| 1. |
- Alsholm, Linda, et al.
(författare)
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Interrupted transport by the emergency medical service in stroke/transitory ischemic attack : A consequence of changed treatment routines in prehospital emergency care.
- 2019
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Ingår i: Brain and Behavior. - : Wiley. - 2162-3279.
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The discovery that not all patients who call for the emergency medical service (EMS) require transport to hospital has changed the structure of prehospital emergency care. Today, the EMS clinician at the scene already distinguishes patients with a time-critical condition such as stroke/transitory ischemic attack (TIA) from patients without. This highlights the importance of the early identification of stroke/TIA.AIM: To describe patients with a final diagnosis of stroke/TIA whose transport to hospital was interrupted either due to a lack of suspicion of the disease by the EMS crew or due to refusal by the patient or a relative/friend.METHODS: Data were obtained from a register in Gothenburg, covering patients hospitalised due to a final diagnosis of stroke/TIA. The inclusion criterion was that patients were assessed by the EMS but were not directly transported to hospital by the EMS.RESULTS: Among all the patients who were assessed by the EMS nurse and subsequently diagnosed with stroke or TIA in 2015, the transport of 34 of 1,310 patients (2.6%) was interrupted. Twenty-five of these patients, of whom 20 had a stroke and five had a TIA, are described in terms of initial symptoms and outcome. The majority had residual symptoms at discharge from hospital. Initial symptoms were vertigo/disturbed balance in 11 of 25 cases. Another three had symptoms perceived as a change in personality and three had a headache.CONCLUSION: From this pilot study, we hypothesise that a fraction of patients with stroke/TIA who call for the EMS have their direct transport to hospital interrupted due to a lack of suspicion of the disease by the EMS nurse at the scene. These patients appear to have more vague symptoms including vertigo and disturbed balance. Instruments to identify these patients at the scene are warranted.
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| 2. |
- Karpul, David, et al.
(författare)
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Vibrotactile sensitivity of patients with HIV-related sensory neuropathy: An exploratory study
- 2019
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Ingår i: Brain and Behavior. - : WILEY. - 2162-3279. ; 9:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: HIV-associated distal polyneuropathy (HIV-PN) affects large and small sensory nerve fibers and can cause tactile insensitivity. This exploratory study forms part of an effort to apply subsensory electrical nerve stimulation (SENS) to improve tactile sensitivity of patients with HIV-PN. This work presented an opportunity to use a robust protocol to quantitatively describe the vibrotactile sensitivity of individuals with HIV-PN on effective antiretroviral therapy (ART) and correlate these findings with commonly used clinical vibration testing and scoring grades. Methods: The vibration perception thresholds (VPTs) of 20 patients with HIV-PN at three vibration frequencies (25, 50, and 128 Hz) were measured. We compare the vibration perception threshold (VPT) outcomes to an age- and gender-matched control cohort. We further correlated VPT findings with 128 Hz tuning fork (TF) assessments performed on the HIV-PN participants, accrued as part of a larger study. HIV-PN was defined as having at least one distal symmetrical neuropathic sign, although 18 of 20 had at least two neuropathic signs. Conclusions: HIV-PN participants were found to have lower VPT sensitivity than controls for all three vibration frequencies, and VPT was more sensitive at higher vibration frequencies for both HIV-PN and controls. VPT sensitivity was reduced with older age. Years on ART was correlated with VPT-25 Hz but not with VPT in general. Notably, VPT sensitivity did not correlate with the clinically used 128 Hz TF severity grades. Outcomes of tests for interaction with vibration frequency suggest that HIV-PN pathology does not affect all mechanoreceptors similarly.
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| 3. |
- Martens, Kris, et al.
(författare)
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Remediating reduced memory specificity in bipolar disorder : A case study using a Computerized Memory Specificity Training
- 2019
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Ingår i: Brain and Behavior. - : Wiley. - 2162-3279. ; 9:12
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Reduced autobiographical memory specificity (rAMS) is a vulnerability factor found across unipolar depression (UD), posttraumatic stress disorder (PTSD), eating disorder, schizophrenia, and bipolar disorder (BD). A group delivered psychological therapy training called Memory Specificity Training (MeST) remediates rAMS in UD and PTSD, with additional downstream effects on related psychological processes and symptoms. Its impact in BD is unknown. In this case study, we examined the impact of a computerized version of MeST (c-MeST) on improving AMS and related symptoms and processes in participant with rapid cycling type I BD.METHOD: An experimental case study with an ABA design was used. During baseline (14 days, Phase A), the training phase (nine sessions across 17 days, Phase B), and a 1-month follow-up (Phase A), memory specificity, depressive symptoms, and related processes and symptoms were repeatedly measured.RESULTS: Memory specificity increased significantly after the participant completed c-MeST. Session-to-session scores indicated that AMS improved most from the in-person baseline assessment to the first online session. All other measures of processes and symptoms deteriorated during the training phase but regressed to baseline during follow-up.CONCLUSION: Memory specificity was improved as indicated by increased AMS from pre-intervention measurement to 1-month follow-up. Other improvements in symptoms were not observed. Rather, some related maladaptive psychological processes and symptoms worsened during the training phase and regressed to baseline during follow-up.
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| 4. |
- Ozanne, Anneli, 1978, et al.
(författare)
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Symptom relief during last week of life in neurological diseases
- 2019
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Ingår i: Brain and Behavior. - : Wiley. - 2162-3279. ; 9:8
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Tidskriftsartikel (refereegranskat)abstract
- Objectives The aim of this study was to investigate symptom prevalence, symptom relief, and palliative care indicators during the last week of life, comparing them for patients with motor neuron disease (MND), central nervous system tumors (CNS tumor), and other neurological diseases (OND). Material & Methods Data were obtained from the Swedish Register for Palliative Care, which documents care during the last week of life. Logistic regression was used to compare patients with MND (n = 419), CNS tumor (n = 799), and OND (n = 1,407) as the cause of death. Results The most prevalent symptoms for all neurological disease groups were pain (52.7% to 72.2%) and rattles (58.1% to 65.6%). Compared to MND and OND, patients with CNS tumors were more likely to have totally relieved pain, shortness of breath, rattles, and anxiety. They were also more likely to have their pain assessed with a validated tool; to receive symptom treatment for anxiety, nausea, rattles, and pain; to have had family members receive end-of-life discussions; to have someone present at death; and to have had their family members offered bereavement support. Both patients with CNS tumor and MND were more likely than patients with OND to receive consultation with a pain unit and to have had end-of-life discussions. Conclusions The study reveals high symptom burden and differences in palliative care between the groups during the last week of life. There is a need for person-centered care planning based on a palliative approach, focused on improving symptom assessments, relief, and end-of-life conversations.
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| 5. |
- Qiao, Ya-Mei, et al.
(författare)
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Reciprocal associations between job strain and depression : A 2-year follow-up study from the Survey of Health, Ageing and Retirement in Europe
- 2019
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Ingår i: Brain and Behavior. - : Wiley. - 2162-3279. ; 9
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Tidskriftsartikel (refereegranskat)abstract
- Background: A growing number of people suffered from depression. This study examined the depression prevalence in workers across 10 European countries plus Israel and the reciprocal associations between job strain and depression.Methods: The study population consisted of 7,879 workers aged 50-63 years at baseline (2004) from the Survey of Health, Ageing, and Retirement in Europe (SHARE). Job demands (physical or psychosocial) and job control variables were derived from the Job Content Questionnaire (JCQ). Two 4-category job strains (physical and psychosocial) were obtained based on the cross-tabulation of these dichotomized demands and control variables. There were 4,284 depression-free, 3,259 high physical strain-free and 3,195 high psychosocial strain-free participants at baseline who were followed up for 2 years to detect incident depression, high physical job strain, or high psychosocial strain, respectively. The reciprocal associations between job strain and depression were analyzed by multivariate logistic regression and multivariate multilevel logistic regression adjusting for potential confounders.Results: The prevalence of depression varied from the lowest 12.5% in Germany to the highest 27.2% in France. Compared to individuals with low strain, a significantly higher risk of depression were found in individuals with high physical strain (OR = 1.39) and high psychosocial strain (OR = 1.55), after adjusting for potential confounders. Depression at baseline was not significantly associated with subsequent high job strain. Similar results were observed from multilevel models that took into consideration of the potential country-level influences.Conclusions: The prevalence of depression varies across countries in Europe. Avoiding high job strain may be an effective preventive strategy to prevent depression epidemic.
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| 6. |
- Rejnö, Åsa, 1970-, et al.
(författare)
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Changes in functional outcome over five years after stroke
- 2019
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Ingår i: Brain and Behavior. - : Wiley. - 2162-3279. ; 9:6
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Data on the long-term time course of poststroke functional outcome is limited. We investigated changes in functional outcome over 5 years after stroke in a hospital based cohort. Materials and Methods Consecutive patients who were independent in activities of daily living (ADL) and admitted to a Stroke Unit at Skaraborg Hospital, Sweden for a first acute stroke from 2007 to 2009 (n = 1,421) were followed-up after 3 months and thereafter annually over 5 years using a postal questionnaire. Clinical variables at acute stroke and 3 months post stroke were obtained from the Swedish Stroke Register. ADL dependency was defined as dependence in dressing, toileting or indoor mobility. Results The proportions of survivors who reported ADL dependency remained stable throughout follow-up (19%-22%). However, among survivors who were ADL independent at 3 months, about 3% deteriorated to dependency each year. Deterioration was predicted by age (HR 1.11; 95% CI 1.08-1.13), diabetes (HR 1.65; 95% CI 1.12-2.44), NIHSS score (HR 1.07; 95% CI 1.04-1.10), and self-perceived unmet care needs one year post stroke (HR 2.01; 95% CI 1.44-2.81). Transitions from ADL dependency to independence occurred mainly during the first year post stroke. Improvement was negatively predicted by living alone before stroke (HR 0.41 95% CI 0.19-0.91), NIHSS score (HR 0.90; 95% CI 0.86-0.95) and ischemic stroke (vs. hemorrhagic stroke), HR 0.39; 95% CI 0.17-0.89. Conclusion Transitions between ADL independence and dependency occur up to 5 years after stroke. Some of the factors predicting these transitions are potentially modifiable.
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| 7. |
- Svensson, Joel, et al.
(författare)
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Occupational gaps 5years after stroke.
- 2019
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Ingår i: Brain and behavior. - : Wiley. - 2162-3279. ; 9:3
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Tidskriftsartikel (refereegranskat)abstract
- To investigate the incidence and number of occupational gaps 5years after stroke and find possible predictors and explanatory factors for increased number of experienced gaps.The participants were diagnosed with first-time stroke in Gothenburg during 2009-2010. Medical records from their hospital stay were used to obtain baseline data. The Occupational Gaps Questionnaire and the Swedish stroke registers follow-up questionnaire were sent out. Data from the Occupational Gaps Questionnaire were used as a dependent variable and baseline data and questions from the stroke registry were used as independent variables in logistic regression.Five years poststroke, 49.5% experienced a higher number of occupational gaps compared to a healthy reference population. Predictors for an increased number of gaps were higher age at stroke onset and a higher degree of functional dependency. Explanatory factors for an increased number of gaps in the study population were higher age at follow-up and feelings of depression.Older age at the time of stroke and functional dependency can predict an increased number of occupational gaps. Older age and feelings of depression are connected to an increased number of occupational gaps. Individuals at risk should be provided with additional interventions to reduce participation restrictions.
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| 8. |
- Sörbo, Ann, 1955, et al.
(författare)
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Mental fatigue assessment may add information after aneurysmal subarachnoid hemorrhage
- 2019
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Ingår i: Brain and Behavior. - : Wiley. - 2162-3279. ; 9:7
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Tidskriftsartikel (refereegranskat)abstract
- Background Mental fatigue, as part of cognitive dysfunction, has been reported to be common after subarachnoid hemorrhage and it significantly affects quality of life. Aims of the Study The aim of this study was to assess mental fatigue one year after an aneurysmal subarachnoid hemorrhage and to correlate the degree of mental fatigue to functional outcome assessed with the Extended Glasgow Outcome Scale (GOSE). Methods One year after an aneurysmal subarachnoid hemorrhage, the GOSE was assessed and a questionnaire for self-assessment of mental fatigue, the Mental Fatigue Scale, was distributed to all included patients. The maximum score is 42 and a score of >= 10.5 indicates mental fatigue. Results All patients with GOSE 8, indicating full recovery, had a mental fatigue score of <10.5. A linear correlation between the GOSE and the mental fatigue score was observed (p < 0.0001). Conclusions Patients with a favorable outcome and GOSE 5-7 could benefit from the assessments of mental fatigue in order to receive satisfactory rehabilitation.
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| 9. |
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| 10. |
- Zelano, Johan, 1981, et al.
(författare)
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Neuronal antibodies in adult patients with new-onset seizures: A prospective study
- 2019
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Ingår i: Brain and Behavior. - : Wiley. - 2162-3279. ; 9:11
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Immunotherapy in addition to antiepileptic drugs can improve seizure freedom rates in autoimmune epilepsy, highlighting the importance of early diagnosis. A diagnosis of autoimmune epilepsy can be supported by presence of serum antibodies to neuronal antigens. We asked how often neuronal antibodies are found in the serum of unselected adult patients with new-onset seizures and whether such testing could improve detection of autoimmune epilepsy. Material and Methods We included 44 patients over the age of 25 presenting after at least one unprovoked seizure to the Neurology Clinic at Sahlgrenska University Hospital, Gothenburg, Sweden. The median time between the first-ever seizure in life and the serum sampling was 50 days (range 22-11,000). Antibody testing in serum was performed according to the manufacturer's instructions. The patients were followed for at least 1 year. Results Epilepsy could be diagnosed already at the first visit in 21/44 patients (47.7%). Two patients (4.5%) were positive for neuronal antibodies: one against contactin-associated protein 2 (CASPR-2) and one against glutamate acid decarboxylase (GAD). Three patients (6.7%) displayed very weak immunoreactivity that was deemed clinically insignificant. One of the antibody-positive patients had only a single seizure. The other had a focal cortical dysplasia and was seizure-free on levetiracetam. None of the five patients with antibodies or immunoreactivity displayed any feature of autoimmune epilepsy. Conclusions We conclude that indiscriminate testing in patients presenting to a first seizure clinic with new-onset seizures or epilepsy is unlikely to improve detection of autoimmune epilepsy.
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