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Background: Treatment at stroke units is superior to treatment at other types of wards. The objective of the present study is to determine the effect size of stroke unit care in subgroups of patients with stroke. This information might be useful in a formal priority setting.Methods: All acute strokes reported to the Swedish Stroke Register from 2001 through 2005 were followed until January 2007. The subgroups were age (18-64, 65-74, 75-84, 85+ years and above), sex (male, female), stroke subtype (intracerebral haemorrhage, cerebral infarction and unspecified stroke) and level of consciousness (conscious, reduced, unconscious). Cox proportional hazards and logistic regression analyses were used to estimate the risk for death, institutional living or dependency.Results: 105,043 patients were registered at 86 hospitals. 79,689 patients (76%) were treated in stroke units and 25,354 patients (24%) in other types of wards. Stroke unit care was associated with better long-term survival in all subgroups. The best relative effect was seen among the following subgroups: age 18-64 years (hazard ratio (HR) for death 0.53; 0.49 to 0.58), intracerebral haemorrhage (HR 0.61; 0.58 to 0.65) and unconsciousness (HR 0.70; 0.66 to 0.75). Stroke unit care was also associated with reduced risk for death or institutional living after 3 months.Conclusions: Stroke unit care was associated with better long-term survival in all subgroups, but younger patients, patients with intracerebral haemorrhage and patients who were unconscious had the best relative effect and may be given the highest priority to this form of care. [ABSTRACT FROM AUTHOR]

Objective/background: Because restless legs syndrome (RLS) is a problematic syndrome, demonstrating an association between use of selective serotonin reuptake inhibitors (SSRIs)/serotonin-norepinephrine reuptake inhibitors (SNRIs) and RLS may help direct patient care. The goals of this study were (1) to establish the incidence of RLS in mental health patients being treated with SSRIs or SNRIs in a local Veterans Affairs medical center and (2) to evaluate the frequency with which certain SSRIs or SNRIs are associated with RLS and the trend in frequency of the diagnosis since the revision of the criteria for RLS offered by the International Restless Leg Syndrome Study Group (IRLSSG), the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the International Classification of Sleep Disorders, Revised (ICSD-3)., Methods: A retrospective chart review was used to evaluate the number of patients receiving SSRI/SNRI therapy with and without a diagnosis of RLS, with the date of the RLS diagnosis and initiation of SSRI/SNRI therapy noted. The frequency with which certain SSRIs/SNRIs were associated with RLS, and the frequency of RLS diagnoses since January 2012 were also noted. Descriptive statistics and logistic regression were used for data analysis., Results: A total of 254 charts were reviewed. A majority of the patients (89.8%) were male, and 14 (5.5%) were diagnosed with RLS. A logistic regression equation approached significance in predicting RLS (P=0.053). Age and sex emerged as significant predictors of RLS. The prevalence of any individual SSRI or SNRI being associated with RLS was indeterminable. No difference was seen in the number of RLS diagnoses since the refining of the IRLSSG, DSM-5, and ICSD-3 criteria., Conclusions: The use of SSRIs/SNRIs does not seem to be associated with a diagnosis of RLS. In addition, the diagnosis of RLS does not seem to have become more common since the revision of the diagnostic criteria for the disorder.

Military stressors such as survival training can affect endocrine functioning in the short term, and combat has been associated with endocrine changes linked to psychopathology. However, studies with military samples examining whether there are individual differences in these changes as part of normal development, or as an adaptive mechanism in adulthood are lacking. This study examined whether exposure to combat in a sample of veterans was associated with differential endocrine activity to a laboratory frustration task. Results indicated that Army veterans demonstrated significant testosterone reactivity to frustration and negative coupling between cortisol and testosterone. Alternatively, Navy and Marine veterans demonstrated little testosterone reactivity to frustration and positive coupling between cortisol and testosterone. Positive cortisol-testosterone coupling was stronger among individuals who had more dangerous combat experiences. This latter pattern may better prepare individuals for stressful life experiences and supports the contention that adulthood stressors may calibrate endocrine systems. Results are explained in the context of the Adaptive Calibration Model (Ellis et al., 2012, Developmental Psychology, 48(3), 598-623) which proposes that exposure to key environmental dimensions during endocrinologically malleable life stages (e.g., puberty) can change stress responsivity, resulting in a faster life history trajectory (e.g., increased risk-taking and aggression)., (© 2014 Wiley Periodicals, Inc.)

Given the growing number of women who are incarcerated across the United States, the current study investigated the relationships among female inmates' perceptions of their own stress, external locus of control (LOC), social support adequacy, and various aspects of psychological functioning. Generally, female inmates with a self-reported history of childhood sexual abuse did not differ from their nonabused counterparts on the variables of interest. Results suggested that female inmates' perceptions of higher stress, a higher degree of external LOC, and inadequate social support correlated with greater symptoms of depression and hopelessness as well as lower self-esteem. In regression analyses, stress and social support were significant predictors for depression and anxiety. In contrast, stress was the only significant predictor of hopelessness and self-esteem. Finally, none of the predictors examined here was significant in the prediction of traumatic stress. Overall, findings suggested the importance of stress and social support in the prediction of female inmates' adjustment, specifically their symptoms of depression and anxiety.

We report the results of a study based on 1,428 patients with eating disorders treated at 6 clinics. These patients were consecutively referred over 18 years and used inpatient and outpatient treatment. The subjects were diagnosed with anorexia nervosa, bulimia nervosa, or an eating disorder not otherwise specified. Patients practiced a normal eating pattern with computerized feedback technology, they were supplied with external heat, their physical activity was reduced, and their social habits restored to allow them to return to their normal life. The estimated rate of remission for this therapy was 75% after a median of 12.5 months of treatment. A competing event such as the termination of insurance coverage, or failure of the treatment, interfered with outcomes in 16% of the patients, and the other patients remained in treatment. Of those who went in remission, the estimated rate of relapse was 10% over 5 years of follow-up and there was no mortality. These data replicate the outcomes reported in our previous studies and they compare favorably with the poor long-term remission rates, the high rate of relapse, and the high mortality rate reported with standard treatments for eating disorders.

The rates of marijuana abuse are steadily increasing in the U.S. Data suggest that comorbid marijuana abuse and depression is associated with worse outcomes than either diagnosis. Genetic studies independently link the DRD4 gene polymorphism to substance use and to internalizing disorders, but no study has examined whether the DRD4 polymorphism is linked to comorbid marijuana use and depression in a population sample. This study examined associations between the DRD4 gene 48bp VNTR polymorphism and comorbidity between marijuana use frequency and depression in a diverse, non-clinical adolescent sample (n=1882; ages 14 to 18) from the National Longitudinal Study of Adolescent Health (Add Health). Multinomial regression analyses indicated that the odds of being comorbid for depressive symptoms and marijuana use are approximately 2.5≥ with the ≥7R/≥7R genotype than youths who carry the <7R/<7R genotype, controlling for the effects of ethnicity, gender, age, violent victimization, and alcohol related problems. Findings provide genetic clues for psychopathology characterized by prominent externalizing and internalizing features., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Internalizing problems are common among college students and have been linked consistently to deficits in emotion regulation (ER). Also, hostility/anger (animosity toward others, phenomenological aspect of anger) is an important feature of internalizing problems, but has received limited attention as a mediator between ER and outcomes. Results (N = 160) indicated that although college students' ER abilities corresponded with all three types of internalizing symptoms, hostility/anger mediated fully the relationship for symptoms of depression and social anxiety, but not generalized anxiety (GAD). The stronger interpersonal aspect inherent in depression and social anxiety relative to GAD may in part explain findings, but findings must be viewed in lieu of limitations, which include self-report, a non-clinical sample, and a cross-sectional design. Overall, hostility/anger may be important to address in interventions and programs aimed at reducing internalizing problems, especially among those who demonstrate ER deficits and are prone to depression and social anxiety.

Rates of substance use and maltreatment are alarmingly high among incarcerated women. Although the direct link between trauma and substance use has been established, less is known about potential mediators. Thus, we examined substance use coping as a mediator between trauma symptoms and substance use consequences among a sample of incarcerated females (N = 111) who were survivors of childhood sexual abuse. Trauma symptoms predicted the severity of substance use consequences, with this relationship being mediated fully by avoidance coping (e.g., using substances to cope). Overall, trauma histories are important in predicting outcomes but must be examined in the context of current coping behaviors and substance use. Findings (data collected in 2007/2008) may help promote interventions that target patterns of coping and/or emotional avoidance among trauma survivors with substance use problems in incarcerated populations. The study's limitations are noted.

Despite a general consensus in the United States that overtly racist acts are unacceptable, many ambiguous situations in everyday life raise questions of whether racism has influenced a person's behavior in an interracial encounter. The authors of the present study sought to (a) examine simultaneously an array of variables thought to be related to perceived racism and (b) investigate how the contribution of these variables may differ with respect to the asymmetry hypothesis, which suggests that acts of discrimination from a dominant person toward a subordinate person will be viewed as more biased than if the situation were reversed. The authors used a dual structural equation modeling approach. Results indicated that ethnic identity significantly predicted perceived racism. In addition, the extent to which cognitive interpretation style significantly predicted perceived racism depended on the ethnicity of participants involved in the interaction.

Objectives: To explore nation-wide use of anticoagulation in stroke patients with atrial fibrillation, in routine clinical practice in Sweden., Design: Cross-sectional cohort study., Setting: Patients included in Riks-Stroke, the Swedish national quality register for stroke care, during 2001., Subjects: Hospitals with incomplete coverage were excluded, leaving 4538 stroke patients with atrial fibrillation amongst 18 276 stroke patients from 75 hospitals in six health care regions., Main Outcome Measure: Treatment with oral anticoagulants., Results: At stroke onset, the proportion of patients with atrial fibrillation and first-ever stroke, receiving oral anticoagulants as primary prevention was 11.0% (range 8.4-13.5% between regions and 2.5-24.4% between hospitals). Younger age, male sex and diabetes at stroke onset independently predicted primary prevention with oral anticoagulants. The proportion of stroke patients with atrial fibrillation receiving oral anticoagulants as secondary prevention at discharge was 33.5% (range 29.9-40.6% between regions and 16.4-61.9% between hospitals). Independent predictors for secondary prevention were younger age, male sex and independent activities of daily life (ADL) function before the stroke, being discharged to home, being fully conscious on admission and health care region., Conclusion: There were variations between hospitals and regions that differences in age, sex, functional impairments and comorbidities could not fully explain. This indicates that evidence-based primary and secondary prevention of embolic stroke is insufficiently practised. Local factors seem to determine whether patients with atrial fibrillation gain access to optimal prevention of stroke or not.

Background and Purpose: It is disputed whether there are sex differences in management and outcome after stroke; early studies have shown inconsistent results. The objective of this study was to verify and explain differences between men and women in management and outcome after stroke in a national perspective., Methods: In 2001, 20 761 stroke patients were registered in Riks-Stroke, the national quality register for stroke care in Sweden in which all 84 hospitals participate. Data from 9 hospitals that had reported <70% of the estimated stroke events were excluded from analyses, leaving 19 547 patients (9666 women, 9881 men) at 75 hospitals for the present analyses., Results: Women were older than men (77.8 versus 73.2 years). After age adjustment, female patients were more often disabled, living at home with community support, or in institutions before the stroke. They also had a different cardiovascular risk factor profile. Case fatality ratios during the first 3 months were similar in men and women. After 3 months, more women were physically and mentally impaired and dependent on other persons. Female patients with atrial fibrillation received oral anticoagulants less often than men. Even after multiple adjustments for differences between sexes, female sex was independently associated with institutional living 3 months after the stroke (odds ratio, 1.2; 95% confidence interval, 1.0 to 1.4)., Conclusions: Women have a worse prestroke condition. Except for case fatality ratios, they also have a worse outcome after stroke after adjustment for other prognostic factors. There are also sex differences in the medical management of stroke that need to be rectified.

Background: Riks-Stroke, the Swedish national quality register on stroke care, provides unique opportunities to evaluate stroke units in routine clinical care., Methods: Basic patient characteristics, process indicators and outcome variables are recorded in all 85 hospitals admitting acute stroke patients. A 3-month follow-up is included., Results: There are wide variations between hospitals in the proportion of patients admitted to a stroke unit, in secondary prevention and in the proportion of patients in institutional care at 3 months. Even after adjustment for available prognostic indicators, case fatality is lower and functional outcome is better in patients treated in stroke units than in patients treated in general wards., Conclusion: Riks-Stroke shows that outcome is consistently better in patients treated in a stroke unit than in general wards, not only in randomised trials but also in routine stroke care., (Copyright 2003 S. Karger AG, Basel)

The National Board of Health and Welfare together with Riks-Stroke (the Swedish National Registry for Quality Assessment of Acute Stroke Care) were commissioned by the government to study the circumstances of 4,023 stroke patients, two years after the event. Both physical and psychological impairments together with psychosocial consequences were common. Approximately one fifth of the patients did not receive enough help and support, and the most common reason for this was the high cost. Instead many were dependent upon next-of-kin. This indicates that the long-term care of stroke patients needs to be improved.

Thirty persons who had remained in long-term care for one year or more post-stroke were assessed with respect to motor function, cognitive, perceptual, and communication ability and ADL capacity. Before the stroke they had lived an independent life, although 40% suffered from cardiovascular disease. At the follow-up, all patients had severe impairments due to the brain damage. None could walk or stand independently, ten could not call for help or attract attention in any way, and 13 could not take part in a conversation. Eleven patients had severe pain in spite of treatment with analgesics. Pain treatment and training methods that can reduce dependence and improve the quality of life for patients like these need to be developed. More appropriate assessment instruments for this patient group have to be constructed to make evaluation of training and care possible.

In order to study change in disability and sickness impact after stroke, 36 patients were followed during a period of three years. ADL-status (Activities of Daily Living) was assessed by means of Katz' ADL Index. Interviews according to the Sickness Impact Profile (SIP) were carried out 6-9 months and 3 years post-stroke. The results showed an increased sickness impact over time in physical as well as psychosocial aspects. Mobility and home management were the categories that deteriorated most. The highest sickness impact was found in home management, and recreation and pastimes activity. The SIP scores were strongly correlated to the level of ADL-dependence, although the ADL-status had not deteriorated between the two assessments. Subjective measures of disability together with objective measures are recommended for planning of long-term rehabilitation after stroke.

In 1986, the functional capacity of 124 patients with an acute stroke was assessed one week after admission to Södertelje hospital, Sweden. In order to analyse health-related quality of life, interviews were undertaken to determine sickness impact 6-9 months after stroke. 57 of the 91 surviving patients could participate. 53 persons were living in their own homes. 70% had a clinically significant subjective dysfunction, which correlated both to the objective functional capacity and to age. Sickness Impact Profile was a useful measure, yielding information of value for planning of long-term rehabilitation and home care.

In order to study the need for medical care among elderly stroke patients, a prospective registration of cerebrovascular diseases started on January 1, 1986 in Enköping-Håbo health service district, Sweden. This article reports the design of the stroke register and the registration procedures, the annual events of stroke, both first-ever and recurrent, during 1986-1988 and the fatality rate with special regard to the very old population. The annual incidence of first-ever stroke was 0.33/1,000 among persons younger than 65 years of age, 10.6/1,000 among persons aged 65-84 years, and 34.5/1,000 among persons aged 85 years and older. The fatality rate of first-ever strokes was 7.5% within one month for persons younger than 65 years of age, 20.3% in the age-group 65-84 years, and 41% for the population 85 years and older. These results are compared with a similar Swedish study from Söderhamn and four comparable international studies. The results from this study gave a basis for designing special care programs in hospital and in home-care also for old stroke patients.

The predictive validity of Katz' Index of ADL (Activities of Daily Living) regarding length of hospital stay, discharge to own home or death within one month, and its reproducibility in clinical practice was studied prospectively in Södertälje and in Enköping, Sweden. The Södertälje study included 124 consecutive patients, who were all assessed on days 5-7 after stroke by an occupational therapist. The Enköping study included 106 consecutive patients, who were assessed similarly by trained nurses. Ninety-six and 94%, respectively, of patients in grades A-C on days 5-7 after stroke were discharged to their own homes within one month. Ninety-six and 92%, respectively, of patients in grades D-G stayed in hospital longer than one month or died. Sixty-two and 68%, respectively, of patients in grade G died within one month. The instrument is now used as a valid tool for early prognosis of stroke outcome in order to facilitate the planning of care and rehabilitation in clinical practice.

The cumulative structure of personal daily activities (Katz' Index of ADL) and four well-defined instrumental activities (cooking, transportation, shopping, and cleaning) have been studied in a population of 76-year-olds (N = 659) in Gothenburg, Sweden. Sixty-five percent of the population were independent, 22% were dependent in instrumental activities, and 13% were dependent in both instrumental and personal activities. No person was dependent in personal ADL and independent in instrumental ADL. The internal consistency and the coefficient of scalability were well above the acceptance level, which indicated an internal reliability and validity of the new scale. The frequency of personal and home-assistance care, type of accommodation, self-assessment of self-care and domestic activities were compared with the level of dependence in ADL and indicated external validity. This cumulative instrument of ADL can be used to describe and compare the level of disability in elderly populations and to define the need for personal assistance in home care among disabled persons.

Cerebrovascular diseases with neurological deficits can be supposed to be a risk factor for oral health problems. 29 patients who were admitted consecutively to the Hospital of Enköping, Sweden, due to an acute history of stroke, were followed up with regard to their oral health at two weeks and at three months after admission. Only four patients had signs of a bad oral health, and three of them had dentures. There will be a long-term follow-up at 18 months after stroke.

In order to initiate early activation and counteract the negative effects of bed rest, 71 patients acutely admitted to hospital with a confirmed stroke were randomized to either training or control wards. Sixty-three persons participated in a first orthostatic tolerance test on days 5-7 after admission, which was replicated on days 10-12. A third test was performed three months later. Regular stand-ups were initiated on days 1-2 after admission to hospital and were continued for 1-2 weeks. The trained group had a lower increase in heart rate during tilting and a lower proportion of severely disabled patients on days 5-7 compared with the control group. This difference was statistically significant but cannot be proved to be a result from the regular stand-ups. Still, this minimum type of early activation can be recommended for acute stroke patients, mainly those with a cerebral infarction, who are able to cooperate with the nursing staff.

In order to describe both the process and the impact of introducing a program of early activation for acutely admitted elderly patients in medical wards, two populations, one before and the other after the intervention of the program, were followed up. The program was implemented in cooperation with the nursing staff, who were integrated in the rehabilitation work. Population I (219 admissions) was collected in 1981 and Population II (272 admissions) during a corresponding period in 1983. Survival, type of residence and ADL status 5 months after hospital admission were recorded as outcome measures. There were no differences between 1981 and 1983. In 1983 the mean length of stay was 4.7 days shorter than in 1981. The program cannot be shown to have caused the difference in length of stay. The study shows that such a program of early activation was easy to apply in clinical practice for aged and disabled patients in general medical wards.

This study was performed in order to investigate the biological effects of chronic exposure to low intensity radio frequency fields. By using CHO cells in culture, it was possible to extend exposure to several cell generations. The RF field consisted of a 27 MHz magnetic field (6 A/m), which produces a specific absorption rate of 1 W/kg. Exposure was continued for two to five days. The cells were then studied with respect to certain cell biological parameters: vital staining, plating efficiency, growth rate, volume and physical properties of the intracellular water, as measured by NMR. Scanning electron microscopy studies were also performed. A significant difference between exposed and control cells was found only with respect to intracellular water. A 10% decrease in line width which may indicate a corresponding increase in the spin-spin relaxation time was noted after exposure. A change in the colony forming pattern was also observed in thin cultures after two days of exposure.

Katz' Index of ADL has been supplemented by five well-defined instrumental activities, namely cooking, washing, transportation, cleaning, and shopping. Eighty-five persons, mainly elderly, who had consecutively consulted a district occupational therapist, were assessed in their homes in order to study the reliability, the scalability, and the validity of the expanded index. The inter-observer reliability was high. The coefficient of scalability was well above the acceptance level, indicating construct validity. No person was dependent in personal ADL and totally independent in instrumental ADL. Persons who were dependent in both personal and instrumental ADL were older and lived in sheltered accommodation more often than persons who were dependent only in instrumental ADL, indicating external validity. This study shows that there was a cumulative relationship between certain well-defined instrumental activities and between personal and instrumental activities. This supplemented index can be useful for assessing and differentiating the need for personal assistance and homecare among disabled elderly people.

In order to study physicians' ability to predict survival, site of living after discharge, and length of stay in a hospital department of internal medicine, five physicians rated a total of 156 patients 65 years of age and older, who had been admitted due to acute illness. Predicted and observed outcome were compared. The results showed no relation except with regard to predicted and observed discharge to own home. Inter-rater reliability was found to be low except with regard to discharge to own home. This study shows that the physicians had difficulties in predicting survival or death in the ward, site of living after discharge, other than to own home, and length of stay in the ward. In order to increase the knowledge about elderly with acute illness and improve planning of individual care, it is desirable to develop reliable and valid instruments for clinical prediction of outcome for elderly persons in short-term hospital care.

In order to study the value of Katz' Index of ADL (Activities of Daily Living) for monitoring ADL-status among elderly persons receiving home-care, and to study their use of short-term hospital care, 40 consecutive recipients of a home-care subsidy in a health service district were followed during a period of six months. A licensed practical nurse visited them monthly, assessed their ADL-performance, and recorded their use of short-term hospital care. Twenty-seven persons changed in ADL-grade: 8 improved, 13 deteriorated, and 6 changed temporarily between the first and the final observation. Twenty-one persons were admitted to short-term hospital care; 19 of these changed in ADL-grade. The medical conditions that motivated hospital admission were serious and required hospital resources. The Index of ADL was found to monitor changes in ADL-status and is used today as a common language of disability between caretakers in the home and in hospital care.

Aged and disabled patients' need for coordinated services has increased the importance of a common language for their ability to perform the activities of daily living (ADL). This article aims at presenting Katz's Index of ADL and the use of it in six selected studies in order to show the availability for different purposes in divergent contexts. Katz's index is based on developmental principles and includes six common personal activities ordered into a cumulative scale. The use of the instrument provided both qualitative and quantitative information about disability among rather severely disabled patients in short-term and long-term hospital care, in nursing homes, in day-care and in home-care. The level of disability among the less disabled persons, who were independent in all of the six activities, were not differentiated by the index. A supplement of instrumental activities based on the same developmental principles is required, before a common language also for less disabled people can be established.

The predictive validity of ratings based on Katz' Index of ADL (Activities of Daily Living) and of physician ratings of patient outcome was studied in a department of internal medicine, 129 patients, 65 years of age or older, were assessed independently and simultaneously by licensed practical nurses using Katz' Index of ADL and by a physician using clinical judgement. These assessments were related to observed outcome regarding survival or death in the ward, length of stay, and type of hospital discharge. Two alternative ADL-groupings were used, grade A-E versus grade F-G and grade A-F versus grade G. Sensitivity and specificity of ADL-ratings and of physician ratings were found to be rather similar regarding length of stay less than 10 days and discharge to own home. Predictions regarding patient deaths based on ADL-grades F-G and G had a higher sensitivity than predictions based on physician ratings. The specificity of the two types of predictions was about the same. There was only a fair correlation between age and ADL-grade. ADL-assessments may thus be useful for planning purposes for elderly patients also in acute medical wards.

This article deals with the Katz Index of Independence in Activities of Daily Living and presents a study of its reliability and validity carried out at a Department of Internal Medicine in Sweden. Enrolled nurses assessed independently 100 aged patients. Scalability and interobserver variability were tested with Guttman scale-analysis. The results indicated that the activities are ranked according to a cumulative scale and that the index is reliable. Patients independent in ADL had shorter hospitalization and were discharged home more often than were the dependent patients. This indicates that the scale is valid. One year later most dependent patients were either dead or living in institutions: thus the index has a predictive potential. The systematic errors of scale were used to refine the index for use in short-term care. It is recommended as a basic measure of functional ability among aged abled or disabled patients also in short-term care.