The Effects of Multifactorial Fall Prevention on the Psychological Risk Factors of Falling

Psychological factors, such as depression or depressive symptoms and fear of falling are linked to falls among the aged. According to previous studies, they may increase the risk of falls and injurious falls. In addition, depression or a high amount of depressive symptoms and fear of falling may hinder participation in preventive activities. Despite the severe consequences of both conditions and their high prevalence among the aged, they have rarely been studied in the context of fall prevention. The study aimed to assess the effects of multifactorial fall prevention on the psychological risk factors of falling (depressive symptoms and fear of falling) among the community-dwelling aged at increased risk of falling. In addition, it aimed to determine factors predicting high adherence to preventive activities. Volunteers aged 65 or over, who had fallen during the year previous to randomisation were recruited. Participants (n=591) were randomised into an intervention or a control group. The intervention group received a multifactorial fall prevention programme including geriatric assessment, individual guidance on fall and fracture prevention, group- and home-based physical exercise, psychosocial group activities, lectures and home hazards assessment. The control group had a one-time counselling on fall and fracture prevention. The data on psychological risk factors of falling were collected by self-rated questionnaires. Multifactorial fall prevention was not effective in reducing depressive symptoms or fear of falling compared to one-time counselling in the total sample. However, in subgroup analyses, depressive symptoms reduced statistically significantly more among the men and older participants of the intervention group compared to the control group. Female gender, high physical and cognitive abilities and low self-perceived probability of falling were independent predictors of higher adherence in organised activities. In conclusion, few psychological benefits were gained during this multifactorial fall prevention trial. More attention should be focused on adherence, especially among the aged with functional disabilities.Laaja-alaisen kaatumisenehkäisyn vaikutukset kaatumisten psyykkisiin vaaratekijöihin Psyykkiset tekijät, kuten masennus tai masennusoireet ja kaatumisen pelko ovat yhteydessä kaatumisiin ikääntyneillä. Aikaisemmissa tutkimuksissa molempien on todettu lisäävän kaatumisten vaaraa. Lisäksi sekä masennus tai masennusoireet ja kaatumisen pelko voivat rajoittaa yksilön osallistumista kaatumisenehkäisyohjelmiin. Psyykkisiä tekijöitä on harvoin tutkittu kaatumisten ehkäisyn yhteydessä, huolimatta niiden vakavista seurauksista ja yleisyydestä ikääntyneiden keskuudessa. Tutkimuksen tavoitteena oli selvittää laaja-alaisen kaatumisenehkäisyohjelman vaikutuksia kaatumisten psyykkisiin vaaratekijöihin: masennusoireisiin ja kaatumisen pelkoon. Ohjelman vaikutuksia tarkasteltiin kotona tai palveluasunnossa asuviin ikääntyneisiin, joilla oli kohonnut kaatumisen riski. Lisäksi tarkoituksena oli selvittää, mitkä tekijät ennustavat korkeaa osallistumisaktiivisuutta kaatumisenehkäisyinterventioon. Tutkimukseen osallistui vapaaehtoisia, jotka olivat kaatuneet vähintään kerran tutkimusta edeltävän vuoden aikana. Tutkittavat (n=591) satunnaistettiin interventio- tai kontrolliryhmään. Interventioryhmäläiset osallistuivat laaja-alaiseen kaatumisenehkäisyohjelmaan, johon sisältyi geriatrin arviointi, yksilöllistä neuvontaa kaatumisten ja murtumien ehkäisystä, ryhmäliikuntaa, kotivoimistelua, psykososiaalista ryhmätoimintaa, luentoja sekä kodin vaaratekijöiden kartoitus. Aineisto kerättiin itse täytettävin lomakkein. Kun tarkasteltiin koko aineistoa, laaja-alaisella kaatumisenehkäisyohjelmalla ei ollut kertaneuvontaa suurempaa vaikutusta masennusoireisiin tai kaatumisen pelkoon. Alaryhmäanalyyseissa selvisi kuitenkin, että masennusoireet vähenivät tilastollisesti merkitsevästi enemmän interventioryhmän miehillä sekä yli 75-vuotiailla kuin kontrolliryhmän vastaavissa alaryhmissä. Kaatumisenehkäisyohjelmaan osallistumista puolestaan lisäsivät naissukupuoli, korkea kognitiivinen ja fyysinen toimintakyky ja vähäiseksi koettu kaatumisen todennäköisyys. Laaja-alaisen kaatumisenehkäisyohjelman vaikutukset kaatumisten psyykkisiin vaaratekijöihin jäivät vähäisiksi. Erityisesti huonokuntoisten iäkkäiden osallistumisaktiivisuutta tulisi edistää.Siirretty Doriast

A minor field study on abortion legislation and practice in Vietnam

Abort är lagligt i Vietnam sedan 1945. Vietnam har under flera årtioden haft bland de högsta aborttalen i världen. Avsaknaden av trovärdiga siffror på abort och samlad information på abort talar för ett behov av en övergripande beskrivning av nuvarande lagstiftning och situation. Inget övergripande arbete har tidigare gjorts kring abortlagstiftningen. Denna uppsats, till viss del utförd i Vietnam, erbjuder en översikt av Vietnams abortlagstiftning och användningen av abort genom samhällsvetenskapliga metoder såsom intervjuer, litteraturstudier, enkäter och statistik. Vietnam har ingen specifik abortlag utan abort regleras i olika lagtexter. Det finns problem med implementeringen och förståelsen av nuvarande abortlagstiftning. Detta är framförallt tydligt i den lagstiftning som förbjuder könsselektiva aborter och identifiering av fostrets kön. Befolkningstillväxten har sedan 1960-talet setts som ett problem för landets utveckling och därför har olika åtgärder tagits för att minska tillväxten. Familjeplanerings och befolknings policys som har funnits de senaste 50 åren har misslyckats på några områden. Erbjudande av preventivmedel till ogifta kvinnor har dröjt tills nyligen och det har ej erbjudits rådgivning i samband med abort. Utöver detta så har Vietnam en uppskattad ökning av aborter på den privata marknaden. Dessa privata tjänster erbjuder en möjlighet för kvinnor att få en snabb och anonym abort men möjligtvis på bekostnad av deras hälsa. Vietnam håller för närvarande på att skapa en ny befolkningslag som kommer att innebära förändrade möjligheter för kvinnor att göra en abort.Abortion was legalized in Vietnam in 1945. Vietnam has for decades had among the highest abortion rates in the world. Due to the lack of reliable numbers on abortion and a lack of collected information on abortion a comprehensive picture of the current legislation and situation is well needed. No overview of the abortion legislation in Vietnam has been provided earlier. This thesis, partly conducted in Vietnam, offers an overview of the Vietnamese abortion legislation and the practice of abortion by using social science methods such as interviews, review of literature, surveys and statistics. Vietnam does not have a specific abortion law, but rather regulations concerning abortion incorporated in different legislative texts. Currently there are issues with the implementation and understanding of the abortion legislation. This is especially apparent in the legislation on prohibition of sex selective abortions and fetal sex determination. The population growth in Vietnam was from the 1960s and onwards seen as a problem for the development of the country and therefore different measures has been taken to slow down the population growth. The family planning program and population policies implemented for the last 50 years are failing in some issues. Only recently did the family planning program provide contraceptives to unmarried women and it did not provide counselling in connection with abortion. In addition, Vietnam faces an increase of abortion services performed by private providers. These providers offer an opportunity for women to get a quick and anonymous abortion, but possibly on the expense on their health. Vietnam is in the process of drafting a new population law which will have an impact on the possibility for women to have an abortion

Comparative study of two tools intended for ecosystem service analyses

Det nuvarande stadsplaneringsidealet leder till att många städer blir allt tätare och att urbana grönytor går förlorade i en accelererande takt. Förtätningen bidrar därmed till att livsviktiga ekosystemtjänster utarmas eller elimineras totalt, vilket i sin tur resulterar i ett flertal negativa konsekvenser på samhällelig nivå. Att ekosystemtjänster utarmas extensivt påverkar exempelvis den allmänna folkhälsan, den biologiska mångfalden och städers förmåga att hantera skadliga naturfenomen. Med anledning av detta är det viktigare än någonsin tidigare att medvetenheten kring ekosystemtjänster ökar, och att deras bevarande prioriteras. För att bevarandet överhuvudtaget ska vara möjligt krävs det att ekosystemtjänster kan synliggöras och identifieras på ett korrekt vis. På grund av detta är syftet med uppsatsen att undersöka och jämföra två olika analysmetoder som används för att identifiera ekosystemtjänster. Anledningen till att denna undersökning genomförs är för att ta reda på om valet av analysmetod har någon signifikant påverkan på resultatet, det vill säga om samma plats kan få varierande värden beroende på vilken analysmetod som nyttjas. Analysmetoderna som valdes för jämförelsen är Boverkets ESTER 2.0, samt Ekologigruppens EKOguide. För att kunna jämföra dessa analysverktyg applicerades de på Siegbahnsparken i centrala Uppsala, där ekosystemtjänster haft en nyckelroll i utformningen. Det kunde konstateras att båda analysverktygen har fördelar och nackdelar, samt styrkor och svagheter. Det fastställdes även att samma plats kan få varierande värden beroende på vilken analysmetod som används. Utifrån detta kunde ett flertal slutsatser dras, bland annat att det är problematiskt att analysverktygen inte producerade likvärdiga resultat eftersom detta är en förutsättning för att ekosystemtjänster ska kunna bevaras. De skilda resultaten kan även få konsekvenser för städers förmåga att uppnå FN:s globala mål på lång sikt.The current urban planning ideal causes cities to become increasingly dense and urban green spaces to be lost at an accelerating rate. Therefore, the densification contributes to the degradation or total elimination of vital ecosystem services, which in turn results in a number of negative consequences on a societal level. The extensive reduction of ecosystem services affects, for example, general public health, biological diversity, and cities ability to manage harmful natural phenomena. Due to this, it is more important than ever before that the awareness of ecosystem services increases, and that their conservation is prioritized. In order for the conservation to be possible, it is required that ecosystem services can be made visible and identified correctly. Because of this, the purpose of this paper is to examine and compare two different analysis methods used to identify ecosystem services. The reason why this subject is being examined is to determine whether the choice of analysis method has any significant influence on the result, as in, if the same location can get varying values depending on which analysis method is used. The analysis methods chosen for this comparison are Boverket’s ESTER 2.0 and Ekologigruppen’s EKOguide. In order for the comparison to be possible, the analysis methods were applied to the Siegbahns-park in central Uppsala, where ecosystem services played a key role in the design. It could be established that both analysis methods have advantages and disadvantages, as well as strengths and weaknesses. It was also determined that the same location can get varying values depending on which analysis method is used. Based on this, a number of conclusions could be drawn, including that it is problematic that the analysis methods did not produce equivalent results, since this essential for ecosystem services to be preserved. The different results can also have consequences for cities’ ability to achieve the UN:s global goals in the long term

Phylogeny-Directed Search for Murine Leukemia Virus-Like Retroviruses in Vertebrate Genomes and in Patients Suffering from Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Prostate Cancer

Gammaretrovirus-like sequences occur in most vertebrate genomes. Murine Leukemia Virus (MLV) like retroviruses (MLLVs) are a subset, which may be pathogenic and spread cross-species. Retroviruses highly similar to MLLVs (xenotropic murine retrovirus related virus (XMRV) and Human Mouse retrovirus-like RetroViruses (HMRVs)) reported from patients suffering from prostate cancer (PC) and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) raise the possibility that also humans have been infected. Structurally intact, potentially infectious MLLVs occur in the genomes of some mammals, especially mouse. Mouse MLLVs contain three major groups. One, MERV G3, contained MLVs and XMRV/HMRV. Its presence in mouse DNA, and the abundance of xenotropic MLVs in biologicals, is a source of false positivity. Theoretically, XMRV/HMRV could be one of several MLLV transspecies infections. MLLV pathobiology and diversity indicate optimal strategies for investigating XMRV/HMRV in humans and raise ethical concerns. The alternatives that XMRV/HMRV may give a hard-to-detect “stealth” infection, or that XMRV/HMRV never reached humans, have to be considered

Mast Cell Accumulation in Glioblastoma with a Potential Role for Stem Cell Factor and Chemokine CXCL12

Glioblastoma multiforme (GBM) is the most common and malignant form of glioma with high mortality and no cure. Many human cancers maintain a complex inflammatory program triggering rapid recruitment of inflammatory cells, including mast cells (MCs), to the tumor site. However, the potential contribution of MCs in glioma has not been addressed previously. Here we report for the first time that MCs infiltrate KRas+Akt-induced gliomas, using the RCAS/TV-a system, where KRas and Akt are transduced by RCAS into the brains of neonatal Gtv-a- or Ntv-a transgenic mice lacking Ink4a or Arf. The most abundant MC infiltration was observed in high-grade gliomas of Arf−/− mice. MC accumulation could be localized to the vicinity of glioma-associated vessels but also within the tumor mass. Importantly, proliferating MCs were detected, suggesting that the MC accumulation was caused by local expansion of the MC population. In line with these findings, strong expression of stem cell factor (SCF), i.e. the main MC growth factor, was detected, in particular around tumor blood vessels. Further, glioma cells expressed the MC chemotaxin CXCL12 and MCs expressed the corresponding receptor, i.e. CXCR4, suggesting that MCs could be attracted to the tumor through the CXCL12/CXCR4 axis. Supporting a role for MCs in glioma, strong MC infiltration was detected in human glioma, where GBMs contained significantly higher MC numbers than grade II tumors did. Moreover, human GBMs were positive for CXCL12 and the infiltrating MCs were positive for CXCR4. In conclusion, we provide the first evidence for a role for MCs in glioma

Effects of risk-based multifactorial fall prevention on health-related quality of life among the community-dwelling aged: a randomized controlled trial

BACKGROUND: This study aimed to assess the effects of a risk-based, multifactorial fall prevention programme on health-related quality of life among the community-dwelling aged who had fallen at least once during the previous 12 months. METHODS: The study is a part of a single-centre, risk-based, multifactorial randomised controlled trial. The intervention lasted for 12 months and consisted of a geriatric assessment, guidance and treatment, individual instruction in fall prevention, group exercise, lectures on themes related to falling, psychosocial group activities and home exercise. Of the total study population (n = 591, 97% of eligible subjects), 513(251 in the intervention group and 262 in the control group) participated in this study. The effect of the intervention on quality of life was measured using the 15D health-related quality of life instrument consisting of 15 dimensions. The data were analysed using the chi-square test or Fisher's exact test, the Mann-Whitney U-test and logistic regression. RESULTS: In men, the results showed significant differences in the changes between the intervention and control groups in depression (p = 0.017) and distress (p = 0.029) and marginally significant differences in usual activities (p = 0.058) and sexual activity (p = 0.051). In women, significant differences in the changes between the groups were found in usual activities (p = 0.005) and discomfort/symptoms (p = 0.047). For the subjects aged 65 to 74 years, significant differences in the changes between the groups were seen in distress (p = 0.037) among men and in usual activities (p = 0.011) among women. All improvements were in favour of the intervention group. CONCLUSION: Fall prevention produced positive effects on some dimensions of health-related quality of life in the community-dwelling aged. Men benefited more than women

Temporal Associations between Daytime Physical Activity and Sleep in Children

Peer reviewe

Electric field-navigated transcranial magnetic stimulation for chronic tinnitus: a randomized, placebo-controlled study

Objective: Repetitive transcranial magnetic stimulation (rTMS) may alleviate tinnitus. We evaluated effects of electric field (E-field) navigated rTMS targeted according to tinnitus pitch. No controlled studies have investigated anatomically accurate E-field-rTMS for tinnitus. Design: Effects of E-field-rTMS were evaluated in a prospective randomised placebo-controlled 6-month follow-up study on parallel groups. Patients received 10 sessions of 1Hz rTMS or placebo targeted to the left auditory cortex corresponding to tonotopic representation of tinnitus pitch. Effects were evaluated immediately after treatment and at 1, 3 and 6 months. Primary outcome measures were visual analogue scores (VAS 0-100) for tinnitus intensity, annoyance and distress, and the Tinnitus Handicap Inventory (THI). Study sample: Thirty-nine patients (mean age 50.3 years). Results: The mean tinnitus intensity (F-3=15.7, p<0.0001), annoyance (F-3=8.8, p=0.0002), distress (F-3=9.1, p=0.0002) and THI scores (F-4=13.8, p<0.0001) decreased in both groups over time with non-significant differences between the groups. After active rTMS, 42% and 37% of the patients showed excellent response at 1 and 3 months against 15% and 10% in the placebo group (p=0.082 and p=0.065). Conclusions: Despite the significant effects of rTMS on tinnitus, differences between active and placebo groups remained non-significant, due to large placebo-effect and wide inter-individual variation

Evaluating Privacy - Determining User Privacy Expectations on the Web

Individuals don’t often have privacy expectations. When asked to consider them, privacy realities were frequently perceived not to meet these expectations. Some websites exploit the trust of individuals by selling, sharing, or analysing their data. Without intervention, individuals do not often understand privacy implications, nor do anything to address it. This study has identified that many users do not have privacy expectations. An extension developed for this study improved privacy awareness, privacy behaviour, and created privacy expectations in participants. The extension also demonstrated that privacy-focused behavioural changes occur when individuals consider the implications of privacy policies, and are exposed to the ways in which their data is being used