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Abstract Background Few longitudinal cohort studies have focused on the impact of substances abused and psychiatric disorders on premature mortality. The aim of the present study was to identify predictors of increased risk of drug related death and non drug related death in substance abusers of opiates, stimulants, cannabis, sedatives/hypnotics, hallucinogens and alcohol over several decades. Methods Follow-up study of a consecutive cohort of 561 substance abusers, admitted to a detoxification unit January 1970 to February 1978 in southern Sweden, and followed up in 2006. Demographic and clinical data, substance diagnoses and three groups of psychiatric diagnoses were identified at first admission. Causes of death were coded according to ICD-10 and classified as drug related deaths or non drug related deaths. To identify the incidence of some probable risk factors of drug related premature death, the data were subjected to a competing risks Cox regression analysis. Results Of 561 patients in the cohort, 11 individuals had either emigrated or could not be located, and 204/561 patients (36.4%) were deceased by 2006. The cumulative risk of drug related death increased more in the first 15 years and leveled out later on when non drug related causes of death had a similar incidence. In the final model, male gender, regular use of opiates or barbiturates at first admission, and neurosis were associated with an increased risk of drug related premature death, while cannabis use and psychosis were associated with a decreased risk. Neurosis, mainly depression and/or anxiety disorders, predicted drug related premature death while chronic psychosis and personality disorders did not. Chronic alcohol addiction was associated with increased risk of non drug related death. Conclusions The cohort of drug abusers had an increased risk of premature death to the age of 69. Drug related premature death was predicted by male gender, the use of opiates or barbiturates and depression and anxiety disorders at first admission. The predicted cumulative incidence of drug related death was significantly higher in opiate and barbiturate abusers over the observed period of 37 years, while stimulant abuse did not have any impact. Alcohol contributed to non drug related death.

Abstract Background Midwives' support of breastfeeding in maternity wards has been proven to provide an impact on women's breastfeeding experiences. In previous studies women describe professional support unfavourably, with an emphasis on time pressures, lack of availability or guidance, promotion of unhelpful practices, and conflicting advice. Thus, the present study aims to investigate women's experiences and reflections of receiving breastfeeding support and midwives' experiences and reflections of giving breastfeeding support. Methods This study was carried out in a county in southwestern Sweden during 2003-2004. A qualitative method, content analysis, was chosen for the study. The data came from interviews with women as well as interviews with midwives who were experienced in breastfeeding support. Results The women's and midwives' experiences and reflections of receiving and giving breastfeeding support were conceptualized as one main theme: "Individualized breastfeeding support increases confidence and satisfaction." This theme contained three categories: "The unique woman," "The sensitive confirming process," and "Consistency of ongoing support." In order to feel confident in their new motherhood role, the women wanted more confirmation as unique individuals and as breastfeeding women; they wanted to be listened to; and they wanted more time, understanding, and follow-up from health professionals. In contrast, the midwives described themselves as encouraging and confirming of the women's needs. Conclusions If health care professionals responded to the woman's unique needs, the woman felt that the breastfeeding support was good and was based on her as an individual, otherwise a feeling of uncertainty emerged. The midwives, however, expressed that they gave the women individual support, but they also expressed that the support came from different points of view, because the midwives interpreted women's signals differently.

Social contextual circumstances have an influence on parental transition, and social support has been shown to facilitate the transition to parenthood, among other states. Further knowledge is, however, needed to explore how partners of pregnant women use their social networks during pregnancy. Therefore, the aim of this study was to explore how partners of pregnant women use their social networks when preparing for childbirth and parenting. Within this study, a social network is defined as social connections such as family, friends and significant others. In total, 14 partners (expectant fathers and co-mothers) were interviewed. Data were analysed using qualitative content analysis. EQUATOR Network guidelines and the COREQ checklist were applied. The analysis resulted in one theme of meaning: Partners use their social networks to receive social support, which facilitates understanding about how to prepare for childbirth and parenthood, which was described through three sub-themes. The results highlight the importance of social networks for partners when preparing for childbirth and parenthood. Professionals should aim to strengthen and extend partners' social networks and access to social support. This could be done not only to support partners to attend parental classes, but also to participate socially as well as engage with other expectant parents within the classes. [ABSTRACT FROM AUTHOR]

Abstract Background We investigated whether individual differences in baseline executive control capacity could predict state anxiety during a potentially life-threatening situation. Methods 19 Swedish military conscripts were assessed during two measurement occasions. During a baseline measurement, data regarding performance on a letter fluency task and state anxiety were assessed. During a second measurement, performed immediately prior to participation in a live hand-grenade throwing exercise, data regarding state anxiety was assessed. All participants were male, right-handed and had fulfilled 12 years of education. Results The level of state anxiety was significantly increased between the two measurement occasions (p < .01). Both the number of words produced (β = -.37; p < .05) and the number of perseveration made (β = .43; p < .05) on the verbal fluency task predicted, while controlling for state anxiety at baseline, the level of experienced state anxiety during the threatening situation. Conclusion Although more research is needed the present finding suggests that individual differences in executive control capacity might be related to emotion regulation ability during acute stressor exposure.

Abstract Background Fluorescence activated cell sorting (FACS) is a powerful technique for the qualitative and quantitative detection of biomolecules used widely in both basic research and clinical diagnostic applications. Beads displaying a specific antigen are used to bind antibodies which are then fluorescently labelled using secondary antibodies. As the individual suspension bead passes through the sensing region of the FACS machine, fluorescent signals are acquired and analysed. Currently, antigens are tediously purified and chemically cross-linked to preformed beads. Purification and coupling of proteins often renders them inactive and they will not be displayed in its native configuration. As an alternative, we genetically engineered Escherichia coli to produce biopolyester (polyhdroxyalkanoate=PHA) granules displaying diagnostically relevant antigens in their native conformation and suitable for FACS analysis. Results Hybrid genes were constructed, which encode either the mouse interleukin-2 (IL2) or the myelin oligodendrocyte glycoprotein (MOG) fused via an enterokinase site providing linker region to the C terminus of the PHA granule associated protein PhaP, respectively. The hybrid genes were expressed in PHA-accumulating recombinant E. coli. MOG and IL2 fusion proteins were abundantly attached to PHA granules and were identified by MALDI-TOF/MS analysis and N terminal sequencing. A more abundant second fusion protein of either MOG or IL2 resulted from an additional N terminal fusion, which did surprisingly not interfere with attachment to PHA granule. PHA granules displaying either IL2 or MOG were used for FACS using monoclonal anti-IL2 or anti-MOG antibodies conjugated to a fluorescent dye. FACS analysis showed significant and specific binding of respective antibodies. Enterokinase treatment of IL2 displaying PHA granules enabled removal of IL2 as monitored by FACS analysis. Mice were immunized with either MOG or OVA (ovalbumin) and the respective sera were analysed using MOG-displaying PHA granules and FACS analysis showing a specific and sensitive detection of antigen-specific antibodies within a wide dynamic range. Conclusion E. coli can be genetically engineered to produce PHA granules displaying correctly folded eukaryotic proteins and which can be applied as beads in FACS based diagnostics. Since PHA granule formation and protein attachment occurs in one step already inside the bacterial cell, microbial production could be a cheap and efficient alternative to commercial beads.

Cost-optimal planning is a very well-studied topic within planning, and it has proven to be computationally hard both in theory and in practice. Since cost-optimal planning is an optimisation problem, it is natural to analyse it through the lens of approximation. An important reason for studying cost-optimal planning is heuristic search; heuristic functions that guide the search in planning can often be viewed as algorithms solving or approximating certain optimisation problems. Many heuristic functions (such as the ubiquitious h+ heuristic) are based on delete relaxation, which ignores negative effects of actions. Planning for instances where the actions have no negative effects is often referred to as monotone planning. The aim of this article is to analyse the approximability of cost-optimal monotone planning, and thus the performance of relevant heuristic functions. Our findings imply that it may be beneficial to study these kind of problems within the framework of parameterised complexity and we initiate work in this direction. [ABSTRACT FROM AUTHOR]

To evaluate the test–retest reliability and internal consistency of the Swedish version of the MAastrIcht Nurses Activities INventory (MAINtAIN(S)) developed to measure nursing staff perceived behaviours and barriers for promotion of everyday activities in nursing home residents. Nursing staff completed the MAINtAIN(S) questionnaire on two occasions at 3-week intervals. Relative reliability, absolute reliability and internal consistency with Cronbach's alpha were calculated. The test-–retest reliability of MAINtAIN(S)-behaviours subscales ranged from ICC 2. = 0.78-–0.91 and MAINtAIN(S)-barriers subscales from ICC 2.1 = 0.60-–0.84. Cronbach's alpha varied between 0.60 and 0.91 for the different subscales. The MAINtAIN(S) inventory shows acceptable reliability and internal consistency. MAINtAIN(S) seems to be a promising tool for identifying behaviours and barriers in promoting everyday activities in nursing home residents and can be used to develop ward specific interventions for promotion of daily physical activity level in the care of older adults. [ABSTRACT FROM AUTHOR]

Abstract Background The brain-derived protein S100B has been shown to be a useful marker of brain injury of different etiologies. Cognitive dysfunction after cardiac surgery using cardiopulmonary bypass has been reported to occur in up to 70% of patients. In this study we tried to evaluate S100B as a marker for cognitive dysfunction after coronary bypass surgery with cardiopulmonary bypass in a model where the inflow of S100B from shed mediastinal blood was corrected for. Methods 56 patients scheduled for coronary artery bypass grafting underwent prospective neuropsychological testing. The test scores were standardized and an impairment index was constructed. S100B was sampled at the end of surgery, hourly for the first 6 hours, and then 8, 10, 15, 24 and 48 hours after surgery. None of the patients received autotransfusion. Results In simple linear analysis, no significant relation was found between S100B levels and neuropsychological outcome. In a backwards stepwise regression analysis the three variables, S100B levels at the end of cardiopulmonary bypass, S100B levels 1 hour later and the age of the patients were found to explain part of the neuropsychological deterioration (r = 0.49, p < 0.005). Conclusions In this study we found that S100B levels 1 hour after surgery seem to be the most informative. Our attempt to control the increased levels of S100B caused by contamination from the surgical field did not yield different results. We conclude that the clinical value of S100B as a predictive measurement of postoperative cognitive dysfunction after cardiac surgery is limited.

Background: This study aims to compare the progression of motor and cognitive decline in dementia with Lewy bodies (DLB) compared with Parkinson's disease (PD) using a large multicentre international consortium with up to 15 years of follow‐up. Method: Longitudinal data from 12 cohorts of patients with PD and DLB were included. The PD cohort (n=1108) included newly diagnosed patients from large, on‐going studies. The DLB cohort (n=290) included patients with probable DLB from the European DLB consortium (Table 1). The Mini Mental State Examination (MMSE) was used to explore cognitive functioning and UPDRS‐III for motor impairment. The differences in the rate of progression of MMSE and UPDRS‐III were analyzed with Linear Mixed Effects Model (LMEM) adjusted for baseline variables, with interactions for time. We used square root transformation of the number of errors to obtain an MMSE variable with normal distribution. Result: Both DLB and PD groups presented motor and cognitive decline. The MMSE (figure 1A) showed a mean annual worsening of 2.35 points (95% CI 1.67‐3.03) for DLB patients and 1.05 points (95% CI 0.62‐1.47) for PD patients (P <0.001). In PD the rate of decline increased with time and from the tenth year, the annual rate of decline of the transformed MMSE scores matched the rate in the DLB group. While DLB patients had lower UPDRS‐III scores at baseline, the rate of decline in UPDRS‐III (figure 1B) scores was faster in DLB compared to PD (P <0.001). The annual increase in UPDRS III in DLB was 5.8 points (95% CI 5.71‐5.90), while in PD it was 1.9 points (95% CI 1.76‐1.97). Conclusion: Our findings suggest that patients with DLB experience not only more rapid cognitive decline, but also accelerated motor deterioration compared to patients with PD. After ten years of follow‐up (and 12.9 years from the onset of symptoms), PD patients reach DLB's degree of yearly cognitive decline. This is the first large study to compare the natural history of PD and DLB and provides important information about the prognosis of these diseases. [ABSTRACT FROM AUTHOR]

Objectives: Aim of the work is to present the feasibility of using an Instrumented Human Head Surrogate (IHHS-1) during multidirectional impacts while wearing a modern ski helmet. The IHHS-1 is intended to provide reliable and repeatable data for the experimental validation of FE models and for the experimental evaluation of modern helmets designed to enhance the degree of protection against multidirectional impacts.Design: The new IHHS-1 includes 9 triaxial MEMS accelerometers embedded in a silicone rubber brain, independently molded and presenting lobes separation and cerebellum, placed into an ABS skull filled with surrogate cerebrospinal fluid. A triaxial MEMS gyroscope is placed at the brain center of mass. Intracranial pressure can be detected by eight pressure sensors applied to the skull internal surface along a transversal plane located at the brain center of mass and two at the apex. Additional MEMS sensors positioned over the skull and the helmet allow comparison between outer and inner structure kinematics and surrogate CSF pressure behavior.Methods: The IHHS-1 was mounted through a Hybrid III neck on a force platform and impacted with a striker connected to a pendulum tower, with the impact energies reaching 24J. Impact locations were aligned with the brain center of mass and located in the back (sagittal axis), right (90° from sagittal axis), back/right (45°), and front right (135°) locations. Following dynamic data were collected: values of the linear accelerations and angular velocities of the brain, skull and helmet; intracranial pressures inside the skull.Results: Despite the relatively low intensity of impacts (HIC at skull max value 46), the skull rotational actions reached BrIC values of 0.33 and angular accelerations of 5216rad/s2, whereas brain angular acceleration resulted between 1,44 and 2,1 times lower with similar values of BrIC.Conclusions: The IHHS-1 is a physical head surrogate that can produce repeatable data for the interpretation of inner structures behavior during multidirectional impacts with or without helmets of different characteristics. [ABSTRACT FROM AUTHOR]