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Biomedical subjects

K Boman

Publications and source records attributed to K Boman.

At least 37 records · Page 2Linked to original sources
PubMed1999

[Cost-effectiveness analysis of cardiovascular disease prevention: a graded list as aid to the rational distribution of resources].

In a study designed to compare the cost-effectiveness of three cardiovascular disease prevention programmes, subject to a defined budget, a population was subgrouped according to risk levels. Cost per year of life saved and annual budget expenditure were calculated for each subgroup. Budget expenditure was defined in terms of current direct costs. A ranked list was constructed, and the cut-off level of 'acceptable' cost-effectiveness elicited.

Adult↗
PubMed1999

Cost-effectiveness analysis with defined budget: how to distribute resources for the prevention of cardiovascular disease?

The aim of the study was to undertake cost-effectiveness calculations subject to a defined budget. The setting chosen was the prevention of cardiovascular disease (CVD) by means of three intervention programmes in a Swedish county council. The population in the county was divided into subgroups according to risk level. For each subgroup the cost per years of life saved was calculated, as well as the annual budget claims. The budget available was defined as present direct cost in the programmes. The calculations resulted in a programming solution showing the optimal distribution of resources between the programmes. Also a league table was constructed and the cut-off value for a 'acceptable' cost-effectiveness was shown. The conclusion that can be drawn is that a combination of internationally published intervention results and local data regarding epidemiology and resource improves the accuracy and usefulness of cost-effectiveness ratios. However, the model presented is a first attempt containing only three interventions: the planned next phase is to integrate more interventions in the model.

Adult↗
PubMed1999

Shifting the distribution of risk: results of a community intervention in a Swedish programme for the prevention of cardiovascular disease.

STUDY OBJECTIVE: To examine the impact of a systematic risk factor screening and counselling carried out by family physicians and family nurses within the larger framework of a community intervention programme for the prevention of cardiovascular disease (CVD). DESIGN: Quasi-experimental study comparing trends in an intervention area with those in a reference area. SETTING: A Northern Sweden municipality (5500 inhabitants) constituted the intervention area while the Northern Sweden region (510,000 inhabitants) served as the reference area. PARTICIPANTS: All 30, 40, 50, and 60 year old inhabitants were invited each year from 1985 to 1992. Among 2046 eligible 1893 participated (92.5%), which formed eight independent cross sections. One cross section, 1986, was re-surveyed forming a panel. MAIN RESULTS: In the cross sections, mean total cholesterol was reduced from 7.09 to 6.27 mmol/l for men (p < 0.001) and from 7.13 to 5.89 mmol/l for women (p < 0.001) and mean systolic blood pressure from 132.2 to 123.7 mm Hg for men (p < 0.05) and from 129.2 to 122.0 mm Hg for women (p < 0.001) during the eight years. Body mass index (BMI) increased from 25.6 to 26.2 for men (p < 0.05) and from 25.0 to 25.5 for women (NS). A corresponding reduction in cholesterol and blood pressure (for women) occurred in the panel, while BMI was unchanged. The risk for CVD, using the Framingham equation, was estimated to be reduced overall by 19% (p = 0.0021) when comparing early cross sections (1985/86) with the later cross sections (1990/91). CONCLUSIONS: It was concluded that a long term community based CVD prevention programme that combines population and individual strategies can substantially promote a health shift in CVD risk in a high risk rural population. The individual attention and evaluation provided by the health provider survey seem to accelerate, but not increase the amount of, risk reduction.

Adult↗
PubMed1999

Apoptosis, proliferation, and sex hormone receptors in superficial parts of human endometrium at the end of the secretory phase.

Apoptosis with one regulator, Bcl-2, and proliferation with the marker Ki-67 were studied in 75 endometrial biopsies representing superficial parts of endometrium from 35 regularly menstruating women premenstrually and menstrually. Hormonal withdrawal was studied in serum samples and potentiated in epithelium by the decreasing 17beta-estradiol and progesterone receptor scores 4 days premenstrually. The apoptotic index increased 2 days before the onset of menstruation and peaked on the second menstrual day. The high apoptotic index together with low proliferation in endometrial epithelium at the end of the menstrual cycle are similar to the involution process seen in other hormone-dependent organs. In stroma, the apoptotic index increased later, at the onset of menstruation, and the increase was lower than that in epithelium. The Ki-67 index increased during the last 3 days of the secretory phase, parallel with an increasing progesterone receptor score and decreasing Bcl-2 staining, and peaked at the onset of menstruation. The findings in stroma concur with high proliferation at the end of the menstrual cycle and high cell turnover during menstruation, suggesting the participation of stroma in the renewal process of endometrium.

Adult↗
PubMed1998

High plasminogen activator inhibitor and tissue plasminogen activator levels in plasma precede a first acute myocardial infarction in both men and women: evidence for the fibrinolytic system as an independent primary risk factor.

BACKGROUND: In patients with established ischemic heart disease, prospective cohort studies have indicated that plasminogen activator inhibitor (PAI-1), the inhibitor of the fibrinolytic system, may predict cardiovascular events. So far, there have been no primary prospective studies of PAI-1. METHODS AND RESULTS: The aim of the present study was to test whether plasma levels of PAI-1, tissue-type plasminogen activator (tPA), von Willebrand factor (vWF), and thrombomodulin (TM) could predict the occurrence of a first acute myocardial infarction (AMI) in a population with high prevalence of coronary heart disease by use of a prospective nested case-control design. Mass concentrations of PAI-1 and tPA were significantly higher for the 78 subjects who developed a first AMI compared with the 156 references matched for age, sex, and sampling time; for tPA, this increase was independent of smoking habits, body mass index, hypertension, diabetes, cholesterol, and apolipoprotein A-I. The ratio of quartile 4 to 1 for tPA was 5.9 for a patient to develop a first AMI. The association between tPA and AMI was seen in both men and women. Increased levels of vWF were associated with AMI in a univariate analysis. High levels of TM were associated with AMI in women but not in men. CONCLUSIONS: The plasma levels of PAI-1, tPA, and vWF are associated with subsequent development of a first AMI; for PAI-1 and tPA, this relation was found in both men and women. For tPA but not for PAI-1 and vWF, this association is independent of established risk factors.

Adult↗
PubMed1998

A study evaluating the efficacy and tolerability of tropisetron in combination with dexamethasone in the prevention of delayed platinum-induced nausea and emesis.

BACKGROUND: Chemotherapy-induced emesis is one of the most disturbing side effects of cancer therapy. Control of acute emesis has improved substantially during recent years, but control of delayed emesis and nausea remains a challenging problem. The role of 5-HT3 receptor antagonists in the treatment of delayed emesis is disputed. METHODS: Tropisetron, a highly specific 5-HT3 receptor antagonist, was compared (as an adjunct to dexamethasone) with placebo in a randomized, double blind, multicenter trial for the prevention of delayed emesis during platinum-containing chemotherapy. Three hundred chemotherapy-naive women with gynecologic malignancies were included. The cisplatin dose was in the range of 50-100 mg/m2. RESULTS: Acute emesis was prevented completely in 87% of patients and acute nausea in 77% of patients in the complete series. During the complete delayed period (Days 2-6), total control of emesis was achieved in 77% of the dexamethasone and tropisetron-treated patients and in 72% of the patients receiving dexamethasone and placebo (P = 0.2473). During the same period nausea was controlled completely in 42% of the dexamethasone and tropisetron group and in 41% of the dexamethasone and placebo group. On Day 3, complete protection from nausea was achieved in 65% of patients receiving tropisetron and in 51% of patients receiving placebo (P = 0.0304). Constipation occurred more frequently in the tropisetron group. CONCLUSIONS: Tropisetron added to dexamethasone improved control of delayed nausea on Day 3 compared with placebo. No significant differences were recorded regarding control of delayed emesis.

Adult↗
PubMed1998

Long-term results from a phase II study of single agent paclitaxel (Taxol) in previously platinum treated patients with advanced ovarian cancer: the Nordic experience.

BACKGROUND: Owing to the wide spread perception of a possible benefit from paclitaxel in the second-line situation the Nordic Gynecologic Oncology Group (NGOG) conducted two prospective phase II studies of paclitaxel single agent treatment (175 mg/m2, three-hour i.v. infusion with standard pre-medication every third week) in patients with relapsing or progressing epithelial ovarian cancer following platinum. PATIENTS AND METHODS: Between 1992-1994 138 patients in total were enrolled of whom 136 received paclitaxel and were included in the toxicity and survival analysis, while 112 were evaluable for response. RESULTS: The overall response rate (CR + PR) was 28% with 16 patients achieving a CR (14%). The estimated median (range) time to progression was 4.1 (0.7-60.7) months. The projected four-year overall survival was 7%, with a median (range) of 9.6 (0.3-60.7) months. A multivariate logistic regression analysis showed that platinum resistance, and WHO performance status at baseline, independently correlated with survival at all three time points (median survival time 9.6, 18, and 24 months). Patients with platinum sensitive tumors and WHO performance status 0 had a median survival of 25.6 months compared to 7.0 months for the rest of the patients (P < or = 0.0001). No serious toxicity was registered. CONCLUSION: Paclitaxel could safely be administered in an outpatient setting using this schedule. Patients with platinum sensitive tumors and a good performance status were most likely to survive. However, these patients are also most likely to respond to re-treatment with a platinum compound. With reference to the reasonably good tumor control and limited toxicity observed in this study, we conclude that paclitaxel single agent therapy is a viable option in the salvage situation, which in some patients can give long-lasting responses. However, although responses can be induced in a significant number of patients, the survival figures remain poor.

Adult↗
PubMed1998

Perceived health modifies the effect of biomedical risk factors in the prediction of acute myocardial infarction. An incident case-control study from northern Sweden.

OBJECTIVES: To assess the importance of biomedical risk factors, social factors and self-reported health in the prediction of the first event of acute myocardial infarction (AMI) in an apparently healthy middle-aged population. DESIGN: An incident case-control study. SETTING: The study was nested within the Västerbotten Intervention Program and the Northern Sweden MONICA cohorts. SUBJECTS: The study consists of 78 AMI cases with two randomly selected controls per case from the same study cohorts. RESULTS: Significant odds ratios were found for history of diabetes, daily smoking, cholesterol, body-mass index, hypertension, lower education and perceived ill health. In multivariate logistic regression smoking, hypertension and cholesterol of > or =7.8 mmol L(-1) remained significant. An interaction was observed between number of biomedical risk factors and perceived health. CONCLUSIONS: Smoking, hypertension and hypercholesterolaemia explain a major share of incident AMI events in a Swedish middle-aged population. The study further illustrates that perceived ill health negatively modifies the impact of these risk factors.

Case-Control Studies↗
PubMed1997

High concentration of thrombomodulin in plasma is associated with hemorrhage: a prospective study in patients receiving long-term anticoagulant treatment.

BACKGROUND: The aim of this study was to prospectively test whether the risk of bleeding complications in 212 consecutive outpatients treated with oral anticoagulants could be predicted by levels of endothelium-derived hemostatic variables. METHODS AND RESULTS: All bleeding complications were recorded during 5 years of follow-up; serious bleeding was defined as intracranial bleeding or hemorrhage causing death or necessitating hospitalization. The relationships of bleeding complications and plasma concentrations of tissue plasminogen activator, von Willebrand factor, and thrombomodulin, plasminogen activator inhibitor activity, and other possible risk factors were studied. Twenty-two patients suffered from bleeding complications during anticoagulant treatment; in 14 patients, these were serious. We found that the numbers both of serious hemorrhages and of total hemorrhages were significantly associated with increased levels of thrombomodulin. The number of bleeding episodes increased exponentially through quartiles one to four of the thrombomodulin distribution. CONCLUSIONS: Thrombomodulin concentrations in plasma are related to the risk of hemorrhage in patients treated with oral anticoagulants.

Adult↗
PubMed1996

Obesity treated with phototherapy: four case studies.

We studied the effect of phototherapy on body weight in 4 overweight women. Melatonin was measured in the serum and urine before and after 1 hr of bright light (350 cd/m2). Psychiatric self-ratings with the Comprehensive Psychopathological Rating Scale (CPRS) and Visual Analog Scale (VAS) were performed. Phototherapy (1,500 lux) was given daily at 7-9 a.m. for 10 days and thereafter twice weekly for another 4 1/2 weeks. Three of the 4 women reduced their net weight (1.5-2.4 kg) and improved in mood. All were sensitive to light. The findings indicate that phototherapy affects the melatonin-serotonin system and carbohydrate regulation and may reduce body weight.

Dietary Carbohydrates↗
PubMed1996

Increased levels of plasma thrombomodulin are associated with vascular and all-cause mortality in patients on long-term anticoagulant treatment.

BACKGROUND: The aim of the study was to test if plasma levels of thrombomodulin could predict mortality in 209 patients on long-term anticoagulant treatment followed up for 3.8 years. METHODS AND RESULTS: The thrombomodulin level was 60.9 +/- 29.8 micrograms.l-1 for all 45 patients who died and 60.5 +/- 30.5 micrograms.l-1 for the 38 vascular deaths, compared to 52.3 +/- 20.7 micrograms.l-1 for the 164 survivors. We found that, in Cox regression analyses, all-cause (P = 0.025) and vascular mortality (P = 0.042) was significantly and independently associated with increased levels of thrombomodulin. CONCLUSIONS: The level of plasma thrombomodulin can predict all-cause and vascular mortality in patients on long-term anticoagulant treatment.

Anticoagulants↗
PubMed1996

Epidemiology and clinical characteristics of seizures in patients with acute intermittent porphyria.

The objectives of this study were to investigate the lifetime prevalence of epileptic seizures in a population with acute intermittent porphyria (AIP) and to characterize the seizures and the seizure-triggering factors. A letter was sent to all patients with known AIP in Sweden registered at the National Porphyria Center (n = 294). The medical records of patients who had had epileptic seizures were reviewed in detail. The letter was answered by 268 patients (91.2%). Ten patients (3.7%) reported epileptic seizures. Eight were women (mean age 54.1 years, range 30-81 years), and 2 were men (mean age 19 years, range 9-29 years). Six patients had tonic-clonic seizures and 4 had partial seizures becoming secondarily generalized. Serum sodium levels were low in 3 patients (mean 110, range 103-120 mM), and normal in 5. Excretion of 5-aminolevulinic acid (ALA) in the urine was increased in 4 patients at the time of the seizures. In 6 patients, the seizures were associated with an acute attack of AIP (all patients with hyponatremia included). The lifetime prevalence of AIP-associated seizures was 2.2% of all those with known AIP and 5.1% of all those with manifest AIP. Epileptic seizures among persons with AIP are less common than has been previously described.

Adolescent↗
PubMed1996

Skeletal muscle magnesium and potassium in asthmatics treated with oral beta 2-agonists.

Dietary magnesium has been shown to be important for lung function and bronchial reactivity. Interest in electrolytes in asthma has so far mainly been focused upon serum potassium, especially linked to beta 2-agonist treatment. It is known that serum levels of magnesium and potassium may not correctly reflect the intracellular status. We therefore investigated whether asthmatics treated with oral beta 2-agonists had low magnesium or potassium in skeletal muscle and serum, and whether withdrawal of the oral beta 2-agonists would improve the electrolyte levels. Magnesium and potassium levels in skeletal muscle biopsies, serum and urine were analysed in 20 asthmatics before and 2 months after withdrawal of long-term oral beta 2-agonists, and for comparison in 10 healthy subjects. Skeletal muscle magnesium in the asthmatics was lower both before (3.62 +/- 0.69 mmol.100 g-1 (mean +/- SD)) and after (3.43 +/- 0.60 mmol.100 g-1) withdrawal of oral beta 2-agonists compared with the controls (4.43 +/- 0.74 mmol.100 g-1). Skeletal muscle potassium and serum magnesium did not differ between the groups. Serum potassium was significantly lower both before (4.0 +/- 0.2 mmol.L-1) and after (3.9 +/- 0.2 mmol.L-1) the withdrawal of oral beta 2-agonists compared with the control group (4.2 +/- 0.2 mmol.L-1). The asthmatics had lower skeletal muscle magnesium and lower serum potassium than the healthy controls, both with and without oral beta 2-agonists. Whether the findings are related to asthma pathophysiology or treatment is currently being investigated.

Administration, Oral↗