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Biomedical subjects

M Carlsson

Publications and source records attributed to M Carlsson.

At least 55 records · Page 3Linked to original sources
PubMed2000

The T 54 allele of the intestinal fatty acid-binding protein 2 is associated with a parental history of stroke.

To test the hypothesis that the A/T polymorphism of the fatty acid-binding protein 2 gene (FABP2) is associated with impaired lipid metabolism and cardiovascular disease, we compared clinical characteristics and a parental history of cardiovascular disease between 213 sibling pairs discordant for the polymorphism. Siblings with an excess of the T54 allele had higher triglyceride (P = 0.002) and cholesterol (P = 0.019) concentrations than siblings with the A54 allele. Parents of offspring with the T54T and T54A genotypes reported an increased prevalence of stroke compared to parents of offspring with the A54A genotype (P = 0.007). In summary, we have confirmed the association of the FABP2 T54 allele with increased concentrations of cholesterol and triglycerides in genotype-discordant sibling pairs. We also present novel evidence that genetic variation in the FABP2 gene may increase susceptibility to stroke.

Adult↗
PubMed2000

Effect of visco-elastic foam mattresses on the development of pressure ulcers in patients with hip fractures.

This study had three aims: to investigate if visco-elastic foam mattresses are more effective than standard hospital mattresses in reducing the incidence of pressure ulcers in patients with hip fractures; to compare pressure ulcer grade and location and documented nursing prevention and treatment interventions in patients using the two types of mattresses; to identify possible predictors of pressure ulcer development. Using a prospective randomised controlled trial design 101 patients (mean age: 84 years) were randomly allocated either a visco-elastic foam mattress or a standard mattress. There was no significant difference in the incidence of pressure ulcers between the two groups, but patients on standard mattresses tended to develop more severe pressure ulcers. Furthermore, according to the documentation, patients with grade I pressure ulcers who were allocated a standard mattress received more preventive interventions, which may have reduced the differences in outcomes between the two groups. The researchers concluded that the results support the use of the test mattress. Significant predictors of pressure ulcer development were long waiting times for surgery and low haemoglobin levels at hospital admission.

Aged↗
PubMed2000

Insulin secretion and insulin sensitivity in relation to glucose tolerance: lessons from the Botnia Study.

Recently, a new stage in glucose tolerance, impaired fasting glucose (IFG) (fasting plasma glucose level of 6.1-6.9 mmol/l), was introduced in addition to impaired glucose tolerance (IGT) (2-h glucose level of 7.8-11.0 mmol/l). It is not clear whether IFG and IGT differ with respect to insulin secretion or sensitivity. To address this question, we estimated insulin secretion (by measuring both insulin levels and the ratio of insulin-to-glucose levels in 30-min intervals) and insulin sensitivity (by using the homeostasis model assessment [HOMA] index) from an oral glucose tolerance test (OGTT) in 5,396 individuals from the Botnia Study who had varying degrees of glucose tolerance. There was poor concordance between IFG and IGT: only 36% (303 of 840) of the subjects with IFG had IGT, whereas 62% (493 of 796) of the subjects with IGT did not have IFG. Compared with subjects with normal glucose tolerance (NGT), subjects with IFG were more insulin resistant (HOMA-insulin resistance [IR] values 2.64 +/- 0.08 vs. 1.73 +/- 0.03, P < 0.0005), had greater insulin responses during an OGTT (P = 0.0001), had higher waist-to-hip ratios (P < 0.005), had higher triglyceride and total cholesterol concentrations (P < 0.0005), and had lower HDL cholesterol concentrations (P = 0.0001). Compared with subjects with IFG, subjects with IGT had a lower incremental 30-min insulin-to-glucose area during an OGTT (13.8 +/- 1.7 vs. 21.7 +/- 1.7, P = 0.0008). Compared with subjects with IGT, subjects with mild diabetes (fasting plasma glucose levels <7.8 mmol/l) showed markedly impaired insulin secretion that could no longer compensate for IR and elevated glucose levels. A progressive decline in insulin sensitivity was observed when moving from NGT to IGT and to subjects with diabetes (P < 0.05 for trend), whereas insulin secretion followed an inverted U-shaped form. We conclude that IFG is characterized by basal IR and other features of the metabolic syndrome, whereas subjects with IGT have impaired insulin secretion in relation to glucose concentrations. An absolute decompensation of beta-cell function characterizes the transition from IGT to mild diabetes.

Adult↗
PubMed2000

The development of pressure ulcers in patients with hip fractures: inadequate nursing documentation is still a problem.

The aims of the study were to investigate, on a daily basis: (i) the development and progress of pressure ulcers, (ii) the documented nursing interventions for prevention and treatment of pressure ulcers, and (iii) when nursing interventions regarding prevention and treatment of pressure ulcers were documented, in relation to patient risk status and the development of pressure ulcers. The study design was prospective, comparative and descriptive. A total of 55 patients with hip fracture were included. To facilitate the nurse's assessment, a 'pressure ulcer card' was developed, consisting of the Modified Norton Scale (MNS) and descriptions of the four stages of pressure ulcers. The incidence of pressure ulcers was 55%. The mean rank of the lowest MNS score was significantly lower for patients who developed pressure ulcers than for patients without pressure ulcers. The majority of the pressure ulcers occurred between admission to the ward and the fourth day after surgery. Documented interventions regarding prevention and treatment were: repositioning, overlays, cushions, use of lotion and observation. The mean number of interventions per patient was 2.2 for patients who developed pressure ulcers during their hospital stay. The comprehensiveness and quality of the nursing record was unsatisfactory, and only three nursing records reached the level required by Swedish law. Preventive interventions such as repositioning were documented when the pressure ulcer had already occurred. The lack of nursing documentation regarding prevention and treatment of pressure ulcers may indicate that nurses did not identify pressure ulcers as a prioritized nursing problem for this patient group. The Modified Norton Scale could be a valuable tool for nurses, both identifying the patient at risk and acting as a guide for nursing interventions. The study was approved by the ethics committee of the Faculty of Medicine at Uppsala University.

Aged↗
PubMed2000

Perceived consequences of being a renal failure patient.

This study describes the perceived consequences of illness and treatment among end stage renal disease (ESRD) patients. A qualitative, explorative-descriptive design was used, which included continuous ambulatory peritoneal dialysis (CAPD) (n = 26), hemodialysis (HD) (n = 30), and transplantation (n = 30) patients. Data collection was performed using unstructured interviews, mostly in the patients' homes. All interviews were tape-recorded with permission from the informants, transcribed verbatim, and analyzed by content analysis. An overall theme was identified, "Wishes for independence and normality." Four main categories emerged: "Wish for normality," "Wish to manage one's own life," "Deprivation of one's normal life," and "Concerns." Interview statements were classified in 11 subcategories: live as usual, keep up appearances, social comparison, hope/fulfilled dreams, freedom/lack of freedom, control/lack of control, losses, dependence on others, physical problems, disgusted with oneself, and broodings. The perceived consequences of being an ESRD patient are multidimensional and involve several aspects of everyday life. It is important for nurses to appreciate the patient's view of illness as well as the patient's perceived stressors and expectations. It may help to direct the focus of nursing assessment in planning and implementing nursing care.

Adult↗
PubMed2000

Coping strategies and styles assessed by the Jalowiec Coping Scale in a random sample of the Swedish population.

A random sample of the Swedish general population (n = 1,200), age range 18-80 years, was studied with regard to coping strategies and styles used for handling stressful situations. The total response rate was 65% (n = 519), and coping was assessed by the Jalowiec Coping Scale (JCS). The three most frequently used coping styles were the confrontative, the optimistic and the self-reliant. The three least used styles were the emotive, the supportant and the palliative. There were few differences between the age groups for the total material or for each gender separately. Young (18-29 years) and middle-aged (30-59 years) groups used confrontative and emotive styles significantly more than did the elderly (60-80 years) group. Young and middle-aged women used significantly more optimistic, evasive, emotive and supportant coping than did elderly women. All subscales except the self-reliant showed significant gender differences, with women reporting more frequent use than men. Ethnicity is a major determinant of the use of the emotionally-oriented coping styles. Those of Swedish origin used less of these styles than did those of non-Swedish origin. The results illustrate the importance of using different norm values for the JCS for groups differering in these demographic variables.

Adaptation, Psychological↗
PubMed2000

Effects of group motor skill intervention on five- to six-year-old children with developmental coordination disorder.

The purpose of this study was to determine whether group motor skill intervention is an effective form of treatment when added to consultative services in 5- to 6-year-old children with developmental coordination disorder (DCD). An experimental group of DCD children (n = 17) was compared with a DCD control group without intervention (n = 20). The intervention was conducted once a week for 10 weeks. No significant differences between the groups in either Movement ABC motor test or the Movement ABC checklist were found before or after this intervention. When subgroups with different categories of motor difficulties were compared, significantly more children with borderline motor difficulties in the experimental group than in the control group had changed (improved) their category after intervention. It is concluded that children with definite motor difficulties do not benefit from this type of intervention. Future research should include comparison of well-defined subgroups of children with DCD.

Journal Article↗
PubMed1999

[Percutaneous dilatation tracheostomy at an intensive care unit].

Fourty-five cases of percutaneous dilatational tracheostomy (PDT) performed in the intensive care unit, Kolding Hospital, are reported in a retrospective study. All patients (mean age 60.8 years) had been on a ventilator due to critical diseases and had been subjected to translaryngeal intubation for an average of 6.1 days (range 1-12). PDT was uncomplicated in 41 cases (91%). Early bleeding, which required minor intervention, was described in three cases (7%). There was one case (2%) of minor bleeding seven days after PDT during haemodialysis. There had been no procedure-related death, and no life-threatening complications such as pneumothorax, paratracheal tube position or bleeding requiring transfusion were seen. Nineteen patients (42%) died due to progression of their underlying diseases with the tracheostomy functioning well, the mean cannulation time being 23.3 days. Twenty-six patients (58%) lived to decannulation with a mean length of cannulation of 13.7 days. The PDT procedure has the advantage of being bedside, thus avoiding transportation of a critically ill patient to the operating theatre.

Adolescent↗
PubMed1999

Long-term survival and complete cures of B16 melanoma-carrying animals after therapy with tumor-targeted IL-2 and SEA.

The bacterial superantigen (SAg) staphylococcal enterotoxin A (SEA) is a potent inducer of CTL activity and cytokine production in vivo. To engineer SAg for cancer immunotherapy, we genetically fused SEA to a Fab fragment of the C215 tumor-reactive antibody. Strong reduction of lung metastasis was seen in mice carrying established lung metastases of the poorly immunogenic B16-C215 melanoma after Fab-SEA therapy. However, important anti-tumor effector functions, such as IFN-gamma secretion and CTL activity, gradually declined during therapy. In this study, we show that Fab-SEA immunotherapy is strongly potentiated by Fab-IL-2 co-administration. Combined Fab-IL-2 and Fab-SEA therapy prolongs the immune response in vivo, limits the development of immunological unresponsiveness and promotes maximal anti-tumor effects. Significantly prolonged survival was noted in tumor-carrying animals treated with Fab-SEA/Fab-IL-2 as compared with Fab-SEA or Fab-IL-2 alone. Combination therapy resulted in complete cure in 90% of tumor-bearing animals, whereas only 10% long-term survival was seen in Fab-SEA or Fab-IL-2-treated animals. Single Fab-SEA therapy induced a hyporesponsive state after 2 cycles of treatment. In contrast, the immune response after combination therapy was characterized by substantially augmented IFN-gamma and TNF-alpha production and strong CTL activity. Our data demonstrate that combined Fab-SEA and Fab-IL-2 therapy prolongs the immune response in vivo and induced long-term survival of more than 90% of the animals carrying the highly aggressive B16 melanoma.

Animals↗
PubMed1999

Psychometric assessment of the Life Satisfaction Questionnaire (LSQ) and a comparison of a randomised sample of Swedish women and those suffering from breast cancer.

In a previous study, the Life Satisfaction Questionnaire (LSQ) was developed especially for women with breast cancer. The aim of the present study was to assess the psychometric properties of the LSQ in a randomized sample of Swedish women and to compare the perceived quality of life with that of women suffering from breast cancer. Another aim was to relate the result to educational background. A total of 257 women aged 20-80, randomly selected from the Swedish population register, answered the LSQ. The result was compared with that from 362 women aged 27-78 suffering from breast cancer. The construct validity was calculated by a principal component analysis, and the reliability by Cronbach alpha-coefficients. It was concluded that the LSQ has acceptable validity and reliability. The result also showed that the women with breast cancer rated their perceived quality of life higher than women in general with respect to the quality of personal relations and the quality of daily activities, but lower for physical symptoms. In the comparison with respect to educational background, women with university education rated their quality of life higher than women with other types of education. The testing of the LSQ will continue.

Adult↗
PubMed1999

The expression of CCAAT/enhancer binding protein (C/EBP) in the human ovary in vivo: specific increase in C/EBPbeta during epithelial tumour progression.

The CCAAT/enhancer binding protein (C/EBP) family of transcription factors is involved in metabolism and differentiation of cells, especially in rodent liver cells and adipocytes. Their roles in vivo and in particular during pathophysiological conditions in humans are largely unknown. We have investigated the presence of C/EBPalpha, -beta, -delta and -zeta in normal ovaries and in epithelial ovarian tumours of different stages. Immunohistochemical experiments demonstrated that C/EBPalpha and C/EBPbeta were preferentially expressed in epithelial/tumour cells irrespective of stage or grade of the tumour. C/EBPbeta was located in the nuclei of the cells, in contrast to C/EBPalpha, which was present only in the cytoplasm of these cells. The nuclear localization of C/EBPbeta indicates an active role of this transcription factor in tumour cells, whereas the cytoplasmic distribution suggests a more passive function of C/EBPalpha. C/EBPdelta and -zeta demonstrated a more diverse distribution with predominant localization to epithelial cells, but stromal distribution was also noted. The intracellular distribution was confined to both the nucleus and the cytoplasm for C/EBPdelta and -zeta. Western blotting demonstrated that C/EBPalpha, -beta, -delta and -zeta were present in a majority of the samples. The amount of C/EBPbeta increased markedly with malignancy, i.e. with degree of dedifferentiation, while the other members of the C/EBP family displayed a more constant expression level. These results demonstrate an association between the expression of members of the C/EBP family and the formation of epithelial ovarian tumours, with C/EBPbeta as a potential marker for these tumours. As C/EBPbeta is known to be expressed during proliferation of cells in vitro, it may participate in the proliferative process of ovarian epithelial tumour cells in vivo and play a central role in tumour progression.

Adenocarcinoma↗
PubMed1999

Implementation of risk assessment and classification of pressure ulcers as quality indicators for patients with hip fractures.

The aims of the study were (i) to investigate the prevalence of pressure ulcers in patients with hip fracture, on arrival at a Swedish hospital, at discharge, and two weeks post-surgery; (ii) to test whether clinical use of the Modified Norton Scale (MNS) could identify patients at risk for development of pressure ulcers; and (iii) to compare the reported prevalence of pressure ulcer in the experimental group, where risk assessment and classification of pressure ulcers was performed on a daily basis, with that of the control group, where it was not. The study design was prospective, with an experimental and a control group. The intervention in the experimental group consisted of risk assessment, risk alarm and skin observation performed by the nurse on duty, in the A & E Department, and daily throughout the hospital stay. To facilitate the nurse's assessment, a 'Pressure Ulcer Card' was developed, consisting of the MNS and descriptions of the four stages of pressure ulcers. On arrival at the hospital, approximately 20% of patients in both groups had pressure ulcers. At discharge, the rate had increased to 40% (experimental) and 36% (control). Clinical use of the MNS made it possible to identify the majority of patients at risk for development of pressure ulcers. Patients who were confused on arrival developed significantly more pressure ulcers than patients who were orientated to time and place. No significant difference was found in the reported prevalence of pressure ulcers between the experimental and control groups.

Aged↗
PubMed1999

Staphylococcus aureus Cowan strain 1 activation of B-chronic lymphocytic leukaemia cells augments the response to CD40 stimulation.

The signals involved in regulating the proliferation, differentiation and survival of B-chronic lymphocytic leukemia (B-CLL) cells are fully understood. B-CLL cells have been found to respond poorly to various activation signals and only after successful Epstein-Barr virus (EBV) transformation has it been possible to maintain such cells in long-term cultures. In this work we describe a new method to activate and induce proliferation in B-CLL cells and to maintain such cells in long-term culture for longer than 1 month. We used a combination of protocols in an attempt to mimic some of the signals of a thymus-dependent immune response. The B-CLL cells were first activated with Staphylococcus aureus Cowan strain 1 (SAC) particles plus thioredoxin (Trx), followed by stimulation with interleukin (IL)-2 + Trx. This treatment primed the cells for further stimulation with anti-CD40 monoclonal antibody (MoAb) presented on irradiated CD32L cells (the CD40-system) or soluble CD40 Ligand, and a combination of Trx and cytokines (IL-4 + IL-10), which allowed the cells to be maintained for up to 1 month with preserved viability and a variable rate of proliferation. However, induced proliferation of the B-CLL cells was limited to approximately 1 month, suggesting that additional signals are required to facilitate further proliferation.

Burkitt Lymphoma↗
PubMed1999

Monitoring ethanol exposure in a clinical setting by analysis of blood, breath, saliva, and urine.

BACKGROUND: Several new technologies have been developed for estimating blood alcohol concentration (BAC), among others, by the analysis of alcohol in saliva specimens. The Q.E.D. is a new quantitative test designed for measuring ethanol in saliva and promising results have been obtained in various experimental settings. METHODS: In the present study, venous BAC was determined in 28 patients on arrival and when they were discharged from a detoxification unit. The results were compared with breath, saliva, and urine alcohol concentrations. Headspace gas chromatography was used for analysis of ethanol in blood and urine, and breath alcohol was determined with an Alcolmeter S-D2 instrument. RESULTS: The concentration of alcohol in urine was always higher than the BAC (mean difference, 0.62 mg/ml) and individual values were highly correlated (n=42; r=0.92). The handheld breath-alcohol instrument (Alcolmeter S-D2) showed good agreement with venous BAC (n=52; r=0.97; mean difference, 0.04 mg/ml). The saliva-alcohol test failed to perform well in our tests (n=36; r=0.75; mean difference, 0.55 mg/ml) mainly because of problems encountered in obtaining a sufficient sample for analysis in highly intoxicated patients. CONCLUSIONS: Because of the relatively low cost of the Q.E.D. ' saliva test, in comparison with a breath alcohol analyzer, the saliva test could be a cost-effective alternative in public health settings where mildly to moderately intoxicated persons are encountered.

Alcoholism↗
PubMed1999

Aggregation and reclassification--assessment of GALEN methods in the domain of thoracic surgery.

This paper reports on the experiences from evaluation of GALEN methods for mapping of follow-up categories in the domain of thoracic surgery to an existing classification of surgical procedures. The mapping of the aggregated levels or groups of thoracic procedures presents a genuine problem in relation to strict hierarchical classifications, since the follow-up categories not necessarily fit in the pre-set structure of the classification. The paper reports on the experiences from modelling of the traditional classification as well as modelling of the follow-up categories, together with an analysis of results with a discussion of opportunities and potential problems and pitfalls when applying GALEN models and tools.

Humans↗
PubMed1998

Treatment of anemia in myelodysplastic syndromes with granulocyte colony-stimulating factor plus erythropoietin: results from a randomized phase II study and long-term follow-up of 71 patients.

Treatment with erythropoietin (epo) may improve the anemia of myelodysplastic syndromes (MDS) in approximately 20% of patients. Previous studies have suggested that treatment with the combination of granulocyte colony-stimulating factor (G-CSF) and epo may increase this response rate. In the present phase II study, patients with MDS and anemia were randomized to treatment with G-CSF + epo according to one of two alternatives; arm A starting with G-CSF for 4 weeks followed by the combination for 12 weeks, and arm B starting with epo for 8 weeks followed by the combination for 10 weeks. Fifty evaluable patients (10 refractory anemia [RA], 13 refractory anemia with ring sideroblasts [RARS], and 27 refractory anemia with excess blasts [RAEB]) were included in the study, three were evaluable only for epo as monotherapy and 47 for the combined treatment. The overall response rate to G-CSF + epo was 38%, which is identical to that in our previous study. The response rates for patients with RA, RARS, and RAEB were 20%, 46%, and 37%, respectively. Response rates were identical in the two treatment groups indicating that an initial treatment with G-CSF was not neccessary for a response to the combination. Nine patients in arm B showed a response to the combined treatment, but only three of these responded to epo alone. This suggests a synergistic effect in vivo by G-CSF + epo. A long-term follow-up was made on 71 evaluable patients from both the present and the preceding Scandinavian study on G-CSF + epo. Median survival was 26 months, and the overall risk of leukemic transformation during a median follow-up of 43 months was 28%. Twenty patients entered long-term maintenance treatment and showed a median duration of response of 24 months. The international prognostic scoring system (IPSS) was effective to predict survival, leukemic transformation, and to a lesser extent, duration of response, but had no impact on primary response rates.

Aged↗
PubMed1998

Multidose pharmacokinetics of factor IX: implications for dosing in prophylaxis.

The aim of this study was to investigate the use of single-dose pharmacokinetic data for factor IX (FIX) to predict multidose pharmacokinetics and explore their use for pharmacokinetic dosing in prophylactic treatment of haemophilia B. Eight patients with severe haemophilia B were enrolled. Using single-dose pharmacokinetic data for each patient, plasma factor IX procoagulant activity (FIX:C) curves during prophylactic dosing were computer-simulated. The simulations were verified by repeated blood sampling and measurements of FIX:C. Theoretical dosing regimens to maintain a plasma trough level of 1.0 U dL-1 of FIX:C were calculated. A 2 x 2 week cross-over study on standard dosing according to bodyweight vs. dosing every three days based on individual pharmacokinetics was carried out. FIX:C was measured during each treatment period. FIX:C data from the plasma sampling generally confirmed the single-dose pharmacokinetic data used. Pharmacokinetically tailored dosing of FIX could result in considerable savings of factor concentrate as compared to current standard dosing. The study demonstrates the applicability of individual pharmacokinetics as a tool for cost-effective utilization of FIX concentrates in the prophylactic treatment of haemophilia B.

Adult↗