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Biomedical subjects

G Persson

Publications and source records attributed to G Persson.

At least 19 recordsLinked to original sources
PubMed2004

Reorganization of perinatal care in Greenland.

INTRODUCTION: September 2000 the planning of a major reform of health services was launched aimed at improving perinatal care and decreasing perinatal mortality and morbidity. The activities became effective from January 2002. METHODS: A new organization plan was developed, a special medical record was designed for perinatal care and training programs for health workers in perinatal care were instituted, including basic ultrasound scan for gestational age. Professional guidelines for perinatal care were distributed countrywide, stipulating that at risk pregnancies should be referred for delivery to Queen Ingrid's Hospital, as well as offering treatment suggestions for various complications. RESULTS: There was a marked improvement in the referral rate for at risk pregnancies and consequently a sharp rise in the share of at risk patients in Queen Ingrid's Hospital, calling for extra resources to be allocated. However, the rate for instrumental deliveries remained low at the special unit at the same time as the rural health care centres were relieved of the burden of high-risk deliveries. DISCUSSION: Transferring women for delivery, in many cases leaving their families for a substantial amount of time, undoubtedly has psychosocial implications. Will the impact of the programme on perinatal mortality and morbidity make up for these costs? Will we be able to reduce the rate of instrumental deliveries in the rural health care centres as well as the number of acute--and very costly--evacuations of patients by chartered aircraft? The questions are many--we hope to provide some answers.

Female↗
PubMed2003

Randomized clinical trial of the effect of interferon alpha on survival in patients with disseminated midgut carcinoid tumours.

BACKGROUND: Midgut carcinoid tumours often present with widespread disease making curative surgery impossible. Medical treatment therefore plays a major role in the treatment of these patients. METHODS: In this prospective randomized study, the effect of interferon (IFN) alpha on survival and risk of tumour progression was evaluated in 68 patients with midgut carcinoid tumours metastatic to the liver. All patients had undergone primary surgical treatment and hepatic arterial embolization of liver metastases before randomization. Patients were randomized to treatment with either octreotide alone (n = 35) or octreotide in combination with IFN-alpha (n = 33). RESULTS: Forty-one of the 68 patients died during a follow-up period of 33-120 months, equivalent to a 5-year survival rate of 46.5 per cent. There was no significant difference in survival between patients treated with octreotide alone (5-year survival rate 36.6 per cent) and those given octreotide in combination with IFN-alpha (56.8 per cent). However, patients treated with IFN-alpha had a significantly reduced risk of tumour progression during follow-up (P = 0.008). CONCLUSION: Addition of IFN-alpha to octreotide may retard tumour growth in patients with midgut carcinoid tumours.

Adult↗
PubMed2001

Protection against cold air and exercise-induced bronchoconstriction while on regular treatment with Oxis.

This study aimed to compare the duration of protection against exercise-induced bronchoconstriction (EIB) after inhalation of formoterol (Oxis) Turbuhaler with that of terbutaline Turbuhaler and placebo Turbuhaler in asthmatic patients treated regularly with formoterol Turbuhaler 9 microg b.i.d. and inhaled steroids. The study. performed at three centres (Göteborg and Lund, Sweden, and Trondheim, Norway), consisted of an open-label part with formoterol Turbuhaler 9 microg b.i.d. and a randomized, double-blind, cross-over part with a single dose (on top of the regular treatment) of either formoterol Turbuhaler 9 microg, terbutaline Turbuhaler 0.5 mg or placebo Turbuhaler. The patients attended the clinic six times: twice for screening visits, three times for randomized treatment and once for a follow-up visit. Patients received regular b.i.d. treatment with formoterol 9 microg for a mean period of 16 days. Formoterol gave a post-exercise fall of 12, 10, 15 and 17% in forced expiratory volume in 1 sec (FEV1) 15 min, 4, 8 and 12 h after inhalation. The differences compared with placebo (falls of 26, 22, 23 and 22%) and terbutaline (falls of 17, 18, 22 and 22%) were all statistically significant (P<0.05 for all comparisons). Patients on regular treatment with formoterol Turbuhaler 9 microg b.i.d. have a significant protection against EIB up to 12 h after inhalation of formoterol 9 microg. The protection was also significantly better than that of terbutaline Turbuhaler 0.5 mg.

Adult↗
PubMed2001

Is there equity in access to health services for ethnic minorities in Sweden?

BACKGROUND: This paper addresses the extent to which equity of treatment according to need, as defined by self-reported health status, is received by members of ethnic minorities in Swedish health services. METHODS: The study was based on a multivariate analysis of cross-sectional data from the Swedish Survey of Living Conditions and Immigrant Survey of Living Conditions in 1996 on use of health services, morbidity and socioeconomic indicators. The study population consisted of 1,890 Swedish residents aged 27-60 years born in Chile, Poland, Turkey and Iran and 2,452 age-matched, Swedish-born residents. MAIN RESULTS: Residents born in Chile, Iran and Turkey were more likely to have consulted a physician during the 3 months prior to the interview compared to Swedish-born residents; odds ratios (ORs) 1.4 (95% CI: 1.2-1.7), 1.3 (95% CI: 1.1-1.7) and 1.5 (95% CI: 1.3-1.9) respectively. The higher consultation rate in these ethnic minorities was primarily explained by a less satisfactory, self-reported health status compared to Swedish-born residents. Thirty-eight percent of the minority study groups reported exposure to organised violence in their country of origin, which was associated with a higher level of use of consultations with a physician (OR 1.3, 95% CI: 1.1-1.6). CONCLUSIONS: This study did not indicate any gross pattern of inequity in access to care for ethnic minorities in Sweden. Systems for allocating resources to health authorities need to consider the possibility that ethnic minorities in Sweden and in particular victims of organised violence, use health services more than is suggested by socioeconomic indicators only.

Adolescent↗
PubMed2001

Recovery from eutrophication: experiences of reduced phosphorus input to the four largest lakes of Sweden.

In-lake concentration changes of phosphorus (P) and nitrogen (N) in lakes Vättern, Vänern, Mälaren, and Hjälmaren in response to diminished input has been examined from the mid-1960s onwards. In the former two deep and oligotrophic lakes with slow water renewal, drastic reductions in P-input from the middle of 1970s caused just minor reductions in P-concentration over a very long time. At the same time accumulation occurred in the water mass of inorganic N and possible reasons are discussed. In the latter two mesotrophic to hypertrophic lakes, two shallow basins in L. Hjälmaren showed slow recovery due to release of P from sediments. The same basins and two basins in L. Mälaren have suffered from N-deficiency, particularly during the pre-phosphorus reduction years, and nitrogen fixation was indicated. In two L. Mälaren basins recovery of in-lake P concentrations was better than expected in comparison to the so-called IMSA-model for lake recovery from nutrient pollution. In the other five lakes/basins chlorophyll concentrations after 20 years were similar compared to those modeled.

Biomass↗
PubMed2001

Phosphorus in tributaries to Lake Mälaren, Sweden: analytical fractions, anthropogenic contribution and bioavailability.

Riverine phosphorus (P) concentration and P-transport to Lake Mälaren, the third largest lake in Sweden, has been monitored for 35 years in 12 major tributaries. During a period of 15 months, complementary assessments of particulate P, suspended matter and dissolved reactive P were made. Particulate P comprised 64%, dissolved unreactive P 23% and dissolved reactive P 13% as flow-weighted means, with high seasonal variability. "Background" or "reference" P-transports in the streams were estimated by different methods and the anthropogenic contribution to P-transport was shown to be reduced over time. Potential algal availability of particulate P showed a mean availability of c. 45% for water draining arable and forested land, while the availability was higher for sewage discharge particulate P and algal P. Calculated total bioavailable P in tributaries was shown to equal reactive P measured on coarsely filtered water and it was indicated that the proportion of bioavailable P was higher during the period with high anthropogenic P-contribution than with a lower contribution.

Ecosystem↗
PubMed2000

Growth hormones reverse desensitization of P2Y(2) receptors in rat mesangial cells.

Rat glomerular mesangial cells (GMC) express P2Y(2) purinoceptors and respond to nucleotide stimuli with a transient increase in the cytosolic Ca(2+) concentration and the receptors desensitize upon repeated stimulation with nucleotide. We demonstrate that there is a cross-talk from the signaling of tyrosine kinase to P2Y(2) receptors. For most cells repeated applications of ATP completely abolished the response, as did activation of PKC with 500 nM PMA. In contrast, preincubation with the PKC inhibitor chelerythrine (100 nM) prevented desensitization. Desensitization after application of ATP was reversed by subsequent incubation with PDGF-BB (50 ng/ml) or insulin (660 mU/ml). We conclude that the desensitization is caused by phosphorylation due to PKC and is under the control of growth factors. The findings support the hypothesis that growth hormones potentiate nucleotides as proinflammatory mediators and we hypothesize that they have bearing on the hyperfiltration seen in diabetes.

Adenosine Triphosphate↗
PubMed2000

Relative systemic dose potency and tolerability of inhaled formoterol and salbutamol in healthy subjects and asthmatics.

OBJECTIVES: To compare the relative systemic dose potency and tolerability of inhaled formoterol and salbutamol and to describe elimination of formoterol, particularly any enantioselectivity. METHODS: Twelve healthy subjects, aged 18-28 years, completed three open study days, and eleven asthmatic patients, aged 20-56 years, completed four double-blind study days in randomised, placebo-controlled and crossover fashions. The healthy subjects inhaled 13.5 + 13.5 + 27 microg formoterol (Oxis) via Turbuhaler and 300 + 300 + 600 microg salbutamol (Ventoline) via a pressurised metered dose inhaler (pMDI). The asthmatics, being on formoterol 9 microg twice daily via Turbuhaler during the study, inhaled the same single doses as the healthy subjects plus 900 + 900 + 1800 microg salbutamol via pMDI. Doses were given cumulatively 30 min apart on separate study days. Placebo was a day of no treatment in the healthy subjects. Double dummies were used for the asthmatics. Cardiovascular and metabolic effects were evaluated. Elimination of formoterol was addressed in the healthy subjects. RESULTS: Formoterol was estimated to be 28-109 times as potent as salbutamol, depending on the systemic effect variable. The duration of systemic action seemed to differ marginally at approximately equieffective doses of formoterol and salbutamol. Systemic effects were well tolerated and tended to be more pronounced in the healthy subjects than in the asthmatic patients. The half-life of the pharmacologically more active (R;R)-formoterol was longer than that of (S;S)-formoterol. CONCLUSIONS: Systemically, formoterol was shown to be 28-109 times as potent as salbutamol. Equieffective doses seemed to have a similar duration of effect. Formoterol and salbutamol were well tolerated by healthy subjects up to the tested total doses of 54 microg and 1200 microg, respectively, and by asthmatic patients up to the tested total doses of 54 microg and 3600 microg, respectively. Elimination of formoterol was enantioselective.

Administration, Inhalation↗
PubMed1999

Ca2+ response of rat mesangial cells to ATP analogues.

The aim of this investigation was to characterise the effects of ATP analogues and UTP on the single cell intracellular Ca2+ concentration ([Ca2+]i) in cultured rat mesangial cells. Typically, there were two phases in the Ca2+ response to the agonists, an initial fast transient peak and a subsequent slower decline, or plateau, phase. For the peak amplitude in [Ca2+]i the agonists had about equal effect. But when taking in consideration the percentage of responding cells and the integrated Ca2+ response over 1 min, the order of efficacy of nucleotide agonists (100 microM) was UTP = ATP > ATPgammaS > ADP = 2MeS-ATP (2-methylthio-ATP). Adenosine, AMP and beta,gamma-Me-ATP (100 microM) had no effect. Suramine (100 microM) and reactive blue (50 microM) decreased the number of responding cells. Removing Ca2+ from the bath diminished neither the peak in [Ca2+]i nor the percentage of responding cells, but the average [Ca2+]i increase in 1 min was significantly reduced. The results indicate that P2Y2 receptors are present in rat mesangial cells but it cannot be excluded that there are receptors distinct from P2Y2 which also mediate a rise in [Ca2+]i.

Adenosine↗
PubMed1999

Family history of diabetes in middle-aged Swedish men is a gender unrelated factor which associates with insulinopenia in newly diagnosed diabetic subjects.

We have investigated the association of a family history of diabetes with glucose tolerance in a population of Swedish men. All men 35-54 years of age in 1992 and living in four different local municipalities of the outer Stockholm area were screened by questionnaire. From 10236 completed questionnaires 1622 men, selected for presence of such a history but without known diabetes, as well as 1507 men without a family history underwent an oral glucose tolerance test. Diabetes (2 h-plasma glucose levels > 11.0 mmol/l) was detected in 55 and impaired glucose tolerance (plasma glucose levels 7.8-11.0 mmol/l) in 172 subjects. The odds ratio of diabetes, associated with a family history, was 4.1, confidence interval 2.1-8.3 and for impaired glucose tolerance 1.6, confidence interval 1.2-2.3. Influence of a family history was measurable also within the range of normal 2-h glucose concentrations: compared to 2-h glucose levels < 3.8 mmol/l; the odds ratio associated with a family history was 1.4, confidence interval 1.1-1.7 and 1.3, confidence interval 1.1-1.6 for concentrations 4.8-5.7 mmol/l and 5.8-7.7 mmol/l respectively. The odds ratio of diabetes and impaired glucose tolerance among men with a family history increased with number and closeness of relatives with diabetes but was not affected by the gender of the family member. Overweight (BMI > 25.0 kg/m2) increased the odds ratio of diabetes in subjects with a family history, the odds ratio being 24, confidence interval 3-177, when both conditions were present. In subjects with Type II (non-insulin-dependent) diabetes mellitus discovered during the investigation, the presence of a family history of diabetes was associated with decreased insulin secretion rather than insulin resistance as assessed by fasting insulin, homeostasis model assessment, and the 2-h insulin response to the oral glucose tolerance test. We conclude that a family history of diabetes strongly but independently of gender associates with decreased glucose tolerance. Furthermore, the results are compatible with a major role for low insulin secretion in the diabetogenic influence of a family history of diabetes in middle-aged Swedish men. Lastly, the very high risk for diabetes in middle-aged men with both a family history of diabetes and obesity indicates that such people should, for the purpose of therapeutic intervention, be identified in the general population.

Adult↗
PubMed1998

[Which patients need gallstone surgery?].

Although gallstone disease is common, few patients develop serious complications. Recent decades have witnessed manifest changes in the frequency of gallstone surgery in Sweden. Although variation in the prevalence of gallstone disease may be one explanation, uncertain indications for gallstone surgery may also be a contributory determinant of the varying cholecystectomy rates. Findings in epidemiological and clinical studies suggest that cholecystectomy should be performed in cases of frequent gallstone symptoms or acute gallstone complications, whereas expectant management is to be recommended in cases of infrequent symptoms or where their link with gallstone problems is in doubt.

Adult↗
PubMed1997

Inhaled dry-powder formoterol and salmeterol in asthmatic patients: onset of action, duration of effect and potency.

Salmeterol and formoterol are two long-acting beta2-agonists for inhalation, currently being used in clinical practice. The aim of the present study was to investigate the onset of action, duration of effect and potency of these two beta2-agonists in asthmatic patients. Patients (n=28) were included on the basis of salbutamol stepwise reversibility (100, 100 and 200 microg, given cumulatively; total reversibility > or =15%). In a double-blind placebo-controlled crossover study, the bronchodilating properties of formoterol 6, 12 and 24 microg were compared with the effects of salmeterol 50 microg. Formoterol was given via Turbuhaler and salmeterol via Diskhaler, and forced expiratory volume in one second (FEV1) was monitored during 12 h. Formoterol at all doses had a more rapid onset than salmeterol as judged from bronchodilation at 3 min after the dose. Formoterol at all doses had a similar duration of effect to salmeterol 50 microg, as judged from bronchodilation at 12 h after dose administration. When the relative potency of the two drugs was compared, salmeterol 50 microg was estimated to correspond to formoterol 9 microg (95% confidence interval: 3-19 microg). We confirm that formoterol and salmeterol are both long-acting beta2-agonists, but with some differences in effect profile. We confirm the more rapid onset of action of formoterol compared with salmeterol, and furthermore, no difference in duration of effect is evident.

Administration, Inhalation↗