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- Strand, Tage, 1950-
(författare)
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Stroke : patient characteristics, efficacy of a stroke unit and evaluation of hemodilution therapy
- 1986
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stroke is a major health problem in all developed countries. These studies, performed in a stroke unit at a medical department, were designed to characterize essential clinical features of the different cerebrovascular disorders on admission to hospital, to evaluate the efficacy of admitting unselected stroke patients to a stroke unit and, to evaluate hemodilution as a therapeutical regime in patients with cerebral infarction.A prospective registry included 409 patients admitted to the stroke unit over a five-year period. Modern diagnostic equipment (CT scan and CSF analyses) and strict diagnostic criteria revealed a diagnostic distribution of 11% hemorrhagic, 76% ischemic cerebrovascular lesions and 13% TIAs. Mean age varied between 65.8 and 77.5 years in the various diagnostic groups with the highest in patients with embolic cerebral infarctions. Concomitant disorders affecting the cardiovascular system were highly prevalent and only 14% was free of such diseases prior to the stroke.In a comparative prospective study, over 16 months, no differences were found between patients treated in the stroke unit (n = 110) and the general medical wards (n = 183) regarding prognostic indicators on admission such as age, concomitant disorders and neurological symptoms. The stroke patients treated in the stroke unit had a statistically significant better prognosis regarding functional outcome and the need for long-term hospitalization was reduced up to one year after the stroke when compared to patients treated in general medical wards. All stroke patients seemed to benefit with the possible exception of patients in coma on admission. These results were achieved within the same or shorter length of initial hospital stay for patients in the stroke unit. Neither overall mortality, nor mortality in subgroups of prognostic importance was significantly affected by the stroke unit regime. Rapid hemodilution in the early phase of cerebral infarction by the combination of venesection and administration of dextran 40 was evaluated in a prospective controlled trial. After randomization 52 hemodi- luted and 50 control patients were comparable in prognostic variables. Signs of blood-brain-barrier breakdown and hemorrhagic admixture to the cerebrospinal fluid in the acute phase were less frequent in hemodiluted subjects. The hemodi luted patients showed a significantly higher degree of early improvement and fewer progressions. Neurological and functional disability in survivors and need for long-term hospitalization was significantly reduced at 3 months and at one year after the stroke compared to controls. Mortality was not affected.
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| 2. |
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| 3. |
- Byström, Anders, 1935-
(författare)
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Evaluation of endodontic treatment of teeth with apical periodontitis
- 1986
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Apical periodontitis, an acute or chronic inflamination around the apex of the tooth, is caused by bacteria in the root canal. In Sweden the dentists devote around 10X of their total time to treating this disease. The treatment usually requires 3 to 5 sessions. The treatment may fail in up to 25X of the cases. In the present study various treatment regimens were evaluated. One hundred and forty singlerooted teeth with apical periodontitis were treated. The importance of mechanical instrumentation, irrigating solutions and antibacterial dressings in eliminating bacteria from the infected root canals was studied using bacteriological techniques. The healing of the apical periodontitis after treatment was followed for 2 to 5 years on recall radiographs.Bacteria were found in all 140 root canals at the beginning of the treatment. Most of these bacteria were anaerobes and they represented a restricted group of bacteria compared to the bacteria present at other sites in the oral cavity. Mechanical instrumentation with files and reamers in combination with saline irrigation reduced the number of bacterial cells in the root canal 100- to 1000-fold during one treatment session. Bacteria could be eliminated from about half the number of root canals if this treatment was performed at 4 sessions.Mechanical instrumentation and irrigation with 0.5X or 5X sodium hypochlorite solutions or with the 5X solution in combination with 15X EDTA solution wa3 more efficient and the bacteria were eliminated from about half the treated canals after one treatment session. The bacteria which persisted in the root canal after this treatment usually increased in number during the interval up to the next session and reached levels which were often as high as in the initial sample at the previous session.All bacteria persistent in the root canals after the previous treatment regimens were with 2 exceptions eliminated by dressing the root canals for 1 to 2 months with calcium hydroxide paste. Thirty-four out of 35 root canals treated at the first session with mechanical instrumentation, irrigation with sodium hypochlorite solution and dressed with calcium hydroxide paste were free of bacteria at the second session. Calcium hydroxide paste was superior to camphorated phenol and camphorated paramonochlorophenol as dressing.Healing of 79 out of the 140 treated teeth was followed for 2 to 5 years. The majority of the lesions healed completely or decreased in size in such a way that they could be expected to heal. There was no or only an insignificant decrease in the size of the lesions in 5 cases. In 2 of these cases bacteria were demonstrated in the periapical tissues and in a third case dentin chips. Periapical lesions may thus fail to heal in a few cases due to an establishment of bacteria outside the root canal, and in that site the bacteria are inaccessible to conventional endodontic treatment.The present study showed that treatment of the majority of infected non-vital teeth can be completed in only 2 sessions, if mechanical instrumentation, sodium hypochlorite irrigation and calcium hydroxide dressing are combined.
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| 4. |
- Grahn, Eva, 1954-
(författare)
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Bacteriological aspects of treatment failures in streptococcal tonsillitis
- 1986
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- ß-hemolytic streptococci persist in 10-25% of patients with acute streptococal tonsillitis (about 10.000-25.000 per year in Sweden) in spite of treatment with a recommended dosage and schedule of Phenoxymethylpenicillin. The aim of the study was to investigate different bacteriological factors involved in treatment failures of streptococcal tonsillitis. Patients included in the study were 33 patients who underwent tonsillectomy, 62 persons included in a tonsillitis epidemic outbreak, 267 tonsillitis patients contacting the ENT-clinic, Sahlgrenska Hospital, Göteborg, and 20 healthy volunteers taking Phenoxymethylpenicillin. It was found that the Steer's steel pin replicator was a useful tool to study interference between a- and ß-hemolytic streptococci and a guantitative differen ce in. the inhibitory capacity of the different a-strains was noted, a-streptococci with a strong inhibitory capacity on ß-streptococci were isolated mainly from individuals seemingly resistant to ß-streptococcal tonsillitis, while from patients with repeated tonsillitis no or low numbers of inhibiting a-streptococci were demonstrated. Patients with clinical treatment failure had less a-streptococci with inhibiting capacity on their own ß-streptococcal strain compared with the healthy carriers. These treatment failures also showed beta-lactamase activity in their saliva pellet significantly more often than patients in the control groups. In volunteers penicillin was released from ordinary sugar coated tablets already in the mouth resulting in a decrease of the a-strep- tococcal flora. A synergistic effect on ß-hemolytic killing by low concentration of penicillin and inhibition of a-streptococci was noted in vitro and in vivo. Penicillin tolerance was registered in most strains from the treatment failure group, but in none of the strains from the group of successfully treated patients. A co-operation between different bacteriological factors (bacterial interference, beta-lactamase production, penicillin tolerance) seems to be important in treatment failures of streptococcal tonsillitis.
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| 5. |
- Lennmarken, Claes, 1948-
(författare)
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Skeletal muscle function and energy metabolism in various nutritional states : a clinical study
- 1986
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The clinical picture of the malnourished patient consists of loss of body fat and lean body mass resulting in weight loss and impaired vital organ function. Weakness and fatigue are often prominent symptoms arising from affected skeletal muscle in these patients.Skeletal muscle is intimately involved in the process of body energy metabolism and its regulation. The effect of insufficient nutritional intake on skeletal muscle function and energy metabolism was studied in subjects, with various nutritional states. Involuntary muscle function was assessed in the adductor pollicis muscle after electrical stimulation of the ulnar nerve. Energy metabolites were measured in needle biopsy samples from the quadriceps femoris muscle.After total starvation, muscle function was found to be altered and indicated a low rate of energy turn-over. In extremely obese patients, muscle function was also changed but indicated a high rate of energy turn-over. Semi-starved surgical patients had normal skeletal muscle function.In anorexia nervosa patients 3-5 weeks of total patenteral nutrition largely normalized their deranged muscle energy metabolism. In the obese patients energy metabolism was found to be altered, indicated a high metabolic rate. This is probably a physiological adaptation to a high body weight. In semi-starved surgical patients normal contents of energy metabolites were found.These findings indicate that major changes in the nutritional state, induced alterations in skeletal muscle energy metabolism. Skeletal muscle function was concomitantly altered indicating a relationship between energy metabolism and function in skeletal muscle. In moderately malnourished patients however, skeletal muscle function was normal.
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| 6. |
- Sandman, Per-Olof, 1950-
(författare)
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Aspects of institutional care of patients with dementia
- 1986
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of the present study was to investigate all long-term institutions in the county of Västerbotten, Northern Sweden, to give a detailed description of the institutionalized population with respect to motor functions, vision, hearing, speech, ADL-functions, prevalence of psychiatric symptoms and behavioral disturbances, staff work load, use of psychoactive drugs and prevalence of dementia. Another aim was to select some specific 'problem areas' in the nursing care of demented patients for further descriptive and interventional studies. For this reason, morning care procedure (hygiene, dressing), meal behavior (eating, communication), nutrition, constipation and relocation between institutions were selected.The results of the study have been reported in six papers summarized below:I.The study has shown that the proportion of demented patients is increasing in longterm institutions in Sweden. Furthermore, demented patients were shown to be more impaired in all rated functioning abilities and exhibited more psychiatric symptoms and behavioral symptoms. A high proportion of the demented probands were also prescribed psychoactive drugs, i.e. neuroleptics.II. Five patients with Alzheimer-type dementia were monitored during morning care. A 12-step classification system was developed to be used as a guide to understand and determine abilities essential for performance of morning care for demented patients. The quantitative assessment showed that none of the patients were able to manage morning care independently, but there was a wide variation in their highest level of performance.III. Five patients with Alzheimer-type dementia were observed (video taped) during their meals in a changed meal milieu and with new meal routines. When the patients ate without staff participation, the two least demented patients became 'caregivers'. When two mental nurses joined the group, first in civil clothes and then in white uniforms, the patients dropped their roles as helpers. The patients were able to compose complete meals in 0-79 per cent of the meals. The conversation during the meals could be characterized as incomplete, with short sentences and a lot of breaks. Sixty-three per cent of all utterances were about food and eating and almost all conversation concerned the present time.IV. Thirty-three psychogeriatric patients, with severe constipation were given a high- bran bread instead of their accustomed laxatives. During the high-bran treatment period, the number of bowel evacuations and the volume of faeces increased. The total laxative consumption decreased by 93 per cent.V. Nutritional status and dietary intake were studied in a sample of severely demented, institutionalized patients. Energy and /or protein malnutrition was found in 50 per cent of the patients. The mean energy intake was 2059 kcal. Malnourished patients had had four times as many infectious periods during their hospital stay as patients without malnutrition. Thirty-nine of 44 patients lost weight during their hospital stay.VI. Thirty-three psychogeriatric patients were followed for 36 weeks after relocation from a mental hospital to two newly built nursing homes. An intensive pre-relocation program was performed. No negative effects of the relocation were found. On the contrary, the relocated group improved their ADL-functions after the transfer.Based upon the above cited studies, a model for nursing care of demented patients is presented.
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| 8. |
- Stecksén-Blicks, Christina, 1949-
(författare)
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Epidemiological studies of dental caries in groups of Swedish children
- 1986
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In a cross-sectional study the extent and distribution of dental caries was studied in 817 children, 4, 8 and 13 years old in three areas inSweden. The importance of dietary habits, sugar intake, social conditions, professional dental care, oral hygiene and the use of fluorides on caries prevalence was analyzed. In a subsample, consisting of 88 8-year-olds and 91 13-year-olds the net caries increment during aone-year period was studied.In this longitudinal study, the salivary levels of lactobacllli and S. mutans were determined and correlated to sugar intake and caries increment.The cross-sectional study showed obvious differences in caries prevalence among the studied areas. These differences could mainly be explained by variations in the age from which children had received professional dental care, frequency of tooth-brushing and the use of topical fluorides. There were no differences in dietary habits or sugar intake that could explain the differences in caries prevalence among the areas studied.Examples are given of how changes in some determinants may affect the caries prevalence by means of path analysis.The longitudinal study showed that caries Increment was higher when sugar intake and meal frequency were high (> the mean value for the age group). The highest mean caries increment was found in children with high prevalence of lactobacllli and S. mutans in the saliva combined with a high sugar intake.Groups of children with high salivary levels of both Iactobac ì II i and S. mutans developed 3-4 times more caries than other children. This relation did not always exist in the Individual case.Children with a low caries Increment during one year (0-2 surfaces) brushed their teeth more often and rinsed their mouths more frequently with fluoride solution than children with a high caries increment (> 3 surfaces). The use of fluoridated toothpaste was somewhat more common, however, in the low carles increment group only in the.8-year-oIds.The gingival status was used as a measure of oral hygiene and gingivitis scores revealed statistically significant differences between groups with a low caries increment and a high carles increment (p < 0.01, p < 0.05) in the two age groups, respectively.With the variables frequency of meals, total sugar intake, salivary level of lactobacilli and S. mutans, oral hygiene and use of topical fluorides the net caries increment during one year could be correctly predicted in 79 % of the 8-year-olds and 81 % of the 13-year-olds when the children were divided Into two groups according to their net caries increment; 0-2 surfaces and > 3 surfaces.
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| 9. |
- Damber, Lena, 1950-
(författare)
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Lung cancer in males : an epidemiological study in northern Sweden with special regard to smoking and occupation
- 1986
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In a case-control study comprising 589 cases of male lung cancer in northern Sweden longitudinal data concerning occupations, employments and smoking habits were collected by questionnaires.Pipe smoking was as common as cigarette smoking and gave very similar relative risk. The pipe smoking cases, however, had significantly higher mean age and mean smoking years at the time of diagnosis than the cigarette smoking cases. In ex- smokers, the relative risk gradually decreased from 5 years after smoking cessation but this decrease was much less pronounced in ex-pipe smokers than in ex-cigarette smokers. High relative risks were obtained for small cell and squamous cell carcinomas. For adenocarcinoma the relative risk was considerably lower but still significantly increased. The population etiologic fraction attributable to smoking was about 80% in this series.Some occupational groups (underground miners, copper smelter workers, electricians and plumbers) exposed to previously known lung carcinogenic agents had considerably increased odds ratios, which persisted after adjustment for smoking. A slightly elevated odds ratio was observed in a group of blue collar workers potentially exposed to lung carcinogenic agents but this elevation generally disappeared after adjustment for smoking. For two specific subgroups, asphalt and concrete workers and pulp workers, the overrisk persisted after adjustment for smoking. Farmers and foresters had strikingly low odds ratios, which could only partly be explained by their more moderate smoking habits. The population etiologic fraction attributable to occupation was in the reported material assessed to 9 per cent.Professional drivers had higher average tobacco consumption than non-drivers, which explained the slightly increased crude odds ratio found for the occupational group as a whole. Smoking drivers in an upper age group (70 and over), however, had a high relative risk of lung cancer, while in a lower age group (under 70) no significant increase was found. The results in the older age group suggested a multiplicative effect between smoking and the occupational exposure.The study clearly verified the increased lung cancer risk in underground miners. An obvious dose-response relation was found with high risk after long time exposure. All analyses concerning underground miners suggested an interaction of a multiplicative type between underground mining and smoking in the causation of lung cancer. The cases of small cell carcinoma among the underground miners had shorter average latency time and in contrast to the other part of the material, shorter average age than the cases with epidermoid cancer.
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| 10. |
- Nilsson, Eskil, 1940-
(författare)
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Individual and environmental risk factors for hand eczema in hospital workers
- 1986
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Individual and environmental risk factors in hand eczema have been investigated in a prospective cohort study of 2452 newly employed hospital workers with a follow-up time of 20 months. Current hand eczema was analyzed in 142 wet hospital workers from this cohort with respect to the etiologic importance of irritants, allergens and contact urticants. The density of the microflora and the effect on the microflora of topical treatment with a potent corticosteroid were studied in 20 patients with hand eczema.’Wet’ hospital work was found to increase the odds of developing hand eczema only twice compared to 'dry' office work. Nursing children under four years old and the lack of a dish-washing machine significantly increased the risk of contracting hand eczema. Unfavourable combinations of these domestic factors increased the risk as much as wet work. A history of atopic dermatitis approximately tripled the odds both in wet as well as in dry work.Histories of earlier hand eczema (HHE), metal dermatitis (HMD) and of atopy were analyzed as risk factors for hand eczema in 1857 women in wet work. HHE increased the odds by a factor of 12.9 and created a subdivision of the population into high risk individuals and normal risk individuals. HHE was found in half of the subjects with atopic dermatitis, in one quarter of the subjects with atopic mucosal symptoms and in one fifth of the non-atopics. A HMD increased the odds by a factor of 1.8. This increase was seen as a high risk level in subjects with HHE and as a normal risk level in subjects with no HHE. A history of atopic disease as a complement to information about HHE and HMD increased the odds by another 1.3 times. The predicted probability of developing hand eczema ranged from 91 % in subjects with a combination of HHE, HMD and atopy to 24% in subjects with none of these risk factors.Subjects with AD were found to suffer a more severe form of hand eczema with significantly higher figures for medical consultation, sick- leave, termination due to hand eczema, early debut, permanent symtoms and vesicular lesions.Amongst the patients investigated for current hand eczema high risk individuals were overrepresented. It was claimed in 92.3% of the cases that trivial irritant factors had elicited the current episodes of hand eczema. In 35% of the cases the exposure to the irritant took place largely at home. Although contact sensitivity and contact urticaria were fairly common, they mostly seemed to be of minor importance in the etiology of the current hand eczema.Staphylococcus aureus colonized eczematous lesions of the hands in 18/20 patients. The density exceeded 105 colony forming units/cm2 in 15/20 patients. Only three of these patients showed signs of clinical infection. Successful topical treatment with a potent corticosteroid significantly reduced the colonization of S. aureus.
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