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Aim: To explore factors associated with one-year mortality risk after hip fracture among very old adults (85 +) in Northern Sweden.

Methods: This cohort study includes data derived from Umeå 85 + /Gerontological Regional Database (GERDA), encompassing a representative sample of those aged 85, 90 and ≥ 95 years in Northern Sweden. Data were assessed during home visits and interviews conducted between 2000 and 2017. Associations of baseline characteristics with hip fracture during a follow-up period of 5 years and one-year mortality were analyzed using Cox proportional hazards regression.

Results: Of 1,277 participants, 184 (14.4%) sustained a hip fracture during follow-up, of whom 47.8% died within 1 year of the fracture. Among those with hip fracture, 65% were women. Increased 1-year mortality risk was associated with the presence of depressive disorders (hazard ratio, HR 2.55, 95% confidence interval 95%CI, 1.32–4.93), history of stroke (HR 2.34, 95%CI 1.17–4.66) and subtrochanteric fractures (HR 4.40, 95%CI 1.73–11.21). Conversely, obesity (HR 0.26, 95%CI 0.10–0.67) was associated with reduced mortality risk.

Conclusion: Nearly half of all very old adults sustaining a hip fracture die within 1 year. Depressive disorders, history of stroke and subtrochanteric fractures were identified as significant predictors of increased mortality, whereas obesity appeared to mitigate mortality risk. These findings underscore the need for targeted interventions to manage these risk factors in hip fracture patients very old adults.

How the brain generates conscious experiences remains profoundly mysterious. Pharmacological interventions that alter the state of consciousness have been proposed as a tool to investigate the neural mechanisms of consciousness. However, we have recently demonstrated that the sedative Propofol influences both conscious and unconscious neural processing. Altered arousal, and other pharmacological effects, therefore cannot be assumed a priori to provide information specifically on conscious neural processes. Instead, effects on both conscious and unconscious processes need to be considered. Here we investigated the role of noradrenergic activity in conscious and unconscious visuospatial processing. In Study 1 we used Dexmedetomidine, a sedative that specifically targets α2A noradrenergic receptors. In Study 2, we used sleep deprivation as a natural state of altered arousal, which exerts partially overlapping effects on noradrenaline levels. Unlike Propofol, both Dexmedetomidine and sleep deprivation selectively altered brain activity (fMRI BOLD signal change) during conscious processing. However, the two methods produced distinct effects on visuospatial bias during low arousal: while Dexmedetomidine reduced leftward bias, sleep deprivation increased leftward bias. These differential effects on spatial bias were explained by an unexpected increase in sympathetic drive, as indexed by increased activity in the central autonomic network and in heart rate, from sleep deprivation, that indicate increased rather than decreased noradrenaline levels during task performance. Together, these findings emphasize noradrenergic activity as a target for pharmacological manipulations of consciousness, which could open a window to its neurophysiological underpinnings.

BACKGROUND: Femoral neck fractures (FNF) are a severe and common injury that affect older adults physically, psychologically, and socially. Variation in the trajectory of recovery remains underexplored. This study was conducted to investigate older adults' recovery experiences during the first year after FNF.

METHOD: This longitudinal interview-based study was conducted with 13 participants aged ≥75 years with FNF who were admitted to the orthopedics wards of two hospitals in Sweden. Semi-structured interviews were conducted with participants at 1, 4, and 12 months after fracture. Reflexive thematic analysis of the interview transcripts was performed.

RESULTS: Participants described their recovery after FNF as a complex and non-linear journey. Four interrelated themes were identified as key aspects influencing recovery during the first year after FNF: engagement in daily activities, fear of falling, family members' bridging of the support gap, and striving for independence. Recovery was represented as a fluctuating personal experience that evolves over time.

CONCLUSION: Recovery after FNF extends beyond physical healing, encompassing emotional adjustment and social reintegration. The understanding of recovery as an evolving and individualized process highlights the need for follow-up and rehabilitation strategies that address not only functional outcomes, but also patients' confidence, motivation, and support in daily life.

Depressive disorders are characterized by heterogeneous symptoms and variable treatment response. Current interventions primarily aim to manage symptoms, yet their effectiveness remains limited. This highlights the need for early neurobiological markers to improve understanding of depression pathophysiology and guide treatment development. In this study, 38 healthy participants aged 18–40 years (21 females and 17 males) completed the self-report version of the Montgomery-Åsberg Depression Rating Scale (MADRS-S), followed by proton magnetic resonance spectroscopy (1H-MRS) data acquisition from the anterior cingulate cortex (ACC). Spectra were acquired from the dorsal (dACC) and pregenual (pgACC) subdivisions, and analyses focused on metabolite levels of γ-aminobutyric acid (GABA), glutamate + glutamine (Glx), total N -acetyl aspartate (tNAA), and total creatine (tCr). Simple and multiple linear regression analyses, controlling for age, sex, tobacco use, and alcohol consumption, revealed a negative association between depressive symptom scores and tNAA/tCr levels in both the pgACC and dACC. However, no significant associations were observed for GABA/tCr or Glx/tCr. These findings suggest that reduced tNAA/tCr levels in the dACC and pgACC may be associated with depressive symptom severity in non-clinical individuals. Given that tNAA reflects neuronal integrity and mitochondrial function, its reduction may reflect early neuronal and metabolic variation associated with depressive symptom scores. Thus, tNAA may represent an in vivo biomarker for early affective vulnerability, potentially enabling detection of depressive symptom scores in healthy individuals.

Background: Individuals with a restrictive spirometric pattern have a high burden of cardiovascular and metabolic morbidity.

Objective: To assess prevalence of elevated cardiac biomarkers among individuals with a restrictive spirometric pattern compared to those with a normal lung function and to evaluate the association between cardiac biomarkers and mortality.

Methods: In 2002–04, individuals with airway obstruction were identified from population-based cohorts, together with age- and sex-matched non-obstructive referents. The analysis population consisted of the non-obstructive referents stratified according to whether they had a restrictive spirometric pattern or normal lung function in whom cardiac biomarkers were measured. Deaths were recorded until 31 December 2010.

Results: Participants with a restrictive spirometric pattern were older and more likely to be obese with a higher burden of cardiovascular risk factors than those with normal function. Elevated cardiac troponin but not natriuretic peptide levels were more common in those with a restrictive spirometric pattern independent of age, sex, BMI, or risk factors (adjusted OR 1.8, 95% CI 1.29–2.74). At 5 years, death occurred more frequently in participants with restrictive spirometric pattern compared to those with normal function (15.7% [31/197] versus 7.6% [57/751]), with highest mortality rate in those with restriction and elevated cardiac troponin (28.7% [27/94]). Cardiac troponin was independently associated with death among those with a restrictive spirometric pattern (HR 4.91, 95% CI 1.58–15.26) but not in those with normal lung function.

Conclusion: Cardiac troponin was elevated more often in people with a restrictive spirometric pattern in whom it was a strong independent predictor of death.

In vivo proton magnetic resonance spectroscopy is a non-invasive technique used to measure biochemical molecules such as choline, glutamate, glutamine, and γ-Aminobutyric acid (GABA), many of which are relevant to anxiety and pain. However, the relationship between these neurotransmitters/metabolites and their implications for anxiety and subjective experience of pain is not yet fully understood. The objective of this cross-sectional study was to investigate the association between anxiety and pain ratings with levels of total choline, glutamate and GABA in brain regions known to be involved in anxiety and emotional experience of pain, specifically pregenual anterior cingulate cortex (pgACC) and dorsal anterior cingulate cortex (dACC). The levels of the neurotransmitters/metabolites were measured using GABA-edited Mescher–Garwood PRESS for GABA measurements, with the OFF-sequence measurements for total choline (tCho) and Glx (combined glutamate + glutamine). The total choline (tCho) signal in our analysis included glycerophosphocholine (GPC) and phosphocholine (PC), which is consistent with standard practices in MRS studies. This approach ensures a robust estimation of tCho concentrations across participants. The study collected data from 38 participants (17 males and 21 females). The analysis revealed a significant correlation between anxiety ratings before a standardized pain provocation and the rated pain unpleasantness during the pain provocation. tCho correlated negatively with these parameters in pgACC. A linear regression analysis indicated that tCho levels in pgACC have a significant negative association with anxiety and perceived pain when controlling for age, depressive symptoms, and alcohol and tobacco intake. We also found that sex significantly moderates the relationship between pgACC choline levels and pain unpleasantness. The study suggests that levels of choline, an essential precursor of acetylcholine, are associated with anxiety and perceived pain. These levels may influence how Glx and GABA contribute to affective pain experiences by modulating the balance between excitatory and inhibitory signals. However, future research is needed to identify the mechanisms involved. Furthermore, the study indicates that sex is a significant factor in this relationship, with lower choline levels being associated with higher pain ratings in females but not in males. This highlights the significance of addressing sex as a biological factor in pain research to better understand the different responses to treatments and to facilitate the development of more effective interventions in the future.

Background: MR-generated acoustic noise may be particularly concerning at 7-Tesla (T) systems. Noise levels can be reduced by altering gradient output using software optimization. However, such alterations might influence image quality or prolong scan times, and these optimizations have not been well characterized.

Purpose: To evaluate image quality, sound pressure levels (SPLs), and perceived noise levels when using the acoustic noise reduction technique SofTone for T2-weighted fast spin echo (T2W FSE) and three-dimensional T1-weighted turbo field echo (3D T1W TFE), and to compare with conventional imaging during 7-T brain MRI.

Study Type: Prospective.

Subjects: Twenty-eight volunteers underwent brain MRI, with n = 26 for image quality evaluations.

Field Strength/Sequence: Conventional and SofTone versions of T2W FSE and 3D T1W TFE at 7 T.

Assessment: Peak SPLs (A-weighted decibels, dBA), participant-perceived noise levels (Borg CR10-scale), qualitative image assessments by three neuroradiologists (four-graded ordinal scales), interrater reliability, and percentage agreement.

Statistical Test: Paired t-test, Wilcoxon's Signed-Rank Test, and Krippendorff's alpha; p < 0.05 were considered statistically significant.

Results: SofTone significantly reduced peak SPLs: from 116.3 to 97.0 dBA on T2W FSE, and from 123.7 to 101.5 dBA on 3D T1W TFE. SofTone was perceived as significantly quieter than conventional scanning. T2W FSE showed no significant differences in image quality assessments (p = 0.21–1.00), except one radiologist noting significantly less artifact interference with SofTone. General image quality remained acceptable for 3D T1W TFE, though one radiologist scored it significantly lower with SofTone (mean scores: 3.08 vs. 3.65), and two radiologists observed significantly worse white and gray matter differentiation with SofTone (mean scores: 3.19 vs. 3.54; 2.27 vs. 2.81). Data Conclusion: SofTone can significantly reduce sound intensity and perceived noise levels while maintaining acceptable image quality with T2W FSE and 3D T1W TFE in brain MRI. It appears to be an effective tool for providing a safer, quieter 7-T scan environment. Evidence Level: 4. Technical Efficacy: Stage 5.

Patients undergoing anesthetic surgery are treated postoperatively in a Post-Anesthesia Care Unit (PACU). Traditional planning methods often fail to account for the complexity of patient data. This study aims to develop a machine learning (ML) tool to predict PACU-care times and to improve patient throughput. By integrating local-explanation models, we seek to gain clinical acceptance by providing insights into individual predictions. The project utilizes data from over 84,000 patients, including more than 170 variables.

Background: In the perioperative care of individuals with obesity, it is imperative to consider the presence of risk factors that may predispose them to complications. Providing optimal care in such cases proves to be a multifaceted challenge, significantly distinct from the care required for non-obese patients. However, patients with morbidities regarded as self-inflicted, such as obesity, described feelings of being judged and discriminated in healthcare. At the same time, healthcare personnel express difficulties in acting in an appropriate and non-insulting way. In this study, the aim was to analyse how registered nurse anaesthetists positioned themselves regarding obese patients in perioperative care.

Methods: We used discursive psychology to analyse how registered nurse anaesthetists positioned themselves toward obese patients in perioperative care, while striving to provide equitable care. The empirical material was drawn from interviews with 15 registered nurse anaesthetists working in a hospital in northern Sweden.

Results: Obese patients were described as “untypical”, and more “resource-demanding” than for the “normal” patient in perioperative care. This created conflicting feelings, and generated frustration directed toward the patients when the care demanded extra work that had not been accounted for in the schedules created by the organization and managers.

Conclusions: Although the intention of these registered nurse anaesthetists was to offer all patients equitable care, the organization did not always provide the necessary resources. This contributed to the registered nurse anaesthetists either consciously or unconsciously blaming patients who deviated from the “norm”.

Background: The use of information communication technologies such as telemedicine has increased over the years, offering access to specialized healthcare even in remote locations. However, telemedicine in interprofessional team training is seldom included in medical or nursing programs, and little is known about how to practise these scenarios. This study aimed to explore how medical and nursing students experience teamwork when one team member is participating remotely and digitally.

Methods: Following interprofessional team training in which one team member participated remotely, focus group interviews were conducted with three teams, each comprising one medical student and two nursing students (n = 9 students in total). The focus group interviews were analysed with thematic content analysis. The Systems Engineering Initiative for Patient Safety model was applied as a theoretical framework and served as a lens in the analysis.

Results: Three themes were identified in the analysis: challenging the dynamic of leadership, becoming familiar with a new setting, and finding new strategies to communicate.

Conclusions: The results of this study suggest that future physicians and nurses need to enhance their knowledge of practicing teamwork through telemedicine during their education, as the use of telemedicine continues to grow.