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K S Johansen

Publications and source records attributed to K S Johansen.

At least 19 recordsLinked to original sources
PubMed1996

The WHO (Ten) Well-Being Index: validation in diabetes.

BACKGROUND: In a European trial in 8 countries, the subjective well-being of patients on alternative forms of treatment for insulin-dependent diabetes was compared using the 28-item WHO Well-Being Questionnaire, covering four dimensions of depression, anxiety, energy and positive well-being. The objective of the analysis reported here has been to identify the items of the WHO questionnaire which belong to an overall index of negative and positive well-being. METHODS: Adult patients at 10 study centres in 8 countries who had been on insulin for at least 2 years were invited to participate in a randomised, cross-over trial to compare insulin pump treatment with injection therapy. At each phase, patients completed questions on well-being and general health. Internal validity of the well-being index was evaluated by Cronbach's alpha and Loevinger's and Mokken's homogeneity coefficients, as well as factor analysis. External validity was evaluated by comparisons with results of the general assessment questions and by the ability to discriminate between the alternative forms of treatment. RESULTS: 358 patients had sufficient data for analysis. Ten items were found to constitute a valid index of well-being with respect to internal and external validity. Coefficients of homogeneity were acceptable and there was evidence for both concurrent and discriminant validity. CONCLUSIONS: The WHO (Ten) well-being index includes negative and positive aspects of well-being in a single uni-dimensional scale. Its advantage lies in its ability to show overall change along the continuum of well-being, thus facilitating comparisons between patient groups and treatments. It is not specific to diabetes, and therefore may be useful as a disease-independent index of well-being in a broad range of health care studies.

Adaptation, Psychological↗
PubMed1995

Technology for the continuous improvement of the quality of health care.

Since medical technology impinges on the structure, process and outcome of health care it has a profound effect on attempts to achieve improvement in this field. The present article discusses the links between medical technology and continuous quality development, with particular reference to utilization, appropriateness and cost-benefit.

Canada↗
PubMed1994

ORATEL: telematic system for quality assurance in oral health care (AIM Project A2029).

ORATEL is a 3-year project with the ultimate objective of improving oral health through use of appropriate computerized information systems. These tools will promote quality assurance and development in oral health care by using common quality indicators/standards. The project has completed its first phase, during which two European surveys were made, one on quality assurance clinical practices, and another on existing computerized information systems in oral health care. Pan European consensus was reached on 3 and 4 September 1992 when quality assurance indicators for oral health care services were endorsed. A manual on quality assurance indicators in oral health care has also been issued by the project.

Computer Communication Networks↗
PubMed1994

Osmolal and anion gaps in patients admitted to an emergency medical department.

1. Osmolal and anion gaps are helpful in the diagnosis and evaluation of intoxications with methanol and ethylene glycol. Reported reference values for osmolal gap and anion gap are -1 (+/- 6) mosm kg-1 H2O and 16 (+/- 2) mmol l-1, respectively. However, we have repeatedly found unexplained increased gaps in patients admitted to our department, and the relevance of the established reference values has been questioned. 2. Osmolal and anion gaps were determined in an unselected population of patients consecutively admitted to an emergency medical department. In the case of unexplained gaps, the blood samples were analysed with respect to the presence of alcohols and organic acids. 3. We included all accessible patients admitted during 14 days. Appropriate blood samples were obtained in 177 patients (88 male, 89 female), with a mean age of 65 years (range 17-94). 4. The mean and (standard deviation) for osmolal and anion gaps in our material were 5.2 mosm kg-1 H2O (7.0) and 12.9 mmol/l (4.2). Neither methanol nor ethylene-glycol was detected in serum from any patients. Small amounts of ethanol were found in 5 patients, and high lactate levels explained in part the most extensively increased anion gaps. However, the calculated analytical standard deviation accounted entirely for the variation in our material, and we suggest that the present reference values be adjusted.

Acid-Base Equilibrium↗
PubMed1993

Prevalence of infections and use of antibiotics among hospitalized patients in Mauritius. A nationwide survey for the planning of a national infection control programme.

As part of a programme for improving hospital infection control in Mauritius a nationwide survey, including a prevalence study, was carried out in order to identify characteristics of the hospitals, the population, and the infections. Community-acquired infections were three times more prevalent than nosocomial infections: 15.0% and 4.9%, respectively. Surgical wound infection was by far the most common nosocomial infection, with a prevalence rate of 8.2 per 100 operations, followed by urinary tract infection with a low rate of 0.8 per 100 admissions. The survey showed that these hospitals in Mauritius housed mainly a young population (mean of 36.8 years for females and 39.4 years for males) with few risk factors for acquiring nosocomial infection. Although diabetes mellitus is prevalent in Mauritius the diagnosis of diabetes was not associated with nosocomial infection. The spectrum of operations offered was limited, and Caesarean section was the most prevalent operation. The amount and types of antibiotics used in hospitalized patients were recorded. More than one third of the patients received antibiotic treatment at the time of the survey, which is comparable to figures reported from large teaching hospitals in Western Europe. The information gathered from the survey, the interviews and the inspection were used to establish priorities for a collaborative programme for improved infection control. It included the draft of a set of custom-made guidelines, which were eventually studied by staff members from hospitals in Mauritius during a training period in Denmark. We believe that a prevalence survey is useful for initiating infection control programmes in hospitals in developing countries.

Adult↗
PubMed1993

Adequate iron stores and the 'Nil nocere' principle.

There is a need to change the policy of unselective iron supplementation during periods of life with physiologically increased cell proliferation. Levels of iron stores to be regarded as adequate during infancy and pregnancy are still not well established. Recent data support the view that it is not justified to interfere with physiological adaptations developed through millions of years by sophisticated and precisely coordinated regulation of iron absorption, utilization and storage. Recent data suggest that the chelatable intracellular iron pool regulates the expression of proteins with central importance in cellular iron metabolism (TfR, ferritin, and erythroid 5-aminolevulinic synthetase) in a coordinately controlled way through an iron dependent cytosolic mRNA binding protein, the iron regulating factor (IRF). This factor is simultaneously a sensor and a regulator of iron levels. The reduction of ferritin levels during highly increased cell proliferation is a mirror of the increased density of TfRs. An abundance of data support the vigorous competition for growth-essential iron between microbial pathogens and their vertebrate hosts. The highly coordinated regulation of iron metabolism is probably crucial in achieving a balance between the blockade of readily accessible iron to invading organisms and yet providing sufficient iron for the immune system of the host. The most evident adverse clinical effects of excess iron have been observed in immunodeficient patients in tropical countries and in AIDS patients. Excess iron also increases the risk of initiation and promotion of malignant processes by iron binding to DNA and by the iron-catalysed release of free radicals. Oxygen radicals were shown to damage critical biomolecules leading, apart from cancer, to a variety of human disease states, including inflammation and atherosclerosis. They are also involved in processes of aging and thrombosis. Recent clinical trials have suggested that the use of iron-chelators, natural and synthetic antioxidants, and anti-TfR monoclonal antibodies can contribute in retarding malignant cell proliferation. Hypoferraemia during pregnancy is--like haemodilution--an adaptation to the risks involved in the natural hypercoagulable state of pregnancy. It may also serve to prevent the risk of infections and mutagenicity in the highly proliferating tissues of the foetus. Blunted erythropoiesis has been revealed during the first 30 weeks of pregnancy by the use of the newly developed method of determining the soluble serum transferrin receptor. The lack of increase in erythropoietin levels proves that there is no hypoxia. Decreases in Hb and iron levels are parts of a physiological adaptation. As a consequence they should neither be treated nor prevented. It is stressed that whenever a widespread and ingrained routine medical intervention has to be changed it is essential to first monitor the potential health effects of the recommended change in a national policy.

Adult↗
PubMed1992

Diagnosis, antibiotic treatment and outcome of acute tonsillitis: report of a WHO Regional Office for Europe study in 17 European countries.

The diagnostic and prescribing habits of general practitioners from 17 European countries for 4094 patients with acute tonsillitis were assessed, and differences in outcome were identified. At least 10 general practitioners from each country filled in a questionnaire for each episode of acute tonsillitis treated during a three month period, November 1989-May 1990. Differences in days of fever and illness were tested by one-way analysis of variance. Bacteriological tests were rarely used for diagnosis in East Germany, Poland and the Netherlands, while a high percentage (70-96%) occurred in Turkey, Romania, Israel, Yugoslavia, Finland and Greece. Group A beta-haemolytic streptococci (40 per cent) and a negative test result (43 per cent) were the most common results. Ninety per cent or more patients were treated with an antibiotic. Oral penicillin was especially prescribed in the northern countries of Europe and parenteral penicillin in southern Europe. For almost all countries the mean number of days with fever was between 2 or 3 days. The mean number of days with illness differed greatly (F = 62.12; P = 0.0000). Turkey had the lowest mean (2.56), while Poland had the highest mean (8.23).

Adolescent↗
PubMed1991

Big ticket health technology: is rational utilization possible?

Medical technologies that have high initial and operating costs are commonly labeled 'Big Ticket Technologies'. However, technologies with lower initial and operating costs, but which are utilized extensively in patient care, should be considered Big Ticket as well. Some of these technologies are product innovations, because they represent a new product or service. Others are process innovations because they provide an alternative way of delivering health care. Radiology and radiation oncology offer many examples of Big Ticket technologies in medicine, including CT scanners, MRI units and linear accelerators. Other examples include extracorporeal shock wave lithotripsy and resuscitation and intensive care technologies. Differences in the availability of these technologies in various countries reflects financial incentives and disincentives at work in the countries, expectation levels for health care in the countries, and the degree to which the diffusion and use of medical technologies are regulated. Evidence of the cost-effectiveness of medical technologies, and the impact of their use on health outcomes, is rapidly being added as an additional criterion for evaluation of the usefulness of medical technologies in health care.

Cost-Benefit Analysis↗
PubMed1983

Effect of temperature on polymorphonuclear leukocyte function.

The effect of temperature on the function of polymorphonuclear leukocytes (PMN) has been investigated in vitro. Increases in temperature from 37 degrees C to 40 degrees C progressively increased chemiluminescence (CL) responses by PMN after stimulation by Staphylococcus aureus, zymosan or phorbol myristate acetate (PMA) while increases above 40 degrees C decreased these functions. Temperature increases from 37 degrees C to 40 degrees C also produced increased PMN bactericidal activity against S. aureus. In contrast, similar increases in temperature did not change superoxide production by PMN stimulated by PMA. Incubation of PMN at the various temperatures did not cause release of LDH indicating that damage to PMN was not the cause of reduced PMN chemiluminescence and bactericidal activity seen within the temperature range studied. The discrepancy between the influence of temperature on PMN chemiluminescence and bactericidal activity of PMN compared to superoxide anion production by PMN suggests that superoxide anion production may not be solely, or at least directly, responsible for killing of bacteria. Careful temperature control is needed when assaying PMN function. Febrile responses up to 40 degrees C may play a beneficial role in host defense.

Adult↗
PubMed1983

Effect of sodium benzoate on polymorphonuclear leukocyte function.

Sodium benzoate is widely used as a food preservative and reputed to be a scavenger of hydroxyl radical (.OH). The effects of sodium benzoate on the function of polymorphonuclear leukocytes (PMN) stimulated by S. aureus or the chemical agent, phorbol myristate acetate (PMA) were examined in vitro using assays of chemiluminescence (CL), total bactericidal activity, intracellular recovery of bacteria, as well as release of lactate dehydrogenase (LDH), lysozyme and superoxide anion (O2(-)). Sodium benzoate decreased chemiluminescence, superoxide anion and lysozyme release by PMN stimulated with S. aureus but did not similarly affect these responses of PMN to the chemical agent, PMA. The ability of PMN to kill S. aureus was also impaired by sodium benzoate and associated with a reduced number of intracellular bacteria recovered after 90 minutes incubation. LDH release from PMN was not demonstrable at concentrations of sodium benzoate below 100 mM indicating that damage can not account for these findings. The underlying mechanism of the altered bactericidal function of PMN treated with sodium benzoate appears to be a result of decreased uptake of S. aureus.

Adult↗
PubMed1983

Nitroblue tetrazolium slide test. Use of the phorbol-myristate-acetate-stimulated NBT-reduction slide test for routine and prenatal detection of chronic granulomatous disease and diagnosis of heterozygous carriers.

Chronic granulomatous disease (CGD) in utero has recently been detected by a new qualitative nitro blue tetrazolium (NBT) reduction slide test using phorbol-myristate-acetate (PMA) as a stimulus. The technique is simple and inexpensive and requires only a few microlitres of blood. Reported here is an evaluation of this method as applied to routine clinical diagnosis. The blood granulocytes from 300 normal individuals and 49 CGD patients and their relatives were tested and the results compared to the conventional in vitro function tests. In normal individuals the number of abnormal cells was very low never exceeding 2% of granulocytes. CGD patients (14 out of 15) diagnosed by conventional functional tests showed no positive cells in the NBT-PMA test. One patient diagnosed by functional tests had 4% positive cells. Thirty-four relatives of these patients were tested and eleven were found to have fewer positive cells than normal in the NBT-PMA slide test ranging from 16-88% of all granulocytes. These are presumably carriers, a finding supported by granulocyte function tests. All these individuals were female, mothers, sisters or maternal aunts of male CGD patients, thus presumably X-linked heterozygote carriers of CGD. An example of successful prenatal diagnosis using the PMA-NBT test is described. The results show that the PMA-NBT test provides a simple and reproducible method for routine diagnosis of CGD and CGD X-linked heterozygote carriers.

Female↗