Assessing the consistency of shedder status under various experimental conditions.

Shedder status is defined as the propensity of an individual to leave DNA behind on touched items or surfaces and has been suggested as one of the major factors influencing DNA transfer. However, little is known about whether shedder status is a constant property of an individual across multiple measurements or when the environmental conditions are changed. We have assessed DNA depositions of six males on 20 occasions to acquire a reference data set and to classify the participants into high, intermediate, or low shedders. This data set was also used to investigate how the probability of a correct shedder status classification changed when the number of DNA deposition measurements increased. Individual sweat rates were measured with a VapoMeter and data regarding hygiene routines were collected through a questionnaire on each sampling occasion. Next, we investigated how changes in the experimental conditions such as seasonal variation, hygiene routines, the temperature of the touched object, and repeated handling of an object influenced the DNA shedding. Additionally, we assessed DNA collected from the face and from T-shirts worn by the six participants to explore whether shedder status may be associated with the relative amount of DNA obtained from other body parts. Our results indicate that shedder status is a stable property across different seasons and different temperatures of handled objects. The relative DNA amounts obtained from repeatedly handled tubes, worn T-shirts, and from faces reflected the shedder status of the participants. We suggest that an individual's shedder status is highly influenced by the DNA levels on other body parts than hands, accumulating on the palms by frequently touching e.g., the face or previously handled items harboring self-DNA. Assessing physiological differences between the participants revealed that there were no associations between DNA shedding and individual sweat rates.

Individual shedder status and the origin of touch DNA.

Due to improved laboratory techniques, touched surfaces and items are increasingly employed as sources of forensic DNA evidence. This has urged a need to better understand the mechanisms of DNA transfer between individuals. Shedder status (i.e. the propensity to leave DNA behind) has been identified as one major factor regulating DNA transfer. It is known that some individuals tend to shed more DNA than others, but the mechanisms behind shedder status are largely unknown. By comparing the amounts of DNA deposited from active hands (i.e. used "as usual") and inactive hands (i.e. not allowed to touch anything), we show that some of the self-DNA deposited from hands is likely to have accumulated on hands from other parts of the body or previously handled items (active hands: 2.1 ± 2.7 ng, inactive hands: 0.83 ± 1.1 ng, paired t-test: p = 0.014, n = 27 pairs of hands). Further investigation showed that individual levels of deposited DNA are highly associated with the level of DNA accumulation on the skin of the face (Pearson's correlation: r = 0.90, p < 0.00001 and Spearman's ranked correlation: rs = 0.56, p = 0.0016, n = 29). We hypothesized that individual differences in sebum secretion levels could influence the amount of DNA accumulation in facial areas, but no such correlation was seen (Pearson's correlation: r = - 0.13, p = 0.66, n = 14). Neither was there any correlation between DNA levels on hands or forehead and the time since hand or face wash. We propose that the amount of self-DNA deposited from hands is highly influenced by the individual levels of accumulated facial DNA, and that cells/DNA is often transferred to hands by touching or rubbing one's face.

Pharmacodynamic evaluation of dihydroxyflavone derivate chrysin in a guinea pig model of allergic asthma.

OBJECTIVE: This experimental study evaluated the anti-asthmatic capacity of the dihydroxyflavone chrysin in the settings of ovalbumin (OVA)-induced allergic inflammation. METHODS: The parameters that were used to assess the anti-asthmatic activity of chrysin included the specific airway resistance to histamine, the sensitivity to a chemically induced cough and the activity of chrysin on the ciliary beat frequency (CBF) of the respiratory epithelium. The anti-inflammatory potential was confirmed by the measurement of cytokine concentrations Th2 (IL-4, IL-5 and IL-13), Th1 (Granulocyte-macrophage colony-stimulating factor [GM-CSF], INF-γ and IL-12), leucocyte count in the bronchoalveolar lavage fluid (BALF) and growth factor TBF-ß1 in lung homogenate. KEY FINDINGS: Chronic administration of chrysin (30 mg/kg/day for 21 days) to OVA-sensitised guinea pigs showed bronchodilatory activity comparable to that of long-acting ß 2 receptors agonist (LABA) salmeterol. Chrysin revealed antitussive efficiency but was not able to abolish the negative effect of OVA on CBF. Chrysin managed to ameliorate the progression of chronic airway inflammation by decreasing the count of eosinophils, lymphocytes and basophils, IL-5, L-13, GM-CSF, INF-γ in BALF, and TGF-ß1 in lung homogenate. CONCLUSIONS: The acquired results support the complex anti-asthmatic profile of chrysin. The flavone may represent an attractive compound for further studies concerning the prevention or treatment of asthma.

Enhanced forensic DNA recovery with appropriate swabs and optimized swabbing technique.

Efficient sampling with swabs is crucial for optimal forensic DNA analysis. The DNA recovery is determined by the skill of the practitioner and the compatibility between the applied swab and the surface. Here we investigate the impact of swabbing technique and swab type on the DNA yield. Thirteen different swabs from four categories (cotton, flocked nylon, small foam and large foam) provided equal DNA yields for smooth/non-absorbing surfaces. Large foam swabs gave higher DNA recovery for an absorbing wood surface. Factorial design of experiments and ANOVA was applied to study swabbing techniques for cotton swabs. Two key factors for efficient sampling were found to be 1) holding the swab with an approximate 60° angle against the surface and 2) to rotate the swab during sampling. For absorbing wood, it was beneficial to wet the swab heavily. The results of the factorial experiments were used to develop swabbing protocols for different surfaces. When ten experienced practitioners sampled according to these protocols, the DNA yield was increased for ridged plastic (around 1.25 times more DNA) and absorbing wood (2.2-6.2 times more DNA). For window glass, representing a smooth/non-absorbing surface, sampling according to the protocol gave DNA yields equivalent to applying individual sampling techniques. The protocol lowered person-to-person variation for ridged plastic. In conclusion, we have developed instructive protocols for cotton swab sampling on three types of surfaces: smooth/non-absorbing, ridged/non-absorbing and smooth/absorbing. We believe that such swabbing protocols will streamline and simplify the training of new practitioners and improve sampling efficiency for invisible DNA residues in casework.

Effects of Inhalation of STIM-Orai Antagonist SKF 96365 on Ovalbumin-Induced Airway Remodeling in Guinea Pigs.

Airway remodeling (AR) consists of wall thickening and hyperreactivity. STIM (stromal interaction molecule) and Orai protein pathways mediate extracellular Ca2+ signals involved in AR. This study aims to define the effects on AR of the STIM-Orai antagonist SKF 96365 given by inhalation in three increasing doses in ovalbumin-induced AR. In the control group, the antiasthmatic budesonide and salbutamol were given in the same model. The airway structure was evaluated by histological and immunohistochemistry and reactivity by specific airway resistance, contraction strength of isolated airway smooth muscles, and mucociliary clearance expressed by ciliary beating frequency. The immuno-biochemical markers of chronic inflammation were evaluated by BioPlex and ELISA assays. The AR was mediated by inflammatory cytokines and growth factors. The findings show significant anti-remodeling effects of SKF 96365, which were associated with a decrease in airway hyperreactivity. The anti-remodeling effect of SKF 96365 was mediated via the suppression of IL-4, IL-5, and IL-13 synthesis, and IL-12-INF-γ-TGF-ß pathway. The budesonide-related AR suppression had to do with a decrease in proinflammatory cytokines and an increase in the anti-inflammatory IL-10, with negligible influence on growth factors synthesis and mucous glands activity.

Factors affecting DNA recovery from cartridge cases.

Cartridge cases are often the sole items left behind after a shooting incident and DNA traces from these can identify persons connected to the shooting. However, the chance of retrieving usable DNA profiles from cartridge cases is limited, due to the low amounts of deposited DNA and subsequent DNA loss associated with the firing process. In the current study, we set out to increase the DNA recovery from cartridge cases and cartridges by evaluating different swab types and detergents used for trace collection. A protocol applying nylon-flocked swabs instead of cotton swabs was implemented in casework at the Swedish National Forensic Centre (NFC), increasing DNA yield. The number of samples providing a DNA concentration ≥ 0.001 ng/µL (the in-house cut-off for processing low-template samples) increased from 11.1 to 28.6 % for cartridge cases and from 16.0 to 43.3 % for cartridges. There was also a substantial increase in mixed STR profiles, too complex to use for comparisons. Thus, it was not possible to take the full advantage of the elevated DNA yield provided by nylon-flocked swabs. The number of usable STR profiles increased from 5.0 to 8.0 % for cartridge cases and remained unchanged for cartridges. Controlled studies were performed to assess the impact on the DNA recovery from different persons handling the ammunition, different material and size of the cartridge cases, and the type of firearm used. These studies reflected an ideal situation, where all cartridges were extensively handled and loaded without gloves, thus providing a higher expected DNA yield compared to most casework samples. The total peak height differed by up to a factor of ∼50 when 20 different persons handled cartridges prior to shooting. By evaluating eleven combinations of different firearms and ammunition, it was found that the casing material and type of firearm also have a substantial impact on DNA yield.

The double-swab technique versus single swabs for human DNA recovery from various surfaces.

Most crime scene DNA evidence is retrieved using cotton swabs. Since the late 90's, the double-swab technique has been favoured by many practitioners throughout the world. However, the superiority of double-swabbing over applying single wet swabs has not been broadly verified. Here we set out to evaluate the need for the second dry swab for various surfaces, aiming at mimicking the range of surfaces encountered at crime scenes: flat and ridged, absorbing and non-absorbing. For the tested non-absorbing surfaces, i.e., window glass, steel, brass, synthetic leather and ridged plastic, the first wet swabs gave at least 16 times higher DNA yields compared to the second dry swabs. In addition, second wet swabs gave more DNA than second dry ones, opposing the common notion that the purpose of the second swab is to absorb excess liquid. When ten experienced staff members sampled saliva stains on a window glass surface the variation between persons was considerable, with mean DNA yields for the first wet swabs ranging from 0.045 ± 0.022 to 0.13 ± 0.024 ng/µL. The first wet swabs gave 4-162 times more DNA than the second dry swabs, with higher DNA amounts on second swabs coinciding with lower amounts for first swabs. We show that for non-absorbing surfaces, the first wet swab takes up most of the cells in dried stains, making it less valuable to apply a second dry swab. The differences in DNA recovery between first and second swabs were notable also for absorbing surfaces. Double-swabbing may be preferable for some complex surfaces, but focusing on efficient sampling technique with single wet swabs is likely a better general approach.

Feasibility and Effects of a Nursing Intervention for Patients with Peripheral Vestibular Disorders.

PURPOSE: To explore the feasibility and possible outcomes of a nursing intervention in patients with peripheral vestibular disorders. DESIGN: A randomized controlled trial (RCT). METHODS: Thirty-six patients participated in the study: the intervention group (n = 18), who received the intervention, and patients in a control group (n = 18), who received standard care. The intervention includes patient education and individualized nursing support during a 6-month rehabilitation period. Outcomes were symptoms, well-being, sense of coherence, and self-care measured at baseline before randomization and at 6 and 9 months later. FINDINGS: At the 9-month follow up, the patients who received the intervention rated significantly fewer vertigo-related symptoms and a higher sense of coherence than the control group. CONCLUSION: The intervention was feasible and seems to support the patients to manage symptoms, but confirmative studies are warranted. CLINICAL RELEVANCE: Patient education in combination with individual support may be beneficial to help patients with peripheral disorders during their rehabilitation.

Assessing patient outcomes and cost-effectiveness of nurse-led follow-up for women with breast cancer - have relevant and sensitive evaluation measures been used?

AIMS AND OBJECTIVES: To explore how interventions using nurse-led follow-up in breast cancer care have been evaluated with a focus on patient outcomes and cost-effectiveness. BACKGROUND: As part of the advancement of breast care, nurse-led follow-up is increasingly used as an alternative to routine hospital follow-up in outpatient clinics. There is evidence suggesting that patients appear to be satisfied with the nurse-led follow-up, but there is a lack of evidence of whether this perception equates to patients' satisfaction with the model of physician-led follow-up. DESIGN: Systematic review. METHOD: Three databases were searched, and 29 RCT were initially screened. Finally, 13 articles were critically appraised. Searches included articles between 2005-2013. The quality of appraisal assessment was inspired by the GRADE system. RESULTS: The results show that there are many different instruments used when evaluating nurse-led follow-up, which makes it difficult to compare the studies. Several of the studies used QoL as an outcome measure; this is a broad concept that includes several aspects ranging from social role and psychosocial issues to symptoms and therefore difficult to use as an outcome measure. Only two of the studies made any cost-effective analyses, and the results are hard to interpret. CONCLUSIONS: Nurse-led follow-up can potentially result in better continuity of care and the availability of more time to provide psychosocial support and address patients' information needs. However, more well-conducted research is needed before equivalence to physician-led follow-up can be assessed in terms of survival, recurrence, patient well-being and cost-effectiveness. RELEVANCE TO CLINICAL PRACTICE: Results from well-conducted evaluation studies of nurse-led services based on theory are needed so that relevant interventions can be implemented in clinical practice. There is a need to in future studies include cost-effectiveness analyses to compare nurse-led services with other types of follow-up.

High-throughput DNA extraction of forensic adhesive tapes.

Tape-lifting has since its introduction in the early 2000's become a well-established sampling method in forensic DNA analysis. Sampling is quick and straightforward while the following DNA extraction is more challenging due to the "stickiness", rigidity and size of the tape. We have developed, validated and implemented a simple and efficient direct lysis DNA extraction protocol for adhesive tapes that requires limited manual labour. The method uses Chelex beads and is applied with SceneSafe FAST tape. This direct lysis protocol provided higher mean DNA yields than PrepFiler Express BTA on Automate Express, although the differences were not significant when using clothes worn in a controlled fashion as reference material (p=0.13 and p=0.34 for T-shirts and button-down shirts, respectively). Through in-house validation we show that the method is fit-for-purpose for application in casework, as it provides high DNA yields and amplifiability, as well as good reproducibility and DNA extract stability. After implementation in casework, the proportion of extracts with DNA concentrations above 0.01ng/µL increased from 71% to 76%. Apart from providing higher DNA yields compared with the previous method, the introduction of the developed direct lysis protocol also reduced the amount of manual labour by half and doubled the potential throughput for tapes at the laboratory. Generally, simplified manual protocols can serve as a cost-effective alternative to sophisticated automation solutions when the aim is to enable high-throughput DNA extraction of complex crime scene samples.

Effects of preventive home visits by district nurses on self-reported health of 75-year-olds.

AIM: The aim of this study was to analyse the effects of preventive home visits (PHVs) by district nurses (DNs) on the self-reported health of 75-year-olds, including changes in self-reported health after the visits. The study also investigated whether or not the participants believed the visit was useful. BACKGROUND: There is a need for methods that promote health among older persons so that they can remain healthy as long as possible. One such method is PHVs. In Sweden, the Stockholm County Council decided to implement such visits to 75-year-olds. METHODS: The study was a cluster-controlled trial carried out in Stockholm. Sixteen healthcare centres (HCCs) were randomly selected from five geographic medical areas in the county. Eight were assigned to the study group (SG) and eight to the control group (CG). The 75-year-olds registered at these centres (SG n=176, CG n=262) filled in a questionnaire before and after the intervention. Each SG member received a PHV from a DN, and the CG was treated as usual. FINDINGS: At follow-up, both the groups reported decreased health and well-being. However, the SG reported a significant reduction in pain as an effect of the PHV. Participants in the SG reported increased knowledge of local community and county council services, more contacts with their HCCs and increased use of medication. The PHV had no effect on health behaviour. The CG reported significantly more problems in the categories of activities of daily living (ADL) and breathing/circulation. Eighty-four per cent of the participants reported that the PHV was somewhat useful, useful or very useful.

Views concerning patient dignity among relatives to patients experiencing psychosis.

BACKGROUND: Mental illness influences not only the suffering patient but often changes family life forever and results in experience of reduced dignity for both patients and relatives. AIM: The aim of this study was to reveal relatives' opinions regarding what is important for taking care of patients' dignity. PARTICIPANTS: Thirteen relatives of patients experiencing psychosis were recruited through a relatives' user organisation. RESEARCH DESIGN: The methodological approach is Q methodology. A Q sample of 51 statements was sorted in a quasinormal distribution curve. Postinterviews were conducted with all participants. RESULTS: Four viewpoints emerged described as 'value based', 'expectations', 'asymmetric' and 'nuanced'. CONCLUSION: Focus on overarching values such as honesty and respect, to involve patients and relatives in care, by reducing asymmetry between patients and staff, with staff taking total responsibility for a patient's situation when needed, all represent aspects of taking care of patient dignity.

Capitalizing on synergies-a discourse analysis of the process of collaboration among providers of integrative health care.

BACKGROUND: Integrative health care (IHC) combines therapies and providers from complementary and conventional health care. Previous studies on IHC have shown power relations between providers but few studies have explored how the interaction develops over time. The objective of this study was to explore the development of IHC collaboration and interaction among participating providers during a series of consensus case conferences for managing patients with back and neck pain. METHODS: This qualitative study was conducted within a pragmatic randomized controlled clinical trial in primary care. Patients' treatment plans were developed based on IHC provider consensus conferences (n = 26) of which 15 (5 of the first, 5 in the middle, and 5 of the last in the clinical trial) were selected for analysis. Findings were derived by means of discourse analysis, focusing on the participants' use of subject positions during the conferences. FINDINGS: The IHC team in this study gradually formed a group identity, moving their subject positions from individual treating subjects to members of a team and were able to make consensus-based decisions about patients' individual treatment plans. In the discourse, the IHC team identified collaborative shortcomings and problematized the provision of IHC. They were able to capitalize on the synergies in their collaboration and developed a shared vision of IHC provision. CONCLUSIONS: The process of IHC collaboration involved the gradual formation of an IHC team identity, which facilitated interdisciplinary, non-hierarchical consensus-based decision-making in the team. The discourse further suggests that a reform of some legal and organizational health sector barriers might be needed to realize sustainable implementation of IHC services in Sweden.

Patients Experience High Levels of Anxiety 2 Years Following Aneurysmal Subarachnoid Hemorrhage.

OBJECTIVE: To explore anxiety levels during the first 2 years after rupture of aneurysmal subarachnoid hemorrhage. METHODS: A consecutive sample of patients with aneurysmal subarachnoid hemorrhage (aSAH) (n = 88, 84.6% of eligible) from a Swedish neurosurgical clinic were followed-up with a prospective cohort design at 3 time points; 6 months, 1 year, and 2 years after the onset. Data were collected by postal questionnaires and telephone interviews: State trait anxiety inventory, Hospital anxiety and depression scales, Barthel index, Telephone interview for cognitive status, and a set of study-specific questions. RESULTS: Most of the respondents scored above the State trait anxiety inventory Swedish norm value on anxiety levels at all 3 follow-up time points. About 59% (n = 52) of respondents scored above the cutoff value for clinical significant level of anxiety in at least 1 time point during the first 2 years after rupture of aSAH. There were no significant differences in levels of anxiety versus the observational period and the 3 follow-up time points. The most significant explanatory variable to high levels of anxiety at all 3 follow-up time points was low perceived recovery. CONCLUSIONS: Levels of anxiety remained high and stable throughout the first 2 years after rupture of aSAH. High levels of anxiety may reduce health-related quality of life substantially. Identification of individuals with high levels of anxiety and supportive care could therefore potentially improve long-term outcome.

Suffering related to dignity among patients at a psychiatric hospital.

This article discusses dignity from a Q-methodological study among patients at a psychiatric hospital. The aim of this study is to gain a deeper understanding of the subjective experiences of patients in a psychiatric hospital with respect to dignity. A Q-sample of 51 statements was developed. A total of 15 participants ranked these statements from those they most agreed with to those they most disagreed with. Post-interviews were also conducted. Principal Component Factor Analysis and varimax rotation followed by hand rotation produced the clearest results. Four different viewpoints emerged: being met as equal human being, experience of dignity despite suffering, suffering due to inferior feelings and suffering and fighting for one's own dignity. There seem to be variations in those with dignity-promoting experiences in Viewpoint 1 and to some extent in Viewpoint 2, to those with dignity-inhibiting experiences in Viewpoints 3 and 4.

Transitional experiences in patients following intracranial aneurysm rupture.

AIMS AND OBJECTIVES: To describe changes and transitions in everyday life in the first two years following an intracranial aneurysm rupture. BACKGROUND: An intracranial aneurysm rupture causes a haemorrhagic stroke, and the physical and mental consequences of this condition are numerous and complex. In Sweden, some, but not all, patients receive rehabilitation for this condition. Patients with this type of stroke are not included in the national stroke registry; thus, information on the recovery period for these particular patients is lacking. DESIGN: A longitudinal mixed methods study design was used. METHODS: The sample was consecutive and consisted of 88 patients (84·6% of 104 eligible), acutely admitted to a neurosurgical clinic in Stockholm for intracranial aneurysm rupture. Data were collected through a postal study-specific questionnaire at 6 months, 1 year and 2 years postaneurysm rupture. Intramethod mixing was used in the data collection, and quantitative and qualitative data were analysed parallel with statistical and qualitative content analysis. RESULTS: A majority of participants perceived changes in their everyday lives during the first two years following aneurysm rupture, and the changes were ongoing with little differences reported between 6 months and 2 years after the onset. Internal changes, or transitions, were revealed within changes in personality, changed social roles and relationships and changed abilities and behaviour. CONCLUSIONS: Recovering from an intracranial aneurysm rupture involves a period of intense changes and transitions, a vulnerable period for many people that may be made easier to manage by the intervention of nurses. RELEVANCE TO CLINICAL PRACTICE: Patients experiencing transitions in the recovery period after intracranial aneurysm rupture may benefit from nursing interventions that support them through the transitional process. Nurse-led follow-up care by a specialist nurse from the neurosurgical clinic may be a possible way to provide support.

Cognitive, physical, and psychological status after intracranial aneurysm rupture: a cross-sectional study of a Stockholm case series 1996 to 1999.

OBJECTIVE: We sought to (1) describe psychological, physical, and cognitive functions in patients 10 years after intracranial aneurysm rupture and (2) identify any differences in outcome variables between age groups, gender or aneurysm locations. METHODS: A consecutive sample of patients (n=217) treated for intracranial aneurysm rupture at a neurosurgical clinic in Stockholm, Sweden, were followed-up in a cross-sectional design 10.1 years after the onset with questionnaires and telephone interviews. The outcome measures were psychological functions in terms of symptoms of anxiety or depression and physical and cognitive functions. RESULTS: Compared with the reference groups, the aneurysm patients scored greater levels of anxiety and depression than normal values. Patients with aneurysm rupture in the posterior circulation scored significantly more problems with anxiety and depression. Only 2.8% of the patients scored for severe physical disability. On a group level, cognition was lower than normal population levels; 21.7% of respondents scored below the cut-off value, indicating cognitive impairments. CONCLUSIONS: Ten years after aneurysm rupture the majority of patients seem to be well-functioning physically, whereas the psychological and cognitive functions are affected. A screening of the mental health of these patients in connection to radiological follow-up might be helpful to identify which patients need further referral to psychiatric treatment for anxiety and depression disorders.

Descriptive epidemiology in relation to gender differences and treatment modalities 10 years after intracranial aneurysm rupture in the Stockholm cohort 1996-1999.

OBJECTIVE: To describe epidemiology in relation to gender differences and treatment modalities 10 years after intracranial aneurysm rupture in the Stockholm cohort 1996-1999. METHODS: A total of 468 consecutive patients with aneurysmal subarachnoid hemorrhage were followed-up in a retrospective cohort design 10 years after rupture. Information on medical history, clinical variables, and treatments were obtained from patient records. Causes of death were obtained from patient records and The Swedish Cause of Death Register. Incidence of ruptured aneurysms per 100,000 people were calculated from male, female, and overall population data per year from 1996-1999. RESULTS: Ten years after aneurysm rupture 63.9% (n = 296) of patients were still alive. The overall 28-day case fatality was 19.4%; most often deaths were due to the initial hemorrhage. There were no significant differences in survival time between patients treated with clipping (8.4 years, 95% confidence interval 8.1-8.8), compared with endovascularly treated patients (8.2 years, 95% confidence interval 7.4-9.1) (log rank P = 0.550). The female incidence was higher than that of men, and women were significantly older at the onset of aneurysm rupture (55.7 vs. 52.8 years, P = 0.027). CONCLUSIONS: Ten years after rupture, most treated patients were still alive. The mortality was highest in the first month after rupture, due to the initial hemorrhage. Gender differences were apparent in incidence, but 10 years after the rupture mortality rates and survival times were equal between men and women. Survival time was equal between patients within active treatment modalities.

Health-related quality of life 10 years after intracranial aneurysm rupture: a retrospective cohort study using EQ-5D.

BACKGROUND: Experiencing an aneurysmal subarachnoid hemorrhage (SAH) could affect health-related quality of life (HRQoL) several years after the onset. Long-term studies are scarce, and there is a lack of knowledge of whether HRQoL is affected > 5 years after the onset and, if so, in what dimensions. In the general population, HRQoL decreases with age and with the occurrence of a disease and differs between sexes. Factors that may influence HRQoL after aneurysmal SAH include neurological outcome, perceived recovery, aneurysm treatment, and family support. OBJECTIVE: To measure HRQoL and to explore factors affecting HRQoL 10 years after aneurysmal SAH. METHODS: A consecutive sample of all patients admitted for intracranial aneurysm rupture at a neurosurgical clinic in Stockholm (n = 217, 79.5% of eligible) were followed up from 2007 to 2008, approximately 10 years after aneurysm rupture. HRQoL was measured with EQ-5D, and the results were compared with a general population sample from the Stockholm Public Health Survey 2006 matched by age and sex. RESULTS: Compared with the general population, the aneurysm sample reported significantly more problems in 4 of 5 EQ-5D dimensions-mobility, self-care, usual activities, and anxiety/depression-and had significantly lower EQ-5Dindex and EQ visual analog scale values. Within the aneurysm sample, HRQoL was most affected in respondents with worse Glasgow outcome scale values at hospital discharge, respondents with comorbidities, and respondents with low perceived recovery. CONCLUSION: Aneurysmal SAH affects HRQoL to a large extent, even 10 years after the onset, indicating a need for long-term follow-up and support after the onset.

Risk attitude and preferences in person's hypothetically facing open repair of abdominal aortic aneurysm.

The aim of this study was to describe risk attitude and preference for treatment using a proxy measurement of a general population sample hypothetically facing treatment for open repair (OR) of abdominal aortic aneurysm (AAA). In a telephone interview, a standard gamble (SG) and a time trade-off (TTO) question were asked to elicit risk attitude and preference for treatment in a general population sample of 200 persons, stratified in four age groups. When facing the two questions of (1) either live a shorter life without an AAA compared to a longer life with an AAA (TTO) or (2) taking a risk of living with AAA compared to taking the risk with surgical treatment (SG), the oldest age group was neither willing to live a shorter life without AAA, nor willing to take a risk with surgical treatment to the same extent as the younger age groups: age 50-59 (TTO P = 0.03, SG P = < 0.001), age 60-69 (TTO P = 0.01, SG P = < 0.001), age 70-79 (TTO P = 0.02, SG P = 0.002). These results suggest that persons in the age groups over 80 years old in the general population sample are more inclined to go on living with an AAA without taking the immediate risk associated with OR as well as the postoperatively impaired health-related quality of life (HRQL). Preference for treatment in different age groups is important to consider during the decision-making process, especially for patients over 80 years old. Patient education about treatment options, specific risks as well as postoperative impairment of HRQL is necessary in this process.