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L Nyström

Publications and source records attributed to L Nyström.

At least 73 records · Page 4Linked to original sources
PubMed1999

Appearance of islet cell autoantibodies after clinical diagnosis of diabetes mellitus.

Islet cell antibodies (ICA) and glutamic acid decarboxylase antibodies (GAD65Ab) are often present at diagnosis of insulin dependent diabetes mellitus (type I diabetes) and are supposed to decline in level and frequency during the first years of disease. We have analysed ICA and GAD65Ab at onset and after one year in 395 population based randomly selected 15-34 year old patients newly diagnosed with diabetes mellitus, to study how these autoantibodies persist, disappear and appear and their relation to C-peptide levels. Of the 395 samples 212 (54%) were positive for ICA, 250 (63%) were positive for GAD65Ab and 170 (43%) were positive for both. At follow up after one year, 27/183 (15%) of the ICA negative patients and 25/145 (17%) of the GAD65Ab negative patients had converted to positivity. Among the 103 patients negative for both ICA and GAD65Ab, 16 turned positive for one or both antibodies after one year. Patients converting to positivity for one or the other antibody after one year, had lower C-peptide levels after one year than patients who initially were and remained negative, supporting the hypothesis that these patients have a genuine type I diabetes. In conclusion, newly diagnosed patients may be negative for autoantibodies at diagnosis but develop these antibodies later on during the disease.

Adolescent↗
PubMed1999

Effectiveness of primary level antenatal care in decreasing anemia at term in Tanzania.

BACKGROUND: In Tanzania the prevalence of anemia in pregnancy is high inspite of a high antenatal attendance and an established national policy of routine hematinic supplementation and malaria chemosuppression to all pregnant women, free of cost in all antenatal clinics. OBJECTIVES: To assess the effectiveness of reinforcing existing antenatal clinic routines for prevention and treatment of anemia in pregnancy, combined with individual and community health education. METHODS: A prospective controlled intervention study in two antenatal clinics at primary level. At booking (median 24 weeks), 1045 women were screened for anemia and followed-up to late pregnancy (gestational age > or =34 weeks). In addition to hematinic and malaria prophylaxis, extra interventions at the study clinic included retraining of staff, group and individual counselling of women and community health education in the area. RESULTS: There was a significant overall increase in median Hb from 10.1 g/dl at booking to 10.6 g/dl in late pregnancy, and prevalence of anemia (Hb < or =10.5 g/dl) was reduced from 60% at booking to 47%, at both clinics, with 57% reduction in the proportion with severe anemia (Hb <7.0 g/dl). Severely anemic women increased their median Hb by 3.2 g/dl during antenatal care. No additional effect was observed from an individual and community information program. CONCLUSION: Ensuring an adequate supply of drugs seems to be the most important activity to achieve safe hemoglobin levels in pregnant women, but even an active antenatal program has a limited effect when anemia is highly prevalent and booking is late.

Adult↗
PubMed1998

Purification of recombinant apolipoprotein A-1Milano expressed in Escherichia coli using aqueous two-phase extraction followed by temperature-induced phase separation.

A method for purification of recombinant apolipoprotein A1 in aqueous two-phase systems has been studied. A mutant of apolipoprotein A-1, the Milano variant, was expressed in E. coli. Phase systems containing ethylene oxide (EO)-propylene oxide (PO) random copolymers have been used. These polymers are thermoseparating and have the ability to separate into one water-rich and one polymer-rich phase when heated above a critical temperature i.e. the cloud point. The filtrate from an E. coli fermentation was added to a primary aqueous two-phase system composed of an EO-PO copolymer and Reppal, which is an inexpensive hydroxypropyl starch. Apolipoprotein A-1 was partitioned to the top EO-PO copolymer phase and contaminating proteins to the bottom starch phase. The phase diagrams for Reppal PES 100-EO50PO50 (Ucon) and Reppal PES 100-EO30PO70 were determined. The effect on partitioning, when changing parameters such as polymer concentration, type of polymer, protein concentration, pH, salt concentration and volume ratio, were studied. Studies on E. coli DNA partitioning showed that DNA could be partitioned strongly to the bottom phase. An optimal system was scaled up from 5 g to 5 kg with similar degrees of purification, i.e. 2.5 and 2.7 and yields of 79% and 82% respectively. Furthermore temperature-induced phase formation was used for separation of apolipoprotein A-1 from the copolymer by raising the temperature above the copolymer cloud point; thus, recovering protein in a 'clean' water phase.

Apolipoprotein A-I↗
PubMed1998

Prevalence and incidence of asthma and rhinoconjunctivitis in Swedish teenagers.

In 1987, we studied the prevalence of asthma and rhinoconjunctivitis in 1112 grade-eight students in the town of Umeå, northern Sweden. The present study is based on the same cohort, reinvestigated in 1991. We aimed to estimate the changes in the prevalence of asthma and rhinoconjunctivitis and to examine some presumed risk factors of asthma and rhinoconjunctivitis. A postal questionnaire on present asthma, rhinoconjunctivitis, symptoms from the upper and lower airways, and the need for medication was used. Questions about living conditions, smoking, and present education were also included. The questionnaire was answered by 89% (990) of the subjects. The prevalence of self-reported asthma was 10.8% (boys 7.9%, girls 13.7%). The incidence rate/year was 1.1%, the remission rate/year was 5.7%, and the relapse rate/year was 10%. The risk factors for developing asthma appeared to be atopy, having a family history of asthma or rhinoconjunctivitis, and smoking. The prevalence of self-reported rhinoconjunctivitis was 14.3% (boys 15.6%, girls 13.1%). The incidence rate/year was 1%, the remission rate/year was 22%, and the relapse rate/year was 11%. Stopping smoking and having no family history of rhinoconjunctivitis or asthma appeared to favor remission in rhinoconjunctivitis.

Adolescent↗
PubMed1997

Simple and sensitive method for determination of nicotine in plasma by gas chromatography.

Smoking and other forms of nicotine consumption are among the most important risk factors for cardiovascular disease and cancer. Many of the cessation therapies require administration of nicotine. Accordingly, precision analysis for nicotine in plasma has become increasingly important. Several of the recently published methods require elaborate sample handling and/or processing. We report a simple, rapid and reliable gas chromatography method with a high sensitivity for determination of unchanged nicotine in plasma, which can be used in the processing and quantification of large series of nicotine samples, e.g., in clinical trials of nicotine-based smoking or tobacco cessation drug delivery systems.

Chromatography, Gas↗
PubMed1997

A follow-up of an incident case-referent study of febrile convulsions seven years after the onset.

A cohort of 92 children with an initial febrile convulsion (FC), prospectively identified in a community-based study 1985-1987, was compared with a cohort of 185 age- and sex-matched referents from the same study area. The median time of follow-up was 6.7 years (range: 5.7-7.7) and the median age at follow-up was 8.3 years (range 6.5-14). The cases had their first FC at a median age of 18 months (range 5-67 months), their second FC at 24 months (11-108 months) and their third FC at 26 months (13-92 months). FC recurred in 42% of the FC cohort, and 3.8% of the children in the referent cohort experienced FC. Single or recurrent afebrile seizures occurred in 4.3% and epilepsy in 3.3% of the FC cohort, while no afebrile seizures occurred in the referent cohort. The risk of having a sibling with FC was three times (95% confidence interval 1.3-6.2) higher in the FC cohort, while there was no difference between the cohorts in the risk of siblings developing afebrile seizures. There was no difference between the cohorts in the utilization of health services during the follow-up period. Two children in the FC cohort went to a school for the mentally retarded. There was no aetiological relationship between the FC and the mental retardation in these cases. All other children attended normal schools and none needed remedial instruction.

Adolescent↗
PubMed1997

Operational factors affecting maternal mortality in Tanzania.

Identification of the main operational factors in cases of maternal death within and outside the health care system is necessary for safe motherhood programmes. In this study, a follow-up was done of all 117 cases of maternal deaths in Ilala district, Dar es Salaam, 1991-1993, at all levels of care. In all, 79% received some medical care whereas 11% arrived too late for treatment. For each case the major operational factors and all health care interventions were defined through interviews with family members and health care staff and from hospital records, and the avoidability of each case was determined. In the health institutions where the women had consulted, the available resources were assessed. It was found that in most cases the husband (29%) or the mother (31%) of the woman decided on her care in cases of complications, and together with the lack of transport, this often caused delay at home. Also, delay in transfer from the district hospital was common. Cases of abortion complications were often not managed on time because of the delay in reporting to hospital or misleading information. Suboptimal care was identified in 77% of the cases reaching health care. Inadequate treatment was identified by the district health staff in 61% and by the referral centres in 12% of their cases. Wrong decision at the district level and lack of equipment at the referral centre were the main reasons for inadequate care. It is concluded that although community education on danger signs in pregnancy and labour is important, provision of the core resources and supplies for emergency obstetric interventions, as well as clear protocols for management and referral, are absolutely necessary for improvement of maternal survival.

Developing Countries↗
PubMed1997

Updated overview of the Swedish Randomized Trials on Breast Cancer Screening with Mammography: age group 40-49 at randomization.

The purpose of this overview is to estimate more precisely the long-term effect of mammography screening by adding four more years of follow-up to women aged 40-49 years in the four Swedish trials on mammography screening. Data from the four, trials were merged and linked to the Swedish Cancer and Cause of Death Register for 1958-1993 and 1951-1993 respectively to identify date of breast cancer diagnosis and cause and date of death. The invited and control groups comprised 48,569 and 40,247 women respectively. At the December 1993 follow-up, 602 and 482 breast cancer cases were identified in the two groups respectively, of which 104 and 111 had breast cancer as the underlying cause of death. This corresponds to a relative risk (RR) of 0.77 (95% CI: 0.59-1.01) for the two groups. In the 40-44 age group at randomization, 94% of breast cancer patients in the study and 89% in the control group were diagnosed before the age of 50; however, among breast cancer deaths in this age group, only two in the invited and five in the control group died after age 50. At follow-up of women 40-44 years at randomization 208 women in the invited and 184 in the control group were reported to the Cancer registry with breast cancer. Out of these 195 (94%) and 163 (89%) respectively were reported before the age of 50. Further, the relative risk for the age group 40-44 years at randomization by age at follow-up was 1.11, 0.51 and 0.46 for the age groups 45-49, 50-54, and 55-59 at follow-up. This study shows a 23% reduction in the breast cancer mortality in women 40-49 years at randomization achieved from a median trial time of 7.0 years, a median follow-up time of 12.8 years, and a screening interval of 18-24 months. Almost all of the effect in the 40-44 year age group at randomization was due to screening before the age of 50.

Adult↗
PubMed1997

A community-based investigation of maternal mortality from obstetric haemorrhage in rural Zimbabwe. Maternal Mortality Study Group.

In the rural province Masvingo in Zimbabwe, 25% of maternal deaths were caused by obstetric haemorrhage, which had a cause specific maternal mortality rate (MMR) of 40 per 100,000 live births. Forty per cent of cases were due to a ruptured uterus, and 30% to an atonic uterus. Forty-two per cent were more than 35 years old and 44% para 5 or more. In spite of antenatal coverage for 85% of the women, 42% died outside any health facility. Fifty per cent of the women had had no intervention whatsoever before death from haemorrhage. The most important factor for prevention at community level is provision of emergency transport, which would have saved 50% of the women. Other non-health service factors contributing to the adverse outcome were found in actions of the patient herself or a traditional birth attendant. In the health services avoidable factors were identified in 58% of women. More effective antenatal attention to high risk factors, especially high age and parity, appropriate use of maternity waiting shelters, action programmes for management and haemorrhage at all levels, basic resources for resuscitation, improved surgical skills with supervision and available transport for referrals are all necessary parts of a programme to prevent maternal deaths from obstetric haemorrhage.

Adult↗
PubMed1996

Smoking and colorectal cancer: a 20-year follow-up study of Swedish construction workers.

BACKGROUND: Although cigarette smoking has consistently been shown to be positively related to the risk of adenomatous polyp development (benign neoplastic growth of epithelial tissue in the colon), most studies of cigarette smoking and the risk of colorectal cancer have been negative. However, in two large prospective studies in women and men, a statistically significant association between cigarette smoking and an increased risk of colorectal cancer was found, but only after more than 35 years of smoking. PURPOSE: To shed further light on the alleged relationship between long-term smoking and colorectal cancer risk, we performed a retrospective cohort study among Swedish construction workers, with many long-term smokers, complete long-term follow-up, and a large number of observed cases. METHODS: We analyzed the association of smoking with colon cancer and with rectal cancer, using data on a cohort of approximately 135000 male construction workers. High-quality exposure information was collected with the use of a comprehensive questionnaire filled out at the time of enrollment in the cohort, from 1971 through 1975. Complete follow-up was achieved through 1991 and the subjects were observed for an average of 17.6 years, thereby contributing approximately 2375000 person-years of follow-up. We calculated age-adjusted rate ratios (RRs) with the use of Poisson-based multiplicative multivariate models followed by further multivariate modeling that adjusted for other variables. RESULTS: A total of 713 incident colon cancers and 505 rectal cancers were observed. There was no statistically significant association between current smoking status, number of cigarettes smoked or number of years smoking, and risk of colorectal cancer. The age-adjusted RRs were 0.98 (95% confidence interval [CI] = 0.82-1.17) and 1.16 (95% CI = 0.94-1.44) for colon and rectal cancers, respectively, among current smokers, and 1.07 (95% CI = 0.63-1.82) and 1.08 (95% CI = 0.58-2.03) among smokers of 25 or more cigarettes per day, relative to nonsmokers. Among smokers for more than 30 years at the start of follow-up, the age-adjusted RRs were 1.03 (95% CI = 0.85-1.25) and 1.21 (95% CI = 0.96-1.53) for colon and rectal cancers, respectively, relative to nonsmokers. Heavy smokers of cigars and pipes had a statistically nonsignificant tendency toward excess risk for colon cancer, but there was no clear dose-risk trend. CONCLUSION: Our large cohort study did not indicate any excess risk of colon cancer in males who were long-term heavy smokers and provided only weak support for an association with rectal cancer. Our data are thus consistent with the majority of previous reports. The reasons for the discrepancies in comparison with recent U.S. data have yet to be identified.

Adult↗
PubMed1996

Randomised controlled trial of a reduced-visits programme of antenatal care in Harare, Zimbabwe.

BACKGROUND: Many of the individual components of antenatal care have been studied in randomised controlled trials, but few studies have compared whole programmes of antenatal care. Our aim was to test the hypothesis that a new programme of antenatal care with fewer goal-oriented visits would give an equivalent or better result in the outcomes associated with pregnancy and delivery. METHODS: In a randomised clinical trial in Harare, Zimbabwe, we compared a new programme of antenatal care with the standard programme. The new programme consisted of fewer but more objectively oriented visits and fewer procedures per visit. Seven primary care clinics were randomly assigned to the two programmes-three to the standard programme and four to the new programme. FINDINGS: Over a 2-year period, 15,994 women were recruited into the study at the time they booked antenatal care. 97% of the women were followed up, 9,394 who had followed the new programme, and 6,138 from clinics with the standard one. Women allocated to the new programme made, as planned, fewer visits than those in the standard programme (median 4 vs 6 visits, respectively). The proportion of antenatal referrals was also lower (13.6 vs 15.3%; odds ratio 0.87 [95% CI 0.79-0.95]) because of significantly fewer referrals for pregnancy-induced hypertension (2.5 vs 3.8%; 0.66 [0.55-0.79]). Nevertheless, there were significantly fewer labour referrals for severe hypertension or eclampsia (2.1 vs 2.6%; 0.81 [0.66-1.00]). The risk for preterm (< 37 weeks) delivery was significantly lower for women on the new programme (10.1 vs 11.5%; 0.86 [0.78-0.96]). There were no other significant differences between the programmes in other major indices of pregnancy outcome, including antenatal referrals for other causes, labour referrals, obstetric interventions, low birthweight, and perinatal and maternal mortality and morbidity. INTERPRETATION: An antenatal care programme with fewer more objectively oriented visits can be introduced without adverse effects on the main intermediate outcome pregnancy variables.

Adult↗
PubMed1996

Diabetes mellitus and health service utilization: a case-control study of outpatient visits 8 years after diagnosis.

All incident cases of diabetes mellitus in the age group 15 to 34 years have been prospectively registered in Sweden since January 1983. To analyse the utilization of outpatient services 8 years after disease onset, we selected the cases registered in 1983 and two controls per case from the general population, matched by age, gender, and county of residence. In 1991, retrospective data about utilization patterns during a 3-month period were collected via a mailed questionnaire, returned by 317 (72%) patients with diabetes and 586 (68%) controls. Seventy-four percent of the cases and 19% of the controls reported at least one visit to a hospital outpatient clinic, including accident and emergency departments. The odds ratio for one visit was 14 (95% CI 9.6-20), for two visits 11 (95% CI 7.0-18), and for three or more visits 8.9 (95% CI 5.6-14). Even when specialized diabetes clinics were excluded from the analysis, the cases had higher odds for visits to internal medicine clinics, to ophthalmology clinics, and to gynaecology clinics, but not for visits to surgical clinics or to accident and emergency departments. Of non-hospital outpatient services, only visits to nurse practitioners were reported by a higher percentage of diabetic responders. Twenty-seven percent of patients with diabetes, as compared to 9% of the controls, had visited both hospital and non-hospital outpatient offices. Females were overrepresented among diabetic high-consumers. The results indicate that most young to middle-aged Swedish persons with diabetes are monitored at hospital outpatient offices, but considerable overlap exists between hospital and non-hospital outpatient services. Further research is needed into the determinants of utilization patterns in diabetes, such as gender.

Adolescent↗
PubMed1996

Stillbirths and intrauterine infection, histologic chorioamnionitis and microbiological findings.

OBJECTIVE: To analyze whether placental inflammation is associated with stillbirth in Zimbabwe. METHOD: Placentas from 66 stillbirths (> 22 weeks' gestation; patients with congenital malformations, diabetes or preeclampsia were excluded) and 66 term live births were studied for the presence and severity of chorioamnionitis. The morphological results were compared with earlier presented microbiological findings in the same material. RESULTS: Chorioamnionitis was present in 79% of stillbirths and 30% of live births (O.R. 8.5, 95% C.I. 4.0-18). Nine percent of stillbirths but no live births presented vasculitis of the chorionic plate, which verified an inflammatory response from the infant (O.R. 14, 95% C.I. 2.8-72). The same types of microorganisms were isolated from stillbirths and liveborns, but Escherichia coli and group B streptococci were more frequent among stillbirths. CONCLUSIONS: Morphological chorioamnionitis occurred 2.6 times more often in women with stillbirths than in women with live births. In 9% of stillbirths the infant showed an inflammatory response. Thus the infant was alive when the infection occurred and it is therefore reasonable to assume that infection was the cause of death.

Cause of Death↗
PubMed1996

Patient administrative system as a tool to validate the ascertainment in the diabetes incidence study in Sweden (DISS).

The aim of this study was to evaluate the degree of ascertainment in a nationwide prospective registration of incident cases of diabetes mellitus in the age group 15-34 years (The Diabetes Incidence Study in Sweden (DISS)). Incident cases of diabetes mellitus in DISS during a five year period were compared with inpatients, with the diagnosis of diabetes mellitus, registered in a routine computer-based administrative register. The Patient Administrative System-Inpatient Care (PAS-IC). To clarify this issue the two-sample capture-recapture phenomena was employed in the two southernmost counties in Sweden, Malmöhus and Kristianstad, covering 9.2% of the total of 2.3 million people aged 15-34 years in Sweden. The results showed that the ascertainment level in DISS was 0.86 for insulin dependent diabetes mellitus (IDDM). Hence, the DISS registry is a valid tool to monitor the incidence of IDDM in young (15-34 years) adult subjects.

Adolescent↗
PubMed1996

Influence of epilepsy on mortality in mental retardation: an epidemiologic study.

PURPOSE: A cohort consisting of all persons with known mental retardation (MR) and living in a Swedish province on December 31, 1985, was followed for 7 years (1987-1992) to study the mortality pattern. METHODS: A file of the cohort was linked to the cause-of-death pattern of the general population in the study area. RESULTS: One hundred twenty-four deaths (8.4%) occurred among the 1,478 persons with MR. Thirty deaths (10.1%) occurred among the 296 persons with epilepsy and MR. The standardized mortality ratio (SMR) in those with only MR was significantly increased as compared with that of the general population: 1.6 [95% confidence interval (CI) 1.3-2.0]; MR and epilepsy, 5.0 (CI 3.3-7.5); and MR, epilepsy, and cerebral palsy (CP), 5.8 (CI 3.4-9.7). Mortality was increased both in patients with partial seizures without seizures secondarily generalized (SMR 3.7, CI 1.0-13.6) and in patients with seizures secondarily generalized (5.0, CI 2.3-11.0). The highest mortality occurred in patients who had seizures that were always generalized from the onset: 8.1 (CI 5.7-11.5). Mortality increased with increasing seizure frequency during the year preceding the prevalence date. In patients with epilepsy and MR, pneumonia was the most common cause of death and a seizure was the probable cause of death in 6.7%. CONCLUSIONS: Epilepsy is associated with a significantly increased mortality in persons with MR. The increase is related to seizure type and seizure frequency. Death in persons with epilepsy and MR is seldom directly due to seizures. Other impairments associated with epilepsy and MR are important causes of death.

Adult↗