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Biomedical subjects

K Asplund

Publications and source records attributed to K Asplund.

At least 73 records · Page 4Linked to original sources
PubMed1998

Comparison of effects of quinapril and metoprolol on glycaemic control, serum lipids, blood pressure, albuminuria and quality of life in non-insulin-dependent diabetes mellitus patients with hypertension. Swedish Quinapril Group.

OBJECTIVE: To compare the long-term effects of the angiotensin-converting enzyme (ACE)-inhibitor quinapril and the cardioselective beta-adrenergic blocking agent metoprolol on glycaemic control, with glycosylated haemoglobin (HbA1c) as the principal variable, in non-insulin-dependent diabetes mellitus (NIDDM) patients with hypertension. DESIGN: A randomized, double-blind, double-dummy, multicentre study during 6 months preceded by a 4 week wash-out and a 3 week run-in placebo period. Quinapril (20 mg) and metoprolol (100 mg, conventional tablets) were given once daily. No change was made in the treatment of diabetes (diet and hypoglycaemic agents). SUBJECTS: Seventy-two patients fulfilling the criteria were randomized and entered the double-blind period. Twelve patients did not complete the study. Sixty patients, 26 on quinapril and 34 on metoprolol, were available for the final analysis. MAIN OUTCOME MEASURES: The effect was assessed by changes in HbA1c, the fasting serum glucose and the post-load serum glucose, C-peptide and insulin levels during the oral glucose tolerance test. RESULTS: In the quinapril group, the fasting serum glucose, oral glucose tolerance and the C-peptide and insulin responses, determined as the incremental area under the curves (AUC), showed no change, but the mean HbA1c level increased from 6.2 +/- 1.1% to 6.5 +/- 1.3% (P < 0.05). In the metoprolol group, the rise in the mean level of HbA1c, from 6.3 +/- 1.0% to 6.8 +/- 1.3% (P < 0.01), tended to be more marked than after quinapril, although there was no significant difference between the increments. The mean fasting serum glucose showed an increase from 9.1 +/- 1.9 mM to 10.1 +/- 2.8 mM (P < 0.01) which correlated significantly with the duration of diabetes (P < 0.01) and the increase in fasting serum triglycerides (P < 0.001). Moreover, in the metoprolol group we found significant decreases in the oral glucose tolerance as well as C-peptide and insulin responses to the glucose load. CONCLUSIONS: Treatment with quinapril for 6 months appears to have advantages over metoprolol in NIDDM patients with hypertension. Although treatment with quinapril or metoprolol over 6 months was concomitant with a rise in the HbA1c, increased fasting blood glucose, decreased oral glucose tolerance and decreased C-peptide and insulin responses to a glucose challenge were observed only in patients treated with metoprolol.

Adrenergic beta-Antagonists↗
PubMed1998

The meaning of caring for patients on a long-term psychiatric ward as narrated by formal care providers.

Seventeen care providers were interviewed about their caring experiences on a hospital psychiatric ward. The interviews focused on the meaning of their work, including the care they provide and the nature of the patient as a person. The study was guided by a phenomenological hermeneutic perspective inspired by Ricoeur (1976). The analysis focused on context and form. Three themes illuminate the meaning of care provided. These themes are as follows; being in the midst of human storage, moving towards a human care of relations, and struggling with 'the old' and 'the new'. Experiencing work as being in the midst of a human storage reflects the historical and human situation of warehousing psychiatric patients. The care providers are experiencing a shift in their view of the patient and the meaning of their work, towards a more human care of relations. For these care providers, there is a struggle between the past, the present and the future. This struggle between 'the old' and 'the new' conveys a struggle between doing as a nurse, which dominates the past, and relating, which is, or needs to be, the current and future focus in psychiatric care. The shift in view distinguished itself by the care providers viewing the patient as being vulnerable and having problems with relations. The results have been interpreted and discussed in the light of a previously published interview study with the patients, carried out at the same time on the same ward. Attending to ingrained attitudes of the past and their influence on new approaches to care is essential to understanding not only changes in ways of doing nursing tasks, but also ways of relating.

Adult↗
PubMed1998

Time trends in long-term survival after stroke: the Northern Sweden Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, 1985-1994.

BACKGROUND AND PURPOSE: Stroke mortality rates and case fatality of stroke have declined since the beginning of the 1970s in Sweden, but the incidence of stroke has been stable. The aim of this study was to analyze trends in long-term survival after stroke. METHODS: Within the framework of the population-based WHO Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) Project, all acute stroke events were recorded in the age group 25 to 74 years in northern Sweden during the period 1985 to 1994. All first-ever stroke patients were followed for information on vital status (minimum follow-up time was 1 year). Survival time was related to time period of stroke onset, stroke diagnosis, and concomitant diseases. RESULTS: Survival times for a total of 6819 first-ever stroke patients (4057 men and 2762 women) were analyzed. Age-adjusted odds ratio for death within 1 year after stroke was 0.70 (95% confidence interval [CI], 0.55 to 0.88) in the period 1993 to 1994 as compared with the period 1985 to 1986 in men and 0.69 (95% CI, 0.53 to 0.90) in women. Corresponding odds ratios were 0.73 in men and 0.70 in women among those who survived the first 28 days. Similar improvements were seen for 3- and 5-year survival. Improvements in survival over time were most marked among patients with ischemic stroke. There was no improvement in survival over time among patients with the most severe deficits at onset. CONCLUSIONS: Gradually improved survival, both short and long term, was observed during the 10-year study period. The improvements are not explained by changes in known confounding prognostic factors.

Adult↗
PubMed1998

Bovine mastitis in Finland in 1988 and 1995--changes in prevalence and antimicrobial resistance.

Two surveys were carried out (during 1988 and 1995) to estimate the prevalence of bovine mastitis in Finland. In 1988, 17,111 quarter milk samples were obtained from 4495 cows, and in 1995 the corresponding figures were 10,410 and 2648. Antimicrobial susceptibility of mastitis pathogens was studied. Prevalence of mastitis on cow basis decreased from 47.8% in 1988 to 37.8% in 1995. Staphylococci was the largest group of pathogens isolated. The proportion of Staphylococcus aureus decreased and that of coagulase-negative staphylococci (CNS) increased. The proportion of strains resistant to at least one antibacterial drug increased with regard to S. aureus from 36.9% in 1988, to 63.6% in 1995 and with CNS from 26.6% to 49.7%. Most of the increase in antibacterial resistance was due to a higher number of beta-lactamase producing strains. Multiresistance also increased, but it was proportional to the overall increase in resistance. All the predominant mastitis streptococci were susceptible to beta-lactams tested.

Animals↗
PubMed1997

Two variants of extracellular-superoxide dismutase: relationship to cardiovascular risk factors in an unselected middle-aged population.

OBJECTIVE: Description of the distribution of plasma levels of two variants of extracellular-superoxide dismutase (EC-SOD) and their relationship to cardiovascular risk factors in the general population. DESIGN: A cross-sectional study. SETTING: Norrbotten and Västerbotten counties in northern Sweden. SUBJECTS: Four thousand, nine hundred 25-74-year-old randomly selected subjects. MAIN OUTCOME MEASURES: Plasma levels of EC-SOD. Genotyping by an allele-specific PCR method. RESULTS: Plasma EC-SOD levels showed a distinct bimodal distribution with the smaller group (3.8%) having a variant of the enzyme with about eight-fold-higher plasma levels. Genotyping was performed in 65 individuals with the high-level variant. All but one were found to carry the same mutation, Arg213Gly, affecting the heparin-binding domain of EC-SOD. Subjects with the high-level variant of EC-SOD had modestly higher body mass index and higher levels of serum cholesterol, serum triglycerides and plasma fibrinogen than those with the common EC-SOD phenotype. Within the population with common EC-SOD, the plasma levels were lower in men than in women and increased with age. Low levels of common phenotype EC-SOD were associated with smoking, high plasma levels of fibrinogen and low activity of tissue plasminogen activator in both univariate and multivariate analyses. Obesity and total serum cholesterol were associated with high common phenotype EC-SOD levels. CONCLUSIONS: A high-level variant of EC-SOD caused by one and the same mutation and with low tissue binding and high plasma levels is present in approximately four per cent of an unselected middle-aged population in northern Sweden. Plasma levels of EC-SOD may be modulated by lifestyle factors such as smoking and show a complex covariation with many of the conventional cardiovascular risk factors.

Adult↗
PubMed1997

Age-period-cohort effects on ischaemic heart disease mortality in Sweden from 1969 to 1993, and forecasts up to 2003.

AIMS: Mortality from ischaemic heart disease has been decreasing in most industrialized countries since the 1960s. The aim of this study was to analyse ischaemic heart disease mortality during 1969-1993 in Sweden, and to predict mortality trends until 2003. METHODS AND RESULTS: Age-period cohort models were used to analyse ischaemic heart disease mortality in Sweden between 1969 and 1993, and to predict age-specific death rates and total number of deaths for the periods 1994-1998 and 1999-2003. Mortality rates in the age group 25-89 years decreased from 719 to 487 per 100,000 for men, and from 402 to 215 per 100,000 for women over the study period (average annual decrease of 1.5% for men and 2.2% for women). The decline started earlier for women than for men. The ratio of age-adjusted mortality between men and women increased steadily over the study period. Predictions based on the full age-period cohort model for the period 1999-2003 gave mortality rates of 346 and 155 per 100,000 for men and women, respectively. Despite the ageing of the population, the total numbers of ischaemic heart disease deaths in Sweden are predicted to decline by approximately 25% in both men and women from 1989-93 to 1999-2003. CONCLUSION: A major decline in ischaemic heart disease mortality has been observed in the last 15 years in Sweden. Both factors, cohort and calendar period, contain information which helps explain the decline in ischaemic heart disease mortality trends in Sweden. Predictions indicate that the decline of both age-specific and total mortality is to continue.

Adult↗
PubMed1997

Increased levels of tissue plasminogen activator antigen in essential hypertension. A population-based study in Sweden.

OBJECTIVE: To investigate components of the haemostatic and fibrinolytic system in borderline hypertensives and hypertensives, drug-treated or not, from a defined population. DESIGN AND METHODS: A randomly selected sample of the population of northern Sweden, 1558 subjects aged 25-64 years, was studied. Eight per cent of them were being treated with antihypertensive drugs (trHT). Remaining subjects were classified according to their mean diastolic blood pressure (DBP). Normotension, DBP < 85 mmHg, was found in 63%, borderline hypertension (bHT), DBP 85-94 mmHg, in 21% and untreated hypertension (uHT), DBP > or = 95 mmHg, in 8% of the subjects. RESULTS: Mean age increased from the normotensive group through the bHT and uHT groups to the trHT group, members of which were the oldest. Age-adjusted values for the body mass index, waist: hip ratio, serum triglyceride and Phadeseph plasma insulin levels increased with each level of hypertension. Plasma fibrinogen levels and plasminogen activator inhibitor type 1 activity (in men) increased stepwise from normotensives through bHT and uHT to the highest values found in the trHT group. The tissue plasminogen activator (tPA) activity in men declined strongly across the groups, trHT having the lowest fibrinolytic activity (P < 0.001). tPA antigen levels increased strongly from normotensives through bHT to uHT, but then were lower in the trHT group. Even after adjustment for possible confounders, men in the uHT group had 21% higher (P = 0.027) tPA antigen levels than did the normotensives. In bHT men, the tPA antigen and plasminogen activator inhibitor type 1 activities were 14 and 24% respectively, higher (P < 0.01) than those in the normotensives. CONCLUSION: Hypertension is associated with multiple metabolic and fibrinolytic disturbances that are accentuated in drug-treated hypertensives and already discernible in subjects with borderline hypertension. Decreased fibrinolysis is associated with, and possibly secondary to, metabolic disturbances linked to the insulin-resistance syndrome. The independent increase in tPA antigen in hypertensive men might indicate an endothelial dysfunction.

Adult↗
PubMed1997

Diabetes as a risk factor for myocardial infarction: population and gender perspectives.

OBJECTIVES: To investigate diabetes as a risk factor for acute myocardial infarction (AMI) from a population perspective in a region with high cardiovascular disease (CVD) risk. DESIGN: Population screenings for diabetes and a population-based AMI register. SETTING: Northern Sweden MONICA area. SUBJECTS: Representative sample (Norrbotten and Västerbotten counties) of 2432 men and women 35-64 years was investigated 1990 and 1994. All patients with AMI aged 35-64 years were included, in total 3031 between 1989 and 1993. RESULTS: The prevalence of diabetes was 5% in men and 4.4% in women. The relative risk (RR) in diabetic men was 2.9; 95% confidence interval (CI) 2.6-3.4, and in diabetic women, RR 5.0; CI 3.9-6.3. The risk for re-infarction was about twice as large in patients with diabetes as in patients without diabetes. In both sexes the overall 28 day case fatality (CF) was significantly higher in diabetic compared to non-diabetic subjects. When compared to the non-diabetic population, the overall mortality from AMI in the diabetic population was 4 times higher among men and 7 times higher among women. The population attributable risk (PAR), a crude estimate of all AMIs ascribed to diabetes, was 11% in men and 17% in women. CONCLUSIONS: Diabetes increases the risk for AMI attack rate, incidence, case-fatality, recurrence and mortality and is an important contributor to all AMIs in middle-aged people.

Adult↗
PubMed1997

Stroke incidence and mortality correlated to stroke risk factors in the WHO MONICA Project. An ecological study of 18 populations.

BACKGROUND: The aim of the present study was to determine the extent to which the variation in conventional risk factors contributed to the variation in stroke incidence among these populations. METHODS: Within the WHO MONICA Project, stroke has been recorded in 18 populations in 11 countries. In population surveys, risk factors for cardiovascular diseases have been examined in the age group 35 to 64 years. Over a 3-year period, 12,224 acute strokes were registered in men and women within the same age range. RESULTS: The highest stroke attack rates were found in Novosibirsk in Siberia, Russia, and Finland, with a more than three-fold higher incidence than in Friuli, Italy. The mean diastolic blood pressure among the populations differed by 15 mm Hg between Novosibirsk (highest) and Denmark (lowest). In multiple regression analyses, the presence of conventional cardiovascular risk factors (smoking and elevated blood pressure) explained 21% of the variation in stroke incidence among the population in men and 42% in women. In Finland, in China, and in men in Lithuania, the stroke incidence rates were higher than expected from the population risk factor levels. CONCLUSION: Prevalence of smoking and elevated blood pressure explain a substantial proportion of the variation of stroke attack rates between populations. However, other risk factors for stroke that were not measured in the present study also contribute considerably to interpopulation differences in stroke rates.

Adult↗
PubMed1997

Outcomes of individualized interventions in patients with severe eating difficulties.

The aim of this case study is to describe the outcomes of individualized interventions for patients with severe eating difficulties. The participants were 15 patients who had severe eating difficulties following a stroke or brain tumor and were receiving oral feeding or tube feeding. Interventions focused on training functions needed for eating, activities in eating, and discussions with the patient. Improvements were especially noted in eating activities, and some improvements were noted in oral movements and nutritional status. Before the interventions, none of the patients ate regular food; afterward, six did, and in four patients, the feeding tube was removed. The patients said eating was easier, and they could eat in a safe way. Furthermore, they appreciated the attention to their experience during meals. Although the impairments were not always alleviated, the patients found means to cope with their eating difficulties.

Activities of Daily Living↗
PubMed1996

Exploring the declining case fatality in acute stroke. Population-based observations in the northern Sweden MONICA Project.

OBJECTIVES: Declining case fatality in acute stroke has been reported from many western countries. The aim of this study was to explore in what subset of patients the decline in case fatality has occurred. SETTING: In a population-based study, acute stroke events were recorded in the age group 25-74 years in northern Sweden during the years 1985-1993 within the framework of the WHO MONICA Project. SUBJECTS: In total 3486 men and 2212 women with a first-ever stroke (except subarachnoid haemorrhage) were included. MAIN OUTCOME: Change in stroke incidence, case fatality and neurological deficits at onset over a 9-year period. RESULTS: The incidence (first-ever stroke) did not change over the years, while the overall case fatality decreased from 18.2% in 1985-1987 to 13.5% in 1991-1993. In both men and women with non-haemorrhagic stroke, a trend was seen towards an increasing incidence of mild stroke events over the years. In both sexes, a significant decline in case fatality was seen in patients with minor deficits at onset, while no change in case fatality was seen in patients with extensive deficits. There was no change in incidence of intracerebral haemorrhage, but the case fatality in patients with intracerebral haemorrhage declined significantly from 36% to 29% during the study period. CONCLUSIONS: A declining case fatality was observed in both men and women. Among patients with non-haemorrhagic stroke, the decline was confined to patients with minor deficits. The declining case fatality can be attributed both to a shift in the severity towards more patients presenting with mild symptoms, and an improved prognosis in patients with minor deficits at onset, probably because of improved medical management.

Adult↗
PubMed1996

Insulin resistance syndrome and fibrinolytic activity: the northern Sweden MONICA study.

BACKGROUND: Many studies have, in small and highly selected study populations, described how cardiovascular risk factors tend to cluster in subjects with insulin resistance. Recently, interest has focused on possible relationships between this insulin resistance syndrome and fibrinolysis, and the role of triglycerides in this association. The present study addresses these issues in a general population. METHODS: A subsample of participants in the population-based Northern Sweden MONICA (MONItoring of trends and determinants in CArdiovascular diseases) Study, consisting of 353 men and 403 women in the 25-64 year age range, was investigated. Insulin resistance was estimated indirectly from the fasting levels of insulin and glucose. Fibrinolytic activity was measured both as plasminogen activator inhibitor type 1 (PAI-1) activity and tissue plasminogen activator ((t)PA) activity. RESULTS: Insulin resistance was highly correlated with those cardiovascular risk factors that have been associated with the insulin resistance syndrome, and to the measures of fibrinolytic activity. Subjects in the upper tertile of insulin resistance had a PAI-1 activity that was three times higher than that of the lower third men and twice as high in women. There was a strong interaction between insulin resistance and serum triglycerides. Low versus high levels of both variables together were associated with a fivefold difference in PAI-1 activity in men and a threefold difference in women. The (t)PA activity was inversely correlated to both insulin resistance and serum triglycerides. CONCLUSIONS: In a general population, the 'insulin resistance syndrome' is closely associated with low fibrinolytic activity. Serum triglyceride levels interact with insulin resistance to predict fibrinolytic activity.

Adult↗
PubMed1996

Regular leisure time physical activity predicts high activity of tissue plasminogen activator: The Northern Sweden MONICA Study.

BACKGROUND: Leisure time physical activity protects against the development of cardiovascular disease, partly by lowering blood pressure, cholesterol and body weight. Little is known about the effects of regular exercise on fibrinolytic variables in the population. METHODS: In a population sample of 733 men and 774 women aged 25-64 years physical activity during leisure time was related to fibrinolytic variables. RESULTS: The activity of tissue plasminogen activator (tPA) increased linearly with greater physical activity, the difference between sedentary and most active subjects being 28.9% in men and 11.6% in women. The tPA mass concentrations decreased by 27.4% and 28.0% in men and women respectively, as did also plasminogen activator inhibitor (PAl-1) activity; 38.5% and 30.6%. Tests for trend were significant (P < 0.001) for all but tPA activity in women. Adjusting for age, body mass index and waist:hip ratio only slightly decreased three relationships. When taking triglyceride into account, tPA activity and PAl-1 activity (in men) were no longer significantly related to physical activity level but lower tPA mass concentrations and PA1-1 activity (in women) were still found in those who exercised regularly. Further adjustment for insulin levels abolished all differences, except for PA1-1 activity in women. CONCLUSION: Greater leisure time physical activity is associated with an increased fibrinolytic activity. This may contribute to less cardiovascular disease in subjects who exercise regularly.

Adult↗
PubMed1996

Note: inhibition of the growth of Yersinia enterocolitica O:3 by the microflora of porcine caecum and ileum in an in vitro model.

The growth of Yersinia enterocolitica O:3 was tested in an in vitro model of the porcine intestine at the physiological temperature of 39 degrees C of growing pigs. The model supported a stable population of Y. enterocolitica at a level 10(8)-10(9) cells ml-1. Plasmid profile analysis and the Ca(2+)-dependent proportion of the population suggested that the great majority of the Y. enterocolitica population retained the 70 kb virulence plasmid, pYV, throughout the experimental period of 5 d. The growth of Y. enterocolitica was substantially inhibited by the ileal and the caecal flora compared to the growth of the bacterium alone. Yersinia enterocolitica was not isolated after 3 d of cultivation.

Animals↗
PubMed1996

Cost effectiveness and equity of a community based cardiovascular disease prevention programme in Norsjö, Sweden.

STUDY OBJECTIVE: To evaluate the cost effectiveness and equity of a community based cardiovascular disease prevention programme. DESIGN: A prospective cross sectional design. SETTING: A community based intervention to reduce cardiovascular disease in the district of Norsjö (n = 5500), Sweden. The intervention was aimed at both the general population and at individuals thought to be at special risk, the emphasis being on changing dietary habits and reducing cholesterol concentrations. PARTICIPANTS: The participants were men and women aged 30-60 years. MAIN RESULTS: The mean serum cholesterol concentration in the Norsjö population was reduced by nearly 20% during the first six years of intervention. It was estimated that the programme's overall total societal costs were 363,000 pounds and estimates of the cost per year of life saved ranged from 14,900 pounds to net savings, according to different assumptions. Taking only health care costs and savings into account, the cost per year of life saved ranged from 1100 pounds to 4050 pounds. The results varied between different sex and age groups, but not between social classes. Even if a causal relationship exists between low cholesterol concentrations and excess mortality, the estimated side effects of lowering cholesterol values in Norsjö were negligible in comparison with the expected benefits. CONCLUSIONS: The community based intervention in Norsjö seems to be cost effective even under conservative assumptions. The approach used seems to have benefited all social classes. Cost effectiveness analyses that take consequences for equity into account are valuable tools in decision making.

Adult↗
PubMed1996

Age-period-cohort effects on stroke mortality in Sweden 1969-1993 and forecasts up to the year 2003.

BACKGROUND AND PURPOSE: Variations in stroke mortality could be explained by changes in factors that act around the time of death (period effect) and by risk factors that are present in early life (cohort effect). The aim of this study was to analyze mortality rates for stroke in Sweden during the period 1969 through 1993 and to predict mortality trends until the year 2003, taking into account age, cohort, and period effects. METHODS: Age-period-cohort models were used to analyze stroke mortality in Sweden between 1969 and 1993 and to predict age-specific death rates and total number of deaths for the periods 1994 through 1998 and 1999 through 2003. RESULTS: Mortality rates in the age group 25 to 89 years decreased from 203 to 143 per 100,000 for men and from 185 to 113 per 100,000 for women over the study period (average annual decrease of 1.3% for men and 1.9% for women). The decline was present in all age groups. The full age-period-cohort model provided an acceptable fit in both sexes. Predictions based on these models gave a mortality rate of 122 and 92 per 100,000 for the period 1999-2003 in men and women, respectively. Despite an aging and increasing population, the total number of stroke deaths in Sweden is predicted to decline by approximately 10% in both men and women from 1989-1993 to 1999-2003. CONCLUSIONS: Both factors, cohort and calendar period, contain relevant information to explain the decline in stroke mortality trends in Sweden. Predictions indicate that the decline of both age-specific and total mortality will continue.

Adult↗