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Biomedical subjects

B Winblad

Publications and source records attributed to B Winblad.

At least 361 records · Page 20Linked to original sources
PubMed1991

Staff burnout in dementia care--relations to empathy and attitudes.

Sixty nursing staff in geriatric and psychogeriatric care (RNs, LPNs and nurse's aides) were selected to be studied on two occasions with an interval of one year regarding the relationships between their experience of burnout, empathy and attitudes towards demented patients. A semistructured interview was performed on the second occasion to learn more about their work experience and to relate the ratings of burnout, empathy and attitudes to their experience at work. The staff's experience of burnout changed from a mean score of 2.7 in 1987 to 2.5 in 1988. Their empathic ability was moderately high and increased from 398 (m) in (1987) to 450 (m) in 1988. The attitudes of staff remained unchanged from 1987 to 1988 and no differences were found regarding the staff's age, place of work or time at present place of work. As for the staff's empathy, there was no difference with respect to sex, category of staff or place of work. RN's showed the most positive attitudes towards demented patients both in 1987 and 1988 and differed compared to the nurse's aides and LPN's. Burnout correlated with lower empathy and less positive attitudes in the staff. Regression analysis showed that 'experience of feed-back at work' and 'time spent at present place of work' were the most important factors when explaining burnout among the staff. Staff with high empathy experienced "a close contact with the patient" as the most stimulating factor at work while staff with low empathy experienced "improvement of the patient's health" and "contact with colleagues" as the most stimulating factors. The importance of counteracting burnout in the care of demented patients is stressed.

Adolescent↗
PubMed1991

Regional distribution of somatostatin receptor binding and modulation of adenylyl cyclase activity in Alzheimer's disease brain.

We have previously reported a reduction in the inhibitory effect of somatostatin on adenylyl cyclase activity in the superior temporal cortex of a group of Alzheimer's disease cases, compared to a group of matched controls. In the present study, the levels of high affinity 125I-Tyr11-somatostatin-14 binding, its modulation by guanine nucleotides and the effects of somatostatin on adenylyl cyclase activity have been measured in preparations of frontal cortex, hippocampus, caudate nucleus and cerebellum from the same patient and control groups. A significant reduction in 125I-Tyr11-somatostatin-14 binding was observed in the frontal cortex, but not other regions, of the Alzheimer's disease group, compared with control values. The profiles of inhibition of specific 125I-Tyr11-somatostatin-14 binding by Gpp(NH)p were similar in all regions in both groups. No significant differences in basal, forskolin-stimulated, or somatostatin and neuropeptide Y inhibitions of adenylyl cyclase activity were found between the two groups. The pattern of change of somatostatin binding in the Alzheimer's disease cases observed in the present study differs from the reported pattern of loss of somatostatin neurons and may be secondary to the degeneration of somatostatin receptor-bearing cholinergic afferents arising from the nucleus basalis. The results of this study indicate that impaired somatostatin modulation of adenylyl cyclase is not a global phenomenon in Alzheimer's disease brain and also that there are no major disruptions of somatostatin receptor-G-protein coupling or of adenylyl cyclase catalytic activity in this disorder.

Adenylyl Cyclases↗
PubMed1991

ADL performance and dependency on nursing care in patients with hip fractures and acute confusion in a task allocation care system.

In a prospective study 35 patients operated on for cervical hip-fractures were followed with respect to Acute Confusional State (ACS), problems of basic nursing care and dependency on care-givers. Fifteen patients became acutely confused after the fracture. They turned out to be more dependent on help from others than the non-confused patients were even before the fracture. They rapidly reached a significantly higher level of dependence than the non-confused patients and remained on that level throughout the study month. Six months after the fracture the post-operatively confused patients were still highly dependent on care-givers, significantly more than they were before the fracture. Only three of them were not hospitalised. All the non-confused patients lived in their own homes six months after the fracture and had regained the same level of independence as before it. These findings will be discussed in relation to the organisation of the nursing care. Task allocation nursing care was applied in the wards. A model for the development of dependency in acutely confused hip-fracture patients will be presented and suggestions for how to reduce nurse/patient dependency induced by nursing care will be made.

Activities of Daily Living↗
PubMed1991

Abilities and activities of patients with dementia in day hospitals.

The proportion of individuals with dementia is increasing in all kinds of institutions. Specialised day hospitals are now being developed as an alternative to long term care for the demented. Twelve day hospital wards, with 312 individuals suffering from dementia, were included in a study aiming to assess functional abilities and frequencies of participation in different activities. Eighty-nine per cent of the day hospital patients could be classified as having a dementia disease. Seventy-eight per cent of the population were dependent on some kind of help from a caregiver in the performance of ADL activities. The most common occupations that could be seen in the programmes were physical activities, entertainment, and personal care activities. The activities were often undertaken as large group activities, often including more than ten patients. The functional abilities that characterise the population are comparable with those of the population living in pensioners' service blocks with full board.

Activities of Daily Living↗
PubMed1991

Care of demented patients with severe communication problems.

Two time-studies and an interview study were carried out at a geriatric clinic. The aim was to elucidate how much time caregivers use for direct patient care in their contact with severely demented patients compared with non-demented patients as well as how they experience the care of demented patients in a task assignment care system. The analysis showed that more time was used to help non-demented patients than demented patients with the same ADL-performance. Five types of patient reactions to communicative attempts made by the caregivers were described: the patient seems to enjoy contact, he avoids contact, contact leads to aggression, he reacts only sporadically to contact and he does not show any reactions to it. The caregivers described negative reactions to demented patients with communication problems. Communication problems seem to be a threat to caregivers' commitment.

Activities of Daily Living↗
PubMed1991

Underdiagnosis and poor documentation of acute confusional states in elderly hip fracture patients.

STUDY OBJECTIVE: To determine the accuracy of diagnosis and documentation of acute confusional states (ACS) in the medical records of patients with hip fracture. DESIGN: The diagnosis of ACS in two prospective clinical studies was compared to its diagnosis in the medical records of the same patients on the same hospitalization. In order to determine if the simultaneous prospective study influences the diagnostic and documentary practices evidenced in the medical records, a further comparison was done by reviewing medical records of two series of patients seen some years prior to the prospective studies. SETTING: Patients with femoral neck fractures treated at a department of orthopedic surgery in a university hospital and one retrospective control sample from a department of general surgery in a county hospital. SUBJECTS: Two prospective samples of patients 65 years and older treated for femoral neck fractures (n = 111 and n = 57, respectively) and two earlier retrospective samples (n = 66 and n = 68, respectively). MEASUREMENTS AND MAIN RESULTS: All comparisons showed that both physicians and nurses diagnosed ACS unsatisfactorily and documented the patients' mental status poorly. The analysis of the two retrospective medical record control samples gave the same results. Neither the physicians nor the nurses used any kind of diagnostic instrument to detect cognitive disorders in the patients. CONCLUSIONS: ACS is a common and severe complication in elderly people treated for femoral neck fractures. Acute confusional states have, by definition, one or more causes that can often be identified and treated. Poor assessment and documentation is a threat to the patients as a correct diagnosis of ACS is a prerequisite for further assessment of its underlying causes and the consequent necessary medical and nursing care.

Acute Disease↗
PubMed1991

A geriatric-anesthesiologic program to reduce acute confusional states in elderly patients treated for femoral neck fractures.

The aim of this study was to evaluate the effect of a geriatric-anesthesiologic intervention program for the prevention and treatment of acute confusional states (ACS) in elderly patients treated for femoral neck fractures. The intervention program was based on the results of previous prospective studies in similar patient populations. The outcome of the intervention, comprising 103 patients, was compared with that of an earlier study comprising 111 patients. The intervention program consisted of pre- and post-operative geriatric assessments, oxygen therapy, early surgery, prevention and treatment of peri-operative blood pressure falls and treatment of post-operative complications. The incidence of ACS was lower, 47.6%, in the intervention study compared with 61.3% (P less than 0.05) in the control study. Furthermore, the ACS that occurred in the intervention study was less severe and of shorter duration than that in the control study. The incidence of post-operative decubital ulcers, severe falls, and urinary retention was also lower. The mean duration of orthopedic ward stay was 17.4 days in the control study and 11.6 days in the intervention study (P less than 0.001). It can be concluded that the intervention program reduced the incidence, severity, and duration of ACS which resulted in a shortened orthopedic ward stay.

Aged↗
PubMed1991

International comparison of long-term care: the need for resident-level classification.

Differences between long-term care facilities in Stockholm (1134 residents) and New York (95,000 residents statewide) were examined. The comparison employed a resident classification system, Resource Utilization Groups (RUG-II), which links individuals' characteristics to resource use. Distributions of Activity of Daily Living functionality and RUG-II categories demonstrated significant differences between these two populations, with the Stockholm facilities more akin to the heavier care skilled nursing facilities in New York. These differences may indicate different uses of long-term care beds in the United States and Sweden and demonstrate the need for resident-level classification systems in cross-national studies.

Activities of Daily Living↗
PubMed1991

Prevalence of Alzheimer's disease and other dementias in an elderly urban population: relationship with age, sex, and education.

We studied the prevalence of different types of dementia in an elderly population in Stockholm, Sweden, in relation to age, sex, and education. The study confirmed Alzheimer's disease (AD) as the most frequent type of dementia and the positive association of dementias with age, even in the most advanced ages. In contrast to previously reported data, we found the same proportion of AD and vascular dementia in the different age strata, and no sex differences regarding the prevalence of different dementia types. Finally, less educated people had a higher prevalence of all dementias, due essentially to a higher prevalence of alcoholic dementia and unspecified type of dementia. The prevalence of AD was similar across different levels of education.

Age Factors↗
PubMed1991

Metals and trace elements in plasma and cerebrospinal fluid in normal aging and Alzheimer's disease.

Cerebro-spinal fluid (CSF) and blood levels of aluminium, cadmium, calcium, copper, lead, magnesium, and mercury were studied in 24 subjects with dementia of the Alzheimer type (DAT) and in 28 healthy volunteers. Furthermore, arsenic, bromine, chrome, iron, manganese, nickel, rubidium, selenium, strontium, and zinc were measured only in blood. There were significant changes in the DAT group when compared to the controls. The plasma levels of aluminium, cadmium, mercury and selenium were increased and the contents of iron and manganese were lower in the DAT group as compared to control subjects. In CSF there were low levels of cadmium and calcium and increased content of copper in DAT cases. Iron and zinc levels in blood and calcium in both blood and CSF of DAT patients correlated with memory and cognitive functions. Iron, manganese and strontium levels of DAT sufferers in blood and aluminium in CSF were related with changes in behaviour.

Aged↗
PubMed1990

Environmental influence on behaviour and nerve growth factor in the brain.

The influence of the environment on the endogenous levels of nerve growth factor (NGF) in the cortex, hippocampus and septum was examined in adult (82 days old) and juvenile (51 days old) rats. Animals were reared/housed for 30 days in an enriched, standard or isolated environment prior to analysis. In addition, another group of rats were given behavioural tests (4 days) after differential rearing/housing before measurements of NGF. We found complex variations in the level of NGF both in juvenile and adult hippocampus after differential environmental rearing/housing. Rearing/housing in an enriched environment improved performance in the Morris maze and decreased spontaneous motor activity. Exposure to behavioural tests caused alterations in adult hippocampus and septum NGF levels. The results show that testing in a novel environment causes small but significant changes in the hippocampal and septal NGF levels depending upon the environmental history of the animal. In view of the purported involvement of the septohippocampal pathway and NGF in the pathophysiology of Alzheimer's disease, our finding suggests that lack of adequate environmental stimulation might be of importance in age-related behavioural and neurochemical deficits.

Analysis of Variance↗
PubMed1990

Substance P-like immunoreactivity, choline acetyltransferase activity and cholinergic muscarinic receptors in Alzheimer's disease and multi-infarct dementia.

Substance P-like immunoreactivity, choline acetyltransferase (ChAT) activity and muscarinic cholinergic receptors were measured in brains from 9 individuals with senile dementia of the Alzheimer type (AD), 4 individuals with multi-infarct dementia (MID), 6 individuals with mixed type of dementia (AD/MID) and 9 controls. The ChAT activity was markedly reduced (50-60%) in the hippocampus of all demented brains. The number of muscarinic cholinergic receptors was reduced only in the MID and AD/MID brains. No significant difference in substance P-like immunoreactivity was measured in 4 regions of AD brains in comparison to controls. In the combined MID plus AD/MID groups a significant reduction in substance P-like immunoreactivity (-35%) was measured in the hippocampus while no change was found in the frontal cortex, amygdala and caudate nucleus. The findings support the assumption of differences in selectivity of damage between AD and AD/MID, MID.

Aged↗
PubMed1990

Amino acid concentrations in cerebrospinal fluid and plasma in Alzheimer's disease and healthy control subjects.

Cerebrospinal fluid (CSF) and plasma levels of 18 amino acids were studied in 22 subjects with dementia of the Alzheimer type (DAT) and in 11 healthy volunteers with no clinical or family history of dementia. Significant decreases of plasma taurine and glutamate were seen in the DAT cases compared with the controls. The CSF concentrations of glycine, leucine and valine were also significantly reduced in the DAT cases. Furthermore, in the DAT cases significant decreases were observed in the ratio between CSF and plasma (CSF/P) levels for alanine, glutamine, glycine, phenylalanine and valine, when compared with controls. In the DAT group there were significant correlations between behaviour and CSF glutamine; memory and cognitive functions and CSF valine; copying ability and CSF glutamate. CSF/P ratios of glutamine and glutamate correlated with behaviour and copying performances, respectively. The results of this study provide further evidence for a disruption of amino acid metabolism in DAT.

Aged↗
PubMed1990

Decreased uptake and binding of 11C-nicotine in brain of Alzheimer patients as visualized by positron emission tomography.

Positron emission tomography of the brain following intravenous injection of (+) (R) and (-) (S) N-[11C-methyl]nicotine showed a marked reduced uptake of both isomers, especially the (R) form, in Alzheimer patients as compared to age-matched controls. The significantly larger difference between the uptake values of the (S)- and (R)-enantiomers of 11C-nicotine in Azheimer brains may be of diagnostic value.

Aged↗
PubMed1990

Multiple effects of tetrahydroaminoacridine on the cholinergic system: biochemical and behavioural aspects.

9-Amino-1,2,3,4-tetrahydroaminoacridine (THA) in combination with lecithin has been reported to improve the memory of Alzheimer's disease patients. We have examined some properties of THA in vitro and in vivo so as to define some of the mechanism(s) by which THA might produce its therapeutic effects. In vitro, THA was more potent at inhibiting human plasma cholinesterase (IC50 = 0.03 microM) than human erythrocyte acetylcholinesterase (IC50 = 0.3 microM) and rat brain acetylcholinesterase (IC50 = 0.32 microM). Radioligand binding studies indicated that THA binds reversibly and competitively to primary M1 and M2 human cortical muscarinic receptors with similar affinities. Moreover, THA showed similar affinity for temporal cortices muscarinic receptors from Alzheimer and non-Alzheimer (control) brains. In vivo, subcutaneous administration of THA (1-8 mg/kg body weight) to adult rats (6 months old) produced a dose dependent decrease in general activity compared to saline-treated rats. However, at a concentration of 0.5 mg/kg body weight, the general activity of the rats was increased compared to saline-treated rats. The cognitive function of the THA-treated adult rats (subcutaneously 2 mg/kg body weight) was not significantly improved compared to saline-treated rats. It is concluded that the mechanisms of action of THA on the cholinergic system involve reversible inhibition of cholinesterases and reversible and competitive interaction with muscarinic acetylcholine receptors. These effects might be of therapeutic value in the treatment of Alzheimer's disease.

Aged↗
PubMed1990

Empathy, experience of burnout and attitudes towards demented patients among nursing staff in geriatric care.

A non-anonymous questionnaire was distributed to all nursing staff (n = 557) including RNs, LPNs (psychiatric), LPNs (somatic) and nurses' aides, in one nursing home, one somatic long-term care clinic and one psychogeriatric clinic. Scales measuring empathy, burnout experience and attitudes towards demented patients were included in the questionnaire. The aim of the study was to compare levels of empathy, burnout experience and attitudes among different categories of nursing staff and to examine connections between empathy, burnout and attitudes. The nursing staff showed an overall figure of moderately well-developed empathy and the RNs showed the highest empathy. The RNs had a significantly lower degree of burnout compared to the nurses' aides and the LPNs. Of all respondents, 27.4% were assessed at risk from burnout. Overall, the staff showed a moderately positive attitude towards demented patients and the RNs were most positive. No linear correlation was found between empathy, burnout experience and attitudes. However, a weak negative correlation between burnout and empathy is in accordance with other authors who are suggesting that burnout experience leads to lower empathy in the nursing staff. The fact that the RNs showed the most positive attitudes towards demented patients and had the highest level of empathy compared to LPNs and nurses' aides could be related to lower degree of burnout assessed in the RNs. Qualitative and quantitative overload among the LPNs and nurses' aides connected to the growing number of demented patients in the institutions examined are discussed.

Adult↗