Perceived Changes in Communicative Interaction in Atypical Parkinsonism

The aim of this study was to examine if atypical parkinsonism affects the communicative ability in conversational interaction. Fifteen persons close to individuals with atypical parkinsonism answered a questionnaire, “Assessment of Change in Communicative Interaction” (ACCI), estimating perceived change in interactive skills compared to before the onset of the disease. The study also examined if perceived change correlated with disease duration. The results showed that at group level, the participants experienced change in many aspects of conversational interaction, particularly regarding the affected person's speech, body communication, response latency, phrase length, word finding, and ability to make themselves understood. There was no correlation between perceived change and disease duration. In conclusion, results indicated that the communicative interaction of individuals with atypical parkinsonism is significantly affected and that information elicited from significant others can help define specific problem areas or foci of concern that need to be targeted in communicative intervention or at least considered in interaction with these persons

Mellan Pod och Patient – hur förändras arbetet när vården blir digital, slutrapport

Teknikutvecklingen inom e-hälsoområdet möjliggör ständigt nya och mer avancerade arbetssätt för att övervaka och vårda patienter digitalt. Vården sker då genom kontinuerlig övervakning av patientens hälsa via digitalt överförda data och kommunikation mellan vårdpersonal och patient där feedback och rekommendationer skräddarsys efter patientens behov och tillstånd. Denna typ av digital vård är ett växande område inom e-hälsan. Syftet med digital vård är att avståndet ska minska mellan vårdpersonal och patient i tid och rum, vården ska bli mer kontinuerlig och proaktiv samt att resurser allokeras till de delar av vården där de behövs bäst. Eftersom tekniken är relativt ny genomförs för tillfället olika studier för att undersöka effekterna på patienternas hälsa.För vårdpersonalen betyder tekniken dock ett förändrat arbetssätt som innebär: ett skifte från personliga möten med patienten till digital kommunikation; från att själv mäta olika parametrar till att ta emot värden som patienterna registrerat; från bokade patientmöten till en mer kontinuerlig övervakning av patientens värden samt att en algoritm i det digitala systemet föreslår vilken/vilka patient(er) som ska prioriteras. Hur personalen upplever denna övergång från traditionell vård till digital vård vet vi mycket lite om eftersom detta inte har studerats och fokus i de studier som genomförts hittills har varit på effekter på patientens hälsa. Det finns inte1heller studier av huruvida det digitala arbetssättet är mer kostnadseffektivt även om det finns ett sådant antagande.I det här projektet har vi studerat och jämfört hur vårdpersonalen arbetar digitalt respektive ”traditionellt” med digital övervakning av kroniskt sjuka. Syftet är att öka kunskapen om 1) hur digital vård påverkar vårdpersonalens arbetssätt och arbetsmiljö jämfört med ”traditionell” vård, 2) om och i så fall hur personalen integrerar de digitala systemen i sitt sätt att arbeta och att 3) jämföra kostnadseffektiviteten mellan de två arbetssätten.Projektet genererar kunskap om hur övergången till digital vård påverkar vårdpersonal i flera dimensioner som exempelvis förändrat arbetssätt, integration av den digitala vården i övrigt arbete, upplevelse av kontroll över det egna arbetet i förhållande till ställda krav, förändrade roller gentemot kollegor osv samt om kostnadseffektiviteten av digital vård jämfört med traditionell vård. Ett teoretiskt ramverk med bla Normaliseringsprocessteori (NPT) modellen har testas, modifierats och utvecklas utifrån de resultaten

Will PatientsLikeMe.com affect the doctor -patient relation and the work environment of doctors?

There have been large changes in the area of healthcare in the past decades concerning patient participation, patient empowerment and the development of knowledge in healthcare. This has consequences for, amongst other things, the relationship between patients and caregivers. Web. 2.0 made different types of online communities for patients possible and the concept Medicine 2.0 was developed for health issues on the Internet. This paper addresses one such community, namely PatiensLikeMe.com (PLM). PLM is designed for patients' independent use to get information and knowledge about their disease, and to get in contact with other patients with the same diagnosis to share experiences. Our aim is to analyse the online community PatientLikeMe.com from the perspective of how the type of information it allows for, can be used by patients and what consequences it may have for the doctor-patient relationship and thereby on the work environment of the doctors. Traditionally the doctor's knowledge base has been seen as specific and difficult to gain for actors outside the profession. This might now change due to the patients' opportunity to build their own knowledge base on PLM and other similar sights. This may enhance patient empowerment and literacy but also lead to impairment of the doctor-patient relationship and ultimately the working conditions of the medical profession through loss of control over their knowledge base. Practitioner Summary: PatientsLikeMe.com is an example of an online community that enables patients to communicate, interact and share their information about their health conditions. Patients can thus build a knowledge base of their own on the site. Traditionally this type of knowledge base has been exclusive to the doctors. In the paper we discuss how this may change the doctor-patient relationship and the working conditions for the medical profession

Interacting With a Visiting Dog Increases Fingertip Temperature in Elderly Residents of Nursing Homes

The aim of this study was to investigate whether interacting with a visiting dog influences fingertip temperature and cortisol levels in residents living in nursing homes for the elderly. The study included two groups, the dog group (n= 13) and the control group (n= 11-15) and lasted for 8 weeks for the dog group and 6 weeks for the control group. All participants were residents living at nursing homes for the elderly. The researchers visited small groups of the participants twice weekly during the entire study in both the dog and the control group. The visiting dog and the dog handler accompanied the researchers during weeks 3-6. Fingertip temperature was measured and saliva samples for cortisol determination were collected at 0, 20 and 60 min for the dog group and at 0 and 20 min for the control group. For analysis the study was divided into periods; Period 1 (week 1-2), Period 2 (week 3-4), Period 3 (week 5-6) and Period 4 (week 7-8, only the dog group). Mean values based on all data obtained at 0 and 20 min during period 1-3 were compared between groups. A second, separate analysis for the dog group also included data from 60 min and for period 4. For the dog group fingertip temperature increased significantly between period 1 and 2, 1 and 3 and 1 and 4 (p< 0.05). In addition, fingertip temperature rose significantly between 0 and 20 min and between 0 and 60 min within all periods. For the control group a significant decrease in fingertip temperature was observed between period 1 and 3 (p< 0.05). Fingertip temperature did not differ between the two groups during period 1, but was significantly higher for the dog group than for the control group during periods 2 and 3 (p< 0.05 andp< 0.001, respectively). Cortisol results are only presented descriptively due to that many samples had too low volume of saliva to be analyzed. In the present study interaction between elderly residents and a visiting dog resulted in increased fingertip temperature, probably reflecting a decrease in the activity of the sympathetic nervous system and therefore a decrease in stress levels

Dysphonia - Illustrating a Nationwide Initiative to Provide Students with High Quality e-Learning Resources

Dysphonia is one of 16 e-learning projects coordinated and supported by the MedCal committee of the Council for Renewal of Higher Education. The application as such is a multimedia program about voice disorders and comprises a collection of patients suffering from hoarseness, which the user can explore in an interactive manner. The greatest benefits can be reaped by being able to integrate sound (voice) with images, video clips and descriptive text of various pathological conditions. Voice acoustic analysis is also provided. Each diagnosis is explicitly accounted for in classic textbook style. Descriptions of examination techniques, therapeutic sessions, and surgical interventions are included. The material can be accessed in multiple ways and supports explorative learning. The Dysphonia project is the product of a network of collaborators of various expertise supported by a nationwide initiative

Bacteria Penetrate the Inner Mucus Layer before Inflammation in the Dextran Sulfate Colitis Model

Protection of the large intestine with its enormous amount of commensal bacteria is a challenge that became easier to understand when we recently could describe that colon has an inner attached mucus layer devoid of bacteria (Johansson et al. (2008) Proc. Natl. Acad. Sci. USA 105, 15064-15069). The bacteria are thus kept at a distance from the epithelial cells and lack of this layer, as in Muc2-null mice, allow bacteria to contact the epithelium. This causes colitis and later on colon cancer, similar to the human disease Ulcerative Colitis, a disease that still lacks a pathogenetic explanation. Dextran Sulfate (DSS) in the drinking water is the most widely used animal model for experimental colitis. In this model, the inflammation is observed after 3-5 days, but early events explaining why DSS causes this has not been described.When mucus formed on top of colon explant cultures were exposed to 3% DSS, the thickness of the inner mucus layer decreased and became permeable to 2 microm fluorescent beads after 15 min. Both DSS and Dextran readily penetrated the mucus, but Dextran had no effect on thickness or permeability. When DSS was given in the drinking water to mice and the colon was stained for bacteria and the Muc2 mucin, bacteria were shown to penetrate the inner mucus layer and reach the epithelial cells already within 12 hours, long before any infiltration of inflammatory cells.DSS thus causes quick alterations in the inner colon mucus layer that makes it permeable to bacteria. The bacteria that reach the epithelial cells probably trigger an inflammatory reaction. These observations suggest that altered properties or lack of the inner colon mucus layer may be an initial event in the development of colitis

Behavior in a stressful situation, personality factors, and disease severity in patients with acute myocardial infarction: baseline findings from the prospective cohort study SECAMI (The Secondary Prevention and Compliance following Acute Myocardial Infarction-study)

<p>Abstract</p> <p>Background</p> <p>Psychosocial stress has been identified as a risk factor in association with cardiovascular disease but less attention has been paid to heterogeneity in vulnerability to stress. The serial Color Word Test (CWT) measures adaptation to a stressful situation and it can be used to identify individuals that are vulnerable to stress. Prospective studies have shown that individuals with a maladaptive behavior in this test are exposed to an increased risk of future cardiovascular events. The aim of the present study was to investigate whether maladaptive behavior in the serial CWT alone or in combination with any specific personality dimension was associated with severity of myocardial infarction (MI).</p> <p>Methods</p> <p>MI-patients (n = 147) completed the test and filled in a personality questionnaire in close proximity to the acute event. The results were analyzed in association with four indicators of severity: maximum levels above median of the cardiac biomarkers troponin I and creatine kinase-MB (CKMB), Q-wave infarctions, and a left ventricular ejection fraction (LVEF) ≤ 50%.</p> <p>Results</p> <p>Maladaptive behavior in the serial CWT together with low scores on extraversion were associated with maximum levels above median of cardiac troponin I (OR 2.97, CI 1.08-8.20, p = 0.04) and CKMB (OR 3.33, CI 1.12-9.93, p = 0.03). No associations were found between the combination maladaptive behavior and low scores on extraversion and Q-wave infarctions or a decreased LVEF.</p> <p>Conclusions</p> <p>Maladaptive behavior in combination with low scores on extraversion is associated with higher cardiac biomarker levels following an MI. The serial CWT and personality questionnaires could be used to identify individuals vulnerable to the hazardous effects of stress and thereby are exposed to an increased risk of a more severe infarction.</p

The impact of personality factors on delay in seeking treatment of acute myocardial infarction

<p>Abstract</p> <p>Background</p> <p>Early hospital arrival and rapid intervention for acute myocardial infarction is essential for a successful outcome. Several studies have been unable to identify explanatory factors that slowed decision time. The present study examines whether personality, psychosocial factors, and coping strategies might explain differences in time delay from onset of symptoms of acute myocardial infarction to arrival at a hospital emergency room.</p> <p>Methods</p> <p>Questionnaires on coping strategies, personality dimensions, and depression were completed by 323 patients ages 26 to 70 who had suffered an acute myocardial infarction. Tests measuring stress adaptation were completed by 180 of them. The patients were then categorised into three groups, based on time from onset of symptoms until arrival at hospital, and compared using logistic regression analysis and general linear models.</p> <p>Results</p> <p>No correlation could be established between personality factors (i.e., extraversion, neuroticism, openness, agreeableness, conscientiousness) or depressive symptoms and time between onset of symptoms and arrival at hospital. Nor was there any significant relationship between self-reported patient coping strategies and time delay.</p> <p>Conclusions</p> <p>We found no significant relationship between personality factors, coping strategies, or depression and time delays in seeking hospital after an acute myocardial infraction.</p