[GT is superior as a marker of alcohol abuse].
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Alcohol Drinking↗
Biomedical subjects
E Trell
Publications and source records attributed to E Trell.
Multi centre systems analysis study of primary health care: a study of socio-organizational and human factors.
The information management systems to support health programmes are inadequate. As computers become cheaper and more powerful, their application in the strengthening of the information infrastructure becomes more feasible. However, the high cost of specialized applications software limits their potential, especially in developing countries. A multi-centre systems analysis, (a descriptive study using a questionnaire), was made of District Health Sites in developing countries to analyse whether a common specialized application software design for implementation at a primary health care centre was feasible. Responses to the questionnaires by physicians at the primary health centres were compared between district health sites using contingency tables. Significant inter-site differences in social factors existed, respondents had no prior experience, but with near unanimity (98%) accepted the idea of computer assistance in their work. However, general reservations (31%) and fears (26%) about computer interference in the doctor-patient relationship were expressed. The human factor must be considered in interface design and training before implementation.
Attitude of Health Personnel↗
Impact on the management and delivery of primary health care by a computer-based information system.
Timely and accurate information forms the basis for management to plan and for care providers to take appropriate action. We report from a developing country a research project aimed to strengthen the information infrastructure with a computer at a Primary Health Centre. The software (MCHS) was designed to assist the care providers in the information management for the Maternal and Child Health (MCH) programme activities. In Phase I, a baseline survey was conducted to identify the needs and target groups. In Phase II, the MCHS was integrated into routine delivery of MCH to monitor the target population and help in evaluation. The research project's impact is reflected in enhanced utilization of services and quality in care, as seen by reduction of dropouts from the immunization program. In economic terms, we see that the costs for a fully immunised child are reduced with reduction of dropouts; thus, the computer system contributes to quality assurance and cost effectiveness in delivery of care.
Adolescent↗
Towards an essential data set: applicability in the domain of maternal health services.
There is a need for consensus on the quantity of data that must be available in a computer-based information system of a health care organization. In this paper we take up the issue of defining the data content of an information system and introduce the concept of Essential Data Sets with an explicit methodology which was applied to define a data set for the Maternal Health Services program. A key step in the method was a recognized technique used in systems development process called data modelling, in this case infological modelling, by an interdisciplinary group. A preliminary set of 86 data elements was identified and it provided the foundation for development of an application software for discussion and a real-world testing framework. The acceptability of the data set was tested in a laboratory perspective by retrospective data entry from records of 94 pregnant women registered at a maternal health care center in Sweden. Data from a total of 1,318 prenatal visits, an outcome visit, and a postnatal visit for each woman was entered into a computer using the software, with no loss of information. Thus, in a short-term perspective the acceptability of the data set was demonstrated. The software has since been implemented for pilot prospective studies at sites in India and Sweden. The use of a common data protocol is an essential foundation for patient outcome research, especially as the trend of health care management has changed from a "process of care" orientation to an "outcome of care" orientation.
Electronic Data Processing↗
A multicenter study of data collection and communication at primary health care centers.
Health care delivery is information intensive. As computer applications make information available to the decision maker with speed and accuracy, informatics applications will strengthen the infrastructure. This paper is the second part of a multicenter systems analysis study to design a common application software to support primary health care focused on information flow. We present the questionnaire analysis and observations from a field study of a district health site. Analyses using contingency tables revealed differences, some statistically significant. The field study confirmed that minor differences exist even within a district health site. Development of a common application software on the basis of information flow studies is feasible. However, to make optimum use of computer implementation, revision of the health information systems was recommended. It was suggested that application software be developed with the core data set required by the care providers to deliver and administrators to manage a vertical health program.
Communication↗
Laryngeal cancer, aryl hydrocarbon hydroxylase inducibility and smoking. A follow-up study.
In 58 cases with laryngeal cancer (10 supraglottic and 48 glottic), aryl hydrocarbon hydroxylase (AHH) inducibility and smoking habits were studied. All but 2 were smokers and most of them heavy tobacco consumers. The AHH levels were divided into high, intermediate and low groups and were compared to a large healthy control material also divided into the aforementioned groups. A highly significant overrepresentation of patients with a high AHH level (p less than 0.0005) as well as a significant underrepresentation of low AHH levels (p less than 0.025) were found. Smokers with a high AHH level run a fourfold risk of developing laryngeal cancer as compared to non-smokers with low AHH levels. They also develop cancer earlier in life and get recurrences and secondary malignancies more frequently. As in oral and oropharyngeal cancer a high AHH inducibility seems to be of pathogenetic as well as of prognostic importance even in laryngeal cancer.
Alcohol Drinking↗
Motilin response to a glucose load aberrant in smokers.
Smoking is known to influence the blood glucose response to an oral glucose load, possibly by altering the gut motility. Because the peptide hormone motilin might be involved in the regulation of the gastric emptying pattern, we studied 12 heavy smokers and 9 non-smokers after an overnight fast and tobacco abstinence. After an oral glucose load non-smokers showed falling serum motilin levels, as expected, whereas the smokers had initially increasing values. We conclude that smoking affects the gastrointestinal tract, not only during acute nicotine exposure but also chronically.
Blood Glucose↗
Evaluation of possibilities for mass screening for colorectal cancer with Hemoccult fecal blood test.
Data from a health survey including the Hemoccult fecal blood test, together with official cause-specific death rates, were used to assess the magnitude of a controlled trial that would be required to prove a 25 percent reduction of the mortality from colorectal cancer associated with screening. All men in three age groups in the city of Malmö, Sweden, were invited, but 46 percent did not participate in, the Hemoccult screening. One carcinoma and 89 adenomas were detected in 56 of the 2422 who did. With the risk function used in our calculation and a compliance rate of 60 percent, a study population among 45- to 69-year-olds of 605,000 is required to prove an expected 25 percent reduction of the mortality with 90 percent power. Considering the size of such a trial, we question whether a controlled trial is feasible. With known risk functions for death from all causes and death from colorectal cancer, the study population was calculated using variable statistical power, participation rate, and risk reduction. Statistical methods and computer programs are given. In addition, alternative study models to assess the benefits associated with screening are discussed.
Adenoma↗
[Smoking, oral and oropharyngeal cancer in relation to AHH-enzyme activity].
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Aged↗
Secretion rate and buffer effect of resting and stimulated whole saliva in relation to general health.
The aim of this investigation was to study the possible relationship between general health and the salivary secretion rate and buffer effect. Based on the results of duplicate salivary tests, 92 consecutive dental patients with a very low secretion rate and/or buffer effect of resting and/or stimulated whole saliva were referred for a medical examination, which included blood and urine analyses. Various medical findings were made for 39 per cent of these patients. As comparison, the same medical and salivary variables were studied in 50 subjects who participated in medical screening programs. Medical findings were made for 32 per cent of the subjects, of whom only about one fourth had one or more very low salivary values. For both groups, no statistically significant difference was found for any of the variables studied when comparing individuals with and without medical findings. Therefore, the results obtained did not indicate a relationship between impaired health and a very low salivary secretion rate and/or buffer effect of whole saliva.
Adolescent↗
Distribution and reproducibility of aryl hydrocarbon hydroxylase inducibility in a prospective population study of middle-aged male smokers and nonsmokers.
Aryl hydrocarbon hydroxylase (AHH) inducibility was determined in a lymphoblast test system in 2,000 consecutive middle-aged male smokers, 304 ex-smokers, and 218 never-smokers in the same birth-year cohorts. Intraindividual, intraobserver, and interobserver, as well as temporal, reproducibility was checked in a special double-blind quadruplet sample series from 20 other consecutive middle-aged men. The results showed a three-modal phenotype distribution of AHH inducibility with high (fold induction greater than or equal to 3.6), intermediate (2.6-3.6) and low (less than or equal to 2.5) levels ranging between 7.6% to 10.5%, 38.5% to 43.0%, and 46.5% to 53.9%, respectively, in all the smoking categories. The reproducibility of the measurements was excellent, with one-way variance in the order of 0.007 to 0.033, and the applied assay method can therefore be used in large-scale prospective population investigations. Such are required in order to establish a cause-effect association between high AHH inducibility and smoking-related malignancies of the respiratory tract and oral cavity, as has been suggested from earlier retrospective studies in more limited clinical materials of cancers and precanceroses of these varieties.
Aryl Hydrocarbon Hydroxylases↗
Screening and intervention for alcohol-related disease in middle-aged men: the Malmö Preventive Programme.
In the Malmö Preventive Programme the tracing and prevention of alcohol-related disease was attempted by means of the enzyme serum gamma-glutamyltransferase (GGT) in a large unselected population of middle-aged men. Alcohol was considered to be the underlying factor in 70% of subjects with raised GGT values. In a prospective analysis, alcohol-related death turned out to be a major contributor to death in men who died within five years of the screening. GGT was the variable that was most predictive for premature death in this population. There were also statistically significant correlations between alcohol-related death and a questionnaire, the Mm-MAST, positively, and serum creatinine and serum cholesterol, negatively. In the randomized intervention programme, reductions in sickness benefit days, hospital admissions and mortality were seen in the intervention group in comparison with the control group, after four years of follow-up. The intervention programme was therefore effective in preventing the consequences of heavy drinking, and a risk factor approach to alcohol-related diseases seems feasible. This approach, however, encounters several problems, such as the recruitment of the non-participants in the screening, the investigation of the GGT-high/non-alcoholic subjects, and the identification of the GGT-normal/alcoholic subjects.
Alcoholism↗
Alcohol and the vascular system.
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Alcoholism↗
Differences in airway obstruction between heavy smokers.
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Airway Obstruction↗
Blood lipid variability in relation to relative weight and biochemical markers of tobacco and alcohol consumption.
Carboxyhaemoglobin (COHb%) and gamma-glutamyl-transferase (GGT) are today frequently used as objective indicators of tobacco and alcohol consumption. The relationships between COHb%, GGT and relative body weight, cholesterol, triglyceride and apolipoprotein AI (Apo-AI) were studied in middle-aged men attending a preventive medical programme in Malmö, Sweden. Although statistically significant the influence of COHb% on cholesterol and triglyceride was found to be clinically insignificant. GGT and body weight had, independent of each other, a significant influence on cholesterol and triglyceride. GGT was found to have a positive correlation to Apo-AI whereas body weight was found to have a negative correlation to Apo-AI. Four per cent of the cholesterol variability, 16% of the triglyceride variability and about 10% of the variability in Apo-AI could, in this study, be accounted for by COHb%, GGT and relative body weight.
Alcohol Drinking↗
Oral and oropharyngeal cancer, aryl hydrocarbon hydroxylase inducibility and smoking. A follow-up study.
In a series of 50 consecutive cases with oral or oropharyngeal malignancies, aryl hydrocarbon hydroxylase (AHH) inducibility and smoking habits were studied. 82% of the patients were smokers. The AHH levels were divided into high, intermediate and low groups and were correlated to a healthy control material also divided into the groups mentioned. A significant overrepresentation of patients with a high AHH level (p less than 0.0005) as well as an underrepresentation of low AHH levels (p less than 0.01) was found. Smokers with a high AHH level run a sixfold risk of developing cancer in this area and develop it earlier in life than people with low or intermediate AHH levels. Recurrences or secondary malignancies in the upper digestive tract or airways were substantially higher in the high AHH level group as compared to the other. A high AHH inducibility level thus is of both pathogenetic as well as prognostic importance in oral and/or oropharyngeal cancer.
Adult↗
Ultrasonographic screening for gallstone disease in middle-aged women. Detection rate, symptoms, and biochemical features.
Five hundred and forty-seven middle-aged women, selected at random from the population of Malmö, Sweden, were invited to a screening survey for gallstone disease; 424 participated (77.5%). Forty-one had previously been operated on for gallbladder disease. The prevalence of gallstone disease, on the basis of a positive finding at ultrasonography and cholecystography, was 11%. The predictive value of a positive finding at ultrasonography was 86%. Six out of 10 women with gallstone were classified as asymptomatic. Body weight, blood pressure, liver enzymes, fasting blood glucose, and blood lipids, including apolipoprotein-A, did not differ significantly in women with and without gallstone disease. At least 9 out of 10 gallstones appeared to be cholesterol stones. Approximately half were of a size that would make them accessible for dissolution therapy.
Cholecystography↗
Design, findings and five-year follow-up of preventive medical lipid intervention clinic in Malmö.
In a separate lipid intervention clinic integrated within the framework of a multiphasic preventive medical population program in Malmö, 401 of 2431 screening attenders in a male birth-year cohort born in 1927 and 1928 had elevated values of triglyceride and/or cholesterol. Hypertriglyceridemia was more than three times as frequent as hypercholesterolemia. Of these attenders 20% had normal values at the second control, 5% did not attend the second test and 92 (31.2%) of the remaining were referred to other clinics because of other high risk factors. Thus, 209 (8.6% of the screening attenders) males born in 1927 and 1928 attended the lipid clinic for isolated hyperlipidemia. Disregarding a 5-year drop-out frequency of 13 sections, a significant reduction in the lipids was obtained during the follow-up period in those remaining in treatment. This study demonstrates the feasibility in taking care of hyperlipidemic individuals after a screening detection program. Detection and treatment of hyperlipidemia should of course also be initiated in the individual case in ordinary medical practice.
Cholesterol↗