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Biomedical subjects

B Kjellman

Publications and source records attributed to B Kjellman.

At least 19 recordsLinked to original sources
PubMed2003

"A school for all kinds of minds." The impact of neuropsychiatric disorders, gender and ethnicity on school-related tasks administered to 9-10-year-old children.

This cross-sectional study of reading,writing and mathematics skills in a total population of 589 children attending 4th grade in regular public schools showed that neuropsychiatric disorder was a strong predictor of poor performance, girls scored better than boys on language tests and some mathematics test, and immigrant children had similar results as native Swedish children on most tests. Sixty percent of boys with and 7% of boys without DAMP (Deficits in Attention,Motor control and Perception) or ADHD (Attention- Deficit/Hyperactivity Disorder) had substantial school difficulties. The rate of children requiring individualised special education measures was estimated at a minimum of 15%. This constitutes a major challenge to a society claiming to offer equal opportunities and participation for all children.

Attention Deficit Disorder with Hyperactivity↗
PubMed2003

Peripheral airway involvement in asthma assessed by single-breath SF6 and He washout.

The aim of the study was to assess how deep into the acinar region the airway response to cold dry-air hyperventilation challenge (CACh) reaches in subjects with asthma of different severity. Peripheral airway function was measured using a single-breath sulphur hexafluoride (SF6) and helium (He) washout test and overall airway function by forced expiratory volume in one second (FEV1) at rest, after CACh and beta2-therapy in 55 adults with a history of asthma. The normalised phase-III slopes (SnIII) for SF6 and He were used to assess peripheral airway obstruction and the (SF6-He) SnIII difference to indicate where obstruction occurred. While a greater He versus SF6 slope increase indicates a response close to the acinar entrance, the reverse indicates a response deeper into the acinar airspaces. Twelve subjects had a major fall in FEV1 (> or = 20%) after CACh, 16 a minor fall (10-19%), and 27 did not react. Resting He and SF6 SnIII were significantly greater in major responders with respect to minor and nonresponders, while resting FEV1 did not differ between the three groups. The major responders showed marked increases of He and SF6 SnIII after CACh, with greater increase for He resulting in a negative (SF6-He) SnIII difference. To conclude, airways close to the acinar entrance participate in the overall airway response to cold-air challenge in asthmatic adults with marked airway hyperresponsiveness to cold, dry air.

Adrenergic beta-Agonists↗
PubMed2002

Asthma severity, allergy and lung function during young middle life in subjects with asthma in childhood.

The further course of asthma severity lung function, bronchial hyperresponsiveness (BHR) to cold air challenge (CACh), clinical allergies and allergic sensitization in young middle adulthood was studied in a cohort of 55 subjects with childhood asthma. All subjects (27 females) have attended all five previous and the current follow-up visit, undertaken at a mean age of 35 years. Twelve subjects (22%) reported no current asthma, 28 (51%) mild/intermittent, and 15 (27%) moderate/severe asthma. Asthma severity changed little in the individual subjects over the last 5-year period. Females continued to have higher asthma severity scores than the males, but the previously noted lower resting and post-bronchodilator % predicted FEV1 in females was not confirmed now. Pathological BHR to CACh tended to be more common among the males. Forty-four subjects were still allergic to animal danders and 35 to pollens. Sensitization rates (skin prick test or RAST) were similar to those recorded 5 years earlier and there was no clear evidence of tolerance developing. Five subjects have never shown evidence of allergy or sensitization. The extent of sensitization to animal danders showed statistically significant relationships to asthma severity and BHR to CACh. Social development and professional careers continued to be good.

Adult↗
PubMed2000

[Children with asthma followed up for 21 years. Reduced severity, but patients seldom grow out of asthma by adulthood].

The course of asthma severity, clinical allergies, allergic sensitization, lung function, changes in living conditions and social outcome were studied prospectively in 55 asthmatic children for 21 years, from a mean age of 9 to 30 years. Asthma severity improved, but only 16 percent were in remission at the final follow-up. After adolescence, clinical improvement continued among males but not among females. Lung function showed a similar gender difference with respect to clinical course. Generally, clinical allergies and sensitization to pollens and animal danders persisted in adulthood. In adulthood, asthma severity and degree of bronchial hyperresponsiveness correlated with the extent of sensitization to furred animals.

Adolescent↗
PubMed2000

Asthma from childhood to adulthood: course and outcome of lung function.

Lung function (FEV1 before and after bronchodilatation) was studied prospectively over five visits in 55 asthmatic children (28 boys) from childhood to adulthood (age 30). At the last follow-up recordings were made at rest, after cold air challenge (CACh), and after bronchodilatation. Results were related to clinical asthma scoring and to sensitization to furred animals, as described in a companion paper. Lung function outcome was shown to be influenced by initial FEV1 (% predicted) and gender, but not by initial asthma severity or sensitization. FEV1 (% predicted) was higher in females than in males over the first two follow-ups, but the reverse was found over the subsequent visits. It deteriorated from childhood to adulthood in the females but improved in the males. In adulthood the females (for height 170 cm) had a steeper normalized annual fall in post-bronchodilator FEV1 than the males (55 +/- 38 vs. 25 +/- 36 ml; P = 0.006). The degree of bronchial hyperresponsiveness was associated significantly with asthma severity and the extent of sensitization to furred animals, but not with gender. The results indicate a better lung function outcome for asthmatic boys than for girls, confirming trends seen in clinical asthma severity. In adulthood the extent of sensitization to relevant perennial inhaled allergens significantly influences airway responsiveness and asthma severity, but not lung function.

Adolescent↗
PubMed2000

Asthma from childhood to adulthood: asthma severity, allergies, sensitization, living conditions, gender influence and social consequences.

The course of asthma severity, clinical allergies, allergic sensitization, changes in living conditions and social outcome were studied prospectively over five follow-up visits from the mean age of 9 to 30 years in a cohort of 28 boys and 27 girls, selected randomly among asthmatic children attending a paediatric outpatient unit. Asthma severity improved from childhood to adulthood, judged by symptom and medication scores and by the number of hospital admissions, but only nine subjects (16%) had been free from symptoms and medication over the last year of follow-up. After adolescence, asthma continued to improve among the males but not among the females. This difference could not be explained by gender differences in the course of clinical allergies or sensitization (skin-prick-tests and RAST) to common inhaled allergens, or by differences in environmental or social conditions. Sensitization to relevant perennial inhaled allergens correlated with asthma severity during adulthood. In general, clinical allergies and sensitization to inhaled allergens adopted during childhood persisted into adulthood. Approximately 10% of the subjects never adopted a clinical allergy or a positive allergy test. The social outcome was good.

Adolescent↗
PubMed2000

Respiratory syncytial virus bronchiolitis in infancy is an important risk factor for asthma and allergy at age 7.

We previously reported an increased risk for bronchial obstructive disease and allergic sensitization up to age 3 in 47 children hospitalized with a respiratory syncytial virus (RSV) bronchiolitis in infancy compared with 93 matched control subjects recruited during infancy. The aims of the present study were to evaluate the occurrences of bronchial obstructive disease and allergic sensitization in these children at age 7(1)/ (2). All 140 children reported for the follow-up, which included physical examination, skin prick tests, and serum IgE tests for common food and inhaled allergens. The cumulative prevalence of asthma was 30% in the RSV group and 3% in the control group (p < 0.001), and the cumulative prevalence of "any wheezing" was 68% and 34%, respectively (p < 0.001). Asthma during the year prior to follow-up was seen in 23% of the RSV children and 2% in the control subjects (p < 0.001). Allergic sensitization was found in 41% of the RSV children and 22% of the control subjects (p = 0.039). Multivariate evaluation of possible risk factors for asthma and sensitization using a stepwise logistic statistical procedure for all 140 children showed that RSV bronchiolitis had the highest independent risk ratio for asthma (OR: 12.7, 95% CI 3.4 to 47.1) and a significantly elevated independent risk ratio for allergic sensitization (OR: 2.4, 95% CI 1.1 to 5.5). In conclusion, RSV bronchiolitis in infancy severe enough to cause hospitalization was highly associatied with the development of asthma and allergic sensitization up to age 7(1)/ (2). The results support the theory that the RSV influences the mechanisms involved in the development of asthma and allergy in children.

Asthma↗
PubMed2000

Deficits in attention, motor control and perception (DAMP): a simplified school entry examination.

OBJECTIVE: To suggest an empirically based school entry screening examination for the detection of deficits in attention, motor control and perception (DAMP) in 6-y-old children. MATERIAL AND METHODS: A population-based cohort of 113 children, 6-7 y of age (62 with and 51 without DAMP), compared on measures of attention, motor functions, language and cognition. RESULTS: Attention deficits were convincingly identified by both parents and paediatrician. The motor function tests clearly distinguished between the two groups. Linguistic and meta-linguistic tests demonstrated greater phonological processing difficulties in the DAMP group. The cognitive test revealed an overall lower IQ but no consistent characteristic pattern in the DAMP group. CONCLUSIONS: A simplified paediatric school entry examination test is suggested. Four motor tests (standing on one foot, Fog test, design copying and diadochokinesis) administered by the paediatrician, combined with a brief structured clinical observation and a structured parent interview, identified 80% of children with DAMP-and all those with severe DAMP-as well as a small number of false positives.

Attention Deficit Disorder with Hyperactivity↗
PubMed1999

Pharmacokinetics of bambuterol during oral administration to asthmatic children.

AIMS: To investigate dose proportionality, dosing frequency, and ethnic aspects of the pharmacokinetics of bambuterol in asthmatic children, and to discuss the relationship with previous observations in adults. METHODS: Forty-eight children in four different studies completed two double-blind bambuterol treatments each (daily doses of bambuterol hydrochloride): 12 preschool (5 mg x 2 vs 10 mg) and 12 school (10 mg vs 20 mg) Caucasians, 12 preschool (2.5 mg vs 5 mg), and 12 school (10 mg vs 20 mg) Orientals. Peak plasma concentrations and dosing interval area under curve (AUC) of bambuterol and the active metabolite terbutaline were assessed at steady state. Treatment differences were analysed statistically within each study. Differences between the studies and the relation to steady-state AUC in adults were described. RESULTS: Dose proportionality was seen for terbutaline but not for bambuterol. Twice-daily dosing (2 x AUC(0,12 h)) could not be shown to differ from once-daily dosing (AUC(0,24 h)) in the preschool Caucasians. Mean AUC of terbutaline was 128 and 242 nmol l-1 h in the preschool Caucasians (5 mg/12 h; 10 mg/24 h), 213 and 406 nmol l-1 h in the Caucasian school children (10 mg; 20 mg), 87.4 and 202 nmol l-1 h in the Oriental preschool children (2.5 mg; 5 mg), and 356 and 640 nmol l-1 h in the Oriental school children (10 mg; 20 mg). Oriental school children had higher plasma concentrations of bambuterol and terbutaline than Caucasian school children. The strict ethnic implication of the difference could not be elucidated, because demographic data were not perfectly matched. Terbutaline AUC was only moderately increased in the Caucasian school children compared with Caucasian adults. The increase was more pronounced in Oriental children and in some preschool Caucasians. The highest concentration of terbutaline, 58 nmol l-1, was seen in an Oriental school child after a 20 mg dose. CONCLUSIONS: Caucasian school children can be given bambuterol hydrochloride very much as Caucasian adults, 10 or 20 mg once daily, but Oriental preschool and school children plus preschool Caucasians should be given lower doses.

Administration, Oral↗
PubMed1999

Multidisciplinary assessment of children with deficits relating to attention, motor activity and perception: evaluation of the ANSER model.

This study describes a process for multidisciplinary assessment of children having deficits in attention, motor activity and perception (DAMP) with an evaluation of that process based on the opinions of parents, teachers and team members. The process named the 'ANSER model' consists of six steps (I to VI) conducted over a 2-month period and a follow-up 2 years later (step VII). Parents and teachers are fully involved early in the process and their participation is considered essential for a good result. Particular consideration is given to directly helping a child understand him/herself and become aware of his/her own difficulties. Strategies to overcome those difficulties are developed together with the child, the parents and the teacher. A specific aspect of the assessment is the aim to provide therapy through discussion of the questions, thoughts and feelings evoked during, and by the process. The expectations of parents and teachers regarding the assessment, and their completion of six steps of the process were ascertained from questionnaires. A large majority of both parents and teachers had high expectations of the assessment. Slightly more parents than teachers were convinced of its necessity. Their expectations were satisfied. Parents, teachers and team members emphasized the importance of the participation of parents and teachers in the process. The average time required for a complete assessment according to the process and including the work of all the specialists was 33 hours.

Adolescent↗
PubMed1999

Effects of maternal dietary avoidance during lactation on allergy in children at 10 years of age.

This study investigated the long-term effects of maternal dietary avoidance during lactation on the occurrence of atopic symptoms, development of immunoglobulin E (IgE) antibodies to food and inhaled allergens and occurrence of positive skin-prick tests (SPT) in 65 children with a family history of atopy whose mothers adhered to a diet devoid of eggs, cow's milk and fish during the first 3 months of lactation (D group) and in a matched group of 50 children with mothers not practising such a diet (ND group). The diets of the D and ND children were similar. All children attended 7 follow-ups from the age of 3 months to the age of 10 y. After the first follow-up there was a 100% retention of participants. The results of the seventh follow-up at 10 y are presented. Total IgE values and IgE antibodies to seven food and seven inhaled allergens were determined by the Phadebas IgE CAP and the Phadebas RAST, respectively. SPT were conducted for five food and seven inhaled allergens. High rates of atopic symptoms occurred in both groups, but there were no differences between the groups. Sensitization to the three foods avoided by the mothers during lactation was similar, but the overall test reactivity to foods was lower in the D group. Sensitization to inhaled allergens was similar in the two groups. During the 10 y of follow-up, there was no difference between the groups in the occurrence of indoor furred animals, tobacco smoking, changes in heredity for atopy or development of total IgE, but a higher rate of maternal sensitization was found in the ND group, as judged by a screening test for IgE antibodies to inhalants (Phadiatop). The results do not support general recommendations to implement prophylactic maternal dietary avoidance during lactation in allergy-prone families.

Breast Feeding↗
PubMed1999

Light treatment of seasonal affective disorder in combination with citalopram or placebo with 1-year follow-up.

This placebo-controlled, double-blind, 1-year pilot study aimed at investigating possible clinical advantages of combining initial light therapy with the selective serotonin reuptake inhibitor (SSRI) citalopram as well as the effects of continuous long-term administration of this drug in patients with seasonal affective disorder (SAD). Eight physically healthy women who met the DSM-III-R criteria for SAD were included in the study. Four women were randomized to the citalopram group receiving 40 mg citalopram daily from the first of 10 light treatment days and throughout the 1-year study. The remaining four women were allocated to the placebo group using the same double-blind repeated measures design. The clinical outcome was measured by using three versions of the Comprehensive Psychopathological Rating Scale (CPRS) and Visual Analog Scales (VAS), respectively. Taking the initial rating scores into account in covariance analyses, no statistically significant group difference was found during the light treatment period. However, during the follow-up period the full version of the CPRS and the self-rating version of CPRS and the VAS-scales for global condition and depressed mood were statistically significantly lower in the citalopram group compared with the placebo group. Thus, in this small but carefully observed sample of SAD-patients combining initial light therapy and long-term citalopram treatment was clinically more effective over time than the placebo combination. Our findings support the notion that light therapy with concomitant and continued SSRI (citalopram) treatment is a useful strategy to achieve beneficial long-term effects in patients with the SAD syndrome.

Adult↗
PubMed1998

Attention deficit disorder with developmental coordination disorders.

AIMS: To analyse the contribution of certain social, familial, prenatal, perinatal, and developmental background factors in the pathogenesis of deficits in attention, motor control, and perception (DAMP). METHODS: A population based case-control study was carried out with 113 children aged 6 years, 62 diagnosed with DAMP and 51 controls without DAMP. The children's health and medical records were studied and their history with regard to background factors was taken at an interview with the mother using a standardised schedule. Familial factors, possible non-optimal factors during pregnancy (including smoking), developmental factors (including early language development), and medical and psychosocial data were scored in accordance with the reduced optimality method. RESULTS: Low socioeconomic class was common in the group with DAMP. Familial language disorder and familial motor clumsiness were found at higher rates in the DAMP group. Neuropathogenic risk factors in utero were also more common in the children with DAMP. Maternal smoking during pregnancy appeared to be an important risk factor. Language problems were present in two thirds of the children with DAMP. Sleep problems and gastrointestinal disorders, but not atopy or otitis media, were significantly more common in the DAMP group. CONCLUSIONS: Prenatal familial and neuropathogenic risk factors contribute to the development of DAMP. Primary prevention, such as improved maternal health care and early detection or treatment, or both, of associated language problems appear to be essential.

Attention Deficit Disorder with Hyperactivity↗
PubMed1997

Season of birth as predictor of atopic manifestations.

The relation between month of birth, sensitisation, and manifestations of atopy was assessed in 209 children who were followed from birth to 12-15 years. Children born during the tree pollen season were less likely to develop allergic rhinoconjunctivitis, IgE antibodies to pollen, or a positive screening test for IgE antibodies (odds ratio 0.28, 0.41, 0.35, respectively) than children born during the rest of the year. The prevalence of IgE antibodies to food and animal dander at 9 months and to atopic disease was higher in children born in the autumn and winter, that is, September to February, compared to the spring and summer (egg 20% v 6%; milk 10% v 2%). Thus sensitisation to pollen and allergic rhinoconjunctivitis is least common in children born in the spring, while birth in September to February is associated with an increased incidence of sensitisation to food and of atopic disease.

Dermatitis, Allergic Contact↗
PubMed1996

Induction of heat shock protein in monocytic cells by oxidized low density lipoprotein.

The atherosclerotic lesion may be characterized as a chronic inflammatory process, and oxidized LDL is believed to be a key event in the development of atherosclerosis, though the mechanisms by which oxidized LDL exerts its proatherogenic properties are largely unknown. Heat shock proteins (hsp) are a group of proteins with a highly conserved structure and of these, hsp60 has been suggested to play a role in autoimmunity due to T lymphocyte crossreactivity between bacterial and human hsp60. The present study was designed to investigate the effects of oxidized LDL on the expression of hsp60 using the monocytic cell lines U937 and HL60 as models. The expression of hsp60 was determined by using monoclonal antibodies to hsp60 in FACScan, Western blot, and a sandwich ELISA. The results show that hsp60 is induced in both cell types after 2 h exposure to oxidized LDL, with a maximal effect at 20 micrograms/ml for U937 cells and 5 micrograms/ml for HL60 cells. A close to 3-fold increase in the expression of hsp60 was seen after culturing oxidized LDL (20 micrograms/ml) treated U937 cells for a period of 24 h. Interleukin 1-beta had similar effects on hsp60 expression to oxidized LDL. The results indicate that expression of hsp60 by monocytes in the vascular wall may be enhanced by oxidized LDL. It is thus possible that the chronic inflammatory process characterizing atherosclerosis is perpetuated by autoreactive T cells, which recognize hsp60 expressed by monocytes, induced by oxidized LDL.

Arteriosclerosis↗
PubMed1996

ADHD, DAMP and other neurodevelopmental/psychiatric disorders in 6-year-old children: epidemiology and co-morbidity.

A total population of 589 6-year-old children were screened for neurodevelopmental/neuropsychiatric disorders by questionnaires to parents and preschool teachers, and by examination of motor abilities at the Child Health Center. Fifty screen-positive and fifty screen-negative children were assigned for complete neuropsychiatric assessment comprising a detailed history, psychiatric and neurodevelopmental assessment, neuropsychological examination and speech/language evaluation. Comprehensive diagnoses were made on the basis of all the available information. In the total population, 63 children (10.7%) with disorders were identified, 10 of whom had a diagnosis established before the study. The prevalence rates for deficits in attention, motor control and perception (DAMP) were 5.3 to 6.9%, for attention deficit hyperactivity disorder (ADHD) they were 2.4 to 4.0% and for mental retardation, 2.5%. Co-morbidity was established for ADHD on the one hand and DAMP, mental retardation and Tourette syndrome on the other. The findings suggest the need for a school entrant screening examination for the types of problems examined in this study.

Attention Deficit Disorder with Hyperactivity↗
PubMed1996

Long term treatment with betaine in methylenetetrahydrofolate reductase deficiency.

A girl aged 7.5 years with deficiency of 5,10-methylenetetrahydrofolate reductase was treated from early infancy with betaine, 3-6 g daily. She has slight microcephaly, moderate developmental delay, and impaired vision but there have been no obvious signs of folate deficiency. From 4 years of age, she developed an unexplained extreme increase in appetite and weight. Recent magnetic resonance imaging of her brain was normal. The plasma methionine levels have been normal but in the lower range, and the total plasma homocysteine concentrations have been moderately increased (54 to 85 mumol/l) without obvious correlation with the different betaine doses given. Folic acid has sometimes been added.

Appetite↗