267 results on '"E Nyström"'
Search Results
2. 234 LONG-TERM RESULTS OF APP-BASED SELF-MANAGEMENT OF URGENCY AND MIXED URINARY INCONTINENCE IN WOMEN
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T Wadensten, E Nyström, A Nord, A Lindam, M Sjöström, and E Samuelsson
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Diseases of the genitourinary system. Urology ,RC870-923 - Published
- 2022
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3. The influence of organizational models on the implementation of internet-based cognitive behavior therapy in primary care: A mixed methods study using the RE-AIM framework
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Elisabet Gervind, Mathilda Ben Salem, Cecilia Svanborg, Monica E. Nyström, Josefine L. Lilja, Viktor Kaldo, and Sandra Weineland
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Internet-based cognitive behavior therapy ,iCBT ,Implementation science ,Complex intervention ,Primary care ,RE-AIM framework ,Information technology ,T58.5-58.64 ,Psychology ,BF1-990 - Abstract
Background: Internet-Based Cognitive Behavioral Therapy (iCBT) holds great potential in addressing mental health issues, yet its real-world implementation poses significant challenges. While prior research has predominantly focused on centralized care models, this study explores the implementation of iCBT in the context of decentralized organizational structures within the Swedish primary care setting, where all interventions traditionally are delivered at local Primary Care Centers (PCCs). Aim: This study aims to enhance our understanding of iCBT implementation in primary care and assess the impact of organizational models on the implementation's outcome using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. Method: A mixed-methods research design was employed to identify the factors influencing iCBT implementation across different levels, involving patients, therapists and managers. Data spanning two years was collected and analyzed through thematic analysis and statistical tests. The study encompassed 104 primary care centers, with patient data (n = 1979) sourced from the Swedish National Quality Register for Internet-Based Psychological Treatment (SibeR). Additionally, 53 iCBT therapists and 50 PCC managers completed the Normalization Measure Development Questionnaire, and 15 leaders participated in interviews. Results: Our investigation identified two implementation approaches, one concentrated and one decentralized. Implementation effectiveness was evident through adherence rates suggesting that iCBT is a promising approach for treating mental ill-health in primary care, although challenges were observed concerning patient assessment and therapist drift towards unstructured treatment. Mandatory implementation, along with managerial and organizational support, positively impacted adoption. Results vary in terms of adherence to established protocols, with therapists working in concentrated model showing a significantly higher percentage of registration in the quality register SibeR (X2 (1, N = 2973) = 430.5774, p = 0.001). They also showed significantly higher means in cognitive participation (Z = −2.179, p = 0.029) and in reflective monitoring (Z = −2.548, p = 0.011). Discussion: Overall, the study results demonstrate that iCBT, as a complex and qualitatively different intervention from traditional psychological treatment, can be widely implemented in primary care settings. The study's key finding highlights the substantial advantages of the concentrated organizational model. This model has strengths in sustainability, encourages reflective monitoring among therapists, the use of quality registers, and enforces established protocols. Conclusion: In conclusion, this study significantly contributes to the understanding of the practical aspects associated with the implementation of complex internet interventions, particularly in the context of internet-based cognitive-behavioral therapy (iCBT). The study highlights that effective iCBT integration into primary care requires a multifaceted approach, taking into account organizational models, robust support structures, and a commitment to maintaining quality standards. By emphasizing these factors, our research aims to provide actionable insights that can enhance the practicability and real-world applicability of implementing iCBT in primary care settings.
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- 2024
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4. Systems thinking in practice when implementing a national policy program for the improvement of women's healthcare
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Monica E. Nyström, Sara Tolf, Vibeke Sparring, and Helena Strehlenert
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systems thinking ,healthcare improvement ,policy implementation ,public health ,healthcare services ,Public aspects of medicine ,RA1-1270 - Abstract
IntroductionInterest in applying systems thinking (ST) in public health and healthcare improvement has increased in the past decade, but its practical use is still unclear. ST has been found useful in addressing the complexity and dynamics of organizations and welfare systems during periods of change. Exploring how ST is used in practice in national policy programs addressing complex and ill-structured problems can increase the knowledge of the use and eventually the usefulness of ST during complex changes. In ST, a multi-level approach is suggested to coordinate interventions over individual, organizational, and community levels, but most attempts to operationalize ST focus on the individual level. This study aimed to investigate how ST is expressed in policy programs addressing wicked problems and describe the specific action strategies used in practice in a national program in Sweden, using a new conceptual framework comprising ST principles on the organizational level as an analytical tool. The program addresses several challenges and aims to achieve systems change within women's healthcare.MethodsThe case study used a rich set of qualitative, longitudinal data on individual, group, and organizational levels, collected during the implementation of the program. Deductive content analysis provided narrative descriptions of how the ST principles were expressed in actions, based on interviews, observations, and archival data.ResultsThe results showed that the program management team used various strategies and activities corresponding to organizational level ST. The team convened numerous types of actors and used collaborative approaches and many different information sources in striving to create a joint and holistic understanding of the program and its context. Visualization tools and adaptive approaches were used to support regional contact persons and staff in their development work. Efforts were made to identify high-leverage solutions to problems influencing the quality and coordination of care before, during, and after childbirth, solutions adaptable to regional conditions.Discussion/conclusionsThe organizational level ST framework was useful for identifying ST in practice in the policy program, but to increase further understanding of how ST is applied within policy programs, we suggest a multi-dimensional model to identify ST on several levels.
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- 2023
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5. Sense-Making, Mutual Learning and Cognitive Shifts When Applying Systems Thinking in Public Health – Examples From Sweden; Comment on 'What Can Policy-Makers Get Out of Systems Thinking? Policy Partners’ Experiences of a Systems-Focused Research Collaboration in Preventive Health'
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Monica E. Nyström, Sara Tolf, and Helena Strehlenert
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systems thinking ,soft systems methodology ,healthcare development ,double-loop learning ,policy-makers ,sweden ,Public aspects of medicine ,RA1-1270 - Abstract
It is widely acknowledged that systems thinking (ST) should be implemented in the area of public health, but how this should be done is less clear. In this commentary we focus on sense-making and double-loop learning processes when using ST and soft systems methodology in research collaborations with policy-makers. In their study of policy-makers’ experiences of ST, Haynes et al emphasize the importance of knowledge processes and mutual learning between researchers and policy-makers, processes which can change how policy-makers think and thus have impact on real-world policy concerns. We provide some additional examples from Sweden on how ST has been applied to create learning and shared mental models among stakeholders and researchers in national and regional healthcare development initiatives. We conclude that investigating and describing such processes on micro-level can aid the knowledge on how to implement ST in public health.
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- 2021
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6. Advancing Health Services Collaborative and Partnership Research; Comment on 'Experience of Health Leadership in Partnering with University-Based Researchers in Canada – A Call to ‘Re-imagine’ Research'
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Monica E. Nyström and Helena Strehlenert
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research partnerships ,collaborative research ,integrated knowledge translation ,health services research ,sweden ,Public aspects of medicine ,RA1-1270 - Abstract
Bowen et al highlight the trend towards partnership research to address the complex challenges currently facing healthcare systems and organizations world-wide. They focus on important strategic actors in partner organizations and their experiences, views and advice for sustainable collaboration, within a Canadian context. The authors call for a multi-system change to provide better conditions for research partnerships. They highlight needs to re-imagine research, to move beyond an ‘acute care’ and clinical focus in research, to re-think research funding, and to improve the academic preparation for research partnerships. In this commentary we provide input to the discussion on practical guidance for those involved in research partnerships based on our partnership experiences from ten research projects conducted within the Swedish healthcare system since 2007. We also highlight areas that need attention in future research in order to learn from approaches used for collaborative and partnership research.
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- 2021
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7. Working with national quality registries in older people care: A qualitative study of perceived impact on assistant nurses’ work situation
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Anna Westerlund, Vibeke Sparring, Henna Hasson, Lars Weinehall, and Monica E. Nyström
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care of older people ,national quality registries ,quality improvement ,team interaction ,work environment ,Nursing ,RT1-120 - Abstract
Abstract Aim The aim was to investigate assistant nurses’ perceptions of how working with national quality registries affected their work situation in care of older people. Design Qualitative interview study. Methods Sixteen semi‐structured interviews were conducted at four special housing units in Sweden, and a conventional content analysis, with elements of thematic analysis, was applied. Results The introduction of national quality registries contributed to role clarifications and the development of new formal work procedures in terms of documentation and arenas and routines for communication. The increased systematics and effectiveness gained from these changes had a perceived positive effect on the work situation, workload, work satisfaction, staff interactions and learning and reflection.
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- 2021
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8. Digital tools as promoters for person-centered care practices in chronic care? Healthcare professionals’ experiences from rheumatology care
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Emma Granström, Carolina Wannheden, Mats Brommels, Helena Hvitfeldt, and Monica E. Nyström
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Patient-centered care ,Person-centered care ,Digital tools ,Chronic care ,Improvement ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Person-centered care (PCC) emphasize the importance of supporting individuals’ involvement in care provided and self-care. PCC has become more important in chronic care as the number of people living with chronic conditions is increasing due to the demographic changes. Digital tools have potential to support interaction between patients and healthcare providers, but empirical examples of how to achieve PCC in chronic care and the role of digital tools in this process is limited. The aim of this study was to investigate strategies to achieve PCC used by the healthcare professionals at an outpatient Rheumatology clinic (RC), the strategies’ relation to digital tools, and the perceived impact of the strategies on healthcare professionals and patients. Methods A single case study design was used. The qualitative data consisted of 14 semi-structured interviews and staff meeting minutes, covering the time period 2017–2019. The data were analyzed using conventional content analysis, complemented with document analyses. Results Ten strategies on two levels to operationalize PCC, and three categories of perceived impact were identified. On the individual patient level strategies involved several digital tools focusing on flexible access to care, mutual information sharing and the distribution of initiatives, tasks, and responsibilities from provider to patients. On the unit level, strategies concerned involving patient representatives and individual patients in development of digital services and work practices. The roles of both professionals and patients were affected and the importance of behavioral and cultural change became clear. Conclusions By providing an empirical example from chronic care the study contributes to the knowledge on strategies for achieving PCC, how digital tools and work practices interact, and how they can affect healthcare staff, patients and the unit. A conclusion is that the use of the digital tools, spanning over different dimensions of engagement, facilitated the healthcare professionals’ interaction with patients and the patients’ involvement in their own care. Digital tools complemented, rather than replaced, care practices.
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- 2020
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9. One size fits none – a qualitative study investigating nine national quality registries’ conditions for use in quality improvement, research and interaction with patients
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Vibeke Sparring, Emma Granström, Magna Andreen Sachs, Mats Brommels, and Monica E. Nyström
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National quality registry ,Clinical registry ,Clinical database ,Quality improvement ,Registry-based research ,Patient-centred care ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Swedish National Quality Registries (NQRs) are observational clinical registries that have long been seen as an underused resource for research and quality improvement (QI) in health care. In recent years, NQRs have also been recognised as an area where patients can be involved, contributing with self-reported experiences and estimations of health effects. This study aimed to investigate what the registry management perceived as barriers and facilitators for the use of NQRs in QI, research, and interaction with patients, and main activities undertaken to enhance their use for these purposes. The aim was further to identify potential differences between various types of NQRs for their use in these areas. Methods In this multiple case study, nine NQRs were purposively selected. Interviews (n = 18) were conducted and analysed iteratively using conventional and directed content analysis. Results A recent national investment initiative enabled more intensive work with development areas previously identified by the NQR management teams. The recent focus on value-based health care and other contemporary national healthcare investments aiming at QI and public benchmarking were perceived as facilitating factors. Having to perform double registrations due to shortcomings in digital systems was perceived as a barrier, as was the lack of authority on behalf of the registry management to request participation in NQRs and QI activities based on registry outcomes. The registry management teams used three strategies to enhance the use of NQRs: ensuring registering of correct and complete data, ensuring updated and understandable information available for patients, clinicians, researchers and others stakeholders, and intensifying cooperation with them. Varied characteristics of the NQRs influenced their use, and the possibility to reach various end-users was connected to the focus area and context of the NQRs. Conclusions The recent national investment initiative contributed to already ongoing work to strengthen the use of NQRs. To further increase the use, the demands of stakeholders and end-users must be in focus, but also an understanding of the NQRs’ various characteristics and challenges. The end-users may have in common a need for training in the methodology of registry based research and benchmarking, and how to be more patient-centred.
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- 2018
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10. Exploring the potential of a multi-level approach to improve capability for continuous organizational improvement and learning in a Swedish healthcare region
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M. E. Nyström, E. Höög, R. Garvare, M. Andersson Bäck, D. D. Terris, and J. Hansson
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Continuous quality improvement ,Organizational learning ,Change management ,Organizational development ,Health care ,Social services ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Eldercare and care of people with functional impairments is organized by the municipalities in Sweden. Improving care in these areas is complex, with multiple stakeholders and organizations. Appropriate strategies to develop capability for continuing organizational improvement and learning (COIL) are needed. The purpose of our study was to develop and pilot-test a flexible, multilevel approach for COIL capability building and to identify what it takes to achieve changes in key actors’ approaches to COIL. The approach, named “Sustainable Improvement and Development through Strategic and Systematic Approaches” (SIDSSA), was applied through an action-research and action-learning intervention. Methods The SIDSSA approach was tested in a regional research and development (R&D) unit, and in two municipalities handling care of the elderly and people with functional impairments. Our approach included a multilevel strategy, development loops of five flexible phases, and an action-learning loop. The approach was designed to support systems understanding, strategic focus, methodological practices, and change process knowledge - all of which required double-loop learning. Multiple qualitative methods, i.e., repeated interviews, process diaries, and documents, provided data for conventional content analyses. Results The new approach was successfully tested on all cases and adopted and sustained by the R&D unit. Participants reported new insights and skills. The development loop facilitated a sense of coherence and control during uncertainty, improved planning and problem analysis, enhanced mapping of context and conditions, and supported problem-solving at both the individual and unit levels. The systems-level view and structured approach helped participants to explain, motivate, and implement change initiatives, especially after working more systematically with mapping, analyses, and goal setting. Conclusions An easily understood and generalizable model internalized by key organizational actors is an important step before more complex development models can be implemented. SIDSSA facilitated individual and group learning through action-learning and supported systems-level views and structured approaches across multiple organizational levels. Active involvement of diverse organizational functions and levels in the learning process was facilitated. However, the time frame was too short to fully test all aspects of the approach, specifically in reaching beyond the involved managers to front-line staff and patients.
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- 2018
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11. Implementation of clinical practice guidelines on lifestyle interventions in Swedish primary healthcare – a two-year follow up
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Therese Kardakis, Lars Jerdén, Monica E. Nyström, Lars Weinehall, and Helene Johansson
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Implementation ,Lifestyle ,Clinical practice guidelines ,Primary health care ,Preventive health services ,Health promotion ,Public aspects of medicine ,RA1-1270 - Abstract
Abstract Background Implementation of interventions concerning prevention and health promotion in health care has faced particular challenges resulting in a low frequency and quality of these services. In November 2011, the Swedish National Board of Health and Welfare released national clinical practice guidelines to counteract patients’ unhealthy lifestyle habits. Drawing on the results of a previous study as a point of departure, the aim of this two-year follow up was to assess the progress of work with lifestyle interventions in primary healthcare as well as the uptake and usage of the new guidelines on lifestyle interventions in clinical practice. Methods Longitudinal study among health professionals with survey at baseline and 2 years later. Development over time and differences between professional groups were calculated with Pearson chi-square test. Results Eighteen percent of the physicians reported to use the clinical practice guidelines, compared to 58% of the nurses. Nurses were also more likely to consider them as a support in their work than physicians did. Over time, health professionals usage of methods to change patients’ tobacco habits and hazardous use of alcohol had increased, and the nurses worked to a higher extent than before with all four lifestyles. Knowledge on methods for lifestyle change was generally high; however, there was room for improvement concerning methods on alcohol, unhealthy eating and counselling. Forty-one percent reported to possess thorough knowledge of counselling skills. Conclusions Even if the uptake and usage of the CPGs on lifestyle interventions so far is low, the participants reported more frequent counselling on patients’ lifestyle changes concerning use of tobacco and hazardous use of alcohol. However, these findings should be evaluated acknowledging the possibility of selection bias in favour of health promotion and lifestyle guidance, and the loss of one study site in the follow up. Furthermore, this study indicates important differences in physicians and nurses’ attitudes to and use of the guidelines, where the nurses reported working to a higher extent with all four lifestyles compared to the first study. These findings suggest further investigations on the implementation process in clinical practice, and the physicians’ uptake and use of the CPGs.
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- 2018
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12. Experiences gathered from geophysical surveying in five small Harbour yards, SW Sweden
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M. Persson, E. Nyström Hult, and A. Håkansson
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Yard ,Hydrogeology ,business.industry ,Environmental resource management ,Harbour ,Drilling ,Land development ,business ,computer ,Geology ,Sea level ,computer.programming_language - Abstract
Summary Small-scale harbour yards are attractive locations for land development, and they are currently being subjected to large investments and adaption to raising sea levels. This abstract aims at showcasing the use of electrical resistivity measurements as well as single and multichannel ground penetrating radars under varied geotechnical, hydrogeologic and contaminant conditions in the nearshore transition zone. An optimal balance between drilling, geophysics and marine surveying is key in the early stages of such development projects as several potential obstacles may otherwise cause costly surprises later. Arguably geophysical surveying from land and small boats can decrease the need for near-shore drilling while maintaining project quality and adding detail.
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- 2021
13. Experiences gathered from geophysical surveying in five small Harbour yards, SW Sweden
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Persson, M., primary, Håkansson, A., additional, and Hult, E. Nyström, additional
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- 2021
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14. The Apology of Justin Martyr
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David E. Nyström
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media_common.quotation_subject ,Art ,Theology ,media_common ,Martyr - Published
- 2018
15. The Apology of Justin Martyr : Literary Strategies and the Defence of Christianity
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David E. Nyström and David E. Nyström
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- Christianity, Apologetics--History--Early church, ca. 30-600
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In his Apologia pro Christianis, Justin Martyr uses some major apologetic strategies to defend and promote Christianity. These are here identified as the'logos doctrine', the'theft theory', the'proof from prophecy'and the demonological arguments. David E. Nyström analyses each strategy on its own terms as well as in relation to the others in order for them to yield a picture of how they work, rhetorically and literarily, in Justin's grand argument. He also explores possible literary models as well as the purpose and function of the literary form Justin chose for his work.
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- 2018
16. Adequate iodine nutrition in Sweden: a cross-sectional national study of urinary iodine concentration in school-age children
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Maria Andersson, Lena Hulthén, Helena Filipsson, Malin Hansson, E Nyström, Mille Milakovic, Robert Eggertsen, Elisabeth Gramatkovski, and Gertrud Berg
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Male ,medicine.medical_specialty ,Goiter ,Cross-sectional study ,education ,Iodine nutrition ,Nutritional Status ,Medicine (miscellaneous) ,chemistry.chemical_element ,Urine ,Iodine ,Nutrition Policy ,Environmental health ,medicine ,Cluster Analysis ,Humans ,Child ,Sweden ,Nutrition and Dietetics ,business.industry ,medicine.disease ,Surgery ,Iodised salt ,Cross-Sectional Studies ,chemistry ,National study ,Female ,business ,Goiter, Endemic ,Body mass index - Abstract
Sweden has a long-standing salt iodization program; however, its effects on iodine intake have never been monitored on a national level. The objective of this study was to evaluate iodine nutrition in the Swedish population by measuring the urinary iodine concentration (UIC) in a national sample of Swedish school-age (6-12 years of age) children.A stratified probability proportionate to size cluster sampling method was used to obtain a representative national sample of school-age children from 30 clusters. Spot urine samples were collected for UIC analysis using a modified Sandell-Kolthoff method.The median UIC of the children (n=857) was 125 microg/l (range 11-757 microg/l). The proportion of children with a UIC100 microg/l was 30.0% and the proportion of children with a UIC50 and300 microg/l was 5.5 and 3.0%, respectively.The iodine nutritional status of the Swedish population is adequate. Iodized table salt remains the main dietary source of iodine in Swedish diet. Recommendations to reduce total salt intake in the population urge increased use of iodized salt in the production of processed foods. Pregnant and lactating women with high iodine requirements may still be at risk for low iodine intake. This study will serve as the basis for future monitoring of iodine nutritional status in Sweden.
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- 2008
17. Consequences of inadvertent radioiodine treatment of Graves’ disease and thyroid cancer in undiagnosed pregnancy. Can we rely on routine pregnancy testing?
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Jan Tennvall, Gertrud Berg, E Nyström, Lars Jacobsson, and Katarina Sjögreen Gleisner
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Adult ,Pregnancy test ,endocrine system ,medicine.medical_specialty ,endocrine system diseases ,Urinary system ,Graves' disease ,Thyroid Gland ,Iodine Radioisotopes ,Pregnancy ,medicine ,Humans ,Chorionic Gonadotropin, beta Subunit, Human ,Radiology, Nuclear Medicine and imaging ,Thyroid Neoplasms ,Thyroid cancer ,reproductive and urinary physiology ,Gynecology ,Fetus ,business.industry ,Obstetrics ,Pregnancy Outcome ,Cancer ,Abortion, Induced ,Hematology ,General Medicine ,medicine.disease ,Graves Disease ,Perinatal Care ,Oncology ,embryonic structures ,Gestation ,Female ,business ,Pregnancy Complications, Neoplastic - Abstract
Radioiodine and most cytostatic treatments are contraindicated in pregnancy. Still, inadvertent therapy does occur. Radioiodine was given to two pregnant women with Graves' disease and thyroid cancer respectively, both in their 20th gestational week. Routine pregnancy tests based on urinary beta-hCG had failed to indicate pregnancy in both cases.Estimation of doses to the foetuses and foetal thyroids. Scrutiny of pregnancy testing.Doses to foetal thyroids were ablative (250-600 Gy). Total foetal dose in the Graves' patient was 100 mGy and compatible with survival, whereas a foetal dose of approximately 700 mGy together with induced hypothyroidism was fatal for the foetus of the cancer patient. Routine pregnancy tests may fail early and late in pregnancy. The possibility of pregnancy should be considered in all fertile women before therapy with radionuclides or cytostatic regimens, and a clinical investigation undertaken on wide indications with determination of serum beta-hCG, preferably together with an ultrasound examination.
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- 2008
18. Amiodarone inhibits thyroidal iodide transport in vitro by a cyclic adenosine 5'-monophosphate- and iodine-independent mechanism
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S. Tedelind, Fredrik Larsson, H C van Beeren, Mikael Nilsson, E. Nyström, W. M. Wiersinga, C. Johanson, Laboratory for Endocrinology, Amsterdam Gastroenterology Endocrinology Metabolism, and Endocrinology
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Adenosine monophosphate ,medicine.medical_specialty ,Swine ,Iodide ,Thyroid Gland ,Amiodarone ,Thyrotropin ,chemistry.chemical_element ,Iodine ,Electrolytes ,chemistry.chemical_compound ,Endocrinology ,Internal medicine ,Cyclic AMP ,medicine ,Animals ,RNA, Messenger ,Iodide transport ,Dronedarone ,Cells, Cultured ,chemistry.chemical_classification ,Symporters ,Chemistry ,Thyroid ,Biological Transport ,Iodides ,Adenosine ,Epithelium ,medicine.anatomical_structure ,Symporter ,Anti-Arrhythmia Agents ,medicine.drug - Abstract
Thyroid side effects are common in patients treated for cardiac arrhythmias with amiodarone (AM). A major disturbance is inhibited thyroidal radioiodine uptake in AM-induced thyrotoxicosis, which makes 131I therapy ineffective. On the other hand, failure to escape from the Wolff-Chaikoff effect by down-regulation of the sodium/iodide symporter (NIS) is proposed to explain AM-induced hypothyroidism. However, previously no experimental studies on the possible mechanisms have been conducted. We therefore investigated the early effects of AM on thyroidal iodide transport using bicameral chamber cultures of primary pig thyrocytes that reproduce the three tissue compartments (epithelium, lumen, and extrafollicular space) of the gland. AM dose-dependently (1-50 microm) inhibited the TSH-stimulated transepithelial (basal to apical) transport of 125I- by up to 90%. The inhibitory effect was noticed already after 8 h and was further pronounced after 1-4 d, depending on the AM concentration. The intracellularly accumulated 125I- was reduced by perchlorate but not AM, and quantitative real-time RT-PCR revealed no change in the NIS expression in AM-treated cells. Blocking of cAMP degradation with 3-isobutyl-1-methylxanthine or withdrawal of AM reversed AM-induced changes in electrolyte transport but were unable to recover the suppressed 125I- transport. The iodine-free AM analog dronedarone also inhibited 125I- transport to the same extent as AM. The findings indicate that AM blocks thyroidal iodide uptake by reducing the iodide permeability of the apical plasma membrane of the thyroid epithelial cells. The effect is iodine independent and long-lasting and does not involve impaired function of NIS or the TSH receptor/cAMP signaling pathway.
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- 2006
19. The liquorice effect on the RAAS differs between the genders
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Magnus Axelson, Helga Agusta Sigurjonsdottir, Karin Manhem, Gudmundur Johannsson, E Nyström, and Sven Wallerstedt
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Adult ,Male ,medicine.medical_specialty ,Blood Pressure ,Essential hypertension ,Pseudohyperaldosteronism ,Renin-Angiotensin System ,chemistry.chemical_compound ,Sex Factors ,Mineralocorticoid receptor ,Internal medicine ,Renin–angiotensin system ,Glycyrrhiza ,Internal Medicine ,medicine ,Humans ,Aldosterone ,Mineralocorticoid Receptor Antagonists ,biology ,business.industry ,Case-control study ,General Medicine ,medicine.disease ,biology.organism_classification ,Endocrinology ,Blood pressure ,chemistry ,Case-Control Studies ,Hypertension ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Liquorice-induced increase in blood pressure (BP) is more profound in subjects with essential hypertension (HT) than in healthy individuals. Liquorice induces pseudohyperaldosteronism by inhibiting the 11beta-hydroxysteroid dehydrogenase type 2 and is also known to inhibit the renin-angiotensin-aldosterone system (RAAS). We explored the difference in response in BP, considering the RAAS and the genders.Patients with HT (eight men and three women, mean age 40.7 years) and healthy controls (13 men and 12 women, mean age 31.2 years) consumed 100 g of liquorice (150 mg glycyrrhetinic acid) daily for 4 weeks.Blood, urine samples and BP were evaluated before and after 4 weeks of liquorice consumption and 4 weeks after cessation of liquorice consumption.The relative change in serum aldosterone levels differed between the genders (p0.02), men being more responsive than women, but not between patients with HT and healthy subjects.The liquorice-induced inhibition of aldosterone secretion differs between the genders and is not influenced by the BP levels. This difference between the genders has not been exposed before.
- Published
- 2006
20. Liquid-gel chromatography on lipophilic-hydrophobic Sephadex derivatives
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J. Ellingboe, E. Nyström, and J. Sjövall
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alkyl ether ,column chromatography ,reversed- and straight-phase partition ,wax ,fatty acid ,glyceride ,Biochemistry ,QD415-436 - Abstract
Hydrophobic long-chain alkyl ethers of Sephadex have been synthesized and tested for use in liquid chromatography. With columns prepared in such polar solvents as methanol, reversed-phase systems are obtained where compounds separate in order of decreasing polarity. In such nonpolar solvents as heptane, straight-phase systems are formed, and separations occur in order of increasing polarity. The retention volume of a compound is determined mainly by its polarity, the type and degree of substitution of Sephadex, and the nature of the solvent system. Examples are given of straight- and reversed-phase separations of waxes, fatty acids, glycerides, glycerol ethers, sterols, bile acids, and hormonal steroids. The Sephadex derivatives are simple to make, the columns are easy to prepare, and they can be used over long periods of time. Liquid-gel chromatography on alkyl ethers of Sephadex is a mild separation technique and should be a useful complement to other chromatographic methods.
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- 1970
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21. Inhibitory Effect of Piracetam on Platelet-rich Thrombus Formation in an Animal Model
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Jm Stassen, Hans Deckmyn, Filip Stockmans, E. Nyström, Åke Nyström, Jozef Vermylen, and W Deberdt
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Pathology ,medicine.medical_specialty ,medicine.diagnostic_test ,business.industry ,Piracetam ,Fibrinogen binding ,Hematology ,Pharmacology ,medicine.disease ,Bleeding time ,medicine ,Platelet aggregation inhibitor ,Platelet ,Thrombus ,business ,Fibrinolytic agent ,medicine.drug ,Whole blood - Abstract
SummaryIntravenous administration of piracetam to hamsters reduced the formation of a platelet-rich venous thrombus induced by a standardised crush injury, in a dose-dependent fashion with an IC50 of 68 ± 8 mg/kg. 200 mg/kg piracetam also significantly reduced in vivo thrombus formation in rats. However, in vitro aggregation of rat platelets was only inhibited with piracetam-concentrations at least 10-fold higher than plasma concentrations (6.2 ± 1.1 mM) obtained in the treated animals. No effects were seen on clotting tests.In vitro human platelet aggregation, induced by a variety of agonists, was inhibited by piracetam, with IC50’s of 25-60 mM. The broad inhibition spectrum could be explained by the capacity of piracetam to prevent fibrinogen binding to activated human platelets. Ex vivo aggregations and bleeding times were only minimally affected after administration of 400 mg/kg piracetam i.v. to healthy male volunteers, resulting in peak plasma levels of 5.8 ± 0.3 mM.A possible antiplatelet effect of piracetam could be due to the documented beneficial effect on red blood cell deformability leading to a putative reduction of ADP release by damaged erythrocytes. However similarly high concentrations were needed to prevent stirring-induced “spontaneous” platelet aggregation in human whole blood.It is concluded that the observed antithrombotic action of piracetam cannot satisfactorily be explained by an isolated direct effect on platelets. An additional influence of piracetam on the rheology of the circulating blood and/or on the vessel wall itself must therefore be taken into consideration.
- Published
- 1998
22. Association of the transferrin locus on chromosome 13 with early body weights in pigs
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L. Andersson-Eklund, R. K. Juneja, Kjell Johansson, P.‐E. Nyström, and K. Andersson
- Subjects
chemistry.chemical_classification ,Genetics ,Locus (genetics) ,General Medicine ,Biology ,Glucose phosphate ,Blood proteins ,Molecular biology ,Breed ,Food Animals ,chemistry ,Transferrin ,Genotype ,Animal Science and Zoology ,Phosphogluconate dehydrogenase ,Chromosome 13 - Abstract
Summary The effect of the genotypes of five different blood protein loci (α1B-glycoprotein, A1BG; glucose phosphate isomerase, GPI; phosphogluconate dehydrogenase, PGD; postalbumin 1A, PO1A; transferrin, TF) on early body-weight traits was studied in one large population of Swedish Yorkshire breed pigs. A highly significant association was observed, between the transferrin genotypes and the piglet body weights, at 6 and 9 weeks of age. The TF BB type pigs were heavier than those of TF AB types at 3, 6, and 9 weeks of age, by 130, 340, and 370 g, respectively. In the light of previously published data, it was discussed that TF is an additional chromosome 13 marker that may affect early body weights in pigs. The other four loci studied, located on chromosomes 6 and 7, did not show any significant effect. Zusammenfassung Zusammenhange zwischen Transferrinlocus an Chromosom 13 und Ferkelgewichten Die Wirkung von funf verschiedenen Blutproteinloci (αB-Glykoprotein, A1BG; Glukose Phosphat Isomerase, GPI; Phosphoglukonat Dehydrogenase, PGD; Postalbumin 1A, PO1A; Transferrin, TF) auf Ferkelwichte wurde bei Schwedischen Yorkshire Schweinen untersucht. Der Zusammenhang zwischen Transferrin Genotypen und 6 und 9 Wochen Gewichten war hochsignifikant, TF BB Ferkel waren bei 3, 6 und 9 Wochen Alter um 130, 340 und 370 g schwerer als TF AB Ferkel. In zusammenhang mit fruheren Studien wird TF als ein weiterer Chromosom 13 Marker fur Ferkelgewicht erortert. Die anderen vier Loci an Chromosomen 6 bzw. 7 zeigten keine signifikante Wirkung.
- Published
- 1997
23. Clinical outcome of radioiodine treatment of hyperthyroidism: a follow-up study
- Author
-
Gertrud Berg, Annika M.K. Michanek, E Nyström, and Erik Holmberg
- Subjects
Adult ,Male ,Pediatrics ,medicine.medical_specialty ,Goiter ,medicine.medical_treatment ,Population ,Hyperthyroidism ,Iodine Radioisotopes ,Age Distribution ,Quality of life ,Surveys and Questionnaires ,Internal Medicine ,Humans ,Medicine ,Euthyroid ,Sex Distribution ,education ,Aged ,Aged, 80 and over ,Sweden ,Response rate (survey) ,education.field_of_study ,business.industry ,Smoking ,Thyroid ,Middle Aged ,medicine.disease ,Graves Disease ,Surgery ,Radiation therapy ,Treatment Outcome ,medicine.anatomical_structure ,Quality of Life ,Female ,medicine.symptom ,business ,Weight gain ,Follow-Up Studies ,Goiter, Nodular - Abstract
Objectives. To study the clinical outcome of treatment of hyperthyroid patients with radioiodine. Design. Records of patients treated for hyperthyroidism with radioiodine from 1989 to 1992 were examined in 1994, and a questionnaire was sent to patients 70 years with Graves' disease (GD) and toxic nodular goitre (TNG) to obtain information regarding thyroxine substitution, smoking habits and present state of health. Setting. Outpatients in a thyroid unit; follow-up by primary care. Subjects. Seven hundred and fifty-four patients with hyperthyroidism treated with radioiodine, 327 receiving the questionnaire, 72% response rate. Intervention. Radioiodine treatment using a delivered absorbed dose method, aiming at an absorbed dose to the thyroid of 100–120 Gy. Main outcome measures. Statistical analysis of clinical records and results from questionnaire. Results. Only 10% of the patients needed more than one treatment. At the time of follow-up, thyroxine supplementation was given to 178 (93%) of the GD and to 21 (47%) of the TNG patients. Smoking was more common in GD patients than in the general population (44% vs. 26%; P
- Published
- 1996
24. Thyroid volume in Swedish school children: a national, stratified, population-based survey
- Author
-
Gertrud Berg, Maria Andersson, Lena Hulthén, Robert Eggertsen, Mille Milakovic, E Gramatkowski, H Filipsson Nyström, Marie Hansson, E Nyström, and Sahlgrenska University Hospital [Gothenburg]
- Subjects
Male ,medicine.medical_specialty ,Goiter ,Urban Population ,Thyroid Gland ,Medicine (miscellaneous) ,030209 endocrinology & metabolism ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,children ,Reference Values ,Internal medicine ,Prevalence ,Medicine ,Humans ,030212 general & internal medicine ,Child ,Population based survey ,Iodine intake ,Ultrasonography ,2. Zero hunger ,Body surface area ,Sweden ,Nutrition and Dietetics ,business.industry ,Thyroid ,goitre ,national ,Age Factors ,thyroid volume ,Organ Size ,medicine.disease ,3. Good health ,Endocrinology ,medicine.anatomical_structure ,El Niño ,Population Surveillance ,Cluster sampling ,Female ,business ,Body mass index ,Demography ,Iodine - Abstract
International audience; Background/ Objectives: Sweden has had a salt iodination program since 1936. This first national surveillance study on iodine nutrition infers an adequate level of urinary iodine concentration (UIC 125 ug/L) and the aim is now to evaluate thyroid volume (Tvol) in the same national sample. Subjects/ Methods: A stratified probability proportionate to size cluster sampling was used to obtain a representative national sample of Swedish children aged 6-12 years. Median Tvol obtained ultrasonografically and the prevalence of enlarged thyroid glands were compared with an international reference standard. Regional differences were evaluated through comparisons of Tvol between coastal and inland areas, urban and rural regions, and former goitre and non-goitre regions. Results: Tvol correlated to age, body surface area (BSA), weight, height, and BMI for both sexes, (p
- Published
- 2010
25. Effect of lifelong iodine supplementation on thyroid 131-I uptake: a decrease in uptake in euthyroid but not hyperthyroid individuals compared to observations 50 years ago
- Author
-
Robert Eggertsen, Mille Milakovic, E Nyström, and Gertrud Berg
- Subjects
Male ,endocrine system ,medicine.medical_specialty ,Time Factors ,endocrine system diseases ,Population ,Thyroid Gland ,Medicine (miscellaneous) ,chemistry.chemical_element ,Scintigraphy ,Iodine ,Hyperthyroidism ,Iodine Radioisotopes ,Hypothyroidism ,Oral administration ,Internal medicine ,medicine ,Humans ,Euthyroid ,Sodium Chloride, Dietary ,education ,Radionuclide Imaging ,Aged ,Sweden ,education.field_of_study ,Nutrition and Dietetics ,medicine.diagnostic_test ,business.industry ,Thyroid ,Middle Aged ,Multinodular goitre ,medicine.anatomical_structure ,Endocrinology ,chemistry ,Female ,business - Abstract
BACKGROUND: In Sweden, iodine has been added to table salt (10 mg/kg) since 1936; this amount was increased in 1966 to 50 mg/kg. OBJECTIVE: To investigate a euthyroid Swedish population (n = 44, 60-65 years) with its entire lifespan with iodine supplementation as for 24-h 131-I uptake (24 h IU) and thyroid nodularity (thyroid scintigraphy). To compare the euthyroid 24 h IU with uptake of thyrotoxic individuals, and with observations from 1955. METHODS: The 24 h IU was used in euthyroid individuals after oral administration of 0.1 MBq/2.7 microCi radioiodine and imaging of the thyroid gland was carried out using 99mTc-pertechnetate. RESULTS: In 1999-2000, the mean 24 h IU in the euthyroid individuals was 21% (range 11-33%) and the normal (central 95%) reference interval was 14-30%. Scintigraphy suggested multinodular goitre in three euthyroid individuals. In Graves' patients (n = 53, 50-65 years), the mean 24 h IU was 61% (range 29-89%). In 1955, the 24 h IU in euthyroid individuals was higher (38%, range 10-70%), while hyperthyroid patients had uptake values similar to those recorded in the present investigation (mean 62%, range 40-90%). CONCLUSIONS: The population sample studied had to be small for ethical reasons. We conclude that the reference interval for 24 h IU is 14-30% in this population that had spent its entire lifespan with iodine supplementation. This is lower than that recorded in a Swedish euthyroid population half a century ago having had low-grade table-salt iodine supplementation for 20 years. Values for hyperthyroid patients, however, do not appear to have been affected likewise.
- Published
- 2005
26. 10-year follow-up of onlay bone grafts and implants in severely resorbed maxillae
- Author
-
E Nyström
- Subjects
Otorhinolaryngology ,Surgery ,Oral Surgery - Published
- 2003
27. Approaches to interval mapping of QTL in a multigeneration pedigree: the example of porcine chromosome 4
- Author
-
S A, Knott, P E, Nyström, L, Andersson-Eklund, S, Stern, L, Marklund, L, Andersson, and C S, Haley
- Subjects
Male ,Heterozygote ,Stochastic Processes ,Genotype ,Swine ,Chromosome Mapping ,Chromosomes ,Pedigree ,Quantitative Trait, Heritable ,Animals ,Regression Analysis ,Female ,Inbreeding ,Least-Squares Analysis ,Alleles - Abstract
Quantitative trait loci (QTLs) have been mapped in many studies of F2 populations derived from crosses between diverse lines. One approach to confirming these effects and improving the mapping resolution is genetic chromosome dissection through a backcrossing programme. Analysis by interval mapping of the data generated is likely to provide additional power and resolution compared with treating data marker by marker. However, interval mapping approaches for such a programme are not well developed, especially where the founder lines were outbred. We explore alternative approaches to analysis using, as an example, data from chromosome 4 in an intercross between wild boar and Large White pigs where QTLs have been previously identified. A least squares interval mapping procedure was used to study growth rate and carcass traits in a subsequent second backcross generation (BC2). This procedure requires the probability of inheriting a wild boar allele for each BC2 animal for locations throughout the chromosome. Two methods for obtaining these probabilities were compared: stochastic or deterministic. The two methods gave similar probabilities for inheriting wild boar alleles and, hence, gave very similar results from the QTL analysis. The deterministic approach has the advantage of being much faster to run but requires specialized software. A QTL for fatness and for growth were confirmed and, in addition, a QTL for piglet growth from weaning at 5 weeks up to 7 weeks of age and another for carcass length were detected.
- Published
- 2002
28. Smoking — A risk factor for hypothyroidism
- Author
-
Leif Lapidus, E Nyström, Calle Bengtsson, Göran Lindstedt, and K. Petersen
- Subjects
Adult ,endocrine system ,medicine.medical_specialty ,Pediatrics ,Goiter ,endocrine system diseases ,Smoking habit ,Endocrinology, Diabetes and Metabolism ,Endocrinology ,Hypothyroidism ,Risk Factors ,Internal medicine ,medicine ,Humans ,Euthyroid ,Longitudinal Studies ,Risk factor ,business.industry ,Smoking ,Follow up studies ,Middle Aged ,Serum concentration ,medicine.disease ,Confidence interval ,Relative risk ,Female ,business ,hormones, hormone substitutes, and hormone antagonists - Abstract
Smoking is associated with a spectrum of disorders. Recent reports have shown decreased serum concentrations of thyrotropin in euthyroid smokers, and there is an association between smoking and development of goiter (toxic and euthyroid). In a 12-year follow-up of a randomly selected sample of women we found a strong association between smoking at the time of initial screening and later development of hypothyroidism, the relative risk for a female smoker to develop hypothyroidism being 3.9 (95% confidence interval 1.6-9.1). There was, however, no association between smoking habits at the end of the follow-up and hypothyroidism. This indicates that several women who developed hypothyroidism may have done so in association with a change in smoking habits.
- Published
- 1993
29. Implant versus tooth-implant supported prostheses in the posterior maxilla: a 2-year report
- Author
-
T, Lindh, T, Bäck, E, Nyström, and J, Gunne
- Subjects
Male ,Statistics as Topic ,Dental Abutments ,Statistics, Nonparametric ,Weight-Bearing ,Maxilla ,Humans ,Life Tables ,Dental Restoration Failure ,Longitudinal Studies ,Bone Resorption ,Denture Design ,Aged ,Aged, 80 and over ,Dental Implants ,Jaw, Edentulous, Partially ,Middle Aged ,Survival Analysis ,Maxillary Diseases ,Sample Size ,Denture, Partial, Fixed ,Female ,Dental Prosthesis, Implant-Supported ,Stress, Mechanical ,Tooth ,Follow-Up Studies - Abstract
When implants are used for restoration of a jaw with a residual dentition, the possibility of combining implants with natural abutments may be considered. In a longitudinal comparative study, 26 patients (15 women11 men, age 49-84 years) with residual anterior dentitions were treated with two different designs of fixed partial dentures bilaterally in the posterior maxilla. On one side the reconstruction was supported by implants only, while on the contralateral side an implant and a tooth in combination were used. The patients were followed at intervals of 3, 6, 12 and 24 months after loading of the implants. 95 implants were placed, of which 11 non-loaded. A total of 10 implants failed, 7 prior to loading and three within the first three months of service (88.0+/-SE 6.7% cumulative survival for tested implants after two years' follow-up). There was no difference in failure rate for the implants in the two different prosthesis designs. The total mean loss of marginal bone height close to the implants was within acceptable standards, but was more pronounced at the implants not combined with teeth. The results indicate a correlation between the prosthesis design and the loss of marginal bone.
- Published
- 2001
30. Screening for thyroid disease of 15-17-year-old schoolchildren in an area with normal iodine intake
- Author
-
Robert Eggertsen, Mille Milakovic, Göran Lindstedt, Gertrud Berg, and E Nyström
- Subjects
Male ,endocrine system ,medicine.medical_specialty ,Pediatrics ,endocrine system diseases ,Adolescent ,medicine.medical_treatment ,Thyroid Function Tests ,Thyroid function tests ,Thyroiditis ,Internal medicine ,Internal Medicine ,medicine ,Humans ,Mass Screening ,Euthyroid ,Mass screening ,Subclinical infection ,Aged ,Sweden ,medicine.diagnostic_test ,business.industry ,Antithyroid agent ,Thyroid disease ,Incidence ,Thyroid ,Thyroiditis, Autoimmune ,Middle Aged ,medicine.disease ,Thyroid Diseases ,medicine.anatomical_structure ,Endocrinology ,Cross-Sectional Studies ,Female ,business - Abstract
Milakovic M, Berg G, Eggersten R, Lindstedt G, Nystrom E (Sahlgrenska University Hospital, Goteborg, Sweden). Screening for thyroid disease of 15–17-year-old schoolchildren in an area with normal iodine intake. J Intern Med 2001; 250: 208–212. Objective. The prevalence of thyroid disease in Swedish schoolchildren is today insufficiently known. The aim of the study was therefore to determine the prevalence of abnormal thyroid function and thyroid autoimmunity in teen-age schoolchildren and to compare the findings with a healthy control group of 60–65-year-old inhabitants from the same community. Setting. A semirural community of approximately 15 000 inhabitants. Design. Cross-sectional study. Main outcome measures. Thyroid volume and serum concentrations of serum thyrotropin (TSH), total and free thyroxine (T4), total and free 3,5,3′-triiodothyronine (T3), and antithyroperoxidase antibodies (TPOAb). Results. Four schoolchildren (7%, 59 screened) had elevated TPOAb concentration, three of the subjects being girls (8%). One girl with a goitre was overtly hypothyroid and one girl showed borderline-high serum TSH concentration suggesting subclinical autoimmune thyroid disease. One euthyroid boy had a goitre and high concentration of TPOAb. The serum free T3 concentration was significantly higher in 15–17-year-old than 60–65-year-old (7.4 vs. 6.4 pmol L–1, P
- Published
- 2001
31. [Comment: cost-efficient investigation of chronic fatigue]
- Author
-
G, Lindstedt, P A, Lundberg, G, Sundbeck, S, Edén, R, Eggertsen, and E, Nyström
- Subjects
Fatigue Syndrome, Chronic ,Cost-Benefit Analysis ,Thyroid Gland ,Thyroiditis, Autoimmune ,Humans ,Thyroid Function Tests ,Iodide Peroxidase ,Sensitivity and Specificity ,Autoantibodies - Published
- 2000
32. [TSH and TPOAb should be the first to analyze in suspected dysfunction of thyroid gland]
- Author
-
G, Lindstedt, P A, Lundberg, G, Sundbeck, S, Edén, R, Eggertsen, and E, Nyström
- Subjects
Reference Values ,Practice Guidelines as Topic ,Thyroiditis, Autoimmune ,Humans ,Thyrotropin ,Thyroid Function Tests ,Iodide Peroxidase ,Thyroid Diseases ,Antibodies ,Aged - Published
- 2000
33. Oftalmopatia Basedowiana dopo trattamento dell’ipertiroidismo con farmaci antitiroidei o iodio-131
- Author
-
P. Hedner, M. Lantz, M. Abraham-Nordling, Adam Taube, G. Berg, Michele Marinò, P. Asman, G. Lundell, T. Andersson, J. Calissendorff, V. Ponjavic, Leif Tallstedt, G. Wallin, E. Nyström, B. Hallengren, O. Törring, and F. Träisk
- Subjects
business.industry ,Medicine ,business ,Humanities - Abstract
Precedenti studi randomizzati hanno suggerito un’associazione tra la terapia con radioiodio per l’ipertiroidismo del morbo di Basedow (MB) e l’oftalmopatia basedowiana (OB). Lo scopo di questo studio era di confrontare la comparsa o il peggioramento della OB in pazienti trattati con radioiodio o con farmaci antitiroidei. Veniva condotto uno studio randomizzato in 96 pazienti con un follow-up di 4 anni. Pazienti con una diagnosi recente di MB con ipertiroidismo venivano randomizzati al trattamento precoce con radioiodio (163 pazienti) o a 18 mesi di terapia con farmaci antitiroidei. Ad entrambi i gruppi veniva somministrata la tiroxina a scopo sostitutivo. Il peggioramento o lo sviluppo di OB erano significativamente piu frequenti nel gruppo trattato con radioiodio (63 pazienti; 38,7%) rispetto al gruppo trattato con antitiroidei (32 pazienti; 21,3%) (p
- Published
- 2009
34. Preface
- Author
-
Åke E. Nyström
- Subjects
Internal Medicine - Published
- 2009
35. [How reliable is the laboratory? Increased needs of patient-related quality assurance]
- Author
-
G, Lindstedt, R, Ekman, P, Fernlund, R, Forberg, B, Lindblad, K, Hellsing, and E, Nyström
- Subjects
Male ,Thyroid Hormones ,Quality Assurance, Health Care ,Chemistry, Clinical ,Humans ,False Positive Reactions ,Female ,Thyroid Function Tests ,Laboratories, Hospital ,Thyroid Diseases ,Antibodies ,Biomarkers - Abstract
Recent developments in medical care and research involve the increased use of immunochemical assays for hormones, tumour markers, vitamins and drugs. External quality assurance programmes using pooled human sera usually fail to detect analytical interference due to substances (e.g. anti-immunoglobulin or anti-ligand antibodies) present in individual serum specimens. The article reports on experience gained during a three-year period when specimens from individual patients attending a thyroid unit were distributed to hospital laboratories in Sweden for analysis. Specimen selection criteria were based on contradictory findings at the initial clinical or laboratory evaluation. The programme has given rise to the formation of a network of the laboratories involved, under the co-ordination of EQUALIS (External quality assurance in laboratory medicine in Sweden).
- Published
- 1999
36. [Increased value of TSH should always be investigated. Risk of incorrect treatment when the diagnosis is wrong]
- Author
-
G, Lindstedt, G, Berg, and E, Nyström
- Subjects
Diagnosis, Differential ,Risk Factors ,Thyroiditis, Autoimmune ,Humans ,Thyrotropin ,False Positive Reactions ,Diagnostic Errors ,Thyroid Diseases ,Antibodies - Published
- 1999
37. Body weight and body composition changes after treatment of hyperthyroidism
- Author
-
L, Lönn, K, Stenlöf, M, Ottosson, A K, Lindroos, E, Nyström, and L, Sjöström
- Subjects
Adult ,Male ,Thyroid Hormones ,Absorptiometry, Photon ,Body Weight ,Body Composition ,Humans ,Female ,Middle Aged ,Energy Intake ,Energy Metabolism ,Tomography, X-Ray Computed ,Hyperthyroidism - Abstract
Body composition changes in nine adults with hyperthyroidism were determined with dual energy x-ray absorptiometry and computed tomography at diagnosis and after 3 and 12 months of euthyroidism achieved by surgery, antithyroid drugs, or treatment with radioiodine. Mean body weight was 67.6 kg at diagnosis and increased 2.7 kg (P=0.06) and 8.7 kg (P0.001) after 3 and 12 months of euthyroidism, respectively. Basal metabolic rate decreased from 2087 Cal/24 h at diagnosis to 1601 Cal/24 h at 12 months (P=0.001), whereas reported energy intake dropped from 3244 to 2436 Cal/24 h (P=0.01). According to dual energy x-ray absorptiometry, body fat was unchanged at 3 months, but increased by 5.3 kg (P0.0001) at 12 months. Fat-free mass increased 2.7 kg (P=0.003) at 3 months and 3.5 kg (P0.0001) at 12 months. Changes in bone mineral content and density did not reach significance. According to computed tomography, skeletal muscle plus skin areas increased by 11% (trunk) and 18% (thigh) at 3 months and by 17% (trunk) and 25% (thigh) at 12 months. There was no increase in sc adipose tissue (AT) at 3 months, but at 12 months this AT depot increased by 15% (thigh) and 33% (trunk). Intraperitoneal AT showed a borderline significant increase by 28% (P=0.08) at 3 months and by 40% (P=0.015) at 12 months. Areas of visceral organs and bone tissue of femur did not change significantly during the study. It is concluded that during early recovery from hyperthyroidism, priority is given to the replenishment of skeletal muscles and ip AT, whereas sc AT is increased at a later stage.
- Published
- 1998
38. [Hypothyroidism--a common disease with many faces. Thyroid function in women should be regularly examined]
- Author
-
G, Lindstedt and E, Nyström
- Subjects
Male ,Sweden ,Sex Factors ,Hypothyroidism ,Risk Factors ,Prevalence ,Humans ,Mass Screening ,Female ,Thyroid Function Tests - Published
- 1998
39. The relations of microalbuminuria to ambulatory blood pressure and myocardial wall thickness in a population
- Author
-
Göran Lindstedt, Leif Lapidus, A. Svensson, Robert Eggertsen, E Nyström, and T. Nilsson
- Subjects
Blood Glucose ,Male ,medicine.medical_specialty ,Ambulatory blood pressure ,Population ,Hemodynamics ,Blood Pressure ,Body Mass Index ,Risk Factors ,Diabetes mellitus ,Internal medicine ,medicine ,Internal Medicine ,Albuminuria ,Humans ,education ,Triglycerides ,Aged ,Sweden ,education.field_of_study ,business.industry ,Myocardium ,Middle Aged ,medicine.disease ,Heart septum ,Surgery ,Blood pressure ,Cardiovascular Diseases ,Echocardiography ,Creatinine ,Population Surveillance ,Ambulatory ,Cardiology ,Microalbuminuria ,Female ,business - Abstract
Nilsson T, Svensson A, Lapidus L, Lindstedt G, Nystrom E, Eggertsen R (Molnlycke Primary Health Care and Research Centre; Goteborg University, Goteborg, Sweden). The relations of microalbuminuria to ambulatory blood pressure and myocardial wall thickness in a population. J Intern Med 1998; 244: 55–9. Objectives To examine the relationship between microalbuminuria (20–200 μg min−1) and 24 h ambulatory blood pressure and heart wall thickness, in a representative population sample of men and women aged 56–65 years. Design Every second individual aged 56–65 years (n= 488) in the district, was invited for a health examination, which included determination of urinary albumin and creatinine (overnight sample). The highest and lowest decentile of urinary albumin/creatinine ratio were compared. Setting The district of the Primary Health Care and Research Centre of Molnlycke, Sweden. Subjects After excluding 2 individuals with a urinary albumin excretion exceeding 200 μg min−1, 26 subjects (group 1) could be compared with 27 subjects in the lowest decentile (group 2). Main outcome measures Comparison between the determinations of the ambulatory blood pressure and echocardiographic variables in the two groups. Results Group 1 had significantly higher 24 104 ambulatory blood pressure, and heart septum and posterior wall thickness as well as significantly higher fasting blood glucose and serum triglyceride concentrations. The differences in blood pressure (P < 0.05) but not heart wall thickness remained significant (P < 0.05) after excluding subjects with hypertension, angina pectoris, treated diabetes mellitus, and/or history of heart or cerebrovascular disease. When excluding individuals with both treated and untreated diabetes mellitus, fasting blood glucose concentration was higher in group 1. The waist-hip ratio, weight and body mass index did not differ between the groups. Conclusions The findings indicate that microalbuminuria is related to signs of cardiovascular and metabolic influence and therefore could be a valuable tool for grading the risk of later cardiovascular morbidity.
- Published
- 1998
40. Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique
- Author
-
S, Lundgren, E, Nyström, H, Nilson, J, Gunne, and O, Lindhagen
- Subjects
Adult ,Dental Implants ,Male ,Wound Healing ,Bone Transplantation ,Bone Screws ,Dental Implantation, Endosseous ,Dental Abutments ,Alveolar Ridge Augmentation ,Maxillary Sinus ,Middle Aged ,Transplantation, Autologous ,Osteotomy ,Ilium ,Osseointegration ,Patient Satisfaction ,Maxilla ,Humans ,Jaw, Edentulous ,Female ,Dental Restoration Failure ,Atrophy ,Nasal Cavity ,Aged ,Follow-Up Studies - Abstract
This study presents the results from 20 consecutive patients treated with an autogenous bone graft from the iliac crest. In ten patients the graft was placed in the maxillary sinuses and the floor of the nose (inlay group). Ten patients, in addition to the inlay graft, had a corticocancellous bone block secured with mini-screws to the anterior maxillary ridge (inlay/onlay group). Endosteal implants (Brånemark) were placed six months after surgery. A total of 136 implants were placed, of which eight failed to integrate during the six-month healing period. A further 15 implants were lost during the follow-up period. For the inlay group the average follow-up period was 22 months and for the inlay/onlay group 19 months. Donor site morbidity was significantly less when iliac bone was harvested with a trephine (inlay group) than in patients treated with our routine procedure for bone harvesting (inlay/onlay group). Surgical technique, donor site morbidity, implant survival and patient acceptance are presented.
- Published
- 1998
41. Autogenous onlay bone grafts fixed with screw implants for the treatment of severely resorbed maxillae. Radiographic evaluation of preoperative bone dimensions, postoperative bone loss, and changes in soft-tissue profile
- Author
-
E, Nyström, J, Ahlqvist, K E, Kahnberg, and J B, Rosenquist
- Subjects
Adult ,Male ,Chin ,Cephalometry ,Nose ,Transplantation, Autologous ,Sex Factors ,Maxilla ,Humans ,Jaw, Edentulous ,Dental Restoration Failure ,Bone Resorption ,Aged ,Dental Implants ,Bone Transplantation ,Dental Implantation, Endosseous ,Vertical Dimension ,Alveolar Ridge Augmentation ,Middle Aged ,Lip ,Maxillary Diseases ,Radiography ,Face ,Subtraction Technique ,Female ,Follow-Up Studies - Abstract
Thirty patients with severely resorbed edentulous maxillae underwent combined treatment of iliac bone onlay graft and titanium implants. The patients were followed for 3 years. They were radiographically examined before surgery to evaluate the bone volume at the intended implant sites. Only 13/156 implant sites were suitable for implant insertion. The bone level at the implant surfaces was evaluated after 6 months and 1, 2, and 3 years, respectively. There was a continuing decrease of the bone level throughout the follow-up period with a mean loss of 4.9 mm after 3 years and with no difference between sexes. Twenty-six implants were radiographically examined before removal, and only three of these implant sites showed radiographic signs of failure. The soft-tissue profile was analyzed cephalometrically by the subtraction technique. The upper lip generally moved inward and the apex of the nose and the columella downward and inward. The anterior facial height increased in most of the patients, resulting in a downward and inward change of the lower lip, the mentolabial sulcus, the soft-tissue pogonion, and the soft-tissue gnathion.
- Published
- 1996
42. Combined use of bone grafts and implants in the severely resorbed maxilla. Postoperative evaluation by computed tomography
- Author
-
E, Nyström, P E, Legrell, A, Forssell, and K E, Kahnberg
- Subjects
Adult ,Dental Implants ,Male ,Bone Transplantation ,Dental Implantation, Endosseous ,Alveolar Bone Loss ,Reproducibility of Results ,Alveolar Ridge Augmentation ,Middle Aged ,Maxillary Diseases ,Statistics, Nonparametric ,Treatment Outcome ,Maxilla ,Humans ,Female ,Tomography, X-Ray Computed ,Aged - Abstract
Combined horseshoe-shaped iliac bone grafts and Brånemark fixtures were used to rehabilitate patients with severely resorbed maxillae. Twenty patients were followed-up by computed tomography (CT) examination with axial slices to assess the fixture sites and to study the changes in height and width of the bone graft 3 weeks and 3, 6, 12, and 24 months postoperatively. The mean height of the bone graft at the 3-week postoperative examination was 8.2 mm; after 2 years the mean value had decreased to 6.2 mm. The height reduction occurred mainly between the 3-month and 1-year examinations. The mean width of the bone graft at the 3-week postoperative examination was 12.2 mm, and it decreased to 8.6 mm after 2 years. Most of the width reduction took place during postoperative months 1-3. From 1 year after the grafting procedure, the rate of reduction of both height and width was very low.
- Published
- 1995
43. Bone grafts and implants in the treatment of the severely resorbed maxillae: a 3-year follow-up of the prosthetic restoration
- Author
-
J, Gunne, E, Nyström, and K E, Kahnberg
- Subjects
Adult ,Dental Implants ,Male ,Bone Transplantation ,Chi-Square Distribution ,Alveolar Bone Loss ,Alveolar Ridge Augmentation ,Middle Aged ,Survival Analysis ,Maxillary Diseases ,Statistics, Nonparametric ,Prosthesis Failure ,Treatment Outcome ,Patient Satisfaction ,Surveys and Questionnaires ,Humans ,Female ,Bone Remodeling ,Prospective Studies ,Aged ,Follow-Up Studies - Abstract
Thirty patients with severely resorbed maxillae were treated in a one-stage procedure using bone graft and implant placement. A horseshoe-shaped bone graft was taken from the iliac wing and fixed to the residual maxillary ridge using titanium implants, which supported the prostheses placed after a 6-month healing period. The material constituted two groups: a development group, the first 10 patients; and a routine group, the following 20 patients. At the 3-year follow-up, the implant survival was 87.5% and the prosthesis stability was 100% in the routine group. The probing depth did not change during the follow-up period, while the grafted region decreased in volume during the first postoperative year. The patients reported improved chewing ability and improved life quality. Very few technical and prosthodontic complications occurred.
- Published
- 1995
44. [Amiodarone--a warning! Clarify possible thyroid disease before treatment!]
- Author
-
E, Nyström, G, Lindstedt, L E, Tisell, G, Berg, N, Edvardsson, H, Walfridsson, and A, Adlerberth
- Subjects
Thyroid Gland ,Amiodarone ,Humans ,Thyroid Function Tests ,Anti-Arrhythmia Agents ,Thyroid Diseases - Published
- 1994
45. Purification of recombinant human granulocyte-macrophage colony-stimulating factor from the inclusion bodies produced by transformed Escherichia coli cells
- Author
-
L.-E. Nyström, S. Wang, J.-C. Janson, Y. Zhou, and M. Belew
- Subjects
Quality Control ,Size-exclusion chromatography ,Molecular Sequence Data ,medicine.disease_cause ,Biochemistry ,Inclusion bodies ,Mass Spectrometry ,Analytical Chemistry ,law.invention ,Transformation, Genetic ,law ,Complementary DNA ,medicine ,Escherichia coli ,Humans ,Amino Acid Sequence ,Inclusion Bodies ,Chromatography ,biology ,Molecular mass ,Chemistry ,Organic Chemistry ,Granulocyte-Macrophage Colony-Stimulating Factor ,General Medicine ,biology.organism_classification ,Chromatography, Ion Exchange ,Enterobacteriaceae ,Recombinant Proteins ,Molecular Weight ,Recombinant DNA ,Chromatography, Gel ,Specific activity ,Electrophoresis, Polyacrylamide Gel - Abstract
Recombinant human granulocyte-macrophage colony-stimulating factor (rhGM-CSF), produced as inclusion bodies in genetically transformed Escherichia coli cells was purified to homogeneity by a three-step chromatographic procedure involving hydrophobic interaction, ion exchange and gel filtration. Each purification step is reproducible and well suited for process-scale operations. The purification process also leads to a significant decrease in DNA and endotoxin levels in the final product. Of the three gel media used, Phenyl Sepharose 6 FF (high sub) was most effective in reducing the DNA content (by a factor of ca. 2000) while Superdex 75 prep grade was more effective for removing endotoxins (reduction factor ca. 15). The recovery of purified rhGM-CSF was 35% by enzyme-linked immunosorbent assay and 70% by a biological assay method. The overall purification factor obtained was about 4.6, which is in the range of those reported for recombinant proteins produced in E. coli as inclusion bodies. The purified rhGM-CSF is an acidic protein (p I = 5.4) and has a specific activity of ca. 3.3 · 10 7 units/mg, which is in excellent agreement with that reported for its natural counterpart. Its monomer molecular mass of 14 605, as determined by electrospray mass spectrometry, corresponds exactly to the mass calculated from its cDNA sequence. Its amino acid composition and partial NH 2 -terminal sequence (up to seventeen residues) are also identical with those reported for this protein. These and other results confirm the identity of the purified rhGM-CSF with its natural counterpart. However, the results also showed that it is apparently heterogeneous from its NH 2 -terminal side as it is composed of three polypeptides having Met, Ala and Pro as the NH 2 -terminal residues in which the intact Met analogue accounts for 60% for the mixture. This heterogeneity does not seem to have any biological significance since the specific activity of the purified rhGM-CSF is identical with that of its natural counterpart.
- Published
- 1994
46. Clinical use of laboratory thyroid tests and investigations
- Author
-
G, Lindstedt, G, Berg, S, Jansson, O, Törring, S, Valdemarsson, B, Warin, and E, Nyström
- Subjects
Adult ,Humans ,Thyroid Neoplasms ,Immunologic Tests ,Prognosis ,Thyroid Diseases ,Algorithms - Abstract
Laboratory thyroid testing involves in vitro tests for autoimmune thyroid disease, thyroid dysfunction and neoplasia, in vivo investigations of thyroid function, and investigations of thyroid morphology. The authors describe, in tabular form, the diagnostic information carried by the tests and their clinical utility as well as clinically relevant interferences.
- Published
- 1994
47. Overweight--a common problem among women treated for hyperthyroidism
- Author
-
E. Nyström, G. Lindstedt, G. Berg, A. Michanek, and Svante Jansson
- Subjects
Adult ,Pediatrics ,medicine.medical_specialty ,Goiter ,Levothyroxine ,Overweight ,Weight Gain ,Body Mass Index ,Iodine Radioisotopes ,Internal medicine ,medicine ,Humans ,Longitudinal Studies ,Obesity ,business.industry ,General Medicine ,Middle Aged ,medicine.disease ,Endocrinology ,Population study ,Female ,medicine.symptom ,business ,Body mass index ,Weight gain ,Hormone ,medicine.drug ,Follow-Up Studies ,Research Article - Abstract
Summary We sent out a questionnaire to 112 women treated for diffuse toxic goitre 2-5 years earlier to evaluate the prevalence of problems with overweight after the disease. Of 87 responders, about 50% (irrespective of surgical or radioiodine treatment) reported weight problems, and we randomly selected 40 of these women (20 with and 20 without reported weight problems) for a clinical follow-up (32 appearing). At the follow-up examination (mean 4 years after treatment for hyperthyroidism), 27 women had a higher weight than their estimated premorbid weight. The weight gain correlated with the estimated premorbid body mass index (BMI; P < 0.005), indicating that excess weight gainers may have had a premorbid problem now exaggerated in the post-hyperthyroid period. However, many women with a BMI within the limits stated to be ideal (21-25 kg/m2) also showed dramatic increases in weight. In contrast, the average middle-aged woman in our region did not appear to have gained in weight during a corresponding time period as judged from a longitudinal population study. Women with reported weight problems (mean weight increase 15.6%, n = 16) did not differ from women without (mean weight increase 6.7%, n = 16) as regards pretreatment hormone levels, method of treatment, (change of) smoking habits or post-treatment levothyroxine administration, or in serum concentrations of thyroid hormones, thyrotrophin, cortisol, procollagen-III-peptide, cholesterol, HDL cholesterol or triglycerides. Women with hyperthyroidism should be informed about the risk of gaining weight after therapy and given early support as to dietary and lifestyle change.
- Published
- 1993
48. Treatment of the severely resorbed maxillae with bone graft and titanium implants: histologic review of autopsy specimens
- Author
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E, Nyström, K E, Kahnberg, and T, Albrektsson
- Subjects
Dental Implants ,Male ,Bone Transplantation ,Osseointegration ,Alveolar Bone Loss ,Humans ,Alveolar Ridge Augmentation ,Maxillary Diseases - Abstract
One of a series of patients with extremely resorbed maxillae treated with bone grafts from the hip in combination with Brånemark self-tapping fixtures died in a car accident 4 months after implant surgery. Autopsy specimens from this patient were analyzed to evaluate the amount and extent of "osseointegration" after 4 months of healing. Histologic examination revealed that minimal bone was in direct contact with the titanium and the general pattern was that of soft tissue screw anchorage. There were no signs of sequestering of the transplanted bone. The connection between the nasal cavity and the sinus mucosa with respect to the transplants seemed to be without adverse reactions. The superior part of the transplant did show signs of newly formed bone. The grafted specimens showed indications of delayed bone response compared to the nongrafted situation. All implants were clinically stable as studied postmortem.
- Published
- 1993
49. [Who will receive iodine-131 therapy in thyrotoxicosis?]
- Author
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E, Nyström and G, Berg
- Subjects
Adult ,Iodine Radioisotopes ,Neoplasms, Radiation-Induced ,Thyrotoxicosis ,Risk Factors ,Humans ,Middle Aged - Published
- 1992
50. Thyroid disease in middle-aged and elderly Swedish women: thyroid-related hormones, thyroid dysfunction and goitre in relation to age and smoking
- Author
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Göran Lindstedt, E Nyström, Per-Arne Lundberg, Calle Bengtsson, K. Petersen, and Leif Lapidus
- Subjects
endocrine system ,medicine.medical_specialty ,Thyroid Hormones ,Goiter ,endocrine system diseases ,Physiology ,Disease ,Thyroid dysfunction ,Risk Factors ,Internal medicine ,Internal Medicine ,medicine ,Prevalence ,Humans ,Longitudinal Studies ,Mild disease ,Aged ,Sweden ,business.industry ,Thyroid disease ,Thyroid ,Smoking ,Age Factors ,Middle Aged ,medicine.disease ,Thyroid Diseases ,Endocrinology ,medicine.anatomical_structure ,Thyroid hormones ,Female ,business ,Hormone - Abstract
The prevalence of thyroid disease and the concentration of thyroid hormones and thyrotropin were studied in a random population sample of 1154 women, aged 50-72 years, with special reference to the effect of age and smoking. The prevalence of spontaneous hypothyroidism was 3.3% (previously unknown overt and mild disease 1.3%) and the prevalence of hyperthyroidism was 2.5% (previously unknown disease 0.2%). Clinically suspected hyper- or hypothyroidism (very weak to strong) was recorded in 288 women, but was only verified in three cases. The prevalence of visible and palpable thyroid enlargement was 2.1% and 13-14%, respectively. Total thyroxine concentrations increased and free tri-iodothyronine levels decreased significantly with age (P less than 0.001). The serum thyrotropin concentrations were lower in smoking women than in non-smokers in the 50- and 58-year age groups (P less than 0.05). There was no increase in the prevalence of thyroid disease or goitre in the women who were smokers at the time of the study.
- Published
- 1991
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