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Biomedical subjects

E Allander

Publications and source records attributed to E Allander.

At least 19 recordsLinked to original sources
PubMed1992

Evidence for efficacy of drugs affecting bone metabolism in preventing hip fracture.

OBJECTIVE: To examine the effects of taking drugs affecting bone metabolism on the risk of hip fracture in women aged over 50 years. DESIGN: Retrospective, population based, case-control study by questionnaire. SETTING: 14 centres in six countries in southern Europe. SUBJECTS: 2086 women with hip fracture and 3532 control women matched for age. MAIN OUTCOME MEASURES: Number of drugs affecting bone metabolism taken and length taken for. RESULTS: Women taking drugs affecting bone metabolism had a significantly decreased risk of hip fracture. After adjustment for differences in other risk factors, the relative risk of hip fractures was 0.55 (95% confidence interval 0.31 to 0.85) in women taking oestrogens, 0.75 (0.60 to 0.94) in those taking calcium, and 0.69 (0.51 to 0.92) in those taking calcitonin. The fall in risk was not significant for anabolic steroids (0.6 (0.29 to 1.22)). Neither vitamin D nor fluorides were associated with a significant decrease in the risk of hip fracture. The effect on hip fracture risk increased significantly with increasing duration of exposure (risk ratio 0.8 (0.61 to 1.05) for less than median exposure v 0.66 (0.5 to 0.88) for greater than median exposure). Drugs were equally effective in older and younger women, with the exception of oestrogen. CONCLUSIONS: Oestrogen, calcium, and calcitonins significantly decrease the risk of hip fracture. Short term intervention late in the natural course of osteoporosis may have significant effects on the incidence of hip fracture.

Aged↗
PubMed1992

Risk of cancer in patients with dermatomyositis or polymyositis. A population-based study.

BACKGROUND: An association between polymyositis and cancer was first proposed in 1916, but the existence of the association has been disputed. An association between dermatomyositis and cancer is better accepted, but its magnitude is not known. METHODS: We undertook a study to provide accurate estimates of the risk of cancer in patients with dermatomyositis or polymyositis. We studied the incidence of cancer and the rate of mortality from cancer in a population-based cohort of 788 patients with dermatomyositis or polymyositis in Sweden from 1963 through 1983. The results were compared with those for the general population. RESULTS: Among the 396 patients with polymyositis, 42 cancers were diagnosed at the same time or after polymyositis was diagnosed in 37 patients (9 percent). The relative risk of cancer was 1.8 (95 percent confidence interval, 1.1 to 2.7) in the male patients and 1.7 (95 percent confidence interval, 1.0 to 2.5) in the female patients. Eighty-four males and 85 females died, and in 24 of these cases (14 percent) cancer was the principal cause of death. The mortality ratio (the rate of mortality from cancer in these patients as compared with that in the general population) was 0.90 (95 percent confidence interval, 0.6 to 1.4). Among the 392 patients with dermatomyositis, 61 cancers were diagnosed at the same time or after dermatomyositis was diagnosed in 59 patients (15 percent). The relative risk of cancer was 2.4 (95 percent confidence interval, 1.6 to 3.6) in the male patients and 3.4 (95 percent confidence interval, 2.4 to 4.7) in the female patients. Fifty-seven males and 110 females died, and in 67 of these cases (40 percent) cancer was the principal cause of death (mortality ratio, 3.8; 95 percent confidence interval, 2.9 to 4.8). CONCLUSIONS: The risk of cancer is increased in patients with polymyositis or dermatomyositis. In patients with dermatomyositis there is also a higher rate of mortality from cancer.

Confidence Intervals↗
PubMed1992

The apparent incidence of hip fracture in Europe: a study of national register sources.

The objective of this study was to examine the apparent incidence of hip fracture from discharge rates in European countries. A request was sent to the Ministries of Health in all European countries, asking for the number of hip fracture patients by age and sex, between the years 1983 and 1985. Seventeen countries responded. As expected, hip fracture was most frequently found amongst the elderly, particularly women. The incidence of hip fracture rose exponentially with age in both sexes. It was higher in women than men and there was a three-fold range between countries in the female to male sex ratio. There was an eleven-fold range in apparent incidence amongst women and a seven-fold range amongst men between the various countries. The highest incidence was found in the northern part of Europe and the lowest in the Mediterranean area. There was a significant positive correlation between the age-standardized incidence rates reported in men from each country and that in women. There was a larger difference in incidence between countries than between sexes, which suggests important genetic or environmental factors in the causation of hip fracture. The extent to which this reflects imperfect capture of data is uncertain but will be important to determine in order to identify reasons for differences and to enable confident projections of the future magnitude of this disorder.

Adult↗
PubMed1991

The Mediterranean Osteoporosis (MEDOS) Study questionnaire.

The Mediterranean osteoporosis study (MEDOS) questionnaire was designed by a group of specialists in bone disease from Southern Europe (MAB Group) and the WHO Collaborating Centre for the Epidemiology of Rheumatic Conditions, assisted by experts from WHO in Geneva and from the European Foundation for Osteoporosis and Bone Disease. The purpose of the questionnaire was to identify putative risk factors for hip fracture in a retrospective case control study applied during a prospective study of the incidence of hip fracture in 14 regions of Europe.

Aged↗
PubMed1991

Auranofin treatment in early rheumatoid arthritis may postpone early retirement. Results from a 2-year double blind trial.

The effect of early vs delayed initiation of slow acting antirheumatic drug (SAARD) therapy on the ability to maintain regular work, was evaluated in 83 patients with early rheumatoid arthritis (RA) in a placebo controlled, double blind 24-month study. The estimated probability to maintain working ability was higher in the early treatment group, especially during the second study year. Predicting factors were age, type of work, degree of disability and number of swollen joints. Despite the difficulties in interpreting the results due to the complexity of the underlying socioeconomical and labor market situation, the study supports early treatment in RA with regard to the maintenance of normal life.

Arthritis, Rheumatoid↗
PubMed1990

Disease-modifying anti-rheumatic drug therapy. An expensive therapy despite inexpensive drugs.

In a study of the costs for drug therapy, 81 patients with rheumatoid arthritis taking parenteral gold, penicillamine or chloroquine were included. The patients were assessed for costs, directly and indirectly caused by the therapy, during a 12-week period. The three therapy groups were comparable in terms of number of patients, sex, age and duration of disease. There were substantial differences in costs for therapy between the three disease-modifying anti-rheumatic drugs. Treatment with parenteral gold gave the highest cost, 2.2 times that of chloroquine and 1.4 times the cost of penicillamine. The cost for the antirheumatic drug constituted a minor part of the total cost (4.4-15.4%). The need for patient visits for treatment and safety controls was a major factor in the overall cost.

Adult↗
PubMed1976

Do you die from rheumatism? The five-year mortality in a middle-aged population sample with respect to reported joint symptoms.

With special reference to reported joint symptoms, the five-year mortality was studied of a population sample of 3394 persons, 56-60 years old in 1965. An age- and sex-matched comparison was made between the mortality of the total population of the same age-group, and the sample investigated. A significant excess mortality was found for males reporting previous hospital admission for "rheumatoid arthritis". In this group, however, only 28% really had rheumatoid arthritis according to generally used criteria. The other diseases were mainly previous rheumatic fever and degenerative joint disease. It is concluded that males are harder hit by degenerative joint disease than females. The sample investigated had a lower mortality than the population from which it was sampled. The comparability of a fixed sample and a mean population found in official statistics is discussed. The non-response group was estimated to have a considerable excess mortality.

Arthritis, Rheumatoid↗
PubMed1976

The layman's medical vocabulary. A study of illness definitions and perceived need for medical care.

A knowledge of the layman's illness concepts is of value both for diagnosis and therapy in the practical application of the medical services. It is also valuable for the estimation of morbidity and of the need for medical assistance. The present article describes an investigation intended to throw light on the import of ten different illness concepts and on the implications these may have for the utilization of the medical services. The study is based on interviews with 100 middle-aged women. Most of the respondents considered that an illness may have many causes--a multifactorial aetiology. Great differences between the illnesses were noted with respect to the opinions as to whether examination by a doctor was necessary for diagnosis. The interpretations as to whether an illness needed treatment--medical attention, medicine, hospital care--seemed however to be more closely related to its duration than to its nature. A long duration was regarded by a surprisingly large number as a sign that hospitalization was required--even in the case of a common cold! Only 8% considered obesity 'serious'. As regards the choice of illness alternatives, earlier experience of illness influenced this only in the case of 'shortness of breath' and 'nervous symptoms'. Social class was not found to affect the type of answer.

Adult↗
PubMed1975

Varicose ulcers.

The results of a combined dermatological and surgical treatment of varicose ulcers was studied in 100 patients. This chronic disease, often persisting for decades, was halted in 90 percent of leg operated upon. Even when the general outcome of the treatment was favourable, it was found that, for 5 out of the 12 ulcers which were the same or larger in size at follow-up than before operation, the patient assessed the result as good or even excellent. This finding deserves further study. It indicates that patients and physicians sometimes use different standards by which to measure therapeutic success.

Aged↗
PubMed1975

Screening--an efficient tool in outpatient endocrine care. Studies of the diagnostic process.

A screening procedure based on physical examination alone was used in the outpatient unit of a department of endocrinology and metabolism. The effectiveness, efficiency, and volume of this diagnostic process were evaluated by a study of the case records and a mail questionnaire. In 1968, 296 subjects were examined by this screening procedure; 103 of these could immediately be referred back. The percentage of confident endocrine diagnoses increased from 31 to 39%. The corresponding figure for the group of subjects immediately referred back was 100%. A considerable change in the diagnoses was also recorded. The use of the screening procedure saved approximately ately +30,000. It is concluded that diagnostic screening by an experienced endocrinologist is inexpensive, efficient and safe. The use of the screening procedure made it possible to offer highly specialized medical treatment to more people.

Adolescent↗
PubMed1975

The diagnostic process in outpatient endocrine care with special reference to screening. Further study of diagnostic patterns, their changes, total and diagnosis-specific resource consumption.

A screening procedure based on physical examination alone was used in the outpatient unit of a department of endocrinology and metabolism. The volume effectiveness and efficiency of this diagnostic process was evaluated by studying the case-records and by mail questionnaire. The case-records of 296 patients admitted to the clinic during 1968 were analyzed. It was found that 103 of these patients were immediately referred back after a brief physical examination only. The pattern of diagnosis, its changes during the screening procedure, and the outpatient-investigation were also studied. 50% of the patients subjected to outpatient-investigation ended up with a new diagnosis. It was also possible to construct a diagnosis-specific cost estimate for outpatient-investigation, starting from a non-confident and arriving at a confident diagnosis. The distribution of these costs was very skew. The cost for the physician performing the screening was estimated to represent only 2.6% of the costs saved by the introduction of the screening.

Adolescent↗
PubMed1975

Rheumatic fever and Yersinia arthritis. Criteria and diagnostic problems in a changing disease pattern.

A study of rheumatic fever (RF) in Finland and Sweden was carried out by examining (a) the patients with RF in two hospitals in Helsinki, Finland during the years 1969-72, (b) the case reports of RF patients in Uppsals hospital region (UHR) in Sweden during the years 1968-69. In Helsinki there were 22 and 2n UHR 16 patients with an acceptably certain diagnosis of RF. Of the five "major manifestations" according to Jones' revised criteria (Circulation, 32: 664, 1965), carditis and polyarthritis were the most valuable diagnostic criteria, whereas only 8 cases of the whole material had erythema marginatum. The two remaining criteria, chorea and subcutaneous nodules, have lost their diagnostic value, since they are extremely rare nowadays. The diagnosis of RF was substantially influenced by arthritis associated with Yersinia enterocolitica infection. Some of the patients with YA met completely the Jones revised criteria for the diagnosis of RF. The symptomatology of Yersinia arthritis (YA) and that of RF are similar in some cases it is impossible to separate then even on the basis of serological tests. Diagnostic criteria should therefore be viewed against the geographical distribution of the disease. In addition to the required Jones' criteria, we concluded that at least in Sweden and Finland, in order to be categorized under RF, a patient must demonstrate clinical and serological evidence of acute streptococcal infection and, furthermore, Yersinia infection must be excluded.

Adolescent↗
PubMed1975

Need, demand, and supply of medical care in a population sample of rheumatoid arthritis.

Estimates of medical need in persons with rheumatoid arthritis (RA) are rarely based on data from population surveys. In a population survey of RA in Stockholm City, 293 RA sufferers were identified in four random samples of four age-groups in the adult population, age-range 31-74 years. The influence of age, sex, and severity of disease on the number of pervious hospital admissions was slight, indicating that diagnosis, rather than rehabilitation, is the impetus to hospital admission. Hospital patient inventories might give quite misleading information as to need. Need for hospital admission, out-atient care, reconstructive surgery, ADL-devices, physical therapy, and rehousing were all considered. 17% of the RA group accounted for 48% of the need. Steinbrocker functional classes I and II contributed to 61% of individuals in need of hospital care greatly exceeded those previously having enjoyed such care and possible availabel resources. Estimates of need for outpatient care for joint disease exceeded provided treatment by only 1.7 times. It is concluded that the psychological distance between doctor's decision to choose inpatient or outpatient treatment in the case of RA is generally fairly short. Figures are given for estimates of need based on a population of 100 000 with known age and sex distribution and prevalence of disease.

Activities of Daily Living↗