Mental stimulation and multimodal trials to prevent cognitive impairment and Alzheimer ́s disease

Theoretical models of dynamic biomarkers underlying the development of Alzheimer´s Disease (AD) acknowledge that there is inter-individual variability in the cognitive performance associated with any level of AD pathology. Mentally stimulating activities such as schooling, occupation, and leisure activities, may contribute to this variability, but it is yet unclear how this can be best assessed, and how such effects can vary across AD severity and among individuals at-risk for cognitive impairment. The association between mental stimulation and cognitive performance also suggests that it is important to account for mental stimulation levels in randomized clinical trials (RCTs) comparing rates of cognitive change between interventions (i.e., drugs, lifestyle interventions) and controls. The aim of this thesis was to investigate a) how pre-existing levels of occupational complexity affect the cognitive outcomes of a multimodal lifestyle-based RCT among older adults at increased risk for dementia based on a validated risk score b) if occupational complexity is associated to cognitive performance among individuals at-risk for dementia, including individuals in the early stages of symptomatic AD (prodromal AD) and c) if occupational complexity is associated with resilience to AD pathology, measured with validated biomarkers and neuroimaging among individuals at-risk for cognitive impairment and with prodromal AD. The four studies in this thesis were based on data from the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability (FINGER), the Karolinska University Hospital electronic database and biobank for clinical research (GEDOC) and The Multimodal Prevention Trial for Alzheimer´s Disease (MIND-ADmini). Study I. This study used data from the FINGER study (N=1026) to investigate if preexisting levels of occupational complexity were associated with cognitive function at baseline, and if occupational complexity was associated with the rate of change in cognition during the 2-year intervention period. For all measures of occupational complexity, higher levels of complexity were associated with better cognitive outcomes at baseline. Occupational complexity was not associated with the rate of cognitive change during the intervention, except for the executive function outcome, for which higher levels of complexity with data predicted increased improvement ((ß[SE]: .028[.014], p=.044). Study II. This study used data from the FINGER neuroimaging cohort, to investigate if the association between occupational complexity and cognition was moderated by measures of brain integrity, both in terms of magnetic resonance imaging (MRI, N=126) and Pittsburgh-B Compound – Positron Emission Tomography (PiB-PET, N=41). The results showed that higher levels of occupational complexity were associated with better cognitive performance for some outcomes after adjusting for Alzheimer’s Disease Signature (ADS) and medial temporal atrophy (MTA). However, for most types of neuropathology and cognitive outcomes, moderation effects indicated that higher occupational complexity levels were associated with better cognitive performance only in people with higher brain integrity, suggesting lack of occupational complexity-related resilience mechanisms. Study III. This study investigated the association between mental stimulation (occupational complexity and education) and validated AD biomarkers, Aβ1–42, p-tau and t-tau measured in cerebrospinal fluid (CSF). Using data from the GEDOC database, 174 individuals with prodromal AD were included, and analyses were adjusted for cognitive function. The results indicated that both higher occupational complexity and education were associated with higher levels of p-tau and t-tau. For education the association with tau pathology was age dependent. No association was found with Aβ1– 42. This suggests that higher education and occupational complexity may provide resilience against tau-related pathology in prodromal AD. Study IV. This study used data from FINGER, GEDOC, and MIND-ADmini, thus including a total of 1410 individuals, 1207 at-risk for dementia and 203 with Prodromal AD. The aim was to to compare the two most common rating systems for occupational complexity, the Occupation Information Network (O*NET) and the Dictionary of Occupational Titles (DOT) and assess if there was an association between occupational complexity and episodic memory performance among individuals at-risk for dementia. The study found that higher occupational complexity was only associated with memory performance in the FINGER cohort but not the two prodromal AD cohorts. The correlation between the two rating systems was moderate to strong, and highly significant (Spearman’s rho = 0.5-0.6, p <.001). Conclusions. Higher levels of Occupational complexity are associated with better cognitive performance among older individuals at-risk for dementia (and with no substantial cognitive impairment), but does not affect the intervention effect in the FINGER multidomain lifestyle-based RCT, apart from the effect on executive function. Occupational complexity does not seem to provide strong resilience against neuropathology among individuals at-risk for cognitive impairment. Among individuals with prodromal AD, higher levels of occupational complexity do seem to provide resilience to tau-related pathology measured with CSF markers but is not associated with better episodic memory performance. Measuring occupational complexity with the DOT or O*NET system seems to yield similar results, as the two systems scores are correlated

The influence of attachment on implicit affective opinions towards caregivers

The influence of attachment quality and style on implicit emotional opinions towards caregivers was measured using an affective priming task very similar to a lexical decision task. The reaction time in milliseconds for each prime and target word combination was recorded and used and indication of associative strength between the two. Two attachment tests was administered, the ASQ-Sw questionnaire, a self-report questionnaire with 40 questions measuring attachment style on five different dimensions and an electronic version of the SBST test, which is a narrative-based test measuring the presence of an secure-base script. The priming task had four different primes, mother and father and two control primes and a total of 128 different negative and positive target words. A total of 33 participants completed all of the tests and results show that one of the attachment styles indicating an insecure attachment had an influence on the participants implicit emotional opinions towards their caregivers, the other attachment styles did not, the two attachment tests was positively linked to each other and showed similar results, gender differences in regard to attachment was also found. The priming task reveled that participants in general had more positive than negative emotional opinions towards their caregivers, especially towards mothers. The participants also had more positive than negative emotional opinions towards the control prime Gandhi but no difference was found for Hitler.Anknytningens påverkan på implicita emotionella åsikter gentemot vårdnadsgivare studerades genom ett experiment som innehöll en affektiv priming uppgift liknande den välkända lexikala beslutsuppgiften ”lexical decision task” (LDT). Reaktionstiden i millisekunder för varje prime och mål ord kombination registrerades och användes som indikator för den associativa styrkan mellan de två. Två anknytningstest administrerades, dels ASQ-Sw testet, som är ett självfrågeformulär innehållande 40 frågor som mäter anknytning på fem olika dimensioner samt en elektronisk version av SBST testet, vilket är ett narrativt test för att mäta förekomsten av säker bas skript. Priming testet hade fyra olika primes, mamma och pappa samt två kontroll primes och totalt 128 stycken olika positiva och negativa mål ord. 33 stycken deltagare genomförda samtliga tre tester och resultaten visade att en av anknytningsstilarna som indikerar en osäker anknytning påverkade deltagarnas implicita emotionella åsikter gentemot deras vårdnadsgivare, de andra anknytningsstilarna uppvisade inget sammanband. De två anknytningstesten som användes var positivt sammanlänkade och visade liknande resultat, könsskillnader i anknytning hittades också. Priming testet visade att deltagarna generellt hade mer positiva än negativa åsikter om deras vårdnadsgivare, speciellt gentemot deras mammor, deltagarna hade också mer positiva än negativa åsikter gentemot Gandhi medan inga skillnader fanns för Hitle

"I'm an ordinary faggot" – Scripts of male homosexuality in urban and rural Sweden in the 1940s

The paper explores the flux of male homosexual identity between urban subcultures and small rural settings in Sweden. Eve Kosofsky Sedgwick has claimed that we cannot interpret Foucault’s History of Sexuality as if one understanding of sexuality was substituted by another, but that many forms of sexuality coexist in any given time. Inspired by her analysis, this paper claims that a shift between two paradigms took place in Sweden in the 1920s, but that they continued to coexist and that one person could perform according to different scripts in different situations. Urban homosexual subcultures had developed in Stockholm, Göteborg and Malmö since the end of the 19th century. It was not until the spreading of the concept of homosexuality that some men desiring men in the countryside began identifying as homosexuals. The policing of sexuality changed profoundly during the first half of the 20th century and reflects the different ways men who desired other men negotiated their feelings in rural areas, small towns and big cities. Examples from Stockholm, Göteborg and Malmö will be compared to expressions of male-male desire in places like Halmstad (pop. 26,000) Sandviken (13,000), and Långsele (700)

“Don’t forget that matrimony is a holy act, even when it is a civil ceremony”: Changes in sexual norms and the conceptualization of gay families in Scandinavia since the 1990s

In 1994, a Swedish marriage registrar motivated his refusal to perform partnership registrations of same-sex couples by referring to matrimony—even non-religious marriage ceremonies—as a holy act. The perception of marriage as sacred and only intended for the union of man and woman was strong in the 1990s, but there seem to have been a rapid shift in the discursive field since then. Between 1989 (Denmark) and 2002 (Finland), Scandinavian lesbians and gays were granted limited marital rights that also barred them from adoption, assisted fertilization, and joint custody of children. In 2009, however, Norway and Sweden adopted gender-neutral marriage laws, and all other Scandinavian countries have recognized the right of same-sex couples to raise children. The registered partnership laws were narrowly accepted by the parliaments while gender-neutral marriage was carried by broad majorities (67 percent in Norway and 92 percent in Sweden). Shortly thereafter, the State Church in both countries accepted church weddings of same-sex couples. The conceptual image of homosexual couples has thus evolved from barren relationships to that of fertile rainbow families existing in many different forms. Resistance to gay marriage has become relegated to the Christian Democratic parties. Drawing on Gayle Rubin and Lee Edelman, this paper will discuss the rapid shift in sexual norms and the conceptualization of same-sex couples in Scandinavia. It argues that the registered partnership laws themselves have contributed to changing the discursive field. In this process, the alternatives discussed in the 1970s and 1980s, involving extended families, have disappeared from the discussions: the idea of lifelong fidelity between two persons has become the norm. However, the many same-sex parents who now demand to be included in the welfare state fabric of maternity wards, day-care centers, and schools, truly challenge old norms of what a family can look like

Odd Couples

The concept of marriage as a union of a man and a woman was fundamentally challenged by the introduction of registered partnership in Denmark in 1989. "http://www.aup.nl/do.php?a=show_visitor_book&isbn=9789052603810">Odd Couples. A History of Gay Marriage in Scandinavia is the first comprehensive history of registered partnership and gay marriage in Scandinavia. It presents an outstanding study of the interaction between gay activism and traditional party politics. Based on interviews, parliamentary print and party documents, it gives a first-hand account of how the political stakeholders acted in a short and decisive period of Scandinavian history. The author traces the origins of laws which initially were extremely controversial - inside and outside the gay community - but have now gained broad popular and political support. The different experiences in all Scandinavian countries (Denmark -including Greenland and the Faroe Islands-, Norway, Sweden, Iceland, and Finland) are investigated in order to present a nuanced understanding of a fascinating political process that began in the 1960s and continues to change the ways we understand family, sexuality and nation

The Role of Digitalization in New Practice Creation: The institutionalization of UX at AutoInc

Although information systems research has brought the role of new practice creation in innovation processes to the fore, few studies focus on initial activities of digital innovation and how they eventually lead to institutional transformation. Using a framework of institutional enablers of digital innovation, this study analyses the role of new practice creation in digital innovation. The study is based on a 20-yearlong case study in the automotive industry and follows the emergence of User Experience (UX) practices in an automotive manufacturer. We do this study to understand how UX could develop from a marginal position scattered over the organization to the institutional core as the main logic of innovation. The study theorizes the role of organizational forms, digital institutional infrastructures, and digital institutional building blocks in the legitimization of new practices for organizational transformation

De privata säkerhetsföretagens betydelse för mänsklig säkerhet : en innehållsanalys av den Statliga utredningen Ds 2003:50

Syftet med denna studie är att bidra till en ökad förståelse för individens säkerhet, men även att diskutera om utredarna i den svenska utredningen Ordningsvakter och Väktare (Ds 2003:50) tar tillräckligt mycket hänsyn till perspektivet av individens säkerhet och den påverkan som utredningen kan ha på denna. Detta är ett lämpligt perspektiv då det fokuserar på vardagssäkerhet och sätter individers säkerhet i fokus. Anledningen till detta är att det tycks finnas en brist på studier om vardagssäkerhet. Arbetet analyserar utredningen Ordningsvakter och Väktare (Ds 2003:50) med utgångspunkt och tillvägagångssätt som är en kombination av olika teorier, perspektiv och en kvalitativ innehållsanalys. Metoden är lämplig eftersom den genererar god vali- ditet genom att redovisa uppsatsens primärmaterial i form av blockcitat. De förestående teorier som används är teoretiska verktyg från Herbert Wulfs rapport om privatisering och internationalisering av våldskapital och ett mänskligt säkerhetsperspektiv som tar avstamp i Alkires ramverk för mänsklig säkerhet. Wulfs teoretiska regler, även kallat för kriterier är som följer; 1) verklig och hållbar konkurrens, 2) en bra kontroll och 3) verifieringsmekanismer och tydlig förståelse för vilka tjänster som förväntas utföras av de privata säkerhetsföretagen. Alkire menar att betydelsen av en stats institutioner, ka- pacitetsuppbyggnad och andra processer som öppenhet är viktiga aspekter att beakta när en stat väljer att fördela våldsbefogenhet till privata säkerhetsföretag för att upprätthålla mänsklig säkerhet. Studiens frågeställning är: Hur speglas utredarnas förhållningssätt i Ds 2003:50 till privata säkerhetsföretags våldsbefogenheter i förhållande till mänsklig säkerhet? Utredarna gör slutsatsen att det är bra med privatiserade våldsbefogenheter, förut- satt att det finns en god kontroll av verksamheten, vilket visade sig vara, utifrån utre- darnas förståelse, ett bärande element för att inte inskränka på mänsklig säkerhet. Av denna studie framkom även indikationer på att materialet Ds 2003:50 är förlegat men samtidigt att nya undersökningar skulle vara för kostsamma och eventuellt leda till re- sultat som inte anses önskvärt för statens behov. Å andra sidan kommer denna studie fram till att det vore en god långsiktig investering att prioritera en ny politisk utredning då mänsklig säkerhet är något som inte bör undervärderas eller undermineras, utan stän- digt utgöra ett fundament inom staten. Mänsklig säkerhet kan komma att äventyras om statens våldsmonopol försvagas utan att utvecklingen är kontrollerad och tillräckligt transparent.The title of this study is “The importance of the private security companies for human security – a content analysis of state investigation Ds 2003:50”. The aim of this thesis is to investigate and discuss whether the investigators of the Swedish policy document, Watchmen and Security Guards (Sw. Ordningsvakter och väktare, Ds 2003: 50, have taken sufficient consideration of human security and the impact of their approach. The purpose is to contribute to an increased insight into the perspective of outsourced human security and to give a more nuanced view of this investigation field. This perspective is suitable for this type of investigation as it focuses on everyday safety that affects us all and has a people-centered approach. By utilizing a qualitative content analysis on a Swedish policy document, this study analyzes the author’s attitude and opinions in Ds 2003: 50 reflected on the capa- bilities of private security companies in relation to human safety, through the lens of elaborated theory from Herbert Wulf as well as a human security perspective, which is based on Sabina Alkire's paper ”A Conceptual Framework for Human Security” (2014). Wulf’s criteria’s, are the following: 1) True and sustainable competition must be opera- ble; competition is essential to prevent companies from realizing monopoly profits. 2) Government or its agencies must have a clear understanding of what kind of services are expected by private companies. 3) Control and verification mechanisms must be in place. Wulf believes that these criteria are paramount if a state has outsourced parts of the state’s monopoly of violence to the private sector. Alkire believes that if a state has outsourced parts of their monopoly of violence and still wants to maintain human safe- ty, the state of their institutions, capacity limits and transparency processes are im- portant aspects to consider for maintaining human security. This study came to the conclusion that the investigators of the report had observed that the private security companies have a positive impact on individual safety, given that there is a good understanding of what service they provide and proper control and verification mechanisms in place in order to control the security companies, thereby attaining a good level of individual safety. Furthermore this study indicated that the ma- terial Ds 2003:50 is outdated material and a new investigation should be conducted. It goes on to speculate that it could be too costly and possibly lead to results that are not considered desirable for the government's needs. However, this study concludes that human security may be jeopardized if the state's monopoly of violence is weakened without the developed control and transparency. Therefore, it would be a beneficial long-term investment to prioritize a new political investigation, as it relates to individual safety - something which can hardly be overestimated

Förebyggande djuromvårdnad mot post-anestetisk myopati hos häst

Post-anaesthetic myopathy (PAM) is a serious occasional complication of general anaesthesia in horses. It causes not only pain and suffering to the horse, but also suffering (trauma) to the owner with increased veterinary costs. In the worst case PAM can be fatal. The anaesthetic nurse must know which parameters have to be taken into consideration in the prevention of PAM, to be able to prevent it, and use that knowledge for the animals safety. The aim of this literature review was to investigate and make a presentation of the factors and measurements associated with PAM, with focus on how to monitor these measurements to prevent it from happening, and the advice a Veterinary nurse can give to the horse owner regarding this condition. According to literature there a few factors that greatly increase the risk of PAM, these include- hypotension, periods less than 60 mmHg significantly increases the risk. Duration of the anaesthesia, over 90 min also significantly increases the risk, and pressure on the skeletal muscles. Physiological measurements associated with these factors: mean arterial blood pressure (MAP), cardiac output (CO), intra compartmental pressure, perfusion pressure, muscle perfusion, muscle metabolism, lactate, end-tidal carbon dioxide, stroke volume (SV), system vascular resistance (SVR) and heart rate. Different monitoring devices and techniques comprises: (direct) blood pressure, electrocardiography, capnography manual palpation of peripheral pulse rate and quality, pulse oximetry, mucous membrane colour, capillary refill time (CRT) and some less common methods (laser doppler flowmetry and microdialyse), not yet developed for clinical use. Prophylactic measures: maintaining adequate blood pressure that is more than 70 mmHg, reducing the length of the anaesthesia and the use of protective padding and proper positioning. Regarding advice for horse owners it’s best to give a cautious prognosis, and show great empathy in all consultations. Horse owner's role in preventing post-anaesthetic myopathy still needs to be clarified as well as what advice the veterinary nurse can give. Focus is to inform horse owners about the risks. In the current situation, good animal care during anaesthesia is paramount

Lilian Andersson (1937-2019) in memoriam

Minnesord över en förgrundsfigur inom den svenska sexarbetarrörelsen. Andersson var en av medgrundarna till Sexualpolitisk Front, Nordens första sexarbetarorganisation. Under hela sitt vuxna liv arbetade hon för att sexsäljares situation i samhället skulle förbättras, och 2017 tilldelades hon Jasminepriset, föreningen Rose Alliances pris för arbete mot våld mot sexarbetare