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Biomedical subjects

L A Johansson

Publications and source records attributed to L A Johansson.

At least 19 recordsLinked to original sources
PubMed2000

Comparing Swedish hospital discharge records with death certificates: implications for mortality statistics.

BACKGROUND: The quality of mortality statistics is of crucial importance to epidemiological research. Traditional editing techniques used by statistical offices capture only obvious errors in death certification. In this study we match Swedish hospital discharge data to death certificates and discuss the implications for mortality statistics. METHODS: Swedish death certificates for 1995 were linked to the national hospital discharge register. The resulting database comprised 69 818 individuals (75% of all deaths), 39 872 (43%) of whom died in hospital. The diagnostic statements were compared at Basic Tabulation List level. RESULTS: The last main diagnosis and the underlying cause of death agreed in 46% of cases. Agreement decreased rapidly after discharge. For hospital deaths, the main diagnosis was reported on 83% of the certificates, but only on 46% of certificates for non-hospital deaths. Malignant neoplasms and other dramatic conditions showed the best agreement and were often reported as underlying causes. Conditions that might follow from some other disease were often reported as contributory causes, while symptomatic and some chronic conditions were often omitted. In 13% of cases, an ill-defined main condition was replaced by a more specific cause of death. CONCLUSIONS: There is no apparent reason to question the death certificate if the main diagnosis and underlying cause agree, or if the main diagnosis is a probable complication of the stated underlying cause. However, cases in which the main diagnosis cannot be considered a complication of the reported underlying cause should be investigated, and assessments made of the feasibility and cost-effectiveness of routinely linking hospital records to death certificates.

Adolescent↗
PubMed1998

Pulmonary function in adult survivors of severe acute lung injury treated with inhaled nitric oxide.

BACKGROUND: Following an episode of acute respiratory distress syndrome (ARDS), some degree of measurable pulmonary impairment may be anticipated. ARDS is thought to be the more severe form of acute lung injury (ALI) and a recently proposed addition to conventional therapy in ALI/ARDS is inhaled nitric oxide (INO). We carried out a non-randomised follow-up study with pulmonary function tests on survivors of severe ALI/ARDS treated with INO. METHODS: Sixteen previously healthy pulmonary patients, survivors of severe ALI/ARDS, were evaluated with pulmonary function tests >8 months after the acute event. The tests included static and dynamic spirometry, diffusion capacity for carbon monoxide (DLCO), blood gas analysis and evaluation of a chest radiograph. RESULTS: The most common abnormality seen was a low DLCO in 69% of the patients. Abnormally low values were seen in forced vital capacity in 31%, in forced expiratory volume in 1 s in 13%, and in residual volume and total lung capacity in 6%. Blood gas data were within normal limits in 15/16 patients. All chest radiographs showed resolution of the interstitial and alveolar changes present during the acute event. CONCLUSION: In this non-randomised follow-up study we conclude that a degree of measurable pulmonary impairment after INO treatment in severe ALI/ARDS was common, but did not differ markedly from other published studies on pulmonary function in similar patient material. No late unexpected major abnormalities due to the inhaled nitric oxide treatment could be identified in these survivors.

Administration, Inhalation↗
PubMed1997

National adaptations of the ICD rules for classification--a problem in the evaluation of cause-of-death trends.

In 1981, the registration routines of the Swedish cause-of-death register were adjusted. The aim of this study was to assess what influence these changes in registration practice might have had on the cause-of-death trends after 1981. The Eighth Revision of the International Classification of Diseases (ICD-8) was used throughout the study period (1976-1985). Significant changes in the registered number of cases were found in 13 of the 18 diagnostic groups scrutinized. Four main types of outcomes were observed: (a) the number of underlying causes increased while the number of contributing causes decreased or vice versa; (b) the number of both underlying and contributory causes changed in the same direction, due to the transfer of a diagnostic group from one ICD category to another; (c) the number of both underlying and contributory causes changed in the same direction, but not due to the transfer of a diagnostic group; or (d) the number of either underlying or contributory causes changed, but not both. In general, the altered registration practice led to more conditions that are often considered as terminal complications to other diseases being registered as the underlying cause of death. While most of the 1981 instructions meant a more literal application of the ICD-8, those concerning cardiac valvular diseases deviated substantially from it. We conclude that (a) important changes in registration practice may occur at any point in time, and not only in connection with the implementation of a new version of the ICD; and (b) national adaptations of the ICD coding instructions may amount to a reversal of the instructions included in the ICD manuals. These findings must be considered when comparing cause-of-death statistics from different countries, and both underlying and contributing cause-of-death statistics should be considered in such analyses of cause-of-death trends.

Cause of Death↗
PubMed1997

A retrospective analysis of nitric oxide inhalation in patients with severe acute lung injury in Sweden and Norway 1991-1994.

BACKGROUND: Patients with severe acute lung injury (ALI) have been treated compassionately on doctors' initiative with inhaled nitric oxide (INO) in Sweden and Norway since 1991. In 1994 the previously used technical grade nitric oxide was replaced by medical grade nitric oxide. METHODS: We have carried out a retrospective data collection on all identified adult patients treated with INO for >4 h during the period 1991-1994 focusing on safety aspects and patient outcome. We used the following exclusion criteria (1) Age <18 years, (2) Simultaneous treatment with extracorporeal removal of CO2 (3) NO inhalation period <4 h, (4) Incomplete or missing patient charts, (5) Use of INO in order to treat pulmonary hypertension following cardiac surgery, with little or no acute lung injury. RESULTS: Inclusion criteria were met by 56 out of 73 identified patients. Mean age was 48+/-19 years and the median duration of INO treatment was 102 h. PaO2/FIO2 ratio at start of treatment was 85 +/- 33 mm Hg with a lung injury score (LIS) of 3.2+/-0.8. The aetiology of the lung injury was pneumonia (n= 27), sepsis (n=12) and trauma (n=8). Survival to hospital discharge was 41% and survival after 180 d was 38%. Three serious adverse events were identified, two from technical failures of the INO delivery device and one withdrawal reaction necessitating slow weaning from INO. No methaemoglobin values >5% were reported during treatment. CONCLUSION: The overall mortality did not differ dramatically from historical controls with high mortality. Only a randomised study may determine whether INO as an adjunct to treatment alters the outcome in severe ALI. One cannot at present advocate the routine use of INO in patients with ALI outside such studies.

Administration, Inhalation↗
PubMed1994

Multiple cause-of-death data as a tool for detecting artificial trends in the underlying cause statistics: a methodological study.

The aims of the study were: (i) to identify trends in the underlying cause-of-death statistics that are due to changes in the coders' selection and coding of causes, and (ii) to identify changes in the coders' documented registration principles that can explain the observed trends in the statistics. 31 Basic Tabulation List categories from the Swedish national cause-of-death register for 1970-1988 were studied. The coders' tendency to register a condition as the underlying cause of death (the underlying cause ratio) was estimated by dividing the occurrence of the condition as underlying cause (the underlying cause rate) with the total registration of the condition (the multiple cause rate). When the development of the underlying cause rate series followed more closely the underlying cause ratio series than the multiple cause rate series, and a corresponding change in the registration rules could be found, the underlying cause rate trend was concluded to be due to changes in the coders' tendency to register the condition. For thirteen categories (fourteen trends), the trends could be explained by changes in the coders' interpretation practice: five upward, four insignificant, and five downward trends. In addition, for three categories the trends could be explained by new explicit ICD-9 rules.

Arthritis, Rheumatoid↗
PubMed1992

The periodate oxidation of sucrose in aqueous N,N-dimethylformamide.

Sucrose has been oxidized with sodium periodate in 0-50% aqueous N,N-dimethylformamide (DMF). In 50% aqueous DMF the reaction is selective for the glucose ring, yielding a dialdehyde. The increased selectivity is not due to conformational factors but is ascribed to the dissociation of water from cyclic periodate ester species which makes the reaction via the acyclic ester on fructose unfavourable.

Carbohydrate Sequence↗
PubMed1992

Clinical responses to subgingival application of a metronidazole 25% gel compared to the effect of subgingival scaling in adult periodontitis.

A newly developed metronidazole 25% dental gel was compared with subgingival scaling in the treatment of adult periodontitis. 206 patients in 9 centres participated in the study. Probing pocket depth (PPD) and bleeding on probing (BOP) were recorded before treatment and 2, 6, 12, 18, and 24 weeks after the treatment. All patients had at least 1 tooth in each quadrant with a PPD of 5 mm or more. The treatments consisted of 2 applications of dental gel (days 0 and 7) in 2 randomly selected quadrants (split mouth design) and 2 sessions of subgingival scaling (1 quadrant on day 0, and 1 quadrant on day 7). Instruction in oral hygiene was given 2 weeks after completed treatment. The average PPD and the average frequency of BOP were calculated over all sites with initial PPD of 5 mm or more. PPD and BOP were thus, at each examination, calculated from the same sites. The mean PPD was 5.9 mm before gel application and 5.8 mm before scaling (p = 0.31). BOP was 88% in both treatment groups. 24 weeks after the treatment, PPD and BOP were significantly reduced in both groups and for both parameters (p < 0.01). PPD was reduced by 1.3 mm after gel application and 1.5 mm after scaling; BOP was reduced by 32% and 39%, respectively. The difference between the treatments was statistically significantly, but considered as clinically unimportant.

Adult↗
PubMed1992

Fatal systemic poisoning after skin exposure to monochloroacetic acid.

Little information is available on the toxicity of monochloroacetic acid. We report the case of a 38 year-old man who was splashed with an 80% monochloroacetic acid solution on 25-30% of his body surface. In addition to epidermal and superficial dermal burns, features of systemic poisoning occurred within a few hours including disorientation, agitation, cardiac failure and coma. He later developed severe metabolic acidosis, rhabdomyolysis, renal insufficiency and cerebral edema, and died due to uncal herniation on d 8. The 4 h post exposure plasma monochloroacetic acid concentration was 33 mg/L confirming skin absorption. In addition to its corrosive action, monochloroacetic acid probably blocks the tricarboxylic acid cycle (Kreb's cycle) and may also react with sulfhydryl groups in enzymes, causing severe tissue damage in energy-rich organs.

Accidents↗
PubMed1991

Autotransplantation of third molars as treatment in advanced periodontal disease.

The aim of this study was to investigate the prognosis of replacing molars with advanced periodontitis by autotransplanted fully developed third molars. The patient sample consisted of 18 subjects, 24-58 years of age. The patients selected had at least 1 molar with advanced periodontal tissue destruction. After extraction of the diseased molar, autotransplantation of a third molar was immediately performed. After a splinting and healing period of 2-3 weeks, endodontic treatment was carried out. The follow-up included recordings of the clinical parameters, probing periodontal pocket depth, probing attachment level, percussion sound, and mobility. Radiographs were taken immediately after the surgical procedure, after 6 months, 1 year, and thereafter annually. The results of this study indicate that autotransplantation may be an alternative treatment procedure for molars with advanced periodontal disease.

Adult↗
PubMed1984

Marginal bone height in adolescents participating in different preventive dental care programs.

A radiographic evaluation was made of the marginal bone height in youth, subject to different preventive dental care regimens. A test group consisted of 14-15-year-olds who for 4 years had received preventive dental care based on oral hygiene education, professional tooth cleaning and topical fluorides and/or mouth rinsings every 3rd week. A comparison group had been given solely fluoride mouth rinsings every 2nd week with no particular emphasis on oral hygiene measures. The radiographic evaluation showed average differences between the investigated groups of less than 0.3 mm in the distance from the cementoenamel junction to the alveolar bone crest. In the mandibular premolar-molar region of the comparison group, the marginal bone height differed significantly from the corresponding region in the test group. No such differences in the maxillary regions were noted. The clinical relevance of the results is discussed.

Adolescent↗
PubMed1984

Evaluation of cause-related periodontal therapy and compliance with maintenance care recommendations.

An evaluation of the long-term clinical effects of an intense period of cause-related periodontal therapy provided by dental hygiene students, was made in patients with moderately advanced periodontitis. By the evaluation, we also intended to gain information about compliance with given recommendations for periodontal health maintenance. The results after 3 years without supervision by the specialist team showed that achieved beneficial effects on the gingival conditions were maintained despite a significant increase in plaque prevalence. Recommendations as to the daily use of a variety of additional oral hygienic measures besides toothbrushing met with a considerable lack of compliance. Maintenance visits to the referring general practitioner were mostly made once a year and included regular dental care. Despite this, no further deterioration of periodontal status was observed. The results indicate that it may be possible to maintain successful effects of periodontal therapy in this patient category with less personal and professional effort than traditionally recommended.

Adult↗
PubMed1984

Effect of combined systemic antimicrobial therapy and mechanical plaque control in patients with recurrent periodontal disease.

The aim of the present study was to analyze the effect of systemic antimicrobial therapy and mechanical plaque control in patients with recurrent periodontal disease. 9 patients volunteered for the combined therapy. At a baseline examination they were randomly distributed into 2 groups, one given tetracycline therapy for 2 weeks and the other metronidazole therapy for 1 week. A mechanical plaque control program comprising oral hygiene training, professional cleaning of all teeth and subgingival debridement at diseased sites was carried out at the baseline examination and at all recall visits, i.e. once every month during the first 6 months and then after 9, 12, and 18 months. The results demonstrated clinically and microbiologically that a combination of an initial antimicrobial and a continuous systematic mechanical plaque control program may be a valuable therapeutic approach in a strictly selected group of refractory patients. Recurrent periodontal lesions which still displayed severe inflammation despite renewed conventional therapy showed a marked reduction in probing depths, bleeding and suppuration from the pockets, and further, a reduced presence of spirochetes and motile rods during the trial. The results indicate that the level and longevity of success is also related to whether or not self-performed oral hygiene measures are sufficiently carried out. No superior effect of the combined program could be observed in cooperating patients receiving tetracycline as compared with those given metronidazole.

Adult↗
PubMed1984

Clinical effects of preventive regimens for young people in their early and middle teens in relation to previous experience with dental prevention.

The clinical effects of different preventive regimens provided for young people in their early and middle teens were studied during a 2-year period. The regimens studied during the 1st year of the trial were professional tooth-cleaning plus fluoride mouth-rinsing every 3rd week versus fluoride varnish treatment every 6 months. During the 2nd year, the preventive measures were given in accordance with the estimated needs of each individual. The results were related to the individuals' previous experience with dental prevention to determine whether this had a significant influence. The results showed that fairly good or excellent effects on the individuals' oral hygiene and gingival status were readily achieved and maintained with a professional tooth-cleaning plus fluoride mouth-rinsing regimen. The study failed to demonstrate any superior caries-preventive effect of the fluoride varnish treatments. Subsequent individualized prevention produced similar average end results in all groups. Differences in the results in accordance with the individuals' previous experience with dental prevention indicate a superior and prolonged influence on dental health of professional tooth-cleaning plus fluoride mouth-rinsing in comparison with a fluoride-based program alone.

Adolescent↗