Title: Effect of risk-based capitation model on caries inequalities in preschool children assesse... more Title: Effect of risk-based capitation model on caries inequalities in preschool children assessed by geo-mapping Authors: Svante. Twetman (stwe@sund.ku.dk) Anders Holmen (anders.holmen@regionhalland.se) Ulf Stromberg (ulf.a.stromberg@gu.se) Gunnel Hakansson (gunnel.hakansson@regionhalland.se) Version: 1 Date: 02 Nov 2017 Author’s response to reviews: Editor Comments: Please comment in particular on description of outliers as well as of the influence of migration on the results.
The Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambul... more The Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambulance nurses based on patient needs regarding appropriate levels of care. A new model for patients with non-urgent medical conditions has been introduced. The main objective of this study was to examine early prehospital assessment of non-urgent patients, and its impact on the choice of the appropriate level of care. The study design was a 1-year, prospective study, involving an ambulance district in southwestern Sweden with a population of 78,000. Eligible patients were from18years of age, assessed as priority GREEN by Rapid Emergency Triage and Treatment System (RETTS). Ambulance nurses contacted primary care physicians on decisions on whether a patient should be transported to a primary healthcare unit or an A&E. Data was collected from electronic health records from April 2014 to July 2015. A comparison was made with a retrospective control group without consulting a physician concerning the appropriate level of care. 394 patients were included, 184 in the intervention group, and 210 in the control group. There were statistically significant differences in favor of the study group (p<0.001) regarding no transport, or transport and admission to an A&E. The groups did not differ significantly regarding transport to a primary care unit. This prehospital assessment model indicates a decrease in ambulance transports to an A&E and admissions to a hospital ward. Collaboration between ambulance nurses and primary physicians affects the decision for the appropriate level of care for patients with a non-urgent condition.
The rationale behind screening for atrial fibrillation (AF) is to prevent ischemic stroke. Socio-... more The rationale behind screening for atrial fibrillation (AF) is to prevent ischemic stroke. Socio-demographic differences are expected to affect screening uptake. Geographic differences may provide further insights leading to targeted interventions for improved uptake. The objective of this study was to evaluate geographic and socio-demographic differences in uptake of AF screening in the population-based study STROKESTOP I. STROKESTOP was carried out in two Swedish counties with a total population of 2.3 million inhabitants. Half of the residents aged 75-76years were randomized to the screening arm: invitation to clinical examination followed by ambulant ECG recording. Information on each invited person's residential parish (n=157) was used. On parish-level, aggregated data for the participants and non-participants, respectively, were obtained with respect to socioeconomic variables: educational level, disposable income, immigrant and marital status. Geo-maps displaying participation ratios were estimated by hierarchical Bayes methods. The overall participation rate was similar in men and women but lower in Stockholm, 47.6% (5665/11,903) than in Halland, 61.2% (1495/2443). Participation was clearly associated with the socioeconomic variables. Participation not taking into account socioeconomy varied more markedly across the parishes in the Stockholm county (range: 0.65-1.26) than in the Halland county (0.94-1.27). After adjustment for socioeconomic variables, a geographic variation remained in Stockholm, but not in Halland. Participation in AF screening varied according to socioeconomic conditions. Geographic variation in participation was marked in the Stockholm county, with only one screening clinic. Geo-mapping of participation yielded useful information needed to intervene for improved screening uptake.
Screening strategies need to consider differences in late-stage disease detection linked to socio... more Screening strategies need to consider differences in late-stage disease detection linked to socio-demographic and geographic factors. We specifically addressed disparity in melanoma stage at diagnosis linked to residential municipality, gender and marital status within the middle- and old-age population of southern and western Sweden. Population-based registers were used to identify the melanoma cases diagnosed in 2004-2013 (n=7,417). Disease mapping for each population group based on gender and marital status showed marked spatial disparities in melanoma incidences and the overall patterns differed by stage at diagnosis. The incidence of early-stage melanoma was markedly higher in the western region, whereas the incidence of late-stage melanoma was markedly higher in the southern region except for married women. Excess mortality among cases was observed to be higher in the southern than in the western region, with significant regional differences for the married male cases and the unmarried female cases.
Journal of Investigational Allergology Clinical Immunology, 1996
The results of skin prick tests (SPTs) performed between 1981 and 1992 on 7099 adult patients wit... more The results of skin prick tests (SPTs) performed between 1981 and 1992 on 7099 adult patients with asthma and/or rhinitis were retrospectively analyzed. Standardized Soluprick extracts of Dermatophagoides pteronyssinus, animals and pollen, and unstandardized extracts of Cladosporium++ and chironomids (red mosquito larvae, Chir), were used. The proportion of atopics (patients with positive SPT results) was 44 percent, decreasing from 61 percent in patients 14-20 years old to 18 percent in patients 61-70 years old. The decrease with age was most pronounced with timothy, cat and horse allergens. In the whole patient group, timothy, cat and birch gave the highest number of positive SPTs. Positive SPTs with dog and Chir were more common in asthmatics than in patients with rhinitis, whereas pollen allergy was more common in patients with rhinitis. Sensitization against D. pteronyssinus, timothy and Chir was more common in men than in women. Of the atopic patients, 65 percent were sensitized against several allergens and 35 percent had a mono-allergy, most frequently to D. pteronyssinus (7.4 percent) and timothy (70 percent). The proportion monoallergies/multi-allergies was higher in older patients than in younger ones. The degree of atopy, expressed as the sum of plusses of the test results with eight allergens for each patient, was higher in younger patients than in older ones. The size of the wheals induced by the positive histamine control increased with age, and the histamine-induced wheals were larger in men than in women and larger in non-atopics than in topics. Strong correlations were found between test results with cat, dog and horse. A greater proportion of the patients with an isolated pollen allergy were born in February-May than was to be expected. The proportion of positive SPTs with mugwort (Artemisia), in relation to positive SPTs with other pollen allergens, decreased from 1981 to 1992. It can be concluded that sensitization to various inhalant allergens is influenced by age, and to a lesser extent by sex, and that pollen sensitization is influenced by the month of birth. During a 12-year period, sensitization to mugwort showed a decrease, as compared to other pollen allergens.
Mutation Research Fundamental and Molecular Mechanisms of Mutagenesis, Aug 31, 1998
This is an investigation of 54 boys and 23 girls with a median age of 19 years (range 18-22 years... more This is an investigation of 54 boys and 23 girls with a median age of 19 years (range 18-22 years). The study group contained 12 boys and five girls with asthma and 23 boys and seven girls with allergic rhinitis. Sensitivity to pollen and furred animals were reported by 22 boys and eight girls and by 17 boys and six girls, respectively. The levels of serum immune proteins (IgA, IgE and IgG with subclasses, and IgM) were determined by immunological techniques. As a biomarker of chromosomal damages, the lymphocyte micronuclei was used. We analyzed the frequencies of micronuclei in 3000 B-lymphocytes and in equal numbers of T4- and T8-lymphocytes. The lymphocytes were separated by magnetic attraction in T4 (CD4), T8 (CD8) and B (CD19) fractions using Dynabeads(R). The most interesting finding of this investigation was that the three markers of atopic disease, asthma, hypersensitivity to pollen and IgE levels, associated significantly with increased frequencies of micronuclei in B-lymphocytes. There was also a relation between IgA and the frequency of micronuclei in B-cells. In an epidemiological study of 7000 individuals with allergic diseases, we have found an over-risk for lymphomas in the group with positive skin prick test. Hypothetically, we think that there may be a link between our present finding of an increased mutagenic activity and the lymphoma over-risk among individuals with allergic disease since most lymphomas stem from B-lymphocytes.
ABSTRACT A liquid chromatographic method for the determination of antiepileptic drugs in serum is... more ABSTRACT A liquid chromatographic method for the determination of antiepileptic drugs in serum is described. The drugs were adsorbed on activated charcoal from which they were recovered by extraction with methylene chloride. The organic extracts were evaporated to dryness and the residues were dissolved in small volumes of the mobile phase. The extracts were clean. Only trace amounts of endogenic compounds were detected. The chromatographic separation was performed with a radially compressed column (C18) that was used daily for several months.
The objective was to identify dental professionals' attitudes and awareness on evidence based... more The objective was to identify dental professionals' attitudes and awareness on evidence based dentistry (EBD), and to elucidate perceived barriers and views on how to move towards EBD. A questionnaire was sent to 290 dental professionals (dental hygienists, general dentists, specialist dentists) in the county of Halland, Sweden. The questionnaire consisted of closed questions and free text sections, related to attitudes, awareness and skills on databases, EBD, and terms related to scientific publications, as well as perceived barriers towards EBD. A majority of the respondents had a welcoming attitude towards EBD. The respondents perceived their colleagues less positive towards EBD. The respondents considered EBD, at least partly, useful in daily dental practice. With the exception of general dentists in private practice, a vast majority of the dental professionals thought that EBD would improve the care of their patients. Dental professionals in the county of Halland, in Sweden...
This is an investigation of 54 boys and 23 girls with a median age of 19 years (range 18-22 years... more This is an investigation of 54 boys and 23 girls with a median age of 19 years (range 18-22 years). The study group contained 12 boys and five girls with asthma and 23 boys and seven girls with allergic rhinitis. Sensitivity to pollen and furred animals were reported by 22 boys and eight girls and by 17 boys and six girls, respectively. The levels of serum immune proteins (IgA, IgE and IgG with subclasses, and IgM) were determined by immunological techniques. As a biomarker of chromosomal damages, the lymphocyte micronuclei was used. We analyzed the frequencies of micronuclei in 3000 B-lymphocytes and in equal numbers of T4- and T8-lymphocytes. The lymphocytes were separated by magnetic attraction in T4 (CD4), T8 (CD8) and B (CD19) fractions using Dynabeads(R). The most interesting finding of this investigation was that the three markers of atopic disease, asthma, hypersensitivity to pollen and IgE levels, associated significantly with increased frequencies of micronuclei in B-lymph...
This investigation studied the effects of a shift from a well-balanced mixed diet to a lacto-vege... more This investigation studied the effects of a shift from a well-balanced mixed diet to a lacto-vegetarian diet on the mutagenic activity in urine and feces and on some cancer-associated bacterial enzymes in human feces (beta-glucuronidase, beta-glucosidase, and sulphatase). Three months after the shift to the lacto-vegetarian diet, there was a significant decrease in mutagenic activity in urine and feces, beta-glucuronidase, beta-glucosidase, and sulphatase per gram feces wet weight. In contrast, the fecal mutagenic activity and the enzyme activities remained unchanged if expressed per daily output. However, the urinary mutagenic activity expressed as total daily output decreased. Part of the explanation for the decreased fecal mutagenic activity and the decreased enzyme activities is obviously a dilution effect, because much of the increased fecal weight after the shift in diet was associated with a higher water content.
Title: Effect of risk-based capitation model on caries inequalities in preschool children assesse... more Title: Effect of risk-based capitation model on caries inequalities in preschool children assessed by geo-mapping Authors: Svante. Twetman (stwe@sund.ku.dk) Anders Holmen (anders.holmen@regionhalland.se) Ulf Stromberg (ulf.a.stromberg@gu.se) Gunnel Hakansson (gunnel.hakansson@regionhalland.se) Version: 1 Date: 02 Nov 2017 Author’s response to reviews: Editor Comments: Please comment in particular on description of outliers as well as of the influence of migration on the results.
The Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambul... more The Ambulance Organization of Sweden provides qualified medical assessment and treatment by ambulance nurses based on patient needs regarding appropriate levels of care. A new model for patients with non-urgent medical conditions has been introduced. The main objective of this study was to examine early prehospital assessment of non-urgent patients, and its impact on the choice of the appropriate level of care. The study design was a 1-year, prospective study, involving an ambulance district in southwestern Sweden with a population of 78,000. Eligible patients were from18years of age, assessed as priority GREEN by Rapid Emergency Triage and Treatment System (RETTS). Ambulance nurses contacted primary care physicians on decisions on whether a patient should be transported to a primary healthcare unit or an A&E. Data was collected from electronic health records from April 2014 to July 2015. A comparison was made with a retrospective control group without consulting a physician concerning the appropriate level of care. 394 patients were included, 184 in the intervention group, and 210 in the control group. There were statistically significant differences in favor of the study group (p<0.001) regarding no transport, or transport and admission to an A&E. The groups did not differ significantly regarding transport to a primary care unit. This prehospital assessment model indicates a decrease in ambulance transports to an A&E and admissions to a hospital ward. Collaboration between ambulance nurses and primary physicians affects the decision for the appropriate level of care for patients with a non-urgent condition.
The rationale behind screening for atrial fibrillation (AF) is to prevent ischemic stroke. Socio-... more The rationale behind screening for atrial fibrillation (AF) is to prevent ischemic stroke. Socio-demographic differences are expected to affect screening uptake. Geographic differences may provide further insights leading to targeted interventions for improved uptake. The objective of this study was to evaluate geographic and socio-demographic differences in uptake of AF screening in the population-based study STROKESTOP I. STROKESTOP was carried out in two Swedish counties with a total population of 2.3 million inhabitants. Half of the residents aged 75-76years were randomized to the screening arm: invitation to clinical examination followed by ambulant ECG recording. Information on each invited person's residential parish (n=157) was used. On parish-level, aggregated data for the participants and non-participants, respectively, were obtained with respect to socioeconomic variables: educational level, disposable income, immigrant and marital status. Geo-maps displaying participation ratios were estimated by hierarchical Bayes methods. The overall participation rate was similar in men and women but lower in Stockholm, 47.6% (5665/11,903) than in Halland, 61.2% (1495/2443). Participation was clearly associated with the socioeconomic variables. Participation not taking into account socioeconomy varied more markedly across the parishes in the Stockholm county (range: 0.65-1.26) than in the Halland county (0.94-1.27). After adjustment for socioeconomic variables, a geographic variation remained in Stockholm, but not in Halland. Participation in AF screening varied according to socioeconomic conditions. Geographic variation in participation was marked in the Stockholm county, with only one screening clinic. Geo-mapping of participation yielded useful information needed to intervene for improved screening uptake.
Screening strategies need to consider differences in late-stage disease detection linked to socio... more Screening strategies need to consider differences in late-stage disease detection linked to socio-demographic and geographic factors. We specifically addressed disparity in melanoma stage at diagnosis linked to residential municipality, gender and marital status within the middle- and old-age population of southern and western Sweden. Population-based registers were used to identify the melanoma cases diagnosed in 2004-2013 (n=7,417). Disease mapping for each population group based on gender and marital status showed marked spatial disparities in melanoma incidences and the overall patterns differed by stage at diagnosis. The incidence of early-stage melanoma was markedly higher in the western region, whereas the incidence of late-stage melanoma was markedly higher in the southern region except for married women. Excess mortality among cases was observed to be higher in the southern than in the western region, with significant regional differences for the married male cases and the unmarried female cases.
Journal of Investigational Allergology Clinical Immunology, 1996
The results of skin prick tests (SPTs) performed between 1981 and 1992 on 7099 adult patients wit... more The results of skin prick tests (SPTs) performed between 1981 and 1992 on 7099 adult patients with asthma and/or rhinitis were retrospectively analyzed. Standardized Soluprick extracts of Dermatophagoides pteronyssinus, animals and pollen, and unstandardized extracts of Cladosporium++ and chironomids (red mosquito larvae, Chir), were used. The proportion of atopics (patients with positive SPT results) was 44 percent, decreasing from 61 percent in patients 14-20 years old to 18 percent in patients 61-70 years old. The decrease with age was most pronounced with timothy, cat and horse allergens. In the whole patient group, timothy, cat and birch gave the highest number of positive SPTs. Positive SPTs with dog and Chir were more common in asthmatics than in patients with rhinitis, whereas pollen allergy was more common in patients with rhinitis. Sensitization against D. pteronyssinus, timothy and Chir was more common in men than in women. Of the atopic patients, 65 percent were sensitized against several allergens and 35 percent had a mono-allergy, most frequently to D. pteronyssinus (7.4 percent) and timothy (70 percent). The proportion monoallergies/multi-allergies was higher in older patients than in younger ones. The degree of atopy, expressed as the sum of plusses of the test results with eight allergens for each patient, was higher in younger patients than in older ones. The size of the wheals induced by the positive histamine control increased with age, and the histamine-induced wheals were larger in men than in women and larger in non-atopics than in topics. Strong correlations were found between test results with cat, dog and horse. A greater proportion of the patients with an isolated pollen allergy were born in February-May than was to be expected. The proportion of positive SPTs with mugwort (Artemisia), in relation to positive SPTs with other pollen allergens, decreased from 1981 to 1992. It can be concluded that sensitization to various inhalant allergens is influenced by age, and to a lesser extent by sex, and that pollen sensitization is influenced by the month of birth. During a 12-year period, sensitization to mugwort showed a decrease, as compared to other pollen allergens.
Mutation Research Fundamental and Molecular Mechanisms of Mutagenesis, Aug 31, 1998
This is an investigation of 54 boys and 23 girls with a median age of 19 years (range 18-22 years... more This is an investigation of 54 boys and 23 girls with a median age of 19 years (range 18-22 years). The study group contained 12 boys and five girls with asthma and 23 boys and seven girls with allergic rhinitis. Sensitivity to pollen and furred animals were reported by 22 boys and eight girls and by 17 boys and six girls, respectively. The levels of serum immune proteins (IgA, IgE and IgG with subclasses, and IgM) were determined by immunological techniques. As a biomarker of chromosomal damages, the lymphocyte micronuclei was used. We analyzed the frequencies of micronuclei in 3000 B-lymphocytes and in equal numbers of T4- and T8-lymphocytes. The lymphocytes were separated by magnetic attraction in T4 (CD4), T8 (CD8) and B (CD19) fractions using Dynabeads(R). The most interesting finding of this investigation was that the three markers of atopic disease, asthma, hypersensitivity to pollen and IgE levels, associated significantly with increased frequencies of micronuclei in B-lymphocytes. There was also a relation between IgA and the frequency of micronuclei in B-cells. In an epidemiological study of 7000 individuals with allergic diseases, we have found an over-risk for lymphomas in the group with positive skin prick test. Hypothetically, we think that there may be a link between our present finding of an increased mutagenic activity and the lymphoma over-risk among individuals with allergic disease since most lymphomas stem from B-lymphocytes.
ABSTRACT A liquid chromatographic method for the determination of antiepileptic drugs in serum is... more ABSTRACT A liquid chromatographic method for the determination of antiepileptic drugs in serum is described. The drugs were adsorbed on activated charcoal from which they were recovered by extraction with methylene chloride. The organic extracts were evaporated to dryness and the residues were dissolved in small volumes of the mobile phase. The extracts were clean. Only trace amounts of endogenic compounds were detected. The chromatographic separation was performed with a radially compressed column (C18) that was used daily for several months.
The objective was to identify dental professionals' attitudes and awareness on evidence based... more The objective was to identify dental professionals' attitudes and awareness on evidence based dentistry (EBD), and to elucidate perceived barriers and views on how to move towards EBD. A questionnaire was sent to 290 dental professionals (dental hygienists, general dentists, specialist dentists) in the county of Halland, Sweden. The questionnaire consisted of closed questions and free text sections, related to attitudes, awareness and skills on databases, EBD, and terms related to scientific publications, as well as perceived barriers towards EBD. A majority of the respondents had a welcoming attitude towards EBD. The respondents perceived their colleagues less positive towards EBD. The respondents considered EBD, at least partly, useful in daily dental practice. With the exception of general dentists in private practice, a vast majority of the dental professionals thought that EBD would improve the care of their patients. Dental professionals in the county of Halland, in Sweden...
This is an investigation of 54 boys and 23 girls with a median age of 19 years (range 18-22 years... more This is an investigation of 54 boys and 23 girls with a median age of 19 years (range 18-22 years). The study group contained 12 boys and five girls with asthma and 23 boys and seven girls with allergic rhinitis. Sensitivity to pollen and furred animals were reported by 22 boys and eight girls and by 17 boys and six girls, respectively. The levels of serum immune proteins (IgA, IgE and IgG with subclasses, and IgM) were determined by immunological techniques. As a biomarker of chromosomal damages, the lymphocyte micronuclei was used. We analyzed the frequencies of micronuclei in 3000 B-lymphocytes and in equal numbers of T4- and T8-lymphocytes. The lymphocytes were separated by magnetic attraction in T4 (CD4), T8 (CD8) and B (CD19) fractions using Dynabeads(R). The most interesting finding of this investigation was that the three markers of atopic disease, asthma, hypersensitivity to pollen and IgE levels, associated significantly with increased frequencies of micronuclei in B-lymph...
This investigation studied the effects of a shift from a well-balanced mixed diet to a lacto-vege... more This investigation studied the effects of a shift from a well-balanced mixed diet to a lacto-vegetarian diet on the mutagenic activity in urine and feces and on some cancer-associated bacterial enzymes in human feces (beta-glucuronidase, beta-glucosidase, and sulphatase). Three months after the shift to the lacto-vegetarian diet, there was a significant decrease in mutagenic activity in urine and feces, beta-glucuronidase, beta-glucosidase, and sulphatase per gram feces wet weight. In contrast, the fecal mutagenic activity and the enzyme activities remained unchanged if expressed per daily output. However, the urinary mutagenic activity expressed as total daily output decreased. Part of the explanation for the decreased fecal mutagenic activity and the decreased enzyme activities is obviously a dilution effect, because much of the increased fecal weight after the shift in diet was associated with a higher water content.
Uploads
Papers by Anders Holmén