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Biomedical subjects

J Olsen

Publications and source records attributed to J Olsen.

At least 91 records · Page 5Linked to original sources
PubMed2001

Using continuous quality improvement techniques to determine the causes of hospital readmission.

This 6-month retrospective study provided our medical center with a profile of the population of patients readmitted within 31 days of discharge. We found that chronic illness and age greater than 65 years were the high risk factors related to patient readmissions. These 2 attributes are common in critical care patients. In addition, the study indicated that data input and collection procedures must be correctly followed in order to have accurate information on admission and readmission. Accurate information is important to management and external agencies. Accuracy is also important so that future problems with continuous quality improvement can be recognized and resources properly assigned. Recommendations for improving the data collection and reporting procedures and for improving the readmission rates were made to management, to the quality improvement coordinator, and to the quality improvement/risk management director.

Age Factors↗
PubMed2000

Increased lymphocytic aminopeptidase N/CD13 promoter activity after cell-cell contact.

Aminopeptidase N (APN)/CD13 is a transmembrane ectoenzyme expressed on a wide variety of cells. With respect to haematopoietic cells, APN/CD13 has been considered specific for the myeloid lineage, because granulocytes and monocytes/macrophages, but not lymphocytes of peripheral blood, show a surface expression of CD13 antigen. However, we could recently show that cell-cell contact of lymphocytes with endothelial cells, monocytes, and fibroblast-like synoviocytes (SFCs) results in an increase of steady-state APN/CD13 mRNA and a rapid expression of cell-surface protein on the lymphocytes. In this study using the Dual-Luciferase reporter assay, we demonstrate that interaction of the T-cell line Jurkat with SFCs results in a higher activity of the APN/CD13 myeloid promoter in T cells. An enhancer located between the myeloid and epithelial APN/CD13 promoter increases the response of the promoter to the cell-cell contact-induced expression of APN/CD13 in lymphocytes. Adhesion of lymphocytes to extracellular matrix did not result in increased promoter activity. The lymphocytic promoter response induced by direct cell-cell contact with SFCs is not affected by mutations of a proximal promoter element (nucleotides -48 to -35), which has a possible functional role in the basal APN/CD13 gene expression in lymphocytes. Upregulated peptidase-promoter activity via cell-cell contact shown in this study for the first time is discussed as a general mechanism in peptidase induction.

Base Sequence↗
PubMed2000

[Stress and fertility. A follow-up study among couples planning the first pregnancy].

Mental distress has often been suggested as a cause of unexplained infertility. However, the causal direction may well be from infertility to distress, and prospective data are needed. We therefore followed 393 couples, who were planning their first pregnancy, with prospective collection of information on distress from termination of birth control until pregnancy for a maximum of six menstrual cycles. The analyses included 1,475 menstrual cycles, and mental distress was measured in each cycle by the General Health Questionnaire (GHQ). Urine samples from each period of vaginal bleeding were analyzed for human chorionic gonadotrophic hormone, indicating early embryonal loss. We found that for cycles with the highest distress score (GHQ score above the 80 percentile) the probability of conception per cycle was 12.8% compared to 16.5% in other cycles (adjusted OR 0.6; 95% CI 0.4-1.0). The effect of distress was almost exclusively found among women with long menstrual cycles (OR 0.1; 95% CI 0.01-0.4 and OR 0.9; 0.5-1.4 for women with cycles > or = 35 and < 35 days, respectively). An increased incidence of early embryonal loss was also found among highly distressed women with long cycles, but was based on a small number of observations. It is concluded that psychological distress may be a risk factor for reduced fertility in women with long menstrual cycles.

Adult↗
PubMed2000

Serious life events and congenital malformations: a national study with complete follow-up.

BACKGROUND: Emotional stress during organogenesis could, in theory, cause congenital malformations. We undertook a follow-up study to test the hypothesis that psychosocial stress increases the prevalence of malformations, particularly of the cranial neural crest. METHODS: We defined severe life events as death or first hospital admission for cancer or acute myocardial infarction in partners or children. From 1980 to 1992 all women exposed to severe life events during pregnancy and up to 16 months previously were identified by means of five national registers. We included 3560 exposed pregnancies and 20,299 pregnancies without such exposures randomly selected as a control cohort. FINDINGS: The frequency of cranial-neural-crest malformations was higher in pregnancies with exposure to severe life events than in those without such exposure (42 [1.18%] vs 131 [0.65%]; adjusted odds ratio 1.54 [95% CI 1.05-2.27]). For other malformations, the frequencies were 3.04% and 3.26% (1.14 [0.94-1.42]). Women exposed in two consecutive pregnancies had a higher risk of cranial-neural-crest malformations (2.99 [1.06-8.43]). Death of an older child during the first trimester was associated with an adjusted odds ratio of cranial-neural-crest malformations of 4.75 (1.63-13.8). Unexpected death of a child during the first trimester was associated with adjusted odds ratios of 8.36 (2.41-29.0) for cranial-neural-crest malformations and 3.64 (1.29-10.3) for other malformations. INTERPRETATION: These findings support the hypothesis that severe emotional stress during pregnancy, especially that related to death of a child, may cause congenital malformations, particularly those of the cranial neural crest.

Adolescent↗
PubMed2000

Maternal age and fetal loss: population based register linkage study.

OBJECTIVE: To estimate the association between maternal age and fetal death (spontaneous abortion, ectopic pregnancy, stillbirth), taking into account a woman's reproductive history. DESIGN: Prospective register linkage study. SUBJECTS: All women with a reproductive outcome (live birth, stillbirth, spontaneous abortion leading to admission to hospital, induced abortion, ectopic pregnancy, or hydatidiform mole) in Denmark from 1978 to 1992; a total of 634 272 women and 1 221 546 pregnancy outcomes. MAIN OUTCOME MEASURES: Age related risk of fetal loss, ectopic pregnancy, and stillbirth, and age related risk of spontaneous abortion stratified according to parity and previous spontaneous abortions. RESULTS: Overall, 13.5% of the pregnancies intended to be carried to term ended with fetal loss. At age 42 years, more than half of such pregnancies resulted in fetal loss. The risk of a spontaneous abortion was 8.9% in women aged 20-24 years and 74.7% in those aged 45 years or more. High maternal age was a significant risk factor for spontaneous abortion irrespective of the number of previous miscarriages, parity, or calendar period. The risk of an ectopic pregnancy and stillbirth also increased with increasing maternal age. CONCLUSIONS: Fetal loss is high in women in their late 30s or older, irrespective of reproductive history. This should be taken into consideration in pregnancy planning and counselling.

Abortion, Spontaneous↗
PubMed2000

Body mass index and delayed conception: a European Multicenter Study on Infertility and Subfecundity.

Obesity has become a health problem in affluent societies, but few studies have investigated its effect on subfertility. Previous studies were based on select groups of women, focused mainly on ovulatory dysfunctions, and yielded controversial results. The authors evaluated the effect of body mass index on delayed conception by using a European population-based survey of pregnant women from five countries. Delayed conception was defined as a time to pregnancy that exceeded 9.5 months of unprotected intercourse. During 1992, 4,035 pregnant women from well-defined geographic areas were recruited consecutively at antenatal clinics or hospitals after at least 20 weeks of gestation. For women smokers, after adjustment for sociodemographic, biologic, and lifestyle-related factors, there was a strong association between obesity (body mass index of > or =30 kg/m2) and delayed conception (odds ratio = 11.54, 95% confidence interval: 3.68, 36.15) and also an increased risk for women whose body mass index was <20 kg/m2 (odds ratio = 1.70; 95% confidence interval: 1.01, 2.83). The same analysis conducted for women nonsmokers showed no association. The authors concluded that for women who achieve a clinically detectable pregnancy, those who are underweight or obese require a longer time to conceive only if they also smoke.

Adult↗
PubMed2000

[Antibiotic pre-hospital treatment and the course of meningococcal disease].

The aim of the study was to assess the effect of pre-hospital antibiotic treatment given by general practitioners to patients with meningococcal disease. It was carried out as a 16-year population-based historical follow-up study based on referral letters and hospital records in the County of North Jutland, Denmark, and included 320 patients with meningococcal disease, of whom 302 were examined by a general practitioner before admission to hospital. The main outcome measure was death. We found that 44 patients (14.6%) were given antibiotic treatment by the referring general practitioner. Nine of these (20.5%) died, compared with 16 (6.2%) patients who did not receive pre-hospital antibiotic treatment. The presence of skin bleeding, petechiae and impaired consciousness were strongly associated with case fatality. Even after adjustment for these variables the odds ratio for death in patients treated with antibiotics was high (3.2; 95% CI 0.9-10.6). In the 15 patients with skin bleeding (ecchymoses, suggillations) the case fatality rate was 100% in patients treated with antibiotics, and 50% in patients who did not receive antibiotics before hospitalization. It is concluded that pre-hospital treatment is mainly given to the most severe cases with expected high case fatality, and this confounding by indication was probably not fully adjusted for with the available data. The results contradict previous findings and provide reason to doubt the benefit of pre-hospital antibiotic treatment in patients with meningococcal disease.

Adolescent↗
PubMed2000

Involvement of activator protein 1 complexes in the epithelium-specific activation of the laminin gamma2-chain gene promoter by hepatocyte growth factor (scatter factor).

Laminin-5 is a trimer of laminin alpha3, beta3 and gamma2 chains that is found in the intestinal basement membrane. Deposition of the laminin gamma2 chain at the basement membrane is of great interest because it undergoes a developmental shift in its cellular expression. Here we study the regulatory elements that control basal and cytokine-activated transcriptional expression of the LAMC2 gene, which encodes the laminin gamma2 chain. By using transient transfection experiments we demonstrated the presence of constitutive and cytokine-responsive cis-elements. Comparison of the transcriptional activity of the LAMC2 promoter in the epithelial HT29mtx cells with that in small-intestinal fibroblastic cells (C20 cells) led us to conclude that two regions with constitutive epithelium-specific activity are present between positions -1.2 and -0.12 kb. This was further validated by transfections of primary foetal intestinal endoderm and mesenchyme. A 2.5 kb portion of the LAMC2 5' flanking region was equally responsive to PMA and hepatocyte growth factor (HGF), whereas it was less responsive to transforming growth factor beta1. A minimal promoter limited to the initial 120 bp upstream of the transcriptional start site maintained inducibility by PMA and HGF. This short promoter fragment contains two activator protein 1 (AP-1) elements and the 5'-most of these is a composite AP-1/Sp1 element. The 5'AP-1 element is crucial to the HGF-mediated activity of the promoter; analysis of interacting nuclear proteins demonstrated that AP-1 proteins containing JunD mediate the response to HGF.

Base Sequence↗
PubMed2000

Risk of subarachnoid haemorrhage in first degree relatives of patients with subarachnoid haemorrhage: follow up study based on national registries in Denmark.

OBJECTIVE: To estimate the risk of occurrence of subarachnoid haemorrhage in first degree relatives (parents, siblings, children) of patients with subarachnoid haemorrhage. DESIGN: Population based cohort study using data from the Danish National Discharge Registry and the Central Person Registry. SUBJECTS: Incident cases of subarachnoid haemorrhage admitted to hospital from 1977 to 1995 (9367 patients) and their first degree relatives (14 781). MAIN OUTCOME MEASURES: The incidence rate of subarachnoid haemorrhage was determined for the relatives and compared with that of the entire population, standardised for age, sex, and calendar period. This process was repeated for patients discharged from neurosurgery units, as diagnoses from these wards had high validity (93%). RESULTS: 18 patients had a total of 19 first degree relatives with subarachnoid haemorrhage during the study period, corresponding to a standardised incidence ratio of 2.9 (95% confidence interval 1.9 to 4.6). Patients discharged from neurosurgery wards had a higher standardised incidence ratio (4.5, 2.7 to 7.3). CONCLUSIONS: First degree relatives of patients with subarachnoid haemorrhage have a threefold to fivefold increased risk of subarachnoid haemorrhage compared with the general population.

Adolescent↗
PubMed2000

[Epidemiology].

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Epidemiology↗
PubMed2000

Vacuum-assisted stereotactic breast biopsy: histologic underestimation of malignant lesions.

HYPOTHESIS: The histopathologic correlation between stereotactic core needle biopsy and subsequent surgical excision of mammographically detected nonpalpable breast abnormalities is improved with a larger-core (11-gauge) device. DESIGN: Retrospective medical record and histopathologic review. SETTING: University-based academic practice setting. PATIENTS: Two hundred one patients who underwent surgical excision of mammographic abnormalities that had undergone biopsy with an 11-gauge vacuum-assisted stereotactic core biopsy device. MAIN OUTCOME MEASURE: Correlation between stereotactic biopsy histologic results and the histologic results of subsequent surgical specimens. RESULTS: Results of stereotactic biopsy performed on 851 patients revealed atypical hyperplasia in 46 lesions, ductal carcinoma in situ (DCIS) in 89 lesions, and invasive cancer in 73 mammographic abnormalities. Subsequent surgical excision of the 46 atypical lesions revealed 2 cases of DCIS (4.3%) and 4 cases of invasive carcinoma (8.7%). Lesions diagnosed as DCIS on stereotactic biopsy proved to be invasive carcinoma in 10 (11.2%) of 89 patients on subsequent excision. Stereotactic biopsy completely removed 21 (23.6%) of 89 DCIS lesions and 20 (27.4%) of 73 invasive carcinomas. CONCLUSIONS: In summary, 11-gauge vacuum-assisted core breast biopsy accurately predicts the degree of disease in the majority of malignant lesions; however, understaging still occurs in 11% to 13% of lesions showing atypical hyperplasia or DCIS.

Biopsy↗
PubMed2000

Oral phenoxymethylpenicillin treatment during pregnancy. Results of a population-based Hungarian case-control study.

The objective of the study was to examine the human teratogenic potential of oral penicillin V: phenoxymethylpenicillin treatment during pregnancy in the large population-based dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities, 1980-1996. The dataset included 22,865 pregnant women who had fetuses or newborns with congenital abnormalities and 38,151 matched pregnant women who had newborn infants without any congenital abnormality (population control group). Of 22,865 case pregnant women, 173 (0.8%) had phenoxymethylpenicillin treatments, while of 38,151 population controls, 218 (0.6) were treated by this penicillin V (crude OR 1.3 with 95% CI: 1.1-1.6). This difference was explained mainly by recall bias and confounders because adjusted OR for medically documented phenoxymethylpenicillin treatments did not show difference during the second-third months of gestation, i.e. in the critical period for most major congenital abnormalities in case-matched control pairs. Thus, treatment with oral phenoxymethylpenicillin during pregnancy presents very little if any teratogenic risk to the fetus.

Abnormalities, Drug-Induced↗
PubMed2000

A population-based cohort study of birth and neonatal outcome in older primipara.

OBJECTIVES: To examine the risk of adverse birth outcome in older primiparous women. METHODS: We identified 14,676 primiparae of 20 years of age or more from 1991 to 1996 using the Birth Registry in the North Jutland County, Denmark. We evaluated the risk of adverse birth outcome in the primiparous women aged 30-34 years and above 35 years using the primiparae aged 20-29 years at time of birth as reference. RESULTS: The risks of induced labor, perineotomy, stimulating contraction and vacuum extraction were significantly higher (adjusted odds ratio: 1.3 to 1.7) in the primiparae of 35 years or more. The odds ratio for cesarean section delivery was 2.1 (95% confidence interval: 1.7-2.6) and the odds ratio for delivering a low birth weight child among the primiparae of 35 years or more was 2.2 (95% confidence interval: 1.4-3.3) compared with the primiparae of 20-29 years of age. These risk estimates were independent of women's infertility treatment history. CONCLUSIONS: A negative effect of maternal age on birth and neonatal outcome may be seen even after 30 years of age and is partly related to chronic diseases. However, it is impossible to rule out selection bias, but the actual risk must be taken into consideration in antenatal care.

Adult↗
PubMed2000

A population-based case-control teratologic study of oral chloramphenicol treatment during pregnancy.

The objective of the study was to check the human teratogenic potential of oral chloramphenicol treatments during pregnancy. Pair analysis of cases with congenital abnormalities and matched population controls was performed in the large population-based dataset of the Hungarian Case Control Surveillance of Congenital Abnormalities, 1980-1996. Of 38,151 pregnant women who had babies without any defects (control group), 51 (0.13%), while of 22,865 pregnant women who had newborn infants or fetuses with congenital abnormalities, 52 (0.23%) pregnant women were treated with oral chloramphenicol. The case-control pair analysis did not show any human teratogenic potential of chloramphenicol during the second-third months of pregnancy in the different groups of congenital abnormalities. The occurrence of chloramphenicol treatment in the total control group as referent was compared with the occurrence of chloramphenicol treatment in the different congenital abnormality groups during the second-third months of gestation (i.e., in the critical period for major congenital abnormalities) and a higher adjusted OR for this drug was found only in the group with undescended testis based on only two cases. At the evaluation of medically documented chloramphenicol treatment a higher OR was not found in any congenital abnormalities. Thus, chloramphenicol treatment during early pregnancy presents little, if any, teratogenic risk to the fetus in humans.

Abnormalities, Drug-Induced↗
PubMed2000

Is there an association between alcohol intake or smoking and small bowel adenocarcinoma? Results from a European multi-center case-control study.

OBJECTIVE: To discover whether tobacco smoking and intake of different types of alcoholic drinks are associated with small bowel adenocarcinoma (SBA). METHODS: A population-based European multi-center case-control study was conducted from 1995 to 1997. RESULTS: After a histological review using uniform diagnostic criteria, 47 (33%) of the 142 identified cases of SBA were excluded due to reclassification as either tumors of the papilla of Vater (n = 22), stromal tumors, or metastases; 95 cases were accepted for study. In all, 70 cases of SBA together with 2070 controls matched by age, sex, and region were interviewed. A high intake (more than 24 g alcohol per day) of beer or spirits was associated with SBA, an odds ratio (OR) of 3.5 and 95% confidence intervals (CI) of 1.5-8.0 and 3.4 (95% CI 1.3-9.2), respectively). There was no association with wine intake or total alcohol intake. Tobacco smoking was probably unrelated to SBA. CONCLUSIONS: A high intake of beer or spirits seems to be a risk factor for SBA. Since this association was not seen for wine drinkers, protective components of wine may counterbalance a carcinogenic effect of alcohol on the small bowel. Alternatively, the result may be confounded by other factors, e.g. dietary factors.

Adenocarcinoma↗