| 861801. |
- Lethagen, ÅsaLinda
(författare)
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Clinical, Genetic and Metabolic Characterisation of LADA (Latent Autoimmune Diabetes in Adults)
- 2002
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Latent autoimmune diabetes in adults (LADA) comprises about 10% of patients initially diagnosed with type 2 diabetes but who are positive for pancreatic islet antibodies, especially to glutamic acid decarboxylase (GADabs). The present studies focused on clinical, genetic and metabolic characterisation of patients with LADA. In LADA, the frequency of the type 1 diabetes susceptibility genotype HLA-DQB1*0201/*0302 and genotypes including the 0302 allele was higher than in type 2 diabetes but lower than in type 1 diabetes. No difference was seen between LADA and type 2 diabetic or control subjects regarding the frequency of the insulin gene alleles associated with the risk of type 1 diabetes, whereas the frequency of these alleles was high in type 1 diabetic patients. In the LADA subjects, beta-cell function was significantly impaired at diagnosis compared with type 2 diabetic patients, but was markedly better preserved compared with age-matched adult type 1 diabetic patients. GADab positivity was linked with decreased insulin secretion in non-diabetic subjects, suggesting that GADabs are markers of beta-cell autoimmunity, although this does not always lead to overt diabetes. Features of the metabolic syndrome in LADA were fewer than in type 2 diabetes but more common than in type 1 diabetes. The results show that although LADA shares characteristics with both type 1 and type 2 diabetes it can be clinically, genetically, and metabolically distinguished from both types. The distinction is of clinical importance for identifying LADA and to achieve proper care of these patients.
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| 861802. |
- Lethagen, ÅsaLinda, et al.
(författare)
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Glutamic acid decarboxylase antibody positivity is associated with an impaired insulin response to glucose and arginine in nondiabetic patients with autoimmune thyroiditis
- 2002
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Ingår i: Journal of Clinical Endocrinology and Metabolism. - 1945-7197. ; 87:3, s. 1177-1183
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Tidskriftsartikel (refereegranskat)abstract
- To study whether antibodies to glutamic acid decarboxylase (GADab) are associated with subclinical beta-cell damage and impaired insulin secretion, we screened 441 nondiabetic patients with autoimmune thyroiditis (AT) for GADab, and 15 (3.4%) were found positive. Antibodies to IA-2 were found in two GADab+ and one GADab- patients. We matched 11 GADab+ and 13 GADab- AT patients who were euthyroid on thyroxin supplementation, and 13 control subjects for sex, age, and body mass index and measured insulin, C-peptide, and glucagon response to glucose and arginine at three blood glucose concentrations (fasting, 14 mmol/liter, >25 mmol/liter). In the fasting state, all groups had similar blood glucose concentration and HbA1c level, but the serum insulin concentration was higher in the AT patients compared with the control subjects (P < 0.04). The acute insulin response to arginine was lower in GADab+ than in GADab- thyroiditis subjects at glucose concentration of 14 and >25 mmol/liter (AIR,4: 76.8 +/- 52.0 vs. 158.2 +/- 118.2 mU/liter, P = 0.040; AIR(>25): 84.3 +/- 64.4 vs. 167.9 +/- 101.5 mU/liter, P = 0.035). In conclusion, GADab were associated with a decreased insulin secretion capacity in nondiabetic subjects with thyroiditis, which suggests that GADab positivity could be a marker of subclinical insulitis.
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| 861803. |
- Lethbridge, Emily, et al.
(författare)
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Inscribing Environmental Memory in the Icelandic Sagas and the Icelandic Saga Map
- 2016
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Ingår i: Publications of the Modern Language Association of America. - : Modern Language Association (MLA). - 0030-8129 .- 1938-1530. ; 131:2, s. 381-391
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Tidskriftsartikel (refereegranskat)abstract
- This essay discusses strategic efforts to develop new digital research tools and approaches as key elements of an inter-disciplinary research initiative in progress, Inscribing Environmental Memory in the Icelandic Sagas (IEM), which aims to study aspects of Icelandic literature, history, archaeology, environment, and geography in order to better understand societal responses to environmental change over the longue durée. The essay showcases a particular digital humanities project, Icelandic Saga Map (ISM), which not only provides an extremely useful tool for helping achieve many of the identified aims and methodological needs of an integrated environmental humanities initiative such as IEM but also is a valuable example of how innovative digital humanities tools can foster new research trajectories and open up new horizons for interdisciplinary engagement and synthesis of knowledge and diverse data.
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| 861804. |
- Lethin, Connie, et al.
(författare)
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Demensvård i primärvården
- 2013
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Ingår i: Omvårdnad i primärvården. - 9789144076881 ; 1, s. 243-256
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Bokkapitel (populärvet., debatt m.m.)abstract
- Demens är den fjärde största folksjukdomen i Sverige och cirka 148 000 människor har någon form av demenssjukdom. Med stigande ålder hos befolkningen ökar antalet stadigt och varje år insjuknar cirka 25 000 personer. Alzheimers sjukdom och vaskulär demens samt blandformer av dessa är de vanligaste demensdiagnoserna och de utgör tillsammans 50–75 procent av all demenssjukdom. Personer med demenssjukdom möter vi överallt i vårt samhälle och framför allt inom hälso- och sjukvården. Personer med minnesproblem kan i flera år ha haft en odiagnostiserad demenssjukdom eller varit ofullständigt utredda och söker ofta primärvården på grund av andra åkommor. Hos yngre personer med demens misstas ibland symtomen för tillstånd som depression och utmattningsdepression. Tidig utredning och diagnos av demenssjukdom bör oftast utföras i primärvården och i särskilda fall inom specialistsjukvården. Detta skulle underlätta personcentrerad omvårdnad genom vårdkedjan för patienten och för de närstående. Detta kapitel beskriver basal demensutredning, utvidgad demensutredning, demenssjuksköterskan i primärvården, personcentrerad omvårdnad, samt närstående som informella vårdare. Det behandlar även övergrepp och våld mot äldre.
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| 861805. |
- Lethin, Connie, et al.
(författare)
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Dementia care and service systems - a mapping system tested in nine Swedish municipalities
- 2018
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundIn dementia care, it is crucial that the chain of care is adapted to the needs of people with dementia and their informal caregivers throughout the course of the disease. Assessing the existing dementia care system with regard to facilities, availability and utilization may provide useful information for ensuring that the professional dementia care and service system meets the needs of patients and their families from disease onset to end of life.MethodsThe aim of this study was to further develop and test a mapping system, and adapt it to a local context. In addition, the aim was to assess availability and utilization of care activities as well as professional providers' educational level in nine municipalities under the categories of Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care. This cross-sectional study was conducted in April through May 2015. Data was derived from the health care and social service systems in nine rural and urban municipalities in two counties in Sweden. The mapping system covered seven categories with altogether 56 types of health care and social service activities.ResultsThe mapping system was found to be reliable with minor adaptations to the context mainly in terms of activities. Availability of care activities was common with low utilization regarding Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care and dementia trained staff was rare. Availability and utilization of care activities and professionals' educational level was higher concerning screening, the diagnostic procedures and treatment compared with outpatient care facilities, institutional care and palliative care.ConclusionsThe mapping system enables policy makers and professionals to assess and develop health care and social service systems, to be offered proactively and on equal terms to people with dementia and their informal caregivers throughout the course of the disease. The educational level of professionals providing care and services may reveal where, in the chain of care, dementia-specific education for professionals, needs to be developed.
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| 861806. |
- Lethin, Connie, et al.
(författare)
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Dementia care and service systems - A mapping system tested in nine Swedish municipalities 11 Medical and Health Sciences 1117 Public Health and Health Services
- 2018
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Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 18:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: In dementia care, it is crucial that the chain of care is adapted to the needs of people with dementia and their informal caregivers throughout the course of the disease. Assessing the existing dementia care system with regard to facilities, availability and utilization may provide useful information for ensuring that the professional dementia care and service system meets the needs of patients and their families from disease onset to end of life. Methods: The aim of this study was to further develop and test a mapping system, and adapt it to a local context. In addition, the aim was to assess availability and utilization of care activities as well as professional providers' educational level in nine municipalities under the categories of Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care. This cross-sectional study was conducted in April through May 2015. Data was derived from the health care and social service systems in nine rural and urban municipalities in two counties in Sweden. The mapping system covered seven categories with altogether 56 types of health care and social service activities. Results: The mapping system was found to be reliable with minor adaptations to the context mainly in terms of activities. Availability of care activities was common with low utilization regarding Screening, the diagnostic procedures, and treatment; Outpatient care facilities; Institutional care and Palliative care and dementia trained staff was rare. Availability and utilization of care activities and professionals' educational level was higher concerning screening, the diagnostic procedures and treatment compared with outpatient care facilities, institutional care and palliative care. Conclusions: The mapping system enables policy makers and professionals to assess and develop health care and social service systems, to be offered proactively and on equal terms to people with dementia and their informal caregivers throughout the course of the disease. The educational level of professionals providing care and services may reveal where, in the chain of care, dementia-specific education for professionals, needs to be developed.
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| 861807. |
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| 861808. |
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| 861809. |
- Lethin, Connie, et al.
(författare)
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Family caregivers experiences of formal care when caring for older persons with dementia through the stages of the disease
- 2013
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Ingår i: Abstract book. ; , s. 94-94
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Konferensbidrag (refereegranskat)abstract
- Aim: The aim of this study was to investigate family caregivers’ experiences of formal care when caring for an older person with dementia through the stages of the disease to be able to improve formal care and develop best practice.Method: A qualitative approach with focus groups interviews was chosen. The participants were family caregivers caring for older persons with dementia at home or in a nursing home. A total of 23 spouses and children took part in the study. An interview guide was used and contained questions about experiences of collaboration, communication and information with formal care. The family caregivers were also asked about improvement of formal care. The transcribed verbatim was analysed using content analysis to find the underlying meaning.Results: The result showed various themes describing family caregivers’ experiences of formal care when caring for an older person with dementia through the stages of the disease. The themes were predominating in one stage of the disease, but aroused in addition to a lower extent in other stages. “Being in an unexpected life situation with changes in roles” reflected the early stage of the disease describing the transition from being a relative to becoming a caregiver. Participants expressed that information from health care and getting knowledge was important. “Getting care resources or finding your own way” reflected the intermediate stage of the disease and the need of resources to be able to keep on caring at home. Participants experienced that collaboration and communication with municipal and health care was essential. “Being secure with formal care or struggling for security” reflected the last stage of the disease and family caregivers relation to formal care usually in a nursing home. Participants expressed that communication was important and to some degree also collaboration.Conclusion: Family caregiver´s had various experiences of formal care. From family caregivers view, formal care seems to be either supporting or troublesome when providing care to a person with dementia through the stages of the disease. On the behalf of RightTimePlaceCare consortium. http://www.righttimeplacecare.eu
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| 861810. |
- Lethin, Connie, et al.
(författare)
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Family caregivers experiences of formal care when caring for persons with dementia through the process of the disease
- 2016
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Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell. - 0283-9318 .- 1471-6712. ; 30:3, s. 526-534
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Family caregivers' experiences of formal care when caring for persons with dementia through the process of the disease is sparsely investigated.AIMS: To investigate family caregivers' experiences of formal care when caring for a person with dementia, through the stages of the disease.DESIGN: A qualitative approach with focus group interviews.METHODS: Four focus group interviews were conducted in October 2011 with 23 spouses and adult children of persons with dementia and analysed with content analysis.RESULTS: The participants' experiences of formal care when caring for a person with dementia were captured in the theme 'Family caregiving requires collaboration with formal care to get support adjusted to needs specific to the stages of dementia'. This can be broken down into the categories 'The dementia diagnosis - entry into formal care as a novice family caregiver', 'Needing expanded collaboration with formal care to continue care at home' and 'Being dependent on a nursing home and trying to maintain involvement'.CONCLUSION: Family caregiving requires collaboration with formal care to get support adjusted to the individual's needs, specific to the stages of dementia. Caregivers experience a transition process with three main turning points: the dementia diagnosis; when they realise increased need for formal care to continue caring at home; and when the person with dementia is moved into a nursing home. The interviewed caregivers experience formal care reactive to their needs and this often promoted unhealthy transitions. Formal care needs to be proactive and deliver available care and support early on in the dementia trajectory. Interventions should focus on facilitating a healthy transition for family caregivers through the trajectory of the dementia disease to ensure their well-being.
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