Going back to school – an opportunity for lifelong learning for people with dementia in Denmark (Innovative practice)

The provision of lifelong learning for older people is often promoted as a way of engaging socially and maintaining cognitive function. The concept is also used with people with dementia, but is often limited to short-term programmes. Innovative practice from Denmark takes this concept further, offering people with early stage dementia the opportunity to return to school to attend classes in cognitive training, music, art and woodcraft. A pilot study conducted by the school of teaching and communication (VUK), offers evidence for the benefits of prolonged educational programmes for people with dementia in maintaining decision making, cognitive function and social interactions, with limited evidence of the impact on memory. Further evidence is required to understand the impact of a person with dementia attending school as a student and to understand if this concept is transferrable to a different cultural setting

Serotype-specific mortality from invasive Streptococcus pneumoniae disease revisited

BACKGROUND: Invasive infection with Streptococcus pneumoniae (pneumococci) causes significant morbidity and mortality. Case series and experimental data have shown that the capsular serotype is involved in the pathogenesis and a determinant of disease outcome. METHODS: Retrospective review of 464 cases of invasive disease among adults diagnosed between 1990 and 2001. Multivariate Cox proportional hazard analysis. RESULTS: After adjustment for other markers of disease severity, we found that infection with serotype 3 was associated with an increased relative risk (RR) of death of 2.54 (95% confidence interval (CI): 1.22–5.27), whereas infection with serotype 1 was associated with a decreased risk of death (RR 0.23 (95% CI, 0.06–0.97)). Additionally, older age, relative leucopenia and relative hypothermia were independent predictors of mortality. CONCLUSION: Our study shows that capsular serotypes independently influenced the outcome from invasive pneumococcal disease. The limitations of the current polysaccharide pneumococcal vaccine warrant the development of alternative vaccines. We suggest that the virulence of pneumococcal serotypes should be considered in the design of novel vaccines

Pneumococcal Serotypes and Mortality following Invasive Pneumococcal Disease: A Population-Based Cohort Study

Analyzing population-based data collected over 30 years in more than 18,000 patients with invasive pneumococcal infection, Zitta Harboe and colleagues find specific pneumococcal serotypes to be associated with increased mortality

Surfactant Protein D Deficiency Aggravates Cigarette Smoke-Induced Lung Inflammation by Upregulation of Ceramide Synthesis

Cigarette smoke (CS) is the main cause of chronic obstructive pulmonary disease. Surfactant protein D (SP-D) is an important anti-inflammatory protein that regulates host immune defense in the lungs. Here, we investigated the role of SP-D in a murine model of CS-induced inflammation. Pulmonary SP-D localization and abundance was compared between smoker and non-smoker individuals. For in vivo studies, wildtype, and SP-D-deficient mice were exposed to CS for either 12 weeks or 3 days. Moreover, the effect of therapeutic administration of recombinant fragment of human SP-D on the acute CS-induced changes was evaluated. Pulmonary SP-D appeared with heterogenous expression in human smokers, while mouse lung SP-D was uniformly upregulated after CS exposure. We found that SP-D-deficient mice were more susceptible to CS-induced macrophage-rich airway inflammation. SP-D deficiency influenced local pro-inflammatory cytokine levels, with increased CCL3 and interleukin-6 but decreased CXCL1. Furthermore, CS exposure caused significant upregulation of pro-inflammatory ceramides and related ceramide synthase gene transcripts in SP-D-deficient mice compared to wildtype littermates. Administration of recombinant fragment of human SP-D (rfhSP-D) alleviated CS-induced macrophage infiltration and prevented induction of ceramide synthase gene expression. Finally, rfhSP-D treatment attenuated CS-induced human epithelial cell apoptosis in vitro. Our results indicate that SP-D deficiency aggravates CS-induced lung inflammation partly through regulation of ceramide synthesis and that local SP-D enrichment rescues CS-induced inflammation

Gerinnungsveränderungen unter In-vitro-Fertilisationstherapie

Unterschiedliche Hormonpräparate, wie beispielsweise orale Kontrazeptiva oder Substitutionspräparate in der Menopause sind in den letzten Jahren vermehrt in die Schlagzeilen geraten. Es wurden viele Studien veröffentlicht, die zeigten, daß es unter bestimmten Hormongaben zu Veränderungen der Blutgerinnung kommt im Sinne von Steigerung des pro- bzw. Reduktion des antikoagulatorischen Potentials. Somit besteht ein erhöhtes Thromboserisiko unter Verwendung bestimmter Hormonpräparate, insbesondere, wenn weitere Risikofaktoren für thromboembolische Ereignisse (Rauchen, Adipositas, Immobilisation usw.) hinzu kommen. Da die In-vitro-Fertilisation in den letzten 20 Jahren immer mehr an Bedeutung gewonnen hat und während eines IVF-Zyklus Hormone in hoher Dosierung verabreicht werden, stellte sich die Frage, ob und inwieweit es auch hier zu Gerinnungsveränderungen kommt. In der vorliegenden Arbeit konnten wir anhand unterschiedlicher Gerinnungs-parameter und Hormonwertbestimmungen bei zwei unterschiedlichen IVF-Stimu-lations-Protokollen zeigen, daß es unter In-vitro-Fertilisations-Therapie zu Veränderungen der Blutgerinnung der Patientinnen kommt. In beiden von uns untersuchten Patientengruppen (LONG- versus SHORT-Protokoll Programm) wiesen sowohl die Globaltests der plasmatischen Gerinnung (Quick-Wert, aPTT und Fibrinogen) als auch die Gerinnungsaktivierungsparameter Prothrombinfragment F1+2 und D-Dimer auf eine Erhöhung des prokoagulatorischen Potentials bzw. eine Gerinnungsaktivierung hin. Die in den letzten Jahren auf dem Gebiet der Gerinnungsaktivierung bzw. -inhibierung erst genauer erforschten Faktoren Tissue factor und Tissue factor pathway inhibitor verhielten sich unterschiedlich in den beiden von uns untersuchten Gruppen und zeigten keine eindeutig signifikanten Veränderungen. In bezug auf die Hormonwertveränderungen unter IVF-Therapie konnten wir zeigen, daß die Gerinnungswerte, insbesondere Prothrombinfragment F1+2 und D-Dimer, der Patientinnen beider Protokolle signifikant mit den Progesteron-Werten korrelierten. Estrogen-Spiegel scheinen dagegen bei der In-vitro-Fertilisations-Hormontherapie eine untergeordnete Rolle zu spielen in bezug auf die Gerinnungsaktivierung. Zwischen den beiden Patientengruppen bestanden kaum Unterschiede hinsichtlich Ansteigen bzw. Abfallen der einzelnen Parameter. Lediglich in bezug auf die Höhe des jeweiligen Anstiegs bzw. Abfalls konnte gezeigt werden, daß, außer bei den F 1+2-Werten, jeweils die Endwerte der Patientinnen der LONG-Protokoll Gruppe deutlich über bzw. unter denen der SHORT-Protokoll Gruppe lagen, was auf ein stärkeres Ansteigen des prokoagulatorischen Potentials in diesem Protokoll weist, insbesondere im Zusammenhang mit dem auch in dieser Gruppe stärkeren Ansteigen des Progesterons

Association between solar insolation and a history of suicide attempts in bipolar I disorder

In many international studies, rates of completed suicide and suicide attempts have a seasonal pattern that peaks in spring or summer. This exploratory study investigated the association between solar insolation and a history of suicide attempt in patients with bipolar I disorder. Solar insolation is the amount of electromagnetic energy from the Sun striking a surface area on Earth. Data were collected previously from 5536 patients with bipolar I disorder at 50 collection sites in 32 countries at a wide range of latitudes in both hemispheres. Suicide related data were available for 3365 patients from 310 onset locations in 51 countries. 1047 (31.1%) had a history of suicide attempt. There was a significant inverse association between a history of suicide attempt and the ratio of mean winter solar insolation/mean summer solar insolation. This ratio is smallest near the poles where the winter insolation is very small compared to the summer insolation. This ratio is largest near the equator where there is relatively little variation in the insolation over the year. Other variables in the model that were positively associated with suicide attempt were being female, a history of alcohol or substance abuse, and being in a younger birth cohort. Living in a country with a state-sponsored religion decreased the association. (All estimated coefficients p <0.01). In summary, living in locations with large changes in solar insolation between winter and summer may be associated with increased suicide attempts in patients with bipolar disorder. Further investigation of the impacts of solar insolation on the course of bipolar disorder is needed.Peer reviewe