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Biomedical subjects

U Persson

Publications and source records attributed to U Persson.

At least 55 records · Page 3Linked to original sources
PubMed1994

Comparison of excess costs of care and production losses because of morbidity in diabetic patients.

OBJECTIVE: To assess and compare excess costs of care and production losses because of morbidity in diabetic patients and the general population of a Swedish community. RESEARCH DESIGN AND METHODS: Costs of production losses were calculated from medical and social insurance records on sickness benefit days (short-term illness) and premature retirement (permanent disability) in people with diabetes and in the entire population of the community (a municipality comprising a town and rural surroundings, with 28,000 inhabitants). Care costs included those of consultations and inpatient care, as well as costs of insulin, oral antidiabetic medications, other drugs, test material, and treatment devices, and they were obtained from patient records, the health care administration, and the statistics of community pharmacy sales. RESULTS: Of the diabetic patients < 65 years of age, above which both diabetic and nondiabetic people get retirement pension, and sickness benefits cease, 62% of those on insulin treatment in each gender had insulin-dependent diabetes mellitus (IDDM). All insulin-treated non-insulin-dependent diabetes mellitus (NIDDM) patients were > 40 years of age. Both the insulin-treated and the non-insulin-treated diabetic patients were prematurely retired twice as often as the average population and had twice as many inpatient days. The insulin-treated subjects also had twice as many sickness benefit days. The excess costs of production losses as a result of morbidity in people with diabetes were about $7,000 per individual and year. The corresponding excess costs of inpatient care were $800. The therapeutic expenditures for control of diabetes were about $600 per individual and year. If converted to U.S. conditions, the costs of lost production as a result of excess morbidity (< 65 years of age) would be $12 billion and $9 billion for people with insulin-treated and non-insulin-treated diabetes, respectively. CONCLUSIONS: If improved metabolic control by intensified treatment would reduce excess morbidity in both IDDM and NIDDM, the predominant costs of production losses imply that intensified antidiabetic treatment might save costs.

Adult↗
PubMed1992

Restricted V alpha 2.3 gene usage by CD4+ T lymphocytes in bronchoalveolar lavage fluid from sarcoidosis patients correlates with HLA-DR3.

The alpha/beta T cell receptor (TcR) V gene usage of bronchoalveolar lavage (BAL) lymphocytes and peripheral blood lymphocytes (PBL) from 11 sarcoidosis patients and 4 healthy controls was investigated, using eight alpha/beta TcR V gene product-specific monoclonal antibodies (mAb). Twenty-seven percent (3/11) of the sarcoidosis patients had a highly significant increase in V alpha 2.3+CD4+ T lymphocytes in the bronchoalveolar space, while displaying normal frequencies of these T cells in peripheral blood. The reactivities with the remaining seven TcR mAb were normal. In the control group, no compartmentalization of any T cells was seen. Four of the patients expressed the HLA-DR3 (w17), DQw2 haplotype. Interestingly, the three patients with distinct signs of compartmentalized V alpha 2.3+CD4+ T cells all expressed this HLA haplotype. Additionally, a fourth patient with pronounced, although less significant, accumulation of V alpha 2.3+CD4+ T cells in the lung, was also HLA-DR3(w17), DQw2+. Expression of V alpha 2.3+CD4+ T cells in BAL of these patients correlated with clinical disease, as revealed on re-analyzing the four patients after 6 months or longer. Predominant TcR V alpha 2.3 gene usage in compartmentalized CD4+ BAL T lymphocytes, linked to HLA-DR3(w17), DQw2 haplotype, may thus indicate presence of a specific antigen localized to the lungs of sarcoidosis patients.

Adult↗
PubMed1992

Rejection associated with early appearance of donor-reactive antibodies after kidney transplantation treated with plasmapheresis and administration of 15-deoxyspergualin. A report of two cases.

In two kidney transplant patients, one of whom had panel-reactive antibodies (PRA) before transplantation, a pretransplant negative donor-recipient crossmatch became positive within the 1st week after transplantation. Simultaneously, good graft function deteriorated to a state of anuria. One patient graft biopsy showed a vascular rejection, whilst the other patient biopsy was unrevealing. Both patients were treated with plasmapheresis and a new immunosuppressive drug, 15-deoxyspergualin (DSG). Plasmapheresis was performed for 6 and 9 days, respectively, and DSG was given for 5 days in a dosage of 6 mg/kg body weight per day. One of the patients received methylprednisolone i.v. in addition. During treatment the cross-match became negative and has since remained that way. In both patients the graft function was restored. No adverse effects were seen from the treatment, except for a slight leukocytopenia and thrombocytopenia.

Adult↗
PubMed1992

Assembly of MHC class I molecules in ex vivo carcinoma cells induced by IFN-gamma or by a binding peptide.

It has been reported that the assembly of MHC class I molecules in mutagenized cell lines could be induced by specific binding peptides. We have now demonstrated that the defect in assembly between heavy and light chains of class I molecules naturally occurred in tumor cells of one spontaneous ovarian carcinoma detected by one-dimensional isoelectric focusing of immunoprecipitates with anti-monomorphic class I MAb (W6/32) and by immunostaining with free heavy chain and beta 2m-specific MAbs. In vitro treatment of the tumor cells with IFN-gamma induced the assembly and surface expression of majority class I molecules (A2.1, B7, B15, Cw6, Cw7 out of A2.1, A2*, B7, B15, Cw6, Cw7). Moreover, assembly of A2 and Cw6 was induced by exposure of the tumor cells to a HLA A2-binding peptide K62 derived from influenza A matrix protein. Autologous blood T lymphocytes were activated in mixed lymphocyte-tumor cell culture (MLTC) by the IFN-gamma-treated but not by the unmanipulated tumor cells. Although activated lymphocytes damaged both IFN-gamma-treated and untreated tumor cells, the alpha class I MAb (W6/32) efficiently inhibited the lysis of IFN-gamma-treated targets, but not the untreated targets. These results indicate that the defect of MHC class I assembly may result in the escape of tumor cells from immune response.

Amino Acid Sequence↗
PubMed1992

Ultraviolet radiation and ultra-clean air enclosures in operating rooms. UV-protection, economy, and comfort.

Ultraviolet radiation (UVC), as an air-cleaning method for operating rooms, has received increasing attention, due to its low cost. Recent work shows that UVC can provide ultra-clean air (< 10 CFU/m3) in the operating room. However, the UVC air-cleaning method has been criticized because of the protective clothing needed and the risk of UVC exposure for staff and patients. To evaluate the practicability of the UVC method, the aspects of UV-protection were thoroughly evaluated regarding UVC intensities and the transmission properties of clothing commonly used in the operating room. A comparison between UVC and the Charnley-Howorth enclosure, regarding the aspects of economy and comfort, was performed.

Asepsis↗
PubMed1992

Cost-effectiveness of simvastatin versus cholestyramine: results for Sweden.

Cost-effectiveness ratios were estimated for each of 2 plasma cholesterol-lowering drug therapies, the HMG-CoA reductase inhibitor simvastatin and the well established cholestyramine, in comparison with a nonpreventive drug treatment alternative. The study was confined to Swedish men (aged 37 to 64 years at start of therapy) with total serum cholesterol levels above 6.2 mmol/L who were free of coronary artery disease (CAD). Costs included expected direct costs of plasma cholesterol-lowering treatment less expected savings resulting from preventing CAD. Effects were defined as changes in life expectancy. A discount rate of 5% and Swedish kronor (SEK) 1988 prices were used. The impact on CAD risks was calculated using multivariate logistic risk estimates from the Framingham Heart Study; Swedish estimates were used to calculate intervention costs and changes in healthcare costs. Over the range of cholesterol levels examined (6.2 to 9.8 mmol/L), simvastatin was consistently more cost-effective than cholestyramine.

Adult↗
PubMed1992

Cost-effectiveness analysis of treatment with liposomal amphotericin B versus conventional amphotericin B in organ or bone marrow transplant recipients with systemic mycoses.

Economic appraisal of pharmaceuticals is becoming increasingly important. In a retrospective study of patient records from 58 organ or bone marrow-transplanted patients with systemic mycoses, the cost-effectiveness of treatment with a liposomal amphotericin B formulation was compared with that of conventional amphotericin B. Treatment with liposomal amphotericin B results in fewer adverse reactions, increased life expectancy and higher costs than treatment with conventional amphotericin B. Pricing liposomal amphotericin B at about SKE6000 per patient treatment day will result in an additional cost per life-year gained of about SEK150 000 relative to that using conventional amphotericin B for patients receiving kidney, kidney and pancreas, or pancreas transplants. For liver and bone marrow transplant (BMT) recipients the marginal cost-effectiveness ratio was about SEK195 000 and SEK150 000 per life-year gained. Compared with alternative use of resources in society and health care, use of liposomal amphotericin B rather than conventional amphotericin treatment can be considered cost-effective at the price assumed.

Adult↗
PubMed1992

Decreased incidence of graft-versus-host disease and improved survival with methotrexate combined with cyclosporin compared with monotherapy in recipients of bone marrow from donors other than HLA identical siblings.

Recipients receiving marrow from donors other than HLA identical siblings (alternative donors) treated by monotherapy with either methotrexate (MTX, n = 5) or cyclosporin A (CSA, n = 10) were compared with 28 recipients of alternative donor marrow receiving MTX + CSA. The former group had a cumulative incidence of grade II-IV acute graft-versus-host disease (GVHD) of 73% compared with 34% in the latter group (p = 0.009). The incidence of chronic GVHD was 75% and 41% in the two groups respectively, a difference that was not statistically significant. Death caused by GVHD was 47% in recipients of alternative bone marrow treated with monotherapy vs 12% in those treated with MTX + CSA (p = 0.008). The actuarial 4-year patient survival was 7% and 46% in the two groups, respectively (p = 0.04). Compared with HLA identical siblings the recipients of alternative marrow treated with monotherapy had an increased risk of grade II-IV acute GVHD (p less than 0.0001), an increased death rate by GVHD (p = 0.0001) and a decreased survival (p less than 0.0001). When MTX was combined with CSA the recipients of alternative marrow had an increased risk of grade II-IV acute GVHD (p = 0.005), but death by GVHD (12 vs 6%) and 4-year patient survival (46 vs 45%) did not differ.

Adolescent↗
PubMed1991

Clinical outcome and health care costs in renal revascularization--percutaneous transluminal renal angioplasty versus reconstructive surgery.

Clinical outcome and health care costs related to investigation, treatment with either percutaneous transluminal renal angioplasty (PTRA) or reconstructive surgery, and follow-up of patients with renovascular hypertension with or without uraemia were analysed in 21 PTRA-treated and 16 operated patients. Most renal artery stenoses were atherosclerotic. Nineteen PTRAs were successful or partly successful and two failed; the patients were operated on without delay. All surgical reconstructions were successful. In the PTRA group six restenoses occurred after 4-24 months. Four were treated with re-PTRA and two were operated on. No recurrence occurred in the operated group. At the end of follow-up (median 48, range 9-84 months) primary patency in the PTRA group was 69 per cent and in the operated group 100 per cent. Secondary patency in the PTRA group was 100 per cent. With regard to hypertension, including primary and secondary results, 19 out of 21 (90 per cent) patients were improved in the PTRA group and 13 out of 16 (81 per cent) in the operated group. The diagnostic and preprocedure costs were the same in both groups, whereas the procedure and postprocedure costs were lower in the PTRA group. However, the follow-up costs were considerably higher because of recurrences and their treatment in the PTRA group. The total median cost of reconstructive surgery was 12 per cent higher than for PTRA, a non-significant difference.

Adolescent↗
PubMed1991

Expression of MHC-class-I antigens in human carcinomas and sarcomas analyzed by isoelectric focusing.

We analyzed the expression of class-I antigens in ex vivo human tumor cells by isoelectric focusing (IEF) the anti-class-I mAb W6/32 immunoprecipitates prepared from cell lysates. Out of 42 experiments, 27 were technically successful. The patient's blood lymphocytes were used as controls. In vitro exposure of the tumor cells to IFN gamma and TNF alpha elevated class-I antigen expression. In 11 cases, defects in MHC-class-I-antigen expression were observed. In 2 cases the antigens were detected only in the cytokine-treated tumor samples, probably due to a defect in the association between beta 2m and class-I heavy chains. Selective changes in the expression of alleles were seen in 10 cases and might involve HLA A, B and C antigens. Alterations in class-I expression as compared with the lymphocytes were observed in 9 of 13 cases in which the tumor cells were collected from metastases, and only in 2 of 14 primary tumors.

Adenocarcinoma↗
PubMed1991

Home service costs: the Swedish experience.

This article will show that the annual cost of service and care for a receiver of home service in Sweden ranges from SEK 5,000 to SEK 435,000 according to individual disability. In our sample, the average annual cost amounts to slightly less than SEK 100,000. Furthermore, the cost of service and care for pensioners of good mental health is about SEK 50,000 higher than for the group of mentally disabled (everything else being the same). Not quite unexpectedly, the annual cost of service and care decreases when assistance from relatives increases. Without help from relatives, the annual cost increases by approximately SEK 16,000 per individual. The average annual cost is higher for home service receivers who live at home and have an alarm telephone than for those who have not got an alarm telephone (everything else being the same). Alarm telephone systems which require staff for supervision and home visits account for half of the recorded difference in cost. Both living in one's own home with handicap adjustment and living in a service flat mean a lower cost of service and care than living in one's own home without handicap adjustment (everything else being the same). For persons who are in great need of daily help, living at home implies a cost that is slightly more than 20 per cent higher than the cost for living in a service flat.

Activities of Daily Living↗
PubMed1991

EuroQol: health-related quality of life measurement. Results of the Swedish questionnaire exercise.

The EuroQol Group, which currently comprises 7 centres in 5 countries, has been testing the feasibility of jointly developing a standardised non-disease-specific instrument for describing and valuing health-related quality of life. The instrument employs a visual analogue scale of the 'thermometer' type to allow respondents to rank a number of health states. As part of the Swedish IHE's contribution to the EuroQol Group's work, questionnaires were sent to 1000 people randomly selected to provide a representative sample of the Swedish population aged 16-84 years. 349 persons responded and 208 provided sufficient information for detailed analysis. From these 208 it proved possible to derive health status information in a quantitative form. The most interesting result was that the health state valuations from this survey indicated a striking similarity with those of EuroQol studies in Frome (England) and Bergen op Zoom (The Netherlands). The lessons learned from undertaking the survey are briefly discussed. The Swedish IHE is encouraged by the exercise to continue to play its part in the continuing developments of the EuroQol methodology.

Attitude to Health↗
PubMed1991

Cost effectiveness of blood substitution in elective orthopedic operations.

Cost effectiveness was compared between substitution with autologous blood, implying no risk of transmission of diseases, and homologous blood, with a definite risk of transmission. Primary and revision hip arthroplasties were included in this study, as well as scoliosis operations. The risk of contracting chronic non-A, non-B hepatitis (NANBH) was included in the calculations of the long-term economic consequences of a transmittable disease. Our study showed that predonated blood alone, with a donation of up to four units, was the most suitable and cost-effective method for substitution of blood losses up to about 2.5-3 liters A combination of predonated blood and intraoperative autotransfusion was more suitable and less expensive for substituting blood losses of 2.5 liters or more. Homologous blood was the least cost-effective alternative considering the influence of non-A, non-B hepatitis.

Adult↗
PubMed1990

Direct costs of stroke for a Swedish population.

Direct costs were estimated for the treatment, rehabilitation, and nursing of 125 patients with first stroke in the Lund and Orup health districts (population of 200,191). Patients were followed from the onset of stroke in 1983 until October 31, 1985. The data were used to calculate the present value of the expected lifetime direct costs for an individual contracting his or her first stroke at various ages. For example, at the age of 72, these costs were estimated at SEK 283,000 for a man and SEK 561,000 for a woman. Hospital care was the major cost component (75% for males and 89% for females) at this age of onset. The results could be used to estimate the economic benefits of preventing new strokes, hence, forming part of a cost-effectiveness or cost-utility analysis. Together with prognoses of the expected developments in the incidence of stroke, they could also serve as the basis of forecasts of future costs of the health care and social service sectors.

Adult↗
PubMed1990

Screening for scoliosis. A cost-effectiveness analysis.

The cost-effectiveness of three different screening methods was studied: the no specific screening, the conventional clinical screening, and the combined clinical moiré screening alternative. A multistage model of the treatment process was developed. Data from retrospective studies in Malmo were used. The costs for health care and production loss were calculated and applied to the time profiles of the three screening alternatives. Health care costs as well as costs in loss of production increased with the introduction of the conventional clinical screening program. However, when the clinical screening was combined with the moiré technique, the costs were markedly reduced. Thus, the combined clinical moiré screening would be the cost-effective way of using resources to prevent scolioses from developing into a more severe deformity.

Cost-Benefit Analysis↗