| 1. |
- Abu-Zidan, Fikri M.
(författare)
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Role of platelet-activating factor in sepsis and shock : an experimantal study
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objectives: To study the role of platelet-activating factor (PAF) on cardiovascular and pulmonary dysfunction in sepsis and shock.Design: Experimental study. Setting: Trauma research unit, university department of surgery, Sweden.Material: 76 juvenile domestic pigs. Interventions: The effects of a specific PAF receptor antagonist (BB-882) on haemodynamics and on PAF-induced haemodynamic changes were studied (n = 16). BB-882 was given as pretreatment in non-hypotensive Escherichia coli endotoxaemia (n = 9), during resuscitation after severe haemorrhagic shock (n = 7), hefore post-ischaemic shock which was induced by clamping the aorta above the coliac axis for 45 minutes (n = 8), and as pretreatment in post-haemorrhage septic shock: (n = 6). BB~882 groups were compared with controi groups having the same number of animals which received vehicle instead.Major outcome measures: Heart rate, intravascular pressures, cardiac output, pulmonary and systemic vascular resistance, arteriai blood gas tensions, lung thorax compliance, serum lactic acid and blood sugar concentrations, and packed cell volume.Results: BB-882 effectively counleracted the PAF-induced response on the mean systemic and pulmonary arteriai pressures. lt reduced the rise in pulmonary and systemic vascular resistance and improved the cardiac output in non-hypotensive and post-haemorrhage septic shock when given as pretreatment. lt reduced the hypertension in non-hypotensive sepsis and the hypotension in post-haemorrhage septic shock. BB-8B2 did not infiuence the endotoxin-induced hypoxia or reduced lung thorax compliance in non-hypotensive sepsis and post-haemorrhage septic shock. It did not improve the mean arterial pressure or the cardiac output in haemorrhagic shock alone but it reduced the systemic vascular resistanc'e and was associated with tachycardia and acidosis. It did not affect the post-ischaemic shock after clamping the aorta.Conclusion: PAF is a major mediator of the cardiovascular, but not pulmonary dysfunction in sepsis whether associated with shock or not, while its role on the cardiovascular dysfunction in haemorrhagic and post-ischaemic shock is small.
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| 2. |
- Alexandersson, Kristina
(författare)
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Sickness absence in a Swedish county : with reference to gender, occupation, pregnancy and parenthood
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The occurrence of sickness absence in relation to gender, occupation, age, pregnancy and parenthood was analysed in a Swedish county. Data on all new sick-leave spells exceeding 7 days in the county of Östergötland (400,000 inhabitants) were recorded in 1985-1987. Information on diagnoses, occupation, age, gender, number of children etc. for each of the 45,000 persons sicklisted/year were included in the database. Incidence measures were obtained using census data as denominator.The largest and most consistent variation in occurrence of sickness absence concerned occupation and gender, When categorising the occupations according to degree of gender-segregation, women in the extremely maledominated group (>90% men) had exceptionally high sick-leave rates, while both men and women in the group of gender-integrated occupations had significantly lower sick-leave rates. These variations with male-and female domination of occupational groups were found for sickness absence in general as well as for sick-leave due to pregnancy-related diagnoses. Men with custody of young children had the lowest sickness absence, young women in the same situation the highest, while there were no gender differences in persons without young children. Sickness absence due to pregnancy-related diagnoses varied to a large degree with occupation, but was still high in occupations with a generally low sickness absence, and increased much more than in any otherdiagnostic group over the three years. About half of the gender differences in sickness absence could be explained by sickness absence among pregnant women.In conclusion, the occurrence of sickness absence was associated with gender, age, occupation, gender segregation of occupation, pregnancy and parenthood. Further research should focus on etiological studies and intervention trials.
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| 3. |
- Almer, Sven, 1953-
(författare)
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Ulcerative colitis : Imaging of inflammation
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Ulcerative colitis is a chronic inflannnatory disorder of unknown origin engaging the large bowel. Based on the need for accurate assessment of inflammation, three different non-invasive techniques, two leukocyte scintigraphy techniques and one radiological method, were evaluated in the assessment of active inflammation in altogether 131 patients with ulcerative colitis. Results were compared to those of endoscopy with biopsy, and with histopathological grading of depth of ulceration in colectomy specimens. Nine non-inflamed controls were also includedLeukoeyte scintigraphy using technetium-99m exarnetazime-labelled lenkocytes was found to reliably differ between patients with and without colonic inflammation. A good correlation existed between a simple visual scoring system of lenkocyte scans and colonic inflannnation viewed endoscopically and histologically in ulcerative colitis. In active disease, inflammation was better visualized with technetiurn-99m exametazimelabelled leukocytes than with technetium-99m anti-granulocyte antibody BW 250/183.Air enema radiology was of value in estimating severe mucosal inflammation in acute ulcerative colitis. Presence of faecal residue or a normal air enema film were associated with normal or only mildly inflamed mucosa at colonoscopy, i.e. a friable or ulcerated mucosa can be excluded. The absence of faecal residue or an abnormal finding at air enema X-ray were predictive of endoscopically inflamed mucosa. Air enema radiology underestimated the extent of inflannnation compared to endoscopy or lenkocyte scintigraphy. Air enema radiology was able to demonstrate presence of deep histopathological ulceration in the colectomy specimens from patients with an acute attack of ulcerative colitis.In conclusion, scintigraphy with technetium-99m exarnetazime-labelled lenkocytes can be applied in excluding or confirming bowel inflammation in individual patients, and, in assessing intensity and extent of ulcerative colitis. Air enema radiology should be a first-line investigation in acute colitis to assess the presence of mucosal or deeper ulceration.
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| 4. |
- Andersson, Inger S
(författare)
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Utveckling av metoder för mätning av vårdkvalitet : Med inriktning mot omvårdnad
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The present thesis has its roots in the need to measure and evaluate quality of care, especially in times when resources allocated to health- and medical care are being limited. This is of concern for many groups in society, but perhaps mOst of all for patients, hospital staff and politicians.The main purpose of the thesis was to develop methods for measuring quality of care within nursing.The thesis has been organised in three main parts, the first of which deals with the principal concepts in this research,in addition to research and develop- ment in existing instruments for measuring quality of care. The second part contains the empirical study and its results. Finally, the third part deals with the development of variables for methods of measurement based on the empirical study: it also looks ahead, at visions and viewpoints governing future research and development work.Data collection was carried out by means of a thematic interview, and by measuring attitudes to quality of care on a modified attitude scale based on Osgood's semantic differential. The interview group comprised 128 people; 25 patients and 25 staff members at a local hospital, 25 patients and 27 staff members at a health centre, and 26 county council politicians. The interview material was analysed inductively using qualitative and quantitative content analysis. On analysing the three themes which dealt with the interviewees' perception of health, quality of life as a result of care received, the quality of selfcare as well as care goals, literature studies were added which dealt with the above-mentioned phenomena.The result of the interview study, and the literature studies included in the analysis phase, can be stated in brief, that the main focus in the perception of quality of care held by the patients, the staff and the politicians was on 1) the quality of the staff, with an emphasis on the characteristics and skills of the staff, 2) quality in implementing care, involving care measures of an affective nature and the quality of the patient- staff relationship, and 3) the patient-related quality of results, consisting of such changes in the patient's health status as a cure or a change in health; cognitively oriented results like better knowledge about one's condition; wellbeing as a result of care; satisfaction with the care and treatment provided, and with the staff.The result of the attitudes survey was that politicians were the most positive towards the quality of the care provided, while the personal at the health centre were the least positive. Of the various professional categories interviewed, physicians were the most positive. Other staff comprising paramedical groups were the least positive.Further groups of variables have been generated from the data collected and from the literature studies in order to extend the evaluation of the quality of nursing care. All of the variable groups developed in the present thesis have been named and grouped together in a system called the KISAAL system, after the initials of the author. The different groups of variables can be related to each other to facilitate a total assessment of the quality of nursing care, and its management.
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| 5. |
- Andersson, Thomas
(författare)
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Cutaneous microdialysis : a technique for human in vivo sampling
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Microdialysis enables in vivo sampling of endogenous and exogenous substances in the interstitial fluid. A probe equipped with a tubular semi-permeable dialysis membrane is inserted into the skin, and perfused with a physiological solution. Diffusion of molecules from the extracellular space to the perfusate takes place, and the perfusate is collected for analysis. In this thesis, experimental and clinical applications of human cutaneous microdialysis in the fields of skin inflammation and percutaneous absorption are presented.The in vivo absorption kinetics of the model solvents ethanol and isopropanol, applied in excess to the skin over the dialysis probe, could be demonstrated in all subjects. Ethanol levels increased in a linear fashion to reach a peak at about 100 min, then establishing a plateau level. Isopropanol absorption showed similar kinetics. The absolute levels detected were lower for isopropanol than for ethanol.Laser Doppler perfusion imaging visualized the skin circulatory response to the microdialysis probe insertion. An immediate increase in skin blood perfusion was observed. The response began to subside after 15 min and returned to near normal within 60 min after probe insertion.Histamine, a ubiquitous inflammatory mediator, was studied as a model. Following the skin trauma caused by probe insertion, peak histamine levels were observed in the first 10-min sample, then falling successively to reach baseline within 40-60 min. Multiple regression analysis did not reveal any correlation between probe depth, as measured by ultrasoundtechnique, and obtained histamine levels during the equilibration period following probe insertion. Provocation with compound 48/80 as a positive control for skin histamine release, resulted in increased histamine levels in the perfusate. Histamine release was followed in reactions provoked in the skin of patients with cold urticaria. An up to 80-fold increase of histamine levels was observed, with peak levels 20-30 min after start of ice provocation, returning to baseline within 50-60 min.Human, in vivo, cutaneous microdialysis has the potential to be an important sampling method in studies of skin inflammation and percutaneous absorption of noxious chemicals as well as in dennal and transdermal drug delivery studies.
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| 6. |
- Bergman, Hanna
(författare)
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Intraocular and intracranial transplantation of neural tissue : Studies on hypothalamic and hippocampal neuros
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Previous studies has demonstrated the possibility to transplant monoaminergic neurons intracranially and to the anterior chamber of the eye, where these neurons continue to develop into functional, transmitter expressing cells. In the present study, investigations were undertaken to examine the development of transplanted hypothalamic and hippocampal neurons in the rat. The intention was to examine synaptic maturation in the isolated brain tissue and the possibility of histaminergic neurons to survive transplantation intraocularly and intracranially into the denervated hippocampus. Properties such as fiber ingrowth into eo-transplanted tissue, electrophysiological activity and histaminergic H3-receptor response, and influence of hypothalamic tissue on eo-transplanted tissues were evaluated. Synaptic maturation was studied using an immunoblot assay of the synapsin I and II proteins and synapsin immunohistochemistry. The hypothalamic grafts were examined with immunohistochemistry and histamine assay of the levels of histamine in the transplants. Electrophysiological recordings of single cell activity was used to study the effect of H3-receptor agonist and antagonist. The isolated intra ocular transplants of hippocampal tissue developed significant amounts of synapsin proteins with an overall distribution pattern as in the hippocampus in situ. Histaminergic neurons in the hypothalamic transplants survived transplantation both intraocularly and intracranially. The neurons were found to send neurites into the host iris and into eo-grafted CNS tissue. The hypothalamic transplants were also found to have a stimulatory effect on the growth of eo-grafted hippocampal tissue and on pyramidal cell differentiation. Neurons within the hypothalamic transplants exhibited spontaneous activity that was suppressed upon agonist stimulation of H3-receptors. These findings demonstrate that histaminergic neurons grow and develop in transplanted hypothalamic tissue and that neurons in these transplants expressed histamine and functional H3-receptors.
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| 7. |
- Blomstrand, Peter
(författare)
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Echocardiographic methods for assessment of coronary artery disease
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Upright bicycle exercise echocardiography with digital image acquisition in seated position during exercise and in recumbent position before and immediately after exercise was performed in 66 men, one month after an episode of unstable coronary arte1y disease. It was difficult to obtain images of adequate quality during exercise but new or worsening of wall motion abnormalities not seen in recumbent position after exercise were detected at peak-exercise in patients with good image quality. Therefore, image acquisition seated at peak bicycle exercise and in the recumbent position immediately after exercise are of complementary value.Bicycle exercise echocardiography and 201-Tl myocardial perfusion scintigraphy SPECT were compared in 65 men after an episode of unstable coronary artery disease. Reversible abnormalities were seen in 55 patients with cchocardiography and in 43 patients with 201-Tl scintigraphy {pThe hemodynamic alterations induced by dobutamine stress testing were investigated using Doppler-echocardiography and venous occlusion plethysmography in 11 healthy women and 18 female patients. The healthy subjects received a lower peak-dose of dobutamine, 22±7.5 j.lg kg-I miu-1 compared with 33±9.7 j.lg kg- I min-I administered to the patients (p10 mm Hg). One patient in the hypotension group developed a paradoxical vagal reaction with bradycardia at peak-dose and two patients had a very low increase in cardiac output (12%). The fomth patient with hypotension did not differ in change in cardiac output compared to the other patients. Despite a more pronounced decrease in total peripheral vascular resistance in these four patients compared with other patients, there was no difference in leg peripheral vascular resistance between the groups. The disparity between the pattern of total to legperipheral vascular resistance in patients with hypotension might reflect a baroreceptor mediated compensatmy increase in vasoconstrictor tone of muscle vessels not matched in other vascular territories.Echocardiographic M-mode recordings of mitral annulus motion were compared with Doppler registrations of mitral and pulmonary venous flow velocities in 38 patients with heart failure (NYHA ll-IU) after myocm·dial infarction. Patients with an increased atlial component of annulus motion in absolute (a :::::5.1 mm, n::::l9) or relative terms (a/T >57%, n::::l2) had a higher miti·allate to early flow velocity ratio and pulmonmy venoussystolic to diastolic filling ratio (p
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| 8. |
- Bråbäck, Lennart
(författare)
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Respiratory symptoms and atopic sensitization among school children in different settings around the Baltic Sea
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to assess the prevalence of respiratory symptoms and atopic sensitization and related risk faCtors amo:Og school children in urban and rural areas of Sundsvall in Northern Sweden and urban areas of Konin in Poland and Tallinn and Tartu in Estonia. Ambient levels of N02 were similar in urban Sundsvall and Konin whereas levels of S02 and smoke were about 5 times higher in Konin than in Sundsvall. Children in Estonia and Poland had a lower standard of living and were more exposed to indoor air pollutants.Among 10 527 school children in Sundsvall aged 7-16 years the prevalence of asthma was 4% in 1985. No differences were seen between urban and rural Sundsvall. School absenteeism due to asthma was uncommon.The prevalence of positive skin prick tests in 642 school children (aged 10, 12 and 14 years) from urban and rural areas of Sundsvall was detem1ined in 1988. In this study, urban living was a risk factor for at least one positive skin prick test to pollen or animal dander, OR 1.83(95% Cl 1.26- 2.67). The increased risk was only demonstrated among children with atopic heredity. Passive monitoring of nitrogen dioxide in Sundsvall showed that urban children as compared with rural children were exposed to higher levels of NC>z (13 ;tglm3 and 7 ;tglm3, respectively). The children spent 90% of their time indoors. The most important source of exposure were the indoor skating arenas, where levels up to 8()(X) ;tglm3 were measured during 1-hour periods.Parental questionnaires, skin prick tests and serial peak flow measurements for a period of 2 weeks were used in the next study involving 2594 10-12 year old children from Sweden, Poland and Estonia. Respiratory symptoms were common whereas positive skin prick tests were uncommon in Poland and Estonia. The risk for positive skin prick test was decreased in Konin, OR 0.58 (95% CI 0.37- 0.91) but increased in urban Sundsvall, 1.67 (95% Cl 1.15- 2.42) (rural Sundsvall reference group). The odds ratios in Estonia were similar to Poland. Current maternal smoking had a strong dose-resp.:mse association with current coughing attacks but only in Eastern Europe. An inverse relationship was recorded between domestic crowding and sensitization, the risk of scnsitization increased as the number of persons in the household decreased (OR 0.58, 95% Cl 0.43- 0.77).The study suggests that factors related to domestic crowding protect against atopic sensitization in Estonia and Poland. In Sweden, by contrast, an increased standard of living with less crowding and less infections is associated with enhanced vulnerability to air pollutants andother adjuvant factors.
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| 9. |
- Filbey, Derek
(författare)
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Alloimmunization during pregnancy with special emphasis on anti-D : Laboratory and clinical management
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The laboratory and clinical management of alloimmunized in pregnancy has been investigated according to a protocol currently in use in Örebro region. A 12 year epidemiological study showed the prevalence of alloimmunization to be 0.57% in this Swedish populationwith a 0.24% incidence of clinically significant antibodies that can induce haemolytic disease of the newborn (HDN). Rh antibodies, predominantly anti-D, are still the causes of most cases of severe HDN in which 45/47 babies required exchange transfusion. During the studyperiod, 14 mothers were successfully treated with plasma exchange during pregnancy owing to high anti-D antibody concentrations. Only two other blood group syswms, Kell and Duffy, besides Rh affected newborns to alloimmunized mothers to such a grade that exchange transfusion of the newborns was necessary. All generally accepted for the fetus clinically nonsignificant antibodies were also followed and shown not to cause HDN. In 3 instances, anti-D was detected in partial RhO-positive mothers who were carrying normal RhO-positive fetuses,a study to identify these partial RhD individuals and to group them into D-categories was performed. The ability of the indirect antiglobulin titre (IAT), AutoAnalyzer (AA) quantitation and chemiluminescence l£st (CLT) performed on maternal anti-D serum during pregnancy to discriminal£ babies affected or unaffected by HDN has been studied. It was found that all methods had their weaknesses, but AA-quantitation and CLT improved speeifieity when compared to the IAT-titration method. However, a great improvement was achieved when the results of IAT-titration and AA-quantitation, as determined by the cut-offlimits applied to discriminate unaffected from affected newborns, were combined; specificity was then found to increase from 60-78% to 93% and was further increased with the addition of the CLT test to 95%. Finally, the detection of HLA class II monocyte-reactive antibodies and their potential protective role in ameliorating HDN has been viewed.
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| 10. |
- Foldevi, Mats, 1952-
(författare)
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Implementation and evaluation of problem-based learning in general practice.
- 1995
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The Faculty of Health Sciences, Linköping, Sweden, started the reformedmedical curriculum in 1986. Problem-based Learning as an educational method was introduced into the entire curriculum. It was a response to requests for community-orientation by increasing the involvement of general practice. A new extensive communication skills training - the 'Strand', a new form of examination- 'phase examination', and recurrent clerkships in general practice in the clinical phase were also introduced. The medical cuniculum, with its focus on general practice, together with these innovations are presented in a case report of its implementation and development.The similarities between quality assurance and problem-based learning, as processes and methods, are also identified, described and discussed.Two of the innovations where general practice is a main contributor, namely, the clerkships in general practice and the phase examination 1 and 2 have been evaluated. Of the 115 students, in semester six to nine in the autumn of 1992, 74% filled in the clerkship evaluation questionnaire. The overall rating was very positive. Regression analysis of the rated variables showed that the quality of the tutoring was the strongest determinator of the overall rating. No decline in the students' ratings in the latter semesters was found.A qualitative study was made on all free comments made by the same study group in the same questionnaires. This study identified an area not covered in the quantitative evaluation, the important elements of the student-tutor relationship.The 'phase examinations' have been found to be a valid assessment ofcommunication skills, integrative knowledge and the search for scientificinformation. The use of general practitioners as assessors has strengthened the role of general practice in the curriculum.
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