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Biomedical subjects

K Asplund

Publications and source records attributed to K Asplund.

At least 109 records · Page 6Linked to original sources
PubMed1993

Lipoprotein (a) in a randomly selected 25-64 year old population: the Northern Sweden Monica Study.

Lipoprotein (a) (Lp (a)) was determined in 1527 individuals participating in the Northern Sweden WHO MONICA project for monitoring of cardiovascular risk factors in the general population. Subjects were randomly selected and stratified according to sex and age. A weak but significant relation between Lp (a) and increasing age was found in both sexes (p < 0.01). Menopausal status was the strongest independent predictor of Lp (a) level in women (p = 0.010). Fibrinogen was independently related to Lp (a) in both men and women (p < 0.05). An inverse relation between waist-to-hip ratio and Lp (a) was found in men (p < 0.01). Hypertensive subjects treated with diuretics had significantly higher Lp (a) than hypertensives on other agents (p < 0.05). Only a minor proportion of Lp (a) variance could be explained by lifestyle factors, which supports the contention that genetic factors primarily control Lp(a) level.

Adult↗
PubMed1993

High serum insulin, insulin resistance and their associations with cardiovascular risk factors. The northern Sweden MONICA population study.

OBJECTIVES: To estimate the prevalence of insulin resistance and high serum insulin levels and to investigate their relationship to other cardiovascular risk factors. DESIGN: Cross-sectional cardiovascular risk factor survey. SETTING: Northern Sweden. SUBJECTS: A subsample of the population-based Northern Sweden MONICA Study. This subsample underwent an oral glucose tolerance test after an overnight fast, and consisted of 354 men and 404 women in the 25-64-year age range. MAIN OUTCOME MEASURES: Delineation of low insulin sensitivity and high serum insulin by the diagnostic test technique, prevalence of these variables and their associations with cardiovascular risk factors. RESULTS: The participants were classified into four subgroups by an insulin sensitivity index and fasting serum insulin. The combination of low insulin sensitivity and high serum insulin was present in 17% of the male and in 18% of the female 25-64-year-old population. In both sexes this combination was closely associated (P < 0.001) with body mass index, waist-hip ratio, blood pressure and serum triglycerides, and correlated inversely with serum HDL cholesterol (P < 0.001). When high serum insulin was present as an isolated entity it was as closely associated with other cardiovascular risk factors such as isolated low insulin sensitivity, except that impaired glucose tolerance occurred exclusively in the group with isolated low insulin sensitivity. CONCLUSIONS: The combination of insulin resistance and high insulin levels is associated with a marked clustering of cardiovascular risk factors and is present in one-sixth of the middle-aged population in the north of Sweden.

Adult↗
PubMed1993

Different linkage of depression to hypercortisolism early versus late after stroke. A 3-year longitudinal study.

BACKGROUND AND PURPOSE: Using the dexamethasone suppression test, we studied the suppressibility of the cortisol axis and its clinical determinants at various time points after stroke. A major aim was to examine the dexamethasone test as a diagnostic tool for the diagnosis of major depression in stroke patients. METHODS: The dexamethasone suppression test, major depression, functional ability, and disorientation were assessed in a cohort of 70 patients with acute stroke and after 3 months (n = 63) and 3 years (n = 43). RESULTS: Early after stroke, 24% of the patients were nonsuppressors, with about the same proportion at 3 months (22%) and 3 years (21%). None of the controls (17 healthy elderly volunteers) were nonsuppressors. High cortisol levels early after stroke were significantly associated with functional impairment (r = 0.35; p = 0.003) and disorientation (r = 0.27; p = 0.03). Three years after stroke, high postdexamethasone cortisol levels were significantly associated with major depression (r = 0.57; p < 0.001). The sensitivity of the dexamethasone test was 70% and the specificity 97%. In a longitudinal analysis of the long-term survivors (n = 42), postdexamethasone cortisol values at 3 months predicted major depression at 3 years. CONCLUSIONS: Hypercortisolism is associated with major depression late (3 years) but not early (0-3 months) after stroke. Patients with hypercortisolism 3 months after stroke are at risk of major depression later in the course and warrant careful follow-up from a psychiatric viewpoint.

Aged↗
PubMed1993

Major depression in stroke patients. A 3-year longitudinal study.

BACKGROUND AND PURPOSE: This prospective study was designed to examine the contributions of neurobiological, functional, and psychosocial factors to major depression after stroke. In addition, the prevalence and longitudinal course of major depression were studied. METHODS: Major depression, functional ability, and social network were assessed repeatedly for a period of 3 years in a population-based cohort of 80 patients with acute stroke (mean age, 73 years). Cerebral atrophy and brain lesion parameters were determined from computed tomographic scans performed acutely and after 3 years. RESULTS: The prevalence of major depression was 25% at the acute stage and approximately the same at 3 months (31%). It decreased to 16% at 12 months, was 19% at 2 years, and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in activities of daily living was the most important predictor at 3 months. From 12 months on, the patient's having few social contacts outside the immediate family contributed most to depression, and at 3 years cerebral atrophy also contributed. At 1 year, 60% of the patients with early depression (0 to 3 months) had recovered; those not recovered at this follow-up had a high risk of development of chronic depression. CONCLUSIONS: The study has provided evidence of a differentiation of factors likely to be implicated in the development of depression after stroke based or the period of time since the stroke event.

Activities of Daily Living↗
PubMed1993

The prognostic value of admission blood pressure in patients with acute stroke.

BACKGROUND AND PURPOSE: Patients with acute stroke are often found to have high blood pressures at hospital admission. Previous studies have shown variable results regarding the prognostic value of high blood pressure in acute stroke. The aim of this study was to investigate the prognostic value of admission blood pressure in a population-based sample of patients with acute stroke. METHODS: Eighty-five patients with intracerebral hemorrhage and 831 with ischemic disease were included in the study. The relations between admission blood pressure and 30-day mortality were studied by logistic regression analyses. RESULTS: High blood pressure in patients with impaired consciousness on hospital admission was significantly related to 30-day mortality in patients with intracerebral hemorrhage (P = .037) and in patients with ischemic disease (P < .0001). In patients without impaired consciousness, high blood pressure at time of admission was not related to increased mortality at 30 days. CONCLUSIONS: High admission blood pressure in alert stroke patients was not related to increased mortality. Stroke patients with impaired consciousness showed higher mortality rates with increasing blood pressure. However, this does not provide a basis for recommending antihypertensive therapy for such patients.

Aged↗
PubMed1993

Caregivers' reactions to the physical appearance of a person in the final stage of dementia as measured by semantic differentials.

The semantic differential (SeD) technique was applied to 158 caregivers from a nursing home in the northern part of Sweden. The questionnaire contained fifty-eight bipolar scales of adjective pairs and the interviewees indicated their reactions to a described picture of a severely demented person: A factor analysis revealed three dimensions; an ethical one, an esthetical one, and one about the person's own feelings. The fifty-eight scales were mostly rated toward the negative poles. The severely demented person was rated as painful, apathetic, suffering, weak, afraid, sad, cold, dark, rough, and ugly. Four years later a comparable group of caregivers (n = 93) answered a revised questionnaire containing the 26 SeD scales with factor loadings > .50 for the picture of the severely demented person. The result was nearly identical and alternative interpretations are discussed.

Adult↗
PubMed1993

The occurrence of Salmonella in airline meals.

The occurrence of Salmonella in airline meals was studied in 1989-1992. Samples were collected from flight kitchens in 29 countries. The material consisted of 400 cold dishes and 1,288 hot dishes as well as salads, cheese plates and deserts. Total number of samples was 2211. Salmonella spp. were isolated from 6 samples; 1 contaminated sample was a cold dish prepared in Bangkok, 1 was a hot dish prepared in Mombasa and the remaining 4 contaminated samples were hot dishes prepared within one week in Beijing. The isolated serotypes were S. ohio, S. manchester and S. braenderup. The contaminated cold dish prepared by a flight kitchen in Bangkok was found to be connected with a Salmonella outbreak which occurred in Finland in 1990. Cold airline dishes containing food of animal origin seems to be more risky as a source of Salmonella infections among airline passengers.

Aerospace Medicine↗
PubMed1993

Use of smokeless tobacco and cigarettes--effects on plasma levels of antioxidant vitamins.

In a population-based sample of 40-49-year-old men, plasma levels of antioxidant vitamins were measured in 17 regular users of smokeless tobacco (oral snuff), 26 regular smokers and 54 non-tobacco users. Vitamin intake by tobacco use was assessed by a food frequency questionnaire in 174 men in the 40-49 year age range. Compared with non-tobacco users, snuff dippers had similar plasma levels of ascorbate, tocopherols and carotenoids, whereas these were all significantly reduced in smokers. Smokers, but not snuff dippers, had plasma levels of ascorbate significantly below those expected from ascorbic acid intake, indicating enhanced expenditure of ascorbate in smokers but not in snuff dippers. The results show that plasma levels of antioxidant vitamins are not reduced in snuff dippers as they are in smokers, possibly as the combined result of higher intake and lower expenditure of ascorbate and tocopherols in those who use smokeless tobacco.

Adult↗
PubMed1992

Cost effectiveness of primary stroke prevention in atrial fibrillation: Swedish national perspective.

OBJECTIVE: To assess the potential effects of primary prevention with anticoagulants or aspirin in atrial fibrillation on Swedish population. DESIGN: Analysis of cost effectiveness based on the following assumptions: about 83,000 people have atrial fibrillation in Sweden, of whom 22,000 would be potential candidates for treatment with anticoagulants and 55,000 for aspirin treatment; the annual 5% stroke rate is reduced by 64% (with anticoagulants) and 25% (with aspirin); incidence of intracranial haemorrhage of 0.3%, 1.3%, or 2.0% per year; direct and indirect costs of a stroke of Kr180,000 and Kr90,000; estimated annual cost of treatment is Kr5030 for anticoagulants and Kr100 for aspirin. SETTING: Total Swedish population. MAIN OUTCOME MEASURES: Direct and indirect costs of stroke saved, number of strokes prevented, and cost of preventive treatment. RESULTS: Depending on the rate of haemorrhagic complications 34 to 83 patients would need to be treated annually with anticoagulants to prevent one stroke; 83 patients would need to be treated with aspirin. Giving anticoagulant treatment only would reduce costs by Kr60 million if the incidence of intracranial haemorrhage were 0.3% but would imply a net expense if the complication rate exceeded 1.3%. The total savings from giving anticoagulant (22,000 patients) and aspirin (55,000 patients) treatment would be Kr175 million per year corresponding to 2 million pounds per million inhabitants each year. CONCLUSIONS: Treatment with anticoagulants and, if contraindications exist, with aspirin is cost effective provided that the risk of serious haemorrhage complications due to anticoagulants is kept low.

Aged↗
PubMed1992

Tobacco and myocardial infarction: is snuff less dangerous than cigarettes?

OBJECTIVE: To estimate the risk of myocardial infarction in snuff users, cigarette smokers, and non-tobacco users in northern Sweden, where using snuff is traditional. DESIGN: Case-control study. SETTING: Northern Sweden. SUBJECTS: All 35-64 year old men who had had a first myocardial infarction and a population based sample of 35-64 year old men who had not had an infarction in the same geographical area. MAIN OUTCOME MEASURE: Tobacco consumption (regular snuff dipping, regular cigarette smoking, non-tobacco use) and risk of acute myocardial infarction. RESULTS: 59 of 585 (10%) patients who had a first myocardial infarction and 87 of 589 (15%) randomly selected men without myocardial infarction were non-smokers who used snuff daily. The age adjusted odds ratio for myocardial infarction was 0.89 (95% confidence interval 0.62 to 1.29) for exposure to snuff and 1.87 (1.40 to 2.48) for cigarette smoking compared with non-tobacco users, showing an increased risk in smokers but not in snuff dippers. Regular cigarette smokers had a significantly higher risk of myocardial infarction than regular snuff dippers (age adjusted odds ratio 2.09; 1.39 to 3.15). Smoking, but not snuff dipping, predicted myocardial infarction in a multiple logistic regression model that included age and level of education. CONCLUSIONS: In middle aged men snuff dipping is associated with a lower risk of myocardial infarction than cigarette smoking.

Adult↗
PubMed1992

Measuring stroke in the population: quality of routine statistics in comparison with a population-based stroke registry.

The validity of routine stroke data (official mortality statistics and hospital discharge registries) and a population-based MONICA stroke registry was assessed in a population of 309,806 25- to 74-year-old people in Sweden. The 'true' number of strokes in the population was estimated by screening for non-stroke diagnoses in death certificates and hospital discharge records and by a period of intensified search for otherwise unrecognized non-hospitalized stroke cases. Applying strict stroke criteria, the proportion of false-positive diagnoses was 10% and false-negative 17% in official mortality statistics. Among patients discharged alive from hospital, there were 32% false-positive and 6% false-negative stroke diagnoses. In the MONICA registry, the proportion of false-negative cases was 6% in fatal cases and 4% in non-fatal cases. Diagnostic information for subtyping stroke improved over time in non-fatal cases but remained essentially unchanged in fatal cases. We conclude that official mortality statistics give a reasonably good estimate of fatal stroke cases in Sweden, whereas hospital discharge records reflect poorly the incidence of stroke in the population. The overall quality of the population-based MONICA registry is good, although 4% of all strokes are missed. The proportion of unspecified stroke is substantial and changes over time; this makes longitudinal studies of stroke subtype difficult.

Adult↗
PubMed1992

Psychosocial function and life satisfaction after stroke.

BACKGROUND AND PURPOSE: This prospective study was designed to describe different aspects of psychosocial function after stroke and the development of changes over time. A major aim has been to identify mental, functional, and social factors associated with low life satisfaction late after stroke. METHODS: Social network, functional ability, leisure-time activities, experience of ill health, major depression, and life satisfaction were assessed repeatedly over 3 years in a population-based sample of 50 long-term survivors of stroke (mean age 71.4 years). RESULTS: Compared with a general elderly population, patients 3 years poststroke had more psychiatric symptoms, lower functional ability, and reduced life satisfaction. Contacts with children were maintained over the 3-year follow-up period, whereas contacts with friends and neighbors declined early after stroke and remained lower than in the general elderly population (p less than 0.05). When time dependency was analyzed, activities of daily living and somatic/neurological symptoms were found to change little after 3 months, while psychiatric symptoms showed changes later. Between 3 and 12 months poststroke, the prevalence of major depression decreased, leisure-time activities and social contacts were partly resumed, and life satisfaction improved (p less than 0.01). Once good life satisfaction was restored it was maintained, and poor life satisfaction at 1 year remained poor for the entire 3 years. CONCLUSIONS: It is concluded that major depression early after stroke, functional disability, and an impaired social network interact to reduce life satisfaction for the long-term survivors of stroke.

Activities of Daily Living↗