In dieser retrospektiven Pilotstudie wurde die Aussagekraft klinischer und paraklinischer Parameter in Prä-, Peri- und früher Postnatalphase für die Diagnostik der klinischen Early-Onset Sepsis beim Neugeborenen untersucht. Der postnatal innerhalb von drei Tagen beim Kind gemessene CRP-Wert mit einem Cut-off von 10 mg/l wurde für die Differenzierung klinische Sepsis / keine Sepsis herangezogen. Die Analyse der zwei nach CRP-Werten getrennten Kollektive erfolgte hinsichtlich verschiedener Faktoren (wie z.B. Kreislauf und Laborparameter der Mutter vor der Geburt bzw. Labor – und Kreislaufparameter des Kindes bis 96 h postnatal). In der Auswertung zeigen sich signifikante Unterschiede der einzeln betrachteten Variablen. In einer Multivarianzanalyse konnten keine statistisch relevanten Differenzen bestätigt werden, daher werden weiterführende, prospektive randomisierte Studien zur Evaluation dieses Ansatzes empfohlen. Aufgrund der hohen und signifikanten Unterschiede bei Einzelbetrachtung und der sehr frühen Verfügbarkeit können die mütterlichen Parameter CRP > 12,3 mg/l und Herzfrequenz > 76,5 Schläge pro Minute sowie die unmittelbar postnatal gemessenen kindlichen Laktatwerte > 3,55 mml/l jedoch als wichtige Indikatoren zur Identifikation von Kindern mit einer Early-Onset Sepsis empfohlen werden.

Background: Cardiovascular disease (CVD) is the leading cause of death globally since the turn of the century. One major risk factor is tobacco smoking with a particular risk associated with early initiation/greater duration. Research also indicates that alcohol use can offer both risk or protective cardiovascular benefits depending on consumption characteristics (intensity, frequency, dose, type). The purpose of this study is to examine the early onset of smoking, heavy smoking, and alcohol behavior as they relate to CVD risk. Methods: Using the data from the 2019 National Survey on Drug Use and Health (N=56,136), logistic regression analysis were conducted to examine trends in heavy substance use predictive of CVD risk (Independent variables of heavy substance use: number of cigarettes smoked per day, ≤ 12 years of tobacco smoking, ≥ 5 drinks for males or ≥ 4 drinks for females on each of 5 or more days in the past 30 days; and the dependent variable - ever told by a doctor or other health care professional that you had heart condition) while controlling for sociodemographic factors. Results: Overall, 19.7% of the study population reported CVD conditions, 5.9% heavy alcohol consumption, and 4.9% early onset of smoking. Overall, the odds of having heart condition among heavy alcohol drinkers was 23.6% less than those who were not heavy alcohol drinkers (odds ratio (OR): 0.76, 95% confidence interval (CI): (0.63-0.92), 44% more among those smoked 26 or more cigarettes per day than 25 or less 1.44 (1.01-2.05), 49% more among those with early onset of smoking than none 1.49 (1.15-1.93). By age, we found that heavy alcohol consumption could be either risk factor or protective factor of heart condition or no effect on heart condition across different age groups: for aged 12-18, OR 1.69 (CI 0.69-4.16); 19-25, 0.75 (0.48-1.15), 26-29, 1.21 (0.57-2.53); 30-34, 0.80 (0.36-1.77); 35-49, 0.61 (0.40-0.93); 50-64, 1.12 (0.77-1.62); >64, 0.93 (0.57-1.52). Based on gender, CVD risk was higher in males than females, 1.22 (1.13-1.32). In terms of race, the odds of CVD risk were lower for all groups when compared with non-Hispanic White. Based on income, the odds of CVD risk were higher in high-income earners with at least a college education when compared to low-income earners with high school education or less (≥$50k vs.Conclusion: Study findings demonstrate that the association of heavy alcohol consumption related to CVD risk varied by age. For heavy tobacco smoking, early onset of tobacco smoking, being male, white race, having above high school level education, high income, and advanced age were found to be significant predictors of CVD risk. Future observational studies should be performed to determine the combined effects of heavy alcohol consumption and heavy smoking as it relates to CVD risk by other behavioral risk factors such as types of alcohol consumed (i.e, spirits vs wine) and related behaviors.

Bakgrund Upplevelserna hos närstående till en person som fått en tidigt debuterande demenssjukdom kan skilja sig från upplevelserna de närstående har vid en sent debuterande demenssjukdom. En tidig debut av demenssjukdom, till skillnad från en debut efter 65 års ålder, innebär större risk att närstående i yngre åldrar påverkas. Det behövs ökad kunskap kring vilka upplevelserna är hos de närstående, för att underlätta deras liv efter diagnosen tidigt debuterande demenssjukdom. Syfte Syftet var att belysa närståendes upplevelser av att leva med en person med tidigt debuterande demenssjukdom. Metod En icke-systematisk litteraturöversikt gjordes baserat på artiklar av en kvalitativ design. Genom sökorden demens, tidig diagnos, närstående samt upplevelser tillsammans med varianter av dessa begrepp, genomfördes sökningar i PubMed och CINAHL. Artiklarna sammanställdes därefter i en integrerad dataanalys. Resultat Utifrån de 16 artiklarna i litteraturöversikten framkom ett resultat som indikerade på att närstående upplevde svårigheter i vardagen, redan från tiden innan diagnostiseringen av en tidig demenssjukdom. I samband med att demenssjukdomen fortskred skapades nya varianter av roller och relationer. Dessa förändringar i livet påverkade på sikt ekonomin såväl som det sociala livet negativt. På det emotionella planet fanns rädslor som främst grundade sig i det otänkbara, att förlora någon i sin närhet för att senare fortsätta att leva på egen hand. Närstående upplevde även att tillgänglig information till personer som berörs av just en tidigt debuterande demenssjukdom var otillräcklig. Slutsats Brist på tillgänglig information minskade närståendes möjligheter till att hantera vardagen samt att få rätt sorts hjälp och stöd. Detta skapar svårigheter för närstående att hantera och uppleva meningsfullhet i livet tillsammans med personen med tidigt debuterande demenssjukdom. Mer kunskap hos personal inom vården behövs för att kunna ge ett personcentrerat stöd. / Background  The experiences of close family and friends to a person with a diagnosis of early-onset dementia can differ from the experiences the close family and friends has when it comes to a late onset dementia. An early-onset dementia diagnosis, unlike an onset after the age of 65, means that there is a bigger risk that relatives of a younger age are affected. There is a need for increased knowledge about the experiences of close family and friends, to make their lives easier after the diagnosis of early-onset dementia. Aim The aim of this study was to describe close families and friends’ experiences of living with a person with early-onset dementia. Method A non-systematic literature review was done based on articles of a qualitative design. Through the keywords dementia, early diagnosis, relatives and experience together with versions of these concepts, searches were conducted in PubMed and CINAHL. The articles were then compiled in an integrated data analysis. Results From the 16 articles in this literature review a result emerged that indicated that the family and friends experienced difficulties in everyday life, beginning even before the diagnosis of early-onset dementia. In connection to the progress of the dementia disease, new versions of roles and relations were formed. These changes in life eventually affected both the economy as well as the social life negatively. On the emotional level there were fears mainly based on the unthinkable, to lose someone standing close to oneself and to have to continue living life alone. Family and friends also experienced that the information available for the people affected by an early-onset dementia was insufficient. Conclusions  Lack of available information reduced the family and friends’ possibilities to cope with everyday life and to get the right kind of help and support. This creates difficulties for the family and friends to both cope with and experience meaningfulness in life together with the person with an early-onset dementia. More knowledge among care personnel is needed to be able to give person-centered care.

No description available.

Underage drinking has featured prominently in both scholarly and conventional literature in recent decades as a major health and socio-economic concern in the United States. As new evidence emerges associating underage drinking with a host of negative outcomes for both the youth who drinks and society in general, a closer examination of the long-term effects of underage drinking is critical. This exploratory study was designed to examine predictor variables and their ramifications (1) using logistic regression to identify a model for underage drinking history (UDHISTORY) as a predictor of concomitant alcohol dependence and poor educational attainment (CADAPEA) among individuals aged 25 and above, and (2) obtain a better understanding of how demographic variables (age, gender, race/ethnicity) influence the prediction. The nature and strength of the effect(s) of these demographic variables on the prediction were also investigated. The 2010 National Survey on Drug Use and Health data set ICPSR 32722-0001 which is previously unexploited for this purpose is utilized in this study. The data analysis tool, SDA on SAMHSA's website and IBM SPSS were used for correlation analysis and logistic regression to test the hypothesis that currently legal age drinkers 25 years and older with UDHISTORY are more likely to experience CADAPEA than their counterparts without UDHISTORY. When considered alone, UDHISTORY was a strong and statistically significant predictor of CADAPEA. The identified bivariate logistic regression model was statistically significant, &chi2 (1, n = 60) = 13.39, Adjusted Wald F1, 60 = 13.39, p = 0.001 < .05, accounting for 1.26% (Cox and Snell R square), 1.3% (Log Likelihood Pseudo R square), to 7.9% (Nagelkerke R square) of the variance in CADAPEA. However, adding demographic variables to the model made UDHISTORY a much stronger and more statistically significant predictor. The identified final multivariable logistic regression model was statistically significant, &chi2 (6, n = 55) = 170.43, Adjusted Wald F6, 55 = 26.04, p = 0.00 < .001, accounting for 1.8% (Cox and Snell R square), 7.2% (Log Likelihood Pseudo R square) to 7.9% (Nagelkerke R square) of the variance in CADAPEA. The model also correctly classified 99.1% of cases.

Antalet personer som diagnostiseras med en kognitiv sjukdom ökar i världen. De kognitiva sjukdomarna är vanligare i hög ålder men även yngre människor insjuknar. Sjukdomarna ger ett ökat behov av stöd i vardagen och den största delen av vård och omsorg ges idag av de anhöriga.  Syftet var att beskriva upplevelsen av att leva tillsammans med en partner som drabbats av enkognitiv sjukdom med tidig debut. Metoden som använts har varit en litteraturstudie med induktiv ansats. Sökningar i databaserna Pubmed, Cinahl och PsycInfo gjordes med begränsningen artiklar som publicerats mellan 2012 – 2023 för att endast inkludera aktuell forskning. Studien baserades på 15 kvalitativa forskningsartiklar som bedömdes kunna svara på syftet.  Resultatet presenteras i sex kategorier. Det visar att partners till personer med kognitivasjukdomar med tidig debut upplever svårighet för den sjuke att få en diagnos. De upplever även okunskap och bristfälligt stöd från hälso-och sjukvårdspersonal. Känslorna är svåra och rollerna i relationen förändras. Stigmatiseringen kring sjukdomarna är stor och det sociala livet berörs negativt. Även den egna hälsan, ekonomin och arbetslivet påverkas och de vårdande partnerna känner en oro inför framtiden. Slutsatsen är att stigmatiseringen och okunskapen är stor, både hos samhället och inom hälso- och sjukvård och påverkar livet för de som lever tillsammans med en partner med en kognitiv sjukdom. Kunskaperna om kognitiva sjukdomar med tidig debut behöver ökas för att minska skamkänslor och social isolering hos dem som drabbas. Det stöd som finns idag behöver ses över och utgå mer från behoven hos den som är sjuk och dennes anhöriga. / The number of people diagnosed with a cognitive disease are increasing worldwide. Cognitive disorders are more common in the elderly, but younger people also fall ill. The diseases givesan increased need for support in everyday life, and most of the care is provided by the family. The aim was to describe the experience of living together with a partner who was affected byan early onset cognitive disease. The method used has been a literature study with an inductive approach. Searches in thedatabases PubMed, Cinahl and PsycInfo were made with the limitation of articles published between 2012 - 2023 to include only current research. The study is based on 15 qualitative research articles that we considered able to answer to the purpose.  The results are presented in six categories. It shows that partners of people with an early onset cognitive disease experience difficulties for the person affected by the disease to get a diagnosis. They also experience ignorance and lack of support from health professionals. The emotions are difficult and the roles in the relationship change. The stigma surrounding the diseases is big and the social life is negatively affected. Their own health, finances and working life are also affected, and the caring partners are worried about the future. The conclusion is that the stigma and ignorance is substantial both in society and in health care and affects the lives of those who live with a partner with a cognitive disorder. Knowledge of cognitive disease with an early onset needs to be increased in order to reduce feelings of shame and social isolation in those affected. The support that exists today needs to be reviewed and based more on the needs of the person who is ill and their family.

Abstract from the original paper: Aims: The study investigated a putative association between early-onset-sepsis (EOS) and poor neurodevelopmental outcomes at 2 years corrected age in very low birth weight infants. Methods: This was a single-center cohort study on infants weighing less than 1500g with a gestational age below 35 weeks at birth born between 2008 and 2011. Neurodevelopmental outcomes were assessed at follow-up with the Bayley Scales of Infant Development-II. EOS was defined as either culture-proven EOS or clinical EOS using blood culture, CrP levels, and clinical symptoms and treatment. Neurodevelopmental impairment (NDI) was defined as one or more of the following: Mental Developmental Index (MDI) and/or Psychomotor Developmental Index (PDI) scores lower than 70; presence of cerebral palsy. Results: Of 405 eligible newborns in the study period 166 were included. Two had culture-proven and 29 clinical EOS. Median MDI scores in patients with EOS were 96 (IQR: 86–106) and in the control group 94 (84–106, p=0.77). PDI scores in patients with EOS were 96 (86–106) and in the control group 99,5 (92–103, p=0.03). Of infected patients 7/31 (24%) showed NDI as defined, whereas only 11/135 (8%) showed NDI in the control group (OR 3.3, p=0.03). Multiple regression analyses identified chorioamnionitis and poor CRIB-Scores as individual risk factors for MDI or PDI values <70. Conclusion: In our study, EOS among VLBW-infants significantly impaired the neurodevelopment at two years corrected age. As shown in previous reports infection continues to be a problem and strategies for a reduction need further improvement.:Table of contents I. PRELIMINARY REMARKS 1 i. Tables and Figures 2 a. Figures and subtitles 2 b. Tables and titles 2 ii. Abbreviations 3 iii. Bibliographic Summary 4 1 Introduction 5 1.1. Early-onset-sepsis 5 1.1.1 Epidemiology 5 1.1.2 Pathogenesis 7 1.1.3 Pathogens causing EOS 7 1.1.4 Risk factors of EOS 8 1.1.5 Diagnosis of EOS 9 1.1.6 Treatment of EOS 10 1.2 Intrauterine infection 11 1.3 Neurodevelopment of neonates and brain injury 12 1.4 Rationale and objectives of our study 14 2 Original Publication 16 3 Summary 30 4 References 34 5 German Supplement 39 5.1. Darstellung des eigenen Beitrages 39 5.2. Erklärung über die eigenständige Abfassung der Arbeit 40 5.3. Curriculum vitae 41 5.4. Danksagung 42

No description available.

Bakgrund: I dag lever 3,4 miljoner människor världen över med en tidigt debuterande demenssjukdom, vilket avser personer under 65 år. Sjukdomen påverkar inte bara den demenssjuke, utan även personens partner då denna fas i livet innefattas av ett socialt sammanhang av familje- och arbetsliv. Rollen ändras från att vara partner till att bli anhörigvårdare vilket resulterar i en stor förändring i livet. Syfte: Syftet var att belysa partners upplevelser av att leva med en anhörig som drabbats av tidigt debuterande demens. Metod: En allmän litteraturstudie med induktiv ansats där 10 kvalitativa artiklar har granskats. Resultat: Utifrån anhörigvårdares erfarenheter framkom fyra kategorier. Anhörigvårdare beskriver en känsla av ovisshet, förändrade roller och relationer, social avskildhet och bristfälligt stöd. Konklusion: Slutsatsen visar på att livet för anhörigvårdare påverkas från första symptom vidare genom förändrade relationer och roller som uppstår och det bristande stöd som samhället erbjuder. Sjuksköterskor behöver ökad kunskap om anhörigvårdares upplevelser av tidigt debuterande demens för att tillgodose upplevelsen av hälsa och välbefinnande. / Background: Today 3,4 million people worldwide are living with young onset dementia which refers to people under the age of 65. The disease affects not only the person with dementia, but also the person's partner as this phase of life is embedded in a social context of family and work life. The role changes from being a partner to being a caregiver which results in major change in life. Aim: The purpose of the study was to illustrate the partners' experiences of living with a relative affected by early onset dementia. Method: A general literature review with an inductive approach where 10 qualitative articles have been reviewed. Results: Based on the caregivers' experiences, four categories emerged. Caregivers describe a sense of uncertainty, changing roles and relationships, social isolation and lack of support. Conclusion/implication: The conclusion shows that the life of the caregivers' changes from the symptoms, throughout the changing of the relations and roles to the lack of support that the society provides. Nurses need increased knowledge about caregivers' experience of early onset dementia in order to provide accommodate the experience of health and well-being.

Background: Neonatal sepsis is one of the most important causes for elevated morbidity and mor-tality rates in neonatal intensive care units worldwide. While the clinical manifestations of a neo-natal sepsis tend to be nonspecific, its rapid development and life-threatening potential calls for reliable markers for early detection. Methods: We conducted a retrospective single center study including all neonates suspected of having developed a neonatal sepsis within 2013 - 2016. Perinatal and clinical characteristics, as well as microbiological and laboratory findings were evaluated. Neonatal sepsis was either defined as culture proven sepsis (positive blood culture) or clinical sepsis (at least one symptom and elevated C-reative protein (CRP) concentrations within 72h with nega-tive blood culture). We further differentiated between early-onset (EOS) and late-onset (LOS) sepsis. Results: Microbiological colonisation screening frequently did not detect the organism which sub-sequently caused the sepsis. Depending on the age of the newborn with sepsis (EOS or LOS), as-sociations between different anamnestic and clinical factors (prenatal or postnatal ones) were found. Especially the central-peripheral temperature difference showed a strong association to LOS. Laboratory results useful for the early detection of a neonatal sepsis included interleukin-6 (IL-6) and CRP concentrations. Conclusion: Elevated IL-6 >100 ng/l was a strong marker for neonatal sepsis. When choosing the antibiotics for treatment, data from microbiological colonisation screening should be considered, but not solely relied on. Some indicators for infection depended also on postnatal age.:Einführung 1 Definition 1 Sepsis 1 Pathophysiologie der Sepsis 2 Early-onset Sepsis vs. Late-onset Sepsis 4 Klinik und Diagnostik 6 AWMF-Leitlinie „Bakterielle Infektionen bei Neugeborenen“ 10 Mikrobiologisches Kolonisationsscreening 14 Aufgabenstellung und Zielsetzung 16 Patient:innen und Methoden 18 Datenerhebung 18 Gruppenbildung 20 Statistische Analyse 22 Ergebnisse 23 Early-onset Sepsis mit mikrobiologischem Nachweis 23 Early-onset Sepsis mit nur paraklinischem Nachweis 30 Late-onset Sepsis mit mikrobiologischem Nachweis 36 Late-onset Sepsis mit nur paraklinischem Nachweis 44 Diskussion 50 Art der Erreger in Leipzig 50 Mikrobiologisches Kolonisationsscreening 51 Anamnestische und klinische Risikofaktoren 55 Laborchemische Faktoren 60 Aussagekraft der Blutkultur 69 Grenzen der Studie 71 Weiterer Ausblick 72 Zusammenfassung 75 Literaturverzeichnis 78 Abkürzungsverzeichnis 83 Tabellenverzeichnis 85 Abbildungsverzeichnis 86 Erklärung über die eigenständige Abfassung der Arbeit 88 Curriculum vitae 89 Danksagung 91