Stress and work-related mental illness among working adults with ADHD: a qualitative study.

BACKGROUND: Though many adults with ADHD underperform professionally, are more stressed, and have more days of sickness absence compared to adults without ADHD, few studies have explored the experience of working as an adult with ADHD. This study explores the general experience of working with ADHD, including stress and work-related mental illness. METHODS: Semi-structured telephone interviews were conducted with 20 working adults with ADHD. Interview topics included how the ADHD diagnosis and/or symptoms of ADHD may have affected participants on the job, how work may have affected participants' well-being, and the need for support and accommodation. Qualitative content analysis was used to explore verbatim transcripts from the interviews. RESULTS: The analysis yielded three themes that describe some of the challenges of working with ADHD: Working and living with ADHD, Needs, and Special abilities, with a total of eight subcategories. Subcategories were Specific challenges; Relationships and cooperation; Negative consequences; Planning, prioritization, organization, and structure; Support, interventions, accommodations, and aids; Openness, understanding, and acceptance; Strategies; Strengths and qualities. CONCLUSION: Further knowledge about the challenges of working with ADHD is needed in workplaces; where organizational support is lacking, much in terms of accommodations and aids is up to the employee, and the disclosure of diagnoses may be associated with great dilemma.

The reminiscence bump is blind to blindness: Evidence from sound- and odor-evoked autobiographical memory.

The reminiscence bump is the disproportionally high reporting of autobiographical memories from adolescence and early adulthood and is typically observed when memories are evoked by cues, such as words, pictures, and sounds. However, when odors are used the bump shifts to early childhood. Although these findings indicate that sensory modality affects the bump, the influence of the individual's sensory function on the reminiscence bumps is unknown. We examined the reminiscence bumps of sound- and odor-evoked autobiographical memories of early blind and sighted individuals, since early blindness implies considerable effects on sensory experience. Despite differences in sensory experience between blind and sighted individuals, the groups displayed similar age distributions of both sound- and odor-evoked memories. The auditory bump spanned the first two decades of life, whereas the olfactory bump was once again found in early childhood. These results demonstrate that the reminiscence bumps are robust to fundamental differences in sensory experience.

Multimedia learning trumps retrieval practice in psychology teaching.

It is well established that studying with (vs. without) visual illustrations as well as taking tests (vs. restudying) is beneficial for learning, but on which strategy should one put the efforts, or should they be combined for best learning? Eighty-eight upper secondary school students were given a brief lecture presented verbally (6 classes) or with the aid of a visual illustration (visuoverbal, 6 classes). The information was processed again by taking a memory test or by restudying. Recall and transfer tests were conducted after some few minutes and again after one week. The visuoverbal lecture resulted in better learning than verbal presentation only. A significant study strategy by retention interval interaction was found. However, this interaction was not qualified by a testing effect. Hence, taking tests (retrieval practice) did not lead to better learning than restudying. It was concluded that it is worthwhile to use visual illustrations in teaching. However, the present study did not reveal any synergistic effects from the combination of visuoverbal presentation and retrieval practice.

Ease-of-learning judgments are based on both processing fluency and beliefs.

Processing fluency influences many types of judgments. Some metacognitive research suggests that the influence of processing fluency may be mediated by participants' beliefs. The current study explores the influence of processing fluency and beliefs on ease-of-learning (EOL) judgments. In two experiments (Exp 1: n = 94; Exp 2: n = 146), participants made EOL judgments on 24 six-letter concrete nouns, presented in either a constant condition (high fluency) with upper-case letters (e.g., BUCKET) or an alternating condition (low fluency) with mixed upper- and lower-case letters (e.g., bUcKeT). After judging words individually, participants studied the words and completed a free recall test. Finally, participants indicated what condition they believed made the words more likely to be learned. Results show constant-condition words were judged as more likely to be learned than alternating condition words, but the difference varied with beliefs. Specifically, the difference was biggest when participants believed the constant condition made words more likely to be learned, followed by believing there was no difference, and then believing the alternating condition made words more likely to be learned. Thus, we showed that processing fluency has a direct effect on EOL judgments, but the effect is moderated by beliefs.

Primary triage nurses do not divert patients away from the emergency department at times of high in-hospital bed occupancy - a retrospective cohort study.

BACKGROUND: Emergency department (ED) overcrowding is frequently described in terms of input- throughput and output. In order to reduce ED input, a concept called primary triage has been introduced in several Swedish EDs. In short, primary triage means that a nurse separately evaluates patients who present in the Emergency Department (ED) and either refers them to primary care or discharges them home, if their complaints are perceived as being of low acuity. The aim of the present study is to elucidate whether high levels of in-hospital bed occupancy are associated with decreased permeability in primary triage. The appropriateness of discharges from primary triage is assessed by 72-h revisits to the ED. METHODS: The study is a retrospective cohort study on administrative data from the ED at a 420-bed hospital in southern Sweden from 2011-2012. In addition to crude comparisons of proportions experiencing each outcome across strata of in-hospital bed occupancy, multivariate models are constructed in order to adjust for age, sex and other factors. RESULTS: A total of 37,129 visits to primary triage were included in the study. 53.4 % of these were admitted to the ED. Among the cases referred to another level of care, 8.8 % made an unplanned revisit to the ED within 72 h. The permeability of primary triage was not decreased at higher levels of in-hospital bed occupancy. Rather, the permeability was slightly higher at occupancy of 100-105 % compared to <95 % (OR 1.09 95 % CI 1.02-1.16). No significant association between in-hospital bed occupancy and the probability of 72-h revisits was observed. CONCLUSIONS: The absence of a decreased permeability of primary triage at times of high in-hospital bed occupancy is reassuring, as the opposite would have implied that patients might be denied entry not only to the hospital, but also to the ED, when in-hospital beds are scarce.

Long-term memory for odors: influences of familiarity and identification across 64 days.

Few studies have investigated long-term odor recognition memory, although some early observations suggested that the forgetting rate of olfactory representations is slower than for other sensory modalities. This study investigated recognition memory across 64 days for high and low familiar odors and faces. Memory was assessed in 83 young participants at 4 occasions; immediate, 4, 16, and 64 days after encoding. The results indicated significant forgetting for odors and faces across the 64 days. The forgetting functions for the 2 modalities were not fundamentally different. Moreover, high familiar odors and faces were better remembered than low familiar ones, indicating an important role of semantic knowledge on recognition proficiency for both modalities. Although odor recognition was significantly better than chance at the 64 days testing, memory for the low familiar odors was relatively poor. Also, the results indicated that odor identification consistency across sessions, irrespective of accuracy, was positively related to successful recognition.

The probability of readmission within 30 days of hospital discharge is positively associated with inpatient bed occupancy at discharge--a retrospective cohort study.

BACKGROUND: Previous work has suggested that given a hospital's need to admit more patients from the emergency department (ED), high inpatient bed occupancy may encourage premature hospital discharges that favor the hospital's need for beds over patients' medical interests. We argue that the effects of such action would be measurable as a greater proportion of unplanned hospital readmissions among patients discharged when the hospital was full than when not. In response, the present study tested this hypothesis by investigating the association between inpatient bed occupancy at the time of hospital discharge and the 30-day readmission rate. METHODS: The sample included all inpatient admissions from the ED at a 420-bed emergency hospital in southern Sweden during 2011-2012 that resulted in discharge before 1 December 2012. The share of unplanned readmissions within 30 days was computed for levels of inpatient bed occupancy of <95%, 95-100%, 100-105% and >105% at the hour of discharge. A binary logistic regression model was constructed to adjust for age, time of discharge, and other factors that could affect the outcome. RESULTS: In all, 32,811 visits were included in the study, 9.9% of which resulted in an unplanned readmission within 30 days of discharge. The proportion of readmissions was 9.0% for occupancy levels of <95% at the patient's discharge, 10.2% for 95-100% occupancy, 10.8% for 100-105% occupancy, and 10.5% for >105% occupancy (p = 0.0001). Results from the multivariate models show that the OR (95% CI) of readmission was 1.11 (1.01-1.22) for patients discharged at 95-100% occupancy, 1.17 (1.06-1.29) at 100-105% occupancy, and 1.15 (0.99-1.34) at >105% occupancy. CONCLUSIONS: Results indicate that patients discharged from inpatient wards at times of high inpatient bed occupancy experience an increased risk of unplanned readmission within 30 days of discharge.

Elevated Troponin Levels in Acute Stroke Patients Predict Long-term Mortality.

BACKGROUND: Elevated plasma levels of troponin in acute stroke patients are common and have in several studies been shown to predict in-hospital and short-term mortality. Little is, however, known about the long-term prognosis of these patients. The aim of this study was to determine patient characteristics and 5-year mortality in patients with acute stroke and troponin elevation on admission. METHODS: A retrospective cohort study of all consecutive patients with acute stroke and a plasma troponin I (TnI) analyzed on admission to Danderyd Hospital between January 1, 2005, and January 1, 2006 (n = 247). Patient characteristics were obtained from the Swedish National Stroke Register, Riksstroke, as well as hospital records. Mortality data were obtained from the Swedish Cause of Death Register. RESULTS: There were 133 patients (54%) with TnI less than .03 µg/L (normal), 74 patients (30%) with TnI .03-.11 µg/L (low elevation), and 40 patients (16%) with TnI greater than .11 µg/L (high elevation). TnI elevations were associated with a higher age, prior ischemic stroke, chronic heart failure, renal insufficiency, stroke severity, and ST segment elevation or depression on admission. The rate of hyperlipidemia decreased with increasing TnI. Adjusted for age and comorbidity, elevated TnI values on admission had a significantly and sustained increased mortality over the 5-year follow-up, with a hazard ratio of 1.90 (95% confidence interval, 1.33-2.70). CONCLUSIONS: Troponin elevation in patients with acute stroke, even when adjusted for several possible confounders, is associated with an almost 2-fold increased risk of 5-year mortality.

Effects of testing on subsequent re-encoding and long-term forgetting of action-relevant materials: On the influence of recall type.

Testing one's memory of previously studied information reduces the rate of forgetting, compared to restudy. However, little is known about how this direct testing effect applies to action phrases (e.g., "wash the car") - a learning material relevant to everyday memory. As action phrases consist of two different components, a verb (e.g., "wash") and a noun (e.g., "car"), testing can either be implemented as noun-cued recall of verbs or verb-cued recall of nouns, which may differently affect later memory performance. In the present study, we investigated the effect of testing for these two recall types, using verbally encoded action phrases as learning materials. Results showed that repeated study-test practice, compared to repeated study-restudy practice, decreased the forgetting rate across 1 week to a similar degree for both noun-cued and verb-cued recall types. However, noun-cued recall of verbs initiated more new subsequent learning during the first restudy, compared to verb-cued recall of nouns. The study provides evidence that testing has benefits on both subsequent restudy and long-term retention of action-relevant materials, but that these benefits are differently expressed with testing via noun-cued versus verb-cued recall.

Trends in stroke treatment and outcome between 1995 and 2010: observations from Riks-Stroke, the Swedish stroke register.

BACKGROUND: Continuous changes in stroke treatment and care, as well as changes in stroke characteristics, may alter stroke outcome over time. The aim of this paper is to describe time trends for treatment and outcome data, and to discuss if any such changes could be attributed to quality changes in stroke care. METHODS: Data from Riks-Stroke, the Swedish stroke register, were analyzed for the time period of 1995 through 2010. The total number of patients included was 320,181. The following parameters were included: use of computed tomography (CT), stroke unit care, thrombolysis, medication before and after the stroke, length of stay in hospital, and discharge destination. Three months after stroke, data regarding walking, toileting and dressing ability, as well social situation, were gathered. Survival status after 7, 27 and 90 days was registered. RESULTS: In 1995, 53.9% of stroke patients were treated in stroke units. In 2010 this proportion had increased to 87.5%. Fewer patients were discharged to geriatric or rehabilitation departments in later years (23.6% in 2001 compared with 13.4% in 2010), but more were discharged directly home (44.2 vs. 52.4%) or home with home rehabilitation (0 vs. 10.7%). The need for home help service increased from 18.2% in 1995 to 22.1% in 2010. Regarding prevention, more patients were on warfarin, antihypertensives and statins both before and after the stroke. The functional outcome measures after 3 months did improve from 2001 to 2010. In 2001, 83.8% of patients were walking independently, while 85.6% were independent in 2010. For toileting, independence increased from 81.2 to 84.1%, and for dressing from 78.0 to 80.4%. Case fatality (CF) rates after 3 months increased from 18.7% (2001) to 20.0% (2010). This trend is driven by patients with severe strokes. CONCLUSIONS: Stroke outcomes may change over a relatively short time period. In some ways, the quality of care has improved. More stroke patients have CT, more patients are treated in stroke units and more have secondary prevention. Patients with milder strokes may have benefited more from these measures than patients with severe strokes. Increased CF rates for patients with severe stroke may be caused by shorter hospital stays, shorter in-hospital rehabilitation periods and lack of suitable care after discharge from hospital.

Adjustment factors for toluene, styrene and methyl chloride by population modeling of toxicokinetic variability.

The availability of experimental data suitable as a basis to quantify human variability in response to chemical exposure has increased in recent years. It has enabled scientifically based, data driven adjustment factors (AF) to be deployed in the risk assessment process. As part of this development, we derive AF for human toxicokinetic variability (HK) for three lipophilic organic solvents; toluene, styrene and methyl chloride using physiologically based pharmacokinetic (PBPK) models in a population framework. The Monte Carlo simulations cover the influence of age and gender on toxicokinetic variability in the general population, as well as workplace ventilation rates and fluctuations in exposure level and workload in adult male and female workers. The derived AFHK are below 2.2 (95th percentile) for all subpopulations, exposure scenarios and chemicals, except for markers of acute effects in workers, where the factors are up to 5.0.

How crucial is the response format for the testing effect?

Combining study and test trials during learning is more beneficial for long-term retention than repeated study without testing (i.e., the testing effect). Less is known about the relative efficacy of different response formats during testing. We tested the hypothesis that overt testing (typing responses on a keyboard) during a practice phase benefits later memory more than covert testing (only pressing a button to indicate successful retrieval). In Experiment 1, three groups learned 40 word pairs either by repeatedly studying them, by studying and overtly testing them, or by studying and covertly testing them. In Experiment 2, only the two testing conditions were manipulated in a within-subjects design. In both experiments, participants received cued recall tests after a short (~19 min) and a long (1 week) retention interval. In Experiment 1, all groups performed equally well at the short retention interval. The overt testing group reliably outperformed the repeated study group after 1 week, whereas the covert testing group performed insignificantly different from both these groups. Hence, the testing effect was demonstrated for overt, but failed to show for covert testing. In Experiment 2, overtly tested items were better and more quickly retrieved than those covertly tested. Further, this does not seem to be due to any differences in retrieval effort during learning. To conclude, overt testing was more beneficial for later retention than covert testing, but the effect size was small. Possible explanations are discussed.

Complexity complicates lean: lessons from seven emergency services.

PURPOSE: The purpose of this paper is to explain how different emergency services adopt and adapt the same hospital-wide lean-inspired intervention and how this is reflected in hospital process performance data. DESIGN/METHODOLOGY/APPROACH: A multiple case study based on a realistic evaluation approach to identify mechanisms for how lean impacts process performance and services' capability to learn and continually improve. Four years of process performance data were collected from seven emergency services at a Swedish University Hospital: ear, nose and throat (ENT) (two), pediatrics (two), gynecology, internal medicine, and surgery. Performance patterns were linked with qualitative data collected through realist interviews. FINDINGS: The complexity of the care process influenced how improvement in access to care was achieved. For less complex care processes (ENT and gynecology), large and sustained improvement was mainly the result of a better match between capacity and demand. For medicine, surgery, and pediatrics, which exhibit greater care process complexity, sustainable, or continual improvement were constrained because the changes implemented were insufficient in addressing the higher degree of complexity. ORIGINALITY/VALUE: The variation in process performance and sustainability of results indicate that lean efforts should be carefully adapted to the complexity of the care process and to the educational commitment of healthcare organizations. Ultimately, the ability to adapt lean to a particular context of application depends on the development of routines that effectively support learning from daily practices.

Statin therapy and outcome after ischemic stroke: systematic review and meta-analysis of observational studies and randomized trials.

BACKGROUND AND PURPOSE: Although experimental data suggest that statin therapy may improve neurological outcome after acute cerebral ischemia, the results from clinical studies are conflicting. We performed a systematic review and meta-analysis investigating the relationship between statin therapy and outcome after ischemic stroke. METHODS: The primary analysis investigated statin therapy at stroke onset (prestroke statin use) and good functional outcome (modified Rankin score 0 to 2) and death. Secondary analyses included the following: (1) acute poststroke statin therapy (≤ 72 hours after stroke), and (2) thrombolysis-treated patients. RESULTS: The primary analysis included 113 148 subjects (27 studies). Among observational studies, statin treatment at stroke onset was associated with good functional outcome at 90 days (pooled odds ratio [OR], 1.41; 95% confidence interval [CI], 1.29-1.56; P<0.001), but not 1 year (OR, 1.12; 95% CI, 0.9-1.4; P=0.31), and with reduced fatality at 90 days (pooled OR, 0.71; 95% CI, 0.62-0.82; P<0.001) and 1 year (OR, 0.80; 95% CI, 0.67-0.95; P=0.01). In the single randomized controlled trial reporting 90-day functional outcome, statin treatment was associated with good outcome (OR, 1.5; 95% CI, 1.0-2.24; P=0.05). No reduction in fatality was observed on meta-analysis of data from 3 randomized controlled trials (P=0.9). In studies restricted to of thrombolysis-treated patients, an association between statins and increased fatality at 90 days was observed (pooled OR, 1.25; 95% CI, 1.02-1.52; P=0.03, 3 studies, 4339 patients). However, this association was no longer present after adjusting for age and stroke severity in the largest study (adjusted OR, 1.14; 95% CI, 0.90-1.44; 4012 patients). CONCLUSIONS: In the largest meta-analysis to date, statin therapy at stroke onset was associated with improved outcome, a finding not observed in studies restricted to thrombolysis-treated patients. Randomized trials of statin therapy in acute ischemic stroke are needed.

Study for now, but judge for later: delayed judgments of learning promote long-term retention.

Delayed judgments of learning (JOL) are assumed to be based on covert retrieval attempts. A common finding is that testing memory during learning improves later retention (i.e., the testing effect), and even more so than an equivalent amount of study, but only after a longer retention interval. To test the assertion that also delayed JOLs improve memory, the participants either studied Swahili-Swedish word pairs four times, or they both studied (two times) and performed delayed JOLs (two times) alternately. Final cued recall test were given after either five minutes or one week. Results showed a reliable learning-group by retention-interval interaction, with less forgetting in the group that alternated between studying and making JOLs. The results are discussed in relation to the self-fulfilling prophecy account of Spellman and Bjork (1992), and in terms of study advice, the results further underscore the importance of delaying JOLs when studying and evaluating one's ongoing learning.

Eyewitness accuracy and retrieval effort: Effects of time and repetition.

An important task for the law enforcement is to assess the accuracy of eyewitness testimonies. Recent research show that indicators of effortful memory retrieval, such as pausing and hedging (e.g. "I think", "maybe"), are more common in incorrect recall. However, a limitation in these studies is that participants are interviewed shortly after witnessing an event, as opposed to after greater retention intervals. We set out to mitigate this shortcoming by investigating the retrieval effort-accuracy relationship over time. In this study, participants watched a staged crime and were interviewed directly afterwards, and two weeks later. Half the participants also carried out a repetition task during the two-week retention interval. Results showed that the retrieval-effort cues Delays and Hedges predicted accuracy at both sessions, including after repetition. We also measured confidence, and found that confidence also predicted accuracy over time, although repetition led to increased confidence for incorrect memories. Moreover, retrieval-effort cues partially mediated between accuracy and confidence.

Depot- and ethnic-specific differences in the relationship between adipose tissue inflammation and insulin sensitivity.

OBJECTIVE: It is unclear whether there are differences in inflammatory gene expression between abdominal and gluteal subcutaneous adipose tissue (SAT), and between black and white women. We therefore tested the hypotheses that SAT inflammatory gene expression is greater in the abdominal compared to the gluteal depot, and SAT inflammatory gene expression is associated with differential insulin sensitivity (S(I) ) in black and white women. DESIGN AND METHODS: S(I) (frequently sampled intravenous glucose tolerance test) and abdominal SAT and gluteal SAT gene expression levels of 13 inflammatory genes were measured in normal-weight (BMI 18-25 kg/m²) and obese (BMI >30 kg/m²) black (n = 30) and white (n = 26) South African women. RESULTS: Black women had higher abdominal and gluteal SAT expression of CCL2, CD68, TNF-α and CSF-1 compared to white women (P < 0·01). Multivariate analysis showed that inflammatory gene expression in the white women explained 56·8% of the variance in S(I) (P < 0·005), compared to 20·9% in black women (P = 0·30). Gluteal SAT had lower expression of adiponectin, but higher expression of inflammatory cytokines, macrophage markers and leptin than abdominal SAT depots (P < 0·05). CONCLUSIONS: Black South African women had higher inflammatory gene expression levels than white women; however, the relationship between AT inflammation and S(I) was stronger in white compared to black women. Further research is required to explore other factors affecting S(I) in black populations. Contrary to our original hypothesis, gluteal SAT had a greater inflammatory gene expression profile than abdominal SAT depots. The protective nature of gluteo-femoral fat therefore requires further investigation.

Affected by smells? Environmental chemical responsivity predicts odor perception.

Strong negative reactions, physical symptoms, and behavioral disruptions due to environmental odors are common in the adult population. We investigated relationships among such environmental chemosensory responsivity (CR), personality traits, affective states, and odor perception. Study 1 showed that CR and neuroticism were positively correlated in a sample of young adults (n = 101), suggesting that persons high in neuroticism respond more negatively to environmental odors. Study 2 explored the relationships among CR, noise responsivity (NR), neuroticism, and odor perception (i.e., pleasantness and intensity) in a subset of participants (n = 40). High CR was associated with high NR. Regression analyses indicated that high CR predicted higher odor intensity ratings and low olfactory threshold (high sensitivity) predicted lower pleasantness ratings. However, neuroticism was not directly associated with odor ratings or thresholds. Overall, the results suggest that CR and odor thresholds predict perceptual ratings of odors and that high CR is associated with nonchemosensory affective traits.

Olfactory working memory: effects of verbalization on the 2-back task.

Working memory for odors, which has received almost no attention in the literature, was investigated in two experiments. We show that performance in a 2-back task with odor stimuli is well above chance. This is true not only for highly familiar odors, as has been shown by Dade, Zatorre, Evans, and Jones-Gotman, NeuroImage, 14, 650-660, (2001), but also for unfamiliar ones that are notoriously difficult to name. We can conclude that information about an olfactory stimulus can be retained in the short term and can continuously be updated for comparison with new olfactory probes along the lines of a functional odor working memory. However, the performance in the working memory task is highly dependent on participants' verbalization of the odor. In addition, results indicated that odor working memory performance is dependent on the ability to discriminate among the odor stimuli (Experiment 2). The results are discussed in relation to recent ideas of a separate olfactory working memory slave system.

Nasal cavity size, airway resistance, and subjective sensation after surgically assisted rapid maxillary expansion: a prospective longitudinal study.

INTRODUCTION: The aims of this study were to measure changes in nasal minimum cross-sectional area and nasal airway resistance after surgically assisted rapid maxillary expansion and to explore a possible correlation with the subjective sensation of nasal obstruction. METHODS: Minimum cross-sectional area and nasal airway resistance were measured in 39 consecutive patients treated with surgically assisted rapid maxillary expansion. Subjective nasal obstruction was assessed by a questionnaire at pretreatment and at 3 and 18 months postoperatively. RESULTS: Subjective nasal obstruction had improved significantly by 3 months postoperatively. Minimum cross-sectional area increased and nasal airway resistance decreased. No correlations were found. In subjects with pretreatment subjective nasal obstruction and initially narrow anterior minimum cross-sectional area, there was a significant correlation between a moderate increase in anterior minimum cross-sectional area and improvement in perceived nasal obstruction. Eighteen months postoperatively, no changes were found from pretreatment values for subjective nasal obstruction, minimal cross-sectional area, or nasal airway resistance, and there were no correlations. Subjects with a sensation of nasal obstruction at treatment start reported a lasting significant subjective improvement. CONCLUSIONS: The postoperative effects of surgically assisted rapid maxillary expansion did not persist in the long term. No correlation was found between objective and subjective findings. Subjects with pretreatment nasal obstruction, however, reported a lasting sensation of improved nasal function after surgically assisted rapid maxillary expansion.