Ejnar Forchhammer als Siegfried, Rollenbild, in: Richard Wagner: Der Ring des Nibelungen

Signatur des Originals: S 36/F10710

Kurt Christoph Gottfried Sommer als Siegfried, Rollenbild, Kniestück, in: Richard Wagner: Der Ring des Nibelungen

Signatur des Originals: S 36/F11817

Julius Lieban als Mime, Rollenbild, in: Richard Wagner: Der Ring des Nibelungen

Signatur des Originals: S 36/F12383

Mitral valve prolapse and its relationship with stroke

The purpose of this study was to elucidate the relationship between mitral valve prolapse and stroke. A population-based historical cohort investigation was conducted among residents of Olmsted County, Minnesota who had an initial echocardiographic diagnosis of mitral valve prolapse from 1975 through 1989. This cohort (N = 1085) was followed for stroke outcomes using the resources of an operational medical record linkage system. There was an overall two-fold increase in the incidence of stroke among individuals with mitral valve prolapse relative to a standard population (standardized morbidity ratio = 2.12, 95% confidence limits = 1.33-3.21). When the data were partitioned by duration of follow-up from the diagnosis of mitral valve prolapse, or by the calendar years at echocardiographic diagnosis, respectively, the association between mitral valve prolapse and stroke was not modified. Mitral valve prolapse subjects 85 years and older were at highest increased risk of developing strokes relative to the general population (standardized morbidity ratio = 5.47, 95% confidence limits = 2.20-11.24). Coronary heart disease, atrial fibrillation, diabetes mellitus and hypertension, were unlikely to have confounded the association between mitral valve prolapse and stroke.^ The cumulative risk of first stroke among individuals initially diagnosed with mitral valve prolapse age 15 to 64 years, given survival to 15.2 years of follow-up, was 4.0%. The cumulative risk of first stroke among individuals initially diagnosed with mitral valve prolapse age 65 to 74 years, given survival to 11.2 years of follow-up, was 13.2%. The cumulative risk of first stroke among individuals initially diagnosed with mitral valve prolapse age 75 years and older, given survival to 6.7 years of follow-up, was 30.6%.^ Among individuals with mitral valve prolapse, age, diabetes, and atrial fibrillation were associated with an increased risk of stroke. Atrial fibrillation was associated with a four-fold rate of stroke and diabetes associated with a seven-fold rate of stroke.^ Findings from this research support the hypothesis that mitral valvular heart prolapse is linked with a stroke sequela. ^

‘The best thing I’ve ever done is ring these people…’: Making a Difference through Family Support

Effective family support strategies offer early intervention and help for families and children at risk of experiencing social exclusion and maltreatment. This paper reports a study which evaluated client outcomes from participation in an Intensive Family Support Service by comparing views of workers and service users on perceived benefits. It profiles the characteristics and circumstances of families recruited to service, services and interventions delivered and the potential of IFSS to lead to safe and positive outcomes for children and families. Findings discussed highlight the individualized and collaborative approach and the high degree of engagement with service users that facilitated gains in the domains of child and family functioning targeted. Implications of the findings for policy and practice in responding to vulnerable families and children are discussed.