satisfaction scale predicted dementia. However, the competing risk of mortality was very high for some items. A global single-item measure of life satisfaction predicts dementia over a five year period in older adults without cognitive impairment.

  14. Neuropsychiatric Inventory data in a Belgian sample of elderly persons with and without dementia

    Directory of Open Access Journals (Sweden)

    Squelard GP

    2012-10-01

    Full Text Available Gilles P Squelard,1 Pierre A Missotten,1 Louis Paquay,2 Jan A De Lepeleire,2 Frank JVM Buntinx,2 Ovide Fontaine,1 Stephane R Adam,1 Michel JD Ylieff11Clinical Psychology of Ageing, Qualidem Research Project, University of Liège (ULg, Liège, Belgium; 2KU Leuven, Department of Public Health and Primary Care, Leuven, BelgiumBackground/aims: This study assesses and compares prevalence of psychological and behavioral symptoms in a Belgian sample of people with and without dementia.Methods: A total of 228 persons older than 65 years with dementia and a group of 64 non-demented persons were assessed using the Neuropsychiatric Inventory (NPI in 2004.Results: Within the group without dementia, the most frequent symptoms were depression, agitation, and irritability. Within the group with dementia, the most common symptoms were depression, irritability, apathy, and agitation. Prevalence of delusions (P < 0.05, hallucinations (P < 0.05, anxiety (P < 0.05, agitation (P < 0.05, apathy (P < 0.01, aberrant motor behavior (P < 0.01, and eating disorders (P < 0.05 were significantly higher in the group with dementia.Conclusion: Depression, elation, irritability, disinhibition, and sleeping disorders are not specific to dementia. Agitation, apathy, anxiety, and delusions are more frequent in dementia but were not specific to the dementia group because their prevalence rates were close to 10% in the group without dementia. Hallucinations, aberrant motor behavior, and eating disorders are specific to dementia. The distinction between specific and nonspecific symptoms may be useful for etiological research on biological, psychological, and environmental factors.Keywords: behavior, behavior disorders, epidemiology, dementia, psychiatric symptoms, neuropsychiatry

  15. Critical thinking of registered nurses in a fellowship program.

    Science.gov (United States)

    Zori, Susan; Kohn, Nina; Gallo, Kathleen; Friedman, M Isabel

    2013-08-01

    Critical thinking is essential to nursing practice. This study examined differences in the critical thinking dispositions of registered nurses (RNs) in a nursing fellowship program. Control and experimental groups were used to compare differences in scores on the California Critical Thinking Disposition Inventory (CCTDI) of RNs at three points during a fellowship program: baseline, week 7, and month 5. The control group consisted of RNs who received no education in critical thinking. The experimental group received education in critical thinking using simulated scenarios and reflective journaling. CCTDI scores examined with analysis of variance showed no significant difference within groups over time or between groups. The baseline scores of the experimental group were slightly higher than those of the control group. Chi-square analysis of demographic variables between the two groups showed no significant differences. Critical thinking dispositions are a combination of attitudes, values, and beliefs that make up one's personality based on life experience. Lack of statistical significance using a quantitative approach did not capture the development of the critical thinking dispositions of participants. A secondary qualitative analysis of journal entries is being conducted. Copyright 2013, SLACK Incorporated.

  16. Depression as a modifiable factor to decrease the risk of dementia

    Science.gov (United States)

    Almeida, O P; Hankey, G J; Yeap, B B; Golledge, J; Flicker, L

    2017-01-01

    Depression is an accepted risk factor for dementia, but it is unclear if this relationship is causal. This study investigated whether dementia associated with depression decreases with antidepressant use and is independent of the time between exposure to depression and the onset of dementia. We completed a 14-year longitudinal study of 4922 cognitively healthy men aged 71–89 years, and collected information about history of past depression, current depression and severity of depressive symptoms. Other measures included use of antidepressants, age, education, smoking and history of diabetes, hypertension, coronary heart disease, and stroke. The onset of dementia and death during follow-up was ascertained via the Western Australian Data Linkage System. A total of 682 men had past (n=388) or current (n=294) depression. During 8.9 years follow-up, 903 (18.3%) developed dementia and 1884 (38.3%) died free of dementia. The sub-hazard ratios (SHRs) of dementia for men with past and current depression were 1.3 (95% confidence interval (CI)=1.0, 1.6) and 1.5 (95% CI=1.2, 2.0). The use of antidepressants did not decrease this risk. Compared to men with no symptoms, the SHRs of dementia associated with questionable, mild-to-moderate and severe depressive symptoms were 1.2 (95% CI=1.0, 1.4), 1.7 (95% CI=1.4, 2.2) and 2.1 (95% CI=1.4, 3.2), respectively. The association between depression and dementia was only apparent during the initial 5 years of follow-up. Older men with history of depression are at increased risk of developing dementia, but depression is more likely to be a marker of incipient dementia than a truly modifiable risk factor. PMID:28463236

  17. Appropriateness of using a symbol to identify dementia and/or delirium: a systematic review.

    Science.gov (United States)

    Hines, Sonia; Abbey, Jenny; Wilson, Jacinda; Sacre, Sandy

    2009-01-01

    Alzheimer's Australia contracted the Dementia Collaborative Research Centre - Consumers, Carers and Social Research to conduct a systematic review to explore the appropriateness of a symbol for dementia.The concept of a symbol for people with dementia was an outcome of the Alzheimer's Australia National Consumer Summit on Dementia held in Canberra in October 2005. People living with dementia and their carers identified that a national symbol would be helpful in order to encourage appropriate treatment of people with dementia.Funding was provided as part of the Australian Government's Dementia Initiative to Alzheimer's Australia to work in collaboration with the Queensland University of Technology and Catholic Health Australia to explore, through research, the viability and potential impact of such a symbol in a range of care settings. The main objective of this systematic review was to evaluate any published and unpublished evidence regarding the appropriateness of developing a symbol for dementia and/or delirium, which could be used in a variety of settings to indicate that a person has dementia and/or delirium. A literature search was performed using the following databases: Ageline, APAIS Health, CINAHL, Dissertations and Theses Abstracts, Embase, MEDLINE, PsycEXTRAS, PsycINFO, PsycArticles, Current Contents, LegalTrac, Health and Society, Sociological Abstracts, Family and Society, CINCH, and Hein Online databases. The reference lists of articles retrieved were hand searched, as well as a range of literature from health, legal, ethical and emergency services. Grey literature was searched for using a number of Internet sites, and personal email communication with authors of relevant studies and known researchers in the field was initiated. Papers were retrieved if they provided information about attitudes or perceptions towards the appropriateness of symbols, identifiers or alerts used to inform others that someone has dementia, delirium and/or another medical

  18. The Sociolinguistic Status of Islamic English: A Register Approach

    Directory of Open Access Journals (Sweden)

    Zaidan Ali Jassem

    2013-12-01

    Full Text Available This paper investigates the special use of English by Muslim scholars in different fields of en¬quiry, which has been termed Islamic English by some. The data consists of several pieces of evidence from (i different kinds of publications in the UK, KSA, Malaysia, and South Africa, (ii international participant feedback in response to an earlier presentation in a Greek Symposium about the same topic to which this paper is a followup in essence, and (iii participant observations of Muslims' conversations worldwide. The results indicate that Islamic English is not only real as much as Biblical English is, but it is also a continuum with several varieties ranging from the light to the heavy. It has certain universal features, including lexis, grammar, topic, style, audience, codeswitching, and Arabicity, thus, marking it as a register, variety, or dialect of English which expresses their social and cultural identity. In the conclusion, the paper recommends teaching students Islamic English from the perspective of social and cultural identity.

  19. A new music therapy engagement scale for persons with dementia.

    Science.gov (United States)

    Tan, Jane; Wee, Shiou-Liang; Yeo, Pei Shi; Choo, Juliet; Ritholz, Michele; Yap, Philip

    2018-05-25

    ABSTRACTObjectives:To develop and validate a new scale to assess music therapy engagement in persons with dementia (PWDs). A draft scale was derived from literature review and >2 years of qualitative recording of PWDs during music therapy. Content validity was attained through iterative consultations, trial sessions, and revisions. The final five-item Music Therapy Engagement scale for Dementia (MTED) assessed music and non-music related elements. Internal consistency and inter-rater reliability were assessed over 120 music therapy sessions. MTED was validated with the Greater Cincinnati Chapter Well-being Observation Tool, Holden Communication Scale, and Participant Engagement Observation Checklist - Music Sessions. A total of 62 PWDs (83.2 ± 7.7 years, modified version of the mini-mental state examination = 13.2/30 ± 4.1) in an acute hospital dementia unit were involved. The mean MTED score was 13.02/30 ± 4.27; internal consistency (Cronbach's α = 0.87) and inter-rater reliability (intra-class correlation = 0.96) were good. Principal component analysis revealed a one-factor structure with Eigen value > 1 (3.27), which explained 65.4% of the variance. MTED demonstrated good construct validity. The MTED total score correlated strongly with the combined items comprising Pleasure, Interest, Sadness, and Sustained attention of the Greater Cincinnati Chapter Well-being Observation Tool (rs = 0.88, p < 0.001). MTED is a clinically appropriate and psychometrically valid scale to evaluate music therapy engagement in PWDs.

  20. Safety of Adrenaline Use in Anaphylaxis: A Multicentre Register.

    Science.gov (United States)

    Cardona, Victòria; Ferré-Ybarz, Laia; Guilarte, Mar; Moreno-Pérez, Nuria; Gómez-Galán, Catalina; Alcoceba-Borràs, Eva; Delavalle, Maria Belén; Garriga-Baraut, Teresa

    2017-01-01

    The use of intramuscular adrenaline to treat anaphylaxis is suboptimal, despite being the first-line treatment recommended by national and international anaphylaxis guidelines. Fear of potentially severe side effects may be one of the underlying factors. The aim of this study was to assess the incidence and severity of adverse side effects after the use of adrenaline in anaphylaxis, as well as potential risk factors. Observational study based on a multicenter online registry of cases of adrenaline administration for suspected anaphylaxis. 277 registered valid cases were included: 138 (51.49%) female, median age 29 years (12-47), and 6 children under 2 years with a median age of 9 months (1-21). Side effects occurred in 58 cases (21.64%), with tremors, palpitations, and anxiety being the most frequent. There was a significant association of developing side effects with older age, higher dose of adrenaline, or use of the intravenous route. Potentially severe adverse effects (high blood pressure, chest discomfort, or ECG alterations) occurred only in 8 cases (2.99%); in these cases, no differences were found according to age or adrenaline dose, but again, intravenous administration was associated with more severe adverse events. This study shows that side effects affect less than 1 in 5 patients who receive adrenaline for an anaphylactic reaction, and are usually mild and transient. Therefore, in an emergency situation such as anaphylaxis, restricting adrenaline administration due to potential adverse effects would, in general, not be justified. © 2017 S. Karger AG, Basel.