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Biomedical subjects

E Hansen

Publications and source records attributed to E Hansen.

At least 55 records · Page 3Linked to original sources
PubMed1997

HIPAA (Health Insurance Portability and Accountability Act) rules: federal and state enforcement.

Title I of the Health Insurance Portability and Accountability Act (HIPAA), signed into law in August 1996, pertains to "health care access, portability, and renewability," and affects the Employment Retirement Income Security Act, the Public Health Service Act, and the Internal Revenue Code. In this article, the author examines the regulations that will implement Title I of HIPAA on both the state and federal levels.

Career Mobility↗
PubMed1997

Determinants of general practice utilization in Denmark.

The study was undertaken to identify determinants of health services' utilization related to organizational characteristics of the health services, social characteristics of the community, and health and socio-demographic characteristics of the population. We used a follow-up design involving a time dimension of 12 months. A cohort of 3000 50-year old males and females were randomly selected from an urban county near Copenhagen and a rural county in Western Jutland and 65% agreed to participate. Data were collected through: 1) mailed questionnaires to the participants every three months, 2) a mailed questionnaire to all general practitioners in the counties, and 3) the Health Insurance Register. Data were analyzed by multivariate logistic regression analysis. Utilization of health services was found to be strongly associated with gender and health characteristics, especially with respect to functional status and chronic diseases. Health service characteristics, demographic and psycho-social factors had very little impact on utilization patterns. The utilization of publicly financed health services was found to be determined by health needs rather than by social, psychological and organizational factors, indicating geographical and social equity in the access to the Danish health services.

Catchment Area, Health↗
PubMed1996

The characterisation of the 5' regulatory region of a temperature-induced myosin-heavy-chain gene associated with myotomal muscle growth in the carp.

We have isolated and characterised the 5' region of a member of the carp myosin heavy chain gene family. Expression of this gene has previously been shown to be induced by an increase in environmental temperature and is restricted to the small-diameter white myotomal muscle fibres which are associated with growth. The whole isoform gene, including potential regulatory sequence 5' to the transcription start site and the 3' untranslated region was cloned in a lambda2001 bacteriophage vector. Studies of the structure of the 5'-end of the gene revealed high amino acid sequence similarity with translated exons 3-7 of mammalian myosin heavy chain genes indicating identical exon/intron boundaries. The overall length of the gene was however only about one half of that in mammals and birds due to shorter introns. The region 5' to the transcription unit was sequenced and revealed the presence of putative TATA and CCAAAT boxes. In order to study the regulation of expression, a series of endonuclease-generated fragments from the 5' flanking sequence were spliced to chloramphenicol acetyltransferase reporter vectors and used in cell transfection assays or direct gene injection into carp skeletal muscle. The 5' flanking region, which contains a consensus sequence known as an E-box (CANNTG) and a MEF2 binding site, was shown to improve the expression of the reporter gene in fish acclimated at 18 degrees C or 28 degrees C. Unlike the coding region, there was little similarity between the 5'-upstream sequence (promoter region) when compared with sequences flanking the 5'-end of the other myosin heavy chain genes in mammals or chicken.

Acclimatization↗
PubMed1996

Incidence of registered visual impairment in the Nordic child population.

A collaborative, population based, prospective register study on the incidence of visual impairment in children during the year 1993 was carried out in five Nordic countries with a total population of 17 million inhabitants. The child population was 3.8 million individuals aged 0-17 years. The following variables were taken into account: nationality, age, sex, diagnoses, aetiology, degree of visual impairment, and additional impairments. Classification routines from an earlier prevalence study were used. The present study included 304 children corresponding to an incidence of notification of 8/100,000 children, varying from 5.7 to 11.1 in the five countries. Fifty per cent of the visually impaired children were reported before they were 3 years of age. In approximately 45% of the children, visual impairment was due to various brain disorders, with cerebral amblyopia and secondary optic atrophy as the two leading causes. The relative impact of retinopathy of prematurity had decreased from the third most frequent cause (10%) in the prevalence study to seventh place (4%) in the incidence study. Two thirds of the children had additional impairments and these children also suffered from the most severe visual impairments. Among aetiological factors the majority (64%) were prenatal. The overall male:female ratio of 1.4:1 was identical to the sex ratio of the prevalence study.

Adolescent↗
PubMed1996

Provider deselection: "cause" or "no cause".

Termination of provider contracts by MCOs rankles most in the provider community. Oftentimes, no cause is given for the termination, as permitted in the contract between the MCO and the provider. Yet, there is always a cause for termination, and providers generally don't like the reason.

Contract Services↗
PubMed1996

[Experimental principles and general practice of intraoperative autotransfusion with blood irradiation in tumor operation].

Clinical studies fail to verify or to exclude the lethal risk of tumor spread after intraoperative autotransfusion in tumor surgery. An alternative approach is the development of methods for the elimination of tumor cells in the salvaged blood. The radiosensitivity of tumor cells especially in oxygenated single cell suspensions is well known, while the non-nucleated red blood cells are radioresistant. With 50 Gy a 12 log reduction in proliferating cells is expected. This we have tested experimentally and put into clinical practice. The suppression of colony formation in cell culture by irradiation with 50 Gy was tested with tumor cells from established cell lines or from solid tumors after admixture in high cell number to red blood cells from volunteer blood donations. DNA metabolism was tested by incorporation of bromodesoxyuridine (BrdUrd) and staining with mcab-anti-BrdUrd. Colony formation and DNA metabolism was absent in all samples of cell lines or tumor cells in blood after irradiation with 50 Gy, reflecting a 10 log, or 7 log reduction, respectively. In clinical practice the method of intraoperative blood salvage during tumor surgery with blood irradiation showed its practicability and efficacy in reducing homologous transfusions.

Adult↗
PubMed1995

Theta power decreases in preparation for voluntary isometric contractions performed with maximal subjective effort.

In order to find EEG parameters that can be attributed to movements performed with maximal subjective effort, EEG recordings and force measurements were realized in connection with isometric contractions (IMC). IMC were performed with submaximal and maximal subjective effort. Mean spectral power density within the theta band was found as an indicator for maximal subjective effort. The theta power across the parieto-occipital area decreases from rest through movements performed with submaximal force to movements performed with maximal effort. It is argued that this theta decrease possibly reflects a down-regulation of the posterior attention system in order to minimize the influences of external stimuli during the preparation for voluntary IMC performed with maximal subjective effort.

Adult↗
PubMed1995

[Treatment of spasticity with a transcutaneous neurostimulator. A pilot study].

In this pilot study the neurostimulator KDC 5000 is used with efficacy on seven out of 11 patients with spastic palsy, and treatment was given without any side-effects. No other treatment has sufficiently helped these patients, and we therefore conclude that such treatment with a neuro-stimulator could be beneficial for selected patients with spastic palsy of extremities.

Adolescent↗
PubMed1995

Tumor cells in blood shed from the surgical field.

OBJECTIVES: To analyze blood shed from the surgical field during oncologic surgery for tumor cells and to assess functional characteristics of these cells. DESIGN AND PATIENTS: Series of 61 patients with cancer who underwent surgery for an abdominal, orthopedic, urological, gynecological, or head and neck malignant tumor, and blinded comparison with 15 patients with benign diseases undergoing surgery. SETTING: A 500-bed tumor center and a tertiary care hospital. MAIN OUTCOME MEASURES: Tumor cells were isolated from intraoperatively salvaged and washed blood by density gradient centrifugation. They were identified in cytospin specimens by their content of cytokeratins and nucleolar organizer regions with a sensitivity of 10 cells in 500 mL of blood. Clonogenicity was tested in a cell colony assay; invasiveness, in Boyden chambers; and tumorigenicity, in nude mice. RESULTS: In 57 of 61 patients, tumor cells were detected in the blood shed during oncologic surgery. They demonstrated proliferation capacity, invasiveness, and tumorigenicity. The total number of tumor cells identified ranged from 1 x 10(1) to 7 x 10(6), with no close correlation to the amount of blood loss. Circulating tumor cells were demonstrated in only 26% of these patients and in small numbers. CONCLUSIONS: Malignant cells identified regularly in the blood shed during tumor surgery and different from circulating tumor cells are of concern, since at the surgical site they may cause local tumor recurrence, or in the salvaged blood they may cause hematogenic metastasis after retransfusion. Therefore, the contraindication of intraoperative autotransfusion in tumor surgery is strongly supported, and a review of surgical procedures and adjuvant therapy may be indicated, as the passage of the identified cells to the shed blood is yet unknown.

Blood Loss, Surgical↗
PubMed1995

Effect of interleukin-1 receptor antagonist and soluble tumor necrosis factor receptor in animal models of infection.

Intracisternal or intraarticular inoculation of rabbit recombinant interleukin (IL)-1 beta and rabbit tumor necrosis factor-alpha combined with IL-1 receptor antagonist (IL-1RA) and soluble tumor necrosis factor receptor (sTNFR), respectively, produced significantly less inflammation in rabbits than after inoculation of these cytokines alone. In contrast, when Haemophilus influenzae type b (Hib) or Hib lipooligosaccharide (LOS) was given intraarticularly with IL-1RA, sTNFR, or the combination, there was no significant or consistent modulation of synovial inflammation and cartilage proteoglycan degradation. In the experimental meningitis model, IL-1RA and sTNFR did not significantly reduce the meningeal inflammatory response associated with intracisternal inoculation of Hib LOS. These data indicate that specific cytokine inhibitors (sTNFR and IL-1RA) may not be effective in modulating inflammation induced by a broad inflammatory stimulus such as gram-negative bacteria or their products and suggest caution in using them to treat these infectious conditions in humans.

Animals↗
PubMed1995

Is the transfusion requirement predictable in critically ill patients after admission to the intensive care unit?

OBJECTIVE: In intensive care medicine the clinical decision to order and transfuse red blood cells (RBC) is usually based on hematocrit or hemoglobin levels. The intention of this study was to investigate whether clinical or laboratory variables, taken after the admission of patients to the intensive care unit (ICU), are able to predict the transfusion requirement of the following 72 h. DESIGN: The values of initially measured systolic blood pressure, hematocrit level, and the values of 2 scores of severity of disease (Acute Physiology And Chronic Health Evaluation [APACHE-II], Mortality Prediction Model [MPM]) were calculated after the admission of patients to the ICU. The decision for transfusion was based on specific criteria. The median values of the scores, those of the variables, and the median number of transfused RBC units of the surviving group were compared to the values of the group of patients who died during hospital stay. The quantity of RBC transfusions was compared to the variables and score values by linear regression analysis. Additionally, the values of the patients who did not receive blood transfusion were compared to those of patients who required RBC. Furthermore, the patient group with neurosurgical diseases was compared to the group without neurosurgical diseases. PATIENTS: 117 patients were prospectively and consecutively investigated in an 8-bed ICU of a university hospital. RESULTS: Nonsurvivors required significantly more units of RBC during the first 72 h (p < 0.05). Patients who did not require transfusion had a higher hematocrit and a lower APACHE-II value at admission (p < 0.001). In the MPM values no differences were found. Patients with neurosurgical diseases had a higher initial hematocrit value, and they required less units of RBC in comparison to patients without neurosurgical diseases. In the analysis of linear regression neither in the initially measured systolic blood pressure nor in the APACHE-II and MPM we found a strong linear correlation to the quantity of blood transfusion. CONCLUSIONS: A hematocrit value < or = 20% and a APACHE-II score > or = 20 at the time of admission to the ICU referred to a demand for blood transfusion. We believe that these parameters are useful as predictive instruments. The initially measured systolic blood pressure had no prognostic capacity. In the individual patient a number of factors should be taken into account to decide whether to transfuse or not.

APACHE↗
PubMed1995

1995 in the states: refinement of reform.

With the exception of Kentucky, all state legislatures met in regular session in 1995. By mid-September, all but 10 had adjourned for the year. Not surprisingly, health care reform continued to be a priority for lawmakers. However, in sharp contrast with reform activity in past years, state lawmakers chose refinement over sweeping reform as their preferred approach to health care issues. The year was not without its significant legislative initiatives, including the roll-back of far-reaching reform plans in Minnesota and Washington. However, the fine tuning of insurance market reforms, Medicaid reform, continued growth of medical savings account (MSA) legislation, and making managed care more consumer-friendly were the mainstream activities of this legislative year.

Cost Sharing↗
PubMed1994

Activation processes during mental practice in stroke patients.

In healthy subjects, mental practice is known to improve motor performance. It is also known to be accompanied by a higher central nervous activity. Since such effects seem to be desirable for rehabilitation, we investigated the possibility of detecting changes in central nervous activity by means of EEG in stroke patients, and whether these changes were similar to those observed in healthy subjects. 12 left-sided hemiplegic patients who underwent a specific post-stroke rehabilitation treatment were requested to perform a simple arm movement sequence. In the following mental practice period the patients were requested to image the same sequence without any real movement. EEG background activity was recorded during rest and imagination periods. After the calculation of z-transformed power values within the theta, alpha, and beta-1 band, differences between rest and imagination periods were evaluated for their significance. Stroke patients show significant decreases of theta, alpha, as well as beta-1 power during mental practice in comparison to the rest period. These changes are similar to those obtained in healthy subjects. Theta power decreases in central and parietal leads. Central alpha power diminishes only during imagination of the contralateral arm. This phenomenon as well as the decrease of beta-1 power in central derivation were also obtained during real motor performance and might indicate an activation of the sensorimotor cortex. In accordance with the hypothesis of internal feedback mechanisms, this activation is a necessary prerequisite for motor learning during mental practice.

Aged↗
PubMed1994

Mental practice of motor skills used in poststroke rehabilitation has own effects on central nervous activation.

In the last years it has been shown that the use of the EMG triggered electrical myostimulation (ETEM) brings good results in poststroke rehabilitation. It has been hypothesized that the relearning effects obtained by means of ETEM are due to the reinstatement of proprioceptive feedback. However, the technique is most powerful if imagination of motor acts (the so called mental practice) is used as an initial part of ETEM. Since mental practice in healthy people leads to central nervous activation processes as well as to an improvement of motor skills, we investigated the effects of mental practice alone on central nervous activity by means of EEG in stroke patients. Twelve left-sided hemiplegic patients who underwent a specific poststroke rehabilitation treatment were requested to perform a simple arm movement sequence. In the following mental practice period the patients were requested to imagine the same sequence without any real movement. EEG background activity was recorded during baseline and imagination periods. After the calculation of z-transformed power values within the alpha and beta-1 band, differences between rest and imagination periods were evaluated for significance. Stroke patients showed significant decreases of alpha as well as beta-1 power during mental practice in comparison to the rest period. These changes are similar to those obtained in healthy subjects. Central alpha power diminished only during imagination of the contralateral arm. This phenomenon as well as the decrease of beta-1 power in central derivation were also obtained during real motor performance and might indicate an activation of the sensorimotor cortex. In accordance with the hypothesis of internal feedback mechanisms, this activation is a necessary prerequisite for motor learning during mental practice. We conclude that mental practice of motor skills might have own effects in poststroke rehabilitation.

Aged↗
PubMed1994

[Autologous blood transfusion in tumor operations].

OBJECTIVE: The potential and limits of autologous transfusion in tumor patients are discussed according to the literature. New aspects are derived from own recent studies. DATA SOURCES AND SELECTION CRITERIA: The critical review of the German and English literature is based on a Medline and DIMDI backsearch covering the last 20 years. Own data not yet published are presented. RESULTS: Predeposit autologous blood represents an important and practical alternative to homologous transfusion also for tumor patients. Predeposit programs are limited by tumor anemia, the urgent time schedule for surgery, and the variable need for transfusions. Intraoperative autotransfusion is contraindicated in these patients. Our own studies on the presence of tumor cells in the blood shed from the surgical field during oncologic surgery confirm the concerns about a systemic spread of tumor cells after retransfusion. Further efforts aim to an elimination of contaminating tumor cells. In contrast to the literature filters for white blood cell depletion were found to fail to completely remove tumor cells. A 3 log10 retention was measured. Proliferative activity of tumor cells was completely abolished by irradiation of the blood. CONCLUSIONS: Irradiation with 50 Gy allows safe retransfusion of blood salvaged during tumor surgery. This promising possibility is now to be tested in clinical studies.

Blood Loss, Surgical↗
PubMed1994

[Irradiation of wound blood from tumor surgery for retransfusion].

Intraoperative autotransfusion is contraindicated in tumor surgery because of the danger of tumor cell dissemination. We have tested the elimination of tumor cells in blood by irradiation for safe retransfusion. Tumor cells of various origin were mixed to washed red blood cells from volunteer blood donations. The blood was irradiated with 50 Gy. After isolation of the tumor cells by density gradient centrifugation they were tested for colony formation. While with different tumor cell lines (n = 12) 10 cells were sufficient to yield several colonies, as many as 10(10) cells did not result in any colony after irradiation of the blood. Similar results were obtained with cells cultured from blood salvaged during tumor surgery (n = 3), and with tumor cells prepared from various carcinomas (n = 10). Flow cytometric DNA analysis showed the irradiated cells in mitotic arrest. None of these cells had residual DNA metabolism expressed as incorporation of BrdUrd. We were able to demonstrate a rate of reduction in dividing cells of up to 10(9). With the typical irradiation sensitivity of tumor cells, with D0 values between 1 and 2 Gy, a dose of 50 Gy results in an effective log 12 reduction, sufficient for safe elimination of tumor cells found in shed blood. No adverse effects of the gamma-irradiation on the blood cells are to be expected, especially since the blood is retransfused without storage.

Blood↗
PubMed1993

Visual impairment due to retinopathy of prematurity in Nordic children.

The registers of visually impaired children in Denmark, Finland, Iceland and Norway have been compiled into a common database by a Nordic study group of ophthalmologists, NORDSYN. The database contains information on 2527 children aged 0-17 years. The total number of children with visual impairment due to retinopathy of prematurity (ROP) is 247. ROP is the 3rd most common single diagnosis in the database. The age-specific national prevalence of registration (N/100 000) of visual impairment due to ROP varies from 12 in Denmark to 5 in Finland and Norway and 4 in Iceland. The differences can partly be explained by varying efficiency of registration. The age-distribution indicates that visual impairment due to ROP is not decreasing. Of the 247 children 175 had a visual acuity less than 1/60 and 58 had one or more additional impairments. Incidence studies on visual impairment in Nordic children are being prepared.

Adolescent↗