| 1. |
- Wennergren, Göran, 1947, et al.
(författare)
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Short- and long-term efficacy. Childhood asthma.
- 1998
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Ingår i: The European respiratory journal. Supplement. - 0904-1850. ; 27
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Forskningsöversikt (refereegranskat)abstract
- In clinical studies of asthma, great attention should be focused on the choice and validation of outcome measures. The outcome parameters to be used when evaluating efficacy of early intervention in childhood asthma treatment must be closely linked to the aims of the intervention and considered in the design of the study. In an interventional study, possible adverse consequences should also be considered as outcome measures when designing the study. The appropriate time span for assessing different types of interventions may vary from days to several decades, depending on the character of the intervention. Not only outcome parameters, such as improvement in symptom score and improvement of lung function, but also those that measure reduction in frequency and severity of acute exacerbations, reduction in morbidity and improvement in quality of life should be used. For some purposes, a more detailed approach to symptom severity is needed, such as separation of acute from chronic symptoms. Other outcome measures that need to be considered are: cost-effectiveness, normalization of inflammatory changes in the airways, control of airway hyperresponsiveness, airway growth and prevention of airway remodelling and importantly, whether an intervention against asthma can alter the natural course, or cure, the disease. Interventions should be evaluated to see to what extent such aims have been met.
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| 2. |
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| 3. |
- Hochbergs, Peter
(författare)
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Magnetic Resonance Imaging in Legg-Calvé-Perthes Disease
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this study were: to compare the cartilaginous outline of the femoral head obtained on arthrograms with those on MR images and to correlate it to the bony head outlines on conventional radiograps; to study early, postoperative cartilaginous and bony remodeling of the femoral head, after proximal femoral varus derotation extension osteotomy, with MR imaging and conventional radiography; to describe signal abnormalities on MR images in the femoral epiphysis, their location, extent and restitution over time; to evaluate the degree and persistence of synovitis in the hip joint by MR imaging; to analyze the metaphyseal histology and to correlate it to the signal intensity on the MR images in the corresponding biopsy region. Results and conclusions: MR imaging and arthrography define the shape of the femoral head cartilage equally well. The bony head outlines on conventional radiographs do not adequately reflect the cartilaginous outlines of the femoral head obtained by MR imaging. There is an early, postoperative, continuous, spherical remodeling following proximal femoral varus derotation extension osteotomy. The cartilaginous remodeling as seen in MR images appears earlier than the bony remodeling seen on conventional radiographs. In the coronal plane on MR images, the pathological signal is lowest in the central portion of the necrotic epiphysis. In addition, hips with advanced disease show signal changes in the peripheral regions. Repair processes start from the periphery, slowly progressing towards the center of the necrotic epiphyseal region. Signal changes persist in the period 3-6 years after diagnosis. All diseased hips have synovitis initially. The degree of synovitis on MR images in the inferomedial aspect of the hip joint correlates to the extent of the epiphyseal necrosis seen in conventional radiography or MR imaging. Synovitis is most intense initially in the disease, slowly decreasing, but persisting for several years, in some hips for more than 5 years after diagnosis. There is no correlation between the uniform histological patterns of consistent morphologic changes of the metaphysis and MR imaging with a low-field unit.
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| 4. |
- Hagelin, Elisabet
(författare)
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Barnhälsovårdsjournalen som kunskapskälla : En analys av fullständighet, instruktionsenlighet och tillförlitlighet : [an analysis of completeness, reliability and accuracy of recording]
- 1998
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Information contained in medical records is increasingly used for the evaluation of the process of care and to study the health status of individuals. Hence, if recorded information were accurate and reliable, records would be a valuable data source in quality assessment and research.The main objectives of this thesis were to determine (a) the extent to which information about preschool children's living conditions, health and development and provision of care was completely recorded in Child Health (CH) records; (b) whether information was recorded in accordance with recommendations; (c) whether information was in agreement with other sources and with the care actually provided; and (d) whether information could be reliably transferred to a structured protocol. Three sample records were reviewed and parent-child consultations were observed.The results demonstrated that different types of information were recorded with varying degrees of completeness and concordance. There was low agreement between record information and information from other sources. Moreover, the observations of health consultations indicated that the care actually provided was more extensive in relation to recorded care. Most types of information in CH records could be reliably transferred to coding protocols.To increase the quality of medical record data, the CHS staff need to be reminded of the importance of exhaustive documentation of central tasks in CHS. Finally, the arrangement of national instructions for record keeping and a classification system for children's health problems are recommended.
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| 5. |
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| 6. |
- Adlerberth, Ingegerd, 1959, et al.
(författare)
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High turnover rate of Escherichia coli strains in the intestinal flora of infants in Pakistan.
- 1998
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Ingår i: Epidemiology and infection. - 0950-2688. ; 121:3, s. 587-98
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Tidskriftsartikel (refereegranskat)abstract
- The Escherichia coli flora of infants in developed countries is dominated by one or a few strains which persist for prolonged periods of time, but no longitudinal studies have been performed in developing countries. To this end, we studied the rectal enterobacterial flora in 22 home-delivered Pakistani infants during their first 6 months of life. Three colonies were isolated and species typed on each of 11 sampling occasions. E. coli isolates were strain typed using electromorphic typing of cytoplasmic enzymes, and their O serogroups were determined. There was a very rapid turnover of enterobacterial strains in the rectal flora of individual infants. On average, 8.5 different E. coli strains were found per infant, and several biotypes of other enterobacteria. Less than 50% of the infants were colonized with E. coli from their mothers, but strains of maternal origin were four times more likely to persists in the infants' flora than other E. coli strains. Enterobacteria other than E. coli were always of non-maternal origin, and Enterobacter cloacae and Klebsiella pneumoniae biotypes recovered from contaminated feeds were later identified in the infants' rectal flora. An early colonization with klebsiella or enterobacter was significantly associated with diarrhoea during the neonatal period, although these bacteria were not likely to be the cause of the disease. The results suggest that poor hygienic conditions result in an unstable and diverse enterobacterial flora, which may influence infant health.
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| 7. |
- Adlerberth, Ingegerd, 1959, et al.
(författare)
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P fimbriae and other adhesins enhance intestinal persistence of Escherichia coli in early infancy.
- 1998
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Ingår i: Epidemiology and infection. - 0950-2688. ; 121:3, s. 599-608
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Tidskriftsartikel (refereegranskat)abstract
- Resident and transient Escherichia coli strains were identified in the rectal flora of 22 Pakistani infants followed from birth to 6 months of age. All strains were tested for O-antigen expression, adhesin specificity (P fimbriae, other mannose-resistant adhesins or type 1 fimbriae) and adherence to the colonic cell line HT-29. Resident strains displayed higher mannose-resistant adherence to HT-29 cells, and expressed P fimbriae (P = 0.0036) as well as other mannose-resistant adhesins (P = 0.012) more often than transient strains. In strains acquired during the first month of life, P fimbriae were 12 times more frequent in resident than in transient strains (P = 0.0006). The O-antigen distribution did not differ between resident and transient strains, and none of the resident P-fimbriated strains belonged to previously recognized uropathogenic clones. The results suggest that adhesins mediating adherence to intestinal epithelial cells, especially P fimbriae, enhance the persistence of E. coli in the large intestine of infants.
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| 8. |
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| 9. |
- Saalman, Robert, 1952, et al.
(författare)
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Antibody-dependent cell-mediated cytotoxicity to gliadin-coated cells with sera from children with coeliac disease.
- 1998
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Ingår i: Scandinavian journal of immunology. - 0300-9475. ; 47:1, s. 37-42
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Tidskriftsartikel (refereegranskat)abstract
- Antibody-dependent cell-mediated cytotoxicity (ADCC) has been suggested as a contributing immunological mechanism in the disease process of coeliac disease. In the present study, sera from coeliac children were examined for their capacity to mediate ADCC against gliadin-coated target cells. The ADCC-mediating efficacy of sera were tested using monocytes from healthy adults as effector cells and gliadin-coated erythrocytes from the same donor as targets. Using monocytes as effector cells, sera from children with active coeliac disease (untreated or challenged), demonstrated significantly higher ADCC-mediating capacity than sera from healthy and disease references as well as children with treated coeliac disease. A positive correlation was found between the ADCC-mediating capacity and serum IgG as well as IgA anti-gliadin antibody levels. The results suggest that an antibody-dependent monocyte/macrophage-induced cytotoxic reaction might be involved in the disease process of coeliac disease.
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| 10. |
- Strannegård, Inga-Lisa, 1937, et al.
(författare)
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Prevalence of allergy in children in relation to prior BCG vaccination and infection with atypical mycobacteria.
- 1998
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Ingår i: Allergy. - 0105-4538. ; 53:3, s. 249-54
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Tidskriftsartikel (refereegranskat)abstract
- By influence on the Th1/Th2 cell balance, infectious agents may affect the development of atopic allergy. In this study, we investigated whether previous BCG vaccination or infection with atypical mycobacteria might be related to the development of atopic disease. The study, which involved skin testing with mycobacteria and answers to a questionnaire for more than 6000 children in Sweden, revealed a low prevalence of allergy among BCG-vaccinated children who were immigrants or adopted from other countries. Vaccinated children born in Sweden, however, did not have significantly lower allergy prevalence than age-matched, unvaccinated children. Furthermore, the overall frequencies of skin-test reactivity to the atypical mycobacteria M. avium and M. scrofulaceum were higher rather than lower in allergic than in nonallergic children. By contrast, there was a tendency toward a lower frequency of more strongly positive skin reactions (> or = 10 mm) to mycobacteria in allergic than in nonallergic children. These findings do not support the hypothesis that early mycobacterial infections have a suppressive effect on the development of atopic disease. Earlier findings of an apparent association between atopy and lack of previous mycobacterial infection may possibly be explained by a relatively decreased ability of atopic patients to mount strong Th1 cell-mediated immune responses.
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