Biomedical subjects

V Horstmann

Publications and source records attributed to V Horstmann.

12 recordsLinked to original sources

PubMed2004

Dementia in first-degree relatives of patients with frontotemporal dementia. A family history study.

Several studies have found a clustering of dementia in relatives of patients with frontotemporal dementia (FTD). This study analysed the familial aggregation of FTD specifically as well as the occurrence of dementia in general in first-degree relatives of patients with FTD. A family history study was carried out on 478 first-degree relatives of 74 index patients suffering from FTD. Cases of organic dementia and of FTD were diagnosed according to internationally accepted diagnostic criteria. Age- and sex-specific incidences of organic dementia and of FTD were calculated as was the proportion of FTD in relation to organic dementia in general; comparisons with clinical and population studies were made. There was a tenfold increase in the incidence of FTD in the first-degree relatives of FTD patients compared with the incidence of FTD in a population study. The proportion of FTD in relation to all types of organic dementia was much higher in relatives of FTD patients compared to the corresponding proportions in clinical and population-based studies. There was a small, non-significant difference between the present family history study and the population studies as regards the incidence of organic dementia. The findings suggest that hereditary and/or shared environmental factors are strongly involved in the aetiology of FTD. There were no indications of familial clustering of organic dementia in general in relatives of FTD patients.

Adult↗

PubMed2004

Efficacy and tolerability of levetiracetam in patients with therapy-resistant epilepsy and learning disabilities.

INTRODUCTION: The purpose was to evaluate the effects of levetiracetam (LEV) in routine therapy in learning disabled patients with therapy-resistant epilepsy. METHODS: In an open observational add-on study design, 46 patients (residents of the Bethel Epilepsy Centre) with severe therapy-resistant epilepsy and different degrees of learning disabilities, who were treated with LEV between its introduction in Autumn 2000 and February 2002, were evaluated retrospectively. Information on monthly seizure frequencies, seizure severity and psychiatric status was extracted from the current patient case records. A 3 months baseline and a 3 months LEV treatment period (after 3 months of titration) were compared. Responders were defined as having a 50% reduction in seizure frequency and being evaluated as good or very good in an ad hoc global clinical efficacy scale. When only one criterion was positive, a careful individual decision was made based on the impact on the patients' daily activities. RESULTS: The responder rate was 41.3% (34.8 for 50% seizure reduction). It was higher in focal and multifocal epilepsy as compared to symptomatic generalised epilepsy/Lennox Gastaut Syndrome (P<0.05). Antiepileptic response occurred in doses between 500 and 4000 mg/day. Changes in seizure severity were rare. Nine patients experienced positive psychotropic effects (mostly improved vigilance and mood); six of these patients had antiepileptic effects as well. Twelve patients had adverse effects, mostly mild; in three cases, however, more severe effects led to discontinuation. CONCLUSIONS: LEV is an effective and generally well-tolerated drug for this patient group, especially in focal and multifocal epilepsy.

Adolescent↗

PubMed2003

Evaluation of predictors of mortality in frontotemporal dementia-methodological aspects.

OBJECTIVES: To retrospectively evaluate pre-diagnostic clinical features (predictors) of mortality in frontotemporal dementia (FTD). The main aim was to investigate if there were indications against interpreting missing data as signs of absence. MATERIAL AND METHODS: 96 cases with FTD, here defined as Dementia in Pick's disease according to ICD-10. The predictors were behavioural/psychiatric features, language impairment and neurological deficits up to the date of diagnosis. Each predictor was rated as present (Yes), absent (No) or not recorded (Missing), and evaluated according to its distribution and mortality pattern: if a feature was not recorded because it was absent, the mortality of the Missing and the No-category should hypothetically be close. Statistical methods included Kaplan-Meier survival curves and Cox regression analyses. RESULTS: Neurological deficits and language impairments were frequently recorded as present or absent, while non-recordings were more prevalent among the behavioural/psychiatric features. Some features were excluded as predictors because they showed too little variation. Analyses of the survival pattern indicated that in some features, the observations of the Missing-category could be interpreted as absence of the symptoms. In other features these observations had to be regarded as truly missing. CONCLUSIONS: In the retrospective evaluation of predictors of mortality a method for treating missing data was applied. The interpretation of non-recordings as signs of absence was supported by the analyses of the survival patterns in some of the studied features. However, the study underscores the importance of systematic estimations of pre-diagnostic clinical features in dementia.

Aged↗

PubMed2003

Predictors of mortality in frontotemporal dementia: a retrospective study of the prognostic influence of pre-diagnostic features.

OBJECTIVES: To find associations between predictors and survival in frontotemporal dementia (FTD). METHODS: 96 patients with FTD, here defined as Dementia in Pick's disease, were studied. The predictors included psychiatric/behavioural features, language impairment and neurological deficits present up to the time of diagnosis. The influence on mortality was studied by means of Cox regression analyses. RESULTS: Most of the behavioural/psychiatric features were associated with longer survival. Among these features, anxiety and suicidal ideation were associated with a statistically significant decreased mortality. Semi-mutism/mutism and neurological deficits were associated with a statistically significant increased mortality. Analyses of the dementia-specific mortality strengthened the already significant results and revealed dysphagia as significantly related to increased mortality. CONCLUSIONS: Two groups of predictors with different influence on survival were identified in FTD. Most behavioural/psychiatric features were associated with longer survival. These features may indicate a slower disease progress and a better preserved cerebral function. By contrast, semi-mutism/mutism, neurological deficits and dysphagia were associated with shorter survival, indicating an aggressive, degenerative process.

Female↗

PubMed2000

Musculoskeletal symptoms among dental personnel; - lack of association with mercury and selenium status, overweight and smoking.

Our objective was to describe the occurrence of musculoskeletal symptoms and how they affect the daily life of three different occupational groups of dental personnel. A cross sectional-study was performed among 268 dental staff members and 111 referents. Female dental hygienists and female dentists showed, compared with their referents, higher prevalence of symptoms during the past 12 months from neck, shoulders and hands/wrists. Both dental groups also had higher frequencies of combined symptoms from these body regions, as well as longer duration of symptoms in neck and shoulders during the past 12-month period. Male dentists had higher frequencies of neck and shoulder symptoms compared with their referents. Female dental assistants did not deviate from their referents. The symptoms from each single body region, or the occurrence of symptoms from multiple regions in a subject, did not show any statistically significant association with mercury (whole blood and urinary levels) or selenium (plasma level) status, neither with smoking habits nor overweight (Body Mass Index). The high frequency of musculoskeletal disorders probably reflects the specific work load in dentistry, with high demands on vision and precision and fine manipulative hand movements and work with unsupported, elevated arms. The symptoms might impair work capacity and the future possibility to stay in the profession. Further studies are needed to verify this.

Adult↗

PubMed1996

Survival in cohorts of asbestos cement workers and controls.

OBJECTIVES: To measure the impact on survival of being exposed to asbestos cement dust. METHODS: Survival of 866 asbestos cement workers and 755 controls was studied with Cox's proportional hazards regression models with age as the basic time variable. The effect of cumulative exposure up to the age of 40 was investigated in an internal analysis of 635 asbestos cement workers who had dose estimates. RESULTS: The death risk was higher for the asbestos cement workers than for the controls with a hazard ratio (HR) of 1.15 (95% confidence interval was 1.00 to 1.31). The increased risk found seemed to be confined to the period 20-40 years from start of employment. The estimates of the cohort effect were almost unaffected by adjustment for smoking habits. The estimates of the exposure effect rose with increasing dose (< 4 fibre-years/ml (f-y/ml): HR = 1.00, 4-9.9 f-y/ml: HR = 1.06, > or = 10 f-y/ml: HR = 1.35, for workers with at least five years of employment), and were higher when restricted only to deaths from malignant or non-malignant respiratory disease. However, none of the point estimates were significantly increased. Median age at death was two years lower in the high than in the low, exposure group. CONCLUSIONS: The results indicate that even a moderate asbestos exposure may shorten the median duration of life in an exposed population. Compared with the estimated effect on duration of life from ever being a smoker, that of ever being an asbestos cement worker was less, although that of having a high exposure was similar.

Adult↗

PubMed1995

Adjustment of a sparse and irregular reference rate matrix.

Regional sex-specific rates of a rare disease often show conspicuous fluctuations over conventional strata of age and calendar time. In a cohort study, when such rates are used as references in the calculation of the expected number of cases, the accumulated person-time of the study cohort may somewhat haphazardly contribute to the result. For example, only the person-time observed in the strata with at least one reference case registered contributes to the expected number of cases. It may therefore be important to evaluate whether the regional rates seem to differ systematically from the more stable national rates. When such differences may be indicated, a fairly simple method is proposed for smoothing rates. This method aims to produce rates that better reflect the underlying, supposedly smooth, rate pattern over age and calendar time in a population of interest. The present paper illustrates the technique by considering right-sided colon cancer incidence rates from a regional male population, which the authors use to calculate the expected number of such cases in an occupational cohort.

Cohort Studies↗

PubMed1995

Neuropathy in female dental personnel exposed to high frequency vibrations.

OBJECTIVE: To evaluate early neuropathy in dental personnel exposed to high frequency vibrations. METHODS: 30 dentists and 30 dental hygienists who used low and high speed hand pieces and ultrasonic scalers were studied, and 30 dental assistants and 30 medical nurses not exposed to vibration (all women). Vibrotactile sensibility, strength, motor performance, sensorineural symptoms and signs, and vascular symptoms in the hands, as well as mercury concentrations in biological samples and cervicobrachial symptoms, were studied. RESULTS: The two groups exposed to vibration had significant impairments of vibrotactile sensibility, strength, and motor performance, as well as more frequent sensorineural symptoms. In the dentists there were significant associations between the vibrotactile sensibility and strength, motor performance, superficial sensibility, and sensorineural symptoms. There were no associations between these findings and cervicobrachial symptoms, mercury concentrations, or smoking. There was no increase of vascular symptoms of the hands in the groups exposed to vibration. CONCLUSION: Dental hygienists and dentists had a slight neuropathy, which may be associated with their exposure to high frequency vibrations, and which may be detrimental to their work performance. Thus, development of safer equipment is urgent.

Adult↗

PubMed1993

Mortality and tumour morbidity among Swedish market gardeners and orchardists.

In order to investigate possible effects of exposure to pesticides, mainly fungicides and insecticides, we studied a cohort of 2370 subjects, who, during the period 1965-1982, had been members of a horticulturists' trade association (market gardeners and orchardists). Compared to a regional reference population, total mortality (542 deaths; standardized mortality morbidity ratio, SMR = 0.8; 95% confidence limits, CLs = 0.7, 0.9) and mortality due to malignant tumours (133 deaths, SMR = 0.9; CLs = 0.7, 1.0), and cardiovascular and respiratory deaths were somewhat decreased. Suggestive excesses in mortality were seen for mental disorders and tumours of the stomach, skin and nervous system. The tumours of the nervous system were in particular excess in the young and middle-aged horticulturists (below age 60; six cases, SMR = 2.9; CLs = 1.1, 6.2). During the period 1965-1986, the total tumour morbidity was slightly decreased (255 cases; SMR = 0.9; CLs = 0.8, 1.0), as were gastrointestinal and respiratory tract tumours. The incidence of melanomas was increased (15 cases, SMR = 2.1; CLs = 1.2, 3.5), and tumours of the female genital organs, myelomas, and brain tumours (12 cases, SMR = 1.5; CLs = 0.8, 2.7) were slightly numerically elevated. Brain tumours in the young and middle-aged horticulturists (11 cases, SMR = 3.2; CLs = 1.6, 5.7), including meningiomas (four observed, SMR = 6.8; CLs = 1.9, 17.4), were increased, especially in the period 1975-1979. The mortality and tumour morbidity patterns in gardeners and orchardists, analysed separately, were similar to the patterns in all the horticulturists.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1993

Mortality and cancer morbidity among cement workers.

OBJECTIVE: To explore associations between exposure to cement dust and cause specific mortality and tumour morbidity, especially gastrointestinal tumours. DESIGN: A retrospective cohort study. SUBJECTS AND SETTING: 2400 men, employed for at least 12 months in two Swedish cement factories. MAIN OUTCOME MEASURES: Cause specific morality from death certificates (1952-86). Cancer morbidity from tumour registry information (1958-86). Standardised mortality rates (SMRs; national reference rates) and standardised morbidity incidence rates (SIRs; regional reference rates) were calculated. RESULTS: An increased risk of colorectal cancer was found > or = 15 years since the start of employment (SIR 1.6, 95% confidence interval (95% CI) 1.1-2.3), mainly due to an increased risk for tumours in the right part of the colon (SIR 2.7, 95% CI 1.4-4.8), but not in the left part (SIR 1.0, 95% CI 0.3-2.5). There was a numerical increase of rectal cancer (SIR 1.5, 95% CI 0.8-2.5). Exposure (duration of blue collar employment)-response relations were found for right sided colon cancer. After > or = 25 years of cement work, the risk was fourfold (SIR 4.3, 95% CI 1.7-8.9). There was no excess of stomach cancer or respiratory cancer. Neither total mortality nor cause specific mortality were significantly increased. CONCLUSIONS: Diverging risk patterns for tumours with different localisations within the large bowel were found in the morbidity study. Long term exposure to cement dust was a risk factor for right sided colon cancer. The mortality study did not show this risk.

Cause of Death↗

PubMed1992

Allergy to methyltetrahydrophthalic anhydride in epoxy resin workers.

One hundred and forty four current and 26 former workers in a plant producing barrels for rocket guns from an epoxy resin containing methyltetrahydrophthalic anhydride (MTHPA; time weighted average air concentration up to 150 micrograms/m3) were studied. They showed higher frequencies of work related symptoms from the eyes (31 v 0%; p < 0.001), nose (53 v 9%; p < 0.001), pharynx (26 v 6%; p < 0.01), and asthma (11 v 0%; p < 0.05) than 33 controls. Also they had higher rates of positive skin prick test to a conjugate of MTHPA and human serum albumin (16 v 0%; p < 0.01), and more had specific IgE and IgG serum antibodies (18 v 0%; p < 0.01 and 12 v 0%; p < 0.05 respectively). There were statistically significant exposure-response relations between exposure and symptoms from eyes and upper airways, dry cough, positive skin prick test, and specific IgE and IgG antibodies. There was a non-significant difference in reaction to metacholine between exposed workers and non-smoking controls. In workers with and without specific IgE antibodies, differences existed in frequency of nasal secretion (54 v 23%; p < 0.05) and dry cough (38 v 12%; p < 0.05). Workers with specific IgG had more dry cough (38 v 12%; p < 0.05), but less symptoms of non-specific bronchial hyperreactivity (0 v 26%; p < 0.05). Atopic workers sneezed more than non-atopic workers (65 v 30%; p < 0.01). In a prospective study five sensitised workers who left the factory became less reactive to metacholine, and became symptom free. In 41 workers who stayed, there was no improvement, despite a 10-fold reduction in exposure. The results show the extreme sensitising properties of MTHPA.

Adolescent↗

PubMed1984

The overall mortality rate in patients with total hip arthroplasty, with special reference to coxarthrosis.

The mortality rate was calculated in 1385 patients with total hip arthroplasties compared with the population at risk in the period from 1968 to 1981. In elderly women with coxarthrosis, after the age of 70, the mortality rate decreased after the first postoperative year. There was no such effect in men. In women, there were no changes in mortality rate in those who had had revision operations, whereas in men operated on for coxarthrosis who were over the age of 70, there was an increased mortality rate after the first postoperative year following revision. Patients operated on for complications after hip fracture and/or rheumatoid arthritis had an increased mortality rate after the first postoperative year, including both women and men below age 70.

Adult↗