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Physical activity has a preventive and an acute effect on both depression and anxiety syndromes. The effect of just physical activity, usually 3 times/week for 8-12 weeks, is equal to treatment with psychotherapy or antidepressants for mild to moderate depression, according to several meta-analyses. Addition of physical exercise to psychotherapy has a significantly greater effect than psychotherapy alone. Few high-quality studies on anxiety syndromes have been performed regarding the treatment effect of physical activity. In anxiety syndromes, physical activity for 10-12 weeks has a better effect than no treatment. Yet, psychotherapy or pharmacological treatment has a better effect than physical exercise in panic disorder. The article describes a variety of positive physiological, neurobiological and psychological mechanisms of physical activity.

Sars-cov-2 PCR is a cornerstone of COVID-19 clinical diagnostics and epidemiological surveillance. Viral shedding in COVID-19, as measured by isolation of infectious virus, is most prominent around symptom onset. Sars-cov-2 PCR, however, may stay positive for months and thereby does not reflect infectiousness. PCR tests are both specific and sensitive but the performance in clinical diagnostics depends on sampling technique, sample material and disease stage. Self-sampling in individuals with mild symptoms aims rather to assess infectiousness and a lower sensitivity of the test can be accepted. False positive tests are a global problem and may have serious consequences for both the tested individuals and society. Awareness of contamination risks and continuous quality assurance is vital in all laboratories to ensure test reliability. Rapid, less sensitive sars-cov-2 antigen tests are potential new tools in infection control.

In this article on the effect of physical activity on depression, data have been drawn from several meta-analyses, in particular, the latest Cochrane review entitled »Exercise for depression« published in 2013. The results show that physical activity can help prevent the onset and relapse of depression. Depressed people should be recommended aerobic or muscular strength training. There is clear evidence that physical activity alone is beneficial for the treatment of mild and moderate depression and can reduce symptoms of mild to moderate depression to the same extent as standard treatments (psychotherapy and antidepressant medication). Combining physical activity with these treatments may yield additional benefits. Individuals with depression should be recommended physical activity in adjunct to psychotherapy and medication.

Creutzfeldt-Jakob disease (CJD) is a prion disease characterized by rapid neurodegeneration that leads to the death of the patient within months to a few years. Since the disease is transmissible, there is an obligation in Sweden to report possible CJD cases to the Swedish Institute for Infectious Disease Control. To make a diagnosis of CJD is difficult, especially early in the course of the disease when the clinical features may be very vague and heterogeneous. Hence, accurate biological markers both for confirming and excluding CJD would be of great value. The currently recommended investigation of a patient with possible CJD comprises clinical evaluation. electroencephalography, computed tomography or magnetic resonance imaging of the brain and test for 14-3-3 protein in the cerebrospinal fluid (CSF). Recent studies suggest that analysis of total tau (T-tau) and phospho-tau (P-tau) in CSF is a valuable complement to this set of investigations. Here, we review how CSF T-tau and P-tau may aid in the diagnosis of CJD and illustrate this by presenting cases from routine clinical practice.

We studied the care of patients in homes for the elderly and in special homes for the demented in the city of Malmö. Nine district nurses were interviewed using a tape recorder, and the content of the interviews was analyzed. Many patients needed extensive care, and resources were insufficient regarding both number of staff and their competence. The management of nursing in the various districts of the city was not well-defined. More consulting time was requested on the part of both district nurses and general practitioners in homes for the elderly and homes for the demented.

The clinical diagnosis of Creutzfeldt-Jakob disease (CJD) is often difficult, since the clinical presentation varies between patients and is often uncharacteristic. Therefore, CJD is often not suspected until late in the disease process, due to the rapid progress of the disease. Suspected CJD is, however, frequent in routine clinical practice, in the investigation of patients with rapidly progressing dementia and/or uncharacteristic neurological symptoms. We present results from cerebrospinal fluid (CSF) analyses in CJD, focusing on the two neuron-specific proteins 14-3-3 and tau. Analysis of 14-3-3 protein is performed by Western blotting, in which 14-3-3 is either detectable in CSF or not, while CSF-tau is analyzed using quantitative ELISA methodology, in which a markedly increased CSF level of tau (< 1500 pg/mL) is indicative of CJD. Tau and 14-3-3 findings show comparable sensitivity and specificity, higher than the presence of spike and wave complexes on an EEG. The increase in CSF-tau in CJD is substantially higher than in Alzheimer's disease, with low overlap between the disorders. Instead, false positive results are found in disorders with massive acute neuronal damage (encephalitis, stroke and CNS tumors). In cases in which these disorders cannot be differentiated from CJD on clinical grounds, they can often be identified by MRT or by the finding of blood-brain barrier damage or signs of inflammation upon CSF analysis. CSF-tau is increasingly used in the routine diagnosis of Alzheimer's disease, and the analysis also seems to be of use in the clinical diagnosis of CJD. We also present three cases from routine clinical practice, all with a marked increase in CSF-tau, which was the only positive objective sign in two of the cases.

Both the Diabetes Control and Complications Trial (DCCT) in USA/Canada, and Stockholm Diabetes Intervention Study (SDIS) showed intensified insulin treatment and reduced glycaemia to prevent complications in patients with insulin-dependent (type I) diabetes mellitus. In the DCCT, the intensified treatment was considered cost-effective. In the SDIS, investigation of the direct increase in costs due to the intensified insulin treatment showed the saving in direct costs due to the reduction in photocoagulation requirements, and in the prevalence of renal insufficiency and of amputation, to correspond to 10 years' intensive insulin treatment. Thus, as intensified insulin treatment in type I diabetes reduces direct suffering at a low cost, it may be regarded as 'evidence-based' and mandatory.