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K Asplund

Publications and source records attributed to K Asplund.

At least 91 records · Page 5Linked to original sources
PubMed1995

Diabetes as a risk factor for stroke. A population perspective.

Stroke incidence, case fatality and mortality in diabetic patients were compared to non-diabetic subjects in a 35-74-year-old population in northern Sweden (target population 241,000). During an 8-year period, 1,544 stroke events in diabetic patients and 4,826 events in non-diabetic subjects were recorded. The crude incidence of stroke was 1,000 per 100,000 in the diabetic men vs 247 in the non-diabetic men (relative risk 4.1; 95% confidence interval 3.2-5.2). Among diabetic women, the crude incidence was 757 per 100,000 and 152 in non-diabetic women (relative risk 5.8; 95% confidence interval 3.7-6.9). The 28-day case fatality among men was similar in the diabetic and non-diabetic stroke patients (18.6 vs 17.1%; p = 0.311), but significantly higher in diabetic women compared with non-diabetic women (22.2 vs 17.9%; p = 0.02). When compared with the non-diabetic population, the overall mortality from stroke in the diabetic population (first and recurrent) was 4.4-times higher in male and 5.1-times higher in the female patients. Hypertension, atrial fibrillation, heart failure or myocardial infarction were all significantly more common in diabetic than in non-diabetic stroke patients. The population attributable risk, a crude estimate of all strokes ascribed to diabetes mellitus, was 18% in men and 22% in women. In Sweden, about 50 strokes are annually directly attributed to diabetes in a population of 100,000 in this age group.

Adult↗
PubMed1995

Relationship of cigarette smoking and snuff dipping to plasma fibrinogen, fibrinolytic variables and serum insulin. The Northern Sweden MONICA Study.

The influence of cigarette smoking and use of smokeless tobacco on plasma fibrinogen level, fibrinolytic variables, glucose tolerance and serum insulin was studied in a randomly selected population sample consisting of 604 men and 662 females between 25 and 64 years. Subjects were grouped according to tobacco habits as follows: regular smokers (> 1 cig/day), ex-smokers, snuff dippers, and non-tobacco users. An oral glucose tolerance test was performed on 54% of the participants. Tissue plasminogen activator (tPA) activity and plasminogen activator inhibitor type 1 (PAI-1) activity were used to study fibrinolysis. Men who smoked had 0.34 g/l (95% CI 0.17 to 0.49) higher fibrinogen level than non-tobacco users and numbers of cigarettes smoked correlated with plasma fibrinogen levels (r = 0.21, P = 0.006). Female smokers had significantly higher fibrinogen levels than ex-smokers but the difference compared with non-smokers was not significant. Snuff dipping did not affect fibrinogen levels. We found no relationship between tPA activity, PAI-1 activity and tobacco use. Post-load plasma glucose was lower in women who smoked, otherwise no influence of tobacco use on glucose levels was seen. Lower post-load insulin levels (-8.8 mU/ml, 95% CI -2.4 to -16.3) than in non-smokers were also found in women who smoked. This was only partially explained by a lower body mass index in smokers. We conclude that cigarette smoking is associated with increased fibrinogen levels, unaltered fibrinolysis, normal glucose tolerance and insulin levels. The use of smokeless tobacco, as moist oral snuff, does not appear to affect these potential cardiovascular risk factors.

Adult↗
PubMed1995

Patients with dementia in group living: experiences 4 years after admission.

Sixteen patients with dementia were studied 4 years after admission to group-living (GL) units, an intermediate level of dementia care. Of eight patients who were still alive, four lived in the GL units and four had been institutionalized. The eight patients who had died had spent 89% of their survival time in GL. Aggression was the most frequent cause of institutionalization.

Activities of Daily Living↗
PubMed1995

Facial expressions of patients with dementia: a comparison of two methods of interpretation.

Two methods of interpreting the videotaped facial expressions of four patients with severe dementia of the Alzheimer type were compared. Interpretations of facial expressions performed by means of unstructured naturalistic judgments revealed episodes when the four patients exhibited anger, disgust, happiness, sadness, and surprise. When these episodes were assessed by use of a modified version of the Facial Action Coding System, there was, in total, 48% agreement between the two methods. The highest agreement, 98%, occurred for happiness shown by one patient. It was concluded that more emotions could be judged by means of the unstructured naturalistic method, which is based on an awareness of the total situation that facilitates imputing meaning into the patients' cues. It is a difficult task to find a balance between imputing too much meaning into the severely demented patients' sparse and unclear cues and ignoring the possibility that there is some meaning to be interpreted.

Aged↗
PubMed1995

Stories about living in a hospital ward as narrated by schizophrenic patients.

Ten schizophrenic patients were interviewed about their own experiences of life in a hospital ward, of their care provider and of the care received. The interview texts were analysed using a phenomenological hermeneutic method. Fatigue, thinking about problems/inner activities, relations and longings for the pre-illness days were themes that occurred in the stories. Seven of the ten interviewees stated that they suffered from fatigue. They were preoccupied with an inner dialogue, trying to solve problems on their own. The patients were alone in their stories. The problems that the patients expressed with regard to relationships arose because they both longed for and feared contact with others, and they felt that they were not 'themselves' when they were with others. For developing care, the importance of learning more about the patients' experiences, especially regarding fatigue, is emphasized.

Adaptation, Psychological↗
PubMed1995

Multinational comparisons of stroke epidemiology. Evaluation of case ascertainment in the WHO MONICA Stroke Study. World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease.

BACKGROUND AND PURPOSE: As part of the WHO MONICA Project (World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease), mortality and incidence rates of acute stroke in 14 centers covering 21 populations from 11 countries were compared. METHODS: In this report, coverage and quality of the MONICA stroke registers were evaluated on five key indicators using data submitted to the MONICA Data Center. RESULTS: A low ratio of MONICA stroke register to routine statistics of stroke mortality and a low proportion of nonfatal out-of-hospital events were the most common biases; they indicate that identifications of fatal cases and/or case finding of nonfatal events occurring outside the hospital were inadequate in many MONICA centers. In 10 populations, the data quality analyses suggested that clarification of possible biases would be needed before these populations can be included in a comparative study. Data from the remaining 11 populations meet the data quality standards for multinational comparisons with respect to case ascertainment. CONCLUSIONS: These results show that multinational comparisons of stroke incidence involve considerable problems in developing and maintaining appropriate standards of data quality. However, after considerable efforts to ensure quality, comparisons of stroke data within the MONICA Project are possible among a large number of the MONICA populations. Our observations also indicate that results from multinational comparisons of stroke mortality based on routine statistics must be interpreted with caution.

Acute Disease↗
PubMed1995

Stroke incidence, case fatality, and mortality in the WHO MONICA project. World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease.

BACKGROUND AND PURPOSE: This report compares stroke incidence, case fatality, and mortality rates during the first years of the WHO MONICA Project in 16 European and 2 Asian populations. METHODS: In the stroke component of the WHO MONICA Project, stroke registers were established with uniform and standardized rules for case ascertainment and validation of events. RESULTS: A total of 13,597 stroke events were registered from 1985 through 1987 in a total background population of 2.9 million people aged 35 to 64 years. Age-standardized stroke incidence rates per 100,000 varied from 101 to 285 in men and from 47 to 198 in women. The combined stroke attack rates for first and recurrent events were approximately 20% higher than incidence rates in most populations and varied to the same extent. Stroke incidence rates were very high among the population of Finnish men tested. The incidence of stroke was, in general, higher among populations in eastern than in western Europe. It was also relatively high in the Chinese population studied, particularly among women. The case-fatality rates at 28 days varied from 15% to 49% among men and from 18% to 57% among women. In half of the populations studied, there were only minor differences between official stroke mortality rates and rates measured on the basis of fatal events registered and validated for the WHO MONICA stroke study. CONCLUSIONS: The WHO MONICA Project provides a unique opportunity to perform cross-sectional and longitudinal comparisons of stroke epidemiology in many populations. The present data show how large differences in stroke incidence and case-fatality rates contribute to the more than threefold differences in stroke mortality rates among populations.

Adult↗
PubMed1994

Metabolic control, food intake and mood during the menstrual cycle in patients with insulin-dependent diabetes.

The impact of menstruation on metabolic control was studied among 20 insulin-dependent diabetics (IDDM) and 20 healthy controls during two menstrual cycles. No systematic fluctuation in glycated protein, blood glucose levels, food intake, intake of mono- and disaccharides, body weight, or mood could be seen during different weeks in the menstrual cycle. A tendency towards menstruation-related variations in the number of insulin reactions and amount of extra injected insulin was observed in the patient group. Levels of glycated protein were significantly (P < 0.05) higher during the premenstruational than during the postmenstruational week, although the difference was small in absolute terms. A poorer mood during the premenstruation weeks (indicating premenstruation syndrome) was associated with a high number of hypoglycemic events (P < 0.01) and frequent changes in insulin doses (P < 0.01). Thus, taken as a group diabetic women do not experience great changes in food intake or metabolic control during the menstrual cycle. This does not exclude the possibility that a small proportion of women have major menstruation related difficulties in controlling their diabetes.

Activities of Daily Living↗
PubMed1994

Hyperinsulinemia predicts low tissue plasminogen activator activity in a healthy population: the Northern Sweden MONICA Study.

Fibrinogen levels predict atherothrombotic disease, and impaired fibrinolysis has been proposed as a risk factor for myocardial infarction. Fibrinolysis is mainly dependent on the activity of tissue plasminogen activator (tPA) and its inhibitor plasminogen activator inhibitor type-1 (PAI-1). Oral glucose tolerance tests were performed in 318 randomly selected healthy men and 324 women aged 25 to 64 years. tPA activity was strongly predicted by fasting insulin in both univariate analysis (r = -.37 and -.34 in men and women, respectively) and multivariate analysis with age, anthropometric measurements, lipids, and blood pressure included. Fasting insulin was the strongest predictor of PAI-1 activity (r = .49 and .51). In women, the influence of fasting insulin level on tPA and PAI-1 activity was consistently stronger after than before menopause, and a threshold effect was seen with distinctly lower fibrinolytic activity in the highest quartile of insulin (> 7.0 mU/L). In men, the relation between insulin and fibrinolytic variables was linear. Fibrinogen levels were not related to insulin or glucose levels after adjustment for age and other risk factors in a multiple regression. Subjects with previously unknown diabetes or impaired glucose tolerance tended to have elevated fibrinogen and PAI-1 activity and decreased tPA activity. Our data support previous findings of a strong correlation between insulin and PAI-1 activity in small highly selected groups, and extend them to randomly selected population samples. The strong inverse relation between endogenous insulin levels and tPA activity has not previously been demonstrated in a healthy population.

Adult↗
PubMed1994

The worldwide problem of stroke.

Cardiovascular disease is the leading cause of death worldwide with almost one third of all cardiovascular deaths ascribed to stroke. In contrast to coronary heart disease, most of the strokes occur in developing countries; China alone has about 1 million deaths from stroke each year. From a global perspective the stroke situation is changing rapidly, and considerable progress has been made in documenting the changes in stroke mortality. Despite the favorable trends in stroke mortality in many countries, stroke will become an increasingly important health problem as the world's population continues to age.

Aged↗
PubMed1994

Geographical distribution of TTR met30 carriers in northern Sweden: discrepancy between carrier frequency and prevalence rate.

The first Swedish case of familial amyloidotic polyneuropathy (FAP) was published in 1965. The same transthyretin (TTR met30) mutation as that seen in Japanese, Portuguese, and other populations was also found in Swedish FAP patients. More than 350 patients with clinical manifestations of FAP have been diagnosed in northern Sweden, most of them originating from the areas around Skellefteå and Piteå. The mean age of onset is 56 years, much later than in patients from Japan and Portugal. To estimate the frequency of the TTR met30 mutation in the counties of Västerbotten and Norrbotten, sera from 1276 persons aged 24 to 65 years, randomly sampled from a health programme (MONICA), were screened with the monoclonal antibody FD6. In 19 persons, 13 females and six males, a positive reaction was seen in an Elisa test using this antibody. DNA analysis confirmed the TTR met30 mutation and showed that 18 were heterozygous and one homozygous for this mutation. Other mutations were not looked for in this study. The mean TTR met30 carrier frequency in the area was 1.5% ranging from 0.0 to 8.3% in 23 subpopulations. There was a notable discrepancy between the regional distribution of the TTR met30 allele and the morbidity rate for FAP. The estimated number of TTR met30 gene carriers in a total population of 500,000 in the area is approximately 7500. The penetrance of the TTR met30 mutation shows considerable variation between families, and the overall diagnostic (predictive) value in this population is as low as around 2%.

Adult↗
PubMed1994

Costs of stroke in Sweden. A national perspective.

BACKGROUND AND PURPOSE: Cost-effectiveness analyses of stroke management are hampered by paucity of economic data. We made an update of the direct and indirect costs of stroke in Sweden (population, 8.5 million). METHODS: Direct costs (ie, the costs for hospital and outpatient care and social services) were estimated on the basis of two prospective population-based studies of stroke and of two nationwide cross-sectional inventories of bed-days and diagnoses. Indirect costs (ie, the costs for loss of productivity and early retirement) were based on official statistics. RESULTS: The direct annual costs of care for stroke patients in 1991 equaled 7836 million Swedish krona (SKr) ($1306 million in US dollars), and the indirect costs, 2430 million SKr ($405 million). The cost of stroke care was 1208 SKr ($201) per inhabitant in Sweden. The expected direct costs per patient from first stroke to death were 440,000 SKr ($73,333). When prestroke costs for other diseases and advanced age were subtracted, the sum was reduced to 180,000 SKr ($30,000). CONCLUSIONS: Costs for hospital and outpatient care and social services accounted for 76% of Swedish stroke costs and for 24% of costs for loss of production and early retirement. Only 41% of direct costs were stroke-related.

Aged↗
PubMed1994

Trends in incidence, case-fatality rate, and severity of stroke in northern Sweden, 1985-1991.

UNLABELLED: BACKGROUND AND PURPOSE--Incidence, case-fatality rate at 28 days, and severity of acute stroke were recorded for 7 years in a large population-based stroke register to understand the reasons for the decline in stroke mortality in northern Sweden. METHODS: Within the framework of the World Health Organization MONICA Project, acute stroke was monitored in people aged 35 to 74 years in northern Sweden from 1985 through 1991 (target population in 1985, 238,948). RESULTS: The annual incidence of stroke decreased by an average of 2.3%/y in men aged 35 to 64 years (P = .074) and increased significantly by 1.1%/y in men aged 65 to 74 years (P = .041). No significant changes in incidence occurred in either age group in women. The 28-day case-fatality rate in first-ever strokes (both sexes together) declined from 21.9% to 15.4% in patients aged 65 to 74 years (P = .02). Among survivors, the proportion with extensive motor deficits (at any time during the first 28 days) declined in patients younger than 65 years as well as in those older than 65 years (P = .007 and P = .019, respectively). In patients aged 35 to 64 years, the proportion with aphasia/dysphasia also decreased significantly (P = .032), but no such trend was seen in those aged 65 to 74 years. CONCLUSIONS: A shift toward higher ages has been noted in the occurrence of first-ever strokes in men, while incidence has remained unchanged in women. During the 7 years of observation, stroke has become a less severe disease.

Adult↗