Biomedical subjects

D Holst

Publications and source records attributed to D Holst.

At least 55 records · Page 3Linked to original sources

PubMed1993

[N2O-supplemented intravenous anesthesia versus inhalation anesthesia. A comparative study of the sympathoadrenergic reaction and postoperative vigilance].

The aim of the present study was a comparison of the intraoperative sympathoadrenergic response and the postoperative vigilance of a propofol/alfentanil anaesthesia to a conventional isoflurane anaesthesia. 25 patients were admitted to the study undergoing septorhino surgery. Patients with continuous intravenous anaesthesia with propofol/alfentanil combined with nitrous oxide showed better haemodynamic conditions without an increase of blood pressure and catecholamines under laryngoscopy, intubation and surgical stimulation. In contrast to that the patients with isoflurane anesthesia showed a significant increase in haemodynamic parameters and capillary bloodflow. The measured plasma adrenalin levels showed wide intraindividual fluctuation but no significant difference between the groups. The suppression of plasma noradrenaline was more pronounced under intravenous anaesthesia. Recovery was significantly faster and vigilance significantly better in the patients undergoing intravenous anaesthesia. After 30 min patients with i.v. anaesthesia fulfilled all the conditions to be transferred to the regular ward; the other group needed more than one hour. It can be concluded that continuous i.v. anaesthesia with propofol/alfentanil is superior in suppressing the stress response to invasive stimuli and provides faster recovery and better postoperative analgesia.

Adult↗

PubMed1993

Use of fluoride tablets in childhood: a 10-year prospective study.

Regular and persistent use of fluoride tablets throughout childhood is part of the national population-based preventive strategy and of the individual risk strategy of the Public Dental Health Service in Norway. The purpose of this study was to describe intraindividual stability in use of fluoride tablets in childhood and to analyze change in stability with respect to previous caries risk. Data stemmed from a 10-year prospective study of 231 Norwegian children. Intraindividual stability was described as individual profiles, showing that individual use of fluoride tablets varied substantially over the 10-year period. The significance of previous caries risk for change in use of fluoride tablets was analyzed by logistic regression analysis. The probability of increase in use of fluoride tablets increased significantly with previous caries activity. The results are discussed in light of population strategy and individual risk strategy in the Public Dental Health Service in Norway. Intraindividual variation in use of fluoride tablets over time may reflect the limited individual impact of preventive measures in pursuance of the population strategy. On the other hand, increase in use subsequent to a period of high caries risk indicates that intraindividual change in use of fluoride tablets may be initiated by individual risk strategy.

Child↗

PubMed1993

[Postmortem high-resolution computed tomography of the lung. Radiologic-morphologic correlations].

To establish precise correlations between high-resolution computed tomography (CT) and normal pulmonary anatomy and pulmonary pathology, 49 lungs affected by different diseases were analysed. Post-mortem high-resolution CT scans were compared with the corresponding macroscopic and microscopic pathological findings. For scanning, lungs were inflated and fixed, which avoided any decrease in the structural resolution of pulmonary parenchyma and allowed a topographically exact correlation between CT appearances and morphological changes. After demonstration of the structural details relevant for CT in normal pulmonary parenchyma, an attempt is made to establish the morphological basis of the following CT phenomena: thickening of interlobular septae, increase in pulmonary translucency, consolidation of the non-nodular alveolar and of the nodular type, and changes in the pleural region. Although CT findings in pulmonary lesions are mainly non-specific, knowledge of the corresponding morphological basis is helpful in diagnostic evaluation.

Animals↗

PubMed1992

Extending recall intervals--effect on resource consumption and dental health.

The dental health of children has improved in recent years. This has stimulated more flexible planning and implementation of public dental care programs. The aim of the study was to compare time required for dental care and changes in dental health over a 2-yr period for patients examined and treated every 12 months and patients examined and treated every 24 months. The material comprised 185 children aged 3, 16 and 18 yr. Children with high caries prevalence were not included in the material. Time used for examination and treatment and dental health parameters were recorded. The data were analyzed using multiple linear regression analysis. Mean time used for examinations and mean total time used by the dental health service over the 2-yr period were significantly less for patients examined every 24 months than for patients examined every 12 months, while the treatment times did not differ between the groups. The longer recall interval was associated with greater DMFS increment but this was not statistically significant. The study indicates that the dental health service in Norway could save resources, i.e. increase the productivity in the short term by extending the intervals between examinations.

Adolescent↗

PubMed1992

Policy and research in oral health care.

The purpose of the paper is to highlight the interrelationship between social and health policy, and health services research. The principles and concepts in social and health policy in the Scandinavian welfare states are described with reference to oral health care. The concept of policy analysis is defined and distinctions are made between "analysis of policy", and "analysis for policy". The policy perspective is discussed with the focus on the planning--budgeting--implementation--evaluation cycle and related to the WHO Strategy for Health for All. Finally, the implications for oral health services research in Scandinavia are emphasized.

Adolescent↗

PubMed1992

Health services research in oral health care: an empirical example.

Health services research is mainly applied research which can contribute to the production of knowledge necessary to appropriate decisions in health care. As an example, a study of the occurrence of tooth extractions is presented. Two hypotheses were tested: a negative relationship between provider density and consumer income, and the probability of tooth extractions and the number of teeth extracted, conditional upon extraction. A nationwide sample of 1286 non-institutionalized Norwegians 20 yr and above was interviewed by a public survey institute. The data were analyzed using a two-part model including logistic regression and multiple regression analysis. One third of the sample had had a tooth extraction during the last 5 yr. The majority of the sample had few teeth extracted at the time of extraction. The probability of tooth extraction was related to provider density and not to consumer income. The number of teeth extracted was related neither to provider density nor to income. Tooth extraction was not related to age. Some policy implications are discussed.

Adult↗

PubMed1992

Supply decisions among dentists working within a fixed-fee system of dental care provision.

In Norway fees for dental treatment did not increase at the same rate as prices for other goods and services during the 1980s. The aim of this study was to examine how this decrease in fees in real terms has influenced dentists' work decisions with respect to supply of services. Data on characteristics of the dentist and the dental practice were collected for 1979, 1984, and 1986. The dependent variable was supply of dental services, measured as the number of patient care hours worked per annum. The hourly fee for dental care was equivalent to dentists hourly wage rate. Supply increased as fees decreased. This could be explained either as a response of the patient or the dentist to reduced fees. Although the data did not give conclusive evidence as to which effect was most important, the authors have put forward the view that the main effect was dentists' response to reduced fees. The main argument put in favor of this view is that dentists have an overall knowledge of the effect of a change in fees on their income. The impact of a change in fees is much greater on the provider who supplies the services to many individuals over a long period of time, than on an individual consumer who buys the services once or twice a year. It was concluded that, in the short run, a fixed-fee schedule may not be very effective in limiting costs for dental care.

Adult↗

PubMed1992

[Spinal endoscopy in the detection of problems caused by continuous spinal anesthesia].

Continuous spinal anaesthesia has a number of advantages, but there are a number of drawbacks as well: difficulties in threading the catheter, distribution of the local anaesthetics and the development of cauda equina syndrome. Spinaloscopy was done to visualize the fate of catheters during and after their insertion, as well as the distribution of local anaesthetics injected through these fine-bore catheters. METHOD. The studies were conducted in preserved and fresh cadavers donated to the Anatomic Institute for Medical Studies. The spinal column from T12 to S1, together with the back musculature (in order to preserve the normal curvature of the spine) were removed from the cadaver. Spinaloscopy was done with a 4 mm endoscope with a 0 degree optic (Storz, Tutlingen, FRG). All observations were made from the lumbosacral region of the dissected preparation. In this fashion, it was possible to observe the insertion of the spinal needle used to introduce the catheter into the subdural space. The distribution of local anaesthetics injected through a 22-gauge spinal needle or a 28-gauge catheter was shown by injecting 0.5% hyperbaric bupivacaine colored with a small amount of 1% methylene blue. Pictures were taken 15, 30 and 45 s after beginning the injection. RESULTS. Difficulty in threading the catheter: our observations indicate that the difficulty in inserting microbore catheters is most likely due to inserting the needle too far. It is impossible for the catheter to bend and be inserted into the subarachnoid space. In many cases the catheter encountered the anterior wall of the spinal canal and would slide along various structures. Distribution of the drug: the injection is better dispersed with a 22-gauge needle and it completely fills the subarachnoid space. The local anaesthetics injected through the 28-gauge nylon catheter (Kendall Healthcare, Mansfield, Mass.) are distributed in the dependent portions of the spinal canal. If high doses and a high concentration are injected, the distribution pattern may result in an overconcentration in some parts of the subarachnoid space. Possibility of trauma: the catheter stretches around the roots, the potential for trauma is that untoward stress may be applied to the root, either during full insertion of the catheter or during its withdrawal. CONCLUSION. Spinaloscopy was done in a non-fixated anatomic spinal column preparation with a 4 mm 0 degree endoscope (Storz, Tuttlingen, FRG). Based on our observations, we conclude: The catheter should only be inserted 2 cm into the subarachnoid space. This may decrease the risk of malpositioning. After the tip of the catheter has reached the subarachnoid space, the stylet should be with drawn 2 or 3 cm to minimize the risk of nerve injury and/or bleeding.

Anesthesia, Spinal↗

PubMed1992

[Legionnaires' disease in intensive care patients. Results of plain film thoracic radiography].

We reviewed the chest radiographs and clinical data of 30 patients in an intensive care unit with legionellosis diagnosed by significant serological findings (n = 18), microscopic demonstration of the organism in the transtracheal aspirate (n = 5) or both (n = 7) and investigated the correlation between the identification of Legionella and signs of pulmonary infection. In 13 patients legionnaires' disease was diagnosed with a high degree of confidence. Typical radiographic findings included distal air space disease, which initially appeared to be unilateral, progressing towards bilateral infiltrates. Patchy infiltration at the onset of disease was followed by consolidation. Small pleural effusions were common, while no abscess formation was observed. Characteristically, infiltration persisted for weeks even with clinical convalescence. These radiological findings correspond well with observations in otherwise healthy patients with legionnaire's disease. In 10 patients the etiology of pulmonary infiltrates could not be identified. Seven patients did not develop radiological or clinical signs of pneumonia; therefore, the serological/microscopic detection of Legionella was not interpreted as legionnaires' disease. According to the results of our investigation the diagnosis of legionnaires' disease requires radiological findings in addition to laboratory data.

Adolescent↗

PubMed1992

[Subdural intra-arachnoid spread of local anesthetics. A complication of spinal anesthesia].

Accidental subdural injections and catheterisations are a complication of epidural and spinal anaesthesia. The incidence of subdural spread in myelographies is estimated to be over 10% by the spinal technique. With spinaloscopy in an anatomic human model, we analysed the puncture process and the influence of different needle types on the incidence of subdural injection. We compared 22-gauge Sprotte, Quincke, and 18-gauge Tuohy needles in median and paramedian approaches with various bevel orientations. METHOD. The studies were performed in a preserved and recently expired cadaver donated to the Institut für Anatomie, Westfälische Wilhelms-Universität, Münster. The spinal column from T12 to S1, together with the back musculature (in order to preserve the normal curvature of the spine), were removed from the cadaver. Spinaloscopy was performed with a 4-mm endoscope with a 0 degree optic (Storz, Tuttlingen, Germany). All observations were made in the lumbosacral region of the dissected preparation. The endoscope was inserted from the caudal end of the spinal canal and, depending on the observations being made, the spinal canal was filled with air or artificial cerebrospinal fluid (CSF). To obtain information on the distribution of local anaesthetics injected into the subarachnoid space, 0.5% bupivacaine was coloured with a small amount of 1% methylene blue. The distribution of the coloured anaesthetic was clearly visible during and after injection. RESULTS. Needle insertion: Multiple observations were made using median or paramedian advancement of the needle into the spinal canal. With all needles, including the pencil-point, we saw an unexpected inward movement of the dura to the epidural space before penetration. This dural movement was independent of the direction of the dural fibres in the lumbar area. Distribution of local anaesthetics: Our observations indicate that difficulty with injecting drugs occurred when needle insertion was stopped too close to the dura, especially with the Sprotte needle. After manually registered penetration of the dura, the lateral opening of the needle only partially penetrates the dura. This allows CSF to appear in the needle hub, and injection into the vertical subdural space is possible. In all cases with the Sprotte needle, we could reproduce deposition of methylene-blue-coloured local anaesthetics into the subdural space. With the Quincke and Thuohy needles, it was not possible to deposit local anaesthetics into the subdural space in this model. CONCLUSION. Spinaloscopy was done in a non-fixated anatomic preparation of a spinal column with a 4-mm, 0 degree endoscope. From these observations we conclude that both manually registered penetration of the dural and the appearance of CSF in the needle hub can mimic correct needle position. Especially with the lateral opening of the Sprotte needle, deposition of local anaesthetics in the subdural space is possible.

Anesthesia, Spinal↗

PubMed1992

[The reuse of 29-gauge spinal needles following combined spinal-epidural anesthesia].

The technique of combined spinal epidural anaesthesia (CSE) combines the versatility of spinal with the variability of epidural anaesthesia. Spinal application of the local anaesthetic achieves a fast response, reliable sensorial and motor block at a low dose with little toxicity. The epidural catheter allows for the duration of surgical anaesthesia to be extended and provides analgesia for the postoperative period. As the incidence of post dural puncture headache (PDPH) is inversely related to the size of the spinal needle, PDPH rarely or never occurs when 29 gauge needles are used. In 1775 parturients receiving spinal anaesthesia for caesarean section, Dittmann et al. [4] reported an incidence of PDPH of 1.37% with 29 gauge needles. The 29 gauge needle produced by Becton-Dickinson is the one now most frequently used for this technique. It is recommended that these needles be reused after resterilization. The objective of this study was to examine how clean 29 gauge spinal needles really are after resterilization. MATERIALS AND METHODS. Fifteen needles (29 gauge; Becton-Dickinson) were routinely used for combined spinal epidural anaesthesia. After identification of the epidural space at the L3-4 spinal segment with the 18 gauge Tuohy needle, the 29 gauge needle was advanced through the Tuohy needle. Immediately after use the needles were cleaned, rinsed with 20 ml distilled water, dried with pressurized air and subsequently resterilized in gas. Preparation of the used needles was in accordance with the manufacturer's recommendations ("wash, rinse, dry, sterilize before initial and each subsequent use") and with generally accepted principles [6]. Two needles were additionally cleaned in an ultrasonic bath for 15 min. The needles were examined using a scanning electron microscope. After this analyses, eight needles were sterilized again and then taken for hygienic examination. They were incubated with trypticase soy broth and checked for bacterial growth. RESULTS. Scanning electron microscopy (ScEM) showed organic impurities on all needles. These impurities were equally distributed among all needles. Even the two cleaned in the ultrasonic bath were not free of organic particles. However, no material defects or damage could be seen. Hygienic evaluation proved sterility as no bacterial growth could be detected. CONCLUSION. Owing to the possibility of medico-legal consequences, which sometimes occur a long time after anaesthesia has been given, we think it is unwise to reuse such needles. We hope that disposable and cheap 29 gauge needles will soon become available.

Anesthesia, Epidural↗

PubMed1991

Relationship between number of teeth and periodontal pockets.

The relationship between number of teeth and the prevalence of periodontal disease is an important factor to consider when planning future needs for periodontal care. This is of particular relevance today, when the level of tooth loss is steadily reducing. The aim of the present study was to examine this relationship. Three dependent variables associated with periodontal disease were included in the analysis: 1. The probability of having pockets 4 mm or more. 2. The mean pocket depth for individuals with pockets 4 mm or more. 3. The number of pockets for individuals with pockets 4 mm or more. Age was included in the analysis as a control variable. The study population comprised 2219 individuals in the county of Trøndelag, Norway. The data were analyzed using logistic regression and multiple regression analysis. The probability of having pockets 4 mm or more increased with increasing number of teeth. The average pocket depth decreased with increasing number of teeth. There was no relationship between number of pockets and number of teeth. The increase in the probability of having pockets with a marginal increase in number of teeth was greatest for those aged 53 years and above. It is concluded that this group of people are likely to have the greatest need for periodontal care.

Adult↗

PubMed1991

Recent changes in health related dental behaviors in Norway.

There has been a substantial decrease in the prevalence of caries in younger age groups in the western world during the last 15 years. A corresponding increase has been reported regarding use of preventive remedies. Since prevention and control of dental disease is highly dependent upon personal behavior, investigations of dental health behaviors within subgroups of the population are important for future preventive strategies. Occurrence and changes in individual dental health behaviors in Norway were studied through four sets of cross-sectional data collected in 1981, 1983, 1985, and 1987. Personal interviews performed by trained interviewers were held with probability samples, each of about 1400 persons, covering the Norwegian population aged 15 and above. During the 6-yr period the proportion of individuals who brushed their teeth and used fluoride dentifrice every day increased. The number of people who used toothpicks or dental floss every day also increased from 1981 to 1985. A marked decrease was, however, observed in use of interdental remedies from 1985 to 1987. Daily use of dental floss was reduced by 10 percent points. Logistic regression showed that the reduction in the probability of using interdental aids was most pronounced among those with few teeth. Lower importance attached to dental health education, at all levels, combined with difficult economic times since 1987, might account for the decrease in daily use of interdental aids in Norway.

Adolescent↗

PubMed1991

Legislation and reality in public dental services in Norway: dental health services for children and adolescents in 1975 and 1985.

The act relating to dental health service implied a reorganization of the public dental health services in Norway in 1984. The act intended to extend the target group of public dental health services and to achieve social and geographic equality in the distribution of dental health services among children and adolescents. The purpose of this study was to assess the degree to which these intentions had been fulfilled. The material comprised two nationwide, stratified, and randomly selected samples of 3,356 and 2,970 children and adolescents in the age group zero to 18 years. Data were collected in 1975 and 1985. Both the theoretical and the empirical models applied structural and individual resources to explain individual variation in use of dental health services. The results showed that the proportion of zero- to 18-year-olds who had seen a dentist within the past 12 months was higher in 1985 than in 1975 (81.7% and 75.8%, respectively). Bivariate and trivariate table analyses showed that statistically significant associations between structural resources and use of dental health services disappeared when controlling for a third variable. Use of dental health services among children and adolescents in Norway was not systemically influenced by the same factors, as was the use of dental health services in the adult population. Thus, the Public Dental Health Service in Norway seems to have had the capability of compensating for most of the discriminating effects that individual and structural factors may have on the use of dental health services both before and after the reorganization of the public dental health service.

Adolescent↗

PubMed1991

Is there a long-term caries-preventive effect of sugar restrictions during World War II?

Wartime decrease in caries prevalence among children explained by restrictions in sugar availability and consumption is widely documented. The aim of the present investigation was to study possible long-term effects of this regimen on dental caries. Norwegian age cohorts who were 7 years old during World War II were reexamined in 1983. On the basis of DMF recordings of their first permanent molars, a long-lasting beneficial effect of the wartime caries decrease could not be demonstrated.

Adult↗

PubMed1990

Supplier inducement. Its effect on dental services in Norway.

In many western countries, supply of dental services exceeds demand, mainly because of the marked reduction in the prevalence of dental diseases during the last 10-15 years. An important issue is whether dentists can counteract this fall in demand by stimulating increased demand and/or utilization for their services. Some evidence that this may be the case was found in the present study, in Norway. The results indicate that demand and utilization for dental services are influenced by supplier inducement.

Cluster Analysis↗

PubMed1990

Dental health behaviors and periodontal disease indicators in Danish youths. A 10-year epidemiological follow-up.

The purpose of the present study was to analyse the epidemiologic relationship between dental health behaviors and periodontal disease. Indicators of periodontal disease in terms of bleeding and calculus were measured dichotomously (absence/presence). Periodontal pockets were as follows: normal pockets (0-3 mm), shallow pockets (4-5 mm), and deep pockets (6+ mm). The indicators were measured on 4 surfaces on 6 index teeth (16, 11, 26, 36, 31, 46) in 1984-85. The highest value for each tooth of bleeding (0/1), calculus (0/1) and pockets (0/1/2) was used for calculation of the bleeding index, the calculus index and the pocket index. The participation rate in 1984-85 was 86%, and the study population involved 368 males and 388 females. Information concerning dental health behavior was obtained both in childhood (1974) when the individuals were 9-10 years of age, and in adulthood (1984-85) when the individuals were 20-21 years of age. Information concerning dental health behaviors in adulthood, i.e., regularity of dental visits, frequency of tooth brushing, and regular use of interdental aids, was obtained through a self-administered questionnaire (1984-85). Dental health behaviors in childhood (1974) was operationalized as level of plaque, gingivitis, and dmfs. The results showed that dental health behaviors in childhood and in adulthood were together responsible for 9.4-13.8% of the variance in level of periodontal disease indicators. Determinants of early dental health behaviors in terms of plaque and dmfs at age 9-10 years were significant predictors in pocket index at age 20-21.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

Patterns of sugar consumption in early childhood.

Patterns of sugar consumption were studied prospectively in a birth cohort of 231 Norwegian children. Information on dietary habits and sugar consumption was collected at the children's ages of 10 months, 18 months, and 2 yr. The results of the factor analyses showed that the children's sugar consumption constituted a separate dimension of dietary habits. Patterns of sugar consumption seemed to be established already during infancy. The children's sugar consumption increased from infancy to the age of 2 yr, and the patterns of sugar consumption also seemed to be maintained throughout the first years of early childhood. Sugar consumption was also analyzed multivariately using indicators of social background and family size as explanatory variables, but the explanatory power of these variables was rather poor and decreasing with age.

Analysis of Variance↗