In small trials with control groups that receive no intervention, acupuncture has been reported to improve functional outcome after stroke. We studied effects of acupuncture and transcutaneous electrical nerve stimulation on functional outcome and quality of life after stroke versus a control group that received subliminal electrostimulation.
In a multicenter randomized controlled trial involving 7 university and district hospitals in Sweden, 150 patients with moderate or severe functional impairment were included. At days 5 to 10 after acute stroke, patients were randomized to 1 of 3 intervention groups: (a) acupuncture, including electroacupuncture; (b) sensory stimulation with high-intensity, low-frequency transcutaneous electrical nerve stimulation that induces muscle contractions; and (c) low-intensity (subliminal) high-frequency electrostimulation (control group). A total of 20 treatment sessions were performed over a 10-week period. Outcome variables included motor function, activities of daily living function, walking ability, social activities, and life satisfaction at 3-month and 1-year follow-up.
At baseline, patients in each group were closely similar in all important prognostic variables. At 3-month and 1-year follow-ups, no clinically important or statistically significant differences were observed between groups for any of the outcome variables. The 3 treatment modalities were all conducted without major adverse effects.
When compared with a control group that received subliminal electrostimulation, treatment during the subacute phase of stroke with acupuncture or transcutaneous electrical nerve stimulation with muscle contractions had no beneficial effects on functional outcome or life satisfaction.
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.
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.
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.
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.
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.
Meeting the needs and wishes of people with severe dementia is difficult and demanding for carers, and a number of approaches can be used in encounters with dementia sufferers. The aim of this study was to explore how registered nurses in a northern Norwegian county thought about approaching people with severe dementia. A patient case was used as a vignette, followed by a questionnaire with 13 sets of statements, each set containing two alternative approaches (one reality orientation approach and one personhood focused approach). In 12 out of the 13 sets of statements the reality orientation alternative was usually chosen, but responses to the statement regarding the meaning of confusion tended more towards the personhood focused approach. RNs with more than the basic education and staff nurses working in a team nursing system, chose the personhood focused approach significantly more often than RNs with no post-basic education and nurses working in a primary nursing system. The article discusses how reflection on daily experiences can improve one's ability to reflect on one's own experiences and encourage a personhood focused approach. Working in a team means gaining opportunities to reflect together with coworkers, while working in a primary nursing care system might afford fewer such opportunities.
OBJECTIVES: This paper evaluates the 10-year outcomes of a Northern Sweden community intervention program for the prevention of cardiovascular disease (CVD), with special reference to the social patterning of risk development. METHODS: Using a quasi-experimental design, trends in risk factors and predicted mortality in an intervention area (Norsjö municipality) are compared with those in a reference area (Northern Sweden region) by repeated independent cross-sectional surveys. RESULTS: There were significant differences in changes in total cholesterol level and systolic blood pressure between the intervention and reference populations. The predicted coronary heart disease mortality (based on the North Karelia risk equation). after adjustment for age and education, was reduced by 36% in the intervention area and by 1% in the reference area. CONCLUSIONS: We conclude that a long-term community-based CVD prevention program which combines population and individual strategies can substantially promote a health shift in CVD risk in a high risk rural population. When evaluated for different social strata, we found no signs of an increasing health gap between socially privileged and less privileged groups. Socially less-privileged groups benefited the most from the present prevention program.
In the WHO MONICA Study, determinants and trends in cardiovascular disease are monitored during a 10-year period in 40 centers in 27 countries. The Northern Sweden MONICA Center is located furthest to the north of all participating centers. In this report, baseline data on cardiovascular risk factors are presented. In the first population screening, 1,625 of 2,000 (81%) invited individuals participated. Diastolic blood pressure greater than or equal to 90 mmHg was recorded in 19% and 9% were on drug treatment for hypertension. Median cholesterol level was 6.10 mmol/l and the frequency of hypercholesterolemia was high. A body mass index of greater than or equal to 30, indicating severe obesity, was observed in 9%, a lower proportion than in most other European populations. Among men, the total proportion of tobacco consumers was 49%, including 22% snuffers. Of the women, 31% were tobacco consumers, very few being snuffers. Women had, in general, a more favorable cardiovascular risk factor profile up to the age of 45. Thereafter, the two genders were similar. By international comparisons, the population in northern Sweden is characterized by high serum cholesterol levels, intermediate blood pressure levels, a relatively low prevalence of severe obesity and a high consumption of smokeless tobacco.
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.
Clinical features of different types of stroke were investigated in a sample of 409 patients representative of all cases admitted for acute stroke, except subarachnoidal hemorrhages, within a well defined population. A specific cerebrovascular diagnosis was obtained by detailed clinical investigation, including CT scan. In people greater than 50 years old, men/women risk for stroke was estimated to be 1.40:1. The risk was higher in men up to the age of 80; above this age similar risk for the two genders was observed. Eleven per cent had intracerebral hemorrhage, 13% TIA, 51% non-embolic and 25% embolic brain infarction. In all diagnostic categories there were similar proportions of patients who had a history of hypertension and previous stroke, neither did hemoglobin and hematocrit levels differ between the different stroke disorders. TIA preceded intracerebral hemorrhage in 11% and brain infarction in 15-20%. As opposed to patients with ischemic lesions, subjects with intracerebral hemorrhage had higher systolic blood pressure levels and more severe symptoms on admission to hospital. Ischemic stroke was associated with male predominance, different ischemic manifestations of heart diseases and diabetes.
The strongest correlations between coffee consumption and serum cholesterol levels have been found in countries where people drink coffee brewed by mixing coffee grounds directly in boiling water (boiled coffee). In the present study of a population-based sample of 1625 middle-aged subjects (the Northern Sweden MONICA Study), approximately 50% of the participants were drinking boiled coffee, and 50% were drinking filtered coffee. Consumers of boiled coffee had significantly higher serum cholesterol levels than consumers of filtered coffee. Subjects who drank boiled coffee reported a higher intake of fat. A linear multiple regression analysis with serum cholesterol as the dependent variable confirmed that boiled coffee was an important independent determinant of cholesterol levels. We conclude that subjects who drink boiled coffee have higher serum cholesterol levels than those who drink filtered coffee, and that the most likely explanation for this finding lies in the type of brewing method.