<p>Congestive heart failure (CHF) is a major cause of morbidity and mortality and the identification of modifiable risk factors is crucial in order to diminish suffering of this common disease. </p><p>The primary aim of this thesis was to investigate novel metabolic risk factors for CHF, with a focus on insulin resistance and inflammation. The secondary aim was to examine the validity of the CHF diagnosis in the Swedish hospital discharge register.</p><p>This thesis was based on the Uppsala Longitudinal Study of Adult Men (ULSAM) cohort, a community-based prospective study started in 1970. The participants were examined at age 50 and 70 and the data was completed with annual updates on mortality and in-hospital morbidity using national registers. </p><p>We showed that insulin resistance predicts CHF incidence independently of established risk factors in both middle-aged and elderly men. The previously described association between obesity and subsequent CHF may be mediated partly by insulin resistance. Moreover, it was established that inflammation, measured as erythrocyte sedimentation rate is a significant predictor of CHF, independent of established risk factors including an interim myocardial infarction. Furthermore, a low beta-carotene level, as well as an increased apolipoprotein B/A-I-ratio was found to predict CHF independently of established risk factors.</p><p>We also showed that the validity of the CHF diagnosis in the Swedish hospital discharge register appears less precise than for other recently investigated cardiovascular diagnoses. However, when including only cases from selected clinics or cases with a primary diagnosis of CHF, the validity is comparable to the above diagnoses. </p><p>In conclusion, insulin resistance and inflammation are strong independent risk factors for the development of CHF, and seem to be involved in the early process leading to CHF. If confirmed, our observations could have large clinical implications as they may offer new approaches in the prevention of CHF.</p>

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Two main goals of geriatric rehabilitation are to re-establish ability for physical function in order to facilitate independence in activities of daily living (ADL), and to promote an optimal degree of well-being, i.e. life satisfaction, in the individual. In this research a new scale, the General Motor Function assessment scale (GMF), was developed and evaluated. Subsequently, factors perceived as important for the life satisfaction of people undergoing geriatric rehabilitation were investigated. The GMF includes both mobility and upper limb functions and comprises three subscales covering different aspects of functioning, namely performance-related Dependence, Pain and Insecurity. The clinical practicality of the GMF was evaluated by a field test. Its psychometric properties were analysed in both hospital and community-based settings of geriatric rehabilitation, using non-parametric statistical methods. The results indicated that the GMF is clinically adequate, possesses good reliability and is sensitive enough to demonstrate changes from pre- to post-intervention in different forms of geriatric rehabilitation. For investigation of perceptions of life satisfaction, individual qualitative interviews were conducted with old (80+) care recipients and with their significant others, who had a helping relationship with them. The results revealed that habitual activity, independence and adaptation were generally considered to be important for the life satisfaction of the care recipients. Recalling of pleasant past memories in an effort to achieve current life satisfaction was a commonly used adaptive strategy among the care recipients. This strategy created a temporary sense of life satisfaction, with a potential for concealing dissatisfaction with conditions that might otherwise be correctable. From the perspective of the significant others, protection of the continuity of the care recipients’ self was seen as vital for the latter's life satisfaction, and was thus an underlying general purpose of the informal caregiving.

Congestive heart failure (CHF) is a major cause of morbidity and mortality and the identification of modifiable risk factors is crucial in order to diminish suffering of this common disease. The primary aim of this thesis was to investigate novel metabolic risk factors for CHF, with a focus on insulin resistance and inflammation. The secondary aim was to examine the validity of the CHF diagnosis in the Swedish hospital discharge register. This thesis was based on the Uppsala Longitudinal Study of Adult Men (ULSAM) cohort, a community-based prospective study started in 1970. The participants were examined at age 50 and 70 and the data was completed with annual updates on mortality and in-hospital morbidity using national registers. We showed that insulin resistance predicts CHF incidence independently of established risk factors in both middle-aged and elderly men. The previously described association between obesity and subsequent CHF may be mediated partly by insulin resistance. Moreover, it was established that inflammation, measured as erythrocyte sedimentation rate is a significant predictor of CHF, independent of established risk factors including an interim myocardial infarction. Furthermore, a low beta-carotene level, as well as an increased apolipoprotein B/A-I-ratio was found to predict CHF independently of established risk factors. We also showed that the validity of the CHF diagnosis in the Swedish hospital discharge register appears less precise than for other recently investigated cardiovascular diagnoses. However, when including only cases from selected clinics or cases with a primary diagnosis of CHF, the validity is comparable to the above diagnoses. In conclusion, insulin resistance and inflammation are strong independent risk factors for the development of CHF, and seem to be involved in the early process leading to CHF. If confirmed, our observations could have large clinical implications as they may offer new approaches in the prevention of CHF.

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Essän utgår från den praktiska klokheten, ett av Aristoteles kunskapsbegrepp. Den praktiska klokheten finns i sättet att vara och i sättet att kommunicera. Det behövs lyhördhet, uppmärksamhet och känslomässig begåvning för att vara praktisk klok. Genom att söka och beskriva det lika, det olika och det unika jämför jag ledarskapet för en mångkulturell arbetsgrupp i en stockholmsnära kommun med ledarskapet i en landsortskommun. Jag beskriver och diskuterar ett medskapande ledarskap samt behovet av att ibland tillämpa ett mer auktoritärt ledarskap. Essän handlar också om olika sätt att göra nytta, nämligen att göra vackert, att förbättra, att använda resurser på ett klokt sätt, att ta ansvar samt att möta människor på ett respektfullt sätt. Jag belyser ett antal olika förhållningssätt i mötet med andra människor, och resonerar även kring integrerad kunskap. Avslutningsvis utgår jag från det som Martha Nussbaum skriver, nämligen att den praktiska klokheten är ett slags komplex känslighet. Vidare konstaterar jag att det medskapande ledarskapet och den praktiska klokheten kan ses som två konstformer som ständigt måste utvecklas.

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