Could gastrointestinal disorders differ in two close but divergent social environments?

<p>Abstract</p> <p>Background</p> <p>Many public health problems in modern society affect the gastrointestinal area. Knowledge of the disease occurrence in populations is better understood if viewed in a psychosocial context including indicators of the social environment where people spend their lives. The general aim of this study was to estimate the occurrence in the population and between sexes of common gastrointestinal conditions in two neighborhood cities representing two different social environments defined as a "white-collar" and a "blue-collar" city.</p> <p>Methods</p> <p>We conducted a retrospective register study using data of diagnosed gastrointestinal disorders (cumulative incidence rates) derived from an administrative health care register based on medical records assigned by the physicians at hospitals and primary care.</p> <p>Results</p> <p>Functional gastrointestinal diseases and peptic ulcers were more frequent in the white-collar city, while diagnoses in the gallbladder area were significantly more frequent in the blue-collar city. Functional dyspepsia, irritable bowel syndrome, and unspecified functional bowel diseases, and celiac disease, were more frequent among women while esophageal reflux, peptic ulcers, gastric and rectal cancers were more frequent among men regardless of social environment.</p> <p>Conclusions</p> <p>Knowledge of the occurrence of gastrointestinal problems in populations is better understood if viewed in a context were the social environment is included. Indicators of the social environment should therefore also be considered in future studies of the occurrence of gastrointestinal problems.</p

The Challenge of Infections in Frail Elderly : The Story of Mr. Nilsson

Signs and symptoms of infection in Nursing Home Residents (NHR) are often atypical with a lack of specific ones, causing a delay in diagnosis and treatment. The complexity of detecting infections in NHR can be explained by difficulties in understanding and interpreting non-specific signs and symptoms and co-existing chronic diseases that blur the clinical picture. The case of Mr. Nilsson illustrates the process from the first signs and symptoms of infection to diagnosis in an elderly person with severe cognitive decline and physical impairment. What we can learn from this case is to reflect on changed behavior from habitual status and/or non-specific symptoms as possible suspected infection, and to consider a rise from individual baseline temperature, so called DiffTemp™, instead of traditional decided cut-off values for fever

Correction fo writing disorders for 3rd grade students with phonetic – phonematic insufficiency

Diplomdarba autore: Laila Raiska. Darba nosaukums: Rakstīšanas traucējumu korekcija 3. klases skolēniem ar fonētiski fonemātisko nepietiekamību. Diplomdarba mērķis: Izpētīt rakstīšanas traucējumu korekcijas metodes un paņēmienus darbam ar 3. klases skolēniem, kuriem ir fonētiski fonemātiskā nepietiekamība un pārbaudīt to efektivitāti. Lai sasniegtu pētījuma mērķi tiek izvirzīti šādi uzdevumi. 1. Analizēt zinātnisko literatūru par 3. klases skolēnu attīstības likumībām un rakstīšanas traucējumiem. 2. Iegūt un salīdzināt datus par 3. klases skolēnu rakstīšanas traucējum raksturu pirms un pēc koriģējoši attīstošās darbības. 3. Izzināt kādas darba metodes un formas ir visefektīvākās rakstīšanas traucējumu mazināšanā. 4. Izdarīt secinājumus par pētījumu. Diplomdarbs sastāv no titullapas, anotācijas latviešu un angļu valodā, satura rādītāja, ievada, teorētiskā daļas ar divām nodaļām un trīs apakšnodaļām, empīriskās daļas ar vienu nodaļu un trīs apakšnodaļām, secinājumiem, izmantotās literatūras un citu avotu saraksta un pielikumiem. Teorētiskajā daļā raksturota 3. klases skolēnu attīstība veselumā, izvirzītās problēmas skatījumā. Sniegts fonētiski fonemātiskās nepietiekamības raksturojums un izpausmes. Aprakstīta rakstīšanas iemaņu attīstība, rakstīšanas traucējumu veidi un to izpausmes. Apkopotas teorētiskās atziņas V. Krutecka, I. Miltiņas, S. Tūbeles, J. Lūses, u.c. autoru skatījumā. Praktiskajā daļā sniegta pētījumu metodoloģija, veikts iesaistīto skolēnu raksturojums, dots koriģējoši attīstošā darbībā izmantoto vingrinājumu rakstīšanas traucējumu novēršanai apraksts, veikta pētījumā iegūto rezultātu apstrāde un analīze. Pētījuma rezultātā pierādījās hipotēze: rakstīšanas traucējumu korekcija 3. klases skolēniem ar fonētiski fonemātisko nepietiekamību noritēs veiksmīgi, ja tiks ievērotas šī vecumposma attīstības likumsakarības, katra bērna individuālās vajadzības, ja tiks atbilstoši un mērķtiecīgi izraudzītas un pielietotas koriģējošās darbības metodes, paņēmieni un mācību materiāli. Pētījuma bāze ir novada X pamatskolas 6 skolēni ar rakstīšanas traucējumiem. Diplomdarbā ir 113 lappuses, 16 attēli, 6 tabulas, 9 pielikumi, 74 izmantotās literatūras un citu avotu vienības. Atslēgas vārdi: fonētiski fonemātiskā nepietiekamība, 3. klases skolēni, rakstīšanas traucējumi, koriģējoši attīstošā darbība, vingrinājumi.Author of the diploma paper: Laila Raiska. The title of the diploma paper: "Correction of writing disorders for 3rd grade students with phonetic – phonemic insufficiency ". The aim of the diploma paper: investigate correction methods of writing disorders for working with 3rd grade students who have phonetic – phonemic insufficiency and to check their effectiveness In order to achieve the aim of the research, the following objectives are set: 1. To analyse scientific literature about regularities of the development and writing disorders of 3rd grade students. 2. To get and compare the data on the writing disorders of 3rd grade students before and after corrective developing activities. 3. To finde out which work methods and types are the most effective in reducing the writing disorders. 6. To draw conclusions on the research. The diploma work consists of a title page, an annotation in Latvian and English, a table of contents, introduction, theoretical part with two chapters and three subchapters, empirical part with one chapter and three subchapters, conclusions, list of literature and other sources. attachments. The theoretical part describes the development of the 3rd grade students in their development, in view of the problems set. The characterization and manifestations of phonetic – phonemic insufficiency is provided. There is described development of writing skills, types of writing disorders and their manifestations. Summerized theoretical knowledge of V. Krutecka, I. Miltiņa, S. Tūbel, J. Lūses, and others. In the practical part the research methodology is given, a description of the students involved is given, a description of the exercises for writing corrective action is given, and the processing and analysis of the results obtained in the research is performed. As a result of the research, the hypothesis was proved: the correction of writing impairment for 3rd grade students with phonetic-phonemic insufficiency will be successful if the specific features of development of this age group, individual needs of each child are met, if the corrective action methods, techniques and study materials will be appropriately and purposefully selected and applied. The research base: 6 students of elementary school with writing disabilities, 1 speech therapist. Diploma paper contains 113 pages, 16 pictures, 6 tables, 9 annexes, 74 literature and other sources sources used. Keywords: phonetic – phonemic insufficiency, 3rd grade students, writing disorder, corrective developmental activity, exercises

Patients with irritable bowel syndrome are more burdened by co-morbidity and worry about serious diseases than healthy controls- eight years follow-up of IBS patients in primary care

Background Irritable Bowel Syndrome (IBS) is a hidden public health disease that affects up to 20% of the general population. Although co-morbidity can affect diagnose setting and treatment of the disease, there are few studies concerning diagnosed and registered co-morbidity for IBS patients in primary care. The aim of this study was to analyse co-morbidity among IBS-patients compared to age- and sex-matched controls from the general population using data from a county-wide computerized medical record system. Methods IBS cases were recruited from three Swedish primary health care centres during a five-years period and controls from the same corresponding geographical areas. Co-morbidity data for IBS-patients and morbidity data for controls were derived from a population-based Health Care Register (HCR) covering all diagnoses in primary as well as hospital care in the region. Odds Ratios with 95% confidence intervals for morbidity in gastro-intestinal and non-gastrointestinal diagnoses for cases with irritable bowel syndrome compared to controls were calculated separately for each gender and diagnosis. Results We identified more co-morbidity among IBS patients of both sexes, compared to matched controls in the general population. Patients with IBS were particularly more worried about having a serious disease than their control group. The risk among male IBS-cases to get this latter diagnose was three times higher compared to the male controls. Conclusions In this population based case–control study, the analysis of diagnoses from the HCR revealed a broad spectrum of common co-morbidity and significantly more physician-recorded diagnoses among IBS-patients in comparisons to the control group

The value of fever assessment in addition to the Early Detection Infection Scale (EDIS). A validation study in nursing home residents in Sweden

Abstract Background In order to improve detection of suspected infections in frail elderly there is an urgent need for development of decision support tools, that can be used in the daily work of all healthcare professionals for assessing non-specific and specific changes. The aim was to study non-specific signs and symptoms and fever temperature for early detection of ongoing infection in frail elderly, and how these correlates to provide the instrument, the Early Detection Infection Scale (EDIS), which is used to assess changes in health condition in frail elderly. Methods This was an explorative, prospective cohort study, including 45 nursing home residents, 76 to 99 years, in Sweden. Nursing assistants measured morning ear body temperature twice a week and used the EDIS to assess individual health condition daily for six months. The outcome comprised events of suspected infection, compiled from nursing and medical patient records. Factor analysis and multivariate logistic regression analysis were performed to analyse data. Results Fifteen residents were diagnosed with at least one infection during the six-month follow-up and 189 observations related to 72 events of suspected infection were recorded. The first factor analysis revealed that the components, change in cognitive and physical function, general signs and symptoms of illness, increased tenderness, change in eye expression and food intake and change in emotions explained 61% of the variance. The second factor analysis, adding temperature assessed as fever to > 1.0 °C from individual normal, resulted in change in physical function and food intake, confusion and signs and symptoms from respiratory and urinary tract, general signs and symptoms of illness and fever and increased tenderness, explaining 59% of the variance. In the first regression analysis, increased tenderness and change in eye expression and food intake, and in the second change in physical function and food intake, general signs and symptoms of illness and fever (> 1.0 °C from individual normal) and increased tenderness were significantly associated with increased risk for ongoing infection. Conclusion No items in the EDIS should be removed at present, and assessment of fever as > 1.0 °C from individual normal is a valuable addition. The EDIS has the potential to make it easier for first line caregivers to systematically assess changes in health condition in fragile elderly people and helps observations to be communicated in a standardised way throughout the care process. The EDIS thus contributes to ensuring that the decisions not being taken at the wrong level of care

Differences in levels of albumin, ALT, AST, gamma-GT and creatinine in frail, moderately healthy and healthy elderly individuals

Background: Reference intervals are widely used as decision tools, providing the physician with information about whether the analyte values indicate ongoing disease process. Reference intervals are generally based on individuals without diagnosed diseases or use of medication, which often excludes elderly. The aim of the study was to assess levels of albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine and gamma-glutamyl transferase (gamma-GT) in frail, moderately healthy and healthy elderly indivuduals. Methods: Blood samples were collected from individuals amp;gt; 80 years old, nursing home residents, in the Elderly in Linkoping Screening Assessment and Nordic Reference Interval Project, a total of 569 individuals. They were divided into three cohorts: frail, moderately healthy and healthy, depending on cognitive and physical function. Albumin, ALT, AST, creatinine and gamma-GT were analyzed using routine methods. Results: Linear regression predicted factors for 34% of the variance in albumin were activities of daily living (ADL), gender, stroke and cancer. ADLs, gender and weight explained 15% of changes in ALT. For AST levels, ADLs, cancer and analgesics explained 5% of changes. Kidney disease, gender, Mini Mental State Examination (MMSE) and chronic obstructive pulmonary disease explained 25% of the variation in creatinine levels and MMSE explained three per cent of gamma-GT variation. Conclusions: Because a group of people are at the same age, they should not be assessed the same way. To interpret results of laboratory tests in elderly is a complex task, where reference intervals are one part, but far from the only one, to take into consideration.Funding Agencies|Landstinget i Ostergotland Sverige [LIO-359661]</p

Potential blood-based markers of celiac disease

Background: Blood-based diagnostics has the potential to simplify the process of diagnosing celiac disease (CD). Although high levels of autoantibodies against tissue transglutaminase (anti-TG2) are strongly indicative of active CD, several other scenarios involve a need for additional blood-based CD markers. Methods: We investigated the levels of messenger RNA (mRNA) in whole blood (n = 49) and protein in plasma (n = 22) from cases with active CD (n = 20), with confirmed CD and normalized histology (n = 15), and without a CD diagnosis (n = 14). Group differences were analyzed using Kruskal-Wallis one-way analysis of variance by ranks. We also investigated correlations between levels of potential markers, histopathology according to the modified Marsh scale, and CD risk gradient based on HLA type, using Spearman rank correlation. The relation between HLA-DQ2 gene dose effect and the expression levels of selected blood-based markers was investigated using the Mann-Whitney U test. Finally, the diagnostic performance of anti-TG2, potential blood-based CD markers, and logistic regression models of combined markers was evaluated using receiver operating characteristic (ROC) curve analysis. Results: CXCL11 protein levels and TNFRSF9 and TNFSF13B mRNA levels were identified as potential CD markers. These are all affected by or involved in the regulation of the NF-kappa B complex. CXCL11 protein levels and IL21 and IL15 mRNA levels were correlated with histopathology according to the modified Marsh scale, as were the established CD markers. HLA genotype risk and HLA-DQ2 gene dose effect did not show any significant relations with either the potential CD markers or the established CD markers. ROC curve analysis revealed a slight, non-significant increase in the area under the curve for the combined use of anti-TG2 and different constellations of potential blood-based CD markers compared to anti-TG2 alone. Conclusions: The CD markers identified in this study further emphasize the significance of components related to NF-kappa B regulation in relation to CD. However, the relevance of CXCL11, TNFSF13B, TNFRSF9, and other NF-kappa B interacting proteins recognized by pathway analysis, needs to be further investigated in relation to diagnosis and monitoring of CD.Funding Agencies|Futurum - the Academy for Healthcare; Jonkoping County Council; Medical Research Council of Southeast Sweden</p

Classification of ≥80-year-old individuals into healthy, moderately healthy, and frail based on different frailty scores affects the interpretation of laboratory results

Background: Interpretation laboratory analyses are crucial when assessing the patient’s condition. Reference intervals from apparently healthy and disease-free individuals may cause problems when outcomes from elderly patients with chronic diseases and on medications are being interpreted. Elderly individuals are a heterogeneous group ranging from individuals managing their daily life independently to individuals with diseases and impairment, in need of nursing care around the clock, that is, frail; a term widely used although there is no consensus on the definition. Aims and Objectives: The aim of the study was to study the effect of classification of elderly into healthy, moderately healthy, and frail, based on activities of daily living (ADL) and Mini-Mental State Examination (MMSE) or frailty index (FI), on the interpretation of outcomes regarding: Albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, and gamma-glutamyltransferase (γ-GT) levels. Materials and Methods: Individuals ≥80 years (n=568) were classified either on ADL and MMSE or number of deficits, (FI). Results: Individuals classified as frail based on FI had lower mean levels for ALT, creatinine and γ-GT than individuals classified based on ADL and MMSE (P&lt;0.05). Conclusion: The model to define health status to some extent affected laboratory analyte levels in ≥80 years old, classified as healthy, moderately healthy, and frail based on ADL and MMSE versus FI