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Biomedical subjects

L Strömberg

Publications and source records attributed to L Strömberg.

At least 19 recordsLinked to original sources
PubMed2002

Diagnostic accuracy of the atopy patch test and the skin-prick test for the diagnosis of food allergy in young children with atopic eczema/dermatitis syndrome.

AIM: To evaluate the diagnostic value of the skin-prick test and the atopy patch test in diagnosing basic food allergy in young children suffering from atopic eczema/dermatitis syndrome. METHODS: 141 children, the majority under 2 y of age (mean 16 mo) with atopic eczema/dermatitis syndrome were investigated using skin-prick and atopy patch tests for milk, egg, wheat and rye. Open diagnostic elimination challenge was done since this has been reported to be a reliable method in young children. RESULTS: A positive challenge response was found to milk in 63 (45%), egg in 78 (55%), wheat in 61 (43%) and rye in 61 (43%). Sensitivity/specificity of the atopy patch test was 60%/97% for milk, 71%/97% for egg, 90%/94% for wheat and 93%/90% for rye. For the skin-prick test the corresponding figures were 41%/99%, 60%/97%, 13%/98% and 15%/99%. CONCLUSION: Patch testing was found to be a more sensitive method than the skin-prick test in diagnosing food allergy in children with atopic eczema/dermatitis syndrome, especially in those under 2 y of age. Many children with a negative skin-prick test result have a positive patch test result, especially in the case of cereals. A diagnosis of food allergy should be confirmed by elimination and in the research setting also by challenge.

Child, Preschool↗
PubMed2000

Heroin impurity profiling. A harmonization study for retrospective comparisons.

Three laboratories present a harmonised system for the retrospective comparison of south west Asian heroin. It consists of an improved gas chromatographic (GC) profiling method and a computerised data retrieval. The investigations of the GC were necessary with a view to improve the reproducibility of the system. The necessity of a strict quality control is emphasized. The peaks of the GC profile were investigated for abundance, intensity, GC behaviour (reproducibility) and correlations; 16 of them were selected for describing the heroin profile in the database. The results from intra-lab profile comparisons are reported. The reproducibility of the analysis was good and the variation between the samples was large, thus, allowing conclusions with a high degree of certainty. The criteria of similarity were defined. The system is successfully running in all three labs. In connection with inter-laboratory comparison, the aspects of method harmonisation and standardisation are discussed. It appeared that the GC method is a very subtile one, urging for a strict standardisation between the three labs. Despite a long cooperation between three well-equipped and experienced labs, a more or less serious loss of reproducibility was noticed in the inter-lab results in comparison with the intra-lab results. The loss could for the greater part be attributed to the (limits of the) GC technique; a number of compounds, necessary for making the discrimination between samples, showed difficult chromatographic behaviour, leading to insufficient inter-lab reproducibility. Using the actual variables, improvements in performance can hardly be expected in the near future. The loss of reproducibilty implies that the number of false positive matches in a database search increases. This may strongly reduce the value of a relatively large, international database. The study shows that so far, the best option for international comparison is the analysis in a central laboratory. The idea of local determination at a large number of national labs and the use of a common database is not a realistic aim for this type of analysis.

Chromatography, Gas↗
PubMed1999

Efficacy of once-daily versus twice-daily administration of budesonide by Turbuhaler(R) in children with stable asthma.

We evaluated the efficacy of once-daily versus twice-daily treatment with budesonide, delivered by a Turbuhaler(R), in the management of children with stable asthma in a randomized, double-blind, parallel-group study involving 206 children (age 5-15 years). After a 2-week run-in period during which the children were maintained on their usual dose of budesonide (200 microg or 400 microg/day), patients were randomized to receive the same daily dose in either two daily administrations (morning and evening) or as a single dose in the morning over a period of 12 weeks. The primary efficacy variable was morning peak expiratory flow (PEF). The mean morning PEF during the run-in phase was 271 L/min in patients randomized to once-daily treatment and 264 L/min in those randomized to twice-daily treatment. The mean change from baseline to the last 2 weeks of the treatment period in the two groups was -0.3 L/min (95% confidence limits -6.6 to +6.0) and 2.5 L/min (-4.3 to +9.3). The estimated difference between the groups was -2.8 L/min, with 90% confidence limits of -10.4 + 4.5; these were close to the limits regarded as indicative of equivalence (-10 to +10), and hence the difference was not regarded as clinically relevant. Similarly, there were no significant differences between the groups in regard to secondary efficacy measures such as spirometric tests and symptom scores. Both treatments were well tolerated. We conclude that once-daily administration of budesonide by Turbuhaler(R) is as effective as twice-daily treatment in the management of stable asthma in children treated with inhaled steroids at doses of 200-400 microg/day.

Administration, Inhalation↗
PubMed1999

Postoperative mental impairment in hip fracture patients. A randomized study of reorientation measures in 223 patients.

Mental impairment is a common and serious complication in geriatric surgery. We studied 223 hip fracture patients. They were over 64 years of age (mean 81), with no history of mental deterioration and acutely admitted to hospital from independent living conditions. They were randomized into two groups. One of these was subjected to reorientation measures during the perioperative phase, i.e., presurgery admission to the orthopedic ward, accompanied home visits during the hospital stay and access to reorientation devices--they received a large clock, calendar, radio, TV-set, telephone and were encouraged to wear their own clothing. Otherwise, there were no differences in the treatment given to the two groups. We used monitoring of cognitive function with the Short Portable Mental Status Questionnaire (SPMSQ) and a feedback program for evaluation of the treatment results. There was a low incidence of postoperative cognitive deterioration in both groups, compared with historical controls. However, no difference in mental status was noted when we compared the two groups. The conclusion is that attributes were less important than the psychological environment for postoperative mental deterioration. The mean total continuous hospitalization (transfers between departments and hospitals included) in the reorientation group was 22 (95% CI: 17-43) days, the corresponding figures for the controls were 30 (14-29) days.

Aftercare↗
PubMed1999

Continuity, assessment and feedback in orthopaedic nursing care practice is cost-effective.

Hip fracture treatment and rehabilitation are often considered as separate issues and generally performed in different locations. The rapidly increasing proportion of patients that is old and very old now calls for a new approach. This is a prospective study of 909 consecutive hip fracture patients, over 64 years old, admitted to hospital from an independent living situation. In a specialized hip fracture unit, 256 patients were given an early and intense rehabilitation program. It focused on continuity, feedback, reorientation and continuous monitoring of cognitive function and activities of daily living (ADL). Eighty-five percent of the patients could return directly to their own home after the initial treatment period. The mean total utilization of health care resources during the first 4 months after the injury was lower (28 institutional days) than in 286 historical controls given conventional rehabilitation (39 days, p < 0.05). At 4 months, 81% of the patients still lived in their own home vs. 72% of the controls and the 1-year mortality was 14% (21% in the controls, p < 0.05). After the project had been completed 297 patients formed an additional control group. In this group the proportion discharged to their own home decreased to 44% and the number of bed-days during the first 4 months returned to the pre-study level (39 days). It thus appears to be cost-effective to allocate sufficient rehabilitation resources early in the treatment of elderly patients with hip fractures. Annual savings in the catchment area due to the intervention were calculated to approximately 5,000,000 SEK. Continuous assessment and adequate continuity gives the staff emotional feedback, which promotes their personal commitment.

Activities of Daily Living↗
PubMed1997

The appearance and disappearance of cognitive impairment in elderly patients during treatment for hip fracture.

We studied the natural course of cognitive state in 256 consecutive hip fracture patients who were admitted from an independent living situation. We employed a treatment programme that focused on preventing postoperative cognitive impairment. Cognitive function was assessed with the SPSMQ screening test. The incidence of postoperative cognitive impairment among those lucid on admission was 13%, which generally was reversed before discharge. Thirty-seven percent were cognitively impaired on admission; of those, 51% reached normal test scores while in hospital. Those who recovered within the first week had as good a prognosis during the first year as those who remained lucid throughout the hospital stay. Cognitive impairment was associated with an increased complication rate, e.g. a three-fold increase of early fracture displacement and a four-fold increase of wound infection. This increased risk was present even in patients with mild/moderate cognitive impairment and could not entirely be explained by age. Our results suggest that it is possible to decrease postoperative cognitive impairment by routine monitoring of cognitive status, a high level of continuity and a reorientation programme. The routine assessment of the cognitive function is recommended in geriatric patients who are admitted for surgery.

Activities of Daily Living↗
PubMed1997

Prospective payment systems and hip fracture treatment costs.

We studied the health care consumption and costs after a hip fracture in 1,060 and 1,178 elderly patients admitted from their own home before and after the implementation of a prospective payment system in Stockholm. The total number of bed-days was estimated by merging the inpatient database and the municipal records of living accommodations for the elderly. By using a detailed patient-related accounting system and separating cost for surgery and "hotel" cost, we could compare costs in different types of rehabilitation. After the change in reimbursement system, the orthopedic stay was almost halved from 20 to 12 days. This was achieved by earlier and increased discharge to geriatric wards, where bed-day consumption doubled (107%), so that the total cost actually increased by 12%. This is not readily apparent from the official heath care statistics, which depict a more favorable cost development, as diagnosis-related registration for a large part of the geriatric care is no longer included. In contrast, a rehabilitation program in one of the acute hospitals, emphasizing continuity in the postoperative phase, reduced the total cost for treatment and rehabilitation by 12%. A prospective reimbursement aiming at reducing the costs of acute care does not necessarily result in overall savings.

Aged↗
PubMed1997

The cost of a hip fracture. Estimates for 1,709 patients in Sweden.

We calculated the costs related to hip fractures and estimated the potential cost savings from preventing hip fractures. Subjects for this retrospective study were 1,709 hip fracture patients admitted for a primary hip fracture during 1992 in Stockholm, Sweden. Direct costs were compiled for the services of hospital orthopedics, hospital geriatrics, nursing homes, home for the elderly, group living, other acute hospital care, and municipal home help. The direct costs per patient during 1 year after a fracture amounted to about USD 40,000. The county council was responsible for 59% of the direct costs during 1 year after a hip fracture, while the remaining 41% were referred to the municipality. In the morbidity group, the potential cost savings per patient from preventing hip fractures was about USD 22,000.

Aged↗
PubMed1996

Decreasing admissions for childhood asthma to a Swedish county hospital.

Hospital admission rates for childhood asthma have increased in many countries. To study if this is also true for Norrköping Hospital, paediatric admission rates for asthma every fifth year were examined for the period 1973 to 1993. Admission rates were found to have fallen over the last 10 years, especially in children of school age. Among the younger age groups (below 5 years of age) a fall in admission rates was also observed over the last 5 years. This fall occurred in spite of reported increases in the prevalence of childhood asthma. The relative risk for admission due to asthma thus decreased from 1 in 1973 to 0.09 in 1993. The readmission rate has been stable. The mean length of stay in hospital for asthma decreased significantly. The observed decreasing trend in hospital admissions for childhood asthma is contrary to that found in many other countries. Possible explanations are discussed.

Adolescent↗
PubMed1996

Prediction of the outcome after hip fracture in elderly patients.

We report a prospective study of 232 consecutive patients with hip fractures. All were over 64 years of age and living independently before admission to a geriatric orthopaedic ward. We assessed the value, at admission, of predicting factors for independent living at one year after injury. The most important factors were: (1) preinjury function in activities of daily living (grade A or B on the Katz et al (1963) scale); (2) absence of other medical conditions which would impair rehabilitation; and (3) cognitive function better than 7 on the Pfeiffer (1975) mental questionnaire. The odds ratios (95% CI) for these three predictors were 3.5 (1.3 to 9.1), 2.9 (1.3 to 6.1) and 2.4 (1.9 to 4.9), respectively. When all predictors were positive at admission, 92% were living independently at one year; with one, two or three negative predictors, the percentages living independently were 76, 61 and 27, respectively. The median values of the total number of days in hospital, irrespective of diagnosis, during the first year were 12, 24, 29 and 149 days for the four groups. The mortality at one year was predictable on admission only by the number of medical conditions: with no other diagnosis than the fracture the mortality was 0%; with one or two additional conditions the mortality was 14%; and with three or more additional diagnoses it was 24%. These simple and robust predictors can be used to optimise resources for rehabilitation.

Activities of Daily Living↗
PubMed1994

Nedocromil sodium 2% eye drops for twice-daily treatment of seasonal allergic conjunctivitis: a Swedish multicentre placebo-controlled study in children allergic to birch pollen.

This was a multicentre, double-blind, randomized group comparative study in which 77 children, aged 6-16 years, received 2% nedocromil sodium eye drops and 72 received placebo, one drop into each eye twice daily. The treatment period was 4 weeks, covering the peak birch pollen season. Prior to the start of the season, patients who had attended the clinic the previous 2 years because of seasonal allergic conjunctivitis (SAC) to birch pollen, entered a one week baseline period during which symptoms were assessed, dairy cards completed, and routine sampling of blood and urine carried out. The double-blind treatment period then commenced at the onset of the birch pollen season. Patients/parents kept daily diary record cards of eye symptom severity and concomitant therapy. Conjunctivitis was mild in both treatment groups but nedocromil sodium was more effective than placebo in controlling symptoms. During the 2-3 weeks of peak pollen counts, this therapeutic effect was statistically significant for itching (P < 0.01), watering (P < 0.05) and total symptom score (P < 0.01), but was not significant for grittiness (P = 0.08) or redness (P = 0.06). Global opinions of efficacy showed no difference between treatments, due to a high placebo effect (however, the diary card data indicated a significant improvement with nedocromil sodium). We therefore conclude that nedocromil sodium 2% eye drops, administered twice daily, is an effective treatment for SAC in children.

Adolescent↗
PubMed1993

Enhancement of bone formation in rabbits by recombinant human growth hormone.

We studied the effect of human recombinant growth hormone on diaphyseal bone in 40 adult rabbits. The diaphyseal periosteum of one femur in each animal was mechanically stimulated by a nylon cerclage band. The bands induced an increase in bone formation, bone mineral content, and maximum torque capacity of the diaphyseal bone at 1 and 2 months. Growth hormone enhanced the anabolic effect of the cerclage bands on bone metabolism, evidenced by a further increase in torsional strength of the femurs.

Animals↗
PubMed1993

Computer aided retrieval of common-batch members in Leuckart amphetamine profiling.

Comparison of profiles is a well established way to find links between confiscated drugs. It is a laborious and time consuming task to manually compare large numbers of profiles to find common-batch links. To facilitate the comparison a computerized method has been developed. It is described and applied to a set of amphetamine impurity profiles. From each profile, areas of selected peaks are fed to the computer. By using quotients of corresponding peaks, the computer finds pairs of closely related profiles. With a sufficient numbers of peaks, the method is tolerant to variations in intensity between profiles, random peak area variations and a few strongly deviating peak areas. The program was written in Q-basic from Microsoft and may be run on any IBM-compatible personal computer. The method may also be used for analyzing data from other forensic objects, when the descriptors chosen are affected by errors like those described in the text.

Amphetamines↗
PubMed1992

Treatment of nummular psoriasis with a clobetasol propionate stick.

Twenty-two consecutive patients with nummular psoriasis were treated with a 0.05% clobetasol propionate stick on the right side of the body and with 0.05% clobetasol propionate ointment (Dermovate, Glaxo) on the left according to an intermittent application schedule. The trial was open and lasted for 3 weeks. The patients were assessed at the beginning and at the end of the trial. The variables studied included: an overall clinical assessment, assessment of the lesion area, scaling, erythema and thickness and the amount of clobetasol propionate used during the trial, and a questionnaire on patients' opinions about hygienic and cosmetic qualities of the stick. No significant difference was found between the stick and corresponding ointment. From a hygienic and cosmetic point of view, the patients preferred the stick formulation.

Adolescent↗
PubMed1989

Stress shielding by rigid fixation studied in osteotomized rabbit tibiae.

In 48 rabbits the bone-formation rates and strength in the tibial shaft, osteotomized and treated with rigid internal plate fixation, were compared with contralateral bones, which were treated with plate fixation without osteotomy. The plate fixation alone induced a 35 percent decrease in torsional strength after 12 weeks. The healing of the osteotomy counteracted the decrease in strength induced by stress protection of the rigid plate at 6 weeks, but this effect subsided within 12 weeks. The osteotomy also induced a 2-3-fold increase in the synthesis of bone matrix and mineral accretion of the bone underlying the plate at 6 and 9 weeks when compared with the contralateral side, which was plated but not osteotomized. The bone-formation levels returned to normal within 12 weeks; and the bone underlying the plate became subject to atrophy, resulting in decreased mechanical strength.

Animals↗
PubMed1989

Treatment of chronic leg ulcers with a hydrocolloid dressing.

The effects of a hydrocolloid dressing (Comfeel Ulcus) on the physical environment of chronic leg ulcers in 58 consecutive out-patients were investigated. Patients were subdivided into two groups of which Group 1 included 31 (53.4%) and Group 2, 27 (46.6%) patients. Twenty-three (39.7%) patients healed within 7 weeks (study period) and 49 (84.5%) within 1 year (follow-up period). Aerobic and anaerobic bacterial cultures as well as mycotic cultures were performed from ulcer bases of both groups of patients. In Group 1 a 3 mm punch biopsy was taken from the ulcer margins for histopathological examination. In Group 2 serum levels of iron, zinc, copper and selenium were measured and in these latter patients a mean temperature difference of 2.8 degrees C between the ulcer base and the skin surrounding the ulcer was found. There was no difference in ulcer pH in patients belonging to Group 2, independent of bacterial or fungal contamination. Low serum iron was found in 74.1% and anaemia in 40.7% of the patients in Group 2. No differences in ulcer healing were seen in these patients compared with those without iron-deficiency or anaemia. No differences were seen in serum iron, zinc, copper or selenium levels between good and poor healers. There were 22.2% ulcer relapses in Group 1 within a year of the start of the study, with no relapses in those 15 patients of Group 2 who used specially designed compression stockings.

Adult↗
PubMed1988

Predictive sites of inflammatory manifestation in the prostatic gland: an experimental study on nonbacterial prostatitis in the rat.

In rats that had been subjected to standardized experimental stress stimuli for 3 and 10 days, respectively, prostatic inflammatory changes of type nonbacterial prostatitis were found in a lobe-differentiated histological examination. The inflammatory manifestations were marked in the ventral lobes, whereas they were sparse in the dorsolateral lobes. The lobe difference in this respect corresponds to a concomitant difference in morphology and tissue chemical content.

Animals↗