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Biomedical subjects

U Bergman

Publications and source records attributed to U Bergman.

At least 19 recordsLinked to original sources
PubMed2006

Healthcare associated infections in university hospitals in Latvia, Lithuania and Sweden: a simple protocol for quality assessment.

Surveillance of healthcare associated infections is an overlooked parameter of good clinical practice in most healthcare institutions, due to the workload demanded in the absence of adequate IT-systems. The aim of the present study was to investigate whether a simple protocol could be used to estimate the burden of healthcare associated infections in three university hospitals in Huddinge in Sweden, Riga in Latvia and Vilnius in Lithuania and form the basis for initiating a long term follow up system. The medical records of all patients receiving antibiotics were reviewed according to a standardised protocol, focusing on the indications for the drugs and on the frequency of hospital acquired infection (HAI) in a point-prevalence survey. Only comparable specialties were included. The proportion of patients treated with antibiotics (prophylaxis not included) were 63/280 (22%) in Huddinge, 73/649 (11%) in Riga and 99/682 (15%) in Vilnius. The proportion of admitted patients treated for a HAI were 15%, 3% and 4%, respectively, (both comparisons Huddinge versus other centres P <0.001). Surgical site infections were most common, followed by infections with an onset more than 2 days after admission without any of the other registered risk factors present. Our inexpensive and simple method showed that healthcare associated infections were a significant problem among patients admitted to Huddinge. The figures obtained can be used for further discussion and form a baseline for follow up at the local level. The comparison of figures between centres was far less relevant than the process the study created.

Anti-Bacterial Agents↗
PubMed2002

Differential effects of olfactory toxicants on olfactory regeneration.

The aim was to study the long-term response in the olfactory mucosa of NMRI mice after exposure to the olfactory toxicants dichlobenil (a herbicide) or methimazole (an antithyroid drug). Three and six months after exposure to dichlobenil (2x or 1 x 25 mg/kg i.p.), the dorsomedial part of the olfactory region showed a respiratory metaplasia with abundant invaginations and a fibrotic lamina propria. In contrast, 3 months after exposure to a toxic dose of methimazole (2 x 50 mg/kg i.p.), the olfactory neuroepithelium and lamina propria had been restored. To study the regenerative events, we used an antibody derived against growth-associated protein 43 (GAP-43), which stains immature neurons. To study epithelial differentiation and horizontal basal cells (HBCs) we used an antibody derived against some cytokeratins. Two weeks after methimazole treatment, there was a marked increase of GAP-43-stained cells in the whole olfactory region, which correlated with the observed regeneration at that time. Two weeks after dichlobenil treatment, the damaged atypical epithelium in the olfactory region showed a distinct keratin staining of basal and columnar cells whereas GAP-43-stained cells were not found. Despite a transient increase of GAP-43-stained cells in the border zone between damaged and undamaged olfactory mucosa, an expansion of a normal neuroepithelium into the damaged olfactory region was not detected in the dichlobenil-treated mice. An intact lamina propria is suggested as a prerequisite for repopulation of the neuroepithelium after toxicant-induced injury.

Animals↗
PubMed2001

[Quality assurance of drug prescription in primary health care. A new database software makes the drug therapy surveillance easier].

Quality assurance of drug prescription is a pre-requisite for rational drug use. From 22 health-care centres in the south-western area of the Stockholm County Council region, drug-prescription data were obtained from the patients' computerised medical recordings. This could be done with the aid of a specially designed database program. The drug-prescription data from the 22 health-care centres were collected and compiled in a central unit. Thereafter the results were brought back to the health-care centres, in which the quality assurance of drug prescription could be started.

Community Health Centers↗
PubMed2001

[How many prescription drugs does a general practitioner handle? A prescription database study].

INTRODUCTION: General practitioners must know of treatments for a broad range of diseases, but it may be difficult to keep abreast of the effects and adverse reactions of a large spectrum of drugs, and a good quality of prescribing implies the use of a limited number of analogue products. The aims were to investigate the number of different drugs prescribed per practice and to analyse the influence of practice characteristics on this number. MATERIAL AND METHODS: The study comprised 173 general practices (99 single and 74 group practices in the County of Funen, Denmark. All prescription registered on the Odense Pharmaco-epidemiological Database (OPED) were analysed. The main outcome measure was the number of different drugs prescribed per dispensing unit. RESULTS: The number of different drugs prescribed per dispensing unit varied almost fourfold (range: 102 to 381) and four practice characteristics were able to predict 74% of this variation. Practices with several doctors, a high number of patients listed per doctor, a high percentage of elderly patients, and a heavy workload showed the highest number of different drugs prescribed. CONCLUSION: There is almost a fourfold variation in the number of different drugs used in general practice, and three-quarters of this variation is associated with factors related to the practice.

Databases, Factual↗
PubMed2001

[Feedback on prescribing profiles at a primary health center. Important element in quality assurance of drug prescription].

DU90%--the number of drugs that account for 90% of DDDs--and adherence to guidelines in this segment were proposed by the Swedish Medical Quality Council (MKR) as indicators for assessing the quality of drug prescribing. We tested these indicators at a primary health care (PHC) center in Stockholm. Bar-coded prescriptions purchased at pharmacies were compared with the guidelines issued by the regional drug committee. The data were presented and discussed at the PHC center. Although the DU90% method neither examines the appropriateness of use nor provides outcome data, it was shown to be an inexpensive, flexible and simple method for assessing the general quality of drug prescribing.

Community Health Centers↗
PubMed2001

Antiepileptic drug therapy and its management in sudden unexpected death in epilepsy: a case-control study.

PURPOSE: Because frequent seizures constitute a major risk factor for sudden unexpected death in epilepsy (SUDEP), the treatment with antiepileptic drugs (AEDs) may play a role for the occurrence of SUDEP. We used data from routine therapeutic drug monitoring (TDM) to study the association between various aspects of AED treatment and the risk of SUDEP. METHODS: A nested case-control study was based on a cohort consisting of 6,880 patients registered in the Stockholm County In Ward Care Register with a diagnosis of epilepsy. Fifty-seven SUDEP cases, and 171 controls, living epilepsy patients, were selected from the cohort. Clinical data including data on TDM were collected through medical record review. RESULTS: The relative risk (RR) of SUDEP was 3.7 (95% CI, 1.0-13.1) for outpatients who had no TDM compared with those who had one to three TDMs during the 2 years of observation. RR was 9.5 (1.4-66.0) if carbamazepine (CBZ) plasma levels at the last TDM were above and not within the common target range (20-40 microM). High CBZ levels were associated with a higher risk in patients receiving polytherapy and in those with frequent dose changes. Although the subgroup of patients with high CBZ levels was small (six cases of 33 with CBZ therapy), and the result should be interpreted with caution, no similar associations were demonstrated for phenytoin plasma levels and risk of SUDEP. No association was found between SUDEP risk and within-patient variation in AED levels over time. CONCLUSIONS: Polytherapy, frequent dose changes, and high CBZ levels as identified risk factors for SUDEP all point to the risks associated with an unstable severe epilepsy. It is unclear whether high CBZ levels per se represent a risk factor or just reflect other unidentified aspects of a severe epilepsy. Our results, however, prompt further detailed analyses of the possible role of AEDs in SUDEP in larger cohorts and suggest that reasonable monitoring of the drug therapy may be useful to reduce risks.

Adolescent↗
PubMed2001

A study of benzodiazepine users claiming drug-induced psychiatric morbidity.

To ascertain whether benzodiazepines (BZDs) cause behavioural side effects other than those already known or trigger latent mental illness processes, the medical records of 32 patients who had submitted claims for BZD-induced side effects to the Swedish Pharmaceutical Insurance (SPI) claims office during 1985-92 were re-assessed by two psychiatrists on the basis of the DSM-IV system to determine whether a psychiatric syndrome existed before, during, or after the prescription of BZDs. Of the 32 case reports entered into the study, 22 concerned women; mean age at the time of SPI claim submission was 47 years, and the mean duration of BZD treatment was 11.7 years. The BZD dosages were in most cases within recommended therapeutic limits. Twenty-five claimants had also been using other psychotropic drugs. In 28 of the 32 cases a psychiatric syndrome in accordance with DSM-IV was present before the start of BZD treatment-in most cases an anxiety syndrome or anxious personality trait. In the other four cases no diagnosis could be given owing to paucity of information. In the 12 cases of claimants who fulfilled BZD dependence criteria at some point during treatment, withdrawal syndromes might have affected the clinical picture to some extent. Four claimants received additional post-BZD-treatment Axis I diagnoses, but in all four cases the new diagnoses were clearly related to the pre-existing symptom pattern. Thus, apart from the dependence on the drug there was no evidence of psychiatric morbidity caused by the BZDs. The symptoms reported by the claimants as evidence of BZD-induced psychiatric morbidity seem in most cases to have been a feature of pre-existing psychopathology which became more manifest after discontinuation of BZD treatment.

Adult↗
PubMed2001

Marked differences in antibiotic use and resistance between university hospitals in Vilnius, Lithuania, and Huddinge, Sweden.

Antibiotic use and antimicrobial resistance was compared between Vilnius and Huddinge University hospitals. Drug use data were expressed in number of defined daily doses/100 bed-days; antimicrobial resistance were given as percentages of resistant isolates. Thirty-five and 48 different antibiotic drugs were used in Vilnius and Huddinge, respectively. The overall consumption of antibiotics was 15 DDD/100 bed-days in Vilnius and 43 DDD/100 bed-days in Huddinge. Benzylpenicillin, ampicillin, and aminoglycosides were the major antibiotics in Vilnius; beta-lactamase-resistant penicillins, cefalosporins, and quinolones in Huddinge. In Vilnius, gentamicin made up one-quarter of the use. Staphylococcus aureus and Gram-negative isolates from wounds and blood were more resistant to gentamicin in Vilnius. S. aureus was more often methicillin resistant in Vilnius than in Huddinge. There was no S. aureus-resistant to vancomycin in either hospital. The vancomycin-resistant enterococci made up from 4% to 10% in Vilnius hospital, but they were not detected in Huddinge hospital (0%). The majority of Streptococcus pneumoniae isolates were sensitive to benzylpenicillin in both hospitals. The higher resistance of microorganisms to some antibiotics in Vilnius may be explained by heavy use of few antibiotics. Lower level of hygiene procedures, sampling bias, and other methodological issues may also have contributed. Guidelines for antibiotic use and hygienic procedures are now under development in Vilnius.

Anti-Bacterial Agents↗
PubMed2000

Persistent olfactory mucosal metaplasia and increased olfactory bulb glial fibrillary acidic protein levels following a single dose of methylsulfonyl-dichlorobenzene in mice: comparison of the 2,5- and 2, 6-dichlorinated isomers.

Histopathology was used to characterize long-term toxic effects in the olfactory system following a single ip dose (4-65 mg/kg) of methylsulfonyl-2,6-dichlorobenzene, (2,6-(diCl-MeSO(2)-B)), in female NMRI mice. The effects of 2,6-(diCl-MeSO(2)-B) and its 2, 5-chlorinated isomer, (2,5-(diCl-MeSO(2)-B)), on the levels of glial fibrillary acidic protein (GFAP; a biomarker for neurotoxicity) in different brain regions were examined by an enzyme-linked immunosorbent assay (ELISA). The histopathologic effects of 2, 6-(diCl-MeSO(2)-B) were dose-, time-, and tissue-dependent. At the highest doses (16-65 mg/kg), the initial effect of 2, 6-(diCl-MeSO(2)-B) was necrosis of the Bowman's glands, followed by a sequence of secondary events including degeneration of the olfactory neuroepithelium, repopulation of the basement membrane by a ciliated respiratorylike epithelium, fibrosis and ossification in the lamina propria, formation of bilateral polyps, angiogenesis, and disappearance of nerve bundles. Remodeling was most pronounced in the dorsal meatus of the olfactory mucosa and persisted for the duration of the experiment (46 weeks). A dose-dependent induction of GFAP in the olfactory bulb of mice treated with 2,6-(diCl-MeSO(2)-B) was observed at all doses examined (16-65 mg/kg). GFAP levels were highest 2 weeks after treatment (eightfold induction at 65 mg/kg) and then gradually decreased to normal within 26 weeks. The 2, 5-substituted isomer (65 mg/kg) did not induce GFAP in the olfactory bulb and or toxicity in the olfactory mucosa. In conclusion, a single dose of 2,6-(diCl-MeSO(2)-B) results in persistent metaplasia and remodeling of the olfactory mucosa, and a long-lasting but transient induction of GFAP in the olfactory bulb. It is proposed that methylsulfonyl-2,6-dichlorobenzene may serve as an experimental tool with a unique ability to produce persistent primary and/or secondary lesions in the olfactory system of mice.

Animals↗
PubMed2000

Deviations from evidence-based prescribing of non-steroidal anti-inflammatory drugs in three European regions.

OBJECTIVE: We examined to what extent the evidence of the relative gastrointestinal toxicity with non-steroidal anti-inflammatory drugs (NSAIDs) was implemented in clinical practice in Bologna, Italy, Funen, Denmark, and Stockholm, Sweden, areas with accurate computerised information on prescriptions purchased by defined populations. METHODS: We ranked each NSAID by purchased volume in defined daily doses during September 1996 and compared it with the ranking of gastrointestinal complications from a meta-analysis of controlled epidemiological studies published between 1986 and 1994. We restricted our comparison to those NSAIDs that accounted for 90% of the use and within this DU90% segment we determined the proportion of "high risk" (azapropazone, ketoprofen, piroxicam) and "low risk" (ibuprofen, diclofenac) drugs with respect to gastrointestinal toxicity. RESULTS: In Funen, Denmark, we found the best NSAID profile (63% low risk/11% high risk) while Bologna, Italy, had the other extreme (26% low risk/38% high risk), with Stockholm, Sweden, in between (43% low risk/20% high risk). CONCLUSION: Our study suggests that factors other than evidence-based medicine had a dominating impact on the use of prescription NSAIDs in 1996.

Anti-Inflammatory Agents, Non-Steroidal↗
PubMed2000

Workplace drug testing (WDT) likely to increase in Europe. Report from the First European Symposium on WDT including selected abstracts.

Will it take a series of drug-related accidents that have already occurred in the USA before workplace drug testing (WDT) becomes accepted in Europe as a preventive measure? Currently, the development of WDT in most European countries lags some 10-15 years behind that in the USA. Labour authorities in Europe now ought to take initiatives to demand a mandatory programme for accrediting drug analytical laboratories for WDT. Companies should realise that illicit drug use is no longer only a problem at street corners, and that having a testing system in place is important, not just for public health, but also for their reputations as responsible societal actors. Improved networking among police and regulatory authorities is required to keep pace with the rapid appearance and dissemination of new substances of abuse. European research collaboration, including the newly formed European Workplace Drug Testing Group, is needed to assess the impact of drug-testing policies on accidents and other outcome variables, and thereby to convince the general public and politicians that drug testing is beneficial and necessary. A 1993-1994 survey of quality analysis in some 200 European laboratories reported from Institut Municipal d'Investigació Medica (IMIM), Spain, showed good agreement between nominal and found concentrations but that only 10% of the laboratories could both screen, identify and quantify samples. Experiences from Italy show that proficiency testing schemes lead to improved accuracy of results. These were some major conclusions of the First European Symposium on Drug Testing held at Huddinge University Hospital in Stockholm, Sweden, 30 March to 1 April 1998, organised by Karolinska Institute, with participants from 22 countries.

Europe↗
PubMed2000

Transfer of dopamine in the olfactory pathway following nasal administration in mice.

PURPOSE: The aim of the study was to investigate whether dopamine is transferred along the olfactory pathway to the brain following nasal administration to mice. METHODS: [3H]-Dopamine was administered nasally or intravenously to female mice. Brain tissue samples were excised and the radioactive content was measured. The precise localisation of dopamine radioactivity in the brain was studied using autoradiography. The presence of dopamine or its metabolites in the olfactory bulb and mucosa was ascertained using thin layer chromatography (TLC). RESULTS: After administration of [3H]-dopamine into the right nostril, the amount of dopamine in the right bulb increased with time until. after 4 h, it was 27 times higher than in the left bulb. Among the other brain tissue samples, significantly higher amount of radioactivity was detected in the lateral olfactory tract. Radioactivity in the right olfactory bulb was shown by autoradiography to be selectively located in the peripheral layers 1 to 4 h after administration. Selective uptake of radioactivity was not seen in other regions of the brain. TLC data indicated that approximately 75% and 10% of the radioactivity in the olfactory bulb and mucosa, respectively, coeluted with dopamine. CONCLUSIONS: The results indicate that unchanged dopamine is transferred into the olfactory bulb following nasal administration of [3H]-dopamine.

Administration, Intranasal↗
PubMed2000

Lack of adherence to lipid-lowering drug treatment. A comparison of utilization patterns in defined populations in Funen, Denmark and Bologna, Italy.

AIMS: The objective was to explore differences in lipid-lowering drug (LLD) prescribing in Italy and Denmark. METHODS: We used two geographical areas with computerized drug prescription records in defined populations, one in Funen, Denmark with 500 000 inhabitants, the other in Bologna, Italy with 400 000 inhabitants. Prescriptions for patients who had purchased a LLD from 1994 until 1996 were retrieved as well as coprescriptions of antidiabetic and cardiovascular drugs as markers for diabetes and cardiovascular disease. Only patients surviving and remaining in the area were included. Compliance was defined as percentage of DDDs purchased divided by the number of days within the time window. The limit between good and poor compliance was set at 82%. RESULTS: In Bologna, LLD consumption measured in DDD increased by 41% and in Funen by 129%. Annual prevalence increased from 36.9 to 46.3 users/1000 inhabitants from 1994 to 1996 and from 3.2 to 6.6 users/1000 inhabitants in Bologna and Funen, respectively. From 1995 to 1996, the incidence of use decreased slightly in Bologna from 19.3 to 18. 8/1000 inhabitants/year, whereas in Funen the incidence increased from 1.8 to 2.3/1000 inhabitants/year. In Bologna 48% and in Funen 91% of users persisted with treatment for 2 years or longer. In Bologna, 7% and in Funen 45% were good compliers. In Bologna, 61% and in Funen, 72% received other drugs indicating cardiovascular or diabetic comorbidity. CONCLUSIONS: Patterns of use differed substantially between the two areas. In contrast with Funen, where long-term use was common, Bologna LLD use was sporadic. Based on a higher rate of coprescription, LLDs seemed to be used for secondary prevention to a higher extent in Funen than in Bologna. In Funen it appeared that the correct patients, but an insufficient number of them, were being treated adequately according to guidelines. The higher discontinuation rate of lipid lowering drugs in the Bologna area indicates that a large proportion of patients use these drugs for too short a period of time to benefit from treatment. Since society's health care resources are limited it is difficult to justify public funding of these medications without at the same time giving appropriate attention to these problems.

Adult↗
PubMed2000

Wide variation in the number of different drugs prescribed by general practitioners. A prescription database study.

OBJECTIVES: To investigate the number of different drugs prescribed per dispensing unit and to analyse the influence of practice characteristics on this number. DESIGN: Register analysis based on the Odense Pharmacoepidemiological Database (OPED). SETTING: General practices in the County of Funen, Demnark. SUBJECTS: 173 general practices (99 single-handed and 74 group practices). MAIN OUTCOME MEASURES: Number of different drugs prescribed per dispensing unit. RESULTS: The number of different drugs prescribed per dispensing unit varied nearly fourfold (range 102-381) and four practice characteristics were able to predict 74% of this variation. Practices with several doctors, a high number of patients listed per doctor, a high percentage of elderly individuals, and a heavy workload showed the highest number of different drugs prescribed. CONCLUSION: As the quality of drug prescribing is associated with the use of a limited number of drugs, it is suggested that GPs should agree on a formulary containing the most essential drugs in primary health care.

Age Factors↗
PubMed2000

An effect of body massage on voice loudness and phonation frequency in reading.

The effect of massage on voice fundamental frequency (F(0)) and sound pressure level (SPL) was investigated. Subjects were recorded while reading a 3-min passage of prose text. Then, a 30-min session of massage was administered by a trained naprapathy therapist. Sixteen subjects were given the massage, while 15 controls rested, lying down in silence for the same amount of time. The subjects were then recorded reading the same passage again. The F(0), and SPL averages across the whole passage were measured for the pre- and post-treatment recordings. In the post-massage recordings, subjects had lowered their F(0) by 1.1 semitones and their SPL by 1.0 dB, with very high statistical significance. The drop in F(0) was somewhat larger for the males than for the females. The control subjects showed no effect at all.

Adult↗
PubMed2000

Evaluation of the BioRID P3 and the Hybrid III in pendulum impacts to the back--a comparison to human subject test data.

The BioRID P3 (Biofidelic Rear Impact Dummy) and the Hybrid III were evaluated in pendulum impacts to the back and compared to data from previous cadaver tests. The test setup impacting seated cadavers was reproduced with a pendulum impacting seated dummies at the level of T6 (6th thoracic vertebra). The pendulum mass was 23 kg and the impact velocity 4.6 m/s. The results showed that the BioRID P3 was more biofidelic than the Hybrid III in terms of the peak responses and the temporal window of the head and head relative to T1 horizontal, vertical, and angular displacement. This study is an evaluation of both the BioRID P3 and the Hybrid III against a recently available set of human subject data. The study meets the need for validation of the BioRID P3 at a higher impact severity than has been previously accomplished.

Acceleration↗